2 international passengers held for allegedly carrying medicines worth Rs 80 lakh at IGI Airport

New Delhi: Two international passengers were apprehended for allegedly carrying medicines worth Rs 80 lakh at IGI Airport in New Delhi, an official statement issued by the Central Industrial Security Force (CISF) said on Tuesday.

According to CISF, the two persons identified as Md Raihan Fazal and Azeem Khan were planning to go to Kabul via Dubai on a flight.
“On 24.12.2023 at about 6:10 pm, on the basis of behaviour detection, CISF surveillance and intelligence staff noticed suspicious activities of two international passengers at Check-in area, Terminal-3 of IGI Airport. On suspicion, passengers later identified as Md Raihan Fazal and Azeem Khan bound for Kabul via Dubai by Air India flight No. AI-995 (STD-2020 hrs) were diverted to the random checking point for thorough checking of their 4 big-size trolley bags,” CISF said in a statement.
CISF said that the images of the bags after their screening raised suspicion and a physical check was done further, which led to the seizure of medicines.
“On screening their four trolley bags through the X-BIS machine, CISF personnel noticed suspicious images. On physical checking, a huge quantity of medicines of approximate value Rs 80 lakh were detected,” CISF said.
“On inquiry, the passengers could not produce supporting documents for carrying such huge quantity of medicines,” the central security force added.
CISF further mentioned that passengers along with detected medicines were handed over to Customs for further action in the matter.
Medical Dialogues team had earlier reported that Narcotics Control Bureau (NCB) Mumbai had successfully busted an international network involved in the illicit trafficking of pharma drugs from India to Australia.

Read also: International network involved in pharma drugs illicit trafficking busted, 3 held

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Medical infrastructure inadequate, Delhi HC directs Govt to submit report in four weeks

New Delhi: The Delhi High Court, during the hearing of a suo motu public interest litigation, expressed its concerns regarding the healthcare facilities in various government hospitals in the capital. The court noted that the medical infrastructure in the national capital is inadequate and there is a shortage of hospital beds.

The division bench, comprising acting Chief Justice Manmohan and Justice Mini Pushkarna, has directed the Delhi government to provide a status report outlining their plan for ensuring a sufficient medical infrastructure to cater to the increasing population of the city.

In an order issued on December 13, the court said “Learned counsel for GNCTD is directed to file a status report within four weeks. The status report will indicate as to how the GNCTD plans to ensure that the medical infrastructure keeps pace with the city’s population.”

Also read- Death Of 14 Year Old Due To Cancer: AIIMS, Safdarjung Hospital Deny Accusations Of Admission Denial

This directive was issued in response to a suo motu PIL initiated in 2017 concerning the issue of the availability of ICU beds and ventilator facilities in government hospitals in the city.

During the proceedings, amicus curiae advocate Ashok Aggarwal presented a newspaper report titled “Turned Away by three hospitals fourteen-year-old cancer patient dies.” The report was published by Hindustan Times on December 07.

Medical Dialogues team had also reported the incident where a 14-year-old girl suffering from blood cancer passed away at AIIMS on December 5 after being denied treatment at several Delhi hospitals. 

According to AAP leader Dilip Pandey, the girl was referred from the Delhi government’s Cancer Institute. Her relatives jostled around AIIMS and Safdarjung Hospital but couldn’t get a bed. As per the report, the minor’s family alleged that three government hospitals in Delhi refused treatment citing lack of medicines, beds or equipment.

However, AIIMS and Safdarjung Hospital had denied these allegations and termed them as “baseless”.

“Upon a reading of this report, it is apparent that medical infrastructure in the city of Delhi is inadequate and the number of hospital beds is insufficient. The demand is far in excess of the supply. The said report is taken on record,” the court observed.

The matter will now be heard on January 29, 2024.

