New Care Approach Lowers Opioid Use and Hospital Stay in Infants with opioid Withdrawal Syndrome: Study

A recent study published in the Journal of American Medical Association demonstrated that a novel care method, the eat, sleep, console (ESC) approach, substantially lowers opioid exposure and the length of hospital stays for infants with neonatal opioid withdrawal syndrome (NOWS) when compared to the traditional care practices.

The study was conducted from September 2020 to March 2022 and included a total of 463 infants across 26 U.S. hospitals as part of the ESC-NOW clinical trial. These infants were born at 36 weeks of gestation or later with evidence of antenatal opioid exposure and were pharmacologically treated for NOWS under two different care protocols, which is the ESC care approach and the usual care using the Finnegan scoring tool.

The results revealed that infants managed with the ESC care approach had significantly lower total opioid exposure, with a mean difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) when compared to the individuals who receive usual care. Also, infants in the ESC group received an average of 4.8 MME/kg, whereas the infants in the usual care group received 8.9 MME/kg.

This study found that initiation of pharmacologic treatment was delayed by an average of 22.4 hours in the ESC group that allowed more time for non-pharmacological interventions and assessments. Also, there was no significant increase in the peak opioid dose required by suggesting that the ESC approach does not compromise the efficacy of the treatment when pharmacological intervention is necessary.

One of the most significant findings was the reduction in both the length of opioid treatment and total length of hospital stay. Infants in the ESC care group completed their treatment 6.3 days earlier than the infants in the usual care group and were discharged from the hospital an average of 6.2 days earlier. This not only suggests better outcomes for the infants but also indicates potential cost savings and more efficient use of hospital resources. Overall, the ESC method offers a more compassionate and sustainable option for treating vulnerable newborns exposed to opioids in utero by focusing on supportive care measures that allow for natural parental involvement and less reliance on medications.

Source:

Devlin, L. A., Hu, Z., Merhar, S. L., Ounpraseuth, S. T., Simon, A. E., Lee, J. Y., Das, A., Crawford, M. M., Greenberg, R. G., Smith, P. B., Higgins, R. D., Walsh, M. C., Rice, W., Paul, D. A., Maxwell, J. R., Fung, C. M., Wright, T., Ross, J., … McAllister, J. M. (2024). Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal. In JAMA Pediatrics. American Medical Association (AMA). https://doi.org/10.1001/jamapediatrics.2024.0544

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Full pulpotomy bests partial pulpotomy for managing of spontaneous symptomatic pulpitis: Study

Full pulpotomy bests partial pulpotomy for managing spontaneous symptomatic pulpitis suggests a study published in the Journal of Endodontics.

The aim of this study was to compare the outcome and prognostic factors for partial and full pulpotomy in the management of mature teeth with spontaneous symptomatic pulpitis. The study was a parallel double blind randomized clinical trial, 200 carious mature permanent teeth with spontaneous symptomatic pulpitis were randomized using a block randomization technique to either partial pulpotomy (n=99) or full pulpotomy (n=101). Intraoperative assessment of the pulp under magnification was done, hemostasis was achieved with 2.5% NaOCl moist pellet, and NeoPUTTY was the pulpotomy material. Preoperative pain levels were recorded and revaluated after 1 week. Clinical and radiographic evaluation was done after 6 and 12 months. Data were analyzed using Chi-square, Wilcoxon rank tests and regression analysis. Results: At 1week immediate failure occurred in 4 cases in partial pulpotomy, and 196/200 subjects reported pain relief and were satisfied with the treatment with no significant difference. At 6 months, 6 teeth failed in partial pulpotomy and 1 tooth in full pulpotomy, with a higher success rate for full pulpotomy (98.96 vs 89.69, p= 0.003). At 12 months the recall rate was 98% (96/200). Full pulpotomy was more successful than partial pulpotomy (98.98% (98/99), vs 84.53% (82/97), p< 0.001). Multivariate analysis revealed that the odds of success for full pulpotomy were 13.6 times higher than partial pulpotomy. Increased age and higher time to hemostasis were significantly associated with decreased odds of success. Full pulpotomy has higher success rate than partial pulpotomy in the management of spontaneous symptomatic pulpitis. Hemostasis within 4 minutes in partial pulpotomy can be set as cutoff point beyond which further tissue removal is indicated.

