50 per cent salary cut for Contractual Medical officers, Rajasthan Govt faces backlash

Jaipur: In a recent job notification that went viral on social media, the Rajasthan government has announced that contractual Allopathy Medical Officers will now receive a monthly salary of Rs 28,050. This decision has drawn widespread criticism from the medical community, as it is a major cut from the previous salary of Rs 56,000 per month. 

The official advertisement, signed by the Mission Director on April 17, 2025, under the National Health Mission (NHM), announced 162 vacancies for Allopathy Medical Officers. To be eligible, candidates must have an MBBS degree from a recognised institution, completed a mandatory rotatory internship, and be registered with the Rajasthan Medical Council. For this, the government will only pay them Rs 28,050 monthly. 

The significant salary cut has angered doctors across the state, who believe they deserve fair pay for the critical role they play in every emergency, saving countless lives. After investing years of hard work and a large amount of money into completing their medical education, they feel disrespected and frustrated by such a low amount.

Also read- Salary Hike! WB Senior Residents to now get Rs 15,000 MORE, Junior Doctors Rs 10,000

Previously, doctors who were employed on a contract basis were earning Rs 56,000 per month, but with the new salary structure, the pay has been slashed by almost 50 per cent. This has come as a major disappointment for doctors, especially at a time when healthcare workers have been demanding better pay and improved working conditions in the public health system for a long time. 

Slamming the state government for giving such a low salary, several doctors took to social media to express their frustration. They strongly criticised the significant pay cut for MBBS doctors, especially when compared to other welfare schemes where beneficiaries earn more.

The recruitment notice going viral on the internet and igniting rage among doctors states, “In accordance with the above reference and under the provisions of the Rajasthan Contractual Hiring to Civil Posts Rules, 2022, approval is hereby granted to proceed with the recruitment for vacant contractual posts under NHM through the District Health Committee, considering the urgent need for human resources and operational efficiency. Approval has been received from the Finance Department’s letter No. 152500633 dated 29.03.2025. Recruitment may be carried out either through a walk-in process or on a merit basis no later than 30.03.2026, and action must be taken at the district level accordingly.”

The notice also adds that the government is planning to recruit a total of 2,855 health workers under NHM. The posts include Allopathy Medical Officers, Female Health Workers, Nurses, Lab Technicians, Pharmacists, and Radiographers. All appointments will be made at the district level by the respective health committees.

Along with medical officers, 159 posts have also been announced for Female Health Workers, with a monthly pay of Rs 13,150. Applicants for this role must have completed the Auxiliary Nurse Midwifery (ANM) training or Health Worker Female course and must be registered with the Rajasthan Nursing Council as a B Grade Nurse.

The government has also announced the hiring of 1,941 nurses at a monthly pay of Rs 18,900. Applicants must have completed their senior secondary education and hold a GNM diploma or equivalent qualification, along with registration in the Rajasthan Nursing Council. Additionally, the government is recruiting for 414 Lab Technician posts, 151 Pharmacist posts, and 28 Radiographer posts, each offering a salary of Rs 13,150 per month. 

With the new salary structure, healthcare workers have raised concerns that such a drastic pay cut could affect the morale of doctors and their willingness to work passionately. Not only doctors but also the general public slammed the government for paying such low salaries to the healthcare workers. 

Sharing the information, one doctor wrote on X (formerly Twitter), “In a shocking move, the Rajasthan government has slashed the monthly salary of contractual doctors from ₹56,000 to ₹28,050, contrary to expectations of a hike. Can it improve the health structure?

Similarly, Dr Harshad Sharma, State executive member at Indian Medical Association (IMA), said in a tweet, “This decision is completely contrary to the previous orders. On March 30, 2022, the then Mission Director, Dr. Jitendra Kumar Soni had fixed the salary of full-time contract doctors at Rs 56,600. Even in another order issued on March 1, 2024, the same salary was fixed for contract doctors.