To view the official order, click on the link below: 

https://medicaldialogues.in/pdf_upload/delhi-high-court-order-228767.pdf

Also read- AIIMS Nagpur Inaugurates Autopsy Complex

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DPP-4 inhibitors may Reduce Osteoporosis Risk among Diabetes patients

DPP-4 inhibitors may Significantly improve BMD and Reduce Osteoporosis Risk in Diabetes patients suggests a new study published in the Journal of Clinical Densitometry

Type 2 Diabetes Mellitus (T2DM) frequently coexists with osteoporosis and reduced bone mineral density (BMD). Dipeptidyl peptidase-4 inhibitors (DPP-4i), a class of antihyperglycemic agents, are commonly employed in T2DM treatment. However, the influence of DPP-4i on bone health remains unclear and debated. This meta-analysis is conducted to explore the relationship between the use of DPP-4i and changes in BMD, as well as the prevalence of osteoporosis among T2DM patients.

They conducted a comprehensive search in PubMed, Embase, and Cochrane Library and Web of Science databases for relevant studies published up until June 2023. Studies included in the meta-analysis were those investigating T2DM patients under DPP-4i treatment, and examining the effects on BMD and osteoporosis. Random-effects models and fixed-effect models were utilized to compute the pooled effects. Heterogeneity among the included studies was evaluated using I² statistics.

Results This meta-analysis incorporated a total of 10 studies, encompassing a combined population of 214,541 individuals. The results from this meta-analysis indicated an increase in BMD following DPP-4i usage (SMD 0.15, 95 % confidence interval 0.03-0.26). Additionally, the risk of osteoporosis was significantly reduced (OR 0.90, 95 % confidence interval 0.86-0.94) with very low heterogeneity, recorded at 0 % and 53.0 % respectively. No publication bias was detected in the funnel plot, and sensitivity analyses affirmed the stability of the study’s conclusions.

The results offer valuable insights into the positive impact of DPP-4i on bone health in T2DM patients, contributing to informed clinical decision-making. These findings may inform the development of more comprehensive T2DM management strategies that account for bone health.

Reference:

Huang L, Zhong W, Liang X, Wang H, Fu SE, Luo Z. Meta-Analysis on the Association Between DPP-4 Inhibitors and Bone Mineral Density and Osteoporosis. J Clin Densitom. Published online November 28, 2023. doi:10.1016/j.jocd.2023.101455

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Adenovirus Alert: ICMR cautions West Bengal Govt over deadly variant in kids

Kolkata: Indian Council of Medical Research (ICMR) has cautioned the West Bengal health department over the prevalence of a deadly variant of adenovirus among the children in Kolkata and its adjacent districts.

The revelation has been made following the recent findings of the ICMR- affiliated National Institute of Cholera and Enteric Diseases (NICED)- based on sample testing of persons for adenovirus. 

Also Read:Adenovirus-linked deaths underreported, West Bengal doctor claims children not getting beds

Of the 3,115 individuals tested for adenovirus, a total of 1,257 tested positive and the deadly variant was among 40 individuals, most of whom were children. Confirming the receipt of the alert, a senior official of the state health department said necessary precautions are being taken to tackle any emergency-like situation.

Adenovirus has taken an alarming shape in West Bengal at the beginning of the current financial year of 2023. As per the records of the state health department, as many 1,200 cases of adenovirus-positive persons were detected in the period between the end of December 2022 and the end of March 2023, mostly kids, and the total death figure being affected by it during that period stood at 19.

However, at that point of time there had been controversies over the death figure as doctors’ associations had accused the state health department of showing the figure as truncated.

At that point of time, the state government had even set up an eight-member task force to monitor cases of adenovirus-affected people and ensure proper treatment of them.

Medical Dialogues team had earlier reported that West Bengal was witnessing a spike in Adenovirus cases among children, a prominent doctor has slammed the state government for inadequate preparedness and lack of hospital beds for their treatment. Dr Manas Gumta, general secretary of the Association of Health Service Doctors, alleged that the West Bengal government “underreported” the number of deaths caused by infection of the virus. 

