Fluoride in drinking water associated with impaired childhood cognition, reveals research

Elevated concentrations of fluoride can occur in well water, and in some countries, it is added to drinking water to counteract caries in the population. A study from Karolinska Institutet in Sweden now supports a few previous studies indicating that exposure to fluoride during the fetal stage or early childhood may impair cognition in children. The study is published in the journal Environmental Health Perspectives.

Fluoride occurs naturally as fluoride ions in drinking water, but the concentrations are generally low in public water supplies. In some countries, such as the USA, Canada, Chile, Australia and Ireland, fluoride is commonly added to the municipal water supply at around 0.7 mg per litre to prevent caries.

“Given the concern about health risks, the addition of fluoride to drinking water is controversial and has been widely debated in the USA and Canada,” says Maria Kippler, associate professor at the Institute of Environmental Medicine, Karolinska Institutet. “Our results support the hypothesis that even relatively low concentrations of fluoride can impact children’s early development.”

500 mothers and children

The researchers followed 500 mothers and their children in rural Bangladesh, where fluoride occurs naturally in the drinking water, to investigate the association between early exposure to fluoride and children’s cognitive abilities. The concentrations are similar to those found in many other countries worldwide.

Trained psychologists evaluated the children’s cognitive abilities at five and ten years of age, using well-established tests. The exposure to fluoride in the mothers and children was determined by measuring the concentrations in urine samples, which reflects ongoing exposure to all sources, such as drinking water, food and dental care products.

“I’d like to stress that dental care products such as toothpaste are not normally a significant source of exposure since they are not intended for ingestion,” says Dr Kippler. “Fluoride in toothpaste is important for prevention of caries, but it’s important to encourage small children not to swallow the toothpaste during brushing.”

Decreased cognitive abilities

The median concentration of fluoride in urine of the pregnant Bangladeshi women was 0.63 mg/L. Increasing concentrations of fluoride in the pregnant women could be linked to decreasing cognitive abilities in their children at five and ten years of age.

Children that had more than 0.72 mg/L fluoride in their urine by the age of ten also had lower cognitive abilities than children with less fluoride in their urine, with most pronounced associations for verbal reasoning skills and the ability to interpret and process sensory input. The exposures that were associated with impaired cognitive development are lower than those obtained at the existing WHO and EU threshold for fluoride in drinking water, which is 1.5 mg/L.

The researchers found no statistically significant link between fluoride concentrations in the urine of the five-year-olds and their cognitive abilities.

“This may be due to the shorter exposure time,” Dr Kippler speculates, “but also to the fact that urinary fluoride concentrations aren’t as reliable in younger children owing to greater variations in how much fluoride is taken up and stored in the body, particularly in the bones.”

More studies needed

Since it was an observational study, no firm conclusions can be drawn about causalities. It is therefore important to assess the overall results of several similar longitudinal studies, according to the researchers. They will now investigate the associations in other populations and establish experimental models to determine the possible molecular mechanisms driving it.

“There is a need for more research to create a robust basis for reviewing fluoride health risks and thresholds for drinking water, foods, and dental care products, especially for children,” she continues. “Even small changes in cognition at a population level can have serious public health consequences.”

Reference:

 Taranbir Singh, Klara Gustin, Syed Moshfiqur Rahman, Shamima Shiraji, Fahmida Tofail, Marie Vahter, Mariza Kampouri, and Maria Kippler, Prenatal and childhood exposure to fluoride and cognitive development: findings from the longitudinal MINIMat cohort in rural Bangladesh, Environmental Health Perspectives, https://doi.org/10.1289/EHP14534. 

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Trabecular Bone Score Enhances Bone Health Assessment in Postmenopausal Women with Type 2 Diabetes: Study Finds

India: A recent cross-sectional study has highlighted the significance of the Trabecular Bone Score (TBS) in assessing bone health among Asian-Indian postmenopausal women across different stages of hyperglycaemia.

