Researchers develop new synthetic surfactant that could improve lung treatments for premature babies

USA: Scientists have developed a synthetic surfactant that could potentially have lower production costs, longer shelf life, less batch variability, and pose less risk of an immune response versus animal-derived lung surfactants. 

The new lung surfactant is produced synthetically rather than using animal tissue. With further development, the formulation could provide a cheaper and more readily available alternative to Infasurf, a medication used to prevent and treat respiratory distress in premature babies.

Surfactants are substances that decrease surface tension where liquids interface with other liquids, gases, or solids. In addition to their use in medicines, they are found in a wide range of products including detergents, cosmetics, motor oils, and adhesives.

Suzanne Farver Lukjan, a lecturer in chemistry at Troy University in Alabama, led the work.

“A synthetic surfactant could potentially have a longer shelf life, lower production costs, have less batch variability and pose less risk of an immune response compared to animal-derived lung surfactants,” she said. “We hope our formulation will one day be used in hospitals.”

Lukjan will present the research at Discover BMB, the annual meeting of the American Society for Biochemistry and Molecular Biology, which is being held March 23–26 in San Antonio.

Lung surfactants help premature babies breathe while their lung cells finish developing. In addition to offering a potential alternative to replace Infasurf for babies, researchers say the new synthetic surfactant could be useful for treating adults with lung injuries as a result of diseases such as chronic obstructive pulmonary disorder, miner’s lung or emphysema.

Researchers have previously attempted to develop synthetic lung surfactants, but some have been removed from the market and others have not been able to lower surface tension as well as animal-derived formulations.

In the new work, Lukjan’s team created candidate surfactants from synthetic lipids (fats) and peptides (short chains of amino acids) and then tested their surface-tension-lowering capabilities. They aimed to mimic the composition, lipid phase behavior and biophysical function of Infasurf as closely as possible.

After tweaking a step in the sample preparation process, the researchers found a few formulations that showed particular promise. Although tests demonstrated that the chemical behavior of the synthetic surfactants was quite different from that of Infasurf, the new surfactants were able to mimic the drug’s functionality in terms of lowering surface tension and seem to achieve the optimal range in terms of peptide concentration.

As a next step, Lukjan said, the group plans to continue to refine and test their formulation to further optimize the combination of lipids and peptides. The surfactant would also need to undergo safety testing before it could be used clinically.

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Intratonsillar Immunotherapy Safe and Effective for Allergic Rhinitis, suggests research

Allergic rhinitis (AR) is a common condition affecting millions globally, often triggered by allergens such as house dust mites (HDM). Allergen-specific immunotherapy (AIT) is the only curative treatment for IgE-mediated allergies like AR; however, its lengthy duration and adverse effects hinder patient adherence. Thus, investigating alternative AIT routes is crucial to improving treatment outcomes.

Traditional AIT involves subcutaneous or sublingual administration, necessitating frequent visits and increasing the risk of systemic adverse reactions. Intratonsillar injection, a novel approach, targets the tonsils, which play a crucial role in immune responses, potentially enhancing treatment efficacy and safety.

A recent randomized, double-blind, placebo-controlled clinical trial aimed to evaluate the efficacy and safety of intratonsillar injection with HDM extract in patients with HDM-induced AR. This study was published in the Annals of Allergy Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology. The study was conducted by Junyan Z. and colleagues.

Eighty patients with HDM-induced AR were randomly assigned to receive either intratonsillar injections of HDM extract or placebo over three months. Various outcome measures, including total nasal symptom score (TNSS), visual analogue scale, symptom and medication score, quality of life questionnaire, and serum allergen-specific IgG4 levels, were assessed at baseline and up to 12 months post-treatment.

The key findings of the study were:

• At 3 months post-treatment, TNSS and ΔTNSS significantly improved in the active group compared to placebo.

• Sustained improvements in visual analogue scale, combined symptom and medication score, and quality of life questionnaire in the per-protocol set.

• Patients receiving intratonsillar immunotherapy exhibited a significant increase in serum Der p IgG4 levels at 3, 6, and 12 months post-treatment.

• No systemic adverse reactions were observed, indicating the safety of intratonsillar injection with HDM extract.

The study demonstrates the potential of intratonsillar immunotherapy as a safe and effective treatment for HDM-induced AR. The observed improvements in symptoms and serum IgG4 levels highlight the promising role of this innovative approach in AIT.

Intratonsillar injection offers a convenient and well-tolerated alternative to traditional AIT methods, potentially enhancing patient adherence and treatment outcomes. Further optimization of protocols and allergen formulations may enhance the efficacy and durability of this novel approach.

Intratonsillar immunotherapy with HDM extract emerges as a promising therapeutic option for patients with AR, offering both efficacy and safety benefits. Continued research and refinement of this approach hold potential for significant advancements in AIT for allergic diseases.

Reference:

Zhang, J., Yang, X., Chen, G., Hu, J., He, Y., Ma, J., Ma, Z., Chen, H., Huang, Y., Wu, Q., Liu, Y., Yu, L., Zhang, H., Lai, H., Zhang, J., Zhai, J., Huang, M., Zou, Z., & Tao, A. (2024). Efficacy and safety of intratonsillar immunotherapy for allergic rhinitis: A randomized, double-blind, placebo-controlled clinical trial. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 132(3), 346-354.e1. https://doi.org/10.1016/j.anai.2023.10.029

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Prophylactic pancreatic stent with rectal indomethacin prevents post ERCP pancreatitis: Lancet

Pancreatitis is a known risk following ERCP and has long posed challenges for clinicians due to its complexity and potential harm. A recent study suggests a promising strategy to prevent pancreatitis in high-risk individuals who undergo endoscopic retrograde cholangiopancreatography (ERCP). The key findings were published in the recent edition of the The Lancet journal.

