Nomogram Model reliable tool to quantify possibility of postoperative DVT in hip fractures patients

A nomogram is a method of visualizing complex mathematical models that consider multiple risk factors, predict disease prognoses, and displaying them in an intuitive manner for clinical treatment guidance.

Ruting Bo et al conducted a study to establish a nomogram model for predicting the probability of postoperative deep vein thrombosis (DVT) risk in patients with hip fractures. The study has been published in “Indian Journal of Orthopaedics.”

504 patients were randomly assigned to the training set and validation set, and then divided into a DVT group and a non-DVT group. The study analysed the risk factors for DVT using univariate and multivariate analyses. Based on these parameters, a nomogram model was constructed and validated. The predicting performance of nomogram was evaluated by discrimination, calibration, and clinical usefulness.

The key findings of the study were:

• The predictors contained in the nomogram model included age, surgical approach, 1-day postoperative D-dimer value and admission ultrasound diagnosis of the lower limb vein.

• Furthermore, the area under the ROC curve (AUC) for the specific DVT risk-stratification nomogram model (0.815; 95% CI 0.746–0.884) was significantly higher than the current model (Caprini) (0.659; 95% CI 0.572–0.746, P < 0.05).

• According to the calibration plots, the prediction and actual observation were in good agreement. In the range of threshold probabilities of 0.2–0.8, the predictive performance of the model on DVT risk could be maximized.

The authors concluded that – “In our research, we have established a beneficial nomogram model using four risk factors to predict the risk of DVT in patients with hip fractures, validated this model and determined its high performance. Moreover, the discriminatory capacity of the nomogram model was superior to that of each variable independently and the Caprini score. Based on the application of the proposed model, clinicians will have the ability to determine with greater accuracy which patients are likely to develop thrombosis and provide them with appropriate adequate prevention and treatment measures.”

Further reading:

A Nomogram Model to Predict Deep Vein Thrombosis Risk After Surgery in Patients with Hip Fractures

Ruting Bo et al

Indian Journal of Orthopaedics (2024) 58:151–161

https://doi.org/10.1007/s43465-023-01074-3

Powered by WPeMatico

Can PET help diagnose neurosarcoidosis?

FDG-PET imaging shows promise for use as a diagnostic criterion for neurosarcoidosis, with a recent case series illustrating the approach was effective when gold-standard approaches were not, according to a group of researchers in Berlin.

The diagnosis of neurosarcoidosis (NS) remains challenging due to the difficulty to obtain central nervous system (CNS) biopsies. Various diagnostic parameters are considered for the definition of possible, probable and definite NS. Magnetic resonance imaging (MRI) is the imaging gold standard and considered in diagnostic criteria. Fluorodeoxyglucose positron emission (18F-FDG PET) is sometimes performed additionally to identify possible systemic biopsy targets. However, at present, its findings are not incorporated into the diagnostic criteria for neurosarcoidosis (NS). They conducted a single center retrospective search for the period 2020–2022, for patients with neurological symptoms in a diagnostic context of suspected NS who underwent MRI and additional 18F-FDG PET scans to identify potential hypermetabolism in the CNS and biopsy targets.Results: They identified three cases of NS, where Gadolinium-enhanced MRI scans did not show abnormalities while 18F-FDG PET revealed hypermetabolic lesions in areas of the CNS. Additional MRI scans were still inconclusive for structural changes. We diagnosed a “probable” NS in all cases with histopathological confirmation of systemic sarcoidosis which led to an intensified therapy regime. 18F-FDG PET is an early indicator for metabolic changes. It appears to be a useful add-on to improve accuracy of diagnostic criteria in suspected NS without MRI findings.

