Shorter dental implants viable option to longer dental implants among patients with Limited Ridge Height in Posterior Maxilla

Shorter dental implants viable option to longer dental implants among patients with Limited Ridge Height in the Posterior Maxilla suggests a new study published in the Journal of Clinical Periodontology.

A study was done to compare implant survival and complication rates between shorter and standard-length implants with sinus augmentation and restored with single crowns, at 10 years of loading. One-hundred and one patients (137 implants) with a ridge height of 5–7 mm in the posterior maxilla were randomly assigned to two treatment modalities: shorter implants (6 mm) (group short [GS]) or standard-length implants (11–15 mm) with sinus grafting (group graft [GG]). Following the insertion of final restorations, patients were regularly recalled for up to 10 years. Assessed outcomes encompassed implant survival, marginal bone levels (MBLs), biological and technical parameters and patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile). Non-parametric statistical analysis was used to analyse the data. Results: For the 5- to 10-year follow-up period, 77 patients with 105 implants (GS: 36 patients/48 implants; GG: 41/57) were available for re-examination (drop-out rate 21%). Implant survival rates at the patient level were 96.0% (GS; 2 failures) and 100% (GG) (inter-group p = .24). Median MBLs amounted to 0.00 mm (min 0.00; max 3.25; GS) and 0.00 mm (min 0.00; max 4.55; GG) (inter-group p = .73). Technical complications predominantly occurred within the first 5 years (inter-group p > .05). Peri-implantitis rates were 4.2% (GS) and 13.3% (GG) (intergroup p = .37). Median OHIP-49 scores were 7.00 (0.00; 39.00; GS) and 9.00 (0.00; 196; GG) (inter-group p = .61) at 10 years. Based on similar 10-year implant survival rates, reduced patient morbidity and lower costs, the use of shorter dental implants might well serve as an alternative treatment concept to longer implants placed in conjunction with sinus grafting for patients with a limited ridge height in the posterior maxilla.

Reference:

Thoma, D. S., Haas, R., Sporniak-Tutak, K., Garcia, A., Taylor, T. D., Tutak, M., Pohl, V., & Hämmerle, C. H. F. (2024). Randomized controlled multi-centre study comparing shorter dental implants (6 mm) to longer dental implants (11–15 mm) in combination with sinus floor elevation procedures: 10-year data. Journal of Clinical Periodontology, 1–11. https://doi.org/10.1111/jcpe.13954

Keywords:

Journal of Clinical Periodontology, Thoma, D. S., Haas, R., Sporniak-Tutak, K., Garcia, A., Taylor, T. D., Tutak, M., Pohl, V., & Hämmerle, C. H. F, Shorter dental implants, longer dental implants, Limited Ridge Height, Posterior Maxilla

Powered by WPeMatico

Women with HPV infection face higher risk of death from cardiovascular disease

Women have a four times higher risk of dying from cardiovascular disease if they have an infection with a high-risk strain of the human papillomavirus (HPV), according to research published in the European Heart Journal.

HPV is a very common infection and high-risk strains are known to cause cervical cancer. Previous research has suggested that HPV may also contribute to the build-up of dangerous plaque in the arteries. However, this is the first study to show a link between high-risk HPV infection and deaths from cardiovascular disease.

The research was led by Professors Seungho Ryu, Yoosoo Chang and Hae Suk Cheong from the Sungkyunkwan University School of Medicine, Seoul, Korea. Prof. Ryu said “Despite remarkable advances in controlling well-known risk factors for heart disease – such as smoking, high cholesterol, hypertension, and diabetes – heart disease continues to be a major cause of death. Interestingly, these conventional risk factors don’t explain all heart disease cases; about 20% occur in people who don’t have these issues. This highlights the need to investigate other changeable risk factors. Our research focuses on examining the impact of HPV, particularly in relation to cardiovascular mortality, as a potential risk factor for heart disease.”

The research included 163,250 young or middle-aged Korean women who had no cardiovascular disease at the start of the study. The women were given a variety of health screening tests, including cervical screening for 13 high-risk strains of HPV. The women returned for health checks every year or two for an average of eight and half years.

Researchers were able to combine data on the women’s HPV test results with national data on deaths from cardiovascular disease, including heart disease and stroke.

As a group of relatively young, healthy women, their risk of dying of cardiovascular disease was generally low (9.1 in 100,000 overall).

