Archive for category: News

Taiwan: A recent cohort study has highlighted the potential benefits of combining glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with sodium-glucose cotransporter-2 inhibitors (SGLT2i) in individuals diagnosed with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF).

A ‘chasm of misunderstanding and miscommunication’ is often experienced between clinicians and patients, leading to autoimmune diseases such as lupus and vasculitis being wrongly diagnosed as psychiatric or psychosomatic conditions, with a profound and lasting impact on patients, researchers have found.

A study involving over 3,000 participants-both patients and clinicians – found that these misdiagnoses (sometimes termed “in your head” by patients) were often associated with long term impacts on patients’ physical health and wellbeing and damaged trust in healthcare services.

The researchers are calling for greater awareness among clinicians of the symptoms of such diseases, which they recognise can be difficult to diagnose, and for more support for patients.

Autoimmune rheumatic diseases such as rheumatoid arthritis, lupus and vasculitis are chronic inflammatory disorders that affect the immune system and can damage organs and tissues throughout the body. They can be very difficult to diagnose as people report a wide range of different symptoms, many of which can be invisible, such as extreme fatigue and depression.

Dr Melanie Sloan from the University of Cambridge led a study exploring patient-reported experiences from two large groups, each of over 1,500 patients, and in-depth interviews with 67 patients and 50 clinicians. The results are published today in Rheumatology.

Patients who reported that their autoimmune disease was misdiagnosed as psychosomatic or a mental health condition were more likely to experience higher levels of depression and anxiety, and lower mental wellbeing. For example, one patient with multiple autoimmune diseases said: “One doctor told me I was making myself feel pain and I still can’t forget those words. Telling me I’m doing it to myself has made me very anxious and depressed.”

More than 80% said it had damaged their self-worth and 72% of patients reported that the misdiagnosis still upset them, often even decades later. Misdiagnosed patients also reported lower levels of satisfaction with every aspect of medical care and were more likely to distrust doctors, downplay their symptoms, and avoid healthcare services. As one patient reported, it “has damaged my trust and courage in telling doctors very much. I even stopped taking my immunosuppressive medicine because of those words”.

Following these types of misdiagnoses, patients often then blamed themselves for their condition, as one individual described: “I don’t deserve help because this is a disease I’ve brought on myself. You go back to those initial diagnosis, you’ve always got their voices in your head, saying you’re doing this to yourself. You just can’t ever shake that. I’ve tried so hard.”

One patient described the traumatising response their doctor’s judgement had on them: “When a rheumatologist dismissed me I was already suicidal, this just threw me over the edge. Thankfully I am terrible at killing myself, it’s so much more challenging than you think. But the dreadful dismissiveness of doctors when you have a bizarre collection of symptoms is traumatizing and you start to believe them, that it’s all in your head.”

Dr Melanie Sloan, from the Department of Public Health and Primary Care at the University of Cambridge, said: “Although many doctors were intending to be reassuring in suggesting a psychosomatic or psychiatric cause for initially unexplainable symptoms, these types of misdiagnoses can create a multitude of negative feelings and impacts on lives, self-worth and care. These appear to rarely be resolved even after the correct diagnoses. We must do better at helping these patients heal, and in educating clinicians to consider autoimmunity at an earlier stage.”

Clinicians highlighted how hard it was to diagnose autoimmune rheumatic diseases and that there was a high risk of misdiagnosis. Some doctors said they hadn’t really thought about the long-term problems for patients, but others talked about the problems in regaining trust, as one GP from England highlighted: “They lose trust in anything that anyone says…you are trying to convince them that something is OK, and they will say yes but a doctor before said that and was wrong.”

However, there was evidence that this trust can be rebuilt. One patient described having been “badly gaslit by a clinician”, but that when they told the clinician this, “She was shocked and had no idea … She was great. Took it on the chin. Listened and heard. Apologised profusely…For me, the scar of the original encounter was transformed into something much more positive.”

