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Pediatricians are hesitating to prescribe medicines like Wegovy, citing their newness and uncertainties around them.Dr. Edward Lewis, a pediatrician in Rochester, N.Y., has seen hundreds of children with obesity over the years in his medical practice. He finally may have a treatment for their medical condition — the powerful weight loss drug Wegovy.But that does not mean Dr. Lewis is prescribing it. Nor are most other pediatricians.“I am reluctant to prescribe medications we don’t use on a day-to-day basis,” Dr. Lewis said. And, he added, he is disinclined to use “a medicine that is a relative newcomer to the scene in kids.”Regulators and medical groups have all said that these drugs are appropriate for children as young as 12. But like Dr. Lewis, many pediatricians hesitate to prescribe Wegovy to young people, fearful that too little is known about long term effects, and mindful of past cases when problems emerged years after a drug was approved.Twenty-two percent of adolescents age 12 to 19 have obesity. Research shows that most are unlikely to ever overcome the condition — advice to diet and exercise usually has not helped. The reason, obesity researchers say, is that obesity is not caused by a lack of will power. Instead, it is a chronic disease characterized by an overwhelming desire to eat.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

University at Buffalo research has identified how a misstep in the genesis of a key component of the kidney causes infantile cystinosis, a rare disease that significantly shortens the lifespan of patients. Published Nov. 30 in the International Journal of Molecular Sciences, the work reveals that the mechanisms that cause the disease could be addressed and potentially cured through the genome-editing technique CRISPR. That could make kidney transplants, the most effective treatment currently available for these patients, unnecessary.
Infantile cystinosis, the most common and most severe type of cystinosis, occurs as the result of an accumulation in the body’s cells of cystine, an amino acid. The buildup damages cells throughout the body, especially the kidneys and the eyes. Treatment consists of medications that work to lower the level of cystine in the body, as well as therapies that address the impaired growth of these children due to the inability to properly absorb nutrients. Some children require feeding tubes. Eventually, patients with infantile cystinosis, also called nephropathic cystinosis, will require dialysis and a kidney transplant.
Promise of stem cells
Human-induced pluripotent stem cells (hiPSCs) are stem cells that can differentiate into many different cell types. They hold tremendous potential for studying genetic diseases; the drawback has been that differentiation into certain cell types has been problematic. Such is the case with many cell types found in the kidney.
But a new protocol developed by this research team was successful.
“When our normal human-induced pluripotent stem cells were subjected to the differentiation protocol we developed, we were able to demonstrate extensive expression of physiologically important markers of the renal proximal tubule, the specific nephron segment that is altered in this disease,” says Mary L. Taub, PhD, senior author on the paper and professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences at UB.
Ramkumar Thiyagarajan, PhD, assistant professor of geriatric studies at the University of Kansas and formerly a postdoctoral fellow at UB, is first author on the paper.

The protocol involved extracting stem cells from a healthy individual and an individual with infantile cystinosis. The researchers developed a culture medium to grow stem cells that included a small number of defined components present in blood, including insulin, specific proteins, growth factors and others. “Conducting the differentiation protocol under these conditions occurred in a timely manner,” says Taub, “we didn’t have to wait for weeks on end, and it occurred in a reproducible manner.”
The researchers were able to efficiently differentiate the hiPSCs into the kidney proximal tubule, the type of nephron in the kidney that is impaired in infantile cystinosis, as well as in other kidney diseases.
“Unlike in other studies, we were able to retain a number of markers in the tubule that are physiologically important in the kidney’s reabsorptive functions,” says Taub. “Although these markers were expressed in both the normal and the cystinosis-derived hiPSCs, the genesis of the tubule was impaired in the cystinosis-derived cells, mimicking what happens in infantile cystinosis.”
A potential cure
That finding means that the CRISPR genome-editing technique could be used to repair the defective genome and potentially cure the disease. “The normal gene can be introduced in the genome of cystinotic hiPSCs, which can then be injected in the kidney to replace the defective proximal tubules of individuals with infantile cystinosis,” Taub says.
“In cystinotic individuals, it is the renal proximal tubule that degenerates, presumably due to programmed cell death,” explains Taub, “so the entire kidney would not need to be replaced. The defective renal proximal tubules of individuals with this disease can be replaced with normal tubules following the introduction of the normal gene into cystinotic hiPSCs obtained from the patient. And because these tubules are from cells derived from the patient, there should be no problem with tissue rejection.”
The findings are applicable to other kidney diseases where the renal proximal tubule is damaged, including acute kidney injury that can lead to chronic kidney disease and renal failure, and can be fatal.
Initial studies will need to be conducted with animal models as well as with in vitro tissue culture cells.
The research was funded by UB’s WNYSTEM and The Cystinosis Research Foundation.