Reference:

Taha NA, Albakri SW. Outcome and prognostic factors for partial and full pulpotomy in the management of spontaneous symptomatic pulpitis in carious mature permanent teeth: A randomized clinical trial. J Endod. 2024 Apr 5:S0099-2399(24)00224-3. doi: 10.1016/j.joen.2024.03.012. Epub ahead of print. PMID: 38583758.

Keywords:

Full pulpotomy, bests, partial pulpotomy, managing, spontaneous, symptomatic pulpitis, study, Taha NA, Albakri SW, age; bleeding time; full pulpotomy; outcome; partial pulpotomy; spontaneous symptomatic pulpitis.

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Time-restricted fasting may effect weight loss and improve cardiometabolic function: Study

China: A recent meta-analysis published in BMC Cardiovascular Disorders has shown the potential of time-restricted fasting (TRF) as a treatment strategy for total body weight reduction by targeting adipose tissue with potential improvements in cardiometabolic function.

The study suggests that time-restricted fasting interventions can effectively reduce fat mass and body weight while retaining lean body mass; indicating that subjects lost fat rather than muscle and water.

According to the study, the results showed slight differences when the calculation method was modified, for example, by introducing the Hartung-Knapp adjustment. Although the reduction in body fat percentage remained statistically significant, the researchers noted no significant difference in weight loss. However, a significant decrease in systolic blood pressure was observed in this context.

Time-restricted fasting, an eating pattern that limits food intake to a specific time window each day, has garnered attention for its potential health benefits. In recent years, researchers have conducted numerous studies to investigate its effects on various aspects of health, including cardiovascular disease (CVD) risk factors.

A meta-analysis pooling the results of these studies aimed to investigate the impact of TRF on key risk factors, including glucose metabolism, body weight, blood pressure, and lipid profile.

Juntao Kan, Nutrilite Health Institute, Shanghai, China, and colleagues conducted a systematic search in five databases for relevant studies up to January 2023. Twelve studies were eligible for analysis after applying inclusion criteria. Quality assessment was conducted using the ROBINS-I and ROB-2.0 tools. The risk of bias was mapped using Revman 5.3, and data analysis included Hartung-Knapp adjustment using R 4.2.2.

“The group that underwent the TRF intervention exhibited a significant decrease in body weight (SMD: -0.22) and fat mass (SMD: -0.19), while maintaining lean mass (SMD: -0.09),” the researchers reported.

In conclusion, the research showed that time-restricted fasting effectively reduces body weight and fat mass without affecting lean body mass, indicating a preference for fat loss.

This finding highlights the potential of TRF as a strategy for improving body composition. However, there is a need for further clinical trials to explore the underlying mechanisms and broader impacts of this intervention, particularly with cardiovascular health.

“Future research should aim to clarify gender-specific responses to TRF, considering differences in adipose tissue characteristics and metabolism,” the researchers wrote. “This will enhance our understanding of the role of time-restricted fasting in promoting metabolic health.”

Reference:

Qiu, Z., Huang, E.Y.Z., Li, Y. et al. Beneficial effects of time-restricted fasting on cardiovascular disease risk factors: a meta-analysis. BMC Cardiovasc Disord 24, 210 (2024). https://doi.org/10.1186/s12872-024-03863-6

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Photon-counting CT improves coronary artery disease assessment, reveals study

Ultrahigh-spatial-resolution photon-counting detector CT improved assessment of coronary artery disease (CAD), allowing for reclassification to a lower disease category in 54% of patients, according to a new study published  in Radiology, a journal of the Radiological Society of North America (RSNA). The technology has the potential to improve patient management and reduce unnecessary interventions.

Coronary CT angiography is a first-line test in the assessment of coronary artery disease. However, its diagnostic value is limited in patients with severe calcifications, or calcium buildup in the plaque of the coronary arteries.

Ultrahigh-spatial-resolution photon-counting detector CT (PCD-CT) improves image quality compared to conventional CT. Additionally, it provides better spatial resolution, or the ability to differentiate two adjacent structures as being distinct from one another.

“Our study provides a glimpse into the potential impact of performing coronary CT angiography using ultrahigh spatial resolution technology on risk reclassification and recommended downstream testing,” said study co-author Tilman Emrich, M.D., attending radiologist at the University Medical Center Mainz in Germany, and assistant professor of radiology at the Medical University of South Carolina in Charleston.

