Patients with premature ovarian insufficiency and early menopause at high Multimorbidity risk, suggests study

A new study published in the journal of Fertility and Sterility showed that individuals with premature ovarian insufficiency (POI) and early menopause have higher rates of multimorbidity when compared to women going through menopause at a normal age.

Deficient ovarian sex hormones and a diminished ovarian reserve are the hallmarks of premature ovarian insufficiency, which combined cause an early onset of menopause and a rapid decline in ovarian function. Hot flashes, night sweats, and sleeplessness are just a few of the many menopausal symptoms brought on by the reduction in estrogen output.

A woman’s health may suffer from a number of long-term negative effects from premature estrogen deprivation brought on by POI, such as an elevated risk of coronary artery disease, osteoporosis, dementia, diabetes, dyslipidemia, and other chronic illnesses that accelerate ageing and multimorbidity accumulation. Therefore, to compare the average age of menopause to that of patients with early menopause and premature ovarian insufficiency, Abirami Kirubarajan and colleagues undertook this study to describe the incidence of multimorbidity.

Women who had gone through menopause were included in this prospective cohort from the Canadian Longitudinal Study on Ageing (CLSA). The CLSA acquired cross-sectional data on 50,000 community-dwelling Canadians from 45 to 85 years of age between 2010 and 2015. Primary ovarian insufficiency, which is characterised by menopause beginning before age 40, was the main exposure. The age range of 46 to 55 years, early menopause (40-45 years), late onset menopause (56–65 years), and hysterectomy patients were the comparators. Multimorbidity, or having two or more chronic illnesses, was the main outcome. Severe multimorbidity and the frequency of particular chronic illnesses among a complete list of 15 distinct conditions comprised the secondary result.

A total of of 12,339 postmenopausal individuals were included, with 374 experiencing POI and 1396 undergoing early menopause. Multimorbidity was prevalent in 64.8% and 51.1% of patients with POI and early menopause, respectively. Also, only 43.9% of the women who reached menopause at the usual age had several medical conditions. The OR for multimorbidity in the POI sample was 2.5 times that of women who went through menopause at the typical age. This association remained after accounting for confounders. In addition, the POI group had double the prevalence of severe multimorbidity as the usual age group. Overall, the POI group had a considerably higher chance of developing ischemic heart disease, stomach ulcers, and osteoporosis.

Reference:

Kirubarajan, A., Sohel, N., Mayhew, A., Griffith, L. E., Raina, P., & Shea, A. K. (2024). The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort (Canadian Longitudinal Study on Aging). In Fertility and Sterility. Elsevier BV. https://doi.org/10.1016/j.fertnstert.2024.08.345

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Women with endometriosis have higher odds of postpartum hemorrhage: Study

Endometriosis is a common gynecological condition and is
estimated to affect between 6% and 10% of women of reproductive age. The
prevalence of deep and ovarian endometriosis in pregnancy is approximately 5%,
which is similar to that of women attending a general gynecology clinic (6%),
and approximately 50% of women are unaware that they have this condition. There
is no consensus regarding specialist care for women with a diagnosis of
endometriosis during pregnancy; however, recent data suggest that endometriosis
may increase the risk of adverse obstetric and neonatal outcomes, including
preterm birth. Preterm birth, defined as birth at <37 ± 0
weeks of gestation, accounts for 7.4% of all live births in England and Wales.
It is the most important single determinant of adverse infant outcomes in terms
of both survival and quality of life and is the leading cause of perinatal
death and disability.

There is an urgent need for high-quality prospective
observational data to better define the obstetric risks for women with
endometriosis. The aim of this study by Elisabeth M. R. Bean et al was to
prospectively evaluate the relationship between pelvic endometriosis and
obstetric and neonatal outcomes in pregnant women who underwent screening for
endometriosis early in pregnancy.

