Even small dose of Liquorice can elevate blood pressure, finds study

According to a study conducted by researchers at Linköping University, Sweden, consuming even small quantities of liquorice can lead to an increase in blood pressure. Those who react most strongly also display indications of cardiac strain.

The study was published in The American Journal of Clinical Nutrition.

Liquorice is produced from the root of plants of the Glycyrrhiza species and has long been used as a herbal remedy and flavouring. However, it is known that eating liquorice can also raise blood pressure. This is mainly due to a substance called glycyrrhizic acid that affects the body’s fluid balance through effects on an enzyme in the kidney. High blood pressure, in turn, increases the risk of cardiovascular disease.

Both the European Union and the World Health Organization have concluded that 100 mg of glycyrrhizic acid per day may be safe to eat for most individuals.

In the study, 28 participants aged 18-30 were split into two groups. They were instructed to alternate between consuming liquorice and a control product containing salmiak, which gives salty liquorice its flavour. Participants were randomly assigned to eat either liquorice or the control product for two weeks, take a break for two weeks, and then eat the other variety for two weeks. Participants monitored their blood pressure daily, and at the end of each period, researchers evaluated hormone levels, salt balance, and heart workload to compare the effects of both substances.

The study found that liquorice consumption led to an average increase of 3.1 mmHg in participants’ blood pressure. Additionally, levels of the hormones, renin and aldosterone, which regulate fluid balance, decreased after consuming liquorice. The most sensitive quarter of participants, identified by the greatest decrease in these hormones, also experienced slight weight gain likely due to increased fluid retention. This group also showed elevated levels of NT-proBNP, indicating heightened fluid volume and heart workload in response to liquorice.

“In the study, we found that a daily intake of liquorice containing 100 mg glycyrrhizic acid raised blood pressure in young healthy people. This hasn’t previously been shown for such small amounts of liquorice,” said Peder af Geijerstam, doctoral student at the Department of Health, Medicine and Caring Sciences at Linköping University, general practitioner, and lead author of the study.

Reference: Peder af Geijerstam, Annelie Joelsson, Karin Rådholm, Fredrik H Nyström. A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial. Journal: The American Journal of Clinical Nutrition, 2024; 119 (3): 682 DOI: 10.1016/j.ajcnut.2024.01.011

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ACG and SAR release consensus recommendations on the role of imaging for GI bleeding

USA: The American College of Gastroenterology (ACG) and the Society of Abdominal Radiology (SAR) have released consensus recommendations on the role of imaging for gastrointestinal (GI) bleeding.

GI bleeding is the most common GI diagnosis, resulting in hospitalization. Prompt diagnosis and treatment of GI bleeding are improving for improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques are frequently used to evaluate GI bleeding patients and complement GI endoscopy. However, multiple management guidelines differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion about using these tests for evaluating GI bleeding.

In the article, published in Radiology, a panel of experts from ACG and SAR reviewed the radiologic examinations used to evaluate for GI bleeding including technique, nomenclature, advantages, performance, and limitations. It also included a comparison of advantages and limitations relative to endoscopic examinations. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques are provided for GI bleeding.

Consensus Recommendations for Imaging in Overt Lower GI Bleeding (LGIB)

CT Angiography

  • Unenhanced images (conventional or virtual noncontrast) should be acquired in all cases.
  • Images should be acquired during a late arterial phase and a portal venous or delayed phase.
  • No oral contrast material should be administered.
  • Three-dimensional CTA images can be generated to help guide subsequent conventional angiography.
  • Dual-energy CT techniques may be used, if available, to improve the visibility of sites of contrast material extravasation.
  • CTA should be performed as the first diagnostic study in hemodynamically unstable patients.
  • CTA could be considered the first-line study in hemodynamically stable patients where the suspicion of active bleeding is high.
  • CTA is not indicated as a first-line test in hemodynamically stable patients in whom bleeding has subsided.
  • A for LGIB can be performed through the common femoral artery or radial artery access.
  • Permanent agents, such as microcoils or glue, are used to embolize the vasa recta at the site of identified bleeding.
  • In most cases, if CTA is negative for GI bleeding, CA is not indicated.
  • In unstable patients with active extravasation at CTA, CA with embolization can be used as the primary treatment modality.
  • If the patient has recurrent intermittent LGIB and all modalities have failed to identify the source of bleeding, provocative CA can be performed to identify and treat the culprit lesion.

