Omalizumab safely manages Chronic spontaneous urticaria during pregnancy

Treating a pregnant patient with chronic spontaneous urticaria (CSU) can be quite challenging. According to recent findings, most CSU treatments for pregnant patients involved the use of second-generation H1-antihistamines (sgAHs), while information on the safety of Omalizumab is limited.

A study found Omalizumab to be a safe treatment option for pregnant women with a history of chronic spontaneous urticaria. This study was led by Cataldo Patruno and colleagues and was published in Clinical and Experimental Dermatology.

This study assessed the effectiveness and safety of Omalizumab for individuals with severe chronic spontaneous urticaria (CSU) who are either pregnant during treatment or initiate the medication during pregnancy in a typical clinical practice setting.

A team of researchers performed a retrospective analysis on women who were 18 years old or older, pregnant, and had received one or more doses of Omalizumab at any point during their pregnancy or were taking Omalizumab at the time of conception or within the eight weeks before conception.

Key findings are:

  • Twenty-nine pregnant patients were evaluated. There were two groups, A and B.
  • In group A, 23 patients, constituting 79.31%, conceived during omalizumab therapy.
  • In group B, six patients, constituting 20.69%, initiated omalizumab therapy during pregnancy.
  • Among group A, 23 births and one miscarriage were reported.
  • 15/23 patients discontinued Omalizumab after discovering the pregnancy state, while 8/23 patients were exposed to Omalizumab during the entire pregnancy period.
  • In group B, Omalizumab was introduced at 10.83 ± 3.60 weeks of gestation. The patients in this group were exposed to it until the end of pregnancy. This group had seven live-born infants, including five singletons and one twin pair.
  • No adverse events, complications or congenital anomalies were reported.

The objective of this retrospective study was to evaluate the efficacy and safety of Omalizumab in a cohort of 29 pregnant women who had severe chronic spontaneous urticaria and were resistant to second-generation H1-antihistamines.

They said Omalizumab for managing CSU before and during pregnancy does not negatively affect maternal and fetal outcomes.

Reference:

Cataldo Patruno et al. Safety of Omalizumab for chronic urticaria during pregnancy: a real-life study, Clinical and Experimental Dermatology, 2023; llad386.

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Prehospital tourniquet use tied to improved mobility and limb preservation in vascular extremity trauma

Recent data suggest tourniquet use decreases shock without increasing limb complications, supporting its use in prehospital settings.

According to a recent study published in Surgery, researchers from Case Western Reserve University, Cleveland, said that Encouraging tourniquet use in the civilian setting may improve outcomes and reduce limb loss risk, as it has been associated with increased functional mobility and decreased delayed amputation.

The researchers in this study established the Hypothesis that Prehospital tourniquet use in vascular extremity trauma reduces delayed amputation and improves mobility compared to no prehospital tourniquet application.

The team evaluated adults with extremity vascular trauma at an urban Level 1 trauma centre (2016-2021). Outcomes included delayed amputation and mobility at discharge, measured by the 6 Clicks Basic Mobility Score. Higher scores indicated better mobility. Data on injury mechanisms, lactate, transfusions, mortality, and kidney injury were also collected. χ2, Fisher Exact and Wilcoxon tests were used to perform comparisons.

The results of this study could be summarised as follows:

  • Of 232 patients, prehospital tourniquet application had no association with mortality or lactate level.
  • The prehospital tourniquet application group had more transfusions, lower acute kidney injury rates, and fewer delayed amputations.
  • Ninety-one patients, (45 in prehospital tourniquet application and 46 without it) were evaluated for “Moving between Bed and Chair” in the “6 Clicks” Basic Mobility Score. Those in the prehospital tourniquet application group had higher levels of independence.

In this study, they said we used the “6 Clicks” score to assess the differences in functional mobility between patients who had extremity vascular trauma with and without tourniquet use.

The use of Prehospital tourniquets was associated with fewer delayed amputations. The outcomes were favourable, including higher functional mobility and decreased delayed amputation.

The results of this study suggest that tourniquet use should be encouraged in the civilian setting as it improves outcomes and reduces limb loss risk.

