Breakthrough Treatment Offers Hope for Electrical Storm Patients

In
a groundbreaking effort to address the clinical emergency posed by electrical
storms (ES) and the scarcity of effective treatments, researchers have unveiled
compelling findings from the STAR study, a multicenter observational
investigation. The study focused on the potential efficacy and safety of
percutaneous stellate ganglion block (PSGB) as a novel intervention for ES,
refractory to standard treatments. The results, spanning the period from July
1, 2017, to June 30, 2023, present a ray of hope for patients grappling with
this challenging condition.

The
study results were published in the European Heart Journal.

Electrical
storms, characterized by three or
more episodes of ventricular arrhythmias or ventricular fibrillation (VF),
represent a critical clinical scenario with limited established therapeutic
options. Initial reports on PSGB hinted at its safety and effectiveness, but
questions lingered, prompting the need for a comprehensive study. The STAR
study aimed to fill this void, shedding light on the potential of PSGB as a
viable intervention for ES.

Conducted
as a multicenter observational study, STAR enrolled 131 patients from 19
centers, all experiencing ES refractory to standard treatments. The primary
focus was on assessing the reduction of treated arrhythmic events by at least
50%, comparing the 12 hours following PSGB with the 12 hours preceding the
procedure. Operators underwent specialized training for both the anterior
anatomical and lateral ultrasound-guided approaches.

Key
Findings:

  • The results of the STAR study are nothing short of promising.
  • Among the 184 PSGB procedures conducted, 92% of patients achieved the primary outcome, showcasing a significant reduction in arrhythmic events.
  • The median reduction of arrhythmic episodes between 12 hours before and after PSGB was an impressive 100%, underscoring the potential efficacy of this intervention.
  • Importantly, arrhythmic episodes requiring treatment exhibited a noteworthy decline, with a statistically significant difference observed between the 12 hours before the first PSGB and the 12 hours after the last procedure.
  • The reduction continued when comparing 1 hour before and 1 hour after each procedure, emphasizing the sustained impact of PSGB.
  • Moreover, the study reported a low incidence rate of one major complication, emphasizing the safety profile of the intervention.

The
STAR study marks a significant stride in the pursuit of effective treatments
for electrical storms. The compelling evidence supporting the effectiveness and
safety of PSGB in treating refractory ES offers newfound hope for patients and
clinicians alike. These findings pave the way for further exploration and
potential incorporation of PSGB into the standard armamentarium for managing
this complex clinical emergency.

Further reading: Savastano S, Baldi E, Compagnoni S, et al. Electrical storm treatment by percutaneous stellate ganglion block: the STAR study. Eur Heart J. Published online January 30, 2024. doi:10.1093/eurheartj/ehae021

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Higher dietary niacin consumption tied to 30% lower risk of all-cause mortality among NAFLD patients

There is a lack of Evidence on the effect of dietary niacin intake on the mortality risk among patients with NAFLD.

An Original Investigation on Global Health published in JAMA Network Open has concluded that patients with nonalcoholic fatty liver disease (NAFLD) may benefit from increased dietary niacin intake.
This study investigated the relationship between dietary niacin intake and all-cause and CVD mortality among individuals with NAFLD. The analysis included data from the National Health and Nutrition Examination Survey between 2003 and 2018, and 4,315 adults aged 20 or older with NAFLD were included in the study.
Key points from the study are:
· This study analyzed 4315 participants with a mean age of 52.5 years
· 1670 participants≥60 years of age, and 2351 were men.
· Over 560 deaths were recorded during an average follow-up of 8.8 years, with 197 attributed to CVD.
· Among NAFLD patients, the Participants with higher niacin intake (26.7 mg or more) had lower all-cause mortality risk compared to those with lower niacin intake (18.4 mg or less),
· The adjusted hazard ratios for individuals with higher niacin intake for all-cause mortality and CVD risk were 0.70 and 0.65, respectively,
This study of US adults with NAFLD indicates that a higher intake of niacin through diet may be linked to a lower risk of all-cause mortality among individuals with NAFLD but not with lower CVD mortality risk. More research is needed to determine the ideal intake levels for niacin to reduce all-cause and CVD mortality risk among NAFLD patients.
Reference:
Pan J, Zhou Y, Pang N, Yang L. Dietary Niacin Intake and Mortality Among Individuals With Nonalcoholic Fatty Liver Disease. JAMA Netw Open. 2024;7(2):e2354277.
doi:10.1001/jamanetworkopen.2023.54277