Catheter Angiography

  • A for LGIB can be performed through the common femoral artery or radial artery access.
  • Permanent agents, such as micro coils or glue, are used to embolize the vasa recta at the site of identified bleeding.
  • In most cases, if CTA is negative for GI bleeding, CA is not indicated.
  • In unstable patients with active extravasation at CTA, CA with embolization can be used as the primary treatment modality.
  • If the patient has recurrent intermittent LGIB and all modalities have failed to identify the source of bleeding, provocative CA can be performed to identify and treat the culprit lesion.

99mTc-RBC Scan

  • The in vitro RBC labeling method has the highest labeling efficiency and is the preferred method.
  • Imaging should be continued for 1 hour if no bleeding is detected.
  • In a hemodynamically stable patient with evidence of ongoing LGIB, negative evaluation with colonoscopy, and a CTA examination is negative, contraindicated, or not available, tagged RBC scanning can be performed.

Consensus Recommendations for Imaging in Suspected Small Bowel Bleeding

CT Enterography

  • CTE should be performed using the multiphase technique in patients older than 40 years of age where vascular lesions are a common cause for bleeding.
  • Multiphase CTE should include at least arterial, and enteric or portal venous phases.
  • Multiphase CTE is the recommended term for a CTE examination performed for suspected small bowel bleeding and acquired with multiple phases after the administration of intravenous contrast material.
  • A single phase performed during the enteric or portal venous phase is adequate to evaluate for inflammatory conditions such as Crohn’s disease, radiation enteritis, nonsteroidal anti-inflammatory drug enteropathy, and most malignancies.
  • Neutral enteric contrast material should be administered in divided doses beginning 1 hour before CTE.
  • CTE should be performed instead of CTA in hemodynamically stable patients presenting with ongoing suspected small bowel bleeding after negative colonoscopy esophagogastroduodenoscopy (EGD), and capsule endoscopy (if negative or not performed).
  • If there is brisk ongoing bleeding with hemodynamic instability, CTA should be performed instead of CTE.
  • CTE should be the first-line imaging test for suspected small bowel bleeding in hemodynamically stable patients if patients are at increased risk for video capsule retention.
  • CTE should be the first-line study for suspected small bowel bleeding in hemodynamically stable patients if small bowel neoplasm is the suspected cause for small bowel bleeding.
  • CTE can be performed as the first-line diagnostic study for suspected small bowel bleeding in hemodynamically stable patients depending on clinical scenarios such as local availability and expertise.
  • CTE should be performed if there is no definitive cause for small bowel bleeding identified at capsule endoscopy and there is suspicion of ongoing bleeding.

Meckel Scan

Meckel scan can be considered to identify the cause of unexplained intermittent GI bleeding in children and adolescents after negative endoscopic evaluation, including capsule endoscopy if available, and cross-sectional evaluation of the small bowel.

Consensus Recommendations for Imaging in Nonvariceal UGIB

  • CA with intent to treat is indicated when an EGD is unsuccessful in achieving initial hemostasis, or the patient experiences recurrent bleeding after a successful initial EGD and a repeat EGD is either unsuccessful or not recommended.
  • In the setting of ongoing bleeding, CTA can be considered:
    • If the patient is not thought to be suitable for EGD or if there is no in-house emergency gastroenterology coverage.
    • After negative EGD or if EGD is unable to identify the site of bleeding.

Reference:

Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology. 2024 Mar;310(3):e232298. doi: 10.1148/radiol.232298. PMID: 38441091.

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Consumption of Sweetened Drinks Associated with Increased Atrial Fibrillation Risk: JAHA

A recent study explored the health risks associated with sweetened beverages by uncovering a concerning link between the consumption of sugary drinks and atrial fibrillation (AF), a common heart rhythm disorder. The findings were published in the journal of Circulation: Arrhythmia and Electrophysiology.

This study analyzed data from over 200,000 participants who were initially free of AF. This study by Ying Sun and team examined the association between the consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), pure fruit juice (PJ) and the risk of developing AF over nearly a decade of follow-up.

