AI-Enabled ECG System Can Reduce Mortality in Hospitalized cardiac Patients: Nature

A recent trial published in the Nature Medicine journal found an artificial intelligence (AI)-enabled electrocardiogram (ECG) system to demonstrate significant potential in reducing mortality rates among the hospitalized patients. The study involved 39 physicians and close to 15,965 patients to evaluate the effectiveness of AI-driven alerts in identifying the mortality of patients at high risk.

The primary outcome of the trial was positive by showing a reduction in all-cause mortality within 90 days. The results indicated that 3.6% of patients in the AI-ECG alert intervention group died within this period when compared to 4.3% in the control group. This translates to a hazard ratio (HR) of 0.83 with a confidence interval (CI) of 0.70–0.99 that signals towards a statistically significant improvement in patient outcomes due to the intervention.

A deeper analysis revealed that the most significant benefits were observed in patients who were identified by the AI system as high-risk based on their ECG readings. In this sub cohort, the reduction in all-cause mortality was even more pronounced with a hazard ratio of 0.69 and a confidence interval of 0.53 to 0.90.

The study showed a dramatic reduction in the risk of cardiac death among the high-risk patients who received the AI-ECG alert. Only 0.2% of patients in the intervention group underwent cardiac death when compared to 2.4% in the control group by illuminating a hazard ratio of 0.07 (CI = 0.01–0.56). This suggests that the AI system effectively identifies high-risk patients and also facilitates the timely care, including elevated levels of intensive care interventions.

While the study has successfully attained its primary goals, the specific mechanisms by which the AI-ECG alerts contribute to reduced mortality rates are yet to be fully unraveled. But, the evidence points towards the role in improving the detection of vulnerable patients and thereby enabling more immediate and intensive medical intervention.

This AI-ECG system represents a marked advancement in medical technology with the potential to transform monitoring and response to patient risks. The findings are a crucial stride ahead in the integration of AI in clinical practice which suggest similar technologies could be further developed to support clinicians in making more informed and timely decisions by ultimately enhancing the standards of care and patient safety.

Reference:

C.-S., Liu, W.-T., Tsai, D.-J., Lou, Y.-S., Chang, C.-H., Lee, C.-C., Fang, W.-H., Wang, C.-C., Chen, Y.-Y., Lin, W.-S., Cheng, C.-C., Lee, C.-C., Wang, C.-H., Tsai, C.-S., Lin, S.-H., & Lin, C. (2024). AI-enabled electrocardiography alert intervention and all-cause mortality: a pragmatic randomized clinical trial. In Nature Medicine. Springer Science and Business Media LLC. https://doi.org/10.1038/s41591-024-02961-4

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Early Otitis Media may adversely impact auditory and language development in children, finds study

Otitis media seems to affect auditory and language development, according to a study published in the January issue of the International Journal of Pediatric Otorhinolaryngology.

Otitis media is a common disorder of early childhood suspected of hindering auditory and language development, but evidence regarding these effects has been contradictory. To examine potential sources of these contradictory past results and explore in more detail the effects of early otitis media on auditory and language development, three specific hypotheses were tested: (1) Variability in children’s general attention could influence results, especially for measures of auditory functioning, leading to spurious findings of group differences; (2) Different language skills may be differentially affected, evoking different effects across studies depending on skills assessed; and (3) Different mechanisms might account for the effects of otitis media on acquisition of different language skills, a finding that would affect treatment choices. Children 5–10 years old participated: 49 with and 68 without significant histories of otitis media. The auditory function examined was temporal modulation detection, using games designed to maintain children’s attention; two additional measures assessed that attention. Measures of lexical knowledge and phonological sensitivity served as the language measures.Results: Sustained attention was demonstrated equally across groups of children with and without histories of otitis media. Children with histories of otitis media performed more poorly than peers without those histories on the auditory measure and on both sets of language measures, but effects were stronger for phonological sensitivity than lexical knowledge. Deficits in temporal modulation detection accounted for variability in phonological sensitivity, but not in lexical knowledge. When experimental factors are tightly controlled, evidence emerges showing effects of otitis media early in life on both auditory and language development. Mechanism of effects on language acquisition appear to involve both delayed auditory development and diminished access to the ambient language.

