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Study finds warning signs for dementia in blood

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Researchers at the DZNE and the University Medical Center Gottingen (UMG) have identified molecules in the blood that can indicate impending dementia.

Their findings, which are presented in the scientific journal “EMBO Molecular Medicine”, are based on human studies and laboratory experiments. Various university hospitals across Germany were also involved in the investigations. The biomarker described by the team led by Prof. Andre Fischer is based on measuring levels of so-called microRNAs. The technique is not yet suitable for practical use; the scientists therefore aim to develop a simple blood test that can be applied in routine medical care to assess dementia risk. According to the study data, microRNAs could potentially also be targeted for dementia therapy.

“When symptoms of dementia manifest, the brain has already been massively damaged. Presently, diagnosis happens far too late to even have a chance for effective treatment. If dementia is detected early, the odds of positively influencing the course of the disease increase,” says Andre Fischer, research group leader and spokesperson at the DZNE site in Gottingen and professor at the Department of Psychiatry and Psychotherapy at UMG. “We need tests that ideally respond before the onset of dementia and reliably estimate the risk of later disease. In other words, tests that give an early warning. We are confident that our current study results pave the way for such tests.”

Molecular Signature

The biomarker that Fischer and his colleagues have found is based on measuring so-called microRNAs in the blood. MicroRNAs are molecules with regulatory properties: they influence the production of proteins and thus a key process in the metabolism of every living being. “There are many different microRNAs and each of them can regulate entire networks of interdependent proteins and thus influence complex processes in the organism. So, microRNAs have a broad impact. We wanted to find out whether there are specific microRNAs whose presence in the blood correlates with mental fitness,” Fischer says.

Through extensive studies in humans, mice and cell cultures, the researchers ultimately identified three microRNAs whose levels were associated with mental performance. For this, they analyzed data from both young, cognitively normal individuals and from elderly people with mild cognitive impairment (MCI). For the data from healthy individuals, the Gottingen scientists cooperated with Munich University Hospital. The data from MCI patients came from a DZNE study that has been running for years and involves university clinics throughout Germany.

Omens of Dementia

In the end, the various findings came together like pieces of a puzzle: In healthy individuals, levels of microRNAs correlated with mental fitness. The lower the blood level, the better the subjects performed in cognition tests. In mice, in turn, this score increased even before the rodents started to show mental decline – regardless of whether this was due to age or because they developed symptoms similar to those of Alzheimer’s dementia. Further evidence came from patients with MCI: Of those in whom the blood marker was highly elevated, about 90 percent developed Alzheimer’s disease within two years. “We therefore see an increased blood level of these three microRNAs as a harbinger of dementia,” Fischer says. “We estimate that in humans this biomarker indicates a development that is about two to five years in the future.”

Potential Targets for Therapy

In their studies on mice and cell cultures, the researchers also found that the three identified microRNAs influence inflammatory processes in the brain and “neuroplasticity” which includes the ability of neurons to establish connections with each other. This suggests that the three microRNAs are more than warning signals. “In our view, they are not only markers, but also have an active impact on pathological processes. This makes them potential targets for therapy,” Fischer says. “Indeed, we see in mice that learning ability improves when these microRNAs are blocked with drugs. We’ve observed this in mice with age-related mental deficits, as well as in mice with brain damage similar to that occurring in Alzheimer’s disease.”

Application in Routine Care

The novel marker still requires further testing; moreover, the current measurement procedure is too complex for practical use: “In further studies, we aim to validate this biomarker clinically. In addition, we intend to develop a simple test procedure for point-of-care screening,” says Fischer. “Our goal is to have a low-cost test, similar to the rapid test for SARS-CoV-2 with the difference that for our purposes, you would need a drop of blood. Such a test could be used during routine checkups in doctors’ practices to detect an elevated risk of dementia early on. Individuals with suspicious results could then undergo more elaborate diagnostics.”

