Tag: 14/5/26

Categories : Metabolic DisordersTags :

‘Yo-yo’ Fluctuations in Weight, Blood Pressure Linked to Kidney Disease in Type 1 Diabetes

On By ModernMedia
Photo by I Yunmai on Unsplash

Fluctuations – known as the ‘yo-yo’ effect – in body mass index (BMI) and blood pressure are associated with the progression of diabetic kidney disease in people with type 1 diabetes, new papers have revealed.

The findings, shown in two studies from Dr Murat Ozdede, Visiting Research Fellow, and Janaka Karalliedde, Professor of Diabetes, both from King’s College London, indicate that only having good average blood pressure and weight may not be enough to prevent progression of the disease. Instead, keeping fluctuations under control may be a better way to keep the kidneys healthy.  

Variability – also known as ‘yo-yo-ing’ – in weight and blood pressure has been shown to be harmful in people with type 2 diabetes with regard risk heart and kidney disease. Our work is the first demonstration of this potential risk in people with type 1 diabetes, many of whom had normal weight, BMI and blood pressure. Future studies will need to explore if reducing variability with treatments can reduce the risk of kidney disease.”

Janaka Karalliedde, Professor of Diabetes, King’s College London

Diabetic Kidney Disease (DKD) affects up to 40% of people with diabetes and is one of the leading causes of kidney failure in the UK and many countries around the world. Individuals with kidney failure require kidney replacement therapy. Doctors already know that DKD is linked to higher blood glucose, higher blood pressure and protein in the urine. However, these biological functions change over time. Therefore, the researchers were interested in exploring whether variation of these risk factors may affect the body in ways that stress the kidneys and contribute to progression of kidney disease.

The first study looked at changes in systolic blood pressure (max pressure) and diastolic blood pressure (when the heart rests in between beats). The researchers measured variation in visit-to-visit changes, taken from test results of 3,079 adults with type 1 diabetes between 2004 and 2018.

They used estimated glomerular filtration rate (eGFR) test results to understand how well the kidneys were filtering the blood. A 50% fall of eGFR, or a final eGFR below 30 – indicating serious kidney damage – were the primary endpoints.

They found that both a higher systolic blood pressure and diastolic blood pressure variability was linked to substantially higher risk of kidney decline. This was independent of average blood pressure, meaning two people could have the same average systolic blood pressure, but the one who has higher variability may be at greater risk of kidney harm.

The second study explored whether BMI fluctuation – also known as metabolic cycling – could add additional stress to the kidneys and lead to the progression of the disease.

The researchers studied 3,270 adults over roughly 9.6 years, taking at least six BMI measurements during that time. They used four different ways of measuring variability to confirm their analyses.

They found that one of the key factors contributing to worsening of the disease was higher BMI variability, even after adjusting for other risk factors. After 12 years, cumulative incidence of the kidney endpoint was 11.9% in the highest variability group, compared with just 2.1% in the most stable group.

Baseline BMI itself was fairly similar between the different groups, suggesting that simply ‘being heavier’ was less of a risk factor than BMI that changed over time.

These findings are of particular importance considering recent trends in weight loss diets and medication, that can cause sudden weight loss caused by weight gain – a phenomenon known as the ‘yo-yo’ effect.

Rapid fluctuations in weight or blood pressure can cause damage to the blood vessels in the kidney. People with diabetes are more susceptible to blood vessel damage and it’s vital to prevent further aggravating factors. Avoiding fluctuations in weight, blood pressure, and blood sugar levels may help reduce to risk of kidney damage.”

Janaka Karalliedde, Professor of Diabetes, King’s College London

Source: King’s College London

Categories : Mental Health Substance UseTags :

Cannabis and Tobacco Co-use Increases Psychosis Chances in High-risk Cohorts

On By ModernMedia

Results highlight concern about co-use, a growing trend that has been understudied until now

Photo by Thought Catalog on Unsplash

A new multisite study published May 12 in Nature Mental Health found that using cannabis and tobacco together increases the risk of developing psychotic disorders like schizophrenia among those considered high risk.  

Researchers led by Heather Ward, MD, assistant professor of Psychiatry and Behavioral Sciences and director of Neuromodulation Research at Vanderbilt Health, analysed data from more than 1,000 participants in the North American Prodrome Longitudinal Study, which tracks individuals at “clinical high risk” for psychosis. These individuals often experience mild or early symptoms but have not yet developed a full psychotic disorder.  

