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Researchers at the University of Jyväskylä’s Faculty of Sport and Health Sciences have found that women who exhibit disturbed eating behaviours and engage in low physical activity tend to have more central body fat and a higher risk of metabolic low-grade inflammation. This condition increases the risk of cardiovascular diseases, which become more prevalent after menopause. However, the combined effect of exercise and healthy eating behaviour offers the most effective protection against inflammation and may also reduce it after menopause.

Body fat distribution changes as menopause progresses and estrogen levels decrease, causing the adipose tissue concentrated in the hips and thighs to gradually shift to the midsection as harmful visceral fat. This predisposes women to low-grade inflammation and cardiovascular diseases, which increase significantly after menopause.

A study by the University of Jyväskylä investigated the connection between health behaviours and low-grade inflammation. Health behaviours in this study include sleeping, eating and physical activity and related disorders. For example, disordered eating behaviour refers to a situation in which a person may restrict their eating to control their weight or body shape. They may also have a limited understanding of ​​what they are allowed to eat or what their body should look like.

“In line with previous studies, a higher amount of visceral fat was, as expected, associated with low-grade inflammation,” says Hannamari Lankila, a doctoral researcher at the Faculty of Sport and Health Sciences. “Visceral fat accumulated in the midsection secretes cytokines that increase inflammation, and this can increase the risk of metabolic diseases.”

The results show that those individuals who exhibit more disordered eating behaviour, as well as those who were physically less active, had more visceral fat, and thus the risk of low-grade inflammation was also higher.

When eating and physical activity behaviours were examined together, higher physical activity was associated with lower visceral fat, especially in those women who did not display disordered eating behaviour.

“The connection was weaker, meaning that the protective effect of even a high amount of exercise was less if the individual had eating-related difficulties,” Lankila continues. “Surprisingly, sleep was not a significant factor in this equation.”

Previous research has shown that both exercise and various diets and foods are associated with low-grade inflammation to some extent, but the combined effects of health behaviours during menopause have not previously been studied. The menopause phase is significant, however, as women live more than a third of their lives after menopause on average. During this period, the risk of metabolic and cardiovascular diseases increases significantly.

The study highlighted the link between visceral fat and inflammation, especially in women with low physical activity. Both physical activity and flexible eating behaviour can help reduce visceral fat, but the effect is likely to be more effective when the two are combined.

“It’s good to remember that even after menopause, it is possible to reduce the accumulation of harmful visceral fat and thus prevent metabolic and cardiovascular diseases that may result from it,” Lankila concludes.

The study also assessed sleep duration and perceived sleep quality as well as physical activity with the help of self-report questionnaires. Eating behaviour was assessed with the Eating Disorder Examination Questionnaire (EDE-Q), which consisted of 28 questions. The questionnaire can be used to assess whether a person restricts their eating and whether they have specific concerns about their eating, weight or body shape. In addition, the participants’ age, income level and use of menopausal hormone therapy were considered.

Reference:

Lankila, H., Kekäläinen, T., Hietavala, EM. et al. A mediating role of visceral adipose tissue on the association of health behaviours and metabolic inflammation in menopause: a population-based cross-sectional study. Sci Rep 15, 1999 (2025). https://doi.org/10.1038/s41598-025-85134-8

Recent study investigates the effectiveness of the El-Ganzouri risk index (EGRI) and skin-to-epiglottis distance (SED) as predictors of difficult laryngoscopy, which is a critical component of airway management in anesthesia. Conducted on 129 patients classified as American Society of Anesthesiologists (ASA) class I or II, aged between 25 and 70, the research focused on comparing these two assessment methods prior to tracheal intubation. Various preoperative assessments were performed, including EGRI, which incorporates factors such as mouth opening, thyromental distance, head and neck movements, obesity, and previous intubation difficulties. The study sought to correlate these preoperative findings with laryngoscopic views classified by the Cormack-Lehane (CL) grading system, which determines the visibility of the glottis during intubation. Results indicated that the EGRI exhibited a sensitivity of 88.9%, specificity of 6.7%, positive predictive value (PPV) of 33.3%, and negative predictive value (NPV) of 99%. In contrast, the SED demonstrated superior diagnostic performance with a sensitivity of 96%, specificity of 100%, PPV of 100%, and NPV of 99% when a threshold of 18 mm was applied. These findings underscore the utility of sonographically measured SED as a more reliable parameter for anticipating challenging intubations.

