Chronic kidney disease may increase mortality in patients with COPD: Study

A 6-minute walk of less than 350 meters tripled the mortality risk, whereas chronic kidney disease (CKD) independently quadrupled it, in patients with chronic obstructive pulmonary disease (COPD). The patients with CKD who also had COPD were older, more likely to develop heart failure, and saw a quicker loss in lung function. The results published in the Respiratory Medicine journal highlight the necessity of careful observation in this high-risk population.

Lung cancer, osteoporosis, depression, diabetes, arrhythmia, congestive heart failure, and ischemic heart disease are all linked to COPD. Despite being acknowledged as a prevalent comorbidity of COPD, the impact of CKD on the longevity of COPD patients is still unknown because of the heterogeneity of current study groups. The patients with concomitant COPD had a higher risk of respiratory-related and all-cause death, according to a cohort study of CKD patients.

With an estimated median incidence of 9.5% worldwide, chronic kidney disease represents another significant health care burden. According to a prior meta-analysis, individuals with COPD had a greater frequency of CKD than the general population. Limited exercise capacity in people with COPD has been linked to the presence of numerous comorbidities.

The 6-minute walk distance (6MWD) is a well-established metric for forecasting the prognosis of patients with chronic pulmonary diseases, and the 6-minute walk test (6MWT) is a valid instrument for assessing their functional exercise ability. Chen-Chuan Hsu examined the clinical effects of chronic kidney disease in patients with COPD in this study, taking into consideration 6MWT parameters and clinically relevant data.

COPD patients who finished the 6MWT and a 3-year follow-up were included in the trial retrospectively. This study gathered and examined data on clinical information, 6MWT parameters, and results. A total of 33 (23.4%) of the 141 COPD patients that were included also had concomitant CKD. When compared to patients without CKD, individuals with CKD were much older and had higher risks of heart failure, death, and FEV1 decrease.

The results of multivariate analysis showed that CKD (OR: 4.66, 95% CI: 1.30–16.76, p = 0.018) and a 6-minute walking distance < 350 m (odds ratio [OR]: 3.65, 95% CI: 1.05–12.06, p = 0.041) were independent risk factors for death. Overall, in individuals with COPD, comorbid CKD was linked to a higher death rate and a quicker fall in FEV1. During therapy, patients with COPD and concomitant CKD may need close observation.

Source:

Hsu, C.-C., Tung, P.-H., Lin, T.-Y., Huang, S.-W., Li, T.-C., Wu, B.-C., Chang, C.-H., Wu, H.-M., Lo, C.-Y., Lin, C.-Y., Lin, H.-C., & Lin, S.-M. (2025). Effect of chronic kidney disease on survival in patients with chronic obstructive pulmonary disease. Respiratory Medicine, 244(108181), 108181. https://doi.org/10.1016/j.rmed.2025.108181

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Antibiotic Prophylaxis During Pregnancy Shows No Significant Benefit on Birth Weight: Trial Shows

Zimbabwe: A widely used antibiotic combination, trimethoprim–sulfamethoxazole, did not significantly improve birth weight in infants when administered to pregnant women in a new large-scale clinical trial conducted in Zimbabwe. The findings, published in the New England Journal of Medicine, provide critical insights into the use of antimicrobial prophylaxis during pregnancy and its role in addressing poor birth outcomes.  

The randomized, double-blind, placebo-controlled trial was led by Bernard Chasekwa and colleagues from the Zvitambo Institute for Maternal and Child Health Research in Harare. Researchers enrolled 993 pregnant women, including 131 with HIV infection, to examine whether daily administration of trimethoprim–sulfamethoxazole could lead to healthier birth weights by mitigating maternal infections, which are known contributors to low birth weight and other neonatal complications.

Participants were randomized to receive either the antibiotic (960 mg daily) or a placebo, beginning no earlier than 14 weeks into pregnancy and continuing until delivery. The median gestational age at which treatment began was 21.7 weeks. The primary endpoint of the study was infant birth weight.