This comprehensive research was conducted across 20 referral centers in the USA and Canada and highlights a combination therapy that involved rectally administered indomethacin and prophylactic pancreatic stent placement. The findings of this study challenge the existing practices and offer a potentially safer and more effective alternative. 

The randomized, non-inferiority trial included over 1950 patients who were aged 18 years and above and deemed to be at high risk for post-ERCP pancreatitis. The patients were randomly assigned to receive either rectal indomethacin alone or a combination of indomethacin and a pancreatic stent. 

The results revealed that post-ERCP pancreatitis occurred in 14.9% of patients in the indomethacin alone group when compared to 11.3% in the combination therapy group. While the difference did not meet the predetermined criteria for non-inferiority, a subsequent analysis suggested that the combined approach was superior to indomethacin alone.

Also, this study highlighted consistent benefits of stent placement across various patient subgroups among the individuals at the highest risk for pancreatitis. Overall, the safety outcomes which includes the serious adverse events and hospital stays did not differ significantly between the two treatment groups.

These findings have significant implications for clinical practice. Dr. [Lead Researcher’s Name], the lead investigator of the study, emphasized the importance of incorporating prophylactic pancreatic stent placement alongside indomethacin administration in high-risk patients, aligning with current clinical guidelines.

These outcomes mark a crucial stride in the management of ERCP by offering clinicians a more robust strategy to reduce the risk of post-procedural pancreatitis. The combined approach demonstrates effectiveness and additionally address the concerns regarding the technical complexity and cost associated with pancreatic stent placement.

Source:

Elmunzer, B. J., Foster, L. D., Serrano, J., Coté, G. A., Edmundowicz, S. A., Wani, S., Shah, R., Bang, J. Y., Varadarajulu, S., Singh, V. K., Khashab, M., Kwon, R. S., Scheiman, J. M., Willingham, F. F., Keilin, S. A., Papachristou, G. I., Chak, A., Slivka, A., Mullady, D., … Durkalski-Mauldin, V. (2024). Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial. In The Lancet (Vol. 403, Issue 10425, pp. 450–458). Elsevier BV. https://doi.org/10.1016/s0140-6736(23)02356-5

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Overweight or obese children and teenagers more likely to develop high BP as adults: Study

Blood pressure in adult men increased in a linear relationship with both higher childhood BMI (at age 8 years) and greater BMI change during puberty (BMI at 20 years minus childhood BMI), independent of each other, according to results of a Swedish population-based study.

In women, blood pressure in middle age increased in linear association with greater pubertal BMI change, but not childhood BMI.

“Our results suggest that preventing overweight and obesity beginning in childhood matters when it comes to achieving healthy blood pressure in later life”, says lead author Dr Lina Lilja from the University of Gothenburg in Sweden. “Children and teenagers living with overweight or obesity might benefit from targeted initiatives and lifestyle modifications to reduce the substantial disease burden associated with high blood pressure in later life from diseases such as heart attacks, strokes, and kidney damage.”

Children and teenagers living with overweight or obesity are more likely to have high blood pressure as adults (aged 50-64 years), suggesting the processes behind the condition could begin as early as childhood, suggests the new research being presented at this year’s European Congress on Obesity (ECO) in Venice, Italy (12-15 May).

Hypertension (persistent high blood pressure) is an important public health challenge worldwide because of its high prevalence and the associated risk of cardiovascular disease. WHO estimates that 1.28 billion adults aged 30-79 years are living with hypertension around the world . High blood pressure is the main cause of heart attacks, strokes, and chronic kidney disease, and is one of the most preventable and treatable causes of premature deaths worldwide. Modifiable risk factors include unhealthy diets, physical inactivity, and being overweight or obese.

A high BMI in adults is strongly associated with increased blood pressure and hypertension. However, the relative contribution of an elevated BMI during childhood and puberty to blood pressure in midlife is unknown.

To find out more, researchers analyzed data on 1,683 individuals (858 men and 825 women) born between 1948 and 1968 who were involved in two population-based cohorts-both the BMI Epidemiology Study Gothenburg (BEST) cohort and the Swedish CArdioPulmonary bioImage Study (SCAPIS)-to examine the association between BMI during development and systolic and diastolic blood pressure in midlife (50-64 years of age).

The researchers measured the developmental BMI of participants from the BEST Gothenburg cohort using school health care records (at the age of 7 to 8 years) and for young adult age (at age 18 to 20) from school health care or medical examinations on enrolment in the military which was mandatory for young men until 2010. Information on blood pressure in midlife (at age 50-64 years) was taken from participants in the SCAPIS study who were not on medication for high blood pressure at the time of blood pressure measurement. All analyses were adjusted for birth year.

The researchers used standard deviation, a commonly used statistical tool that shows what is within a normal range compared to the average.

In analyses including both childhood BMI and the pubertal BMI change in the same model, results showed that for men, an increase of one BMI unit from the average BMI in childhood (BMI 15.6kg/m2) was associated with a 1.30 mmHg increase in systolic blood pressure and a 0.75 mmHg increase in diastolic blood pressure, independent of each other.

Similarly, a one BMI unit increase from the average pubertal BMI (equivalent to an average pubertal BMI change of 5.4kg/m2) in men was associated with a 1.03 mmHg increase in systolic blood pressure and a 0.53 mmHg increase in diastolic blood pressure in middle age, independent of each other.

In women, a one BMI unit increase in pubertal BMI was associated with a 0.96 mmHg increase in systolic blood pressure and a 0.77 mmHg increase in diastolic blood pressure in middle age, irrespective of childhood BMI. In contrast, childhood BMI was not linked with systolic or diastolic blood pressure in midlife, irrespective of the pubertal BMI change.

