Medically Speaking Team

Despite occasional relapses from the rapid recovery seen in the years after surgery, gains in pain, physical function, and job productivity continue at least seven years.

The study’s findings were published in the journal JAMA Network Open. The findings of the study – which suggest that gains remain even as people age over the course of the study – can aid physicians, health insurance providers, and patients, many of whom have surgery to relieve joint discomfort and enhance mobility.

“Adults with severe obesity are much more likely to experience significant joint pain and limits to their physical abilities,” said Wendy C. King, Ph.D., associate professor of epidemiology in Pitt’s School of Public Health. “Obesity leads to an earlier need for knee and hip replacement. However, adults with severe obesity may be denied joint surgery until they lose weight. And, if physical limitations and pain interfere with job performance, losing weight could be necessary to maintain employment.”

King and her colleagues tracked 1,491 people who had Roux-en-Y gastric bypass or sleeve gastrectomy between 2006 and 2009, the two most popular and successful surgical procedures for extreme obesity. The research participants had a median age of 47 years at the time of surgery, and 80% were female.

The patients were included in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective cohort study of weight-loss surgery patients in the United States.

The current study relies on a previous study by King and her colleagues, which found that 50% to 70% of study participants reported clinically significant improvements in pain levels, physical function, and typical walking pace three years after bariatric surgery.

The researchers discovered that after seven years after surgery, 43% of patients showed clinically significant improvements in pain, 64% in physical function, and 50% in 400-meter walk time, all of which were down between 7 and 11 percentage points from the three-year evaluation.

At seven years post-surgery, 65% of individuals with symptoms suggestive of osteoarthrosis reported improvements in hip pain, while 72% reported improvements in knee function, both down from 77% at three years post-surgery.

The minor to moderate decreases in pain and increases in physical function are not surprising, given that the patients matured to a median of 54 years throughout the duration of the trial, according to King.

Previous research shows that some aspects of physical function, such as balance and strength, start to decline when people enter their 50s, and others, such as walking speed and aerobic endurance, typically decline in the sixth decade of life.

“On average, participants experienced durable improvements in walking speed, fitness and almost all metrics of pain,” King said.

In addition, participants reported that pain and health status interfered less with their ability to work post-surgery, with 43% of participants reporting impaired work due to health seven years post-surgery, down from 63% pre-surgery.

“Combined, our study provides great news about the lasting effects of bariatric surgery,” King said. “But clinicians should look at patients as individuals and consider their complete health history, goals and motivations for weight loss when providing presurgical counseling on potential results.”

More than a decade after the role of pyramidal neurons in mental representations of space and location was discovered, a group of researchers has made an important contribution to scientists’ understanding of the brain’s navigation system by identifying a subtype of these neurons that can gauge speed with great precision.

“In experiments involving animals, we demonstrated an association between the electrical activity of inhibitory interneurons and speed representations in the brain,” Alexandre Kihara, a neuroscientist at the Federal University of the ABC in Sao Paulo state, Brazil, told Agencia FAPESP. Kihara is a co-author of an article on the study published in Scientific Reports, a journal owned by Springer Nature.

Excitatory neurons and inhibitory interneurons are located in the hippocampus, a bilateral brain structure in the temporal lobe (behind the ears) that is associated with the formation of new memories, learning, emotions and, as has recently been discovered, spatial representation. Excitatory neurons activate other neurons, while inhibitory interneurons hinder or block them. Together they can modulate signaling in brain regions to avoid the excess activity associated with seizures, for example.

“Although they all play a role in encoding space, we found that inhibitory neurons have some additional functions,” said Juliane Midori Ikebara, who holds a bachelor’s degree in science and technology and a PhD in neuroscience and cognition from UFABC.

Ikebara is the lead author of the article, alongside Peter Schuette, a researcher in the Psychology Department at the University of California, Los Angeles (UCLA) in the United States.

Analyzing video images of neural activity in mice, the group also observed that inhibitory neurons reacted differently to changes in the environment such as rotation or size. “They were more stable than excitatory neurons, which sometimes alter position encoding in response to environmental changes,” Kihara said.