Arriving amongst protests, Rishi Sunak defends his time as chancellor during the pandemic, as he gives evidence to the Covid inquiry.

Published1 hour agoShareclose panelShare pageCopy linkAbout sharingThis video can not be playedTo play this video you need to enable JavaScript in your browser.By Kate WhannelPolitical reporterRishi Sunak has robustly defended his Eat Out To Help Out scheme, implemented in summer 2020, saying it prevented “devastating” job losses.The scheme encouraged people to attend pubs and restaurants by subsidising meals after lockdown rules were eased.Mr Sunak said it was introduced after the safe reopening of restaurants.He dismissed criticism that senior advisers were not consulted, saying they had had “ample opportunity” to raise concerns.In previous sessions of the inquiry senior scientific advisers, as well as health secretary at the time Matt Hancock, have said they were not consulted about the Eat Out To Help Out Scheme before it was announced. The inquiry has also been told that chief medical officer Sir Chris Whitty referred to the scheme as “eat out to help out the virus” and Sir Patrick Vallance – who was chief scientific adviser during Covid – said the scheme was “highly likely” to have fuelled deaths.However, Mr Sunak – who was chancellor during the pandemic – strongly backed his decision to introduce the scheme.More on Covid and the Covid InquiryDid Sunak’s Eat Out scheme help to spread Covid?Five takeaways from Boris Johnson’s evidenceWhat is the UK Covid inquiry and how long will it take?How inquiry is exposing deep flaws in Covid decision-makingThe private WhatsApp messages from inside Downing StreetWhat to do if you have Covid: Can you go to work or school?He said it was announced on 8 July and came into force at the beginning of August, and that in that period the chief medical officer had identified children returning to school, and winter, as “two significant risk moments”. “He did not mention Eat Out To Help Out,” Mr Sunak said. He also argued it was a “micro policy” introduced along with other safety measures such as table-only service, contactless payments and one-way systems. “This was a very reasonable, sensible policy intervention to help safeguard those jobs in that safe reopening.”I didn’t believe that it was a risk. I believe it was the right thing to do.”All the data, all the evidence, all the polling, all the input from those companies suggested that unless we did something, many of those jobs would have been at risk with devastating consequences for those people and their families.”He added that the evidence “conclusively demonstrates that this was in no way, shape or form responsible for a second wave”.Image source, PA MediaMr Sunak was also asked about claims the Treasury had been nicknamed the “pro-death squad” due to its stance on keeping hospitality and retail sectors open. The prime minister said that wasn’t “a fair characterisation”, adding that the Treasury had worked “very hard” and “done things to save millions of people’s livelihoods”. He argued that the sectors most impacted by the lockdown, such as retail and hospitality, were more likely to employ “the most vulnerable in society” such as those on the lowest incomes.He said trying to protect jobs in those areas was a “matter of social justice”.The inquiry has also heard criticism about Boris Johnson’s leadership style, with advisers saying he had a tendency to change his mind. However, Mr Sunak defended his former boss, saying his interactions with No 10 “felt fine” and that Mr Johnson was right to “go over the arguments”. He added he was not aware of complaints from advisers about Mr Johnson’s approach.Mr Sunak also told the inquiry: Increases in the cost of government borrowing in March 2020 caused “enormous anxiety” in the TreasuryHe saw more of Boris Johnson than his own wife during the early days of the pandemicHe was not a “prolific user” of WhatsApp and that he no longer had access to messages during the pandemic, having changed his phone “multiple times” over the past few yearsThe amount the government borrowed during lockdown led to the current record-high tax burden “which we’re grappling with today” Changes were made to the process of buying personal protective equipment that enabled “pace at the expense of the same normal amount of rigour and scrutiny that would go into those approvals”The prime minister began his evidence by saying he was “deeply sorry” to all of those who lost loved ones and family members in the pandemic.He also offered an apology to “all those who suffered in the various different ways throughout the pandemic as a result of the actions that were taken”.He added it was “important we learn the lessons so we can better prepare in the future”.

