Rs 10 Crore Ayushman Bharat Fraud in UP: Over 6000 fake claims approved

Lucknow: A major scam involving fraudulent medical insurance claims worth Rs 10 crore under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and Mukhyamantri Jan Arogya schemes has been uncovered at multiple private hospitals across Uttar Pradesh. An FIR was registered at Hazratganj police station on Monday after irregularities were flagged during a routine audit.

The complaint, filed by BK Srivastava, State Nodal Officer of the State Agency for Comprehensive Health and Integrated Services (SACHIS), alleges large-scale irregularities in the submission and approval of claims by private hospitals empanelled under the two health schemes.

According to the FIR, between May 1 and May 22, 2025, a total of 6,239 high-value insurance claims from 39 private hospitals were fraudulently approved and paid through the National Health Authority’s online portal. These approvals occurred largely during odd hours—late at night or outside working hours—raising suspicions about the legitimacy of the claims.

Investigators found that login credentials of key officials — including those belonging to the Implementation Support Agency (ISA), financial officers, and the CEO of SACHIS — had been misused to process and approve claims without authorisation.

The fraudulent activity involved unauthorised access and digital manipulation of login IDs such as UP003507, UP008126, UP008171, UP008038, UP008039 (ISA users), UP001730, UP003881 (Finance/Accounts), and UP008296 (CEO-SACHIS), reports TOI.

These IDs were used to approve claims without the knowledge or consent of the actual users. ISA officials have denied any role in the fraudulent activity, stating that none of the disputed claims were routed through their system as per protocol.

Under standard operating procedures, hospital claims are submitted after treatment and must go through multiple levels of scrutiny, including medical auditing by ISA, financial verification by SACHIS, and final approval by the CEO. However, this process was entirely bypassed, with fraudulent claims being approved using compromised login credentials.

Also Read: Gujarat: Private Hospitals, doctors exit AB-PMJAY over payment delays

Speaking to TOI, ACP Hazratganj Vikas Jaiswal said the FIR stated that the timestamps of the transactions indicated deliberate manipulation, as several claims were processed outside normal office hours, suggesting either an insider conspiracy or a highly sophisticated cyber breach.

The scam was uncovered when internal office audits noticed a pattern of large, disproportionate payouts originating from a finance manager’s login that was not in use by the designated officer during the time of those transactions. Subsequent verification confirmed that online recommendations for claim settlements were made without any actual input from the registered users.

The audit also revealed that many of the hospitals receiving the payments either did not qualify under the scheme or had inflated their treatment data significantly.

Also Read: Delhi Govt Hospitals to implement unified health information system

An internal review, along with verification from the ISA, revealed that the online recommendations for claim settlements were not made by genuine users, indicating a possible systemic breach.

Further investigation and forensic audits are now underway. Authorities believe the actual scale of the scam could be even larger than Rs 10 crore once all suspicious transactions are reviewed.

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Semaglutide increases walking distance in diabetic patients with peripheral artery disease: Lancet

A new study published in The Lancet journal showed that patients with type 2 diabetes and symptomatic peripheral arterial disease were able to walk farther after using semaglutide. Few treatments help patients with lower limb peripheral artery disease enhance their functional ability and health-related quality of life. Therefore, Marc Bonaca and his team set out to determine if semaglutide improves symptoms, quality of life, and outcomes in individuals with peripheral vascular disease and type 2 diabetes, as well as function as indicated by walking ability.

In 20 countries throughout North America, Asia, and Europe, 112 outpatient clinical trial sites participated in the STRIDE study. The participants were of at least 18 year old who had peripheral artery disease, type 2 diabetes, intermittent claudication (Fontaine stage IIa, able to walk >200 m), and an ankle-brachial index of less than or equal to 0·90 or 0·70.

Using an interactive online response system, the participants were randomly randomized (1:1) to receive either a placebo or subcutaneous semaglutide 1·0 mg once weekly for 52 weeks. The ratio to baseline of the maximal walking distance at week 52, as determined by a constant load treadmill in the whole study set, served as the main endpoint. 