The study, published in the Indian Journal of Endocrinology and Metabolism, showed that postmenopausal women with type 2 diabetes had significantly lower trabecular bone scores despite having similar areal bone mineral density (aBMD) as non-diabetic and prediabetic individuals. TBS negatively correlated with HbA1c levels and diabetes duration, highlighting its relevance in fracture risk assessment. The researchers suggest that TBS incorporation alongside BMD may improve bone health evaluation in this population.

The researchers note that type 2 diabetes mellitus (T2DM) is associated with a higher risk of fragility fractures, even when the areal bone mineral density (aBMD) remains normal or elevated compared to non-diabetic individuals. This discrepancy has led to growing interest in the trabecular bone score as a potential alternative for assessing bone health in this population. To explore its clinical utility, Dr. Sanjay K. Bhadada, Department of Endocrinology, PGIMER, Chandigarh, India, and colleagues evaluated TBS in postmenopausal women with T2DM and compared it with non-diabetic individuals, aiming to provide deeper insights into bone quality and fracture risk assessment.

For this purpose, the researchers conducted a cross-sectional study involving 101 individuals with T2DM and 101 without overt diabetes, including 43 with prediabetes and 58 with normal glucose levels. All participants underwent a detailed medical history assessment, physical examination, biochemical testing, and a dual-energy X-ray absorptiometry (DXA) scan with TBS measurement to evaluate bone health.

Key Findings:

  • Postmenopausal women with T2DM showed no significant difference in aBMD levels compared to those with prediabetes or normoglycaemia.
  • Despite similar aBMD across groups, the mean TBS value was significantly lower in the T2DM group.
  • Higher glycated haemoglobin (HbA1c) levels and longer diabetes duration were significantly associated with lower TBS values.

The researchers highlighted the importance of incorporating the Trabecular Bone Score alongside aBMD assessments for a more comprehensive evaluation of bone health in individuals with T2DM. Their findings suggest that TBS could be a valuable marker of bone quality, particularly when aBMD alone does not accurately reflect fracture risk.

“Both glycaemic control and diabetes duration significantly influence TBS values, further emphasizing the need for tailored bone health assessments in this population. Future studies with larger cohorts are needed to validate these findings and explore the clinical utility of TBS in fracture risk prediction for individuals with T2DM,” the researchers concluded.

Reference:

Aggarwal, Tanushi; Shah, Ravi1; Pal, Rimesh1; Rastogi, Ashu1; Singla, Veenu2; Bhadada, Sanjay K.1. Trabecular Bone Score in Asian-Indian Post-menopausal Women Across the Spectrum of Hyperglycaemia: Insights from a Cross-Sectional Study. Indian Journal of Endocrinology and Metabolism 29(1):p 43-48, Jan–Feb 2025. | DOI: 10.4103/ijem.ijem_310_24

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HPV Vaccination Promising in Reducing Actinic Keratosis Burden: VAXAK Trial Findings

Denmark: A recent randomized clinical trial, VAXAK, has highlighted the potential benefits of human papillomavirus (HPV) vaccination in managing actinic keratosis (AK), a prevalent precancerous skin condition. The study findings, published in JAMA Dermatology, suggest that standard alphapapillomavirus vaccination could reduce the burden of AK among immunocompetent individuals with multiple lesions.

Actinic keratosis, commonly seen in fair-skinned populations, is a chronic and recurrent condition primarily caused by prolonged exposure to ultraviolet (UV) radiation. The researchers note that while current treatment options include topical medications, cryotherapy, and photodynamic therapy, recurrence remains a significant challenge.

Observations indicate that HPV vaccination may have potential therapeutic and preventive benefits against AK and keratinocyte carcinomas (KCs). Considering this, Emily Wenande, Department of Dermatology, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark, and colleagues aimed to examine the impact of HPV vaccination on disease burden in immunocompetent patients with multiple AK lesions.

