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Dr Jaiswal, who served at INS Jeevanti in Goa and the
Andaman and Nicobar Islands, was discharged from service in 2012 after being
classified with a disability. The disability was due to his service. He was supposed to receive the disability pension of a retired naval doctor.

However, he has been engaged
in a legal battle to secure his pension. Although the Navy had assured the
Armed Forces Tribunal (AFT), Mumbai, that his pension would be reinstated, the
Navy unexpectedly revoked Jaiswal’s pension payment order (PPO).

According to the Times of India, the Navy began disbursing Dr Jaiswal’s disability pension in
March 2023, following the AFT’s 2019 ruling. However, the Navy has since ceased
these payments, despite the absence of a stay on the AFT’s decision. The court
has scheduled the next hearing for June 28, after its summer recess. “The Navy asked for time to reconsider, and the high court has given the Navy six weeks to respond. If they don’t respond, then our contempt petition will be accepted,” said Jaiswal’s lawyer Satendra Kumar.

Dr Jaiswal stated that a simple notice had been misinterpreted as a stay order. “What the Navy has done is it has misrepresented a notice as a stay order by the high court. They have deliberately made the stay order letter to stop the pension to harass me,” said Jaiswal. 

Armed Forces personnel who are retired or discharged from service with a disability sustained under circumstances accepted as Category ‘D’ and assessed not less than 20% are awarded a monthly disability compensation called Liberalized Impairment Relief. This is not a pension and ceases upon the recipient’s death.

Also Read: Patna HC dismisses petition seeking age extension for appointment of Assistant Professors

The study revealed that the medically supervised 5:2 energy-restricted diet could be an alternative strategy for improving glycemic control, and the exercise regimen could improve body composition, although it inadequately improved glycemic control.

Type 2 diabetes, a chronic metabolic disorder characterized by insulin resistance and hyperglycemia, poses a formidable public health challenge worldwide, with obesity emerging as a major predisposing factor. While lifestyle modifications, including diet and exercise, are cornerstone strategies in diabetes management, the optimal regimen for achieving glycemic control and reducing cardiovascular risk remains a subject of ongoing debate.

Mian Li, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues aimed to investigate the effects of a 5:2 regimen diet (2 days per week of energy restriction by formula diet) or an exercise (2 days per week of high-intensity interval training and resistance training) intervention versus routine lifestyle education (control) on cardiometabolic health and glycemic control among adults with overweight/obesity and type 2 diabetes.

For this purpose, the researchers conducted a two-center, open-label, three-arm, parallel-group, randomized controlled trial that recruited 326 participants with obesity/overweight and type 2 diabetes. They were randomized into 12 weeks of diet intervention (n = 109), exercise intervention (n = 108), or lifestyle education (control) (n = 109).

The study’s primary outcome was the glycemic control change measured as glycated hemoglobin (HbA1c) between the diet or exercise intervention groups and the control group after the 12-week intervention.

Based on the study, the researchers reported the following findings:

• The diet intervention significantly reduced HbA1c level (%) after the 12-week intervention (−0.72) compared with the control group (−0.37) (diet versus control −0.34).
• The reduction in HbA1c level in the exercise intervention group (−0.46) did not significantly differ from the control group (exercise vs. control −0.09).
• The exercise intervention group was superior in maintaining lean body mass.
• Both diet and exercise interventions induced improvements in adiposity and hepatic steatosis.

The findings showed that two days a week of a medically supervised energy-restricted diet may lower blood glucose levels in adults with overweight or obesity and type 2 diabetes.

“The diet intervention group experienced a greater energy deficit with a more pronounced metabolic benefit,” the researchers wrote. “Our study indicates that a medically supervised 5:2 energy-restricted diet could be an alternative strategy for improving glycemic control.”

Reference:

Mian Li, Jie Li, Yu Xu, Jinli Gao, Qiuyu Cao, Yi Ding, Zhuojun Xin, Ming Lu, Xiaoting Li, Haihong Song, Jue Shen, Tianzhichao Hou, Ruixin He, Ling Li, Zhiyun Zhao, Min Xu, Jieli Lu, Tiange Wang, Shuangyuan Wang, Hong Lin, Ruizhi Zheng, Jie Zheng, Callum John Baker, Shenghan Lai, Nathan Anthony Johnson, Guang Ning, Stephen Morris Twigg, Weiqing Wang, Yan Liu, Yufang Bi; Effect of 5:2 Regimens: Energy-Restricted Diet or Low-Volume High-Intensity Interval Training Combined With Resistance Exercise on Glycemic Control and Cardiometabolic Health in Adults With Overweight/Obesity and Type 2 Diabetes—A Three-Arm Randomized Controlled Trial. Diabetes Care 2024; dc240241. https://doi.org/10.2337/dc24-0241

Researchers found that in RA patients on anti‐inflammatory therapy, despite a reduction in inflammatory markers like high‐sensitivity CRP (hs-CRP) & interleukin‐1b, there was no significant improvement in myocardial flow reserve (MFR). Nearly half had coronary microvascular dysfunction at baseline, yet neither high‐sensitivity cardiac troponin T (hs‐cTnT) nor MFR levels changed significantly.