After 1,363 individuals were evaluated for eligibility between October 1, 2020, and July 12, 2024, 792 of them were randomized to receive either semaglutide (n=396) or a placebo (n=396). Of the participants, 597 (75%) were men and 195 (25%) were women. The median age (IQR 61·0–73·0) was 68·0 years.

The semaglutide group outperformed the placebo group in terms of the estimated median ratio to baseline in maximum walking distance at week 52 (1·21 [IQR 0·95–1·55] vs. 1·08 [0·86–1·36]; estimated treatment ratio 1·13 [95% CI 1·06–1·21]; p=0·0004). The most common adverse event was a serious gastrointestinal event (two events reported by two [1%] in the semaglutide group and five events reported by three [1%] in the placebo group).

Additionally, 6 serious adverse events in 5 (1%) participants in the semaglutide group and 9 serious adverse events in 6 (2%) participants in the placebo group were possibly or probably related to treatment. No one died as a result of therapy. Overall, walking distance was considerably enhanced with semaglutide when compared to a placebo. 

Source:

Bonaca, M. P., Catarig, A.-M., Houlind, K., Ludvik, B., Nordanstig, J., Ramesh, C. K., Rasouli, N., Sourij, H., Videmark, A., Verma, S., & STRIDE Trial Investigators. (2025). Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial. Lancet, 405(10489), 1580–1593. https://doi.org/10.1016/S0140-6736(25)00509-4

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Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

Prediabetes and CKD: A Growing Double Burden

The rising prevalence of prediabetes and chronic kidney disease (CKD) in India reflects an often-overlooked interaction in the early phases of this metabolic disease. Analysis of 19,66,449 adult HbA1c samples from India found 22.25% to be prediabetic, (1) while pooled data from Indian community-based studies reported a CKD prevalence of 13.24%. (2) On a global scale, the IDF (2025) reported 634.8 million adults (12%) with impaired glucose tolerance (IGT), with South-East Asia showing the highest burden at 13.8%. (3) Beyond overt diabetes, prediabetes and insulin resistance are increasingly recognized as contributors to early renal dysfunction. Low-grade inflammation and neurohormonal activation, hallmarks of insulin resistance, are implicated in glomerular hyperfiltration, albuminuria, and early GFR decline. (4)

Prediabetes & Correlation with CKD Onset: Evidence from the Latest 2025 CURE-CKD Study

The CURE-CKD Registry cohort study (2025) analyzed 281,933 adults with prediabetes, defined per ADA criteria. Over a median 2.5-year follow-up, 3.6% (n=10,104) developed CKD, with a standardized incidence of 10.9 cases per 1000 person-years. Incidence increased with age and was higher in individuals with hypertension or ASCVD (11.9 vs. 9.4 per 1000 person-years).

Mechanistic findings suggest that glomerular hyperfiltration and high-normal albuminuria, early renal abnormalities, are more common in prediabetes. These alterations, likely driven by low-grade inflammation and hyperfiltration-induced stress, may promote CKD progression even before diabetes onset. (5)

Potential Role of Metformin in Early Renal Risk: Renal Protection Beyond Glycemic Control

In a nationwide Scottish cohort of 4,278 adults with type 2 diabetes and newly diagnosed stage 4 CKD, stopping metformin within 6 months was associated with a 26% higher risk of all-cause mortality [HR 1.26, 95% CI: 1.10–1.44]. (6) A recently published 2025 cohort study analyzed 10,330 matched patients with eGFR ≥60 mL/min/1.73 m² found that metformin reduced the risk of ESRD by 35% and preserved renal function. (7)

The figure below presents key mechanisms by which metformin confers renoprotective effects in diabetic kidney disease.

