Kerala HC rejects 12 year old’s abortion petition

In a shocking revelation, the Kerala High Court has dismissed a plea seeking the termination of the pregnancy of a 12-year-old girl allegedly involved in an incestuous relationship with her minor brother. The court, in its December 22 order, cited the advanced stage of the pregnancy, currently at 34 weeks, and declared termination at this point as not tenable, if not impossible. Instead, the court ruled that the child must be allowed to be born through either a caesarean section or normal delivery, leaving the decision to medical experts.

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https://medicaldialogues.in/

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Cashless medical facility for Haryana Govt employees under Ayushman Bharat

Chandigarh: The Haryana government on Monday announced a cashless medical facility for government employees and their dependents on the occasion of New Year.

The state government had initiated the scheme on a pilot basis, initially covering employees from the fisheries and horticulture departments, offering cashless healthcare facilities starting November 1, 2023.

Today, the coverage has been expanded to include all regular government employees and the entire expenditure under the scheme will be borne by the state government, said an official statement.

Also Read:Cashless medical facility to be launched in Haryana on Nov 30

Implementation of this scheme is carried out through the Ayushman Bharat Haryana Health Protection Authority (State Health Authority), said the statement.

Governor Bandaru Dattatreya, in the presence of Chief Minister Manohar Lal Khattar, inaugurated the cashless healthcare facility, it said.

Dattatreya and Khattar also symbolically distributed Ayushman cards to the beneficiaries during the event here.

“All beneficiaries will greatly benefit from this scheme as the procedures listed under it will be completely cashless and the hospitals will get their claims approved from a single platform within a specified time frame. The scheme will provide more efficient, seamless, hassle-free and time-bound services to the beneficiaries and other stakeholders,” the statement said.

“The scheme not only covers six life-threatening emergencies, that is cardiac emergency, cerebral hemorrhage, coma, electric shock, third and fourth stage cancer, and any kind of accidents as per the existing provisions, but it also covers all types of indoor treatments/daycare procedures, catering to the healthcare needs.

“These services will be available to the beneficiaries in all the hospitals empanelled with Director General of Health Services under this scheme,” it said.

E-card/CCHF card will be issued to all the beneficiaries to avail benefits under the scheme. The beneficiaries can avail benefits using payee code, Aadhaar number or Parivar Pehchan Patra (family ID) number, the statement said.

Also Read:Free treatment at all Govt hospitals from June 1: Chhattisgarh Health Minister

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Healthy omega-3 fats may delay progression of deadly pulmonary fibrosis

UVA  researchers  have found in a new study that higher levels of omega-3 were associated with better lung function  and longer transplant-free survival in pulmonary fibrosis patients.

Researchers conducted  the study to  find out whether healthy fats found in nuts and fish slow the progression of potentially deadly lung scarring known as pulmonary fibrosis and delay the need for lung transplants.

UVA pulmonary researchers looked at the association between blood-plasma levels of omega-3 fatty acids-the heart-healthy fats found in foods such as salmon and flaxseeds-and the progression of pulmonary fibrosis, as well as how long patients could go without needing a transplant. The researchers found that higher levels of omega-3 were associated with better lung function and longer transplant-free survival.

While more research is needed, the researchers say their findings warrant clinical trials to determine if interventions that raise omega-3 levels could be a useful tool to improve outcomes for patients with pulmonary fibrosis and other chronic lung diseases.

“We found that higher levels of omega-3 fatty acids in the blood, which reflects several weeks of dietary intake, were linked to better lung function and longer survival,” said researcher John Kim, MD, a pulmonary and critical care expert at UVA Health and the University of Virginia School of Medicine. “Our findings suggest omega-3 fatty acids might be a targetable risk factor in pulmonary fibrosis.”

Omega-3 and Pulmonary Fibrosis

Omega-3 fatty acids have already been linked to a host of health benefits. Studies have suggested, for example, that they may lower the risk of heart disease, stroke-causing blood clots, breast cancer and other cancers, Alzheimer’s disease and dementia.

Kim and his colleagues wanted to determine if omega-3s could play a protective role in interstitial lung disease, a group of chronic lung diseases that can lead to pulmonary fibrosis. A growing problem around the world, pulmonary fibrosis is an irreversible condition that leaves the lungs unable to exchange oxygen and carbon dioxide properly. This can cause patients to become short of breath, weak, unable to exercise and a host of other symptoms. Smoking is a major risk factor.

The researchers looked at anonymized data on patients with interstitial lung disease collected in the Pulmonary Fibrosis Foundation Registry, as well as information volunteered by patients at UVA Health and the University of Chicago.

In total, the scientists reviewed information on more than 300 people with interstitial lung disease. Most were men (pulmonary fibrosis is more common in men than women), and most suffered from “idiopathic” pulmonary fibrosis, one of the conditions that fall under the banner of interstitial lung disease.

