Portable MRI promising for expanding brain imaging for Alzheimer’s disease, claims research

Globally, approximately 139 million people are expected to have Alzheimer’s disease (AD) by 2050. Magnetic resonance imaging (MRI) is an important tool for identifying changes in brain structure that precede cognitive decline and progression with disease; however, its cost limits widespread use. A new study by investigators from Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system, demonstrates that a simplified, low magnetic field (LF) MRI machine, augmented with machine learning tools, matches conventional MRI in measuring brain characteristics relevant to AD. Findings, published in Nature Communications, highlight the potential of the LF-MRI to help evaluate those with cognitive symptoms.

“To tackle the growing, global health challenge of dementia and cognitive impairment in the aging population, we’re going to need simple, bedside tools that can help determine patients’ underlying causes of cognitive impairment and inform treatment,” said senior author W. Taylor Kimberly, MD, PhD, chief of the Division of Neurocritical Care in the Department of Neurology at MGH. “To do this, we brought a research team together to design a patient-centered approach to brain imaging to improve access and convenience, reduce costs, and streamline cognitive evaluations.”

The research team behind the project included clinical researchers, MRI physicists, health system delivery experts, and AI experts. Investigators at MGH have explored LF-MRI for several years as an alternative to traditional high-field (HF) MRI, which provides detail-rich, cross-sectional images of the body by generating powerful magnetic fields. HF-MRI machines are expensive, require designated imaging centers/suites for operation, and are frequently absent from low-resource settings in the U.S. and around the world. In contrast, LF-MRI machines use magnetic fields 50 times weaker than those required for conventional MRI. This makes LF-MRI scanners smaller and portable, requiring just one electrical outlet for operation, but also results in reduced image quality.

To improve LF-MRI image quality and make it easier to use in the clinic, the researchers leveraged artificial intelligence (AI) tools. The researchers created artificial datasets and matched HF- and LF-MRI scans from both healthy people and patients with neurological conditions. They used these datasets to train an algorithm to recognize features relevant to AD on LF-MRI, including the size of brain structures like the hippocampus (the brain’s memory center), and white matter hyperintensity (WMH) regions, which can indicate neurodegeneration or blood vessel problems. When they tested their method in 54 patients with mild cognitive impairment or AD-related dementia, the AI-based LF-MRI scans closely matched traditional, HF-MRI measurements of the hippocampus and white matter volume.

The new approach will require regulatory clearance and new clinical protocols, but it holds the promise of expanding neuroimaging in settings with limited MRI access. Beyond advancing AD diagnosis, LF-MRI may help streamline care for AD patients who require MRI monitoring during treatment with novel AD drugs. The portable LF-MRI could also be used in emergency rooms, community health centers, or ambulatory units, especially for patients who have experienced or are at risk of stroke.

“Access to traditional MRI is not evenly distributed and not available to everyone,” Kimberly said. “We envision a future where a person with cognitive complaints visiting a primary care physician, geriatrician or neurologist can get a brain scan, a blood test and a cognitive test, all in a single visit. Low-cost, easier to deploy technology can help provide information to clinicians, right at the bedside.”

Reference:

Sorby-Adams, A.J., Guo, J., Laso, P. et al. Portable, low-field magnetic resonance imaging for evaluation of Alzheimer’s disease. Nat Commun 15, 10488 (2024). https://doi.org/10.1038/s41467-024-54972-x

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Vitamin D deficiency in hip fracture patients associated with increased mortality: study

John M. Bayram et al conducted a study to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture. The study was conducted at Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK.

Vitamin D deficiency is defined by the Endocrine Society Task Force as a serum 25-hydroxyvitamin D [25(OH)D] level < 50 nmol/l.

A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality.

Key findings of the study were:

• The cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l).

• The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022).

• Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk.

• Vitamin D deficiency was not associated with length of hospital stay.

The authors opined – “In conclusion, there was an independent association between vitamin D deficiency and increased mortality in hip fracture patients. These results agree with the wider literature, but the independence from confounders may be due to lack of inclusion of a comprehensive measure of comorbidity in this study. The role of routinely measuring vitamin D status in this population is debated. While some consider it mandatory, others, like the Scottish Hip Fracture Audit (SHFA), consider vitamin D deficiency so prevalent that measurement is unnecessary and treat all hip fracture patients for vitamin D deficiency. Ensuring hip fracture patients receive vitamin D supplementation during their hospital stay remains important given its high prevalence and the increased mortality, falls and fracture risks linked to vitamin D deficiency.” 

Further reading:

Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk.