Reference:

Thai, A. P., Tseng, E. S., Kishawi, S., Robenstine, J. C., & Ho, V. P. (2023). Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes. Surgery, 174(6), 1471–1475. https://doi.org/10.1016/j.surg.2023.08.002

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Urinary endocrine-disrupting chemicals do not increase risk of metabolic syndrome among women

A recent multiethnic study highlighted the potential connection between exposure to certain environmental chemicals and the prevalence of metabolic syndrome (MetS) in women. The findings of the study were published in the Journal of the Endocrine Society.

Metabolic syndrome is a group of conditions associated with an elevated risk of cardiovascular disease, includes factors like high blood pressure, elevated fasting glucose, increased triglycerides, expanded waist circumference, and low levels of high-density lipoprotein cholesterol.

This analysis focused on four classes of urinary endocrine-disrupting chemicals (EDCs), the bisphenol A (BPA), triclosan, parabens, and phthalates. The study involved 1728 women after adjusting for variables such as age, body mass index (BMI), racial and ethnic background, and breast cancer status.

The results showed that metabolic syndrome was identified in 30.0% of the women. There were no statistically significant associations between MetS and BPA, triclosan, or phthalate metabolite excretion. Also, an intriguing inverse relationship emerged with total parabens (Ptrend = .002) was noticed which indicated a potential protective effect against metabolic syndrome.

The study explored potential variations in these associations based on race, ethnicity, and BMI. While these were suggestive of inverse associations between EDCs and MetS among Latino and African American women, no statistically significant heterogeneity was detected in those with a BMI under 30 kg/m2.

The findings of this study suggest a complex interplay between environmental exposures and metabolic health, particularly among women. This inverse association observed here with parabens prompts further investigation into the potential protective role of these chemicals in the context of MetS.

Reference:

Ihenacho, U., Guillermo, C., Wilkens, L. R., Franke, A. A., Tseng, C., Li, Y., Sangaramoorthy, M., Derouen, M. C., Haiman, C. A., Stram, D. O., Le Marchand, L., Cheng, I., & Wu, A. H. (2023). Association of endocrine disrupting chemicals with the Metabolic syndrome among women in the Multiethnic Cohort Study. Journal of the Endocrine Society, 7(12). https://doi.org/10.1210/jendso/bvad136

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‘Long flu’ has emerged as consequence similar to long COVID

Since the COVID-19 pandemic began, extensive research has emerged detailing the virus’s ability to attack multiple organ systems, potentially resulting in a set of enduring and often disabling health problems known as long COVID. Now, new research from Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System indicates that people hospitalized with seasonal influenza also can suffer long-term, negative health effects, especially involving their lungs and airways.

The new study comparing the viruses that cause COVID-19 and the flu also revealed that in the 18 months after infection, patients hospitalized for either COVID-19 or seasonal influenza faced an increased risk of death, hospital readmission, and health problems in many organ systems. Further, the time of highest risk was 30 days or later after initial infection.

“The study illustrates the high toll of death and loss of health following hospitalization with either COVID-19 or seasonal influenza,” said senior author Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University. “It’s critical to note that the health risks were higher after the first 30 days of infection. Many people think they’re over COVID-19 or the flu after being discharged from the hospital. That may be true for some people. But our research shows that both viruses can cause long-haul illness.”

The findings are published Dec. 14 in The Lancet Infectious Diseases.

The statistical analysis spanned up to 18 months post-infection and included a comparative evaluation of risks of death, hospital admissions and 94 adverse health outcomes involving the body’s major organ systems.

“A review of past studies on COVID-19 versus the flu focused on a short-term and narrow set of health outcomes,” said Al-Aly, who treats patients within the VA St. Louis Health Care System and is an assistant professor of medicine at Washington University. “Our novel approach compared the long-term health effects of a vast array of conditions. Five years ago, it wouldn’t have occurred to me to examine the possibility of a ‘long flu.’ A major lesson we learned from SARS-CoV-2 is that an infection that initially was thought to only cause brief illness also can lead to chronic disease. This revelation motivated us to look at long-term outcomes of COVID-19 versus flu.

“We wanted to know whether and to what degree people with flu also experience long-term health effects,” Al-Aly said. “The big answer is that both COVID-19 and the flu led to long-term health problems, and the big aha moment was the realization that the magnitude of long-term health loss eclipsed the problems that these patients endured in the early phase of the infection. Long COVID is much more of a health problem than COVID, and long flu is much more of a health problem than the flu.”

