Electrophysiological Study Superior to ECG for Prophylactic Pacing Selection in Myotonic Dystrophy Type 1: JAMA

France: The findings of a new study published in JAMA Cardiology suggest that an electrophysiological study (EPS) provides greater accuracy than an electrocardiogram (ECG) in identifying patients with myotonic dystrophy type 1 (DM1) who may benefit from prophylactic permanent pacing.

The multicenter cohort analysis, led by Dr. Nicolas Clementy of the Department of Cardiology at Université de Tours, CHU de Tours, Paris, France, evaluated 706 adults with genetically confirmed DM1 drawn from the DM1 Heart Registry. The study aimed to determine whether ECG or EPS criteria better predict major bradyarrhythmic events (MBAEs), which include sudden cardiac death, resuscitated cardiac arrest, or advanced atrioventricular block.
The study revealed the following findings:
  • Participants had a median follow-up of nearly six years.
  • At baseline, 38% of patients had a His-ventricular (HV) interval ≥70 milliseconds.
  • At baseline, 32% of patients met ECG-based criteria (PR interval ≥240 milliseconds or QRS duration ≥120 milliseconds).
  • During follow-up, 14% of patients experienced a major bradyarrhythmic event (MBAE).
  • Multivariable analysis showed that the HV interval was the only variable significantly associated with MBAE incidence.
  • An HV interval ≥70 milliseconds was a stronger predictor of MBAEs than ECG criteria, with hazard ratios of 2.89 versus 1.95.
  • EPS correctly identified 68.35% of patients at risk, compared with 34.76% for ECG-based assessment.
  • Lowering the HV threshold to 65 milliseconds increased sensitivity to over 90% and improved net patient reclassification by 33.7%.
According to the researchers, these results suggest that EPS allows for more precise risk stratification in DM1 patients, potentially guiding timely prophylactic pacemaker implantation and preventing sudden cardiac death. In contrast, reliance on ECG criteria alone may underestimate risk in a substantial proportion of patients, potentially leaving high-risk individuals unprotected.
Professional practice guidelines currently recommend prophylactic pacemaker implantation in asymptomatic DM1 patients who meet ECG or EPS thresholds as class IIa indications. This study provides strong evidence that EPS, particularly HV interval assessment, may be the more reliable method for selecting patients who would benefit most from pacing.
The authors note that adopting a slightly lower HV threshold could further optimize patient care by identifying more at-risk individuals without significantly increasing unnecessary interventions. While the study is retrospective and observational, it is strengthened by a large, multicenter cohort and long-term follow-up.
“The study highlights the clinical value of electrophysiological evaluation over ECG in DM1. Using EPS to guide prophylactic pacemaker implantation could significantly improve outcomes by accurately identifying patients at the highest risk for major bradyarrhythmic events, ultimately enhancing both survival and quality of care in this vulnerable population,” the authors concluded.
Reference:
Clementy N, Labombarda F, Grolleau F, et al. Electrocardiogram vs Electrophysiological Study and Major Conduction Delays in Myotonic Dystrophy Type 1. JAMA Cardiol. Published online September 24, 2025. doi:10.1001/jamacardio.2025.3055

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Empagliflozin Fails to Preserve Beta-Cell Function After Gestational Diabetes: Trial Finds

Canada: Empagliflozin did not significantly preserve beta-cell function in women with a recent history of gestational diabetes, according to a randomized, placebo-controlled trial published in Diabetes, Obesity and Metabolism. While the study did not show a clear benefit for beta-cell health, researchers observed signals suggesting the drug might help stabilize insulin sensitivity and fasting glucose, highlighting the need for larger, longer studies.

