Medically Speaking Team

A recent study discovered that nitrogen-containing bisphosphonates (N-BPs) like alendronate, which are often used to treat postmenopausal osteoporosis, are associated with decreased risks of pneumonia and death from pneumonia. The study’s findings have been published in the Journal of Bone and Mineral Research.

The research comprised 4,041 hip fracture patients who got N-BPs and 11,802 who did not. N-BPs were related with a 24% decreased incidence of pneumonia compared to no therapy across a median follow-up duration of 2.7 years (69 versus 90 cases per 1,000 people per year).

A similar link was seen with pneumonia mortality, with N-BPs being associated with a 35% decreased risk (23 versus 35 per 1,000 patients per year for the N-BP and non-N-BP groups, respectively).
Previous animal investigations show that N-BP therapy causes a high concentration of N-BPs in the respiratory system.

“Together with its anti-inflammatory and immune-modulatory properties, this may explain why N-BPs were associated with reduced risk of pneumonia, as revealed in our study,” said senior author Ching-Lung Cheung, PhD, of The University of Hong Kong. He added that studying the potential of N-BPs for treating symptoms of COVID-19 may be warranted.

A recent study from the University of South California demonstrates that a specific pattern of white matter connectivity has been found in the brains of autistic people. It is also distinct from the pattern seen in those with Developmental Coordination Disorder (DCD).

According to the study, which was published in the journal ‘Scientific Reports,’ roughly 85 percent of autistic persons have had or are at risk of being diagnosed with DCD, a disorder that interferes with learning and motor control. DCD can impede daily tasks such as typing, dressing, and walking, reducing one’s social involvement and enjoyment.

Distinguishing between the brain activity patterns of autism spectrum disorder (ASD) and DCD populations is critical because the widespread comorbidity of ASD and DCD confounds previous autism research, which was thought to be exclusively investigating its core social-communication symptoms at the time it was conducted.

“As the scientific community has learned more about DCD, we realised that white matter disparities previously observed in the autism literature might really be attributable to this underlying motor comorbidity,” stated senior author Lisa Aziz-Zadeh. “In reality, that’s exactly what our team discovered: many earlier research findings are likely not representing autism’s core symptoms, but rather co-occurring DCD.”

Aziz-Zadeh is an associate professor in the USC Dornsife College of Letters, Arts, and Sciences’ Brain and Creativity Institute and the Department of Psychology. She is the director of the USC Center for the Neuroscience of Embodied Cognition, which manages research projects funded by the National Institutes of Health, the US Department of Defense, and the Intelligence Advanced Research Projects Activity of the Office of the Director of National Intelligence.
Aziz-Zadeh and colleagues employed diffusion weighted MRI, a method for evaluating functional brain connections, on children and teenagers aged 8 to 17 years old who were randomly allocated to one of three research groups: those with ASD, those with suspected DCD, and those who were normally developing.

The photos were evaluated, compared, and connected with physical and social behaviour assessments performed by the participants. The researchers discovered that numerous structural brain connection patterns previously associated with autism also overlap with DCD. The team was able to identify three white matter pathways with distinctly different connectivity, distinct from the DCD and typically developing groups: the longitudinal fibres and u-fibers of the mid-cingulum, the corpus callosum forceps minor/anterior commissure, and the left middle cerebellar peduncle. These disparities were also connected to autistic participants’ emotional performance and/or autism severity. Children with DCD had distinct white matter patterns in the left cortico-spinal and cortico-pontine tracts.

“These findings show that we can use advanced imaging to differentiate between autism’s hallmark social symptoms and other motor-related symptoms at the level of brain anatomy,” said Emily Kilroy, the study’s first author and a former postdoctoral scholar in Aziz-lab Zadeh’s during the data collection period. “Of course, people are much more than their brain structure,” says the researcher, “but this level of clarity and precision at the anatomical level brings us one step closer to understanding the molecular foundation and presentation of autism.”

According to a recent study, a little painful ulcer in the corner of the mouth may indicate the presence of the Monkeypox virus. Stefan Schlaube and co-authors examine the case of a 51-year-old HIV-positive patient who developed an ulcer at the corner of his mouth as the first symptom of monkeypox infection in a case study published in the journal ‘Deutsches Arzteblatt international’ on November 11. This introduced another symptom to the illness, which had few apparent indications or symptoms in its early stages. At initially, just a few skin vesicles were visible.