For the study, researchers evaluated coronary stenoses, or narrowing in the coronary arteries, in a vessel phantom (in-vitro) containing two different stenosis grades (25%, 50%), and retrospectively in 114 patients (in-vivo) who underwent ultrahigh-spatial-resolution cardiac PCD-CT for the evaluation of coronary artery disease. In-vitro values were compared to the phantom’s manufacturer specifications, and patient results were assessed regarding effects on coronary artery disease reporting and data system reclassification (CAD-RADS).

“The study used a combination of artificial vessel models and real-world patient data,” Dr. Emrich said. “It simulated three types of reconstructions from a single PCD-CT scan, resembling conventional CT, high-resolution, and ultrahigh-spatial-resolution scans. Observers evaluated the severity of stenosis and generated CAD-RADS classifications, guiding further patient management decisions.”

In-vitro results demonstrated a reduced overestimation of the stenosis by ultrahigh-spatial-resolution scans by reducing the adverse effects of the calcifications on the image.

Results from the patients with suspected or diagnosed coronary artery disease confirmed a lower median degree of stenosis for calcified plaques (29% vs. 42%) with ultrahigh-spatial-resolution PCD-CT compared to standard CT. Ultrahigh-spatial-resolution often led to patients being reclassified to a lower CAD-RADS category. Of the 114 patients, 54% were given a lower CAD-RADS classification than they were originally assigned. The researchers found in-vitro quantification of the 193 coronary CT angiography-based stenoses was also more accurate using ultrahigh-spatial-resolution than standard resolution.

“We found that ultrahigh-spatial-resolution reconstructions resulted in significant changes in recommendations for over 50% of patients,” Dr. Emrich said. “The impact was particularly notable in cases with calcified plaques, where ultrahigh-spatial-resolution reduced the overestimation of stenosis.”

Dr. Emrich explained that ultrahigh-spatial-resolution may address the current limitations of conventional cardiac CT angiography by reducing the overestimation of stenosis due to calcium blooming, an effect which can cause small, high-density structures-such as calcifications-to appear larger than their true size.

“This could significantly alter recommendations for downstream testing, potentially leading to a reduction of unnecessary procedures (and their potential complications) and reduced healthcare costs,” he said.

No substantial benefits of ultrahigh-spatial-resolution were observed for mixed and non-calcified plaques.

“It is important to note that these findings are from a simulation study, and further validation is needed in real-world comparisons,” Dr. Emrich said.

Reference:

Moritz C. Halfmann, Stefanie Bockius, Tilman Emrich , Michaela Hell, U. Joseph Schoepf, Gerald S. Laux, Larissa Kavermann, Dirk Graafen, Tomasso Gori, Yang Yang, Roman Klöckner, Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment, Radiology, https://doi.org/10.1148/radiol.231956

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Healthy diet lowers heart disease risk in breast cancer survivors

A new paper in JNCI Cancer Spectrum, published by Oxford University Press, finds that following a healthy diet lowers the risk of cardiovascular disease in breast cancer survivors.

Cardiovascular disease is the top non-breast cancer related cause of death in women with breast cancer. There are more than 3.8 million female breast cancer survivors in the United States. These women are at higher risk for cardiovascular disease than women who have not had breast cancer. This is likely due to the cardiotoxic effects of breast cancer treatment, as well as common risk factors for both breast cancer and cardiovascular disease, such as aging, lack of exercise, and smoking. Dietary guidance for breast cancer survivors is limited and until recently has been based primarily on research related to cancer prevention.

Researchers used data from the Pathways Study, a prospective cohort study of women diagnosed with invasive breast cancer, to examine associations between diet quality and cardiovascular-related events. The analysis included 3,415 women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and monitored through 2021.

To assess diet quality, researchers used a scoring system based on the Dietary Approaches to Stop Hypertension (DASH) diet which was developed in the 1990s to manage and treat hypertension. The diet emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy. It also limits sodium, red and processed meats, and sugar sweetened beverages. The diet is similar to that recommended by the American Cancer Society, but also encourages consumption of low-fat dairy and nuts, and discourages sodium. The study evaluated heart health tied to these two diets as well as a plant-based diet, the 2020 Healthy Eating Index, and the alternate Mediterranean diet.