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STUDY FINDS LIVING NEAR OIL, GAS WELLS INCREASES AIR POLLUTION EXPOSURE

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Stanford researchers have observed higher levels of air pollutants within 2.5 miles of oil and gas wells, likely worsening negative health outcomes for residents.

The findings of the study were published in the journal ‘Science of The Total Environment’.

The scientists analysed local air quality measurements in combination with atmospheric data and found that oil and gas wells are emitting toxic particulate matter (PM2.5), carbon monoxide, nitrous oxide, ozone and volatile organic compounds (VOCs). The findings will help researchers determine how proximity to oil and gas wells may increase the risk of adverse health outcomes, including preterm birth, asthma and heart disease.

“In California, Black and Latino communities face some of the highest pollutions from oil and gas wells. If we care about environmental justice and making sure every kid has a chance to be healthy, we should care about this. What’s novel about our study is that we’ve done this at a population, state-wide scale using the same methods as public health studies,” said lead author David Gonzalez, who conducted research for the study in Stanford’s Emmett Interdisciplinary Program in Environment and Resources (E-IPER).

The findings align with other smaller-scale studies that have measured emissions from a handful of wells. At least two million Californians live within one mile of an active oil or gas well.

“It’s really hard to show air quality impacts of an activity like oil and gas production at a population scale, but that’s the scale we need to be able to infer health impacts,” said senior study author Marshall Burke, an associate professor of Earth system science at Stanford’s School of Earth, Energy and Environmental Sciences (Stanford Earth).

The research has revealed that when a new well is being drilled or reaches 100 barrels of production per day, the deadly particle pollution known as PM2.5 increases by two micrograms per cubic meter about a mile away from the site.

A recent study published in ‘Science Advances’ found that long-term exposure to one additional microgram per meter cubed of PM2.5 increases the risk of death from COVID-19 by 11 per cent.

“We started in 2006 because that’s when local agencies started reporting PM2.5 concentrations. We’re very concerned about the particulate matter because it’s a leading global killer,” said Gonzalez.

The team evaluated about 38,000 wells that were being drilled and 90,000 wells in production between 2006 and 2019. They developed an econometric model incorporating over a million daily observations from 314 air monitors in combination with global wind direction information from the National Oceanic and Atmospheric Administration (NOAA) to determine if the pollutants were coming from the wells. They analysed locations with air quality data of before and after a well was drilled.

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Ranking healthfulness of foods from first to worst: Study

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A new tool has been developed by scientists at the Friedman School of Nutrition Science and Policy at Tufts to help consumers, food companies, restaurants, and cafeterias choose and produce healthier foods and officials to make sound public nutrition policy.

The findings of the study were published in the journal ‘Nature Food’. Food Compass is a new nutrient profiling system, developed over three years, that incorporates cutting-edge science on how different characteristics of foods positively or negatively impact health. Important novel features of the system include:

1. Equally considering healthful vs. harmful factors in foods (many existing systems focus on harmful factors);

2. Incorporating cutting-edge science on nutrients, food ingredients, processing characteristics, phytochemicals, and additives (existing systems focus largely on just a few nutrients); and

3. Objectively scoring all foods, beverages, and even mixed dishes and meals using one consistent score (existing systems subjectively group and score foods differently).

“Once you get beyond ‘eat your veggies, avoid soda,’ the public is pretty confused about how to identify healthier choices in the grocery store, cafeteria, and restaurant,” said the study’s lead and corresponding author, Dariush Mozaffarian, dean of the Friedman School.

The new Food Compass system was developed and then tested using a detailed national database of 8,032 foods and beverages consumed by Americans. It scores 54 different characteristics across nine domains representing different health-relevant aspects of foods, drinks, and mixed meals, providing for one of the most comprehensive nutrient profiling systems in the world.

The characteristics and domains were selected based on nutritional attributes linked to major chronic diseases such as obesity, diabetes, cardiovascular problems, and cancer, as well as the risk of undernutrition, especially for mothers, young children, and the elderly.