However, the old doctors will continue to get a salary of Rs 56,600, but the new doctors will get a reduced amount. Experts say that after deducting the contract part, this amount will be only around Rs 25,000. The government’s decision to cut doctors’ salaries by up to 50% is not just an administrative order but a blatant insult to our dedication, sacrifice and spirit of service to humanity. This decision is not only an economic injustice but also a deep blow to the dignity of an ideal profession like medicine. We are the ones who sacrificed our youth under the burden of books, the ones who sacrificed their sleep, festivals, family and personal happiness to save the lives of unknown faces, the same people who risked their lives to protect the country during the storm of the pandemic.”

Dr Lakshya Mittal, National President of United Doctors Front (UDF), tweeted, “Rajasthan- The first state in India where medical education was made a joke. Faculty from YouTube, study by yourself, job on contract, and the salary of Rs 56100 is now only Rs 25000.”

Medical Dialogues had previously reported that despite completing their postgraduate degrees, the doctors in 13 different specialities in Rajasthan are unable to contribute to the State public health sector as the Rajasthan Government has not created any posts of junior specialists, senior specialists, and principal specialists in those specialities in its hospitals. 

These specialities include biochemistry, radiation oncology, transfusion medicine, preventive and social medicine, emergency medicine, physical medicine and rehabilitation, palliative medicine, anatomy, physiology, pharmacology, nuclear medicine, family medicine, and hospital administration.

Even though the MBBS doctors have completed their post-graduation in these 13 different specialities in the State’s medical colleges and many are studying the courses, there is not a single approved position in those 13 specialities in medical colleges, district and sub-district hospitals.

Due to this, neither the people nor the State Government are able to utilise the money invested in the specialised education of the doctors studying these specialities. On the other hand, the medical students who are pursuing their PG degrees in these specialities are also worried about their future due to the limited opportunities to work in the State.

Also read- Rajasthan’s Healthcare Paradox: Trained Doctors, But No Jobs in 13 specialities

Powered by WPeMatico

Invasive Coronary Function Testing Safe and Effective for Diagnosing Vasomotor Dysfunction in ANOCA Patients: Study

Netherlands: A recent study published in JAMA Cardiology has demonstrated that coronary function testing (CFT) is a feasible and safe procedure across various healthcare settings. The findings highlight the high diagnostic yield of the test, reinforcing its role in assessing coronary vasomotor function. 

Notably, the study also found that invasive coronary functional testing to identify the cause of angina in patients with nonobstructive coronary artery disease (ANOCA) can be safely performed at highly experienced and less-experienced centers, further supporting its broader clinical applicability.

“The invasive testing was conducted across 15 tertiary and nontertiary hospitals in the Netherlands, yielding a high diagnostic success rate. Spasm emerged as the most common ANOCA endotype, while the procedure was associated with low rates of both major and minor complications,” the researchers reported.

The researchers note that patients with angina and no obstructive coronary artery disease often have coronary vasomotor dysfunction, including epicardial spasm, microvascular spasm, and microcirculatory dysfunction. Invasive coronary function testing effectively diagnoses these endotypes and has previously been deemed safe in expert tertiary centers. Considering this, Caïa Crooijmans, Department of Cardiology Radboudumc, Nijmegen, the Netherlands, and colleagues aimed to assess the prevalence of vasomotor dysfunction in clinically referred ANOCA patients while evaluating the safety and feasibility of coronary function testing.

For this purpose, the researchers conducted a quality improvement study using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective observational registry involving 15 hospitals, including two tertiary and 13 nontertiary centers. The study included patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated coronary function test (CFT) between December 2020 and January 2024. A complete CFT comprised of acetylcholine spasm provocation testing and the assessment of microcirculatory function. The study evaluated the prevalence of different endotypes based on test results while also assessing the overall safety of the procedure.

The investigation uncovered the following findings:

  • 1,207 patients were included, with 978 (81%) females. The mean age of participants was 60 years.
  • Coronary vasomotor dysfunction was highly prevalent, affecting 78% of patients.
  • Major complications were reported in 11 cases (0.9%), while minor complications occurred in 10 of the cases (0.8%).
  • Among these, three major and all minor complications were directly related to the coronary function test.
  • No cases of procedural death, myocardial infarction, or stroke were observed.
  • The occurrence of complications was similar between tertiary and nontertiary centers.