This behavior was unknown and may be associated with spatial memory. “These more stable neurons may be linked to the ability to remember routes or the location of the living room or bathroom when we wake up in the same house, for example,” said Kihara, who supervised Ikebara’s PhD research.

In practice, Ikebara noted, this is the first study to evidence the functions of inhibitory cells, which account for less than 10% of pyramidal neurons. The idea of studying these cells arose while she was doing a sandwich doctorate in the US in 2020-21. Having been awarded a scholarship by FAPESP, she went to work for a period at the UCLA laboratory led by Professor Avishek Adhikari, the corresponding author of the Scientific Reports article, to learn to build the miniature microscope used to record neuronal electrical activity.

The standard device used in this type of experiment, the Miniscope developed at Stanford University, also in California, sells for a prohibitive price. “About seven years ago, a group at UCLA opened it up, studied what it contained, and published a blueprint free of charge, with very well-specified instructions for building and using it. Thanks to this feat, hundreds of researchers in other countries have been able to obtain the technology,” said Adhikari, who has lived in Sao Paulo.

In addition to the miniature microscope built by Ikebara, who brought the technology to UFABC, the study of neuronal electrical activity in mice also involves biosensors and algorithms. “First of all, the mice were injected with a virus bearing instructions to infect the cells and make them produce a protein that becomes fluorescent in the presence of increased levels of calcium, which occur when the cells are activated,” Ikebara explained.

A cylindrical lens was then placed over the hippocampus, and the miniature microscope was fixed to the skull surface to document neuronal activity. During the experiments, the animals were placed in enclosures that were rotated and made to change size or shape.

After recording hundreds of hours of videos, the researchers used information theory and algorithms to map the activated neurons in conjunction with the positions of the mice in the enclosures.

“We found it was possible to predict very precisely where a mouse was located in the environment just by looking at the map of electrically activated neurons, without having to watch the videos,” Adhikari told Agencia FAPESP.

The findings, according to Ikebara, lead to a deeper understanding of how individuals monitor and remember knowledge about routes as well as learn new places. Based on prior research into the effects of oxygen deprivation at birth on adult rat brains, Ikebara believes these newest findings indicate to new directions in the study of difficulty learning new routes and places in patients with Alzheimer’s and other neurodegenerative disorders.

Birth oxygen deprivation can cause spatial memory problems, which have also been linked to changes in inhibitory neurons.

According to World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus, the number of weekly reported COVID-19 deaths last week fell to its lowest level since March 2020, and the end of the pandemic is now in sight.

“We have never been in a better position to end the pandemic”, the WHO chief told media personnel during his regular weekly press conference. The UN health agency’s Director-General explained, however, that the world is “not there yet”. “A marathon runner does not stop when the finish line comes into view. She runs harder, with all the energy she has left. So must we. We can see the finish line. We’re in a winning position. But now is the worst time to stop running”, he underscored.

The WHO chief also warned that if the world does not take the opportunity now, there is still a risk of more variants, deaths, disruption, and uncertainty. “So, let’s seize this opportunity”, he urged, announcing that WHO is releasing six short policy briefs that outline the key actions that all governments must take now to “finish the race”.

The policy briefs are a summary, based on the evidence and experience of the last 32 months, outlining what works best to save lives, protect health systems, and avoid social and economic disruption.

“[They] are an urgent call for governments to take a hard look at their policies and strengthen them for COVID-19 and future pathogens with pandemic potential”, Tedros explained.

The documents, which are available online, include recommendations regarding vaccination of most at-risk groups, continued testing and sequencing of the SARS-CoV-2 virus, and integrating effective treatment for COVID-19 into primary healthcare systems.

They also urge authorities to have plans for future surges, including the securing of supplies, equipment, and extra health workers. The briefs also contain communications advice, including training health workers to identify and address misinformation, as well as creating high-quality informative materials.

Tedros underscored that WHO has been working since New Year’s Eve 2019 to fight against the spread of COVID and will continue to do so until the pandemic is “truly over”.

“We can end this pandemic together, but only if all countries, manufacturers, communities and individuals step up and seize this opportunity”, he said.

