PG Medico Rape-Murder Case: Police Commissioner reviews security measures at RG Kar Hospital

Kolkata: Kolkata Police Commissioner Manoj Verma visited R G Kar Medical College and Hospital on Sunday, just a day before the Supreme Court is set to hear the rape-murder case of a female post-graduate trainee doctor. 

According to the PTI report, sources said that Verma took stock of the security system at the hospital, spoke to the police personnel present there, and went to the emergency department.  

The police commissioner’s visit comes a day before the rape-murder case comes up for hearing again before the Supreme Court on Monday.  

A mob attack at the hospital took place in the early hours of August 15, vandalising the emergency department of the government-run hospital, just a day after the Calcutta High Court had ordered the transfer of investigation into the rape-murder case to the CBI.       

Also Read:Kolkata PG Medico Death Case: Doctors’ forum submits fresh note of unmet demands

The city police are investigating the vandalism at the hospital.  

Junior doctors, who resumed work after more than a month-long agitation seeking justice for their murdered colleague, said on Saturday night that they would decide on resuming total ‘cease work’ in West Bengal’s medical colleges after observing the state government’s submission on their safety and security at workplaces during the hearing of the RG Kar case before the apex court, news agency PTI reported.  

Their announcement came after three doctors and three nurses were assaulted at the College of Medicine and Sagore Dutta Hospital on the northern outskirts of Kolkata following the death of a patient on Friday night.   

The medics alleged that the attacks at the state-run hospital have shown that the government has “totally failed” to deliver promises to provide them security.     

Also Read:Threat Culture Allegations: Only 8 out of 51 doctors, students appear before RG Kar Hospital inquiry committee

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Rs 3 lakh penalty for discontinuing PG medical courses in Andhra Pradesh this year

Vijayawada: All the PG medical candidates getting admitted to Dr NTR University of Health Sciences will have to pay Rs 3 lakh as a discontinuation penalty if they do not complete their courses.

In this regard, the selected candidates will have to execute a bond at the time of admission. This rule applies to all the candidates getting admitted to either the competent authority quota or management quota seat for the academic year 2024-2025.

The Rules specified by the University in its prospectus are as follows: 

 All the candidates joining the Post Graduate degree/diploma courses should execute bond on a stamped paper of Rs. 100/- value as prescribed in Annexure-IV to the effect that he/she will complete the prescribed period of training or in default to pay Rs.3,00,000/- + 18% GST to the University and shall refund the amount received as stipend upto that date to the Government as notified by the University from time to time.

 As per G.O.Ms.No.67, HM&FW (C1) Department dated 21-04-2017 candidates have to pay the discontinuation penalty of Rs. 3,00,000/- + 18% GST and they will be debarred for three years for admission into Post Graduate Medical Degree/Diploma courses at the colleges in the State of Andhra Pradesh for admission into PG Medical courses subject to receipt of orders from the Government if any and as notified by the University from time to time.

The Prospectus also includes a prescribed format for executing the bond regarding the course discontinuation fee. It is applicable for all the candidates and has to be executed in a Non-Judicial Stamped paper for Rs 100. 

“I, Dr…. selected for Post Graduate Degree/Diploma for the year 2024-25 do hereby undertake to complete the said course as per the requirements of the University. In the event of my leaving the studies after joining the course, I undertake to pay to Dr. NTR University of Health Sciences a sum of ₹.3,00,000/- + 18% GST and refund the amount received as stipend up to that date to Government,” states the bond document.

It will have to be signed by the candidate, and two witnesses (along with their names and addresses).

To view the prospectus click on the links below:

https://medicaldialogues.in/pdf_upload/prospectus-competent-authority-quota-254624.pdf

https://medicaldialogues.in/pdf_upload/prospectus-management-quota-254625.pdf

Also Read: UP scraps Seat Leaving Penalty, now Candidates to be Debarred from next academic year’s Counselling for Discontinuing medical courses

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Osmania General Hospital perform Life-Saving Cadaver Liver Transplants

Hyderabad : Osmania General Hospital (OGH) in Telangana, a tertiary care center, has been transforming lives through successful organ transplantations provided completely free of charge to underprivileged patients.