Figure: Key pathways of metformin’s renoprotective action in DKD, including AMPK activation and suppression of fibrosis, inflammation, and oxidative stress. Adapted from Kawanami D et al., Int J Mol Sci. 2020;21(12):4239. doi:10.3390/ijms21124239

Metformin Use in CKD: What the Guidelines Say

Guideline

Recommendations

Asian Pacific Society of Nephrology (2025)

Recommends metformin as first-line therapy in diabetic kidney disease with eGFR ≥30 mL/min/1.73 m². Dose adjustment is advised for eGFR 30–44, and discontinuation below 30. Initiation is discouraged if eGFR is <45. (8)

ADA (2025)

Advised using metformin if eGFR is ≥30 mL/min/1.73 m², with 50% dose reduction for eGFR 30–44, and discontinuation when eGFR falls below 30. (9)

KDIGO (2024)

Recommends continuing metformin in CKD patients with eGFR ≥30 mL/min/1.73 m², using lower doses if eGFR is 30–44, with individualized risk-benefit assessment. (10)

ADA-KDIGO (2022)

Consensus recommends metformin as first-line therapy in type 2 diabetes with CKD and eGFR ≥30 mL/min/1.73 m². A reduced dose (500–1000 mg daily) is advised for eGFR 30–44, and it should be discontinued if eGFR falls below 30 or during acute illness. (11)

Key Considerations for Practice

Since metformin is now approved for use in patients with eGFR as low as 30 mL/min/1.73 m², regular eGFR monitoring is essential to guide dosing. UACR testing aids in detecting early glomerular injury and risk stratification.

Though rare, lactic acidosis risk warrants caution during acute illness or in elderly patients with declining renal reserve. To avoid therapeutic inertia, early renal risk, such as hyperfiltration or high-normal albuminuria, should prompt timely intervention in prediabetic patients. (8,9,10,11)

Take Home Message

  • A significant portion of Indian adults show early metabolic risk, with widespread prediabetes and rising chronic kidney disease prevalence.
  • In the CURE-CKD study, over 10,000 prediabetic individuals progressed to CKD within just 2.5 years.
  • Metformin may offer renal protection in prediabetes through AMPK activation, anti-inflammatory, and anti-fibrotic pathways.
  • Guidelines from APSN, KDIGO, ADA, and the ADA-KDIGO consensus recommend the consideration of metformin in CKD patients with an eGFR of≥30 mL/min/1.73 m².

Reference:

1. Vora, Hardeep, and Preet Kaur. “Prediabetes and diabetes in India: An HbA1c based epidemiology study.” Diabetes research and clinical practice vol. 217 (2024): 111889. doi:10.1016/j.diabres.2024.111889

2. Talukdar, Rounik et al. “Chronic Kidney Disease Prevalence in India: A Systematic Review and Meta-Analysis From Community-Based Representative Evidence Between 2011 to 2023.” Nephrology (Carlton, Vic.) vol. 30,1 (2025): e14420. doi:10.1111/nep.14420

3. International Diabetes Federation. IDF Diabetes Atlas. 11th ed., 2025, www.diabetesatlas.org. Accessed on 3rd June 2025

4. Rico-Fontalvo, Jorge, et al. “Prediabetes and CKD: Does a Causal Relationship Exist.” Nefrología, vol. 44, no. 5, Sept.–Oct. 2024, pp. 628–638. Elsevier, https://doi.org/10.1016/j.nefro.2024.06.008.

5. Alicic, Radica Z et al. “Incidence of chronic kidney disease among adults with prediabetes in the CURE-CKD registry, 2013-2020.” Diabetes, obesity & metabolism vol. 27,6 (2025): 3536-3541. doi:10.1111/dom.16365

6. Lambourg, Emilie J et al. “Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study.” American journal of kidney diseases : the official journal of the National Kidney Foundation vol. 85,2 (2025): 196-204.e1. doi:10.1053/j.ajkd.2024.08.012

7. Lin, Yu-Ling et al. “Role of Metformin in Preventing New-Onset Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus.” Pharmaceuticals (Basel, Switzerland) vol. 18,1 95. 14 Jan. 2025, doi:10.3390/ph18010095

