Heat stress may still affect babies once born, first evidence suggests

Exposure to high levels of heat may both impact the growth of foetuses during pregnancy and infants up to the age of two, a new analysis suggests.

The study is the first of its kind to show that heat stress may impact the development of babies after they’re born and adds to previous research by the team showing the impact of heat stress on foetal development.

The research, which examined data from infants and their mothers collected during a clinical trial in The Gambia, found a small decrease in birth weight for gestational age for every 1°C increase in average daily heat stress during the first trimester.

No effect on growth was observed for heat stress experienced during the second trimester. The research suggested there could be an increase in head circumference compared to the body for gestational age in foetuses exposed to heat stress during the third trimester, but this was less confident.

The findings also show that infants up to the age of two exposed to high heat in their environment may have lower weights and heights for their age. The largest decreases were seen in infants aged between 6-18 months who had experienced higher average daily levels of heat stress in the previous three-month period.

At 12 months old, infants exposed to an average heat stress value equivalent to 30°C were more likely to have a reduced weight for their height and age, compared to those who experienced heat stress equivalent to 25°C.

The results were found in both male and female infants.

The team, led by researchers at the Medical Research Council Unit The Gambia (MRCG) at the London School of Hygiene & Tropical Medicine (LSHTM), say that the impacts of heat exposure must urgently be considered in public health interventions to reduce the impact of climate change to pregnant women and their children.

The findings are published in The Lancet Planetary Health.

The data was originally collected through the Early Nutrition and Immunity Development (ENID) randomised controlled trial conducted in West Kiang, the Gambia, between January 2010 and February 2015. A total of 668 infants were followed across their first 1000 days of life, made up of 329 (49%) female and 339 (51%) male infants.

The trial analysed the relationship between heat stress and foetal growth based on clinically-recognised scores for weight, length and head circumference for gestational age. It also evaluated the effect of heat stress on infant growth based on weight and height scores from 0-2 years of age.

At birth, 66 (10%) infants weighed less than 2.5 kg, described as a low birthweight, 218 (33%) were small for gestational age and nine (1%) were born prematurely.

Heat strain occurs when our body’s way of controlling its internal temperature is compromised by external factors such as weather or physical activity. In the study, heat stress was defined using the Universal Thermal Climate Index, which considers factors including heat, humidity, wind speed, and solar radiation, and assigns an equivalent temperature (°C) with an associated risk of developing heat strain.

Over the course of the study, the average heat stress exposure level was 29.6°C. The highest daily maximum was 45.7°C and highest daily minimum was 28.9°C.

Dr Ana Bonell, Assistant Professor based at MRCG and lead author of the study, said:

“Our study demonstrates that the intersecting crises of climate change, food insecurity, and undernutrition are disproportionately affecting the most vulnerable, including young children.

“These findings build on previous evidence showing that the first trimester is a vulnerable time to heat exposure and it’s important that we now consider which factors may be contributing to the relationship.

“It’s likely that heat stress may impact appetite, food intake and availability, and we’re also already looking into whether there may be direct effects on cellular and inflammatory pathways, adding to the already reduced capacity of pregnant mothers and infants to regulate their own body temperature.

“We need to explore which populations are projected to experience heat stress the most and where growth faltering may be being recorded, to enable us to develop effective public health measures.

“With global rates of child wasting remaining unacceptably high and ongoing planetary warming, these findings must spur action on improving child health.”

The researchers say that further research is needed to assess the relationship between heat stress and health impacts in regions beyond The Gambia. The available data did not contain information on dietary practices, maternal infections, or socioeconomic status, which may also impact foetal and infant growth.  

Reference:

Bonell, Ana et al., Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial, The Lancet Planetary Health.

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Can adrenaline auto-injectors prevent fatal anaphylaxis?

