Maternal Depression during pregnancy may negatively impact Executive Functioning of child: Study

Maternal depression affects approximately 1 in 7 pregnancies and is associated with pregnancy complications and adverse fetal outcomes. However, there are significant gaps in identifying and treating this condition. Recent study focused on examining the impact of maternal depression and anxiety during pregnancy on child executive functioning at 4.5 years of age. The research involved 323 mother-child dyads from the Ontario Birth Study, an open pregnancy cohort in Toronto, Canada. The study aimed to determine whether the timing and severity of maternal depression and/or anxiety during pregnancy affect child executive functioning, which is crucial for school readiness and long-term quality of life.

Impact of Maternal Depression and Anxiety

The results indicated that greater maternal depressive symptoms at 12 to 16 weeks of gestation were associated with impaired executive functioning in children at age 4.5 years. The study found that children of mothers meeting screening criteria for major depression in early pregnancy scored 11.3% lower on the Flanker test (a measure of attention) and 9.8% lower on the Dimensional Change Card Sort (a measure of cognitive flexibility) compared to children of mothers without maternal depressive symptoms in early pregnancy. The study also demonstrated that mild depressive symptoms had no significant effect on executive function scores. However, there was no significant effect of anxiety symptoms or maternal antidepressant use in early pregnancy or at later pregnancy stages.

Urgent Need for Maternal Depression Treatment

The study emphasized the urgent need to improve the recognition and treatment of maternal major depression, particularly in early pregnancy, to minimize its negative impact on child cognitive development. The findings suggested that fetal exposure to maternal major depression, but not milder forms of depression, at 12 to 16 weeks of gestation is associated with impaired executive functioning in the preschool years. The study provided detailed insights and nuanced findings related to the specific timing and severity of maternal depressive symptoms during pregnancy and their impact on child executive functioning. It analyzed the association between maternal depression and child executive functioning using standardized computerized assessments of attention and cognitive flexibility, highlighting the significance of early recognition and treatment of maternal major depression to minimize its negative effects on child cognitive development. The study results have implications for guiding clinical interventions and emphasizing the importance of addressing maternal mental health during pregnancy to optimize child neurodevelopment.

Key Points

– The study examined the impact of maternal depression and anxiety during pregnancy on child executive functioning at 4.5 years of age using a sample of 323 mother-child dyads from the Ontario Birth Study in Toronto, Canada.

– Greater maternal depressive symptoms at 12 to 16 weeks of gestation were found to be associated with impaired executive functioning in children at age 4.5 years. Children of mothers meeting screening criteria for major depression in early pregnancy scored significantly lower on measures of attention and cognitive flexibility compared to children of mothers without maternal depressive symptoms in early pregnancy.

– The study found no significant effect of anxiety symptoms or maternal antidepressant use in early pregnancy or at later pregnancy stages on child executive functioning. – The findings emphasized the urgent need to improve the recognition and treatment of maternal major depression, particularly in early pregnancy, to minimize its negative impact on child cognitive development. It was suggested that fetal exposure to maternal major depression at 12 to 16 weeks of gestation is associated with impaired executive functioning in the preschool years.

– The study provided detailed insights into the specific timing and severity of maternal depressive symptoms during pregnancy and their impact on child executive functioning through standardized computerized assessments of attention and cognitive flexibility.

– The results have implications for guiding clinical interventions and emphasize the importance of addressing maternal mental health during pregnancy to optimize child neurodevelopment. The study’s findings underscore the critical need for early recognition and treatment of maternal major depression in pregnancy to mitigate its adverse effects on child cognitive development, particularly in relation to executive functioning. These findings are crucial for informing clinical interventions and supporting the prioritization of maternal mental health during pregnancy to enhance child neurodevelopment.