Reference:

Susan Nittrouer, Joanna H. Lowenstein. Early otitis media puts children at risk for later auditory and language deficits. International Journal of Pediatric Otorhinolaryngology,

Volume 176, 2024, 111801, ISSN 0165-5876. https://doi.org/10.1016/j.ijporl.2023.111801. (https://www.sciencedirect.com/science/article/pii/S0165587623003683)

Keywords:

Early Otitis Media, auditory, language development, children, Journal of Pediatric Otorhinolaryngology, Susan Nittrouer, Joanna H. Lowenstein, Otitis media; Temporal processing; Language; Children

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High circulating acetylcholine levels associated with severe pulmonary hypertension and poor prognosis: Study

China: A recent study published in BMC Pulmonary Medicine has revealed an association between high circulating acetylcholine (ACh) levels and severe pulmonary hypertension (PH) conditions and poor prognosis. The findings suggest that circulating acetylcholine might be a potential biomarker in pulmonary hypertension.

Pulmonary hypertension is a life-threatening cardiovascular disease (CVD) characterized by a progressive and chronic increase in pulmonary vascular resistance (PVR), resulting in remodelling of the right ventricle and eventual right ventricular failure.

Acetylcholine is a well-established signalling molecule that serves as the primary chemical neurotransmitter regulating various physiological functions. Previous studies have revealed an increased ACh level in the right ventricle tissue of PH, indicating the important role of ACh in disease pathogenesis. However, no investigation has been done on the relationship between plasma ACh levels, disease conditions and patients’ prognosis.

Against the above background, Changming Xiong, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, and colleagues aimed to explore the association between plasma ACh levels and the prognosis of patients with pulmonary hypertension. They also discussed the feasibility of plasma ACh as a biomarker, which may contribute to managing PH patients in the future.

For this purpose, the research team enrolled patients with confirmed PH in Fuwai Hospital from 2019 to 2020. The study’s primary clinical outcome was defined as a composite outcome including lung transplantation/death, worsening of symptoms, and heart failure. Fasting plasma was collected to detect ACh levels. The association between ACh levels and patients’ prognosis was explored.

The study enrolled four hundred and eight patients with PH and followed for a mean period of 2.5 years.

The study led to the following findings:

  • Patients in the high ACh group had worse World Health Organization Functional Class (WHO-FC), lower 6-minute walk distance (6 MWD), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP).
  • Hemodynamic and echocardiographic parameters in the high metabolite group also suggested a worse disease condition compared with the low ACh group.
  • After adjusting for confounders, compared with low ACh patients, those with high metabolite levels still have worse prognoses characterized as elevated risk of mortality, symptoms worsening, and heart failure.

The findings showed that high circulating ACh levels were associated with severe pulmonary hypertension conditions. Compared with low ACh patients, those with high metabolite levels had worse prognoses characterized by an elevated risk of heart failure, mortality, and symptoms worsening. This suggests that circulating ACh may serve as a potential biomarker in PH.

The limitations were that it was a single-centre study, the specific role of ACh in PH pathogenesis was still unknown, and basic research was warranted to reveal the inner association.

“Nevertheless, our study first demonstrated the potential biomarker role of ACh in PH, indicating its value in disease management,” the research team wrote.