Individuals at risk of anaphylaxis-an acute systemic hypersensitivity reaction to an allergen or trigger, typically associated with skin reactions, nausea/vomiting, difficulty breathing, and shock-are often prescribed adrenaline (epinephrine) autoinjectors such as EpiPens. A recent review published in Clinical & Experimental Allergy finds that these autoinjectors, which people use to self-administer adrenaline into the muscle, can deliver high doses of adrenaline into the blood, but these levels are short-lived and may not be sufficient to save lives in cases of fatal anaphylaxis.

Investigators noted that data from animal and human studies suggest that intravenous adrenaline infusions delivered directly into the blood can prevent fatal anaphylaxis, but adrenaline autoinjectors may have little impact in such deadly cases.

“For effective management of the most severe allergic reactions, adrenaline given by continuous intravenous infusion, with appropriate fluid resuscitation, is likely to be required-how this is safely achieved in the pre-hospital setting remains to be determined,” the authors wrote. This challenge stems from the fact that fatal anaphylaxis is unpredictable and fast. Fortunately, fatality is rare, with a population incidence of 0.03–0.51 per million per year.

Reference:

Adrenaline Auto-injectors for Preventing Fatal Anaphylaxis, Clinical & Experimental Allergy, DOI: 10.1111/cea.14565

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Confusion over RGUHS PG final exam eligibility requirements! Doctors seeks clarification from NMC

Highlighting the concerns regarding the contradictory eligibility criteria set by the National Medical Commission (NMC) and the State Health Universities, the doctors have sought clarification from the Postgraduate Medical Education Board (PGMEB) of the Apex Medical Commission.
In this regard, the United Doctors Front Association (UDFA) referred to a recent notice issued by the Rajiv Gandhi University of Health Sciences (RGUHS) on 01.10.2024 and also the notice issued by NMC on 06.09.2024 and claimed that these two notices have created confusion in the minds of the PG students of the 2021 batch who are due to appear for their final exams.
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Implementation of facial recognition-based attendance system opposed by TN Govt doctors

Objecting to the proposal of implementing a facial recognition-based attendance system for government doctors, the Service Doctors and Post Graduates recently approached the Chief Secretary of the State Government.
Writing to the Chief Secretary, the General Secretary of Service Doctors and Post Graduates Association (SDPGA), A. Ramalingam questioned the need to implement such an attendance system for doctors employed under the Directorates of Public Health and Preventive Medicine and Medical and Rural Health Services, The Hindu has reported.

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Govt invites applications to fill up top NMC vacant posts

The Union Ministry of Health and Family Welfare has invited applications to fill up the vacant posts in the four Autonomous Boards of the National Medical Commission (NMC), Mint has reported.
Applications have been invited for the posts of President, Secretary, and members of the Commission, along with the key positions in the four boards under the NMC.
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New Study Shows Chest CT Scans Can Predict Hip Fracture Risk Using PMI and T4HU

China: In a recent study published in Orthopaedic Surgery, researchers discovered that chest CT scans—commonly used for diagnosing respiratory conditions—can also serve as a valuable tool for assessing the risk of hip fractures.

The study found that chest CT scans, conducted for other medical reasons, can predict hip fracture risk by assessing the pectoral muscle index (PMI) and the attenuation values of vertebral bodies. Using CT scans in this manner demonstrates an impressive area under the receiver operating curve of 0.86.

The research team noted, “Our findings reveal that, compared to the healthy control group, individuals with hip fractures were older and exhibited lower body mass index, bone mineral density, T4 Hounsfield Units (T4HU) at the fourth thoracic vertebra, and pectoral muscle index volume.”

Hip fractures (HF) are often referred to as the “last fracture of life” for the elderly, making their risk assessment critically important. While research into the link between chest computed tomography (CT) imaging and HF has been limited, recent findings offer new insights.

Sheng Pan, Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China, and colleagues showed that PMI and vertebral body attenuation values obtained from chest CT scans can predict HF risk. This approach provides an opportunistic method to evaluate HF risk in patients without access to bone mineral density (BMD) testing, leveraging chest CT scans performed for other medical conditions.