This was a single-center, prospective cohort study of women
presenting to the Early Pregnancy Unit at University College London Hospital
(UCLH) between October 2017 and November 2019. Women were divided into
‘‘endometriosis’’ or ‘‘no endometriosis’’ groups, depending on whether they had
a diagnosis of pelvic endometriosis. Women with a live pregnancy progressing
beyond 12 weeks’ gestation who booked for antenatal care at University College
London Hospital were included in the study.

All women underwent a pelvic ultrasound examination in early
pregnancy to examine for the presence of endometriosis and uterine
abnormalities. Main outcome measures: The primary outcome of interest was
preterm birth, defined as delivery before 37 completed weeks’ gestation.
Secondary outcomes included late miscarriage, antepartum hemorrhage, placental
site disorders, gestational diabetes, hypertensive disorders of pregnancy,
neonates small for gestational age, mode of delivery, intrapartum sepsis,
postpartum hemorrhage, and admission to the neonatal unit.

Women with a diagnosis of endometriosis did not have
statistically significantly higher odds of preterm delivery (adjusted odds
ratio [aOR] 1.85 [95% confidence interval {CI} 0.50–6.90]), but they did have
higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI
2.07–6.35]) and admission of their newborn infant to the neonatal unit (aOR
3.24 [95% CI 1.089.73]). Women with persistent or recurrent deep endometriosis
after surgery also had higher odds of placental site disorders (aOR 8.65 [95%
CI 1.17–63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02–11.75]).

This study showed that most women with endometriosis do not
have statistically significantly higher odds of preterm delivery, irrespective
of their disease subtype. Women with endometriosis do appear to have higher
odds of excessive bleeding during CSs, and their newborn infants are more
likely to be admitted to the neonatal unit. Women with residual or recurrent
deep disease who have had previous surgery may have higher odds of adverse
outcomes, including placental site disorders and intrapartum sepsis.

This study did not identify endometriosis as a statistically
significant risk factor for preterm delivery and supports the European Society
of Human Reproduction and Embryology guidance that women with endometriosis do
not warrant increased antenatal care. There is no evidence to support routine
screening of women for the presence of endometriosis preconceptually or in
early pregnancy

Source: Elisabeth M. R. Bean, M.B.B.S., B.Sc.,a Jure Knez,
M.D.,b Nikolaos Thanatsis, M.D., Ph.D; Fertil Steril® Vol. 122, No. 4, October
2024 0015-0282

https://doi.org/10.1016/j.fertnstert.2024.05.162

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Ciprofloxacin Outperforms Cotrimoxazole and Doxycycline for cobatting Klebsiella pneumoniae Infections, Study Finds

Indonesia: Recent research has shed light on the effectiveness of three antibiotics—ciprofloxacin, cotrimoxazole, and doxycycline—against Klebsiella pneumoniae, a common pathogen known for causing serious infections, particularly in healthcare settings. A time-kill curve analysis was conducted to compare the antibacterial activities of these drugs on both non-extended Spectrum Beta-Lactamase (non-ESBL) producing and ESBL-producing strains of the bacterium.

According to the study, ciprofloxacin, a fluoroquinolone, demonstrated superior efficacy against non-ESBL and ESBL-producing Klebsiella pneumoniae strains. Results indicated that as the concentration of ciprofloxacin increased, its inhibitory effect became more pronounced, leading to significant bacterial cell death within a short period.

“Time-kill studies revealed that ciprofloxacin and doxycycline exhibited bactericidal activity, with ciprofloxacin demonstrating a stronger bactericidal effect than doxycycline. In contrast, cotrimoxazole displayed primarily bacteriostatic activity,” the researchers wrote in Annals of Medicine and Surgery.

Antibiotic resistance is a major global issue, making it essential to optimize antibiotic use. Klebsiella pneumoniae is a Gram-negative bacterium responsible for various infections, including bacteremia, sepsis, urinary tract infections, pneumonia, and nosocomial infections. It can also produce Extended Spectrum Beta-Lactamase (ESBL). Ciprofloxacin, cotrimoxazole, and doxycycline are broad-spectrum antibiotics in the WHO’s list of essential drugs.