McGill University researchers have made a breakthrough in diagnostic technology, inventing a ‘lab on a chip’ that can be 3D-printed in just 30 minutes. The chip has the potential to make on-the-spot testing widely accessible.
As part of a recent study, the results of which were published in the journal Advanced Materials, the McGill team developed capillaric chips that act as miniature laboratories. Unlike other computer microprocessors, these chips are single-use and require no external power source — a simple paper strip suffices. They function through capillary action — the very phenomena by which a spilled liquid on the kitchen table spontaneously wicks into the paper towel used to wipe it up.
“Traditional diagnostics require peripherals, while ours can circumvent them. Our diagnostics are a bit what the cell phone was to traditional desktop computers that required a separate monitor, keyboard and power supply to operate,” explains Prof. David Juncker, Chair of the Department of Biomedical Engineering at McGill and senior author on the study.
At-home testing became crucial during the COVID-19 pandemic. But rapid tests have limited availability and can only drive one liquid across the strip, meaning most diagnostics are still done in central labs. Notably, the capillaric chips can be 3D-printed for various tests, including COVID-19 antibody quantification.
The study brings 3D-printed home diagnostics one step closer to reality, though some challenges remain, such as regulatory approvals and securing necessary test materials. The team is actively working to make their technology more accessible, adapting it for use with affordable 3D printers. The innovation aims to speed up diagnoses, enhance patient care, and usher in a new era of accessible testing.
“This advancement has the capacity to empower individuals, researchers, and industries to explore new possibilities and applications in a more cost-effective and user-friendly manner,” says Prof. Juncker. “This innovation also holds the potential to eventually empower health professionals with the ability to rapidly create tailored solutions for specific needs right at the point-of-care.”

People who have been subject to abuse are more likely to experience physical and mental health effects than previously thought, according to a new study.
In a global review and meta-analysis of evidence published in Nature Medicine today, researchers have found that there are elevated risks between intimate partner violence or childhood sexual abuse, and some health conditions including major depressive disorder, maternal miscarriage for partners, and alcohol misuse and self-harm among children.
Globally, one in three ever-partnered women have experienced intimate partner violence in their lifetime, and around 20% of young women and 10% of young men have experienced some form of childhood sexual abuse. However, research investigating health outcomes associated with intimate partner violence and childhood sexual abuse has been limited.
The authors found that exposures to intimate partner violence had a moderate association with an increased risk of major depressive disorders (63%) and an increased risk of maternal abortion and miscarriage (35%). Childhood sexual abuse was shown to be moderately associated with an increased risk of alcohol use and an increased risk of self-harm (45% and 35%, respectively). The authors indicate these findings are larger in magnitude and more extensive than previously suggested.
Dr Joht Singh Chandan, Clinical Associate Professor in Public Health at the University of Birmingham and senior co-lead author of the paper said:
“This comprehensive study marks a significant step in understanding the profound health impacts of intimate partner violence against women and childhood sexual abuse. Our findings reveal not only the alarming associations these forms of violence have with conditions like major depressive disorder, miscarriage, alcohol use disorders, and self-harm, but also underscore the urgent need for robust preventive measures and support systems.”
Professor Emmanuela Gakidou from the Institute of Health Metrics and Evaluation at the University of Washington and senior co-lead author of the paper
“While we’ve shed light on these critical health issues, our research also highlights the gaps in current knowledge and the necessity for continued investigation to fully grasp the extensive consequences of such violence. It’s imperative that we use these insights to inform policy, healthcare, and community interventions, ensuring a safer and healthier future for individuals affected by these pervasive forms of violence.”

