Naloxone Addition to Opioid Mixture may reduce Pruritis in Spinal Anesthesia for Cesarean Section, finds study

Regional anesthesia techniques, such as spinal anesthesia, are frequently employed for cesarean section (CS) due to their benefits of providing postoperative pain relief and reducing the potential risks of aspiration, awareness, and difficulty in managing the airway. Adding a small amount of naloxone to intrathecal opioids can reduce the high risk of pruritis associated with their use. Recent study evaluated the effect of adding a low dose of naloxone (20 μg) to a fentanyl-bupivacaine mixture on the incidence of pruritus in pregnant women undergoing cesarean section under spinal anesthesia. The study included 80 pregnant patients scheduled for cesarean section under spinal anesthesia. They were randomly divided into two groups: Group F: Received 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl Group FN: Received 10 mg of 0.5% hyperbaric bupivacaine (2 ml), 25 μg fentanyl, and 20 μg naloxone.

Study Findings

The study found that compared to the F group, the FN group showed a significant decrease in the incidence of pruritus (33.33% vs 60.53%, p=0.022), prolongation of the onset of pruritus (p=0.006), shortening of the duration of pruritus (p=0.029), and decrease in the severity of pruritus (p=0.039).

Postoperative Comparison

However, the postoperative pain scores, rescue analgesic consumption, and time for first rescue analgesia request were comparable between the two groups (p>0.05). The incidence of maternal side effects and fetal APGAR scores were also similar between the groups.

Conclusion

The authors concluded that the addition of an ultra-low dose of naloxone (20 μg) to the fentanyl-bupivacaine mixture significantly reduced the incidence, duration and severity of pruritus without affecting postoperative analgesia in pregnant women undergoing cesarean section under spinal anesthesia.

Key Points

1. The study evaluated the effect of adding a low dose of naloxone (20 μg) to a fentanyl-bupivacaine mixture on the incidence of pruritus (itching) in pregnant women undergoing cesarean section under spinal anesthesia.

2. The study included 80 pregnant patients who were randomly divided into two groups: – Group F: Received 10 mg of 0.5% hyperbaric bupivacaine plus 25 μg fentanyl – Group FN: Received 10 mg of 0.5% hyperbaric bupivacaine, 25 μg fentanyl, and 20 μg naloxone.

3. The study found that compared to the F group, the FN group showed a significant decrease in the incidence of pruritus (33.33% vs 60.53%, p=0.022), prolongation of the onset of pruritus (p=0.006), shortening of the duration of pruritus (p=0.029), and decrease in the severity of pruritus (p=0.039).

4. The postoperative pain scores, rescue analgesic consumption, and time for first rescue analgesia request were comparable between the two groups (p>0.05).

5. The incidence of maternal side effects and fetal APGAR scores were also similar between the groups.

6. The authors concluded that the addition of an ultra-low dose of naloxone (20 μg) to the fentanyl-bupivacaine mixture significantly reduced the incidence, duration and severity of pruritus without affecting postoperative analgesia in pregnant women undergoing cesarean section under spinal anesthesia.

Reference –

Ahmed SA, Amer AF, Lotfy HA, Mansour RF. The effect of addition of ultra‑low dose of naloxone to fentanyl–bupivacaine mixture on the incidence of pruritis after spinal anesthesia for cesarean delivery: Randomized clinical study. J Anaesthesiol Clin Pharmacol 2024;40:381‑7.

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Will not allow any dilution in AIIMS standards of teaching and faculty: JP Nadda

New Delhi:  “It takes 10 to 20 years for any institution to grow and function in full swing. I will not allow the dilution of the standards of AIIMS and will protect its brand name,” stated the Union Health Minister while addressing the BJMFCON 2024.

Addressing the BJMFCON 2024, a forum of doctors from Bihar and Jharkhand practising in Delhi-NCR, Nadda said AIIMS-Delhi was set up in the ’60s but it was only in the ’80s that it became a brand name.

Union Health Minister J P Nadda further said he would not allow any dilution in the standards of teaching and faculty at all the new AIIMS set up across the country as he vowed to protect the institute’s brand.