Also Read:Bengaluru registers surge in Adenovirus cases, health experts say no reason to worry

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Transcutaneous Auricular vagus nerve stimulation Effective in Treating Functional Dyspepsia

A recent study published in the The American Journal of Gastroenterology found that transcutaneous auricular vagal nerve stimulation (taVNS) is an effective therapeutic avenue for adults who suffer from functional dyspepsia (FD). FD is a condition marked by persistent upper abdominal discomfort that affects millions globally. This approach pf targeting the vagal nerve has remarkable effectiveness in modulating gastrointestinal motility, inflammation, and nociception.

The study randomly enrolled consecutive FD patients meeting Rome IV criteria. The patients were allocated to receive either 10-Hz taVNS, 25-Hz taVNS, or a sham treatment. Over a period of 4 weeks, participants underwent 30-minute sessions twice a day. The primary outcome measured was the response rate at week 4 that indicated a reduction of ≥5 points in the modified FD Symptom Diary score compared to baseline. Secondary outcomes included the rate of adequate relief and monitoring adverse events.

Among the total 300 patients enrolled, the participants in the V10 and V25 groups demonstrated significantly higher response rates (81.2% and 75.9%, respectively) compared to the sham group (47%). Both V10 and V25 groups also exhibited higher rates of adequate relief (85.1% and 80.8%, respectively) in contrast to the sham group (67%). Also, there was no statistically significant difference between the V10 and V25 groups in terms of response rates and adequate relief. The therapeutic effects of taVNS endured through weeks 8 and 12 of the follow-up period showed its lasting impact, while the adverse events were minimal and comparable across all groups (1%-3%).

This study is the first to demonstrate that a 4-week regimen of taVNS at 10 Hz or 25 Hz  which is both effective and safe for treating adult FD. The findings open new doors for non-invasive neuromodulation techniques in the context of gastrointestinal disorders that provides hope for those seeking relief from the burdens of functional dyspepsia.

Reference:

Shi, X., Zhao, L., Luo, H., Deng, H., Wang, X., Ren, G., Zhang, L., Tao, Q., Liang, S., Liu, N., Huang, X., Zhang, X., Yang, X., Sun, J., Qin, W., Kang, X., Han, Y., Pan, Y., & Fan, D. (2023). Transcutaneous auricular vagal nerve stimulation is effective for the treatment of functional dyspepsia: A multicenter, randomized controlled study. The American Journal of Gastroenterology. https://doi.org/10.14309/ajg.0000000000002548

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Mineral Trioxide Aggregate as root canal filling material tied to less Postoperative Pain

A recent randomized trial published in the BMC Oral Health unveiled promising results regarding root canal filling materials in the management postoperative pain. The study was conducted on 119 patients by comparing the postoperative pain levels between two commonly used materials—gutta-percha (GP) and sealer versus mineral trioxide aggregate (MTA). Researchers found  that Mineral Trioxide Aggregate as root canal filling material tied to less Postoperative Pain compared to gutta-percha (GP) and sealer.

Postoperative pain has been a challenge for clinicians which prompts a rigorous exploration of effective interventions. This trial focused on patients of 18-65 years of age with single-canal premolars diagnosed with asymptomatic apical periodontitis to address a critical gap in pain management techniques.

This two-arm, parallel-group, single-blind trial employed permuted block randomization to group participants into two cohorts. In the GP group (N = 46), root canals were filled with gutta-percha and AH Plus sealer, while the MTA group (N = 48) utilized MTA for apical filling and a combination of gutta-percha and sealer coronally. Pain levels were assessed at specific intervals (6, 12, 24, 48, and 72 hours postoperatively) using a 10-point visual analog scale (VAS).

Over the time this study revealed a significant decrease in mean VAS scores in both groups (P < 0.001). But, the MTA group exhibited notably lower VAS scores compared to the GP group, signifying a superior pain management profile (P < 0.05). Also, an intriguing finding emerged regarding gender differences, with female patients reporting higher VAS scores at specific intervals (6- and 12-hour periods) in both groups (P < 0.05).