However, after taking account for other factors that are known to increase the risk of cardiovascular disease, researchers found that women with high-risk HPV had a 3.91 times greater risk of blocked arteries, a 3.74 times greater risk of dying from heart disease and a 5.86 times greater risk of dying from a stroke, compared to women who did not have a high-risk HPV infection. Researchers also found that the risk was higher still in women who had a high-risk HPV infection and obesity.

Prof. Cheong said: “We know that inflammation plays a pivotal role in the development and progression of cardiovascular disease and viral infections are potential triggers of inflammation. HPV is known for its link to cervical cancer, but research is starting to show that this virus can also be found in the blood stream. It could be that the virus is creating inflammation in the blood vessels, contributing to blocked and damaged arteries and increasing the risk of cardiovascular disease.

“This study highlights the importance of comprehensive care for patients with high-risk HPV. Clinicians should monitor cardiovascular health in patients with high-risk HPV, particularly those with obesity or other risk factors. It’s important for people with high-risk HPV to be aware of the potential for both heart disease and cervical cancer risks. They should engage in regular health screenings and adopt a healthy lifestyle to mitigate their risk of cardiovascular disease.”

The researchers say more work is needed to find out whether high-risk HPV infection has similar effects on men and to see if the HPV vaccine can prevent deaths from heart disease. Prof. Ryu added: “If these findings are confirmed, they could have substantial implications for public health strategies. Increasing HPV vaccination rates may be an important strategy in reducing long-term cardiovascular risks.”

In an accompanying editorial Prof. James S. Lawson from the University of New South Wales, Sydney, Australia, and colleagues said: “The evidence that viruses in general and HPV in particular increase the risk of adverse outcomes from atherosclerotic cardiovascular disease has become compelling enough to add to the already strong case for vaccination against influenza virus, SARS-CoV-2, and HPV. The evidence that HPV is causal in the initiation or progression of atherosclerotic cardiovascular disease is highly suggestive but would become definitive if the results of randomized trials evaluating HPV vaccines for prevention of cervical cancer showed a reduction in atherosclerotic cardiovascular disease.

“These findings, when added to other evidence linking HPV and other viruses to higher cardiovascular disease mortality, make a strong case for accepting viruses as risk factors for adverse outcomes from atherosclerotic cardiovascular disease.”

Reference:

Hae Suk Cheong, Yoosoo Chang, Yejin Kim, Min-Jung Kwon, Yoosun Cho, Bomi Kim, Eun-Jeong Joo, Young Ho Bae, Chanmin Kim, Seungho Ryu, Human papillomavirus infection and cardiovascular mortality: a cohort study, European Heart Journal, 2024;, ehae020, https://doi.org/10.1093/eurheartj/ehae020.

Powered by WPeMatico

Comprehensive Study Reassues Neonatal Safety of COVID-19 Vaccination during Pregnancy

In a groundbreaking effort to allay concerns
surrounding the safety of COVID-19 vaccination during pregnancy, a recent
population-based cohort study, covering all infants born in Sweden and Norway
from June 2021 to January 2023, has delivered reassuring findings. With a
specific focus on evaluating potential risks of neonatal adverse events after
maternal COVID-19 vaccination, the study, involving an impressive 196,470
newborns, brought forth compelling findings.


The study results were published in the
journal JAMA Network.

Also Read: High maternal cortisol, associated with unpredicted birth complications

COVID-19 vaccination during pregnancy,
recommended by various authorities, demonstrates reduced rates of infection in
pregnant individuals and infants. Concerns persist, prompting a detailed study
on neonatal safety, especially cerebrovascular outcomes. Hence, researchers
conducted a population-based cohort study to evaluate the risks of neonatal
adverse events after exposure to COVID-19 vaccination during pregnancy.


A population-based cohort study spanning
infants born in Sweden and Norway from June 2021 to January 2023 employed
unique personal identity numbers for data linkage. The study examined the
administration of mRNA COVID-19 vaccines during pregnancy and assessed
outcomes, utilizing logistic regression and stratified analyses.