For this purpose, the researchers conducted the VAXAK trial, a parallel-design, double-blind, randomized sham-controlled clinical study at Bispebjerg University Hospital, Copenhagen, from May 2021 to June 2024. Immunocompetent adults with 15 or more AK lesions in a defined test area were enrolled and randomized 1:1 to receive either a 9-valent alphapapillomavirus vaccine or a sham vaccine at 0, 2, and 6 months. Thick AK lesions underwent cryotherapy at months 6 and 9, with no other treatments administered.

The primary outcome was the percentage reduction in baseline AKs, while secondary measures included total lesion count, new AKs, thick lesions, and incident keratinocyte carcinomas over 12 months.

The following were the key findings of the study:

  • Out of 163 screened patients, 70 participants were enrolled, with 69 completing the study.
  • The median age of participants was 75.5 years, and 67% were male.
  • The HPV-vaccinated group showed a consistently higher reduction in AK burden than the sham group over time:
    • Month 2: 35% vs 25%
    • Month 6: 47% vs 29%
    • Month 9: 58% vs 42%
    • Month 12: 58% vs 47%
  • Total AK numbers were lower in the HPV-vaccinated group at:
    • Month 6: 14 vs 17
    • Month 12: 10 vs 16
  • There were fewer thick AKs in the HPV-vaccinated group:
    • Month 6: 5 vs 6.5
    • Month 12: 3 vs 5
  • No significant differences were noted in new AK development (1-2 per month) or keratinocyte carcinoma incidence over 12 months.

The researchers demonstrated that standard HPV vaccination effectively reduced AK burden in immunocompetent individuals with multiple lesions.

“While its impact on skin cancer development remains uncertain, their findings suggest that HPV-targeted vaccines could be valuable in managing AK, a chronic and relapsing condition, that represents the most common precancer in fair-skinned populations,” they concluded.

Reference:

Wenande E, Hastrup A, Wiegell S, et al. Human Papillomavirus Vaccination and Actinic Keratosis Burden: The VAXAK Randomized Clinical Trial. JAMA Dermatol. Published online March 06, 2025. doi:10.1001/jamadermatol.2025.0531

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Intraoperative unfractionated heparin may prevent thrombotic complications and enhance flap viability in reconstructive surgery: Study

In reconstructive surgery, specifically free flap reconstructive surgery, concerns persist regarding the risk of failures due to thrombosis and bleeding complications, leading to flap loss. Even with advancements in surgical techniques and perioperative care, standardized protocols for anticoagulation management remain lacking. Recent study aimed to investigate the role of anticoagulation and perioperative practices in free flap reconstructive surgery and their impact on surgical outcomes.

The retrospective single-center study included 489 free flap surgeries from 2009 to 2020, with most flaps taken from the upper extremity for tumor-related reconstructions. Flap loss occurred in 14.5% of cases, with intraoperative unfractionated heparin (UFH) significantly predicting flap survival. Prothrombin time (PTT) values on day 1 post-surgery were also significantly related to flap survival, with each unit increase reducing the relative probability of flap loss by 5.2%. There was no significant difference in flap survival between patients treated with heparin alone and those treated with both heparin and aspirin. However, the aspirin-only group was limited in size. The study highlighted the importance of intraoperative UFH and PTT-guided postoperative management in enhancing free flap survival. The findings emphasized the need for standardized anticoagulation protocols to optimize outcomes in free flap reconstructive surgery. Moreover, the study noted that factors such as the location of the defect, flap origin, and duration of surgery significantly influenced perioperative flap survival rates.

Recommendations for Anticoagulation Strategies

The study recommended intraoperative UFH administration and continued postoperative therapy with PTT-controlled UFH to minimize bleeding risk. It suggested targeting a PTT range of 40–60 seconds for an effective balance between thrombosis and bleeding risks. There was no significant benefit observed from combining UFH with aspirin postoperatively. The research emphasized the importance of a standardized perioperative anticoagulation protocol to improve flap survival rates and surgical success in free flap surgery. Although the study had limitations like its retrospective nature and diverse patient cohort, it concluded that anticoagulation is crucial for free flap preservation. The authors called for future research, suggesting a prospective multicenter study to address the lack of consensus in perioperative anticoagulation therapy. Ultimately, the study underlined the significance of optimized anticoagulation practices in achieving successful outcomes in free flap reconstructive surgery.