Keywords:

Chen, J., Metzger, G., Furth, C. et al. Reevaluating the relevance of 18F-FDG PET findings for diagnosis of neurosarcoidosis: a case series. Neurol. Res. Pract. 6, 12 (2024). https://doi.org/10.1186/s42466-023-00299-9

Reference:

PET, neurosarcoidosis, Neurological Research and Practice, Fluorodeoxyglucose positron emission, Metabolic imaging, Imaging discordance, Diagnostic criteria,

Chen, J., Metzger, G., Furth, C

Powered by WPeMatico

Diabetes patients taking SGLT2 inhibitors may exhibit false positive urine ethanol tests: NEJM

USA: A recent article published in the New England Journal of Medicine described a patient with diabetes who was taking empagliflozin, an SGLT2 inhibitor, showing false-positive screening tests for ethanol in a room-temperature sample. This was due to bacterial fermentation of glucose that yielded ethanol.

Despite not ingesting alcohol for over 10 months, the man in his early 60s tested positive in his urine for ethanol on the last four urine samples he provided to a probation office. None of the urine samples contained any traces of illicit or non-prescribed substances.

But after he called his primary care provider for fear of going to jail over the positive tests, the PCP’s lab revealed no detectable ethanol in a new urine sample, Aaron L. Schwartz, MD, PhD, of the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center in Philadelphia, detailed in the case study.

On the repeat urine test, they did not find ethanol, but the primary care lab did find the presence of glycosuria — an expected finding as the patient was newly prescribed 20 mg daily of empagliflozin (Jardiance) just 5 months prior for his diabetes.

Schwartz called the city probation office to ask about their storage of urine samples. He was told that urine samples were samples were sent once daily to an external laboratory to be tested, but samples were not refrigerated before transport.

To test the theory, the primary care office took their new urine sample out of refrigeration. One day later the urine was retested for ethanol after it remained at room temperature for 24 hours. Now, the sample tested positive for ethanol.

He explained how the SGLT2 inhibitor drugs produce glycosuria even when blood glucose levels are within the normal range and also increase the presence of microbes in the urinary tract — two ingredients needed for microbial fermentation.

Following the positive ethanol tests at the city probation centre, the urine sample collected by the primary care facility 3 days later had a glucose level of 1,000 mg/dL. It was negative for urinary ethyl glucuronide, urinary ethanol, nitrites, leukocyte esterase, blood, ketones, and bilirubin. A urine culture showed less than 50,000 CFU/mL of mixed gram-positive organisms.

According to Schwartz, since the class of SGLT2 inhibitors is frequently prescribed for a wide range of diabetes, kidney, and cardiovascular indications, this could have the potential to affect a lot of patients. The SGLT2 inhibitors include canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro).

Given the potential for false positive results, he recommended that he would encourage clinicians to be mindful of whether a patient is subject to urine toxicology testing when taking this medication. A clinician should be somewhat sceptical of positive tests in these situations.

To conclude, SGLT2 inhibitors like empagliflozin are effective in diabetes management but can lead to unexpected test results. As science continues to evolve, so does understanding of these complex interactions. By staying vigilant and informed, patients and healthcare providers can navigate these challenges and ensure optimal diabetes management.

Reference:

Schwartz AL “SGLT2 inhibitors and false positive toxicology tests” N Engl J Med 2024; DOI: 10.1056/NEJMc2313463.

Powered by WPeMatico

Polycystic ovary syndrome tied to memory, thinking problems

People with polycystic ovary syndrome may be more likely to have memory and thinking problems in middle age, according to new research published in the January 31, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that polycystic ovary syndrome causes cognitive decline. It only shows an association.

Polycystic ovary syndrome is a hormonal disorder that is defined by irregular menstruation and elevated levels of a hormone called androgen. Other symptoms may include excess hair growth, acne, infertility and poor metabolic health.

“Polycystic ovary syndrome is a common reproductive disorder that impacts up to 10% of women,” said study author Heather G. Huddleston, MD, of the University of California, San Francisco. “While it has been linked to metabolic diseases like obesity and diabetes that can lead to heart problems, less is known about how this condition affects brain health. Our results suggest that people with this condition have lower memory and thinking skills and subtle brain changes at midlife. This could impact a person on many levels, including quality of life, career success and financial security.”