According to an ANI report, a patient, Ravi Sundar, 45, a native of Nalgonda, was admitted to OGH with full-blown liver failure due to viral infection. He was very sick, having very high bilimbin (25 mg/d) with coagulopathy (blood not clotting) and drowsiness (hepatic encephalopathy).

Another patient from Bathina, Narender, 46, a resident of Vallampatla, Maddur, Siddipet, and farmer by occupation. He was suffering with decompensated chronic liver disease due to viral hepatitis.

Also Read:Govt to relocate Osmania General Hospital to Goshamahal police stadium: CM Revanth Reddy

The doctors did cadaver liver transplantation as a lifesaving measure, and one is recovered and discharged, while the latter is in a recovering state. They also retrieved skin from both donors and preserved it in their skin bank for burn patients.

Recently, patients’ attendees and family members have also come forward for organ donation. Receiving the positive response from the people, has also motivated the Osmania team.

Dr. Rakesh Sahay, Superintendent, Osmania Hospital, said, “In last month, two in-house organ donations transpired at OGH, and one more organ donation was also in the process. With this organ donation, we did two cadaver liver transplants, four cadaver kidney transplants, four corneal donations, and skin donations for burn patients”, news agency ANI reported.

“In general, organ transplant surgeries are very expensive in PVT hospitals, which cost around 25 to 35 lakhs per case. Many of poor patients cannot offered that much money so they are coming to OGH. The Government of Telangana is providing all consumables and drugs free of cost under aarogyasri scheme,” he added.

“We are also providing life-long free immunosuppression drugs for them. One good sign is that not only poor people are coming to government hospitals, but doctors are also undergoing treatment at OGH. We did one emergency liver transplantation for doctor as life-saving procedure at OGH on 29-08-2024,” he further said.

Kidney transplants are performed by Prof. Manisha Sahai, Dr. Mallikarjun, Dr. Kiran Mayi, and Dr. Anand. Skin harvesting is carried out by Prof. Naga Prasad and Prof. Lakshmi, adds ANI.

The team of doctors involved in this surgeries are Prof Dr CH Madhusudhan (SGE/HOD). Dr Wasif Ali, Sudarshan Reddy, Dr Abhimanyu Singh (HOD Anaesthesia), Prof Chandra Shakar (Anaesthesia), Dr. Madhavi (Professor of Anaesthesia), Dr. Raghu (Professor of Anaesthesia), Dr. Lakshmi Narayana, Dr. N Sunil, Dr. Uma Devi, Dr. Ramesh Kumar, Dr. Nadeem, and Dr. Pavan (radiology). Dr. Rupa (biochemist), Dr. Sai Sai Sudha (blood bank), Dr. Nala Kishore, Dr. Shankar, and Mrs. Manjula, Mrs. Subba Laxmi, Mrs. Madhavi, Mr. Krishna, Mr. Babu, and other team members involved in this surgery.

Also Read:Telangana Doctors Association demand new Osmania General Hospital Building

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Carotenoid Supplementation Shows Potential for Improving Blood Sugar Control in Type 2 Diabetes, Study Reveals

Germany: A recent systematic review and meta-analysis of randomized clinical trials has explored the potential effects of carotenoid supplementation on blood sugar control, particularly in individuals with type 2 diabetes (T2D). It found that carotenoid supplementation enhanced glycemic parameters, particularly in individuals with type 2 diabetes.

The researchers noted, “However, the certainty of the evidence was quite low, primarily due to small sample sizes and indirect findings. As a result, no specific recommendations can be made at this time, and well-designed randomized controlled trials are necessary.” 