John M. Bayram et al

European Journal of Orthopaedic Surgery & Traumatology (2024) 35:33

https://doi.org/10.1007/s00590-024-04162-8

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Prophylactic calcium reduces postspinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplements: Study

Prophylactic calcium reduces postspinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation suggests a study published in the American Journal of Obstetrics & Gynecology MFM.

Preeclamptic women, in addition to traditional antihypertensive medications, often receive magnesium supplementation and are at increased risk of postspinal hypotension Postspinal hypotension increases the risk of fetomaternal morbidity. Calcium is a physiological antagonist of magnesium in vascular smooth muscle. Therefore, the study hypothesized that calcium is better suited for preserving systemic vascular resistance and preventing postspinal hypotension during cesarean delivery. The study aimed to evaluate the effect of prophylactic calcium administration on postspinal hypotension in preeclamptic women receiving magnesium supplementation. This prospective, randomized, placebo-controlled, double-blinded, two-arm parallel trial was conducted in preeclamptic women receiving magnesium sulfate supplementation undergoing cesarean delivery. The women were randomized to receive intravenous calcium or a placebo (normal saline) before spinal anesthesia. The study drug (calcium gluconate 500 mg or normal saline) was administered over 15 minutes and ended immediately before spinal anesthesia. The primary outcome measure was the incidence of postspinal hypotension, and secondary outcome measures were postpartum blood loss and maternal and neonatal outcomes. Results: A total of 100 women (50 each calcium and placebo arm) completed the study. The baseline demographic variables, mean blood pressure and heart rate were comparable. The incidence of postspinal hypotension was significantly lower in the calcium arm compared to the placebo arm (32% vs 60%; Relative risk [95% CI]; 1.87 [1.18–2.97]; P=.007). The mean phenylephrine requirement (5.60±14.59 vs 14.80±22.42 mcg; P=.01) and mephentermine requirement (3.30±5.11 mg vs 5.82±4.97 mg; P=.008) was significantly lower in the calcium group. Furthermore, the calcium group’s mean postpartum blood loss was significantly lower (406.90±94.34 vs 472.20±122.49 ml, P=.004). However, the Neonatal Intensive Care Unit admission rate, Apgar score, umbilical artery PH, and maternal serum calcium were comparable. Prophylactic calcium infusion significantly reduces the incidence of postspinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation. Furthermore, the effect of prophylactic calcium in decreasing postpartum blood loss is encouraging. However, large trials are required to validate the findings of this study.

Reference:

Navin Kumar Yadav, Suman Lata, Nivedita Jha, Deepak Chakravarthy, Ajay Kumar Jha,

Role of prophylactic intravenous calcium in prevention of postspinal hypotension among women with preeclampsia undergoing cesarean delivery: a placebo controlled randomized clinical trial. American Journal of Obstetrics & Gynecology MFM, Volume 7, Issue 1, 2025,

101541, ISSN 2589-9333, https://doi.org/10.1016/j.ajogmf.2024.101541.

(https://www.sciencedirect.com/science/article/pii/S2589933324002672)

Keywords:

Prophylactic, calcium, reduces, postspinal, hypotension, during, cesarean, delivery, preeclamptic, women, receiving, magnesium, supplementation, Study, American Journal of Obstetrics & Gynecology MFM, Navin Kumar Yadav, Suman Lata, Nivedita Jha, Deepak Chakravarthy, Ajay Kumar Jha

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Gluten-free diet improves celiac disease associated with cryptogenic cirrhosis, suggests study

Researchers have discovered that patients who also have biopsy-proven celiac disease (CeD) with cryptogenic cirrhosis benefit significantly by the treatment with a gluten-free diet (GFD). A recent study was conducted by Pachisia and colleagues which was published in The American Journal of Gastroenterology.

Celiac disease frequently involves the liver, and as many as 4.6% of patients with cryptogenic cirrhosis are likely to have undiagnosed CeD. The aim of this study was to determine the prevalence of CeD in patients with cryptogenic cirrhosis and compare liver-related outcomes of these patients after a gluten-free diet (GFD) compared with a propensity-score-matched cohort of patients without CeD on standard care (SOC).

This multicenter study screened 232 consecutive patients with cryptogenic cirrhosis for CeD using IgA anti-tissue transglutaminase antibody (anti-tTG), anti-endomysial antibody (AEA), and duodenal and liver biopsies. Biopsy samples underwent IgA/anti-tTG colocalization studies for definitive diagnosis.