Led by Caroline K. Kramer of the Leadership Sinai Centre for Diabetes at Mount Sinai Hospital, Toronto, the trial addressed an important question: can early pharmacological intervention protect women with prior gestational diabetes mellitus (GDM) from progressing to type 2 diabetes? Women with a history of GDM are known to face a heightened risk of beta-cell decline and subsequent dysglycemia, yet few clinical trials have tested strategies to slow this process.
The double-blind study enrolled 91 participants between 6 and 36 months after childbirth. All had experienced GDM during pregnancy. They were randomly assigned to receive either 10 mg of the sodium–glucose cotransporter-2 (SGLT-2) inhibitor empagliflozin or a placebo once daily for 48 weeks. Investigators used the Insulin Secretion-Sensitivity Index-2 (ISSI-2) derived from an oral glucose tolerance test to evaluate beta-cell function. Additional measures included the insulinogenic index/HOMA-IR and ΔC-peptide/Δglucose multiplied by the Matsuda index.
The study revealed the following findings:
  • After nearly a year of treatment, there was no significant difference in beta-cell function between the empagliflozin and placebo groups.
  • Baseline-adjusted ISSI-2 scores were 525 for the empagliflozin group and 560 for the placebo group, a nonsignificant difference.
  • Other indicators of beta-cell activity and insulin secretion showed similar results, confirming no meaningful preservation of beta-cell capacity with empagliflozin.
  • Rates of dysglycemia were comparable, affecting 65.7% of the empagliflozin group and 48.2% of the placebo group.
  • Only 9.4% of women on empagliflozin experienced worsening glucose tolerance compared with 28% in the placebo group, a trend approaching statistical significance.
The researchers pointed out that the relatively small sample size limited the trial’s power to detect subtle effects. They also emphasized that although the main beta-cell endpoint was negative, the data hinted at potential benefits in insulin sensitivity and fasting glucose trajectories among those taking empagliflozin.
“Given the persistent risk of type 2 diabetes in women with prior gestational diabetes, the findings underscore the importance of continued investigation. Larger, longer trials are needed to clarify whether SGLT-2 inhibitors like empagliflozin can play a preventive role in this high-risk population,” the authors wrote.
“While empagliflozin did not demonstrate a protective effect on beta-cell function over 48 weeks, its favorable influence on glucose trends suggests it may warrant further evaluation as part of a broader strategy to reduce diabetes risk after gestational diabetes,” they concluded.
Reference: https://doi.org/10.1111/dom.70146

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Long COVID in children may be twice as high after a second infection: Lancet

A new study published in The Lancet Infectious Diseases involving over 460,000 children and adolescents across 40 paediatric hospitals in the USA suggests that children who were infected with COVID-19 for the second time during the Omicron wave had more than double the risk of developing long COVID.

Conducted by researchers under the US National Institutes of Health (NIH)-funded RECOVER Initiative*, this is the largest study to date examining the long-term effects of COVID-19 reinfection in young people. The study analysed electronic health records from January 2022 through October 2023, a period dominated by the highly transmissible Omicron variant. Researchers compared health outcomes following children’s first and second documented COVID-19 infections to isolate the risks associated with reinfection.

They found that after a first COVID-19 infection, about 904 children per million developed long COVID within six months. Following a second infection (reinfection), this number more than doubled to approximately 1,884 children per million. The higher risk was observed across many different groups in the study, regardless of whether they were vaccinated, how serious their first illness was, their age, gender, race or ethnicity, or if they were living with overweight or obesity. The authors say this increased risk of long COVID following reinfections highlights the continued importance of preventing COVID-19 infections through vaccination and other protective measures such as masking and social distancing.

Reinfection was linked to a wide range of rare but persistent and sometimes serious conditions potentially associated with long COVID in children, including heart inflammation (myocarditis), blood clots, kidney injury, cognitive difficulties, fatigue, and respiratory problems.

The authors emphasise that while vaccines and other prevention measures may not completely eliminate the risk of contracting COVID-19, they remain the most effective way to prevent both initial infections and reinfections, thereby reducing the risk of long-lasting symptoms in children. They say the study’s findings reinforce the need to strengthen public health efforts to increase COVID-19 vaccination coverage among children and adolescents.

*The NIH’s RECOVER (Researching COVID to Enhance Recovery) Initiative is dedicated to understanding long COVID, developing better treatments, and guiding strategies to protect people of all ages from the prolonged effects of COVID-19.

Reference:

Zhang, Bingyu et al., Long COVID associated with SARS-CoV-2 reinfection among children and adolescents in the omicron era (RECOVER-EHR): a retrospective cohort study, The Lancet Infectious Diseases, DOI:10.1016/S1473-3099(25)00476-1.

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Habitual Scratching among atopic dermatitis patients linked to increased disease Severity: Study

According to a new study habitual scratching was prevalent across patients of all levels of atopic dermatitis (AD) severity and was linked to greater disease severity, emphasizing the need to recognize and manage unconscious scratching as part of holistic atopic dermatitis care.