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Evolocumab reduces major adverse cardiovascular events in patients with and without multivessel disease: FOURIER

USA: The PCSK9 inhibitor evolocumab significantly reduces the rate of major adverse cardiovascular events (MACEs) in patients with and without multivessel coronary artery disease (MVD), according to a new analysis of FOURIER and its open-label extension study. The findings were published online in the Journal of the American College of Cardiology.

“The magnitude of effect with evolocumab was about twice as large in those who had multivessel disease, benefit emerged early and grew larger over time in this higher-risk subgroup,” the researchers reported.

“In those without MVD, the treatment effect was observed roughly after one year and did become larger during extended follow-up.”

In the FOURIER, risk reduction for MACEs with evolocumab was greater in patients with multivessel disease, during a median follow-up of 2.2 years. The FOURIER Open-Label Extension (FOURIER-OLE) provides an additional median follow-up of 5 years.

Daniel J. McClintick, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA, and colleagues aimed to assess the long-term benefit of evolocumab in patients with and without MVD.

FOURIER randomized 27,564 patients to evolocumab versus placebo; 6,635 entered FOURIER-OLE. Based on the presence of MVD (≥40% stenosis in ≥2 large vessels), patients with coronary artery disease (CAD) were categorized.

The new study included patients in FOURIER and FOURIER-OLE, the open-label extension study including those initially randomized to evolocumab continued on treatment as well as placebo-treated patients who switched to evolocumab. At the start of FOURIER, 6,007 had an MVD and 17,649 had CAD without multivessel disease.

The median follow-up of FOURIER was 2.2 years, but the 5,887 patients who entered FOURIER-OLE were followed for an additional 5.0 years. The median and maximum follow-up for the analysis were 7.1 and 8.6 years, respectively.

The primary endpoint of the study was myocardial infarction, cardiovascular death, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary endpoint was myocardial infarction, cardiovascular death, or stroke.

Key findings were as follows:

  • Of 23,656 patients in FOURIER with CAD, 25.4% had MVD; 5,887 patients continued into FOURIER-OLE.
  • The risk reduction with initial allocation to evolocumab tended to be greater in patients with MVD than in those without 23% (HR: 0.77) versus 11% (HR: 0.89) for the primary and 31% (HR: 0.69) versus 15% (HR: 0.85) for the key secondary endpoints.
  • The magnitude of benefit tended to grow during the first several years, reaching 37% to 38% reductions in risk in patients with MVD and 23% to 28% reductions in risk in patients without MVD.

The findings showed a reduction in MACE rates with evolocumab in patients with and without MVD. The benefit tended to occur earlier and was larger in patients with MVD. However, in both groups, the magnitude grew over time.

“These data support early initiation of intensive low-density lipoprotein cholesterol lowering both in patients with and without multivessel disease,” the researchers concluded.

Reference:

McClintick DJ, O’Donoghue ML, De Ferrari GM, Ferreira J, Ran X, Im K, López JAG, Elliott-Davey M, Wang B, Monsalvo ML, Atar D, Keech A, Giugliano RP, Sabatine MS. Long-Term Efficacy of Evolocumab in Patients With or Without Multivessel Coronary Disease. J Am Coll Cardiol. 2024 Feb 13;83(6):652-664. doi: 10.1016/j.jacc.2023.11.029. PMID: 38325990.

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Ipragliflozin treatment improves blood sugar control avoiding ketoacidosis in patients with type 1 diabetes

Japan: Ipragliflozin treatment for type 1 diabetes (T1D) may help improve glycaemic control/variability while avoiding ketoacidosis, according to findings from a multicentre, open-label, prospective study published in Diabetes, Obesity and Metabolism.

