[Vol 28] Medi-Scene: Your Weekly Health News Update

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MediScene Magazine Vol 28

1. Higher than normal platelet count could indicate cancer: Study

Platelets are an important component of the blood that helps blood to clot and wounds to heal. According to University of Exeter’s new research, higher end of normal platelet count suggests a high risk of cancer in men aged 60 and above. However, researchers at Exeter University have previously found that cancer risk is notably raised by having an abnormally high blood platelet count (more than 400 x 109/l,) a condition known as thrombocytosis. Now, they have found that cases of cancer greatly increased in older males with a platelet count on the high end of the normal range (326 to 400 x 109/l), stipulating that these patients should be investigated for cancer. The study was conducted on 30,00 patients who had platelet count higher than normal range. Funded by NIHR and published in the British Journal of General Practice, the data was taken from Clinical Practice Research Datalink and the National Cancer Registration and Analysis Service. Dr Sarah Bailey, Senior Research Fellow at the University of Exeter Medical School who led the research, said: “After finding that having a blood platelet count above normal range put people at high risk of cancer, we investigated the risk at the high end of normal. We found that men aged over 60 whose platelet count is on the higher end of a normal are more likely to have underlying cancer. Updating guidance for GPs to investigate higher platelet counts could save lives. This is particularly important in a post-Covid era; clues to help GPs identify cancer earlier are crucial to targeting the backlog in cancer investigation and diagnosis.” 

2. Study: Fusion protein holds promise in treating pulmonary arterial hypertension

A recent study suggests that symptoms of pulmonary arterial hypertension (PAH) could begin slowly even before they appear. Extensive damage could be caused by the obstruction of small arteries leading to increased blood pressure in the lungs. By the time notable symptoms appear, like shortness of breath, it becomes severe enough for someone with PAH to seek care and obtain a definitive diagnosis. The patient’s chances of survival at five years are slightly better than 50% on currently available treatments. Paul B Yu, MD, PhD, a cardiovascular medicine specialist at Brigham and Women’s Hospital has been studying PAH for more than 15 years to better understand the fundamental process in which blood vessels in the lungs are lost to the disease. Dr Yu said, “We were delighted to contribute to the pre-clinical validation of sotatercept, and improve our understanding of the signalling molecules that drive pulmonary arterial hypertension. We hope these advances will lead to new treatment options for this incredibly vexing disease.” In their Science Translational Medicine paper, Yu and colleagues present data from both human and rodent models to cohesively connect these various protein players. The team found increased levels of activin A, GDF8, and to a lesser degree GDF11 in lung lesions from patients with PAH and rodent models of the disease. The team then tested what would happen when they added a “ligand trap” , a fusion protein that captures GDF and activin, blocking their activity. Co-lead author Peiran (Brian) Yang, PhD, a senior member of Yu’s group at Brigham said, “It was unexpected to find such a prominent role for GDF and activin in PAH, but if they are helping to drive pulmonary vascular disease, it may help explain why a therapy that targets these ligands may be effective against PAH. Our research demonstrates that this central genetic pathway of PAH is tractable and can be exploited as a drug target.”

3. Probiotics alone or with prebiotics could lower depression symptoms

A new research review shows that those who took probiotics alone or with prebiotics saw a significant drop in symptoms of depression. Researchers inspected data from seven published studies that evaluated the influence of at least one probiotic strain on adults with symptoms of anxiety and/or depression. Four of the studies in the analysis looked at combinations of multiple strains of probiotics or prebiotics. Researchers looked at 12 probiotic strains including Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum. All studies found a significant reduction or improvement in anxiety symptoms or clinically relevant changes in biochemical measures of anxiety or depression with probiotics alone or in combination with prebiotics as compared with placebo or no treatment.  Dr. Esther Aarts, of the Donders Centre for Cognitive Neuroimaging at Radboud University in Nijmegen, The Netherlands said, “The results of this study show that it is promising and probably worthwhile to further look into the effects of probiotics on depression. However, it is too early to give any clear clinical advice. The number of studies is too low so far, the type of probiotic strain – or, combination of strains – that is most effective is unclear, as is the dose and duration of intervention. The idea that probiotics can decrease self-reported depressive symptoms more than depression is in line with previous research reviews demonstrating a reduction in depressive symptoms. These previous reviews indicated a reduced risk for depression by using probiotics, whereas the current study might indicate a therapeutic effect of probiotics in depression.” Dr Richard Liu, director of suicide research at Massachusetts General Hospital and Harvard Medical School in Boston said, “The current study found little evidence for a role of immune responses and mixed support for the role of tryptophan. It suggests that more research needs to be done in this area,” Liu, who wasn’t involved in the study, said by email. “These findings matter for clinical care because if probiotics are effective, they have potential to become a new treatment for anxiety and depression with little risk of side effects and no risk of addiction.”

