Risk of young-onset dementia could be reduced by targeting health and lifestyle factors

Researchers have identified a wide range of risk factors for young-onset dementia. The findings challenge the notion that genetics are the sole cause of the condition, laying the groundwork for new prevention strategies.

The largescale study identified 15 risk factors, which are similar to those for late-onset dementia. For the first time, they indicate that it may be possible to reduce the risk of young-onset dementia by targeting health and lifestyle factors.

Relatively little research has been done on young-onset dementia, though globally there are around 370,000 new cases of young-onset dementia each year.

Published in JAMA Neurology, the new research by the University of Exeter and Maastricht University followed more than 350,000 participants younger than 65 across the United Kingdom from the UK Biobank study. The team evaluated a broad array of risk factors ranging from genetic predispositions to lifestyle and environmental influences. The study revealed that lower formal education, lower socioeconomic status, genetic variation, lifestyle factors such as alcohol use disorder and social isolation, and health issues including vitamin D deficiency, depression, stroke, hearing impairment and heart disease significantly elevate risk of young-onset dementia

Professor David Llewellyn of the University of Exeter emphasized the importance of the findings: “This breakthrough study illustrates the crucial role of international collaboration and big data in advancing our understanding of dementia. There’s still much to learn in our ongoing mission to prevent, identify, and treat dementia in all its forms in a more targeted way. This is the largest and most robust study of its kind ever conducted. Excitingly, for the first time it reveals that we may be able to take action to reduce risk of this debilitating condition, through targeting a range of different factors.

Dr Stevie Hendriks, Researcher at Maastricht University, said: “Young-onset dementia has a very serious impact, because the people affected usually still have a job, children, and a busy life. The cause is often assumed to be genetic, but for many people we don’t actually know exactly what the cause is. This is why we also wanted to investigate other risk factors in this study.”

Sebastian Köhler, Professor of Neuroepidemiology at Maastricht University, said: “We already knew from research on people who develop dementia at older age that there are a series of modifiable risk factors. In addition to physical factors, mental health also plays an important role, including avoiding chronic stress, loneliness and depression. The fact that this is also evident in young-onset dementia came as a surprise to me, and it may offer opportunities to reduce risk in this group too.”

Dr Janice Ranson, Senior Research Fellow at the University of Exeter, said: “Our research breaks new ground in identifying that the risk of young-onset dementia can be reduced. We think this could herald a new era in interventions to reduce new cases of this condition.”

Dr Leah Mursaleen, Head of Clinical Research at Alzheimer’s Research UK, which co-funded the study, said: “We’re witnessing a transformation in understanding of dementia risk and, potentially, how to reduce it on both an individual and societal level. In recent years, there’s been a growing consensus that dementia is linked to 12 specific modifiable risk factors such as smoking, blood pressure and hearing loss . It’s now accepted that up to four in 10 dementia cases worldwide are linked to these factors.

“This pioneering study shines important and much-needed light on factors that can influence the risk of young-onset dementia. This starts to fill in an important gap in our knowledge. It will be important to build on these findings in broader studies.’

Reference:

Hendriks S, Ranson JM, Peetoom K, et al. Risk Factors for Young-Onset Dementia in the UK Biobank. JAMA Neurol. Published online December 26, 2023. doi:10.1001/jamaneurol.2023.4929.

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High-sensitivity troponin HEART pathway allows earlier detection of acute myocardial infarction: JAMA

USA: A recent cohort study published in JAMA Network Open has suggested that the high-sensitivity troponin HEART pathway may allow earlier detection of acute myocardial infarction (AMI) and improve resource use.

The multicenter cohort study involved 17 384 emergency department (ED) patients with chest pain risk stratified with a HEART pathway incorporating conventional vs high-sensitivity (hs) troponin levels. The study revealed that the high-sensitivity troponin group demonstrated a higher rate of AMI diagnosis during the ED visit and a lower AMI diagnosis rate within 30 days after the visit, along with lower rates of revascularization, stress testing, and admission. Mortality was rare and similar across groups.

Patients presenting to the EDs with chest pain are routinely risk-stratified for major adverse cardiac events (MACEs) using the HEART (History, Electrocardiogram, Age, Risk factors, and Troponin) score pathway. The pathway incorporates risk factors, clinical features, initial serum troponin testing, and electrocardiography findings hs-troponin levels are suggested to improve risk stratification among patients with possible acute myocardial infarction.

Mackensie Yore, Veterans Affairs/University of California Los Angeles National Clinician Scholars Program, Los Angeles, and colleagues aimed to compare resource use and health outcomes among emergency department patients undergoing cardiac risk stratification with a HEART pathway using conventional vs high-sensitivity serum troponin.

