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No Evidence that Testosterone Improves Brain Fog During Menopause

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There is not enough evidence to determine whether testosterone helps with thinking and memory in midlife women, even though it is often prescribed in the UK, according to a UCL study.

Published in Reproduction and Fertility, the review examined five existing studies of women aged 41 to 65 to understand whether testosterone treatment improves thinking and memory in women during and after menopause.  

Senior author and Director of the UCL Menopause Mind Lab Professor Aimee Spector (UCL Psychology and Language Sciences) said: “Social media is flooded with claims that testosterone improves memory and brain fog, and we hear of many women taking testosterone specifically to manage these symptoms during the menopause. While there may be some anecdotal evidence for this in perimenopausal women (who are missing from these trials), we cannot claim testosterone improves cognition during menopause without further evidence. 

“More research is needed to understand any links between testosterone and brain health.”

The menopause is when a woman’s periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55. Post menopause is the stage of life that begins 12 consecutive months after a woman’s final menstrual period and lasts for the rest of her life.  

The menopause transition and post menopause have been associated with cognitive complaints, often described as ‘brain fog’. This includes difficulties recalling words and numbers, misplacing items, trouble concentrating and forgetfulness. It is thought that testosterone levels do not acutely change during menopause but instead begin to decline from a woman’s mid-20s to early 30s. 

Researchers reviewed five different studies to determine whether testosterone improved executive function, verbal learning and memory, and visuospatial learning and memory in post-menopausal women.  

Many of the study participants were given testosterone while most of the other participants were given a placebo, administered on a daily, weekly or monthly basis for periods ranging between four to 26 weeks. Researchers then compared the effects of cognition between testosterone and the placebo.  

The authors conducted a meta-analysis on the results of three of the five studies, which examined a total of 244 women in randomised controlled trials, and they did not find any statistically significant improvements for cognitive function among participants taking testosterone. 

Hormone treatments are often used to manage menopause symptoms, but it is unclear whether they help with brain fog. Current guidance from the British Menopause Society and the International Menopause Society only supports testosterone therapy for low libido, and the researchers note its effects on thinking and memory are not well understood. 

The researchers say that testosterone prescribing has anecdotally increased across NHS and private clinics in the UK, reflecting growing interest in its role during menopause.    

Corresponding author Dr Alexandra Faulkner (UCL Psychology and Language Sciences) said: “Our review found that the available evidence is limited and insufficient to determine the effect of testosterone therapy on cognition in women during the menopause transition and post menopause. This reflects a lack of sufficient evidence rather than evidence of no effect.” 

Further research is needed to guide treatment decisions and support women in making informed choices about their care, particularly in women going through the menopause. Future research should also explore how women perceive changes in their thought processes and memory. 

Data was included from Australia, Canada, the USA and Sweden to complete this review.  

The researchers note that the studies available were limited in number and sample size, with the existing evidence base too small to draw firm conclusions about whether testosterone therapy helps cognitive symptoms during menopause. The findings should not be interpreted as proof that testosterone has no effect on cognition.  

Source: University College London

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Night Shifts During Pregnancy Linked to Greater Neurodevelopmental Abnormality Risk

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But nightly prenatal sleep length may modify this association, exploratory findings suggest

Working night shifts during pregnancy is linked to a heightened risk of neurodevelopmental abnormalities detected by screening in the child by the age of 4, finds research published online in Occupational & Environmental Medicine.

But nightly prenatal sleep length during this period may modify this observed association, exploratory findings suggest.

Night shift work during pregnancy has been associated with unfavourable health outcomes for both mother and child, including neurodevelopmental issues, potentially related to body clock and sleep disturbances, note the researchers.

They therefore wanted to explore the associations between mums’ night shift work and their children’s neurodevelopment and to find out if there are potentially modifiable prenatal factors, such as changes in night shift patterns and sleep duration.

They drew on nationwide survey data for around 100 000 pregnant women from the Japan Environment and Children’s Study (JECS) who were enrolled between January 2011 and March 2014.