The findings revealed that individuals who consumed more than 2 liters per week of SSB or ASB underwent an higher risk of AF when compared to non-consumers. Specifically, the risk was increased by 10% for SSB consumers and by 20% for ASB consumers. Also, the individuals who consumed less than or equal to 1 liter per week of pure fruit juice showed a modestly lower risk of AF.

One of the most striking revelations of the study was the interaction between genetic predisposition and beverage consumption. The participants at high genetic risk for AF who consumed large quantities of ASB underwent a sharp 3.5-fold increase in AF risk, while the individuals at low genetic risk who consumed minimal PJ expressed a 23% reduction in risk.

This comprehensive research underscores that the association between sweetened beverages and AF risk persisted even after adjusting for genetic susceptibility which indicates the consumption of these beverages may predict AF risk independent of traditional risk factors. Overall, these findings carry significant implications for public health strategies to reduce the burden of cardiovascular diseases.

Source:

Sun, Y., Yu, B., Yu, Y., Wang, B., Tan, X., Lu, Y., Wang, Y., Zhang, K., & Wang, N. (2024). Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study. In Circulation: Arrhythmia and Electrophysiology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circep.123.012145

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Tirzepatide reduces body weight and waist circumference in people with obesity regardless of duration of their condition: Study

New research to be presented at this year’s European Congress on Obesity (Venice, Italy, May 12-15) shows that the obesity medication tirzepatide consistently reduces bodyweight and waist circumference regardless of the length of time the person has been living with overweight or obesity. The study is by Dr Giovanna Muscogiuri, University of Naples Federico II, Naples, Italy, and colleagues.

Tirzepatide (Mounjaro®) was approved by the US Food and Drug administration (FDA) and the European Medicines Agency (EMA) for the treatment of type 2 diabetes in 2022. In November 2023, the FDA approved tirzepatide (Zepbound®) for chronic weight management in adults with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with at least one weight-related comorbidity. Also in November 2023, the EMA Committee for Medicinal Products for Human Use offered a positive opinion on extension of the Mounjaro® label to include weight management in adults with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and at least one weight-related comorbid condition.

The SURMOUNT phase 3 trials evaluated tirzepatide versus placebo in people with obesity or overweight with at least 1 weight-related comorbidity without type 2 diabetes (SURMOUNT-1, 72 weeks), with type 2 diabetes (SURMOUNT-2, 72 weeks), and without type 2 diabetes after a 12-week intensive lifestyle intervention (SURMOUNT-3, 72 weeks from randomisation) or after a 36-week open label tirzepatide lead-in (SURMOUNT-4, 52 weeks from randomisation).

In this subgroup analysis, participants in each study were grouped based on overweight/obesity disease duration at baseline (10 years or less, between 10 and 20 years, and above 20 years, determined by patient report). Percentage bodyweight change, the proportions achieving weight loss targets of 5, 10, 15, 20, and 25%, and the change in waist circumference were analysed.

Participants randomised to tirzepatide achieved greater weight reductions compared to placebo at study endpoint regardless of the duration of disease (see figure in full abstract). This was consistent across the different SURMOUNT studies, and the magnitude of reduction was generally similar across the disease duration categories. Generally, more tirzepatide-treated participants achieved the weight reduction targets of 5, 10, 15, 20, and 25% compared with placebo-treated participants, regardless of disease duration. Tirzepatide reduced waist circumference to a greater extent than placebo for each disease duration category in SURMOUNT-1 to -4 (see table in full abstract). These reductions were consistent across disease duration subgroups.

For example, in the SURMOUNT-1 trial, for patients given 10mg dose of tirzepatide, those with disease duration under 10 years lost 21% of their weight after 72 weeks, compared to 20% body weight loss for those with 10-20 years disease duration and 23% for those with over 20 years disease duration. In the SURMOUNT-2 trial (where all participants were also living with type 2 diabetes), for patients given the 15mg dose of tirzepatide, those with disease duration under 10 years lost 13% of their bodyweight, compared with 16% in those with disease duration of 10-20 years and 17% bodyweight loss for those living with overweight or obesity for over 20 years. Waist circumference reductions followed similar trends (see table full abstract).

The authors conclude: “Tirzepatide consistently reduced body weight and waist circumference in people living with obesity or overweight with weight-related comorbidities regardless of the duration of disease. These results are consistent with the overall findings from each study in the SURMOUNT programme.”