Food Compass was designed so that additional attributes and scoring could evolve based on future evidence in such areas as gastrointestinal health, immune function, brain health, bone health, and physical and mental performance; as well as considerations of sustainability.

Potential uses of Food Compass include encouraging the food industry food purchasing incentives for employees through worksite wellness, health care, and nutrition assistance programs; supplying the science for local and national policies such as package labelling, taxation, warning labels, and restrictions on marketing to children and enabling restaurants and school, business, and hospital cafeterias to present healthier food options.

Each food, beverage, or mixed dish receives a final Food Compass score ranging from 1 (least healthy) to 100 (most healthy). The researchers identified 70 or more as a reasonable score for foods or beverages that should be encouraged. Foods and beverages scoring 31-69 should be consumed in moderation. Anything scoring 30 or lower should be consumed minimally.

Across major food categories, the average Food Compass score was 43.2. The lowest-scoring category was snacks and sweet desserts (average score 16.4).The highest scoring categories were vegetables (average score 69.1), fruits (average score 73.9, with nearly all raw fruits receiving a score of 100), and legumes, nuts, and seeds (average score 78.6). Among beverages, the average score ranged from 27.6 for sugar-sweetened sodas and energy drinks to 67 for 100per cent fruit or vegetable juices.

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STUDY FINDS LARGE DOSES OF INTENSIVE THERAPY BETTER FOR CHILDREN WITH CEREBRAL PALSY

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Scientists report that children with cerebral palsy benefited most from 60 hours of Constraint-Induced Movement Therapy (CIMT) over four weeks.

The findings of the study were published in the journal ‘Pediatrics’.The study also showed that intensive therapy did not add stress for families. The findings could have far-reaching impacts on the treatment of children’s movement disorders.

The study by researchers at Virginia Tech’s Fralin Biomedical Research Institute at VTC, UVA Children’s, The Ohio State University, and Nationwide Children’s Hospital, has shown that higher doses of CIMT therapy — 20 three-hour sessions over four weeks — yield significant and lasting improvement in the use of their arms and hands, especially in everyday functional activities.

The Children with Hemiparesis Arm-and-hand Movement Project (CHAMP) study is the first to compare different dosage levels of the same type of CIMT intervention for similar children.

The study was funded by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

“CHAMP provides new findings that are practically useful for clinicians and families in choosing treatment likely to produce meaningful benefits for children with hemiparetic cerebral palsy,” said Sharon Landesman Ramey, Distinguished Research Scholar at the Fralin Biomedical Research Institute and professor of psychiatry, psychology, and neuroscience at Virginia Tech, who led the study and is the paper’s corresponding author.

The study focused on children with hemiparetic cerebral palsy (HCP), the most common childhood neuromotor disorder. Cerebral palsy affects one to four children per 1,000 in the United States, and about 40 per cent of these children will develop hemiparesis — impaired voluntary control on one side of the body, according to the Centers for Disease Control and Prevention.

The study group included 118 children with HCP, two to eight years old, at three sites — Roanoke and Charlottesville in Virginia and Columbus, Ohio. CHAMP randomised and assigned children to different CIMT treatment groups that varied in their dosage level (30 versus 60 hours in four weeks) and the type of constraint used (cast versus splint). These treatment groups were compared with a Usual and Customary Treatment group — that later was offered a form of CIMT as an ethical option for study participation.

The form of CIMT therapy, known as ACQUIREc, was developed by co-principal investigators Stephanie DeLuca and Ramey, who also co-direct the Fralin Biomedical Research Institute at VTC Neuromotor Research Clinic, along with Karen Echols and other colleagues at the University of Alabama at Birmingham.

The CHAMP study found that the higher intensity therapy sessions — three hours a day, five days a week for four weeks — significantly improved upper arm and hand abilities while a lower dosage of 30 hours per month (2.5-hour sessions, three days a week for four weeks) produced fewer gains. The children’s early improvements continued for at least six months after higher-intensity CIMT.

