Archive for month: December, 2023

A comprehensive study evaluating the extended outcomes of topical atropine eye drops for childhood myopia control has shed light on its long-term safety and efficacy. The prospective, double-masked observational study, stemming from the Atropine for the Treatment of Myopia (ATOM) 1 and ATOM2 randomized clinical trials, delved into the effects of short-term atropine use during childhood throughout 10 to 20 years. The study found that the use of short-term topical atropine eye drops did not alter the final refractive errors 10 to 20 years after treatment.  

The study results were published in the journal JAMA Ophthalmology. 

Clinical trials exploring the efficacy of topical atropine eye drops for childhood myopia control have revealed varied outcomes in short-term studies, lacking sufficient data on long-term safety or other critical outcomes. Hence, researchers conducted a study to report the long-term safety and outcomes of topical atropine for childhood myopia control.  

The study encompassed participants from the ATOM1 study (atropine 1% vs placebo; 1999 through 2003) and the ATOM2 study (atropine 0.01% vs 0.1% vs 0.5%; 2006 through 2012), with evaluations conducted in 2021 through 2022. The primary focus was on assessing the change in cycloplegic spherical equivalent (SE) with axial length (AL) and monitoring the incidence of ocular complications.

Results: 

• The research team examined 71 participants from the ATOM1 study and 158 from the ATOM2 study, with baseline characteristics representative of the original cohorts.
• The results demonstrated that, on long-term evaluation, short-term topical atropine use during childhood (ranging from 0.01% to 1.0% for 2 to 4 years) did not lead to significant differences in final refractive errors 10 to 20 years post-treatment.
• In the ATOM1 participants, the refractive errors and axial lengths were comparable between the 1% atropine-treated group and the placebo group.
• Similarly, in ATOM2 participants across varying atropine concentrations (0.01%, 0.1%, and 0.5%), there were no significant differences in the outcomes.

Crucially, the study also addressed safety concerns, revealing no increased incidence of treatment or myopia-related ocular complications in the 1% atropine-treated group compared to the placebo group. The findings have significant implications for the design of future clinical trials targeting childhood myopia control, emphasizing the need for further research to delve into the optimal duration and concentration of atropine for effective and safe outcomes. This landmark study provides valuable insights into the long-term implications of atropine use in childhood myopia management, paving the way for more informed approaches in addressing this prevalent vision concern.

Further reading: Li Y, Yip M, Ning Y, et al. Topical Atropine for Childhood Myopia Control: The Atropine Treatment Long-Term Assessment Study. JAMA Ophthalmol. Published online November 30, 2023. doi:10.1001/jamaophthalmol.2023.5467

USA: A recent study published in Environmental Health Perspectives has revealed a link between exposure to phthalates and a lower probability of getting pregnant, but not pregnancy loss. Phthalates are a group of plasticizing and solvent chemicals found in many household products such as shampoo, makeup, vinyl flooring, toys and medical devices.

The study also noted an association between preconception exposure to phthalates and changes in women’s reproductive hormones, as well as increased inflammation and oxidative stress.

“Phthalates are ubiquitous endocrine disruptors and we’re exposed to them every day,” says lead author Carrie Nobles, assistant professor of environmental health sciences in the School of Public Health and Health Sciences.

People are exposed primarily by ingesting food and liquid that has come in contact with products containing the chemicals, according to a Centers for Disease Control and Prevention fact sheet.

Nobles and team analyzed data from a “unique cohort” of women in the preconception time-to-pregnancy study known as EAGeR (Effects of Aspirin in Gestation and Reproduction), which evaluated the effect of low-dose aspirin on live-birth rates.

The study includes detailed information on 1,228 participants during six menstrual cycles when they are attempting to get pregnant.

The women who became pregnant were followed through pregnancy.

“We were able to look at some environmental exposures like phthalates and how that relates to how long it takes to get pregnant. There was detailed data for each menstrual cycle, so we had a good handle on the date of ovulation and the timing of pregnancy when that happened,” Nobles says.

The body breaks down phthalates into metabolites that are excreted in urine and can be analyzed.

The researchers measured 20 phthalate metabolites in urine samples taken when the participants enrolled in the study.

“We found there were three parent compounds that seem to be most strongly associated with taking longer to get pregnant, although we saw a general trend toward it taking longer to get pregnant across the phthalates we looked at,” Nobles says.

“As exposure got higher, we saw more and more of an effect.”