Reference –

Levitan RD, Atkinson L, Knight JA, et al. Maternal major depression during early pregnancy is associated with impaired child executive functioning at 4.5 years of age. Am J Obstet Gynecol 2024;231:246.e1-10

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Lifestyle modifications can bring down the incidence of GDM and gestational hypertension: Study

The body mass index (BMI) before pregnancy and gestational
weight gain (GWG) may have an association with the outcome of pregnancies. Preeclampsia,
gestational diabetes, macrosomia show an association with the BMI. Small-for-gestational
age (SGA) infants and preterm births are more seen with mothers with low BMI. Obese
women are likely to benefit from low GWG. Both BMI and GWG are closely related
to lifestyle, and genetic traits and other medical conditions. Physiologic
weight gain in pregnancy is contributed to by the foetus (3.2-3.6 kg), fat
deposition (2.7-3.6 kg), increased blood volume (1.4-1.8 kg), increased
extravascular fluid volume (0.9-1.4 kg), amniotic fluid volume (0.9 kg), breast
enlargement (0.45-1.4 kg), uterine hypertrophy (0..9kg), and placenta (0.7kg).

Glucose intolerance of first onset in pregnancy or first
recognition during pregnancy is considered as gestational diabetes mellitus
(GDM). GDM is a known risk factor for perinatal complications, and later
development of type2 diabetes mellitus. The pregnancy related weight gain can
contribute to fat deposition and insulin resistance and it is usually in the
second trimester. Insulin resistance is more if there is a rapid or disproportionate
increase of weight.

A retrospective analysis of the data collected from 720
pregnant mothers during the period from January 2017 to January 2019 in a
tertiary health care centre.

Gestational hypertension was significant in overweight women
and those who gained weight above recommended range. (22.4% Vs. 0%; p
<0.001).

GDM was noted in a significant percentage of pregnant women
within the recommended weight gain group. (12.4% Vs. 0%; p<0.001). Obesity
in pregnancy ranges from 1.8% to 25.3%.

In this study, authors had 75 (10.4%) overweight women and
22 (3.1%) obese women. The results show that both obesity and overweight are
high-risk factors for gestational hypertension. Study results showed that 78.7%
of pre- pregnancy underweight, 4.6% normal weight, and 16.7% overweight had
inadequate GWG. All women with normal pre- pregnancy BMI had adequate GWG.
Further excessive GWG was seen most in pre-pregnancy overweight women (66.4%)
than those with normal weight (30.8%) or underweight (2.8%). GWG was higher in
higher BMI groups, showing that overweight and obese women are more likely to
have more than recommended GWG. Excessive and inadequate GWG both can lead to
adverse pregnancy outcomes. This is echoed by several studies which show that
women with weight gain outside the recommended range have a higher incidence of
pregnancy complications. The study also
showed that excessive weight gain was associated with hypertensive disorders in
pregnancy.

About three fourth of the antenatal patients had normal
weight gain. All patients with normal BMI had recommended weight gain. Most
women with low pre-pregnancy BMI, had low GWG and most women with high BMI had
more GWG. Gestational hypertension was associated with high prepregnancy BMI and
more than recommended GWG. No mothers with recommended weight gain
developedgestational hypertension. Both Women with recommended and less than
recommended GWG developed GDM, while no women in more than recommended GWG
group had GDM. Pre- pregnancy dietary counselling, physical and lifestyle
modifications have a role in bringing down the incidence of gestational
diabetes mellitus and gestational hypertension. Efforts should be taken to
reduce weight before pregnancy and control excessive GWG during pregnancy to
reduce such complications.

Source: Sreelakshmy K and Shahnas M / Indian Journal of
Obstetrics and Gynecology Research 2024;11(1):66–69; https://doi.org/10.18231/j.ijogr.2024.012

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Albumin Administration in Severe Burns fails to Improve survival: Study

A recent study assessed the effect of albumin administration on mortality rates in patients with severe burns from the dataset of the Diagnosis Procedure Combination Database in Japan. Severe burns often lead to significant fluid loss which necessitates careful fluid resuscitation to maintain hemodynamic stability. Albumin is sometimes administered in these cases to help restore blood volume and improve patient outcomes.

The study spanned from April 2014 to March 2021 and focused on patients the aged 15 years and older who were admitted with severe burns which was defined by a burn index of 15 or more. The study categorized 2,492 eligible patients into two groups, one group who received albumin within the first two days of admission (albumin group, n = 1,128) and the other group who did not receive albumin (control group, n = 1,364). To ensure a more accurate comparison, the research employed a one-to-one propensity score matching method, which resulted in 530 matched pairs of patients from each group.

