Rs 18k stipend granted for FMGs in Maharashtra, similar benefits demanded across India

Mumbai: Granting major relief to the Foreign Medical Graduates (FMGs) undergoing internship in the State, the Maharashtra Government has decided to give them Rs 18 thousand as a monthly stipend.

Pointing out that Maharashtra is the third State across India to grant such a favour to the FMGs, the medical graduates from abroad are demanding that other States/UTs across the country should also follow suit.

Lauding the move, the National Convenor and the Former State President for Maharashtra, All India Medical Students Association- Foreign Medical Students Wing (AIMSA-FMSW), Dr. Apurv Dalvi told Medical Dialogues, “Since 15-20 years, students have been going abroad from various States of India. Till now, no stipend was being paid to the students undergoing Internship. NMC published the FMGL Regulations in 2021. Maharashtra is the third State from India to declare the Stipend for the FMGs.”

He further added that “Until 2021, students had to pay certain amount of fees to the Government and the respective authorities to do the internship. Now, Maharashtra Government is implementing the NCM rules and therefore, the students do not have to pay any Internship fees. Further, the State has also granted Rs 18 thousand as stipend to the FMGs.”

Welcoming the decision, Dr. Dalvi highlighted the issues faced by the FMGs, and said, “Students going abroad face many problems. They go abroad, far away from their home. After coming back and obtaining a degree from the foreign institute, they have to clear the screening test and again undergo a year of internship.”

He stressed the fact that all the students going abroad to pursue medical education are equivalent to Indian medical graduates and opined “This decision should have taken much earlier. Nevertheless, the State Government of Maharashtra has declared the decision. This is not only positive news for the students in Maharashtra, but also for the FMGs belonging to different States across India.”

Also Read: FMG internship in India: NMC releases clarification on CRMI, check out details

The association is now demanding that similar benefits should be extended to the FMGs belonging to other States across India as well. Commenting on the matter, Dr. Dalvi added, “FMGs belonging to major States like Rajasthan, Gujarat, Delhi, southern States including Tamil Nadu, Kerala, Karnataka, Madhya Pradesh, are undergoing internship without any stipend. So, on behalf of the association, we are planning to raise the issue to the respective State Governments.”

Medical Dialogues had earlier reported that the decision to grant stipends to FMGs was taken by the Maharashtra Government recently when it sanctioned a substantial raise in the monthly stipend for the MBBS intern doctors from the Government Medical Colleges in the State. As per the decision, which was finalized during a cabinet meeting under the leadership of Chief Minister Eknath Shinde, the stipend of MBBS interns in the GMCs has been increased from Rs 11,000 to Rs 18,000.

Along with increasing the stipend for the Indian Medical Students undergoing internship, the State also decided to extend the benefit to the FMGs also, who have completed their MBBS outside India and are interning in the GMCs in Maharashtra upon their return.

What do the rules say?

Medical Dialogues had reported back in 2022 that providing major relief to the FMGs who want to pursue Internship in India, NMC had clarified that the Indian medical colleges shall not charge any fees from the medical graduates from abroad for permitting them to do Internship in India.

NMC had further clarified that the FMGs would also be paid equal stipend and other facilities just like the Indian Medical Graduates who are being trained at Government Medical Colleges. However, last year, the matter was once again addressed by NMC, which issued a clarification regarding the conduct of internships for medical graduates from abroad.

Issuing a circular in this regard on May 9, 2023, the President of UG Medical Education Board (UGMEB), Dr. Aruna V Vanikar addressed several issues including important provisions under CRMI Regulations 2021 for the FMGs, validation for Online study by Commission, applicability of NMC Public notice dated 28.07.2022 on FMGs, requirement of Domicile by FMGs for internship, completion of Internship by FMGs in parts at hospitals and medical colleges, issue concerning payment of stipend to FMGs, and one-time relaxation to Foreign Medical Graduates to complete internship.

Referring to the issue of stipend, NMC had mentioned, “However, considering the requests/representations from various State Governments/UTs/medical colleges wherein it was intimated that there has been no budgetary provision in their allocation of annual budget to provide stipend to Foreign Medical Graduates, the Commission vide circular dated 19.10.2022 has already clarified that the amount of stipend to be paid to the interns is to be decided/fixed by the appropriate authority applicable to the Institution/University or State. The implementation of these guidelines/instructions/advisory is solely at the discretion of the concerned State authorities under which the medical college/institute is located.”

Meanwhile, the issue of internships for FMGs is being considered by the Supreme Court, which recently issued notices on a plea filed by FMGs challenging the non-payment of stipend during the compulsory internship.