Reference:

Tirzepatide reduces body weight and waist circumference in people living with overweight or obesity regardless of duration of their condition, European Association for the Study of Obesity, Meeting: European Congress on Obesity (ECO2024).

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Are all sugars equal? Study finds fruits score over honey, fruit juices, and sugar-sweetened beverages

UK: In a recent study published in the European Journal of Nutrition, Javier T. Gonzalez, Department for Health, University of Bath, Bath, UK, sought to determine whether all sugars are equal.

The study shed light on the role of the food source in physiological responses to sugars, emphasizing fruit and fruit juice. It found that adding whole fruit to the diet can lower markers of systemic inflammation, blood pressure, and body mass, and with substitution, can improve markers of glycemic control.

“Therefore, from a cardiometabolic health standpoint, whole fruit can consistently and reliably improve markers of cardiometabolic health and are a cornerstone of a healthy dietary pattern,” the study stated.

Previous studies have shown that high (free) sugar consumption can increase self-reported energy intake and is associated with unfavorable cardiometabolic health. However, sugar sources may modulate the effects of sugars due to several mechanisms, including the food review. Dr. Gozalez aimed to assess the current state of evidence concerning food source effects on the physiological responses to dietary sugars in humans relevant to cardiometabolic health in a review. Additionally, the authors reviewed the potential mechanisms by which food sources may influence such responses.

Evidence from meta-analyses of controlled intervention trials was used to establish the balance of evidence relating to sugar addition to the diet from sugar-sweetened beverages, honey, fruit juice, and whole fruit on cardiometabolic outcomes. Subsequently, the author discussed studies that directly compared whole fruit with fruit juices or variants of fruit juices.

Key points of the review:

  • Sugar sources vary widely in their food matrices, which includes differences in nutritional composition and physical structure.
  • Sugar-sweetened beverages could have a “simple” physical structure, being in liquid form and with few additional nutrients (i.e., negligible polyphenols, fiber, and potassium).
  • Honey may contain a small quantity of polyphenols, but it is unclear if these are in sufficient quantities to exert meaningful physiological effects.
  • Fruit juices typically contain relatively higher concentrations of polyphenols, fiber, and potassium, especially when expressed per g of sugar, and whole fruit has the additional complexity of a solid (or semi-solid) physical structure and a higher fiber content.
  • These characteristics may contribute to the physiological effects of consuming these sugar sources, whereby meta-analyses demonstrate the addition of SSBs to the diet can increase fasting glucose and insulin concentrations in addition to body mass.
  • Honey appears to decrease fasting glucose concentrations but increase some markers of inflammation, the relevance of which is currently unclear.
  • Adding fruit juices to the diet may increase fasting glucose and HbA1c but can lower blood pressure and body mass and, when substituted into the diet, can lower some markers of systemic inflammation.

In conclusion, there is currently relatively little direct comparison of sugar sources on health outcomes or cardiometabolic markers. There is no clear evidence for meaningful differences in inflammation, glycaemic control, or blood pressure, of the currently available data on direct comparisons of whole fruit versus fruit juice. There is, however, consistent evidence that whole apples can lower plasma low-density lipoprotein cholesterol concentrations compared with fruit juice.

Acute appetite responses indicate whole fruit increases satiety to a greater extent than fruit juice, but there has been no detailed study of comparative changes in body mass and composition. Medium-term interventions with daily fruit juice have not led to consistent, significant overall body weight or compositional changes.

“Further research on direct comparisons of sugar sources and complex foods with multiple ingredients and difference structures, would contribute to a better understanding of the causal role of food matrix on the cardiometabolic responses to sugar consumption,” the author wrote.

Reference:

Gonzalez, J.T. Are all sugars equal? Role of the food source in physiological responses to sugars with an emphasis on fruit and fruit juice. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03365-3

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Sulfur Cream Matches Triamcinolone in Treating Hand Eczema: Study

Hand eczema (HE) is a common condition with diverse causes and symptoms. Various treatment options exist, including topical creams.

Hand eczema presents with symptoms such as itching, dryness, burning sensation, and erythema, impacting patients’ quality of life. Triamcinolone cream is a standard treatment, but sulfur cream’s effectiveness remains uncertain. In this study, researchers compared the efficacy of triamcinolone 0.1% cream and sulfur 2% cream in treating Hand Eczema. Researchers have found that topical sulfur cream (2.0%) is equally effective as triamcinolone (0.1%) cream in treating Hand eczema.