Scratching is one of the most disruptive features of atopic dermatitis. It not only worsens inflammation but also damages the protective barrier of the skin, making the condition harder to control. While scratching is often thought to be a direct response to itching, many people affected by atopic dermatitis also develop a different behavior known as habitual scratching. This form of scratching is repetitive, unconscious, and can occur even when there is no itch. Until recently, little was known about how common this behavior is among patients in Japan and how it might influence the course of the disease. A new study set out to explore this question by examining both adults and children who had been diagnosed with atopic dermatitis. Information was gathered through health records and a nationwide questionnaire that asked patients and caregivers about scratching behaviors and recent disease activity. The researchers were particularly interested in whether patients engaged in scratching without feeling itchy and whether they scratched in ways they did not even notice until it was pointed out to them. Disease severity was measured using a patient-focused tool designed to capture symptoms and their impact on daily life. The findings showed that habitual scratching was widespread in both children and adults. Many individuals described scratching even when they did not experience itch, while others reported scratching automatically without awareness. Importantly, these behaviors were more common in people whose atopic dermatitis was more severe. This suggests that unconscious scratching is not just a by-product of the disease but may be closely tied to its intensity and persistence. The researchers concluded that habitual scratching deserves more attention in the management of atopic dermatitis. Recognizing and addressing this behavior could help improve treatment outcomes, as ongoing scratching worsens inflammation and delays healing. They recommended that clinicians, patients, and caregivers work together to develop strategies for noticing and reducing unconscious scratching as part of comprehensive care.

Keywords:

Atopic dermatitis, habitual scratching, itch–scratch cycle, disease severity, pruritus, dermatology, skin barrier dysfunction, holistic care, Nakahara, T., Noto, S., Matsukawa, 

Reference:
Nakahara, T., Noto, S., Matsukawa, M. et al. Habitual Scratching in Atopic Dermatitis and Its Association with Disease Severity: Findings from Japanese Health Insurance Claims and App-Based Data. Dermatol Ther (Heidelb) (2025). https://doi.org/10.1007/s13555-025-01525-9

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SDF Treatment Superior in Arresting Early Approximal Caries: Study

Researchers have found in a new randomized, triple-blinded clinical trial that silver diamine fluoride (SDF) was more effective in halting initial approximal caries lesions in adults during the first six months of treatment. This offers significant disease-control benefits for high-risk patients presenting with multiple early lesions, providing a minimally invasive option for managing dental decay.

The study, published in Journal of Conservative Dentistry and Endodontics (Jaradat et al., 2025), involved adults with early interproximal lesions who were randomly assigned to receive either SDF or a placebo. Lesions were evaluated at six- and twelve-month intervals using bitewing radiographs, digital subtraction radiography (DSR), and histogram analysis of subtraction radiographs (HA). Results showed that while over 90% of lesions in both groups were arrested over 12 months, the SDF-treated lesions performed significantly better during the first six months when assessed using DSR. By the 12-month mark, differences between the groups were no longer statistically significant, but the early benefit highlights SDF’s effectiveness in rapid intervention for lesion control.

What this really means is that SDF can serve as a simple, low-cost, and minimally invasive strategy for arresting early interproximal decay, particularly in adults at high risk for multiple lesions. By stopping the progression of early caries, dental practitioners can reduce the need for more invasive restorations and improve long-term oral health outcomes. The authors also note that while the short-term benefits are clear, further studies are needed to confirm sustained efficacy beyond a year and to explore optimized application protocols. For patients, this study reinforces the importance of early detection and treatment of interproximal lesions, which are often difficult to manage and frequently go unnoticed until more advanced decay develops. Clinicians may consider incorporating SDF into preventive care plans for high-risk adults to enhance early caries control and minimize future restorative needs.

Reference: Jaradat, M., Kolker, J., Owais, A., Guzman-Armstrong, S., Haes, A., Anamali, S., Comnick, C., Zeng, E., & Kanellis, M. (2025). Silver diamine fluoride effectiveness in arresting initial approximal caries lesions in adults: A triple-blinded, randomized controlled clinical trial. Journal of Conservative Dentistry and Endodontics, 28(9), 892–898. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440336/

Keywords: silver diamine fluoride, approximal caries, minimal intervention, subtraction radiography, dental disease control, Jaradat, Journal of Conservative Dentistry and Endodontics.