While considering the plea by the medical graduates from abroad, who are undergoing internship at Atal Bihari Vajpayee Government Medical College, Vidisha, the top court bench comprising Justices B.R. Gavai and Sandeep Mehta issued notice on January 23.

The plea has been tagged with the case titled Abhishek Yadav & Ors. vs. Army Medical College & Ors. (W.P. (C) No. 730/2022). While considering this above-mentioned case, the Supreme Court had taken cognisance of the fact that 70 percent of the medical colleges across the country do not pay any stipend or are not paying the minimum stipend to doctors who are doing MBBS internships.

Also Read: FMGs challenge Non-Payment of Stipend, Supreme Court Issues Notice

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Medical Bulletin 17/February/2024

Here are the top medical news for the day:

Research produces new antibiotic-resistant to bacterial resistance

Researchers at the University of Illinois Chicago and Harvard University have created an antibiotic that could provide medicine with a fresh tool to combat drug-resistant bacteria and their associated diseases.

Published in Nature Chemical Biology, the antibiotic, Cresomycin, effectively suppresses pathogenic bacteria that have become resistant to many commonly prescribed antimicrobial drugs.

The UIC scientists focused on how many antibiotics interact with a common cellular target – the ribosome – and how drug-resistant bacteria modify their ribosomes to defend themselves. Their critical insights into cellular mechanisms and structure aided Harvard researchers in designing and synthesizing new drugs, including the development of the new antibiotic.

More than half of all antibiotics inhibit growth of pathogenic bacteria by interfering with their protein biosynthesis – a complex process catalyzed by the ribosome. Antibiotics bind to bacterial ribosomes and disrupt this protein-manufacturing process, causing bacterial invaders to die.But many bacterial species evolved simple defences against this attack. In one defense, they interfere with antibiotic activity by adding a single methyl group of one carbon and three hydrogen atoms to their ribosomes.

By using a method called X-ray crystallography to visualize drug-resistant ribosomes with nearly atomic precision, scientists discovered two defensive tactics. The methyl group, they found, physically blocks the binding site, but it also changes the shape of the ribosome’s inner “guts,” further disrupting antibiotic activity.

“By determining the actual structure of antibiotics interacting with two types of drug-resistant ribosomes, we saw what could not have been predicted by the available structural data or by computer modelling,” said Yury Polikanov, associate professor of biological sciences at UIC, and colleagues at Harvard.

Cresomycinis synthetic. It’s preorganized to avoid the methyl-group interference and attach strongly to ribosomes, disrupting their function. This process involves locking the drug into a shape that is pre-optimized to bind to the ribosome, which helps it get around bacterial defenses.

“It simply binds to the ribosomes and acts as if it doesn’t care whether there was this methylation or not,” Polikanov said. “It overcomes several of the most common types of drug resistance easily.”

“Without the structures, we would be blind in terms of how these drugs bind and act upon modified drug-resistant ribosomes. The structures that we determined provided fundamental insight into the molecular mechanisms that allow these drugs to evade the resistance.” concluded Polikanov.

Reference: DOI: 10.1126/science.adk8013

Regulating telomerase activity

The natural ends of chromosomes resemble broken DNA, posing a challenge in distinguishing them from intact strands. However, every cell must differentiate between the two, as the best method to safeguard the healthy end of a chromosome is also the least effective way to mend damaged DNA.

The enzyme telomerase is responsible for maintaining protective telomeres at the natural ends of chromosomes. If telomerase were to seal off a broken strand of DNA with a telomere, it would prevent further repair of that break and delete essential genes. The study published in Science describes how cells avoid such mishaps. These findings show that telomerase can indeed run amok, adding telomeres to damaged DNA, and would do so were it not for the ATR kinase, a key enzyme that responds to DNA damage.

“Telomerase is a good thing because it maintains our telomeres, but it should only be acting at the natural ends of chromosomes. It is very bad if it acts at double-stranded DNA breaks because it can lead to the loss of all genes distal to the break,” says Titia de Lange, the Leon Hess professor at Rockefeller. “This detrimental aspect of telomerase is inhibited by the ATR kinase, which, among its many talents, also keeps telomerase away.”

The discovery may help optimize CRISPR techniques and could inform the study of cancer.

Charles Kinzig, an MD/PhD student in the de Lange lab and colleagues first broke bits of human DNA with Cas9, the cutting component of the CRISPR gene-editing tool, and established that telomerase creates “neotelomeres” on broken DNA. Having established telomerase as driving the formation of neotelomeres, Kinzig then began interrogating various molecular pathways to determine what prevents telomerase from interfering with DNA repair under normal circumstances and found that disrupting ATR kinase signaling increases neotelomere formation and demonstrated that when ATR is activated at DNA breaks, it prevents telomerase from ruining the repair.