The study was conducted at 16 Kaiser Permanente Southern California hospitals during hs-serum troponin assay uptake. It included 17 384 adult patients who presented to an emergency department with chest pain and were risk-stratified with a HEART pathway based on high-sensitivity troponin or conventional troponin.

The study’s main outcome was AMI detection in the ED and within 30 days.

The study led to the following findings:

  • Of the 17 384 patients (median age, 58 years; 56.2% were women), 12 440 were risk stratified with a HEART pathway based on conventional troponin, and 4944 were risk stratified with a HEART pathway based on high-sensitivity troponin.
  • Detection of AMI within 30 days was higher for the high-sensitivity troponin group than the conventional troponin group (5.8% versus 4.4%), while the 30-day all-cause mortality rate was unchanged (0.3% versus 0.4%).
  • In the emergency department, 4.6% of patients in the high-sensitivity troponin group received a diagnosis of AMI compared with 2.0% in the conventional troponin group.
  • Among those who did not receive a diagnosis of AMI in the emergency department, an additional 1.2% of patients in the high-sensitivity troponin group and 2.4% in the conventional troponin group received a diagnosis within 30 days.
  • Patients in the high-sensitivity troponin group had lower rates of healthcare use compared with the conventional troponin group, including admission (12.2% versus 15.0%), stress testing within 7 days (10.2% versus 12.8%), and coronary revascularization within 30 days (1.0% vs 2.0%).

“The findings indicate that the hsTn HEART pathway was linked with higher rates of ED AMI diagnoses and lower rates of AMI diagnoses after the index ED visit and within 30 days,” the researchers wrote.

The team added, “We also found less health service use for the hsTn group compared with the cTn group.”

“A high-sensitivity troponin algorithm may improve the ED evaluation of AMI, both catching AMI earlier and mitigating advanced testing and unnecessary admission,” they concluded.

Reference:

Yore M, Sharp A, Wu Y, et al. Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway. JAMA Netw Open. 2023;6(12):e2348351. doi:10.1001/jamanetworkopen.2023.48351

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JIPMER Announces Conduction Of 1st Year Orientation Program For MD, MS, DM, MCH, MDS students

Puducherry: Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) has announced the conduction of 1st year postgraduate orientation program for MD, MS, DM, MCH, and MDS courses for the January 2024 batch. 

The postgraduate orientation program for the first-year postgraduate degree students admitted in the January 2024 session has been scheduled for 2nd January and 5th – 6th February 2024 in the NTTC Hall-1, JIPMER Academic Centre, JIPMER. Registration for the Programme will start sharp at 8.30 am on 2nd January 2024.

All the Heads of Departments are requested to circulate this among the first-year MD, MS, DM, MCh & MDS students who have joined in the first and second round of seat allotment and permit them to attend the program. The Heads should not post them on night duty before and during the program days and inform all unit heads to relieve the students on time, which will enable them to attend all sessions on time.

Also Read:AIIMS Jodhpur Invites Online Applications For PhD Admission January 2024 Session

The guide and PG dissertation topic details of the students as per the format given below to nttc.jipmer@gmail.com on or before 02.02.2024 need to be sent.

Sl. No.

Name of the resident

Name of the research guide

Proposed area of research/ topic (Optional)

The students are to come with a fully charged laptop, pen drive, and a hard copy of the PGRMC (Word Doc) form, which can be downloaded from the link mentioned in the notice below.

The Jawaharlal Institute of Postgraduate Medical Education & Research is a medical school located in Pondicherry. It is an institute of national importance (INI) and a tertiary care referral hospital. It is under the direct administrative control of the Ministry of Health and Family Welfare and the Indian Government, with autonomy to run its internal administration. The courses include undergraduate, postgraduate, super specialty, fellowships, PhD programs, post-basic diplomas, and certified courses.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/circular-i-yr-pgo-for-md-ms-dm-mch-mds-jan-2024-batch-228823.pdf

Also Read:ICMR Announces ICMR-JRF 2023 Entrance Exam results

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2 international passengers held for allegedly carrying medicines worth Rs 80 lakh at IGI Airport

New Delhi: Two international passengers were apprehended for allegedly carrying medicines worth Rs 80 lakh at IGI Airport in New Delhi, an official statement issued by the Central Industrial Security Force (CISF) said on Tuesday.

