December 6, 2023

  1. Tom Nolan, medical editor; sessional GP, Surrey
  1. The BMJ, London

Pred weight

How a lot do you have to fear concerning the impact of weight and blood stress if prescribing long run low dose glucocorticoids? An evaluation of particular person information from 5 randomised managed trials checked out 1112 folks with rheumatoid arthritis who have been both taking prednisolone ≤7.5 mg (or equal) per day or a management drug. After two years of therapy, these taking prednisolone weighed just one kg greater than these within the management teams (95% CI 0.4 to 1.8 kg; P<0.001), and there was no distinction between teams in imply arterial blood stress.

Ann Intern Med doi:10.7326/M23-0192

Useless wait

Within the 18th century within the US, dissection after loss of life was seen as a type of supra-capital punishment, and judges have been allowed so as to add dissection to a loss of life sentence. Within the nineteenth century the demand for our bodies created a profitable market main to numerous scandals—the physique of a senator going lacking and being found within the dissecting room on the Medical Faculty of Ohio—and even riots. Though attitudes and legal guidelines have modified, how medical colleges supply their cadavers continues to intrigue, with a analysis letter in JAMA describing an increase within the variety of “unclaimed” our bodies being accepted by medical colleges in Texas.

Texas, with its inhabitants of almost 30 million folks, has 16 medical colleges, which settle for about 3000 cadavers every year for anatomy coaching. In accordance with the information obtained for the examine, of the 3159 cadavers accepted by 14 of its medical colleges in 2021, 446 of them have been donated by the state after being “unclaimed.” That’s 446 folks with no subsequent of kin to mourn them or contemplate what the deceased would have needed to occur to their physique after loss of life—up from 63 in 2018.

JAMA doi:10.1001/jama.2023.15132


Is the human proteoform challenge about to remodel well being care? Proteomics is the examine of all of the proteins that get expressed within the physique (in the identical means that genomics is the examine of how genes are expressed). A single gene can produce a whole bunch of various types of a single protein, with even a single change in protein construction (by methylating an argine, as an illustration) probably making a major distinction within the protein’s form—or proteoform. The search to map out all 50-100 million of those proteoforms is named the human proteoform challenge.

Measuring the degrees of 1000’s of protein variants linked with heart problems could assist with cardiovascular danger evaluation, argues a brand new examine in JAMA. The retrospective evaluation checked out whether or not including protein danger scores (derived from measuring 4963 plasma protein ranges) to polygenic danger scores and quaint medical danger components, might enhance cardiovascular danger prediction. A modest enchancment in danger prediction for first and recurrent atherosclerotic cardiovascular occasions was discovered.

JAMA doi:10.1001/jama.2023.13258


A examine printed in Nature Medication concludes that an AI histopathology search instrument generally known as PLIP (pathology language–picture pretraining) that discovered pathology from over 200 000 tweets, has achieved “state-of-the-art performances for classifying new pathology photos throughout 4 exterior datasets.” The open-source WebPLIP platform is accessible for all to make use of and permits customers to seek for histopathology photos with phrases or photos. After I had a go, the search outcomes did appear quite like my solutions to histopathology questions in my medical college exams—a bit hit or miss—but when pathology and twitter is your factor, PLIP is likely to be a useful instrument.

Nat Med doi:10.1038/s41591-023-02504-3

Levers to drag after dementia prognosis

A prognosis of dementia is an efficient time to evaluation treatment use and cut back polypharmacy, however, in keeping with a cohort examine of 266 675 Medicare beneficiaries, this doesn’t appear to be occurring. The examine discovered that total prescribing went up after dementia prognosis (by 0.41 drugs versus −0.06 in matched controls with no dementia prognosis), and, though prescribing of anticholinergic medicine did go down, prescriptions for drugs that have an effect on the central nervous system, reminiscent of benzodiazepines and antipsychotics, went up (absolute distinction 3.44% v 0.79%).

Why this occurs is summed up neatly in a linked editorial: “all too typically a brand new prescription for an antipsychotic or benzodiazepine is issued just because we lack one other lever to drag to assist sufferers and caregivers, or the reimbursed time to discover underlying causes and devise artistic behavioural and environmental options.”

JAMA Intern Med doi:10.1001/jamainternmed.2023.3575, doi:10.1001/jamainternmed.2023.3584