The study stated that using SGLT2 inhibitor ipragliflozin for T1D increased postprandial glucagon secretion, which did not exacerbate postprandial hyperglycaemia but might protect against hypoglycaemia, leading to reduced glycaemic variability. The increased secretion of glucagon might accelerate ketogenesis when adequate insulin is not supplied.

Intensive insulin therapy remains the mainstay treatment for T1D, including multiple daily injections with different formulations and insulin pumps. However, intensive insulin therapy can raise the risks of weight gain and hypoglycaemia. Recent advances in insulin formulations, continuous glucose monitoring (CGM) systems, and insulin delivery systems have helped improve glycemic control in T1D patients. However, it is still difficult to keep glucose levels within the normal range without increasing the risks of weight gain and hypoglycaemia even when these new technologies are used. So, there is a demand for additional therapies to supplement insulin treatment that can achieve optimal glycaemic control for patients with T1D.

Clinical trials have shown the efficacy of sodium-glucose cotransporter 2 inhibitors for type 1 diabetes by significant reductions in glycemic variability and body weight, but elevated susceptibility to ketoacidosis via elevated glucagon secretion was a potential concern.

The Suglat-AID evaluated glucagon responses and their associations with glycaemic control and ketogenesis before and after type 1 diabetes treatment with the sodium-glucose cotransporter 2 inhibitor, ipragliflozin.

Yuta Nakamura, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, and colleagues included adults with type 1 diabetes (n=25) who took 50-mg open-labelled ipragliflozin daily as adjunctive to insulin. Clinical/laboratory data, including continuous glucose monitoring, were collected until 12 weeks following the ipragliflozin initiation.

The participants underwent a mixed-meal tolerance test (MMTT) twice [before (first MMTT) and 12 weeks after ipragliflozin treatment (second MMTT)] to evaluate responses of glucose, glucagon, C-peptide, and β-hydroxybutyrate.

The study led to the following findings:

  • The area under the curve from fasting (0 min) to 120 min (AUC0-120min) of glucagon in the second MMTT was significantly increased by 14% versus the first MMTT.
  • The fasting and postprandial β-hydroxybutyrate levels were significantly elevated in the second MMTT versus the first MMTT.
  • The positive correlation between postprandial glucagon secretion and glucose excursions observed in the first MMTT disappeared in the second MMTT, but a negative correlation between fasting glucagon and time below range (glucose, <3.9 mmol/L) appeared in the second MMTT.
  • The percentage changes in glucagon levels (fasting and AUC0-120min) from baseline to 12 weeks were significantly correlated with those in β-hydroxybutyrate levels.

The study showed that an adjunctive treatment of ipragliflozin in type 1 diabetes patients increased postprandial glucagon secretion but improved postprandial hyperglycaemia with a decrease in glycaemic variability. The increased secretion of glucagon might contribute to reduction of glycemic variability and hypoglycaemia without causing postprandial hyperglycaemia.

The elevated postprandial glucagon might indirectly or directly affect ketone production under the condition of insulin insufficiency.

“Our findings may support the proper use of ipragliflozin to improve glycaemic variability/control and avoid ketoacidosis in patients with T1D,” they concluded.

Reference:

Nakamura Y, Horie I, Kitamura T, Kusunoki Y, Nishida K, Yamamoto A, Hirota Y, Fukui T, Maeda Y, Minami M, Matsui T, Kawakami A, Abiru N. Glucagon secretion and its association with glycaemic control and ketogenesis during sodium-glucose cotransporter 2 inhibition by ipragliflozin in people with type 1 diabetes: Results from the multicentre, open-label, prospective study. Diabetes Obes Metab. 2024 Jan 22. doi: 10.1111/dom.15458. Epub ahead of print. PMID: 38253809.

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Acupuncture may curb heightened risk of stroke associated with rheumatoid arthritis BMJ study

A course of acupuncture may curb the heightened risk of stroke associated with rheumatoid arthritis, finds a comparative study published in the open access journal BMJ Open.

The effects seem to be independent of sex, age, medication use, and co-existing conditions, the findings indicate, prompting the researchers to suggest that the procedure may reduce levels of pro-inflammatory proteins (cytokines) in the body that are linked to cardiovascular disease.