However, the overall risk and occurrence of death, hospital admissions, and loss of health in many organ systems are substantially higher among COVID-19 patients than among those who have had seasonal influenza, Al-Aly said. “The one notable exception is that the flu poses higher risks to the pulmonary system than COVID-19,” he said. “This tells us the flu is truly more of a respiratory virus, like we’ve all thought for the past 100 years. By comparison, COVID-19 is more aggressive and indiscriminate in that it can attack the pulmonary system, but it can also strike any organ system and is more likely to cause fatal or severe conditions involving the heart, brain, kidneys and other organs.”

The researchers analyzed de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs, the nation’s largest integrated health-care delivery system. They evaluated information involving 81,280 patients hospitalized for COVID-19 at some point from March 1, 2020, through June 30, 2022, as well as 10,985 patients hospitalized for seasonal influenza at some point from Oct. 1, 2015, through Feb. 28, 2019.

Patients represented multiple ages, races and sexes.

Regarding both viruses, patient vaccination status did not affect results. Those in the COVID-19 cohort were hospitalized during the pre-delta, delta and omicron eras.

During the overall 18-month study period, patients who had COVID-19 faced a 50% higher risk of death than those with seasonal influenza. This corresponded to about eight more deaths per 100 persons in the COVID-19 group than among those with the flu.

Although COVID-19 showed a greater risk of health loss than seasonal influenza, infection with either virus carried significant risk of disability and disease. The researchers found COVID-19 exhibited increased risk of 68% of health conditions examined across all organ systems (64 of the 94 adverse health outcomes studied), while the flu was associated with elevated risk of 6% of health conditions (six of the 94) — mostly in the respiratory system.

Also, over 18 months, COVID-19 patients experienced an increased risk of hospital readmission as well as admission to an intensive care unit (ICU). For every 100 persons in each group, there were 20 more hospital admissions and nine more ICU admissions in COVID-19 than flu.

“Our findings highlight the continued need to reduce the risk of hospitalization for these two viruses as a way to alleviate the overall burden of health loss in populations,” Al-Aly said. “For both COVID-19 and seasonal influenza, vaccinations can help prevent severe disease and reduce the risk of hospitalizations and death. Optimizing vaccination uptake must remain a priority for governments and health systems everywhere. This is especially important for vulnerable populations such as the elderly and people who are immunocompromised.”

In both COVID-19 and the flu, more than half of death and disability occurred in the months after infection as opposed to the first 30 days, the latter of which is known as the acute phase.

“The idea that COVID-19 or flu are just acute illnesses overlooks their larger long-term effects on human health,” Al-Aly said. “Before the pandemic, we tended to belittle most viral infections by regarding them as somewhat inconsequential: ‘You’ll get sick and get over it in a few days.’ But we’re discovering that is not everyone’s experience. Some people are ending up with serious long-term health issues. We need to wake up to this reality and stop trivializing viral infections and understand that they are major drivers of chronic diseases.”

Reference:

Yan Xie, Taeyoung Choi, Ziyad Al-Aly. Long-term outcomes following hospital admission for COVID-19 versus seasonal influenza: a cohort study. The Lancet Infectious Diseases, 2023; DOI: 10.1016/S1473-3099(23)00684-9

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Psilocybin-assisted therapy may reduce depressive symptoms in adults with cancer and depression

Results from a phase II clinical trial indicate that psilocybin, a hallucinogenic chemical found in certain mushrooms of the genus Psiloybe, may benefit individuals with cancer and major depression. Trial participants treated with psilocybin not only experienced a lessening of depressive symptoms but also spoke highly of the therapy when interviewed at the end of the trial. The findings are published by Wiley in two articles appearing online in CANCER, a peer-reviewed journal of the American Cancer Society.

By binding to a specific subtype of serotonin receptor in the brain, psilocybin can cause alterations to mood, cognition, and perception. Psilocybin is currently classified as a Schedule I drug-defined as having no accepted medical use and a high potential for abuse-and is not approved by the US Food and Drug Administration for clinical use. However, multiple randomized controlled trials have demonstrated the safety and potential efficacy of psilocybin-assisted therapy-which combines psilocybin with psychological support from trained therapists-to treat major depressive disorder. Additionally, ongoing research is looking into the use of psilocybin-assisted therapy for various other mental health conditions, such as anxiety, addiction, and post-traumatic stress disorder.