Findings:

·        

  • Contrary to
    apprehensions, the research discovered that nearly half of the newborns (48.0%)
    were exposed to COVID-19 vaccination during pregnancy.        
  • However, the most
    significant revelation emerged as these infants exhibited no heightened odds of
    adverse neonatal outcomes.         
  • Among the notable
    findings, infants exposed to maternal COVID-19 vaccination displayed lower odds
    for neonatal nontraumatic intracranial hemorrhage, hypoxic-ischemic
    encephalopathy, and neonatal mortality.        
  • The event rates
    for these outcomes were significantly lower in the vaccinated group, showcasing
    a robust safety profile associated with maternal vaccination.        
  • The reassuring
    results held firm across various subgroup analyses.        
  • Subgroup analyses, including infants
    delivered by individuals unvaccinated before pregnancy, those vaccinated before
    or after a general recommendation during pregnancy, and those without COVID-19
    infection during pregnancy, consistently showed a similar association between
    vaccination during pregnancy and lower neonatal mortality.      
  • Additionally,
    analyses restricted to term infants, singleton births, or infants without birth
    defects consistently echoed the study’s overall positive conclusion.       
  • Even when stratified by vaccine manufacturers,
    the analysis did not weaken the association between vaccination and reduced
    neonatal mortality.
Also Read: Maternal LDH levels may predict adverse pregnancy outcomes in women with severe preeclampsia


In summary, this large-scale population-based
study serves as a robust testament to the safety of maternal mRNA COVID-19
vaccination. The evidence dispels concerns surrounding potential risks to
neonatal health, providing crucial reassurance for expectant individuals
considering vaccination. As the global community continues its efforts to
combat the COVID-19 pandemic, these findings contribute valuable insights,
fostering confidence in the safety and efficacy of vaccination strategies for
pregnant individuals and their newborns.      

Further reading: Norman M, Magnus MC, Söderling J, et al. Neonatal Outcomes After COVID-19 Vaccination in Pregnancy. JAMA. 2024;331(5):396–407. doi:10.1001/jama.2023.26945

Powered by WPeMatico

Persons diagnosed with PCOS face 8-fold increase in suicide risk

A study of more than 18,000 women found that patients diagnosed with polycystic ovary syndrome (PCOS) were 8 times more likely to attempt suicide compared with control group. These findings highlight the importance of routine monitoring of mental health and suicide risk in persons diagnosed with PCOS. The study is published in Annals of Internal Medicine.

PCOS is a prevalent endocrine disorder, affecting up 10% of women in their reproductive years. Common attributes associated with PCOS include infertility, acne, dysmenorrhea, hirsutism, and obesity, which can collectively contribute to a decreased quality of life. In addition, a substantial body of evidence indicates that persons diagnosed with PCOS have higher risk for psychiatric conditions, such as depressive disorders, anxiety disorders, personality disorder, and schizoaffective disorder.

Researchers from Taipei Veterans General Hospital studied data from the Taiwanese nationwide database from 1997 to 2012 for 18,960 women diagnosed with PCOS to assess suicide risk, accounting for psychiatric comorbid conditions and age group. They found that persons diagnosed with PCOS faced an 8.47-fold increase in risk for suicide attempt compared with the control group, even after accounting for demographics, psychiatric comorbid conditions, physical conditions, and all-cause clinical visits. An adolescent subgroup had a notable 5.38-fold elevated risk for suicide attempt. The authors note that their findings remained robust when excluding the first year or the first 3 years of observation.

Reference:

Tien-Wei Hsu, Yu-Chen Kao, Shih-Jen Tsai, Ya-Mei Bai, Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome, Annals of Internal Medicine, https://doi.org/10.7326/M23-2240.

Powered by WPeMatico

Earlier anticoagulation reversal associated with better survival in patients with intracerebral haemorrhage: JAMA

USA: A cohort study including 9492 patients with anticoagulation-associated intracerebral haemorrhage (ICH) showed that a door-to-treatment time of 60 minutes or less is tied to lower mortality and hospice transfers. Stroke severity and White race were associated with faster administration of reversal interventions.

The study, published in JAMA Neurology, highlights the importance of rapid treatment in improving survival and discharge to hospice for patients with anticoagulation-associated ICH, underscoring the need for efficient healthcare delivery in emergency settings.

“In US hospitals participating in Get With The Guidelines–Stroke, earlier anticoagulation reversal is tied with improved survival for patients with ICH,” the researchers reported.

Intracerebral haemorrhage is the deadliest subtype of stroke, and mortality rates are particularly high in anticoagulation-associated ICH. Recently, there has been the development of specific anticoagulation reversal strategies. Still, there is no clarity on whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice.

