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Lucknow: A major scam involving fraudulent medical insurance claims worth Rs 10 crore under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and Mukhyamantri Jan Arogya schemes has been uncovered at multiple private hospitals across Uttar Pradesh. An FIR was registered at Hazratganj police station on Monday after irregularities were flagged during a routine audit.
The complaint, filed by BK Srivastava, State Nodal Officer of the State Agency for Comprehensive Health and Integrated Services (SACHIS), alleges large-scale irregularities in the submission and approval of claims by private hospitals empanelled under the two health schemes.
According to the FIR, between May 1 and May 22, 2025, a total of 6,239 high-value insurance claims from 39 private hospitals were fraudulently approved and paid through the National Health Authority’s online portal. These approvals occurred largely during odd hours—late at night or outside working hours—raising suspicions about the legitimacy of the claims.
Investigators found that login credentials of key officials — including those belonging to the Implementation Support Agency (ISA), financial officers, and the CEO of SACHIS — had been misused to process and approve claims without authorisation.
The fraudulent activity involved unauthorised access and digital manipulation of login IDs such as UP003507, UP008126, UP008171, UP008038, UP008039 (ISA users), UP001730, UP003881 (Finance/Accounts), and UP008296 (CEO-SACHIS), reports TOI.
These IDs were used to approve claims without the knowledge or consent of the actual users. ISA officials have denied any role in the fraudulent activity, stating that none of the disputed claims were routed through their system as per protocol.
Under standard operating procedures, hospital claims are submitted after treatment and must go through multiple levels of scrutiny, including medical auditing by ISA, financial verification by SACHIS, and final approval by the CEO. However, this process was entirely bypassed, with fraudulent claims being approved using compromised login credentials.
Also Read: Gujarat: Private Hospitals, doctors exit AB-PMJAY over payment delays
The scam was uncovered when internal office audits noticed a pattern of large, disproportionate payouts originating from a finance manager’s login that was not in use by the designated officer during the time of those transactions. Subsequent verification confirmed that online recommendations for claim settlements were made without any actual input from the registered users.
The audit also revealed that many of the hospitals receiving the payments either did not qualify under the scheme or had inflated their treatment data significantly.
Also Read: Delhi Govt Hospitals to implement unified health information system
Further investigation and forensic audits are now underway. Authorities believe the actual scale of the scam could be even larger than Rs 10 crore once all suspicious transactions are reviewed.
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A new study published in The Lancet journal showed that patients with type 2 diabetes and symptomatic peripheral arterial disease were able to walk farther after using semaglutide. Few treatments help patients with lower limb peripheral artery disease enhance their functional ability and health-related quality of life. Therefore, Marc Bonaca and his team set out to determine if semaglutide improves symptoms, quality of life, and outcomes in individuals with peripheral vascular disease and type 2 diabetes, as well as function as indicated by walking ability.
In 20 countries throughout North America, Asia, and Europe, 112 outpatient clinical trial sites participated in the STRIDE study. The participants were of at least 18 year old who had peripheral artery disease, type 2 diabetes, intermittent claudication (Fontaine stage IIa, able to walk >200 m), and an ankle-brachial index of less than or equal to 0·90 or 0·70.
Using an interactive online response system, the participants were randomly randomized (1:1) to receive either a placebo or subcutaneous semaglutide 1·0 mg once weekly for 52 weeks. The ratio to baseline of the maximal walking distance at week 52, as determined by a constant load treadmill in the whole study set, served as the main endpoint.
After 1,363 individuals were evaluated for eligibility between October 1, 2020, and July 12, 2024, 792 of them were randomized to receive either semaglutide (n=396) or a placebo (n=396). Of the participants, 597 (75%) were men and 195 (25%) were women. The median age (IQR 61·0–73·0) was 68·0 years.