The researchers found coronary function testing is feasible and safe across tertiary and nontertiary centers, demonstrating a high diagnostic yield. Their findings suggest considering CFT for all patients with angina and no obstructive coronary artery disease, given its effectiveness in identifying vasomotor dysfunction, which was present in 78% of cases.

“Conducted within the Dutch NL-CFT network, the study reported a very low overall complication rate of 1.7%, reinforcing the procedure’s safety. With no observed cases of procedural death, myocardial infarction, or stroke, and comparable complication rates across different healthcare settings, the results support broader clinical adoption of CFT for improved diagnosis and management of coronary vasomotor dysfunction,” the researchers wrote.

Reference:

Crooijmans C, Jansen TPJ, Meeder JG, et al. Safety, Feasibility, and Diagnostic Yield of Invasive Coronary Function Testing: Netherlands Registry of Invasive Coronary Vasomotor Function Testing. JAMA Cardiol. Published online February 19, 2025. doi:10.1001/jamacardio.2024.5670

Powered by WPeMatico

Smoking, high BP and diabetes independently linked to peripheral vascular disease, suggests study

A new study published in the journal of Cureus showed that smoking, diabetes, and high blood pressure are independent risk factors for peripheral vascular disease (PVD) in Northeast India that are specific to a certain location.

Peripheral arterial disease (PAD) is the subject of this study because of its increased rates of morbidity and mortality associated with cardiovascular fatalities. The majority of research on PVD risk factors comes from Western nations, with little information accessible in developing nations like India. This study was set to examine the different risk factors most frequently linked to peripheral vascular disease in a northeastern Indian tertiary care hospital because there is a severe paucity of data on PVD in this area.

Finding risk variables in patients with PVD was the goal of this hospital-based case-control research, which was carried out in both retrospective and prospective modalities. From January 2015 to January 2025, a tertiary care teaching hospital in Northeast India served as the study’s site. Group A consisted of individuals with PVD, while Group B consisted of healthy volunteers who did not have PVD.

The study examined the course of the disease and the results of treatment over a ten-year period (January 2015–January 2025). It included prospective data (October 2020–January 2025) from a questionnaire survey and follow-ups, as well as retrospective data (January 2015–October 2020) from hospital records.

A total of 688 controls and 172 cases, at a 1:4 ratio, took part in the study. When compared to controls, cases had considerably higher rates of hypertension, diabetes mellitus, smoking history, and cardiac conditions. Peripheral vascular disease was substantially correlated with smokers’ daily cigarette consumption and smoking duration. The risk of peripheral vascular disease was considerably raised when smoking was coupled with diabetes mellitus and hypertension.

The most prevalent vascular pathology was atherosclerosis below the aortic bifurcation, which was detected in 104 patients (60.47%), followed by thromboangiitis obliterans in 63 individuals (36.63%). Male gender, smoking history, daily cigarette use, diabetes mellitus, and hypertension were all found to be distinct risk factors for peripheral vascular disease using multivariate logistic regression analysis.

The most popular therapy was amputation, which was followed by rehabilitation. Amputation was avoided in 17 of the 21 patients who tried bone marrow cell treatment. Overall, in Northeast India, smoking, diabetes, and alcohol use were found to be independent risk factors for PVD that were specific to a given location.

Source:

Hajong, R., Rabha, P., Medhi, B. B., Sharma, S., Pai, P. S., Baruah, A. J., & Devi, K. M. (2025). A retrospective risk-factor analysis of patients presenting with peripheral vascular disease in a tertiary care hospital in North-East India. Cureus. https://doi.org/10.7759/cureus.82661

Powered by WPeMatico

Statin use may improve survival in patients with some blood cancers: Study

Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who were taking cholesterol-lowering statin medications at the start of their cancer treatment had a 61% lower risk of dying from their cancer compared to similar patients who were not taking statins, according to a study published today in the journal Blood Advances.

“This is the first systematic evaluation of the association of statin use with survival outcomes in patients with CLL or SLL who have been treated with contemporary targeted agents such as ibrutinib,” said the study’s principal investigator, Ahmad Abuhelwa, PhD, an assistant professor of pharmacy practice and pharmacotherapeutics at the University of Sharjah in the United Arab Emirates. “Our results highlight a strong link between statin use and improved survival in this patient population.”