In a retrospective study from January 2021 to January 2024, 800 participants with BMD measurements and chest CT scans were initially enrolled. Following exclusions, 472 patients were included in the final analysis, categorized into a healthy control (HC) group and a hip fracture (HF) group.

Clinical data were gathered and compared between the two groups. A predictive model was developed using logistic regression, incorporating the pectoral muscle index (PMI) and the Hounsfield units of the fourth thoracic vertebra (T4HU). The model’s predictive accuracy was evaluated through receiver operating characteristic (ROC) curve analysis. Additionally, decision curve analysis (DCA) and clinical impact curves were used to assess the model’s practical utility in a clinical setting.

The following were the key findings of the study:

  • PMI and T4HU were lower in the HF group than in the HC group; low PMI and low T4HU were risk factors for HF.
  • The predictive model incorporating PMI and T4HU based on age and BMI had excellent diagnostic efficacy with an area under the curve (AUC) of 0.865, sensitivity, and specificity of 0.820 and 0.754, respectively.
  • The clinical utility of the model was validated using calibration curves and DCA.
  • The AUC of the predictive model incorporating BMD based on age and BMI was 0.865, with sensitivity and specificity of 0.698 and 0.711, respectively.
  • There was no significant difference in diagnostic efficacy between the two models.

The researchers concluded that PMI and T4HU are effective predictors of hip fractures. In the absence of dual-energy x-ray absorptiometry (DXA), they found that assessing PMI and T4HU from chest CT scans performed for other medical conditions can reliably gauge HF risk. This method allows for timely intervention and treatment, potentially reducing the incidence of hip fractures.

Reference:

Wang, X. Y., Yun, S. M., Liu, W. F., Wang, Y. K., Pan, S., & Xu, Y. J. Opportunistic Assessment of Hip Fracture Risk Based on Chest CT. Orthopaedic Surgery. https://doi.org/10.1111/os.14224

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H. pylori stool antigen and fecal immunochemical tests combo fails to lower gastric cancer mortality: JAMA

A new study published in the Journal of American Medical Association showed that the combination of testing for H pylori stool antigen (HPSA) and fecal immunochemical tests (FIT) did not lower the incidence of stomach cancer or gastric cancer death when compared to a FIT invitation alone.

It is uncertain how Helicobacter pylori screening affects the incidence and death of stomach cancer. This study was carried out to determine if, among the individuals invited for fecal immunochemical testing-based colon cancer screening, the rates of gastric cancer incidence and death are lower when FIT is combined with a stool antigen test for Helicobacter pylori.

This practical randomized clinical study included the inhabitants of Taiwan between the ages of 50 and 69 who are qualified for biannual fecal immunochemical testing (FIT) for the detection of colon cancer. FIT evaluation alone or an invitation for H. pylori stool antigen (HPSA)+FIT examination was given to participants at random. Between January 1, 2014, and September 27, 2018, this study was carried out. The last follow-up took place on December 31, 2020. Invitation for testing for H. pylori stool antigen was the major intervention technique. The incidence and mortality of stomach cancer were the main results. Every invited person was examined in accordance with the groups to which they were randomly assigned.

  • The screening participation rates for individuals who were invited were 35.7% for FIT alone and 49.6% for HPSA + FIT. Of the 12,142 individuals whose HPSA results were positive, 8664 underwent antibiotic therapy, and 91.9% had their infection eradicated.
  • The incidence rates of gastric cancer were 0.037% in the FIT-alone group and 0.032% in the HPSA+FIT group. The death rates from gastric cancer were 0.013% in the FIT-alone group and 0.015% in the HPSA+FIT group.
  • Following post hoc analysis to account for variations in screening participation, follow-up duration, and patient characteristics, an invitation for HPSA + FIT was linked to decreased incidence of gastric cancer but not gastric cancer death when compared to FIT alone.
  • The most frequent side effects among people who took antibiotics were dyspepsia or decreased appetite and diarrhea or stomach discomfort.

