Stimulating hypothalamus restores walking in paralyzed patients, finds study

Researchers at EPFL and Lausanne University Hospital (CHUV), led by professors Grégoire Courtine and Jocelyne Bloch, have achieved a major milestone in the treatment of spinal cord injuries (SCI). By applying deep brain stimulation (DBS) to an unexpected region in the brain-the lateral hypothalamus (LH)-the team has improved the recovery of lower limb movements in two individuals with partial SCI, greatly improving their autonomy and well-being.

Wolfgang Jäger, a 54-year-old from Kappel, Austria, has been in a wheelchair since 2006 after a ski accident left him with a spinal cord injury. Participating in the clinical trial, he experienced firsthand how deep brain stimulation could restore his mobility and independence. “Last year on vacation, it was no problem to walk a couple of steps down and back to the sea using the stimulation,” Jäger shared, describing the newfound freedom DBS has given him. Beyond walking, the therapy has improved everyday tasks. “I can also reach things in my cupboards in the kitchen,” he added.

DBS is a well-established neurosurgical technique that involves implanting electrodes into specific brain regions to modulate neural activity. Traditionally, DBS has been used to treat movement disorders like Parkinson’s disease and essential tremor by targeting areas of the brain responsible for motor control. However, applying DBS to the lateral hypothalamus to treat partial paralysis is a novel approach. By focusing on the LH, the researchers at .Neurorestore tapped into an unexpected neural pathway that had not been considered before for motor recovery.

In the study published in Nature Medicine, not only did the DBS show immediate results to augment walking during rehabilitation, but patients also showed long-term improvement that persisted even when the stimulation was turned off. These findings suggest that the treatment promoted a reorganization of residual nerve fibers that contribute to sustained neurological improvements.

“This research demonstrates that the brain is needed to recover from paralysis. Surprisingly, the brain is not able to take full advantage of the neuronal projections that survive after a spinal cord injury. Here, we found how to tap into a small region of the brain that was not known to be involved in the production of walking in order to engage these residual connections and augment neurological recovery in people with spinal cord injury,” says Courtine, professor of neuroscience at EPFL, Lausanne University Hospital (CHUV) and UNIL and co-director of the .NeuroRestore center.

Fundamental neuroscience combined with neurosurgical precision

The success of this DBS therapy hinged on two complementary approaches: discoveries enabled by novel methodologies in animal studies and the translation of these discoveries into precise surgical techniques in humans. For the surgery, the researchers used detailed brain scans to guide the precise locations of the small electrodes into the brain, performed by Bloch at CHUV, while the patient was fully awake.

“Once the electrode was in place and we performed the stimulation, the first patient immediately said, ‘I feel my legs.’ When we increased the stimulation, she said, ‘I feel the urge to walk!’ This real-time feedback confirmed we had targeted the correct region, even if this region had never been associated with the control of the legs in humans. At this moment, I knew that we were witnessing an important discovery for the anatomical organization of brain functions,” says Bloch, neurosurgeon and professor at the Lausanne University Hospital (CHUV), UNIL and EPFL, and co-director of the .NeuroRestore centre.

The lateral hypothalamus’ role in walking recovery

The identification of the LH as a key player in motor recovery after paralysis is in itself an important scientific discovery, given that this region has traditionally only been associated with functions like arousal and feeding. This breakthrough emerged from the development of a novel multi-step methodology that began with whole-brain anatomical and functional mapping to establish the role of this region in walking, followed by experiments in preclinical models to establish the precise circuits involved in the recovery. Ultimately, these results led to clinical trials in human participants.

“It was fundamental research, through the creation of detailed brain-wide maps, that allowed us to identify the lateral hypothalamus in the recovery of walking. Without this foundational work, we would not have uncovered the unexpected role this region plays in walking recovery,” says Jordan Squair, a lead author of the study.

The advanced imaging platform at the Wyss Center played a critical role in this research by providing high-resolution imaging capabilities that enabled the team to map the anatomical and functional activity of neurons across the brain, enabling the identification of the lateral hypothalamus.