The study suggests that MTA as a root canal filling material holds significant outcomes for clinicians in reducing postoperative pain. The superior pain management observed in the MTA group positions it as a valuable option by potentially transforming the landscape of root canal procedures.

Reference:

Khabiri, M., Kamgar, S., Iranmanesh, P., Khademi, A., & Torabinejad, M. (2023). Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial. In BMC Oral Health (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12903-023-03372-6

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Burning occipital headache with Palpebral edema during acute Covid phase may lead to persistent headache

With limited understanding of the clinical spectrum and influencing factors, persistent headaches are becoming a prevalent symptom post-COVID-19. A recent cross-sectional study published in the BMC Infectious Diseases focused on a subset of patients suffering with new daily persistent headache (NDPH).

This comprehensive survey involved a total of 421 participants from 11 Latin American countries that explored the characteristics of persistent headaches following SARS-CoV-2 infection. Importantly, one in four participants met the diagnostic criteria for NDPH which revealed a substantial incidence of this debilitating condition. 

The study was conducted on individuals over 18 who were tested positive for SARS-CoV-2 and reported persistent headaches through an online survey. The results indicated that most participants were female (82%), with an average age of 40 years. Over 90% reported mild to moderate COVID-19 symptoms and 58% had a history of headaches, primarily of migraine-type.

Distinct clinical characteristics emerged, including occipital location, severe intensity, burning character, and radiating pain in individuals who were diagnosed with NDPH. Also, the higher proportions of anxiety symptoms, sleep problems, myalgia, mental fog, and various other symptoms were reported in NDPH patients.

The most significant contribution of the study lies in the identification of risk factors associated with NDPH. Palpebral edema during the acute phase of COVID-19, occipital location, and a burning character of the headache were revealed as potential risk factors. This crucial information provides clinicians with important insights for the early identification and customized management of patients with persistent headaches following COVID-19.

Reference:

Carrión-Nessi, F. S., Ascanio, L. C., Pineda-Arapé, A. G., Omaña-Ávila, Ó. D., Mendoza-Millán, D. L., Romero, S. R., Almao-Rivero, A. B., Camejo-Ávila, N. A., Gebran-Chedid, K. J., Rodriguez-Saavedra, C. M., Freitas-De Nobrega, D. C., Castañeda, S. A., Forero-Peña, J. L., Delgado-Noguera, L. A., Meneses-Ramírez, L. K., Cotuá, J. C., Rodriguez-Morales, A. J., Forero-Peña, D. A., & Paniz-Mondolfi, A. E. (2023). New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study. In BMC Infectious Diseases (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12879-023-08898-2

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Subtotal cholecystectomy lowers risk of bile duct injury in tough gallbladders

UK: Subtotal cholecystectomy (STC) seems to be an effective technique to avoid common bile duct (CBD) injuries in difficult cholecystectomy cases; indicating it is a viable alternative to total cholecystectomy (TC) in these situations, a recent study has found. 

“Subtotal cholecystectomy significantly reduced the risk of CBD injury compared to total cholecystectomy,” the researchers reported in the Annals of the Royal College of Surgeons of England. However, compared to TC, STC raised the risk of postoperative endoscopic retrograde cholangiopancreatography (ERCP), bile leaks, need for reoperation, and intraabdominal collections.”

Severe adhesions or inflammation can impede safe dissection in the hepatocystic triangle (HCT), leading to an intraoperative decision to perform subtotal cholecystectomy. The STC rate is likely to increase in the future as an increasing number of cholecystectomies are attempted in the acute setting when inflammation in the HCT may be at its peak. The term subtotal cholecystectomy is used when most of Hartmann’s pouch is left in situ with or without stump closure.