Key Points

– Anticoagulation management in free flap reconstructive surgery is crucial to prevent complications such as thrombosis and bleeding, which can lead to flap loss.

– A retrospective single-center study of 489 free flap surgeries revealed that intraoperative unfractionated heparin (UFH) significantly predicted flap survival, and higher prothrombin time (PTT) values on day 1 post-surgery were associated with reduced relative probability of flap loss.

– Patients treated with UFH alone showed no significant difference in flap survival compared to those receiving both UFH and aspirin, although the aspirin-only group was small. – Intraoperative UFH administration and postoperative therapy with PTT-controlled UFH were recommended to minimize bleeding risk, with a target PTT range of 40–60 seconds proposed for balancing thrombosis and bleeding risks effectively.

– The study emphasized the necessity for standardized anticoagulation protocols in free flap surgery to enhance flap survival rates and ensure surgical success.

– Despite limitations of the study, such as its retrospective design and diverse patient population, the importance of anticoagulation for free flap preservation was underscored, urging the need for future prospective multicenter studies to establish consensus on perioperative anticoagulation therapy.

Reference –

Saeed Torabi et al. (2025). Impact Of Perioperative Anticoagulation Management On Free Flap Survival In Reconstructive Surgery: A Retrospective Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-02975-6

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Predialytic Oral Nutritional Supplement administration may improve serum albumin levels and QOL in dialysis patients: Study

Researchers have found in a new study that predialytic Oral Nutritional Supplement (ONS) administration may help improve serum albumin levels and quality of life (QOL) in dialysis patients. However, its effects on blood pressure (BP), C-reactive protein (CRP), and dialysis adequacy should be carefully evaluated before implementation. This study was published by BMC Nephrology by Mohamed E. and colleagues.

Malnutrition in patients with HD is widespread and results in worse health conditions as well as low QOL. ONS supplied within the dialysis settings have become one option for controlling such issues. This research sought to evaluate the impact of predialytic ONS on serum albumin, QOL, and other metabolic indices in HD patients.

100 HD patients were enrolled in this prospective, multicentric randomized clinical trial. The patients were randomly assigned into two groups: one group was given ONS with 25 g of protein powder one hour prior to their HD sessions, and the other group was given their usual routine nutritional regimen. The trial continued for three months, and the researchers measured serum albumin, body mass index (BMI), anthropometric measurements, subjective global assessment (SGA), QOL scores, blood pressure (BP), and several metabolic parameters.

Key Findings

  • ONS patients had a significant improvement in serum albumin levels (p < 0.001), while no changes were noted in the control group.

  • SGA score fell (improvement) in the ONS group, although this was not statistically significant. In contrast, the control group experienced a significant rise in SGA score (p < 0.001), reflecting a decline in nutritional status.

  • There were no statistically significant differences between groups in terms of BMI or anthropometric assessment.

  • Quality of Life (QOL) was enhanced in three Kidney Disease Quality of Life-36 subscales in the supplemented group, with no changes observed in the control group.

  • The ONS group presented increased blood pressure (p = 0.037) and decreased urea reduction ratio (p = 0.020) and Kt/V (p = 0.021), suggesting decreased dialysis adequacy.

  • Supplemented subjects had increased serum calcium, decreased total cholesterol, and decreased C-reactive protein (CRP) (p = 0.047) compared to the control group.

  • There were no differences between both groups for serum sodium, potassium, phosphorus, or for adverse effects.