“It takes 10 to 20 years for any institution to grow and function in full swing. I will not allow the dilution of the standards of AIIMS and will protect its brand name,” Nadda said, adding that no compromise will be made in the faculty recruitment, quotes PTI
Stating that several policy interventions have been made to transform medical education in the past 10 years, Nadda said, “In the 2017 health policy, we tried to make it comprehensive and holistic. Earlier, the stress was on the curative aspect but now the focus is on preventive, promotive, curative palliative and rehabilitative aspects — a holistic approach.”

The health minister also said that the groundbreaking ceremony for AIIMS-Darbhanga will be held soon, while the commissioning of AIIMS-Deoghar has been done and recruitment of staff is presently underway.

Underlining the government’s efforts on preventive aspects of healthcare and early detection of diseases in the country, he said there are 1.73 lakh high-quality Ayushman Arogya Mandirs in India that go through a high-quality digital assessment. Out of these, 10,716 Ayushman Arogya Mandirs have been set up in Bihar which have witnessed a footfall of 8.35 crore so far while there have been 4.36 crore screenings for non-communicable diseases (NCDs).
There are 3,825 similar facilities in Jharkhand witnessing a footfall of 2.33 crore and 2.12 crore NCD screenings.
The focus of these facilities is on early detection of NCDs.
Highlighting the strides made in mother and child health, Nadda said that “institutional deliveries increased from 78.9 per cent to 88.6 per cent in the first five years of Modi government”.
Nadda also mentioned the implementation of the world’s largest Covid-19 vaccination programme with more than 220 crore doses being administered in the country.
The health minister further commended the healthcare providers “for their relentless efforts to ensure the accessibility of healthcare services even in the remotest areas of the country” as he highlighted their efforts and service during the Covid-19 pandemic.
From 387 before 2014 to 766 now, an increase of 98 per cent in the number of medical colleges has been ensured under Prime Minister Narendra Modi’s leadership, he said.
A total of 157 district hospitals have been converted into medical colleges of which eight are in Bihar, including at Purnia, Saran, Samastipur and Jhajharpur, Siwan, Buxar and Jamui, while five are in Jharkhand at Dumka, Hazaribagh, Palamu, Chaibasa, and Kodarma, Nadda said.
He also emphasised that “the Patna Medical College and Hospital (PMCH) is being redeveloped into Asia’s second-largest hospital”.
The number of MBBS (Bachelor of Medicine and Bachelor of Surgery) seats has gone up by 125 per cent, from 51,348 before 2014 to 1,15, 412 now, he said.

Read also: Health Minister JP Nadda addresses 77th session of Regional Committee of WHO South East Asia

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Do Not Fill 1 MBBS Seat at Kurnool Medical College- HC Orders Varsity

Vijayawada: While considering the grievance of an MBBS candidate seeking admission under the BC-E category, the Andhra Pradesh High Court recently directed Dr. NTR University of Health Sciences not to fill one MBBS seat in the open merit category at Kurnool Medical College (KMC) during the third phase of counselling for admission to first-year MBBS course.

The HC bench comprising Chief Justice Dhiraj Singh Thakur and Justice Ravi Cheemalapati issued this direction after taking note of the petitioner’s submission that even though eight seats were reserved for the BC-E category at KMC, only seven were filled and the institute diverted the remaining seat to the general open merit category.

After appearing in the National Eligibility-Entrance Test Undergraduate (NEET-UG) examination conducted by the National Testing Agency (NTA), the petitioner student secured 626 marks and applied for admission under the BC-E category, as NTRUHS reserved altogether eight seats for this category in its seat matrix.

Also Read: MBBS, BDS Admissions for 2024: NTRUHS Releases eligibility criteria, counselling process, fee structure, Complete details here

However, the petitioner’s counsel argued that instead of the allocated eight seats, the institute filled only seven BC-E category seats and diverted the remaining seat to the general open merit category. 

As per the latest media report by Deccan Chronicle, even though the petitioner was allotted a seat in the Anantapur Government Medical College in the open category, he expressed interest in taking admission at KMC since he hails from Kurnool.

While considering the plea on Saturday, the HC bench observed that the action of NTRUHS to change the seat matrix without cause or justification would prejudice the petitioner’s interests. Further, the court opined that the seat matrix could not be altered after the commencement of the selection process.

Therefore, the Court suggested that as the petitioner had already been selected in the open category for Anantapur Government Medical College, he could be considered to get admitted in the one available seat in the general open category at KMC in the upcoming third phase of counselling.