Combining DBS with spinal implants for enhanced recovery

These remarkable results pave the way for new therapeutic applications to augment recovery from SCI. Future research will explore integrating DBS with other technologies, such as spinal implants that have already shown their potential in restoring movement after SCI. “Integrating our two approaches-brain and spinal stimulation–will offer a more comprehensive recovery strategy for patients with spinal cord injuries,” says Courtine.

Reference:

Cho, N., Squair, J.W., Aureli, V. et al. Hypothalamic deep brain stimulation augments walking after spinal cord injury. Nat Med (2024). https://doi.org/10.1038/s41591-024-03306-x

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High-dose folic acid supplementation during pregnancy linked to increased cancer risk in children born to women with epilepsy: Study

High-dose folic acid supplementation during pregnancy linked to increased cancer risk in children born to women with epilepsy suggests a study published in the Epilepsia.

This study was undertaken to study whether high-dose folic acid (>1 mg daily) use is associated with an increased risk of cancer in all women who have given birth and in women with epilepsy. High-dose folic acid supplementation during pregnancy has been linked to increased cancer risk in children born to mothers with epilepsy. They identified women with their first pregnancy in Denmark (1997–2017), Norway (2005–2017), and Sweden (2006–2017) using medical birth registers, linking individual data across nationwide health registers and statistical agencies. Exposure was defined as filled prescriptions for high-dose folic acid, considered time-varyingly. The primary outcome was the first malignant cancer diagnosis. Hazard ratios (HRs) of cancer after high-dose folic acid exposure were estimated using Cox proportional hazard models with 95% confidence intervals (CIs), adjusted for confounders including antiseizure medication (ASM) use, and stratified by maternal epilepsy diagnosis. A 6-month time lag was applied, as cancer is unlikely to develop immediately. Results: With up to 21 years of follow-up, we identified 1 465 785 women who gave birth, including 64 485 (4.4%) exposed to high-dose folic acid. In the exposed group, 755 cancer cases were observed (208 per 100 000 person-years, 95% CI = 193.8–223.5), compared with 18 702 cases in the unexposed group (164 per 100 000 person-years, 95% CI = 161.5–166.2), yielding a 20% increased cancer risk overall (adjusted HR = 1.2, 95% CI = 1.1–1.2). This risk was attenuated after the 6-month lag analysis (adjusted HR = 1.1, 95% CI = 1.04–1.2). The risk for non-Hodgkin lymphoma was increased in all analyses (n = 28, adjusted HR = 2.0, 95% CI = 1.3–2.9). The association between high-dose folic acid use and overall cancer risk was similar in those with epilepsy regardless of ASM use (adjusted HR = 1.3, 95% CI = 1.0–1.8). High-dose folic acid use was associated with increased overall cancer risk in women who have given birth, with a consistent association with non-Hodgkin lymphoma, including those with epilepsy, regardless of ASM use.

Reference:

Vegrim HM, Dreier JW, Igland J, Alvestad S, Gilhus NE, Gissler M, et al. High-dose folic acid use and cancer risk in women who have given birth: A register-based cohort study. Epilepsia. 2024; 00: 1–14. https://doi.org/10.1111/epi.18146

Keywords:

High-dose, folic acid, supplementation, during, pregnancy, linked, increased, cancer risk, children, born, women, epilepsy, study , Epilepsia,Vegrim HM, Dreier JW, Igland J, Alvestad S, Gilhus NE, Gissler M

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IV lidocaine may decrease catheter-related bladder discomfort and pain in male patients after complex spine surgery: Study

Catheter-related bladder discomfort (CRBD), a regrettable consequence post-surgery, manifests as a compelling urge to urinate, a burning sensation from the lower abdomen to the genitals, and is frequently accompanied by discomfort or a strong urge to void. Recent study aimed to investigate the effectiveness of intravenous lidocaine in preventing catheter-related bladder discomfort (CRBD) and postoperative pain in male patients undergoing complex lumbar spinal surgery. Eighty male patients scheduled for elective fusion spine surgery at least two levels were randomly assigned to receive either intravenous lidocaine or normal saline. The primary outcome was the incidence of moderate-to-severe CRBD in the post-anesthetic care unit (PACU). Secondary outcomes included postoperative pain, 24-hour postoperative opioid requirement, CRBD at various postoperative time points, patient satisfaction, and adverse effects.

