Higher AMH levels lower ovulation chances during induction with clomiphene and metformin in PCOS patients

USA: A recent study published in Fertility and Sterility has shown reduced odds of ovulation with ovulation induction (OI) with clomiphene, metformin, and clomiphene+metformin with a higher Anti-Müllerian hormone (AMH) concentration in women with polycystic ovary syndrome (PCOS) and infertility.

“Higher baseline AMH concentrations were associated with a 10% reduction in the odds of ovulation per 1 ng/mL increase,” the researchers reported. “Women with elevated baseline AMH (>8 ng/mL) had significantly lower ovulation rates in comparison.”

Allison S Komorowski, Department of Obstetrics & Gynecology, Chicago, IL, USA, and colleagues described serum anti-Müllerian hormone concentrations in a large, well-phenotyped cohort of women with PCOS and evaluated whether AMH predicts successful ovulation induction in women treated with clomiphene and metformin.

For this purpose, the researchers performed a secondary analysis of a randomized controlled trial SUBJECTS: 333 women with anovulatory infertility attributed to PCOS who participated in the double-blind randomized trial entitled The Pregnancy in Polycystic Ovary Syndrome I (PPCOS I) study. These participants had serum samples from baseline laboratory testing available for further serum analysis.

The researchers assessed the association between baseline AMH concentration in each of the three treatment groups and ovulation rates, pregnancy rates and live birth rates.

The study revealed the following findings:

  • 322 individuals had a baseline AMH concentration available, of which the mean AMH was 11.7 ± 8.3 ng/mL with a range from 0.1 to 43.0 ng/mL.
  • With each unit (1 ng/mL) increase in baseline AMH, the odds of ovulation reduced by 10 per cent (OR 0.90); this effect did not differ by treatment group.
  • Women with a high baseline AMH concentration (>8 ng/mL) were significantly less likely to ovulate compared to those with a normal baseline AMH concentration (<4 ng/mL) (OR 0.23). This remained statistically significant when controlling for confounders, including body mass index, age, time in study, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score.
  • Ovulation occurred even at very high AMH concentrations; there was no maximum level noted at which no ovulation events occurred.
  • When controlling for confounders, baseline AMH concentration was not associated with pregnancy or live birth rates.

“These AMH values of well-phenotyped women with PCOS add to the literature and will aid in identifying AMH criteria for PCOS diagnosis,” the researchers wrote.

“A higher AMH concentration was associated with reduced odds of ovulation with OI with clomiphene, metformin, and clomiphene+metformin in women with infertility and PCOS,” they concluded.

Reference:

Komorowski AS, Hughes L, Sarkar P, Aaby DA, Kumar A, Kalra B, Legro RS, Boots CE. Anti-Müllerian Hormone Level Predicts Ovulation in Women with Polycystic Ovary Syndrome Treated with Clomiphene and Metformin. Fertil Steril. 2023 Dec 26:S0015-0282(23)02102-7. doi: 10.1016/j.fertnstert.2023.12.031. Epub ahead of print. PMID: 38154770.

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Doxofylline Shows Promise as Steroid-Sparing Treatment for Pediatric Asthma

A recent pilot study conducted in Mexican children with asthma suggests that doxofylline, when used in conjunction with inhaled corticosteroids (ICS), may offer a potential steroid-sparing effect. This study was published in the Journal Of Asthma by Sandra Diaz. and colleagues. The study, a 10-week open-label crossover trial, aimed to evaluate the efficacy of doxofylline as an ICS-sparing agent in pediatric asthma treatment.

In this study involving children aged 6 to 16 years who had been on ICS treatment for at least 8 weeks prior to enrollment, participants were divided into two groups. Group A received a combination of doxofylline and standard-dose budesonide (D + SDB) for the initial 4 weeks, followed by doxofylline along with reduced-dose budesonide (D + RDB) for the subsequent 4 weeks. Conversely, Group B received D + RDB initially, followed by D + SDB.

The clinical outcomes assessed included several key parameters such as lung function measured by forced expiratory volume in 1 second (FEV1), fractional exhaled nitric oxide (FeNO), asthma control, exacerbation frequency, and rescue medication (salbutamol) use.