The study was conducted by Somaiah Aroori, University Hospitals Plymouth NHS Trust, UK, and colleagues to evaluate the safety profile of subtotal cholecystectomy.

For this purpose, the researchers retrospectively reviewed all patients who had STC between 2009 and 2019. STC was divided into two types, reconstituting (R-STC) and fenestrating (F-STC), depending on whether the gall bladder remnant was closed or left open. The study excluded patients who had cholecystectomy for gall bladder malignancy or as part of another operation.

The study led to the following findings:

  • A total of 5,664 patients underwent cholecystectomy during the study period. Of these, 1.7% underwent subtotal cholecystectomy.
  • The laparoscopic to open conversion rate was high at 48.8%, as was the overall postoperative complication rate (45.4%).
  • No patient suffered iatrogenic bile duct injury.
  • 19.6% of patients suffered postoperative bile leak. This was significantly higher in patients who had STC in the acute setting (41% versus 13% for elective STC cases).
  • There was no significant difference in the rate of bile leak or other complications between R-STC and F-STC types. The 90-day readmission rate was 8.2%.
  • No mortalities were recorded within 90 days post-STC.

The study revealed subtotal cholecystectomy to be an effective technique to prevent bile duct injury. However, it is associated with relatively high rates of postoperative morbidity, long hospital stays, and bile leaks.

The researcher suggests, “Surgeons should be aware of the implications of undergoing STC, and suitable precautions must be taken to minimise the STC risk.”

“Patients should be informed of the risks of STC before planned TC and be consented to accordingly,” they concluded.

Reference:

Ibrahim R, Abdalkoddus M, Mahendran B, Mownah OA, Nawara H, Aroori S. Subtotal cholecystectomy: is it a safe option for difficult gall bladders? Ann R Coll Surg Engl. 2023 May;105(5):455-460. doi: 10.1308/rcsann.2021.0291. Epub 2021 Nov 25. PMID: 34821508; PMCID: PMC10149244.

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Novel model based on C-peptide and creatinine measurement predicts diabetes remission after bariatric surgery

Italy: Findings from a pilot study have shown the utility of a novel model for predicting diabetes remission after bariatric surgery (BS) based on serum C-peptide and creatinine measurement. The findings were published online in Nutrition, Metabolism and Cardiovascular Diseases on December 16, 2023.

The researchers revealed the potential clinical application of ln(C-peptide/creatinine) ratio in assessing the likelihood of type 2 diabetes (T2D) remission after bariatric surgery.

Bariatric surgery is effective for type 2 diabetes treatment in obese patients. However, a significant proportion of these patients fail to achieve diabetes remission after the surgery, even after significant metabolic improvement and weight loss. C-peptide is a valuable marker of insulin secretion and beta cell function, but renal function must be considered when interpreting measurements in T2D patients.

Santo Colosimo, School of Nutrition Science, University of Milan, Milan, Italy, and colleagues aimed to investigate the association of serum C-peptide levels adjusted for creatinine with diabetes remission and achievement of the glycemic target after bariatric surgery in patients with T2D and obesity. They used a logarithmic transformation (ln) of the C-peptide/creatinine ratio to reflect beta cell function better.

The research team collected prospective data from a cohort of 84 patients with T2D and obesity submitted to Roux-en-Y gastric bypass (RYGB) at baseline and at least a 6-month follow-up.

Based on the study, the researchers reported the following findings:

  • A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month type 2 diabetes remission.
  • The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75).
  • The same model was also able to predict achieving an HbA1c target of 7% (53mmol/mol) (AUROC 0.96).

“The findings suggest Ln(C-peptide/creatinine) ratio is a useful tool in predicting type 2 diabetes remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients,” the researchers concluded.