“Although the differences in blood pressure are not very large, if blood pressure is slightly elevated over many years, it can damage blood vessels and lead to cardiovascular and kidney disease”, explains co-author Dr Jenny Kindblom from Sahlgrenska University Hospital i Sweden. “Our findings indicate that high blood pressure may originate in early life. Excessive fat mass induces chronic low-grade inflammation and endothelial dysfunction [impaired functioning of the lining of the blood vessels] already in childhood. Higher amounts of visceral abdominal fat increase the risk of developing hypertension in adults. We have previously shown that a large pubertal BMI change in men is associated with visceral obesity [fat around the internal organs] at a young adult age. So enlarged visceral fat mass might, in individuals with a high BMI increase during puberty, be a possible mechanism contributing to higher blood pressure.”

She adds, “This study is important given the rising tide of obesity among children and teens. We must turn the focus from high blood pressure in adults to include people in younger age groups.”

The authors note that the results are from observational findings, so more studies are needed to understand whether there are specific ages in childhood and/or adolescence when BMI is particularly important to blood pressure in adulthood. They also point to some limitations, including that a definite cause-and-effect link between BMI and high blood pressure cannot be determined in this type of population-based study; blood pressure was measured at a single point in time; the analyses were unable to account for the influence of other known risk factors such as diet and physical activity which could have influenced the results; and because most of the study participants were white, the results may not be generalizable to people from other racial or ethnic groups.

High blood pressure is defined as a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg.

Reference:

Study suggests high blood pressure could begin in childhood, European Association for the Study of Obesity, Meeting: European Congress on Obesity (ECO2024).

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Sleeping less than 6 hours daily may raise type 2 diabetes risk, regardless of healthy eating habits: JAMA

Sweden: A cohort study analyzing data from 247 867 adults in the UK Biobank revealed that adopting a healthy diet may not lower the risk of type 2 diabetes (T2D) development among those with habitual short sleep duration.

“Individuals getting sleep of less than 6 hours daily had a notably higher risk of T2D development versus those with 7 to 8 hours of sleep,” the researchers reported in their study published in JAMA Network Open. 

Despite the association between healthier diets and reduced risk of type 2 diabetes, the increased risk linked with short sleep duration persisted even among adults with healthy eating habits.

Previous studies have revealed substantial evidence of the adverse impact of short sleep duration on glucose metabolism. In contrast, current literature does not provide strong evidence that extended sleep in individuals with normal sleep patterns significantly disrupts glucose regulation. Thus, the association between habitual long sleep duration, often defined as more than 8 or 9 hours per day, and type 2 diabetes may not be causally linked.

Understanding the interplay between dietary habits, sleep duration, and the risk of T2D development is crucial for public health and diabetes prevention strategies. Considering this, Diana Aline Nôga, Department of Pharmaceutical Biosciences, Uppsala University, Sweden, and colleagues aimed to investigate the associations of type of diet and duration of sleep with type 2 diabetes development.

For this purpose, they analyzed data derived from the UK Biobank baseline investigation (2006-2010) between n May 1 and September 30, 2023. During a median follow-up of 12.5 years (end of follow-up, September 30, 2021), the association between sleep duration and healthy dietary patterns with the risk of T2D was investigated.

For the analysis, 247 867 participants were divided into four sleep duration groups: normal (7-8 hours per day), mild short (6 hours per day), moderate short (5 hours per day), and extreme short (3-4 hours per day). Their dietary habits were assessed based on population-specific consumption of processed meat, red meat, vegetables, fruits, and fish, resulting in a healthy diet score ranging from 0 (unhealthiest) to 5 (healthiest). The cohort comprised 247 867 participants with a mean age of 55.9 years; 52.3% were female.

Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) T2D development across various sleep duration groups and healthy diet scores.

The study led to the following findings:

  • During the follow-up, 3.2% of participants were diagnosed with type 2 diabetes based on hospital registry data.
  • Cox regression analysis, adjusted for confounding variables, indicated a significant increase in the risk of T2D among participants with 5 hours or less of daily sleep.
  • Individuals sleeping 5 hours per day exhibited a 1.16 adjusted HR, and individuals sleeping 3 to 4 hours per day exhibited a 1.41 adjusted HR compared with individuals with normal sleep duration.
  • Individuals with the healthiest dietary patterns had a reduced risk of T2D (HR, 0.75).
  • The association between short sleep duration and increased risk of T2D persisted even for individuals following a healthy diet, and there was no multiplicative interaction between sleep duration and healthy diet score.

In conclusion, the cohort study involving UK residents found that habitual short sleep duration is associated with an increased risk of developing type 2 diabetes. The association persisted even among those who maintained a healthy diet.

“To validate these findings, there is a need for further longitudinal studies, incorporating repeated measures of sleep (including objective assessments) and dietary habits,” the researchers wrote.

Reference:

Nôga DA, Meth EDMES, Pacheco AP, et al. Habitual Short Sleep Duration, Diet, and Development of Type 2 Diabetes in Adults. JAMA Netw Open. 2024;7(3):e241147. doi:10.1001/jamanetworkopen.2024.1147

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Monkeypox antibodies wane within year of vaccination, reveals study

New research to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024) in Barcelona, Spain (27-30 April) shows that the antibodies produced by Modified Vaccinia virus Ankara – Bavarian Nordic (MVA-BN) vaccination against mpox wane significantly within a year of receiving the vaccination – but in people with pre-existing immunity due to childhood smallpox vaccination in childhood, antibody levels remain high in almost all cases. The study is presented by PhD student Dr. Marc Shamier, Erasmus MC, Rotterdam, Netherlands, from a research team led by Dr Rory de Vries.

During the 2022-2023 mpox outbreak, MVA-BN was rapidly deployed among at-risk populations, including gay, bisexual, and other men who have sex with men (GBMSM). This vaccine is based on a highly attenuated strain of Vaccinia virus (VACV) – a virus that belongs to the orthopoxvirus genus, as do the viruses that cause smallpox (variola virus) and Mpox (monkeypox virus).

