October 10, 2024

Vitamin C deficiency in elderly can cause abnormal bleeding, fatigue: Study

Older adults suffering from abnormal bleeding, fatigue, and weakness, must be assessed for scurvy -- a disease caused by vitamin C deficiency, suggests a study on Monday. Detailing a case study of a 65-year-old woman with mobility issues and social.

Older adults suffering from abnormal bleeding, fatigue, and weakness, must be assessed for scurvy -- a disease caused by vitamin C deficiency, suggests a study on Monday.

Detailing a case study of a 65-year-old woman with mobility issues and social isolation, the study published in CMAJ (Canadian Medical Association Journal) showed that scurvy, or vitamin C deficiency, is not just an 18th-century seafarers' disease.

Researchers from the University of Toronto in Canada implored clinicians to consider scurvy in patients with abnormal bleeding and nonspecific symptoms.

The elderly patient visited the emergency department at a downtown Toronto hospital for leg pain and weakness, skin lesions, and discoloration. She also had several chronic health conditions.

Mobility issues restricted her ability to go grocery shopping, cook, and perform other daily activities. She lived largely on canned soup and fish, with no fresh produce.

“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” said Dr. Sarah Engelhart, a general internist at Mount Sinai Hospital and the University of Toronto.

The researchers noted that vitamin C deficiency is more common than expected in the 21st century. However, its diagnosis is often challenging as symptoms are often nonspecific, such as fatigue, weakness, and shortness of breath.

The patient also smoked, which further contributes to vitamin C deficiency. Her symptoms improved once she started on vitamin C treatment, and a blood test for vitamin C deficiency eventually confirmed the diagnosis, said the doctors.

“Clinicians should be alert to vitamin C deficiency when assessing patients, including children and isolated older adults,” the doctors said.

The team noted that people who follow restrictive eating patterns (for example, those with autism spectrum disorder or those on a tea and toast diet), who smoke cigarettes, who have a substance use disorder, or who have malabsorption syndrome, can also be at risk of scurvy.

https://www.tribuneindia.com/news/health/vitamin-c-deficiency-in-elderly-can-cause-abnormal-bleeding-fatigue-study/

Cannabis pill may reduce agitation in people with Alzheimer's disease

Research has found that cannabis-derived drugs may help improve some Alzheimer’s symptoms.

Agitation is a common problem that people with Alzheimer’s disease experience.

Researchers are interested in finding the best ways to manage agitation, including determining which medications may be most helpful.

One new study suggests that the drug dronabinol derived from cannabis could help reduce agitation in people with Alzheimer’s disease without significantly increasing the risk for adverse events.

Alzheimer’s disease is a chronic and challenging condition to manage, from its diagnosis to the symptoms that individuals experience. For example, people with Alzheimer’s disease can experience agitation that makes care and daily life difficult.

Recent study results were shared at the International Psychogeriatric Association conference that indicate cannabis could help address agitation related to Alzheimer’s disease.

In research including 75 participants over a three-week intervention period, researchers found that the drug dronabinol — a synthetic version of the psychoactive delta-9-tetrahydrocannabinol (THC) compound in cannabis — helped reduce agitation better than the placebo.

The results demonstrate that it might be helpful to use dronabinol in clinical practice for this purpose in the future.

Challenges of diagnosing Alzheimer’s disease

Alzheimer’s disease is a common dementia type that can involve memory loss, changes in learning abilities, and behavioral changes. There is no one test that can diagnose Alzheimer’s disease, which can be challenging for doctors and people experiencing symptoms of Alzheimer’s disease.

DiagnosingTrusted Source Alzheimer’s disease can involve multiple tests, including ways to rule out other causes for the symptoms someone is experiencing.

There are blood tests available that can help with Alzheimer’s disease diagnosis. One recent studyTrusted Source found that biomarkers in blood that are related to Alzheimer’s disease may change based on the time of day. Experts may need to take this into account when it comes to diagnosing and treating Alzheimer’s disease. It also implies that there is even more data to consider when it comes to accurately diagnosing Alzheimer’s disease.

After receiving a diagnosis of Alzheimer’s disease, it’s important for everyone to work together to address Alzheimer’s disease symptoms to come up with the best management strategies.

How to reduce agitation in people with Alzheimer’s disease

AgitationTrusted Source is a symptom related to Alzheimer’s disease. Authors of the current research note that agitation can lead to some challenging behaviors, including resisting care, trouble sleeping, and combativeness. They note that while behavioral strategies are part of agitation management, medication can also play a role.

This current research explored using the drug dronabinolTrusted Source, which is a synthetic version of delta-9-tetrahydrocannabinol (THC). THCTrusted Source is a compound in cannabis that leads to cannabis’ psychoactive effects. Dronabinol can help with nausea and vomiting and help improve appetite.

Researchers compared the use of dronabinol with placebo to see if there would be a noted reduction in agitation symptoms in participants with Alzheimer’s disease.

Using dronabinol twice a day to reduce agitation

The placebo-controlled, double-blind trial had a three-week intervention period. All participants had dementia due to Alzheimer’s disease and were between 60 and 95 years old. Researchers excluded some individuals, such as those taking lithium and those who already had baseline delirium, which is the temporary cognitive and behavioral changes that can occur because someone is taking medication or has a certain illness.

Researchers used several assessment scales to look at participant behavior, including the Pittsburgh agitation scale (PAS) and Neuropsychiatric Inventory, Clinical Version (NPI-C). They utilized questionnaires to look at drug effects and side effects. They also monitored participants for adverse events.

Researchers recruited 75 participants from five different clinical research sites, and 63 participants completed the whole study. The research included inpatient and outpatient participants. Throughout the timeframe, there were no significant differences in adverse events between the control group and placebo group. Three severe adverse events occurred in the intervention group and none in the placebo group, so this was not enough for researchers to make a valid statistical comparison.

Over three weeks, participants received five mg of dronabinol twice a day or a placebo. Overall, researchers found that dronabinol was a safe intervention for participants and helped decrease agitation better than the placebo.