The therapy can be life-changing for children. Kim Hindery, whose daughter, Abigail, 6, was part of the study in Ohio, witnessed a dramatic difference during and then after the therapy.

“I could literally see her brain changing. I’ll never forget when she looked up at her hand and goes, ‘Oh!’ — just mesmerised, like, ‘It exists!’ Being able to see a light bulb go off in your child’s head that you never thought you would see go off is priceless,” Hindery said.

Those benefits are well-known to DeLuca who has overseen the delivery of ACQUIRE therapy to more than 500 children.

“The therapists are trained to ensure each child has many successes in every therapy session,” said DeLuca, who is an associate professor at the research institute and in paediatrics and neuroscience at Virginia Tech.

“The child sees and feels their improvement and becomes an active partner in the therapy. ACQUIRE therapy increases children’s willingness to tackle new and difficult activities,” DeLuca added.

The study shows parents who worried about the intensity of the therapy and use of the cast that they should have little concern. The study also unexpectedly showed that Usual and Customary Treatment benefited children more than it did in the past, which Landesman Ramey said should be reassuring to parents whose children receive other forms of therapy.

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Patients below 40 should avoid knee replacement surgeries, say experts

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Doctors have warned that knee replacement surgeries in osteoarthritis patients less than 40 years of age can do more harm than good.

Osteoarthritis in young people may be caused by surgical removal of an injured meniscus, C-shaped cartilage in the knee, or injury to the articular cartilage (chondro) and the bone under it, or insufficiency of the ligament. This disturbs the alignment of the knee by placing abnormal stresses on the cartilage of the affected compartment, thus causing pain and difficulty in walking.

According to doctors, there are other procedures that can be used to avoid knee surgeries.

“Simpler technically demanding procedures like cartilage regeneration surgeries are done with the help of keyhole made into the joint and cartilage harvested and grown in the lab. These procedures can manage early degenerative changes that happen only in half the need to start with mostly the inner side. If treated on time, they can give almost like natural cartilage growing there and can avoid knee replacement surgery,” said Dr Shubhang Aggarwal, Senior Joint Replacement Surgeon, and Director, NHS Hospital, Jalandhar.

“The need for knee replacement surgery in young arthritic patients who have degenerative changes in one compartment of the knee joint is overemphasised. Even though we do robotic surgery which gives a perfect alignment and ensures that the implants which are put in last up to 30 years, still, it is advisable that in very young patients especially with osteoarthritis alternate methods of treatment even if they are surgical should be considered.” He added

Dr Vivek Mahajan, senior orthopaedic at Indian Spinal Injuries Centre, said, “Usually in younger patients, the cause of knee pain is due to meniscal tear or ligament injury or cartilage damage which if neglected can lead to osteoarthritis in future. These injuries should be addressed in time and can be managed by simple arthroscopy or keyhole surgery which can prolong the life of knee joint.”

Some of the experts also suggest that degenerative or inflammatory arthritis at a young age would be treated by non-operative treatment like weight reduction therapies, physiotherapy etc.

“As far as a knee replacement is considered, it is usually recommended in the older age group. Generally, the procedure is offered after the age of 60. That does not mean that patients below 40 should continue to suffer even if they have significant pain because of arthritis. Inflammatory arthritis such as rheumatoid arthritis can damage the joint at a relatively young age and cause serious disability. This may need a knee replacement at an early age,” said Dr Yash Gulati, Senior Consultant Orthopaedics, Joint Replacement and Spine, Indraprastha Apollo Hospitals, New Delhi.

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FIRST CHILDREN-FRIENDLY COVID-19 VACCINATION CENTRE COMES UP IN DELHI

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One of the private imaging centres in Delhi has become the first Covid-19 vaccination centre for children in India. The centre would cater to children above 2 years to 18 years and their vaccination process.