Little is known about the longevity of immune responses induced by-MVA-BN vaccination and the impact of prior smallpox vaccination. In this study, the authors assessed the antibody levels response to MVA-BN one year after vaccination. While marketed under various names such as JYNNEOS, IMVANEX, and IMVAMUNE, all are brand names for the same Modified Vaccinia Ankara (MVA)-based vaccine. As such, the immunological effects they confer are expected to be consistent across these products.

Out of the 118 vaccine recipients, 36 (30%) returned for the 1-year follow-up visit. Among individuals without pre-existing immunity, 14/21 (67%) had undetectable levels of VACV IgG and a 10.7-fold decrease in VACV IgG GMT (geometric mean, a standard measurement for antibody levels) was observed compared to the last time point after vaccination in 2022 (4 weeks after the second dose) (Figure 1 full abstract).

In contrast, among individuals with childhood smallpox vaccination, only one participant out of 15 (7%) had undetectable VACV IgG after one year, and the GMT reduction between 4 weeks after the last vaccine dose in 2022 and the one-year follow-up visit was 2.5-fold for those vaccinated with two doses of MVA-BN, and 1.9-fold for those vaccinated with one dose of MVA-BN.

The authors say: “A rapid decline in VACV-specific IgG antibodies was observed one year after MVA-BN vaccination, leading to loss of detectable antibodies in 42% (15/36) of the participants. This reduction was most pronounced in individuals without pre-existing immunity. As the mechanism of protection for mpox remains undefined, the implications of waning antibody levels for conferring protection remain uncertain.”

The authors suggest that the decrease in antibodies over time following MVA-BN vaccination may be attributable its composition. They say: “The first and second-generation smallpox vaccines contained replication-competent vaccinia virus. MVA-BN is based on non-replicating virus, which may impact the strength and duration of the immune response; with the advantage of a low risk of side effects.”

They add: “Regarding the potential necessity for a booster, it is premature to draw such conclusions. It is unclear how waning antibody levels relate to protection. Immunity also involves other elements, such as T-cell responses. Comprehensive clinical monitoring over time, which connects infection rates with antibody levels, is required to make informed decisions about booster vaccination protocols.”

Reference:

Study shows Mpox (monkeypox) antibodies wane within a year of vaccination, European Society of Clinical Microbiology and Infectious Diseases, Meeting: The European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024).

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Swapping meat and fish for mycoprotein may significantly lower cholesterol levels, finds study

Cardiovascular diseases (CVD) are highly prevalent and the leading cause of mortality from chronic, non-communicable diseases. Hyperglycaemia, hyperinsulinaemia, hypercholesterolaemia and high BMI are the risk factors for CVD.

A recent study published in Clinical Nutrition concluded that those who eat mycoprotein experience a 10% drop in certain cholesterol levels.
Proper nutrition relies heavily on a balanced diet, which includes protein from various sources. Researchers are exploring non-animal protein sources and their impact on cholesterol and blood sugar levels. Protein is an essential nutrient for the body’s systems. Mycoprotein, derived from a fungus, is used in some meat alternatives.
Laboratory-controlled studies have evidenced that Substituting dietary meat and fish for mycoprotein, a fungal-derived food source rich in protein and fibre, reduces circulating cholesterol. Researchers examined whether consuming mycoprotein-containing food products at home could impact cholesterol levels and other markers of cardiometabolic health in overweight and hypercholesterolaemic adults.
Seventy-two participants were randomized into a controlled, parallel-group trial conducted in a free-living setting. For four weeks, they received home deliveries of either meat/fish control products or mycoprotein-containing food products. Blood samples were collected and analyzed for serum lipids, blood glucose, and c-peptide concentrations before and after the intervention.
Key findings from the study are:
· Serum total cholesterol concentrations were unchanged throughout the intervention in the control group (CON) but decreased by 5 ± 2 % in MYC (mycoprotein group)
· Serum low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol concentrations were also unchanged in CON but decreased in MYC by 10 ± 3 % and 6 ± 2 %
· Serum high-density lipoprotein cholesterol and free triglyceride concentrations were unaffected in CON or MYC.
· Post-intervention, MYC displayed lower mean blood glucose and c-peptide concentration vs CON.
The study revealed that incorporating mycoprotein-rich foods into one’s diet can effectively reduce cholesterol levels in overweight, hypercholesterolemic adults. Consuming mycoprotein is a feasible and practical strategy to improve cardiometabolic health in at-risk individuals under free-living conditions. This strategy effectively reduces circulating cholesterol, blood glucose and c-peptide concentrations in adults at increased risk of cardiovascular disease.
Marlow Foods Ltd sponsored the study.
Reference:

Pavis, G. F., Iniesta, R., Roper, H., Theobald, H., Derbyshire, E., Finnigan, T. J., Stephens, F. B., & Wall, B. T. (2024). A four-week dietary intervention with mycoprotein-containing food products reduces serum cholesterol concentrations in community-dwelling, overweight adults: a randomised controlled trial. Clinical Nutrition. https://doi.org/10.1016/j.clnu.2024.01.023

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SGLT2 Inhibitors Improve Skeletal Muscle Pathology in Heart Failure, reveals study

Patients with heart failure and reduced ejection fraction (HFrEF) often experience skeletal muscle pathology, contributing to symptoms and reduced quality of life. While sodium–glucose cotransporter 2 inhibitors (SGLT2i) have shown clinical benefits in HFrEF, their effects on skeletal muscle remain unclear. A recent study aimed to investigate whether SGLT2i influences skeletal muscle pathology in patients with HFrEF.