The findings were published online in the European Journal of Clinical Nutrition. 

Carotenoids are naturally occurring pigments in fruits and vegetables associated with various health benefits. Considering this, Nafiseh Shokri-Mashhadi, German Center for Diabetes Research (DZD), Partner Düsseldorf, Muenchen-Neuherberg, Düsseldorf, Germany, and colleagues conducted a systematic review and meta-analysis to evaluate the impact of carotenoid supplementation on glycemic indices and the reliability of the evidence.

For this purpose, a systematic literature search was performed across PubMed, SCOPUS, ISI–Web of Science, and the Cochrane Library, covering studies from inception until June 17, 2024. Randomized controlled trials (RCTs) that examined the effects of carotenoid supplementation on circulating glycemic parameters were included. Records were excluded if they involved co-interventions with other nutrients, did not report mean differences (MDs) and standard deviations (SDs) for outcomes, or used whole foods instead of carotenoid supplements.

Summary mean differences (MDs) between the intervention and control groups were calculated using a random-effects model. The risk of bias in the included studies was evaluated using the Risk of Bias 2.0 (RoB 2.0) tool.

Based on the review, the researchers reported the following findings:

  • A total of 36 publications, encompassing 45 estimated effect sizes, were included in the meta-analyses.
  • The results indicated a significant improvement in fasting blood glucose (FBG) levels, with a mean difference (MD) of −4.54 mg/dl, and hemoglobin A1C (HbA1C), which showed an MD of −0.25% in the intervention group compared to the control group.
  • Among individuals with T2D, supplementation with astaxanthin and fucoxanthin resulted in a reduction in FBG by 4.36 mg/dl.
  • The intervention with crocin was particularly noteworthy, leading to a decrease in FBG levels by 13.5 mg/dl (n = 5) and a reduction in HbA1C by 0.55% (n = 5) among T2D patients.
  • The researchers emphasized that the certainty of the evidence was very low.

“While carotenoid supplementation may offer some benefits for glycemic control, particularly in individuals with type 2 diabetes, the current evidence lacks the robustness to guide clinical practice. Healthcare providers and patients should approach carotenoid supplementation cautiously until more conclusive research is available,” the researchers concluded.

Reference:

Baechle, C., Schiemann, T., Schaefer, E., Barbaresko, J., & Schlesinger, S. (2024). Effects of carotenoid supplementation on glycemic control: A systematic review and meta-analysis of randomized clinical trials. European Journal of Clinical Nutrition, 1-13. https://doi.org/10.1038/s41430-024-01511-y

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Radial Access Superior for Coronary Angiography, With Distal Radial and Ulnar Access as Preferred Secondary Options, affirms study

USA: A network meta-analysis has provided new insights into the procedural outcomes associated with different access points for coronary angiography. The study that compared femoral, radial, distal radial, and ulnar access offers valuable guidance for clinicians in selecting the optimal approach for this critical diagnostic procedure.

The findings, published in Circulation: Cardiovascular Interventions, endorse radial access as the primary choice for coronary angiography, with distal radial or ulnar access recommended over femoral access as a secondary option.

Coronary angiography, a key diagnostic tool for assessing coronary artery disease, traditionally uses femoral access. However, radial access has become increasingly popular due to its lower risk of complications and quicker recovery times. Previous studies have shown that radial artery access for coronary angiography or PCI lowers the risk of death, bleeding, and vascular complications compared to femoral artery access, earning it a class 1 recommendation in clinical practice guidelines. Despite this, alternative upper extremity access options, such as distal radial and ulnar access, are not yet addressed in the guidelines, even though randomized trials support their use.

Against the above background, M Haisum Maqsood, Department of Cardiology, DeBakey Heart and Vascular Center, Methodist Hospital, TX, and colleagues aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI.