8. Liew, Adrian et al. “Executive Summary of the Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease-2025 Update.” Nephrology (Carlton, Vic.) vol. 30,5 (2025): e70031. doi:10.1111/nep.70031

9. American Diabetes Association Professional Practice Committee; 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S239–S251. https://doi.org/10.2337/dc25-S011

10. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. “KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.” Kidney international vol. 105,4S (2024): S117-S314. doi:10.1016/j.kint.2023.10.018

11. de Boer, Ian H et al. “Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO).” Diabetes care vol. 45,12 (2022): 3075-3090. doi:10.2337/dci22-0027

Abbreviations: CKD – Chronic Kidney Disease, IGT – Impaired Glucose Tolerance, ADA – American Diabetes Association, IDF – International Diabetes Federation, ASCVD – Atherosclerotic Cardiovascular Disease, CURE-CKD – Center for Kidney Disease Research, Education, and Hope Chronic Kidney Disease Registry, eGFR – Estimated Glomerular Filtration Rate, ESRD – End-Stage Renal Disease, AMPK – AMP-Activated Protein Kinase, TGF-β1 – Transforming Growth Factor Beta 1, KDIGO – Kidney Disease: Improving Global Outcomes, APSN – Asian Pacific Society of Nephrology, UACR – Urine Albumin-to-Creatinine Ratio, AMPK – AMP-activated protein kinase, GLP-1R – Glucagon-like peptide-1 receptor, TGF-β – Transforming growth factor beta, Smad3 – Mothers against decapentaplegic homolog 3 (a downstream signaling protein in TGF-β pathway), NF-κB – Nuclear factor kappa-light-chain-enhancer of activated B cells, STAT3 – Signal transducer and activator of transcription 3, Sirt1 – Sirtuin 1 (a NAD⁺-dependent deacetylase involved in autophagy and stress resistance), FoxO1 – Forkhead box protein O1 (a transcription factor involved in oxidative stress resistance and autophagy), Na-Cl cotransporter – Sodium-chloride symporter, a renal tubular transporter involved in sodium reabsorption

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Viral video shows ayurvedic doctor performing C-section without safety protocols, sparks outrage

Siwan: A shocking video has gone viral on social media showing an Ayurvedic practitioner from Siwan, Bihar, allegedly performing a C-section surgery at her clinic in a poorly equipped and unhygienic room. The incident has drawn widespread outrage due to suspected safety violations and medical negligence.  

According to the viral video shared on ‘X’ by a dermatologist, the woman, identified as Kanchan Kumari from Siwan, appears to be conducting the surgery without following basic medical protocols. The practitioner is reportedly not wearing a surgical mask or cap, and the room looks more like a storage area than a sterile operating theatre.

To make matters worse, her family member is casually recording a reel while the surgery is in progress. The room is crowded with people in normal clothes, possibly the patient’s relatives, standing around without any protective gear such as scrubs, gloves, or masks. There also appears to be no anaesthetist present during the operation.

Also read- Viral Video of Doctor Lying on Patient’s Bed to write Prescription Sparks Outrage

The dermatologist with the user name – ‘The Skin Doctor’ heavily criticised the woman for her blatant disregard for medical safety. He said, “A gynaecologist, who can’t even spell the word ‘gynaecologist’ correctly, is performing a C-section in what appears to be a storage room, with zero regard for universal safety protocols or infection control.”

The remark was made after the Ayurveda practitioner in her Instagram handle claimed herself as ‘gynaecologist’, but instead of writing the word ‘gynaecologist’, she wrote ‘gynelogist’. 

He further questioned whether Kumari, who runs her own clinic in Siwan, is legally qualified to perform such procedures since she is not trained to perform such high-risk medical procedures.

Calling her actions “criminally negligent, the doctor said, “Given how frequently the govt changes healthcare policies, I’m not sure whether she’s qualified or trained to perform this procedure, but judging by her methods, she is certainly liable for criminal negligence.”

The video has sparked widespread criticism online, with many demanding strict action from health authorities.

