Underuse of estrogen therapy in premenopausal women undergoing oophorectomy associated with high morbidity and mortality: Study

Underuse of estrogen therapy in premenopausal women undergoing oophorectomy is associated with high morbidity and mortality suggests a study published in the American Journal of Obstetrics & Gynecology.

Contrary to clinical guidelines, there has been a decrease over time in estrogen therapy use in premenopausal women undergoing bilateral oophorectomy for benign indications. This study aimed to estimate the excess morbidity and mortality associated with current patterns of estrogen therapy use in women who undergo bilateral oophorectomy with hysterectomy for benign indications.They developed 2 Bayesian sampling Markov state-transition models to estimate the excess disease incidence (incidence model) and mortality (mortality model). The starting cohort for both models were women who had undergone bilateral oophorectomy with hysterectomy for benign indications at the age of 45 to 49 years. The models tracked outcomes in 5-year intervals for 25 years. The incidence model estimated excess incidence of breast cancer, lung cancer, colorectal cancer, coronary heart disease, and stroke, whereas the mortality model estimated excess mortality due to breast cancer, lung cancer, coronary heart disease, and all-other-cause mortality. The models compared current rates of estrogen therapy use with optimal (100%) use and calculated the mean difference in each simulated outcome to determine excess disease incidence and death. Results: By 25 years after bilateral oophorectomy with hysterectomy, there were an estimated 94 (95% confidence interval, −158 to −23) fewer colorectal cancer cases, 658 (95% confidence interval, 339–1025) more coronary heart disease cases, and 881 (95% confidence interval, 402–1483) more stroke cases. By 25 years after bilateral oophorectomy with hysterectomy, there were an estimated 189 (95% confidence interval, 59–387) more breast cancer deaths, 380 (95% confidence interval, 114–792) more coronary heart disease deaths, and 759 (95% confidence interval, 307–1527) more all-other-cause deaths. In sensitivity analyses where we defined estrogen therapy use as a duration of >2 years of use, these differences increased >2-fold. Underuse of estrogen therapy in premenopausal women who undergo oophorectomy is associated with substantial excess morbidity and mortality.

Reference:

Ferris JS, Suzuki Y, Prest MT, Chen L, Elkin EB, Hur C, Hershman DL, Wright JD. Excess morbidity and mortality associated with underuse of estrogen replacement therapy in premenopausal women who undergo surgical menopause. Am J Obstet Gynecol. 2024 Jun;230(6):653.e1-653.e17. doi: 10.1016/j.ajog.2024.02.007. Epub 2024 Feb 15. PMID: 38365100.

Keywords:

Underuse, estrogen, therapy, premenopausal, women, undergoing, oophorectomy, high morbidity, mortality, study, American Journal of Obstetrics & Gynecology

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Dietary intervention and metformin fail to change Tubular biomarkers in patients with polycystic kidney disease: Study

Dietary intervention and metformin fail to change Tubular biomarkers in patients with polycystic kidney disease suggests a study published in the BMC Nephrology.

Tubular biomarkers, which reflect tubular dysfunction or injury, are associated with incident chronic kidney disease and kidney function decline. Several tubular biomarkers have also been implicated in the progression of autosomal dominant polycystic kidney disease (ADPKD). We evaluated changes in multiple tubular biomarkers in four groups of patients with ADPKD who participated in one of two clinical trials (metformin therapy and diet-induced weight loss), based on evidence suggesting that such interventions could reduce tubule injury. 66 participants (26 M/40 F) with ADPKD and an estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73m2 who participated in either a metformin clinical trial (n = 22 metformin; n = 23 placebo) or dietary weight loss study (n = 10 daily caloric restriction [DCR]; n = 11 intermittent fasting [IMF]) were included in assessments of urinary tubular biomarkers (kidney injury molecule-1 [KIM-1], fatty-acid binding protein [FABP], interleukin-18 [IL-18], monocyte chemoattractant protein-1 [MCP-1], neutrophil gelatinase-associated lipocalin [NGAL], clusterin, and human cartilage glycoprotein-40 [YKL-40]; normalized to urine creatinine), at baseline and 12 months. The association of baseline tubular biomarkers with both baseline and change in height-adjusted total kidney volume (HtTKV; percent change from baseline to 12 months) and estimated glomerular filtration rate (eGFR; absolute change at 12 months vs. baseline), with covariate adjustment, was also assessed using multiple linear regression. Results: Mean ± s.d. age was 48 ± 8 years, eGFR was 71 ± 16 ml/min/1.73m2, and baseline BMI was 30.5 ± 5.9 kg/m2. None of the tubular biomarkers changed with any intervention as compared to placebo. Additionally, baseline tubular biomarkers were not associated with either baseline or change in eGFR or HtTKV over 12 months, after adjustments for demographics, group assignment, and clinical characteristics. Tubular biomarkers did not change with dietary-induced weight loss or metformin, nor did they associate with kidney disease progression, in this cohort of patients with ADPKD.