Key Findings:

  • The average birth weight in the antibiotic group was 3,040 grams.
  • The average birth weight in the placebo group was 3,019 grams.
  • The 20-gram difference between the two groups was not statistically significant.
  • The antibiotic intervention did not show a measurable effect on birth weight.
  • The frequency of adverse events was comparable in both groups.
  • The antibiotic regimen was generally safe but did not demonstrate a clear benefit in improving birth weight outcomes.

Trimethoprim–sulfamethoxazole is often used to prevent bacterial infections in people with compromised immunity, including those with HIV. Its potential application in improving pregnancy outcomes has been of interest, particularly in low-resource settings where maternal infections are common and access to advanced medical care is limited.

However, the trial’s findings suggest that this specific prophylactic strategy may not yield the anticipated benefits for birth weight, a key indicator of neonatal health. Researchers emphasized the importance of continuing to explore other interventions to address poor birth outcomes, particularly in sub-Saharan Africa, where such risks remain high.

“Our results indicate that while trimethoprim–sulfamethoxazole is well-tolerated during pregnancy, it does not significantly affect birth weight,” the authors concluded. “Future studies should focus on identifying more effective approaches to reducing infection-related pregnancy complications.”

The trial adds to the growing body of evidence guiding maternal health policies, underscoring the need for evidence-based approaches tailored to the specific challenges faced in different global regions.

Reference:

Chasekwa, B., et al. (2025) A Trial of Trimethoprim–Sulfamethoxazole in Pregnancy to Improve Birth Outcomes. New England Journal of Medicine. doi.org/10.1056/NEJMoa2408114.

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Vitamin D and Pregnancy: Unraveling VDR Gene’s Role in Hypertensive Disorders, study finds

Investigating genetic variations in the vitamin D receptor (VDR) gene has revealed inconsistent associations with hypertensive disorders of pregnancy (HDP) across diverse populations. Recently published systematic review focuses on assessing laboratory protocols for VDR gene variant detection and their relationships to HDP. Hypertensive disorders, which include gestational hypertension and preeclampsia, pose significant risks for maternal and infant health. Emerging evidence suggests that vitamin D insufficiency is prevalent in women experiencing HDP, highlighting the importance of vitamin D’s role in various biological processes during pregnancy.

Polymorphisms in the VDR Gene

The VDR gene, located on chromosome 12, has several polymorphisms, notably FokI, BsmI, ApaI, and TaqI. These variations have been associated with altered VDR functionality and may disrupt molecular pathways critical to vascular and immune health, thereby increasing susceptibility to HDP. Specifically, the loss of function associated with these polymorphisms may lead to endothelial dysfunction and an imbalance in the renin-angiotensin-aldosterone system, influencing maternal blood pressure.

Review Methodology and Study Selection

The review systematically searched databases such as PubMed and Scopus, yielding 170 candidate articles, ultimately culminating in the inclusion of nine studies. The majority (67%) of the studies originated from Asia, with others from Europe and Latin America, primarily employing case-control designs. A range of laboratory methods for detecting VDR variants was documented, with PCR-restriction fragment length polymorphism (PCR-RFLP) being the most common. Results indicated that associations with VDR variants were ascribed variably, with FokI presenting a significant relationship with HDP in most Asian studies.

Variability in Study Findings

Notably, two studies utilizing TaqMan PCR found associations with the FokI variant while an AS-PCR method for the ApaI variant showed no link in a Pakistani population, underscoring the variability in findings due to methodological differences. Additionally, while some studies reported BsmI’s relation to HDP, other populations showed no significant associations.

Implications and Future Directions

The inconsistent data may stem from variant detection protocols and contextual factors such as environmental influences and lifestyle, emphasizing the necessity for standardized protocols across studies to improve the reliability of genetic association findings. Strengthening VDR detection methods can enhance precision in individual patient management and public health strategies aimed at minimizing HDP risks, advocating for tailored vitamin D supplementation approaches. Future research should emphasize haplotype analyses and broadening case-control studies to confirm these genetic associations comprehensively.

Key Points

– Investigated genetic variations in the vitamin D receptor (VDR) gene reveal inconsistent relationships with hypertensive disorders of pregnancy (HDP), which include gestational hypertension and preeclampsia, underscoring the significance of vitamin D in maternal and infant health.