According to CISF, the two persons identified as Md Raihan Fazal and Azeem Khan were planning to go to Kabul via Dubai on a flight.
“On 24.12.2023 at about 6:10 pm, on the basis of behaviour detection, CISF surveillance and intelligence staff noticed suspicious activities of two international passengers at Check-in area, Terminal-3 of IGI Airport. On suspicion, passengers later identified as Md Raihan Fazal and Azeem Khan bound for Kabul via Dubai by Air India flight No. AI-995 (STD-2020 hrs) were diverted to the random checking point for thorough checking of their 4 big-size trolley bags,” CISF said in a statement.
CISF said that the images of the bags after their screening raised suspicion and a physical check was done further, which led to the seizure of medicines.
“On screening their four trolley bags through the X-BIS machine, CISF personnel noticed suspicious images. On physical checking, a huge quantity of medicines of approximate value Rs 80 lakh were detected,” CISF said.
“On inquiry, the passengers could not produce supporting documents for carrying such huge quantity of medicines,” the central security force added.
CISF further mentioned that passengers along with detected medicines were handed over to Customs for further action in the matter.
Medical Dialogues team had earlier reported that Narcotics Control Bureau (NCB) Mumbai had successfully busted an international network involved in the illicit trafficking of pharma drugs from India to Australia.

Read also: International network involved in pharma drugs illicit trafficking busted, 3 held

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Medical infrastructure inadequate, Delhi HC directs Govt to submit report in four weeks

New Delhi: The Delhi High Court, during the hearing of a suo motu public interest litigation, expressed its concerns regarding the healthcare facilities in various government hospitals in the capital. The court noted that the medical infrastructure in the national capital is inadequate and there is a shortage of hospital beds.

The division bench, comprising acting Chief Justice Manmohan and Justice Mini Pushkarna, has directed the Delhi government to provide a status report outlining their plan for ensuring a sufficient medical infrastructure to cater to the increasing population of the city.

In an order issued on December 13, the court said “Learned counsel for GNCTD is directed to file a status report within four weeks. The status report will indicate as to how the GNCTD plans to ensure that the medical infrastructure keeps pace with the city’s population.”

Also read- Death Of 14 Year Old Due To Cancer: AIIMS, Safdarjung Hospital Deny Accusations Of Admission Denial

This directive was issued in response to a suo motu PIL initiated in 2017 concerning the issue of the availability of ICU beds and ventilator facilities in government hospitals in the city.

During the proceedings, amicus curiae advocate Ashok Aggarwal presented a newspaper report titled “Turned Away by three hospitals fourteen-year-old cancer patient dies.” The report was published by Hindustan Times on December 07.

Medical Dialogues team had also reported the incident where a 14-year-old girl suffering from blood cancer passed away at AIIMS on December 5 after being denied treatment at several Delhi hospitals. 

According to AAP leader Dilip Pandey, the girl was referred from the Delhi government’s Cancer Institute. Her relatives jostled around AIIMS and Safdarjung Hospital but couldn’t get a bed. As per the report, the minor’s family alleged that three government hospitals in Delhi refused treatment citing lack of medicines, beds or equipment.

However, AIIMS and Safdarjung Hospital had denied these allegations and termed them as “baseless”.

“Upon a reading of this report, it is apparent that medical infrastructure in the city of Delhi is inadequate and the number of hospital beds is insufficient. The demand is far in excess of the supply. The said report is taken on record,” the court observed.

The matter will now be heard on January 29, 2024.

To view the official order, click on the link below: 

https://medicaldialogues.in/pdf_upload/delhi-high-court-order-228767.pdf

Also read- AIIMS Nagpur Inaugurates Autopsy Complex

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DPP-4 inhibitors may Reduce Osteoporosis Risk among Diabetes patients

DPP-4 inhibitors may Significantly improve BMD and Reduce Osteoporosis Risk in Diabetes patients suggests a new study published in the Journal of Clinical Densitometry

Type 2 Diabetes Mellitus (T2DM) frequently coexists with osteoporosis and reduced bone mineral density (BMD). Dipeptidyl peptidase-4 inhibitors (DPP-4i), a class of antihyperglycemic agents, are commonly employed in T2DM treatment. However, the influence of DPP-4i on bone health remains unclear and debated. This meta-analysis is conducted to explore the relationship between the use of DPP-4i and changes in BMD, as well as the prevalence of osteoporosis among T2DM patients.

They conducted a comprehensive search in PubMed, Embase, and Cochrane Library and Web of Science databases for relevant studies published up until June 2023. Studies included in the meta-analysis were those investigating T2DM patients under DPP-4i treatment, and examining the effects on BMD and osteoporosis. Random-effects models and fixed-effect models were utilized to compute the pooled effects. Heterogeneity among the included studies was evaluated using I² statistics.

