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The HbA1c test, or glycated hemoglobin test, is a crucial tool in diabetes management. It measures the average blood sugar level over the past 2-3 months, providing a comprehensive view of long-term glucose control. This test is essential for assessing the effectiveness of diabetes management plans and helping individuals and healthcare providers make informed decisions about treatment adjustments, lifestyle changes, and overall well-being.
Contrary to the popular myth that non-vegetarians cannot get diabetes, it is crucial to understand that diabetes can affect individuals regardless of their dietary preferences, including non-vegetarians. The risk of diabetes is influenced by a combination of genetic, lifestyle, and environmental factors. While diet plays a role, it’s just one aspect of a complex interplay of factors.
Non-vegetarians should also be mindful of their food choices, adopting a balanced and healthy diet to reduce the risk of diabetes and promote overall well-being. It’s important to understand that anyone, irrespective of their dietary preferences, can develop diabetes based on various contributing factors.
In this video, Dr V.K Varmani, a cardiologist and general physician from Lucknow, UP, discusses the HbA1c test for diabetes while addressing the misconception that non-vegetarians cannot get diabetes.
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Agartala: Taking cognizance of the viral video showing an orthopaedic implant material supplier allegedly assisting the surgeons in the operation theatre of an Indira Gandhi Memorial (IGM) Hospital, the Tripura health department has sought a detailed report on the matter.
A purported video, which has gone viral on social media, shows the man wearing a surgeon’s apron and helping two orthopaedic surgeons during surgical procedures of patients at the operation theatre of Indira Gandhi Memorial (IGM) Hospital, on January 19.
The IGM Hospital is the second biggest government hospital in Tripura.
The man, identified as Jantu Debnath, is a supplier of implant materials for orthopaedic patients.
“Based on the footage, a four-member committee headed by Joint Director of Health Services, Dr Souvik Debbarma, will probe into the incident thoroughly and submit its findings within a week,” Dr Supriya Mallik, the Director of Health Services, told PTI.
Action will be taken if the incident proves to be true, he said, adding a businessman cannot join the surgical procedures at a government hospital.
“Jantu Debanth was not present nor helped the orthopaedic surgeons during surgical procedures at the operation theatre,” the medical superintendent of IGM Hospital, Dr Debashri Debbarma, said.
“We don’t support such an adventurous move by any outsider,” he said.
Medical Dialogues team had earlier reported that Chinese authorities were investigating a 2019 incident where a surgeon allegedly punched an 82-year-old woman thrice in the head during surgery, a video of which caused a furore in local social media. Though the incident occurred in December 2019, it only came to the public’s attention this week after a prominent Chinese doctor, Ai Fen, shared CCTV footage of the surgery.
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New Delhi: Akums Drugs and Pharmaceuticals Ltd has filed draft papers with capital markets regulator Sebi to raise funds through an initial public offering (IPO). The initial share-sale is a combination of fresh issue of equity shares worth Rs 680 crore and an offer-for-sale (OFS) of 1.86 crore shares by promoters and an existing investor, according to the draft red herring prospectus (DRHP) filed on Saturday.
Akums Drugs & Pharmaceuticals Ltd. is a contract-manufacturing pharmaceutical company of India. The organization deals in the manufacturing and export of formulations in a wide spectrum of dosage forms & therapeutic segments. The company is currently supplying to almost all Indian and multinational pharmaceutical companies across the globe. The 10 state-of-the-art facilities are dedicated to oral solid dosage forms (with separate units for beta lactum and non-beta lactum formulations), Oral liquid dosage forms, Sterile dosage forms (Injectable, eye, ear & nasal), hormonal (oral and injectable), Ointments & cosmetics, Ayurvedic, food supplements & nutraceuticals and animal health care.
The organization is certified with WHO-GMP, ISO 9001 : 2008, ISO 14001:2004 certificates and various international accreditations, like; ANVISA, Brazil, NAFDAC, Nigeria, FDB, Ghana, PMPB, Malawi amongst others.
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Iran: A case-control study published in BMC Endocrine Disorders has shown a lower likelihood of developing type 2 diabetes (T2D) with a nutrient pattern comprising plant protein, vitamin A, vitamin C, calcium, and potassium.
“The initial results indicate that Participants who consumed higher amounts of plant protein, fibre, vitamin C and potassium had a lower risk of type 2 diabetes compared with those who consumed lower quantities of these nutrients.” the researchers reported.
Type 2 diabetes is a significant concern for public health globally. It leads to high illness and death rates and places a significant financial burden on healthcare systems. In the past few decades, there has been a sharp rise in diabetes occurrence and is expected to continue increasing, with an estimated 693 million people living with the disease by 2045. Complications associated with T2D can also contribute to premature death.