Overall, an offer to test for H pylori stool antigen in conjunction with FIT did not significantly lower incidence of gastric cancer when compared to an invitation for FIT alone, although the results might have been influenced by variations in screening participation and follow-up time between the two groups.

Source:

Lee, Y.-C., Chiang, T.-H., Chiu, H.-M., Su, W.-W., Chou, K.-C., Chen, S. L.-S., Yen, A. M.-F., Fann, J. C.-Y., Chiu, S. Y.-H., Chuang, S.-L., Chen, Y.-R., Chen, S.-D., Hu, T.-H., Fang, Y.-J., Wu, M.-S., Chen, T. H.-H., Yeh, Y.-P., Lin , Jaw-Town, … Hsu, C.-Y. (2024). Screening for Helicobacter pylori to Prevent Gastric Cancer. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2024.14887

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Yoga and Meditation Boosts Quality of Life for Hemodialysis Patients: Study Reveals

India: Recent research highlights the significant benefits of yoga and meditation in improving the quality of life (QoL) for patients undergoing hemodialysis. The study, published in the Indian Journal of Nephrology, emphasizes the positive effects of specific practices such as breathwork, pranayama, and various forms of mindful meditation on multiple dimensions of QoL among individuals facing chronic illnesses. 

The increasing prevalence of chronic kidney disease presents significant challenges for both healthcare systems and the economy. For patients facing kidney failure, hemodialysis becomes the only option until a suitable donor is found, which notably affects their overall quality of life.

Patients receiving hemodialysis often experience a range of physical and emotional difficulties, including fatigue, anxiety, and depression. Traditional treatments have primarily focused on medical interventions, but complementary practices like yoga and meditation are gaining recognition for their potential to improve overall well-being.

Against the above background, Arpitaben Jashbhai Parekh and Anita Prakasam from Sumandeep Vidyapeeth Deemed to be University in Vadodara, Gujarat, India, aimed to assess the impact of yoga and meditation on the quality of life of patients undergoing hemodialysis.

For this purpose, the researchers conducted an experimental study using a one-group pretest-posttest design involving 100 participants at Muljibhai Patel Urology Hospital in Nadiad. Pretests were administered on the first day, followed by a 12-week program of yoga and meditation, after which a post-test was conducted. Data analysis was performed using SPSS-20 software, utilizing descriptive and inferential statistics.

The study population was predominantly male (75%) and included individuals aged 49 or older (55%). Most participants identified as Hindu (55%), were married (70%), and lived in joint families (76%). A significant portion had completed primary-secondary education (45%), and 44% were employed. Family income showed that 34% earned over Rs. 30,000 per month, with a nearly equal representation from rural (52%) and urban (48%) areas. Many participants had been ill for over three years (39%) and underwent three hemodialysis sessions weekly (93%).

Based on the study, the researchers revealed the following findings:

  • The intervention resulted in significant improvements in quality of life (QoL).
  • Participants showed notable mean differences across various domains: general health improved by 5.4, physical health by 14.3, psychological health by 14.2, social relationships by 7.5, and environmental health by 6.1.
  • The QoL scores increased dramatically from a pre-test mean of 51.57 to a post-test mean of 109.4, yielding a mean difference of 57.760.
  • The ‘t’ test value was 65.070, with a p-value of less than 0.0001, indicating highly significant results.

In conclusion, the authors highlight the beneficial effects of yoga and meditation on various aspects of quality of life (QoL) for individuals with chronic illnesses undergoing hemodialysis.

Techniques such as pranayama, anulom vilom (alternate nostril meditation), bhramari, kapalbhati, and mindful meditation—including mindful eating and drinking—have shown significant positive impacts. They emphasize the importance of implementing targeted, long-term interventions tailored to the specific needs of hemodialysis patients to further enhance their QoL across different domains.

