Low FT4 Levels Linked to Higher Gestational Diabetes Risk: Study

Researchers have found in a global study of over 63,000 pregnant women that low free thyroxine (FT4) levels and isolated hypothyroxinaemia are linked to a higher risk of gestational diabetes. Contrary to prior assumptions, subclinical hypothyroidism showed no significant association, suggesting that universal screening and treatment for it may not reduce gestational diabetes risk.

Pregnancy is a state of increased metabolic demand that necessitates major changes in endocrine physiology. Gestational thyroid dysfunction and gestational diabetes are common endocrine conditions of pregnancy that frequently coincide. Although the effects of thyroid hormones on glucose metabolism are well documented, important knowledge gaps remain in terms of the extent and clinical relevance of these effects during pregnancy.

The aim of this meta-analysis is to assess the association of thyroid function test results with gestational diabetes and markers of glucose metabolism. In this systematic review and individual participant data meta-analysis, we searched Ovid MEDLINE, EMBASE, and Web of Science from database inception to Dec 12, 2024, for prospective population-based cohort studies with individual patient data on thyroid function, gestational diabetes, and measures of glucose homoeostasis during pregnancy. Furthermore, open invitations to join the Consortium on Thyroid and Pregnancy were issued to identify unpublished datasets. We excluded participants with multiple pregnancies; pre-existing thyroid disease or diabetes; current use of medications that could affect thyroid or glucose levels; or a history of infertility treatment, miscarriage, or stillbirth.

Exposures were maternal gestational concentrations of thyroid-stimulating hormone (TSH), free T4 (FT4), free T3 (FT3), and total T3; thyroperoxidase antibody positivity; thyroglobulin antibody positivity; and thyroid disease entities (ie, subclinical hypothyroidism, overt and subclinical hyperthyroidism, and isolated hypothyroxinaemia), which were defined according to current guidelines. The primary outcome was presence of gestational diabetes as defined in individual cohorts. Individual participant data were analysed using generalised linear mixed-effects regression models adjusting for maternal age, BMI, smoking status, parity, ethnicity, fetal sex, and gestational age at blood sampling.

They identified 638 published studies with our systematic search, of which 21 studies based on 17 cohorts met inclusion criteria; 11 of these prospective cohort studies provided individual participant data, and data from an additional 14 cohorts were added via personal contacts and open invitations, resulting in a study population of 63 548 participants from 25 cohorts after exclusions. Of the 52 632 participants in 17 cohorts with TPOAb measurements available to define thyroid disease entities, 1687 (3·2%) of these participants had subclinical hypothyroidism, 1153 (2·2%) had isolated hypothyroxinaemia, and 2958 (4·7%) had gestational diabetes. Compared with euthyroidism, isolated hypothyroxinaemia was associated with a higher risk of gestational diabetes (absolute risk 6·5% [72 of 1113] for isolated hypothyroxinaemia vs 3·5% [1555 of 44 787] for euthyroidism; adjusted odds ratio [aOR] 1·52 [95% CI 1·17–1·98], p=0·0017; 45 900 participants).

A lower FT4 concentration was associated with a higher risk of gestational diabetes (non-linear, p<0·0001). A higher risk of gestational diabetes was found both with a higher FT3 concentration (aOR 1·18 [95%CI 1·10−1·28], p<0·0001) and with a higher FT3-to-FT4 ratio (non-linear; p<0·0001). No evidence was found of associations of TSH, thyroid antibodies, or other thyroid function test abnormalities with gestational diabetes. I2 statistics for the primary analyses ranged from 0–43%, indicating low to moderate heterogeneity.

The funnel plot for overt hyperthyroidism indicated a possibility for publication bias (p=0·049), but funnel plots for all other variables did not. A lower FT4 concentration and isolated hypothyroxinaemia during pregnancy are associated with a higher risk of gestational diabetes. Our results challenge the long-standing notion that subclinical hypothyroidism or thyroid autoimmunity are risk factors for gestational diabetes and support both the risk profile for gestational thyroid dysfunction and ongoing efforts on optimisation of treatment targets for pregnant people taking levothyroxine. Follow-up studies are required to establish to what extent levothyroxine initiation or dose adjustments can affect insulin resistance and antihyperglycaemic therapies during pregnancy.