The current literature has highlighted the significance of diet in managing or preventing diabetes complications, but evidence is insufficient regarding the correlation between nutrient patterns and these complications. To fill this knowledge gap, Mohammad Amin Kashani, Islamic Azad University, Tehran, Iran, and colleagues aimed to investigate this relationship by analyzing the dietary intake of nutrients in participants with and without type 2 diabetes.
For this purpose, they conducted a case-control study at the Tabriz Center of Metabolism and Endocrinology. Two hundred and twenty-five newly diagnosed cases of type 2 diabetes and 225 controls were enrolled in the study. The mean age and BMI of the participants were 39.8 years and 27.8 kg/m2, respectively.
A validated semi-quantitative food frequency questionnaire (FFQ) was used to assess the dietary intake of nutrients. Nutrient patterns were obtained using Principal component analysis. Logistic regression analysis was performed to estimate T2D risk.
Key findings of the study include:
“The results indicate that conforming to a nutrient pattern consisting of plant protein, vitamin A, vitamin C, vitamin B2, potassium, and calcium is linked to a lower likelihood of developing T2D,” the researchers wrote. “Our investigation did not reveal any significant correlation between other nutrient patterns and T2D risk.”
“However, there is a need for additional research to authenticate these initial findings and establish the correlation between nutrient patterns and T2D,” they concluded.
Reference:
haramshahi, M., A-Elgadir, T.M.E., Daabo, H.M.A. et al. Nutrient patterns and risk of diabetes mellitus type 2: a case-control study. BMC Endocr Disord 24, 10 (2024). https://doi.org/10.1186/s12902-024-01540-5
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Spain: In patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence, beta-blocker cessation may be particularly beneficial in patients with smaller end-systolic left ventricular volume, a post hoc analysis of a randomized clinical trial has shown.
In the analysis that enrolled 52 patients with HFpEF and chronotropic incompetence taking β-blocker treatment, “lower left ventricular systolic volumes identified patients in which β-blocker cessation was linked with a greater short-term improvement in maximal functional capacity,” the researchers reported in JAMA Cardiology.
In patients with HFpEF, chronotropic incompetence has emerged as a relevant pathophysiological mechanism. Specifically, chronotropic incompetence has been associated with worse clinical outcomes and functional capacity. For this reason, increasing the patient’s heart rate (HR) has emerged as a promising therapeutic option in HFpEF patients. However, the evidence is conflicting, and there is no clarity on the profile of patients who benefit most from this strategy.
Against the above background, Patricia Palau and colleagues from Spain assessed the association of β-blocker treatment withdrawal with changes in the percentage of predicted peak oxygen consumption (VO2) across indexed left ventricular systolic (iLVESV) and indexed left ventricular diastolic volumes (iLVEDV) and left ventricular ejection fraction (LVEF) in patients with HFpEF and chronotropic incompetence.
For the post hoc analysis, the research team used data from the PRESERVE-HR, an investigator-blinded multicenter, randomized, and crossover clinical trial, that took place from 2018 to 2020, to investigate the short-term effects (2 weeks) of β-blocker withdrawal on peak VO2. It included patients with stable HFpEF (New York Heart Association functional class II to III) receiving treatment with β-blocker and chronotropic incompetence.
PRESERVE-HR trial participants were randomized to withdraw versus continue with β-blocker treatment. Following 2 weeks, they were crossed over to receive the opposite intervention. The crossover randomized clinical trial investigated the short-term effect of β-blocker withdrawal on peak VO2. A total of 52 patients (mean age, 73 years; 60% female) were randomized.
The study’s primary outcome was to determine the association between β-blocker withdrawal and short-term changes in the percentage of peak VO2 across iLVESV, iLVEDV, and LVEF in patients with HFpEF and chronotropic incompetence treated with β-blocker.
The researchers reported the following findings:
The findings showed that in patients with HFpEF and chronotropic incompetence receiving β-blocker treatment, lower iLVESV may identify those with a greater short-term improvement in maximal functional capacity after stopping β-blocker treatment.
“Further studies are warranted for further investigation,” the research team concluded.
Reference:
Palau P, de la Espriella R, Seller J, et al. β-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. Published online February 07, 2024. doi:10.1001/jamacardio.2023.5500
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Despite vaccination efforts, COVID-19 treatment options are still needed, especially for those with mild to moderate symptoms. Ensitrelvir, a novel antiviral medication, was evaluated in a randomized clinical trial to assess its ability to reduce symptom duration and improve patient outcomes. As the COVID-19 pandemic continues, the search for effective treatment options remains paramount.
This study was published in the journal JAMA Network Open by Hiroshi Y and colleagues. A recent phase 3 clinical trial investigated the efficacy and safety of ensitrelvir in patients with mild to moderate COVID-19. The phase 3 trial, part of a larger phase 2/3 study, was conducted across 92 institutions in Japan, Vietnam, and South Korea from February 10 to July 10, 2022. A total of 1821 patients aged 12 to <70 years with mild to moderate COVID-19 were enrolled, randomized, and followed for 28 days.