Also read- Chaos in NICU: Resident Doctor, Nurse Violent Clash goes VIRAL

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Parexel successfully completes CRO registration with CDSCO

Mumbai: Parexel, a clinical research organisation (CRO) providing the full range of Phase I to IV clinical development services, has announced the successful completion of its Clinical Research Organization (CRO) registration with the Central Drugs Standard Control Organization (CDSCO).

This registration complies with the new G.S.R 581 (E) regulation, which mandates all CROs operating in India to register with CDSCO.

Sanjay Vyas, President and Managing Director of Parexel India and Global Strategic Business Unit Head for Clinical Logistics & Global Safety Services, said, “This registration reflects our ongoing commitment to meeting regulatory requirements and upholding the highest standards in clinical research. This registration enables us to continue supporting our customers in bringing life-saving treatments to patients safely and efficiently.”

With over 40 years of global experience and a workforce of more than 6,000 in India, Parexel advances clinical research across complex therapeutic areas. 

Read also: CDSCO panel opines Paraxel to study either CKD or heart failure in phase IIb trial of AZD9977,Dapagliflozin FDC

Parexel provides the full range of Phase I to IV clinical development services. Parexel was the recipient of the 2024 and 2023 Society for Clinical Research Sites (SCRS) Eagle Award for advancing the clinical research profession through strong site partnerships, named “Best Contract Research Organization” in November 2023 by an independent panel for Citeline, and “Top CRO to Work With” by investigative sites worldwide in the 2023 WCG CenterWatch Global Site Relationship Benchmark Survey.

Read also: CDSCO panel opines Paraxel to study either CKD or heart failure in phase IIb trial of AZD9977,Dapagliflozin FDC

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AIIMS Delhi set for overhaul, expand services across NCR

New Delhi: In a move set to transform India’s premier healthcare institution, the NITI Aayog is likely to recommend a comprehensive revamp of the All India Institute of Medical Sciences (AIIMS), Delhi, including a strategic expansion of its clinical services across the National Capital Region (NCR).  

Also Read: Delhi opens first brain health clinic at Dwarka Hospital

According to Economic Times, the move is aimed at reducing the load on existing infrastructure and freeing doctors for medical research, said a senior government official.

This restructuring is expected to significantly reduce long waiting times and improve patient flow for non-critical treatments.  Currently, AIIMS Delhi’s outpatient department (OPD) manages an overwhelming 7,200 patients per day, while its emergency section treats approximately 400–500 cases daily, putting immense strain on resources and staff.

According to the news reports, a committee headed by NITI Aayog member Dr. VK Paul is currently reviewing the existing systems at AIIMS and is expected to soon draft a comprehensive reform plan. The blueprint will outline specific timelines and actionable steps to elevate the institute’s healthcare services to international standards.

The committee’s report, due in the latter half of this year, will present policy recommendations. These recommendations will be structured into short-term, medium-term, and long-term interventions, complete with timelines and operational steps.

The official revealed that the committee is exploring the possibility of utilising vacant or underutilised facilities in other government — and potentially private — hospitals to extend AIIMS OPD services.

Also Read: No New AIIMS Planned for Jhansi, NITI Aayog Panel to Propose Reforms AIIMS New Delhi Transformation: MoS Health

The official stated, “All aspects are being considered to ensure quality of service and that medical care is not compromised. A final decision will be taken by the committee.”

“However, the idea of spreading OPDs outside of AIIMS will only succeed if there is a strict monitoring mechanism in place to ensure everyone in need of medical care or advice is catered as is done at AIIMS,” the official added, reports Economic Times. 

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Smoking More Than Doubles Risk of Aortic Dissection, But Quitting Slashes Risk, Study Finds

Norway: A new analysis of UK Biobank data, supported by a meta-analysis of prospective studies, has confirmed a strong association between tobacco smoking and aortic dissection—a rare but fatal cardiovascular condition. Among 500,000 participants, current smokers had over twice the risk of aortic dissection compared to never-smokers (HR 2.48). The risk rose further with higher daily cigarette use (HR 2.63) and greater cumulative exposure (HR 1.66).

