Medical Bulletin 03/ October/ 2024
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Here are the top medical news for the day:
Could a Faulty Hormone in the Skin be the Key to Psoriasis?
New research strongly suggests the hormone hepcidin may trigger the onset of the condition. This marks the first time hepcidin has been considered a potential causal factor. In mammals, hepcidin is responsible for regulating iron levels in the body. The findings were published in nature communication.
The international research team behind this discovery, which includes Dr Charareh Pourzand from the Department of Life Sciences, the Centre for Therapeutic Innovation and the Centre for Bioengineering and Biomedical Technologies at the University of Bath in the UK -- hopes their finding will lead to the development of new drugs able to block the action of the hormone.
Those most likely to benefit from such a treatment are patients with pustular psoriasis (PP) -- a particularly severe and treatment-resistant form of the disease that can affect a patient's nails and joints as well as skin.
Dr Pourzand said, "A new treatment targeting iron hormone imbalance in the skin offers hope. This innovative approach could significantly enhance the quality of life for millions, restoring their confidence and wellbeing."
Currently there is no cure for psoriasis, though treatments that include topical creams, light therapy and oral drugs can help keep symptoms under control for patients with some forms of the condition. Recent treatments have focused on targeting the immune pathways that contribute to psoriasis developing.
Dr Pourzand believes a drug targeting hepcidin has the potential to dramatically improve treatment options for all psoriasis patients.
She said: "Our data strongly suggests hepcidin would be a good target for skin psoriasis treatment. A drug that can control this hormone could be used to treat flare-ups and keep patients in remission to prevent recurrence.
Reference: Abboud, E., Chrayteh, D., Boussetta, N. et al. Skin hepcidin initiates psoriasiform skin inflammation via Fe-driven hyperproliferation and neutrophil recruitment. Nat Commun 15, 6718 (2024). https://doi.org/10.1038/s41467-024-50993-8
Clinical Trial Shows Benefits of Intermittent Fasting in Patients with Metabolic Syndrome and Prediabetes
Risk factors attributing to the metabolic syndrome include elevated blood sugar, high blood pressure and high cholesterol.
In a recent collaborative clinical trial entitled TIMET, researchers from University of California San Diego School of Medicine and the Salk Institute found that a form of intermittent fasting, called time-restricted eating, could improve the health of participants diagnosed with metabolic syndrome and have prediabetes.
The study, published online in the Annals of Internal Medicine, demonstrated significant improvements in key markers of cardiometabolic health, including blood sugar and cholesterol and lower levels of hemoglobin A1c, a marker of long-term blood sugar management.
“Metabolic syndrome, especially when paired with prediabetes, represents a critical tipping point in which the risk for developing type 2 diabetes and heart disease is greatly increased,” said Pam Taub, MD, co-corresponding author of the study and professor of medicine at UC San Diego School of Medicine. “We’re hopeful the findings of this study can help others who are looking to address their metabolic syndrome and reduce their risk for type 2 diabetes.”
The TIMET study is the first to evaluate the benefits of a customized time-restricted eating schedule in patients taking medication for metabolic syndrome.
In the trial, 108 adult patients of UC San Diego Health with metabolic syndrome were randomized into either a time-restricted eating group or a control group. Both groups continued to receive standard-of-care treatments and underwent nutritional counseling on the Mediterranean diet. All participants logged their meals using the myCircadianClock mobile app, developed at the Salk Institute, which was then reviewed by trial researchers.
For the time-restricted eating group, protocols were customized to each participant’s eating habits, sleep/wake schedules and personal commitments. The resulting regimen had each person reduce their eating window to 10 hours per day, beginning at least one hour after waking up and ending at least three hours before going to sleep.
After three months, patients who had completed the time-restricted eating regimen showed significant improvements in key indicators of heart health. The reduction was similar in scale to what is typically achieved through more intensive interventions by the National Diabetes Prevention Program.
“Our bodies actually process sugars and fats very differently depending on the time of day,” said Satchidananda Panda, PhD, co-corresponding author of the study and professor at the Salk Institute. “In time-restricted eating, we are re-engaging the body’s natural wisdom and harnessing its daily circadian rhythms to restore metabolism and improve health.”
Reference: Emily N.C. Manoogian, Michael J. Wilkinson, Monica O’Neal, et al. Time-Restricted Eating in Adults With Metabolic Syndrome: A Randomized Controlled Trial. Ann Intern Med. [Epub 1 October 2024]. doi:10.7326/M24-0859
High Accuracy Ultrasound May Identify 96% of Postmenopausal Women with Ovarian Cancer: Lancet Oncology Study
An ultrasound test that detected 96% of ovarian cancers in postmenopausal women should replace the current standard of care test in the UK according to a new study.
In a paper published in Lancet Oncology, research funded by the National Institute for Health and Care Research (NIHR) and led by Professor Sudha Sundar from the University of Birmingham compared all currently available tests to diagnose ovarian cancer in postmenopausal women head-to-head in a high-quality diagnostic test accuracy study.
Of the six diagnostic tests investigated, the IOTA ADNEX model which looks at ultrasound features had the best accuracy of all and could detect up to 96% of women with ovarian cancer.
Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham and consultant
“The ultrasound test also performs well when delivered by a trained sonographer who have received specific training and certification and quality assurance, and as the vast majority of ultrasound scans are performed by sonographers it is important that a new standard is able to be delivered by as many clinical professionals as possible.
“We found that the higher sensitivity of the IOTA ADNEX model is likely to lead to some women who don’t have cancer also being flagged up as having a higher risk of cancer. We however did discuss this extensively with patients, cancer charity Target ovarian cancer and NHS experts who all agreed that in postmenopausal women who are at higher risk of ovarian cancer, picking up more women with cancer would benefit women overall.”
Reference: Sundar, S., Agarwal, R., Davenport, C., Scandrett, K., Johnson, S., Sengupta, P., ... & Deeks, J. (2024). A multicentre, prospective cohort study investigating the diagnostic accuracy of risk prediction models in women with symptoms of suspected ovarian cancer (The ROCkeTS Study): results for post-menopausal women. The Lancet Oncology.
One in Three Children Short Sighted After Covid Lockdowns: British Journal of Ophthalmology
Children's eyesight is worsening globally, with one in three now suffering from short-sightedness, or myopia, according to a new study published in British Journal of Ophthalmology. The researchers reviewed data from over five million children and teens across 50 countries on six continents.
The highest rates are in Asia - 85% of children in Japan and 73% in South Korea are short-sighted with more than 40% affected in China and Russia.
The report found that global myopia rates tripled from 1990 to 2023, now affecting 36% of children, with a significant spike after the pandemic. Myopia typically begins in primary school and worsens until the eye stops growing, around age 20.
While genetics contribute to eye health, other factors like environmental factors, especially in East Asia, also increase the risk of myopia. In places like Singapore and Hong Kong, children spend more time focusing on books and screens, which strains their eye muscles, contributing to the condition.
During Covid lockdowns worldwide, when millions had to stay indoors for lengthy periods, children and teenagers' eyesight took a hit. "Emerging evidence suggests a potential association between the pandemic and accelerated vision deterioration among young adults," the researchers write.
By 2050, myopia could affect more than half of the world's teenagers. The study also indicated that girls and young women may be more vulnerable, as they typically spend less time outdoors during school years.
To help prevent myopia, researchers recommend that children spend at least two hours outdoors daily, especially between the ages of seven and nine.
Reference: Liang J, Pu Y, Chen J, et al Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis. British Journal of Ophthalmology Published Online First: 24 September 2024. doi: 10.1136/bjo-2024-325427
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