Thefindings have immediate implications for researchers and clinicians involved in CRISPR gene editing and that telomerase can add telomeric DNA to the DNA ends made during CRISPR editing. This could potentially lead to insertion of telomeric DNA or formation of a telomere at the site where CRISPR editing was intended.

Reference: DOI: 10.1126/science.adg3224

A protein-packed breakfast enhances both satiety and concentration

A recent study from Denmark investigates the connection between diet and cognitive abilities, demonstrating that a breakfast high in protein can enhance feelings of fullness and boost concentration.

“Breakfast is the most important meal of the day.” This is a well-known platitude that has never had much basis in scientific evidence.

The study monitored 30 obese women aged 18 to 30 for three days, during which the women consumed a protein-rich breakfast, a carbohydrate-rich breakfast or no breakfast at all. The women’s sense of satiety, hormone levels and energy intake were measured at lunchtime along with their total daily energy intake.Theywere also required to complete a cognitive concentration test during the study.

“We found that a protein-rich breakfast with skyr (a sour-milk product) and oats increased satiety and concentration in the participants, but it did not reduce the overall energy intake compared to skipping breakfast or eating a carbohydrate-rich breakfast,” says Mette Hansen, associate professor and PhD at the Department of Public Health, and one of the authors of the study.

Previous research hasindicated that individuals who consume breakfast tend to have a lower BMI compared to those who skip it. Additionally, protein-rich foods typically exhibit a greater satiety effect in comparison to carbohydrate-rich and high-fat foods with equivalent calorie content.

“The results confirm that protein-rich meals increase a sense of satiety, which is positive in regard to preventing weight gain. However, the results also suggest that for this nutritional strategy to be effective, it’s not enough to just eat a protein-rich breakfast.” concluded the research.

Reference: DOI: 10.3168/jds.2023-24152

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UP Govt launches mass drug administration in 17 districts to eradicate filariasis

Lucknow: In a battle against filariasis, the Uttar Pradesh government has initiated a door-to-door administration of anti-filarial medications across several districts as part of the Mass Drug Administration (MDA) campaign.

The Yogi Adityanath government has set an ambitious target to eradicate filariasis from the state by 2026, aligning with the Central government’s goal to achieve nationwide elimination by 2027. Globally, the target for eliminating this disease has been set for 2030. 

The initiative aims to reach every household in the state in the battle against the debilitating disease.

Also Read:UP Govt allocates Rs 27k crores to boost health sector

As a result of effective monitoring by Chief Minister Adityanath, within the first four days of the door-to-door campaign itself, about 20 per cent of people have taken the medicine. This campaign will run until February 28, an official statement noted.

Simultaneously, identified patients receive specialised training and support through the Morbidity Management and Disability Prevention (MMDP) programme. Those with mild infections benefit from a regimen of regular medication and exercise, facilitating their continuous recovery.

Chief Minister Yogi Adityanath has urged the healthcare teams not only to distribute the medication but also to educate the populace, emphasising the importance of awareness in achieving the campaign’s goals.

Since he assumed office in 2017, Yogi Adityanath has embarked on a crusade against numerous serious diseases prevalent in the state. His proactive stance has led to a significant turnaround, with Uttar Pradesh being now free from many diseases that once afflicted its populace, the statement added.

In various districts across the state, alongside receiving anti-filarial medication, people are actively seeking to enhance their understanding of this disease.

Communities in areas such as Amethi, Azamgarh, Ballia, and Barabanki have displayed keen interest in learning about the potential side effects of the medication.

According to the statement, the health teams are assuring the populace that the anti-filarial medication is entirely safe, despite occasional symptoms like headache, body pain, fever, vomiting, rashes, and itching, which typically subside on their own. They emphasise the importance of consuming the medication after a meal to maximize its effectiveness and minimise any discomfort.

In areas like Lucknow, Unnao, Shahjahanpur, Bareilly, and Hamirpur, initial hesitancy towards taking the medication has been observed among some individuals. However, after receiving information from the health teams, many have willingly come forward to receive the treatment.

State Program Officer for Filariasis Ramesh Singh Thakur said that the MDA campaign aims to administer medication to a total of 3,60,25,891 individuals.

Filariasis, commonly known as elephantiasis, is a chronic and incurable disease that severely impacts the lymphatic system. This intricate network of vessels, organs, and specialised cells is profoundly impacted by filariasis infection, with symptoms often manifesting 10-15 years after contraction.