The women were surveyed in the first and second/third trimesters and answered questions about the number of night shifts they worked in a month.

Their responses were divided into 3 groups: no night shifts reported in either survey (27 655 women); night shifts in the first, but not second survey (‘discontinued night shifts’, 1779 women); and night shifts in both surveys (‘continued night shifts’, 2084 women).

Prenatal sleep length was calculated from self-reported bedtime and wake-up times in the second/third trimester. Sleep length was categorised as short if less than 6 hours; moderate if 6–9 hours; and long if 10 or more hours.

Child neurodevelopmental abnormalities at the age of 4 were assessed using a developmental screening tool—the Japanese version of the Ages and Stages Questionnaire, Third Edition (J-ASQ-3).

This is made up of 5 domains: communication; gross motor skills; fine motor skills (ability to make small, precise, deliberate movements); problem solving; and personal–social functioning (interpersonal skills, emotional/behavioural development, and awareness of personal boundary/space).

In all, 31,528 mothers who worked in the first trimester and completed the child development questionnaire when their children were 4 years old were included in the analysis.

Some 4189 (just over 13%) of the 4 year olds were classified as high risk of an abnormality in at least one of the five J-ASQ-3 domains: 1210 (4%) for communication; 1599 (5%) for gross motor skills; 1906 (6%) for fine motor skills; 913 (3%) for problem solving; and 1495 (5%) for personal–social functioning.

Compared with the children of mothers who didn’t work night shifts, the children of those who discontinued night shift work were more likely to have developmental screening abnormalities, but only in the fine motor skills domain (24% higher risk).

But the children of mothers who continued night shifts during their pregnancy had higher risks of developmental abnormalities in 3 domains compared with children whose mothers didn’t work night shifts.

These were in the domains of communication skills (29% higher risk); fine motor skills (34% higher risk); and personal–social functioning (31% higher risk).

Only the fine motor skills domain showed a significant association, regardless of whether night shifts were continued or discontinued.

“One possible explanation is that maternal inflammation associated with persistent night work may preferentially affect neural pathways involved in fine motor function,” suggest the researchers.

A separate exploratory analysis showed that the observed association between night shift pattern and the child’s neurodevelopmental risk differed according to how long the mothers slept.

Prenatal sleep duration of 10 or more hours was associated with an 80% heightened risk of abnormalities in any of the 5 domains compared with prenatal sleep length of 6-9 hours.

Long prenatal sleep duration may also reflect underlying fatigue, subclinical depression, inflammation, or anaemia, rather than representing a harmful exposure in itself, suggest the researchers.

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that they weren’t able to account for shift rotation systems, individual chronotype, workload, exposure to light, or the timing of night shift discontinuation, all of which might have influenced the findings.

But in light of the findings, it may be worth employers considering flexible work schedules for pregnant night shift workers, they say.

Source: The BMJ Group

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Kidney Trial Challenges Dialysis as Standard for Older Frail Adults

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Human kidney. Credit: Scientific Animations CC0

Dialysis should not necessarily be regarded as the default option for older people with kidney failure, a major study led by Bristol NHS Foundation Trust and the University of Bristol has found.

The findings are from the Prepare for Kidney Care trial, the first randomised study of its kind in the world, published in The Lancet on 5 November. The study suggests a structured, less medicalised approach without dialysis may offer an alternative without compromising a person’s overall length and quality of life.

The trial investigated whether older people living with kidney failure and multiple health conditions or frailty would benefit more from dialysis or a structured programme of care that does not include dialysis. It looked at both quality of life and survival.

The researchers aim to help patients and their families reach the best decision for them, offering by far the best evidence on this issue. They also want to influence NHS policy on care for this group of patients.

Funded by the National Institute for Health and Care Research (NIHR), the study recruited 445 participants from 31 UK kidney centres. This represents around half of all UK kidney services. 

Around 75% of participants were aged 80 or over. The remaining 25% were aged 65–79 and had additional health problems.

Participants were randomly allocated to one of two approaches: prepare for renal dialysis or prepare for responsive management (a form of conservative kidney management). The study took nine years to complete, including seven years to recruit, and participants could choose to withdraw at any time.

