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The age at which a woman has her first period can offer valuable clues about her long-term risk for conditions like obesity, diabetes, heart disease and reproductive health issues, according to a study being presented Sunday at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, Calif.

The Brazilian study found that both early and late menarche-the age when women first get their period-are linked to different health risks. Women who had their first period before age 10 were more likely to develop obesity, high blood pressure, diabetes, heart problems and reproductive issues like pre-eclampsia later in life. Women who started their period after age 15 were less likely to be obese but had a higher risk of menstrual irregularities and certain heart conditions.

“We now have evidence from a large Brazilian population that confirms how both early and late puberty can have different long-term health impacts,” said study author Flávia Rezende Tinano of the University of Sao Paulo in Sao Paulo, Brazil. “While early menarche increases the risk for multiple metabolic and heart problems, late menarche may protect against obesity but increase certain heart and menstrual issues. Most women can remember when they had their first period, but they might not realize that it could signal future health risks. Understanding these links can help women and their doctors be more proactive about preventing conditions like diabetes, high blood pressure and heart disease.”

Tinano said the study is one of the largest of its kind in a developing country, providing valuable data on a topic that has mostly been studied in wealthier countries. “It highlights how early and late puberty can affect a woman’s long-term health, especially in underrepresented populations like those in Latin America,” she said.

The study was part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) and evaluated data from 7,623 women ages 35 to 74. The age of their first period was categorized as early (less than 10 years old), typical (ages 10 to 15) or late (older than 15). They assessed the women’s health through interviews, physical measurements, lab tests and ultrasound imaging.

“Our findings suggest that knowing a woman’s age at her first period can help doctors identify those at higher risk for certain diseases,” Tinano said. “This information could guide more personalized screening and prevention efforts. It also emphasizes the importance of early health education for young girls and women, especially in developing countries.”

Reference:

Age at woman’s first period can offer clues about long-term health risks, The Endocrine Society, Meeting: ENDO 2025.

New Delhi: The National Pharmaceutical Pricing Authority (NPPA), under the Department of Pharmaceuticals, has fixed the ceiling prices of four scheduled formulations, bringing down the maximum permissible retail prices for widely used medicines across respiratory, cardiovascular, antiseptic, and critical care categories.

Seborrheic dermatitis has long been treated with azoles, particularly ketoconazole, due to their effective antifungal and anti-inflammatory properties.[1] treatments, available in various forms like shampoos and oral medications, work by reducing yeast levels on the skin, thereby alleviating symptoms.[1] However, the widespread and prolonged use of antifungals has led to a growing concern: the emergence of resistant fungal strains. This resistance, driven by factors such as over-prescription, limited development of new antifungal agents, and patient noncompliance, is now a significant burden on global healthcare systems. [2,3]

Ketoconazole Resistance

Resistance to antifungal drugs, including ketoconazole, occurs through mechanisms like decreased drug-target interactions and reduced intracellular drug levels via drug efflux pumps.[4]Studies, including the one by Park et al., elaborate on the causes of ketoconazole resistance in M. restricta, such as tandem allele multiplication and enhanced drug efflux.[5] Over time, these resistance mechanisms can evolve in response to treatment. Studies have shown that despite ketoconazole’s initial success against Malassezia species, it can lead to severe side effects such as toxic necrotizing hepatitis.[6] Moreover, evidence has surfaced of ketoconazole’s inability to curb fungal growth in some patients with SD, with certain Malassezia strains exhibiting resistance.[6] These findings underscore the pressing need for alternative treatments, particularly as ketoconazole remains a first-line therapy for seborrheic dermatitis.

A susceptibility testing study by Leong et al. at the University Hospital of Zurich identified Malassezia strains resistant to ketoconazole, highlighting the clinical significance of exploring alternative treatments for seborrheic dermatitis. [7]

Selenium Sulfide: An Alternative Approach

In the search for alternative treatments, selenium sulfide emerges as a promising candidate. Selenium sulfide has been used for treating pityriasis versicolor and seborrheic dermatitis of the scalp. The cytostatic impact of selenium on the epidermis and follicular epithelium lowers corneocyte adhesion, which permits the shedding of fungus in the stratum corneum. Both in vitro and in vivo studies have demonstrated selenium sulfide’s fungicidal activity against Malassezia species, making it a compelling option for managing seborrheic dermatitis, especially in the context of ketoconazole resistance.[8] Selenium sulfide is keratolytic as it impedes the formation of the hydrogen bond in the keratin, and its keratoplastic property weakens the turnover rate of the epidermal cell.[9] Known for its antiseborrheic properties, selenium sulfide is used in anti-dandruff shampoos as an active ingredient.[10] The ubiquitous role of selenium sulfide could be appealing to include in the treatment of seborrheic dermatitis.

