Stroke patient’s zero-degree head positioning before surgery may improve neurological function: Study

USA: Zero-degree head positioning is a safe and effective strategy to optimize blood flow to the brain until the thrombectomy can be performed, and it should be considered the standard of care for stroke patients prior to thrombectomy, a recent study has revealed. 

The findings, presented as preliminary late-breaking science at the American Stroke Association’s International Stroke Conference 2024, suggest that gravitational force can play an important role in improving blood flow temporarily while patients are waiting for surgery. The meeting, held in person in Phoenix, Feb. 7 – 9, 2024, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the study, positioning patients with large vessel ischemic (clot-caused) stroke with their heads flat (0-degrees) before surgery to remove the blood clot resulted in significant improvements in neurological function, compared to patients whose heads were elevated (at a 30-degree angle).. 

Large vessel occlusion is a type of ischemic stroke involving blockage of a major artery in the brain. A surgical procedure called thrombectomy removes the blood clot to restore blood flow and reduce the risk of death or permanent injury to the brain including a potential loss of neurological function.

“Many thrombectomy patients have delays until the procedure can be started, whether due to slow internal hospital processes, multiple patients arriving at the same time or if the patient needs to be transferred to another hospital,” said lead study researcher Anne W. Alexandrov, Ph.D., a professor of nursing and neurology at the University of Tennessee Health Science Center in Memphis. “Optimizing blood flow to the brain while patients are waiting for surgery, is essential to minimize the risk of neurological deficits and ultimately disability.”

Currently, hospital beds for stroke patients awaiting thrombectomy surgery are typically set with the head of the bed at a 30-degree angle, or a slight incline, Alexandrov said. However, pilot studies conducted by Alexandrov’s team have shown that when the head of the bed is flat at 0-degrees, thrombectomy patients benefit from increased gravitational blood flow through the narrowed/blocked artery and more open collateral arteries for the procedure.

In this randomized clinical trial called Zero Degree Head Positioning in Acute Large Vessel Ischemic Stroke or ZODIAC, researchers used the National Institutes of Health Stroke Scale (NIHSS)-which assesses consciousness, vision, speech, motor strength and sensory loss-to evaluate stroke patients with large vessel occlusion acute ischemic stroke. They compared if patients’ conditions remained stable or worsened depending on whether they were set with 0-degree head positioning vs. 30-degree head positioning before thrombectomy surgery.

Stroke patients’ baseline NIHSS scores were measured at 0-degrees immediately after neuroimaging, then they were randomly positioned to head positioning at either 0-degrees or 30-degrees. Patients underwent repeat NIHSS scoring every 10 minutes until the thrombectomy was performed, with a final NIHSS score assessed immediately before they were positioned on the surgical table.

An interim analysis found that 0-degree head positioning before thrombectomy surgery resulted in greater stability and/or clinical improvement prior to surgery based on repeated NIHSS scores in stroke patients compared to patients with 30-degree head positioning.

The investigators also explored whether there would be differences in the NIHSS score at 24 hours following surgery and at 7 days or discharge (whichever came first), however, they didn’t expect to find a difference because thrombectomy itself dramatically improves patient outcomes. They were surprised to find that at both 24 hours after surgery and at 7 days after discharge, the 0-degree-head-position patients had less neurological deficits on the NIHSS compared to patients with head-positioning at a 30-degree incline before surgery.

“By three months following surgery, there was no difference in outcomes for patients in either group, however, it’s exciting to see that we were able to discharge patients from the hospital with less disability requiring rehabilitation,” Alexandrov said.

Due to the efficacy of 0-degree head positioning for stroke patients awaiting thrombectomy, the study’s Data and Safety Monitoring Board stopped enrollment in this trial on November 1, 2023.

“Our findings suggest that gravitational force can play an important role in improving blood flow temporarily while patients are waiting for surgery,” Alexandrov said. “Zero-degree head positioning is a safe and effective strategy to optimize blood flow to the brain until the thrombectomy can be performed, and it should be considered the standard of care for stroke patients prior to thrombectomy.”

Study background and details:

  • The study included 92 patients from 12 stroke centers in the U.S.
  • Demographic information on the patients will be provided at presentation.
  • Alexandrov noted that 0-degree head positioning is NOT a treatment for stroke; it is a way to preserve brain function by optimizing blood flow until the thrombectomy can be performed. “It is a rescue maneuver, not a treatment.”

Reference:

Position of stroke patient’s head before surgery may improve neurological function, American Heart Association, Meeting: ASA International Stroke Conference 2024.