The patient presented to his primary care physician with a vesicle in the left corner of his mouth that had emerged the day before. He had no clinical indications of infection, and his HIV infection had been effectively managed for years with antiretroviral medication, both virologically and immunologically.

The patient’s ulcer was initially treated with a topical combination ointment. He returned to his general practitioner after developing a severe ulcer in the left corner of his mouth. A swab of the ulcer was collected. The monkeypox virus was validated using polymerase chain reaction (PCR). Following that, an increase in monkeypox vesicles was seen not just on the skin, but also on the palate.

With swelling at the base of the tongue and muffled speech, the patient was admitted to the hospital for antiviral treatment with tecovirimat.

According to a pooled data review of the current evidence, regular use of medications to treat type 2 diabetes and decrease cholesterol may reduce the risk of AMD, a degenerative eye illness associated to ageing.
The study’s findings were published online in the British Journal of Ophthalmology. These frequent drugs, according to the data, are associated with a decreased prevalence of AMD (age-related macular degeneration) in European populations.
AMD is the leading cause of significant visual impairment in senior persons in high-income countries. The disease already affects 67 million people in Europe alone, and as the continent’s population ages, the number of new cases is likely to soar.

Both central vision and fine detail perception are impaired by AMD. AMD is thought to be caused by a combination of genetic and environmental ageing factors, but the best approaches to prevent or slow its progression are unknown.
Previous research has showed that drugs used to control cholesterol, manage diabetes, and reduce inflammation may help reduce the risk of developing AMD, but the results were inconsistent and based on small participant numbers.
In order to avoid these issues, the researchers combined the data from 14 population-based and hospital-based studies with 38,694 people from France, Germany, Greece, Ireland, Italy, Norway, Portugal, Russia, and the United Kingdom.

The research is part of the European Eye Epidemiology (E3) project, a pan-European collaborative network whose primary purpose is to develop and analyse large pooled datasets to better understand eye disease and vision loss.
All of the participants were over the age of 50 and were using at least one of the following medications: Levodopa is used to treat movement problems caused by neurodegenerative illnesses; statins are used to decrease cholesterol; insulin is used to manage diabetes; and steroids are used to minimise inflammation.

The prevalence of AMD in the studies evaluated ranged from 12.5% to 64.5%, totaling 9,332 cases, whereas the prevalence of advanced (late) AMD ranged from 0.5% to 35.5 percent, totaling 951. After accounting for any potential affecting factors, the pooled data analysis found that drugs to decrease cholesterol or control diabetes were associated with a 15% and 22% lower prevalence of any kind of AMD, respectively.
Despite the limited number of such cases, the researchers emphasise that no such links were observed for any of the other medication groups or for severe AMD in particular.

The researchers claim that theirs is the first major pooled data study of its sort to incorporate individual-level data from several population-based and hospital-based studies.
“However, further longitudinal data are required to corroborate our findings, which are intrinsically constrained by utilising just cross-sectional data and cannot infer causality,” they continued.

However, the findings imply that metabolic pathways play a crucial role in the development of AMD, which may open up new paths for therapy and have consequences for public health messaging. “According to our findings, frequent use of [lipid-lowering] and anti-diabetic medications is related with a decreased prevalence of AMD in the general population. Given the possibility of these medications interfering with pathophysiological pathways related to AMD, this may lead to a better understanding of AMD aetiology “They reached a conclusion.

With ageing, an inflammatory lipid appears to diminish the amount of macrophages inside the lungs.
The study, led by first author Judy Chen, a Ph.D. candidate, senior author Daniel Goldstein, M.D., the Eliza Maria Mosher Collegiate Professor in Internal Medicine and Professor of Microbiology and Immunology, and their team, looks into why cells known as alveolar macrophages, the lungs’ first line of defence, appear to be compromised with age.

These macrophages are immune cells that dwell in the tiny air sacs, or alveoli, inside the lungs and assault invaders like the flu virus. Importantly, these cells appear to be lost as people age. Another study found that when macrophages from an aged mouse were transplanted into a young mouse, the cells appeared young again. “This led us to conclude that something in the lungs’ environment was contributing to this,” Chen explained. Prostaglandin E2 (PGE2), a lipid immune modulator with wide-ranging effects ranging from labour induction in pregnancy to arthritic inflammation, was implicated. The researchers observed that PGE2 levels in the lungs increase with ageing.