The study involved 907 female participants who were 18 to 30 years old at the start of the study. They were followed for 30 years, at which time they completed tests to measure memory, verbal abilities, processing speed and attention.

At the time of testing, 66 participants had polycystic ovary syndrome.

In a test measuring attention, participants looked at a list of words in different colors and were asked to state the color of the ink rather than read the actual word. For example, the word “blue” could be displayed in red, so the correct response would be red.

Researchers found for this test, people with polycystic ovary syndrome had an average score that was approximately 11% lower compared to people without the condition.

After adjusting for age, race and education, researchers found that people with polycystic ovary syndrome had lower scores on three of the five tests that were given, specifically in areas of memory, attention and verbal abilities, when compared to those without this condition.

At years 25 and 30 of the study, a smaller group of 291 participants had brain scans. Of those, 25 had polycystic ovary syndrome. With the scans, researchers looked at the integrity of the white matter pathways in the brain by looking at movement of water molecules in the brain tissue.

Researchers found that people with polycystic ovary syndrome had lower white matter integrity, which may indicate early evidence of brain aging.

“Additional research is needed to confirm these findings and to determine how this change occurs, including looking at changes that people can make to reduce their chances of thinking and memory problems,” Huddleston said. “Making changes like incorporating more cardiovascular exercise and improving mental health may serve to also improve brain aging for this population.”

A limitation of the study was that polycystic ovary syndrome diagnosis was not made by a doctor but was based on androgen levels and self-reported symptoms, so participants may not have remembered all the information accurately.

Reference:

Huddleston HG, Jaswa EG, Casaletto KB, et al. Associations of polycystic ovary syndrome with indicators of brain health at midlife in the cardia cohort. Neurology. 2024. doi: 10.1212/WNL.0000000000208104.

Powered by WPeMatico

NEET 2024 Registration Process To Begin soon, know how to apply

New Delhi: The National Testing Agency (NTA) is going to start the application process for the NEET UG 2024 anytime soon. More than 20 lakh candidates are expected to register for the entrance test.

The entrance exam for MBBS and BDS courses, NEET UG 2024 exam will be held on May 5.

NEET UG is conducted for four subjects- Physics, Chemistry, Zoology and Botany. Each subject has two sections- A and B. While section A has 35 questions for 140 marks, section B has 15 questions for 40 marks. The paper is for a total of 720 marks. 

The NEET UG 2023 exam will be conducted in 13 languages- English, Hindi, Odia, Tamil, Gujarati, Marathi, Bengali, Urdu, Malayalam, Assamese, Telugu, Kannada and Punjabi

How to Apply?

Step 1: Visit the official website

Step 2: Click on the link for NEET UG 2024 registration on the homepage

Step 3: Click on new registration and fill in details such as name, date of birth, gender, mobile number and email address

Step 4: Once registered, log in using the application number and password

Step 5: Fill out the application form

Step 6: Save, submit and pay the fees

Step 7: Download the application form for future reference

What documents are required during registration? 

The aspirants will have to upload the scanned images of the following in JPG /PDF format only, for uploading the same as part of the submission of his/her online application:

— Latest Passport size Photograph in JPG format (size: 10 kb to 200 kb)

— Post Card size photograph (4” X 6”) in JPG format (Size: 10 kb – 200 kb)

— Signature in JPG format (size: 4 kb to 30 kb)

— Left and Right Hands Fingers impressions in JPG format (file size: 10 kb to 200 kb). Format for left and right hands’ impression to capture both hand impressions of the candidate for NEET 2022.

— Category certificate (SC/ST/OBC/EWS etc.) in PDF format (file size: 50 kb to 300 kb)

— PwD certificate in PDF format (file size: 50 kb to 300 kb)

— Embassy/Citizenship certificate in PDF format (file size: 50 kb to 300 kb)

— Class 10 passed certificate in PDF format (file size: 50 kb to 300 kb)

Powered by WPeMatico

Hypoalbuminemia linked to severe ED in ulcerative colitis patients: Study

Japan: A cross-sectional study published in the International Journal of Urology has shed light on serum albumin levels as a useful complementary marker for erectile dysfunction (ED) in ulcerative colitis (UC).