ROC Analysis

The study employed a receiver operating characteristic (ROC) analysis to evaluate the predictive capabilities of both EGRI and SED. The area under the ROC curve (AUC) for SED was significantly higher at 0.995, compared to 0.662 for EGRI, suggesting that SED measurements provide more accurate predictions of difficult laryngoscopy. Furthermore, a new cut-off for SED was proposed based on ROC analysis, setting the optimal threshold at 15 mm for enhanced predictive value, despite the study utilizing 18 mm as the operational cut-off.

Patient Assessment

During the assessment, patients were positioned appropriately to simulate the conditions of real intubation, and trained anesthesia personnel performed ultrasound measurements to determine SED at the level of the thyrohyoid membrane. The laryngoscopic evaluation revealed that 24 patients (18.6%) experienced difficult laryngoscopy, as classified under CL grades III and IV.

Methodology Comparison

The analysis also drew comparisons to existing airway assessment methods, accentuating the limitations of solely clinical parameters and the variability in their predictive performance due to confounding factors such as inter-observer differences. The superior accuracy of ultrasound-based measurements suggests a shift towards integrating sonographic techniques in routine preoperative airway assessments.

Conclusion and Future Directions

In conclusion, the findings establish that sonologically assessed SED surpasses EGRI in sensitivity and specificity for predicting difficult laryngoscopy, emphasizing its role as a critical adjunct to conventional clinical tests. The proposed combined scoring system, integrating SED and EGRI, aims to further refine the predictive ability regarding laryngoscopy difficulties, although further research with larger sample sizes is warranted to validate these results and the proposed scoring methodology. The study advocates for the adoption of SED in clinical practice to enhance preoperative airway management strategies.

Key Points –

– **Study Design and Population**: The investigation involved 129 patients classified as ASA class I or II, aged 25 to 70. The focus was on comparing the effectiveness of the El-Ganzouri risk index (EGRI) and skin-to-epiglottis distance (SED) in predicting difficult laryngoscopy prior to tracheal intubation.

– **Predictive Performance of EGRI and SED**: Results indicated that EGRI had a sensitivity of 88.9%, specificity of 6.7%, a positive predictive value (PPV) of 33.3%, and a negative predictive value (NPV) of 99%. In contrast, SED demonstrated significantly higher performance with sensitivity of 96%, specificity of 100%, PPV of 100%, and NPV of 99%, especially when using a threshold of 18 mm.

– **ROC Analysis Findings**: Receiver operating characteristic (ROC) analysis showed that the area under the ROC curve (AUC) for SED was 0.995, indicating excellent predictive capability, while EGRI’s AUC was only 0.662. A new optimal cut-off for SED was suggested at 15 mm for enhanced predictive ability.

– **Ultrasound Measurement Methodology**: Patients were accurately positioned for real intubation scenarios, and trained anesthesia personnel utilized ultrasound to measure SED at the thyrohyoid membrane level. Difficult laryngoscopy (CL grades III and IV) was observed in 18.6% of the subjects during laryngoscopic evaluations.

– **Limitations of Existing Assessments**: The study highlighted limitations found in existing airway assessment methods, particularly emphasizing the inadequacies of relying solely on clinical parameters, which can be affected by inter-observer variability. Ultrasound-based measurements provide a more objective and reliable approach.

– **Conclusion and Recommendations**: Findings support that sonologically assessed SED is superior to EGRI for predicting difficult laryngoscopy and propose a combined scoring system incorporating both factors for improved accuracy. The study recommends the integration of SED into clinical practice for better preoperative airway management, while also calling for further research with larger samples to validate the results.

Reference –

Fareeda Karimbanakkal et al. (2025). Comparison Between El-Ganzouri Risk Index And Sonologically Measured Skin-To-Epiglottis Distance For Predicting Difficult Laryngoscopy: A Prospective Observational Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_896_24.

A groundbreaking study published in the journal Current Neuropharmacology highlights a concerning potential link between Glucagon-like Peptide-1 (GLP1) receptor agonists-widely used in blockbuster drugs like Ozempic-and the risk of depression and suicidal ideation (SI). Using advanced pharmacogenomic computational analyses, the international team of 24 researchers revealed genetic pathways that may induce depressive phenotypes in users of GLP1 agonists, raising significant concerns about the safety of these medications for certain individuals.

The study, led by researchers across the United States, Brazil, Iran, and Israel, demonstrates that while GLP1 agonists benefit individuals with hyperdopaminergia (excess dopamine activity), they may have harmful effects on individuals with hypodopaminergia (low dopamine function). The authors found genetic associations between GLP1 receptor agonists and genes such as DRD3, BDNF, and CREB1, which are implicated in mood regulation and reward pathways. Their findings suggest that chronic use of these drugs could dysregulate dopamine signaling, potentially leading to depressive symptoms, mood disturbances, and SI.