Reference:

Wang, W., You, Z., Steele, C.N. et al. Changes in tubular biomarkers with dietary intervention and metformin in patients with autosomal dominant polycystic kidney disease: a post-hoc analysis of two clinical trials. BMC Nephrol 25, 206 (2024). https://doi.org/10.1186/s12882-024-03643-6

Keywords:

Dietary, intervention, metformin, fail, change, Tubular, biomarkers, patients, polycystic, kidney, disease, study, BMC Nephrology, Wang, W., You, Z., Steele, C.N, , ADPKD, Biomarkers, Clinical, Diet, Epidemiology, Metformin

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Novel Erector Spinae Plane Block ok for Postoperative Analgesia in children undergoing hypospadias repair: Study

The caudal block is the commonly employed regional technique in children undergoing hypospadias repair to manage postoperative pain. Recent study evaluated the effectiveness of sacral erector spinae plane block (ESPB) for postoperative analgesia in pediatric patients undergoing hypospadias repair. The study was a randomized controlled trial involving 40 children aged 2–7 years with ASA grade I or II. After general anesthesia induction, group I received ultrasound-guided sacral ESPB with 1 ml/kg of 0.25% bupivacaine, while group II did not receive the block. Pain was assessed using the FLACC scale, and rescue analgesia was given when the FLACC score was ≥4. The primary objective was to compare postoperative analgesic (paracetamol) consumption, and the secondary objective was the time to first rescue analgesia.

The results showed that mean postoperative paracetamol consumption was significantly lower in group I (360 ± 156.60 mg) compared to group II (997.50 ± 310.87 mg), and the time to first rescue analgesia was significantly longer in group I (906 ± 224.51 min) compared to group II (205.00 ± 254.92 min). The study concluded that sacral ESPB effectively reduced postoperative analgesic consumption in pediatric patients undergoing hypospadias repair.

Study Design and Procedure

The study design was a prospective, randomized, and double-blind comparison. The sacral ESPB was found to be safe and effective in all patients, and no complications were observed in any patient. The sacral ESPB was performed using aseptic techniques under ultrasound guidance, and patients remained hemodynamically stable intraoperatively. The study found that the sacral ESPB provided effective pain relief and extended the time to first rescue analgesia, indicating its potential as an alternative to caudal block for pediatric hypospadias repair.

The study’s findings were consistent with previous case reports on the effectiveness of sacral ESPB in various surgeries. The sacral ESPB was observed to have advantages such as ease of administration, widespread local anesthetic spread, and lack of motor block. Overall, the study demonstrated that sacral ESPB is effective at reducing postoperative analgesic consumption and providing prolonged pain relief in pediatric patients undergoing hypospadias repair. This supports the potential use of sacral ESPB as an alternative regional technique in pediatric surgical procedures.

Key Points –

– The study design was prospective, randomized, and double-blind. The sacral ESPB was found to be safe and effective in all patients, and no complications were observed. The procedure was performed using aseptic techniques under ultrasound guidance, and patients remained hemodynamically stable intraoperatively. The sacral ESPB provided effective pain relief and extended the time to first rescue analgesia, suggesting its potential as an alternative to caudal block for pediatric hypospadias repair.

– The findings of the study were consistent with previous case reports on the effectiveness of sacral ESPB in various surgeries. The technique was observed to have advantages such as ease of administration, widespread local anesthetic spread, and lack of motor block. The study demonstrated that sacral ESPB effectively reduced postoperative analgesic consumption and provided prolonged pain relief in pediatric patients undergoing hypospadias repair, supporting its potential use as an alternative regional technique in pediatric surgical procedures.