Concealing symptoms can exacerbate the condition, making it imperative to seek timely assistance from Ayushman Arogya Mandir or government health centres to access the array of benefits extended by the Yogi government’s progressive schemes.

Currently, there are 51 districts in the state grappling with filariasis. The ongoing campaign is operational in 17 of these districts.

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Understanding Rheumatoid Arthritis and its Impact on Knee Joints – Dr Pramod Bhor

While arthritis is difficult, rheumatoid arthritis is debilitating. As opposed to typical wear-and-tear arthritis, RA is an autoimmune disease in which your body’s immune system unintentionally attacks your joints, especially your knees.
Consider it as a friendly fire that causes discomfort, stiffness, edema, and suffering. Over time, RA can have a substantial impact on your knees. Prolonged inflammation damages bones and cartilage, making daily tasks difficult and lowering your quality of life.
Orthopedic surgery in patients with inflammatory rheumatic diseases (IRD) historically represents a challenge for clinicians and orthopedic surgeons. The prevalence of IRD ranges from 0.05% to 1% in the general population, with many patients that need a surgical treatment such as total joint arthroplasty (TJA) because of articular degeneration.
When is surgery the right choice?
While non-surgical treatments prove effective for many RA patients, sometimes joint damage is extensive, requiring more intensive solutions.
In such cases, knee replacement surgery for rheumatoid arthritis becomes a viable option. TJA in IRD is a challenge for surgeons, whose responsibility is to choose the most effective and less invasive technique for these patients.
Challenges in TKR for RA Patients
1)Disease Influence on Surgery: RA complications, such as joint deformity and inflammation, may present challenges in performing the surgery and affect recovery.
2) Risk of Infection and Implant Failure: RA patients undergoing TKR face a higher risk of infection and implant failure due to the underlying disease and potential immune system compromise.
3) Long-term Joint Management: Continuous monitoring and management of RA after TKR is essential to prevent disease-related joint complications in the future.
Advantages of Robotic Knee replacement: Because robotic surgery delivers a level of precision that surpasses that of human vision, it is more accurate than traditional surgery. This makes it possible for the leg to align more correctly and for the soft tissue surrounding the knee to balance out.
As fewer tissues are damaged during minimally invasive incisions used in robotic-assisted surgery, the process is safer. Less scarring, a decreased chance of infection, shorter hospital stays, and quicker healing are further outcomes of this.
All things considered, robotic knee replacement surgery has been demonstrated to produce superior outcomes, less stress to the surrounding tissue and bone, and better patient outcomes when compared to traditional knee replacement surgery.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Hitchhiking cancer vaccine makes progress in the clinic

Therapeutic cancer vaccines are an appealing strategy for treating malignancies. In theory, when a patient is injected with peptide antigens—protein fragments from mutant proteins only expressed by tumor cells—T cells learn to recognize and attack cancer cells expressing the corresponding protein. By teaching the patient’s own immune system to attack cancer cells, these vaccines ideally would not only eliminate tumors but prevent them from recurring.

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Study finds neoadjuvant chemotherapy significantly improves outcomes for penile squamous cell carcinoma patients

Penile squamous cell carcinoma is a rare malignancy with limited treatment options and poor prognosis, especially in advanced stages. Because of its rarity, few studies focus on better understanding and managing this disease.

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New study analyzes link between digit ratio and oxygen consumption in soccer players

The efficiency of oxygen supply to tissues is a factor in the severity of important diseases such as COVID-19 and heart conditions.

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Study finds Moderna vaccine reduces symptomatic COVID-19 in young adults

The COVID-19 pandemic spurred the rapid development of different vaccines, including the messenger RNA (mRNA)-1273 vaccine produced by Moderna.

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Trial data underpins FDA approval of omalizumab for food allergy

Today’s Food and Drug Administration approval of a supplemental biologics license for the monoclonal antibody omalizumab (Xolair) highlights the vital role of the National Institutes of Health-supported research that underpins the FDA decision.

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AstraZeneca Tagrisso with chemotherapy approved in US for EGFR-mutated advanced lung cancer

Cambridge: AstraZeneca’s Tagrisso (osimertinib) with the addition of chemotherapy has been approved in the US for the treatment of adult patients with locally advanced or metastatic epidermal growth factor receptor-mutated (EGFRm) non-small cell lung cancer (NSCLC).

