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According to recent Tulane University study, a low-carb diet can help patients with uncontrolled diabetes and lower blood sugar levels in those at risk of acquiring diabetes.
The research, which was published in the journal JAMA Network Open, examined two groups: one that was allocated to a low-carb diet and another that stayed on their regular diet. When compared to the control group, the low-carb diet group experienced higher declines in haemoglobin A1c, a blood sugar level marker, after six months. The group that followed a low-carbohydrate diet likewise lost weight and had reduced fasting glucose levels.

“The crucial message is that, if followed consistently, a low-carbohydrate diet may be a beneficial therapy for preventing and treating Type 2 diabetes,” said lead author Kirsten Dorans, associate professor of epidemiology at Tulane University School of Public Health and Tropical Medicine.
Diabetes affects around 37 million Americans and is caused by the body’s inability to effectively utilise insulin and manage blood sugar levels. According to the Centers for Disease Control and Prevention, type 2 diabetes accounts for more than 90% of those cases (CDC).

Type 2 diabetes may have a negative influence on quality of life by causing symptoms such as impaired vision, numb hands and feet, and fatigue, as well as other major health conditions such as heart disease, eyesight loss, and kidney disease.
The study’s findings are especially noteworthy for those with prediabetes, who have A1c values that are higher than usual but not high enough to be categorised as diabetic. According to the CDC, around 96 million Americans have prediabetes, and more than 80% of individuals with prediabetes are unaware of it. Those with prediabetes are more likely to develop Type 2 diabetes, heart attacks, or strokes and are less likely to take blood sugar-lowering drugs, making a balanced diet even more important.

Participants in the research had blood sugar levels ranging from prediabetic to diabetic and were not taking diabetes medication. A1c readings dropped 0.23% more in the low-carb group than in the regular diet group, which Dorans described as “small but clinically meaningful.” Importantly, lipids accounted for around half of the calories consumed by the low-carb group, but they were primarily beneficial monounsaturated and polyunsaturated fats found in foods such as olive oil and almonds.
The study, according to Dorans, does not establish that a low-carb diet prevents diabetes. However, it does pave the way for more study into ways to reduce the health risks of those with prediabetes and diabetes who are not being treated with medication.

“We already know that a low-carbohydrate diet is one dietary option utilised among patients with Type 2 diabetes,” Dorans said, “but there isn’t as much research on the impact of this diet on blood sugar in persons with prediabetes.” “Future research might be conducted to see whether this dietary approach could be an alternate option for Type 2 diabetes prevention.”

Researchers observed that one-third of persons with varied degrees of chronic renal illness who did not receive dialysis and replied to yearly questionnaires about their symptoms had a “worse symptom score and worsening trajectory” of symptoms. According to CJASN, these individuals were at a particularly high risk of needing dialysis and dying before commencing treatment.
The Kidney Disease Quality of Life-36 questionnaire was filled out by 2,787 people in France who had CKD but were not on dialysis for a research led by Moustapha Faye, MD (CHRU Nancy, Universite Cheikh Anta Diop de Dakar) and colleagues.

98% of participants reported having at least one symptom, with the prevalence of each symptom ranging from 24% (chest pain) to 83%. (fatigue). After a median follow-up of 5.3 years, 690 patients underwent kidney replacement treatment (KRT), such as dialysis, whereas 490 died before starting KRT. The researchers discovered two types of symptom trajectory profiles: a “worse symptom score and worsening trajectory” in 31% of participants, defined by a low initial symptom score that worsened by more than 10 points (on a scale of 0-100) over time, and a “better symptom score and stable trajectory” in 69% of participants, defined by a high initial score that remained stable over time.

Participants in the “Worse symptom score and deteriorating trajectory” group exhibited more risk factors for CKD progression at baseline, a worse quality of life, and a greater likelihood of KRT and mortality before KRT than other participants.
“In addition to the established CKD categories, it is feasible to actively monitor symptoms and classify patients based on their progression. This monitoring should include practitioners as well as patients “Dr. Faye said. “Through active symptom tracking, early therapy actions to assist control various symptoms may be organised.”