This rise in PGE2, according to Chen, affects lung macrophages, decreasing their general health and capacity to produce.
The researchers believe that the accumulation of PGE2 is yet another indication of senescence, a biological condition that occurs with age. Senescence protects against the uncontrolled division of damaged cells; senescent cells can no longer reproduce. “One of the fascinating aspects of these cells is that they release a lot of inflammatory substances,” Chen explained.

The study found that as people age, the cells lining the air sacs in their lungs become senescent, resulting in increased PGE2 production and immunological suppression. They injected aged mice with a medication that disables a PGE2 receptor to evaluate the relationship between PGE2 and greater susceptibility to influenza. “The aged mice that had that treatment had more alveolar macrophages and survived influenza infection better than the older animals that didn’t get the therapy,” Chen explained.

The researchers will now look at how PGE2 impacts lung macrophages and its possible function in inflammation throughout the body. “As we age, we become more vulnerable not only to influenza, but also to other infections, malignancies, and autoimmune illnesses.”

Man is a sociable animal, as are other primates. Healthy social ties help people stay in good health, both emotionally and physically. According to a new study published in ‘Frontiers in Microbiology,’ the gut microbiome, which keeps the human gut in good shape, plays an important role in keeping our bodily systems intact. So, how does social interaction fit into the gut microbe’s complex and diversified nexus? Dr. Katerina Johnson assists us in our investigation.

Johnson is a research associate at the University of Oxford’s Departments of Experimental Psychology and Psychiatry. The researchers concentrated on a single social group of rhesus macaques (22 males and 16 females between the ages of six and twenty years) on the island of Cayo Santiago, off the eastern coast of Puerto Rico. Macaques were once found only in North Africa and Asia. However, in 1938, 409 rhesus macaques were relocated from India to Cayo Santiago.

On the 15.2-hectare island today, over 1,000 macaques are divided into several social groups. They are free to roam and forage, though their diet is supplemented daily with monkey chow. Every year, researchers conduct behavioural studies on the monkeys.

Between 2012 and 2013, the authors collected a total of 50 uncontaminated stool samples from this social group. As a measure of social connectedness, they used the time each monkey spent grooming or being groomed in 2012 and 2013, and his or her number of grooming partners.

Co-author Dr Karli Watson, from the Institute of Cognitive Science at the University of Colorado Boulder, explained: “Macaques are highly social animals and grooming is their main way of making and maintaining relationships, so grooming provides a good indicator of social interactions.”

“Engagement in social interactions was positively related to the abundance of certain gut microbes with beneficial immunological functions, and negatively related to the abundance of potentially pathogenic members of the microbiota,” said co-author Dr Philip Burnet, a professor from the Department of Psychiatry at the University of Oxford.

For example, genera more abundant in the most sociable monkeys included Faecalibacterium and Prevotella. Conversely, the genus Streptococcus, which in humans can cause diseases such as strep throat and, pneumonia, was most abundant in less sociable monkeys.

“It is particularly striking that we find a strong positive relationship between the abundance of the gut microbe Faecalibacterium and how sociable the animals are. Faecalibacterium is well known for its potent anti-inflammatory properties and is associated with good health,” said Johnson.

But what drives the relationship between social connectedness and gut microbiome composition? Distinguishing between cause and effect isn’t easy.

“The relationship between social behavior and microbial abundances may be the direct result of social transmission of microbes, for example through grooming. It could also be an indirect effect, as monkeys with fewer friends may be more stressed, which then affects the abundance of these microbes. As well as behavior influencing the microbiome, we also know it is a reciprocal relationship, whereby the microbiome can in turn affect the brain and behavior,” said Johnson.

According to Martin Roessler of Technische Universitat Dresden, Germany, and colleagues’ new study published in the journal PLOS Medicine, there is a significant new-onset major complication in children, adolescents, and adults across 13 distinct diagnosis and symptom complexes following COVID-19 infection.

According to research, some patients infected with COVID-19 experience long-term health difficulties after the acute phase of the disease. However, research on post-acute (post-COVID-19) syndrome remains limited, particularly in children and adolescents. Researchers identified patients with a polymerase chain reaction (PCR)-confirmed diagnosis of COVID-19 in the new study, which used a healthcare dataset covering nearly half of the German population and spanned all of 2019 and 2020.