Reference:

Parekh AJ, Prakasam A. Effectiveness of Yoga and Meditation on Quality of Life Among Patients Undergoing Hemodialysis. Indian J Nephrol. 2024;34:533-6. doi: 10.25259/IJN_98_2024

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Use of checklists and educational interventions may improve preparedness for emergency cesarean sections: Study

The cesarean section (CS) is the most frequently performed obstetric surgery globally. Emergency CS procedures have higher rates of illness and death compared to planned elective CS procedures. The World Health Organization’s Safe Surgery Checklist has substantially decreased mortality and underlines the importance of cognitive tools, such as checklists, for evaluating healthcare providers and training residents during emergency situations. Recent research paper focuses on the assessment of preparedness for emergency cesarean sections (CS) using a checklist and an educational intervention as a quality improvement study. The study was conducted in an emergency operating room complex in a hospital in India. The research aimed to assess the preparedness for emergency CS by utilizing a checklist and educational intervention. Approval from the institutional ethics committee was obtained in May 2020.

Methods and Results

The study began with baseline data collection where 65 emergency CS cases were assessed using a 22-action checklist. The mean percentage of completed actions in the baseline period was found to be 78.80%. Following this, educational intervention sessions were conducted for residents of obstetrics and anesthesiology, as well as nursing officers, to emphasize the importance of each step in the checklist. Post-intervention assessment showed an increase in the overall percentage of completed actions to 92.48%. The results indicated that the educational intervention resulted in improved preparedness for emergency CS, as reflected in the positive attitude of the residents towards patient care.

Observations and Deficiencies

The study observed various parameters, including decision-to-delivery time, incidence of intraoperative hypotension, conversion rate from spinal to general anesthesia, and neonatal Apgar scores. The authors also identified deficiencies in their practice through the educational intervention. However, it was noted that the availability of airway adjuncts remained low even after the intervention. The research paper emphasizes the importance of cognitive aids like checklists for the quality improvement of healthcare systems. It also highlights the need for tailored checklists and ongoing improvement cycles. The study did not assess the actual effect of the checklist on patient outcomes and emphasizes that further improvement and multiple improvement cycles would be necessary. Overall, the paper provides valuable insights into the use of checklists and educational interventions for improving the preparedness for emergency cesarean sections and highlights the need for continued quality improvement efforts in healthcare settings.

Key Points

– The study focused on assessing the preparedness for emergency cesarean sections (CS) using a checklist and an educational intervention as a quality improvement study in an emergency operating room complex in a hospital in India.

– Baseline data collection involved assessing 65 emergency CS cases using a 22-action checklist, with the mean percentage of completed actions in the baseline period found to be 78.80%. After educational intervention sessions for residents of obstetrics and anesthesiology, as well as nursing officers, the overall percentage of completed actions increased to 92.48%, indicating improved preparedness for emergency CS.

– Various parameters were observed, including decision-to-delivery time, incidence of intraoperative hypotension, conversion rate from spinal to general anesthesia, and neonatal Apgar scores. Deficiencies in practice were identified through the educational intervention, such as the low availability of airway adjuncts even after the intervention.

– The study emphasizes the importance of cognitive aids like checklists for the quality improvement of healthcare systems and highlights the need for tailored checklists and ongoing improvement cycles. – The research paper did not assess the actual effect of the checklist on patient outcomes and emphasizes that further improvement and multiple improvement cycles would be necessary.

– Overall, the study provides valuable insights into the use of checklists and educational interventions for improving the preparedness for emergency cesarean sections and highlights the need for continued quality improvement efforts in healthcare settings.

Reference –

Sherin S, Kuberan A, Gupta A, Balasubramanian M, Rudingwa P. Assessment of preparedness for emergency cesarean section by utilizing a checklist before and after an educational intervention: A quality improvement study. J Anaesthesiol Clin Pharmacol 2024;40:530-4.

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Psilocybin as good as SSRI for depression and improving psychosocial functioning: Study

A direct comparison between the experimental psychedelic drug psilocybin and a standard SSRI antidepressant shows similar improvement of depressive symptoms, but that psilocybin offers additional longer-term benefits.