Over an average follow-up period of 4.5 years, the team found neither approach resulted in better outcomes when length and quality of life were considered together. 

Only one in four people (28%) who were preparing for dialysis went on to start treatment. Participants in both groups were more likely to die from other causes than to require dialysis, reflecting the vulnerability and complex health needs of this population.

The results do not apply to people already receiving dialysis, or to younger and fitter patients, for whom dialysis and transplantation remain standard care.

Fergus Caskey, Professor of Renal Medicine in Bristol Medical School, Consultant Nephrologist at Bristol NHS Foundation Trust and project lead, said:

“Our findings could have global implications for how kidney failure is discussed and managed in older patients living with multiple health conditions or frailty. Conservative kidney management is an active treatment that does not include dialysis. It is increasingly recognised around the world, but until now there has been limited evidence to compare both approaches.

“This trial establishes that if you are an older person with failing kidneys and other health problems, both preparing for dialysis and conservative kidney management are worth considering. Both have pros and cons. They result in similar overall length and quality of life. Neither should be the default.

“Carrying out a trial like this presented significant ethical challenges, but we worked hard to develop a trial where all participants retained their choice about taking part and could change their treatment pathway at any point.”

Dialysis can place a considerable burden on patients and families, often requiring frequent travel, regular treatments and medical procedures. It also carries the risk of complications. With costs estimated at around £35 000 per patient each year, dialysis also represents a significant commitment of NHS resources.

The trial was co-designed with patients and kidney specialists and included interviews with participants and their families to better understand their experience of the treatments.

The research team recommend that dialysis preparation should no longer be the default pathway for older people living with kidney failure and multiple other health problems or frailty. Instead, both treatment approaches should be presented as equally valid options, with decisions made jointly by patients and their healthcare teams.

Watch the video

Source: Bristol NHS Foundation Trust

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Lung Antibodies Can be Measured in Exhaled Breath

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Illustration: Lovisa Thålin

For the first time, researchers have successfully measured antibodies against specific respiratory viruses in exhaled air. This is shown in a new study involving, amongst others, the Karolinska Institutet, published in eBioMedicine. The method may make it easier to study the immune system in the small airways of the lungs.

Antibodies in the mucosal lining of the respiratory tract play an important role in protecting against respiratory viruses such as influenza virus, SARS-CoV-2 and respiratory syncytial virus (RSV). While antibodies in the upper airways are relatively easy to measure, sampling from the lower airways has previously required invasive procedures such as bronchoscopy.

In the new study, researchers used a non-invasive method called PExA (Particles in Exhaled Air). By breathing into a specially designed instrument, participants generated tiny exhaled particles originating from the respiratory tract lining fluid of the small airways. These particles were collected and analysed for virus-specific antibodies.

“Antibodies in the nasal mucosa are important for protection against respiratory infections, but immune responses further down the lungs are also crucial, particularly for preventing severe disease such as pneumonia. This method opens up new possibilities for understanding how immunity differs between the upper and lower airways,” says Charlotte Thålin, adjunct professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, and co-last author of the study.

The study included 28 participants in the COMMUNITY cohort at Danderyd Hospital, 18 of whom had recently experienced a respiratory tract infection. The researchers analysed paired samples from blood, nasal secretions and exhaled breath.

In the exhaled breath samples, the researchers successfully detected IgA and IgG antibodies directed against SARS-CoV-2, influenza virus and RSV. Virus-specific IgG levels in the lower airway samples largely mirrored those observed in blood, whereas IgA showed a different pattern, consistent with a greater contribution from local mucosal antibody responses.

“Sampling is relatively simple, as participants simply need to breathe into a device. This enables us to collect samples from the small airways without invasive procedures, which is particularly valuable if we wish to take repeated samples and monitor the immune system over time,” says Katherina Aguilera, a PhD student at the same department, and the study’s first author.

