Medical Bulletin 09/ December/ 2024
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Here are the top medical news for the day:
Where You Live May Contribute to Elevated Blood Pressure and Poorer Cognition
New research from Wake Forest University School of Medicine suggests that living in a disadvantaged neighborhood is associated with higher blood pressure and lower cognitive scores, even among people who do not have an existing diagnosis of mild cognitive impairment. The study appears online in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, a journal of the Alzheimer’s Association.
To assess neighborhood disadvantage, the research team used the highly recognized national Area Deprivation Index, which measures housing quality, education and income. For the study, researchers analyzed data from 537 adults over the age of 55 from the Alzheimer’s Disease Research Center Healthy Brain Study at Wake Forest University School of Medicine from 2016 to 2021.
Individuals received clinical exams, neurocognitive testing and neuroimaging, in addition to cardiometabolic tests to screen for diabetes, high cholesterol and high blood pressure. The neurocognitive testing included in the study evaluated constructs such as memory, executive function, language, visuospatial skills, concentration and attention.
“We found an association between neighborhood disadvantage and higher blood pressure and cardiometabolic index, as well as lower cognitive scores in individuals who did not have a diagnosed mild cognitive impairment,” said Sudarshan Krishnamurthy, a fifth-year M.D./Ph.D. student at Wake Forest University School of Medicine and first author of the paper.
Krishnamurthy said that neighborhood disadvantage was only associated with higher hemoglobin A1C, which measures blood sugar, in people with diagnosed mild cognitive impairment.
Reference: Krishnamurthy S, Lu L, Johnson CJ, et al. Impact of neighborhood disadvantage on cardiometabolic health and cognition in a community-dwelling cohort. Alzheimer's Dement. 2024; 16:e70021. https://doi.org/10.1002/dad2.70021
Potential Treatment for Chronic Diseases and Cancer: Understanding Chronic Inflammation
A recently published study led by Wayne State University on a new approach to understanding chronic inflammation could lead to new advancements in the treatment of many debilitating medical conditions, including cancer.
The study, "Distinct etiology of chronic inflammation -- implications on degenerative diseases and cancer therapy," was published in Frontiers in Immunology by Krishna Rao Maddipati, Ph.D., professor of pathology in the School of Medicine and director of the Lipidomics Core Facility.
Maddipati's research suggests that chronic inflammation is not merely a continuation of acute inflammation, which results from injury or disease, but that the two may have different origins within the body.
"This new hypothesis is called unalamation," said Maddipati.
"The compounds that lead to inflammation in our body are always present in everyday healthy physiology, but they are under the control of anti-inflammatory compounds. Acute inflammation results from an increase of the inflammatory compounds at the site of an injury. However, chronic inflammation, according to my studies, comes from a decrease of the anti-inflammatory compounds in a normal healthy physiological state. Because the balance of inflammatory and anti-inflammatory compounds helps maintain a normal health state, the goal of treatment for chronic inflammation may not be to decrease inflammatory compounds but to find a way to increase anti-inflammatory compounds."
"Most physicians think chronic inflammation is behind cancer development. If chronic inflammation is different than acute inflammation, it means that cancer treatment may need to be approached in a completely different way.
"The current mindset in treating cancer is to decrease inflammatory compounds, but anti-inflammatory compounds are still helping tissue proliferate so continued growth, including the growth of cancer tissue, may continue. If you inhibit anti-inflammatory compounds, the body may attack the growing tissue and clear it in an inflammatory response. It is important to remember that inflammation is a defense mechanism of the body. Inducing inflammation, in the proper way, may fight cancer by encouraging the body's own immune responses."
Reference: https://today.wayne.edu/medicine/news/2024/12/04/new-research-explores-potential-treatments-for-chronic-diseases-and-cancer-65062
How a Gluten-Free Diet Affects Coeliac Disease: MRI Study Reveals
Experts have used magnetic resonance imaging (MRI) to better understand the impact a gluten free diet has on people with coeliac disease, which could be the first step towards finding new ways of treating the condition.
The MARCO study – MAgnetic Resonance Imaging in COliac disease – was published in Clinical Gastroenterology and Hepatology (CGH).
The only treatment of coeliac disease is a life- long commitment to a gluten free diet, which helps recovery of the gut tissue but still leaves many patients with gastrointestinal symptoms.The team recruited 36 people who had just been diagnosed with coeliac disease and 36 healthy volunteers to participate in the study. Images were taken of their guts with MRI, along with blood and stool samples. The patients then followed a gluten free diet for one year and came back to repeat the study. The healthy participants came back one year later too and repeated the study, but they did not follow any diet treatment.
The study found that the newly diagnosed patients with coeliac disease had more gut symptoms, more fluid in the small bowel and that the transit of food in the bowel was slower than in the healthy controls.
The microbiota (the ‘bugs’ living in the colon) of the patients showed higher levels of ‘bad bugs’ such as E.coli. After one year of a gluten free diet, gut symptoms, bowel water and gut transit improved in the patients, but without returning to normal values. By contrast, the gluten free diet reduced some of the ‘good bugs’ in the microbiota, such as Bifidobacteria associated with reduced intake of starch and wheat nutrients, due to the different diet.
Reference: Carolyn M. Costigan, Frederick J. Warren, Anthony P. Duncan, Caroline L. Hoad, Nina Lewis, Trevor Hill, Colin J. Crooks, Paul S. Morgan, Carolina Ciacci, Paola Iovino, David S. Sanders, Falk Hildebrand, Penny A. Gowland, Robin C. Spiller, Luca Marciani, bioRxiv 2024.06.20.599876; doi: https://doi.org/10.1101/2024.06.20.599876
Hospital-acquired pressure ulcers associated with worse neurological outcomes: Researchers
Research led by The Ohio State University Wexner Medical Center and College of Medicine along with scientists at the Charité – Universitätsmedizin Berlin in Berlin, Germany, provides first evidence that hospital-acquired pressure ulcers are a potent risk factor for poor neurological recovery among patients with acute spinal cord injury (SCI). Study findings are published online in the journal JAMA Network Open.
This study included 1,282 individuals with spinal cord injury, of which 594 (45.7%) developed pressure ulcers during initial hospitalization at 20 locations across the country.
“Our study found that patients with pressure ulcers regained significantly less motor function through one year after injury. In addition, their recovery of ‘independence in activities of daily living’ was significantly restricted compared to other patients,” said Jan M. Schwab, MD, PhD, co-corresponding author of the study, who is one of the leaders of Ohio State’s Belford Center for Spinal Cord Injury.
“Our results point to the need to refer acute SCI patients to neurological rehabilitation centers such as Ohio State Dodd Rehabilitation Hospital, with specialized protocols and standards to effectively prevent pressure ulcers,” Schwab said.
During this multi-center study, patients were enrolled from 1996 to 2006 and followed-up until 2016. Patients came from the 20 centers of the prospective SCI Model Systems Database in Birmingham, Alabama.
Key inclusion criteria were acute traumatic cervical SCI with relevant motor impairment as measured by American Spinal Injury Association (ASIA) impairment scale.
“We wondered whether just the presence of another inflammatory lesion in the body such as a pressure ulcer – in addition to the spinal cord injury lesion itself – is already sufficient to distract wound healing,” said Schwab, who holds the William E. Hunt, MD & Charlotte M. Curtis Chair in Neuroscience at Ohio State.
Reference: Kopp MA, Finkenstaedt FW, Schweizerhof O, et al. Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury. JAMA Netw Open. 2024;7(12):e2444983. doi:10.1001/jamanetworkopen.2024.44983
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