Against the above background, Andy Setiawan, Study Program of Clinical Microbiology, Universitas Airlangga, Surabaya, Indonesia, and colleagues aimed to identify which of these antibiotics most effectively inhibited both non-ESBL and ESBL-producing strains of Klebsiella pneumoniae using a time-kill curve analysis.

For this purpose, the researchers used Klebsiella pneumoniae ATCC isolates, stored clinical isolates of non-ESBL and ESBL-producing strains, and a control group. The non-control isolates were treated with oral preparations of ciprofloxacin, cotrimoxazole, and doxycycline at concentrations of 1, 2, and 4 times the minimum inhibitory concentration (MIC) at intervals of 0, 2, 4, 6, 8, and 24 hours. The bacteria were cultured and incubated at each time point, and the number of colonies was counted.

The results were analyzed using time-kill curves and various statistical methods. Statistical analyses included ANOVA, post-hoc tests, Mann-Whitney, and Kruskal-Wallis tests.

The following were the key findings of the study:

  • Ciprofloxacin, cotrimoxazole, and doxycycline demonstrated inhibitory effects on both non-ESBL and ESBL-producing Klebsiella pneumoniae.
  • Ciprofloxacin exhibited the strongest inhibitory action.
  • Statistically significant differences were observed between ciprofloxacin and cotrimoxazole at the 4- and 24-hour marks, as well as at 2 hours for concentrations of 1 MIC and 4 MIC.
  • Differences between Klebsiella pneumoniae ESBL and Klebsiella pneumoniae ATCC were noted at the 8-hour time point.

The results indicate that ciprofloxacin is more effective at inhibiting the growth of K. pneumoniae non-ESBL, K. pneumoniae ESBL, and K. pneumoniae ATCC 13883 than cotrimoxazole and doxycycline.

“While all three antibiotics can inhibit these strains, the most notable difference in effectiveness is seen between ciprofloxacin and cotrimoxazole at concentrations of 1 MIC and 4 MIC, particularly for K. pneumoniae ESBL and K. pneumoniae ATCC 13883,” the researchers concluded.

Reference:

Setiawan A, Widodo ADW, Endraswari PD. Comparison of ciprofloxacin, cotrimoxazole, and doxycycline on Klebsiella pneumoniae: Time-kill curve analysis. Ann Med Surg (Lond). 2022 Nov 5;84:104841. doi: 10.1016/j.amsu.2022.104841. PMID: 36536710; PMCID: PMC9758284.

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Women more likely than men to die after heart surgery complications, suggests JAMA study

Despite having no greater chance of developing problems after high risk cardiovascular surgery, women are more likely than men to die from postoperative complications, a University of Michigan-led study suggests.

A patient dying of complications after surgery is often referred to as a “failure to rescue”.

Investigators assessed more than 850,000 cases of Medicare beneficiaries who had high risk heart surgery-including heart bypass, aortic aneurysm repair, and mitral and aortic valve repair-between 2015 and 2020.

Men and women had a similar rate of complications after an operation, around 15%.

However, women died of those complications at a significantly higher rate: Surgical teams failed to rescue female patients 10.7% of the time, compared to 8.6% for male patients.

The results are published in JAMA Surgery.

“This is an issue for the entire United States health care system: we are failing to rescue women after high-risk surgery even though the rate of postoperative complication is similar to men,” said Catherine M. Wagner, M.D., M.Sc., first author and an integrated thoracic surgery resident at University of Michigan Health.

“There needs to be improved recognition and response to these complications if we are to narrow the sex disparities after high risk surgery.”

Researchers found a similar pattern in the failure to rescue rate for each individual procedure.

The most common complications for men and women were kidney failure, pneumonia and lung failure.

The quality of a hospital where the procedure was performed did not affect the failure to rescue disparity between sexes.