4. Vaccination for flu and pneumonia could lower dementia risk

Two big observational studies showed that vaccinations against flu and pneumonia could help protect against Alzheimer’s disease. In a group study of more than 9000 older adults, receiving a single influenza vaccination was connected with a 17% lower frequency of AD in comparison to not receiving the vaccine. Additionally, for those who were vaccinated more than once over the years, there was an additional 13% reduction in AD incidence. Similarly in other research, which included more than 5000 older participants, being vaccinated against pneumonia between the ages of 65 and 75 reduced the risk of developing AD by 30%. Rebecca M. Edelmayer, PhD, director of scientific engagement for the Alzheimer’s Association, told a medical online news that, “The subject of vaccines is obviously very topical with the COVID-19 pandemic. While these are very preliminary data, these studies do suggest that with vaccination against both respiratory illnesses, there is the potential to lower risk for developing cognitive decline and dementia.” For study on flu vaccine, the researchers used electronic health record data to create a propensity-matched cohort of 9066 vaccinated and unvaccinated adults aged 60 and older. Influenza vaccination, increased frequency of administration, and younger age at time of vaccination were all associated with reduced incidence of AD. Lead researcher Albert Amran, a fourth-year medical student at McGovern Medical School at the University of Texas Health Science Center at Houston said, “As people get older, their immune systems become less able to control infection. We’ve seen this with the ongoing pandemic, with older people at much higher risk for dying. Giving people the vaccine once a year may help keep the immune system in shape. Flu infections can be extremely deadly in older patients. Maybe the results of our study will give another reason for people to get vaccinated.” Study on pneumonia vaccine was presented by Svetlana Ukraintseva, PhD, Duke University, Durham, North Carolina. The researchers investigated associations between pneumococcal vaccine, with and without an accompanying influenza vaccine, and the risk for AD among 5146 participants in the Cardiovascular Health Study. Total number of vaccinations against pneumonia and influenza between ages 65 and 75 was also associated with a lower risk for AD (OR, 0.88; P < .01). Svetlana Ukraintseva told a medical news portal that, “However, the effect was not evident for the influenza vaccination alone. The fact that very different pathogens, viral, bacterial, fungal have been linked to AD indicates a possibility that compromised host immunity may play a role in AD through increasing the overall brain’s vulnerability to various microbes. The current findings support further investigation of pneumococcal vaccine as a reasonable candidate for repurposing in personalized AD prevention. These results also support the important role of boosting overall immune robustness/resilience in preventing AD.”