For this purpose, the researchers searched PubMed, EMBASE, and clinicaltrials.gov databases for randomized clinical trials comparing at least two of the four access sites in patients undergoing PCI or angiography. The primary outcomes analyzed were major bleeding and access site hematoma. An intention-to-treat mixed-treatment comparison meta-analysis was then conducted.

The researchers reported the following findings:

  • From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46) and lower risk of access site hematoma with radial (OR, 0.34), distal radial (OR, 0.33), and ulnar (OR, 0.50) access.
  • Compared with radial access, there was a higher risk of hematoma with ulnar access (OR, 1.48).

“Evidence from randomized trials supports a Class 1 guideline recommendation favoring radial access over femoral access for coronary angiography or PCI. Additionally, when radial access is not feasible, distal radial or ulnar access should be considered as preferred alternatives before resorting to femoral access,” the researchers concluded.

Reference:

Maqsood MH, Yong CM, Rao SV, Cohen MG, Pancholy S, Bangalore S. Procedural Outcomes With Femoral, Radial, Distal Radial, and Ulnar Access for Coronary Angiography: A Network Meta-Analysis. Circ Cardiovasc Interv. 2024 Jul 19:e014186. doi: 10.1161/CIRCINTERVENTIONS.124.014186. Epub ahead of print. PMID: 39027936.

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Late Gadolinium Enhancement Helps Predict Sudden Cardiac Death in Youth with Hypertrophic Cardiomyopathy: Study

A recent multicenter study has found that late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging can predict the risk of sudden cardiac death (SCD) in children and adolescents with hypertrophic cardiomyopathy (HCM). This can significantly improve risk stratification for younger patients and increases the ability to identify high-risk patients and potentially guide early interventions. The study results were published in the journal JAMA Cardiology. 

Hypertrophic cardiomyopathy is a genetic heart condition and is one of the leading causes of sudden cardiac death in young people. It is marked by abnormal thickening of the heart muscle. Previous research shows that LGE has been associated with SCD events in adults with HCM, but its prognostic value in younger populations is uncertain. Hence, researchers conducted a study to examine the prognostic significance of LGE in patients with HCM who are younger than 21 years.

Also Read: Vutrisiran offers new lifeline to patients with transthyretin amyloidosis with cardiomyopathy: Study

A multicenter, retrospective cohort study was conducted from April 2015 to September 2022 at 37 international sites in the US, Europe, and South America. The study included 700 patients less than 21 years of age diagnosed with HCM who underwent CMR imaging. The observers were masked from the outcomes and the demographic data for objective analysis. The primary outcome of measurement was to assess the prognostic significance of LGE in predicting SCD or equivalent events, such as resuscitated cardiac arrest or appropriate shocks from implantable defibrillators. 

Key Findings

  • The study’s findings are significant. 
  • During a follow-up period of 1.9 years, 35 individuals experienced SCD or other similar events. 
  • Out of the 700 patients, 230 (32.9%) had evidence of LGE in the left ventricular myocardium, with an average burden of 5.9%.
  • The presence and extent of LGE were more pronounced in older patients and those with greater left ventricular mass and wall thickness.
  • Furthermore, patients with LGE showed signs of declining cardiac function, with lower left ventricular ejection fractions and larger left atrial diameters.
  • The study demonstrated that patients with LGE had a higher likelihood of SCD, even when controlling for other existing risk factors.
  • Notably, those with 10% or more LGE relative to total myocardium had more than double the risk of SCD (hazard ratio [HR] 2.19), suggesting a direct correlation between the extent of LGE and SCD risk.
  • The addition of LGE burden to existing risk prediction models significantly improved their accuracy by improving the performance of the widely used HCM Risk-Kids score that increased from 0.66 to 0.73.
  • The Precision Medicine in Cardiomyopathy score improved from 0.68 to 0.73 suggesting the importance of LGE as a valuable tool in refining current risk assessment methods for young HCM patients.
Also Read: Metformin Associated with Lower Mortality Rates in Diabetes Patients With Heart Failure: Study

Thus, the study concluded that LGE is a critical marker for assessing SCD risk in children and adolescents with HCM. Quantitative LGE enhanced the predictive power of existing risk models and was a risk factor for SCD. This information could be pivotal in improving clinical management, leading to more personalized care for young HCM patients at high risk of sudden cardiac death.