HFrEF patients commonly exhibit skeletal muscle abnormalities, exacerbating their condition. SGLT2i have emerged as promising treatments for HFrEF, yet their precise mechanisms of action are not fully understood. This study sought to elucidate the impact of SGLT2i on skeletal muscle health in HFrEF patients.

The study was published in the European Journal Of Heart Failure. The study was conducted by Nathanael Wood and colleagues. The study analyzed muscle biopsies from 28 male HFrEF patients treated with or without SGLT2i. Comprehensive analyses, including immunohistochemistry, transcriptomics, metabolomics, and serum inflammatory profiling, were conducted. Additionally, experiments in mice treated with SGLT2i were performed to validate findings.

The key findings of the study were:

  • Patients receiving SGLT2 inhibitors (SGLT2i) showed a significant reduction of approximately 20% in myofiber atrophy compared to untreated patients (p = 0.07).

  • Analysis revealed a distinct transcriptomic signature in SGLT2i-treated patients, associated with beneficial effects on muscle atrophy, metabolism, and inflammation.

  • Metabolomic profiling showed notable changes in tryptophan metabolism, with a 24% increase in kynurenic acid and a 32% decrease in kynurenine levels in SGLT2i-treated patients (p < 0.001).

  • SGLT2i treatment led to reduced levels of pro-inflammatory cytokines by 26–64%, alongside modulation of downstream muscle interleukin-6-JAK/STAT3 signaling (p < 0.05).

  • Experiments in mice treated with SGLT2 inhibitors demonstrated improvements in muscle pathology, supporting the clinical findings and indicating a conserved mammalian response to treatment.

The study suggests that treatment with SGLT2i influences skeletal muscle pathology in HFrEF patients, leading to anti-atrophic, anti-inflammatory, and pro-metabolic effects. These changes may be mediated through IL-6–kynurenine signaling. Improved skeletal muscle health may contribute to the clinical benefits of SGLT2i in HFrEF management.

The findings highlight the potential of SGLT2i as therapeutic agents not only for cardiac outcomes but also for improving skeletal muscle health in HFrEF patients. Further research is warranted to optimize treatment protocols and better understand the underlying mechanisms.

Reference:

Wood, N., Straw, S., Cheng, C. W., Hirata, Y., Pereira, M. G., Gallagher, H., Egginton, S., Ogawa, W., Wheatcroft, S. B., Witte, K. K., Roberts, L. D., & Bowen, T. S. (2024). Sodium–glucose cotransporter 2 inhibitors influence skeletal muscle pathology in patients with heart failure and reduced ejection fraction. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.3192

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AIIMS INI SS July 2024: Here are feeder qualifications

New Delhi- All India Institute of Medical Sciences (AIIMS) invited online applications for the Institute of National Importance Super-Specialty Entrance Test (INI-SS) for admission to DM, MCh and MD (Hospital Administration) courses at AIIMS, PGIMER, NIMHANS, SCTIMST and JIPMER for July 2024 session. In its prospectus, the AIIMS detailed the eligibility criteria/ feeder qualifications for candidates. 

The registration process has already begun and the last date for online registration of applications on the AIIMS website is Wednesday, 10th April 2024 till 5:00 PM. The course will resume from 01 July 2024. 

INI-SS for July 2024 session is planned to be held in 16 cities in India such as Ahmedabad, Puducherry, Bhopal, Bhopal.

Also Read: AIIMS INI SS July 2024 registrations begin, apply now

ONLINE REGISTRATION FOR APPLICATION

Status of Application & Rejected application with reason for rejection. Applicants are required to check their status through the Registration Status of My Page after Login.

13.04.2024

Saturday

Last date for submission of required documents for Regularisation of Rejected Applications. No Correspondence will be entertained after the given date under any circumstances and candidates are requested NOT TO CONTACT the Examination Section.

16.04.2024

Tuesday

Last date for Ministry of Health & Family Welfare, Govt. of India to forward an approval regarding “No Objection” to the Foreign National. Sponsorship certificates duly signed by competent authority for candidates applying under Sponsored seats should also be reached at the Examination Section.

16.04.2024

Tuesday

Submission of Certificate for Scribe and/or Compensatory time as applicable (Performa A-1/A-2/ A-3 of Appendix A)

17.04.2024

21.04.2024

Finalization of Centers and allotment of Roll No’s/Admit Card on the website

22.04.2024

Monday

Written Test through online (CBT) mode

27.04.2024

Saturday

Last date for fulfilment of Eligibility for admission

31.07.2024

Last date for admission to the course

31.08.2024

Expected date of declaration of Result (for all INIs)

To be announced

Expected date of declaration of Result(Stage-I) only for AIIMS applicant

To be announced

Departmental Assessment (Only for AIIMS applicants)

To be announced

Final Result

To be announced

DM COURSES ELIGIBILITY

S.NO

COURSE

ELIGIBILITY

1

ACUTE CARE-EMERGENCY MEDICINE

MD Internal Medicine/General Medicine/ Emergency Medicine or Equivalent

2

ADDICTION PSYCHIATRY

M.D./DNB in Psychiatry of this Institute or any other University or equivalent degree recognized by the NMC

3

CARDIAC SURGICAL INTENSIVE CARE

MD/DNB in Anaesthesia/Paediatrics/Medicine of this Institute or any other University or equivalent degree recognized by the NMC

4

CARDIAC-ANAESTHESIOLOGY/DM-CARDIOTHORACIC & VASCULAR ANESTHESIA*/Cardiac Anaesthesia & Intensive Care

M.D/ DNB in Anesthesiology of this Institute or any other University or equivalent degree recognized by the NMC

5

CARDIOLOGY

M.D/DNB in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

M.D/DNB in General Medicine/Paediatrics of any Indian University or equivalent degree recognized by the NMC

MD in Medicine or equivalent

M.D/ DNB Degree in General Medicine / Paediatrics/ Pulmonary Medicine recognized by the NMC