Reference:

Colosimo, S., Martínez-Sánchez, M. A., Balaguer-Román, A., Fernández-Ruiz, V. E., Núñez-Sánchez, M. A., Ferrer-Gómez, M., Frutos, M. D., Tomlinson, J. W., Bertoli, S., Marchesini, G., & Ramos-Molina, B. (2023). A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study. Nutrition, Metabolism and Cardiovascular Diseases. https://doi.org/10.1016/j.numecd.2023.12.008

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Gut-skin connection is key factor in atopic dermatitis, research review shows

Atopic dermatitis (AD) is a chronic inflammatory skin disease whose main symptoms are redness, swelling, and itchy rashes. It is more common in people with a genetic predisposition. Manifestation of symptoms depends on interactions among the immune system, environmental factors and gut microbiota. Many pieces of this complex jigsaw puzzle are still undiscovered, but recent research has identified relevant factors. For example, alterations in gut microbiota composition can contribute to the severity of the disease; environmental factors such as allergens and pollution can also make it worse; genetic variations are associated with susceptibility; and both diet and fecal transplantation are promising strategies for treatment.

Knowing how these factors correlate is fundamental to a better understanding of the disease and serves as a basis for novel therapies, according to a review article published in the International Journal of Molecular Sciences by researchers at the University of São Paulo (USP) and the Federal University de São Paulo (UNIFESP) in Brazil.

Also known as atopic eczema, AD affects 7%-10% of adults and 20%-25% of young children. There is no consensus as to whether boys or girls are more affected. The number of cases has increased significantly in the twenty-first century. Scientists believe the rise is due to several factors, such as genetics, autoimmunity, impaired skin barrier integrity, viral infections, gut microbiome composition, dietary habits and lifestyle changes.

A hypothesis that has been proposed to explain the significant increase in developing countries is lack of exposure to beneficial bacteria, which may affect immune maturation (the process by which the immune system develops a response after first contact with microorganisms).

Importance of gut microbiota

The authors of the review, which was supported by FAPESP, show that gut microbiota is at the center of the most recent research. “Besides being responsible for 70% of immune system regularization, for maintaining skin barrier integrity and the structure of the gastrointestinal tract, and for controlling nutrient absorption and energy balance, the gut microbiome is directly connected to the skin via what’s known as the gut-skin axis,” said Sabri Saeed Sanabani, a researcher at the Institute of Tropical Medicine (IMT-USP) and last author of the article.

The article features recent evidence that alterations to gut microbiome composition can contribute to the pathogenesis of AD. Studies have reported increased abundance of Clostridium difficile, Escherichia coli and Staphylococcus aureus, as well as decreased abundance of bacteria that produce short-chain fatty acid (SCFAs), such as Bifidobacteria and Bacteroides, in the gut microbiome of AD patients compared to healthy controls. A reduction in levels of SCFAs is often associated with intestinal inflammation in otherwise healthy subjects.

With regard to genetics, the latest research on the subject involves genome-wide association studies (GWAS), focusing on the identification of associations between genetic variants and important phenotypes, and has so far found several markers that correlate with susceptibility to AD and its progression, including mutations in the filaggrin gene (FLG) that are the most well-established risk factor for AD. Filaggrin (a portmanteau for filament aggregating protein) is a protein that binds to keratin fibers in epithelial cells. Whether gut microbiome alterations are genetically determined is unknown, however.

While environmental factors also remain mostly unknown, scientists are certain that allergens, irritants, pollution and exposure to microbes contribute to skin barrier impairment and gut microbiome dysbiosis.

The review also covers promising therapeutic approaches, such as those targeting epigenetic alterations and modulation of changes to gut microbiome diversity via diet, probiotics and prebiotics, as well as fecal transplants.

“Like all such reviews, ours set out to analyze the findings of the available scientific studies and verify knowledge gaps that need to be filled by future research,” Sanabani said.

Reference:

Pessôa, R.; Clissa, P.B.; Sanabani, S.S. The Interaction between the Host Genome, Epigenome, and the Gut–Skin Axis Microbiome in Atopic Dermatitis. Int. J. Mol. Sci. 2023, 24, 14322. https://doi.org/10.3390/ijms241814322.

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