The female mosquito will bite everyone, albeit some of us get much more bites than others. Our skin may hold the key to figuring out why.
This is why Vosshall and a former postdoc in her lab, Maria Elena De Obaldia, chose to study the top theory to explain for variances in mosquito attraction: personal odour variations connected to skin microbiota. According to a new study, the strong aroma created by skin-emanating fatty acids may be what repels mosquitoes. Cell published its findings.

“There’s a very, very significant link between having a lot of these fatty acids on your skin and being a mosquito magnet,” says Robin Chemers Neustein Professor at The Rockefeller University and Chief Scientific Officer of the Howard Hughes Medical Institute, Vosshall.
For the length of the three-year study, eight people were required to wear nylon stockings over their forearms for six hours every day. This procedure was repeated multiple times. Over the next several years, the nylons were put against one another in every imaginable pairing in a round-robin type “tournament.”

De Obaldia devised a two-choice olfactometer test for them, consisting of a plexiglass chamber divided between two tubes, each ending in a box containing a stocking. They placed Aedes Aegypti mosquitos in the main room, which are the primary vectors of Zika, dengue, yellow fever, and chikungunya. They stood there watching as the insects flew down the tubes, one nylon after the other.
Subject 33 was by far the most appealing target for Aedes aegypti, attracting mosquitos 100 times more than the least appealing research participant, Subject 19, and four times more than the next most appealing subject.

Because the trial samples were de-identified, the researchers had no means of knowing which participant wore which nylon. However, in any research including Subject 33, they would notice that something was wrong because flies would swarm to that sample. According to De Obaldia, it will become obvious immediately after the test begins. This is the type of material that genuinely interests me as a scientist. This is a real incident. This is not a nitpicking situation. It has a substantial influence.

The patients were separated into high and low attractor groups, and the researchers then asked what made each group distinct. Chemical analysis techniques were used to identify 50 molecular components that were more abundant in the sebum (a moisturising barrier on the skin) of the most attractive people.
This led them to the conclusion that mosquito magnets produced significantly more carboxylic acids than the less attractive people. Bacteria on our skin produce our particular human body odour utilising chemicals present in sebum.
To confirm their findings, Vosshall’s team recruited an additional 56 people for a validation study. Subject 33 remained the most captivating subject throughout history.

“Some participants were in the research for several years, and we discovered that if they were a mosquito magnet, they stayed a mosquito magnet,” De Obaldia explains. “Many aspects about the subject or their behaviours may have altered over time, yet this was a highly stable feature of the person.”
Mosquitoes have two separate sets of olfactory receptors called Orco and IR receptors, which they employ to identify two types of human odours.
The researchers created mutants lacking one or both of the receptors to see whether they might create mosquitos that couldn’t sense humans.

While IR mutants lost their attraction to us to variable degrees but retained the ability to detect us, Orco mutants remained attracted to people and were able to differentiate between mosquito magnets and low attractors.
These discoveries were unexpected by the investigators. “The goal was to generate a mosquito that was no longer attracted to people, or a mosquito that was attracted to everyone but couldn’t tell the difference between Subject 19 and Subject 33.” That would be excellent, according to Vosshall, since it would spur the development of more effective pesticides. “However, we didn’t actually observe that.” It irritated me.”

These findings support one of Vosshall’s previous investigations, which was also published in Cell and highlighted the redundancy of Aedes aegypti’s extraordinarily sophisticated olfactory system. The female mosquito depends on it to survive and reproduce. She can’t do either without blood. That’s why, according to Vosshall, “she has a backup plan and a backup plan and a backup plan and is sensitive to these variances in the skin chemistry of the people she goes after.”
Because of the mosquito smell tracker’s seeming indestructibility, it’s difficult to conceive a future where people aren’t the primary entrée. Changing the microbiomes on our skin, on the other hand, is one approach.