“In contrast, former smokers showed no significant increase in risk (HR 1.03) and had a 48–75% lower risk than current smokers, highlighting the benefits of quitting,” the researchers reported in Scientific Reports. They stressed that while smoking intensity drives up risk, cessation substantially lowers it—underscoring the need for more vigorous public health efforts to curb smoking and promote cessation.

While tobacco smoking raises the risk of aortic dissection, evidence from prospective studies is limited, and the impact of smoking cessation on this risk remains unclear. To address these gaps, Dagfinn Aune, Department of Nutrition, Oslo New University College, Oslo, Norway, and colleagues examined various aspects of tobacco use with aortic dissection within the UK Biobank cohort and further strengthened their findings through a meta-analysis of existing cohort studies.

For this purpose, the researchers investigated the association between various aspects of tobacco smoking and the risk of aortic dissection using data from the UK Biobank Study. They complemented their findings with a meta-analysis of existing cohort studies. In the UK Biobank analysis, multivariable Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

To identify relevant cohort studies for the meta-analysis, systematic searches were conducted in PubMed and Embase up to July 19, 2024, and summary relative risks (RRs) with 95% CIs were calculated using random effects models.

The study led to the following findings:

  • Over a mean follow-up of 12.3 years, 376 new cases of aortic dissection were identified among 499,078 UK Biobank participants.
  • Compared to never-smokers, the multivariable-adjusted hazard ratio (HR) was 2.48 (95% CI: 1.87–3.29) for current smokers and 1.03 for former smokers.
  • There was a clear dose-response relationship between cigarettes smoked per day and risk of aortic dissection, with HRs of 2.31 for 1–9 cigarettes/day, 2.94 for 10–19, and 2.63 for 20 or more.
  • Smoking exposure measured in pack-years also showed a positive association, with an HR of 1.66 for ≥30 pack-years compared to never-smokers.
  • Former smokers who had quit for varying durations experienced a 48–75% lower risk of aortic dissection compared to current smokers.
  • In the meta-analysis, the summary relative risk (RR) was 2.44 for current smokers and 1.32 for former smokers versus never smokers.
  • The risk increased by 52% per 10 cigarettes/day (RR 1.52) and by 16% per 10 pack-years (RR 1.16).
  • The risk decreased by 22% per 10 years since quitting smoking (RR 0.78).

“The findings strengthen the evidence that tobacco smoking increases the risk of aortic dissection, with a possible dose-response relationship associated with smoking intensity and duration,” the authors wrote. They further noted that quitting smoking significantly lowers this risk. Concluding their analysis, they emphasized that while further research is warranted, the results reinforce the need for stronger public health initiatives to reduce smoking prevalence and promote cessation.

Reference:

Khan, M. Y., Dillman, A., Hibino, M., & Aune, D. (2025). Tobacco smoking and the risk of aortic dissection in the UK Biobank and a meta-analysis of prospective studies. Scientific Reports, 15(1), 1-10. https://doi.org/10.1038/s41598-025-96529-y

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Left Atrial Remodeling Predicts Cardiovascular Risk in Asymptomatic Diabetes Patients with Early CKD: Study

China: A recent study published in Reviews in Cardiovascular Medicine highlights the significance of left atrial structural and functional alterations in forecasting major cardiac complications in patients with type 2 diabetes mellitus (T2DM) and early-stage chronic kidney disease (CKD).

Led by Dr. Mingxia Gong and researchers from the Department of Echocardiography at The Third Affiliated Hospital of Soochow University, the study utilized advanced imaging techniques to assess whether changes in the left atrium (LA) could predict future cardiovascular events in this high-risk yet often overlooked population.

“In asymptomatic type 2 diabetes patients, progression of diabetic nephropathy was associated with higher LAVImin and lower LASr, both reflecting declining kidney function. These markers independently predicted major cardiovascular events (AUC: 0.818), emphasizing the value of LA strain analysis in early cardiorenal risk evaluation,” the researchers reported.