“The prevalence of cannabis and tobacco use, known as ‘co-use,’ has been rising in the general population for the past several decades, while exclusive tobacco use has declined and exclusive cannabis use has been on the rise,” Ward said. “However, little is known about cannabis and tobacco co-use in adolescents at risk for psychosis.”  

Substance use patterns – tobacco only, cannabis only, co-use, other substances and no substance use – were assessed over a two-year period in 734 individuals at clinical high risk for psychosis and 278 healthy controls.   

“People with psychosis are much more likely to use cannabis and tobacco than the general population. Because of their heavy cannabis and tobacco use, people with psychosis are also disproportionately affected by the negative consequences of cannabis and tobacco use,” said Ward, who recently presented study findings at the Society of Biological Psychiatry Annual Meeting in an oral session titled, “High Stakes: Consequences of Cannabis Use in Vulnerable Populations.”  

According to Ward, in people with psychosis, tobacco use is associated with a 20-year decreased life expectancy compared to the general population, that is attributable to the medical consequences of tobacco use, such as cardiovascular disease, heart attack, stroke and lung cancer.  

“In people in their first episode of psychosis, it is estimated that 25%–50% use cannabis. Cannabis use is associated with more severe psychosis symptoms, poor response to treatment and psychiatric hospitalisations. There is even evidence that cannabis use may cause psychosis in people who are already at risk,” Ward said.  

“Tobacco and cannabis use in isolation have devastating consequences for people with psychosis, so we wanted to see if people who co-use cannabis and tobacco had more severe psychiatric symptoms and if they were at greater risk for developing psychosis in the first place.”  

The study found that regular use of either cannabis or tobacco was linked to anxiety, depression and early psychotic experiences. However, people who used cannabis and tobacco together did not show worse short-term symptoms than those using just one.  

However, the biggest difference appeared over time. Those who used cannabis heavily and tobacco lightly were almost three times more likely to develop psychosis compared to those who used neither substance.  

The results highlight concern about co-use, a growing trend that has been understudied until now. Researchers defined co-use in the study as “using substances at the same time, on the same occasion, or within a defined time frame where their effects may overlap.”  

“We found that cannabis and tobacco co-use was associated with a nearly threefold increased risk of developing psychosis in people who were already at risk,” Ward said. “There is evidence to suggest that using tobacco and cannabis together may have synergistic effects on the brain.  

“Smoking tobacco and cannabis together increases absorption of THC, the psychoactive component of cannabis. It is possible that co-use itself is contributing to the development of psychosis. However, it is also possible that the people who are going to develop psychosis anyway have an underlying predisposition to using both cannabis and tobacco.”  

Ward said it is important for both patients and clinicians to know that cannabis and tobacco co-use is a risk factor for psychosis. Stopping use of cannabis and tobacco may improve mental health symptoms, and it is possible that stopping cannabis and tobacco co-use could reduce risk of developing psychosis in the first place.  

The next step is to replicate this finding in other groups of people at risk for psychosis, and “we need to test if stopping cannabis and tobacco use reduces risk of developing a psychotic disorder,” Ward said.  

Source: Vanderbilt University Medical Center

Categories : Healthcare Politics and RegulationsTags :

Global Health Progress at Risk Without Stronger Systems, Warns WHO

On By ModernMedia

Organisations working to strengthen health systems in Africa, including COHSASA, are likely to find renewed urgency in the latest report from the World Health Organization, which warns that gains in global health are under threat.

The World Health Statistics 2026 report released yesterday highlights uneven progress, slowing gains and, in some areas, reversals – leaving the world off track to achieve the health-related Sustainable Development Goals (SDGs) by 2030. WHO points to the need for stronger health systems and improved data to sustain progress and close persistent gaps.

There have been notable advances over the past decade. New HIV infections fell by 40% between 2010 and 2024, while the number of people needing interventions for neglected tropical diseases dropped by 36%.

In the WHO African Region, progress in reducing HIV (down 70%) and tuberculosis (down 28%) has outpaced global averages.

However, these gains are fragile. Malaria incidence has increased by 8.5% since 2015, and progress towards universal health coverage has slowed sharply. One quarter of the global population faces financial hardship due to healthcare costs, and an estimated 1.6 billion people were pushed into or further into poverty due to out-of-pocket spending in 2022.