The results demonstrated a potential benefit of combining doxofylline with ICS in pediatric asthma management. Notably, the combined therapy allowed for a reduction in the daily dose of ICS while maintaining lung function and improving asthma control (p = 0.008). The incidence of asthma exacerbations was low, with only one patient requiring systemic corticosteroid treatment. Moreover, a significant decrease in rescue medication usage was observed in patients receiving D + SDB during the initial 4-week period.

The findings from this pilot study suggest that doxofylline could serve as a promising steroid-sparing agent in the treatment of pediatric asthma. However, the study emphasizes the need for longer-term and controlled investigations to validate and further establish these observations.

These results bear potential implications for pediatric asthma management, hinting at the prospect of optimizing treatment regimens by incorporating doxofylline as an adjunct to ICS. The study’s promising outcomes pave the way for future research aimed at validating and expanding upon these preliminary findings.

Reference:

González-Díaz, S. N., Ansotegui, I. J., Macouzet-Sánchez, C., Acuña-Ortega, N., & de la Cruz-de la Cruz, C. Doxofylline as a steroid-sparing treatment in Mexican children with asthma. The Journal of Asthma: Official Journal of the Association for the Care of Asthma,2023:1–10. https://doi.org/10.1080/02770903.2023.2294909

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No need to discontinue SGLT2 inhibitors in response to initial eGFR decline in heart failure patients

USA: SGLT2 inhibitors should not be discontinued in response to an initial decline in the estimated glomerular filtration rate (eGFR) among patients with heart failure and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF), a recent study has suggested.

The findings from the prespecified secondary analysis of the DELIVER randomized clinical trial were published online in JAMA Cardiology on November 12, 2023.

The researchers showed that among 5788 participants of the DELIVER trial, an initial eGFR decline of greater than 10% (vs ≤10%) was frequent and associated with an increased risk of primary cardiovascular outcome in patients randomized to placebo but not among those randomized to dapagliflozin. An initial eGFR decline greater than 10% was not tied to adverse kidney outcomes among dapagliflozin-treated patients.

The researchers note an expected initial decline in eGFR after initiating a sodium-glucose cotransporter-2 inhibitor (SGLT2i), which has been observed across patients with diabetes, heart failure, and chronic kidney disease. Finnian R. Mc Causland, Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues aimed to examine the implications of initial changes in eGFR among patients with HFmrEF or HFpEF enrolled in the DELIVER trial which took place from 2018 to 2022. DELIVER trial is an international multicenter study of patients with ejection fraction greater than 40% and eGFR greater than or equal to 25.

The study included 5788 participants (mean age 72 years; 56% were males). They received 10 mg per day of dapagliflozin or placebo.

The researchers compared the frequency of an initial eGFR decline (baseline to month 1) between dapagliflozin and placebo. Cox models adjusted for baseline and established prognostic factors were fit to determine the association of an initial eGFR decline with kidney (≥50% eGFR decline, eGFR<15 or dialysis, death from kidney causes) and cardiovascular (cardiovascular death or heart failure event) outcomes, landmarked at month 1, stratified by diabetes.

The study led to the following findings:

  • The median change in eGFR level from baseline to month 1 was −1 with placebo and −4 with dapagliflozin (difference, −3).
  • A higher proportion of patients assigned to dapagliflozin developed an initial eGFR decline greater than 10% vs placebo (40% versus 25%; odds ratio, 1.9).
  • An initial eGFR decline of greater than 10% (vs ≤10%) was associated with a higher risk of the primary cardiovascular outcome among those randomized to placebo (adjusted hazard ratio [aHR], 1.33) but not among those randomized to dapagliflozin (aHR, 0.90).
  • Similar associations were observed when alternative thresholds of initial eGFR decline were considered and when analyzed as a continuous measure.
  • An initial eGFR decline of greater than 10% was not associated with adverse subsequent kidney composite outcomes in dapagliflozin-treated patients (aHR, 0.94).

“The findings show that an initial eGFR decline was frequent but not associated with subsequent risk of cardiovascular or kidney events among patients with HFmrEF or HFpEF treated with dapagliflozin,” the researchers wrote.

“These data reinforce clinical guidance that SGLT2 inhibitors should not be discontinued or interrupted in response to an initial eGFR decline,” they concluded.