In fact, women in the study were more likely to receive surgery at hospitals that, traditionally, take on a higher volume of high risk surgeries.

“These high risk procedures are inherently expected to have higher complication rates, but patients are still expected to have a positive outcome if the complication is managed quickly,” said co-author Gorav Ailawadi, M.D, M.B.A., chair of cardiac surgery at U-M Health and a director of the University of Michigan Health Frankel Cardiovascular Center

“In our study, female patients had a lower rate of reoperation than males,” he added, using a term to mean a second operation within days of the first.

“This may not be due to a lower need for reoperation; it could instead be a signal that their complications were not appropriately addressed.”

For years, researchers have shown that women are more likely to die after cardiovascular surgery.

The explanation, so far, has largely centered around that fact that women are older when they receive surgery and have more comorbidities than men.

Women also have smaller anatomy and vessel size, which can make surgery more technically difficult.

This disparity is in addition to previous studies that have found that signs and symptoms of common disease, such as heart attack and stroke, are more often either missed or not taken seriously for female patients.

“After accounting for patient comorbidities and patient risk, we found that men and women had similar rates and types of complications; however, women remained more likely to die from those complications,” said co-author Andrew Ibrahim, M.D., M.Sc., associate professor of surgery at U-M Medical School and co-director of the Michigan Medicine Center for Healthcare Outcomes and Policy.

“In addition to reducing complications overall, we must focus on what happens after a complication occurs. Similarly, we have an opportunity after surgery to improve early recognition when a female patient is having a complication before it cascades to a point where we cannot rescue them. Improving the recognition and response to postoperative complications, especially for women, is needed to reduce longstanding disparities on outcomes after high-risk surgery.”

For years, women have been underrepresented in medical research.

In June 2016, the National Institutes of Health installed a policy that called for sex as a biological variable to be factored into research designs, analyses and reporting.

“In addition to taking steps at a health system level to reduce this disparity, we must continue to examine sex differences in biomedical research to address the longstanding neglect of women’s health and identify underlying mechanisms that, if addressed, can improve outcomes for all patients,” Wagner said.

Reference:

Wagner CM, Joynt Maddox KE, Ailawadi G, Ibrahim AM. Failure to Rescue Female Patients Undergoing High-Risk Surgery. JAMA Surg. Published online October 16, 2024. doi:10.1001/jamasurg.2024.4574

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Increasing levels of open burn pit exposure tied to increased risk of incident headache and migraine: JAMA

Increasing levels of open burn pit exposure tied to increased risk of incident headache and migraine suggests a study published in the JAMA.

Open burn pits have commonly been used for waste disposal by the US military but have not been systematically investigated as an independent risk factor for headache disorders. A study was done to evaluate the association between exposure to open burn pits and incidence of headache and migraine. This retrospective cohort study used data from the Veterans Health Administration Headache Cohort along with data from the US Department of Defense and the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to assess registry participants with potential exposure to open burn pits in the Veterans Health Administration from April 1, 2014, through October 31, 2022. Participants were included by linking data from the AH&OBP Registry to their US Department of Defense and Veterans Health Administration electronic health records. Those with preexisting headache were removed from the analytic sample. The analysis was conducted between November 1, 2022, and January 31, 2024. Results The analytic sample included 247 583 veterans (mean [SD] age, 27.9 [7.7] years; 222 498 [89.9%] male). After covariates were controlled for at baseline, participants who were near an open burn pit with open burn pit duties had the highest adjusted odds of medically diagnosed headache disorders (adjusted odds ratio [AOR], 1.59; 95% CI, 1.46-1.74), migraine (AOR, 1.60; 95% CI, 1.43-1.79), and self-reported disabling migraine (AOR, 1.93; 95% CI, 1.69-2.20) compared with those without exposure. The 2 highest quartiles of cumulative burn pit exposure (290-448 days and >448 days) had significantly higher adjusted odds of medically diagnosed headache (290-448 days: AOR, 1.20; 95% CI, 1.09-1.31; >448 days: AOR, 1.55; 95% CI, 1.41-1.70) and migraine (290-448 days: AOR, 1.19; 95% CI, 1.07-1.34; >448 days: AOR, 1.48; 95% CI, 1.32-1.65). In this cohort study, a dose-dependent association existed between open burn pit exposure and medically diagnosed headache and migraine. These new data identify potentially important associations between open burn bit exposure and new-onset headache among service personnel as well as a possible health condition that may be encountered more frequently in Veterans Health Administration facilities during mandatory screening for military exposures.