The semaglutide group outperformed the placebo group in terms of the estimated median ratio to baseline in maximum walking distance at week 52 (1·21 [IQR 0·95–1·55] vs. 1·08 [0·86–1·36]; estimated treatment ratio 1·13 [95% CI 1·06–1·21]; p=0·0004). The most common adverse event was a serious gastrointestinal event (two events reported by two [1%] in the semaglutide group and five events reported by three [1%] in the placebo group).
Additionally, 6 serious adverse events in 5 (1%) participants in the semaglutide group and 9 serious adverse events in 6 (2%) participants in the placebo group were possibly or probably related to treatment. No one died as a result of therapy. Overall, walking distance was considerably enhanced with semaglutide when compared to a placebo.
Source:
Bonaca, M. P., Catarig, A.-M., Houlind, K., Ludvik, B., Nordanstig, J., Ramesh, C. K., Rasouli, N., Sourij, H., Videmark, A., Verma, S., & STRIDE Trial Investigators. (2025). Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial. Lancet, 405(10489), 1580–1593. https://doi.org/10.1016/S0140-6736(25)00509-4
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Prediabetes and CKD: A Growing Double Burden
The rising prevalence of prediabetes and chronic kidney disease (CKD) in India reflects an often-overlooked interaction in the early phases of this metabolic disease. Analysis of 19,66,449 adult HbA1c samples from India found 22.25% to be prediabetic, (1) while pooled data from Indian community-based studies reported a CKD prevalence of 13.24%. (2) On a global scale, the IDF (2025) reported 634.8 million adults (12%) with impaired glucose tolerance (IGT), with South-East Asia showing the highest burden at 13.8%. (3) Beyond overt diabetes, prediabetes and insulin resistance are increasingly recognized as contributors to early renal dysfunction. Low-grade inflammation and neurohormonal activation, hallmarks of insulin resistance, are implicated in glomerular hyperfiltration, albuminuria, and early GFR decline. (4)
Prediabetes & Correlation with CKD Onset: Evidence from the Latest 2025 CURE-CKD Study
The CURE-CKD Registry cohort study (2025) analyzed 281,933 adults with prediabetes, defined per ADA criteria. Over a median 2.5-year follow-up, 3.6% (n=10,104) developed CKD, with a standardized incidence of 10.9 cases per 1000 person-years. Incidence increased with age and was higher in individuals with hypertension or ASCVD (11.9 vs. 9.4 per 1000 person-years).
Mechanistic findings suggest that glomerular hyperfiltration and high-normal albuminuria, early renal abnormalities, are more common in prediabetes. These alterations, likely driven by low-grade inflammation and hyperfiltration-induced stress, may promote CKD progression even before diabetes onset. (5)
Potential Role of Metformin in Early Renal Risk: Renal Protection Beyond Glycemic Control
In a nationwide Scottish cohort of 4,278 adults with type 2 diabetes and newly diagnosed stage 4 CKD, stopping metformin within 6 months was associated with a 26% higher risk of all-cause mortality [HR 1.26, 95% CI: 1.10–1.44]. (6) A recently published 2025 cohort study analyzed 10,330 matched patients with eGFR ≥60 mL/min/1.73 m² found that metformin reduced the risk of ESRD by 35% and preserved renal function. (7)
The figure below presents key mechanisms by which metformin confers renoprotective effects in diabetic kidney disease.