The researchers found that women whose diets were most similar to DASH at the time of their breast cancer diagnosis had a 47% lower risk of heart failure, a 23% lower risk of arrhythmia, a 23% lower risk of cardiac arrest, a 21% lower risk of valvular heart disease, and a 25% lower risk of venous thromboembolic disease than the women whose diets were least aligned with DASH.

In a closer examination the researchers found that higher consumption of low-fat dairy reduced the risk for cardiovascular disease-related death, after adjusting for all other food groups. They also found that the relationship between DASH and cardiovascular disease appeared to be modified by the type of chemotherapy treatment a woman received. For example, women whose treatment included an anthracycline and had diets closely aligned with the diet had a lower risk of cardiovascular disease than women least aligned with DASH, a relationship that was not apparent among women on other types of chemotherapy regimens.

“Our findings suggest that we need to begin talking to breast cancer survivors about the potential heart benefits of the DASH diet,” said the paper’s lead author, Isaac J. Ergas, PhD, a staff scientist at the Kaiser Permanente Division of Research. “We know that breast cancer survivors have an elevated risk for cardiovascular disease, and the diet might be able to help improve the overall health of this population.”

Reference:

Isaac J Ergas, Richard K Cheng, Janise M Roh, Lawrence H Kushi, Jacob K Kresovich, Carlos Iribarren, Mai Nguyen-Huynh, Jamal S Rana, Eileen Rillamas-Sun, Cecile A Laurent, Valerie S Lee, Charles P Quesenberry, Heather Greenlee, Marilyn L Kwan, Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study, JNCI Cancer Spectrum, Volume 8, Issue 2, April 2024, pkae013, https://doi.org/10.1093/jncics/pkae013.

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Intracytoplasmic sperm injection in non-severe male infertility fails to improve outcomes: Study

A recent study conducted across ten reproductive centers in China suggests that the widely-used fertility treatment known as intracytoplasmic sperm injection (ICSI) may not provide better outcomes than conventional in-vitro fertilization (IVF) in cases of non-severe male infertility. The findings published in The Lancet journal are expected to influence clinical practices and patient choices by emphasizing the importance of tailoring fertility treatments to specific medical profiles.

ICSI was introduced in 1992 and was initially designed to overcome severe male infertility by directly injecting a single sperm into an egg. This method has become a common procedure throughout the globe, for severe cases and for a broader range of fertility issues, including non-severe male infertility.

The multicenter, open-label, randomized controlled trial enrolled a total of 2,387 couples dealing with non-severe male infertility. These couples were without any prior history of poor fertilization issues and were randomly assigned to undergo either ICSI or conventional IVF. The primary focus of the study was the live birth rate after the first embryo transfer.

After several screening and adjustments that included the exclusion of ineligible participants or those who withdrew consent, this study analyzed outcomes for 1,154 couples in the ICSI group and 1,175 in the conventional IVF group. The results observed from April 2018 to November 2021 revealed that the live birth rates were quite similar between the two groups. Also, 33.8% of the couples in the ICSI group and 36.6% in the IVF group achieved live births where the adjusted risk ratio was 0.92, which was not statistically significant (p=0.16).

The research also recorded neonatal mortality that marked slightly higher incidents in the ICSI group (0.2%) when compared to the IVF group (0.1%). This findings raised concerns about the risks associated with the more invasive nature of ICSI, unlike conventional IVF which involves the direct injection of sperm into the egg. Overall, the outcomes of this study advises caution in the routine use of ICSI for couples where male infertility does not reach a severe threshold.

Source:

Wang, Y., Li, R., Yang, R., Zheng, D., Zeng, L., Lian, Y., Zhu, Y., Zhao, J., Liang, X., Li, W., Liu, J., Tang, L., Cao, Y., Hao, G., Wang, H., Zhang, H., Wang, R., Mol, B. W., Huang, H., & Qiao, J. (2024). Intracytoplasmic sperm injection versus conventional in-vitro fertilisation for couples with infertility with non-severe male factor: a multicentre, open-label, randomised controlled trial. In The Lancet (Vol. 403, Issue 10430, pp. 924–934). Elsevier BV. https://doi.org/10.1016/s0140-6736(23)02416-9

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Heart failure, not stroke most common complication of atrial fibrillation, claims study

The lifetime risk of atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) has increased from one in four to one in three over the past two decades, finds a study from Denmark in The BMJ today.