Reference –

Bansal T, Yadav N, Singhal S, Kadian Y, Lal J, Jain M. Evaluation of USG‑guided novel sacral erector spinae block for postoperative analgesia in pediatric patients undergoing hypospadias repair: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2024;40:330‑5.

Evaluation of USG‑guided novel sacral erector spinae block for postoperative analgesia in pediatric patients

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Risk of Parkinson’s more than double for people with anxiety, finds research

The risk of developing Parkinson’s is at least twice as high in people with anxiety compared to those without, finds a new study by UCL researchers.

The research, published in the British Journal of General Practice, investigated whether there was a link between people over the age of 50 who had recently developed anxiety and a later diagnosis of Parkinson’s.

The team used UK primary care data between 2008 and 2018 and assessed 109,435 patients who had developed anxiety after the age of 50 and compared them to 878,256 matched controls who did not have anxiety.

They then tracked the presence of Parkinson’s features – such as sleep problems, depression, tremor and balance impairment – from the point of their anxiety diagnosis up until one year before the date of a Parkinson’s diagnosis, to help them understand each group’s risk of developing Parkinson’s over time and what their risk factors might be.

The team made sure to adjust the results to account for age, sex, social deprivation, lifestyle factors, severe mental illness, head trauma and dementia – which may affect the likelihood of developing the condition in people with anxiety.

Consequently, they found that the risk of developing Parkinson’s increased two-fold in people with anxiety, compared to the control group.

They also confirmed that symptoms such as depression, sleep disturbance, fatigue, cognitive impairment, hypotension, tremor, rigidity, balance impairment, and constipation, were risk factors for developing Parkinson’s in people with anxiety.

Co-lead author, Dr Juan Bazo Avarez (UCL Epidemiology & Health), said: “Parkinson’s disease is the second most common neurodegenerative condition worldwide, and it is estimated that it will affect 14.2 million people by 2040.

“Anxiety is known to be a feature of the early stages of Parkinson’s disease, but prior to our study, the prospective risk of Parkinson’s in those over the age of 50 with new-onset anxiety was unknown.

“By understanding that anxiety and the mentioned features are linked to a higher risk of developing Parkinson’s disease over the age of 50, we hope that we may be able to detect the condition earlier and help patients get the treatment they need.”

Parkinson’s disease is the world’s fastest growing neurodegenerative disorder and currently affects nearly 10 million people across the globe.

The condition is a progressive disorder that is caused by the death of nerve cells in the part of the brain called the substantia nigra, which controls movement. These nerve cells die or become impaired, losing the ability to produce an important chemical called dopamine, due to the build-up of a protein called alpha-synuclein.

A team of researchers, led by scientists at UCL and University Medical Centre Goettingen, Germany, have recently developed a simple blood test that uses artificial intelligence to predict Parkinson’s up to seven years before the onset of symptoms*.

Co-lead author Professor Anette Schrag (UCL Queen Square Institute of Neurology) said: “Anxiety is not as well researched as other early indicators of Parkinson’s disease. Further research should explore how the early occurrence of anxiety relates to other early symptoms and to the underlying progression of Parkinson’s in its early stages.

“This may lead to better treatment of the condition in its earliest stages.”

The researchers advise that future research should explore why people aged over 50 with new-onset anxiety are more at risk of Parkinson’s and whether their outcomes are affected by the severity of anxiety. 

Reference:

Juan Carlos Bazo-Alvarez, Danielle Nimmons, Kate Walters, Irene Petersen and Anette Schrag, Risk of Parkinson’s disease in people aged ≥50 years with new-onset anxiety: a retrospective cohort study in UK primary care, British Journal of General Practice, https://doi.org/10.3399/BJGP.2023.0423.

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New study shows medication abortion without ultrasound to be safe

Researchers compared patients who received care remotely to those who got ultrasounds and found no differences in outcomes. 

Medication abortion patients who receive pills by mail without first getting an ultrasound do just as well as those who are examined and given the drugs in person, new research from UC San Francisco has found.

The study, which appears June 24 in JAMA, adds to evidence from UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) program that using telehealth for medication abortion is safe and effective. 

Although the Supreme Court recently upheld the Food and Drug Administration (FDA) guidelines that permit remote prescribing and delivery of medication abortion, it was a narrow ruling based on the plaintiffs not having the standing to sue.