In the future, the method could help researchers investigate how immune responses in the lower airways change following respiratory infections or vaccinations, and and support the evaluation of preventive treatments. The researchers emphasise that this was an initial methodological study involving a limited number of participants and that further validation in larger studies is needed.

The study was conducted in collaboration between Karolinska Institutet, Danderyd Hospital, Uppsala University, and SciLifeLab. Funding was provided by the European Research Council (ERC), the Knut and Alice Wallenberg Foundation and the Swedish Society for Medical Research (SSMF). 

Source: Karolinska Institutet

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Shockwave Therapy and Manipulation may Bring Temporary Relief for Frozen Shoulder

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Findings may be useful for informing early treatment decisions, but evidence on longer term effectiveness and safety lacking 

Photo by Kampus Production

Extracorporeal shockwave therapy probably reduces short term pain linked to frozen shoulder, while manipulation under anaesthesia – with or without steroid injections – probably improves short term flexion (raising the arm forward and overhead) compared with usual care, finds a review of the latest trial evidence published by The BMJ.

Most other treatment effects remain uncertain due to low certainty evidence and inconsistent data, and comparative safety and longer term effects are not well established.

Frozen shoulder (adhesive capsulitis) occurs when the strong connective tissue surrounding the shoulder joint becomes thick, stiff and inflamed, causing pain and restricted movement. It’s more common in people aged 40-60 years, and among women than men.

Many treatments are available, including drugs, steroid injections, and surgery, but their comparative benefits and harms remain uncertain.

To address this, researchers analysed the results of 189 randomised controlled trials involving 12 988 adults (average age 54 years) with adhesive capsulitis comparing active treatments with another intervention, placebo, or usual care on pain, function, range of motion, and adverse events.

Moderate certainty evidence showed that extracorporeal shockwave therapy (low energy sound waves delivered to damaged tissue to stimulate blood flow and healing) probably reduced short term pain compared with usual care (mean difference -1.97 on a 0-10 scale).

There was some indication that extracorporeal shockwave therapy may also improve short term function, flexion, and abduction, but the researchers say these apparent benefits are less certain because they are based on low certainty evidence and inconsistencies in the data.

Moderate certainty evidence also suggested that manipulation by a clinician under anaesthesia combined with a steroid injection probably improved short term flexion (mean difference 33.29 degrees), as did manipulation under anaesthesia alone (26.16 degrees), compared with usual care.

Evidence for most other treatments, outcomes beyond three months, and comparative safety is substantially less certain because adverse events were incompletely and inconsistently reported.

While this was a comprehensive synthesis of randomised evidence, the researchers acknowledge that most trials were at high risk of bias, factors such as disease duration, clinical stage, and previous treatment, were incompletely or inconsistently reported, and the findings may be limited to patients with primary adhesive capsulitis.

As such, they say these findings might be useful for informing specific treatment decisions within the first six months and do not establish longer term comparative effectiveness or overall benefit-harm profiles.

Treatment decisions should also consider invasiveness, costs, patient preferences, clinical expertise, and uncertainty about longer term benefits and harms, they conclude.

Source: The BMJ Group

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Fireworks are an Underestimated Danger to Public Health, Warn Experts

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Stronger regulations and education campaigns could help avoid life changing injuries

Photo by Gabriel Mihalcea on Unsplash

Fireworks pose an underestimated danger to public health and require stronger regulations and sustained public education campaigns to help prevent devastating, yet entirely avoidable injuries, warn US experts in The BMJ.

Fireworks related injuries are a major cause of vision and limb loss globally, largely affecting already marginalised communities, explain Indu Subramanian and colleagues.

In the UK, for example, almost 4500 people in England attended emergency departments with firework injuries in 2017, double the number in 2009-10, while a Los Angeles trauma centre study found that firework injuries rose 142% from 0.19 per 100,000 in 2015 to 0.66 in 2021, mostly in young men aged 15-34. Typical injuries included burns, eye trauma, and finger amputations, with 79% requiring surgery.

And according to research published in the Indian Journal of Ophthalmology, during Diwali in India, fireworks account for nearly 20% of eye trauma, and firework related eye injuries result in complete blindness in 15% of patients, mainly affecting young boys in rural communities.