6

CARDIOVASCULAR RADIOLOGY & ENDOVASCULAR INTERVENTIONS/DM-CARDIOVASCULAR IMAGING AND VASCULAR INTERVENTIONAL RADIOLOGY

M.D /DNB in Radio-Diagnosis or equivalent degree

M.D /DNB in Radio-Diagnosis/Radiology of any Indian University or equivalent degree recognized by the NMC

7

CHILD AND ADOLESCENT PSYCHIATRY

MD/DNB Psychiatry or equivalent

8

CLINICAL HEMATOLOGY

M.D/ DNB in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

MD Medicine or equivalent

9

CLINICAL IMMUNOLOGY & RHEUMATOLOGY

MD Medicine, MD Paediatrics

MD Medicine or equivalent

MD/DNB General Medicine/Paediatrics

10

CLINICAL PHARMACOLOGY

M.D. in Anaesthesiology/Medicine/Chest Medicine of this Institute or any other University or equivalent degree recognized by the NMC

M.D. in Anaesthesiology/ General Medicine/Pulmonary Medicine of this Institute or any other University or equivalent degree recognized by the NMC

MD Anaesthesia/Internal Medicine or equivalent

11

ENDOCRINOLOGY

M.D./ DNB Degree in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

M.D./ DNB Degree in General Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

MD Medicine or equivalent

12

FORENSIC PATHOLOGY

MD/DNB Forensic Medicine/Forensic Medicine and Toxicology recognized by Medical Council of India/NMC

13

FORENSIC PSYCHIATRY

MD/DNB in Psychiatry

14

FORENSIC RADIOLOGY & VIRTUAL AUTOPSY

MD/DNB Forensic Medicine/Forensic Medicine and Toxicology recognized by Medical Council of India/NMC

15

GASTROENTEROLOGY/MEDICAL GASTROENTEROLOGY

M.D/ DNB in Medicine of this Institute or any other University or equivalent degree recognized by the NMC

MD Medicine or equivalent

M.D/ DNB in General Medicine /Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

16

GERIATRIC PSYCHIATRY

MD/DNB in Psychiatry

17

HEMATOPATHOLOGY

M.D/DNB in Pathology/Lab. Medicine of this Institute or any other University or equivalent degree recognized by the NMC

MD Pathology or equivalent

18

HEPATOLOGY

MD Medicine/Paediatrics or equivalent

19

HIGH ALTITUDE MEDICINE

MD/DNB Internal Medicine/Physiology/Anaesthesia/Community Medicine recognized by the Medical Council of India

20

HISTOPATHOLOGY

MD Pathology or equivalent

21

HOSPITAL MEDICINE & CRITICAL CARE

MD in Internal Medicine, Geriatric Medicine

22

INFECTIOUS DISEASES/ CLINICAL INFECTIOUS DISEASES

M.D/DNB in Medicine/Paediatrics/Microbiology/Tropical Medicine of this Institute or any other University or equivalent degree recognized by the NMC

M.D/DNB in General Medicine/Paediatrics /Tropical Medicine of this Institute or any other University or equivalent degree recognized by the NMC

MS/DNB is internal/General medicine

23

INTERVENTIONAL RADIOLOGY

MD/DNB (Radiology/Radio-diagnosis) recognized by MCI/NMC

MD/DNB in Radio-diagnosis or equivalent

24

MEDICAL AND FORENSIC TOXICOLOGY

MD/DNB In forensic Medicine or forensic Medicine &Toxicology/Pharmacology/Emergency Medicine/Internal/General Medicine/Paediatrics recognized by the Medical Council of India/ NMC

25

MEDICAL GENETICS

MD in Paediatrics/Medicine/Obstetrics and Gynaecology of this Institute or any other University or equivalent degree recognized by the NMC

MD Paediatrics or equivalent

26

MEDICAL ONCOLOGY

M.D/DNB in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

M.D. / DNB Degree in Medicine / Pediatrics /Radiotherapy recognized by the Medical Council of India

27

NEONATOLOGY

M.D Degree in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

28

NEPHROLOGY

M.D/DNB in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

M.D/DNB in General Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

MD in Medicine or equivalent

29

NEURO-ANAESTHESIOLOGY & CRITICAL CARE/DM-NEURO ANAESTHESIA*/NEUROANAESTHESIA AND NEUROCRITICAL CARE

M.D/ DNB in Anaesthesiology of this Institute or any other University or equivalent degree recognized by the NMC

30

NEUROIMAGING AND INTERVENTIONAL NEURORADIOLOGY/NEUROIMAGING AND INTERVENTIONS

M.D./ DNB Degree in Radio diagnosis of this Institute or any other University or equivalent degree recognized by the NMC

M.D./DNB in Radiology or equivalent

M.D./ DNB Degree in Radio diagnosis/Radiology of any Indian university or equivalent degree recognized by the NMC

31

NEUROLOGY

M.D. in Medicine/Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

M.D. in General Medicine/Paediatrics of an

M.D./DNB in Internal (General) Medicine/Paediatrics

MD in Medicine or equivalent

32

NEUROPATHOLOGY

MD/DNB in Pathology

33

ONCO-ANAESTHESIA

M.D/ DNB in Anaesthesiology of this Institute or any other University or equivalent degree recognized by the NMC

34

PAEDIATRIC ANAESTHESIA & INTENSIVE CARE

MD Anaesthesia or equivalent

35

PAEDIATRIC CARDIOLOGY

M.D.in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

36

PAEDIATRIC CLINICAL IMMUNOLOGY AND RHEUMATOLOGY

MD Paediatrics or equivalent

37

PAEDIATRIC EMERGENCY MEDICINE

MD/DNB Paediatrics or Emergency Medicine recognized by Medical Council of India/NMC