In this latest phase II open-label trial involving adults with cancer and major depression, 30 participants at Sunstone Therapies in Rockville, Maryland received a single 25 mg dose of synthesized psilocybin plus a 1:1 session with a therapist and group therapy support.

“This study was differentiated by its group approach. Cohorts of 3-4 patients were simultaneously treated with 25 mg of psilocybin in adjacent rooms open at the same time, in a 1:1 therapist:patient ratio. The cohorts had preparation for the therapy as well as integration sessions following the psilocybin session as a group,” explained lead author Manish Agrawal, MD, of Sunstone Therapies.

Participants enrolled had moderate to severe depression scores at baseline. After eight weeks of treatment, Dr. Agrawal and his colleagues observed that patients’ depression severity scores dropped by an average of 19.1 points, a magnitude that would indicate the majority no longer experienced depression. Furthermore, 80% of participants experienced a sustained response to treatment, and 50% showed full remission of depressive symptoms after one week, which was sustained for eight weeks. Treatment-related side effects such as nausea and headache were generally mild.

“As an oncologist for many years, I experienced the frustration of not being able to provide cancer care that treats the whole person, not just the tumor,” said Dr. Agrawal. “This was a small, open-label study and more research needs to be done, but the potential is significant and could have implications for helping millions of patients with cancer who are also struggling with the severe psychological impact of the disease.”

Dr. Agrawal is also the senior author of a second study led by Yvan Beaussant, MD, MSc, of Dana-Farber Cancer Institute that gathered input from patients in the trial during exit interviews. Participants described generally positive experiences. In terms of safety, they noted that being a part of the group calmed their fears and increased their sense of preparedness to engage in therapy. Regarding therapeutic efficacy, they felt that being connected to the group deepened and enriched their experience, ultimately contributing to their experience of self-transcendence and compassion for one another. Also, the use of both individual and group sessions was found to support the therapy in different ways. For example, the implementation of individual and group sessions allowed the therapy to remain an intimate introspective process while adding a sense of “togetherness” to it.

“As a hematologist and palliative care physician and researcher, it was profoundly moving and encouraging to witness the magnitude of participants’ improvement and the depth of their healing journey following their participation in the trial. Participants overwhelmingly expressed positive sentiments about their experience of psilocybin-assisted therapy while emphasizing the importance of the supportive, structured setting in which it took place,” said Dr. Beaussant. “Many described an ongoing transformative impact on their lives and well-being more than two months after having received psilocybin, feeling better equipped to cope with cancer and, for some, end of life.”

Before this intervention is implemented into clinical practice, additional studies should include larger numbers of patients, along with a control arm to compare its effects with other treatments or placebo.

Reference:

Manish Agrawal, William Richards, Yvan Beaussant, Sarah Shnayder, Rezvan Ameli, Kimberly Roddy, Norma Stevens, Brian Richards, Nick Schor, Betsy Jenkins, Mark Bates, Psilocybin-assisted group therapy in patients with cancer diagnosed with a major depressive disorder, Cancer, https://doi.org/10.1002/cncr.35010.

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Childhood caries tied to poor health and faster ageing in adulthood

Childhood caries is associated with poor health in adulthood and faster ageing suggests a new study published in the Journal of Public Health Dentistry.

Childhood caries is associated with poorer self-rated general health in adulthood, but it remains unclear whether that holds for physical health and aging. The aim of this study was to identify whether age-5 caries is associated with (a) biomarkers for poor physical health, and (b) the pace of aging (PoA) by age 45 years.

Participants are members of the Dunedin Multidisciplinary Health and Development Study birth cohort. At age 45, 94.1% (n = 938) of those still alive took part. Data on age-5 caries experience and age-45 health biomarkers were collected. The PoA captures age-related decline across the cardiovascular, metabolic, renal, immune, dental and pulmonary systems from age 26 to 45 years. We used (a) generalized estimating equations to examine associations between age-5 caries and poor physical health by age 45 years, and (b) ordinary least squares regression to examine whether age-5 caries was associated with the PoA. Analyses adjusted for sex, perinatal health, childhood SES and childhood IQ.