Other negative effects of fireworks include fires, substantial air and noise pollution, and risk of heavy metal poisoning, skin burns, inhalation injuries, and death among workers producing fireworks, mostly in low and middle-income countries, they add.

They note that some countries, such as the Netherlands, Ireland, Chile, and Australia have banned consumer use of fireworks, but in many countries, where consumer bans are not in place, including India, UK, and US, there remains a critical need for education and regulation.

In the US, sales of consumer fireworks more than doubled from $1 billion in 2019 to $2.3 billion in 2025. Firework regulations also vary between states and countries, and policies have become less restrictive over time in some places, despite research showing that firework injuries are more common in states with fewer restrictions.

The authors call for stronger regulations and sustained public education campaigns in the US and internationally.

Global action is needed to increase data collection, regulation, and public safety of fireworks usage and injuries, while medical organisations and public health bodies should encourage people to attend public displays rather than using fireworks at home, they write. Warning labels with graphic images of injuries on firework packaging similar to those on cigarettes may also be impactful.

Harm reduction campaigns for children in primary and secondary schools, using the stories and images of people whose lives have been affected, is also critical to warn of the real-life consequences of mishandling fireworks, they add.

Source: The BMJ Group

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How Canada Lost its Measles Elimination Status Highlights Threat of Immunity Gaps

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90% of cases occurred in historically under-vaccinated communities
Findings offer insights for countries aiming to retain or regain their elimination status 

Photo by Gustavo Fring on Pexels

The outbreak that contributed to Canada losing its measles elimination status in November 2025 was concentrated in historically under-vaccinated communities with close social networks across Canada, the US, Mexico, and beyond, creating opportunities for cross-border transmission, concludes a study published by The BMJ.

The researchers say the findings highlight the ongoing risk of measles resurgence in countries that have previously successfully controlled the disease, and underscore the importance of culturally tailored community engagement to build trust and confidence in vaccination and prevent future outbreaks.

Canada achieved measles-free status in 1998 after introducing a two-dose vaccine schedule and a national catch-up programme for school-aged children, but lost it in November 2025 after a measles outbreak that involved several provinces. In Ontario, the outbreak disproportionately affected historically under-vaccinated communities – groups with historically low vaccine coverage and close social networks across Canada, the US, and Mexico.

To better understand the course of this outbreak and its impact, researchers analysed measles cases reported to Ontario’s public health surveillance system during the outbreak period (28 October 2024 to 6 October 2025).

The outbreak consisted of 2377 cases (2064 confirmed and 313 probable) over 49 weeks. Most cases (90%) occurred among members of historically under‑vaccinated communities, with limited spillover into the broader population.

Among the 2377 cases, around three quarters (73%) occurred in individuals aged 19 years or younger, 2,121 (89%) were unvaccinated and 97 (4%) had unknown vaccination status.

The outbreak was associated with 166 admissions to hospital, 13 admissions to an intensive care unit, 51 infections during pregnancy, 10 congenital measles infections, one case of encephalitis (brain inflammation), and one infant death.

Laboratory tests identified a distinct measles virus strain that was subsequently detected elsewhere in Canada, and in the US, Mexico, and the Netherlands due to close social ties within and between under-vaccinated communities combined with the high transmissibility of measles.

The researchers acknowledge that their analysis is subject to limitations inherent to public health surveillance data, and note that the number of cases and associated complications may be higher than what is reported in the study.

In addition, the proportion of cases in under-vaccinated communities is likely to be conservative, reflecting challenges in data collection for a variety of reasons, including mistrust among some community members and concerns from public health staff about the risk of stigmatisation of affected groups during the outbreak.

However, they say this measles outbreak illustrates the fragility of measles elimination in the presence of substantial immunity gaps within domestically and globally interconnected communities.

Limited spillover beyond these communities also highlights a high degree of vaccine acceptance in the population at large and the success of local partners in closing immunity gaps as part of the outbreak response, they add.