Using four-dimensional automatic left atrial quantification (4D Auto LAQ), the team evaluated 361 individuals with asymptomatic T2DM and early CKD. The imaging measured LA volume indices, such as minimum (LAVImin), maximum, and pre-ejection volumes, and strain values reflecting LA function during reservoir, conduit, and contraction phases.

Over a median follow-up of nearly four years, 70 participants experienced major adverse cardiovascular events (MACEs), which included nonfatal myocardial infarction, stroke, heart failure, or cardiac death. Through detailed statistical analyses, including Cox proportional hazard models, the study identified two LA parameters as independent predictors of cardiovascular risk: increased LAVImin and reduced longitudinal strain during the reservoir phase (LASr).

The key findings of the study include the following:

  • Each unit increase in LAVImin was associated with a 21% higher risk of major adverse cardiovascular events (adjusted HR: 1.21).
  • Higher LASr values were linked to a significantly lower risk of cardiovascular events (adjusted HR: 0.81).
  • Patients with LAVImin >16.9 mL/m² had more than twice the risk of MACEs compared to those with LAVImin ≤16.9 mL/m².
  • Individuals with LASr <18.5% faced nearly a fourfold increased risk of MACEs compared to those with LASr ≥18.5%.
  • LASr was identified as the strongest echocardiographic predictor of cardiovascular events among the parameters studied.
  • The predictive accuracy of LAVImin and LASr for MACEs was high, with an AUC of 0.818.

The researchers emphasize that these structural and functional changes in the left atrium may reflect early cardiovascular stress due to underlying diabetic nephropathy, even in the absence of symptoms. As such, integrating 4D LA quantification—especially LASr—into routine cardiac evaluations could enhance early detection and risk stratification in T2DM patients with renal involvement.

“While further studies with larger populations are warranted, the results emphasize the clinical utility of LA remodeling parameters in guiding early intervention strategies aimed at reducing cardiovascular complications in diabetic patients with early kidney dysfunction,” the authors concluded.

Reference:

Mingxia Gong, Min Xu, Suoya Pan, Shu Jiang, Xiaohong Jiang. Association of Left Atrium Remodeling With Major Adverse Cardiovascular Events in Asymptomatic Type 2 Diabetes Patients With Early Chronic Kidney Disease. Rev. Cardiovasc. Med. 2025, 26(5), 27247. https://doi.org/10.31083/RCM27247

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Positive-Pressure Exhaust Technique Improves Mesh Fixation in TAPP Hernia Repair: Study

Researchers have found in a study on laparoscopic transabdominal preperitoneal (TAPP) hernia repair that the pneumoperitoneum positive-pressure exhaust technique enhances mesh fixation by eliminating dead space and improving tissue apposition. This simple, cost-effective approach may lower recurrence risk and offers benefits such as real-time mesh positioning assessment, multimodal fixation without extra devices, and simplified dead space management. Further large-scale studies are needed to validate its long-term efficacy.

A study was done to investigate the effects of the pneumoperitoneum positive-pressure exhaust technique on mesh fixation and postoperative recovery in laparoscopic transabdominal preperitoneal prosthetic (TAPP) hernia repair. A retrospective cohort analysis was conducted on 655 patients who underwent TAPP between January 2019 and December 2023. Patients were divided into a direct suture group (n=304) and a positive-pressure exhaust group (n=351) on the basis of preperitoneal space management. In the exhaust group, a 20G needle or drainage tube was placed percutaneously before peritoneal closure. After suturing, 12 mmHg pneumoperitoneum pressure was maintained to evacuate residual gas from the preperitoneal space through the externalized needle/tube. The primary outcomes included postoperative complications (bleeding, mesh infection, seroma, reoperation) and hospitalization duration. Results: Baseline characteristics were not significantly different (P>0.05). Although not statistically significant, there were clinically meaningful differences between the groups; the exhaust group had lower seroma (11.97% vs. 16.78%, P=0.079) and mesh infection (0.28% vs. 1.32%, P=0.189) incidence rates than the direct suture group did. The exhaust group had a significantly shorter hospital stay than the direct suture group (median 7 vs. 7 days, P=0.013) and had a 0% recurrence rate at the 1-year follow-up (vs. 1.32% for the direct suture group). The positive-pressure exhaust technique facilitates mesh fixation by eliminating dead space through improved tissue apposition. This simple, cost-effective approach may reduce the risk of recurrence, although larger prospective studies are needed to validate its long-term efficacy.