The researchers revealed an independent inverse association between serum albumin and severe erectile dysfunction in Japanese patients with ulcerative colitis. The findings suggest that hypoalbuminemia might be a useful complementary marker for assessing the severity and prevalence of erectile dysfunction in patients with ulcerative colitis.

Recently, studies have reported a close association between ulcerative colitis and erectile dysfunction. An inverse relationship is found between serum albumin and ED in patients with chronic disease. However, there seemed no clarity on the association between serum albumin levels and ED in patients with UC. Therefore, Shinya Furukawa, Health Services Center, Ehime University, Matsuyama, Ehime, Japan, and colleagues aimed to investigate this issue in Japanese patients with ulcerative colitis.

For this purpose, the researchers enrolled one hundred and thirty-six Japanese male UC patients. Information on medications for UC and serum albumin levels were obtained from medical records, Sexual Health Inventory for Men (SHIM) score information from self-administered questionnaires, and information on UC severity from physician reports were obtained from self-administered questionnaires, medical records, and reports from physicians.

Based on the total protein, serum albumin, serum globulin, aspartate aminotransferase, and C-reactive protein levels, the participants were divided into tertiles. The definitions of ED and severe ED were SHIM score < 22 and SHIM score < 8, respectively. Multivariate logistic regression was used to assess the association between these serum markers and ED.

The study led to the following findings:

  • The prevalence of severe erectile dysfunction in the low, moderate, and high albumin groups was 66.0%, 51.0%, and 28.3%, respectively.
  • After adjusting for confounding factors, the low albumin group was independently and positively associated with severe ED (adjusted odds ratio: 2.74).
  • There was no association between other markers and erectile dysfunction.

“Serum albumin was independently inversely associated with severe erectile dysfunction in Japanese patients with ulcerative colitis,” the researchers wrote. “Hypoalbuminemia might be a useful complementary marker for evaluating the prevalence and severity of ED in UC patients.”

Reference:

Yamamoto, Y., Furukawa, S., Miyake, T., Yoshida, O., Shiraishi, K., Hashimoto, Y., Tange, K., Kitahata, S., Ninomiya, T., Yagi, S., Hanayama, M., Suzuki, S., Shibata, N., Murakami, H., Ohashi, K., Tomida, H., Takeshita, E., Ikeda, Y., & Hiasa, Y. (2024). Serum albumin levels as a useful complementary marker for erectile dysfunction in ulcerative colitis: A cross-sectional study. International Journal of Urology, 31(2), 154-159. https://doi.org/10.1111/iju.15327

Powered by WPeMatico

Do Gender Disparities Impact Cancer Mortality in Women? – Dr Bharath VM

Gender
inequality persists as an ongoing social issue, manifesting in various aspects
of life. From wage disparities to under recognition in sports and politics,
women frequently encounter barriers hindering their access to resources and
well-being.

Although progress has been made to address these disparities, one
area that has been overlooked is the impact of gender inequality on women’s
health, specifically in the realm of cancer care.

The Lancet report has
presented data on the gender inequality experienced by women and has also
outlined policies to help them attain an equal position on par with men.

Women interact with cancer in
multiple and complex ways:

Cancer, the world’s second-largest killer after heart
disease, is on the rise in India. The study report by ICMR and NCRP indicates
that the number of cancer patients, currently around 14.6 lakh, will reach 16
lakh by next year.

The gender inequality in cancer care extends beyond mere
statistics; it profoundly impacts women in various roles. Women engage with
cancer as healthy individuals participating in prevention and screening, as
survivors living beyond diagnosis, caregivers for loved ones, advocates, healthcare
professionals, researchers, and policymakers.

The Lancet report highlights that
cancer ranks among the top causes of premature mortality for women globally,
yet it is often deprioritized in healthcare agendas.

According to the report,
the elimination of key risk factors or early detection and diagnosis could save
approximately 1.5 million lives. Another 800,000 deaths could be avoided if all
women had access to high-quality cancer care.