The primary outcome measured was the 28-day mortality rate where the study found no significant difference in mortality between the two groups. 21.7% of patients in the albumin group died within 28 days when compared to 22.8% in the control group. The risk difference was calculated to be -1.1%, with a 95% confidence interval ranging from -6.1% to +3.9% that indicated the variation in mortality rates between the two groups.

The findings suggest that the administration of albumin within two days of admission does not significantly impact mortality during the acute phase in patients with severe burns. This result challenges the notion that albumin administration is a critical factor in reducing short-term mortality in these patients. The outcomes of this study imply that further research, particularly randomized controlled trials, is necessary to confirm these findings and explore the potential benefits of albumin in other aspects of burn management.

Overall, while albumin administration is a common practice in the management of severe burns which may not be associated with improved survival during the acute phase. Therefore, Clinicians may need to reconsider the routine use of albumin in this context and focus on other aspects of burn care that might have a more significant impact on patient outcomes.

Reference:

Nakamura, K., Isogai, T., Ohbe, H., Nakajima, M., Matsui, H., Fushimi, K., & Yasunaga, H. (2024). Effect of fluid resuscitation with albumin on mortality in patients with severe burns: A nationwide inpatient data analysis. In Burns. Elsevier BV. https://doi.org/10.1016/j.burns.2024.07.031

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Ustekinumab Offers Potential in Protecting Beta-Cells for Adolescents with Type 1 Diabetes, Study Suggests

UK: A multicenter, double-blind, randomized phase 2 trial of Ustekinumab for adolescents with type 1 diabetes was featured in an article in Nature Medicine.

The study found that ustekinumab, a monoclonal antibody approved for psoriasis, psoriatic arthritis, and inflammatory bowel disease, seems to safely preserve pancreatic beta-cell function in children with new-onset type 1 diabetes (T1D) by targeting the interleukin (IL)-12/IL-23 pathway.

Type 1 diabetes results from the autoimmune, T-cell-mediated destruction of insulin-producing β-cells. Unlike other autoimmune diseases where immunomodulatory therapies are well-established, the primary treatment for Type 1 diabetes for over a century has been insulin replacement. However, this approach often fails to achieve optimal glycemic control, particularly in younger patients. Research has shown that even preserving a small amount of endogenous insulin production after diagnosis can significantly reduce both short- and long-term complications. This underscores the importance of targeting immune pathways involved in the Type 1 diabetes pathogenic process.

In the study conducted by Danijela Tatovic, Division of Infection and Immunity, Cardiff University School of Medicine, a report on a phase 2, multicenter, double-blind, randomized, placebo-controlled trial of ustekinumab in children and adolescents within 100 days of T1D diagnosis (the USTEKID study) was conducted.

The findings of the study highlight the crucial role of a small proinflammatory subset of TH17.1 cells in β-cell destruction and demonstrate that targeting this subset through IL-12/IL-23 inhibition helps preserve C-peptide levels.

The key findings of the study are as follows:

  • A double-blind, randomized controlled trial was conducted on 72 adolescents aged 12-18 years with recent-onset T1D.
  • After 12 months, β-cell function, measured by stimulated C-peptide, was 49% higher in the intervention group, meeting the prespecified primary outcome.
  • The preservation of C-peptide was correlated with the reduction of T helper cells co-secreting IL-17A and interferon-γ.
  • There was a notable reduction in a subset of TH17.1 cells co-expressing IL-2 and granulocyte-macrophage colony-stimulating factor.
  • A significant decrease in β-cell-targeted IL-17A-secreting T cells was observed.
  • These findings suggest that targeting an activated subset of TH17.1 cells in Type 1 diabetes can reduce C-peptide loss with minimal adverse effects, though confirmation in a larger study is needed.

The study concluded that ustekinumab showed a high safety profile and effectively preserved β-cells in children and adolescents with recently diagnosed Type 1 diabetes by targeting the IL-12/IL-23 pathway. This trial provides the first prospective, randomized controlled evidence of the pathogenic role of TH17 cells in Type 1 diabetes, confirming the preliminary findings from the earlier pilot study.