Kevin N. Sheth, Yale University School of Medicine, New Haven, Connecticut, and colleagues evaluated whether DTT time is associated with outcomes among patients with anticoagulation-associated ICH treated with reversal interventions.

The researchers used data from the American Heart Association Get With The Guidelines–Stroke quality improvement registry. It included patients with intracerebral haemorrhage who presented within 24 hours of symptom onset across 465 US hospitals from 2015 to 2021.

The primary outcome of interest was the composite inpatient mortality and discharge to hospice. Additional prespecified secondary outcomes were also examined, including functional outcomes (discharge modified Rankin Scale score, discharge venue, and ambulatory status).

Key findings of the study:

  • Of 9492 patients with anticoagulation-associated ICH and documented reversal intervention status, 44.6% were female, and the median age was 77 years.
  • A total of 7469 received reversal therapy, including 4616 of 5429 taking warfarin and 2856 of 4069 taking a non–vitamin K antagonist oral anticoagulant.
  • For the 5224 patients taking a reversal intervention with documented workflow times, the median onset-to-treatment time was 232 minutes, and the median DTT time was 82 minutes, with a DTT time of 60 minutes or less in 27.7%.
  • A DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice (adjusted odds ratio, 0.82) but no difference in functional outcome (i.e., a modified Rankin Scale score of 0 to 3; adjusted odds ratio, 0.91).
  • Factors associated with a DTT time of 60 minutes or less included White race, higher systolic blood pressure, and lower stroke severity.

In the largest quality improvement stroke registry in the US, the researchers found that the earlier administration of reversal interventions in anticoagulant-associated ICH was linked with reduced in-hospital mortality or discharge to hospice but no difference in functional outcomes.

“These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke,” the researchers concluded.

Reference:

Sheth KN, Solomon N, Alhanti B, et al. Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage. JAMA Neurol. Published online February 09, 2024. doi:10.1001/jamaneurol.2024.0221 

Powered by WPeMatico

Not carrying out pre-operative investigations amounts to gross negligence: Consumer Court slaps Rs 10 lakh compensation

Madurai: The District Consumer Disputes Redressal Commission in Madurai has directed a hospital to pay Rs 10 lakh compensation holding it vicariously liable for the acts of omission committed by 2 physicians and a general surgeon, wherein they failed to take an MRI scan to assess the condition of the patient before performing the surgery, resulting in death of a patient.

The Commission noted that non-carrying out of pre-operative investigations including MRI Scan for assessing abdominal adhesions in the case in hand amounted to gross negligence. It further mentioned that the Hospital’s act of not providing the case sheet to the complainant at the time of discharging the patient with referral to Government Hospital was a negligent act.

The complaint was filed on December 14, 2021, before the consumer court against the Hospital (OP 1) and two physicians (Opposite party No.2 Dr Premlatha and 3 Dr Rajaram), a general surgeon, Dr Kumar (Opposite Party No.4) and Rajaji Government Hospital (Opposite Party No.5).

The core of the complaint revolved around the complainant’s wife, who was admitted to Shri Andal Hospital for abdomen pain. The complainant, the husband of deceased patient, brought his wife to the hospital on November 18, 2020, for abdomen pain. The 3rd opposite party physician Dr Rajaram admitted her as an inpatient. On November 19, 2020, the 2nd opposite party physician Dr Premlatha recommended immediate surgery, claiming a cyst in her uterus posed a life-threatening risk. The complainant, persuaded by the 1st physician, agreed to the surgery, initially priced at Rs. 80,000 but settled for Rs. 40,000, with an immediate payment of Rs. 10,000.

The surgery, conducted by Dr Premlatha on November 21, 2020, revealed complications, and additional expenses of Rs. 1,00,000 were demanded. The complainant paid another Rs. 10,000. Subsequently, the services of the 4th opposite party, Dr Kumar were sought. It was at this point that it was realized by the complainant the surgery had been performed negligently without pre-operative tests. Due to the severity of the situation, the patient was shifted to Government Rajaji Hospital, Madurai. The 1st opposite party did not provide medical records but issued a referral letter.

Upon reaching the 5th opposite party, Rajaji Government Hospital on November 22, 2020, they initially refused admission due to the patient’s condition after the incomplete surgery. Later, she was admitted as an inpatient, and the complainant paid Rs. 606 for scan and blood tests. The patient, who had undergone a half-baked colostomy operation, struggled with treatment and ultimately passed away on November 28, 2020. Medical records from the Rajaji Government Hospital revealed that the antecedent cause of death was injury with colostomy.