Reference:

Association of gestational thyroid function and thyroid autoimmunity with gestational diabetes: a systematic review and individual participant meta-analysis. Osinga, Joris A J et al. The Lancet Diabetes & Endocrinology, Volume 0, Issue 0

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Pemivibart Shows Promise as Preventive Treatment for COVID-19, suggests study

A new study published in Clinical Infectious Diseases highlights the potential of pemivibart, a long-acting monoclonal antibody, as a preventive therapy for COVID-19. Researchers evaluated the safety and efficacy of pemivibart in a phase 3 randomized controlled trial involving uninfected adults who were at increased risk of SARS-CoV-2 exposure.

The results showed that a single intramuscular dose of pemivibart significantly reduced the risk of symptomatic COVID-19 over a follow-up period of several months.

The antibody was well tolerated by participants, with adverse events comparable to those observed in the placebo group. Importantly, the study noted that the protective effects were maintained even as new variants of the virus circulated, underscoring the potential for pemivibart to serve as a robust option for pre-exposure prophylaxis-especially among immunocompromised individuals or those for whom vaccination offers limited protection.

Given the waning immunity from vaccines over time and ongoing concerns about breakthrough infections, especially in high-risk groups, long-acting antibodies like pemivibart may fill a critical gap in COVID-19 prevention strategies.

The authors of the study emphasize that further real-world effectiveness data and ongoing surveillance of viral mutations are needed to confirm its broad utility, but early results are encouraging. If approved for wider use, pemivibart could be integrated into preventive care protocols for vulnerable populations, including transplant recipients, cancer patients undergoing chemotherapy, and others with compromised immune systems.

The study adds to a growing body of evidence supporting antibody-based prophylaxis as a complement to vaccination efforts in controlling the COVID-19 pandemic.

Reference:
O’Brien, M. P., Forleo-Neto, E., Sarkar, N., et al. (2024). Efficacy and safety of pemivibart for prevention of symptomatic COVID-19: A phase 3 randomized trial. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaf265

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Alcohol withdrawal syndrome linked to worse surgical outcomes, higher costs, suggests study

Patients who develop alcohol withdrawal syndrome (AWS) after major surgery face significantly higher risks of complications, longer hospital stays, and increased health care costs, according to a study published in the Journal of the American College of Surgeons (JACS).

The findings underscore the need for screening before surgery and targeted interventions.

Using the National Inpatient Sample (2016–2019), researchers analyzed data from 3 million adults who underwent major operations, including colectomy, cardiac surgery, and liver resection. Among them, 16,504 (0.5%) were diagnosed with AWS, including 6,591 (0.2%) with life-threatening delirium tremens (DT). DT is a severe form of alcohol withdrawal that can include shaking, confusion, and hallucinations.

“AWS is a preventable complication, yet it’s often overlooked in surgical planning,” said lead author Timothy M. Pawlik, MD, PhD, MPH, FACS, surgeon-in-chief at the Ohio State University Wexner Medical Center. “Our study shows that proactive screening and multidisciplinary care — involving surgeons, social workers, and addiction specialists — can save lives and reduce costs.”

Key Findings

High-risk patients: AWS was more common in men (median age 61), Medicaid recipients, and those with substance use disorders.

Complications: AWS doubled the risk of respiratory failure and sepsis. DT increased mortality by 40%.

Economic impact: Adjusted hospitalization costs rose by $10,030 per patient with AWS; DT added another $5,300.

Interventions for the Future

The study highlights actionable strategies to improve outcomes:

Preoperative screening: Use validated tools (e.g., AUDIT-C) to identify high-risk patients.

Judgment-free care: “This is a disease, not a moral failing,” stressed Dr. Pawlik. “We need honest conversations to tailor treatment.”

Early intervention: For patients at risk, preventative medications (e.g., benzodiazepines) and ICU-level monitoring may prevent DT.

“A patient recovering from major surgery shouldn’t also battle withdrawal,” said Dr. Pawlik, recalling a case where AWS led to aspiration pneumonia post-surgery. “We can change this by addressing alcohol use before surgery and ensuring safer recovery environments.”