“Strengthening of immunisation systems, improving vaccine coverage, and sustaining culturally appropriate engagement to continue to build trust in immunisation will be essential to prevent future vaccine preventable disease outbreaks and to support re-establishing measles elimination,” they conclude.

In a linked editorial, Jennifer Nuzzo at Brown University School of Public Health warns that Canada’s loss of elimination status signals growing vulnerability to infectious disease threats, even in well-resourced high-income countries.

She argues that elimination requires not just high vaccination coverage, but also sensitive disease surveillance, laboratory capacity, rapid outbreak investigations, timely reporting, effective public health responses, and public trust.

Failing to stop measles within national borders also makes it harder for countries around the world to keep the disease at bay, she adds.

She urges countries to recommit to measles elimination “not simply to restore a designation, but to stop a dangerous, preventable disease and strengthen the public health systems that protect their own populations and those of their neighbours from other serious infectious threats.”

Source: The BMJ Group

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Since 2010, There Have been Major Shifts in Medical Profiles of Adults Diagnosed with Autism

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Pronounced shift from prior diagnosis of epilepsy, psychosis, intellectual disability to ADHD, anxiety, depression
Steep rise in diagnoses among 16-20 year olds, females, and those of White ethnicity

Photo by Alex Green on Pexels

The medical profiles of adults diagnosed with autism have changed hugely since 2010, finds a study of medical records in the UK and Sweden, published in the online journal BMJ Mental Health.

There’s been a pronounced shift from a prior diagnosis of epilepsy, psychosis and intellectual disability to ADHD (attention deficit hyperactivity disorder), anxiety, and depression since 2010, the data analysis indicates.

And the steepest rise in diagnoses has been among 16-20 year olds, females, and those of White ethnic background.

The number of people being diagnosed with autism has increased worldwide in recent decades, although it’s not entirely clear if this has been driven by greater public awareness, reduced stigma, or changes in diagnostic practice, say the researchers.

To explore this further, the researchers studied UK primary care records up to 2023 (CPRD Aurum; 47 413 279 patients from 1784 general practices) and Swedish population-wide registry data (13 345 950 people) up to 2021 to look at trends over time.

They particularly wanted to find out if the social and demographic patterns of incident and prevalent autism diagnoses in adults, and the prevalence of other concurrent neuropsychiatric conditions, have changed over time. They also wanted to know if these trends are consistent in direction and magnitude across both the UK and Sweden.

Eligibility criteria included study entry on 1 January 2010, 16 years of age and, in the UK, at least 1 year registered at a general practice. Monitoring ended at death, ceasing to be registered at a general practice (UK), emigration (Sweden), or study end date (31 December 2023 in the UK and 31 December 2021 in Sweden), whichever came first.

The data were analysed for each person’s first recorded diagnosis of: autism; intellectual disability; ADHD; epilepsy; migraines/headaches; anxiety; depression; psychosis; bipolar disorders; obsessive-compulsive disorder and related conditions; stress-related conditions (including post-traumatic stress disorder); eating disorders; personality disorders; suicidality/self-harm; sleep disorders; and chronic fatigue.

First recorded prescriptions (UK) or dispensations (Sweden) of antipsychotics; antidepressants; antiseizure medications; opioids; gabapentinoids; melatonin and benzodiazepines/z-drugs (sedatives) were also noted.

In the UK, 24 537 039 adults contributed to the study, 141 119 of whom had been diagnosed with autism. In Sweden, 9 096 874 adults contributed, 100, 817 of whom had been diagnosed with autism.

Incident (first recorded) autism diagnoses in adults were consistently higher in Sweden than in the UK, but the number of new cases rose sharply in the UK after 2020.

In the UK, rates of new diagnoses increased from 6/100 000 people in 2010 to 64 in 2023. In Sweden, they rose from 43/100 000 people in 2010 to 65 in 2021.

New diagnoses increased fastest for 16–20 year-olds in both nations, rising from 31/100 000 people in 2010 in the UK to 364 in 2023, and from 165/100 000 people in 2010 in Sweden to 361 in 2021.