Further reading: Chan RH, van der Wal L, Liberato G, et al. Myocardial Scarring and Sudden Cardiac Death in Young Patients With Hypertrophic Cardiomyopathy: A Multicenter Cohort Study. JAMA Cardiol. Published online September 25, 2024. doi:10.1001/jamacardio.2024.2824

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Oral Corticosteroids Significantly Reduce Hospital Stay and Improve Early Preschool Wheeze: Study

In a study reported in The Lancet: Respiratory Medicine, Bohee Lee and colleagues provided evidence that oral corticosteroids decreased hospitalization time and offered early alleviation of symptoms among children aged 12-71 months who suffered from acute preschool wheeze. Corticosteroids demonstrated marked benefits, particularly during the first several hours after its intake in a systematic review and IPD meta-analysis that was performed. Hence, the research stresses that oral corticosteroids, despite previously conflicting evidence, could actually be clinically useful treatment, particularly in children with a history of wheezing or asthma.

Wheeze is a common preschool condition that leads to frequent emergency visits and hospitalizations. Oral corticosteroids are widely prescribed for this condition, yet previous studies have presented conflicting results regarding their effectiveness. The objective of the study was to establish the effectiveness of oral corticosteroids in managing acute preschool wheeze through the critical review of all available randomized controlled trials conducted from 1994 to 2020. The primary outcome measure was the change in WSS; the secondary outcome measure was hospital stay length. Finally, the adverse events due to corticosteroid use were also evaluated.

This systematic review with an IPD meta-analysis searched PubMed, Embase, and WHO Clinical Trials Registry from 1st January 1994 to 30th June 2020. Randomized controlled trials included in this study were all those that compared oral corticosteroids with a placebo among 12-71-month-old children with acute preschool wheeze. A total of 12 trials were found eligible after searching through 16,102 studies and then subsequently screening them. Individual data from 2,172 children of seven trials were available for the review; of those, 1,728 finally participated in the analysis.

Children were randomized to either oral corticosteroids, n=853, 63.8% male, and placebo, n=875, 66.6% male. Analyses were done by one-stage and two-stage meta-analysis with a random-effects model. WSS at 4 and 12 hours after commencing treatment was the primary outcome measure; secondary outcome measures included length of stay and occurrence of any adverse events, including vomiting.

Key Findings

• At 4 hours after treatment, the corticosteroids group showed a significant improvement in WSS compared to the placebo group, with a mean difference of -0.31 (95% CI: -0.38 to -0.24; p=0.011).

• No significant difference was observed at 12 hours (mean difference -0.02, 95% CI: -0.17 to 0.14; p=0.68). The low heterogeneity across studies (I²=0%) reinforces the consistency of this result.

• Oral corticosteroids led to a substantial reduction in hospital stay by an average of -3.18 hours (95% CI: -4.43 to -1.93; p=0.0021; I²=0%).

• Subgroup analysis indicated that this effect was most pronounced in children with a history of wheezing or asthma, where the reduction reached -4.54 hours (95% CI: -5.57 to -3.52; pinteraction=0.0007).

• While adverse events were infrequently reported (in only four of the seven datasets), there was an increased risk of vomiting associated with corticosteroid use (odds ratio 2.27, 95% CI: 0.87 to 5.88). The low heterogeneity (I²=0%) supports the reliability of these findings.

• Six of the seven datasets were found to have a low risk of bias, ensuring the robustness of the study’s conclusions.