Study author Paul B. Rosenberg, M.D. Professor of Psychiatry and Behavioral Sciences with the Johns Hopkins School of Medicine, noted the following highlights of the study’s findings to Medical News Today:

“We found that dronabinol (a prescription form of THC) was safe and effective in treating agitation in Alzheimer’s disease over a 3-week period in 75 patients. This is particularly relevant because this was very much a ‘real-world’ population in that we did not exclude patients with advanced dementia or taking other medications, so it is all the more impressive that we saw the benefit.”

Study limitations

This study does have limitations. First, the full study has not currently been published and is not available to the general public. Second, it only involved a small number of participants, so larger studies can help confirm the findings. The time of the intervention was only three weeks, so it does not address the potential long-term effects.

Participants in both intervention and placebo groups were also receiving other antipsychotic and antidepressant treatments, which could have impacted the results.

Since the data came from multiple facilities, it’s possible there were inconsistencies in assessments and differences between inpatient and outpatient participants. The trial itself was also affected by the COVID-19 shutdown. One measurement of cognitive function was higher in participants who completed the study than those who did not. 65% of participants were female, so future studies could include more male participants.

Addressing symptoms, not curing Alzheimer’s

It is important to note that dronabinol specifically addressed a symptom related to Alzheimer’s disease, not Alzheimer’s disease itself.

David Merrill, MD, PhD, a board certified geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, noted the following:

“While the treatment did show a statistically significant reduction in agitation symptoms, the patients remained with significant symptoms, and the underlying causes of the disease process are not addressed by the drug. The treatment is symptomatic. Similar symptomatic treatments also already exist, and though the authors cite potential side effects of these other drug options, dronabinol itself is not without risks.”

Overall, the study demonstrates that dronabinol may help manage agitation in people with Alzheimer’s disease. If future research confirms the findings, this could lead to dronabinol being used in clinical practice for agitation.

Rosenberg noted the following about continued research in this area:

“We need to determine whether response is long lasting, and we need to study cannabis products available at dispensaries. This latter is very challenging scientifically but very important since we know patients and families are using these products.”

https://www.medicalnewstoday.com/articles/cannabis-pill-may-reduce-agitation-people-alzheimers-disease

The impact of breast cancer on women’s fertility

Breast cancer treatments, such as chemotherapy, radiation, and hormone therapy, can significantly impact fertility in younger women. Fertility preservation options, including egg freezing and ovarian suppression, alongside proper counseling, are crucial for those wanting to conceive post-treatment.

The impact of breast cancer on women’s fertility

Breast cancer, one of the most common cancers affecting women worldwide, not only threatens life but also significantly impacts reproductive health and fertility. For women of reproductive age diagnosed with breast cancer, the concern of whether they will be able to conceive and carry a child becomes as critical as their overall survival. The treatments that are critical for combating cancer, such as chemotherapy, radiation therapy, and hormone therapy, can often affect a woman’s ability to conceive.

Understanding the implications of these treatments on fertility is crucial for women facing breast cancer, as is the importance of fertility preservation and counseling.

Breast Cancer Diagnosis in Younger Women

Although breast cancer is more prevalent in women over the age of 50, an increasing number of younger women are being diagnosed with the disease. Women in their twenties, thirties, and early forties—prime childbearing years—are being confronted with this life-altering diagnosis. The fact that breast cancer therapies can affect ovarian function and reduce fertility means that many of these young women must make difficult decisions about fertility preservation before beginning their cancer treatment.

How Breast Cancer Treatment Affects Fertility

1. Chemotherapy and Ovarian Function

Chemotherapy, a cornerstone of breast cancer treatment, can severely damage ovarian function. The drugs used in chemotherapy target rapidly dividing cells, which include not only cancer cells but also the cells within the ovaries responsible for producing eggs. This damage can lead to diminished ovarian reserve, premature ovarian insufficiency (POI), or early menopause, particularly for women who are closer to 40 years of age. This reduction in ovarian reserve means fewer eggs are available for fertilization, decreasing the chances of conception post-treatment.

The impact of chemotherapy on fertility largely depends on the type of chemotherapy used, the dosage, and the woman's age. Alkylating agents, for example, are particularly toxic to the ovaries. Younger women may be more likely to regain some ovarian function post-treatment, but the risk remains significant, and many may experience permanent infertility.

2. Hormonal Therapy

Hormonal therapies, such as tamoxifen or aromatase inhibitors, are often used in treating hormone receptor-positive breast cancer. These treatments are usually prescribed for several years and are known to affect fertility. While tamoxifen does not cause permanent ovarian damage, it is not recommended to conceive while on this medication due to the risk it poses to the fetus. Thus, women undergoing long-term hormonal therapy must often delay pregnancy for five to ten years, which can be challenging, especially as fertility declines with age.

3. Radiation Therapy

Radiation therapy, particularly when administered near the pelvic area, can also affect fertility. Although breast cancer patients typically undergo radiation to the chest, certain treatments may involve areas close to the reproductive organs, putting the ovaries at risk. The cumulative effect of radiation on ovarian function can result in infertility or increase the risk of miscarriage and pregnancy complications.

Fertility Preservation Options

Fertility preservation has become an essential component of breast cancer care for women who wish to conceive after treatment. Some options include:

1. Egg or Embryo Freezing (Cryopreservation)

Cryopreservation is the most commonly used method to preserve fertility. This process involves stimulating the ovaries to produce multiple eggs, retrieving those eggs, and freezing them for future use. Women may also choose to fertilize their eggs with sperm to create embryos, which can be frozen for later implantation. However, this process must be done before chemotherapy or other treatments that can harm ovarian function, and it requires a delay in treatment for about two weeks.

2. Ovarian Suppression

Some doctors recommend the use of gonadotropin-releasing hormone (GnRH) agonists during chemotherapy to temporarily suppress ovarian function. The theory is that by "putting the ovaries to sleep," they may be protected from the damaging effects of chemotherapy. While studies on the effectiveness of this approach are ongoing, it offers a potential option for women who cannot delay cancer treatment to undergo egg retrieval.

3. Ovarian Tissue Cryopreservation

This is a newer and experimental method where ovarian tissue is removed and frozen before treatment. After cancer therapy, the tissue can be re-implanted into the body, where it may restore hormonal function and fertility. This technique is particularly useful for young girls who have not yet reached puberty, as it does not require ovarian stimulation.