Globally, women face financial challenges in coping with
cancer, aggravated by fewer financial resources than men. In the cancer
workforce, women report pervasive gender-based discrimination, including
bullying and sexual harassment.

Shockingly, only 16% of global cancer-related
organizations are led by women. Moreover, the unpaid caregiving work for those
with cancer is predominantly shouldered by women, representing a significant
percentage of national health expenditures in various countries.

A Call to
Action

Acknowledging the magnitude of gender disparities in cancer
care, the Lancet Commission proposes ten policies and a comprehensive working
plan. The core objectives include prioritizing data collection, ensuring
equitable healthcare access, promoting screening and early diagnosis, spreading
awareness among rural women, and advocating for equal opportunities and pay
standards.

The Lancet Commission report challenges prevailing
misconceptions that addressing gender inequality in cancer care is a mere
feminist or politically driven agenda.

Instead, it emphasizes the urgency of
recognizing the undeniable numbers and statistics that reveal a disparity in
the treatment of women facing cancer.

The report serves as a call for
collective responsibility, urging fathers, brothers, and husbands to stand up
for women’s rights and equity in cancer care and healthcare at large.

As society strives for inclusivity and equality, addressing
gender disparities in cancer care is not just a moral imperative but a public
health necessity.

So, a roadmap for systemic change, emphasizing the need for
individual and collective action to bridge the gap in cancer care, is highly
recommendable. It is time to move beyond rhetoric and translate awareness into
tangible policies that ensure women receive the equitable, compassionate care
they deserve in their battle against cancer.

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.

Powered by WPeMatico

32-year-old doctor assaulted, 2 held

In a jaw-dropping incident, two final-year students of the Banaras Hindu University (BHU) were arrested on Monday for allegedly sexually assaulting a 32-year-old male doctor and forcing him to perform unnatural sex.

The accused locked the doctor in the hostel room and robbed him of Rs 60,000 with other valuable gold items.

According to the police, the accused students called the doctor for a medical emergency at the university’s hostel. They then imprisoned him in the hostel room, physically assaulted him, coerced him into engaging in non-consensual sexual acts, and robbed him by threatening to share a nude video of him on social media.

Along with these two students, three others were also in the hostel room when the incident occurred.

For the full story, check out the link given below:

UP Shocker: Doctor Assaulted, Robbed On Pretext Of Medical Emergency, Forced To Perform Unnatural Sex

32-year-old doctor assaulted, 2 held

Powered by WPeMatico

Kilkari, Mobile Health Academy launched for Maharashtra and Gujarat

Mumbai: Prof S P Singh Baghel and Dr Bharati Pravin Pawar, Union Ministers of State for Health and Family Welfare recently virtually launched the Kilkari programme, a Mobile Health (m-health) initiative for beneficiaries in local content in Gujarat and Maharashtra.

Mobile Academy, a free audio training course designed to expand and refresh the knowledge of Accredited Social Health Activists (ASHAs) and improve their communication skills via their mobile phones was also launched. Shri Rushikesh Patel, Health Minister, Gujarat was also present on the occasion.

Also Read:Mansukh Mandaviya inaugurates 3 CGHS Wellness Centres in Delhi, Robotic Unit at NITRD

Expressing her elation at the launch, Dr. Bharati Pravin Pawar associated the launch of the m-health initiative with the rapid speed of transformation of the health sector in the country in keeping with the vision of Hon’ble Prime Minister, Shri Narendra Modi for a Digital Health India based on harnessing technology for the benefit of mankind.

Applauding the health care professionals, especially the front-line health workers for their contributions in taking up the ‘Kilkari’ Programme, she said that the programme aims to offer weekly services, timely accessible, accurate and pertinent 72 audio messages through IVRS about reproductive maternal, neonatal and child health care to the targeted beneficiaries.

Speaking on the occasion, Prof S P Singh Baghel said, “The launch of the Kilkari Programme is in line with the Government’s commitment to prioritize the public health infrastructure and strengthen citizen-centric health services by leveraging India’s expanding mobile phone penetration.”