There is clear evidence from the study that oral corticosteroids provide early symptomatic relief and decrease hospitalization for children with acute preschool wheeze, particularly in those who have had prior episodes of wheezing or asthma. The WSS improvement data at 4 hours indicates that corticosteroids act quickly, but with their effect waning by the 12-hour mark. The importance of this finding cannot be underestimated in an emergency setting, whereby rapid control of symptoms can impact decisions regarding further treatment and outcome.

This meta-analysis of IPD therefore confirms that oral corticosteroids have a beneficial effect on the management of acute preschool wheeze by reducing early symptoms and hospital stay. Corticosteroids should, therefore, be considered more in children with previous wheezing or asthma, where their effect is much more prominent. The findings of this study may influence guidelines in the future and lead to an improved approach to treatment for preschool wheeze.

Reference:

Lee, B., Turner, S., Borland, M., Csonka, P., Grigg, J., Guilbert, T. W., Jartti, T., Oommen, A., Twynam-Perkins, J., Lewis, S., & Cunningham, S. (2024). Efficacy of oral corticosteroids for acute preschool wheeze: a systematic review and individual participant data meta-analysis of randomised clinical trials. The Lancet. Respiratory Medicine, 12(6), 444–456. https://doi.org/10.1016/s2213-2600(24)00041-9

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Non-metallic implants effective in fixing subcutaneous bone in patellar fractures, reveals research

A new study published in the recent issue of Frontiers of Surgery showed that the non-metallic implants are effective and can be used to treat patella fractures. In orthopedic surgery, patella fractures make up 1% of skeletal fractures. The majority of fractures are comminuted with considerable articular involvement and simple two-part patella fractures are rare. In the past, patella fractures were treated using a tension band approach by utilizing cerclage wire. The drawbacks of this method include soft-tissue irritation, implant migration, and breaking, which can result in up to 37% of patients needing to have a secondary implant removed.

More recent techniques for fixation like the cannulated screws, hook plates, mesh plates, and locking plates, appear promising but are expensive and need a thorough dissection of soft tissues. Suture tape and sutures have been added to patellar fixation procedures by a number of studies, with positive results. In order to treat common patella fracture types, such as AO 34C1.1 (transverse), AO 34C2 (transverse and split), and 34C3 (comminuted), this research by Wie Jie Tee and team suggested a unique all-suture tape approach. 

Technique:

  • The patient is fully extended in a supine position.
  • Anterior midline standard procedure is used.
  • Cerclage wire is substituted with non-absorbable suture tapes after the fracture fragments have been reduced and secured with K-wires.
  • The tapes are passed through the soft tissue several times, forming loops that are subsequently tensioned to compress the fracture pieces.
  • Using extra suture tapes, a tension band fixation is created to finish the procedure.

Reduced operational time, less soft-tissue dissection, and a decreased chance of implant prominence and discomfort are just a few advantages of this approach that were expected. Due to the suture tape’s exceptional tensile strength and little tissue reactivity, problems and the need for additional procedures are decreased. Early findings from two instances indicate union established at 3 months without problems, with patients recovering full range of motion.

Overall, this study provides evidence that non-metallic implants can be used to treat patella fractures. This technique yields encouraging outcomes that points to a possible change in fracture fixing techniques. More dedicated investigations and bigger cohort studies are required to confirm these results.

Source:

Tee, W. J., Yeo, K. S. A., Chua, D. T. C., & Moo, I. H. (2024). Novel technique for comminuted patellar fixation using suture tape in spiderweb configuration. In Frontiers in Surgery (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fsurg.2024.1377921

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Single implant supported prosthesis viable treatment strategy in female patients with primary Sjogren’s syndrome

Single implant supported prosthesis viable treatment strategy in female patients with primary Sjogren’s syndrome suggests a study published in the Clinical Oral Implants Research.

Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren’s syndrome. They hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration. Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020.

The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment. Results: They included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group.

