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The study was published online in the American Journal of Obstetrics and Gynecology on 20 March 2025.

The researchers note that breastfeeding and contraception are vital in patient and public health. The etonogestrel contraceptive implant, a widely used long-acting progestin contraceptive, is highly effective and has few medical restrictions. Although there are concerns that early exposure to exogenous progestin might affect lactation, previous studies have shown that immediate placement does not hinder milk production or long-term breastfeeding. However, no studies have directly compared implant placement within 24 hours of delivery to placement at a later postpartum visit.

To address this, Jamie W. Krashin, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico, 1 University of New Mexico, 4ACC, Albuquerque, New Mexico, USA, and colleagues examined whether inserting the implant within 24 hours of childbirth affects breastfeeding continuation compared to placement at least two weeks later. Breastfeeding rates were assessed at eight weeks postpartum to determine if timing influenced lactation success.

For this purpose, the researchers conducted a non-inferiority randomized controlled trial at two university hospitals in the Mountain West, enrolling postpartum participants planning to breastfeed and use the etonogestrel implant. Eligible participants, aged 13 or older with term deliveries and no contraindications, were randomly assigned to receive the implant within 24 hours or at least two weeks postpartum. Baseline data were collected through chart reviews and questionnaires, while breastfeeding status and implant use were tracked via electronic surveys at multiple postpartum intervals. The study assessed a 15% non-inferiority margin for breastfeeding at 8 weeks in the per-protocol population.

The study led to the following findings:

• One-hundred-fifty participants were enrolled (78 in the immediate group and 72 in the delayed group).
• After excluding 8 participants who declined implant placement, withdrew, or were ineligible, and 16 who lacked primary outcome data, the modified intention-to-treat analysis included 126 participants (69 immediate, 57 delayed).
• The per-protocol analysis included 115 participants (62 immediate, 53 delayed) after excluding 11 who received the implant outside the designated timeframes.
• Both groups were similar in age, race, ethnicity, previous breastfeeding experience, delivery mode, and epidural use, but prior implant use was less common in the delayed group (29% vs. 43%).
• At eight weeks postpartum, 77.4% in the immediate group and 81.1% in the delayed group reported any breastfeeding. The -3.7% difference exceeded the predefined non-inferiority margin, with a lower confidence interval of -16%.
• In the modified intention-to-treat analysis, the difference between groups was smaller (-0.6%) and within the non-inferiority margin (-12.8% lower confidence limit), with 78.3% in the immediate group and 78.9% in the delayed group reporting any breastfeeding.
• Implant continuation at 24 weeks was slightly higher in the immediate group (96%) compared to the delayed group (85%), though the difference was not statistically significant.
• Exclusive or any breastfeeding and implant continuation through 24 weeks were similar between both groups.

The study found no significant differences in breastfeeding or implant continuation between immediate and delayed placement, despite the primary outcome slightly exceeding the non-inferiority margin.

“These findings support the safety and flexibility of initiating the etonogestrel implant at any preferred time postpartum for breastfeeding individuals,” the authors concluded.

Reference:

Krashin, J. W., Rivera-Montalvo, M., Leeman, L., Trujillo, V. Y., Petersen, T. R., Sanchez, D., Bender, E., Carroll, S., Bulleit, E., Alcantara, J., Turok, D. K., Black, P., & Espey, E. (2025). Breastfeeding after immediate versus delayed postpartum contraceptive implant placement: A non-inferiority randomized controlled trial. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2025.03.019

The study evaluated patients treated between February 2012 and January 2024 who received a dexamethasone (Dex) implant in addition to standard ablative therapy, with a follow-up duration exceeding 12 months. Out of 15 enrolled patients, the analysis included 11 patients. The cohort primarily consisted of males (90.9%) with unilateral disease, while the only female participant presented with bilateral involvement. The mean age at diagnosis was 14.8 years, spanning a wide age range from 2 to 60 years, highlighting the diverse presentation of the disease.