Limtations: The study relied on administrative data, potentially underestimating AWS incidence. Long-term outcomes and treatment specifics (e.g., benzodiazepine use) were not assessed.

Coauthors are Azza Sarfraz, MBBS; Areesh Mevawalla MD; Abdullah Altaf, MD; Mujtaba Khalil, MD; Zayed Rashid, MD; Shahzaib Zindani MD

The study is published as an article in press on the JACS website. 

Citation: Nationwide Trends and Perioperative Outcomes of Alcohol Withdrawal Syndrome After Major Operation. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001487

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Impact of kombucha, coffee, and turmeric beverages on the color stability of a single-shade versus a multi-shade resin-based composite: Study

A new study published in PeerJ has found that turmeric causes the most significant discoloration in dental resin-based composites (RBCs) compared to coffee and kombucha, with single-shade RBCs exhibiting poorer color stability than multi-shade composites. Researchers tested 60 composite specimens using two types of materials: a single-shade RBC with an advanced polymerization system (APS) (Vittra APS Unique, FGM Dental Group, Brazil) and a conventional multi-shade universal RBC (Tetric N-Ceram, Ivoclar Vivadent, Germany). Each group was subdivided and immersed in turmeric, coffee, or kombucha for 12 days, and color changes (ΔE*ab and ΔE00) were measured at baseline, day 6, and day 12. Results showed that turmeric caused the highest degree of discoloration (p < 0.001), followed by coffee and then kombucha. Additionally, the universal RBC demonstrated significantly better resistance to staining compared to the single-shade APS-based composite (p = 0.004). Researchers concluded that time, staining medium, and material type all significantly influenced color changes (p = 0.005 for three-way interaction). These findings highlight a potential esthetic limitation of single-shade composites, particularly when patients consume beverages or foods containing strong chromogens like turmeric. While turmeric’s staining potential was already well-documented on natural teeth, this study adds valuable evidence of its impact on modern composite resins, especially those marketed for universal shade-matching convenience. Clinicians may need to consider this when selecting materials for patients with high exposure to staining agents. The authors recommend further long-term studies to confirm these results and to evaluate whether surface finishing, polishing, and sealing techniques can mitigate discoloration over time. This study underscores the importance of patient education regarding dietary habits and the impact of staining beverages on restorative esthetics, especially for those seeking long-lasting cosmetic results.

Reference:
Yeslam, H. E., & Bakhsh, A. F. (2025). Impact of kombucha, coffee, and turmeric beverages on the color stability of a single-shade versus a multi-shade resin-based composite. PeerJ, 13, e19759. https://doi.org/10.7717/peerj.19759

Keywords: resin-based composites, color stability, turmeric staining, single-shade composites, universal RBC, PeerJ, Vittra APS Unique, Tetric N-Ceram, Yeslam & Bakhsh, dental esthetics

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Hypothyroidism May Lower Breast Cancer Risk, Especially After Menopause: Study

Researchers have found that women diagnosed with hypothyroidism may have a lower risk of developing breast cancer, especially after menopause. This conclusion was drawn from a large Danish cohort study that followed over 1 million women for nearly two decades. The study published in the International Journal of Cancer was conducted by Allan J. and colleagues.

The cohort consisted of 1,058,939 Danish-born women from January 1, 1960, to December 31, 1997. Information was gathered from a variety of Danish national registers, such as evidence of thyroid disease and breast cancer diagnoses, demographic characteristics, migration, and death. Median follow-up was 18.8 years, offering a strong longitudinal setting in which to compare long-term risk of cancer.

Among the entire population, 49,015 women were diagnosed with hypothyroidism and 26,950 with hyperthyroidism within the duration of the study. A total of 15,703 individuals were diagnosed with breast cancer. Cox proportional hazard regression models estimated the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for age, comorbidities, and menopausal status.

Key Findings

  • The main conclusion of the study was that hypothyroidism was linked to a statistically significant decrease in the risk of breast cancer.

  • That is, the hazard ratio for women with hypothyroidism was 0.85 (95% CI: 0.78–0.93), which means 15% lower risk compared to women without thyroid conditions.