Dr Nicholas Metheny, Assistant Professor in the School of Nursing and Health Studies at the University of Miami said:
“Our research marks a pivotal shift in how we perceive the societal and health burdens of intimate partner violence (IPV). Previously, our evidence primarily highlighted IPV’s contribution to HIV and depression, substantially underestimating its broader impact. This study expands our understanding, revealing IPV’s extensive influence on a wider range of poor health outcomes.
“This new perspective is crucial in elevating IPV as a public health imperative in the global sphere, hopefully igniting both political and scientific momentum towards effective prevention and intervention strategies.”
4000 studies reviewed — 229 suitable for inclusion
Searching through papers published from seven databases, Emmanuella Gakidou and colleagues identified the available literature on intimate partner violence and childhood sexual abuse and their associated health effects. They reviewed over 4,000 studies, of which 229 studies met the criteria for inclusion. Using the burden of proof methodology (a meta-analytic approach for estimating a conservative measure of the elevated or reduced risk of a particular health outcome after exposure to a harmful or protective risk factor), they evaluated the strength of evidence connecting intimate partner violence and/or childhood sexual abuse to health outcomes, which were supported by at least three studies.
Additional potential health outcomes were also initially identified in the study, including an association of maternal hypertensive disorders with intimate partner violence and an association of smoking with childhood sexual abuse. However, the research concludes that due to a scarcity of evidence, these could not be included in the meta-analysis.
The authors note that the studies are observational and cannot demonstrate causality and highlight that their findings are limited owing to the limited number of studies that explore these relationships. They suggest that their research demonstrates the wide-ranging health effects of intimate partner violence and childhood sexual abuse but emphasize the need for further research to strengthen the evidence base.
The study was funded by the Bill and Melinda Gates Foundation.

Australian researchers have flagged potential concerns over the use of social chatbots, calling for more studies into the impact of the AI software on neurodiverse people and those who find human interaction difficult.
While the AI chatbot is appealing to many people who struggle with face-to-face conversations, the technology may foster bad habits that could lead to further social isolation.
That’s the view of University of South Australia and Flinders University researchers in a recent essay published in the Journal of Behavioural Addictions.
The researchers say that chatbots, now integrated into social networking platforms like Snapchat, could perpetuate communication difficulties for people with autism, anxiety and limited social skills.
Lead researcher, UniSA Psychology Honours student Andrew Franze, says the rapid development of social chatbots has pros and cons which need investigating.
“Young people with social deficiencies tend to gravitate towards companionship with online social chatbots in particular,” Franze says.
“They offer a safe means of rehearsing social interaction with limited or no risk of negative judgement based on appearance or communication style. However, there is a risk they can become dependent on chatbots and withdraw even further from human interactions.”
Franze says the inability of chatbots to have a real “conversation,” or display empathy and soft emotional skills, can reinforce dysfunctional habits in many neurodiverse people.

“Some chatbots have a generally servile quality and so there is no resistance or opposing view that characterises human conversations. This means that users can control the conversation completely; they can pause it, delay it, or even terminate the conversation. All of this is counterproductive to developing appropriate social skills in the real world.”
And while social chatbots may relieve social anxiety, this relief may develop into a form of dependency that negatively impacts on actual relationships.
The researchers say that industry-linked research has promoted the benefits of commercial chatbot applications, but feedback from parents, family members, teachers and therapists is needed to gain a broader understanding of its impacts.
“We need to gather evidence about the myriad of ways that these technologies can influence vulnerable users who may be particularly drawn to them,” Franze says. “Only then can we develop policies and industry practices that guide the responsible and safe use of chatbots.”
“Social chatbot user (e.g., ChatGPT) among individuals with social deficits: risks and opportunities” is published in the Journal of Behavioural Addictions. It is authored by Andrew Franze (University of South Australia); Christina R. Galanis and Daniel L. King (Flinders University).