Applying sebum and skin bacteria from a low-appeal person’s skin, such as Subject 19, to the skin of a high-appeal person, such as Subject 33, is likely to have the effect of concealing mosquitoes.
“We haven’t done that experiment,” says Vosshall. “That is a difficult experiment. But, if that were to succeed, you might envision that by using a nutritional or microbiome intervention in which bacteria on the skin are able to modify how they interact with sebum, you could transform someone like Subject 33 into Subject 19. But this is all theoretical.”
Given the mosquito scent tracker’s seeming impenetrability, it’s difficult to envisage a future where humans aren’t the most popular meal on the menu.

Changing our skin’s microflora is one option. It is possible to create a mosquito-masking effect by transferring sebum and skin bacteria from a low-appeal person’s skin, such as Subject 19, to the skin of a high-appeal person, such as Subject 33.

Vaccines work by effectively creating immune cells that have a long lifespan—often for decades. These immune cells create a defence barrier that can prevent or reduce re-infection, as well as a memory that allows us to detect a past invader, such as a virus, and eradicate it before it causes illness. While the importance of these “long lived plasma cells” has long been recognised, how and when they are created following immunisation has remained unknown. These cells produce the antibody in our blood that acts as a barrier.

A team led by Dr. Marcus Robinson and Professor David Tarlinton from Monash University’s Immune Memory Laboratory, and published in the prestigious Science Immunology journal, demonstrated in real time how immune memory cells are stored in the bone marrow at a rate of one single cell per hour for several weeks after immunisation. To trace the slow growth of these cells, the researchers utilised a genetic approach in mice. This approach, known as timestamping, enables researchers to permanently record all plasma cells present at a certain moment after immunisation and then return later to identify those that have survived and are therefore long-lived.

The researchers showed the history of the accumulation of these long-lived cells by doing this on a regular basis following immunisation, pinpointing when they were formed and where they travelled.
After receiving a vaccine, we are mostly resistant to that illness because our systems continue to produce antibodies against the vaccinated sickness, effectively keeping us topped up on these antibodies.
While we know where these long-lived plasma cells are created in the body, including lymph nodes, tonsils, and the gut, we don’t know what causes some vaccinations to lead to these cells being around for decades vs some that expire after a few months.

Given the global interest in long-term immunity conferred by COVID vaccines, understanding this mechanism is becoming increasingly important.
Using a mouse model in which a fluorescent protein (named the TdTomato protein) was produced only in cells making antibodies against a particular vaccination.
Because these cells fluoresced, researchers were able to follow individual cells as they were generated and preserved.
The researchers employed a number of methods to identify just the plasma cells produced by the vaccination.

All plasma cells in the mouse model produced a fluorescent protein (called TdTomato protein), and among those, they identified those that recognised the vaccination, and ultimately, they determined when those cells were formed and hence how old they were by utilising the timestamp.
According to Professor Tarlinton, monitoring these individual cells as they are created, mature, and are kept to defend us from a certain virus or bacteria’s recurring invasion “may enrich our knowledge of how the recruitment of long-lived plasma cells happens.”
Because of the study’s complexity, the researchers were able to discover other elements of the development of particular immunity:

How do plasma cells get into the bone marrow?
Whether these plasma cells must displace other cells when kept in places like bone marrow.
Or if these cells “discover” an empty niche left by earlier plasma cells dying or going elsewhere.
Mapping these cells indicated that one immunisation in a mouse resulted in the production of around 40,000 persistent plasma cells in the bone marrow. Following the first flourish, these cells drop at a rate of roughly 0.1% per day, with a half life of around 700 days, providing both an indication of the length of protection and identifying the long-lived cells for further investigation.

Understanding how these long-lived plasma cells are generated, live, and die, according to Professor Tarlinton, “will inform our ability to modulate their recruitment, through different vaccine combinations or delivery strategies – ultimately allowing us to be able to increase the longevity of immunity.”
“In fact, there is recent work in Nature that demonstrates how changing the mechanics of vaccination may drastically impact the character of the immune response, and we would expect the development of these particular cells that have been the focus of our work.”

According to new research, women who experienced substantial stress as a result of the COVID-19 epidemic were twice as likely to see changes in their menstrual cycle.
The study’s findings were published in Obstetrics & Gynecology by the University of Pittsburgh. According to the researchers, more than half of the study participants reported changes in menstrual cycle length, period duration, menstrual flow, or increased spotting, which might have economic and health ramifications for women.