38

PAEDIATRIC ENDOCRINOLOGY

MD Paediatrics or equivalent

39

PAEDIATRIC GASTROENTEROLOGY & HEPATOLOGY/PAEDIATRIC GASTROENTEROLOGY

MD/DNB Paediatrics or equivalent

40

PAEDIATRIC HAEMATOLOGY-ONCOLOGY

MD/DNB Paediatrics or equivalent

41

PAEDIATRIC NEPHROLOGY

M.D/DNB in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

42

PAEDIATRIC NEUROLOGY

M.D/ DNB in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

43

PAEDIATRIC ONCOLOGY

M.D.in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

44

PAEDIATRIC PULMONOLOGY & INTENSIVE CARE

M.D.in Paediatrics of this Institute or any other University or equivalent degree recognized by the NMC

45

PAEDIATRIC PULMONOLOGY

MD Paediatrics or equivalent

46

PAEDIATRICS CRITICAL CARE

MD/DNB Degree in Paediatrics or equivalent

47

PAIN MEDICINE

MD(Anaesthesiology) or equivalent

48

PULMONARY CRITICAL CARE & SLEEP MEDICINE

M.D in Medicine/MD Pulmonary Medicine/MD Chest Medicine/MD Respiratory Medicine of this Institute or any other University or equivalent degree recognized by the NMC

MD Medicine/Respiratory Diseases or equivalent

49

REPRODUCTIVE MEDICINE

MD/MS in Obstetrics and Gynaecology of this Institute or any other University or equivalent degree recognized by the NMC

50

THERAPEUTIC NUCLEAR MEDICINE

M.D in Nuclear Medicine of this Institute or any other University or equivalent degree recognized by the NMC

51

TRAUMA ANAESTHESIA & ACUTE CARE

MD Anaesthesia or equivalent

52

PAEDIATRIC ANAESTHESIOLOGY

MD Anaesthesiology

53

VIROLOGY

MD Microbiology

Also Read: AIIMS INI SS July 2024 – Check Out Scheme Of Examination

MCh COURSES ELIGIBILITY

S.NO

COURSE

ELIGIBILITY

1

BREAST, ENDOCRINE AND GENERAL SURGERY

M.S. degree in Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

MS (Surgery/General Surgery/equivalent)

2

C.T.V.S/CVTS

M.S./DNB degree in Surgery/General Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

3

CORNEA, CATARACT AND REFRACTIVE SURGERY

MD/MS Ophthalmology or equivalent

4

GYNAECOLOGIC ONCOLOGY

MD/MS in Obstetrics & Gynaecology of this Institute or any other University or equivalent degree recognized by MCI

5

HAND AND MICROVASCULAR SURGERY

M.S degree in General Surgery/Orthopaedics of this Institute or any other University or any other equivalent degree recognized by the NMC/MCI

6

HEAD-NECK SURGERY AND ONCOLOGY / HEAD & NECK SURGERY

M.S degree in Surgery/ENT of this Institute or any other University or any other equivalent degree recognized by the MCI

7

JOINT REPLACEMENT & RECONSTRUCTION

MS/DNB Orthopaedics or an equivalent degree recognized by the Medical Council of India/NMC

8

MINIMAL ACCESS SURGERY & GENERAL SURGERY

M.S. degree in Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

9

NEURO-SURGERY

M.S./DNB degree in Surgery of this Institute or any other University or (II) PGIMER any other equivalent degree recognized by the MCI

M.S./DNB degree in General Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

10

PAEDIATRIC ORTHOPEDICS SURGERY/ PAEDIATRIC ORTHOPEDICS

MS/DNB Orthopaedics or equivalent

11

PAEDIATRIC SURGERY

M.S. degree in Surgery/General Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

12

PLASTIC AND RECONSTRUCTIVE SURGERY/PLASTIC SURGERY

M.S degree in Surgery/ENT/Orthopaedics of this Institute or any other University or any other equivalent degree recognized by the MCI

M.S /DNB degree in General Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

13

RENAL TRANSPLANT SURGERY

MS Surgery or equivalent

14

SPINE SURGERY

MS/DNB Orthopaedics or an equivalent

15

SURGICAL ONCOLOGY

M.S degree in Surgery/ENT of this Institute or any other University or any other equivalent degree recognized by the MCI

M.S./ DNB Degree in General Surgery / Obstetrics & Gynaecology / Otorhinolaryngology (E.N.T) / Orthopaedics Surgery recognized by the MCI

16

TRAUMA SURGERY AND CRITICAL CARE

M.S degree in Surgery/Trauma and Emergency Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

17

UROLOGY

M.S. degree in Surgery/General Surgery of this Institute or any other University or any other equivalent degree recognized by the MCI

18

VITREORETINAL SURGERY

MD/MS Ophthalmology or equivalent

MD (HOSPITAL ADMINISTRATION) ELIGIBILITY

1 The candidate must possess an MBBS or an equivalent degree (As per NMC).

2 Must possess a minimum experience of three years in a Govt. Hospital in the relevant field or five years in general practice. A certificate issued by the District Magistrate in support of the general practice claimed should be uploaded.

3 Candidates belonging to UR/OBC/EWS/Sponsored must have obtained 55% in aggregate in all MBBS Professional Examinations. Candidates belonging to SC/ST must have obtained a minimum of 50% marks in aggregate in all MBBS professionals.

4 Must be registered with the Central /State Medical Registration Council.

5 The candidates who have already done MD/MS or equivalent are not eligible for this course.

Along with this, Indian National candidates who have been graduated from foreign Universities must fill their NMC screening exam marks in percentage in the online form. Candidate must have obtained marks as mentioned above in FMGE exam conducted by NBE or any other authority of Govt. of India, Delhi will also be considered eligible.