Reference:

Mc Causland FR, Claggett BL, Vaduganathan M, et al. Decline in Estimated Glomerular Filtration Rate After Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial. JAMA Cardiol. Published online November 12, 2023. doi:10.1001/jamacardio.2023.4664

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ChatGPT has low diagnostic accuracy in pediatric cases, finds JAMA study

USA: A recent study published in JAMA Pediatrics has shed light on the diagnostic accuracy of a large language model (LLM) in pediatric case studies.

The researchers found that a LLM-based chatbot gave the wrong diagnosis for the majority of pediatric cases. They showed that the ChatGPT version 3.5 reached an incorrect diagnosis in 83 out of 100 pediatric case challenges. Among the incorrect diagnoses, 72 were incorrect, and 11 were clinically related to the correct diagnosis but too broad to be considered correct.

For example, ChatGPT got it wrong in a case of arthralgia and rash in a teenager with autism. The chatbot’s diagnosis was “immune thrombocytopenic purpura” and the physician’s diagnosis was “scurvy.”

An example of an instance in which the chatbot diagnosis was determined to not fully capture the diagnosis was the case of a draining papule on the lateral neck of an infant. The chatbot diagnosis was “branchial cleft cyst” and the physician diagnosis was “branchio-oto-renal syndrome.”

“Physicians should continue to investigate the applications of LLMs to medicine, despite the high error rate of the chatbot,” Joseph Barile, Cohen Children’s Medical Center, New Hyde Park, New York, and colleagues wrote.

“Chatbots and LLMs have potential as an administrative tool for physicians, demonstrating proficiency in writing research articles and generating patient instructions.”

A previous study investigating the diagnostic accuracy of ChatGPT version 4 found that the artificial intelligence (AI) chatbot rendered a correct diagnosis in 39% of New England Journal of Medicine (NEJM) case challenges. This suggested the use of LLM-based chatbots as a supplementary tool for clinicians in diagnosing and developing a differential list for complex cases.

“The capacity of large language models to process information and provide users with insights from vast amounts of data makes the technology well suited for algorithmic problem-solving,” the researchers wrote.

According to the researchers, no research has explored the accuracy of LLM-based chatbots in solely pediatric scenarios, which need the consideration of the patient’s age alongside symptoms. Dr. Barile and colleagues assessed this accuracy across JAMA Pediatrics and NEJM pediatric case challenges.

For this purpose, the team pasted text from 100 cases into the ChatGPT version 3.5 with the following prompt: “List a differential diagnosis and a final diagnosis.”

The chatbot-generated diagnoses were scored as “correct,” “incorrect,” or “did not fully capture diagnosis” by two physician researchers.

Barile and colleagues noted that more than half of the incorrect diagnoses generated by the chatbot belonged to the same organ system as the correct diagnosis. Additionally, 36% of the final case report diagnoses were included in the chatbot-generated differential list.

Reference:

Barile J, Margolis A, Cason G, et al. Diagnostic Accuracy of a Large Language Model in Pediatric Case Studies. JAMA Pediatr. Published online January 02, 2024. doi:10.1001/jamapediatrics.2023.5750

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Elevated liver enzyme levels tied to risk of incident type 2 diabetes in obese patients

Among obese individuals, elevated liver enzyme levels tied to risk for incident type 2 diabetes suggests a new study published in the Acta Diabetologic

The role of liver steatosis and increased liver enzymes (ALT) in increasing incident type 2 diabetes mellitus (T2DM) is debated, because of their differential effects on different ethnicities and populations. The aim of this study was to evaluate the role of elevated ALT in the development of T2DM in non-diabetic obese subjects receiving routine medical treatment.

A total of 1005 subjects [296 men and 709 women, aged 45.7 ± 13.12 years, body mass index (BMI) 39.5 ± 4.86 kg/m2] were followed for a mean period of 14.3 ± 4.44 years. Subjects were evaluated for several metabolic variables, including the triglyceride-glucose index and the presence of metabolic syndrome (IDF 2005 definition), and were subdivided into ALT quartiles.

Results

T2DM developed in 136 subjects, and the difference was significant between the first and the fourth ALT quartile (p = 0.048). Both at univariate analysis and at stepwise regression, ALT quartiles were associated with incident T2DM. Traditional risk factors for T2DM coexisted, with a somehow greater predictive value, such as triglyceride-glucose index, age, arterial hypertension, LDL-cholesterol, and metabolic syndrome.