CLL is a slow-growing cancer that starts in the blood-forming cells of the bone marrow and is the most common form of leukemia in adults in the United States. SLL, also a slow-growing cancer, affects the same type of cells as CLL but starts in lymphoid tissues such as the spleen instead of in the blood-forming cells.

Statins are among the most widely prescribed medications. It’s estimated that over 90 million adults in the United States take a statin drug to reduce their cholesterol levels and lower their risk for heart disease, which can lead to heart attacks or strokes. Previous studies have linked statin use to reduced death rates from several cancers, including CLL, said Dr. Abuhelwa. However, those studies did not evaluate the effects of statin use in patients who were treated with newer cancer therapies such as the targeted drug ibrutinib, he said.

In the current study, Dr. Abuhelwa and his colleagues analyzed data from 1,467 patients with CLL or SLL who participated in four international clinical trials conducted between 2012 and 2019. In these trials, patients were randomly assigned to treatment with ibrutinib either alone or in combination with other anti-cancer drugs, or to a drug regimen that did not include ibrutinib. A total of 424 patients (29%) were taking a statin at the time they started treatment across the four clinical trials. The median patient age was 65, and 66% were men; 92% had CLL, which was either newly diagnosed, had come back, or had not responded to prior treatment.

The study’s primary endpoints were cancer-specific survival (how long patients lived after starting treatment before dying specifically from their cancer), overall survival (how long patients lived after starting treatment, regardless of the cause of death), and progression-free survival (how long patients lived after starting treatment before their cancer worsened or they died from any cause). The secondary endpoint was the proportion of patients who experienced severe or life-threatening adverse events. The median follow-up time for all patients enrolled in the four trials was five years for overall survival and 22 months for progression-free survival.

To account for potential confounding factors, the investigators adjusted their analysis for variables including each patient’s diagnosis, age, sex, weight, physical functioning (as assessed by doctors), disease severity, length of time since their diagnosis, number of co-existing illnesses, use of other medications for heart conditions or high blood pressure, and the specific anti-cancer treatment regimen received.

Results showed that, regardless of any of these factors, patients who took a statin had, on average, a 61% reduced risk of dying from their cancer, a 38% reduced risk of death from any cause, and a 26% reduced risk of disease progression. Importantly, statin use did not increase the likelihood of severe or life-threatening adverse events.

“These findings don’t allow us to say for certain that statins directly improve cancer outcomes,” said Dr. Abuhelwa. “However, the fact that this association remained strong even after accounting for multiple factors makes it an important area for future research.” As next steps, he recommended conducting laboratory studies to better understand how statins may influence cancer biology, as well as prospective clinical trials in which patients with CLL or SLL are randomly assigned to take a statin or not.

The study has several limitations given its observational nature. For example, patients enrolled in clinical trials tend to be monitored more closely than those who receive treatment outside of a clinical trial, so the study findings may not be generalizable to patients treated in non-clinical trial settings. Additionally, because patients used various statins at different doses, the study could not determine the effects of specific statin types, doses, or duration of use on patients’ survival.

“While our results are very promising, we can’t recommend starting statins for CLL/SLL treatment based on this study alone,” Dr. Abuhelwa said. “Future clinical trials are needed to determine definitively whether statins have a direct benefit on cancer survival.” 

Reference:

Ahmad Y Abuhelwa, Sara A Almansour, Jennifer R. Brown, Humaid O Al-Shamsi, Ziad Abuhelwa, Zelal Kharaba, Yasser Bustanji, Mohammad H Semreen, Salma M. Ali, Ahmad Alhuraiji, Ross A McKinnon, Michael J Sorich, Karem H Alzoubi, Ashley M Hopkins, Statin use and survival in SLL/CLL treated with ibrutinib: Pooled analysis of four randomized controlled trials, Blood Advances, https://doi.org/10.1182/bloodadvances.2024015287

Powered by WPeMatico

Antenatal care Contacts beyond 4 to 7 years fails to enhance immediate or exclusive breastfeeding rates: Study

Recent study investigates breastfeeding practices in sub-Saharan Africa following the 2016 World Health Organization (WHO) antenatal care (ANC) policy update, which recommends a minimum of eight ANC contacts during pregnancy. It examines trends in immediate and exclusive breastfeeding (IEBF) and explores the relationship between ANC uptake (specifically comparing 4-7 contacts versus 8+ contacts) and breastfeeding practices.