And among those with the condition, two in five are likely to develop heart failure over their remaining lifetime and one in five encounter a stroke, with little or no improvement in risk evident over the 20 year study period.

As such, the researchers say stroke and heart failure prevention strategies are needed for people with atrial fibrillation.

Atrial fibrillation is estimated to affect 18 million people in Europe by 2060 and 16 million people in the US by 2050. In the English NHS alone, more new cases of atrial fibrillation are diagnosed each year than the four most common causes of cancer combined, and direct expenditure on atrial fibrillation has reached £2.5 billion.

Once atrial fibrillation develops, patient care has primarily focused on the risk of stroke, but other complications such as heart failure and heart attack have yet to be fully explored.

To address this knowledge gap, researchers analysed national data for 3.5 million Danish adults with no history of atrial fibrillation at age 45 or older to see whether they developed atrial fibrillation over a 23 year period (2000-22).

All 362,721 individuals with a new diagnosis of atrial fibrillation during this time (46% women and 54% men) but with no complications, were subsequently followed until a diagnosis of heart failure, stroke or heart attack.

Potentially influential factors such as history of high blood pressure, diabetes, high cholesterol, heart failure, chronic lung and kidney disease, family income and educational attainment, were also taken into account.

The results show that the lifetime risk of atrial fibrillation increased from 24% in 2000-10 to 31% in 2011-22. The increase was larger among men and individuals with a history of heart failure, heart attack, stroke, diabetes, and chronic kidney disease.

Among those with atrial fibrillation, the most common complication was heart failure (lifetime risk 41%). This was twice as large as the lifetime risk of any stroke (21%) and four times greater than the lifetime risk of heart attack (12%).

Men showed a higher lifetime risk of complications after atrial fibrillation compared with women for heart failure (44% vs 33%) and heart attack (12% vs 10%), while the lifetime risk of stroke after atrial fibrillation was slightly lower in men than women (21% vs 23%).

Over the 23-year study period, there was virtually no improvement in the lifetime risk of heart failure after atrial fibrillation (43% in 2000-10 vs 42% in 2011-22) and only slight (4-5%) decreases in the lifetime risks of any stroke, ischaemic stroke, and heart attack after atrial fibrillation, which were similar among men and women.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that they may have missed patients with undiagnosed atrial fibrillation. Nor did they have information on ethnicity or lifestyle factors, and say results may not apply to other countries or settings.

But despite these caveats, they conclude: “Our novel quantification of the long term downstream consequences of atrial fibrillation highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with atrial fibrillation.”

Interventions to prevent stroke have dominated atrial fibrillation research and guidelines during this study period, but no evidence suggests that these interventions can prevent incident heart failure, say UK researchers in a linked editorial.

They call for alignment of both randomised clinical trials and guidelines “to better reflect the needs of the real-world population with atrial fibrillation” and say this robust observational research “provides novel information that challenges research priorities and guideline design, and raises critical questions for the research and clinical communities about how the growing burden of atrial fibrillation can be stopped.”

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Depression may increase risk of gout study

Depression may increase the risk of gout suggests a new study published in the International Journal of Rheumatic Diseases.

The co-disease of depression and gout is becoming more common in the modern era. However, the relationship between the severity of depressive symptoms and gout prevalence and treatment rate was still unclear. This study aimed to determine the relationship between the prevalence, treatment rate of gout, and the severity of depression in the United States. The cross-sectional analysis of the 2007-2018 National Health and Nutrition Examination Survey (NHANES) for participants with depression was performed. According to their Patient Health Questionnaire-9 (PHQ-9) scores, participants were categorized as none, mild, moderate, moderately severe, and severe. To learn the correlation between the severity of depressive symptoms and the prevalence and treatment rate of gout using multivariate logistic regression to control for confounder interference. Results: A total of 25 022 patients were included in this study. As the severity of the depressive symptoms worsened (Mild, Moderate and Moderately severe), the risk of gout increased in non-adjusted model and model 1,2,3 (p-value for trend =.01 in non-adjusted model, <.0001 in model 1, <.01 in models 2 and 3; prevalence group in Model 1, aOR1.71, 95% CI (1.40, 2.08) in the mild group, aOR1.68, 95% CI (1.19, 2.39) in the moderate group, aOR1.31,95% CI (0.82, 2.11) in the moderately severe group, aOR1.21, 95% CI (0.62, 2.38) in the severe group). However, the lower gout prevalence trend has no statistical significance after adjusting all factors in Model 4(p-value for trend =.98). Compared with patients without depression, only a few patients received treatment, especially patients with severe depression (none, 80.1%; severe, 0.2%). The more severe the depression, the lower the treatment rate. Compared with patients without depression, the patients with depression had a higher risk of gout. With the aggravation of depression, the prevalence of gout and the rate of treatment both decreased. Patients with gout and depression need to receive multidisciplinary care after diagnosis. However, currently, treatment cannot meet the needs of the current patients.