Counselling and Support for Women

A breast cancer diagnosis is emotionally challenging, and for young women who have not yet started or completed their families, fertility concerns add to the distress. Fertility counseling should be an integral part of cancer care for all reproductive-age women diagnosed with breast cancer. Oncologists and fertility specialists need to work collaboratively to provide women with information about their fertility risks and preservation options. Counseling should also address the emotional impact of potential infertility, offering support for coping with loss or changes in reproductive plans.

Conclusion

The impact of breast cancer on fertility is a significant concern for many young women facing this diagnosis. While treatments like chemotherapy, hormonal therapy, and radiation can jeopardize fertility, advances in fertility preservation provide hope for many. With early intervention and proper counseling, women diagnosed with breast cancer can make informed decisions about their fertility, preserving the option to conceive after their cancer treatment is complete. Nevertheless, the emotional toll of these decisions should not be underestimated, and ongoing support is critical for navigating this complex journey.

https://www.hindustantimes.com/lifestyle/health/infertility-alert-how-your-bmi-or-weight-could-be-blocking-your-path-to-parenthood-101728484194094.html

Infertility alert: How your BMI or weight could be blocking your path to parenthood

According to health and fertility experts, Body Mass Index (BMI) has a direct impact on reproductive health and the ability to conceive, making it a crucial factor in women's fertility. BMI is a straightforward formula that accounts for a person's height and weight.

In an interview with HT Lifestyle, Dr Rupali Tambe, Fertility Consultant at Nova IVF in Pune, shared, “Although a healthy reproductive system is frequently linked to a BMI within the normal range (18.5-24.9), women who are underweight or overweight might have difficulties becoming pregnant. For women who intend to become pregnant, knowing how BMI affects fertility is crucial since keeping a healthy BMI can improve the odds of conception.”

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Underweight Women and Fertility

Dr Rupali Tambe explained, “A BMI below 18.5 is regarded as underweight. Hormonal imbalances frequently cause difficulty conceiving for women in this category. The production of vital reproductive hormones like estrogen, which is necessary for controlling the menstrual cycle and ovulation, might be interfered with by low body fat. The likelihood of ovulation and pregnancy is decreased when body fat levels are very low because estrogen production decreases. This might result in irregular periods or even amenorrhea, the full cessation of menstruation.”

She elaborated, “In addition, women who are underweight may not be getting enough nutrients, which might lower the quality of their eggs and raise the chance of miscarriage. Low BMI can also have an impact on the lining of the uterus, which reduces the likelihood that a fertilized egg will implant well. Gaining weight to reach a normal BMI can assist enhance the chances of conception and restore regular ovulation in women who are attempting to get pregnant.”

Overweight and Obese Women

On the other hand, a BMI of more than 25 is regarded as overweight and a BMI of more than 30 is categorised as obese. Dr Rupali Tambe revealed, “The overproduction of estrogen brought on by excess body fat might disrupt ovulation and the menstrual cycle. One of the most frequent reasons of infertility in overweight and obese women is this disorder, called anovulation. Polycystic ovarian syndrome (PCOS), a hormonal condition that reduces egg quality and causes irregular or absent periods, is also more common in women with high BMIs. Additionally, obesity can impact insulin levels, resulting in insulin resistance, which further disrupts the balance of reproductive hormones and hinders ovulation.”

She added, “Furthermore, women who are overweight may experience pregnancy-related issues such as gestational diabetes, hypertension, a higher risk of miscarriage, and birth abnormalities. Because of these reasons, it's critical that women with high BMIs reduce their weight before attempting to conceive. Research indicates that even a little weight loss of 5–10% will boost general reproductive health and restore ovulation, which will increase fertility. Women with advanced maternal age that is more than 30 years and not able to conceive should not waste too much time in weight loss as it can further deteriorate the quantity and quality of oocytes, in such cases an expert opinion from a fertility consultant and a programmed approach towards weight loss plus fertility will help them to achieve desired results.”

The Importance of a Healthy BMI for Assisted Reproduction

The BMI of women using in vitro fertilization (IVF) or other reproductive procedures may potentially have an impact. Dr Rupali Tambe pointed out, “Due to poor egg quality, decreased ovarian response to stimulation, and problems with implantation, women who are underweight or overweight may experience lower success rates with in vitro fertilization.

Maintaining a healthy body mass index (BMI) enhances the chances of successful pregnancy by optimising egg quality, hormone equilibrium, and uterine receptivity.”

Asserting that a key component of women's fertility health is their BMI, Dr Rupali Tambe concluded, “Hormonal imbalances, irregular ovulation and other reproductive difficulties make conception difficult for both overweight and underweight women. Whether pregnancy occurs naturally or through fertility treatments, maintaining a healthy BMI through balanced diet, regular exercise, and lifestyle modifications can greatly enhance reproductive results and increase the odds of conception. In order to maintain their reproductive health and may ensure a more seamless transition to parenting, women who intend to become pregnant should aim for a BMI within the healthy range.”

https://www.hindustantimes.com/lifestyle/health/infertility-alert-how-your-bmi-or-weight-could-be-blocking-your-path-to-parenthood-101728484194094.html

Stressing out your pancreas can lead to diabetes. Study finds new ways to prevent, treat it

Pancreatic cells, like human cells, have a limit to how much stress they can handle before they start to break down. Through overstimulation of these cells, certain stresses like inflammation and hyperglycemia lead to the onset of type 2 diabetes.

As it turns out, pancreatic cell stress tolerance to two distinct types of molecular stress is correlated with DNA sequence variations that are known to raise an individual's risk for diabetes. These findings were made by researchers at The Jackson Laboratory (JAX). Stress and inflammation may increase the risk of failure or death of the insulin-producing cells in individuals with these genetic alterations in the pancreas.

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"Ultimately we want to develop new ways to prevent and treat type 2 diabetes by targeting the genes and pathways that are perturbed in people who are most susceptible to the disease," said Michael L. Stitzel, associate professor at JAX and co-senior author of the new study with JAX professor Dugyu Ucar, published in the Oct. 8 advanced online issue of Cell Metabolism. "These findings give us new insight into some of those genes and pathways."

