Impact of folic acid and vitamin B12 supplementation on arsenic methylation

A recent study demonstrated that folic acid (FA) and vitamin B12 (B12) supplementation improved arsenic methylation in children, leading to a decrease in monomethyl- (MMAs) and an increase in dimethyl- (DMAs) in both blood and urine. Implementing nutritional interventions could enhance arsenic methylation and elimination in children, thereby reducing arsenic toxicity and improving their nutritional status. This study’s results were published in the Environment International journal.

This double-blind, placebo-controlled trial involved 240 participants aged 8-11 years, who were consuming water from wells with arsenic levels exceeding 50 μg/L. They were advised to switch to wells with lower arsenic levels and were randomly assigned to receive either 400 μg FA + 5 μg B12 or a placebo daily for a period of 12 weeks. Samples of urine and blood were taken at the baseline, week 1 (urine only), and week 12. Generalized estimated equation (GEE) models were utilized to evaluate the impact of the treatment on arsenic levels in both blood and urine.

At the baseline, the mean ± SD total urinary and blood arsenic levels were measured as 91.2 ± 89.5 μg/L and 5.3 ± 2.9 μg/L, respectively. After the follow-up period, there was an overall decrease of 11.7% in total blood arsenic and 17.6% in urinary arsenic. In comparison to the placebo group, the supplementation group showed a notable increase in blood DMAs concentration by of 14.0% and blood secondary methylation index (DMAs/MMAs) by 0.19 at 12 weeks. Additionally, the supplementation group had a significantly higher urinary %DMAs (1.62%) and a significantly lower urinary %MMAs (-1.10%) compared to the placebo group after 1 week. The effects of the treatment were stronger in individuals with higher baseline blood arsenic levels. These results remained consistent across both males and females, as well as participants with varying folate and B12 status at baseline.

Thus, it can be concluded that FA and B12 supplementation resulted in improved arsenic methylation in children, resulting in a reduction in MMAs and an elevation in DMAs in both blood and urine.

Safety and efficacy of linaclotide in treating functional constipation in paediatric patients

According to a recent study, linaclotide has proven to be an effective and well-tolerated remedy for functional constipation in pediatric patients. This study’s findings were published in the journal, Lancet. Gastroenterology & hepatology.

In this double-blind, randomised,  placebo-controlled, phase 3 study, patients aged 6-17 years were randomly assigned to receive either oral linaclotide 72 μg [n=166] or placebo [n=164] once daily for 12 weeks. The study's primary efficacy endpoint was the change from baseline (CFB) in the frequency rate of spontaneous bowel movements (SBM) per week over a twelve-week period. The change from baseline in stool consistency during the treatment period was the secondary efficacy endpoint. Efficacy and safety were analyzed in all patients who received at least one dose of the study intervention.

The mean frequency rate for SBMs was 1·28 SBMs per week (SD 0·87) with placebo and 1·16 SBMs per week (0·83) with linaclotide at baseline. This rate increased to 2·29 SBMs per week (1·99) with placebo and 3·41 SBMs per week (2·76) with linaclotide during the intervention. Patients treated with linaclotide demonstrated a significant increase in SBM frequency [least-squares mean (LSM) CFB 2·22 SBMs per week (SE 0·19)] compared to those on placebo [LSM CFB 1·05 SBMs per week (0·19)]. Additionally, linaclotide demonstrated a notable improvement in stool consistency compared to the placebo group [LSM CFB 1.11 (SE 0.08) versus 0.69 (0.08)]. Based on the above results, it can be concluded that linaclotide is an efficacious and well-tolerated treatment for functional constipation in paediatric patients.

Dupilumab enhances lung function parameters in children with type 2 asthma

According to a recent study, dupilumab resulted in significant and sustained improvements in lung function across various measures in children (aged 6-11 years) suffering from uncontrolled, moderate-to-severe type 2 asthma. This study’s findings were published in the Journal of Allergy and Clinical Immunology.

In the LIBERTY ASTHMA VOYAGE phase 3 trial, children with asthma were subjected to randomization in a 2:1 ratio to receive either add-on dupilumab 100/200 mg based on bodyweight or a placebo every 2 weeks for a total of 52 weeks. This study analyzed the spirometry parameters among children with type 2 asthma (baseline blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥20 parts per billion [ppb]), as well as subgroups identified by baseline blood eosinophils or FeNO values.

At baseline, a total of 116 children (49%) who received dupilumab and 59 children (52%) who received placebo had impaired lung function (prebronchodilator percent-predicted forced expiratory volume in 1 second [ppFEV1] less than 80%). The administration of dupilumab resulted in significant improvements in pre- and postbronchodilator ppFEV1 as early as week 2, and these improvements were sustained for up to 52 weeks (the least squares mean difference versus placebo at week 52 was 7.79 percentage points ; 95% confidence interval [CI]: 4.36-11.22; P < .001) and 4.37 points (95% CI: 0.95-7.78; P = .01) for pre- and postbronchodilator measurements, respectively). Additionally, consistent improvements were observed in other lung function parameters, including pre- and postbronchodilator forced vital capacity (FVC), FEV₁/FVC ratio, and prebronchodilator forced expiratory flow, across all populations.

Thus, it can be concluded that dupilumab led to significant and sustained improvements in lung function across various measures in children (aged 6-11 years) with uncontrolled, moderate-to-severe type 2 asthma.

Effect of serum S100B level in the management of pediatric minor head trauma

A recent study demonstrated the efficacy of serum S100B level in managing pediatric minor head trauma through a decrease in the need for cranial computed tomographic (CCT) scans and hospital observation when monitored according to a specific clinical decision algorithm. This study’s findings were published in the journal, JAMA network open.

In this multicenter, prospective, interventional randomized clinical trial, children and adolescents aged 16 years or younger were enrolled. The control group [n= 926] underwent CCT scans or were hospitalized as per the prevailing recommendations. In the S100B biomonitoring group [n=1152], blood sampling was conducted within 3 hours after minor head trauma, and the subsequent management was contingent upon the levels of serum S100B protein. If the S100B level was within the reference range suitable for the child's age, they were discharged from the emergency department. Otherwise, they received the same treatment as the control group. The main outcome of the study was the proportion of patients who underwent CCT scans within 48 hours after experiencing a minor head trauma.

At the end of the study, 299 children (32.3%) in the control group and 112 (9.7%) in the S100B biomonitoring group underwent cranial CT scans. A substantial 50% decline in hospitalizations was observed in the S100B biomonitoring group (479 [41.6%] vs 849 [91.7%]).

Based on the above results, it can be concluded that implementation of S100B biomonitoring resulted in a decline in the number of CCT scans required and the duration of in-hospital monitoring when assessed based on the criteria outlined in a clinical decision algorithm.