Reference:

Yang, Y., Xu, J., Shu, S. et al. Circulating acetylcholine serves as a potential biomarker role in pulmonary hypertension. BMC Pulm Med 24, 35 (2024). https://doi.org/10.1186/s12890-024-02856-7

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Study finds effective concentration of sevoflurane for IOP monitoring in anaesthetized glaucoma children

Recently published study aimed to determine the optimal end-tidal sevoflurane concentration for safely measuring intraocular pressure (IOP) in pediatric patients aged 1–12 months and 12–36 months. After induction with 8% sevoflurane, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as ‘no movement,’ and subsequent concentrations were determined using the Dixon and Massey method. The study included 75 children and found that the effective concentration of sevoflurane causing ‘no movement’ during IOP measurement in 50% of the study population was 1.98% in the 1–12 months group and 0.55% in the 12–36 months group. Probit regression analysis yielded effective concentration values of 2.47% for the 1–12 months group and 0.94% for the 12–36 months group. The results demonstrated that a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in the 1–12 months age group compared to 0.5% required in the 12–36 months age group, achieving success in 50% of the study population.

Clinical Implications and Limitations

The study’s implications for clinical practice included the importance of identifying the optimal timing for IOP measurement during general anesthesia and establishing the minimum effective concentration of the inhalational agent to prevent any undesired movement in pediatric patients. The findings led to the acknowledgment of physiological differences between infants and older children, highlighting the need for higher minimal alveolar concentration (MAC) in infants to achieve adequate anesthesia depth. The study provided valuable insights into achieving accurate IOP measurements without eliciting any movement, particularly in managing glaucoma in pediatric patients. However, the study acknowledged some limitations, such as the need for further exploration of the minimum time for IOP measurement in glaucomatous children and the difference between premedicated and un-premedicated children in the end-tidal sevoflurane concentration required for IOP measurement. Further trials evaluating the timing for IOP measurement in glaucomatous children were also suggested as an avenue for future research.

Study Contribution

The study’s contribution lies in addressing the current absence of consensus on the minimal anesthetic concentration for IOP measurement and uncertainties regarding the accuracy of such measurements for subsequent clinical decisions in pediatric glaucoma cases. The findings have significant implications for guiding decisions regarding surgery or medical interventions based on the obtained IOP values during ophthalmological examinations in pediatric patients.

Key Points

The study’s implications for clinical practice included the importance of identifying the optimal timing for IOP measurement during general anesthesia and establishing the minimum effective concentration of the inhalational agent to prevent any undesired movement in pediatric patients. The findings also highlighted the need for higher minimal alveolar concentration (MAC) in infants to achieve adequate anesthesia depth and provided valuable insights into achieving accurate IOP measurements without eliciting any movement, particularly in managing glaucoma in pediatric patients.

The study’s contribution lies in addressing the current absence of consensus on the minimal anesthetic concentration for IOP measurement and uncertainties regarding the accuracy of such measurements for subsequent clinical decisions in pediatric glaucoma cases. The findings have significant implications for guiding decisions regarding surgery or medical interventions based on the obtained IOP values during ophthalmological examinations in pediatric patients. The study acknowledged some limitations and suggested further trials evaluating the timing for IOP measurement in glaucomatous children as an avenue for future research.

Reference –

Ravichandran, Elayavel; Goel, Nitika; Ghai, Babita; Saini, Vikas; Kaushik, Sushmita1. Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study. Indian Journal of Anaesthesia 68(5):p 480-485, May 2024. | DOI: 10.4103/ija.ija_1058_23

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NPPA Revises Ceiling Prices Of Coronary Stents

New Delhi: Through a recent notification, after considering the Wholesale Price Index (WPI) at 0.00551% for the year 2023 over 2022, the National Pharmaceuticals Pricing Authority (NPPA) has revised and fixed the ceiling price of the two Coronary Stents, Bare Metal Stents and Drug Eluting Stents (DES) including metallic DES and Bioresorbable Vascular Scaffold (BVS)/ Biodegradable Stents.

According to the new price notified by the drug price regulator, the ceiling price of Bare Metal Stent is Rs 10509.79, and Drug Eluting Stents (DES) including metallic DES and Bioresorbable Vascular Scaffold (BVS)/ Biodegradable Stents are Rs.38267.18.