Patients diagnosed with CeD and matched controls without CeD (1:4 ratio, matched by age, sex, Child-Turcotte-Pugh [CTP] score, and MELD score) were treated with GFD plus SOC or SOC alone, respectively. Liver-related outcomes, including MELD and CTP scores, decompensation events, and mortality, were assessed over a one-year follow-up.

Key Findings

Prevalence of CeD in Cryptogenic Cirrhosis :

  • Among 232 patients, 14 had elevated anti-tTG antibody levels (16.9±10.5-fold rise), 9 were AEA positive, and 11 (4.7%) were biopsy-proven for CeD.

Baseline Characteristics:

Patients with CeD (n=11) and matched controls (n=44) showed similar baseline demographics and liver disease severity:

  • Age: 31.3±7.7 (CeD) vs. 31.8±9.3 years (non-CeD).

  • Females: 45.5% (CeD) vs. 34.1% (non-CeD).

  • MELD score: Median 9 (IQR: 8–15.5) vs. 12 (9–15).

  • CTP score: Median 7 (IQR: 6–7.5) vs. 6 (5.75–7).

Liver Outcomes with GFD:

  • Patients with CeD on GFD showed significant improvements in liver scores compared with patients without CeD.

  • Follow-up MELD score: Median 9 (IQR: 7.5–10.5) vs. 18.5 (12–20) (p=0.001).

  • Follow-up CTP score: Median 5 (IQR: 5–5) vs. 8 (7–9) (p<0.001).

  • The number of decompensation events was smaller, and the mortality was not significantly different between CeD patients and non-CeD controls.

  • Decompensations: Less frequent in CeD group; no numbers were reported.

  • Mortality: 9.1% (CeD) vs. 18.2% (non-CeD) (p=0.67).

Liver-related outcomes improved significantly with GFD among these patients, which signifies the importance of early diagnosis and dietary intervention in this population.

Reference:

Pachisia, A. V., Agarwal, A., Mehta, S., Kumari, A., Dwarakanathan, V., Sharma, S., Kumar, S., Mehra, L., Dutta, R., Das, P., Agrawal, S., Shalimar, Ahuja, V., & Makharia, G. K. (2024). Celiac disease is common in adults with cryptogenic cirrhosis and responds favourably to gluten-free diet. The American Journal of Gastroenterology, 10.14309/ajg.0000000000003244. https://doi.org/10.14309/ajg.0000000000003244

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Parental Smoking Linked to Increased Risk of Birth Defects in Offspring: Study Urges Quitting During Pregnancy

China: A recent systematic review and meta-analysis investigating parental smoking and its impact on birth defects has revealed concerning findings. The study, published in Birth Defects Research, highlights that both maternal active and passive smoking, as well as paternal active smoking, are associated with an increased risk of birth defects in offspring.

The evidence from the meta-analysis strengthens the argument that quitting smoking during pregnancy and the perinatal period can prevent these adverse health outcomes.

Kaijuan Wang, Henan Children’s Hospital Zhengzhou Children’s Hospital, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, China, and colleagues conducted a meta-analysis of case-control studies to evaluate the risk of birth defects in offspring in China linked to maternal active and passive smoking, as well as paternal smoking.

For this purpose, the researchers searched four electronic databases for relevant studies up to December 2023. They employed either a random-effect or fixed-effect model to calculate overall risk estimates and examine the association between parental smoking and the risk of birth defects during different stages of pregnancy. Subgroup and sensitivity analyses were conducted to identify potential sources of variation.

Based on the study, the researchers reported the following findings:

  • The analysis included sixty-two studies with 137,574 cases and 8,770,837 controls.
  • Maternal active smoking was significantly associated with an increased risk of birth defects (OR = 2.19).
  • Maternal passive smoking was also linked to higher birth defect risk (OR = 2.59).
  • Paternal active smoking was significantly associated with birth defect risk (OR = 1.47).
  • Subgroup analysis revealed an increased risk of congenital heart disease in offspring due to paternal active smoking (OR = 2.97) and maternal active smoking (OR = 1.51).
  • Sensitivity analysis confirmed the consistency of these findings.

The findings showed that maternal active and passive smoking, as well as paternal active smoking, increase the risk of birth defects in offspring. The researchers suggest that it is important to encourage parents to quit smoking during pregnancy and the perinatal period to reduce this risk.

“The meta-analysis reaffirms the harmful effects of smoking during pregnancy and highlights that both maternal and paternal smoking behaviors impact fetal development. Efforts to reduce smoking rates before conception and throughout the perinatal period are vital for improving birth outcomes and reducing the risk of congenital disorders in offspring,” the researchers concluded.