Aggrieved, the complainant moved the Commission alleging negligence and deficiency in service by the opposite parties, asserting that proper pre-operative investigations could have saved his wife’s life. The complaint sought compensation among other reliefs.

The complainant alleged that the Andal Hospital performed the surgery negligently, puncturing the intestine and causing severe adhesion in the bowel. He claims that proper pre-operative investigation, such as an MRI scan, could have saved his wife’s life. The complainant issued a lawyer’s notice and lodged the complaint, accusing the opposite parties of negligence and deficiency in service.

In response to the consumer complaint, the Rajaji Government Hospital, argued that the complaint is not maintainable as they provide free services, and the complainant did not pay any consideration for the treatment. The hospital contended that they offered proper treatment and there was no negligence on their part. 

Deliberating the case, the Commission raised points for consideration that included, whether the consumer complaint against the Rajaji Government Hospital is maintainable; whether the opposite parties have committed any deficiency in service; If so, to what relief the complainant is entitled.

The Commission, after reviewing the written version of the Rajaji Government Hospital, addressed the first point. They concluded that the complaint against the Government Hospital is not maintainable as the hospital provides free services, and the complainant did not pay any consideration for the treatment. The Commission referred to a Supreme Court judgment supporting this stance. Therefore, Point 1 was answered against the complainant, and the complaint against the Rajaji Government Hospital was deemed dismissed.

Upon examining the records, the Commission observed that it was evident that the doctors conducted proper pre-operative investigations before the surgery. The Commission emphasized the importance of pre-operative assessment to ensure the patient’s fitness for surgery, identify potential issues, and guarantee patient safety. However, the Commission agreed with the complainant’s argument that the doctors failed to conduct an MRI scan to assess the patient’s condition before the surgery. The Commission deemed the failure to perform pre-operative investigations, including an MRI scan for assessing abdominal adhesions, as gross negligence and a deficiency in service on the part of the physcians. It noted;

“We are of the view that pre-operative assessment is necessary prior to surgical procedures, in order to ensure that the patient is fit to undergo surgery, to highlight issues that the surgical or anaesthetic team need to be aware of during the peri-operative period, and to ensure patients’ safety during their journey of care. In addition, unnecessary complications due to inappropriate surgery may be avoided. In the above circumstances we find force in the contention of the complainant that the opposite parties 1 to 4 have failed to take MRI scan to assess the condition of the patient prior to performing the surgery. We are of the considered view that non-carrying out of pre-operative investigations including MRI Scan for assessing abdominal adhesions in the case in hand amount to gross negligence coupled with deficiency in service on the part of the 2nd and 3rd opposite party.”

The complainant asserted that the Shri andal Hospital failed to provide medical records while referring his wife to the Government Hospital, Madurai, presenting only a referral letter. Referring to a judgment by the HON’BLE NATIONAL COMMISSION, the Commission agreed that non-provision of case sheets is a negligent act. It observed;

“We are of the view that the 1st opposite party act of not providing the case sheet to the complainant at the time of discharging the patient with referral to Government Hospital is an negligent act.”

The complainant argued the case as res ipsa loquitor, citing medical records obtained from the 5th Rajaji Government Hospital. The HON’BLE MADRAS HIGH COURT supports this argument, emphasizing the onus on the medical professionals to prove non-negligence.

The Commission concluded that the Shri Andal Hospital, the physicians and the surgeon failed to discharge their burden, and the complainant was entitled to compensation for careless and negligent treatment. It noted;

“The opposite parties 1 to 4 have failed to discharge their burden on the facts and circumstances of the present case and therefore the complainants are entitled compensation for the damages for the careless and negligent treatment. In auxiliary in the case in hand the complainant had proved and established his case by filing proof affidavit and marking requisite documents and in the absence of any evidence in contra being produced and placed before us by the opposite parties 1 to 4 are inclined to accept the case of the complaint that the opposite parties 1 to 4 are guilty of gross negligence and deficiency in service. Accordingly we answer Point 2 in favour of the complainant.”