These data suggest an association between elevated ALT levels and the risk of incident T2DM in obesity.

Reference:

Folli, F., Pontiroli, A.E., Zakaria, A.S. et al. Alanine transferase levels (ALT) and triglyceride-glucose index are risk factors for type 2 diabetes mellitus in obese patients. Acta Diabetol (2023). https://doi.org/10.1007/s00592-023-02209-6

Keywords:

Among, obese, individuals, elevated, liver, enzyme, levels, tied, risk, for, incident, type 2 diabetes, Acta Diabetologic, Folli, F., Pontiroli, A.E., Zakaria, A.S

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DASH Diet reveals Significant Benefits for Liver Health for Patients with NAFLD

In a recent randomized controlled
trial, researchers investigated the potential effect of the Dietary approaches
to stop hypertension (DASH) diet in managing non-alcoholic fatty liver disease
(NAFLD). The findings were published online in the European Journal of
Nutrition on October 19, 2023.

The
study’s findings demonstrated that adhering to the DASH diet results in
significant improvements in hepatic fibrosis, steatosis, and liver enzymes,
including alanine transaminase (ALT), aspartate transaminase (AST), and
gamma-glutamyl transpeptidase (GGT) in the management of NAFLD.

These
significant improvements in steatosis, hepatic fibrosis, and liver enzymes
illustrate the positive effects of dietary interventions for liver health,
indicating that patients with NAFLD may benefit greatly from adhering to a DASH
diet. With the increasing prevalence of NAFLD, lifestyle modifications such as
the DASH diet are proving to be increasingly effective in promoting liver
health and overall well-being.

Study Overview:

In a
12-week randomized controlled trial, seventy patients diagnosed with
non-alcoholic fatty liver disease (NAFLD) were enrolled. In this study,
researchers randomly allocated the patients to either the intervention group,
where they adopted the DASH diet (containing 50–55% carbohydrate, 15–20%
protein, and 30% total fat), or the control group (maintaining a healthy diet
containing 50–55% carbohydrate, 15–20% protein, and 30% total fat). Both groups
followed calorie-restricted diets designed to be 500-700 calories lower than
their energy requirements. The primary focus of this study was to investigate
the effects of the DASH diet on hepatic fibrosis, hepatic steatosis, and liver
enzyme levels, including ALT, AST, and
GGT.

Key Results of the Study:

At
the baseline, there were no significant differences between the two groups
concerning hepatic fibrosis (P = 0.63), hepatic steatosis (P = 0.53), and liver
enzyme levels ((P = 0.53), ALT (P = 0.93), AST (P = 0.18), and GGT (P = 0.76)),
enabling an unbiased evaluation of the implications of the DASH diet on NAFLD
in comparison to a conventional healthy diet.

Effects
on Liver Enzymes like ALT and AST: ALT and AST are crucial for assessing
liver health. The intervention group showed a significant reduction in levels
of ALT and AST compared to the control group. Specifically, ALT levels
decreased impressively by -8.50 ± 8.98 in the intervention group, while the
control group showed a more significant reduction of -2.09 ± 7.29. Similarly,
AST levels significantly dropped by -5.79 ± 6.83 in the intervention group, in
contrast to the control group’s slight decrease of -0.51 ± 6.62. These findings
emphasize the potential of the DASH diet’s ability to promote healthier liver
enzyme levels among NAFLD patients.

Reduction
in Hepatic Steatosis: Hepatic steatosis is a condition that is
characterized by fat accumulation in the liver. Hepatic steatosis also
significantly improved in the intervention group, with a 31-grade decrease
compared to the control group’s 9-grade reduction. This improvement in hepatic
steatosis suggests the potential for the DASH diet to reduce the excessive fat
accumulation in the liver.

Reduction
in Hepatic Fibrosis: Hepatic Fibrosis is a crucial marker of NAFLD
progression. The intervention group exhibited a remarkable drop in hepatic
fibrosis, with a 23-grade decrease compared to the control group’s 7-grade
reduction. This substantial decrease in hepatic fibrosis indicates the
potential for the DASH diet to enhance liver health significantly.