The work points toward dozens of genes that connect cell stress and diabetes risk, including one that is already under investigation as a drug target for type 2 diabetes complications.

When living cells face challenges, including damage, inflammation, or nutrient changes, they activate protective responses to try to cope with and reverse the stress. But over time, sustained stress can overwhelm the cells, causing them to slow down or die.

"Researchers have completed multiple studies looking at what molecular pathways are important in regulating insulin production in happy, healthy islet cells," said Stitzel. "But we were working on this hypothesis that islet cells are not always happy. So what pathways are important when the cells are under stress, and how do diabetes-linked DNA sequence changes in each of us affect them?"

Stitzel's group exposed healthy human islet cells to chemical compounds known to induce either ER stress or cytokine stress. Then, they tracked changes to levels of RNA molecules in the cells as well as how tightly or loosely packed different stretches of DNA were inside the cells--a proxy for what genes and regulatory elements are being used by the cells at any given time.

To analyze the results, the team collaborated with Ucar, a professor and computational biologist at JAX. Together, the scientists found that more than 5,000 genes, or nearly a third of all the genes expressed by healthy islet cells, change their expression in response to ER stress or cytokine stress. Many were involved in the production of proteins, which is crucial for islet cells insulin-producing role. And most of the genes were only involved in one or the other stress response, raising the idea that two separate stress pathways play a role in diabetes.

In addition, around one in eight regulatory regions of DNA typically used in islet cells were altered by stress. Importantly, 86 of these regulatory regions had been previously found to contain genetic variants in people most at risk of type 2 diabetes.

"What this suggests is that people with these genetic variants may have islet cells that respond worse to stress than other people," said Stitzel. "Your environment - things like diabetes and obesity--pulls the trigger with type 2 diabetes, but your genetics loads the gun."

Stitzel hopes that the new list of regulatory regions and genes eventually lead to new drugs to prevent or treat diabetes by potentially making islet cells more resilient to stress.

The researchers homed in one gene that was altered by both ER stress. Called MAP3K5, the gene was shown to alter islet beta cell death in mice containing a diabetes-causing mutation in the insulin-encoding gene.

In the new paper, Stitzel and his colleagues showed that higher levels of MAP3K5 led to more islet beta cells dying in response to ER stress. Eliminating or blocking MAP3K5, on the other hand, made the islet cells more resilient to ER stress and less likely to die.

Early studies of Selonsertib, a drug targeting MAP3K5, have showed that it could reduce the risk of severe complications of diabetes. The new results point toward another possible role of the drug--in the prevention of diabetes in people most at risk of the disease, to help their islet cells remain functioning and alive in the face of cellular stress.

"It's really exciting that this therapeutic is already in clinical trials but much more work is needed to understand whether the drug might be able to be leveraged in primary prevention," said Stitzel. 

More than 85pc of blindness cases in India preventable: Experts

While India has the maximum number of blind people in the world, most do not know that in more than 85 per cent of the cases, the condition is preventable, said experts on Thursday on World Sight Day.

India is home to an estimated 34 million people living with blindness or moderate or severe visual impairment (MSVI).

"Nearly 85 per cent of blindness in the world is avoidable which can either be preventable or treatable," Dr. Rajesh Sinha, Professor, Dept. of Ophthalmology, AIIMS New Delhi said.

The expert called the need for public awareness so that a majority of people in the society who may become blind due to ignorance maintain their sight for life.

"Ocular causes of preventable blindness can be infections, vitamin A deficiency while causes of treatable blindness can be cataract, uncorrected refractive error, diabetic retinopathy," Sinha said.

According to the National Blindness and Visual Impairment Survey, cataract is the leading cause of blindness, accounting for 66.2 per cent of all cases of blindness in India.

Uncorrected refractive errors account for 18.6 per cent, and glaucoma for 6.7 per cent. Other causes of blindness and vision impairment include corneal opacities (0.9 per cent), childhood blindness (1.7 per cent), and diabetic retinopathy (3.3 per cent).

"It is important to spread awareness around preventable blindness because more than 85 per cent of the blindness is preventable if only people know how to address them," said Dr. Ikeda Lal, Senior Cornea, Cataract and Refractory Surgery Specialist, at Sir Ganga Ram Hospital New Delhi.

The common reasons for blindness in India include cataract, glaucoma, macular degeneration, uncorrected refractive error, and corneal blindness.

Diabetic retinopathy is another very important reason for blindness in India, especially considering the high prevalence of diabetes in the country, Lal said.The experts advocated the need for early screenings to detect eye problems and prevent vision loss.

https://www.newkerala.com/news/2024/63766.htm

October 09, 2024

You’re due for a colonoscopy, but what if you don’t want it?

If more people knew about other kinds of colorectal cancer testing, some experts hope, perhaps some who put off colonoscopies would be screened and deaths from colon cancer could be avoided, colonoscopyIf more people knew about other kinds of colorectal cancer testing, some experts hope, perhaps some who put off colonoscopies would be screened and deaths from colon cancer could be avoided.

This year about 53,000 Americans are expected to die from colon or rectal cancer. Doctors say most people should start getting screened at age 45. Yet many who are eligible skip testing.

When most people in this country think of colon cancer screening, they think of colonoscopies, which let doctors examine the colon but can be inconvenient. Yet there are other equally acceptable options for screening.

If more people knew about other kinds of colorectal cancer testing, some experts hope, perhaps some who put off colonoscopies would be screened and deaths from colon cancer could be avoided.

Here’s what you need to know about colonoscopies and fecal tests, which to ask for, and why your doctor might be recommending one over the other.

How do colonoscopies and fecal tests work?

Colonoscopies are widely used, but there is another option available: fecal tests.

Both types of test attempt to find cancers and large polyps — growths on the wall of the colon — that occasionally turn into cancers. Cancers that are found early often can be cured when doctors simply cut them out. Finding and removing polyps can also prevent cancers.

Colonoscopies start with a patient’s taking strong laxatives to empty the colon. On the day of the test, the patient is sedated. Then, a doctor inserts a colonoscope — a flexible tube with a video camera at the end — into the rectum and colon and looks for polyps and cancers to remove. The doctor may also take samples for study in a lab.

If no polyps or cancers are found, the average patient can wait 10 years before having another colonoscopy.