A bare-metal stent is a stent made of thin, uncoated (bare) metal wire that has been formed into a mesh-like tube. The first stents licensed in cardiac arteries were bare metal – often 316L stainless steel. More recent “second generation” bare-metal stents of cobalt-chromium alloy have been made. While plastic stents were first used to treat gastrointestinal conditions of the esophagus, gastroduodenal, biliary ducts, and colon, bare-metal stent advancements led to their use for these conditions starting in the 1990s.

Drug-eluting stents (DES) are vascular prostheses used by interventional cardiologists to reopen and maintain patent coronary arteries narrowed by arteriosclerosis.

The notice stated that in continuation of the notifications issued by the National Pharmaceutical Pricing Authority, Department of Pharmaceuticals, Ministry of Chemical and Fertilizers vide S.O. 639(E) dated 12.02.2018, S.O. 1464(E) dated 02.04.2018, S.O. 1488(E) dated 29.03.2019, SO. 1217(E) dated 25.03.2020, S.O. 1334(E) dated 25.03.2021, 1502(E) dated 30.03.2022, 5249(E) dated 11.11.2022, 1572(E) dated 31.03.2023 and 4663(E) dated 25.10.2023 regarding the fixation of ceiling price of the Coronary Stents as specified in column no. (2) mentioned in the table below; after considering the Wholesale Price Index (WPI) @ 0.00551% for the year 2023 over 2022, it has been decided to revise the ceiling prices of Coronary Stents as mentioned in column no. (4) in the table below, exclusive of Goods and Services Tax as applicable, and unit specified in column (3) with effect from 01.04.2024, as under:

Sl. No.

Coronary Stents

(Sl. No. 28 in Schedule-I of the DPCO, 2013)

Unit

(in Number)

Ceiling price (wef 1.4.2024

with WPI @0.00551%)

(in Rs.)

(1)

(2)

(3)

(4)

1

Bare Metal Stents

1

10509.79

2

Drug-eluting stents (DES) including metallic DES and Bioresorbable Vascular Scaffold (BVS)/ Biodegradable Stents

1

38267.18

The notification further added:

(a) All the existing manufacturers/importers of Coronary Stents having MRP lower than the ceiling price specified in column (4) in the above table (plus Goods and Services Taxes as applicable, if any), may revise the existing MRP of Coronary Stent, based on WPI @ 0.00551% for the year 2023 over 2022 by Paragraph 16(2) of DPCO, 2013, read with Para 13(2) of DPCO, 2013.

(b) The manufacturers/importers of Coronary Stents may add Goods and Services Taxes only if they have paid actually or if it is payable to the Government on the ceiling price mentioned in column (4) of the aforesaid table.

(c) As per Para 24(4) of DPCO 2013, every retailer and dealer shall display the price list and the supplementary price list, if any, as furnished by the manufacturer/importers, on a conspicuous part of the premises where he carries on business in a manner to be easily accessible to any person wishing to consult the same.

(d) The manufacturers not complying with the ceiling price and notes specified hereinabove shall be liable to deposit the overcharged amount along with interest thereon under the provisions of the Drugs (Prices Control) Order, 2013 read with Essential Commodities Act, 1955.

To view the official notice, click the link below:

https://medicaldialogues.in/pdf_upload/13-so1551-dt-26032024-1-237462.pdf

Also Read:Alkem Laboratories Gets CDSCO Panel Nod to Study Amoxicillin,Clavulanate Powder for reconstitution into suspension

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Doctors remove mobile phone from prisoner’s stomach after 20 days

A murder convict in Shivamogga prison, Karnataka, devised a risky scheme to evade detection: he swallowed a mobile phone, as reported by The Indian Express. Suffering from severe stomach pain, Parushuram, 38, was rushed to McGann Teaching District Hospital in Shivamogga and later transferred to Bengaluru’s Victoria Hospital for surgery. During an ultrasound, doctors discovered the electronic device in his stomach and opted for immediate surgery. After a critical 75-minute procedure, surgeons successfully removed a Chinese mobile phone from his pylorus, situated at the start of the small intestine. They revealed that Parushuram had harbored the phone internally for nearly 20 days, causing complications. Interestingly, he had not divulged this information to jail authorities until the phone was discovered during medical examinations. Subsequently, the police registered a case against him for smuggling contraband into the prison.