This study has been published in the Journal Of Cosmetic Dermatology by Asilian and colleagues.

Researchers conducted a randomized, triple-blind clinical trial involving 70 patients with HE, treating both their right and left hands. Participants received either triamcinolone 0.1% cream or sulfur 2.0% cream twice daily for 4 weeks, with a 4-week follow-up period. Hand Eczema Severity Index (HECSI) and symptom scores were collected and compared between the two treatment groups.

  • In the study involving 70 patients with hand eczema (HE), both triamcinolone and sulfur creams demonstrated significant efficacy in reducing Hand Eczema Severity Index (HECSI) scores.

  • As well as alleviating itching, dryness, burning sensation, and erythema.

  • These therapeutic benefits were sustained for at least 4 weeks post-treatment cessation, indicating potential long-term effects.

  • Importantly, neither cream elicited prominent adverse reactions, suggesting their safety profiles are favorable for treating HE.

The study concludes that topical sulfur cream (2.0%) is equally effective as triamcinolone (0.1%) cream in treating Hand eczema, with no significant adverse reactions noted. This finding provides patients and clinicians with another viable treatment option for HE.

Reference:

Asilian, A., Mohammadian, P., Hosseini, S. M., Heidaripour, F., Yekta, A., & Nateghi, M. R. (2024). Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial. Journal of Cosmetic Dermatology. https://doi.org/10.1111/jocd.16208

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Sildenafil flops in Reduction of Risk of Age-Related Macular Degeneration, suggests study

Age-related macular degeneration (AMD) poses a significant public health concern, with its treatment remaining challenging. Prior studies suggested a potential preventive effect of sildenafil, commonly used for erectile dysfunction (ED), on AMD development. However, recent research challenges this notion, highlighting the need for further investigation.

AMD affects millions worldwide and is a leading cause of vision impairment. Treatment options, particularly for the advanced stages, are limited and burdensome. Sildenafil, initially developed for hypertension, found success in treating ED and has been hypothesised to prevent AMD by increasing retinal blood flow.

This study was published in BMC Open Ophthalmology by Han JED and colleagues. A retrospective matched open-cohort study analyzed data from the IQVIA Medical Research Data (IMRD-UK) primary care database, encompassing 307,384 male patients aged ≥40 years with ED. The study compared AMD incidence between sildenafil users (n = 31,575) and non-users (n = 62,155) over a 20-year period.

Key Findings:

  • Among the study cohort, 234 sildenafil users and 398 non-users developed AMD during the follow-up period.

  • After adjusting for confounders, including age, comorbidities, and socioeconomic factors, no significant difference in AMD incidence was observed between sildenafil users and non-users (adjusted hazard ratio [aHR], 0.99; 95% CI, 0.84 to 1.16).

  • Subgroup analysis before the availability of over-the-counter sildenafil yielded similar results (aHR, 0.98; 95% CI, 0.83 to 1.15).

The study, led by Nicola Jaime Adderley, PhD, MPH, from the University of Birmingham, suggests that sildenafil use is unlikely to have a clinically meaningful preventive effect on AMD development. Despite prior hypotheses linking sildenafil to increased retinal blood flow and potential AMD prevention, real-world data did not support this notion.

Given the growing prevalence of AMD and the limited treatment options, understanding potential preventive measures is crucial. While sildenafil remains a widely used medication for ED, clinicians should not rely on it as a preventive strategy for AMD. Further research is needed to explore alternative preventive approaches and enhance AMD management strategies.

Reference:

Han JED, Subramanian A, Lee WH, et al Association of sildenafil use with age-related macular degeneration: a retrospective cohort study BMJ Open Ophthalmology 2024;9:e001525. doi: 10.1136/bmjophth-2023-001525

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Misleading Advertisement case: SC summons Baba Ramdev, MD Balkrishna for failing to reply to show-cause notice

New Delhi: Expressing serious disappointment towards Patanjali Ayurved for neglecting to submit a response to its notice, the Supreme Court today issued a contempt notice to Baba Ramdev (Co-founder of Patanjali) and has summoned him along with its Managing Director Acharya Balakrishna to appear in court in person in the next hearing. 