Reference

Tatovic, D., Marwaha, A., Taylor, P., Hanna, S. J., Carter, K., Cheung, W. Y., Luzio, S., Dunseath, G., Hutchings, H. A., Holland, G., Hiles, S., Fegan, G., Williams, E., Yang, J. H., Pollock, E., Wadud, M., Stenson, R., Levings, M. K., Gregory, J. W., . . . Dayan, C. (2024). Ustekinumab for type 1 diabetes in adolescents: A multicenter, double-blind, randomized phase 2 trial. Nature Medicine, 1-10. https://doi.org/10.1038/s41591-024-03115-2

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20 minutes of mindful breathing can rapidly reduce intensity of cancer pain, reveals study

Twenty minutes of mindful breathing, which focuses a person’s attention on their breath, can rapidly reduce the intensity and unpleasantness of cancer pain and relieve the associated anxiety, suggest the findings of a small comparative study, published online in the journal BMJ Supportive & Palliative Care.

Mindful breathing complements traditional pain relief and broadens the repertoire of options available for cancer patients, say the researchers.

Moderate to severe pain affects an estimated 30-40% of patients with cancer worldwide, as a result of the tumour compressing or invading surrounding tissues, neuropathic mechanisms, and the side effects of treatment, say the researchers.

Despite advances in pain management, and an evolving range of drugs and nerve blocks, inadequate pain control remains a substantial challenge for clinicians, they add.

Among the array of complementary treatments, such as cognitive behavioural therapy, massage, acupuncture, and exercise, the value of mindfulness based interventions is increasingly being recognised, say the researchers.

But the research to date on the effectiveness of mindfulness for pain relief has primarily focused on programmes lasting several weeks or just 5-10 minutes, or on people who don’t have cancer.

In light of previously published research indicating that periods longer than 10 minutes might effectively relieve pain, the researchers wanted to find out if a single session of mindfulness breathing lasting 20 minutes might do the same for patients with cancer.

To find out, they randomly assigned 40 inpatients (out of 259 approached) with different types of cancer, and a pain score of 4 or more out of 10, indicating moderate to severe pain, to one of two groups.

One group (21 people) did a mindful breathing session, guided by a doctor who had been trained in mindfulness techniques. The session involved a brief explanation of mindfulness concepts and practices, followed by 20 minutes of mindful breathing.

The session consisted of 4 steps, each lasting 5 minutes: identifying the in-breath and out-breath; following the entire length of the breath; bringing the mind back to the body; and relaxing the body, starting with the head all the way down to the feet.

The other group (19 people) received a 20-minute supportive listening session led by a doctor, during which they were asked about their experiences of illness using semi-structured questions.

Before and after each intervention, the intensity and unpleasantness of every patient’s pain was measured using the validated Numeric Rating Scale (0-10), while the Hospital Anxiety and Depression Scale (HADS), consisting of 14 items rated on a 4-point scale, was used to assess their mood.

Background information and pertinent clinical data, such as cancer types and stages, and use of pain relief, including morphine, were retrieved from the hospital’s medical records.

The patients’ average age was 63, and although various cancer types were represented among them, 1 in 3 had bowel cancer. Twenty nine had stage III or IV disease. Nearly two-thirds (65%) were using opioids to control their pain.

The results showed that the mindful breathing group experienced a much greater (and significant) reduction in pain intensity and pain unpleasantness than the comparison group. They also experienced a much greater reduction in HADS score.

The researchers acknowledge the relatively small size of the study, and the fact that it was carried out at one medical centre only. The nature of pain intensity/unpleasantness and psychological outcomes were also subjectively assessed.

But patients with cancer often face practical constraints, so brief mindfulness interventions that can quickly reduce pain and complement traditional pharmacological approaches are worth exploring, they suggest.

“Additionally, the 100% response rate and the absence of adverse events underscore the feasibility and safety of the 20-minute mindful breathing intervention. The intervention can be quickly learnt and applied with beneficial effect,” they add.

“The findings suggest that this brief intervention holds promise in reducing pain intensity and unpleasantness, as well as alleviating anxiety among patients with cancer. While further research is needed to consolidate these findings, the study contributes valuable insights into a feasible and accessible non-pharmacological approach to enhance pain management in cancer care,” they conclude.

Reference:

Mindful breathing for cancer pain: efficacy of a single 20-minute session – a randomised controlled study, BMJ Supportive & Palliative Care (2024). DOI: 10.1136/spcare-2023-004762

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Mother’s gut microbiome during pregnancy shapes baby’s brain development, reports study

A study in mice has found that the bacteria Bifidobacterium breve in the mother’s gut during pregnancy supports healthy brain development in the fetus.