The principal cause of death in people with rheumatoid arthritis is cardiovascular disease. And they are more likely to have a stroke than the general population, note the researchers.

Acupuncture is already used to control pain and dampen down inflammation, and the researchers wanted to find out if it might also lower the risk of ischaemic stroke–caused by a blood clot in the brain-that is associated with systemic inflammation.

They drew on national medical records from the Registry for Catastrophic Illness Patients Database (RCIPD), for 47,809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010.

The final analysis included 23,226 patients with complete data, 12,266 of whom were treated with acupuncture following their diagnosis up until the end of December 2010.

Of these, 11,613 were each matched for age, sex, co-existing conditions-diabetes, high blood pressure, high blood fats, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, alcohol dependency, and smoking-medication use-non-steroidal anti-inflammatory drugs, statins, and disease modifying drugs-and year of diagnosis with a patient who hadn’t been treated with acupuncture.

Women, those aged 40–59, and participants with high blood pressure predominated in both groups.

Most (87%) of those in the acupuncture group were treated with manual acupuncture (87%); 3% were treated with electroacupuncture, whereby an electrode producing a low pulse of electricity is attached to the needle; and 10% received both types.

On average, 1065 days elapsed between a rheumatoid arthritis diagnosis and receipt of the first acupuncture treatment, with the number of treatments averaging around 10 in total.

During the monitoring period up to the end of 2011, 946 patients had an ischaemic stroke. Unsurprisingly, risk rose in tandem with increasing age, and with the number of co-existing conditions.

Those with high blood pressure, for example, were more than twice as likely to have a stroke as those with normal blood pressure, while those with diabetes were 58% more likely to do so.

But there were significantly fewer cases of ischaemic stroke among the acupuncture group: 341 vs 605, equivalent to a 43% lower risk. And this was independent of age, sex, medication use, and co-existing conditions.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the researchers also acknowledge that they were only able to estimate disease severity from the drugs the patients took.

Nor did they have information on potentially influential factors, such as height, weight, lab tests or physical activity levels, and not everyone would have had the same pressure points needled, they add.

But they point out: “Inflammation is a consistent and independent predictor of cardiovascular disease in [rheumatoid arthritis],” so acupuncture may lower pro-inflammatory proteins, thereby reducing the risk of cardiovascular disease, including ischaemic stroke, they suggest.

“Unstable blood pressure and lipid profiles are the two risk factors for ischaemic stroke, and acupuncture therapy has the advantage of controlling both hypertension and dyslipidaemia,” they explain, adding: “If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which might also reduce the risk of stroke.”

Reference:

http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2023-075218

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Why ventilators can be tough on preemie lungs

Many premature infants need mechanical ventilation to breathe. However, prolonged ventilation can lead to problems like respiratory diseases or ventilation-induced injury.

Jonas Naumann and Mareike Zink study the physics of mechanical stress from ventilation at Leipzig University, in Leipzig, Germany and discovered some of the mechanisms that explain why premature lungs are especially sensitive to stress. Naumann will present their research at the 68th Biophysical Society Annual Meeting, to be held February 10 – 14, 2024 in Philadelphia, Pennsylvania.

When you breathe normally, your diaphragm and the muscles between ribs create a negative pressure inside the lung. “But when you are undergoing mechanical ventilation, you are creating hydrostatic overpressure. And the forces which are acting during mechanical ventilation are completely different than during normal breathing. And this is probably causing some kind of damage to the cells,” Zink explained.

Using lung tissue from fetal and adult rats, the researchers together with collaborators from the Division of Neonatology, University Clinic Leipzig, used varying amounts of tension with rest phases in between, similar to the actions that occur within the lung during mechanical ventilation. Even with a little pressure, the premature rat lung tissue showed characteristics of being both elastic and viscous. This means the lung tissue changed its shape and responded to stress in a way that wasn’t normal. Moreover, they found that “the fetal lung is much stiffer than the adult lung under deformation,” said Naumann.