“Early in the pandemic, it would come up anecdotally in talks with girlfriends and other women that ‘things have been kind of crazy with my period since the epidemic,'” said lead author Martina Anto-Ocrah, Ph.D., M.P.H., M.T. (A.S.C.P.). “We know that the epidemic has been a tremendously stressful period for many individuals, and we know that stress may appear in women’s bodies as alterations in menstruation function.”
Between March 2020 and May 2021, Anto-Ocrah and her colleagues created a two-part survey that contained a validated COVID-19 stress scale and self-reported menstrual cycle alterations.

The researchers collaborated with a market research firm to recruit a geographically and ethnically diverse set of participants to conduct the online survey in order to reach a varied population that was representative of the United States. They limited the sample to women between the ages of 18 and 45 who did not use chemical birth control.
10.5% of the 354 women who completed both portions of the poll expressed excessive stress.
After controlling for age, obesity, and other factors, the researchers discovered that women with high COVID-19 stress were more likely than their low-stress counterparts to report changes in menstrual cycle length, period duration, and spotting. In the high stress group, there was also a trend for higher menstrual flow, however this result was not statistically significant.

“Women’s responsibilities were reinterpreted throughout the epidemic, and as a society, we made steps back in terms of gender parity,” Anto-Ocrah explained. “Women frequently bore the burden of childcare and domestic responsibilities, and they perceived changes in daily activities and the risk of COVID-19 infection to be more stressful than males.”
Approximately 12% of subjects reported alterations in all four menstrual cycle aspects, which the researchers described as concerning.
“The menstrual cycle is an indicator of women’s general well-being,” Anto-Ocrah explained. “Menstrual cycle disruption and variable hormones can have an influence on fertility, mental health, cardiovascular disease, and other consequences. Finally, these issues can influence interpersonal dynamics, thereby adding strain to partnerships.”

Longer, more frequent, or heavier periods can also strain women’s budgets due to increased prices for feminine hygiene supplies.
“We know that the epidemic has had a detrimental economic impact on many individuals,” Anto-Ocrah added. “It’s a double whammy if modifications to your flow during a time of economic difficulty boost period-related charges – or the ‘tampon tax’ – economically.”
She believes that the findings will spur additional global research on COVID-19 stress and women’s health, including long-term implications on fertility, menopausal transition, and mental health.

An ultrasound scan can be used to diagnose prostate cancer, according to new study.

In a clinical experiment involving 370 men, researchers from Imperial College London, University College London, and Imperial College Healthcare NHS Trust discovered that a novel form of ultrasound scan may accurately detect most prostate cancer cases. When compared to magnetic resonance imaging (MRI) scans, ultrasound scans missed just 4.3 percent more clinically significant prostate cancer cases (cancer that should be treated rather than watched).

MRI scans are expensive and time-consuming. The team believes that an ultrasound scan should be used as a first test in a community healthcare setting and in low and middle-income countries which do not have easy access to high-quality MRI scans. They say it could be used in combination with current MRI scans to maximise cancer detection. The study is published in Lancet Oncology.

Professor Hashim Ahmed, lead author of the study and Chair of Urology at Imperial College London, said: “Prostate cancer is the most commonly diagnosed cancer in the UK. One in six men will be diagnosed with the disease in their lifetimes and that figure is expected to rise.

“MRI scans are one of the tests we use to diagnose prostate cancer. Although effective these scans are expensive, take up to 40 minutes to perform and are not easily available to all. Also, there are some patients who are unable to have MRI scans such as those with hip replacements or claustrophobia fears. As cancer waiting lists build as a result of the COVID-19 pandemic, there is a real need to find more efficient and cheaper tests to diagnose prostate cancer.

“Our study is the first to show that a special type of ultrasound scan can be used as a potential test to detect clinically significant cases of prostate cancer. The can detect most cases of prostate cancer with good accuracy, although MRI scans are slightly better.