Analysis of DHS Data in Sub-Saharan Africa

Data from Demographic and Health Surveys (DHS) conducted between 2018 and 2023 across 19 sub-Saharan African countries were analyzed. The analysis included 25,669 individuals and focused on immediate breastfeeding (IBF), defined as breastfeeding within one hour of birth, and exclusive breastfeeding (EBF) for infants aged zero to six months. Several health service, clinical, social and contextual factors available in DHS surveys for eligible countries were also considered.

Variations in Breastfeeding Rates Across Countries

The study found substantial variations in breastfeeding rates across countries. IBF ranged from 24.4% in Senegal to 86.7% in Rwanda, while EBF ranged from 17.6% in Gabon to 74.2% in Kenya. Most countries’ IBF rates were higher than EBF rates. Only a small fraction of women, 8.6% on average, reported attending eight or more ANC contacts.

Association Between ANC Contacts and Breastfeeding Practices

Pooled analysis across all countries showed that having 8+ ANC contacts, compared to 4-7 contacts, was not significantly associated with either IBF or EBF. However, results did indicate that there was a relationship between health service, clinical, demographic, and contextual factors and IBF and EBF.

Implications for Promoting Optimal Breastfeeding Practices

The findings suggest limited additional benefits of 8+ ANC contacts over 4-7 contacts in promoting IEBF, despite the WHO’s recommendation. It emphasizes the need for comprehensive strategies to promote ANC uptake and improve the quality of ANC contacts through behavior change interventions and complementary health service delivery. The results highlight the need to focus on improved quality of care, tailored interventions, and addressing misconceptions to improve both ANC attendance and breastfeeding outcomes in sub-Saharan Africa.

Key Points

* The study analyzes data from Demographic and Health Surveys (DHS) conducted between 2018 and 2023 in 19 sub-Saharan African countries, involving 25,669 individuals, to assess breastfeeding practices following the 2016 WHO antenatal care (ANC) policy update.

* Immediate breastfeeding (IBF) rates varied significantly across countries, ranging from 24.4% in Senegal to 86.7% in Rwanda, while exclusive breastfeeding (EBF) rates ranged from 17.6% in Gabon to 74.2% in Kenya.

* Across the surveyed countries, a small percentage of women (8.6% on average) reported attending eight or more ANC contacts, as recommended by the WHO.

* Pooled analysis revealed that attending 8+ ANC contacts, compared to 4-7 contacts, did not show a significant association with either immediate or exclusive breastfeeding practices.

* Health service, clinical, demographic, and contextual factors were found to have a relationship with immediate breastfeeding and exclusive breastfeeding practices.

* The findings suggest that increasing ANC contacts beyond 4-7 may not significantly improve immediate and exclusive breastfeeding rates, highlighting the importance of comprehensive strategies focusing on the quality of ANC contacts, behavior change interventions, and complementary health service delivery.

Reference –

Bolanle Olapeju et al. (2025). Antenatal Care And Breastfeeding Practices In Sub-Saharan Africa: An Analysis Of Demographic And Health Surveys. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07188-w.

Powered by WPeMatico

Study Finds TD/PV Ratio Boosts Prostate Cancer Detection When Combined with PI-RADS

Japan: A recent retrospective analysis has highlighted the tumor diameter-to-prostate volume ratio (TD/PV) as an effective predictive marker for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men undergoing MRI/transrectal ultrasound (MRI/TRUS) fusion-targeted biopsies.

Published in Urologic Oncology: Seminars and Original Investigations, the study demonstrated that incorporating TD/PV into the biopsy process enhanced prediction accuracy, surpassing traditional markers. Additionally, when combined with the prostate imaging-reporting and data system (PI-RADS), TD/PV further improved prediction accuracy, achieving AUC values of 0.861 and 0.845 for PCa and csPCa, respectively.