These guidelines have enabled the provision of medication abortion via telehealth, which has improved access to care in recent years. More legal challenges to medication abortion are expected in the wake of the narrow ruling.

After the high court ended the constitutional right to abortion in 2022, a growing number of states enacted restrictions; and medication abortion now accounts for about two-thirds of all abortions in the U.S. healthcare system.

“This study adds to a growing and robust body of evidence demonstrating the effectiveness and safety of medication abortion with telehealth and mailing medications,” said Lauren J. Ralph, PhD, MPH, an associate professor of obstetrics, gynecology and reproductive sciences at UCSF and first author of the study.

“Patient history-based models of medication abortion care without ultrasound and via telehealth offer a safe, effective and urgently needed way to overcome logistical and geographic obstacles to accessing abortion today,” she said.

Testing the “no test” method

The researchers analyzed the experiences of 585 patients at clinics in Colorado, Illinois, Maryland, Minnesota, Virginia and Washington from May 2021 to March 2023, dividing them into three groups.

The first were evaluated for eligibility for medication abortion using telehealth. They underwent a patient history-based screening without ultrasound, also known as the “no-test” method, and received their medication by mail (288 patients). The second were assessed using the “no-test” method and received their medication in person (119 patients). And the third underwent an ultrasound and got their medication in person (238 patients).

All participants took the two-drug regimen of mifepristone, which blocks progesterone, a hormone that is needed to continue pregnancy, and misoprostol, which is used one to two days later to bring on contractions. The safety of mifepristone, the only drug approved by the Food and Drug Administration (FDA) specifically for medication abortion, has been at the center of the Supreme Court case. 

The researchers found that 95% of the participants had a complete abortion without having to repeat the regimen, and the telehealth patients did as well as those who received in-person care. Serious adverse events were rare regardless of the group.

Medication abortion is approved for use in people up to 10 weeks (70 days) of pregnancy. And Ralph said patients can report enough information about their history to assess how far along they are in pregnancy without an ultrasound.

“These models of care that rely on no-test telehealth screening and mailing medications are as effective as in-person care with ultrasound and should be offered to all pregnant people,” she said. 

Research confirms that restrictions were not necessary

The recent Supreme Court case sought to roll back guidelines that have made the medication more widely available, including the FDA’s removal in 2021 of a requirement that mifepristone be dispensed in person at a clinic or doctor’s office. 

In February, UCSF researchers showed that medication abortion can be delivered safely and effectively through telehealth. And in May, they published a study that found dispensing the pills through the mail works as well as requiring patients to pick them up in person.

“The science is clear that telehealth evaluation and pharmacy dispensing of abortion pills is safe and effective,” said ANSIRH’s director, Daniel Grossman, MD, a UCSF professor of obstetrics, gynecology and reproductive sciences and senior author of the latest study. “Any attempt to restrict it is not based on science.” 

Reference:

Ralph LJ, Baba CF, Biggs MA, McNicholas C, Hagstrom Miller A, Grossman D. Comparison of No-Test Telehealth and In-Person Medication Abortion. JAMA. Published online June 24, 2024. doi:10.1001/jama.2024.10680

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Carbonic Anhydrase Inhibitors Show Promise for X-Linked Retinoschisis, suggests study

Researchers have found that carbonic anhydrase inhibitors (CAIs) may offer beneficial short-term management for cystoid fluid collections (CFC) in patients with X-linked retinoschisis (XLRS). A recent retrospective study conducted in Dutch and Belgian tertiary referral centers evaluated the efficacy of oral and topical CAIs on visual acuity and central foveal thickness (CFT) in XLRS patients, showing promising results despite modest changes in visual acuity. This study was published in Ophthalmology Retina journal by Jonathan H. and colleagues.

XLRS is a genetic eye condition characterized by the splitting of the retina, leading to visual impairment. There is currently no standard treatment regimen for CAIs in managing this condition. This study aimed to address this gap by assessing the effects of CAIs on visual acuity and CFT in a cohort of XLRS patients.

This retrospective cohort study included 42 patients diagnosed with XLRS. Patients who had undergone treatment with oral CAI (acetazolamide), topical CAI (brinzolamide/dorzolamide), or a combination of both for at least four consecutive weeks were enrolled. The median age at the baseline visit was 14.7 years, with a range of 43.6 years, and the median follow-up period was 4.0 years.