  • For postmenopausal women, the protective effect looked even more pronounced, with a hazard ratio of 0.78 (95% CI: 0.68–0.90).

  • In contrast, no risk association was seen between hyperthyroidism and the risk of breast cancer.

  • The hazard ratio in this cohort was 1.00 (95% CI: 0.89–1.11), indicating no increase or decrease in risk.

  • These results were similar for different histological subtypes of breast cancer and were not importantly different by time since the first diagnosis of thyroid disease.

This large multicenter national study found that hypothyroidism is associated with a reduced risk of breast cancer, and the protective effect was most evident in postmenopausal women. Conversely, hyperthyroidism was not found to be associated with an altered risk of breast cancer. These results prompt further investigation into the biological rationale for this association and into whether thyroid function should be considered as an element of breast cancer prevention in the future.

Reference:

Jensen, A., Gottschau, M., Christensen, J., Lindquist, S., Aalborg, G. L., Rosthøj, S., Grand, M. K., Pedersen, J., Kjær, S. K., & Nøhr, B. (2025). Risk of breast cancer among women with hypo- and hyperthyroidism: Results from a large nationwide cohort study. International Journal of Cancer. Journal International Du Cancer. https://doi.org/10.1002/ijc.70007

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Age at woman’s first period can offer clues about long-term health risks: Study

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

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

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

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

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

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

Reference:

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

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Probiotics Pretreatment Boosts H. pylori Eradication Rates and Cuts Side Effects, Meta-Analysis Finds

China: A systematic review and meta-analysis published in Annals of Medicine has found that administering probiotics before Helicobacter pylori (H. pylori) eradication therapy can significantly improve treatment success rates while minimizing adverse effects. The research, led by Shiyu Xiao and colleagues from the Department of Gastroenterology at Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, provides moderate to high-quality evidence supporting the use of probiotic pretreatment as an adjunct to standard H. pylori therapy.

H. pylori infection remains one of the most common chronic bacterial infections worldwide and is a major contributor to gastritis, peptic ulcer disease, and gastric cancer. While conventional eradication regimens are effective, treatment failure due to antibiotic resistance and gastrointestinal side effects remains a concern. Probiotics, known to inhibit H. pylori growth and modulate the gut microbiome, have been explored as a potential strategy to enhance eradication outcomes and reduce treatment-related discomfort.

The researchers performed a comprehensive analysis of 12 randomized controlled trials encompassing 2,144 participants to determine whether probiotics used before H. pylori eradication could improve clinical outcomes.

The following were the key findings:

  • The intention-to-treat analysis showed a higher eradication rate in the probiotics pretreatment group compared to controls (80.34% vs. 70.49%), with a relative risk (RR) of 1.14.
  • Per-protocol analysis also indicated better outcomes with probiotics (86.43% vs. 76.88%; RR = 1.12).
  • Patients who received probiotic pretreatment experienced fewer treatment-related side effects (16.0% vs. 28.3% in controls; RR = 0.59).
  • The findings suggest that probiotics can improve both treatment efficacy and tolerability, aiding better adherence to therapy.
  • The benefits of probiotics were consistent across different geographical regions, eradication regimens, and probiotic formulations.
  • Pretreatment durations of 14 days or longer showed the most significant improvement in eradication rates, indicating that sufficient exposure time may be key for probiotics to impact gut microbiome and H. pylori suppression.

The findings highlight the potential of integrating gut microbiome modulation into H. pylori management strategies. “Probiotic pretreatment offers a promising approach to enhance eradication efficacy and reduce side effects, especially in the face of growing antibiotic resistance,” the authors noted.

With H. pylori treatment failures posing a global challenge, this meta-analysis provides a compelling case for incorporating probiotics as part of a comprehensive eradication protocol. The authors recommend further large-scale, well-designed clinical trials to determine optimal probiotic strains, dosing regimens, and treatment durations to maximize therapeutic benefits.

“The research paves the way for a potential paradigm shift in H. pylori therapy, emphasizing the role of probiotics not just as a supportive measure but as a proactive component of eradication strategies aimed at improving patient outcomes and addressing the limitations of current treatment protocols,” the authors concluded.