Figure: Key pathways of metformin’s renoprotective action in DKD, including AMPK activation and suppression of fibrosis, inflammation, and oxidative stress. Adapted from Kawanami D et al., Int J Mol Sci. 2020;21(12):4239. doi:10.3390/ijms21124239
Metformin Use in CKD: What the Guidelines Say
|
Guideline |
Recommendations |
|
Asian Pacific Society of Nephrology (2025) |
Recommends metformin as first-line therapy in diabetic kidney disease with eGFR ≥30 mL/min/1.73 m². Dose adjustment is advised for eGFR 30–44, and discontinuation below 30. Initiation is discouraged if eGFR is <45. (8) |
|
ADA (2025) |
Advised using metformin if eGFR is ≥30 mL/min/1.73 m², with 50% dose reduction for eGFR 30–44, and discontinuation when eGFR falls below 30. (9) |
|
KDIGO (2024) |
Recommends continuing metformin in CKD patients with eGFR ≥30 mL/min/1.73 m², using lower doses if eGFR is 30–44, with individualized risk-benefit assessment. (10) |
|
ADA-KDIGO (2022) |
Consensus recommends metformin as first-line therapy in type 2 diabetes with CKD and eGFR ≥30 mL/min/1.73 m². A reduced dose (500–1000 mg daily) is advised for eGFR 30–44, and it should be discontinued if eGFR falls below 30 or during acute illness. (11) |
Key Considerations for Practice
Since metformin is now approved for use in patients with eGFR as low as 30 mL/min/1.73 m², regular eGFR monitoring is essential to guide dosing. UACR testing aids in detecting early glomerular injury and risk stratification.
Though rare, lactic acidosis risk warrants caution during acute illness or in elderly patients with declining renal reserve. To avoid therapeutic inertia, early renal risk, such as hyperfiltration or high-normal albuminuria, should prompt timely intervention in prediabetic patients. (8,9,10,11)
Take Home Message
Reference:
1. Vora, Hardeep, and Preet Kaur. “Prediabetes and diabetes in India: An HbA1c based epidemiology study.” Diabetes research and clinical practice vol. 217 (2024): 111889. doi:10.1016/j.diabres.2024.111889
2. Talukdar, Rounik et al. “Chronic Kidney Disease Prevalence in India: A Systematic Review and Meta-Analysis From Community-Based Representative Evidence Between 2011 to 2023.” Nephrology (Carlton, Vic.) vol. 30,1 (2025): e14420. doi:10.1111/nep.14420
3. International Diabetes Federation. IDF Diabetes Atlas. 11th ed., 2025, www.diabetesatlas.org. Accessed on 3rd June 2025
4. Rico-Fontalvo, Jorge, et al. “Prediabetes and CKD: Does a Causal Relationship Exist.” Nefrología, vol. 44, no. 5, Sept.–Oct. 2024, pp. 628–638. Elsevier, https://doi.org/10.1016/j.nefro.2024.06.008.
5. Alicic, Radica Z et al. “Incidence of chronic kidney disease among adults with prediabetes in the CURE-CKD registry, 2013-2020.” Diabetes, obesity & metabolism vol. 27,6 (2025): 3536-3541. doi:10.1111/dom.16365
6. Lambourg, Emilie J et al. “Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study.” American journal of kidney diseases : the official journal of the National Kidney Foundation vol. 85,2 (2025): 196-204.e1. doi:10.1053/j.ajkd.2024.08.012
7. Lin, Yu-Ling et al. “Role of Metformin in Preventing New-Onset Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus.” Pharmaceuticals (Basel, Switzerland) vol. 18,1 95. 14 Jan. 2025, doi:10.3390/ph18010095
8. Liew, Adrian et al. “Executive Summary of the Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease-2025 Update.” Nephrology (Carlton, Vic.) vol. 30,5 (2025): e70031. doi:10.1111/nep.70031
9. American Diabetes Association Professional Practice Committee; 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S239–S251. https://doi.org/10.2337/dc25-S011
10. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. “KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.” Kidney international vol. 105,4S (2024): S117-S314. doi:10.1016/j.kint.2023.10.018
11. de Boer, Ian H et al. “Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO).” Diabetes care vol. 45,12 (2022): 3075-3090. doi:10.2337/dci22-0027