To determine whether these tension-related changes in the tissue led to alterations in sodium transport, which is important for removing the water from the lungs that is present at birth, the team used electrophysiology to measure the movement of ions across a layer of premature lung cells. They found that changes in pressure affected the activity of two channels involved in sodium transport-the epithelial sodium channel and the sodium-potassium ion pump in the cells of lung alveoli. This disruption in the normal function of these transporters could explain why mechanical ventilation has negative effects on the infant’s lungs.

“This may be the reason why lung fluid cannot get absorbed that well into the circulation after the preterm births,” Naumann explained. He hopes that there will be more research about what ventilator settings might lead to the best outcomes for preemies. Naumann points out that “small pressure gradients can have such a big impact on the lung mechanics.”

The next phase of their research will be exploring how the lung tissue’s extracellular matrix, the scaffolding and the glue that holds cells together, plays a role in mechanical ventilation. By better understanding how the premature lung responds to pressure, they hope that future studies improve therapies for babies born early.

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Melatonin significantly increases efficacy of full-mouth scaling and root planing in patients with diabetes and periodontitis

In a groundbreaking clinical study
addressing the intricate relationship between diabetes mellitus (DM) and
periodontitis, researchers have unveiled a promising breakthrough that could
transform the landscape of nonsurgical periodontal therapy. This innovative
investigation delves into the clinical efficacy of melatonin supplementation as
a host modulation agent in diabetic patients with periodontitis, providing a
unique perspective on its potential as a therapeutic adjunct.

The study results were published in the Journal of Periodontology. 

Also Read: Reactive soft tissue and absorbable collagen sponge facilitate open wound healing in context of immediate dental implant placement

Diabetes mellitus (DM) has long been
associated with an exaggerated inflammatory response, exacerbating periodontal
tissue destruction. Literature shows that the application of host modulation
agents to enhance nonsurgical periodontal therapy in individuals with diabetes
is an actively researched area. Hence, researchers conducted a study to
investigate the clinical efficacy of melatonin supplementation and shed light
on its underlying biological mechanisms by examining fundamental markers.

The randomized controlled,
single-blind study involved 55 diabetic patients with periodontitis, with 27
undergoing full-mouth scaling and root planing (fmSRP) alone and 28 receiving
melatonin supplementation (6 mg daily for 30 days) in addition to fmSRP (full-mouth
scaling and root planing plus melatonin, fmSRP-mel). The impact of melatonin
was assessed clinically and biochemically through the analysis of gingival
crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels at the 3rd and 6th
months.

Findings:

  • Results from the study indicated that
    melatonin, administered in tablet form at 6 mg daily for 30 days, did not
    induce any local or systemic side effects.
  • FmSRP alone demonstrated a significant
    reduction in serum IL-1β levels, pocket depths, gingival inflammation, and
    gingival crevicular fluid RANKL and MMP-8 levels (p < 0.05).
  • Interestingly, melatonin supplementation
    led to a more pronounced decrease in bleeding and pocket depth scores during
    probing, particularly at the 3-month mark (p < 0.05).
  • Furthermore, RANKL and MMP-8 levels
    exhibited a significant reduction at 3 months, while IL-1β levels decreased at
    6 months compared to the control group (p < 0.05).
  • Notably, OPG levels were
    not significantly affected by the treatments (p > 0.05).
Also Read: Socket-shield therapy promising for preserving inter-implant papilla between adjacent central-lateral incisor implants

In conclusion, melatonin, as
a host modulation agent, demonstrated a significant enhancement in the clinical
efficacy of fmSRP. The observed reduction in periodontal inflammation and
pocket depths is attributed to melatonin’s marked suppression of RANKL-associated
osteoclastogenesis and extracellular matrix damage. This breakthrough offers a
promising avenue for improved periodontal treatment outcomes in diabetic
individuals, showcasing melatonin’s potential as a therapeutic adjunct in
managing periodontitis in this specific patient population.                         

Further reading: Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial. Doi: https://doi.org/10.1002/JPER.23-0335

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The size of your meniscus matters: Knee pain explained

With all of the fantastic imaging techniques available in healthcare today, clinicians are capable of diagnosing tissue and joint deformities using non-invasive imaging with remarkable accuracy. However, one vexing question remains: why are some patients with specific joint deformities symptomatic while others are not?