The complainant contended that the negligent and nonchalant actions of the Shri Andal Hospital and physicians, lacking professional ethics, resulted in the death of his wife, causing immense mental agony to the family. The Consumer Commission acknowledged that compensation is warranted upon proof of loss or injury due to negligence. It noted;

“In the case in hand negligent act and utter lack of devotion to duty and nonchalant attitude of the opposite parties 1 to 3 in observing even minimum professional ethics and principles had resulted in death of the complainant’s wife which would have definitely resulted in caused acute mental agony, pain and anguish to the complainant and his family members posing a great question mark of the entire family’s future.”

It emphasized the need for a fair, reasonable, and commensurate compensation, considering all relevant factors and following established legal principles. The Commission asserted its duty to assess compensation based on the individual circumstances of each case and the proven loss suffered by the consumer.

In light of established medical negligence leading to the complainant’s loss of his wife, aged around 39 years, the Consumer Commission deemed a compensation of Rs. 10,00,000/- just and fair. The hospital (1st opposite party) was held vicariously liable for the acts of negligence by the treating doctors (opposite parties 2 to 4). Therefore, the 1st opposite party was directed to pay Rs. 10,00,000/- as compensation and Rs. 10,000/- as the cost of the complaint. The complaint against the 5th opposite party was dismissed. The Commission held;

“It is well established that a hospital is vicariously liable for the acts of negligence committed by the doctors engaged or empanelled to provide medical care. It is common experience that when a patient goes to a hospital, he/she goes there on account of the reputation of the hospital, and with the hope that due and proper care will be taken by the hospital authorities. If the hospital fails to discharge their duties through their doctors, being employed on job basis or employed on contract basis, it is the hospital which has to justify the acts of commission or omission on behalf of their doctors. Accordingly, we hold the 1st opposite party to be vicariously liable for the acts of omission and commission committed by the opposite parties 2 to 4 and therefore the 1st opposite party is liable to pay compensation the compensation of Rs. 10,00,000/- to the complainant.”

The hearing took place on November 8, 2023, with legal representation on both sides, while the order was pronounced on November 14, 2023, by the Commission President M. Piraviperumal and Member-I P. Shanmugapriya.

To view the original order, click on the link below:

https://medicaldialogues.in/pdf_upload/rs-10-lakh-compensation-jharkhand-231771.pdf

Powered by WPeMatico

Sarcopenia prevalence high among hemodialysis patients, quadriceps muscle ultrasound may detect

Sarcopenia prevalence is high among hemodialysis patients, and quadriceps muscle ultrasound may detect suggests a new study published in the BMC Nephrology.

Sarcopenia is a common problem in hemodialysis (HD) patients, and it is diagnosed by low muscle mass, strength and/or low physical performance. Muscle ultrasound (US) is a non-invasive portable tool that might be used for the assessment of muscle mass. The current study aimed to investigate the concordance between muscle US and bioelectrical impedance analysis (BIA) in the diagnosis of sarcopenia in hemodialysis patients. This cross-sectional study included 41 hemodialysis patients. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP). The skeletal mass index was measured by BIA and the muscle strength was measured by handgrip strength. Muscle ultrasound was used to measure the cross-sectional area (CSA) and thickness of the quadriceps and biceps muscles. Results: The current study included 41 patients on hemodialysis (25 males), with a mean (SD) age of 44.18 (13.11) years and a median hemodialysis duration of 48 months. Sarcopenia was diagnosed in 58.5% of the patients. Patients with sarcopenia had significantly lower quadriceps muscle CSA than those without sarcopenia. The optimal cut-offs of quadriceps muscle cross-sectional area for both males and females for the diagnosis of sarcopenia were 2.96 and 2.92 cm2, respectively. Sarcopenia is prevalent among Egyptian hemodialysis patients. Muscle ultrasound on the quadriceps muscle cross-sectional area could be used for the diagnosis of sarcopenia in these patients.

Reference:

Nagy, E., Samaan, E., El-Gamal, M. et al. Concordance between muscle mass assessed by bioelectrical impedance analysis and by muscle ultrasound: a cross-sectional study in a cohort of patients on chronic hemodialysis. BMC Nephrol 25, 49 (2024). https://doi.org/10.1186/s12882-024-03487-0

Keywords:

Sarcopenia, prevalence, hemodialysis patients, quadriceps, muscle ultrasound, detect, BMC Nephrology, Nagy, E., Samaan, E., El-Gamal, M, Chronic kidney disease

Powered by WPeMatico

Strong mechanism must be in place at AIIMS Selection Committee to protect interests of SC, ST candidates: Parliamentary Panel

New Delhi: Raising concerns regarding bias faced by the SC/ST candidates at All India Institute of Medical Sciences (AIIMS) Delhi, a Parliamentary Committee on Welfare of Scheduled Castes and Scheduled Tribes tabled its report in the Lok Sabha recently.