The researchers found that higher levels of omega-3 fatty acids in the blood plasma were associated with better ability to exchange carbon dioxide and longer survival without the need for a lung transplant. This did not vary much regardless of smoking history or whether the patients had cardiovascular disease.

“Higher levels of omega-3 fatty acids were predictive of better clinical outcomes in pulmonary fibrosis,” Kim said. “These findings were consistent whether you had a history of cardiovascular disease, which suggests this may be specific to pulmonary fibrosis.”

The doctors say additional research is needed to understand just how omega-3s could be having this protective benefit. They are calling for clinical trials and more mechanistic studies to obtain additional insights and determine if omega-3 fatty acid drugs or dietary changes could improve patient outcomes.

“We need further research to determine if there are specific omega-3 fatty acids that may be beneficial and, if so, what are their underlying mechanisms,” Kim said. “Similar to other chronic diseases, we hope to determine whether nutrition related interventions can have a positive impact on pulmonary fibrosis.” 

Reference:

John S. Kim, Shwu-Fan Ma, Jennie Z. Ma, Shrestha Ghosh, Krishnarao Maddipati, Imre Noth, Associations of Plasma Omega-3 Fatty Acids With Progression and Survival in Pulmonary Fibrosis, DOI:https://doi.org/10.1016/j.chest.2023.09.035.

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SGLT-2 inhibitors promising option for CVD prevention in diabetes patients regardless of NAFLD status: JAMA

South Korea: A recent study published in JAMA Network Open has highlighted the potential of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) as a promising option for preventing cardiovascular disease (CVD), irrespective of NAFLD status.

In the population-based cohort study, GLP-1 receptor agonists and SGLT-2 inhibitor therapy were associated with reduced risk of major adverse cardiovascular events in patients with type 2 diabetes and across baseline NAFLD status. SGLT-2i therapy was also associated with a reduced risk of hospitalization for heart failure.

Nonalcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor, but it is uncertain whether glucagon-like peptide-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors are associated with reduced cardiovascular risk in patients with type 2 diabetes (T2D) and concomitant NAFLD remains uncertain. Therefore, Sungho Bea, School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, and colleagues aimed to investigate the outcomes of SGLT-2i and GLP-1RA therapy among T2D patients varied by the absence or presence of NAFLD.

For this purpose, the researchers performed a retrospective, population-based, nationwide cohort study using an active-comparator new-user design. Two distinct new-user active-comparator cohorts of patients aged 40 and above who initiated GLP-1 receptor agonists or SGLT2 inhibitors were propensity score-matched to patients who initiated dipeptidyl peptidase-4 inhibitors (DPP-4i).

The main outcomes were (1) major adverse cardiovascular events (MACE), a composite endpoint of hospitalization for stroke, hospitalization for myocardial infarction (MI), and cardiovascular death, and (2) hospitalization for heart failure (HHF). Cox proportional hazard models were used to estimate hazard ratios (HRs). The Wald test was applied to evaluate heterogeneity by NAFLD.

The researchers reported the following findings:

  • After 1:1 propensity score matching, 140 438 patients were retrieved in the first cohort (SGLT-2i vs DPP-4i; mean age, 57.5 years; 56.7% male) and 34 886 patients were identified in the second cohort (GLP-1RA vs DPP-4i; mean age, 59.5 years; 51.3% male).
  • Compared with DPP-4i, SGLT-2i therapy was associated with a lower risk of MACE (HR, 0.78) and HHF (HR, 0.62).
  • GLP-1RA therapy was associated with a decreased risk of MACE (HR, 0.49) but had statistically nonsignificant findings regarding HHF (HR, 0.64).
  • Stratified analysis by NAFLD status yielded consistent results for SGLT-2i (MACE with NAFLD: HR, 0.73; without NAFLD: HR, 0.81; HHF with NAFLD: HR, 0.76; without NAFLD: HR, 0.56) and for GLP-1RA (MACE with NAFLD: HR, 0.49; without NAFLD: HR, 0.49; HHF with NAFLD: HR, 0.82; without NAFLD: HR, 0.54).

“These results support the current guidelines that recommend GLP-1 receptor agonists as the first line of therapy for patients with T2D and NAFLD,” the researchers wrote.

They added, “Furthermore, this study highlights the potential of SGLT-2i as a promising option for CVD prevention regardless of NAFLD status.”

Reference:

Bea S, Jeong HE, Filion KB, et al. Outcomes of SGLT-2i and GLP-1RA Therapy Among Patients With Type 2 Diabetes and Varying NAFLD Status. JAMA Netw Open. 2023;6(12):e2349856. doi:10.1001/jamanetworkopen.2023.49856

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Graduated compression stockings demonstrate no additional benefit in preventing VTE

Venous thromboembolism or VTE, a common and severe complication of hospitalization, has a high morbidity and mortality rate, with a European epidemiological study reporting an incidence of 110 to 130 cases per 10,000 patients per year and 10% to 12% of deaths being VTE-related.