Researchers have compared the development of the fetal brain in mice whose mothers had no bacteria in their gut, to those whose mothers were given Bifidobacterium breve orally during pregnancy, but had no other bacteria in their gut.

Nutrient transport to the brain increased in fetuses of mothers given Bifidobacterium breve, and beneficial changes were also seen in other cell processes relating to growth.

Bifidobacterium breve is a ‘good bacteria’ that occurs naturally in our gut, and is available as a supplement in probiotic drinks and tablets.

Obesity or chronic stress can alter the gut microbiome of pregnant women, often resulting in fetal growth abnormalities. The babies of up to 10% of first-time mothers have low birth weight or fetal growth restriction. If a baby hasn’t grown properly in the womb, there is an increased risk of conditions like cerebral palsy in infants and anxiety, depression, autism, and schizophrenia in later life.

These results suggest that improving fetal development – specifically fetal brain metabolism – by taking Bifidobacterium breve supplements while pregnant may support the development of a healthy baby.

The results are published today in the journal Molecular Metabolism.

“Our study suggests that by providing ‘good bacteria’ to the mother we could improve the growth and development of her baby while she’s pregnant,” said Dr Jorge Lopez-Tello, a researcher in the University of Cambridge’s Centre for Trophoblast Research, first author of the report.

He added: “This means future treatments for fetal growth restriction could potentially focus on altering the gut microbiome through probiotics, rather than offering pharmaceutical treatments – with the risk of side effects – to pregnant women.”

“The design of therapies for fetal growth restriction are focused on improving blood flow pathways in the mother, but our results suggest we’ve been thinking about this the wrong way – perhaps we should be more focused on improving maternal gut health,” said Professor Amanda Sferruzzi-Perri, a researcher in the University of Cambridge’s Centre for Trophoblast Research and senior author of the report, who is also a Fellow of St John’s College, Cambridge.

She added: “We know that good gut health – determined by the types of microbes in the gut – helps the body to absorb nutrients and protect against infections and diseases.”

The study was carried out in mice, which allowed the effects of Bifidobacterium breve to be assessed in a way that would not be possible in humans – the researchers could precisely control the genetics, other microorganisms and the environment of the mice. But they say the effects they measured are likely to be similar in humans.

They now plan further work to monitor the brain development of the offspring after birth, and to understand how Bifidobacterium breve interacts with the other gut bacteria present in natural situations.

Previous work by the same team found that treating pregnant mice with Bifidobacterium breve improves the structure and function of the placenta. This also enables a better supply of glucose and other nutrients to the developing fetus and improves fetal growth.

“Although further research is needed to understand how these effects translate to humans, this exciting discovery may pave the way for future clinical studies that explore the critical role of the maternal microbiome in supporting healthy brain development before birth,” said Professor Lindsay Hall at the University of Birmingham, who was also involved in the research.

While it is well known that the health of a pregnant mother is important for a healthy baby, the effect of her gut bacteria on the baby’s development has received little attention.

Reference:

Jorge Lopez-Tello, Raymond Kiu, Zoe Schofield, Cindy X.W. Zhang, Douwe van Sinderen, Gwénaëlle Le Gall, Lindsay J. Hall, Amanda N. Sferruzzi-Perri, Maternal gut Bifidobacterium breve modifies fetal brain metabolism in germ-free mice, Molecular Metabolism, https://doi.org/10.1016/j.molmet.2024.102004.

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Nipocalimab Delays or Prevents Fetal Anemia and Intrauterine Transfusions in High-Risk HDFN Pregnancies: NEJM

USA: A recent phase 2 study has revealed that nipocalimab, an investigational treatment, demonstrates significant benefits in managing early-onset severe hemolytic disease of the fetus and newborn (HDFN). The study could transform the approach to treating pregnancies at high risk for this severe condition, offering hope for improved outcomes.

The researchers found that nipocalimab treatment either delayed or prevented fetal anemia and the need for intrauterine transfusions in pregnancies at high risk for early-onset severe hemolytic disease of the fetus and newborn, compared to historical benchmarks. The findings were published online in The New England Journal of Medicine.