Results and Conclusion

The results showed that the group receiving intravenous lidocaine had a significantly lower incidence of moderate-to-severe CRBD in the PACU and at 1 hour postoperatively compared to the control group. Additionally, the lidocaine group experienced lower average pain scores at all time points and reduced postoperative morphine requirement. Patients in the lidocaine group also reported higher satisfaction levels. No adverse outcomes were observed in either group, indicating the safety of intravenous lidocaine administration.

Implications and Limitations

The study highlighted the anti-inflammatory properties of lidocaine, which inhibit muscarinic receptors and reduce prostaglandin release, leading to a decreased incidence of CRBD and postoperative pain. The findings supported the hypothesis that intravenous lidocaine could alleviate CRBD and postoperative pain in male patients undergoing complex spine surgery. Limitations of the study included the lack of plasma lidocaine concentration assessment, the small sample size, and the absence of analysis on hospital stay length or readmission rates. Overall, intravenous lidocaine was found to be effective in reducing CRBD, postoperative pain, and opioid requirement while improving patient satisfaction in complex lumbar spinal surgery without any observed adverse effects.

Key Points

– The study aimed to investigate the effectiveness of intravenous lidocaine in preventing catheter-related bladder discomfort (CRBD) and postoperative pain in male patients undergoing complex lumbar spinal surgery.

– Eighty male patients undergoing elective fusion spine surgery were randomly assigned to receive either intravenous lidocaine or normal saline.

– Primary outcome: The group receiving intravenous lidocaine had a significantly lower incidence of moderate-to-severe CRBD in the post-anesthetic care unit (PACU) and at 1 hour postoperatively compared to the control group.

– Secondary outcomes included postoperative pain, 24-hour postoperative opioid requirement, CRBD at various postoperative time points, patient satisfaction, and adverse effects.

– Patients in the lidocaine group experienced lower average pain scores at all time points, reduced postoperative morphine requirement, and reported higher satisfaction levels.

– Study implications suggest that intravenous lidocaine’s anti-inflammatory properties can inhibit muscarinic receptors and reduce prostaglandin release, leading to decreased CRBD and postoperative pain in male patients undergoing complex spine surgery. Limitations included small sample size and lack of plasma lidocaine concentration assessment.

Reference –

Chantrapannik E, Munjupong S, Limprasert N, Jinawong S. Effect of intravenous lidocaine on catheter related bladder discomfort, postoperative pain and opioid requirement in complex fusion lumbar spinal surgery: a randomized, double blind, controlled trial. BMC Anesthesiol. 2024 Nov 11;24(1):405. doi: 10.1186/s12871-024-02789-y. PMID: 39528937; PMCID: PMC11552165.

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Brain Changes in Preeclampsia and Eclampsia: Hypoperfusion, Infarcts, and Edema Identified in Latest Research

South Africa: A recent study published in the American Journal of Obstetrics and Gynecology has found that eclampsia is associated with cerebral infarcts, vasogenic cerebral edema, vasospasm, and decreased perfusion, which are often not detected on standard clinical imaging. This discovery may explain why some patients experience cerebral symptoms and signs despite normal findings on conventional imaging techniques.

“Cerebral infarcts were identified in 34% of women with eclampsia and 5% of women with preeclampsia, while vasospasm was observed in 18% of women with eclampsia and 6% of women with preeclampsia,” the researchers reported. 

Eclampsia, a severe complication of pregnancy, is linked to cerebral edema and infarctions, though its underlying pathophysiology remains poorly understood. To fill this knowledge gap, Lina Bergman, Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa, and colleagues conducted a study using specialized magnetic resonance imaging techniques to assess diffusion, perfusion, and vasospasm, aiming to gain deeper insights into the mechanisms driving eclampsia.