The court issued the directive while hearing the case, as the firm did not comply with a contempt notice related to Patanjali’s breach of commitment to stop publishing misleading advertisements about medicinal cures.

Clarifying that two weeks were given to Patanjali Ayurved and its MD for a response regarding the issue, the Bench comprising Justices Hima Kohli and Ahsanuddin Amanullah observed “On the last date of hearing, notice to show cause was issued to the Respondent No. 5(Patanjali) and its Managing Director as to why the contempt of court proceedings should not be initiated against them…a period of two weeks was granted to file a reply and reply is not on record”

After being informed that a reply was not filed in this regard, the court responded, “That is not good enough for us…we have taken it very seriously. If you are not filing it means that there will be orders and consequences that follow.” Consequently, Justice Kohli also asked the reason for not filing the reply given that a longer timeline for two weeks instead of one week was granted.

Dissatisfied with the advocate’s response, the court proceeded to issue an order requesting the personal presence of Acharya Balakrishna. In addition to issuing a Contempt notice to Baba Ramdev, it also ordered his personal appearance.

During the hearing session today, the court said “In view of the aforesaid facts and circumstances, it is deemed appropriate to direct the presence of the MD of Resp 5 on the next date of the hearing. Further, having gone through the advertisements issued by Respondent No. 5 in the teeth of the undertaking given to this Court on 21.11.2023 and on noticing that the said advertisements reflect endorsements thereof by Acharya Ramdev, it is deemed appropriate to issue show cause notice as to why the contempt of proceedings should not be issued against him in view of the fact that this Court is prima facie of the opinion that he has also violated the provisions of Section 3 and 4 of the Drugs and Magic Remedies Act…..

List on [..],the proposed contemnor/ managing director of respondent no. 5 shall remain present on the next date of hearing along with the newly impleaded proposed contemnor Acharya Ramdev,”

Medical dialogues team recently reported the incident where the Supreme Court slammed the Ayurveda organization and issued a contempt notice to Patanjali Ayurved and its Managing Director Acharya Balakrishna.

Also read- Misleading Ads Claiming Medicinal Cure: Supreme Court Slaps Contempt Notice On Patanjali

The IMA filed a plea seeking to put a stop to the “smear campaign” and negative advertisements by Patanjali against modern medicines and especially the vaccination drive during the pandemic.

The plea specifically referred to an advertisement titled “MISCONCEPTIONS SPREAD BY ALLOPATHY: SAVE YOURSELF AND THE COUNTRY FROM THE MISCONCEPTIONS SPREAD BY PHARMA AND MEDICAL INDUSTRY,” published on July 10, 2022. The IMA alleged that Patanjali’s advertisements violated laws such as the Drugs & Other Magic Remedies Act, 1954, and the Consumer Protection Act, 2019, by making unverified claims.

Moreover, the petition highlighted Ramdev’s previous controversial remarks, including denigrating allopathy as a “stupid and bankrupt science” and spreading false information about deaths due to allopathic medicines during the COVID-19 second wave. Patanjali was also accused of contributing to vaccine hesitancy and belittling citizens seeking oxygen cylinders during the pandemic’s peak.

Despite a Memorandum of Understanding between the Ministry of AYUSH and the Advertising Standards Council of India (ASCI) aimed at monitoring misleading advertisements of AYUSH drugs, Patanjali continued allegedly violating laws with impunity, the petition added.

Even though last year in November, Patanjali had assured the top court bench that no such statements would be made, the practice continued. The Apex Court bench prima facie observed that the company had violated the undertaking and asked the company and its Managing Director to show cause why action should not be taken against them for the contempt of the court.

While considering the plea filed by the Indian Medical Association (IMA), the court also restrained the Ayurveda company from advertising or branding its products which are meant to address the diseases/disorders specified in the Drugs and Magic Remedies (Objectionable Advertisements) Act 1954.

Last year in November, the Apex Court pulled up Patanjali Ayurved for persistently disseminating misleading claims and advertisements against modern medical systems and warned of a Rs 1 crore penalty if it does not put a halt to such practices in future.

Following this, the counsel for Patanjali had assured that they would not publish any such advertisements in future and they would also make sure that the casual statements are not made in the media. Previously, the top court bench had recorded the undertaking in its order.

