Medical Bulletin 23/May/2025

The researchers analysed data from the Systolic Blood Pressure Intervention Trial (SPRINT), a major randomized study that began in 2010. SPRINT compared intensive blood pressure treatment targeting a systolic level of 120 with standard care targeting 140. The original trial showed that intensive treatment reduced cardiovascular events by 25% and deaths by 27%, influencing updated guidelines in 2017.

In the current study, over 9,000 adults aged 50 and older were grouped by educational attainment: no college, some college or college degree, and education beyond college. Despite similar blood pressure control across all groups, only those with the highest education level saw a significant cardiovascular benefit from intensive treatment. Those with lower education levels did not show the same positive outcomes.

“We determined that intensive systolic blood pressure reduction resulted in similar control of hypertension in SPRINT, regardless of educational attainment. However, only those with the highest education had the benefit of reduced cardiovascular events,” said Dr. Jared W. Magnani, UPMC cardiologist and associate professor of medicine at Pitt. “The results suggest that unmeasured social and structural factors beyond pharmacologic management may inform cardiovascular risk. Further studies of social factors may elucidate how we can improve heart health, regardless of educational attainment.”

Reference: https://doi.org/10.1161/JAHA.124.037712

Currently, global demand for oral cholera vaccines is around 100 million doses per year, but supply is limited due to dependence on a single manufacturer, leading to periodic shortages.

Cholera, a severe diarrheal illness caused by ingesting water or food contaminated with Vibrio cholerae, is responsible for an estimated 2.86 million cases and 95,000 deaths globally each year.

The double-blind, randomized Phase III trial evaluated Hillchol’s safety, immunogenicity, non-inferiority, and lot-to-lot consistency in comparison with the existing vaccine Shanchol. Conducted across 10 clinical sites in India, the study involved 1,800 participants ranging from infants to adults. The subjects were grouped into three categories: infants (1 to under 5 years), children (5 to under 18 years), and adults (18 years and above) and were randomized in a 3:1 ratio to receive either Hillchol or the comparator vaccine.

Highlighting the vaccine’s potential global impact, Dr. Krishna Ella, Executive Chairman of Bharat Biotech, stated, “The new generation oral cholera vaccine features a simplified single stable O1 Hikojima strain, which enhances production efficiency and affordability and is particularly beneficial for lower- and middle-income countries.” He said the company’s facilities in Hyderabad and Bhubaneswar are equipped to produce 200 million doses of Hillchol and can ease the global shortage of oral cholera vaccines.

The successful trial positions Hillchol as a solution to help bridge the global vaccine supply gap and combat cholera outbreaks effectively, especially in vulnerable populations.

Reference: Vadrevu, K. M., Chavan, A., Chawla, A., Chakravarthy, B. S., Singh, C., Redkar, S., ... & Ella, R. (2025). A double-blind, randomised phase III clinical trial to evaluate safety, immunogenicity, non-inferiority & lot to lot consistency of single component oral cholera vaccine BBV131 (Hillchol®) in comparison to Shanchol™. Vaccine, 55, 126998.

8-Minute MRI Scan May Replace Painful Lumbar Puncture for Multiple Sclerosis Diagnosis

New Delhi: A new study by experts from the University of Nottingham, published in Neurology®, has found that multiple sclerosis (MS) can be accurately diagnosed using a specialized MRI scan, eliminating the need for a painful lumbar puncture.

The research introduces an 8-minute T2-weighted MRI scan* that identifies specific lesions in the brain’s white matter centered on veins—a known hallmark of multiple sclerosis. The team developed a diagnostic method called the “rule of six,” where the presence of six such lesions confirms the diagnosis.

The study was conducted with patients who had a suspected but not confirmed multiple sclerosis diagnosis. Each participant underwent both an MRI and a lumbar puncture. After an 18-month follow-up, results showed the MRI scan was just as effective in confirming multiple sclerosis.

The lumbar puncture, often described as painful by patients, can cause complications and typically requires a hospital stay, adding pressure to already stretched healthcare systems. In contrast, the new MRI scan is quick, non-invasive, and allows patients to return home immediately.

Following the study’s success and corroborating research from the USA, the International Committee for the Diagnosis of Multiple Sclerosis has endorsed MRI-based diagnosis as sufficient—making lumbar punctures unnecessary.

The lead author of the study, Professor Nikos Evangelou, Clinical Professor of Neurology at the university, said, "Not only will our findings have huge benefits for patients, but it will also mean cost savings for the NHS. People who have lumbar punctures are required to spend at least most of a day in the hospital, and for a health service already at capacity, this creates more issues. If there are complications with the lumbar puncture, the stay can be longer. With the MRI scan, it takes 8 minutes, is completely safe, and then you can go home. On average, we think we will reach the diagnosis three months earlier, and the change could save the NHS up to five million pounds each year, which can be reinvested in better services for our multiple sclerosis patients."

Reference: https://www.nottingham.ac.uk/news/mri-can-replace-spinal-tap-to-diagnose-ms