On the other hand, the counsel for NTRUHS, T.V. Sri Devi, requested for additional time to file a response. Therefore, the Court scheduled the matter for further hearing on October 22, 2024.

Also Read: Kurnool Medical College initiates action against Invigilator for taking photo of MBBS Anatomy question paper during exam

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Lupin names Claus Jepsen as President, Global Specialty

Mumbai: Global pharma major Lupin Limited (Lupin) recently announced the appointment of Claus Jepsen as President, Global Specialty.
The company, in its statement said that Jespen brings over three decades of experience in commercial strategy, portfolio management, and launch planning across Europe, Asia, and the United States.
Claus joins Lupin from Takeda Pharmaceuticals, where he led the Global Strategy for Rare Diseases.
Prior to that Claus was at GlaxoSmithKline, where he served in many roles including country head in Asia, and Global franchise management in Immunology, Respiratory and Neurology therapeutic areas.
Claus has launched major brands like Ellipta in the U.S. and led Advair and Seretide success in Europe and U.S.
Commenting on the appointment, Lupin’s CEO, Vinita Gupta said, “We are delighted to welcome Claus to our executive leadership team. His experience in leading specialty strategy, commercial planning and portfolio choices across key markets will enable us to build our Specialty brand business.”
Lupin Limited is a global pharmaceutical firm headquartered in Mumbai, India, with products distributed in over 100 markets. Lupin specializes in pharmaceutical products, including branded and generic formulations, complex generics, biotechnology products, and active pharmaceutical ingredients. The company enjoys a strong position in India and the U.S. across multiple therapy areas, including respiratory, cardiovascular, anti-diabetic, anti-infective, gastrointestinal, central nervous system, and women’s health. Lupin has 15 state-of-the-art manufacturing sites and 7 research centers globally, along with a dedicated workforce of over 22,000 professionals. Lupin’s subsidiaries include Lupin Diagnostics, Lupin Digital Health, and Lupin Manufacturing Solutions.

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Global Oral cholera vaccine stockpile empty, says WHO

Geneva: There are no more oral cholera vaccines left in the global stockpile, the World Health Organization said Friday, with the shortage jeopardising work to stop the disease’s spread. 
Global vaccine production is operating at full capacity, but demand is outpacing supply, the UN health agency said in its monthly situation report.
“As of October 14, the global stockpile of oral cholera vaccine is depleted, with no remaining doses available,” the WHO said.
“Although more doses are expected in the coming weeks, this shortage poses significant challenges to outbreak response efforts and hampers efforts to control the spread of the disease.”
The WHO said that between September 1 and October 14, the International Coordinating Group on vaccine provision received requests for oral cholera vaccines from Bangladesh, Sudan, Niger, Ethiopia and Myanmar.
The requests amounted to a total of 8.4 million doses, but due to limited availability, only 7.6 million doses could be shipped.
– Deaths spiking –
The WHO said there had been 439,724 cholera cases and 3,432 deaths reported this year up to September 29.
“Although the number of cases in 2024 is 16 percent lower than last year, the 126 percent spike in deaths is deeply concerning,” it said.
The WHO said the mortality increase might be partially down to where the outbreaks are located.
Those include conflict-affected areas where healthcare access has been severely compromised and areas hit by flooding.
Since last month’s report, new cholera outbreaks have been reported in Niger (705 cases and 17 deaths) and Thailand (five cases with no deaths), pushing the total number of affected countries in 2024 to 30, said the WHO.
In September, 47,234 new cholera cases were reported from 14 countries.
And this month, a cholera case was detected in conflict-hit Lebanon, where the WHO warned the risk of it spreading was “very high” due to the deteriorating sanitation conditions for the large numbers of displaced people.
Cholera is an acute intestinal infection that spreads through food and water contaminated with the bacterium vibrio cholerae, often from faeces.
It causes severe diarrhoea, vomiting and muscle cramps.
Cholera can kill within hours when not treated, though it can be treated with simple oral rehydration, and antibiotics for more severe cases.
In April, the Gavi vaccine alliance and the UN children’s agency UNICEF said South Korean firm EuBiologics was currently the only oral cholera vaccine supplier to the global stockpile, although other manufacturers were expected to have products available in the coming years.