In early-onset severe HDFN, a condition where the mother’s immune system attacks the fetus’s red blood cells, the transplacental transfer of maternal antierythrocyte IgG alloantibodies results in fetal anemia. This often necessitates high-risk intrauterine transfusions to prevent fetal hydrops and potential fetal death. Traditionally, managing this condition has been challenging, and treatment options have been limited. Nipocalimab, an anti-neonatal Fc receptor blocker, reduces the transfer of IgG across the placenta and decreases maternal IgG levels.

Against the above background, Kenneth J. Moise, University of Texas at Austin, Austin, TX, and colleagues evaluated the administration of intravenous nipocalimab (30 or 45 mg per kilogram of body weight per week) from 14 to 35 weeks gestation in participants with pregnancies at high risk for recurrent early-onset severe hemolytic disease of the fetus and newborn in an international, open-label, single-group, phase 2 study.

The primary endpoint was a live birth at 32 weeks gestation or later without requiring intrauterine transfusions, evaluated against a historical benchmark where the rate was 0%. A clinically significant difference was set at 10%.

The study led to the following findings:

  • Live birth at 32 weeks gestation or later without intrauterine transfusions occurred in 54% of pregnancies in the study.
  • No cases of fetal hydrops occurred, and 46% of participants did not receive any antenatal or neonatal transfusions.
  • Six fetuses received an intrauterine transfusion: five fetuses at 24 weeks gestation or later and one fetus before a fetal loss at 22 weeks and five days gestation. Live births occurred in 12 pregnancies.
  • The median gestational age at delivery was 36 weeks and four days.
  • Of the 12 live-born infants, 1 received one exchange transfusion and one simple transfusion, and 5 received only simple transfusions.
  • Treatment-related decreases in the alloantibody titer and IgG level were observed in maternal samples and cord blood.
  • There were no unusual maternal or pediatric infections.
  • Serious adverse events were consistent with HDFN, pregnancy, or prematurity.

“Nipocalimab offers a promising new approach to managing early-onset severe hemolytic disease of the fetus and newborn. Its potential to delay or prevent severe complications represents a significant advancement in prenatal care, offering hope for better outcomes in high-risk pregnancies,” the researchers concluded.

Reference:

Moise, Jr, K. J., et al. (2024) Nipocalimab in Early-Onset Severe Hemolytic Disease of the Fetus and Newborn. New England Journal of Medicine. doi.org/10.1056/NEJMoa2314466.

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Frequent and Severe COPD Exacerbations Linked to Higher Risks of Myocardial Infarction and Pulmonary Embolism: Study

Sweden: A recent study into chronic obstructive pulmonary disease (COPD) has unveiled a troubling correlation between the frequency and severity of acute exacerbations and an increased risk of myocardial infarction (MI) and pulmonary embolism (PE). The research, conducted on a large real-life cohort of COPD patients, underscores the critical need for proactive management of exacerbations to mitigate the risks of these serious cardiovascular events.

The study, published in the CHEST journal, revealed that acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) substantially increase the risk of MI and PE. The risk increases with both the frequency and severity of these exacerbations.

“Patients who experience two or more severe AECOPDs face nearly 1.8 times the risk of MI and more than 2.6 times the risk of PE compared to those without exacerbations. These heightened risks are particularly significant within the first year of follow-up,” the researchers reported.

Chronic obstructive pulmonary disease is characterized by persistent respiratory symptoms and airflow limitation, often exacerbated by factors such as infections, environmental pollutants, and other triggers. These exacerbations can significantly impact a patient’s health, leading not only to worsening pulmonary function but also to a heightened risk of severe complications. It is unclear whether a history of exacerbations is differently linked to the future risk of MI or PE.

To fill this knowledge gap, Oskar Wallström, University of Gothenburg, Gothenburg, Sweden, and colleagues determined if the number and severity of AECOPDs are associated with increased risk of MI or PE in a real-life cohort of patients with COPD.

For this purpose, they analyzed a cohort of 66,422 patients aged 30 and older with a primary diagnosis of chronic obstructive pulmonary disease (COPD) from the Swedish National Airway Register, covering the period from January 2014 to June 2022. All patients had complete lung function data. They were categorized based on exacerbation severity: moderate exacerbations were defined by the prescription of oral corticosteroids, while severe exacerbations were marked by hospitalization in the year leading up to the index date.