Results This meta-analysis incorporated a total of 10 studies, encompassing a combined population of 214,541 individuals. The results from this meta-analysis indicated an increase in BMD following DPP-4i usage (SMD 0.15, 95 % confidence interval 0.03-0.26). Additionally, the risk of osteoporosis was significantly reduced (OR 0.90, 95 % confidence interval 0.86-0.94) with very low heterogeneity, recorded at 0 % and 53.0 % respectively. No publication bias was detected in the funnel plot, and sensitivity analyses affirmed the stability of the study’s conclusions.

The results offer valuable insights into the positive impact of DPP-4i on bone health in T2DM patients, contributing to informed clinical decision-making. These findings may inform the development of more comprehensive T2DM management strategies that account for bone health.

Reference:

Huang L, Zhong W, Liang X, Wang H, Fu SE, Luo Z. Meta-Analysis on the Association Between DPP-4 Inhibitors and Bone Mineral Density and Osteoporosis. J Clin Densitom. Published online November 28, 2023. doi:10.1016/j.jocd.2023.101455

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Adenovirus Alert: ICMR cautions West Bengal Govt over deadly variant in kids

Kolkata: Indian Council of Medical Research (ICMR) has cautioned the West Bengal health department over the prevalence of a deadly variant of adenovirus among the children in Kolkata and its adjacent districts.

The revelation has been made following the recent findings of the ICMR- affiliated National Institute of Cholera and Enteric Diseases (NICED)- based on sample testing of persons for adenovirus. 

Also Read:Adenovirus-linked deaths underreported, West Bengal doctor claims children not getting beds

Of the 3,115 individuals tested for adenovirus, a total of 1,257 tested positive and the deadly variant was among 40 individuals, most of whom were children. Confirming the receipt of the alert, a senior official of the state health department said necessary precautions are being taken to tackle any emergency-like situation.

Adenovirus has taken an alarming shape in West Bengal at the beginning of the current financial year of 2023. As per the records of the state health department, as many 1,200 cases of adenovirus-positive persons were detected in the period between the end of December 2022 and the end of March 2023, mostly kids, and the total death figure being affected by it during that period stood at 19.

However, at that point of time there had been controversies over the death figure as doctors’ associations had accused the state health department of showing the figure as truncated.

At that point of time, the state government had even set up an eight-member task force to monitor cases of adenovirus-affected people and ensure proper treatment of them.

Medical Dialogues team had earlier reported that West Bengal was witnessing a spike in Adenovirus cases among children, a prominent doctor has slammed the state government for inadequate preparedness and lack of hospital beds for their treatment. Dr Manas Gumta, general secretary of the Association of Health Service Doctors, alleged that the West Bengal government “underreported” the number of deaths caused by infection of the virus. 

Also Read:Bengaluru registers surge in Adenovirus cases, health experts say no reason to worry

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Transcutaneous Auricular vagus nerve stimulation Effective in Treating Functional Dyspepsia

A recent study published in the The American Journal of Gastroenterology found that transcutaneous auricular vagal nerve stimulation (taVNS) is an effective therapeutic avenue for adults who suffer from functional dyspepsia (FD). FD is a condition marked by persistent upper abdominal discomfort that affects millions globally. This approach pf targeting the vagal nerve has remarkable effectiveness in modulating gastrointestinal motility, inflammation, and nociception.

The study randomly enrolled consecutive FD patients meeting Rome IV criteria. The patients were allocated to receive either 10-Hz taVNS, 25-Hz taVNS, or a sham treatment. Over a period of 4 weeks, participants underwent 30-minute sessions twice a day. The primary outcome measured was the response rate at week 4 that indicated a reduction of ≥5 points in the modified FD Symptom Diary score compared to baseline. Secondary outcomes included the rate of adequate relief and monitoring adverse events.

Among the total 300 patients enrolled, the participants in the V10 and V25 groups demonstrated significantly higher response rates (81.2% and 75.9%, respectively) compared to the sham group (47%). Both V10 and V25 groups also exhibited higher rates of adequate relief (85.1% and 80.8%, respectively) in contrast to the sham group (67%). Also, there was no statistically significant difference between the V10 and V25 groups in terms of response rates and adequate relief. The therapeutic effects of taVNS endured through weeks 8 and 12 of the follow-up period showed its lasting impact, while the adverse events were minimal and comparable across all groups (1%-3%).

This study is the first to demonstrate that a 4-week regimen of taVNS at 10 Hz or 25 Hz  which is both effective and safe for treating adult FD. The findings open new doors for non-invasive neuromodulation techniques in the context of gastrointestinal disorders that provides hope for those seeking relief from the burdens of functional dyspepsia.