Dr. Maria Van Kerkhove, WHO’s technical lead on COVID-19, highlighted that the virus is still ” intensely circulating” around the world and that the agency believes that case numbers being reported are an underestimate.

“We expect that there are going to be future waves of infection, potentially at different time points throughout the world caused by different subvariants of Omicron or even different variants of concern”, she said, reiterating her previous warning that the more the virus circulates, the more opportunities it has to mutate.

However, she claims that future waves do not have to be “waves or death” because effective measures such as COVID-19 vaccinations and antivirals are now available.

According to a research, the OPS/NPS specimen, as well as possible urine specimens, should be considered crucial specimens for Monkeypox diagnosis in subjects with no active skin lesions. Based on laboratory studies of the Monkeypox fatality in Kerala, the ICMR – NIV pre-print report concluded the death was caused by Monkeypox.

The research also said that it was the first fatal case of Monkeypox recorded from India and that Oropharyngeal swabs (OPS) and Nasopharyngeal swabs (NPS) should be used in Monkeypox diagnosis.

“This case highlights the importance of maintaining a high index of suspicion to diagnose MPXV in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from MPXV endemic or outbreak countries. In conclusion, the overall findings of the case and the history confirm that the case to be infected with MPXV,” read the findings of the study.

The study has also mentioned that other samples like Oropharyngeal swabs (OPS) and Nasopharyngeal swabs (NPS) should also be considered in diagnoses of Monkeypox when there are no active skin lesions, “The OPS/NPS specimen as well as possibly urine specimens should be considered as the critical specimens for MPXV diagnosis in cases with no active skin lesions.”

The project ‘Providing diagnostic help for referred samples of viral haemorrhagic fever and other uncertain aetiology and epidemic investigation’ was authorised by the Institutional Human Ethics Committee of ICMR-NIV, Pune, India.

During the period July-September 2022, India has recorded eleven confirmed cases of monkeypox from Kerala and New Delhi. Nine instances have exhibited total recovery with no sequelae, one patient is still isolated, and another case has died from the condition. All five confirmed cases in Kerala involved visitors from the United Arab Emirates (UAE).

When kidney stones are surgically removed from patients, little stones that do not appear to be causing problems are commonly left behind. According to a recent randomised controlled study, leaving these asymptomatic stones left significantly increases the probability of a patient developing a recurrence in the five years that follow.

The study’s findings were published in the journal ‘New England Journal of Medicine.’ Stones less than 6mm in diameter that are not the primary target of a procedure are generally not removed but are monitored because “secondary” stones have a high rate of successful passage if they move into the ureter, according to lead author Dr Mathew Sorensen, a urologist at the University of Washington School of Medicine.

“Before this study, the clinical views were pretty mixed on whether some of these stones should be treated,” he said. “Most clinicians would decide, based on the size of the kidney stone, whether it hit the bar for treatment, and if it did not, you would often ignore the little stones.”

The investigators studied 75 patients who were treated at multiple institutions over a span from 2015 to 2021. About half of the patients had only their large primary stone treated, while the others had primary and secondary kidney stones removed. Relapse was defined as having to go to the emergency room or undergo an additional procedure due to a recurrence or if a follow-up CT scan showed that the secondary stones grew.

Also Read: Pandemic might have led to health inequalities among ethnic groups, study finds

Removal of the secondary stones reduced the relapse rate by 82 per cent, the researchers found, leading the authors to recommend that smaller stones should not be left behind.

“Results of our trial support the removal of small asymptomatic kidney stones at the time of surgery with a larger stone,” their paper concluded. The authors noted that while the removal of smaller stones could add to the procedure’s duration and cost, those costs would likely be less than those associated with a patient’s repeat procedure or visit to the emergency room.

Some patients in the study visited the emergency department multiple times and then required surgery, the report noted.
Sorensen said he would share the study results with colleagues with the hope of changing their sensibility toward smaller stones. Further study is needed to determine whether treatment of small kidney stones alone is justified, as technology improves and the costs and risks of an intervention diminish, he said.