Reference:

Zhang Y, Tu M, Long P, Zheng J, Du G, Xiao S, Gao C. Efficacy of probiotics pretreatment in Helicobacter pylori eradication therapy: a systematic review and meta-analysis of clinical outcomes. Ann Med. 2025 Dec;57(1):2533431. doi: 10.1080/07853890.2025.2533431. Epub 2025 Jul 23. PMID: 40697099; PMCID: PMC12288164.

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NPPA Caps Prices of Ipratropium, Sodium Nitroprusside, Two Other Essential Drugs

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

The order was published via a Gazette notification dated August 1, 2025, under the Drugs (Prices Control) Order, 2013.

The revised list includes Ipratropium Respirator Solution, Sodium Nitroprusside Injection, Povidone Iodine Ointment, and Diltiazem Modified Release Capsules. These drugs are commonly used in both outpatient and hospital settings, and the ceiling price revisions aim to improve affordability and access to essential treatments.

As per the NPPA notification, Ipratropium, a bronchodilator used in nebulizer therapy for conditions like asthma and COPD, has been priced at Rs 2.96 per mL for the 250 mcg/mL solution. Sodium Nitroprusside, a critical care injectable used to manage hypertensive crises, is now capped at Rs 28.99 per mL for the 10 mg/mL strength. Povidone Iodine Ointment 10%, a staple antiseptic in wound care and infection prevention, has been fixed at Rs 6.26 per gram, and Diltiazem 180 mg Modified Release Capsules, used in the management of hypertension and angina, are priced at Rs 26.72 per capsule.

In exercise of the powers conferred by paragraphs 4, 6, 10, 11, 14, 16, 17 and 18 of the Drugs (Prices Control) Order, 2013, read with S.O. 1394(E) dated 30th May, 2013 and S.O. 5249(E) dated 11th November, 2022 issued by the Government of India in the Ministry of Chemicals and Fertilizers and in supersession of the Order of the Government of India in the Ministry of Chemicals and Fertilizers (National Pharmaceutical Pricing Authority) S.O. 1487(E) dated 27th March, 2025 in so far as it relates to formulation packs mentioned in the table below, except in respect of things done or omitted to be done before such supersession, the National Pharmaceutical Pricing Authority has fixed the price as specified in column (5) of the table herein below as ceiling price exclusive of goods and services tax applicable, if any, in respect of the Scheduled formulation specified in the corresponding entry in column (2) of the said Table with the dosage form & strength and unit specified respectively in the corresponding entries in columns (3) and (4) thereof:

Table

Sl.

No.

Medicines

Dosage form and strength

Unit

Ceiling Price (Rs.)

(1)

(2)

(3)

(4)

(5)

1.

Ipratropium

Respirator solution for use in nebulizer 250mcg/mL

1 ml

2.96

2.

Sodium nitroprusside

Injection10mg/mL

1 ml

28.99

3.

Povidone iodine

Ointment 10%

1 gm

6.26

4.

Diltiazem

Modified Release Capsule

180mg

1 Capsule

26.72

The Gazette further added;