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Karnataka Plans to Establish New GMCs In 11 Districts Under PPP Model

Karnataka- The Karnataka government is planning to set up 11 new medical colleges under the Public Private Partnership (PPP) model in 11 districts of the state which currently do not have government medical colleges.

At present, the state has 22 government medical colleges in 22 districts while 11 other districts have no government medical colleges. To fill this gap, the government has now proposed to open medical colleges in PPP mode in Tumakuru, Davanagere, Chitradurga, Bagalkot, Kolar, Dakshina Kannada, Udupi, Bengaluru Rural, Vijayapura, Vijayanagara and Ramanagara districts of Karnataka.

Also Read: Karnataka HC grants relief to Court Officer, affirms Right to Emergency Expense Reimbursement at Non-Empanelled Private Hospital

Minister for Medical Education Sharan Prakash Patil said, “To improve medical infrastructure, health facilities for the rural people and giving more opportunity in medical education to rural residents, poor and meritorious students, the State government is committed to starting a government medical college in every district. There are no government medical colleges in 11 districts of the state. But the Finance Department has not permitted to start of new medical colleges in these. So, we are planning to start medical colleges under the PPP model in these districts.”, quoted The Hindu

Dr Patil also said “A private organisation has been tasked to study and report on starting medical colleges under the PPP model. A meeting has already taken place in this regard. An appropriate decision will be taken after receiving the complete report. However, 11 colleges cannot be started at once and it will begin with two to three colleges per year”.

As of now, Karnataka has a total of 73 medical colleges, including 22 run by the government and a total of 12,095 seats are available. In 2014-15, the State government announced the setting up of medical colleges in several districts. However, construction of the medical colleges in some districts did not take off owing to financial constraints. Setting up and running a medical college is a huge expense that can go up to ₹600 crore.

Also Read: COVID-19 PPE procurement Scam: Karnataka Govt suspends officer over irregularities

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Gynaecologist, Paediatric surgeon ordered to pay Rs 50 lakh for amputation of newborn’s leg

The National Consumer Disputes Redressal Commission (NCDRC) recently directed two doctors belonging to two private hospitals in Patna to pay Rs 50 lakh compensation to a woman for medical negligence leading to the amputation of her newborn son’s leg.
After being treated for chest infection and breathing problems, initially, the child’s condition stabilized. However, soon afterwards, the complainant noted discolouration of the child’s left foot. Ultimately, the newborn was transferred to Sir Ganga Ram Hospital, where the leg had to be amputated.

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Parexel International Clinical Research gets CDSCO Panel nod to study Dexpramipexole dihydrochloride monohydrate

New Delhi: Parexel has a go-ahead from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organization (CDSCO) to conduct the phase III clinical study of Dexpramipexole dihydrochloride monohydrate.

This came after Parexel International Clinical Research presented Phase III clinical study protocol No. AR-DEX-22-02, India Specific Amendment 1 dated 17-SEP-2024.

Dexpramipexole is an investigational small molecule drug used for amyotrophic lateral sclerosis that incidentally was noted to significantly decrease absolute eosinophil levels.

Dexpramipexole is a first-in-class oral investigational medicine that lowers blood and tissue eosinophils before they can cause damage to the target organ. Dexpramipexole is being developed by Areteia Therapeutics and has the potential to be the first oral treatment ever approved for eosinophilic asthma.

At the recent SEC meeting for pulmonary held on 3rd October 2024, the expert panel reviewed the Phase III clinical study protocol No. AR-DEX-22-02, India Specific Amendment 1 dated 17-SEP-2024.

After detailed deliberation, the committee recommended the grant of permission to conduct the trial as presented by the firm.

Also Read: Regulatory Action Ahead for Entod Pharma: CDSCO directs Gujarat FDCA to act on PresVu claims

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National poll: Many teens use protein supplements for muscle growth, sports performance

Protein bars, shakes and powders are increasingly popular among adults—but many teens may be jumping on the bandwagon too.

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Gynecologic cancers: 4 affirmations to help you advocate for yourself

Gynecologic exams might not top the list of things you look forward to, but whether it’s for a wellness visit or a new concern, such exams are critical for detecting gynecologic cancers early when they are most treatable. Gynecologic cancers include endometrial, ovarian, cervical, vulvar and vaginal cancer.

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