– The VDR gene, located on chromosome 12, has several significant polymorphisms like FokI, BsmI, ApaI, and TaqI, which may disrupt molecular pathways related to vascular and immune health, potentially leading to increased susceptibility to HDP through mechanisms such as endothelial dysfunction and disturbances in the renin-angiotensin-aldosterone system.

– A systematic review employed databases like PubMed and Scopus, filtering down from 170 candidate articles to include nine studies, predominantly derived from Asian populations (67%). The studies primarily utilized case-control design with PCR-restriction fragment length polymorphism (PCR-RFLP) recognized as the most common laboratory method for detecting VDR variants.

– Variability in study findings was noted, with specific methodologies yielding different results; for instance, while associations between the FokI variant and HDP were identified in most Asian studies, results with TaqI and ApaI variants differed, demonstrating how methodological differences can affect outcomes.

– Inconsistent associations with VDR variants could result from variable detection protocols, environmental influences, and lifestyle factors, necessitating standardized methodologies to enhance the reliability of genetic epidemiology findings in relation to hypertensive disorders.

– Recommendations for future research include focusing on haplotype analyses and expanding case-control studies to solidify the understanding of genetic associations, as well as improving VDR detection methods to inform personalized patient care and public health strategies aimed at reducing the risks of HDP through tailored vitamin D supplementation.

Reference –

Yakubu Ibrahim et al. (2025). A Plethora Of Laboratory Protocols For Vitamin D Receptor (VDR) Gene Variants Detection: A Systematic Review Of Associations With Hypertensive Disorders Of Pregnancy. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07510-6.

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At-home heart attacks and cardiac deaths on the rise since COVID-19 pandemic, states research

Heart attacks are the leading cause of death globally, yet some statistics from many different countries suggest these events declined in frequency since the COVID-19 pandemic. Mass General Brigham researchers evaluated whether these cardiac trends reflect a true change in event rates, or if they reflect that more people are dying at home rather than in hospitals. Their findings highlight potential shortcomings of cardiac care during and in the years following the height of the pandemic, suggesting opportunities to better treat and prevent cardiac events in people at risk. The study published today in JAMA Network Open.

“Lots of reports have shown that there have been fewer heart attacks in hospitals since 2020-but something seems to be missing from that data,” said corresponding author Jason H. Wasfy, MD, MPhil, director of Outcomes Research at the at the Massachusetts General Hospital Cardiology Division and a faculty member at the Mongan Institute at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “We now show that if you account for deaths at home, cardiac deaths are going up and have stayed up for years. Today there are a lot more people having cardiac deaths at home, which also raises the concern that people with heart disease haven’t been getting the care they need since the pandemic.”

The researchers looked at death certificate data from 127,746 people who died in Massachusetts and found cardiac deaths exceeded anticipated levels between 2020 and 2023. Using data from 2014 to 2019, the team set an expected cardiac death rate to compare the new 2020 to 2023 rate against. Cardiac deaths were 16% higher than expected in 2020, 17% higher in 2021 and 2022, and 6% higher in 2023. Notably, this significant increase in cardiac deaths happened despite lower cardiac-related hospital admissions, meaning more deaths occurred at home.

“Healthcare systems around the world have experienced multiple shocks since 2020. Our findings suggest that both patient choices about seeking care and outcomes after experiencing a cardiac emergency also have changed,” said senior author John Hsu, MD, MBA, MSCE, faculty member and director of the Program for Clinical Economics and Policy Analysis at the Mongan Institute at MGH. “Had we not examined mortality using death certificate data, the increases in population cardiac mortality could have gone unnoticed.”

Reference:

Wasfy JH, Lin Y, Price M, Newhouse JP, Blacker D, Hsu J. Postpandemic Cardiac Mortality Rates. JAMA Netw Open. 2025;8(5):e2512919. doi:10.1001/jamanetworkopen.2025.12919

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Errors in Question Paper, Delay in Grievance Redressal- Concerns before NEET 2025 Results

New Delhi: The results for the National Eligibility-Entrance Test Undergraduate (NEET-UG) 2025 examination are scheduled to be released within the next few days. Amid this, students and parents/guardians have started raising serious concerns over errors in the question paper in the NEET 2025 exam. Further complaining of the delays in the redressal of the grievances, the students and parents are now urging the National Testing Agency (NTA) to respond quickly.