Powered by WPeMatico

Oral IL-23 inhibitor promising for treatment of moderate-to-severe plaque psoriasis: NEJM

Canada: A recent study showed greater treatment efficacy with the interleukin-23–receptor antagonist peptide JNJ-77242113 after 16 weeks of once- or twice-daily oral administration than placebo in patients with moderate-to-severe plaque psoriasis. The findings from the FRONTIER 1, a phase 2 dose-finding trial, were published online in The New England Journal of Medicine.

“The level of reduction of psoriasis that was observed with higher doses of JNJ-77242113 at week 16 was similar in magnitude to the responses seen with several of the injectable biologics that are currently approved for psoriasis,” investigators in the FRONTIER 1 trial wrote. 

Psoriasis is an immune-mediated, multisystemic, inflammatory disease that predominantly involves the skin and joints. The disease is also a risk factor for atherosclerotic cardiovascular disease. Interleukin-23 plays an important role in pathogenic T-cell activation in psoriasis.

Using monoclonal antibodies has changed the treatment of various immune-mediated inflammatory diseases, including psoriasis. However, these large proteins must be administered via injection. Many patients prefer oral treatments over injections, and injections are especially problematic among children and among patients with a fear of needles. Thus, there is a need for efficacious targeted therapies that can be administered orally.

JNJ-77242113 is a novel, orally administered interleukin-23–receptor antagonist peptide selectively blocks interleukin-23 signalling and downstream cytokine production. Robert Bissonnette, University of Toronto, Toronto, Canada, and colleagues report the results of FRONTIER 1, a phase 2 trial of JNJ-77242113 in patients with moderate-to-severe plaque psoriasis.

In the trial, 255 patients with moderate-to-severe plaque psoriasis were randomly assigned to receive JNJ-77242113 at a dose of 25 mg once daily, 25 mg twice daily, 50 mg once daily, 100 mg once daily, or 100 mg twice daily or placebo for 16 weeks. The study’s primary endpoint was a reduction from a baseline of at least 75% in the Psoriasis Area and Severity Index (PASI) score (PASI 75 response). PASI scores range from 0 to 72, with higher scores implying greater extent or severity of psoriasis) at week 16.

The mean PASI score at baseline was 19.1. The mean psoriasis duration was 18.2 years, and 78% of the patients across all the trial groups had previously received systemic treatments.

The researchers reported the following findings:

  • At week 16, the percentages of patients with a PASI 75 response were higher among those in the JNJ-77242113 groups (37%, 51%, 58%, 65%, and 79% in the 25-mg once-daily, 25-mg twice-daily, 50-mg once-daily, 100-mg once-daily, and 100-mg twice-daily groups, respectively) than among those in the placebo group (9%), a finding that showed a significant dose–response relationship.
  • The most common adverse events included coronavirus disease 2019 (in 12% of the patients in the placebo group and 11% of those across the JNJ-77242113 dose groups) and nasopharyngitis (in 5% and 7%, respectively).
  • The percentages of patients who had at least one adverse event were similar in the combined JNJ-77242113 dose group (52%) and the placebo group (51%).
  • There was no evidence of a dose-related increase in adverse events across the JNJ-77242113 dose groups.

“In patients with moderate-to-severe plaque psoriasis, JNJ-77242113 showed a dose-response relationship and greater efficacy than placebo, as measured by the PASI 75 response at week 16,” the researchers wrote. “Overall, we found no evidence of a relationship between the JNJ-77242113 dose and the incidence of adverse events.”

Limitations include a small number of patients in each trial group and the short duration of treatment. In addition, no corrections were made for multiplicity, so the researchers could not infer definitive effects of JNJ-77242113 for particular dose groups or secondary endpoints.

Reference:

Bissonnette R, Pinter A, Ferris LK, Gerdes S, Rich P, Vender R, Miller M, Shen YK, Kannan A, Li S, DeKlotz C, Papp K. An Oral Interleukin-23-Receptor Antagonist Peptide for Plaque Psoriasis. N Engl J Med. 2024 Feb 8;390(6):510-521. doi: 10.1056/NEJMoa2308713. PMID: 38324484.

Powered by WPeMatico

Three-Port Laparoscopic Cholecystectomy safe option to Standard Four-Port Laparoscopic Cholecystectomy

Recently published study aimed to assess the feasibility and safety of three-port laparoscopic cholecystectomy as an alternative to the conventional four-port approach. The study involved a prospective observational analysis of 102 patients who underwent the three-port approach, evaluating parameters such as age, sex, intra-operative difficulties, outcomes, and the need for conversion to four-port laparoscopic cholecystectomy. Modifications in the technique included the use of a pre-emptive analgesia and specific port placements. The study found that the mean operative time was 52.68 minutes, with difficulty encountered in 18.6% of cases due to various factors such as pericholecystic adhesions and mucocele of the gallbladder. The postoperative pain was minimal, with a mean visual analog scale score of 1.22, and the mean postoperative hospital stay was 1.08 days. Only 2.9% of cases needed conversion to four-port cholecystectomy for safety reasons. The study concluded that three-port laparoscopic cholecystectomy is a feasible and safe alternative, especially in difficult cases such as post-endoscopic retrograde cholangiopancreatography and mucocele of the gallbladder. The researchers emphasized that the reduced number of ports, pre-emptive analgesia, and improved cosmesis make this approach a viable option in the treatment of gallstone disease. However, they acknowledged the need for further comparative studies to establish its safety and feasibility. The study was conducted with approval from the institutional ethics committee, and the authors declared no conflicts of interest.