Exploring the Efficacy of Selenium Sulfide

The treatment of seborrheic dermatitis aims to establish a regimen that is both potent and has low recurrence rates. To encourage patient adherence, treatment should include an antifungal medication that is both effective and pleasant for the patient. An ideal topical agent has anti-inflammatory qualities, remains on the skin, and is administered in a carrier that promotes penetration, fosters healing, and endures.[11] One such effective medication is selenium sulfide which has proven to have immediate relief from itching and flaking in patients with severe dandruff.[12] A study conducted by Hersle emphasized the importance of selenium sulfide as an intermittent suppressive treatment for tinea versicolor where it successfully transformed the yeast to its more pathogenic mycelial phase.[13] Furthermore, a single application of 2.5% selenium sulfide worked as an active agent in reducing residual infection in patients suffering from tinea versicolor.[14] These findings support the inclusion of selenium sulfide in treatment protocols for Malassezia-related conditions, potentially enhancing outcomes in cases where traditional antifungals fail.

The Future of Antifungal Therapy

Primary pathogens that cause life-threatening complications are considered serious and receive more resources compared to opportunistic pathogens like Malassezia, which typically affect immunocompromised individuals.[15] This lack of seriousness augmented the cases of fungal infections and thus the dependency on antifungals increased. The overuse of antifungal agents has ultimately aggravated the issue of antifungal resistance and morbidity.[16] A multimodal strategy is needed to address antifungal resistance, with an emphasis on creating novel medications or combination therapies, funding diagnostic tools, and encouraging infection prevention and control practices. Moreover, the incorporation of ongoing clinical studies and patent data offers a prospective viewpoint, signifying the continuous advancement of antifungal treatments.[17] In this context, selenium sulfide presents itself as a reliable and effective alternative to traditional treatments like ketoconazole. Its potential, however, is still underexplored, particularly in combating Malassezia, highlighting the need for further research and clinical trials.

Conclusion

The emergence of antifungal resistance, particularly in ketoconazole-resistant strains, necessitates a reassessment of current treatment strategies for seborrheic dermatitis. Although developing new antifungal agents is challenging, the effectiveness of alternatives like selenium sulfide presents a promising way forward. Enhanced investment and research into antifungal treatments, including the exploration of selenium sulfide’s potential, are crucial as the landscape of infectious diseases continues to change.

References

[1] Gupta AK, Nicol K, Batra R. Role of antifungal agents in the treatment of seborrheic dermatitis. Am J Clin Dermatol 2004;5:417–22. https://doi.org/10.2165/00128071-200405060-00006.

[2] Fisher MC, Hawkins NJ, Sanglard D, Gurr SJ. Worldwide emergence of resistance to antifungal drugs challenges human health and food security. Science (1979) 2018;360:739–42. https://doi.org/10.1126/SCIENCE.AAP7999.

[3] Fisher MC, Hawkins NJ, Sanglard D, Gurr SJ. Worldwide emergence of resistance to antifungal drugs challenges human health and food security. Science (1979) 2018;360:739–42. https://doi.org/10.1126/SCIENCE.AAP7999.

[4] Cowen LE, Sanglard D, Howard SJ, Rogers PD, Perlin DS. Mechanisms of Antifungal Drug Resistance. Cold Spring Harb Perspect Med 2015;5. https://doi.org/10.1101/CSHPERSPECT.A019752.

[5] Park M, Cho YJ, Lee YW, Jung WH. Genomic Multiplication and Drug Efflux Influence Ketoconazole Resistance in Malassezia restricta. Front Cell Infect Microbiol 2020;10:191. https://doi.org/10.3389/FCIMB.2020.00191/FULL.

[6] Wang K, Cheng L, Li W, Jiang H, Zhang X, Liu S, et al. Susceptibilities of Malassezia strains from pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis to antifungal drugs. Heliyon 2020;6:e04203. https://doi.org/10.1016/J.HELIYON.2020.E04203.

[7] Leong C, Buttafuoco A, Glatz M, Bosshard PP. Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method. J Clin Microbiol 2017;55:1883. https://doi.org/10.1128/JCM.00338-17.

[8] Gupta AK, Mays RR, Foley KA. Topical Antifungal Agents. Comprehensive Dermatologic Drug Therapy, Fourth Edition 2021:480-492.e5. https://doi.org/10.1016/B978-0-323-61211-1.00042-5.

[9] Mueller RS. Topical dermatological therapy. Small Animal Clinical Pharmacology 2008:546–56. https://doi.org/10.1016/B978-070202858-8.50026-9.

[10] Program NT. Selenium Sulfide 2021. https://doi.org/10.22427/NTP-OTHER-1003.

[11] Elewski BE. TherapeuTics for The clinician Safe and Effective Treatment of Seborrheic Dermatitis 2009;83:333.

[12] Godse G, Godse K. Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study. Cureus 2024;16. https://doi.org/10.7759/CUREUS.57148.