Abbreviations: CKD – Chronic Kidney Disease, IGT – Impaired Glucose Tolerance, ADA – American Diabetes Association, IDF – International Diabetes Federation, ASCVD – Atherosclerotic Cardiovascular Disease, CURE-CKD – Center for Kidney Disease Research, Education, and Hope Chronic Kidney Disease Registry, eGFR – Estimated Glomerular Filtration Rate, ESRD – End-Stage Renal Disease, AMPK – AMP-Activated Protein Kinase, TGF-β1 – Transforming Growth Factor Beta 1, KDIGO – Kidney Disease: Improving Global Outcomes, APSN – Asian Pacific Society of Nephrology, UACR – Urine Albumin-to-Creatinine Ratio, AMPK – AMP-activated protein kinase, GLP-1R – Glucagon-like peptide-1 receptor, TGF-β – Transforming growth factor beta, Smad3 – Mothers against decapentaplegic homolog 3 (a downstream signaling protein in TGF-β pathway), NF-κB – Nuclear factor kappa-light-chain-enhancer of activated B cells, STAT3 – Signal transducer and activator of transcription 3, Sirt1 – Sirtuin 1 (a NAD⁺-dependent deacetylase involved in autophagy and stress resistance), FoxO1 – Forkhead box protein O1 (a transcription factor involved in oxidative stress resistance and autophagy), Na-Cl cotransporter – Sodium-chloride symporter, a renal tubular transporter involved in sodium reabsorption
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Siwan: A shocking video has gone viral on social media showing an Ayurvedic practitioner from Siwan, Bihar, allegedly performing a C-section surgery at her clinic in a poorly equipped and unhygienic room. The incident has drawn widespread outrage due to suspected safety violations and medical negligence.
According to the viral video shared on ‘X’ by a dermatologist, the woman, identified as Kanchan Kumari from Siwan, appears to be conducting the surgery without following basic medical protocols. The practitioner is reportedly not wearing a surgical mask or cap, and the room looks more like a storage area than a sterile operating theatre.
To make matters worse, her family member is casually recording a reel while the surgery is in progress. The room is crowded with people in normal clothes, possibly the patient’s relatives, standing around without any protective gear such as scrubs, gloves, or masks. There also appears to be no anaesthetist present during the operation.
Also read- Viral Video of Doctor Lying on Patient’s Bed to write Prescription Sparks Outrage
The dermatologist with the user name – ‘The Skin Doctor’ heavily criticised the woman for her blatant disregard for medical safety. He said, “A gynaecologist, who can’t even spell the word ‘gynaecologist’ correctly, is performing a C-section in what appears to be a storage room, with zero regard for universal safety protocols or infection control.”
The remark was made after the Ayurveda practitioner in her Instagram handle claimed herself as ‘gynaecologist’, but instead of writing the word ‘gynaecologist’, she wrote ‘gynelogist’.
He further questioned whether Kumari, who runs her own clinic in Siwan, is legally qualified to perform such procedures since she is not trained to perform such high-risk medical procedures.
Calling her actions “criminally negligent, the doctor said, “Given how frequently the govt changes healthcare policies, I’m not sure whether she’s qualified or trained to perform this procedure, but judging by her methods, she is certainly liable for criminal negligence.”
The video has sparked widespread criticism online, with many demanding strict action from health authorities.
Also read- Chaos in NICU: Resident Doctor, Nurse Violent Clash goes VIRAL
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Mumbai: Parexel, a clinical research organisation (CRO) providing the full range of Phase I to IV clinical development services, has announced the successful completion of its Clinical Research Organization (CRO) registration with the Central Drugs Standard Control Organization (CDSCO).
This registration complies with the new G.S.R 581 (E) regulation, which mandates all CROs operating in India to register with CDSCO.
Sanjay Vyas, President and Managing Director of Parexel India and Global Strategic Business Unit Head for Clinical Logistics & Global Safety Services, said, “This registration reflects our ongoing commitment to meeting regulatory requirements and upholding the highest standards in clinical research. This registration enables us to continue supporting our customers in bringing life-saving treatments to patients safely and efficiently.”
With over 40 years of global experience and a workforce of more than 6,000 in India, Parexel advances clinical research across complex therapeutic areas.
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