For this purpose, the researchers conducted a cross-sectional study that recruited consecutive pregnant women between April 2018 and November 2021 at Tygerberg Hospital in Cape Town, South Africa. Participants included women with eclampsia, preeclampsia, and normotensive pregnancies who underwent magnetic resonance imaging after childbirth.

The primary outcome measures were the presence of cerebral infarcts, edema, and perfusion assessed through intravoxel incoherent motion imaging, and vasospasm evaluated using magnetic resonance imaging angiography. The imaging protocol was defined before participant inclusion.

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

  • The study included 49 women with eclampsia, 20 with preeclampsia, and 10 normotensive women.
  • Cerebral infarcts were found in 34% of women with eclampsia and 5% of women with preeclampsia, with no cerebral infarcts observed in normotensive controls.
  • Women with eclampsia were significantly more likely to have vasogenic cerebral edema compared to women with preeclampsia (80% versus 20%) and normotensive women (risk differences of 0.60 and 0.80, respectively).
  • Diffusion was increased in women with eclampsia in the parieto-occipital white matter (mean difference, 0.02 × 10−3 mm²/s) and the caudate nucleus (mean difference, 0.02 × 10−3 mm²/s) compared with women with preeclampsia.
  • Diffusion was also increased in women with eclampsia in the frontal white matter (mean difference, 0.07 × 10−3 mm²/s), parieto-occipital white matter (mean difference, 0.05 × 10−3 mm²/s), and caudate nucleus (mean difference, 0.04 × 10−3 mm²/s) compared with normotensive women.
  • Perfusion was reduced in edematous regions, with hypoperfusion observed in the caudate nucleus of women with eclampsia (mean difference, -0.17 × 10−3 mm²/s) compared to preeclampsia. There was no hyperperfusion.
  • Vasospasm was identified in 18% of women with eclampsia and 6% of women with preeclampsia, while no vasospasm was observed in normotensive controls.

The authors concluded that cerebral infarcts were observed in one-third of women with eclampsia, regardless of the disease’s severity. Both preeclampsia and eclampsia were associated with preclinical cerebral edema, as indicated by increased diffusion, which may explain the presence of neurological signs and symptoms even when conventional MRI shows no evident cerebral edema.

“The findings suggest that hyperperfusion and forced capillary dilation are unlikely to be the underlying causes of cerebral edema in eclampsia. Instead, vasospasm leading to decreased capillary blood flow (hypoperfusion) is more likely to contribute to the development of cerebral edema and subsequent neuroinflammation in both preeclampsia and eclampsia. Furthermore, our study emphasizes that conventional MRI does not completely rule out underlying pathology in these conditions,” they wrote.

Reference:

Bergman, L., Hannsberger, D., Schell, S., Imberg, H., Langenegger, E., Moodley, A., Pitcher, R., Griffith-Richards, S., Herrock, O., Hastie, R., Walker, S. P., Tong, S., Wikström, J., & Cluver, C. (2024). Cerebral infarcts, edema, hypoperfusion, and vasospasm in preeclampsia and eclampsia. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2024.10.034

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PToR criteria with high specificity may predict termination of resuscitation among pediatric OHCA patients: Study

Prehospital termination of resuscitation (ToR) guidelines are employed to assess medical futility in adults experiencing out-of-hospital cardiac arrest (OHCA), but there is a lack of sufficient evidence regarding their application in pediatric patients. Recent study aimed to derive a Pediatric Termination of Resuscitation (PToR) prediction rule for use in pediatric non-traumatic out-of-hospital cardiac arrest (OHCA) patients. The researchers analyzed a retrospective cohort of pediatric OHCA patients within the CARES database over a 10-year period from 2013-2022. The primary outcome was non-survival to hospital discharge, and the secondary outcome was non-survival to hospital discharge or survival to hospital discharge with unfavorable neurologic status. The researchers fit logistic regressions with Least Absolute Shrinkage and Selection Operator (LASSO) to select predictor variables and estimate predictive test characteristics.