On the cusp of summer holidays, Aussie kids are looking forward to some well-deserved time off. But too much downtime could create health problems, as new research shows that holidays are the prime time for excessive weight gain in kids.
Conducted by the University of South Australia’s Alliance for Research in Exercise, Nutrition and Activity team, the ‘Life on Holidays’ study assessed changes to children’s fitness and fatness during the holidays. It found that children’s body fat increased at a faster pace during school holidays than in-school periods.
Funded by the NHMRC, the study found that young children (in Grades 4 and 5) expended less energy during holidays than during the school year.
Specifically, children: slept 12 minutes less per day spent 12 minutes less per being physically active spent an additional 70 minutes per day on screen time.Children’s body fat increased at a greater rate during the holidays, and aerobic fitness declined faster than during the in-school periods.
It is the first study of its kind outside of the US.
In Australia, one in four children and teenagers are overweight or obese. Globally, more than 124 million children and adolescents (6% of girls and 8% of boys) are obese.

Lead researcher, UniSA’s Professor Tim Olds says promoting physical activities for children in the school holidays could help address unhealthy weight gain and declining fitness.
“Like all of us, kids (and their parents) deserve some holiday downtime, but the way they spend their time on holidays is very different from the school term — and in ways which is not always good for children’s health,” Prof Olds says.
“On school holidays, kids are significantly less active than when they’re at school, and this translates into higher body fat percentages and lower levels of fitness.
“During the holidays, kids spend about 12 minutes less each day in moderate to vigorous physical activity — almost an hour and a half a week — and get more than an hour’s extra screen time each day. They also spend an extra 20 minutes each day in transport, and a quarter of an hour more per day just chilling.
“It’s not surprising to find that kids get fatter at a faster rate on school holidays compared to school term, and lose a lot of fitness. If kids spent the whole year on holidays, their percentage of body fat would increase by about 4% more each year than if they had no holidays, and their fitness would decline by about 10% each year.
“Kids who are not getting enough exercise and movement have a greater risk of developing health issues, such as cardiovascular disease and Type 2 diabetes later in life, so it’s important that we encourage kids to stay active and embrace a balance of downtime and exercise.”
The two-year study focused on children aged 9-10 years, with data collected at the beginning and end of Terms 1 and 4 in both Grades 4 and 5. More than 150 participants from the ‘Life on Holidays’ study took part in this study.

Co-researcher, UniSA’s Dr Dot Dumuid says that one solution could be for Australia to adopt the American institution of summer camps and holiday programs to improve kids’ use of time during holidays.
“A defining factor of school holidays is that they’re unstructured — they can get food from the fridge when they want it, and generally have access to computers and devices — and there’s no doubt that screen time plays a key role in increased sedentary time during school holidays,” Dr Dumuid says.
“When you compare this to the structure of a school day, where kids have a prepared lunch, and scheduled PE lessons and playtimes, it’s vastly different.
“In contrast, summer camps and holiday programs get a big tick of approval as they provide kids with physical activities in a semi-structured way. Already popular in America, summer camps may be worth investigating as a viable option over Australian holidays.
“We all want our kids to be healthy. And while devices and TV may provide a bit of babysitting, is it really worth your child’s health?”