The comparison, between psilocybin (the active ingredient in “magic mushrooms”) and the SSRI escitalopram gave similar long-term improvements in depressive symptoms over a 6-month period, however patients taking psilocybin also reported better psychosocial functioning including experiencing a greater sense of meaning in life and psychological connectedness.

The work is presented for the first time at the ECNP Congress in Milan. A related paper will appear in the peer-reviewed journal Lancet eClinicalMedicine to coincide with the conference presentation. Lead researcher Mr Tommaso Barba (PhD candidate from Imperial College, London) said:

“This is the first work to compare the long-term effects of these two drugs in the context of overall well-being, not just freedom from depression. In previous work we had found that both treatments led to comparable improvements in alleviating symptoms of depression at the 6-week mark, such as sadness and negative emotions. However, this work shows that psilocybin outperformed escitalopram in several measures of well-being, meaning in life, work and social functioning. These results appeared to be maintained over a 6-month follow-up period. In addition, in previous work* we had found that psilocybin also improves sexual drive, in contrast to SSRIs which tend to lower libido in many patients. So overall it seems psilocybin might give additional positive mental health benefits.”

SSRI drugs (selective serotonin reuptake inhibitors), such as Prozac, Paxil and Zoloft, are one of the main types of drugs used to treat depression. However, around a third of patients don’t respond to SSRI treatment, so for them psilocybin may offer an alternative, although this was not studied in this trial.

Tommaso Barba continued:

“SSRIs work well, but not for everyone. They are also associated with some side effects. However this work implies that psilocybin generally seems to offer a real alternative, and perhaps additional benefits, to people who are worried about taking conventional antidepressants”.

The researchers, from Imperial College in London, undertook a 6-month study (phase 2, double-blind, randomised controlled trial) with 59 patients with moderate to severe depression. 30 were treated with a single dose of psilocybin, 29 patients were given a six-week course of escitalopram. Each group received similar psychological support of around 20 hours in total. Both groups showed significant improvement in depressive symptoms, even up to 6 months after treatment (the researchers stopped monitoring at 6 months). However those given psilocybin reported greater improvements in social functioning and psychological connectedness, with large effect sizes.

Co-first author Dr David Erritzoe, Clinical Director and Deputy Head of the Centre for Psychedelic Research, Imperial College, London, commented:

“This is important because improving connectedness and having greater meaning in life can significantly enhance a person’s quality of life and long-term mental health. The study suggests that psilocybin therapy might be a more holistic treatment option for depression, addressing both the symptoms of depression and overall well-being. This could make a substantial difference in the overall happiness and daily activities of those suffering from depression, providing a more joined-up approach to mental health treatment”.

The researchers note that the patients were only treated for 6 weeks, and that many of the patients received additional treatments over the 6-month follow up.

Dr Erritzoe cautioned:

“Psilocybin is still an experimental drug; it has not yet been approved for general use. It is administered in highly controlled and protected environments: these precautions are not found in recreational psychedelic use, which is known for having unpredictable and potentially harmful effects, especially for vulnerable people struggling with mental health issues”.

Commenting, Johan Lundberg (Adjunct Professor of Psychiatry at the Department of Clinical Neuroscience, Karolinska Institute, Stockholm) said:

“This report is an important attempt to compare the clinical value of psilocybin compared to a state-of-the-art treatment of major depressive disorder. The results come with several caveats, including the lack of a non-inferiority analysis and failure to report other interventions given during the follow-up period. That said, as a hypothesis generating piece it may benefit the field substantially. For now, we don’t know if psilocybin will be approved for the treatment of major depression, but if so, it won’t be for everyone. Some future patients might prefer psychedelic treatment over SSRI, but some patients may be intimidated by the dramatic alterations in perception and confrontations with challenging emotions that psychedelic drugs promote”.

Reference:

Study shows psychedelic drug psilocybin gives comparable long-term antidepressant effects to standard antidepressants, but may offer additional benefits, European College of Neuropsychopharmacology, Meeting: 37th ECNP Congress.

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