The study authors concluded that predialytic ONS delivery could yield significant gains in serum albumin and QOL in HD patients. Its influence on blood pressure, dialysis adequacy, and inflammation must be weighed before routine use can be recommended. Further research must determine how to maximize supplementation regimens while minimizing associated risks.

Reference:

Elsayed, M.M., Abdelkader, M.M., ElKazaz, A.M. et al. The impact of predialytic oral protein-based supplements on nutritional status and quality of life in hemodialysis patients: a randomized clinical trial. BMC Nephrol 26, 103 (2025). https://doi.org/10.1186/s12882-025-03999-3

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Extra-Fine Single-Inhaler Triple Therapy useful for Severe Asthma with small airways dysfunction, may delay need for biological therapies: Study

China: Severe asthma remains a major healthcare challenge, contributing to increased morbidity, reduced quality of life, and higher healthcare costs. One of the key factors influencing disease severity is small airways dysfunction (SAD), which affects the distal airways measuring less than 2 mm in diameter. These airways account for nearly 98.8% of the lung volume and significantly contribute to airway resistance in asthma.

Recent research published in the Journal of the Formosan Medical Association has highlighted that SAD is present across all levels of asthma severity. However, its impact is particularly pronounced in severe cases. The greater the degree of dysfunction in the small airways, the poorer the asthma control and the higher the likelihood of exacerbations. As a result, targeted therapies focusing on small airways dysfunction are crucial for optimizing asthma management.

The research revealed that one of the promising treatment strategies is extra-fine single-inhaler triple therapy, which combines inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and long-acting muscarinic antagonists (LAMA). This approach ensures improved drug delivery to the small airways while also benefiting the larger airways, leading to better asthma control. Evidence suggests that this therapy may also delay the need for biological treatments in individuals with severe asthma.

For patients requiring advanced treatment options, biological therapies have emerged as an effective approach. While direct comparative studies from randomized controlled trials (RCTs) are still limited, recent findings indicate that biologics not only help in managing severe asthma but also show potential benefits for SAD. Most available biologics primarily target type 2 inflammation, which is a dominant pathway in severe asthma. However, not all patients with SAD fall into the type 2-high category, necessitating alternative treatment options.

In such cases, bronchial thermoplasty (BT), a non-pharmacological intervention, has been considered. This procedure reduces airway smooth muscle mass and primarily targets large airways, but emerging evidence suggests it may also benefit small airways dysfunction. BT may be particularly useful for individuals with severe asthma who do not respond adequately to type 2-targeted biologic therapies.

“Given the significant role of small airways dysfunction in asthma severity, incorporating SAD assessment into routine clinical practice is essential. Identifying small airway impairment early can help clinicians tailor treatment strategies more effectively,” Yaqing Xu, Department of Geriatric Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China, and colleagues wrote.

“Future research should focus on validating the role of SAD-targeted therapies, exploring new biologic treatments, and determining the long-term benefits of interventions like bronchial thermoplasty in patients with severe asthma,” they concluded.

Reference:

Deng, N., Xianyu, Y., Xu, Y., & Nie, H. (2025). Small airways dysfunction in severe asthma: Current treatment approaches and future directions. Journal of the Formosan Medical Association. https://doi.org/10.1016/j.jfma.2025.01.021

Recent studies suggest that extra-fine single-inhaler triple therapy can significantly improve severe asthma (SAD) control. This advanced treatment may help delay the need for costly and intensive biological therapies in severe asthma patients. By enhancing airway function and reducing inflammation, this therapy offers a promising alternative for better disease management.

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Depression and Anxiety Affect 40 Percent of Adults With Chronic Pain: JAMA

USA: A recent systematic review and meta-analysis has shed light on the significant burden of depression and anxiety among individuals experiencing chronic pain. The findings, published in JAMA Network Open, indicate that approximately 40% of adults with chronic pain exhibit clinically significant symptoms of depression and anxiety, underscoring the pressing need for comprehensive mental health care in pain management.