Highlighting that “only a healthy mother can deliver a healthy child”, Prof. Baghel said that under the leadership of the Hon’ble Prime Minister, the Union Government has taken several steps towards ensuring the health and well-being of women.

The Union Ministers also appreciated the efforts of all stakeholders involved in the launch of the and invited suggestions from the stakeholders to strengthen the programme further.

Shri Rushikesh Patel, Health Minister, Gujarat thanked the Union Government for the launch of the two initiatives. He also highlighted that more than 95% of deliveries in Gujarat are now institutional which is leading to safer deliveries for both mothers and children.

‘Kilkari’ (meaning ‘a baby’s gurgle’), is a centralized interactive voice response (IVR) based mobile health service which delivers free, weekly, time-appropriate 72 audio messages about pregnancy, childbirth, and childcare directly to families’ mobile phones from the second trimester of pregnancy until the child is one year old.

Women who are registered in Reproductive Child Health (RCH) portal) based on the woman’s LMP (last menstrual period) or the child’s DoB (Date of Birth), receive a weekly call with pre-recorded audio content directly to the mobile phones of pregnant women and mothers with children under the age of one year. Kilkari audio messages are present in the form of voice of a fictitious doctor character called Dr. Anita.

Kilkari Programme is centrally hosted by MoHFW for all the States/UTs and no further investment in the technology, telephony infrastructure or operational costs is required to be borne by States/UTs. This service is FREE of cost for States/UTs and beneficiaries. The programme is service is integrated with centralized Reproductive Child Health (RCH) portal of MoHFW’s and is the single source of information for this mHealth service.

Mobile Academy is a free audio training course designed to expand and refresh the knowledge of Accredited Social Health Activists (ASHAs) and improve their communication skills via their mobile phones, which is both cost-effective and efficient. It is an anytime, anywhere training course that can train thousands of ASHAs simultaneously via mobile phone.

Currently Kilkari is under implementation in 18 States / UTs namely Andhra Pradesh, Andaman & Nicobar Islands, Assam, Bihar, Chhattisgarh, Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu & Kashmir, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Tripura, Uttar Pradesh, West Bengal and Uttarakhand & Mobile Academy is operational in 17 States/UTs except Chandigarh with six languages viz. Hindi, Bhojpuri, Oriya, Assamese, Bengali & Telugu version.Senior officials of the Union Health Ministry, Government of Gujarat, Government of Maharashtra as well as representatives from the implementing agencies were also present on the occasion.

Senior officials of the Union Health Ministry, Government of Gujarat, Government of Maharashtra as well as representatives from the implementing agencies were also present on the occasion.

Also Read:Health Minister inaugurates series of new facilities at AIIMS

Powered by WPeMatico

Study says women antidepressant use spikes post-breakup

Ever wondered how breakups and the loss of a loved one impact men and women differently? A study examining antidepressant usage among over 200,000 individuals aged 50 to 70 in Finland from 1996 to 2018 sheds light on this. Before a breakup, both genders showed an uptick in antidepressant use, but women seemed to be hit harder. In the four years leading up to a split, women’s usage increased significantly more than men’s, and even after, they continued relying more on antidepressants compared to their pre-breakup days. Gender-specific family roles, responsibilities, and economic disparities likely contribute to this discrepancy, as women often bear more caregiving and household duties. Despite facing more challenges, women tend to have broader social networks and stronger social support, which might help them cope better. When it comes to the loss of a partner, both genders saw an increase in antidepressant usage leading up to the event, but women experienced a more significant spike, especially in the months surrounding the bereavement. Interestingly, more men than women entered new relationships within a couple of years after a breakup or loss. It’s an intriguing glimpse into how gender dynamics play out in the realm of relationships and emotional well-being.

Reference: Hu Y, Metsä-Simola N, Malmberg S, et al Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study, J Epidemiol Community Health, DOI: 10.1136/jech-2023-221529

Powered by WPeMatico