Fecal tests can be done at home. Patients collect a stool sample and mail it to or drop it off at a testing lab.

One option is the fecal immunochemical test, or FIT, which should be repeated annually. A lab analyzes the sample for traces of blood, which can indicate a polyp or cancer. Large polyps and colon cancers sporadically ooze small amounts of blood. If blood is detected, the patient must have a colonoscopy.

Another more complex fecal test is Cologuard, repeated every three years. It looks for blood in stool and also for abnormal DNA from large polyps and colon cancers. Like the FIT test, Cologuard must be followed by a colonoscopy if blood or abnormal DNA are present.

If a person who has a large polyp has a colonoscopy, the test will detect it 95% of the time. If that person has a Cologuard test, there is a 42% chance that it will be positive because of the polyp. If the person has a FIT test, there is about a 22% chance it will be positive.

Colonoscopies find 95%. A one-time Cologuard test will be positive 94% of the time if a cancer is present, and a FIT test will be positive 74% of the time.

The ultimate goal, though, is preventing colon cancer deaths. For now, no one really knows which test performs better. One large clinical trial by the Department of Veterans Affairs is comparing the number of colon cancer deaths among 50,000 patients randomly assigned to have a colonoscopy or an annual FIT test and followed for 10 years.

Results are expected in 2027 or 2028.

While those studies are continuing, other studies have compared a screening test with no test.

One study found that after 30 years, people who had fecal tests had a 33% lower death rate from colon cancer than people who were not screened. The death rate fell to 2%, from 3%.

A 10-year European study of colonoscopy found a 30% reduction in the risk of getting colon cancer. It was 0.84% in a group that had colonoscopies and 1.22% in a group that was not screened. There was no difference in the risk of dying from colon cancer.

Whether the reduction in the risk of getting colon cancer is worth a potential risk of injury during the surgery is “in the eye of the beholder,” said Dr. Michael Bretthauer, a gastroenterologist at the University of Oslo who led the study.

The ultimate goal, though, is preventing colon cancer deaths. The ultimate goal, though, is preventing colon cancer deaths. (Source: Freepik)

Can I ask my doctor for a fecal test if I prefer it to a colonoscopy?

Of course — if you are of average risk, meaning no family history of colon cancer and no genetic condition that predisposes to colon cancer. If you are at a higher risk, your doctor is likely to advise a colonoscopy.

When patients of average risk ask Dr. David Lieberman, a gastroenterologist at Oregon Health and Science University, if they can skip the colonoscopy, he explains that a fecal test and a colonoscopy accomplish different things. Fecal tests are likely to find cancers when they are early enough to be cured. But he says those tests are not so good at finding precancerous polyps. While the hope is that, repeated over time, the fecal tests will find polyps, colonoscopies find both with a single test.

Hearing that, he said, most patients decide they want colonoscopies.

What do the tests cost?

Many patients pay little or nothing because insurance, including Medicare, covers the tests. But testing does cost the health care system.

Prices for the testing vary, but one estimate says a colonoscopy for people with private insurance costs the insurer about $3,442. A single Cologuard test costs about $763, and a single FIT test costs about $91.

Why do doctors prefer colonoscopies?

Many doctors think they are saving patients’ lives with colonoscopies.

“The idea of finding and removing cancer precursor lesions became very attractive to physicians,” Lieberman said.

But there is also a financial incentive for the procedure.

“Colonoscopy is a massive revenue generator for hospital systems,” said Dr. Adewole Adamson, of the University of Texas at Austin, who studies cancer screening.

Doctors profit too, said Dr. Samir Gupta, a gastroenterologist at the University of California, San Diego. “When we do the procedure, that’s part of our income,” he said. “We are all conflicted.”

Many other countries with modern national health systems use FIT tests because they are cheap, and because they lack the capacity for wider use of colonoscopies.

But there are places in the U.S. that don’t emphasize colonoscopies. Most VA centers mail FIT tests to eligible patients every year.

So does Kaiser Permanente, one of the nation’s largest medical care providers. In the company’s lab in Northern California, for instance, testing is done “on an industrial scale,” said Dr. Theodore Levin, a Kaiser gastroenterologist, with 15,000 to 20,000 FIT tests processed each week.

In describing some of Kaiser’s motivation for offering FIT, Levin added, “All the physicians are salaried, so they are not doing screening to support their practice.”

Dr. Amitpal S. Johal, director of gastroenterology at Geisinger, a large health care system in Pennsylvania, says Cologuard is preferred because of its greater accuracy and because it only needs to be done every three years. The test is useful for the system’s large rural population for whom a center that does colonoscopies can be far away.

“Some of these people can’t drive five hours” for the test, he said, while “Cologuard will mail the test to them, and UPS will pick it up.”

When can I get a blood test instead of these options?

The Food and Drug Administration recently approved a blood test called Shield by the company Guardant Health. The test looks for fragments of DNA shed from colon cancers and polyps. If it finds evidence of cancer or large polyps, you need a colonoscopy.

The problem is that the test is not very accurate and does especially poorly at finding large polyps. Still, gastroenterologists say it is better than nothing.

https://indianexpress.com/article/lifestyle/health/youre-due-for-a-colonoscopy-but-what-if-you-dont-want-it-9606019/

Nobel Prize for Medicine awarded to US scientists Victor Ambros, Gary Ruvkin

The 2024 Nobel Prize in physiology or medicine has been awarded to Victor Ambros and Gary Ruvkun for their discovery of microRNA, a new class of tiny RNA molecules that play a crucial role in gene regulation.

The Nobel Prize committee announced the prestigious honour in Sweden on Monday.

The Karolinska Institutet awarded the Prize to the scientists for their groundbreaking discovery in the small worm C. elegans, which has revealed a completely new principle of gene regulation, The Nobel Assembly said in a press release.

This turned out to be essential for multicellular organisms, including humans. MicroRNAs are proving to be fundamentally important for how organisms develop and function.

This year's medicine laureates Victor Ambros and Gary Ruvkun studied a relatively unassuming 1 mm long roundworm, C. elegans.

Despite its small size, C. elegans possesses many specialised cell types such as nerve and muscle cells also found in larger, more complex animals, making it a useful model for investigating how tissues develop and mature in multicellular organisms.