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Amendment in nomenclature of DNB Cardio-Thoracic Surgery, notifies NBE

Through a recent notice, the National Board of Examinations in Medical Sciences (NBEMS) has notified about the amendment in the nomenclature of the Diplomate National Board (DNB) Cardio-Thoracic Surgery.

NBE has amended the nomenclature of the above-mentioned qualification as Doctorate National Board (Cardio Vascular & Thoracic Surgery). Accordingly, the abbreviation has also changed from DNB Cardio-Thoracic Surgery to DrNB Cardio Vascular & Thoracic Surgery.
For more information click on the link below:

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NSUI Files Complaint Alleging Multi-Crore Scam at Medical Science University Jabalpur

Bhopal: The National Student Union of India (NSUI) has called for the immediate removal of the Madhya Pradesh Medical Science University’s vice-chancellor Ashok Khandelwal, registrar Pushpraj Baghel, and exam controller Sachin Kuchia, as well as demanding an investigation into the alleged financial misconduct.

Ravi Parmar, coordinator of NSUI medical wing pointed out several inconsistencies and irregularities in the financial activities of Medical Science University, Jabalpur. He has submitted an audit report to the EOW, which indicates potential irregularities in stock ledger management, the use of current accounts, and other financial practices.
Also Read:Madhya Pradesh HC seeks response from DME, GMC over withholding result of Gynaecologist’s Assistant Professor post

In his complaint, Parmar stated that an audit of the previous year found
issues with non-renewable Fixed Deposit Receipts (FDRs), deeming them faulty.
Additionally, the cash register was improperly managed, leading to a potential
financial loss of over Rs 120 crores due to the lack of FDR renewals in recent
years. Parmar claimed that overall financial irregularities at the university
could be even more extensive, reports Freepress Journal.  
He claimed that Pushpraj Baghel, the varsity registrar, had interfered with tenders to further his interests. The NSUI member said in the complaint that there was another case in which exam controller Sachin Kuchia assisted absentee candidates in passing the tests.

The NSUI has called for the immediate removal of the university’s
vice-chancellor Ashok Khandelwal, registrar Pushpraj Baghel, and exam
controller Sachin Kuchia, as well as an investigation into the alleged
financial misconduct. Parmar also submitted an audit report to the EOW, which
reportedly indicates potential irregularities in stock ledger management, the
use of current accounts, and other financial practices, reports the Daily. 

The University has approximately 300 colleges with a yearly intake of approximately 80000 students nationwide. Madhya Pradesh University exercises superintendence and control over the affiliated colleges to establish uniform standards par-excellence in academics and administration of teaching and learning of health sciences.
Also Read: No revision of results, MP Medical University to Re-Conduct Surgery Practicals for 94 MGM Indore Medicos

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LED bulb removed from 5 year old boy’s lung in Chennai

It’s common for children to put things in their mouth while playing, like toys and fingers. But it’s shocking when a five-year-old boy accidentally swallows an LED bulb leading to its lodging in his lungs for nearly a month before doctors successfully removed it without resorting to open chest surgery. The boy, who experienced breathing difficulties and coughing, was rushed to Sri Ramachandra Hospital by his mother in April. Scans revealed the foreign object in his lung, prompting two unsuccessful attempts at removal using a bronchoscope.

Dr. R Madhu, the hospital’s pediatric surgeon, explained the risks involved and the possibility of open surgery. On April 26, the child, experiencing persistent cough and breathing issues, underwent another bronchoscopy at Sri Ramachandra Hospital. Despite potential complications, the medical team was determined to extract the bulb to prevent further harm. The operation, involving multiple pediatric surgeons and anesthesiologists, lasted one-and-a-half hours.

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Rural children struggle to access hospital services, say researchers

Children in rural areas were more than six times as likely to check into a hospital without pediatric services compared to children in urban areas, a new study found. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 2–6 in Toronto.

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