The centralised UG medical entrance examination i.e., NEET UG 2025 exam, was conducted by NTA on May 4, 2025. More than 20 lakh candidates appeared in the exam to get admitted to MBBS, BDS, and other UG medical courses.

Also Read: NEET UG 2025- MP HC Stays Result Declaration for Complainant Candidates citing power outage

As per the latest media report by the Times of India, in Sikar and Gujarat, the NEET candidates alleged that they received faulty booklets with jumbled page numbers. For instance, the students who were given Paper Code 47 in Sikar found that the pages of the question paper were not in order. Similar issue was found in Gujarati-medium Paper Code 48 for candidates in Jamnagar, Gujarat.

TOI has reported that due to the incorrect sequence of pages in the question paper, like question 7 being followed by question 15, some of the candidates claimed that they darkened the circle for the wrong question.

Some of the candidates have alleged that they had to lose valuable time trying to figure out the correct corresponding circles on the answer sheet.

After the exam was over, the guardians reportedly submitted formal complaints to the State Government of Gujarat and the NTA. In their complaints, the guardians had also attached the scanned copies of the faulty booklets as proof. 

Commenting on the matter, a parent wrote, “Students even raised the issue during the test but were told to solve the faulty paper.”

A state official also confirmed receiving such complaints from the guardians of the candidates. However, NTA has denied commenting on the issue, stating that it was sub-judice. 

Meanwhile, some of the candidates and coaching experts have also flagged certain questions as being beyond the medical syllabus. One such example was question 38 of Code 47, which asked the candidates to solve a calculus-based derivative- a topic more suited to engineering entrance tests like JEE (M).

Speaking to TOI in this regard, an NTA official said, “All questions were from the prescribed syllabus. The answer keys have been published and objections invited from candidates. These will be reviewed by a committee of subject experts.”

These complaints are pending before NTA, when recently the Madhya Pradesh High Court stayed the result declaration of the NEET candidates who complained of facing a power outage during the NEET examination on May 4. They claimed that the heavy rainfall, coupled with lack of management by the examination centers, which failed to arrange power backup, affected their performance.

Also Read: Power Outage disrupted NEET 2025- MP HC Stays Result Declaration for Complainant Candidates

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Haryana Govt doctors oppose Geofencing attendance system over privacy concerns

Chandigarh: Following the Haryana health department’s decision to introduce a geofencing-based attendance system for its employees, including doctors and healthcare staff, government doctors across the state have raised strong objections. The system, which uses a mobile app to track the real-time location of doctors to verify their presence at their assigned workplaces, has sparked concerns over privacy and security risks.

Under the new system developed by the National Health Mission (NHM), Haryana, the health department aims to ensure transparency in administration by recording the presence of healthcare professionals at their designated workplaces. The geofencing-based attendance system automatically log attendance when employees enter or leave predefined geographic boundaries, adding an extra layer of security. 

Also read- UP to now track its doctors attendance with geo-fencing

As part of this initiative, the disbursement of salaries to all officers and employees will be strictly based on the attendance data recorded by the geofencing system. In a communication dated May 30, the Additional Chief Secretary of Health informed the Director General of Health Services (DGHS), the Mission Director of the National Health Mission (NHM), and the Chief Executive of Ayushman Bharat Haryana Health Protection Authority that salary payments for health officials would depend entirely on data captured through the geo-fencing-based attendance management system.

But the Haryana Civil Medical Services Association (HCMSA), which represents government doctors in the state, has voiced strong opposition to this move. In a letter sent to the Director General of Health Services (DGHS), the association said that during an internal meeting on June 1, all members unanimously rejected the new attendance system.