Results

High caries experience at age-5 was associated with higher risk for some metabolic abnormalities, including BMI ≥30, high waist circumference, and high serum leptin. Those with high caries experience at age-5 were aging at a faster rate by age 45 years than those who had been caries-free.

Oral health is essential for wellbeing. Poor oral health can be an early signal of a trajectory towards poor health in adulthood. Management for both conditions should be better-integrated; and integrated population-level prevention strategies should be foundational to any health system.

Reference:

Ruiz B, Broadbent JM, Thomson WM, Ramrakha S, Moffitt TE, Caspi A, et al. Childhood caries is associated with poor health and a faster pace of aging by midlife. J Public Health Dent. 2023; 83(4): 381–388. https://doi.org/10.1111/jphd.12591

Keywords:

Childhood, caries, associated, with, poor, health, adulthood, faster, ageing, Ruiz B, Broadbent JM, Thomson WM, Ramrakha S, Moffitt TE, Caspi, J Public Health Dent

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Study reveals association between very irregular sleep and higher risk of dementia

UK: A recent study published in Neurology, the medical journal of the American Academy of Neurology, has revealed that the regularity of a person’s sleep is an important factor when considering a person’s risk of dementia. 

The researchers showed that people who have very irregular sleep patterns may have a higher risk of dementia than those who have more regular sleep patterns. The study does not prove that sleep irregularity causes dementia. It only shows an association.

Sleep regularity is how consistent you are at going to sleep and waking up at the same time each day.

“Sleep health recommendations often focus on getting the recommended amount of sleep, which is seven to nine hours a night, but there is less emphasis on maintaining regular sleep schedules,” said study author Matthew Paul Pase, PhD of Monash University in Melbourne, Australia. “Our findings suggest the regularity of a person’s sleep is an important factor when considering a person’s risk of dementia.”

The study involved 88,094 people with an average age of 62 in the United Kingdom. They were followed for an average of seven years.

Participants wore a wrist device for seven days that measured their sleep cycle. Researchers then calculated the regularity of participants’ sleep. They determined the probability of being in the same sleep state, asleep or awake, at any two time points 24 hours apart, averaged over seven days. A person who sleeps and wakes at the exact same times each day would have a sleep regularity index of 100, while a person who sleeps and wakes at different times every day would have a score of zero.

Researchers then looked at medical data to identify which participants developed dementia and found 480 people developed the disease.

Researchers found links between sleep regularity scores and risk of dementia. Compared to those with an average sleep regularity index, the risk of dementia was highest for people who had the most irregular sleep.

People in the lowest fifth percentile had the most irregular sleep with an average score of 41. Those in the highest 95th percentile had the most regular sleep with an average score of 71. People between these two groups had an average sleep regularity score of 60.

After adjusting for age, sex and genetic risk of Alzheimer’s disease, researchers found that those with the most irregular sleep were 53% more likely to develop dementia than people in the middle group. For people with the most regular sleep, researchers found they did not have a lower risk of developing dementia than people in the middle group.

“Effective sleep health education combined with behavioral therapies can improve irregular sleep patterns,” Pase said. “Based on our findings, people with irregular sleep may only need to improve their sleep regularity to average levels, compared to very high levels, to prevent dementia. Future research is needed to confirm our findings.”

Pase said that although they adjusted for several factors that can affect the risk of dementia, they cannot rule out that another unknown factor may play a role in the association between sleep regularity and dementia.

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High Macular Fluid volume risk factor for progressive neovascular age-related macular degeneration

High Macular Fluid volume risk factor for progressive neovascular age-related macular degeneration suggests a new study published in the Canadian Journal of Ophthalmology.

A study was done to investigate the effect of macular fluid volumes (subretinal fluid [SRF], intraretinal fluid [IRF], and pigment epithelium detachment [PED]) after initial treatment on functional and structural outcomes in neovascular age-related macular degeneration in a real-world cohort from Fight Retinal Blindness!