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SSRIs in Pregnancy may Affect Maternal Care giving behavior, Not Offspring Cognition, reveals study

Findings from a new study show that selective serotonin reuptake inhibitor use during pregnancy and lactation may alter maternal caregiving behaviors but does not impair offspring cognition. Selective serotonin reuptake inhibitors, such as fluoxetine, are widely prescribed for the treatment of depression and anxiety in women of reproductive age, including during pregnancy. Concerns about potential risks for neurodevelopmental impairment in children have often complicated treatment decisions, leading to hesitation among patients and clinicians.

The study offers important clarification by indicating that while maternal behaviors related to caregiving may be influenced by exposure to selective serotonin reuptake inhibitors during the perinatal period, offspring cognitive abilities remain unaffected. Maternal caregiving encompasses essential interactions such as attentiveness, emotional responsiveness, and nurturing practices, all of which are critical for healthy child development.

Pharmacological modulation of serotonin systems during pregnancy may influence these behaviors, underscoring the importance of monitoring and supporting maternal-infant bonding in women undergoing pharmacological treatment. At the same time, the absence of measurable adverse effects on offspring learning, memory, and cognitive performance provides reassurance regarding long-term neurodevelopmental outcomes.

This distinction helps shift the clinical conversation from concerns about irreversible cognitive harm in children to a more practical focus on supporting maternal caregiving capacity. Untreated maternal depression itself carries significant risks, including reduced caregiving quality and poorer child outcomes, highlighting the necessity of balancing risks and benefits when considering treatment options. The findings encourage clinicians to take an integrative approach, combining pharmacological management with psychosocial support strategies that reinforce maternal caregiving behaviors. Further longitudinal research will be important to understand whether early behavioral changes in mothers translate into long-term psychosocial impacts on offspring.

Overall, the evidence suggests that selective serotonin reuptake inhibitors remain a viable therapeutic option during pregnancy, provided maternal support systems are emphasized as part of comprehensive perinatal care.

Keywords: selective serotonin reuptake inhibitors, fluoxetine, pregnancy, lactation, maternal caregiving, offspring cognition, perinatal depression, child development

Reference:
Prado-Rivera MA, Ebbing JJ, Yurova M, Olivier JDA. Perinatal fluoxetine exposure does not impair cognition in offspring. Behavioural Brain Research. 2026;496:115812. doi:10.1016/j.bbr.2025.115812

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Health crisis in a bottle: Rajasthan govt bans cough syrup batch after patients fall ill in Bharatpur, Sikar

Jaipur: The Rajasthan Medical Services Corporation Limited (RMSCL) has imposed a ban on the distribution and use of a batch of cough syrup following reports of adverse reactions in Bharatpur and Sikar districts.

Patients reported alarming symptoms, including vomiting, drowsiness, anxiety, dizziness, restlessness, and even unconsciousness, after taking the medication.

Medical and Health Minister Gajendra Singh Khinvsar directed RMSCL to conduct an urgent probe and take immediate action upon receiving the complaints. Acting swiftly, RMSCL suspended the use of the Dextromethorphan HBr Syrup IP 13.5mg/5ml (Batch No. 440) pending test results.

Principal Secretary of the Medical and Health Department, Gayatri Rathore, confirmed that statutory samples were collected by Drug Control Officers and forwarded to the State Drug Testing Laboratory for quality analysis. She said further steps will be taken once the test results are available.

As per IANS, RMSCL has also ordered a ban on 19 other batches of the same drug supplied by the concerned manufacturer. RMSCL Managing Director Pukhraj Sain emphasised that strict quality control procedures are in place under the Chief Minister’s Free Medicine Scheme.

Every drug batch supplied is first tested in approved laboratories, and only medicines meeting prescribed standards are released for hospital use. If any batch fails, it is barred from distribution. In cases where complaints are received, drugs are retested at the State Drug Testing Laboratory to ensure public safety. Officials stressed that public health remains the government’s top priority and assured that necessary regulatory action will follow based on laboratory findings.

Patients have been advised to immediately discontinue use of the affected batches until further notice. The incident has raised concerns over drug safety standards, but authorities have reiterated their commitment to strict monitoring and swift corrective measures to protect patients.

A 5-year-old child died after reportedly consuming cough syrup supplied under the government’s free medicine scheme in Sikar district. The family alleged that the child, identified as Nityansh, stopped breathing immediately after taking the dose.