Dataset Overview and Findings

The full dataset included 22,697 children, with 2,326 (11.0%) surviving to hospital discharge, and 1,894 (8.9%) surviving to hospital discharge with favorable neurologic status. The derived PToR rule for non-survival to hospital discharge consisted of four criteria: 1) Unwitnessed arrest; 2) Absence of cardiac electrical activity (asystole); 3) Arrest not due to drowning or electrocution; and 4) No sustained ROSC. This rule demonstrated a specificity of 99.1% and a positive predictive value (PPV) of 99.8% in the test dataset.

Expanded PToR Rule

The PToR rule for non-survival to hospital discharge or survival with unfavorable neurologic status consisted of five criteria: 1) Unwitnessed arrest; 2) Absence of cardiac electrical activity (asystole); 3) Arrest not due to drowning or electrocution; 4) No sustained ROSC; and 5) No bystander CPR. This rule also demonstrated a specificity of 99.1% and a PPV of 99.8% in the test dataset.

Conclusions and Future Directions

The researchers found that these PToR criteria had similar performance across different age groups (infants, children, and adolescents) as well as across gender and racial/ethnic groups. The authors concluded that these PToR criteria with high specificity and positive predictive value may help inform termination of resuscitation considerations in the prehospital setting for pediatric OHCA patients. They emphasized that further prospective and validation studies are still necessary to define the appropriateness and applicability of these PToR criteria for routine use.

Key Points

1. The study aimed to derive a Pediatric Termination of Resuscitation (PToR) prediction rule for use in pediatric non-traumatic out-of-hospital cardiac arrest (OHCA) patients.

2. The primary outcome was non-survival to hospital discharge, and the secondary outcome was non-survival to hospital discharge or survival to hospital discharge with unfavorable neurologic status.

3. The derived PToR rule for non-survival to hospital discharge consisted of four criteria: 1) Unwitnessed arrest; 2) Absence of cardiac electrical activity (asystole); 3) Arrest not due to drowning or electrocution; and 4) No sustained ROSC. This rule demonstrated a specificity of 99.1% and a positive predictive value (PPV) of 99.8% in the test dataset.

4. The PToR rule for non-survival to hospital discharge or survival with unfavorable neurologic status consisted of five criteria: 1) Unwitnessed arrest; 2) Absence of cardiac electrical activity (asystole); 3) Arrest not due to drowning or electrocution; 4) No sustained ROSC; and 5) No bystander CPR. This rule also demonstrated a specificity of 99.1% and a PPV of 99.8% in the test dataset.

5. The researchers found that these PToR criteria had similar performance across different age groups (infants, children, and adolescents) as well as across gender and racial/ethnic groups.

6. The authors concluded that these PToR criteria with high specificity and positive predictive value may help inform termination of resuscitation considerations in the prehospital setting for pediatric OHCA patients, but further prospective and validation studies are still necessary to define the appropriateness and applicability of these PToR criteria for routine use.

Reference –

Pranav Shetty et al. (2024). Derivation Of A Clinical Decision Rule For Termination Of Resuscitation In Non-Traumatic Pediatric Out-Of-Hospital Cardiac Arrest.. *Resuscitation*, . https://doi.org/10.1016/j.resuscitation.2024.110400.

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Dorsal cortex line more reliable than transepicondylar axis for rotation in revision TKA with severe bone loss: study

Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss: study

The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, Salzmann et al conducted a study to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement.

A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability.

The key findings of the study were:

• This study introduces a novel landmark for femoral component rotation in revision total knee arthroplasty with severe bone loss.

• The validity and reliability are shown in comparison to the transepicondylar axis.

• This landmark can be helpful, when the condyles are destroyed or total femur replacement is planned.

• The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°.

• The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99).

The author opined – ‘In conclusion, the DCL at 75 mm above the joint line can be measured reproducibly and is approximately 10°externally rotated to the sTEA. This may serve as a valuable landmark for determining femoral component rotation in revision TKA with significant bone loss, when the epicondyles are difficult to assess radiologically, or when the epicondyles are absent. Surgeons should be aware that there are outliers in this study in up to 17% and the trochlea design of the of the implant does not match the natural knee.’