The researchers also looked at a global marker of inflammation, C-reactive protein, and found the women who had higher levels of phthalates exposure also had higher levels of inflammation and oxidative stress, which can lead to organ and tissue damage and ultimately to disease.

In addition, women who showed higher levels of phthalates had lower estradiol and higher follicle-stimulating hormone across the menstrual cycle, which play an important role in ovulation and the early establishment of pregnancy.

“This profile — estradiol staying low and follicle-stimulating hormone staying high — is actually something that we see in women who have ovarian insufficiency, which can happen with age as well as due to some other factors,” Nobles says.

“Ovulation just isn’t happening as well as it used to.”

While women can check consumer product labels and look for phthalate-free options, the ubiquitous nature of the chemicals makes it difficult for an individual to control their exposure.

In Europe, certain phthalates are banned or severely restricted in their use, but the U.S. has no formal prohibitions.

Nobles says the research findings add to the evidence that phthalate exposures harm women’s reproductive health and can be used to help inform policymaking.

“Maybe we want to think differently about our regulatory system and how we identify important exposures that are having adverse effects on whether people can get pregnant and have a healthy pregnancy,” Nobles says.

Reference:

Carrie J. Nobles, Pauline Mendola, Keewan Kim, Anna Z. Pollack, Sunni L. Mumford, Neil J. Perkins, Robert M. Silver, Enrique F. Schisterman. Preconception Phthalate Exposure and Women’s Reproductive Health: Pregnancy, Pregnancy Loss, and Underlying Mechanisms. Environmental Health Perspectives, 2023; 131 (12) DOI: 10.1289/EHP12287

Chandigarh: Investigating the allegations of medical negligence in the case of a 63-year-old woman who had suffered a cardiac arrest due to a pending MRI test and its related treatments, which was believed to have potentially saved her life, the committee has found no substantial evidence against the doctor or the Government Medical College and Hospital (GMCH), Sector 32.

According to the preliminary report submitted by the panel, the doctor was not deemed negligent since there was insufficient evidence implicating him or the hospital in any misconduct that could have resulted in medical negligence and the patient’s demise.

This comes in response to the allegations made by the deceased’s family members, accusing the doctor of providing inadequate healthcare services and delaying treatment to the patient. They alleged that rather than sending the COVID samples to a private institution, GMCH should have taken charge of conducting the tests and administering the appropriate treatment to the patient. 

Also read- Doctors Cannot Be Blamed For Consequences Of Pre-Existing Conditions: Consumer Court Relief To Orthopaedic Surgeon, Hospital

Denying the claims, Hospital director-principal Dr Jasbinder Kaur informed HT, “The medical negligence committee has concluded that there is no substantial evidence which proves that the treating doctor has any monetary consideration for getting laboratory test from a private lab. Further, as per statements given by the doctors and careful examination of the complaint, along with documentary evidence placed on record, the committee thinks that the patient was managed properly as per protocol,” 

According to The Daily, the case involved a 63-year-old woman from Baltana, Mohali, who was admitted to the hospital on May 8, 2021, during the peak time of the COVID-19 pandemic. She was experiencing pain in the upper limbs. 

The medical examination revealed that she was diabetic and had no blood flow in the arteries, causing extreme pain in the right upper limb. The doctors planned an embolectomy (removal of a blood clot) to relieve the thrombus and resume blood flow.

Due to the strict protocol during the peak of the COVID-19 pandemic, all surgery/ICU/MRI patients were required to undergo RTPCR testing. However, due to the high volume of tests, it took more than 24 hours to test patients within GMCH. The RTCPR test was done through a private laboratory after discussing with the patient’s attendants to prioritise patient care.

The medical negligence committee in the report stated that the test samples were sent to a GMCH lab and a private hospital. The private hospital’s report was negative for Covid. Although the report was available before the MRI, the test could not be done as the patient was developing breathlessness. 

On May 11, the patient was moved to a ventilator after severe chest pain and falling unconscious. Despite efforts, including CPR, the patient suffered a cardiac arrest and was subsequently moved to the ICU. Another cardiac arrest occurred on May 13, and despite all measures, the patient could not be revived.   

The GMCH officials decided to engage the police in the matter, consequently submitting the report to the Chandigarh SSP for necessary measures to be taken.

Also read- No Medical Negligence Or Mistake In Diagnosis: SC Dismisses Plea Against Indraprastha Apollo Hospital, Neurosurgeon