Clinical Implications of the Study:

The
significance of this study reveals that adherence to the DASH diet demonstrated
significant positive effects on hepatic fibrosis, hepatic steatosis, and liver
enzyme levels, which holds profound implications for NAFLD patients. As the
prevalence of NAFLD continues to rise, lifestyle and dietary modifications,
such as the DASH diet, are emerging as progressively more successful strategies
for those seeking to take control of their liver health and overall well-being.

The
present trial emphasizes the potential benefits of adhering to the DASH diet as
an effective non-pharmacological approach for enhancing liver health and
combating the growing concerns associated with NAFLD. Future researchers will
likely delve deeper into the effects of these interventions to explore the link
between diet and NAFLD, marking a significant step forward in the way these
conditions are approached in clinical settings.

Reference:

Sangouni,
A.A., Nadjarzadeh, A., Rohani, F.S. et al. Dietary approaches to stop
hypertension (DASH) diet improves hepatic fibrosis, steatosis, and liver
enzymes in patients with non-alcoholic fatty liver disease: a randomized
controlled trial. Eur J Nutr (2023). https://doi.org/10.1007/s00394-023-03221-wi

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Psoriasis Closely Associated to Higher Risk of Kidney Stones Finds Study

In a recent study published in The Journal of Dermatology uncovered a significant association between psoriasis, a chronic skin condition, and an increased risk of urolithiasis (kidney stones). The study involved a prospective analysis of a total of 67 psoriasis patients (PS group) and 65 individuals without psoriasis (NPS group) that aimed to explore potential links between psoriasis and urinary metabolic abnormalities.

The findings revealed that 19.4% of individuals in the PS group experienced stone events, compared to 7.7% in the NPS group which indicated a notable correlation between psoriasis and urolithiasis (P < 0.05).

The analysis of 24-hour urine samples proved crucial in understanding the metabolic nuances. The patients with psoriasis exhibited significantly lower median values of 24-hour citrate (P = 0.029) and higher median values of 24-hour urine uric acid (P = 0.005) when compared to their non-psoriatic counterparts.

Hypernatriuria was found to be significantly higher in the PS group (P = 0.027) by adding another dimension to the metabolic irregularities associated with psoriasis.

Also, the severity of psoriasis appeared to play a role in metabolic abnormalities, with hyperuricosuria detected in 10.4% of patients with severe disease compared to 1.5% in those with mild disease (P = 0.027).

These findings not only underscore a heightened risk of kidney stones in psoriasis patients but also shed light on specific metabolic factors contributing to this increased susceptibility. Hypocitraturia, hyperuricosuria, and hypernatriuria were found as key metabolic abnormalities associated with psoriasis, with hyperuricosuria associated to the severity of the disease.

The findings expand our understanding of the systemic impact of psoriasis and also emphasize the importance of holistic healthcare approaches for individuals suffering with this skin condition. The integration of dermatological considerations along with nephrological issue could prove important in managing and mitigating the risk of urolithiasis in psoriasis patients.

Source:

Oğuz, I. D., Oğuz, U., Usta, M., Kulaklı, S., Tosun, A., Demirelli, E., Akşan, B., Emecen, Ö., & Yüzüak, E. (2023). Relationship between psoriasis and urolithiasis. The Journal of Dermatology. https://doi.org/10.1111/1346-8138.17058

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Women taking oral contraceptive pills less likely to report depression

UK: A recent study published in the Journal of Affective Disorders has found a significantly lower prevalence of major depression (4.6%) amongst users of oral contraceptive pills (OCP), compared to former OCP users (11.4%). 

The research, which analysed data from 6,239 women in the United States aged 18-55 years old, showed that women who are taking the oral contraceptive pill are less likely to report depression. The study was led by researchers at Anglia Ruskin University (ARU), alongside experts from the Dana-Farber Cancer Institute in Boston and the University of California, Davis.

The researchers suggest two possible explanations for their findings, which are contrary to a commonly held belief that OCP can cause depression.

One is that taking the pill can remove concerns about unwanted pregnancy, therefore helping to improve the mental health of OCP users. It is also possible the results could be influenced by “survivor bias”, where women who experience signs of depression while using OCP stop taking it, moving them into the category of former users.

The cross-sectional study, which used data collected by the Center for Disease Control and Prevention in the United States, controlled for demographic characteristics, chronic conditions, and the use of antidepressants.