Reference –

Chatterjee A, Kumar R, Chattoraj A (January 13, 2024) Three-Port Laparoscopic Cholecystectomy as a Safe and Feasible Alternative to the Conventional Four-Port Laparoscopic Cholecystectomy. Cureus 16(1): e52196. doi:10.7759/cureus.52196

Powered by WPeMatico

Antidepressant Use may Increase Risk of Exacerbation in COPD Patients: BMJ

A recent study found a concerning association between antidepressant use and an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation in patients who are already suffering from COPD. The findings were published in the BMJ Thorax underscore the importance of monitoring of antidepressant prescriptions and consideration of alternative interventions.

This research conducted in the UK, employed a self-controlled case series methodology and analyzed data from The Health Improvement Network in the UK. The study focused on over 31,000 patients who were diagnosed with COPD and were prescribed antidepressants which revealed that within 90 days following an antidepressant prescription, patients faced an increased risk of pneumonia (79%) when compared to periods when they were not exposed to the medication. Also, there was a heightened risk of COPD exacerbation about 16% during this timeframe.

These risks were found to reduce gradually once the patients stopped taking antidepressants which indicates a potential causal relationship between the medication and respiratory issues. This study also highlighted a persistent increased risk of COPD exacerbation even after the 90-day period, albeit to a lesser extent.

The study emphasized the importance of close monitoring of patients with COPD who take antidepressants. These findings suggest a need for increased awareness among healthcare providers regarding the potential respiratory side effects of antidepressant medications, This underscores the necessity of considering non-pharmacological interventions and weighing the risks and benefits of antidepressant therapy in COPD patients. While antidepressants are crucial for treating mental health disorders, the outcomes of this study suggest caution and thorough consideration of side effects, particularly in vulnerable patient populations such as the individuals with COPD.

Reference:

Siraj, R. A., Bolton, C. E., & McKeever, T. M. (2023). Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS). In Thorax (Vol. 79, Issue 1, pp. 50–57). BMJ. https://doi.org/10.1136/thorax-2022-219736

Powered by WPeMatico

Visit to visit Systolic BP variability may help predict cardiovascular outcomes

A recent study published in the European Heart Journal highlights the critical role of visit-to-visit systolic blood pressure variability (BPV) as a predictor of cardiovascular (CV) outcomes. This study was conducted as an extension of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm (ASCOT-BPLA) in the UK, which spanned over two decades to evaluate the long-term impact of blood pressure (BP) control and variability.

The findings suggest that BPV significantly influences CV events, independent of mean systolic blood pressure (SBP) and emphasizes its importance even in individuals with well-controlled BP. The study closely followed 8,580 hypertensive participants that underscore the necessity of addressing BP variability along with mean SBP for effective cardiovascular risk management.

During the follow-up period of 21 years, the participants on amlodipine-based treatment expressed a reduced risk of stroke, total CV events, total coronary events and atrial fibrillation when compared to those on atenolol-based treatment. The outcomes of this study challenge the previous assumptions about the primary determinants of CV risk by highlighting the significance of considering BPV as the factor to assess cardiovascular health. The results suggest that interventions that target BPV may offer substantial benefits in reducing the incidence of CV events in strokes and atrial fibrillation.

This research underlines the need for personalized treatment strategies that not only focus on achieving target SBP levels but also address BPV to optimize cardiovascular outcomes. This finds significant implications for clinical practice that help emphasizing the importance of comprehensive BP management in reducing the burden of cardiovascular disease.

Reference:

Gupta, A., Whiteley, W. N., Godec, T., Rostamian, S., Ariti, C., Mackay, J., Whitehouse, A., Janani, L., Poulter, N. R., Sever, P. S., Aldegather, J., Collier, D., Delles, C., Dyker, A., Eaton, M., Heller, S., Hildick-Smith, D., Kristinsson, A., … Lip, G. (2024). Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. In European Heart Journal. Oxford University Press (OUP). https://doi.org/10.1093/eurheartj/ehad814

Powered by WPeMatico

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