They then compared the occurrence of pre-specified diagnoses, entered into the medical record at least three months post-infection, in these patients (11,950 children and adolescent and 145,184 adults) to a control cohort of more than 750,000 individuals with matched age, sex and pre-existing medical conditions, without PCR-confirmed COVID-19.

Overall, children and adolescents who had been infected with COVID-19 were 30% more likely than controls to have documented health problems beginning three months or more after infection (436.91 vs 335.98 per 1,000 person-years, IRR=1.30, 95% CI=1.25-1.35, p<0.01). Adults with COVID-19 were 33% more likely than controls to have health problems (615.82 vs 464.15 per 1,000 person-years, IRR=1.33, 95% CI=1.31-1.34, p<0.01).

Among children and adolescents, rates of malaise/fatigue/exhaustion, cough and throat/chest pain were the most strongly associated with a prior COVID-19 infection, but rates of headache, fever, abdominal pain, anxiety disorder and depression were also increased. Among adults, smell/taste disturbance, fever, and dyspnea (or difficulty breathing) were most strongly associated with COVID-19 infection but also more common were cough, throat and chest pain, hair loss, fatigue, exhaustion and headache.

“The results of the present study indicate that post-COVID-19 syndrome cannot be dismissed among children and adolescents,” the authors say.

“We found that COVID-19 diagnosis was associated with higher long-term demand for healthcare services as reflected in outpatient and inpatient diagnoses of a broad set of outcomes more than three months after confirmed SARS-CoV-2 infection. While children and adolescents appear to be less affected than adults, these findings are statistically significant for all age groups.”

The National Medical Commission (NMC) is expected to issue a notification on the National Exit Test (NExT), according to official sources. The administration has made a critical decision about the NExT. The exam is set to take place in December of next year.

Authorities from the Union Health Ministry acknowledged the situation and stated that a decision was made during a high-level meeting with senior health officials on Thursday at the Union Health Ministry.

“The notification regarding the National Exit test (NExT) is expected soon,” sources claimed.

It’s likely that the test will be conducted under the All India Institute of Medical Sciences (AIIMS), Delhi and the matter is still under discussion, they added.

The admission to PG Medical courses will be based on the marks obtained in the NExt exam. NEET PG 2023 could be the very last edition of the National Eligibility Cumulative Entrance Test- Postgraduate, they said.

The MBBS students from the 2019-2020 batch will be applicable for the NExt test which is likely to be held in December 2023.

According to the NMC Act, the NExt will function as a common final year MBBS qualifying exam for merit-based admissions for Medical postgraduate programs.

It is also a screening exam for those students who are foreign medical graduates and wanted to practice in India, the sources said.

Colon cancer is the third most common illness in the world, with over 2 million new cases diagnosed each year. The vast majority of patients are diagnosed when the tumour is still in the colon or rectum.

These tumours are surgically removed, and chemotherapy is commonly used to treat them in order to prevent recurrence. However, between 20% and 35% of people have cancer recurrence as metastases in other vital organs. These are caused by tumour cells that are still present but are buried during surgery. Metastases are the most prevalent cause of death in nearly all malignancies, including colon cancer.

The majority of colorectal cancer research has concentrated on the main condition. Additionally, there have been significant developments in recent years regarding how to identify metastatic disease after it has already manifested.

But up until recently, it had been impossible to investigate this small group of disseminated tumour cells since they are undetectable by clinical diagnostic methods. Because of this ignorance, there aren’t many medications that can effectively treat the remaining disease and stop it from spreading again, which has a bad prognosis.

Scientists at IRB Barcelona, led by Dr Eduard Batlle, ICREA researcher and group leader within the cancer CIBER network (CIBERONC), have for the first time identified residual tumour cells hidden in the liver and lung and have described how they evolve to give rise to the appearance of metastases in these organs.

“Understanding and avoiding the phenomenon of relapse after surgery is an unresolved medical need. After many years investigating colon cancer, we have taken the first step to prevent metastases in patients who present with localized disease,” explains Dr Eduard Batlle, head of the Colorectal Cancer Laboratory at IRB Barcelona.

How does colon cancer recurrence occur?

A novel experimental mouse model that mimics the process patients go through when they relapse has been created by scientists. The typical progression of this is the diagnosis, curative surgery, and relapse. In addition, they have developed a method that enables the isolation of a minor portion of liver-hidden disseminated tumour cells.