The study highlights that certain groups are more susceptible to these mental health conditions. Women and younger adults were found to have a higher likelihood of experiencing depression and anxiety in the context of chronic pain. Additionally, individuals with nociplastic pain—a type of pain associated with altered central pain processing rather than direct tissue damage—were particularly vulnerable.

The researchers note that depression and anxiety are frequently observed among adults with chronic pain, yet their exact prevalence remains uncertain. Considering this, Rachel V. Aaron, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues aimed to assess the extent of these mental health conditions in individuals experiencing chronic pain while also identifying factors that influence their occurrence.

For this purpose, the researchers conducted a literature search across MEDLINE, Embase, PsycINFO, and Cochrane Library from January 2013 to October 2023. They analyzed studies that reported the prevalence of depression or anxiety using validated assessment tools among adults with chronic pain, excluding chronic headache disorders. From 31,159 initial records, 5177 full texts were screened, and data extraction followed PRISMA guidelines using Covidence.

Two independent reviewers assessed bias and conducted meta-analyses to pool prevalence and identify moderators, including pain condition, recruitment setting, age, gender, and pain duration. The study compared depression and anxiety prevalence in chronic pain versus control groups.

The study led to the following findings:

  • The study analyzed 376 studies from 50 countries, including 347,468 individuals with chronic pain (average age 51.3 years, 70% female).
  • Clinical symptoms of depression were found in 39.3% of adults with chronic pain, while anxiety symptoms were present in 40.2%.
  • Prevalence varied by pain condition, with the highest rates in fibromyalgia (depression: 54.0%, anxiety: 55.5%) and the lowest in arthritis (e.g., osteoarthritis: depression: 29.1%, anxiety: 17.5%).
  • Depression and anxiety were more common among younger individuals and women.
  • Diagnosed major depressive disorder was present in 36.7%, while generalized anxiety disorder was found in 16.7%.
  • People with nociplastic pain were most affected.

“The coexistence of chronic pain with depression and anxiety poses a major public health challenge, highlighting the need for routine mental health screening in clinical practice. Ensuring equitable access to specialized care and developing innovative treatment approaches are essential to address this dual burden and improve patient outcomes effectively,” the researchers concluded.

Reference:

Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268

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New 4D Brain Map reveals potential early warning signs of multiple sclerosis, reports research

Using an animal model of multiple sclerosis (MS), researchers at the National Institutes of Health (NIH) have created a four-dimensional brain map that reveals how lesions similar to those seen in human MS form. These findings, published in Science, provide a window into the early disease state and could help identify potential targets for MS treatments and brain tissue repair.

The researchers, led by postdoctoral fellow Jing-Ping Lin, Ph.D., and senior investigator Daniel S. Reich, M.D., Ph.D., both at NIH’s National Institute of Neurological Disorders and Stroke (NINDS), combined repeated MRI imaging with brain-tissue analysis, including gene expression, to track the onset and development of MS-like lesions. They uncovered a new MRI signature that can help detect brain regions at risk for damage weeks before any visible lesions occur. They also identified “microenvironments” within affected brain tissue based on observed patterns of neural function, inflammation, immune and support cell responses, gene expression, and levels of damage and repair.

“Identifying the early events that occur after inflammation and teasing apart which are reparative versus which are damaging, can potentially help us identify MS disease activity sooner and develop treatments to slow or stop its progression,” said Dr. Reich.

MS is caused by the body’s immune system attacking the protective covering of nerve fibers, called myelin. This leads to inflammation, loss of myelin, and formation of “lesions” or “plaques” within the brain tissue. Most of what is known about MS progression has come from analysis of postmortem human brain tissue, usually obtained decades after the initial onset of disease. This means missing early changes that occurred prior to the onset of symptoms.

To mimic the conditions of the human brain, the researchers opted not to use a mouse model for MS, instead advancing a model that uses the marmoset, a nonhuman primate. Compared to mouse brains, marmoset and human brains have a higher ratio of white matter (the “wires” of the brain) to gray matter (neuronal cell bodies). The marmoset model creates multiple lesions that closely resemble those seen in human MS and that can be tracked in real time using MRI imaging. Because these lesions can be induced experimentally, the model offers a look at the earliest stages of inflammation and immune responses that lead to MS-like demyelination.