The meniscus is a piece of cartilage that cushions the knee joint between the femur (thigh bone) and the tibia (shin bone). Some people are born with a congenital morphological variation in their meniscus, called a discoid lateral meniscus (DLM), where the meniscus is thickened on the lateral, or outer side of the knee. DLM malformations cause the lateral meniscus to form a circle rather than a crescent shape, thickening the cartilage and making it more prone to tears. Some patients develop symptoms such as knee pain and a locking, leading to surgery.

In order to better understand what factors separate symptomatic DLM cases from asymptomatic cases, a multi-institutional team of researchers led by Dr. Kazuya Nishino of the Graduate School of Medicine at Osaka Metropolitan University analyzed 61 knees with discoid lateral meniscus surgery without dislocation (symptomatic group) and 35 without symptoms but with discoid lateral meniscus detected on MRI (asymptomatic group). The percentage of meniscus was calculated in the coronal and sagittal sections, respectively. The researchers also measured the height of the thinnest and thickest part of the meniscus.

The results revealed that the percentage of the meniscus covering the tibia in the coronal and sagittal planes was higher in the symptomatic group than in the asymptomatic group. Additionally, the results showed that the meniscal height was greater in the symptomatic group than in the asymptomatic group.

Overall, preoperative imaging is helpful in determining the amount of tissue resection, or removal, required for patients with symptomatic DLM. “Making surgical decisions and plans based on these characteristics is expected to assist in medical treatment. In the future, we will investigate the morphological changes of the meniscus before and after surgery in three dimensions,” said Dr. Nishino.

While the difference in the morphologies of symptomatic vs. asymptomatic DLMs was the most important finding in the study, the MRIs of symptomatic patients also showed meniscal tears or other evidence of instability. The researchers suggest that these morphological features could be responsible for DLM symptoms in symptomatic patients.

Reference:

Kazuya Nishino, Yusuke Hashimoto, Takuya Kinoshita, Ken Iida, Shuko Tsumoto, Hiroaki Nakamura, Comparative analysis of discoid lateral meniscus size: a distinction between symptomatic and asymptomatic cases, Knee Surgery Sports Traumatology Arthroscopy, https://doi.org/10.1007/s00167-023-07650-2.

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Can inflammation related diseases increase risk of primary acquired nasolacrimal duct obstruction?

Primary Acquired Nasolacrimal Duct Obstruction (PANDO) has long been a concern for patients, impacting their ocular health. A recent retrospective case-control study conducted by Clalit Health Services in Israel delves into the intricate associations between PANDO and various inflammatory conditions. The findings shed light on the multifaceted nature of PANDO, revealing significant connections with ocular surface, eyelid, upper airway, and systemic inflammatory-related diseases.

This study was published in the journal Graefe’s Archive for Clinical and Experimental Ophthalmology by Kerber and colleagues. To evaluate the incidence and risk factors for inflammatory conditions among patients with PANDO. 60,726 patients diagnosed with PANDO, with an average age of 63 years, 63% female. A case-control approach matching controls according to year of birth, sex, and ethnicity.

The key findings of the study were:

Ocular Surface and Eyelid Conditions:

  • Chronic conjunctivitis showed a significant association with PANDO (OR 2.96).

  • Vernal keratoconjunctivitis and blepharitis exhibited notable connections (OR 2.89 and 2.75, respectively).

Upper Airway Conditions:

  • Rhinitis, chronic sinusitis, and deviated nasal septum were significantly associated with PANDO (OR 1.62, 1.71, and 1.76, respectively).

Systemic Conditions:

  • Asthma and atopic dermatitis showed significant associations with PANDO (OR 1.34 and 1.36, respectively).

This comprehensive study underscores the intricate relationship between PANDO and inflammatory-related diseases affecting the ocular surface, eyelids, upper airway, and systemic health. The identified associations provide valuable insights into the pathophysiology of PANDO, emphasizing the role of inflammation. Recognizing these links can contribute to a more holistic understanding of PANDO and guide clinicians in developing tailored management strategies.