“I think we have proven through this rigorous study that removal of the small asymptomatic stones is beneficial when feasible and in patients that are candidates to have all their stones treated in one procedure,” he noted. “Leaving the stones behind risks trouble in the future.”

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Vegetarians had a 33% greater risk of hip fracture than meat eaters, according to a study of nearly 26,000 middle-aged UK women.

University of Leeds research, published in the journal BMC Medicine, investigated the risk of hip fracture in occasional meat-eaters; pescatarians, people who eat fish but not meat; and vegetarians compared to regular meat-eaters. Among 26,318 women, 822 hip fracture cases were observed over roughly 20 years – that represented just over 3% of the sample population. After adjustment for factors such as smoking and age, vegetarians were the only diet group with an elevated risk of hip fracture.

This is one of only a few studies that examine the risk of hip fracture in vegetarians and meat eaters using hospital data to confirm the occurrence of hip fracture.

More investigation into the specific explanations of why vegetarians were at a higher risk of hip fracture is needed, according to the experts.

Vegetarian diets can be ‘healthy or unhealthy’

Study lead author James Webster, a doctoral researcher from the School of Food Science and Nutrition at Leeds, said: “Our study highlights potential concerns regarding risk of hip fracture in women who have a vegetarian diet. However, it is not warning people to abandon vegetarian diets. As with any diet, it is important to understand personal circumstances and what nutrients are needed for a balanced healthy lifestyle.

“Vegetarian diets can vary widely from person to person and can be healthy or unhealthy, just like diets that include animal products.

“However, it is concerning that vegetarian diets often have lower intakes of nutrients that are linked with bone and muscle health. These types of nutrients generally are more abundant in meat and other animal products than in plants, such as protein, calcium, and other micronutrients.

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“Low intake of these nutrients can lead to lower bone mineral density and muscle mass, which can make you more susceptible to hip fracture risk. This makes it especially important for further research to better understand factors driving the increased risk in vegetarians, whether it be particular nutrient deficiencies or weight management, so that we can help people to make healthy choices.”

Plant-based diets growing in popularity

Vegetarian diets have gained popularity in recent years, with a 2021 YouGov survey putting the size of the UK vegetarian population at roughly 5-7%. It is often perceived as a healthier dietary option, with previous evidence that shows a vegetarian diet can reduce the risks of several chronic diseases, including diabetes, heart disease, and cancer compared to omnivorous diets.

There is also a worldwide call for reducing the consumption of animal products in an effort to tackle climate change.
Understanding hip fracture risk in vegetarians is therefore becoming increasingly important to public health.

Study co-author Professor Janet Cade, leader of the Nutritional Epidemiology Group in the School of Food Science and Nutrition at Leeds, said: “Hip fracture is a global health issue with high economic costs that causes loss of independence, reduces quality of life, and increases risk of other health issues.

“Plant-based diets have been linked with poor bone health, but there has been a lack of evidence on the links to hip fracture risk. This study is an important step in understanding the potential risk plant-based diets could present over the long-term and what can be done to mitigate those risks.”

The team used data from the UK Women’s Cohort Study to investigate possible links between diet and hip fracture risk. The national cohort of middle-aged women was established at the University of Leeds to explore links between diet and chronic disease, encompassing a wide range of different eating patterns. Dietary information was collected using a food frequency questionnaire and was validated using a 4-day food diary in a subsample of women.

At the time they were recruited into the cohort study, the women ranged in age from 35 to 69 years.

Effect of low BMI

The research team found that the average BMI among vegetarians was slightly lower than the average among the regular meat eaters. Previous research has shown a link between low BMI and a high risk of hip fracture.

Lower BMI can indicate people are underweight, which can mean poorer bone and muscle health, and higher risk of hip fracture. Further investigation is needed to determine if low BMI is the reason for the observed higher risk in vegetarians.

Study co-author, Dr Darren Greenwood, a biostatistician in the School of Medicine at Leeds, said: “This study is just part of the wider picture of diet and healthy bones and muscles in older age.

“Further research is needed to confirm whether there could be similar results in men, to explore the role of body weight, and to identify the reasons for different outcomes in vegetarians and meat-eaters.”