The report also underscores critical weaknesses in health information systems. As of the end of 2025, only 18% of countries were reporting mortality data within one year, and just one third met WHO standards for high-quality mortality data. These gaps limit the ability to monitor trends, target interventions and ensure accountability.

WHO Director-General Tedros Adhanom Ghebreyesus said the findings reflect “both progress and persistent inequality,” emphasising the need for stronger, more equitable health systems supported by resilient data systems.

For organisations such as COHSASA, the findings reinforce the importance of systematic approaches to improving the quality and safety of care. While the WHO report does not prescribe specific mechanisms, it points to challenges – such as uneven performance, gaps in measurement and preventable harm – that that are directly addressed through structured quality improvement and accreditation processes.

By applying measurable standards, supporting continuous improvement and strengthening the use of data at facility level, accreditation programmes provide a practical means of translating system-wide priorities into day-to-day clinical practice. The report sends a clear message: global health progress is real, but fragile. Strengthening health systems – supported by better data and sustained, measurable improvement – will be essential to regain momentum towards the 2030 health goals.

Categories : Obstetrics & Gynaecology Surgeries & ProceduresTags :

Tranexamic Acid Prevents Severe Bleeding in Caesarean Births

On By ModernMedia

New trial adds high quality evidence on benefits of tranexamic acid for high-risk women

Photo by Jonathan Borba on Unsplash

Giving tranexamic acid to women with placenta praevia (when the placenta covers the cervical opening) undergoing caesarean birth leads to a significant yet modest reduction in severe bleeding after delivery with no evidence of an increase in serious adverse events, finds a trial from China published by The BMJ today.

Tranexamic acid is widely used to prevent or reduce heavy bleeding usually after surgery or trauma. It works by inhibiting blood clot breakdown and is recommended for the treatment of severe bleeding after childbirth (postpartum haemorrhage).

But high quality evidence on its prophylactic use to prevent postpartum haemorrhage in high risk women remains scarce.

To address this gap, researchers in China set out to examine the effect of tranexamic acid in women with placenta praevia, a group at high risk of severe bleeding.

The trial included 1694 pregnant women with placenta praevia who were scheduled for caesarean delivery at 24 maternity units across China between July 2023 and March 2025.

Participants received prophylactic oxytocin – standard treatment to reduce blood loss after delivery – and were randomly assigned to receive either intravenous tranexamic acid (845 women) or placebo (849 women) over 10 minutes, starting within five minutes of umbilical cord clamping.

The main outcome measure was postpartum haemorrhage, defined as blood loss of at least 1000 mL or red blood cell transfusion within two days after delivery. Serious adverse events including blood clots, seizures, acute kidney or liver injury, and maternal death, were also recorded.

The results show that prophylactic tranexamic acid reduced the rate of postpartum haemorrhage by 15%, from 35.1% to 29.7% compared with placebo. This means that for every 19 women receiving prophylactic tranexamic acid, one case of postpartum haemorrhage would be prevented.

Rates of serious adverse effects were similar between the two groups.

The researchers acknowledge various limitations including that the findings are specific to women with placenta praevia receiving prophylactic oxytocin and therefore may not apply to other obstetric populations. However, this was a well-designed trial and results were consistent after further analyses, suggesting that the findings are robust.

As such, they conclude: “In a high risk population – specifically, women with placenta praevia undergoing caesarean delivery – prophylactic tranexamic acid leads to a statistically significant but modest reduction in the incidence of postpartum haemorrhage.”

“Future studies in diverse international settings are warranted to validate these results and to identify specific patient subgroups most likely to benefit from prophylactic use of tranexamic acid,” they add.

In a linked editorial, UK researchers point out that this modest reduction in bleeding understates the impact, particularly in women at high risk of harm from bleeding, for whom even modest relative risk reductions translate into worthwhile benefits.

The focus should now shift from whether tranexamic acid reduces bleeding to how it is used to maximise patient benefit, they say, noting that in non-obstetric surgery, tranexamic acid is given before incision, but in caesarean section trials it is delayed until after cord clamping to avoid placental transfer.

They recommend evaluating pre-incision administration for caesarean section, while carefully monitoring maternal and neonatal outcomes.

Source: The BMJ Group