A world without cardiovascular disease (CVD) is possible, yet millions of lives are lost prematurely to heart disease each year, according to the new Global Burden of Disease (GBD) special report published today in the Journal of the American College of Cardiology. The report provides an update of health estimates for the global, regional and national burden and trends of CVD from 1990-2022 by analyzing the impact of cardiovascular conditions and risk factors across 21 global regions.
Research from this study reflects an urgent need for countries to establish public-health strategies aimed at preventing cardiovascular diseases by underscoring the global action needed to disseminate information and implement health programs, especially in hard-to-reach countries. While cardiovascular disease rates are high globally, regions of Asia, Europe, Africa and the Middle East were estimated to have the highest burden of CVD mortality. High blood pressure, high cholesterol, dietary risks and air pollution remain its leading causes.
“Cardiovascular diseases are a persistent challenge that lead to an enormous number of premature and preventable deaths,” said Gregory A. Roth, MD, MPH, senior author of the paper and associate professor in the Division of Cardiology and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington. “There are many inexpensive, effective treatments. We know what risk factors we need to identify and treat. There are simple healthy choices that people can make to improve their health. This atlas provides detailed information on where countries stand in their efforts to prevent and treat cardiovascular diseases.”
The mortality rates are broken down by location, along with age, sex and time categories. The report identifies disability-adjusted life years (DALYs), the years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs). The results presented include several updates to previously published estimates, reflecting new data and new disease modelling methods.
The paper specifically addresses 18 cardiovascular conditions and provides estimates for 15 leading risk factors for cardiovascular disease: environmental (air pollution, household air pollution, lead exposure, low temperature, high temperature), metabolic (systolic blood pressure, LDL-C, body mass index, fasting plasma glucose, kidney dysfunction) and behavioral (dietary, smoking, secondhand smoke, alcohol use, physical activity.
“We formed the Global Burden of Cardiovascular Diseases Collaboration three years ago to help bring state-of-the-art research to the forefront of the global cardiovascular community,” said Valentin Fuster, MD, PhD, an author of the paper, President of Mount Sinai Fuster Heart Hospital, physician-in-chief of The Mount Sinai Hospital, and editor-in-chief of JACC. “We are excited to publish this 2023 Almanac as a dedicated issue of the Journal to inform the realities of CVD risk and inspire strategies for a heart-healthy world.”
Key takeaways from the report: Ischemic heart disease remains the leading cause of global CVD mortality with an age-standardized rate per 100,000 of 108.8 deaths, followed by intracerebral hemorrhage and ischemic stroke. High systolic blood pressure accounted for the largest contribution to attributable age-standardized CVD disability-adjusted life years (DALYs) at 2,564.9 per 100,000 globally. Dietary risks were the leading contributor to age-standardized CVD DALYs among the behavioral risks, while ambient particulate matter pollution led the environmental risks. Between 2015-2022, age-standardized CVD mortality increased in 27 out of 204 locations. Global death counts due to CVD increased from 12.4 million in 1990 to 19.8 million in 2022 reflecting global population growth and aging and the contributions from preventable metabolic, environmental, and behavioral risks. Eastern Europe had the highest age-standardized total CVD mortality at 553 deaths per 100,000. In contrast, countries in Australasia had the lowest age-standardized total CVD mortality at 122.5 deaths per 100,000 people. Central Asia, Eastern Europe, North Africa and the Middle East had the highest age-standardized mortality rate per 100,000 people attributable to high systolic blood pressure. The regions with the highest rates of CVD burden attributable to dietary risk were Central Asia, Oceania, and parts of North Africa and the Middle East.”Identifying sustainable ways to work with communities to take action to prevent and control modifiable risk factors for heart disease is essential for reducing the global burden of heart disease,” said George A. Mensah, M.D., F.A.C.C., F.A.H.A., director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute (NHLBI). “The 2023 Almanac represents an important resource for using locally relevant data to inform local-level actions for heart-healthy and thriving communities.”
Launched in 2020, the Global Burden of Cardiovascular Diseases Collaboration is an alliance between the Journals of the American College of Cardiology, the Institute for Health Metrics and Evaluation at the University of Washington, and the National Heart, Lung, and Blood Institute. Serving as an update to 2022’s GBD Study, the 2023 publication includes data from 204 countries and territories, highlighting the leading global modifiable cardiovascular risk factors, their contribution to disease burden and recent prevention advancements.