Treatment-naive neovascular age-related macular degeneration patients from Fight Retinal Blindness! (Zürich, Switzerland) were included. Macular fluid on optical coherence tomography was automatically quantified using an approved artificial intelligence algorithm. Follow-up of macular fluid, number of anti-vascular endothelial growth factor treatments, effect of fluid volumes after initial treatment (high, top 25%; low, bottom 75%) on best-corrected visual acuity, and development of macular atrophy and fibrosis was investigated over 48 months.

Results

A total of 209 eyes (mean age, 78.3 years) were included. Patients with high IRF volumes after initial treatment differed by –2.6 (p = 0.021) and –7.4 letters (p = 0.007) at months 12 and 48, respectively. Eyes with high IRF received significantly more treatments (+1.6 [p < 0.001] and +5.3 [p = 0.002] at months 12 and 48, respectively). Patients with high SRF or PED had comparable best-corrected visual acuity outcomes but received significantly more treatments for SRF (+2.4 [p < 0.001] and +11.4 [p < 0.001] at months 12 and 48, respectively) and PED (+1.2 [p = 0.001] and +7.8 [p < 0.001] at months 12 and 48, respectively).

Patients with high macular fluid after initial treatment are at risk of losing vision that may not be compensable with higher treatment frequency for IRF. Higher treatment frequency for SRF and PED may result in comparable treatment outcomes. Quantification of macular fluid in all compartments is essential to detect eyes at risk of aggressive disease.

Reference:

Long-term effect of fluid volumes during the maintenance phase in neovascular age-related macular degeneration: results from Fight Retinal Blindness. Gregor S. Reiter, Virginia Mares Oliver Leingang, Hrvoje Bogunovic, Daniel Barthelmes, Ursula Schmidt-Erfurth

Open AccessPublished:November 18, 2023DOI:https://doi.org/10.1016/j.jcjo.2023.10.017

Keywords:

Long-term, effect, fluid, volumes, during, maintenance, phase, neovascular, age-related, macular, degeneration, results, Fight, Retinal, Blindness, Gregor S. Reiter, Virginia Mares Oliver Leingang, Hrvoje Bogunovic, Daniel Barthelmes, Ursula Schmidt-Erfurth, Canadian Journal of Ophthalmology

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Case of Treatment of woman with severe vasospastic angina with diltiazem- A report

Japan: Initiatin of diltiazem therapy led to pregnancy and the successful birth of a child in a woman diagnosed with severe vasospastic angina (VSA), a recent case study published in JACC: Case Reports has shown.

Vasospastic angina can sometimes result in acute myocardial infarction (MI) in pregnant women, potentially endangering mother and child lives. Hirohiko Aikawa, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan, and colleagues described a case of a young woman with suspected vasospastic angina who wished to become pregnant.

Vasospasm provocation testing revealed severe vasospasm and subsequent appropriate management led to successful delivery.

The case concerns a 29-year-old woman who presented with chest pain only at rest. The Holter electrocardiogram revealed ST-segment depression at the time of chest pain onset. A trial use of nitroglycerin sublingual tablets was effective. She was suggested to have vasospastic angina and wished to become pregnant. She had no medical history.

The possible differential diagnoses included coronary embolism, atherosclerotic coronary artery disease, and spontaneous coronary artery dissection.

The case was discussed by cardiologists and obstetricians who decided to perform invasive coronary catheterization and vasospasm provocation testing to determine a definitive diagnosis and perinatal cardiovascular risk and, to administer a calcium-channel blocker (CCB) if the test was positive.

Coronary angiography performed via her distal radial artery revealed no stenosis. Vasospasm provocation testing with acetylcholine administration into the left coronary artery resulted in sub occlusion in the left main trunk (LMT) with chest pain, ST-segment depression in the V4 to V6 leads, and hypotension. An intracoronary infusion of nicorandil and isosorbide mononitrate improved the LMT occlusion, eliminated electrocardiogram changes, and increased blood pressure (BP). She was confirmed to have severe VSA.

200 mg daily Diltiazem was initiated. She successfully conceived after a few weeks. Diltiazem’s effectiveness was recognised after the appearance of chest pain shortly after the temporary discontinuation of diltiazem because of hyperemesis gravidarum. Her pregnancy progressed without chest pain after the second trimester, and the fetus developed well.