“There was a unanimous disapproval of the proposed system. The system mandates the installation of a mobile application on personal devices to track doctor’s location. This constituted a breach of privacy, which is a fundamental right as upheld by the Supreme Court in its August 24, 2017, judgement in justice KS Puttaswamy versus Union of India case. Tracking a doctor’s location is unwarranted, leading to an environment of constant surveillance,’’ said the representation signed by HCMSA general secretary Dr Anil Yadav, as reported by HT. 

The HCMSA said that the doctors have expressed concerns regarding the potential cybersecurity threats associated with the mobile application, such as unauthorised access to sensitive personal data stored on mobile devices. 

“The requirement to share personal data and install such apps creates vulnerabilities that compromise individual and organisational security. In light of these concerns, it was unanimously decided that HCMS doctors will not share their personal data or install the geo-fencing app on their personal mobile phones. Our concerns will be brought to the notice of higher authorities,” said the association. 

Meanwhile, the Nursing Welfare Association, the Multipurpose Health Workers Association and the Association of Government Pharmacists in Haryana, in separate representations to the DGHS, have also conveyed unanimous disapproval of the proposed geo-fencing-based attendance management system.

What is a Geofencing Attendance System?

A geofencing attendance system is a technology that automatically tracks employee attendance by creating a virtual boundary around a specific location. It could be an office or a job site. When employees enter or leave that area, their attendance is automatically recorded using GPS or RFID technology.

For this, the employees would be required to download the ‘Geofenced Attendance HRY’ app, which is available on the Google Play Store and the Apple App Store. The system utilises geofencing technology, which uses GPS to define a virtual boundary around a specific location. The system provides real-time data on staff presence, allowing for better monitoring and accountability. The department plans to use the geofencing data to verify attendance and process salaries.

Also read- Ghost Faculty, low Attendance Plague Medical Colleges in 2022-23, National Medical Commission Reveals

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‘Humiliated in Public, Apologise in Public’: Doctors Reject Goa Health Minister’s apology

‘Humiliated in Public, Apologise in Public’: Doctors Tell Goa Health Minister

Amid the ongoing controversy over the suspension of a senior doctor at Goa Medical College and Hospital (GMCH) by Goa Health Minister Vishwajit Rane, the concerned doctor has rejected an apology tendered by the Minister on the social media platform X.

Calling it a “studio apology”, Dr. Rudresh Kuttikar, who was suspended by the Rane, demanded a public apology from the Minister at the Casualty Department of the hospital, where he had been berated by the Minister on Saturday.

Speaking to The Indian Express, Dr. Kuttikar said, “The minister should come to the Casualty Department and publicly apologise at the same place.”

Medical Dialogues had earlier reported that Goa Health Minister Vishwajit Rane had lashed out at GMCH Chief Medical Officer (CMO) Dr. Rudresh Kuttikar for allegedly misbehaving with patients during his surprise visit to the premier facility on Saturday and ordered his suspension. The incident took place during the Minister’s surprise visit to the hospital.

For more information, click on the link below:

‘Humiliated in Public, Apologise in Public’: Doctors Tell Goa Health Minister

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Weight loss program shown to improve eating disorder symptoms in at-risk people with type 2 diabetes

An intensive low-energy diet program, similar to the “NHS Type 2 Diabetes Path to Remission”, significantly improved eating disorder symptoms in people with type 2 diabetes and excess weight who were at risk of developing eating disorders, according to a University of Oxford study published in The Lancet Psychiatry.

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Scientists find unusual build-up of soot-like particles in lung cells of COPD patients

Cells taken from the lungs of people with chronic obstructive pulmonary disease (COPD) have a larger accumulation of soot-like carbon deposits compared to cells taken from people who smoke but do not have COPD, according to a study published in ERJ Open Research. Carbon can enter the lungs via cigarette smoke, diesel exhaust and polluted air.

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Researchers call for urgent study of fungal toxins in Ghana’s liver cancer rise

There’s an urgent need to quantify the role of fungal toxins (aflatoxins) found in agricultural crops, such as maize and peanuts (groundnuts), in the escalating rates of liver cancer in Ghana, as well as elsewhere in Africa and Asia, concludes a commentary published in BMJ Global Health.

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