In 1993, this year's Nobel Prize laureates published unexpected findings describing a new level of gene regulation, which turned out to be highly significant and conserved throughout evolution.

The information stored within our chromosomes can be likened to an instruction manual for all cells in our body. Every cell contains the same chromosomes, so every cell contains exactly the same set of genes and exactly the same set of instructions.

This year's Laureates Victor Ambros and Gary Ruvkun were interested in how different cell types develop. How different cell types, such as muscle and nerve cells, have very distinct characteristics and how these differences arise?

The answer lies in gene regulation, which allows each cell to select only the relevant instructions. This ensures that only the correct set of genes is active in each cell type.

If gene regulation goes awry, it can lead to serious diseases such as cancer, diabetes, or autoimmunity. Understanding the regulation of gene activity has been an important goal for many decades, the Nobel committee said.

Incidentally, in the late 1980s, both Ambros and Ruvkun were postdoctoral fellows in the laboratory of Robert Horvitz, who was awarded the Nobel Prize in 2002, alongside Sydney Brenner and John Sulston.

Ambros was born in 1953 in Hanover, New Hampshire, US and received his PhD from Massachusetts Institute of Technology (MIT), Cambridge, MA, in 1979 where he also did postdoctoral research 1979-1985.

He became a Principal Investigator at Harvard University, Cambridge, MA in 1985. He was Professor at Dartmouth Medical School from 1992-2007 and he is now Silverman Professor of Natural Science at the University of Massachusetts Medical School, Worcester, MA.

Meanwhile, Ruvkun was born in Berkeley, California, US in 1952. He received his PhD from Harvard University in 1982 and was a postdoctoral fellow at Massachusetts Institute of Technology (MIT), Cambridge, MA, 1982-1985.

He became a Principal Investigator at Massachusetts General Hospital and Harvard Medical School in 1985, where he is now Professor of Genetics.

The medicine prize has been awarded 114 times to a total of 227 laureates. Only 13 women have won been awarded the prize. Physiology or Medicine was the third prize category that Alfred Nobel mentioned in his will.

Since 1901, the medicine laureates have been selected by the Nobel Assembly at Karolinska Institutet.

Nobel announcements continue with the physics prize on Tuesday, chemistry on Wednesday and literature on Thursday. The Nobel Peace Prize will be announced Friday and the economics award on October 14.

https://www.newkerala.com/news/2024/63183.htm

Study reveals role of gamma-delta T cells in cancer immunology

The significance of gamma-delta T cells in 33 different cancer types is revealed in a recent study that was published in Cell Press. This information sheds light on the cells' potential as clinical biomarkers and therapeutic targets in the treatment of cancer. This thorough examination, which was carried out under the direction of a group of Moffitt Cancer Center experts, marks a substantial breakthrough in our knowledge of these distinct immune cells and how they affect cancer therapy outcomes for patients.

Gamma-delta T cells are a minority in the T cell population, but they are becoming more and more valued for their capacity to activate both innate and adaptive immune responses. The gamma-delta T-cell receptor landscape across 11,000 tumors was analyzed by Moffitt researchers using a novel computational algorithm in collaboration with scientists at Dartmouth College and Duke University. The result is a comprehensive database that tracks the progression of cancer and its response to different treatments, most notably immunotherapy.

"It's like finding a needle in a haystack," said Xuefeng Wang, Ph.D., chair of Moffitt's Biostatistics and Bioinformatics Department and the lead contact of the study. "After two years of effort screening approximately 700 billion tumor RNA sequencing reads, our algorithm distilled 3.2 million gamma-delta T-cell reads, highly informative for the study of gamma-delta T-cell clones. Our findings suggest that the diversity and clonality of gamma-delta T cells can significantly impact patient survival and treatment efficacy."

As the study evolves, researchers will expand the database by incorporating additional T-cell receptor repertoires and functional annotations, including single-cell RNA sequencing analyses. This ongoing work aims to deepen our understanding of the functional roles of gamma-delta T cells in cancer and their interactions within the tumor microenvironment.

"This research not only expands our knowledge of gamma-delta T cells but also opens new avenues for therapeutic strategies," Wang said. "By understanding the specific roles of these cells in different cancers, we can better tailor treatments to improve patient outcomes."

The Immuno-Oncology Program and Biostatistics and Bioinformatics Shared Resources at Moffitt provided critical support and represent leading research expertise in computational immunology and personalized immunotherapy.

https://www.newkerala.com/news/2024/63068.htm

High levels of heat found to affect foetuses, infants up to age 2: Study

For every degree Celsius rise in average daily heat in the first trimester of pregnancy, the weight of a baby at birth corresponding to gestation period was found to be lowered

Exposure to high levels of heat could affect growth of foetuses in the womb and infants up to two years of age, an analysis of over 600 pregnancies in the west African country of The Gambia has suggested.

For every degree Celsius rise in average daily heat in the first trimester of pregnancy, the weight of a baby at birth corresponding to gestation period was found to be lowered, according to the findings published in The Lancet Planetary Health journal. One experiences heat stress when their body's ability to regulate temperature is compromised.

The researchers, led by those at the London School of Hygiene and Tropical Medicine (LSHTM), UK, followed a total of 668 infants, about half of whom were girls and half boys, for their first 1,000 days of life.

At birth, 66 infants (10 per cent) were found to weigh under 2.5 kilograms, described as a low birth weight by the researchers. About a third of the infants studied (218) were found to be small for gestational age, while nine infants were born prematurely.

The researchers also found that heat stress experienced by foetuses can continue to affect them after birth -- infants up to two years of age exposed to high heat had lower weights and heights for their age.

The infants aged between 6-18 months who had experienced higher levels of daily heat stress in the previous three-month period were found to be the most affected.

The study is the first of its kind to show that heat stress can hamper development of babies after birth, the researchers said.

As climate change intensifies, the effects of exposure to heat must be urgently considered in public health interventions, they added.

"Our study demonstrates that the intersecting crises of climate change, food insecurity, and undernutrition are disproportionately affecting the most vulnerable, including young children," said lead author Ana Bonell, an assistant professor at the Medical Research Council Unit The Gambia, LSHTM.