Cautionary Voices from Experts

While the idea of GLP1 agonism induction of depression and SI is controversial with both negative and positive reporting, based on the evidence presented in this article by Alireza Sharafshah, a PhD candidate from Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran, the authors caution against promoting chronic stimulation via GLP-1 agonists.

“This study should not be ignored, despite the hype surrounding the positive clinical outcomes of GLP1 receptor agonists,” said senior author Dr. Kenneth Blum, Research Professor at Western University Health Sciences and Ariel University. “We urge the clinical prescribing community to proceed with caution to avoid another tragic wave of ‘people dying to lose weight.’”

Dr. Mark S. Gold, an addiction psychiatry pioneer and co-author, emphasized, “The paper provides critical evidence for re-evaluating the widespread use of GLP1 receptor agonists. The FDA and other regulatory agencies should carefully consider our findings when it comes to labeling and monitoring these drugs.”

Rising Global Concerns

Professor Albert Pinhasov, Provost of Ariel University, echoed these sentiments, stating, “While there are encouraging short-term benefits of GLP1 receptor agonists, we must acknowledge the potential risks highlighted in this study. These findings should encourage regulatory agencies and clinicians to investigate further, given the heterogeneity of the human population.”

The European Medicines Agency (EMA) has already initiated a review of GLP1 agonists following reports of suicidal thoughts and other psychiatric adverse events. Co-author Dr. Kai Uwe Lewandowski, Professor of Surgery at the University of Arizona School of Medicine, noted, “Depression was the most commonly reported adverse event associated with these drugs, followed by anxiety and suicidal ideation. Our findings strongly support a need for further investigation to safeguard public health.”

The Role of Genetic Testing

The study advocates for personalized medicine approaches, including genetic testing for hypodopaminergia, to identify individuals at risk before prescribing GLP1 receptor agonists. Professor Panayotis K. Thanos of Buffalo University commented, “Before prescribing GLP1 receptor agonists, it would be prudent to use genetic testing tools to assess a patient’s dopamine function and addiction risk profile.”

Balancing Hope with Vigilance

Professor Igor Elman of Harvard University warned, “While GLP1 receptor agonists hold promise for treating addictive and behavioral disorders, we must remain vigilant about their potential harm. This study is not intended to break the bubble of hope but to add a layer of precaution in their over-prescription.”

Reference:

 Alireza Sharafshah, Kai-Uwe Lewandrowski, Mark S. Gold, Brian Fuehrlein, John Wesson Ashford, Panayotis K. Thanos, Gene Jack Wang, Colin Hanna, Jean Lud Cadet,  In Silico Pharmacogenomic Assessment of Glucagon-like Peptide-1 (GLP1) Agonists and the Genetic Addiction Risk Score (GARS) Related Pathways: Implications for Suicidal Ideation and Substance Use Disorder, Current Neuropharmacology, DOI: 10.2174/011570159X349579241231080602.

Postoperative delirium is a common and serious complication affecting older surgical patients, often leading to prolonged hospital stays, increased need for long-term care, and a higher likelihood of cognitive decline and dementia. Despite its prevalence, identifying patients at risk of developing postoperative delirium remains a significant challenge. Prof. Yuan Shen, from Shanghai Mental Health Center, with her team may have found a solution to this issue.

The study, recently published in General Psychiatry, involved 169 patients aged 65 and older who were scheduled for elective surgeries such as hip or knee replacements, or kidney and prostate surgeries at Shanghai 10th People’s Hospital. As part of their preoperative assessment, participants underwent an eye imaging test called optical coherence tomography (OCT) to measure the thickness of the macular layer of the retina. The incidence and severity of postoperative delirium were assessed using the Confusion Assessment Method (CAM) algorithm and CAM-Severity (CAM-S) on the first three days following surgery.

Of the 169 participants, 40 (24%) developed postoperative delirium. These patients had a significantly thicker macular layer in their right eye compared to those who did not experience delirium (mean thickness of 283.35 µm vs. 273.84 µm). The study also found that a thicker preoperative macular layer in the right eye was associated with a 1.593 higher odds of developing postoperative delirium and a greater severity of the condition. Interestingly, the study found no such association in the left eye. The reasons for such asymmetry are not currently well understood.

However, the study has several limitations, including the small sample size and lacks of examination of potential confounding factors. “Further large-scale validation studies with larger samples are needed to confirm these results,” Prof. Yuan Shen noted.