Further reading:

Dorsal cortex line more reliable than trans epicondylar axis for rotation in revision TKA with severe bone loss

M. Salzmann, E. Kropp, R. Prill, N. Ramadanov, M. Adriani, R. Becker

Bone Jt Open 2024;5(12): 1067–1071.

DOI: 10.1302/2633-1462.512.BJO-2024-0140.R1

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New Guidelines Affirm Role of Antenatal Corticosteroids in Reducing Neonatal Complications

UK: The latest Green-top Guideline No. 74, published in BJOG: An International Journal of Obstetrics & Gynaecology, emphasizes the critical role of antenatal corticosteroids in improving neonatal outcomes for women at risk of preterm birth or undergoing cesarean delivery at term. These evidence-based recommendations aim to enhance care and reduce complications associated with prematurity, offering significant benefits to neonatal health.

Antenatal corticosteroids, when administered before anticipated preterm delivery, are among the most effective interventions to improve neonatal outcomes. They significantly reduce risks of neonatal respiratory distress syndrome (RDS), perinatal death, and other complications. Women between 24+0 and 34+6 weeks of gestation at imminent risk of preterm birth—due to established labor, preterm prelabor rupture of membranes (PPROM), or planned early delivery—are strongly advised to receive this treatment.
In multiple pregnancies, such as twins or triplets, targeted use of corticosteroids aligns with the recommendations for singletons. However, medical practitioners are cautioned against delaying necessary delivery to administer corticosteroids if the health of the mother or baby is at risk.
For women undergoing planned cesarean delivery between 37+0 and 38+6 weeks, healthcare providers are encouraged to discuss the potential risks and benefits of antenatal corticosteroids. While they may reduce neonatal respiratory morbidity and admissions to neonatal units, concerns remain about potential adverse effects, including neonatal hypoglycemia and developmental delays.
The timing of corticosteroid administration is pivotal. Studies reveal the greatest reduction in neonatal mortality, and RDS occurs when the first dose is given within seven days of delivery. Benefits extend even when administered within 48 or 24 hours before birth, highlighting the importance of timely treatment.
The guideline emphasizes that women with PPROM should receive corticosteroids due to their increased risk of preterm labor. However, healthcare providers are advised to weigh the timing and necessity of corticosteroid use carefully, ensuring that the treatment does not delay urgent deliveries needed for maternal or fetal well-being.
This updated guideline supplements earlier recommendations from the National Institute for Health and Care Excellence (NICE) and replaces the archived Green-top Guideline No. 7. It aims to guide healthcare providers, policymakers, and stakeholders in making informed decisions, improving neonatal outcomes, and mitigating the long-term impacts of prematurity.
The recommendations offer a balanced approach to antenatal corticosteroid use, emphasizing evidence-based care tailored to individual clinical scenarios to maximize benefits for mothers and their babies.
“Further research is needed to evaluate the effectiveness of antenatal corticosteroids in reducing neonatal morbidity when administered before elective cesarean birth at term. The optimal gestational age for administering corticosteroids remains controversial and requires additional investigation. Additionally, the safety and effectiveness of corticosteroids in multiple pregnancies, as well as in women with diabetes or chorioamnionitis, require further study,” SJ Stock, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, and colleagues wrote.
“Research should also explore the effectiveness of lower corticosteroid doses compared to current regimens, as well as the potential off-target effects of various formulations and dosing schedules. Long-term follow-up studies are necessary to assess the effects of antenatal corticosteroids on cardiovascular function and neurodevelopment. Lastly, investigating sexual dimorphism in response to antenatal corticosteroids is an important area for future research,” they concluded.
Reference:
Stock, S., Thomson, A., & Papworth, S. (2022). Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG: An International Journal of Obstetrics & Gynaecology, 129(8), e35-e60. https://doi.org/10.1111/1471-0528.17027

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Thyroid function and Liver Fibrosis: Study unveils Link Between Liver Fibrosis and Hypothyroid Spectrum

A new study conducted at the Huazhong
University of Science and Technology (Wuhan, China) found that liver fibrosis
is highly prevalent in hypothyroid individuals and across the hypothyroid
spectrum, as per the results published in the Journal of Gastroenterology.