The data for analysis was collected as part of a trial, conducted in West Kiang, The Gambia, between January 2010 and February 2015.

"These findings build on previous evidence showing that the first trimester is a vulnerable time to heat exposure and it's important that we now consider which factors may be contributing to the relationship," Bonnell said.

Further research is needed to look at heat stress and its health impacts in regions beyond The Gambia, the researchers said.

https://www.tribuneindia.com/news/health/high-levels-of-heat-found-to-affect-foetuses-infants-up-to-age-2-study/

October 04, 2024

New Alzheimer's drug shows promise to prevent buildup of tau proteins in brain cells

In a promising breakthrough, an international team of researchers from the UK, US, and Japan has developed a new Alzheimer's drug that effectively prevents the build-up of Tau proteins -- a key driver of neurodegeneration.

The drug, a peptide inhibitor called RI-AG03 blocked both Tau aggregation 'hotspots' for the first time in both lab and fruit fly studies.

While Tau proteins play a crucial role in maintaining the structure and function of brain cells, these, however, malfunction in Alzheimer's disease. The proteins clump together to form long and twisting fibrils, which when accumulated create neurofibrillary tangles.

The masses of twisted Tau proteins then clog the brain cells, preventing them from getting the nutrients leading to their death. The more brain cells die, memory, thinking, and behaviour becomes increasingly impaired, leading to the cognitive decline seen in Alzheimer's.

The research, published in the Alzheimer's & Dementia: The Journal of the Alzheimer's Association, focussed on two specific 'hotspots' of the Tau protein where this clumping tends to happen.

While current treatments target one or the other of these hotspots, RI-AG03 uniquely targets and blocks both.

"There are two regions of the Tau protein that act like a zipper to enable it to aggregate," said lead author Amritpal Mudher, Professor of Neuroscience at the University of Southampton.

"For the first time, we have a drug which is effective in inhibiting both these regions. This dual-targeting mechanism is significant because it addresses both domains that stimulate Tau aggregation, potentially paving the way for more effective treatments for neurodegenerative diseases like Alzheimer's," she added.

RI-AG03 was developed using computational biology and tested in lab dishes.

To test its effectiveness in cells within a living organism, the researchers gave the drug to fruit flies that had pathogenic Tau. The researchers found the drug suppressed neurodegeneration and extended the lives of the flies by around two weeks -- a significant extension considering the life span of the insects.

In fruit flies fed with RI-AG03, "the pathogenic fibrils decreased significantly in quantity," Mudher said, with a higher dose showing a "greater improvement in the fruit fly's lifespan."

Further, the researchers tested the drug in a biosensor cell -- a type of living human cell line that is engineered to detect pathogenic tau fibril formation.

Here too, the drug successfully penetrated the cells and reduced the aggregation of Tau proteins.

The team believes their work will have a significant impact on drug discovery efforts in the field of neurodegenerative diseases and now plans to test RI-AG03 in rodents, before proceeding to clinical trials.

https://www.newkerala.com/news/2024/62377.htm

WHO launches global plan to fight dengue, Aedes-borne arboviral diseases

A mid rising cases of dengue and other Aedes-borne arboviruses such as Zika and chikungunya, the World Health Organization (WHO) on Thursday launched a global plan to reduce the burden of disease, suffering and deaths.

The Global Strategic Preparedness, Readiness, and Response Plan (SPRP) looks to foster a global coordinated response with actions to control transmission. It also offers recommendations to affected countries across various sectors, including disease surveillance, laboratory activities, vector control, community engagement, clinical management, and research and development, through a whole-of-society and regional approach.

"The rapid spread of dengue and other arboviral diseases in recent years is an alarming trend that demands a coordinated response across sectors and across borders," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

The WHO said that an estimated four billion people are at risk of infection from arboviruses around the world, and this number is estimated to increase to five billion by 2050.

An estimated four billion people globally are at risk for dengue, and the disease is now endemic in more than 130 countries. The number of dengue cases has approximately doubled each year since 2021, with over 12.3 million cases as of the end of August this year -- almost double the 6.5 million cases reported in all of 2023.

In December 2023, WHO graded the current global dengue upsurge 2023 as grade 3, the highest level of emergency for the UN health body, to support countries to strengthen their surveillance capacities and implement response activities.

Ghebreyesus urged for "clean environments to support vector control and timely medical care" to fight dengue.

He called the SPRP plan "a roadmap to turn the tide against this disease and other Aedes-borne arboviral diseases, protect vulnerable populations, and pave the way for a healthier future".

Factors such as unplanned urbanisation and poor water, sanitation and hygiene practices, climate change, and international travel, are facilitating the rapid geographical spread of dengue, Zika, chikungunya, and more recently the Oropouche virus disease, the WHO said.

The SPRP comprises emergency coordination, collaborative surveillance, community protection, safe and scalable care, and access to countermeasures. The Plan will be implemented over one year until September 2025.

https://www.newkerala.com/news/2024/62363.htm

Diabetes, obesity increases risk of liver cancer relapse: Study

Diabetes and obesity can fuel the relapse of liver cancer -- the sixth most common cancer worldwide, according to a study.

The study led by Osaka Metropolitan University, focussed on hepatocellular carcinoma (HCC) -- a type of liver cancer associated with hepatitis infections -- known to have a high recurrence rate after cancer removal. It is also the third leading cause of cancer-related deaths globally.

Obesity and diabetes, which are closely associated with metabolic syndrome development, are well known to induce steatotic liver diseases, potentially causing liver cirrhosis and HCC development.

However, obesity and diabetes' effects on patient survival and cancer recurrence have been unclear.

"Because the risk of late recurrence is higher in hepatocellular carcinoma with comorbid obesity and diabetes, controlling obesity and diabetes is an important treatment strategy for the liver cancer," said Dr. Hiroji Shinkawa's research team at the University's Graduate School of Medicine.

In the study, published in the journal Liver Cancer, the team analysed the relationship between diabetes mellitus, obesity, and postoperative outcomes in 1,644 patients with hepatocellular carcinoma who underwent liver resection.

The results revealed that obesity increased the risk of recurrence two years after the operation approximately by 1.5 times, and in the case of diabetes, the risk was 1.3 times higher.