Patients were treated with either oral CAI, topical CAI, or a combination of both. The primary outcomes measured were CFT and best-corrected visual acuity (BCVA). The effectiveness of the CAI treatment was evaluated by the changes in these parameters over the follow-up period.

  • Oral CAI Treatment: Among the 25 patients treated with oral CAI, there was a significant reduction in CFT by 14.37 μm per 100 mg per day (P < 0.001; 95% CI, −19.62 to −9.10 μm). Visual acuity also improved modestly with a change of −0.0059 logMAR per 100 mg (P = 0.008; 95% CI, −0.010 to −0.0013 logMAR).

  • Topical CAI Treatment: For the 24 patients treated with topical CAI, CFT decreased by 7.52 μm per drop per day (P = 0.017; 95% CI, −13.67 to −1.32 μm).

  • Combination Therapy: Eleven patients received a combination of oral and topical CAI, showing trends similar to the individual treatments.

  • Side Effects: Seven patients (17%) experienced side effects that led to the discontinuation of treatment.

The study highlights that oral CAI treatment can significantly reduce CFT in XLRS patients, although the improvement in visual acuity was modest and not of clinical significance. Topical CAI also showed a reduction in CFT, but to a lesser extent. Despite the modest visual acuity improvements, the anatomical benefits of reduced CFT could create a more favorable condition for potential future treatments, such as gene therapy.

Treatment with carbonic anhydrase inhibitors, particularly oral CAIs, may provide short-term benefits for managing cystoid fluid collections in XLRS patients. Although the visual acuity changes were minor, the significant reduction in central foveal thickness suggests that CAIs could play a role in optimizing retinal conditions for future therapeutic options.

Reference:

Hensman, J., Hahn, L. C., van Schooneveld, M. J., Diederen, R. M. H., ten Brink, J. B., Florijn, R. J., Bergen, A. A., Strubbe, I., Heutinck, P., van Genderen, M. M., van den Born, L. I., Thiadens, A. A., de Zaeytijd, J., Leroy, B. P., Hoyng, C. B., & Boon, C. J. F. (2024). Efficacy of carbonic anhydrase inhibitors on cystoid fluid collections and visual acuity in patients with X-linked retinoschisis. Ophthalmology Retina, 8(6), 600–606. https://doi.org/10.1016/j.oret.2023.12.003

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Fingerprints shall predict regularity of TB patients on antitubercular drugs in future, says study

A fingerprint may soon be all a doctor needs to check whether tuberculosis patients are taking their antibiotics – thanks to a new study led by the University of Surrey.

Scientists successfully detected the drugs in finger sweat – and with almost the same accuracy as a blood test.

Professor Melanie Bailey, an analytical chemist and co-author of the study from the University of Surrey, said:   

“Up until now, blood tests have been the gold standard for detecting drugs in somebody’s system.

“Now we can get results that are almost as accurate through the sweat in somebody’s fingerprint. That means we can monitor treatment for diseases like tuberculosis in a much less invasive way.”

Curable tuberculosis (TB) is treated with antibiotics. If patients don’t stick to their full course, the treatment might not work, leading to drug-resistant TB instead.

Scientists wanted to know when was best to test, and whether they could tell how much medication the patient had taken.

To do so, they tested ten TB patients at the University Medical Center Groningen (UMCG), in the Netherlands.

Dr Onno Akkerman, a pulmonary physician with focus on tuberculosis from the UMCG said:

“It was very simple to collect our samples. We asked patients to wash their hands, put on a nitrile glove to induce sweating, and then press their fingertips onto a paper square.

“Finger sweat can be collected without any specialist training. Unlike blood, it isn’t a biohazard, so can be transported and stored much more easily.

“We’re looking forward to working with Surrey to detect other TB drugs using this promising technique.”

The samples were shipped to Surrey’s Ion Beam Centre and they were analysed using mass spectrometry – which breaks the sample down to see what it is made of.

Scientists detected antibiotics in finger sweat with 96% accuracy. The metabolite, produced by actually ingesting the drug, showed up with 77% accuracy.

The drug itself was present between one and four hours after ingestion, while a metabolised version showed up best after six hours.

Dr Katie Longman, co-author of the study from the University of Surrey, explained:

“Doctors need to check whether tuberculosis patients are taking their antibiotics. It’s much quicker and more convenient to do that using fingerprints rather than taking blood.