Mike Bosley, autoimmune patient and co-author on the study, said: “We need more clinicians to understand how a misdiagnosis of this sort can result in long-standing mental and emotional harm and in a disastrous loss of trust in doctors. Everyone needs to appreciate that autoimmune conditions can present in these unusual ways, that listening carefully to patients is key to avoiding the long-lasting harm that a mental health or psychosomatic misdiagnosis can cause.”

The study authors recommend several measures for improving support for patients with autoimmune rheumatological diseases. These are likely to apply for many other groups of patients with chronic diseases that are often misunderstood and initially misdiagnosed.

They propose that clinicians should talk about previous misdiagnoses with patients, discuss and empathise with their patients as to the effects on them, and offer targeted support to reduce the long-term negative impacts. Health services should ensure greater access to psychologists and talking therapies for patients reporting previous misdiagnoses, which may reduce the long-term impact on wellbeing, healthcare behaviours, and patient-doctor relationships. Education may reduce misdiagnoses by encouraging clinicians to consider systemic autoimmunity when they assess patients with multiple, seemingly unconnected, physical and mental health symptoms.

Professor Felix Naughton, from the Lifespan Health Research Centre at the University of East Anglia, said: “Diagnosing autoimmune rheumatic diseases can be challenging, but with better awareness among clinicians of how they present, we can hopefully reduce the risk of misdiagnoses. And while there will unfortunately inevitably still be patients whose condition is not correctly diagnosed, with the correct support in place, we may be able to lessen the impact on them.”

Reference:

Sloan, M, et al. “I still can’t forget those words”: mixed methods study of the persisting impacts of psychosomatic and psychiatric misdiagnoses. Rheumatology; 3 Mar 2025; DOI: 10.1093/rheumatology/keaf115

Turkiye: Researchers have found in a new study that the use of 5.25% sodium hypochlorite (NaOCl) before resin infiltration or resin varnish did not impact microhardness, surface roughness, DIAGNOdent Pen readings, or microleakage. However, resin infiltration outperformed resin varnish in reducing microleakage and DIAGNOdent Pen scores, regardless of NaOCl application. The findings were published online in the Journal of Dentistry on February 20, 2025.

A new study from northern Taiwan revealed a significant association between pre-pregnancy obesity, rapid gestational weight gain (GWG), and the increased likelihood of cesarean section deliveries among women diagnosed with gestational diabetes mellitus (GDM). The findings were published in the BMC Pregnancy and Childbirth.

The retrospective cohort study examined 947 women who delivered between January 2012 and July 2022 to assess the influence of body mass index (BMI) and changes in GWG trajectories from the first to the third trimester on cesarean section rates. This study utilized oral glucose tolerance tests (OGTT) during the 24th to 28th weeks of pregnancy to confirm GDM diagnoses. BMI classifications followed Asian-specific guidelines, and gestational weight patterns were identified using group-based trajectory modeling (GBTM).

The participants were divided into 2 groups based on their GWG patterns where group 1 (non-rapid excessive weight gain) made up 70.2% of the cohort, while group 2 (rapid excessive weight gain) comprised 29.8%. The study uncovered a relationship between rapid excessive weight gain during pregnancy and higher rates of cesarean deliveries.

Women with normal pre-pregnancy BMI had double the odds (OR = 2.06) of cesarean delivery when compared to their underweight counterparts. The patients categorized as overweight or obese faced an even greater risk, with four times the likelihood (OR = 4.04) of cesarean delivery. Also, women who had multiple pregnancies (multiparous) and the individuals experiencing a rapid increase in weight gain during pregnancy were more likely to undergo cesarean sections.

The findings illuminate the importance of early education and intervention for weight management in women both before and during pregnancy. The study emphasized that clinicians should pay special attention to women with GDM who exhibit rapid weight gain, as these individuals face an increased risk of cesarean delivery.

Effective monitoring of weight gain patterns across all three trimesters could help healthcare professionals better tailor recommendations for managing GDM and promoting safer delivery outcomes. Overall, this study adds valuable insight into the role of GWG and pre-pregnancy BMI in cesarean section risk. 