In both users and former users, widowed, divorced or separated women, obese women or those with a history of cancer were more likely to report depression. In addition, in former users, depression was more commonly reported in women who were Black or Hispanic, were smokers, had lower levels of education, or were experiencing poverty.

Lead author Dr Julia Gawronska, a Postdoctoral Research Fellow at Anglia Ruskin University (ARU), said: “Contraception is a crucial component of preventive health care. Most women tolerate taking the oral contraceptive pill without experiencing depressive symptoms but there is a subset of women that may experience adverse mood side effects and even develop depression, and the reasons are not entirely clear.

“Unlike some previous studies, we found that women currently taking the oral contraceptive pill were much less likely to report clinically relevant depression compared to women who previously took the pill.

“Taking the pill could provide positive mental health benefits for some women, simply by removing their concerns about becoming pregnant. The ‘survivor effect’ could also play a part, with women who experience symptoms of depression more likely to discontinue taking it, placing them into the group of former users.

“However, stopping taking the pill without a suitable alternative increases the risk of unintended pregnancy. It is important that women are fully supported, provided with full information, and offered alternative forms of contraception if necessary.”

Reference:

Julia Gawronska, Catherine Meads, Lee Smith, Chao Cao, Nan Wang, Susan Walker,Association of oral contraceptive pill use and depression among US women,  Journal of Affective Disorders, https://doi.org/10.1016/j.jad.2023.10.041

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20 days of Paid leave, weekly offs, reasonable working hours for PG medicos: NMC PGMER 2023

New Delhi: The newly notified Post-Graduate Medical Education Regulations (PGMER) 2023 has specified that post-graduate medical students will get a minimum of 20 days of paid leave (casual leave) per year. Apart from this, under these new regulations, doctors will also be allowed weekly holidays. Further, they will be given maternity leave and paternity leaves as per Government rules and regulations. 

There are also provisions for paid leaves for the PG medicos. However, the National Medical Commission (NMC) has clearly specified in the new PGMER 2023 that if a candidate avails leaves more than the permitted number of days, his/her term shall be extended by the same number of days to complete the training period.

Concerning the eligibility to appear in the examination, the regulations mentioned that the candidates can appear in the examination with 80% attendance.

Clarifying that all Post-graduate students will work as full-time resident doctors, the regulations further mentioned that they will work “reasonable” working hours and will be provided “reasonable time for rest in a day”.

Medical Dialogues had earlier reported that the final Post-Graduate Medical Education Regulations, 2023 (PGMER 2023), which were published in the official Gazette on 29.12.2023, lay down the rules and regulations regarding admission, counselling, and other details related to the postgraduate medical courses.

Leave Rules for Post-graduate Students:

As per the regulations, the following leave rules will be followed:

a. Every post-graduate student will be given minimum 20 days of paid leave (casual leave) per year.

b. Subject to exigencies of work, post-graduate students will be allowed one weekly holiday.

c. Female post-graduate students shall be allowed maternity leave as per existing Government rules and regulations.

d. Male post-graduate students shall be allowed paternity leave as per existing Government rules and regulations.

e. In addition to 20 days’ paid leave, the candidates will be allowed academic paid leave of 5 days per year.

Further, the regulations mentioned that if a “candidate avails leave in excess of the permitted number of days, his/her term of course shall be extended by the same number of days to complete the training period. However, one shall be able to appear in the examination if one has 80% (eighty per cent) of the attendance.”

As per the Gazette notification, the training period for different Postgraduate medical courses shall be as follows:

List of PG Medical Qualifications and Durations:

After specifying the definitions of different terms, the regulations further discussed about different kinds of qualifications and the duration of the courses. According to the regulations, Courses for Postgraduate broad speciality qualifications can be 2-3 years long depending on whether the student has a PG diploma degree in the same subject or not.

“The period of training, including the period of examination, shall be two years for the students, who possess a recognized two-year post-graduate diploma course in the same subject,” it mentioned.

The duration for the PG Diploma Course is 2 years, while Post-Doctoral Certificate Courses (PDCC) are only 1 year long. However, the duration for the Post-Doctoral Fellowship Courses is 2 years and DM/M.Ch is a 6-year long course.

List of qualifications, duration of the course and components of Post-graduate Training shall be as indicated below:

S.No.

Name of Qualification

Duration of Course

(including period of examination)

i.