MRI, alongside PI-RADS and MRI/TRUS fusion-targeted biopsy, has significantly improved the accuracy of prostate cancer diagnosis. However, some suspected PCa lesions in PI-RADS categories 3 and 4 remain undiagnosed, pointing to the need for further refinement of diagnostic methods. The researchers suggest that the accuracy of MRI/TRUS fusion-targeted biopsy can be improved by incorporating lesion size and prostate volume (PV) into the PI-RADS evaluation.

To explore this, Shunsuke Miyamoto and colleagues from the Department of Urology at Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan, investigated how the TD/PV ratio could enhance the prediction of PCa and csPCa in PI-RADS categories 3–5 lesions. They also aimed to develop predictive nomograms that combined TD/PV and PI-RADS.

The researchers reviewed data from patients who underwent MRI/TRUS fusion-targeted biopsy for PI-RADS 2.1 categories 3–5 lesions between 2017 and 2023. TD/PV was calculated by dividing tumor diameter by total prostate volume, with csPCa defined as a Gleason score of ≥ 3+4. The predictive nomograms for PCa and csPCa were created using univariable and multivariable logistic regression. Their accuracy was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC).

Key findings from the study included:

  • A total of 565 patients were analyzed.
  • The AUC of TD/PV was significantly higher than that of PSA, tumor diameter, PSA density, and PI-RADS for predicting PCa (AUC: 0.840) and csPCa (AUC: 0.819).
  • Multivariable analyses confirmed TD/PV as a significant predictive factor for both PCa and csPCa in MRI/TRUS fusion-targeted biopsy.
  • Predictive nomograms combining TD/PV and PI-RADS were developed, with AUCs for PCa and csPCa predictions being 0.861 and 0.845, respectively.

“In the retrospective analysis, the combination of TD/PV and PI-RADS category significantly improved the prediction of PCa and csPCa in MRI/TRUS fusion-targeted biopsy, particularly for PI-RADS categories 3 and 4 lesions,” the authors noted. “The predictive nomograms integrating TD/PV with PI-RADS provided a more accurate prediction of PCa and csPCa diagnoses.”

They concluded, “These findings offer valuable insights for physicians, aiding in better decision-making regarding the indications for MRI/TRUS fusion-targeted biopsy.”

Reference:

Kohada, Y., Miyamoto, S., Hayashi, T., Tasaka, R., Honda, Y., Ishikawa, A., Kobatake, K., Sekino, Y., Kitano, H., Goto, K., Ikeda, K., Goriki, A., Hieda, K., Kitamura, N., Awai, K., & Hinata, N. (2025). Utility of tumor diameter-to-prostate volume ratio for predicting the outcome of magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2025.03.021

Powered by WPeMatico

Twice-Weekly and Thrice-Weekly Hemodialysis have Comparative Survival Outcomes: Study

Researchers have found in a new study that Patients undergoing twice-weekly hemodialysis demonstrated comparable overall survival at two years when compared to those on a thrice-weekly schedule. While a twice-weekly regimen may serve as a viable option during the initial year of dialysis—particularly in resource-limited settings—it poses potential risks that require vigilant monitoring beyond the first year.

The optimal frequency of maintenance hemodialysis remains a subject of debate. In many countries, twice-weekly hemodialysis is still commonly practiced. This trial aimed to compare the outcomes of patients undergoing twice-weekly versus thrice-weekly hemodialysis.

This prospective, multicenter, nonrandomized trial included incident adult patients, with chronic kidney disease stage 5, initiating hemodialysis between January 2018 and August 2021. Patients were allocated to either a twice-weekly or thrice-weekly regimen, and monitored at 1, 3, 6, 12 and 24 months. This trial was terminated before reaching the required sample size due to the COVID-19 pandemic and economic factors. Recruitment achieved 25% of the projected number. Missing baseline factors were imputed using multiple imputation algorithms, then entered in a logistic regression model to estimate propensity scores. The primary outcome was two-year survival analyzed using a Cox regression survival model adjusted for propensity scores and baseline residual urine output. Secondary outcomes included hospitalization rates, uncontrolled hypertension and cumulative erythropoietin dose at two years, analyzed using regression models adjusted for propensity scores and baseline residual urine output. All analyses were conducted on an intention-to-treat basis. Results: A total of 132 patients on thrice-weekly hemodialysis and 71 on twice-weekly hemodialysis were included. The mean age was 67 ± 15 years and the median eGFR at dialysis initiation was 6 (4,8) mL/min/1.73 m2. At one year, patients in the twice-weekly group had greater residual urine output. At two years, there was no significant difference in survival (HR = 0.84; 95% CI: 0.37, 1.90), hospitalization rates (P = 0.515) or uncontrolled hypertension (P = 0.442). The twice-weekly group showed a trend toward higher erythropoietin requirements (P = 0.08). Serum potassium levels and the number of antihypertensive medications were greater in the twice-weekly group. Patients on twice-weekly hemodialysis showed comparable overall survival at two years to those on thrice-weekly hemodialysis. While a twice-weekly regimen may be a viable option during the first year of dialysis, especially in low-resource settings, it carries potential risks that necessitate careful monitoring after the first year.