“We believe that this test can be used in low and middle-income settings where access to expensive MRI equipment is difficult and cases of prostate cancer are growing.”

Prostate cancer is the most common cancer in men in the UK with around 52,300 new cases diagnosed each year. It develops when cells in the prostate grow in an uncontrolled way. Prostate cancer develops slowly and symptoms such as the blood in the urine do not appear until the disease has developed. It usually affects men over 50 and often men with a family history of the disease. Black men are disproportionately impacted by the disease and deaths from prostate cancer have now overtaken those from breast cancer.

One of the main methods to diagnose prostate cancer is a special type of magnetic resonance Imaging (MRI) scan called a multi-parametric MRI (mpMRI) scan, which helps doctors see if there is any cancer inside the prostate and how quickly the cancer is likely to grow. However, the scan takes 40 minutes and costs £350-450.

The new study looked at the use of a different kind of imaging called multiparametric ultrasound (mpUSS), which uses soundwaves to look at the prostate.

The test involves the use of a probe called a transducer to make the images of the prostate. It is placed into the rectum and it sends out sound waves that bounce off organs and other structures. These are then made into pictures of the organs.

The doctor doing the test also uses extra special types of ultrasound imaging that look at how stiff the tissue is and how much blood supply the tissue has. These are called elastography, doppler and contrast-enhancement with microbubbles. As cancers are more dense and have greater blood supply, they show up more clearly.

Although mpUSS is more widely available than mpMRI there has been no large-scale studies to validate its effectiveness as a test to detect prostate cancer cases.

In the new trial, called cancer diagnosis by multiparametric ultrasound of the prostate (CADMUS), the team recruited 370 men at risk of prostate cancer. They were identified following initial tests such as a prostate-specific antigen (PSA) test- a blood test to help detect prostate cancer — and/or an abnormal digital rectal examination — a test that examines a person’s lower rectum, pelvis, and lower belly.

The study took place at seven hospitals in the UK including lead site Charing Cross Hospital, part of Imperial College Healthcare NHS Trust, between March 2016-November 2019.

The men were given both mpUSS and mpMRI scans at separate visits. This was then followed by biopsies — which involves using thin needles to take small samples of tissue from the prostate to analyse under a microscope to check cancer — for 257 patients who had a positive mpUSS or mpMRI test result. The team then compared the results from the tests.
Cancer was detected in 133 men, with 83 men diagnosed with clinically significant cancer.

Individually, mpUSS detected 66 cases of clinically significant cancer compared to mpMRI which detected 77 cases.

Although mpUSS detected 4.3 per cent fewer clinically-important prostate cancers compared to mpMRI the researchers said this method would lead to 11.1 per cent more patients being biopsied. This was because the mpUSS sometimes showed up abnormal areas even though there was no cancer.

The researchers believe that the test can be used as an alternative to mpMRI as a first test for patients at risk of prostate cancer, particularly where mpMRI cannot be carried out. Both imaging tests missed clinically-important cancers detected by the other, so using both would increase the detection of clinically-important prostate cancers compared to using each test alone.

First author, Dr Alistair Grey (UCL Division of Surgery & Interventional Science), said:
“Our results provide an accurate test for prostate cancer in patients who were previously without one using a scan that’s cheap and easy to conduct.”

Also Read: Scientists attempt to alleviate nightmares by manipulating emotions in dreams

Nightmares, those horrific experiences that reappear in dreams, can become commonplace, visiting people numerous times each week for months on end.

Dreamers in treatment may be trained to practise happy versions of their most common nightmares. Still, in a study of such individuals published in the journal Current Biology, Swiss researchers go a step further. They observed that using a wireless headband to broadcast a sound connected with a happy daily experience during sleep may lessen the incidence of nightmares.

“There is a relationship between the types of emotions experienced in dreams and our emotional well-being,” says senior author Lampros Perogamvros, a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva. “Based on this observation, we had the idea that we could help people by manipulating emotions in their dreams. In this study, we show that we can reduce the number of emotionally very strong and very negative dreams in patients suffering from nightmares.”