While agreeing that such misleading ads cannot be accepted, the counsel for the Union Government submitted that it is for the concerned States to take action under the Act. Hence, the bench asked the Union to file an affidavit explaining the steps it has taken.

When asking about the affidavit, ASG K.M. Nataraj apprised the Bench that it was filed yesterday but was not officially recorded. 

On this, Justice Kohli orally asked the ASG as reported by the Live Law “Why did you file it one day before?”

Further, the Court granted the Union of India the last opportunity to make sure that the counter affidavit filed is on record and that copies are furnished to all the relevant parties.

“Ld. ASG appearing for the Union of India had informed the Court that the additional affidavit filed by the Union of India was not sufficient and it be permitted to file a fresh affidavit while withdrawing the earlier affidavit. Permission was granted to the Union to file fresh affidavit setting out the steps taken by it in terms of the order passed in Nov 21.11.2023. The said affidavit is also not on record. It is stated that by Ld. ASG that as per his instructions, the affidavit was filed only yesterday at 5:45 pm. No wonder the said affidavit is not on record,” concluded the court. 

Also read- SC Slams Ramdev Over Plea By IMA, Says He Shouldn’t Criticize Other Systems Of Medicine

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GLP-1 receptor agonists use in youth with type 2 diabetes tied to decreased HbA1c levels: Study

USA: Real-world use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in children and adults between the ages of 11 and 23 with type 2 diabetes (T2D) is associated with decreased HbA1c levels, despite challenges with adherence and access, a recent study has shown.

The findings, published in Diabetes, Obesity and Metabolism, suggest that GLP-1RA treatment may reduce insulin doses for youth with type 2 diabetes.

Stephanie L. Samuels, Yale University School of Medicine, New Haven, Connecticut, USA, and colleagues conducted a multicentre retrospective study to assess the short-term, real-world use and effectiveness of GLP-1 receptor agonist medications in the management of T2D in a diverse cohort of youth.

The researchers analyzed youth prescribed a GLP-1RA for T2D management at two academic paediatric diabetes centres before June 2022. Changes in insulin use and HbA1c from baseline to first (median 91 days) and second (median 190 days) follow-up were determined for those taking a GLP-1 receptor agonist.

Multivariable linear mixed-effects models adjusting for baseline age, sex, race/ethnicity, metformin regimen, insulin regimen, GLP-1RA dosing frequency, and the body mass index Z-score (BMI-Z) examined the HbA1c change for participants for up to 6 months after baseline.

One hundred and thirty-six patients with type 2 diabetes (median age 16.1 years, 54% female) were prescribed GLP-1RAs and taking them at the first or second follow-up.

The researchers reported the following findings:

  • There was a decrease in median HbA1c from 7.9% to 7.6% at a median follow-up of 91 days (n = 109) and, among those with HbA1c available at baseline and second follow-up (n = 83), from 8.4% to 7.4%.
  • The proportion of patients prescribed insulin decreased from baseline to the first follow-up visit (basal 69% to 60%, prandial 46% to 38%).
  • In multivariable analysis, there was a mean decrease in HbA1c by 0.09 percentage points per month.

“Youth with type 2 diabetes had decreases in A1C levels when taking glucagon-like peptide-1 receptor agonists,” the researchers wrote.

“Sustained reduction in A1C for the six months of the study was primarily seen in children who reported partial or complete adherence to GLP-1RAs.”

Reference:

Samuels SL, Chajecki A, Hu P, Kayser M, Weyman K, Pan B, Brown EA, Van Name M, Wolf RM. Real-world use of glucagon-like peptide-1 receptor agonists in youth with type 2 diabetes is associated with short-term improvements in HbA1c. Diabetes Obes Metab. 2024 Jan 16. doi: 10.1111/dom.15430. Epub ahead of print. PMID: 38229444.

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Perceived childhood stress tied to increased risk of high BP, diabetes and obesity in adults: JAHA

USA: Individuals with consistently higher levels of perceived stress from adolescence to adulthood pose greater cardiometabolic risk than individuals with other stress patterns, a recent study published in the Journal of the American Heart Association has revealed.

Cardiometabolic risk factors often occur together and are a significant cause of cardiovascular disease. These include obesity, Type 2 diabetes or prediabetes, high cholesterol and high blood pressure, researchers noted.