Reference:

Aoun, M., Finianos, S., Beaini, C. et al. Twice against thrice-weekly hemodialysis (TATH): a multicenter nonrandomized trial. BMC Nephrol 26, 176 (2025). https://doi.org/10.1186/s12882-025-04105-3

Keywords:

Twice-Weekly, Thrice-Weekly, Hemodialysis, Survival, Outcomes, Study, Aoun, M., Finianos, S., Beaini, C, Hemodialysis, Mortality, Frequency, Twice-weekly Thrice-weekly, Residual diuresis, Residual urine output, Antihypertensive drugs, Erythropoietin, Serum potassium

Powered by WPeMatico

In Pediatric Cardiac Surgery video Laryngoscopy for TEE Probe Insertion safe with higher first attempt success rate: Study

Recent randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

Patient Randomization and Procedures

Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury. The results showed that the incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001). In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

Conclusion and Recommendations

The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Key Points

1. This randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery.

2. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

3. Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury.

4. The incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001).

5. In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

6. The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Reference –

Guriqbal Singh et al. (2025). A Randomised Controlled Trial Comparing Video Laryngoscopy Versus Conventional Blind Technique For Transoesophageal Echocardiography Probe Insertion In Paediatric Patients Undergoing Cardiac Surgery: A Pilot Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_975_24

Powered by WPeMatico

Persistent organic pollutants are associated with higher BP in teenagers after weight loss surgery: Study

Researchers from the Keck School of Medicine of USC have found that persistent organic pollutants (POPs)-synthetic toxic chemicals often found in food sources and stored in body fat-are associated with long term higher blood pressure in adolescents who have undergone bariatric surgery, a weight-loss intervention.

The study, funded by the National Institutes of Health and published in the ACS journal Environmental Science & Technology, suggested that POPs diminished the beneficial effect of bariatric surgery on improved blood pressure due to disruptions in lipid metabolism, which is how the body processes fat. The researchers also identified a plausible biological pathway explaining the relationship between POPs and changes in blood pressure.

These findings could eventually lead to treatments to reduce adverse health effects of exposure to these environmental chemicals on individuals with obesity, particularly for those pursuing weight-loss interventions such as bariatric surgery.

“While bariatric surgery is an effective treatment used to address severe obesity and improve cardiometabolic health, it also releases POPs stored in fat into the bloodstream,” says Shudi Pan, the study’s first author and a fourth year PhD candidate in the Department of Population and Public Health Sciences at Keck School of Medicine of USC.

Although their toxicity led many countries to start restricting the use of POPS more than 20 years ago, they remain a global health challenge since they persist for long periods in the environment. They have been detected at concerning levels worldwide even in regions where these chemicals were never manufactured or used.

“POPs are considered an emerging risk factor for hypertension and our study provided us a unique opportunity to evaluate the relationship between POPs exposure and blood pressure. Until now, few studies have examined how POPs exposures in adipose tissue affect blood pressure,” says Pan. “Similarly, the mechanisms underlying the relationship between POP mixtures and blood pressure have been unclear.”

The study included data from 57 adolescents from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) consortium, who underwent bariatric surgery.

“We measured the level of POPs stored in adipose tissue before surgery. After, we assessed whether it affected blood pressure in the short term—at 6 months, and then five years after surgery,” says Pan.