The following were the notable findings of the study:

• At baseline, 58.3% of the eyes were classified as stage 3a1, 25% as stage 3a2, and 16.7% as stage 2b.
• Over an average follow-up of nearly 66 months, visual acuity remained stable in 50% of the treated eyes.
• One-third of the eyes showed measurable improvement of at least one Snellen line.
• Two eyes demonstrated a two-line gain, while the other two eyes achieved a single-line gain in visual acuity.
• Vision deteriorated in both eyes during the study period.
• Transient intraocular pressure (IOP) elevation was observed in 66.7% of treated eyes.
• Cataract progression occurred in 58.3% of eyes, with one-third requiring cataract surgery.
• One eye developed a secondary vasoproliferative tumor, necessitating CyberKnife therapy and vitrectomy.
• No severe implant-related complications were reported, indicating a favorable safety profile for the treatment.

The findings suggest that intravitreal dexamethasone implants may serve as a useful adjunctive option, particularly in pediatric patients, to reduce the need for repeated general anesthesia and in adults with extensive macular exudation, where conventional ablative therapy alone may be insufficient. While the outcomes are promising, the authors acknowledge key limitations, including the retrospective design, small sample size, absence of a control group, and the study’s setting in a tertiary referral center, which may have resulted in a higher proportion of advanced cases.

Despite these limitations, the research highlights the value of dexamethasone implants in achieving anatomical and functional stabilization in Coats’ disease. With half of the treated eyes maintaining stable vision and one-third showing improvement, the study adds evidence supporting the integration of steroid implants into multimodal treatment strategies,” the authors wrote.

They recommend further studies to validate these findings and better define patient subgroups that may benefit most from this adjunctive approach.

Reference:

Ural Fatihoglu, O., Ayhan, Z., Ozturk, T. et al. Place of dexamethasone implant as an adjunctive treatment in Coats’ disease: a retrospective single-center study. BMC Ophthalmol 25, 435 (2025). https://doi.org/10.1186/s12886-025-04279-2

As per the prospectus, a total of 125 seats for Indian nationals are available for admission to the MBBS course. The reservation matrix would be as per the Medical Counselling Committee (MCC) directives. AIIMS Kalyani has an MBBS course divided into three professional divisions, i.e. First, Second and Third Professional MBBS are of one, one and a half and two years duration respectively.

Admitted candidates must attend the Orientation Program and join classes on the stipulated date. The admission of the candidates, who fail to join the Course by the date stipulated in the letter of intimation, shall automatically be cancelled and such seats shall then be offered to the candidates on the waiting list in order of merit in the same category

The candidates selected for admission to the MBBS course at the AIIMS Kalyani, after verification of their eligibility and being offered admission, should bring the following original certificates/ testimonials/documents at the time of admission-

1 Certificate of having passed the 10+2 or equivalent Examinations, showing the subject offered by him/her in the Examination.

2 Certificate from the Board from which he/she passed the High School/Higher Secondary Examination, showing his/her date of birth.

3 Certificate/Mark sheet from the Board from which he/she passed the 10+2 or equivalent Examination showing that he/she has secured 60% or more marks (50% in case of SC/ST/Persons with Benchmark Disability) in aggregate in English, Physics, Chemistry and Biology.

4 Migration Certificate from the University/Board last attended by him/her.

COMPULSORY ROTATORY INTERNSHIP TRAINING

After passing the Final MBBS Examination, all the candidates will be required to do a compulsory internship for a period of one calendar year (12 months) in the hospital and rural health centres recognised by the AIIMS. During the internship period, the interns are allowed a total of 15 days leave in the full term of one year. The degree of MBBS shall be awarded after satisfactory completion of one year’s internship.

FEES & OTHER PAYMENTS

The dues are to be paid in cash immediately, after the candidates have been declared medically fit in the Medical Board of the Institute, as per details given below-

To view the prospectus, click the link below

https://medicaldialogues.in/pdf_upload/aiims-kalyani-mbbs-2025-125-seats-offered-know-complete-admission-rules-fee-structure-297700.pdf