All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026). Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

Reference:

Hosseini, M., Jensen, S., Gotfredsen, K., Hyldahl, E. and Pedersen, A. (2024), Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren’s Syndrome: A Five-Year Prospective Clinical Study. Clin Oral Impl Res. https://doi.org/10.1111/clr.14356

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Glucagon test useful alternative to insulin tolerance test in Diagnosing GH Deficiency in Transition Age, finds research

Italy: A recent study published in The Journal of Clinical Endocrinology & Metabolism has shed light on the accuracy of glucagon testing across transition in young adults with childhood-onset growth hormone deficiency (GHD).

The study showed that a GH peak to glucagon test (GST) <5.8 μg/L is an accurate diagnostic cutoff for young adults with childhood-onset GHD and a high pretest probability of permanent GHD.

Our data confirm GST to be a safe alternative to insulin tolerance test (ITT) for evaluating GH secretion in young adults with childhood-onset GHD following attainment of adult height and that patients who demonstrated peak GH < 5.8 μg/L can restart rhGH therapy, the researchers wrote.

The insulin tolerance test is the “gold standard” for GHD confirmation following the attainment of adult stature, and a GH threshold of 6 μg/L or less is recommended to determine whether GHD continues at the time of transition to adult care. However, ITT is not suited for patients with epilepsy, seizures, or cardiovascular or cerebrovascular disease. While the GST could be an alternative form of GH stimulation for determining the need for ongoing GH therapy into adulthood, there is no confirmation of diagnostic cutoffs for this test in clinical practice.

The 2019 American Association of Clinical Endocrinologists guidelines indicate peak GH cutoffs to GST of ≤3, and ≤1 µg/L in permanent GHD diagnosis during the transition phase. Considering this, Daniela Fava, Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy, and colleagues aimed to evaluate the accuracy of GST compared to insulin tolerance test in the definition of GHD at adult height achievement.

The study included ninety-seven subjects with childhood-onset GHD (median age, 17.39 years). They underwent ITT, GST, and IGF-1 testing; 44 subjects were idiopathic (isolated GHD), 35 moderate organic GHD (0-2 hormone deficiencies), and 18 severe organic GHD (≥3 hormone deficiencies).

The study led to the following findings:

  • Bland and Altman’s analysis showed a high consistency of GH peak measures after ITT and GST.
  • Receiver operating characteristic analysis identified 7.3 μg/L as the optimal GH peak cutoff to GST [sensitivity 95.7%, specificity 88.2%, positive predictive value (PPV) 88.0%, negative predictive value (NPV) 95.7%] able to correctly classify 91.8% of the entire cohort while 5.8 μg/L was the best GH peak cutoff able to correctly classify 91.4% of moderate organic GHD patients (sensitivity 96.0%, specificity 80.0%, PPV 92.3%, NPV 88.9%).
  • Patients with ≥3 hormone deficiencies showed a GH peak <5 μg/L at ITT and <5.8 μg/L at GST but 1.
  • The optimal cutoff for IGF-1 was a −1.4 SD score (sensitivity 75%, specificity 94%, PPV 91.7%, NPV 81.0%) that correctly classified 85.1% of the study population.

Based on the results, the researchers propose to retest with GST all childhood onset-GHD patients with organic GHD (congenital anomalies, brain tumors, irradiation to the pituitary/hypothalamic region) with 0, 1, or 2 pituitary hormone defects with IGF-1≥ −2 SDS, and patients with idiopathic GHD with IGF-1 < 0 SDS.

Reference:

Fava, D., Guglielmi, D., Pepino, C., Angelelli, A., Casalini, E., Varotto, C., Panciroli, M., Tedesco, C., Camia, T., Naim, A., Allegri, A. E., Patti, G., Napoli, F., Gastaldi, R., Parodi, S., Salerno, M., Maghnie, M., & Di Iorgi, N. Accuracy of Glucagon Testing Across Transition in Young Adults With Childhood-Onset GH Deficiency. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae408

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