5. Midlife cognitive decline tied to cardiovascular risk factors

New research shows that cardiovascular risk factors (CVRFs), including hypertension, diabetes, and smoking, are linked to a remarkably higher risk for cognitive decline in midlife in a dose-dependent manner. study investigator Kristine Yaffe, MD, told Medscape Medical News, “What is new here is that almost no one has looked at cardiovascular risk factors in such a young age (mean, 50) and cognitive change in middle age from 50 to 55 or so. Almost all other studies have looked at mid- or late-life cardiovascular risk factors and late-life cognition or dementia.” Longitudinal studies have also shown that many cognitive domains particularly processing speed and executive function may start to decline in midlife, but whether CVRFs, many of which also emerge in midlife, contribute to these changes is unclear. The analysis was based on data from 2675 participants who underwent CVRF assessment and cognitive testing at baseline and 5 years later. At baseline, participants’ mean age was 50.2 years. Approximately 57% of participants were women, 55% were White, and the mean number of years of education was 15. Dr Kristine Yaffe said, “Most studies have not shown a consistent finding with high cholesterol and later-life cognition, so it is not surprising we did not see one in midlife, when there is not as much cognitive change. The study’s results provide physicians with another good reason to help patients address CVRFs and to work with them to lower blood pressure, stop smoking, reduce diabetes incidence, or control diabetes. We want to know if this earlier cognitive decline [in midlife] is connected to greater decline later in life. We also want to know if improving these risk factors in midlife might prevent or slow dementia later.” M. Mielke, PhD, professor of epidemiology and neurology at Mayo Clinic College of Medicine in Rochester, Minnesota said, “One of the study’s main implications “is that the prevention and treatment of midlife hypertension and diabetes and smoking cessation directly impacts shorter-term changes in cognition. It was also not reported whether a specific midlife cardiovascular risk factor was more strongly associated with accelerated cognitive decline for women or for men. Additional research is needed to understand the emergence of cardiovascular risk factors pre- vs post menopause on subsequent cognition and also consider the use of menopausal hormone therapy. Another future research avenue is to further understand the impact of antihypertensive and diabetes medications, for example, in the current study, it was not clear how many [participants] with hypertension were treated vs untreated and whether this impacted subsequent cognition. Similarly, it is not known whether specific antihypertensives are more beneficial for cognition in midlife.”

6. ICMR: India conducts 5.15L tests in 24 hours on Monday

On Monday, India recorded the highest single-day testing of over 5.15 lakh tests to diagnose Covid-19. Indian Council of Medical Research (ICMR) said as the country’s Covid tally on Monday crossed 14 lakh mark. Latest advisory of ICMR on Covid-19 strategies said, “ICMR advises all concerned state governments, public and private institutions to take required steps to scale-up testing for Covid-19. Since testing, tracking and treatment is the only way to prevent the spread of infection and save lives, it is imperative that testing should be made widely available to all symptomatic individuals in every part of the country and contact tracing mechanisms for containment of infection are further strengthened.” A health ministry official said, “The Central Government has advised all State and UT governments to keep up the strategy of ‘Test, Track and Treat’ with aggressive testing which may lead to a higher number of daily positive cases initially but would eventually achieve a decline as has been demonstrated after Union Government’s targeted efforts in the national capital. Recently, the WHO has issued a guidance note on public health criteria to adjust public health and social measures in the context of Covid-19. In this document, WHO underlines the need for comprehensive surveillance and testing of suspect cases and they further elaborated the meaning of ‘comprehensive surveillance’ stating that if a country is testing 140 people per day per 10 lakh (one million) population. So, we are taking that indication from the WHO document. In the Indian context, there are over 22 states which are conducting over 140 tests per day per million population.” 

7. Coronavirus Update: Total tally crosses 15L on Tue

On Tuesday, India’s coronavirus case went past the 15-lakh mark, even as the country reported its second-biggest jump in infections and the highest death toll of 781 in a single day. New cases rose to 49,292 on Tuesday, the second-highest daily count after Sunday’s record of over 50,000, as per data collated from state governments. Deaths recorded during the day went past the previous single-day high of 757 on July 24. Fresh infections surged in the country although just three states: Karnataka (5,536 new cases), Kerala (1,167) and Punjab (612)  recorded their highest single-day jump in cases. Fresh cases in Maharashtra, which had dropped by nearly 1,500 to 7,924 on Monday, dipped further. For the second day in a row, daily discharges in Maharashtra were higher than daily additions, and discharges in Mumbai were nearly four times the daily addition. Even as the state and city registered a dip in cases, Covid fatalities reported on Tuesday went up to 282.

Reference links:

  1. https://health.economictimes.indiatimes.com/news/industry/study-finds-higher-end-of-normal-blood-platelet-count-could-indicate-cancer/77220418
  2. https://health.economictimes.indiatimes.com/news/diagnostics/fusion-protein-holds-promise-for-treating-pulmonary-arterial-hypertension-study/77179007
  3. https://www.medscape.com/viewarticle/934580
  4. https://www.medscape.com/viewarticle/934759
  5. https://www.medscape.com/viewarticle/933988
  6. https://health.economictimes.indiatimes.com/news/industry/india-conducts-over-5-15-lakh-covid-tests-in-last-24-hours-icmr/77199409
  7. https://health.economictimes.indiatimes.com/news/industry/covid-tally-crosses-15-lakh-record-781-fatalities-on-tuesday/77231748

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