The new children-friendly Covid-19 vaccination centre has been given a catchy look and feel. The centre has been painted with cartoons and animal themes in a way that will help to reduce the injection fear among the children. It also has paintings of popular cartoons like Motu-Patlu, dinosaurs etc on the wall. This kids’ vaccination centre is getting a lot of praise from the residents and Children are also coming to see the centre.

“If we see demographic distribution then the age group of 0-18 years isn’t less. We can’t leave them unvaccinated, because diseases in children are not severe but still, they are potential carriers,” said Dr Sameer Bhati, Director, Star Imaging and Path Labs.

The purpose behind opening this centre is to engage children post-vaccination when they will be under observation and to remove fear from their minds.

Dr Bhati further said, “The anxiety and fear that parents have for children regarding vaccination, and engaging children post-vaccination is important. We have given it a catchy look in a way that can engage children in other activities after vaccination.”

The guidelines for Covid-19 vaccination for children who come under comorbidities is still pending. It’s expected that these guidelines may come soon after the complete clearance of DCGI to Bharat Biotech’s Covaxin for children. The Drugs Controller General of India (DCGI) has already given clearance to Zydus Cadila’s DNA vaccine ZyCoV-D for those above 12-18 years.

“The comorbid group in children is also at high risk. The obesity group is also at high risk. According to the latest studies, we are waiting for Covid-19 vaccination guidelines for children who come under comorbidities. SEC has recommended Covaxin also,” he added.

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How Covid-19 could bring adverse complications for pregnant women

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Assessing 2,471 women in the third trimester of their pregnancy, close to their delivery, researchers found “significant differences” for symptomatic covid positive patients including higher rates of gestational diabetes, lower white blood cell counts, and heavier bleeding during delivery, whilst respiratory complications were witnessed in their babies.

The peer-reviewed findings were published in The Journal of Maternal-Fetal and Neonatal Medicine. The study finds an increased risk of poorer outcomes for the newborns and symptomatic women with COVID-19, which adds further weight to the argument for pregnant women to be vaccinated for the virus.

Thankfully in the group of patients — which included 172 Covid positive women (56 of whom were symptomatic)– monitored at the Mayanei Hayeshua Medical Center in Israel, only one person needed mechanical ventilation, and there were no maternal deaths.

They show, lead Dr Elior Eliasi stated that COVID-19 in the third trimester of pregnancy “has clinical implications, albeit at lower rates than expected once asymptomatic patients are taken into account.”

The analysis found that there was no significant increase in cesarean delivery in women, who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups (healthy, covid positive asymptomatic, covid positive symptomatic). Most pregnancy and delivery outcomes were similar between COVID-19-positive and -negative parturients (a woman about to give birth; in labour).

Dr Eliasi said, “However, There were significant differences between the COVID-19-positive and healthy controls included higher rates of GDM (gestational diabetes), low lymphocyte counts (white blood cell count) which were significantly lower, postpartum hemorrhage (bleeding during birth), and neonatal respiratory complications.”

“Our findings support the importance of vaccinating all pregnant women at all stages of pregnancy,” he added.

The study looked at births at the hospital between 26 March and 30 September 2020. A total of 93 per cent of women admitted to the labour ward during this period were negative for COVID-19. Of the COVID-19-positive patients, 67 per cent were asymptomatic.

On average the increase risk of incidence of adverse outcomes was 13.8 per cent higher for asymptomatic covid patients and 19.6 per cent higher for those symptomatic.

“More data is now needed to better delineate the differences between pregnancy outcomes seen in certain populations, potentially related to different viral characteristics (subtypes, viral load), patient epigenetics, or other factors. Additionally, the effects of maternal infection on the fetus both in terms of symptomatic maternal illness and vertical viral transmission remain to be further investigated,” the authors stated.

Limitations of this study include it being retrospective; whilst another is that the sample includes a relatively healthy population admitted to just a single community hospital. “Therefore,” the authors stated their findings, “may not be generalizable to all populations.”

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