Source:

Chen, T.-L., Cheng, S.-F., Kuo, C.-L., Huang, C.-Y., & Wu, C.-H. (2025). Gestational weight gain patterns as predictors of cesarean deliveries in women diagnosed with gestational diabetes mellitus. BMC Pregnancy and Childbirth, 25(1). https://doi.org/10.1186/s12884-025-07222-x

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a global health challenge, affecting nearly 30% of adults worldwide. A significant subset of MASLD patients progresses to metabolic dysfunction-associated steatohepatitis (MASH), liver fibrosis, and even hepatocellular carcinoma (HCC), yet no universally approved treatment exists outside resmetirom. The increasing prevalence of MASLD, driven by obesity and diabetes, highlights an urgent need for innovative therapeutic strategies.

A new review published in eGastroenterology sheds light on the mechanistic role of long non-coding RNAs (lncRNAs) in MASLD and liver fibrosis. LncRNAs, which do not encode proteins but regulate gene expression, have emerged as critical players in metabolic and fibrotic pathways. This comprehensive review, authored by Dr. Henry Wade, Kaichao Pan, Bingrui Zhang, Dr. Wenhua Zheng, and Dr. Qiaozhu Su, provides insights into the complex interplay between lncRNAs, microRNAs, and key mediators of liver disease progression.

LncRNAs influence several metabolic pathways in hepatocytes, hepatic stellate cells (HSCs), and Kupffer cells, impacting lipid metabolism, inflammation, apoptosis, and fibrogenesis. Among the most studied lncRNAs, H19 has promoted hepatic lipid accumulation and fibrosis through interactions with sterol regulatory element-binding proteins (SREBPs) and peroxisome proliferator-activated receptors (PPARs). Similarly, MALAT1 has been shown to exacerbate liver fibrosis by modulating inflammatory pathways via nuclear factor-kappa B (NF-κB) and toll-like receptors (TLRs).

One of the key findings discussed in the review is how lncRNAs regulate hepatic lipid homeostasis and fibrotic pathways. LncRNAs such as Gas5 and MEG3 appear to exert protective effects, inhibiting hepatocyte lipid accumulation and HSC activation. Conversely, lncRNAs like HOTAIR and NEAT1 drive liver disease progression by activating fibrotic and inflammatory responses. These opposing roles suggest that targeting lncRNAs could provide a dual approach—either suppressing pathogenic lncRNAs or enhancing protective ones—for MASLD treatment.

Additionally, the review explores how lncRNAs interact with microRNAs and transcription factors to regulate liver cell function. For instance, H19 interacts with miR-130a and heterogeneous nuclear ribonucleoprotein A1 (hnRNPA1) to promote steatosis, while HOTAIR regulates DNA methylation through interactions with miR-148b and DNMT1. These complex molecular networks underscore the potential of lncRNA-based interventions.

Dr. Qiaozhu Su, the corresponding author from Queen’s University Belfast, notes that lncRNAs hold promise as both diagnostic biomarkers and therapeutic targets. “Understanding how lncRNAs contribute to MASLD and fibrosis opens new avenues for therapeutic strategies. Given their regulatory roles in metabolism and inflammation, lncRNA-based therapies could be transformative,” said Dr. Su.

While the potential of lncRNA-targeted therapies is exciting, the review acknowledges significant challenges. LncRNAs exhibit species specificity, making translational research difficult. The review suggests that future studies should focus on identifying conserved lncRNAs across species to facilitate clinical applications. Developing delivery mechanisms for lncRNA-based therapeutics, such as nanoparticle-mediated RNA delivery, will be crucial for advancing this field.

This review underscores the urgent need for further investigation into lncRNAs as key regulators of liver disease. As MASLD prevalence continues to rise, unlocking the therapeutic potential of lncRNAs could mark a paradigm shift in liver disease management.

Reference:

Henry Wade, Kaichao Pan, Bingrui Zhang, Wenhua Zheng, Qiaozhu Su – Mechanistic role of long non-coding RNAs in the pathogenesis of metabolic dysfunction-associated steatotic liver disease and fibrosis: eGastroenterology 2024;2:e100115.