Reference:

Sico JJ, Anthony SE, Phadke M, et al. Open Burn Pit Exposure in Headache Disorder and Migraine. JAMA Netw Open. 2024;7(9):e2431522. doi:10.1001/jamanetworkopen.2024.31522

Keywords:

Increasing, levels, open, burn, pit, exposure, tied, increased, risk, incident, headache, migraine, JAMA, Sico JJ, Anthony SE, Phadke M

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Zydus Secures WHO Approval for Typhoid Vaccine ZyVac TCV, Eligible for UN Procurement

Ahmedabad: Zydus Lifesciences Limited has announced that it has received in principle acceptability from World Health Organisation (WHO) for ZyVac TCV. ZyVac TCV is now eligible for purchase by United Nations (UN) agencies.
ZyVac TCV is indigenously developed and manufactured at the Zydus Biotech Park, Ahmedabad.
ZyVac TCV is indicated for active immunization against Salmonella typhi infection in the age group of 6 months to 65 years.
This prequalification for ZyVac TCV makes it eligible to be part of UN agencies procurement programme. Annually over 150 million doses of the typhoid conjugate vaccine is procured by UN agencies to prevent this infectious disease in geographies where it is most prevalent, such as India, Africa and Southeast Asia.
Typhoid fever is systemic febrile illness caused by ingestion of the bacterium Salmonella enterica serovar typhi (S. typhi) through contaminated water and food. In South Asian region, India alone contributes for 75% of incidence and mortality due to typhoid fever. As per GAVI (2022) it is estimated that Typhoid accounts for an estimated 11 to 21 million cases of febrile illness and 117,000 to 161,000 deaths are attributed to the disease each year. Data reviewed by the WHO Strategic Advisory Group of Experts on Immunization (SAGE) indicates that a major burden of severe disease occurs in younger age groups where 27% of all typhoid disease occurs in children under five years of age.
Zydus Lifesciences has a significant presence in cancer related therapies and offers a wide range of solutions with cytotoxic, supportive and targeted drugs. The group employs over 27,000 people worldwide, including 1,400 scientists engaged in R & D, and is driven by its mission to unlock new possibilities in lifesciences through quality healthcare solutions that impact lives.

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Doctor ordered to Pay Rs 6 lakh for medical negligence in kidney removal case

The Telangana State Consumer Redressal Commission has dismissed an appeal from a doctor at a Karimnagar hospital accused of removing a patient’s kidney during surgery for kidney stones. The commission upheld the earlier ruling of the Karimnagar District Consumer Disputes Forum, which had imposed a compensation of ₹6 lakh for medical negligence.
The patient had approached the hospital with severe stomach pain and was diagnosed with kidney stones. After depositing ₹6,000 for the surgery, complications arose post-operation, leading to a transfer to NIMS in Hyderabad for further treatment.

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DoP rejects application challenging NPPA price fixation order on Metoprolol

New Delhi: The Department of Pharmaceuticals (DoP)
has rejected a review application filed by Ajanta Pharma against price fixation order issued by National
Pharmaceutical Pricing Authority (NPPA) concerning Metoprolol Tablet 25mg and
Metoprolol Tablet 50mg.

Ajanta Pharma filed
the review plea under Para 31 of the Drugs (Prices Control) Order, 2013 against
the order issued on 06.01.2023 by the NPPA. The order fixed the ceiling price
of Metoprolol Tablet 25mg and Metoprolol Tablet 50mg.