  • All manufacturers of scheduled formulation, selling the branded or generic or both the versions of scheduled formulations at a price higher than the ceiling price (plus Goods and Services Tax as applicable) so fixed and notified by the Government, shall revise the prices of all such formulations downward not exceeding the ceiling price specified in column (5) in the above table plus goods and services tax as applicable, if any.
  • All the existing manufacturers of above-mentioned scheduled formulations having MRP lower than the ceiling price specified in column (5) in the above table (plus Goods and Services Tax as applicable, if any), shall continue to maintain the existing MRP in accordance with paragraph 13 (2) of the DPCO, 2013.
  • The manufacturers may add Goods and Services Tax only if they have paid actually or if it is payable to the Government on the ceiling price mentioned in column (5) of the above said table.
  • The ceiling price for a pack of the scheduled formulation shall be arrived at by the concerned manufacturer in accordance with the ceiling price specified in column (5) of the above table as per provisions contained in paragraph 11 of the Drugs (Prices Control) Order, 2013. The manufacturer shall issue a price list in Form–V from date of Notification as per paragraph 24 of the DPCO, 2013 to NPPA through IPDMS and submit a copy to State Drug Controller and dealers.
  • As per para 24(4) of DPCO 2013, every retailer and dealer shall display price list and the supplementary price list, if any, as furnished by the manufacturer, on a conspicuous part of the premises where he carries on business in a manner so as to be easily accessible to any person wishing to consult the same.
  • Where an existing manufacturer of scheduled formulation with dosage or strength or both as specified in the above table launches a new drug as per paragraph 2(1)(u) of the DPCO, 2013 such existing manufacturer shall apply for prior price approval of such new drug to the NPPA in Form I as specified under Schedule-II of the DPCO, 2013.
  • The manufacturers of above said scheduled formulations shall furnish quarterly return to the NPPA, in respect of production / import and sale of scheduled formulations in Form-III of Schedule-II of the DPCO, 2013 through IPDMS. Any manufacturer intending to discontinue production of above said scheduled formulation shall furnish information to the NPPA, in respect of discontinuation of production and / or import of scheduled formulation in Form-IV of Schedule-II of the DPCO, 2013 at least six months prior to the intended date of discontinuation.
  • The manufacturers not complying with the ceiling price and notes specified hereinabove shall be liable to deposit the overcharged amount along with interest thereon under the provisions of the Drugs (Prices Control) Order, 2013 read with Essential Commodities Act, 1955.
  • Consequent to the issue of ceiling price of such formulation as specified in column (2) of the above table in this notification, the price order(s) fixing ceiling or retail price, if any, issued prior to the above said date of notification, stand(s) superseded.

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Shocking! 104 out of 125 MBBS students fail in AIIMS Gorakhpur Internal Exams

New Delhi: In a shocking outcome, altogether 104 MBBS students out of 125 students from the 2024 batch at AIIMS Gorakhpur have failed the internal examination of the second semester.

The results of the internal examination, which tests students’ preparations before the final exam, have left the administration in shock. The failure of so many students at once has raised a question mark on the quality of medical education.

While all of these 104 students failed in the subject of Physiology, 70 students have failed in Biochemistry, and 35 students have failed in Anatomy. The results revealed that 83 out of the 125 students have failed in all three subjects, Dainik Bhaskar has reported.

Also Read: Oops: 46 MBBS Students from MGM Indore Fail in Surgery Practical, Dean writes to HOD

As per the latest media report by News 18, some of the students scored less than 25 out of 100 marks in Physiology.

This is the first time that the performance of AIIMS Gorakhpur students has been found to be so poor in the internal exams. Sources informed Dainik Bhaskar that the students are suffering due to the scuffle inside the Physiology department. Meanwhile, taking note of the situation, the AIIMS administration has started the studies of the students with full force. For this, the internal exam was conducted once again on Tuesday night and along with the students, the doctors were also called from their homes. In this exam, the students were also told the answers to the questions. 

While the students have blamed the difficult question paper for such poor results, some of the experts have pointed out that if the students fail to score 50 per cent marks in the internal examinations, they will not be allowed to appear in the main exam. The results revealed that some of the students could not even secure 25 marks.

Taking cognisance of the issue, Executive Director Dr Vibha Dutta has spoken to the concerned doctors. After this, the students were allowed to appear in the exam again on Tuesday night and solve the paper so that the results would be good. Some alleged that the students were also allowed to keep the book. The exam continued from 5 pm to 8 pm, reports Dainik bhaskar.

Commenting on the issue, AIIMS Media Cell Chairperson Dr. Aradhana Singh said that internal exams are conducted to check the preparation of the students, adding that the students receive help by conducting practice exams so that no student is left behind.

Also Read: First Convocation Ceremony of AIIMS Gorakhpur held, 8 doctors conferred Gold medal by President Murmu

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Addressing Ketoconazole Resistance: Exploring the Efficacy of Selenium Sulfide in Resistant Cases

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

Ketoconazole Resistance

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

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

Selenium Sulfide: An Alternative Approach

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

Exploring the Efficacy of Selenium Sulfide

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

The Future of Antifungal Therapy

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

Conclusion

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

References

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

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

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