Pan’s research found that POPs mixtures were linked to higher systolic blood pressure five years after bariatric surgery. Additionally, the researchers incorporated metabolomics to understand the underlying mechanisms of POP mixtures in adipose tissue on changes in blood pressure. Metabolomics refers to the study of metabolites which are small molecules or substances made when the body breaks down food, chemicals, or its own tissue—in this case the breakdown of body fat after bariatric surgery.

“Through a technique called high-resolution mass spectrometry, we assessed these metabolites, thousands at a time, to determine what complex biological changes were occurring that led to changes in blood pressure,” says Pan.

The researchers’ analysis revealed that one particular pathway involved in the production of prostaglandin was key in influencing blood pressure changes in the long-term, making this one of the first studies to identify a plausible rationale. Prostaglandin has long been proved to be involved in blood pressure regulation, and this study found that POPs modified prostaglandin pathways, contributing to disruptions in blood pressure regulations.

“While our study had a small sample size, we think the prostaglandin pathway is a key player in understanding the biological mechanism between POPs and the development of high blood pressure in this demographic and more research is needed to further understand this particular pathway linking POP exposures to blood pressure regulation,” says Pan.

High blood pressure in adolescence is associated with an increased risk of cardiovascular disease and cardiovascular diseases mortality in adulthood. Interventions that can address early life hypertension can help reduce the risk of cardiovascular disease, which remains a leading cause of death worldwide. 

Reference:

Shudi PanZhenjiang Li*Douglas I. WalkerBrittney O. BaumertHongxu WangJesse A. Goodrich, Metabolic Signatures in Adipose Tissue Linking Lipophilic Persistent Organic Pollutant Mixtures to Blood Pressure Five Years After Bariatric Surgery Among Adolescents, Environmental Science & Technology, DOI:10.1021/acs.est.4c13902. 

Powered by WPeMatico

Almost half of children with complicated appendicitis can recover from surgery at home: Study

Almost half of children who require surgery for complicated appendicitis can safely complete their recovery at home, according to a new study.

The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Pediatric Surgery, found more than 40 per cent who received care in the home following a complex appendectomy recovered faster and had fewer complications.

More than 300 patients present with appendicitis to The Royal Children’s Hospital (RCH) every year, with about one in three experiencing a burst appendix or severe infection.

The study involved 83 children, aged five to 18 years, admitted to the RCH for a complicated appendicectomy, with 35 suitable for the Hospital in the Home (HITH) program. All patients needed at least five days of intravenous antibiotics (IV) post-surgery. Under the program, a nurse visited the child’s home daily to administer the antibiotics and record clinical observations.

MCRI Associate Professor Penelope Bryant said under this model, patients at home recovered more quickly and didn’t require readmission to hospital.

“Acute post-operative care at home is rare, but we found it’s possible for children to spend 35 per cent less time in hospital after complicated surgery,” she said. This could be done safely and without prolonging IV courses or broadening antibiotic use.

“These findings will help clinicians to identify which children are suitable for HITH care following surgery for complicated appendicitis.”

MCRI Associate Professor Warwick Teague said the HITH program, used heavily during the COVID-19 pandemic, had the added benefits of reduced hospital and family costs, improved quality of life, less time taken from work and prevention of hospital-acquired infections.

“The pandemic presented us with the need and opportunity to deliver care to children in their home,” he said. This study showed even children who had severe appendicitis can be well cared for at home after surgery, freeing up hospital beds for other sick children and those needing surgery.

“Traditionally after surgery for severe appendicitis, surgeons have insisted on daily reviews in hospital by the surgical team. However, in this study we learnt that optimal postoperative care be delivered at home, by well-trained non-surgical clinicians working as a team with surgeons.”

“For complicated appendicitis, the HITH program also saved over $1,400 per day for the hospital and $300 daily for families, reducing cost-of-living pressures with longer-term benefits for healthcare sustainability.”

Reference:

Ling Chen, Sebastian K. King, Misel Trajanovska, Lynda M. Gaynor, Veronica Cerratti, Rosemary Burgess, Gregory J.G. Nolan, Warwick J. Teague, Penelope A. Bryant, Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis, Journal of Pediatric Surgery Open, 2025,https://doi.org/10.1016/j.yjpso.2025.100196.

Powered by WPeMatico