Reference:

Han, J., Zhang, Y., Liu, Y., Liu, J., Zhang, Y., & Wang, K. (2024). Parental Smoking and the Risk of Birth Defects in Offspring in China: A Systematic Review and meta-Analysis. Birth Defects Research, 116(12), e2422. https://doi.org/10.1002/bdr2.2422

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Adverse Pregnancy Outcomes Tied to Elevated Dementia Risk: Study Highlights Need for Early Monitoring

USA: A recent meta-analysis has found that a history of adverse pregnancy outcomes—such as hypertensive disorders of pregnancy, gestational diabetes, stillbirth, fetal growth restriction, preterm birth, or placental abruption—is associated with a 32% increased risk of all-cause dementia, a 26% higher risk of Alzheimer’s disease, and nearly double the risk of vascular dementia.

The researchers also observed that hypertensive disorders were linked to both all-cause and vascular dementia but not to Alzheimer’s disease. The findings were published online in The Lancet Healthy Longevity on December 12, 2024.

Individuals with adverse pregnancy outcomes face a higher risk of cerebrovascular disease; however, the link between such outcomes and cognitive impairment or dementia remains less clearly established. Therefore, Eliza C Miller, Department of Neurology, Columbia University, New York, NY, USA, and colleagues aimed to synthesize, combine, and evaluate the growing body of evidence exploring the associations between adverse pregnancy outcomes and mild cognitive impairment or dementia in parous women.

For this purpose, the researchers conducted a systematic review and meta-analysis of studies from PubMed, Web of Science, and Embase (up to July 18, 2024), focusing on women with adverse pregnancy outcomes (e.g., hypertensive disorders, gestational diabetes, stillbirth) and their risk of cognitive impairment or dementia. Studies involving men, nulliparous women, or cognitive impairment within six months of pregnancy were excluded. Eligible studies were screened, reviewed, and assessed independently by two investigators. The meta-analysis used random-effects models to pool adjusted hazard ratios (HRs) and confidence intervals (CIs).

The following were the key findings:

  • A total of 11,251 publications were identified, with 15 studies (7,347,202 participants) meeting the inclusion criteria for the systematic review and eleven studies (6,263,431 participants) providing sufficient data for meta-analysis.
  • Any adverse pregnancy outcome was linked to a higher risk of:
    • All-cause dementia (adjusted HR 1.32).
    • Alzheimer’s disease (HR 1.26).
    • Vascular dementia (HR 1.94).
  • Hypertensive disorders of pregnancy were significantly associated with:
    • All-cause dementia (HR 1.32).
    • Vascular dementia (HR 1.78).
    • There is no significant association with Alzheimer’s disease (HR 1.24).
  • Stillbirth was not significantly linked to a higher risk of all-cause dementia (HR 1.26).
  • Preterm birth and fetal growth restriction showed similar effect directions in individual studies, but data were insufficient for meta-analysis.

“Women with a history of adverse pregnancy outcomes should be assessed for additional dementia risk factors and monitored for early signs of cognitive decline due to their elevated risk. To enhance the reliability of findings, future research should prioritize prospective and objective measurement of both exposures and outcomes,” the researchers concluded.

Reference: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00186-7/fulltext

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NEET PG State counseling Delayed, Telangana PG Aspirants Cry Foul

Hyderabad: More than 8,000 medical aspirants in Telangana are facing uncertainty regarding their future with the delay in the National Eligibility-cum-Entrance Test Postgraduate (NEET-PG) counselling process.

Although the two rounds of All India Quota (AIQ) counselling has already been completed, the merit list for the State-level counseling, conducted by the Kaloji Narayana Rao University of Health Sciences (KNRUHS), is yet to release its merit list.

Normally, AIQ and State counselling processes run together and due to this, the students get a chance to make well-informed choices. However, since the State counselling has been delayed, the synchronisation has been disrupted. Therefore, the PG medical aspirants are unaware of their rankings even though they registered for the State counselling weeks ago.

Also Read: Plea in HC Challenges Reservation Policy for Admission of Local Candidates to PG Medical Courses, Notice issued to State, KNRUHS

Commenting on the matter, a representative of Telangana Local PG Students Association, Dr. Siva Rama Krishna told The Hindu, “This delay has left many students in a difficult situation. Some are holding AIQ Round two seats but face uncertainty about their eligibility for counselling. The resignation deadline for AIQ Round two is December 26, and students are unsure whether to retain their AIQ seats or resign to participate in state counselling.”