One key player identified was a specific type of astrocyte, one of the support cell types in the brain, that turns on a gene called SERPINE1 or plasminogen activator inhibitor-1 (PAI1). They found SERPINE1-expressing astrocytes in vulnerable brain borders before visible damage occurs, clustering near blood vessels and the fluid-filled ventricles of the brain and signaling future areas of lesion development. These astrocytes also appeared to influence the behavior of other cells near the lesion area, including the ability of immune cells to enter the brain and contribute to inflammation, as well as the precursor cells involved in myelin repair.

Given that SERPINE1-expressing astrocytes accumulated at the edges of growing lesions, where damage happens but healing also begins, their potential dual role in coordinating signals that could lead to either tissue repair or further damage was an unexpected wrinkle that will require further study. It’s possible that the earliest responses could be a part of a protective mechanism that becomes overwhelmed as the injury progresses. It’s also possible that the same mechanism could itself become disease-causing.

“If one imagines a fort under siege, initially the walls might hold off the attack,” said Dr. Reich. “But if those walls are breached, all the defenses inside can be turned against the fort itself.”

These findings may also have implications for brain injuries beyond what is seen in MS. While there are different types of focal brain injuries, including traumatic brain injury, stroke, inflammation, and infection, there is a finite number of ways the tissue can react to injury. In fact, many of the reactions seen here to inflammation, stress, and tissue damage are likely to be common across injury types, and the brain map created in this study can act as a resource to allow comparisons to be made in a more human-like context.

The scientific teams are building a new model of a different autoimmune condition affecting brain borders. They are also looking to expand their data set to include aged animals, which could help improve our understanding of progressive MS, a disease state with a significant and unmet therapeutic need.

Reference:

Jing-Ping Lin et al. ,4D marmoset brain map reveals MRI and molecular signatures for onset of multiple sclerosis–like lesions.Science387,eadp6325(2025).DOI:10.1126/science.adp6325

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Low-Calorie Diet Safe and Effective for Gestational Diabetes, Reduces Insulin Need: Study Finds

UK: A study in Nature Medicine found that a 1,200-calorie diet per day was safe and effective for pregnant women with gestational diabetes and a BMI of at least 25, significantly reducing the need for long-acting insulin therapy.

The researchers note that gestational diabetes affects 6–15% of pregnancies worldwide and increases health risks for both mother and baby. Overweight, obesity, and excessive weight gain during pregnancy are key risk factors. While weight loss improves blood sugar control in non-pregnant people with type 2 diabetes, its role in gestational diabetes remains unclear. Although international guidelines recommend weight gain based on BMI, studies suggest that lower weight gain or even weight loss may benefit women with gestational diabetes. However, there is little research on effective dietary strategies for managing weight in this group, highlighting the need for further studies on safe energy intake.

To fill this knowledge gap, Claire L. Meek, Cambridge Universities NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK, and colleagues aimed to determine whether losing weight during pregnancy can improve health outcomes for mothers and babies with gestational diabetes.

For this purpose, the researchers conducted a multicenter, randomized, double-blind trial to examine the effects of energy restriction in pregnant women with gestational diabetes and a BMI of 25 or higher. Participants were randomly assigned to either a standard 2,000-calorie diet or a reduced 1,200-calorie diet from 29 weeks of pregnancy until delivery. Diets were provided weekly with a balanced composition of 40% carbohydrates, 35% fat, and 25% protein. Randomization followed a 1:1 ratio, stratified by center and blinded to participants and the study team. The primary outcomes measured were maternal weight change by 36 weeks and newborn birth weight.