In addition, the risk of recurrence after five years postoperatively was 3.8 times higher with obesity, while with diabetes it was 2 times higher.

The findings can contribute to the early detection of cancer recurrence and the design of appropriate treatment strategies, Shinkawa said.

Obesity is a common risk factor for type 2 diabetes, and the two conditions are often linked.

Recent research showed that the number of adults with obesity will increase by six times in the next 40 years, while people with diabetes will soar 642 million by 2040.

https://www.newkerala.com/news/2024/62317.htm

Ban tobacco sales to prevent lung cancer death in 12 lakh youths: Lancet

Banning the purchase of cigarettes and other tobacco products for youth can significantly prevent 12 lakh lung cancer deaths in the young population, according to a study, published in The Lancet Public Health journal on Thursday.

The findings aim to secure future generations from the risks of smoking, which is the biggest risk factor for lung cancer. Smoking is the leading cause of preventable death worldwide and is estimated to cause more than two-thirds of the 18 lakh deaths every year.

In the first-of-its-kind simulation study, researchers from the University of Santiago de Compostela, the International Agency for Research on Cancer (IARC), called for creating a generation of people who never smoke.

They suggested banning the purchase of cigarettes and other tobacco products for people born between 2006 and 2010. Their results showed it can prevent 12 lakh lung cancer deaths in 185 countries by 2095.

This could prevent 40.2 per cent (1.2 of 2.9 million) of the total lung cancer deaths expected to occur in this birth cohort by 2095.

"Lung cancer is a major killer worldwide, and a staggering two-thirds of deaths are linked to one preventable risk factor -- tobacco smoking. Our modelling highlights how much there is to gain for governments considering the implementation of ambitious plans towards creating a tobacco-free generation," said Dr. Julia Rey Brandariz, University of Santiago de Compostela, Spain.

"Not only could this save huge numbers of lives, it could massively reduce the strain on health systems of treating, and caring for people in ill health as a result of smoking," Brandariz added.

The study further showed that banning tobacco sales could prevent almost half of expected lung cancer deaths among men (45.8 per cent), and close to one-third of expected deaths in women (30.9 per cent).

To date, no country has made laws to make it illegal to sell tobacco to young people. While New Zealand took the bold step to ban the sale of tobacco products to anyone born in or after 2009, it was recently repealed.

https://www.newkerala.com/news/2024/62278.htm

Higher doses of lithium aspartate promising for long Covid patients: Study

Low doses of lithium aspartate is ineffective in treating the fatigue and brain fog that is often a persistent feature of long Covid, researchers said on Wednesday. However, higher doses may be promising.

An estimated 17 million people have long Covid in the US, and worldwide the number is estimated at 65 million.

Published in the journal JAMA Network Open, the study was led by Thomas J Guttuso, professor of neurology at University of Buffalo. "It's a negative study with a positive twist," said Guttuso.

Since long Covid is believed to stem from chronic inflammation and lithium has known anti-inflammatory actions, Guttuso had recommended that a patient of his try low-dose lithium for persistent long Covid symptoms.

He was surprised when this patient reported a near full resolution of fatigue and brain fog within a few days of initiating lithium aspartate at 5 milligrams a day.

Based on this single case, Guttuso became interested in lithium aspartate as a potential treatment for long Covid and recommended it to other such patients.

According to Guttuso, nine of 10 long Covid patients he treated with lithium aspartate 5-15mg a day saw very good benefit in terms of improvements to their fatigue and brain fog symptoms.

"Based on those nine patients, I had high hopes that we would see an effect from this randomised controlled trial," says Guttuso. "But that's the nature of research. Sometimes you are unpleasantly surprised."

The randomised controlled trial showed no benefit from 10-15 milligrams a day of lithium aspartate compared to patients receiving a placebo.

After one patient from the study subsequently increased the lithium aspartate dosage to 40 milligrams a day and experienced a marked reduction in fatigue and brain fog symptoms, Guttuso decided to then conduct a dose-finding study designed to explore if a higher dose of lithium aspartate may be effective.

The three participants who completed the dose-finding study reported greater declines in fatigue and brain fog with the higher dose of 40-45 milligrams per day.

"This is a very small number of patients, so these findings can only be seen as preliminary," said Guttuso. "Perhaps achieving higher blood levels of lithium may provide improvements to fatigue and brain fog in long Covid."

https://www.newkerala.com/news/2024/62219.htm

Researchers develop new injectable to prevent hypoglycemia in diabetics

A team of researchers on Wednesday reported a new injectable solution to prevent and treat hypoglycemia condition in diabetic patients.

According to the team, if glucose levels plunge too low, people can experience hypoglycemia, which can lead to dizziness, cognitive impairment, seizures or comas.

Researchers in the journal ACS Central Science report encapsulating the hormone glucagon. Glucagon is a hormone that signals the liver to release glucose into the bloodstream.

It's typically given by injection to counteract severe hypoglycemia in people who have diabetes.

To improve glucagon stability and prevent hypoglycemia, Andrea Hevener and Heather Maynard looked to micelles -- nanoscale, soap-like bubbles that can be customised to assemble or disassemble in different environments and are used for drug delivery.

They developed a glucose-responsive micelle that encapsulates and protects glucagon in the bloodstream when sugar levels are normal but dissolves if levels drop dangerously low.

To prevent hypoglycemia, the micelles could be injected ahead of time and circulate in the bloodstream until they are needed.

In mouse trials, the nanocapsules activated when blood sugar levels dropped dangerously low and quickly restored glucose levels.

In lab experiments, the researchers observed that the micelles disassembled only in liquid environments that mimicked hypoglycemic conditions in both human and mice bodies: less than 60 milligrams of glucose per deciliter.

Next, when mice experiencing insulin-induced hypoglycemia received an injection of the specialized micelles, they achieved normal blood sugar levels within 40 minutes.

From additional toxicity and biosafety studies in mice, the researchers note that empty micelles didn't trigger an immune response or induce organ damage.

"While more studies are needed, the researchers say their proof-of-concept is a first step toward a new on-demand and effective method for preventing or mitigating extremely low blood sugar levels," the researchers noted.

https://www.newkerala.com/news/2024/62159.htm