Patients were randomly assigned to receive either 125 mg or 250 mg of once-daily ensitrelvir or placebo for 5 days. The primary endpoint was the time to resolution of the composite of 5 characteristic symptoms of SARS-CoV-2 Omicron infection.
In patients treated within 72 hours of symptom onset, the 125-mg ensitrelvir group showed a significant reduction in symptom duration compared to placebo (P = .04). The median time to resolution was approximately 1 day shorter in the ensitrelvir group compared to placebo.
Adverse events were observed in 44.2% of patients in the 125-mg ensitrelvir group, 53.6% in the 250-mg ensitrelvir group, and 24.8% in the placebo group. No treatment-related serious adverse events were reported.
The study concluded that ensitrelvir, particularly at the 125-mg dose, demonstrated efficacy in reducing symptom duration in patients with mild to moderate COVID-19, without new safety concerns. These findings highlight ensitrelvir as a potential treatment option for COVID-19, pending confirmation of generalizability to populations outside of Asia.
Reference:
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In a groundbreaking study conducted at Sahlgrenska University Hospital, researchers have unveiled a game-changing approach to the treatment of acute appendicitis, challenging the conventional “wait and see” observation method. The study, involving 126 carefully selected patients, evaluated the effectiveness of early antibiotic treatment as superior compared to active in-hospital observation for the spontaneous regression of acute appendicitis.
The study was published in the journal Surgery.
The administration of antibiotics to patients with acute appendicitis, regardless of specific selection criteria, has been deemed both safe and efficacious. Yet, uncertainties persist regarding the potential for early antibiotic provision to constitute overtreatment, given the possibility of spontaneous healing of appendix inflammation. This study seeks to address this ambiguity by examining the comparative impact of antibiotic treatment and active in-hospital observation on the natural regression of acute appendicitis.
Individuals seeking urgent medical attention at Sahlgrenska University Hospital underwent block randomization based on age (18-60 years) and systemic inflammation criteria (C-reactive protein <60 mg/L, white blood cell <13,000/μL). This process also considered the clinical and abdominal characteristics associated with acute appendicitis. Study participants were subjected to a treatment plan involving both antibiotic administration and active observation. Conversely, control group patients were assigned to the traditional “wait and see observation” approach, allowing for either the natural regression of the condition or the indication for surgical exploration.
Certified surgeons, following established surgical protocols, made the crucial decisions regarding the necessity and timing of appendectomy. A comprehensive screening process was conducted, involving a total of 1,019 patients assessed for eligibility. Among them, 203 met the inclusion criteria, leading to the acceptance of 126 participants. However, 29 individuals opted not to participate, and 48 were inadvertently excluded from the study.
Findings:
The findings challenge the traditional approach to acute appendicitis, paving the way for a paradigm shift in treatment strategies. Early antibiotic treatment emerges as a superior alternative to the conventional “wait and see observation” method, offering a safe and effective means of avoiding surgical exploration and appendectomy.
This breakthrough could have far-reaching implications for the medical community, reshaping the standard of care for acute appendicitis and potentially sparing countless patients from unnecessary surgeries. As the medical field continues to evolve, this study provides a significant contribution toward more tailored and less invasive treatment options for a common abdominal emergency.
Further reading: Iresjö BM, Blomström S, Engström C, Johnsson E, Lundholm K. Acute appendicitis: A block-randomized study on active observation with or without antibiotic treatment. Surgery. Published online January 12, 2024. doi:10.1016/j.surg.2023.11.030
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Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift Diane Ghanem et al conducted a study to assess ChatGPT’s performance on the orthopaedic surgery in-training examination (OITE). Investigation performed at The Johns Hopkins Hospital, Baltimore, Maryland. It has been published in “JBJS Open Access.”
All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website (https://www.aaos. org/education/examinations/ResStudy). Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radio graphs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen’s Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus’ performance on the OITE to national orthopaedic surgery residents in that same year.
Key findings of the study:
• A total of 201 questions were evaluated by ChatGPT Plus.
• Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen’s Kappa coefficient of 0.947. 45.8% (92/201) were media containing questions.
• ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non media questions.
• When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3.
ChatGPT Plus is able to pass the OITE with an overall score of 61.2%, ranking at the level of a third-year orthopaedic surgery resident. It provided logical reasoning and justifications that may help residents improve their understanding of OITE cases and general orthopaedic principles. Further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.
Further reading:
ChatGPT Performs at the Level of a Third-Year Orthopaedic Surgery Resident on the Orthopaedic In-Training Examination
Diane Ghanem et al
JBJS Open Access 2023:e23.00103
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