As per the panel, headed by Lok Sabha MP Dr Kirit Premjibhai Solanki, several candidates belonging to the SC/ST category were “deliberately declared ‘not suitable’ because of wrong biased assessment by the Selection Committee just to deprive SC/ST candidates of their legitimate rights to be part of faculty member.”

To address this issue, the panel has suggested setting up a Selection Committee comprising primarily of SC/ST experts and Chairman. “Following this process, induction of the SC/ST suitable candidates will be seen apparently at all positions of the faculty,” the panel mentioned in its report.

“The Committee are of the considered view that members from SC/ST community should be mandatorily included in the Selection Committee in order to provide representation and to participate in policies being framed to enhance the prospects of SC/ST employees in AIIMS,” the panel mentioned in its report.

The panel highlighted that as per the data submitted by the Union Health Ministry, back in 2018, 19 posts were unfilled due to “candidates not being found suitable”.

Declining to accept the frequently “stereo-type reply” of the Government that “no sufficient number of suitable candidate could be found”, the panel observed that “This is in fact not a correct picture of assessment of the SC/ST candidates who are equally bright and deserving. But they are deliberately declared as ‘not suitable’ because of wrong biased assessment by the Selection Committee just to deprive SC/ST candidates of their legitimate rights to be part of faculty member.”

It was observed by the panel that this vital issue can be addressed in a right direction by constituting a Selection Committee comprising primarily of SC/ST experts and Chairman. Following this process, induction of the SC/ST suitable candidates will be seen apparently at all positions of the faculty.

Noting that there is negligible presece or no presence of SC and ST members in the Standing Selection Committee/Board of AIIMS, New Delhi, the panel opined that this deprives “deprive SCs/STs to be part of the decision making process and policy matters specially with regard to selection/recruitment processes and also in helping and protecting the interests of SCs and STs in recruitment matters.”

“The Committee is of the opinion that a robust recruitment mechanism need to be in place to ensure that the interest of the socially and economically backward section are safeguarded viz. constitution of a Selection Committee comprising primarily of SC/ST experts or mandatorily inclusion of members belonging to SC/ST Community in the Standing Selection Committee. The Committee are of the firm view that following this process, induction of the suitable SC/ST candidates will be seen apparently at all positions of the faculty posts. The Committee expect AIIMS, New Delhi to take concrete steps in this regard, if needed, through amendment in AIIMS Act which will henceforth include members belonging to SC/ST Community in the Standing Selection Committee/Board. The reply of the Government stating that a provision is already in place for selections/recruitments as laid down in AIIMS Act is not acceptable to the Committee. The Committee, strongly reiterate their earlier recommendation that a strong mechanism must be in place at the Selection Committee level to protect the interests of SC/ST candidates in an objective manner during the recruitment processes,” the panel mentioned in its report.

It has also been mentioned by the panel in its report that in the future after filling up all the existing vacant positions, no faculty seat reserved for SC/ST shall be kept vacant for more than six months under any circumstances.

To view the Parliamentary Panel report, click on the link below:

https://medicaldialogues.in/pdf_upload/parliamentary-panel-sc-st-232024.pdf

Also Read: 30 percent sanctioned posts of doctors, paramedical staff in CGHS vacant: Parliamentary Panel

Powered by WPeMatico

Laryngopharyngeal reflux highly High prevalent among patients experiencing persistent hoarseness of voice, reveals study

India: A recent study published in the Indian Journal of Otolaryngology and Head & Neck Surgery suggests considering laryngopharyngeal reflux disease (LPRD) in patients presenting with voice hoarseness for more than three weeks.

The study unveiled a notable association with gender (70.3% female), age (41–50 years), & severity of voice use, with hoarseness identified as the most prevalent symptom. The findings encourage using easily applicable Koufmann Reflux Symptom Index & Reflux Finding Scores in routine assessments.

Laryngopharyngeal reflux is the backflow of gastric contents into the laryngopharynx where it comes in contact with the tissues of the upper aerodigestive tract. It concerns 4 to 10 % of patients who seek Ear Nose Throat (ENT) consultation and 1 % of patients in primary care practice. The most common symptoms reported are throat clearing, globus sensation, and voice disorders such as hoarseness.

