Medical Bulletin 02/ September /2024

Here are the top medical news of the day: 

Novel Rectal Cancer Treatment: Claims Less Risk of Reoccurence and Avoid Surgery, Study Finds

A new treatment for advanced rectal cancer (LARC) called Total neoadjuvant treatment (TNT) has resurfaced and has proved successful enough to avoid surgery and reduce the risk of recurrence, according to a new study published in eClinical Medicine.

Total neoadjuvant treatment (TNT) combines short-course radiotherapy with several rounds of chemotherapy. A study conducted in Sweden revealed that this approach was twice as effective in shrinking tumours compared to earlier methods. Additionally, this treatment has the potential to decrease the necessity for complex bowel surgeries and the associated complications.

For the study, researchers tracked 273 patients with high-risk locally advanced rectal cancer (LARC) across 16 hospitals from July 2016 to June 2020, and an additional 189 patients at 18 hospitals (including the original 16) during the same timeframe. All patients underwent total neoadjuvant treatment (TNT). The study revealed that the proportion of patients with tumour disappearance increased from 14% to 28% compared to earlier treatment regimens, with no rise in recurrence rates.

The usual treatment for rectal cancer often involves over a month of radiotherapy or a mix of radiotherapy and chemotherapy. Surgery usually means removing part of the bowel, which can lead to issues with bowel control and the need for a stoma. Researchers noted that the new total neoadjuvant treatment (TNT) can directly target tumors and might reduce the need for this invasive surgery and its side effects.

Reference: Glimelius, B., Khan, T., Adolfsson, K., Angenete, E., Berglund, Å., & Bondef, K. (2024). Total neoadjuvant treatment using short-course radiotherapy and four CAPOX cycles in locally advanced rectal cancer with high-risk criteria for recurrence: A Swedish nationwide cohort study (LARCT-US). eClinicalMedicine. https://doi.org/10.1016/j.eclinm.2024.102771

Promising Effect of Ancient Medicine On Newly Discovered Cardiovascular Risk Factor: Studies Unravels

A recent study in Nature Medicine reveals clonal hematopoiesis as a new risk factor for atherosclerosis, a key contributor to cardiovascular diseases. Additionally, a second study published in the European Heart Journal by the same team suggests that colchicine, an ancient drug, alleviates the effects of clonal hematopoiesis associated with acquired mutations in the TET2 gene.

In addition to well-established cardiovascular risk factors like high blood pressure, high cholesterol, diabetes, obesity, smoking, and lack of physical activity, clonal hematopoiesis must now be included. This condition, caused by acquired mutations in blood stem cells, has been identified as contributing to increased cardiovascular risk.

An adult produces hundreds of thousands of blood cells daily, which leads to the accumulation of DNA mutations due to the high rate of cell division. These are somatic mutations, meaning they are acquired rather than inherited. While these mutations were previously suggested as a potential risk factor for cardiovascular disease, the precise nature of their relationship was not well understood.

A recent study clarifies that somatic mutations related to clonal hematopoiesis are connected to the development of atherosclerosis. Additionally, the level of atherosclerosis does not affect the growth of mutated blood cells.

The second study highlights that mutations in the TET2 gene are among the most well-defined mutations associated with clonal hematopoiesis. It finds that the negative impact of TET2 mutations on cardiovascular health can be mitigated by using the anti-inflammatory drug colchicine.

The research team showed that colchicine treatment in animals with TET2 mutations slows the progression of atherosclerosis to a rate comparable to that observed in animals without these mutations.

