Medical Bulletin 26/ February/ 2025
Here are the top medical news for the day:
Telemedicine Revolution: Cutting Unnecessary Health Tests, Study Finds
Low-value care—medical tests and procedures that provide little to no benefit to patients—contributes to excess medical spending and both direct and cascading harms to patients. A research team from Mass General Brigham and their collaborators have found that telemedicine may help to reduce the use of low-value tests. The work is published in JAMA Internal Medicine.
“In theory, widespread adoption of telemedicine post-pandemic may influence low-value testing—such as Pap smears and prostate cancer screenings in older adults, and imaging scans for straightforward cases of low back pain,” said lead author Ishani Ganguli, MD, MPH, of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, a founding member of Mass General Brigham, and an Associate Professor of Medicine at Harvard Medical School. “But there was very limited evidence on this. We wanted to look at this question at a national level because there is active policy debate about whether and how Medicare should continue telemedicine coverage, hinging in large part on how telemedicine impacts care quality and spending.”
The results of the research showed that compared to patients in low-telemedicine systems, patients in high-telemedicine systems had slightly higher rates of total visits and lower use of 7 of 20 low-value tests: cervical cancer screening, screening electrocardiograms, screening metabolic panels, preoperative complete blood cell counts, preoperative metabolic panels, total or free triiodothyronine level testing for hypothyroidism, and imaging for uncomplicated low back pain. There were no significant differences in other tests.
The findings suggest that while virtual options may reduce barriers to care, telemedicine may also deter clinicians and patients from completing some low-value tests, especially tests like electrocardiograms and blood counts that would be done on-site during or just after an office visit.
Ref: Ganguli I et al. “Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries” JAMA Internal Medicine DOI: 10.1001/jamainternmed.2024.8354
AI Breakthrough helpful in detecting Hidden Brain Abnormalities in Children with Epilepsy
Scientists have developed an AI-powered tool that detects 64% of brain abnormalities linked to epilepsy that human radiologists miss. MELD Graph is an AI tool that could drastically change the care for 30,000 patients in the UK and 4 million worldwide with one cause of epilepsy, researchers say.
The study, published in JAMA Neurology by a team at King’s College London and University College London (UCL), shows how the tool significantly improves the detection of focal cortical dysplasia’s (FCDs) which is a leading cause of epilepsy.
In the study, the researchers pooled MRI data from 1185 participants – including 703 people with FCD and 482 controls - from 23 epilepsy centres around the world in the Multicentre Epilepsy Lesion Detection project (MELD). Half of the dataset is from children. They then trained the artificial intelligence tool, MELD Graph, on the scans to detect these subtle brain abnormalities that might otherwise go undetected.
Project lead-author, Dr Konrad Wagstyl, from King’s College London, said: “Radiologists are currently inundated with images they have to review. Using an AI-powered tool like MELD Graph can support them with their decisions, making the NHS more efficient, speeding time to treatment for patients and relieving them of unnecessary and costly tests and procedures.”
Co-author Dr Luca Palma, from Bambino Gesù Children's Hospital, Italy, said: “MELD Graph identified a subtle lesion missed by many radiologists in a 12-year-old boy who had daily seizures and had tried nine anti-seizure medications with no improvement to his condition. This tool could identify patients with surgically operable epilepsy and help with surgical planning – reducing risks, saving money, improving outcomes.”
While the tool is not yet clinically available, the research team have released the AI-tool as an open-source software. They are running workshops to train clinicians and researchers around the world, including Great Ormond Street Hospital and the Cleveland Clinic, in how to use it.
Ref: Ripart M et al., 2025. Detection of epileptogenic focal cortical dysplasia using graph neural networks: a MELD study. JAMA Neurol, Feb 24. doi:10.1001/jamaneurol.2024.5406
New p53 Targets Discovered: A Leap Forward in Cancer Treatment
The p53 protein plays a crucial role in preventing cancer by stopping uncontrolled cell growth. However, many cancers mutate or suppress p53, allowing tumors to develop and resist treatment
A new research paper published in Oncotarget discovered several novel downstream p53 targets of potential clinical relevance. Researchers Jessica J. Miciak, Lucy Petrova, Rhythm Sajwan, Aditya Pandya, Mikayla Deckard, Andrew J. Munoz, and Fred Bunz from the Sidney Kimmel Comprehensive Cancer Center and Johns Hopkins University School of Medicine studied the tumor-suppressing protein p53, which plays a key role in preventing cancer. Their findings reveal how p53 affects cancer cell growth, treatment resistance, and potential drug targets, providing new insights that could improve future cancer therapies.
The p53 protein plays a crucial role in preventing cancer by stopping uncontrolled cell growth. However, many cancers mutate or suppress p53, allowing tumors to develop and resist treatment. In this study, researchers restored p53 function in colorectal cancer cells, which led to slower cellular growth, increased cellular aging (senescence), and greater sensitivity to radiation therapy. These findings suggest that p53 status influences cancer progression and response to treatment, making it a promising target for new therapies.
A breakthrough in the study was the identification of two new p53-regulated genes that could be important for cancer treatment. The first, ALDH3A1, helps detoxify harmful substances and may impact cancer cell resistance to oxidative stress. The second, NECTIN4, is a protein found in many aggressive cancers, including bladder and breast cancer
In conclusion, this research highlights the critical role of p53 in cancer biology and suggests that restoring p53 function could make tumors more vulnerable to radiation and chemotherapy. The discovery of new p53-controlled genes provides new opportunities for targeted cancer therapies.
Ref: Miciak J. J., Petrova L., Sajwan R., Pandya A., Deckard M., Munoz A. J., Bunz F. Robust p53 phenotypes and prospective downstream targets in telomerase-immortalized human cells. Oncotarget. 2025; 16: 79-100. Retrieved from https://www.oncotarget.com/article/28690/text/
Common Medications' Hidden Impact on Brain Development through unexpected cholesterol disruption, Study finds
In a peer-reviewed Perspective (review) article, researchers at the University of Nebraska Medical Center have uncovered concerning evidence that commonly prescribed medications may interfere with crucial brain development processes by disrupting sterol biosynthesis. Their findings, published in Brain Medicine suggest that this previously overlooked mechanism could have significant implications for medication safety during pregnancy and early development.
"What we've discovered is that many prescription medications, while designed for entirely different purposes, can inadvertently interfere with the brain's ability to produce and process sterols, including cholesterol," explains Professor Károly Mirnics, lead author of the review. "This is particularly concerning because the brain requires precise sterol regulation for proper development and function."
The research reveals that the brain, which contains 25% of the body's cholesterol despite representing only 2% of body weight, maintains its own independent cholesterol production system behind the blood-brain barrier. This process is essential for numerous developmental processes, including nerve cell connection formation and myelin production.
The researchers emphasize that patients should not discontinue prescribed medications without consulting their healthcare providers. However, they recommend that additional research is needed to fully understand the implications of these findings and to develop more targeted approaches for vulnerable populations.
Ref: Korade Z, Heffer M, Mirnics K. Medication effects on developmental sterol biosynthesis. Mol Psychiatry. 2022 Jan;27(1):490-501. doi: 10.1038/s41380-021-01074-5. Epub 2021 Apr 5. PMID: 33820938; PMCID: PMC8490477.
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