New diagnoses also rose fastest in females in both nations, as well as in people of White ethnicity in the UK and those with Swedish-born parents in Sweden.

In both countries, age-standardised prevalence was consistently higher for males than females, increasing in both sexes over the study period to 1.4% for males and 0.7% for females in the UK in 2023, and to 1.8% for males and 1.2% for females in Sweden in 2021.

Prevalence also increased over time in all age groups and was consistently higher in younger age groups. The prevalence of autism among 16–20 year-olds was 4.1% in 2023 in the UK and in Sweden in 2021.

Over time, the proportion of adults with autism who had a prior diagnosis of epilepsy, psychosis, and/or intellectual disability fell while the proportion of those with a prior diagnosis of ADHD, anxiety, depression, and other mental illnesses increased.

For example, in the UK between 2010 and 2023, a history of epilepsy among adults with newly diagnosed with autism fell from 10% to 4%, while a history of anxiety rose from 29% to just over 58%. Trends were broadly consistent between both sexes.

This is an observational study, and as such, can’t establish the reasons for the observed changes in the profiles of those diagnosed with autism.

But point out the researchers: “The characteristics of individuals diagnosed as autistic have changed dramatically since 2010 in both the UK and Sweden.”

And they conclude: “While these data are unable to shed light on whether these changes indicate greater appreciation of nuanced forms of autism, or misdiagnoses of other psychiatric presentations as autism, efforts will need to be made to recognise and address the needs with appropriate support.”

Source: The BMJ Group

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Minimally Invasive Technique Offers Lasting Relief for Carpal Tunnel Syndrome 

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Figure 1. Photographs depict the in-plane technique of needle insertion for the US-guided hydrodissection procedure using the (A) ulnar approach in right wrist carpal tunnel syndrome (CTS) and the (B) radial approach in left wrist CTS.

A minimally invasive ultrasound-guided technique offers long-term relief for patients with carpal tunnel syndrome with fewer side effects than steroids, according to a new study published in Radiology, a journal of the Radiological Society of North America (RSNA).

Carpal tunnel syndrome occurs when the median nerve, a major nerve that runs from the forearm through a narrow space in the wrist called the carpal tunnel, becomes squeezed or compressed. It is associated with repetitive motions of the wrist and hands that lead to numbness, tingling, weakness and pain. Research has shown that the condition affects roughly 5% to 10% of the general population over their lifetimes, and incidence is rising.

Corticosteroids injection, a common treatment to reduce swelling and relieve pressure on the nerve, has limitations.

“Traditional steroid injection for carpal tunnel syndrome often provides only temporary relief, thus requiring repeats of the procedure,” said study co-author Anupama Tandon, MD, professor in the Department of Radiodiagnosis and Imaging at University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi, India. “Further, steroids carry risk of localised skin changes, fat thinning and tendon weakening.”

Nerve hydrodissection is a steroid-free alternative that involves careful injection of fluid around the affected nerve under ultrasound guidance to release the nerve from surrounding adhesions and improve its mobility. Hydrodissection is generally used in conjunction with steroid treatment, but little is known about its effectiveness as a standalone treatment.

To learn more, Dr Tandon, study lead author Anindita Bose, MD., assistant professor in the Department of Radiology at Mahatma Gandhi Medical College and Hospital in Jaipur, India, and colleagues performed a randomised control trial of 63 patients with confirmed carpal tunnel syndrome who had not responded to conventional treatment.

The researchers divided participants into three equal groups. Two groups underwent ultrasound-guided hydrodissection of the median nerve, with one group receiving normal saline alone and the other getting a combination of normal saline and corticosteroid. The third group received an ultrasound-guided corticosteroid injection alone.

The researchers assessed the patients clinically using standardised symptom, functional and pain scores. They also assessed the median nerve area on ultrasound at four weeks, 12 weeks and 24 weeks after treatment.

All three groups experienced significant improvement at four weeks post-treatment. However, the benefits of hydrodissection were sustained and continued to improve over the subsequent follow-up periods.