“This could ease the time pressure on a busy health service and offer patients a more comfortable solution.

“For some patients, like babies, blood tests are not feasible or desirable – so techniques like this one could be really useful.” 

Reference:

K. Longman, O.W. Akkerman, S. Ghimire, M.S. Bolhuis, M.A. Chambers, M.G.G. Sturkenboom, M.J. Bailey, Measurement of isoniazid in tuberculosis patients using finger sweat with creatinine normalisation: A controlled administration study, International Journal of Antimicrobial Agents, 2024, https://doi.org/10.1016/j.ijantimicag.2024.107231.

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Novo Nordisk Gets CDSCO Panel Nod to Study Cagrilintide plus semaglutide

New Delhi:The drug major Novo Nordisk has got approval from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) to conduct a phase II clinical study of the antidiabetic drug combination cagrilintide plus semaglutide.

However, this approval is subject to the condition that the firm should include the nephrologists as principal investigators (PI) or co-principal investigators (Co-PI) from the same site or institute.

This came after Novo Nordisk presented Phase II clinical study protocol No. NN9388-7700, version 1.0, dated 25 September 2023.

Cagrilintide/semaglutide is a combination of cagrilintide, a dual amylin and calcitonin receptor agonist, and semaglutide, a GLP-1 agonist. It is injected once a week and is being tested for type 2 diabetes and obesity.

Cagrilintide is a long-acting amylin analog under investigation for weight management. Semaglutide, a GLP-1 receptor agonist, reduces appetite via GLP-1 receptors in the hypothalamus, increases the production of insulin, and reduces glucagon secretion, delaying gastric emptying.

At the recent SEC meeting for endocrinology and metabolism held on June 19, 2024, the expert panel reviewed the Phase II clinical study protocol No. NN9388-7700 version No. 1.0 dated 25 September 2023, presented by the drug major Novo Nordisk.

After detailed deliberation, the committee recommended the grant of permission to conduct the trial with the condition that the firm should include the nephrologists as principal investigators (PI) or co-principal investigators (Co-PI) from the same site or institute.

Also Read:Eli Lilly Company Gets CDSCO Panel Nod To Import, Market Antidiabetic drug Tirzepatide for chronic weight management

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Slapped, Abused! BJ Medical College Orthopaedics resident doctor files complaint with NMC accusing 2 senior medicos of harassment

Ahmedabad: Days after an orthopaedic resident doctor accused an associate professor of mentally harassing him, another orthopaedic resident from the 2022 batch at BJ Medical College associated with Ahmedabad Civil Hospital has come forward with serious ragging allegations against two senior doctors of the same department and filed a complaint against them with the NMC. 

In a two-page long complaint letter addressed to the Anti-Ragging Committee of the National Medical Commission (NMC), the first-year orthopaedic resident doctor alleged that he had not attended college for the past year due to being ‘physically, mentally, and financially harassed’ by the seniors. The doctor alleged that he was also slapped, kicked, punched and received death threats from the seniors. 

The complainant, in the letter, accused the seniors of physically assaulting him, claiming that he was beaten in the female orthopaedic ward and the operating theatre. He stated that the seniors beat him in front of patients, used abusive language, and called him derogatory names which forced him to leave the college and his studies. He alleged that he returned to his home in Madhya Pradesh after being unable to bear the ragging, torture and harassment. 

Also read- MBBS Student Undergoes Dialysis 4 Times After Being Forced To Do More Than 300 Situps, 7 Medicos Booked For Ragging

Taking cognizance of the matter, the National Medical Commission (NMC) has demanded a response from BJMC within 24 hours, as reported by TOI. 

The two accused seniors, in this case, are both from the orthopaedic department of BJMC. 

The victim in his first-year residency was originally meant to be in his second year, just like the second-year resident doctor who had accused the orthopaedic department’s associate professor of mental harassment. However, due to being away from the college for a year because of ragging, he has been held back in his first year. 

“I have not attended college for the past year because I was harassed physically, mentally, and financially there. When I initially joined, senior Dr *** slapped me 8-10 times and punched and kicked me on my back in the female orthopaedic ward. Even before that, they used to beat me in the operation theatre, saying, “Leave, or you will die here. At that time, I left the college and went back home (Madhya Pradesh).” stated the doctor in the complaint letter shared on the popular social media platform ‘X’. 