Highlighting the issue of delay, the association has raised serious concerns about its impact. Speaking to the Daily, another representative Dr. Vamshi said, “Without even conducting a single round of state counselling, the government is jeopardising students’ future. Moreover, the AIQ counselling fees of ₹25,000 paid by the students are at risk of being wasted due to this mismanagement. Many students are also facing immense mental stress due to the uncertainty about where to join. The Telangana government and KNRUHS must release the state merit list immediately and ensure the counselling process moves forward without further delays.”

The association referred to the issue and appealed before the National Medical Commision (NMC) to extend the resignation deadline for the AIQ Round two and also delay the commencement of AIQ Round three. As per the association, if NMC agrees to these demands, Telangana would get sufficient time to complete its State merit list and conduct the first round of counselling.

Also Read: Relief to Telangana PG medical candidates: HC junks GO restricting local candidate status

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Dearth of Super Speciality Doctors in Dental Science, SC Grants Relief to Dentists Facing Admission Cancellation

New Delhi: Observing that there is a ‘dearth of Super-Speciality Doctors’ in the field of dentistry, the Supreme Court in a recent order granted relief to MDS (Master of Dental Surgery) graduates of the 2016-2019 batch in the dental colleges of Madhya Pradesh by regularising their admission and directing the State Government authorities to issue necessary degrees to them.

While considering an appeal filed by the MDS graduates, who challenged the Madhya Pradesh High Court’s order cancelling their admission taken in 2016, the top court bench of Justices BR Gavai and KV Viswanathan observed, “It is commonly known that there is a dearth of super specialty doctors even in the field of dental science. If the admission of the appellants is not regularized the education undertaken by them would go in waste.”

For more information, click on the link below:

SC Recognises Dearth of Super Speciality Doctors in Dental Science, Grants Relief to Dentists Facing Admission Cancellation

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CDSCO Panel Approves Novartis Protocol Amendment Proposal for Ianalumab Study

New Delhi: The Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organization (CDSCO) has approved the drug major Novartis protocol amendment proposal for the study of the monoclonal antibody drug VAY736 (Ianalumab).

This came after Novartis presented protocol amendment version 05 dated 28 August 2024 protocol no. CVAY736Q12301. This is a phase 3 randomized, double-blind study of ianalumab (VAY736) versus placebo in addition to eltrombopag in patients with primary immune thrombocytopenia (ITP) who had an insufficient response or relapsed after first-line steroid treatment (VAYHIT2).

The purpose of this study is to evaluate the effect of two different doses of ianalumab added to eltrombopag to prolong Time to Treatment Failure (TTF) in adults with primary ITP who failed previous first-line treatment with steroids. This is a multicenter, randomized, double-blinded phase 3 study to assess efficacy and safety of two different doses of ianalumab versus placebo in addition to eltrombopag in adults with primary ITP (platelet count <30 G/L) who failed previous first-line treatment with corticosteroids.

After completion of the screening period, the participants will enter the randomized treatment period (ianalumab/placebo with eltrombopag) followed by the eltrombopag tapering period. Afterwards, all participants will enter the follow-up period to be monitored for efficacy and safety or safety only depending on how the participants responded to the study treatment.

Ianalumab is a monoclonal antibody that is being investigated for autoimmune hepatitis, multiple sclerosis, pemphigus vulgaris, rheumatoid arthritis, Sjögren syndrome, and systemic lupus erythematosus.

Ianalumab is a human antibody that targets the B-cell-activating factor receptor (BAFF-R). Ianalumab prevents BAFF signaling through its receptor BAFF-R and, in addition, depletes BAFF-R-expressing B-cells through antibody-dependent cellular cytotoxicity.

At the recent SEC meeting for hematology held on 10th December 2024, the expert panel reviewed protocol amendment version 05 dated 28 August 2024 protocol no. CVAY736Q12301.

After detailed deliberation, the committee recommended the approval of the protocol amendment as presented by the firm.

Also Read:CDSCO Panel Approves AstraZeneca’s Protocol Amendment Proposal For Anti-cancer Drug Volrustomig study

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Fake Ayushman Cards Scam: ED raids hospitals, seizes Rs 88 lakh in cash

New Delhi: The Enforcement Directorate (ED) seized approximately Rs 88 lakh in cash, along with incriminating documents and digital devices, during searches at several hospitals in August. The searches were part of an investigation into the alleged creation of fake Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) cards.

The ED conducted searches at 20 locations in a case related to the alleged generation of fake Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) cards in August, Minister of State for Health Prataprao Jadhav said in a written reply in Lok Sabha on Friday.

For more information, click on the link below:

Fake Ayushman Cards Scam: ED raids hospitals, seizes Rs 88 lakh in cash

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