Following
the submission, the Department of Pharmaceuticals sought clarification from
NPPA, leading to a hearing on June 1, 2023, where both parties presented their
arguments.

Ajanta
Pharma contended that NPPA has erred in determining the ceiling price of
the said drug and hence may be directed to revise the same.

The drugmaker challenged the impugned
notification in respect of ceiling price fixation of Metoprolol Tablet 25mg and
Metoprolol Tablet 50mg issued by NPPA as improper, misconceived as it has been
carried out erroneously, arbitrarily, without jurisdiction by NPPA, in
mechanical manner with wrongful inclusion of formulations manufactured by the
Applicant, namely Met XL 25mg Tablet ER 20 (Metoprolol 25mg Tablet Extended
Release) and Met XL 50mg Tablet ER 20 (Metoprolol 50mg Tablet Extended Release)
having modified dosage, incremental innovation and novel drug delivery system.

Ajanta submitted that it made
representation to NPPA on December 8, 2022 within stipulated time against draft
version displayed on its website on December 1, 2022, in respect of calculation
of Metoprolol 25mg Tablet for wrongfully including formulation Met XL 25mg
Tablet ER 20 (Metoprolol 25mg Tablet Extended Release) and Metoprolol 50mg
tablet for wrongful inclusion of Met XL50 mg Tablet ER 20 (Metoprolol 50mg
Tablet Extended Release), respectively, for ceiling price fixation under
revised Schedule-I of DPCO, 2013 as the said formulations manufactured by the firm
are distinct, separate and different and cannot be equated with the plain
conventional Tablets.

Sl. no.

Name of formulation

Scheduled

Dosage form and

Strength

Unit

Ceiling Price in IQs.

8

Metoprolol

Modified Release
Tablet 100 mg.

I Tablet

13.37

9

Metoprolol

Tablet 100 mg.

1 Tablet

9.93

Consequently, Metoprolol tablet
in plain/ conventional dosage cannot be clubbed with modified release dosage as
it would amount to be unreasonable, ultra vires, illegal, anomalous and not
tenable.

Prior to aforesaid amendment of the
DPCO, 2013 on 11 November 2022, earlier amendment in DPCO, 2013
was done via order dated 10th March 2016 in Schedule-I on the basis
NLEM, 2015 wherein Metoprolol tablet was listed at item no, the petitioner mentioned
in its submission.

Additionally, it pointed out
that in existing aforesaid Schedule-I of the DPCO 2013, Metoprolol 25mg and
Metoprolol 50mg plain tablets and sustained release tablets were specified
separately and as under:

Schedule-I National List of Medicines (NLEM) 2015

Section 12- Cardiovascular Medicines

12.1 Medicine used in Angina

Medicine

Level of health care

Dosage form(s) and strength(s)

12.1.7

Metoprolol

P, S, T

Tablet 25mg

Tablet 50mg

SR Tablet 25mg

SR Tablet 50mg

It claimed that NPPA had notified separate ceiling
prices of Metoprolol formulations plain/conventional tablets and modified
dosage sustained release (SR) vide SO. 1499 (E) dated 30.03.2022, as under-

Sl. No.

Name of

Formulation

Dosage and strength

Unit

Ceiling price in Rs.

561

Metoprolol

Capsule 25mg

I Capsule

4.70

562

Metoprolol

Capsule 50mg

I Capsule

7.16

563

Metoprolol

SR Tablet 25mg

1 Tablet

4.47

564

Metoprolol

SR Tablet 50mg

1 Tablet

6.41

565

Metoprolol

Tablet 25mg

1 Tablet

3.46

566

Metoprolol

Tablet 50mg

1 Tablet

5.24

The National Pharmaceutical Pricing Authority
(NPPA) has recognized that plain conventional Metoprolol tablets are distinct
from sustained-release (SR) and extended-release (ER) formulations by setting
separate ceiling prices for each, as outlined in Schedule-I of the National
List of Essential Medicines (NLEM, 2015), the petitioner stated, adding that
pricing for controlled-release formulations should only be considered if
explicitly listed.