Reference:

Kerber, L., Kerman, T., Hazan, I., Ziv, O., Kordelul, S., & Tsumi, E. Are inflammation-related diseases risk factors for primary acquired nasolacrimal duct obstruction? A large scale, national case-control study. Graefe s Archive for Clinical and Experimental Ophthalmology,2024. https://doi.org/10.1007/s00417-023-06352-2

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Private Medical Colleges Failing Students Deliberately, charging additional fees for repeating semester: Parliamentary Panel

New Delhi: Some of the private medical colleges have been deliberately failing medical students during mid-semester exams and charging additional fees for repeating the semester or the exam, a Parliamentary panel recently observed in its report.

The Department-related Parliamentary Standing Committee on Health and Family Welfare further opined in its One Hundred Fifty-Seventh Report that the Undergraduate Medical Education Board (UGMEB) of NMC may develop appropriate feasible modalities to monitor assessment, revaluation, etc. without charging any additional fee.

Chaired by Shri Bhubaneswar Kalita, the panel presented its report before the Parliament on 9th February 2024. Several issues related to medical education such as infrastructure, faculty issues, and quality control of medical education were discussed in the report.

The Committee was apprised of the fact that some private medical colleges seemingly fail medical graduates deliberately during mid-semester exams which results in repetition of the semester, and charging additional fees for repeating the semester or exam.

Referring to the issue, the Parliamentary Panel on Health observed that such a practice causes stress on the medical students – financial and otherwise.

Therefore, advising the Apex Medical Commission to set up proper feasible modalities to monitor assessment and evaluation process, the panel mentioned in its report, “The Committee therefore recommends that UGMEB may develop appropriate feasible modalities for monitoring assessment, revaluation, etc. without charging any additional fee.”

The average MBBS course fees across Government colleges in India (both centrally funded, and State Government funded) can reach 50,000 per annum. However, such subsidized medical education can only be availed by a select few who perform exceedingly well in the NEET UG exam, noted the panel.

It further highlighted that as per the information furnished by the Union Health Ministry, there are only 56,193 Government seats in MBBS and as per NTA, more than 11 lakh candidates qualified for the NEET UG exam in 2023. Therefore, more than 10 lakh MBBS aspirants are left either to opt for MBBS seats in private medical colleges where the course fees can range up to 1.5 crores or to pursue their dream in countries like China, Ukraine, and Russia, where the cost is lower in comparison to private colleges in India.

NMC Fee Order: 

Medical Dialogues had earlier reported that back in 2022, the National Medical Commission issued a direction to all the private medical colleges in the country to charge fees at par with the government institutes for 50 per cent of the total seats.

Issuing an Office Memorandum in February 2022, NMC mentioned, “After extensive consultations, it has been decided that the fee of the 50 per cent seats in the private medical colleges and deemed universities should be at par with the fee in the government medical colleges of that particular State and UT. The benefit of this fee structure would be first made available to those candidates who have availed government quota seats, but are limited to the extent of 50 per cent of the total sanctioned strength of the respective medical college/deemed university.”

“However, if the government quota seats are less than 50 per cent of total sanctioned seats, the remaining candidates would avail the benefit of a fee equivalent to the government medical college fees, based purely on the merit,” the Commission had added.

The validity of the NMC order has time and again been challenged before various High Courts and also Supreme Court, where AHSI challenged the order arguing that the top court in various judgments had reiterated the fact that the method for fixing the fees, would be subject to considering various guidelines such as facilities available in the college, infrastructure, age of investment made, plans for expansion, etc.

Currently, the validity of the NMC fee order is being considered by the Supreme Court and all the connected matters in this regard has been listed for further hearing on 22nd March, 2024.

Meanwhile, the Parliamentary Panel has also recommended that NMC should undertake a comparative study of best practices of its parallel organisation in various countries. The Parliamentary Committee opined that if such a study is undertaken by NMC, it can help the Commission to usher in best practices followed around the world and help make NMC an institution par excellence.

Also Read: Flexner Model: Parliamentary Panel Advises NMC to Study International Best Practices

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