Reference:

Lu S, Qian T, Cao F, Kang T, Liu X, Wang C, Xia Y, Hou X. Prevalence and treatment rate of gout by depressive symptom severity: A cross-sectional analysis of NHANES 2007-2018. Int J Rheum Dis. 2024 Jan;27(1):e14959. doi: 10.1111/1756-185X.14959. Epub 2023 Nov 20. PMID: 37984452.

Keywords:

Depression, risk, gout, Lu S, Qian T, Cao F, Kang T, Liu X, Wang C, Xia Y, Hou X, NHANES; co-morbidity; depression; gout; prevalence; treatment.

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Does watching TV or videos during the day affect nighttime urination?

In a study published in Neurourology and Urodynamics, adults who spent 5 or more hours a day watching TV and/or videos were more likely to develop nocturia, or the need to urinate multiple times during the night.

The study drew from 2011–2016 data from the National Health and Nutrition Examination Survey. Among 13,294 US individuals aged 20 and older, 4,236 (31.86%) reported experiencing nocturia, while 9,058 (68.14%) did not. Participants with 5 or more hours of TV and/or video viewing time per day had a 48% higher risk of experiencing nocturia compared with those with less than 1 hour of daily TV and/or video viewing time.

“As individuals increasingly engage in screen‐based activities, a comprehensive understanding of the impact of extended TV and/or video time on patterns of nocturia is crucial for both healthcare professionals and public health practitioners,” the authors wrote. “For individuals who engage in prolonged TV and/or video time, healthcare professionals can offer behavioral intervention recommendations, encouraging appropriate screen time management.”

Reference:

Junwei Wang, Aiwei Zhang, Miaoyong Ye, Cunming Zhang, Association between TV and/or video time and nocturia in adults: An analysis of the National Health and Nutrition Examination Survey, Neurourology and Urodynamics, https://doi.org/10.1002/nau.25406.

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Lack of infrastructure, teaching staff: Former Medical Council member moves HC seeking discontinuation of CPS courses

Mumbai: Challenging the three notifications that allowed the College of Physicians and Surgeons (CPS) to continue its 19 medical courses, the former president of the Maharashtra branch of the Indian Medical Association (IMA) and a former member of the Maharashtra Medical Council (MMC) approached the Bombay High Court recently.

Worried over the inadequate infrastructure, equipment and teaching and non-teaching staff for the students, Dr Suhas Pingle in his Public Interest Litigation (PIL) has prayed for an order restraining CPS from affiliating or permitting any clinics and hospitals to admit the students for its post-graduate diploma or fellowship courses, reports HT.

In his plea, Dr. Pingle submitted that he recently came to know that clinics are affiliated with CPS as their training and teaching hospitals to confer their medical degrees. As per Dr. Pingle, such clinics and hospitals do not have the essential infrastructure, teaching and non-teaching staff, and equipment. He further claimed that there was no transparency in the process of admitting students to various postgraduate courses and to conduct examinations and evaluation of answer sheets.

The HC bench has listed the PIL for further hearing on April 22, 2024.

Last year, the Maharashtra Government de-recognised the CPS courses and asked the medical institutes and hospitals not to admit students for any of the 26 diplomas or fellowships offered by CPS, Mumbai. However, the State had clarified that the candidates who had already been admitted to these PG courses before notification would not be affected by this.

However, this year, the State Medical Education Department issued a gazette notification on March 15 reintroducing the 10 CPS courses dermatology, midwifery and gynaecology, gynaecology, pathology, surgery, medicine, ophthalmology and diploma courses in gynaecology and obstetrics, pathology and bacteriology, and child health.