Kirubhagaran Ravichandran, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Pondicherry, India, and colleagues aimed to evaluate the presence of laryngopharyngeal reflux in patients with voice disorders thereby aiding in the early management and improving the quality of life.

For this purpose, the researchers conducted a cross-sectional study at a tertiary care hospital, including patients with a history of voice change for more than three weeks. The patients were divided into four groups based on the level of voice use.

Patients were asked to fill Koufmann Reflux Symptom Index questionnaire followed by a video laryngoscopy. The findings were plotted according to the Reflux Finding Score. The impact of LPRD in patients with voice disorders was analysed based on the scoring.

The key findings of the study were as follows:

· Among the 90 study participants, 82.2% were found to have LPRD. The mean age was 42.76 ± 10.33 years.

· Majority (43.2%) belong to the age group of 41–50 years, with female predominance (70.3%).

· Majority (41.9%) of them were level IV voice users.

· 59.5% were positive Koufman reflex symptom index, and 67.6% were positive Reflex finding score.

· Hoarseness (58.1%) was the most common symptom.

The findings have brought to light a high prevalence of laryngopharyngeal reflux disease in patients experiencing persistent voice disorders.

“Simple and highly reproducible scores like Reflux Finding Score and Reflux Symptom Index have proven useful and valuable tools in LPRD diagnosis, thereby aiding in early diagnosis and prompt management and improving the patient’s quality of life,” the researchers wrote.

Reference:

Padmanabhan, K., Ravichandran, K. & Sivanand, N. Impact of Laryngopharyngeal Reflux in Patients with Voice Disorders. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04541-x

Powered by WPeMatico

Antibody Combo Evusheld Fails to show Impressive results in COVID-19 Trial

In the Phase 3 DISCOVERY European trial, although there was a considerable rise in neutralizing antibodies against SARS-CoV-2 at days 3 and 8, Evusheld monoclonal antibody combination drug failed to exhibit significant improvements in the clinical status of hospitalized COVID-19 patients or accelerated viral clearance.

The findings of this clinical trial were reported in a research letter published in the Journal of Infection. The trial involved 399 participants, 214 of whom were administered Evusheld, a combination of tixagevimab and cilgavimab (T-C) monoclonal antibodies (mABs).
A previous study, ACTIV-3-TICO, showed a significant reduction in mortality at day 15 in patients who received Evusheld as an intramuscular injection.
In the current trial, no significant differences in mortality or hospitalization were observed between the participants who were administered Evusheld and those who received standard care (not remdesivir) despite the absence of any major safety events or increased cardiovascular risks, as reported by researchers.
The ACTIV-3-TICO trial primarily enrolled participants infected with the Delta variant, while the DisCoVeRy trial had a substantially higher proportion of patients infected with the Omicron variant, at 40%. Despite the Omicron variant’s greater evasiveness to vaccines and therapeutic monoclonal antibodies, including T-C, as demonstrated by in-vitro neutralization assays, it is generally considered less virulent than prior variants, such as Delta. However, the high mortality rate of 15% observed at day 90 in our trial and the significant morbidity described by Kamboj et al. highlight that many patients who did require hospitalization were still at risk of dying, they said.
According to the researchers, the discrepancy observed between the ACTIV trial and DISCOVERY may be attributed to the presence of variants. Notably, the Omicron variant caused 40% of COVID-19 infections in the DISCOVERY trial, whereas the ACTIV trial occurred primarily during the Delta variant’s prevalence.
In the ambulatory setting, when ancestral strains of the virus were circulating, a study called TACKLE found that administering intramuscular T-C to treat SARS-CoV-2 infections significantly reduced the likelihood of hospitalization and death in high-risk patients compared to a placebo.
The Omicron variant of SARS-CoV-2 and its various sub-lineages have demonstrated a greater ability to evade vaccines and therapeutic monoclonal antibodies (mABs), such as T-C, compared to the ancestral strain or Delta variant.
Reference:
Maya Hites et al. Tixagevimab-cilgavimab (AZD7442) for treating patients hospitalized with COVID-19 (DisCoVeRy): a phase 3, randomized, double-blind, placebo-controlled trial. Journal of Infection. Published: February 15, 2024

Powered by WPeMatico