Reference: Díez-Díez, M., Ramos-Neble, B.L., de la Barrera, J. et al. Unidirectional association of clonal hematopoiesis with atherosclerosis development. Nat Med (2024). https://doi.org/10.1038/s41591-024-03213-1

María A Zuriaga, Zhi Yu, Nuria Matesanz, Buu Truong, Beatriz L Ramos-Neble, Mari C Asensio-López, Md Mesbah Uddin, Tetsushi Nakao, Abhishek Niroula, Virginia Zorita, Marta Amorós-Pérez, Rosa Moro, Benjamin L Ebert, Michael C Honigberg, Domingo Pascual-Figal, Pradeep Natarajan, José J Fuster, Colchicine prevents accelerated atherosclerosis in TET2-mutant clonal haematopoiesis, European Heart Journal, 2024;, ehae546, https://doi.org/10.1093/eurheartj/ehae546

COPD and Asthma May Hide Early Lung Cancer Symptoms, Causing Diagnosis Delays: Study Reveals

A recent study in the British Journal of Cancer indicates that patients with specific long-term health conditions might experience delays in receiving a lung cancer diagnosis.

The research emphasizes that chronic conditions like chronic obstructive pulmonary disease (COPD) and asthma can mask early symptoms of lung cancer, resulting in delayed diagnoses.

Comorbid conditions can delay lung cancer diagnosis by either increasing the workload on general practitioners, which limits their ability to promptly investigate cancer ("competing demand conditions"), or by providing a plausible non-cancer explanation for the symptoms ("alternative explanation conditions").

Scientists reported that patients with one or more conditions that could provide "alternative explanations" for their lung cancer symptoms experienced considerable delays in diagnosis.

For instance, individuals with a single "alternative explanation" condition, such as COPD or asthma, were diagnosed with lung cancer an average of 31 days later. Those with two or more such conditions faced even longer delays, averaging 74 days.

COPD was particularly linked to the longest delay, with affected patients being diagnosed 59 days later than those without the condition.

The research team recommends updating clinical guidelines to emphasize that conditions such as COPD can obscure early lung cancer symptoms. They believe that increasing awareness of this issue will help reduce diagnostic delays and enhance patient outcomes.

Reference: Rogers, I., Cooper, M., Memon, A. et al. The effect of comorbidities on diagnostic interval for lung cancer in England: a cohort study using electronic health record data. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02824-2

Ayurveda Found Cure for Rheumatoid Arthritis: Study Finds

A new study published in the Journal of Ayurveda and Integrative Medicine has found a cure for rheumatoid arthritis in Ayurveda.

Joint pain and cracking sounds in the bones are not only common in older adults but also affect individuals as young as 20 to 35. However, there is new optimism for those dealing with joint diseases.

Ayurveda has discovered a treatment for rheumatoid arthritis. A recent scientific study has emphasised the significant benefits of the Ayurvedic Whole System (AWS) in managing rheumatoid arthritis (RA), an autoimmune condition affecting millions worldwide. The research indicates that AWS not only eases RA symptoms but also restores metabolic changes in patients, providing new optimism for traditional medicine.

The study observed a significant decrease in the Disease Activity Score-28 and erythrocyte sedimentation rate, as well as notable improvements in swollen and weakened joints. Additionally, there was a substantial reduction in the AMA Activity Measure (AAM) score, which assesses toxin levels in the body, following treatment.

The research also analyzed the metabolic profiles of RA patients in comparison to healthy individuals. Initially, levels of certain metabolites in RA patients, such as succinate, lysine, mannose, creatine, and 3-hydroxybutyrate (3-HB), were elevated. However, after undergoing Ayurvedic holistic treatment, the level of alanine decreased, and the other metabolic markers began to normalize, approaching levels seen in healthy individuals. This suggests a return to a more balanced metabolic state.

Researchers assert that this study is the first to clearly illustrate the effects of Ayurvedic Whole System (AWS) in managing rheumatoid arthritis (RA). They claim that AWS treatment not only alleviates symptoms but also creates a favorable metabolic environment for maintaining balance, providing long-term benefits for RA patients.

Reference: Rastogi S, Verma A, Trivedi R, Shukla A, Kumar D. Clinical metabolomics investigation of rheumatoid arthritis patients receiving ayurvedic whole system intervention. J Ayurveda Integr Med. 2024 Jul 6;15(4):101009. doi: 10.1016/j.jaim.2024.101009.