Researchers at Linköping University, Sweden, have examined the brains of 16 patients previously hospitalised for COVID-19 with persisting symptoms. They have found differences in brain tissue structure between patients with persisting symptoms after COVID-19 and healthy people. Their findings, published in the journal Brain Communications, can bring insights into the underlying mechanisms of persisting neurological problems after COVID-19.
Several previous studies of persisting problems after COVID have involved MRI brain scanning. Although researchers have found differences compared with healthy brains, these differences are not specific to COVID-19.
“It can be frustrating for me as a doctor when I understand that the patients have problems, but I can’t find an explanation because there’s nothing in the MRI scan to explain it. To me, this underlines the importance of trying other examination technologies to understand what’s happening in the brain in patients with persisting symptoms after COVID-19,” says Ida Blystad, neuroradiologist in the Department of Radiology at Linköping University Hospital and researcher affiliated with the Department of Health, Medicine and Caring Sciences at Linköping University and the Centre for Medical Image Science and Visualization (CMIV).
In their current study, the researchers have therefore added a new type of MR imaging called advanced diffusion MRI. They were particularly interested in the brain’s white matter. This consists mainly of nerve axons and is very important for transporting signals between the different parts of the brain and the rest of the body.
“Diffusion MRI is a very sensitive technology that allows changes in how the nerve axons are organised to be detected. This is one of the reasons why we wanted to use diffusion MRI to study the effects of COVID-19 on the brain that other imaging technologies might not pick up,” says Deneb Boito, doctoral student at the Department of Biomedical Engineering at Linköping University.
To get an idea of what diffusion MRI is, we can imagine a big city at night. Car headlights and rear lights shine like red and white strings of pearls on the most trafficked roads. We cannot see the road itself, but we understand that it is there, as the cars can easily move about right there. Similarly, doctors and researchers can get an insight into how the brain is constructed on a microscopic level through diffusion MRI. This technology builds on the fact that there is water everywhere in the brain moving in the tissue according to the law of least resistance. Water molecules move more easily along the neural pathways. By measuring the movement of water molecules through the neural pathways, researchers can indirectly infer the structure of neural pathways, just as we can indirectly understand that there is a motorway where there are many cars driving.
Healthcare usages of diffusion MRI include diagnosing stroke and planning brain surgery. In their current study, the researchers used a more advanced version of diffusion MRI. They examined 16 men who had been hospitalised for severe COVID-19 and who are participating in the Linköping COVID-19 Study (LinCos) at the Department of Rehabilitation Medicine in Linköping. They still had persisting symptoms after seven months. This group was compared with a group of healthy individuals without post-COVID symptoms who had not been hospitalised for COVID. The participants’ brains were examined with both conventional MRI and diffusion MRI.

“The two groups differ when it comes to brain white matter structure. This can be one of the causes of the neurological problems experienced by the group that had suffered from severe COVID-19. It’s a result that’s in line with other studies that have shown changes to the brain’s white matter. However, having examined only a small group of patients, we are cautious about drawing any major conclusions. With this technology, we’re not measuring the function of the brain, but its microstructure. To me, these findings are a sign that we must investigate long-term effects of COVID-19 in the brain using more advanced MRI technology than conventional MRI,” says Ida Blystad.
There are several issues that the researchers want to study further. It appears, for instance, that white matter in different parts of the brain is affected in different ways, although it is too early to draw any conclusions as to what these differences mean. An upcoming study will investigate whether changes detected with diffusion MRI are in any way connected to brain activity, and how different parts of the brain communicate with each other through the brain white matter in patients suffering from post-COVID fatigue.
Another question is what happens over time. The MRI scan provides an image of the brain at that particular moment. As the participants were examined on one occasion only, it is not possible to know whether the differences between the two groups will disappear over time or whether they are permanent.
This research was funded by, among others, the Analytic Imaging Diagnostic Arena (AIDA), the ITEA/Vinnova project ASSIST, and the Wallenberg Center for Molecular Medicine at Linköping University.