“At 12 weeks and 6 months, both hydrodissection groups demonstrated further improvement in clinical symptoms and function, whereas patients who received corticosteroid injection alone experienced a recurrence of the symptoms, suggesting that the initial benefit was short-lived,” Dr Tandon said.

The addition of corticosteroids to the hydrodissection injectate did not provide a significant additional long-term benefit compared with saline hydrodissection alone.

The ultrasound findings supported the clinical results. The cross-sectional area of the median nerve decreased by approximately 43% to 45% following hydrodissection, compared with approximately 15% following corticosteroid injection alone, indicating a greater reduction in nerve swelling.

“Most of our patients had been suffering from carpal tunnel syndrome for months to years and did not get much relief despite trying various treatments like pain medications, splints, lifestyle modification and corticosteroids,” Dr Tandon said. “It came as a pleasant surprise to find that a simple procedure of dissecting the median nerve under ultrasound guidance with normal saline provided them long-term relief.”

The procedure took only 15 minutes on average, and the patients tolerated it well. No significant immediate or delayed complications were observed. Questionnaire scores showed that the patients were highly satisfied with procedure. Its cost was low, no anaesthesia or hospitalisation was needed, and the patients were able to go back to work in an hour.

The findings point to a more prominent role for hydrodissection as a treatment for a condition that is increasing in prevalence around the world.

“Overall, the study suggests that ultrasound-guided saline hydrodissection is a safe, minimally invasive treatment that can provide sustained clinical and morphological improvement in patients with refractory carpal tunnel syndrome,” Dr Tandon said. “Thus, hydrodissection merits to be a minimally invasive option for mild to moderate carpal tunnel syndrome and can defer and even alleviate the need for surgery.”

Future multicenter studies with larger cohorts and longer follow-up are warranted, the researchers said. They have already launched a study comparing the long-term effectiveness of different injectates in hydrodissection for carpal tunnel syndrome, such as dextrose versus saline.“This trial features an extended follow-up period to track long-term patient outcomes and establish the true durability of the treatment,” Dr Tandon said.

Source: Radiological Society of North America

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Impaired Relaxation Signal in Pre-eclampsia Vessels Points to New Treatment Targets

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Source: Pixabay CC0

Researchers at the University of Manchester and Manchester University NHS Foundation Trust identified a major defect in microvascular regulation in women with pre-eclampsia. The breakthrough sheds new light on why blood pressure rises so dramatically in the condition and could point towards entirely new ways of treating it.

Pre-eclampsia affects 2–8% of pregnancies worldwide and is linked to serious complications including stroke, organ damage, premature birth and stillbirth. At present there is no cure other than delivering the baby and placenta, often forcing doctors to perform earlier deliveries.

But now the researchers have identified a key failure in the way small arteries regulate blood flow in women with the condition.

The team recruited patients at Saint Mary’s Hospital (SMH), part of MFT, and compared tiny arteries from pregnant women with and without preeclampsia. The researchers discovered that a vital natural relaxation mechanism was severely disrupted in those with the disease.

The vessels were taken from the omentum – a fold of fatty tissue inside the abdomen that helps protect and support the abdominal organs – and placed under pressure in a laboratory to study their functioning.

They found that microscopic calcium sparks (which normally signal arterial smooth muscle to relax) were reduced by up to 75% at physiological pressures. Calcium stores were depleted and less able to refill, impairing the pressure-balancing mechanism and contributing to vasoconstriction and hypertension.

The immune peptide HBD2 did not restore the sparks but still relaxed vessels via an alternative pathway component. This suggests potential therapies that bypass the defective mechanism to control maternal blood pressure, prolong pregnancy and reduce early delivery.

Study lead Dr Stephanie Worton (University of Manchester; Honorary Consultant in Obstetrics, Maternal and Fetal Health Research Centre, Saint Mary’s) stated this is the first demonstration of a profound impairment in this calcium signalling pathway, while vessels remain relaxable via alternative routes. While these are promising, there is further work needed on drug development for pregnancy.

Source: NHS Manchester University