The cohort was monitored until December 2022 for occurrences of hospitalization or death due to myocardial infarction (MI) or pulmonary embolism (PE), resulting in over 265,000 patient-years of follow-up and a maximum follow-up period of 9 years. To assess the risk, we utilized competing-risk regression models based on Fine-Gray to calculate subdistribution hazard ratios (SHRs).

The study led to the following findings:

  • Compared with no AECOPDs in the baseline period, AECOPD number and severity were associated with increased long-term risk of both MI and PE in a gradual fashion, ranging from an SHR of 1.10 and 1.33, respectively, for one moderate exacerbation, to 1.82 and 2.62, for two or more severe exacerbations.
  • In a time-restricted follow-up sensitivity analysis, the associations were stronger during the first year of follow-up and diminished over time.

“The risk of myocardial infarction and pulmonary embolism increases with the frequency and severity of AECOPD in this large real-life cohort of patients with COPD,” the researchers conclude.

Reference:

Wallström O, Stridsman C, Lindberg A, Nyberg F, Vanfleteren LEGW. Exacerbation history and risk of myocardial infarction and pulmonary embolism in chronic obstructive pulmonary disease. Chest. 2024 Jul 31:S0012-3692(24)04880-3. doi: 10.1016/j.chest.2024.07.150. Epub ahead of print. PMID: 39094732.

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MAMC MBBS Admissions 2024: Check list of required documents

Delhi- Through a
recent notice, the Maulana Azad Medical College (MAMC), Delhi released Instructions and a List of required Documents for the information of MBBS Candidates and their Parents.

As per the notice, the admission process will be done only if all the documents are furnished. The institution will be unable to admit the candidate in case of incomplete documents.

All the concerned candidates seeking MBBS Admissions in Maulana Azad Medical College (MAMC), Delhi are advised to take note of the following Instructions: –

Instructions
for the Candidates & Their Parents

• Parents will be seated in the Auditorium and await
instructions of the Academic Branch in the matter of admission of their ward.

The
candidate is required to:

• Download the Allotment Letter from the MCC Website, if he
has been allotted MAMC, before coming to MAMC for admission.

• Register online on the FMS, DU Website.

• After registering on the website, a print out of the same
may be taken by the candidate which is to be furnished at the time of reporting
for admission in MAMC.

The candidate will be called & escorted to the Admission
Desk according to their turn

• A copy of the Allotment Letter of MCC along with a copy of
the proof of registration with FMS, DU is required for admission.

• Collect the file from the concerned official. This file is
to be filled up to facilitate the admission process.

• The documents are to be furnished to the Admission Team as
follows:

One original set and two sets of self-attested photocopies of the
above documents. The admission process will be done only if all the documents
are furnished. The institution will be unable to admit the child in case of incomplete
documents.

Also Read:Gujarat begins NEET 2024 Round 1 Counselling, 8,184 MBBS, BDS Seats Up For Grabs

The
following Documents are required to submit by the student at the time of
Admission (One original set and 2 sets of a Photocopy):

1. Printout of Registration Form of Faculty of Medical
Sciences, University of Delhi for (MBBS) Course-2024.

2. Allotment Letter issued by Medical Counselling Committee
(MCC), Ministry of Health & Family Welfare, Government of India.

3. Admit Card of NEET-UG-2024.

4. Score Card of NEET–UG-2024.

5. Copy of Aadhar Card.

6. Matriculation Certificate for verification of Date of
Birth.

7. 11th Class Marksheet.

8. (10+2) Class Marksheet & Certificate.

9. Character Certificate in Proforma as prescribed by CBSE,
issued by the principal of the school last attended or any Gazetted Officer
(issued on or after 01.04.2024)

10. Certificate from Principal of the School on prescribed
proforma available at faculty website www.fmsc.ac.in (For 85% Delhi Quota).