Metabolic dysfunction n-associated
steatotic liver disease (MASLD) or non-alcoholic fatty liver disease (NAFLD) is
a common disease affecting globally. Studies have shown that hypothyroidism,
even in the low-normal level, can progress the severity of MASLD. Even though
previous literature assessed the prevalence of MASLD in hypothyroidism, there
is uncertainty about the incidence of liver fibrosis. Some studies evaluated
the liver fibrotic burden using serum markers, but there are no studies that
evaluated liver fibrosis using vibration-controlled transient elastography
(VCTE) in hypothyroid individuals. Hence, researchers conducted a study to
evaluate the prevalence of liver fibrotic burden across the spectrum of
hypothyroidism assessed by VCTE.

Also Read: Liver Fibrosis Scores closely Linked to Elevated Heart Failure Risk: Study

A cross-sectional analysis of
about 30,091 individuals who attended a Health management Centre between 2019
and 2021 was carried out. Based on thyroid levels, participants were
categorized as having strict-normal thyroid function, low-normal thyroid
function, subclinical hypothyroidism, and overt hypothyroidism. Using
vibration-controlled transient elastography (VCTE), liver fibrosis was assessed.
Significant and advanced fibrosis was defined as liver stiffness measurements
in VCTE of 8.1–9.6 and 9.7–13.5 kPa, respectively.

Findings:

  • Liver fibrosis was found to be more common in
    the low-normal thyroid function group, subclinical hypothyroidism group, and
    overt hypothyroidism group than in the strict-normal thyroid function group.
  • The fibrosis ranged from mild fibrosis,
    significant fibrosis, advanced fibrosis, and cirrhosis.
  • Liver fibrosis was similar between the low-normal
    thyroid function group and the subclinical hypothyroidism group.
  • The highest liver fibrosis was seen in the overt
    hypothyroidism group.
  • A significant association was found between both
    significant and advanced liver fibrosis and low-normal thyroid function,
    subclinical hypothyroidism, and overt hypothyroidism in both men and women.
Also Read: Bone Mineral Density Declines More Rapidly in Adults With Cystic Fibrosis, finds study

Thus, the study concluded that
Liver fibrotic burden is highly prevalent in subjects with overt
hypothyroidism. The pattern of fibrosis was also increased across the spectrum
of hypothyroidism even within the low normal thyroid function. Hence,
researchers suggested that screening for liver fibrosis should be carried out
in patients with hypothyroidism to rule out fibrosis.

Further reading: Du, T., Huang,
Y., Lv, Y. et al. Liver fibrotic burden across the spectrum of
hypothyroidism. J Gastroenterol (2024).
https://doi.org/10.1007/s00535-024-02184-x

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High-level committee to decide NEET 2025 Exam Format: Online or Pen-paper?

There is a possibility that the National Eligibility-cum-Entrance Test Undergraduate (NEET-UG) examination, which is conducted in pen-and-paper mode, get switched to the Computer-Based Test (CBT) system. The Union Education Ministry is in conversation with the Union Health Ministry to decide on the pattern of holding the NEET-UG examination, PTI has reported.

In this regard, the High-Level Committee, set up to suggest reforms in the National Eligibility-cum-Entrance Test Undergraduate (NEET-UG) examination and the National Testing Agency (NTA), has opined that every district headquarters should have a standardized and well-equipped CBT (Computer-Based Test) testing centre.

For more information, click on the link below:

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Paper publication mandatory for marks and selection: High court denies relief, Doctor denied assistant professor job

The Patna High Court has dismissed a writ petition filed by a doctor challenging the Bihar Public Service Commission’s (BPSC) decision to withhold 10 marks for journal publication during the selection process for an Assistant Professor position in Obstetrics and Gynecology.

Upholding the BPSC’s decision, Justice Bibek Chaudhuri emphasized that the selection criteria clearly stipulated marks for “published” research papers, not merely those accepted for publication. The Court further clarified that the mere acceptance of a paper for publication does not equate to its actual publication.

For more information, click on the link below:

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