The study findings were published online in the Journal of the American Heart Association on April 30, 2024.

Coronary microvascular dysfunction, measured by myocardial flow reserve, is associated with increased cardiovascular risk in rheumatoid arthritis. Brittany Weber, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, and colleagues aimed to determine the association between reducing inflammation with MFR and other measures of cardiovascular risk.

For this purpose, the researchers enrolled patients with RA with active disease about to initiate a tumor necrosis factor inhibitor. All participants underwent a cardiac perfusion PET scan to quantify MFR at baseline before tumor necrosis factor (TNF) inhibitor initiation and after the initiation of TNF inhibitor at 24 weeks. MFR <2.5 in the absence of obstructive coronary artery disease was defined as coronary microvascular dysfunction. Blood samples were measured at baseline and 24 weeks for inflammatory markers (eg, hs-CRP, interleukin‐1b, and hs‐cTnT).

The primary outcome was mean MFR before and after TNF inhibitor initiation, with Δhs‐cTnT as the secondary outcome. Secondary and exploratory analyses included the correlation between ΔhsCRP and other inflammatory markers with MFR and hs‐cTnT. 66 subjects were studied; 82% were women, and the mean RA duration was 7.4 years.

The following were the study’s key findings:

• The median atherosclerotic cardiovascular disease risk was 2.5%; 47% had coronary microvascular dysfunction, and 23% had detectable hs‐cTnT.
• There was no change in mean MFR before (2.65) and after treatment (2.64) or hs‐cTnT.
• A correlation was observed between a reduction in hs-CRP and interleukin‐1b with a decrease in hs‐cTnT.

The findings showed that nearly 50% of subjects had coronary microvascular dysfunction at baseline in the RA cohort with a low prevalence of cardiovascular risk factors. A reduction in inflammation was not associated with improved myocardial flow reserve. However, a modest reduction in interleukin‐1b and no other inflammatory pathways correlated with a decrease in subclinical myocardial injury.

Reference:

Weber B, Weisenfeld D, Massarotti E, Seyok T, Cremone G, Lam E, Golnik C, Brownmiller S, Liu F, Huang S, Todd DJ, Coblyn JS, Weinblatt ME, Cai T, Dahal K, Kohler M, Yinh J, Barrett L, Solomon DH, Plutzky J, Schelbert HR, Campisi R, Bolster MB, Di Carli M, Liao KP. Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study. J Am Heart Assoc. 2024 Apr 30:e030387. doi: 10.1161/JAHA.123.030387. Epub ahead of print. PMID: 38686879.

A new screening algorithm for preeclampsia combining maternal history, ultrasound data and several tests for blood markers may better predict the majority of preeclampsia cases in the first trimester of pregnancy, when it may still be preventable, according to new research published today in Hypertension, an American Heart Association journal.

Preeclampsia is the most dangerous form of high blood pressure during pregnancy (blood pressure measures ≥140/90 mm Hg), and it is a leading cause of maternal death worldwide. Preeclampsia is potentially life-threatening when untreated. It affects 1 in 25 pregnancies in the U.S. and is more common in first-time pregnancies. Symptoms include headaches, vision changes and swelling of the mother’s hands, feet, face or eyes; or a change in the well-being of the baby. Recent research has found that preeclampsia can be linked to an increased risk of developing cardiovascular complications for women later in life.

“Preeclampsia is one of the most severe illnesses of pregnancy and may lead to preterm birth and/or maternal death,” said senior study author Emmanuel Bujold, M.D., M.Sc., professor in the department of obstetrics and gynecology at the Université Laval in Québec City, Canada.

The biological mechanisms that lead preeclampsia usually start in the first trimester of pregnancy (weeks 1 through 12), however, the initial symptoms of preeclampsia most often do not appear before week 20, Bujold noted.

The current risk factor-based guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend pregnant women take aspirin if they have a major risk factor such as chronic high blood pressure, Type 2 diabetes, chronic kidney disease, lupus or preeclampsia in a prior pregnancy. Aspirin is also recommended by ACOG for pregnant women with two moderate risk factors such as being a Black woman, having a sister or mother with history of preeclampsia, having a first pregnancy, obesity or an IVF pregnancy.

“Following those guidelines, almost all Black women should take aspirin during pregnancy, as should about one-third of all women of other races and ethnicities,” Bujold said.