As the population ages, the incidence of postoperative delirium is likely to increase, making the need for effective screening tools more urgent. By leveraging retinal imaging, macular thickness may serve as a non-invasive biomarker to identify individuals vulnerable to developing postoperative delirium after anesthesia and surgery.

Reference:

Zhongyong Shi, Xin Ma, Tianyi Tang, Meijuan Wang, Hailin Zheng, Yupeng Chen, Jingxiao Hu, Ariel Mueller, Timothy T Houle, Edward R Marcantonio, Zhongcong Xie, Yuan Shen – Association between retinal layer thickness and postoperative delirium in older patients: General Psychiatry 2025;38:e101740.

The Xpert MTB/Ultra molecular diagnostic test for stool samples, until now recommended only for children, could be established as an additional test for diagnosing tuberculosis in adults living with HIV. This is the main conclusion of the Stool4TB Alliance study, led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the ”la Caixa” Foundation, in collaboration with the Manhiça Health Research Centre (CISM), the Research Center Borstel, the Makerere University, the Baylor College of Medicine Children’s Foundation – Eswatini, and The Amsterdam Institute for Global Health and Development. The results, published in The Lancet Microbe, could represent a paradigm shift in the diagnosis of the disease in this population.

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, was responsible for 1.25 million deaths in 2023, 13% of which were among people living with HIV. Currently, the main diagnostic strategy for tuberculosis focuses on sputum samples, which are obtained by deep coughing and expectoration of secretions produced in the lungs. So far, the WHO has recommended molecular sputum tests for people living with HIV, in addition to urine antigen detection (TB-LAM). However, access to these diagnostics remains limited in many settings, and they are not effective for all people living with HIV. In fact, people with HIV often struggle to produce sputum; more than half of those in advanced stages of the disease are unable to do so. In addition, the concentration of bacteria in the sputum is often so low that it is undetectable.

To address this problem, researchers from the EDCTP-funded Stool4TB project proposed using a molecular test (called Xpert MTB/RIF Ultra), currently used on respiratory samples, on stool samples. This test is already recommended for children because they have difficulty producing sputum. The research was conducted between December 2021 and August 2024 in medical centres in three African countries -Eswatini, Mozambique, and Uganda-, and recruited 677 patients over 15 years old with HIV and suspected TB. Participants provided sputum, urine, stool, and blood samples.

The challenge of diagnosing TB in vulnerable populations

“People living with HIV are at higher risk of developing pulmonary tuberculosis, but diagnosis in these cases is particularly challenging due to the low sensitivity of conventional tests,” explains George William Kasule, a PhD student at ISGlobal and the University of Barcelona, and the first author of the study. “The variety of samples obtained in this study allowed us to compare the sensitivity and specificity of the Stool Ultra test with a microbiological reference standard consisting of three WHO-recommended tests: TB-LAM in urine, liquid culture, and Xpert Ultra from sputum,” he adds.

A more sensitive test in advanced stages of HIV

The results showed that the stool test had a sensitivity of 23.7% and a specificity of 94.0%, compared with the reference standard. In patients with CD4 counts below 200 cells/μl, sensitivity increased to 45.5%. CD4 lymphocytes are immune system cells that are affected by HIV infection, so people with CD4 counts below 200 are more likely to develop serious opportunistic infections such as tuberculosis.

“The results of our study support the use of the Stool Ultra test as a complementary tool for diagnosing tuberculosis in people living with HIV, especially in those with advanced AIDS, where the risk of tuberculosis is higher,” says Alberto L. García-Basteiro, a researcher at ISGlobal and head of the Vaccine and Immune Response to Infections Unit at Hospital Clínic de Barcelona.

The Stool Ultra test identified additional cases that were not detected by TB-LAM, Ultra in sputum or bacterial culture. “In these patients, the sensitivity of standard tests is much lower than in the HIV-negative population. However, in patients with advanced AIDS, our results show that stool molecular detection is no less effective than sputum testing. Most importantly, it can confirm the disease in many cases where respiratory tests are negative. This demonstrates the potential of this sample, perhaps counterintuitively, for diagnosing tuberculosis in people with HIV, especially when respiratory samples are not available,” concludes García-Basteiro.

Reference:

Kasule, G., Hermans, S., Acacio, S., et al, Performance of stool Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis among adult people living with HIV: a prospective multicentre diagnostic study. Lancet Microbe (2025). https://doi.org/10.1016/j.lanmic.2025.101085