Reference:

Shi, X., Zhao, L., Luo, H., Deng, H., Wang, X., Ren, G., Zhang, L., Tao, Q., Liang, S., Liu, N., Huang, X., Zhang, X., Yang, X., Sun, J., Qin, W., Kang, X., Han, Y., Pan, Y., & Fan, D. (2023). Transcutaneous auricular vagal nerve stimulation is effective for the treatment of functional dyspepsia: A multicenter, randomized controlled study. The American Journal of Gastroenterology. https://doi.org/10.14309/ajg.0000000000002548

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Mineral Trioxide Aggregate as root canal filling material tied to less Postoperative Pain

A recent randomized trial published in the BMC Oral Health unveiled promising results regarding root canal filling materials in the management postoperative pain. The study was conducted on 119 patients by comparing the postoperative pain levels between two commonly used materials—gutta-percha (GP) and sealer versus mineral trioxide aggregate (MTA). Researchers found  that Mineral Trioxide Aggregate as root canal filling material tied to less Postoperative Pain compared to gutta-percha (GP) and sealer.

Postoperative pain has been a challenge for clinicians which prompts a rigorous exploration of effective interventions. This trial focused on patients of 18-65 years of age with single-canal premolars diagnosed with asymptomatic apical periodontitis to address a critical gap in pain management techniques.

This two-arm, parallel-group, single-blind trial employed permuted block randomization to group participants into two cohorts. In the GP group (N = 46), root canals were filled with gutta-percha and AH Plus sealer, while the MTA group (N = 48) utilized MTA for apical filling and a combination of gutta-percha and sealer coronally. Pain levels were assessed at specific intervals (6, 12, 24, 48, and 72 hours postoperatively) using a 10-point visual analog scale (VAS).

Over the time this study revealed a significant decrease in mean VAS scores in both groups (P < 0.001). But, the MTA group exhibited notably lower VAS scores compared to the GP group, signifying a superior pain management profile (P < 0.05). Also, an intriguing finding emerged regarding gender differences, with female patients reporting higher VAS scores at specific intervals (6- and 12-hour periods) in both groups (P < 0.05).

The study suggests that MTA as a root canal filling material holds significant outcomes for clinicians in reducing postoperative pain. The superior pain management observed in the MTA group positions it as a valuable option by potentially transforming the landscape of root canal procedures.

Reference:

Khabiri, M., Kamgar, S., Iranmanesh, P., Khademi, A., & Torabinejad, M. (2023). Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial. In BMC Oral Health (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12903-023-03372-6

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Burning occipital headache with Palpebral edema during acute Covid phase may lead to persistent headache

With limited understanding of the clinical spectrum and influencing factors, persistent headaches are becoming a prevalent symptom post-COVID-19. A recent cross-sectional study published in the BMC Infectious Diseases focused on a subset of patients suffering with new daily persistent headache (NDPH).

This comprehensive survey involved a total of 421 participants from 11 Latin American countries that explored the characteristics of persistent headaches following SARS-CoV-2 infection. Importantly, one in four participants met the diagnostic criteria for NDPH which revealed a substantial incidence of this debilitating condition. 

The study was conducted on individuals over 18 who were tested positive for SARS-CoV-2 and reported persistent headaches through an online survey. The results indicated that most participants were female (82%), with an average age of 40 years. Over 90% reported mild to moderate COVID-19 symptoms and 58% had a history of headaches, primarily of migraine-type.

Distinct clinical characteristics emerged, including occipital location, severe intensity, burning character, and radiating pain in individuals who were diagnosed with NDPH. Also, the higher proportions of anxiety symptoms, sleep problems, myalgia, mental fog, and various other symptoms were reported in NDPH patients.

The most significant contribution of the study lies in the identification of risk factors associated with NDPH. Palpebral edema during the acute phase of COVID-19, occipital location, and a burning character of the headache were revealed as potential risk factors. This crucial information provides clinicians with important insights for the early identification and customized management of patients with persistent headaches following COVID-19.

Reference:

Carrión-Nessi, F. S., Ascanio, L. C., Pineda-Arapé, A. G., Omaña-Ávila, Ó. D., Mendoza-Millán, D. L., Romero, S. R., Almao-Rivero, A. B., Camejo-Ávila, N. A., Gebran-Chedid, K. J., Rodriguez-Saavedra, C. M., Freitas-De Nobrega, D. C., Castañeda, S. A., Forero-Peña, J. L., Delgado-Noguera, L. A., Meneses-Ramírez, L. K., Cotuá, J. C., Rodriguez-Morales, A. J., Forero-Peña, D. A., & Paniz-Mondolfi, A. E. (2023). New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study. In BMC Infectious Diseases (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12879-023-08898-2

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