“The model, which is very similar to the progression of metastatic colon cancer in patients, has allowed us to describe the dynamics of residual disease in detail. We have studied metastases ranging from the micro-scale of 3 or 4 cells to medium-sized or even larger ones and have detailed how each of them evolves during the progression of the disease,” comments Dr Adria Canellas-Socias, a researcher at the laboratory headed by Dr Batlle and first author of the study.

Defining the High Relapse Cells

Colon cancer is made up of various tumour cell types, each of which performs a specific job as the disease progresses, as scientists have long known. Colon cancer is caused by a variety of cell types, and researchers led by Dr Batlle have identified a group of these cells as HRCs (High Relapse Cells). These cells don’t contribute to the underlying tumour’s growth and proliferate infrequently. However, HRC clusters have the capacity to separate from the primary tumour, migrate to the liver, and stay concealed for some time after surgery. Researchers have been able to confirm the existence of these identical cells in people who are most at risk of relapse following treatment in samples from colon cancer patients.

Additionally, scientists have demonstrated that eradicating these cells by genetic methods is sufficient to halt metastasis, as demonstrated by the fact that animals with colon cancer do not recur after the excision of the primary tumour. Additionally, Dr Batlle’s team has created a therapy plan to specifically eliminate any remaining disease and stop it from returning. They have shown that immunotherapy before surgery can eradicate early-stage metastases that are not yet obvious.

“Our discovery reveals how the group of tumour cells responsible for relapse behaves and also the genes that define them. In addition, it represents a proof of concept that paves the way for the development of new therapies, specifically aimed at eliminating residual disease, as well as new diagnostic tools to identify those patients at the greatest risk of relapse. Finally, our study points to the need for a revision of the clinical guidelines in the treatment of this type of cancer because, in many cases, it would be advisable to prescribe immunotherapy before surgery,” concludes Dr Batlle.

In light of these findings, new research areas may be explored. Dr. Batlle’s lab is currently focusing on understanding when HRCs that have reached the liver become “activated” to regenerate a tumour in order to impede this process and stop the spread of metastases. They are also attempting to determine what drives the appearance of these cells and why different patients have varying quantities of these cells.

According to study, the higher sensitivity of evening chronotype persons to anxiety and associated problems—those who function better at night or in the early hours of the morning—may be impacted by altered emotional learning.

Are you aware of your chronotype? Chronotypes relate to the variations in performance that each person has in response to the periods of sleep and wakefulness during the 24 hours of the day. They are also known as our circadian preference profiles. There are three types of people: morning types (those who prefer to rise early and perform well in activities that begin in the morning), evening types (those who are more productive at night or in the early hours of the morning and prefer to remain up later), and intermediate types (if we easily adapt to morning and evening schedules).

Because they can shed light on the onset of mental diseases like anxiety and post-traumatic stress disorder (PTSD), circadian rhythms are being investigated more and more.

In order to study the neurocognitive underpinnings of the association between chronotype and fear responses in healthy humans, researchers Chiara Lucifora, Giorgio M. Grasso, Michael A. Nitsche, Giovanni D’Italia, Mauro Sortino, Mohammad A. Salehinejad, Alessandra Falzone, Alessio Avenanti, and Carmelo M. Vicario turned to the traditional Pavlovian paradigm of fear conditioning.

Enhanced fear acquisition in those with evening chronotypes is discussed in the paper. The researchers from Universita Degli Studi di Messina and Universita di Bologna (Italy), Leibniz Research Center for Working Environment and Human Factors (Germany), and Universidad Catolica Del Maule (Chile), describe their “Virtual Reality Fear Conditioning/Extinction Study” in which they used 40 participants recruited from students at the University of Messina, 20 of whom had an evening chronotype and 20 controls.

“To the best of our knowledge, only one study (Pace-Schott et al., 2015) to date explored the role of chronotypes on the fear acquisition and extinction in healthy humans, but did not test intermediate chronotypes, the ideal control group as they are the most frequent chronotype in the population”, explains Carmelo M. Vicario, a researcher supported by the BIAL Foundation.
The findings in the two groups supported earlier research linking the evening chronotype to a higher risk of anxiety disorders and PTSD. The results in the two groups showed a higher fear acquisition response in evening chronotype individuals compared to intermediate chronotype participants.

“This study provides new insights about the influence of circadian rhythms on cognitive and affective processes, suggesting that the higher vulnerability of the evening chronotype to anxiety and related disorders may be mediated by altered fear acquisition,” says Vicario.