Post-graduate broad-speciality Qualifications (Annexure-1)

3 Years/ 2 years*

ii.

Post-graduate super-speciality Courses (Annexure-2)

3 Years

iii.

Post-graduate diploma Courses (Annexure-3) @

2 Years

iv.

Post-Doctoral Certificate Courses (PDCC) (Annexure-4)

1 year

v.

Post-Doctoral Fellowship (PDF) Courses (Annexure-5)

2 years

vi.

D.M./M.Ch. (6 years Course) (Annexure-6)

6 years

* The period of training, including the period of examination, shall be two years for the students, who possess a recognized two-year post-graduate diploma course in the same subject.

Also Read: Final PGMER 2023 Regulations released in Gazette, details

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NMC issues FAQs on Maintenance of Standards of Medical Education Regulations 2023, details

New Delhi: Through a recent notice, the National Medical Commission (NMC) has released the Frequently Asked Questions (FAQs) for Maintenance of Standards of Medical Education Regulations 2023, (MSMER 2023).

Issuing the FAQs, the NMC discussed the format of the annual disclosure report, areas of evaluation and submission of information to the NMC for assessment.

The notice further stated, “These FAQs are in the nature of explanation for ease of understanding of the general public and cannot be upheld in a court of law. Please refer to the relevant Guidelines for legal validity.”

1. From which date will these Regulations be applicable?

These Regulations shall be applicable from the date of publication i.e. from 19th September, 2023.

2. For whom are these Regulations applicable?

These Regulations are applicable for all stake holders, i.e. for every institution / medical college under jurisdiction of NMC.

3. Where can the format for ANNUAL DISCLOSURE REPORT be available?

Shall be as per the annexure VII pages 60 to 64 on the pdf attached below. However modifications in this format may be made from time to time.

4. Where and when should the Annual Disclosure be uploaded?

After its establishment, the medical college / institution shall upload the annual disclosure as per the notifications put by corresponding Boards – UGMEB or PGMEB; from time to time.

5. Is college required to furnish any other information related to establishment / functioning of the college or MSR/ CBME, etc to NMC or any of its Boards?

The concerned Board may seek such additional information as and when deemed necessary for their assessment and otherwise from the concerned medical institution or related agencies having or exercising control over that medical college / institution.

6. What will be the areas of Evaluation of Report?

Keeping in mind the overall objectives of the Act, the UGMEB or PGMEB may seek information related to (although not necessarily limited to) :

i. verification of physical infrastructure;

ii. availability of required number of qualified faculty for actual teaching, research and to undertake necessary student learning activities on a regular and continued basis;

iii. availability of adequate clinical material in terms of number of patients of different specialties,

iv. variety of patients to fulfill all round training of students,

v. number of variety of procedures, surgeries, laboratory investigations, radiological investigations and other relevant investigations;

vi. assessment of the teaching methodology adopted;

vii. the methods and modes of assessment, grading of the students;

viii. review of feedback from students;

ix. other parameters related to standards of medical education that may be added from time to time by the respective boards or NMC.

7. What will be the time frame for submission of the data to the concerned Board/ NMC?

Not later than 30 days from the date of receipt of communication from the concerned Board or such additional time provided by the respective Board on specific request from the applicant in that regard. Ordinarily the college must be ready with all the required information once the batch of students (for UG/PG) is ready to be admitted for that academic year.

8. What will be the consequences if the applicant fails to submit such information within the prescribed time limit?

Failure in submission of such information or data due to any reason shall be deemed as non-compliance with the Regulations and shall attract penalty. However remedial measures or actions may be contemplated upon by the concerned Board after joint meetings with other Boards/ NMC and such action shall be intimated to the medical college/ institution within a period of 3 weeks.

9. What will be the outcome of Compliance/ successful disclosure of required information provided by the college/ institution?

If the medical college/ institution is found to be successfully meeting requirements as prescribed for the concerned Board, then the concerned Board shall provide a renewal certificate for continuation of the course(s) and admission of students thereof for the forthcoming Academic Year.

Also Read:Rs 1 Crore Penalty for violation: NMC Notifies Final Maintenance of Standards of Medical Education Regulations 2023

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/faq-on-msmer-2023-229413.pdf

https://medicaldialogues.in/pdf_upload/nmc-msmer-229416.pdf

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