Also Read: 10 CPS courses to restart in Maharashtra

According to a recent report by Hindustan Times, Dr. Pingle has challenged the validity of the notifications issued in 2017 and 2018 and argued that the concerned notifications allowed 9 PG courses offered by CPS at 5 specific medical colleges. However, later, those 5 colleges stopped admitting CPS students and started their own MD or MS courses. Referring to this, the petitioner claimed that the CPS courses have been recognised even in those 5 colleges and considering this, it was required to strike down the notifications.

Apart from this, the petitioner has also challenged the notification issued on March 15, 2024, through which 10 CPS courses were re-recognised. Dr. Pingle argued that even though the concerned notification stated that it was issued under Section 28(1) of the MMC Act, after consultations with the MMC, the state-appointed MMC administrator was not present in the meeting in which it was decided to allow the said courses.

Objecting the decision of allowing CPS to continue these 10 courses, the petitioner claimed that 72 hospitals did not even allow MMC inspectors to inspect their premises to check if those institutes had adequate facilities for training the doctors for PG and Fellowship courses offered by CPS.

The petitioner has also challenged the constitutional validity of section 28 of the Maharashtra Medical Council (MMC) Act, which empowers the State Government for including any course offered by any university or medical college in the Schedule to the Act and therefore confers legal validity on the course across the State.

He argued that the MMC Act is enacted for dealing with the registration of qualified persons to practice modern scientific medicine to take disciplinary action in the case of misconduct and not to deal with medical education.

Referring to Section 10 of the MMC Act, Dr. Pingle further submitted that the concerned section limits the power of MMC to regulate the registration of medical professionals to prescribe the code of conduct and take disciplinary action. Therefore, the provision contained in section 28 was ultra-vires- beyond the scope of the Act, argued the petitioner.

Also Read: Maharashtra derecognises College of Physicians and Surgeons courses

The CPS Controversy:

Established in 1912, CPS Mumbai is an autonomous body that imparts Postgraduate medical education and offers fellowship, diploma, and certificate courses for medical professionals. For the Diploma courses, the tenure is two years; in case of Fellowship, the tenure is three years. After obtaining the qualification granted by CPS Mumbai, the practitioners are allowed to register themselves as specialists in the concerned speciality.

CPS courses have been facing major controversies for a long time. Medical Dialogues had earlier reported that referring to significant gaps in the standards or institutes offering CPS courses, the medical education department of Maharashtra previously wrote to the Union Health Ministry asking for its opinion on whether counselling can be conducted for around 1,100 CPS seats.

Writing to the Centre, the department referred to the inspection of the Maharashtra Medical Council conducted last year and how during the inspection, MMC had found “severe deficiencies” in several institutes. In fact, the Central Government has also set up an eight-member committee to look into the matter.

The controversy continued further and then the Postgraduate Medical Education Board (PGMEB) of the National Medical Commission (NMC) recommended to the Union Health Ministry to withdraw the popular DPB- Diploma in Pathology and Bacteriology, DCH – Diploma in Child Health and DGO- Diploma Gynecology and Obstetrics courses run by CPS from the next academic year.

After NMC, the National Board of Examinations (NBE) also offered rejection to the CPS courses by refusing to bring them under the aegis of the NBE. At this outset, States including Rajasthan, Madhya Pradesh, Odisha, and Karnataka were reportedly considering decreasing the intake for the CPS courses or discontinuing them.

Last year, the Maharashtra Government then de-recognised the courses offered by CPS and asked the medical institutes and hospitals not to admit students for any of the 26 diplomas or fellowships offered by CPS, Mumbai.

Ultimately the matter reached the Court and filing a plea, CPS argued that 10 courses which were recognised under NMC Act 2019 cannot be de-recognised by the State. Thereafter, in December 2023, the State filed an affidavit in the Bombay HC and stated that it would review its decision.

Medical Dialogues had earlier reported that last year, opposing the plea by the College of Physicians and Surgeons, which challenged the State Government’s decision to de-recognise the CPS courses, former MMC member Dr. Suhas Pingle had approached the Bombay HC.

Also Read: CPS challenges derecognition, Former Medical Council member moves HC against petition

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