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Researchers have discovered fresh evidence to explain why intensive thinking causes people to feel mentally weary rather than asleep.

Their findings, published in Current Biology, reveal that when hard cognitive labour is performed for several hours, potentially hazardous wastes accumulate in the prefrontal cortex of the brain. As cognitive weariness sets in, this modifies your influence over decisions, causing you to gravitate toward low-cost activities that require little effort or waiting, according to the study.

“Influential theories suggested that fatigue is a sort of illusion cooked up by the brain to make us stop whatever we are doing and turn to a more gratifying activity,” says Mathias Pessiglione of Pitie-Salpetriere University in Paris, France. “But our findings show that cognitive work results in a true functional alteration–accumulation of noxious substances–so fatigue would indeed be a signal that makes us stop working but for a different purpose: to preserve the integrity of brain functioning.”

Pessiglione and colleagues including the first author of the study Antonius Wiehler wanted to understand what mental fatigue really is. While machines can compute continuously, the brain can’t. They wanted to find out why. They suspected the reason had to do with the need to recycle potentially toxic substances that arise from neural activity.

To look for evidence of this, they used magnetic resonance spectroscopy (MRS) to monitor brain chemistry over the course of a workday. They looked at two groups of people: those who needed to think hard and those who had relatively easier cognitive tasks.

They saw signs of fatigue, including reduced pupil dilation, only in the group doing hard work. Those in that group also showed in their choices a shift toward options proposing rewards at short delay with little effort. Critically, they also had higher levels of glutamate in synapses of the brain’s prefrontal cortex.

Together with earlier evidence, the authors say it supports the notion that glutamate accumulation makes further activation of the prefrontal cortex more costly, such that cognitive control is more difficult after a mentally tough workday.

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So, is there some way around this limitation of our brain’s ability to think hard?

“Not really, I’m afraid,” Pessiglione said. “I would employ good old recipes: rest and sleep! There is good evidence that glutamate is eliminated from synapses during sleep.”

Other practical implications may exist. Monitoring prefrontal metabolites, for example, might aid in the detection of severe mental exhaustion, according to the researchers. Such a skill may aid in adjusting work schedules to minimise burnout. He also suggests that individuals avoid making major judgments while they are weary.

They intend to understand more about why the prefrontal brain appears to be more vulnerable to glutamate buildup and tiredness in future investigations. They’re also keen to see if the same tiredness signals in the brain might predict recovery from illnesses like depression or cancer.

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Israeli researchers have identified two antibodies from the immune systems of COVID-19 patients who have recovered. These antibodies have a 95% chance of neutralising all known strains of SARS-CoV-2, including Omicron. The Tel Aviv University researchers stated that, particularly for at-risk groups and those with compromised immune systems, tailored therapy with antibodies and their delivery to the body in high quantities may serve as an efficient replacement for vaccinations.

The researchers claimed there is a chance that antibody therapy would reduce the requirement to administer repeated booster doses to the whole population each time a new variation appears.

The investigation, which was only just published in the journal Communications Biology, is an extension of initial work done in October 2020, at the height of the COVID-19 crisis. At that time, the scientists discovered nine antibodies that the patients made after sequencing all of the B immune system cells from the blood of persons who had recovered from the initial COVID-19 strain in Israel.

The researchers now found that some of these antibodies are very effective in neutralising the new coronavirus variants, Delta and Omicron. “In the previous study, we showed that the various antibodies that are formed in response to infection with the original virus are directed against different sites of the virus,” said Natalia Freund, who co-led the study.

“The most effective antibodies were those that bound to the virus’s ‘spike’ protein, in the same place where the spike binds the cellular receptor ACE2,” Freund said.

The SARS-CoV-2 virus uses the spike protein to infect and enter the cells. In the current study, the researchers proved that two other antibodies, TAU-1109 and TAU-2310, which bind the viral spike protein in a different area from the region where most of the antibodies were concentrated until now are actually very effective in neutralising the Delta and Omicron variants. “According to our findings, the effectiveness of the first antibody, TAU-1109, in neutralising the Omicron strain is 92 per cent, and in neutralising the Delta strain, 90 per cent.,” Freund said.

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