11. Scheduled Caste/Scheduled Tribe certificate as described
in Section B, clause 1A, if applicable.

12. Father’s Scheduled Caste/Scheduled Tribe Certificate.

13. Persons with Disabilities (PwD) Certificate, if
applicable

14. Entitlement Certificate for C.W. category as described
in Section-B Clause E, if applicable.

15. OBC certificate as described in Section-B clause-B, if
applicable (Two Copies).

16. The Non-Creamy Layer Certificate shall be for the
Financial Year 2024-2025, issued on or after 01.04.2024 and OBC caste
Certificate as per the Central list for OBC’s. (Two Copies).

17. Parents’ Income Certificate/Form-16 (For OBC Candidate).

18. Affidavit in stamp paper of Rs. 10/- if there is a gap
of six months or more from the last College/School Attended.

19. Two (02) Passport Size Colour Photographs.

20. Surety Bond of Rs. 3 Lakhs along with copies of Aadhar
Card of two sureties on a Non-Judicial Stamp Paper of Rs. 100/- (Rupees One
Hundred Only, Duly Attested by Notary Public). The Proforma is available on
website.

21. Anti Raging Affidavit submitted through online Both from
the student and parents. Website for submission affidavit are: http//www.amanmovement.org/.
https://antiragging.in/

Also Read:Seeking MBBS, BDS, MD, MS, MDS, Nursing Admissions 2024 in Puducherry! Here is complete fee structure

To view the Instructions and Documents click the link below

https://medicaldialogues.in/pdf_upload/mamc-instruction-249676.pdf

https://medicaldialogues.in/pdf_upload/mamc-documents-249677.pdf

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Betrayal of Medical Profession principles! HC denies relief to Doctor accused of running gender determination racket

Chandigarh: Terming ‘female infanticide’ as a deeply disturbing issue, the Punjab and Haryana High Court recently dismissed a plea filed by a doctor from Haryana’s Hisar seeking the concession of anticipatory bail in a case booked against him under the provisions of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act and IPC. 

As per the Tribune report, Justice Kaul asserted the petitioner was facing serious allegations of operating a widespread illegal sex determination racket in the states of Punjab and Haryana using a portable ultrasound machine in undisclosed locations. Customers were allegedly blindfolded before being taken to the locations to avoid detection. The petitioner was also involved in seven other criminal cases, five of which involved similar offences under the PCPNDT Act.

While considering the plea, the HC bench of Justice Manjari Nehru Kaul termed the involvement of unethical medical practitioners in facilitating the extermination of the female foetus through sex determination tests as “reprehensive”.

The bench further asserted that such actions represent a profound betrayal of the very principles of the medical profession. 

Also Read: Registration of hospitals can’t be cancelled under PC PNDT Act unless appropriate authority deems it necessary in public interest: SC

As per the latest media report by The Tribune, the petitioner doctor was booked under the provisions of the PCPNDT Act back in October 2023 at the Barwala Police Station in Hisar district. Referring to the ‘deeply disturbing’ issue of female infanticide, the HC bench observed,

“An alarming aspect is the involvement of unethical medical practitioners who in violation of the Hippocratic oath covertly conduct sex determination tests, thus, enabling this grave crime.”

Referring to the practice of some doctors, who clandestinely perform the sex determination test, against their ethical commitments and principles of medical practice, the Court noted,

“The Hippocratic oath demands that doctors protect life and cause no harm. However, some of these practitioners motivated by greed, become complicit in the extermination of female foetuses. The involvement of unethical medical practitioners in facilitating this practice through clandestine sex determination test is particularly reprehensible, as it represents the betrayal of the very principles of the medical profession.”

Law Trend has reported that the petitioner doctor was facing multiple criminal cases for allegedly conducting gender determination tests using portable ultrasound machines at undisclosed locations. As per the prosecutors, the clients were blindfolded en route to these locations to keep these sites a secret.

Even though the doctor participated in the investigation since December 2023, the counsel for the State contended that the doctor had been uncooperative, failing to surrender the laptop and ultrasound machine used in the tests. Referring to his repeated lack of cooperation, the State counsel insisted on the need to detain him for further interrogation.

While considering the matter, the HC bench rejected the defence claims that the FIRs under the PC & PNDT Act were inadmissible, emphasising the betrayal of medical ethics and principles by some doctors driven by greed, thereby participating in the destruction of the female fetuses.

Also Read: Violation of PC PNDT Act: Licence of three ultrasound centres suspended, show cause notice issued

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