Epidemiological studies have found that up to 4 per cent of adults have chronic nightmares at any given time, a condition frequently associated with waking up during the night and poor sleep quality. Patients are frequently prescribed imagery rehearsal therapy, which requires them to rewrite the negative dream scenario and rehearse it during the day. While effective, some cases do not respond.

Perogamvros and his colleagues examined 36 patients who were all receiving imagery rehearsal therapy to see if sound exposure during sleep could improve success. The other half of the group was required to create an association between a positive version of their nightmare and a sound during an imagination exercise, which they needed to practice daily and to wear a headband that could send them the sound during REM sleep for two weeks. This is the stage of sleep where most nightmares occur.

“We were positively surprised by how well the participants respected and tolerated the study procedures, for example performing imagery rehearsal therapy every day and wearing the sleep headband during the night,” says Perogamvros.

“We observed a fast decrease in nightmares, together with dreams becoming emotionally more positive. For us, researchers and clinicians, these findings are very promising both for the study of emotional processing during sleep and for the development of new therapies.”

The number of nightmares per week decreased in both groups, but the half who received the combo therapy experienced fewer nightmares both throughout the intervention and three months later. They also experienced more delight in their dreams. The findings back up the hypothesis that such combination therapy should be studied on a bigger scale and with a diverse population to evaluate the degree and generalizability of its efficacy.

Also Read: Tuberculosis cases surged for the first time in many years: WHO

Article By: Dr Sudhir Kumar, Professor & HOD, Neurology Unit, Apollo Institute of Neurosciences, Hyderabad

Stroke is a serious neurological illness caused by blockage of blood supply to or bleeding into a part of brain, resulting in paralysis. It is the third leading cause of death and disability in the world, only behind heart attacks and cancer. One in six persons develop stroke in their lifetime and the prevalence of stroke increases to 1 in 4 people aged 40 or above. Every 20 seconds, one Indian suffers a stroke (or three persons every minute) and the numbers are alarmingly increasing due to changing lifestyle.

In Telangana including Hyderabad, the cases of stroke have spiraled since the COVID-19 pandemic. We have seen at least a 20% rise in cases of stroke in Hyderabad. COVID 19 infection increases the risk of stroke due to inflammation as well as hypercoagulable state (when blood clots easily in brain arteries). Covid vaccines also slightly increase the risk of strokes. Other causes contributing to a rise in stroke cases are anxiety & stress (which have increased since the pandemic), sleep deprivation (due to late office hours or engaging in late night parties) and alcohol abuse (Telangana holds the dubious distinction of being the second ranked state after Arunachal Pradesh in terms of alcohol consuming households).

Stroke prevalence is high in rural Telangana too. In a study conducted by Apollo hospital, Hyderabad in 2020 (published in Journal of Neurosciences in Rural Practice), the prevalence of stroke was found to be 27 per 10,000 population in Moinabad Mandal. Risk factors for stroke in rural Telangana were found to be smoking, alcohol consumption, high BP, high cholesterol, and central obesity.

Another feature noted in Telangana has been a higher incidence of stroke in younger population, mostly men aged 50 or less. Alcohol consumption and smoking have been found to be the causative factor of stroke in 70-80% of them. Post-Covid complications, unhealthy dietary habits and lack of exercise also contributed.

All is not gloomy when it comes to stroke in Telangana, there are silver linings too. People are now more aware of stroke symptoms and the fact that emergency treatment is needed for complete recovery. Compared to 5 years back, we are now doing double the number of stroke thrombolysis (clot buster therapy) and thrombectomy procedures (interventions to remove the clot from brain artery), which are time-bound treatments (effective in the first few hours after symptom onset). Availability of CT/MRI scan facilities and expert stroke care centers have also improved in Hyderabad and rest of Telangana.

We are now able to guide doctors in rural centers through TELESTROKE program (via Telemedicine) to administer advanced stroke treatments. Post-stroke care has also improved. People understand the benefits of rehabilitation and physiotherapy in stroke survivors, and this is reflected in the increased demand for rehabilitation beds in our hospital.

Also Read: Ultrasound scan can detect prostate cancer: Research