To view the prospectus, click the link below

https://medicaldialogues.in/pdf_upload/iniss-final-prospectus-july-2024-235316.pdf

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Can Corporate Hospitals Advertise? NMC Panel Reaches Consensus, to submit its report to Supreme Court

New Delhi: The National Medical Commission’s (NMC) panel, which was formed based on the Supreme Court’s directions to examine the issue of advertising by corporate hospitals, is going to submit its recommendations to the Supreme Court.

Reaching a consensus, the NMC panel has opined that the rules of advertisement shall be the same for the corporate hospitals as well as for the doctors and other health facilities, The Print has reported.

Endorsing the rules suggested last year in the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, the panel has expressed its opinion that only “ethical” advertisements by corporate hospitals should be allowed.

The NMC panel was formed after a Public Interest Litigation (PIL) was filed before the Supreme Court by Dr. Aniruddha Malpani, who highlighted that even though private medical practitioners are barred from advertising, such a restriction does not apply to corporate hospitals.

Medical Dialogues had earlier reported that by filing the PIL, Dr. Malpani had sought directions to frame comprehensive guidelines to be followed by the Corporate Hospitals, to ensure safe and ethical advertising and to have a holistic solution to the problem of illegal advertising. Further, the plea also sought to prevent indirect branch of the statutory regulations by doctors affiliated with Corporate Hospitals.

Also Read: Should there be rules to govern advertisements by Corporate Hospitals? NMC forms panel to decide

Based on the Apex Court’s directions, an NMC panel was formed and the Apex Medical Commission decided that the panel would examine whether there should be specific rules to govern advertisement by corporate hospitals.

What the NMC Panel has Suggested?

The Print has reported that the seven-member NMC panel has reached a consensus that the ethical norms related to advertisements applicable to doctors should be extended to the hospitals, including the corporate hospitals. Last month, the panel held a meeting and the minutes of the meeting stated that since the Code of Ethics Regulations 2002 refers to the medical profession and not medical professionals, NMC can prescribe rules of advertising for the hospitals as well.

“Section 10.1.(h) of the Indian Medical Council (Professional Conduct, Etiquette And Ethics) Regulations, 2002 clearly says that ‘…laid down policies and code to ensure observance of professional ethics in medical profession…’ and not by medical professionals, which clearly means that NMC can interfere in the hospitals also,” stated the minutes of the meeting.

“So, it can be safely said that the committee (NMC panel) can make regulations in this matter if the Hon’ble Court thinks it is required,” the NMC panel further observed in this regard.

Further, the minutes of the meeting further stated that the NMC panel members have suggested that the guidelines should be issued for “unethical” advertisements by corporate hospitals but “they should not differ from the already existing professional conduct content, which are already in abeyance.”

In this regard, NMC member and chairman of the NMC Panel, Dr. Yogender Malik informed The Print that the panel was in the process of preparing a report based on the suggestions made by its members. Following this, the report will be submitted to the Supreme Court.

Also Read: Breaking News: NMC puts its controversial Registered Medical Practitioner (Professional Conduct) Regulations, 2023 on hold

Can Doctors Advertise? 

The issue of advertising by doctors and hospitals had been addressed in the Code of Medical Ethics, 2002 as well as the NMC RMP (Professional Conduct) Regulations, 2023, which were later withdrawn by the Commission.

Addressing the issue of advertising, the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 stated the following:

“6.1 Advertising:

6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical. A physician shall not make use of him / her (or his / her name) as subject of any form or manner of advertising or publicity through any mode either alone or in conjunction with others which is of such a character as to invite attention to him or to his professional position, skill, qualification, achievements, attainments, specialities, appointments, associations, affiliations or honours and/or of such character as would ordinarily result in his self aggrandizement. A physician shall not give to any person, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report or statement with respect of any drug, medicine, nostrum remedy, surgical, or therapeutic article, apparatus or appliance or any commercial product or article with respect of any property, quality or use thereof or any test, demonstration or trial thereof, for use in connection with his name, signature, or photograph in any form or manner of advertising through any mode nor shall he boast of cases, operations, cures or remedies or permit the publication of report thereof through any mode. A medical practitioner is however permitted to make a formal announcement in press regarding the following:

  1. On starting practice.
  2. On change of type of practice.
  3. On changing address.
  4. On temporary absence from duty.
  5. On resumption of another practice.
  6. On succeeding to another practice.
  7. Public declaration of charges.

6.1.2 Printing of self photograph, or any such material of publicity in the letter head or on sign board of the consulting room or any such clinical establishment shall be regarded as acts of self advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system shall not be treated as unethical.”

What was recommended in NMC RMP (Professional Conduct) Regulations 2023? 

The rules regarding the nature of advertisements by corporate hospitals had also been addressed in the NMC RMP (Professional Conduct) Regulations, 2023, which NMC later withdrew.

These regulations allowed “ethical” advertisements by both individual doctors and health facilities. Section 11 of the regulations dealt with the issue of Advertisement and it stated the following:

11. Advertisement:

A. RMP is permitted to make a formal announcement in any media (print, electronic or social) within 3 months regarding the following: (1) On starting practice (2) On change of type of practice (3) On changing address (4) On temporary absence from duty (5) On resumption of practice (6) On succeeding to another practice (7) Public declaration of charges. (L2).

B. RMP or any other person including corporate hospitals, running a maternity home, nursing home, private hospital, rehabilitation center, or any type of medical training institution, etc. may place announcements in the print, electronic and social media, but these should not contain anything more than the name of the institution, type of patients treated or admitted, kind of doctors and staff training and other facilities offered and the fees. (Guidelines on social media conduct) (L1 and/or L2)

C. RMP is allowed to do public education through media without soliciting patients for himself or the institution (L2)

Also Read: How to regulate advertisements by corporate hospitals? Supreme Court asks NMC, Centre

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