[13] K. H. Selenium sulphide treatment of tinea versicolor. Acta Derm Venereol 1971;51:476–8. https://doi.org/10.2340/0001555551476478.

[14] Albright SD, Hitch JM. Rapid Treatment of Tinea Versicolor With Selenium Sulfide. Arch Dermatol 1966;93:460–2. https://doi.org/10.1001/ARCHDERM.1966.01600220072023.

[15] A One Health Approach to Combating Fungal Disease: Forward-Reaching Recommendations for Raising Awareness n.d. https://asm.org/Articles/2019/September/A-One-Health-Approach-to-Combating-Fungal-Disease (accessed August 26, 2024).

[16] Mudenda S, Mudenda S. Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications. Pharmacology & Pharmacy 2024;15:81–112. https://doi.org/10.4236/PP.2024.154007.

[17] Nahar D, Mohite P, Lonkar A, Chidrawar VR, Dodiya R, Uddin MJ, et al. An insight into new strategies and targets to combat antifungal resistance: A comprehensive review. European Journal of Medicinal Chemistry Reports 2024;10:100120. https://doi.org/10.1016/J.EJMCR.2023.100120.

IND2361824 14 JUL 2025

For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only

Chennai: Several doctors across Tamil Nadu have voiced strong concerns over the state government’s recent decision to revise the minimum wages for duty medical officers working in private hospitals, calling the move ‘unfair’ and ‘inadequate’.

While the move was aimed at standardising salaries based on hospital size, many in the medical community feel that the revised pay still doesn’t do justice to their work.

Medical Dialogues, a week ago, reported that Duty Medical Officers (DMOs) working at private hospitals or nursing homes with a bed strength between 1 and 50 will now receive a revised minimum basic wage ranging from Rs 14,875 to Rs 16,057, depending on the hospital’s location. For larger hospitals with over 1,000 beds, the revised minimum wage will range between Rs 15,634 and Rs 16,876. 

This revision followed the Labour Welfare and Skill Development Department issuing a government order categorising hospitals into different zones based on geography and bed strength to determine wage levels.

Also read- TN revises minimum wages for Duty Medical Officers at private hospitals, draws criticism

But many doctors say the hike is too small and unfair, especially considering their workload. They argue that linking pay to the number of beds in a hospital is illogical since the responsibilities remain the same regardless of hospital size. The small difference in pay between small and large hospitals has also been questioned.

According to some medical experts, the new pay structure is not commensurate with the responsibilities of duty doctors and could see corporate hospitals exploiting them.

Doctors criticising the revision of the pay scale said it ridiculed their hard work and did a gross injustice to the entire profession. They feel fixing the minimum wages based on the number of beds in a hospital is absurd since there is very little margin in the pay for 50- and 1,000-bed hospitals. The fraternity is afraid that such a move could discourage people from pursuing the noble profession.

Doctors have raised concerns about being overworked, often clocking in 24 to 36 hours at a stretch without proper rest. They say the revised wages do not reflect the intensity and stress of their work.

The medical community also fears that corporate hospitals may use the revised structure to justify low pay while expecting high output from doctors. 

Speaking to The Federal, Dr GR Rabindranath, general secretary of the Doctors Association for Social Equality said, “This would only lead to private hospitals exploiting the doctors by paying them such low wages. Such practices would discourage doctors from joining the profession. The fixation of minimum wages does not have a specified criterion and is unscientific. Such a move proves that the government is favouring corporate and private hospitals, and such a low wage structure facilitates the exploitation of doctors.” 

Echoing a similar opinion, a cardiologist from Vellore working with a private healthcare institution said, “Increasing the number of seats or building new hospitals without ensuring basic facilities or care for the medical experts makes little sense. With regards to doctors’ pay, interns and postgraduates are still paid a pittance. Even professors are not paid handsomely, and they compensate by working in outside clinics. Those postgraduates who are married are constantly facing marital issues solely because of financial constraints. Somebody working 36 hours at a stretch and 100-plus work hours a week deserves something more than Rs 40,000 a month. We are not expecting to be paid in lakhs and lakhs, but at least pay the bare minimum.”

Dr V Vignesh Rajendran, president of Tamil Nadu Resident Doctors Association, said, “Even the private hospitals hiring these doctors know that the recent revision of minimum pay is very unfair. A peon or worker working in a government hospital is paid equal to that. A staff nurse is paid much more than that. What is the logic in setting the wage at Rs 16,057 per month for a 50-bed hospital and Rs 16,876 per month for a 1,000-bed hospital? How is it justified to pay just Rs 800 more for treating 950 more patients?” It sets a dangerous precedent and makes a mockery of the medical profession. It is one of the reasons why doctors from Tamil Nadu are slowly moving away and settling in other states.”

Also read- Rs 40,000 for Medical Officer Post: Doctor slams TN Govt over low pay scale