Previous studies from the Fetal Medicine Foundation have found that preterm preeclampsia, defined as developing preeclampsia before 37 weeks of gestation, can be predicted in the first trimester using a combination of ultrasound and blood biomarker tests. In this study, researchers recruited over 7,000 women with first-time pregnancies across Canada who were between 11 and 14 weeks pregnant to evaluate the Fetal Medicine Foundation’s screening model. The model consisted of maternal history, ultrasound data and several tests for blood markers.

The study found:

• Using the Fetal Medicine Foundation’s screening model for participants between 11 and 13 weeks of pregnancy, the preeclampsia detection rate was 63.1% for preterm preeclampsia (before 37 weeks of gestation) and 77.3% for early preeclampsia (before 34 weeks of gestation). The false positive rate was 15.8%.
• Using the risk factor-based guidelines from the American College of Obstetricians and Gynecologists, the detection rate for preterm preeclampsia would be 61.5% and 59.1% for early preeclampsia, with a false-positive rate of 34.3%. This would be more than twice the false-positive rate of the Fetal Medicine Foundation’s screening model.

The only way to resolve preeclampsia once it has developed is to deliver the baby. by the study  previous meta-analysis found that taking one low-dose aspirin daily may reduce the risk of developing preeclampsia by up to 53%.

“Using this new screening model, treatment decisions were based on each individual’s personal risk,” Bujold said. “With their personal risk calculated, it’s much easier for a woman to make the right decision, for example, if she chooses to take daily low-dose aspirin, she is much more likely to follow through because it’s based on personalized screening test.”

Study background and details:

• The study was conducted between 2014 and 2020 at five health centers across Canada. Of note: Canada has a national health care service, and coverage is universal for all Canadian citizens and permanent residents.
• 7,554 women who were pregnant for the first time were recruited between 11 and 14 weeks of pregnancy. 7,325 delivered after 20 weeks and remained eligible for the final analysis; 229 had pregnancies with fetal anomalies and were excluded from the analyses for the study.
• At time of enrollment in the study, participants underwent screening for preeclampsia. The data collected included age, weight, ethnicity, smoking status and chronic health conditions (chronic hypertension, Type 1 diabetes or Type 2 diabetes and antiphospholipid syndrome, an autoimmune disease that may be associated with pregnancy complications).
• The study participants had an average age of 29 years. 92% of participants self-identified as white; 4% as Black; 2.6% as South Asian; 0.9% as East Asian; 0.3% as First Nations; and 0.2% as mixed race or undetermined.
• The study excluded women who were taking antihypertensive medication for chronic hypertension, low-dose aspirin or low-molecular-weight-heparin (a blood thinner) on a daily basis were excluded from the study.
• Participants were followed until delivery. The primary outcome was preterm preeclampsia. The secondary outcome was early preeclampsia.
• Of the 7,325 women included in the analysis, 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early preeclampsia.

Among the study’s limitations, several women with risk factors for preeclampsia, such as high blood pressure and Type 2 diabetes before pregnancy, were not included in the study if they were already taking aspirin for preeclampsia prevention. This would make it difficult to determine whether this population would rely solely on the Fetal Medicine Foundation’s screening model to decide whether or not to take daily, low-dose aspirin, Bujold noted. Additionally, only one lab was used to analyze blood samples, and blood samples collected at other centers across Canada were frozen and shipped for analysis, meaning that biomarkers were measured several weeks after the blood was drawn, which may have affected the results.

“It’s reasonable to believe that the inclusion of the entire population and immediate analysis of blood samples may both have improved the screening process. If we implemented a screening program in big cities across North America, the screening would be expected to be even better and more accurate,” Bujold said. “The good news is that we now have a more precise screening approach using existing tests that can predict preeclampsia early in pregnancy. The next step is to make this screening available to all pregnant women so that more women could receive a diagnosis early in pregnancy and begin preventative aspirin treatment, potentially preventing complications of severe preeclampsia.”

According to Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the writing group for the Association’s 2023 scientific statement on Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring, predicting risk for term and preterm preeclampsia remains an important goal and priority to improve maternal health and mitigate disparities. Khan is the Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of medicine and preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago and a preventive cardiologist at Northwestern Medicine.

“Since the risks for preeclampsia may be largely influenced by health before pregnancy, the ability of a screening model to be applied in early pregnancy is very helpful and can initiate conversations between the clinician and patient about strategies to optimize heart health,” Khan said. “However, challenges remain with implementation of models such as this one that integrate biomarkers that are not routinely assessed and may not be widely available, especially among people in vulnerable populations who are most likely to have the highest risk for preterm preeclampsia.”

Reference:

Paul Guerby, Francois Audibert, Jo-Ann Johnson, Nanette Okun, Yves Giguère, Jean-Claude Forest, Nils Chaillet, Benoit Mâsse, David Wright, Louise Ghesquiere and Emmanuel Bujold, Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study), Hypertension, https://doi.org/10.1161/HYPERTENSIONAHA.123.22584.