A labour induction was planned at the 40th gestation week because spontaneous labour did not occur until full term. Epidural analgesia was used at delivery to prevent vasospasm induction caused by hyperventilation or pain stress.

She gave birth to a healthy girl without any anomaly. For postpartum atonic haemorrhage, oxytocin was used instead of methylergonovine. She had no chest pain or electrocardiogram abnormality in the peripartum period.

The patient continued to take diltiazem after delivery and has had no recurrence of angina attacks. The child was growing up without any disabilities. The amount of diltiazem ingested by the infant via breast milk is small and is unlikely to negatively affect breastfed infants.

“It is important to make a definitive VSA diagnosis for women who wish to be pregnant, determine its severity and provide suitable treatment,” the researchers wrote.

“Under conditions of adequate prior consultation with the patient, obstetricians, family, and cardiologists, invasive catheterization including provocation test should be performed, and CCB administration should be considered for VSA,” they concluded.

Reference:

Aikawa H, Murai K, Aoki-Kamiya C, Yoshimatsu J, Noguchi T. Diagnosis and Management of Vasospastic Angina in a Young Woman Wishing to Become Pregnant. JACC Case Rep. 2023 Dec 6;27:102051. doi: 10.1016/j.jaccas.2023.102051. PMID: 38094717; PMCID: PMC10715958.

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NEET PG: In Service Candidate alleges Arbitrary Seat Allotment at RVM Medical College, HC issues notice

Hyderabad: The Telangana High Court bench has recently issued notices in a plea challenging the arbitrary seat allotment to a postgraduate medical candidate in RVM Institute of Medical Sciences and Research Centre, Medak.

Issuing the notice, the HC bench comprising Chief Justice Alok Aradhe and Justice J. Anil Kumar has listed the matter for further hearing after two weeks.

The bench was considering a plea by an in-service PG medical candidate, who also belongs to the scheduled caste category. Approaching the HC bench, the petitioner alleged arbitrary seat allotment at the medical college.

It was submitted by the counsel for the petitioner that he belonged to the SC Category and he has secured 220 marks, whereas another candidate (Respondent No.3) was admitted to the Medak-based medical college while only obtaining 160 marks in the Postgraduate medical entrance examination, i.e. the National Eligibility-cum-Entrance Test Postgraduate (NEET-PG). The petitioner’s counsel also informed the court that the petitioner had submitted an option for the concerned medical institute as well.

The petitioner prayed to the court to issue an order or mandamus declaring the action of Kaloji Narayana Rao University of Health Sciences (KNRUHS) in not allotting a seat to the petitioner in PG SPM in terms of his web options, and allotting a PG SPM seat to another candidate who scored less as “illegal and arbitrary and discriminatory” violating the Article 14 and 21 of the Constitution of India.

Also Read: KNRUHS affiliated private medical, nursing colleges must pay GST on inspection, affiliation fee: HC

During the hearing of the case on 07.11.2023, the counsel for KNRUHS invited the Court’s attention to the notice dated 19.08.2023 issued by the Union Government which provides that the candidates who have participated in the first three rounds of counselling are not entitled to participate in the stray round of counselling.

It was submitted by the KNRUHS counsel that the petitioner has participated in up to the first three phases of counseling and had already been allotted a seat. Therefore, the petitioner was not entitled to participate in the stray round of counselling, which was held on 11.10.2023.

On 15.12.2023, when the matter came up for hearing before the HC bench, the counsel for KNRUHS invited the attention of the court to the stand taken by the university in paragraph 18 of the counter affidavit. 

As per the latest media report by Deccan Chronicle, the respondent informed the court that based on his marks, the petitioner had four options but he had applied for three. The petitioner’s counsel stated that one of the options was RVM Institute of Medical Sciences. While considering the matter, the HC bench said that without hearing the other candidate no orders could be passed and therefore, it directed to issue notice to the other candidate and adjourned the matter by two weeks.

“However, at this point of time, it is noticed that service on respondent No.3 has not been effected. Let service report be filed within two weeks. List thereafter,” the HC bench mentioned in the order.

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

https://medicaldialogues.in/pdf_upload/telangana-hc-kvm-institute-228151.pdf

Also Read: Telangana HC junks pleas seeking cancellation of MBBS seats allotted in stray round counselling

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