After returning home, he attempted to file a complaint but it was not officially recorded due to lack of evidence. Later, the college authorities asked him to rejoin which he did but the seniors again continued to rag and harass him. 

“Senior Dr ** and Dr ** continued to harass me physically, mentally, and financially, threatening that they would not teach me anything and that I would have to work like a junior in front of my juniors. Sir, they caused severe mental harassment, which forced me to go back home, and I haven’t attended college for a year. In the ward, senior Dr *** and Dr *** used to beat me in front of patients, use abusive language, and call me derogatory names. Once, in an emergency O.T., Dr. *** (another doctor) threw my mobile away. Many times, in the emergency ward, seniors asked me to fight with patients, and upon my refusal, they threatened that I would die there. If anything went wrong, they would blame it on me and make me write an application admitting my fault. During my stay, I was not provided with any accommodation. The senior occupied the ward duty room, and we had to sleep on patient chairs. If seniors saw us, they would kick us to wake us up. If we ate in the room, they would scold us,” read the complaint. 

The student alleged that he was also coerced into regularly spending significant amounts on snacks and food for the seniors. He claimed that he was forced to pay Rs 1500-2000 for snacks every Tuesday and Saturday in the OPD and Rs 2000-3000 for food during emergency days. 

“If we didn’t have money, they would force us to arrange it from somewhere. We had to pay workers 12000-20000 INR monthly. Sometimes I had no money and had to ask my father, who often borrowed money to help me,” he stated in the complaint. 

After facing financial difficulties, he asked the committee for assistance in being released from his college seat, as the seat leaving bond amounts to approximately Rs 25 lakhs.

“We worked hard to pass the NEET PG exam and took admission, but the environment there is such that if a student commits suicide, they would attribute it to depression. It would be distressing for the parents, but nothing would happen to them. Please help.” he adds. 

Further, he stated “I am being forced to leave the seat, sir. If I commit suicide and cannot repay the 25 lakh debt, the responsible persons will be: Dr. ** and Dr. ***”

Medical Dialogues team on July 3 reported that accusing an associate professor in the Orthopaedic department, of continuous harassment, a second-year orthopaedic resident doctor at BJ Medical College filed an official complaint detailing serious allegations of harassment continuing for over a year, including the forced harassment of junior resident doctors.

After the medico expressed his intention to commit suicide in a letter due to the alleged toxic environment and torture he allegedly endured by his professor since the beginning of his PG studies, his distress became widely known over the weekend when senior students addressed the issue on the social media platform ‘X’ by sharing the letter written by him leading to a rapid spread of the message and support from other internet users.

In the letter, the doctor expressed his frustration regarding the alleged toxic work culture and torture from the professor that he had endured since he started his postgraduate studies. The student alleged that the harassment began while he was a first-year resident at the medical college hospital. He claimed he was constantly humiliated, blamed for various problems, forced to write self-incriminating letters, and treated as a ‘servant rather than a student.’

Further, he alleged that he was forced to engage in inappropriate behaviour with juniors and his colleagues and was humiliated in front of patients. Although he had apologised to them, the ongoing harassment since the beginning of his residency impacted his mental state making him feel ‘helpless’.

IMA calls for action

Highlighting the harassment incidents of the two postgraduate resident doctors at the BJ Medical College, the Indian Medical Association Junior Doctor’s Network has urged the college authorities to take action by conducting a thorough investigation into the case.  

Addressing the dean of BJMC, the IMA wrote in their letter on July 5 “IMA Junior Doctors Network is writing this letter to bring to your attention a matter of concern regarding the mistreatment of two postgraduate residents in the orthopaedic department at B.J. Medical College, Ahmedabad. Dr Singh has reported instances of mental, financial and physical harassment by the seniors of his department. Such treatment have hampered their professional growth and forced them to leave the residency.”

Calling for action, IMA asked the dean to take measures to ensure a safe and supportive working environment for the postgraduate residents.

Also read- BJ Medical College Orthopaedics Resident Alleges Harassment By Associate Professor, Files Complaint

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Unsafe neighborhoods could drive up smoking rates

It may sound far-fetched, but new research suggests that living in dangerous neighborhoods could trigger an unintended health harm: higher smoking rates among residents.

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