The key findings of the study were as follows:

  • At 36 weeks, maternal weight change and standardized birth weight showed no significant differences between the groups.
  • The reduced-energy diet group had a lower need for long-acting insulin therapy than the standard-energy diet group (27.5% versus 39.2%; OR 0.36).
  • Weight loss of approximately 3 kg in late pregnancy improved maternal blood sugar levels, lowered systolic blood pressure, and reduced the incidence of large-for-gestational-age infants.
  • The occurrence of small-for-gestational-age infants was similar in both groups and remained within expected limits.
  • There were no stillbirths, neonatal deaths, or maternal deaths in the reduced-energy diet group.

The findings showed that for women with gestational diabetes and a BMI ≥ 25 kg/m², incorporating a 1,200 kcal/day diet into evidence-based guidelines should be considered. This approach was found to be safe during pregnancy and effectively reduced the need for initiating long-acting insulin therapy.

“A safe and effective way to achieve energy restriction during pregnancy is through a low-glycemic-index diet, incorporating ample vegetables, lean protein, and some dairy products to ensure adequate nutrient intake,” the researchers wrote.

Reference:

Kusinski, L. C., Jones, D., Atta, N., Turner, E., Smith, S., Oude Griep, L. M., Rennie, K., Sharp, S. J., Farewell, V., Murphy, H. R., Taylor, R., & Meek, C. L. (2025). Reduced-energy diet in women with gestational diabetes: The dietary intervention in gestational diabetes DiGest randomized clinical trial. Nature Medicine, 31(2), 514-523. https://doi.org/10.1038/s41591-024-03356-1

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Even lower doses of Ethambutol can Induce Optic Neuropathy, suggests study

Even lower doses of Ethambutol can Induce Optic Neuropathy, suggests a study published in the Cureus.

The present study aims to determine the incidences of ethambutol-induced optic neuropathy (EON) and its associated risk factors in Central Indian tertiary care centers. A single-centered retrospective observational study was conducted. Data was collected from the Directly Observed Therapy Short-course (DOTS) centre after implementing the revised National Tuberculosis Control Program (RNTCP) 2016 guidelines. The collected data included demographic data, history of underlying diseases, such as diabetes mellitus, hypertension, HIV infection, and history of smoking. The site of tuberculosis infection, daily dose, ethambutol (EMB) treatment duration, onset, and type of ocular symptoms were recorded. We performed regression analyses to investigate the univariate and multivariable associations with different variables. Results: Of the 1676 patients who received ethambutol for TB treatment, 987 had an ophthalmological symptom unrelated to EON, and 13 developed EON (incidence =0.28%). Demographic and clinical variables considered were age, gender, race/ethnicity, body mass index (BMI), and diabetes mellitus status. Examples of current infection information were chronic HIV and other comorbidities uniquely associated with renal function site/type treatment specific dose/duration ethambutol. Longer treatment duration significantly correlates with greater thickness of the left temporal retinal nerve fibre layer (RNFL) and thicker average RNFL. Increased peripapillary retinal nerve fibre layer (pRNFL) thickness on the left nasal RNFL scan was significantly correlated with ethambutol tablets (or count) (p=0.027). The findings indicate that ethambutol toxicity is indeed dose and duration-dependent, evidenced by the relationship between prolonged treatment and increased RNFL thickness, suggesting heightened risk of visual impairment. Moreover, adverse effects were observed at even lower doses (12.3 mg/kg), reinforcing that no dose of ethambutol is entirely safe.

Reference:

Singh P, Karkhur S, Verma V (February 17, 2025) Ethambutol-Induced Optic Neuropathy: A Retrospective Study of Incidences and Risk Factors. Cureus 17(2): e79160. doi:10.7759/cureus.79160

Keywords:

Even, lower, doses, Ethambutol, can, Induce, Optic, Neuropathy, suggests, study, ethambutol, ethambutol-induced optic neuropathy (eon), revised national tuberculosis control programme (rntcp), rnfl thickness, tuberculosis, Singh P, Karkhur S, Verma V

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