It referred to the Hon’ble Supreme Court, in a 2019
ruling, that acknowledged the DPCO’s awareness of different drug delivery
systems, noting that modifications in drug release can enhance stability,
safety, and efficacy. The Court defined “sustained release” as a
system that maintains a consistent rate of drug release over time.
Additionally, the Delhi High Court ruled that price notifications for
conventional tablets do not apply to controlled-release formulations.

The pharma firm claimed that it is suffering
significant losses due to what it considers arbitrary price fixation in the
notification dated January 6, 2023. Therefore, it requested the reviewing
authority to withdraw this notification regarding Metoprolol 25mg and 50mg
Extended Release formulations or amend it appropriately.

NPPA
on the other hand argued that the instant review is not tenable as that the
pricing methodology followed was appropriate. According to NPPA, if a modified
release variant is not specifically mentioned, both conventional and modified
release data could be included in the pricing calculations. This approach
aligns with the methodology outlined in the National List of Essential
Medicines (NLEM) 2015, which aims to ensure the availability of essential
drugs.

The methodology
approved and followed for the pricing of MR Variant/Conventional Variant by the
Authority read;

“Wherever, MR variant is
specifically mentioned in any formulation the data of only MR variants (CR, SR,
XL, ER delayed release etc.) may be considered for fixation of ceiling price.
However, where MR variant is not specifically mentioned, data of conventional
as well as MR variants may be considered for ceiling price fixation. This is in
line with methodology of NLEM 2015 also. Similarly, where
DT/effervescent/soluble/MD, etc. is specifically mentioned in any formulation
in any formulation the data of only such variants may be considered. However,
in absence of any variant being specifically mentioned, the DT/ effervescent
/soluble/MD may be considered along with conventional form.

It further said that the NLEM is prepared with the
objective of satisfying the priority health care needs of the population. The
list is made based on disease prevalence, efficacy, safety and comparative
cost-effectiveness of the medicines. The aim behind formulating NLEM is to
ensure that these medicines are available in adequate quantity, in appropriate
dosage forms and strengths with assured quality. NLEM does recognize such
innovations in drugs where substantial improvements, effectiveness and efficacy
have been introduced either in terms of quality or in the delivery system or
both. Accordingly, NLEM mentions such innovative drugs separately under
different categories commonly named as Modified Release (MR) versions in the
same list where such criteria are fulfilled. When the same is not mentioned
separately, then all such varieties of such drugs for the specified dosages are
considered to be part of variants appearing in the list. The objective of NLEM,
inter alia, is to ensure availability of the essential drugs as well. This
objective may be adversely affected by the exclusion of different variants from
the NLEM based on criteria such as MR etc., as such exclusion may encourage
essential drugs simply moving out of NLEM. This may not be in line with the
spirit and purpose of including these drugs in the list of essential medicines
in the first instance.

Subsequently, the Department upheld the action of NPPA
fixing the ceiling price of Metoprolol Tablet 25mg and Metoprolol Tablet 50mg via
order dated 06.01.2023. The Review Application under
consideration was accordingly rejected.

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Expert panel recommends changes to NEET SS exam pattern, informs NMC Secretary

Changes were introduced in the National Eligibility-Entrance Test Superspeciality (NEET-SS) 2024 exam pattern after an expert panel was constituted to decide the eligibility criteria for admission to various super speciality courses, ET has reported.
This panel comprised experts from related fields, medical institutes, and members of the Postgraduate Medical Education Board (PGMEB) of the National Medical Commission (NMC).

For more information, click on the link below:

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Addiction treatment found to decrease suicide risk among people with opioid dependence

Treating opioid use disorder significantly lowers the very high rate (eight times the general population) of suicide among people with opioid dependence.

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