Reference:

He, W., Chen, B. Efficacy of intraperitoneal positive pressure gas expulsion in laparoscopic transabdominal preperitoneal hernioplasty: a retrospective cohort study. BMC Surg 25, 231 (2025). https://doi.org/10.1186/s12893-025-02965-y

Keywords:

Positive-Pressure, Exhaust, Technique, Improves, Mesh, Fixation, TAPP, Hernia, Repair, Study, He, W., Chen, B, Laparoscopic hernioplasty, Preperitoneal space, Mesh fixation, Pneumoperitoneum pressure, Postoperative complications

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Redefine low lead levels: Even one unit increase in Low Lead Levels tied to Poorer Academic Performance in Children: JAMA

A recent study found that a 1-unit increase in blood lead levels—within the range currently considered low (<3.5 μg/dL) is associated with consistently lower academic performance across school grades. This study was published in JAMA Network Open by George L. and colleagues. This large cohort study from Iowa, reveals that blood lead level increases below the Centers for Disease Control and Prevention (CDC) intervention level are associated with measurable decreases in math and reading scores. These findings imply that the current level is too high to serve as a threshold that protects children’s cognitive development and learning outcomes.

In 2021, the CDC reduced the reference value for blood lead level in children to 3.5 μg/dL or greater, marking the level at which public health action is indicated. But researchers have raised questions about whether even lower levels of lead in the blood might be harmful. This research, undertaken between May 2024 and March 2025, aimed to redress this issue by assessing the academic achievement of children with lead levels below and at or above this cut-off.

With a cohort design, the research associated the birth certificates of 305,256 Iowa children born during 1989 through 2010 with their grades 2 through 11 standardized reading and mathematics test scores and with early childhood blood lead tests. The primary outcome assessed was the National Percentile Rank (NPR) reading and math scores.

Children’s data were joined within 1,782,873 child-grade observations, offering a large sample to analyze. Of the children investigated:

  • 51.0% were boys

  • 41.1% were first-born

  • 43.9% were born to mothers with a high school education or lower

  • The average age at blood lead testing was 1.9 years (SD: 1.5), and 37.7% of children had blood lead levels below 3.5 μg/dL.

The study employed regression modeling to control for sociodemographic, child and maternal health, and school variables in analyzing the relationship between blood lead levels and academic performance.

Key Findings

The analysis demonstrated that even minor increases in blood lead levels—below the 3.5 μg/dL intervention level—were linked to diminished academic performance:

In children with blood lead levels less than 3.5 μg/dL, a 1-unit increase was linked with:

  • −0.47 NPR points in mathematics (95% CI: −0.65 to −0.30)

  • −0.38 NPR points in reading (95% CI: −0.56 to −0.20)

In children with blood lead levels ≥3.5 μg/dL, with each 1-unit increase, there was associated:

  • −0.52 NPR points in mathematics (95% CI: −0.58 to −0.47)

  • −0.56 NPR points in reading (95% CI: −0.62 to −0.51)

Notably, these decreases were consistent through grades 2 to 11, reflecting long-term impacts on cognitive and academic achievement independent of the timing of exposure during early childhood.

These findings suggest a need for reconsidering existing thresholds of intervention and increasing public health measures to prevent lead exposure in all settings in which children reside, learn, and play.

Reference:

Wehby GL. Early-Life Low Lead Levels and Academic Achievement in Childhood and Adolescence. JAMA Netw Open. 2025;8(5):e2512796. doi:10.1001/jamanetworkopen.2025.12796

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