Understanding the effects of perceived stress starting in childhood is important for preventing, lessening or managing higher cardiometabolic risk factors in young adults,” said study author Fangqi Guo, Ph.D., postdoctoral research fellow at Keck School of Medicine, University of Southern California, Los Angeles.

According to the research, young adults who reported higher stress during their teenage years to adulthood were more likely to have high blood pressure, obesity and other cardiometabolic risk factors than their peers who reported less stress. 

“Our findings suggest that perceived stress patterns over time have a far-reaching effect on various cardiometabolic measures including fat distribution, vascular health and obesity,” Guo said. “This could highlight the importance of stress management as early as in adolescence as a health protective behavior.”

In 2020, cardiometabolic diseases, including cardiovascular diseases and Type 2 diabetes, were the most prevalent chronic health conditions and collectively accounted for nearly a quarter of all deaths in the U.S., according to the American Heart Association statistics. In 2023, the American Heart Association noted the strong connections among cardiovascular disease, kidney disease, Type 2 diabetes and obesity, and suggested redefining cardiovascular risk, prevention and management.

Childhood adversities affect cardiometabolic health across the life course, and interventions that improve early exposures may be more appropriate than interventions for cardiovascular disease risk factor effects later in life, according to a 2017 American Heart Association Scientific Statement: Childhood and Adolescent Adversity and Cardiometabolic Outcomes. In recent decades, researchers have found that perceived stress is a risk factor for cardiometabolic health conditions.

For this study, researchers analyzed health information from the Southern California Children’s Health Study. Participants had enrolled in the study as children along with their parents, then participated in follow-up assessments as adolescents-average age 13-and as young adults-average age 24.

At each stage, stress was measured with a 4-item Perceived Stress Scale, a questionnaire about feelings and thoughts during the last month. Study participants were categorized into four risk-based groups: consistently high stress over time, decreasing stress over time, increasing stress over time and consistently low stress over time.

To evaluate cardiometabolic risk in young adulthood, Guo and colleagues used measures of carotid artery intima-media thickness (measures neck artery thickness); systolic (top number) and diastolic (bottom number) blood pressure; weight, percentage of body fat and fat distribution; and hemoglobin A1c. Hemoglobin A1c gauges blood sugar over time; increased thickness of the neck artery’s inner layers suggests blood may not be flowing smoothly; and more fat around the abdomen is associated with a higher risk of cardiovascular diseases and/or Type 2 diabetes.

The analysis found:

  • Consistently high perceived stress from adolescence through adulthood was associated with greater risk for cardiometabolic diseases in young adulthood. If individuals experienced greater levels of stress from their teenage years into adulthood, they were more likely to have worse vascular health, higher total body fat, more fat around the belly and higher risk of obesity compared to those who felt less stressed over time.
  • In general, higher perceived stress levels were also associated with higher risk for cardiometabolic health conditions. For example, adults who experience higher levels of stress tended to have worse vascular health and higher systolic and diastolic blood pressure.

“Although we assumed that perceived stress patterns should have some association with cardiometabolic measures, we did not expect such consistent patterns across various risk factors,” Guo said.

“Health care professionals should consider using the Perceived Stress Scale to evaluate individuals’ stress levels during clinic visits. This way, those with higher stress levels can be identified and receive treatment earlier.”

Study details, background or design:

  • Researchers reviewed data on 276 people from Southern California communities participating in the Southern California Children’s Health Study. Participants enrolled as children from 2003 to 2014 and took part in follow-up health assessments as adults from 2018 to 2021.
  • About 56% of participants were girls/women; 62% identified as white; 5% as Asian; 1% as either Black or Native American; and 13% were classified as “other.” About 47% identified as Hispanic.
  • Researchers investigated perceived stress reported by participants’ parents during childhood (average age of about 6 years); then by participants, themselves, in adolescence (average age about 13 years); and then again in young adulthood (average age nearly 24 years).

Reference:

Guo F, Chen X, Howland S, Danza P, Niu Z, Gauderman WJ, Habre R, McConnell R, Yan M, Whitfield L, Li Y, Hodis HN, Breton CV, Bastain TM, Farzan SF. Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study. J Am Heart Assoc. 2024 Jan 17:e030741. doi: 10.1161/JAHA.123.030741.

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