The approval following a Priority Review by the Food and Drug Administration (FDA) was based on the results from the FLAURA2 Phase III trial published in The New England Journal of Medicine. Tagrisso with the addition of chemotherapy reduced the risk of disease progression or death by 38% compared to Tagrisso monotherapy which is the 1st-line global standard of care (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.49-0.79; p<0.0001). Median progression-free survival (PFS) by investigator assessment was 25.5 months for patients treated with Tagrisso plus chemotherapy, an 8.8-month improvement versus Tagrisso monotherapy (16.7 months).

PFS results from blinded independent central review (BICR) were consistent with the results by investigator assessment, showing 29.4 months median PFS with Tagrisso plus chemotherapy, a 9.5-month improvement over Tagrisso monotherapy (19.9 months) (HR 0.62; 95% CI 0.48-0.80; p=0.0002).

Each year in the US, there are over 200,000 people diagnosed with lung cancer, and 80-85% of these patients are diagnosed with NSCLC, the most common form of lung cancer. Approximately 70% of people are diagnosed with advanced NSCLC. Additionally, about 15% of NSCLC patients in the US have an EGFR mutation.

Pasi A. Jänne, MD, PhD, medical oncologist at Dana-Farber Cancer Institute and principal investigator for the trial, said, “This approval based on the unprecedented data from FLAURA2 brings a critical new treatment option to patients with advanced EGFR-mutated non-small cell lung cancer. Now, with the choice of two highly effective osimertinib-based options, physicians can better tailor treatment to an individual’s needs and help ensure the best possible outcome for each patient.”

Dave Fredrickson, Executive Vice President, Oncology Business Unit, AstraZeneca, said, “This important new treatment option can delay disease progression by nearly nine additional months, establishing a new benchmark with the longest reported progression-free survival benefit in the 1st-line advanced setting. This approval reinforces Tagrisso as the backbone of EGFR-mutated lung cancer treatment either as monotherapy or in combination with chemotherapy. This news is especially important for those with a poorer prognosis, including patients whose cancer has spread to the brain and those with L858R mutations.”

Laurie Ambrose, President and CEO, GO2 for Lung Cancer, said, “We are so excited to see this continued progress advancing more personalized treatment options for our community. The more we can target the right treatments for the right people at the right time, the better outcomes will be for our community – a goal we all collectively share.”

Results from a prespecified exploratory analysis of patients in the FLAURA2 trial with brain metastases at baseline showed Tagrisso plus chemotherapy reduced the risk of central nervous system (CNS) disease progression or death by 42% compared to Tagrisso alone (HR 0.58; 95% CI 0.33-1.01) as assessed by BICR. With two years of follow up, 74% of patients treated with Tagrisso plus chemotherapy had not experienced CNS disease progression or death versus 54% of patients treated with Tagrisso monotherapy.

While the overall survival (OS) results remained immature at the second interim analysis (41% maturity), no trend towards a detriment was observed (HR 0.75; 95% CI 0.57-0.97). The trial continues to assess OS as a key secondary endpoint.

The safety profile of Tagrisso with the addition of chemotherapy was generally manageable and consistent with the established profiles of the individual medicines. Adverse event (AE) rates were higher in the Tagrisso plus chemotherapy arm, driven by well-characterised chemotherapy-related AEs. Discontinuation rates for Tagrisso due to AEs were low in both arms of the trial (11% for Tagrisso plus chemotherapy and 6% for monotherapy).

In December 2023, osimertinib (Tagrisso) with the addition of chemotherapy was added to the NCCN Clinical Practical Guidelines in Oncology (NCCN Guidelines) as a NCCN Category 1 Other Recommended regimen for patients with NSCLC whose tumours have EGFR exon 19 deletion or exon 21 L858R mutations based on the data from FLAURA2.

The US regulatory submission was reviewed under Project Orbis, which provides a framework for concurrent submission and review of oncology medicines among participating international partners. As part of Project Orbis, Tagrisso in combination with chemotherapy is also under review by regulatory authorities in Australia, Canada, and Switzerland. Regulatory applications are also under review in several other countries based on the FLAURA2 results.

Tagrisso is approved as monotherapy in more than 100 countries including in the US, EU, China and Japan. Approved indications include for 1st-line treatment of patients with locally advanced or metastatic EGFRm NSCLC, locally advanced or metastatic EGFR T790M mutation-positive NSCLC, and adjuvant treatment of early-stage EGFRm NSCLC.

“As part of AstraZeneca’s ongoing commitment to treating patients as early as possible in lung cancer, Tagrisso is also being investigated in the neoadjuvant setting in the NeoADAURA Phase III trial with results expected later this year, and in the early-stage adjuvant resectable setting in the ADAURA2 Phase III trial,” the release stated.

Read also: AstraZeneca, BioInvent ink pact to evaluate BI-1206 in combo with rituximab, Calquence

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