Similar incidents have surfaced in Srimadhopur and Bharatpur. In Sikar, three children reportedly fell ill after consuming the same cough syrup. In Bharatpur, even a doctor who examined the children later experienced health complications after consuming the medicine.

The most recent case occurred in Khori Brahmanan village of Sikar, where Nityansh’s family claims that the cough syrup provided at a government hospital was directly responsible for his sudden death.

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56 MBBS students of Darbhanga Medical College booked amid row over alleged ban on exams, hostel stay

Darbhanga: 56 MBBS students of Darbhanga Medical College and Hospital (DMCH) have reportedly been booked for protesting against what they termed as ”arbitrary” academic decisions. According to the Careers360 report, they were opposing the alleged ban on exams, classes, and stay in hostels.

The students have alleged that “false” First Information Reports (FIRs) have been filed against them.

According to the students, the issue arose when the college administration barred around 60-70 students from appearing for the sent-up examinations despite their 75% attendance recorded on the biometric app.

Also Read: ‘Assaulted, blackmailed’- MBBS student alleges ragging, 3 medicos booked

Careers 360 has reported that the stand-off between the DMC management and students escalated after an order was issued by the principal announcing that all classes for 2021, 2023, and 2024 MBBS batches had been cancelled and the medical students would not be allowed to stay in the hospital.

Thereafter, a meeting was held on September 26 with the department heads and the college authorities decided that the girl students enrolled in MBBS 2025 batch would be allowed to stay in the hostel as well as attend classes. Meanwhile, it was also decided that the MBBS students of the 2022 batch would be allowed to attend classes and stay in the hostel from October 7. Regarding the MBBS students of the 2023 and 2024 batches, it was decided that they could appear for the University’s written, departmental, practical and oral examinations while staying outside the DMC hostel.

“All classes for the 2021, 2023, and 2024 batches are cancelled until further notice, and they will not be allowed to stay in the hostel. Therefore, all concerned students are directed to ensure compliance with the above decisions and will be responsible for any action taken against them in the future if they do not follow these rules,” read the notification.

The students started protesting against this decision and consequently, the college administration lodged FIRs against them, the students alleged.

“This is not just an attack on students — it is an attack on the future of medical education and an attempt to silence genuine voices. Criminalizing young medical students for demanding their rights is unacceptable and sets a dangerous precedent,” remarked the medicos.

The Daily has reported that the students have demanded immediate withdrawal of the false FIRs against 56 DMCH students, fair treatment in academics by allowing them to take exams, and accountability of the administration for “misusing” power against students.

“Doctors are the backbone of our healthcare system. Today’s students are tomorrow’s healers. If they are silenced, harassed, and criminalized, what future does healthcare in Bihar hold?” asked the medicos.

Also Read: J P Nadda inaugurates 210-bed super speciality block at Darbhanga Medical College Hospital

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Telangana HC seeks response on hospitals’ plea over biomedical waste fee

Private hospitals in the state have taken their fight against the new bio-medical waste fee system to the Telangana High Court. The petitioners alleged that the system unfairly penalises bedded facilities while non-bedded institutions pay strictly in proportion to the waste they generate.

While hearing the matter, a division bench comprising Justices Abhinand Kumar Shavili and Vakiti Ramakrishna Reddy directed the state and central governments, along with the Telangana Pollution Control Board (TGPCB) and the Central Pollution Control Board, to respond to the plea filed by private hospitals and doctors’ bodies regarding bio-medical waste charges.

For more details, check out the full story on the link mentioned below:

Telangana HC issues notice on hospitals’ plea over biomedical waste fee

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Philippines MD degree not compliant with NMC FMGL regulations- Students raise concerns, seek NMC, Govt intervention

Alleging that the medical education programme in the Philippines does not comply with the three major Foreign Medical Graduates Licentiate (FMGL) Regulations 2021, a group of students has sought intervention from the Union Health Ministry and the National Medical Commission (NMC).

The appeal has been addressed to the Union Health Minister, External Affairs Minister, Home Minister, officials of the National Medical Commission (NMC), state medical councils, and the Embassy of India in Manila. It has also been sent to the Commission on Higher Education (CHED) officials in the Philippines, including its Legal and International Affairs Directors.

For more details, check out the full story on the link mentioned below:

Philippines MD degree not compliant with NMC FMGL regulations- Students allege violations, seek NMC, Govt intervention

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