According to the ENDORSE study, 64.4% of surgical inpatients were at high risk of VTE, according to the American College of Chest Physicians criteria, compared to 41.5% of medical inpatients.

According to a recent study published in the Annals of Surgery, Benedict R.H. Turner and colleagues said that head-to-head meta-analysis and pooled trial arms show no additional benefit of GCS (graduated compression stockings) in preventing VTE and VTE-related mortality. GCS pose a risk of skin complications and economic burden. Their use is not supported for surgical inpatients based on current evidence.

This study compared VTE rates in surgical inpatients with pharmacological thromboprophylaxis and additional GCS vs. thromboprophylaxis alone.

Surgical patients have an elevated VTE risk, and recent studies question whether GCS provides extra protection against VTE compared to pharmacological thromboprophylaxis alone.

The review followed PRISMA guidelines. MEDLINE and Embase databases were searched until November 2022 for randomized trials reporting VTE rates after surgical procedures with pharmacological thromboprophylaxis, with or without GCS. The rates of DVT (deep venous thrombosis), pulmonary embolism, and VTE-related mortality were pooled through fixed and random effects.

Key findings from this investigation are:

  • The DVT risk for GCS and pharmacological thromboprophylaxis was 0.85 versus pharmacological thromboprophylaxis alone (2 studies, 70 events, 2653 participants).
  • The risk of DVT in pooled trial arms for GCS and pharmacological thromboprophylaxis was 0.54 compared to pharmacological thromboprophylaxis alone (33 trial arms, 1228 events, 14,108 participants).
  • The risk of pulmonary embolism for GCS and pharmacological prophylaxis versus pharmacological prophylaxis alone was 0.71 (27 trial arms, 32 events, 11,472 participants).
  • No between-group differences were reported in VTE-related mortality (27 trial arms, three events, 12,982 participants).

This study’s strength lies in its meta-analysis of 2 well-designed, low-bias head-to-head trials involving 2600 participants. The high-quality evidence supports the presentation of pooled DVT, PE, and VTE-related mortality rates, showing no difference between pharmacological prophylaxis and additional GCS versus pharmacological prophylaxis alone.

Reference:

Turner BRH et al. An Updated Systematic Review and Meta-analysis of the Impact of Graduated Compression Stockings in Addition to Pharmacological Thromboprophylaxis for Prevention of Venous Thromboembolism in Surgical Inpatients. Ann Surg. 2024 Jan 1;279(1):29-36.

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Maternal education significantly and positively linked with prenatal continuation of antidepressants

France: A recent meta-analysis published in Acta Psychiatrica Scandinavica has revealed a significant and positive association between maternal education and prenatal antidepressant continuation. However, other social determinants of health, including relationship status, race, and income, were not significantly associated with prenatal antidepressant use and continuation.

“Pregnant women having lower levels of education or high school discontinue their antidepressant medication more frequently compared to those with more years of education,” the researchers reported.

Ketevan Marr and researchers from France suggest that perinatal healthcare providers should be aware that educational level may impact antidepressant intake decision-making.

Prenatal depression is increasingly recognized as the most common morbidity in pregnancy. Its global pooled prevalence rate is estimated to be 15% and is associated with sustained poor maternal mental health in the postpartum period, and a variety of adverse short- and long-term outcomes in children.

Antidepressants are sometimes recommended for severe symptoms. Social determinants are often linked with antidepressant use in the general population, and it is unknown if this is the case for pregnant populations.

According to the study authors, no previous reviews have been conducted examining the relationship between prenatal antidepressant use and continuation and social determination. Therefore, Dr. Marr and colleagues aimed to evaluate these associations through a systematic review of the literature and meta-analyses. They provided pooled association measures between prenatal antidepressant intake and various social determinants (SD).

The researchers conducted a systematic search of five databases to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (continuation/use) and one or more social determinants: race, education, relationship, immigration status, employment, or income. Eligible studies were included in random effects meta-analyses.

The researchers reported the following findings:

  • 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83).
  • Meta-analyses of antidepressant use and education, race, relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity.

“While most social determinants in the review were not linked with prenatal antidepressant intake, lower maternal education levels do seem to be linked with lower rates of prenatal antidepressant continuation,” the researchers wrote. “Education appears to be linked with intake of prenatal antidepressants.”

“Continued investigation into social determinants remains a research venue to disentangle the complex web of how SD and other decision-making factors interrelate during this crucial time for both expectant mothers and their offspring,” they concluded.

Reference:

Marr, K., Maguet, C., Scarlett, H., Dray-Spira, R., Dubertret, C., Gressier, F., Sutter-Dallay, L., & Melchior, M. Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13647

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EDOF intraocular lens effective and acceptable in patients with previous vitrectomy

A recent study explored the satisfaction levels of patients who underwent extended depth-of-focus (EDOF) intraocular lens (IOL) implantation following vitrectomy, shedding light on its efficacy and patient-reported outcomes in a younger demographic. This study was published in the journal Graefe’s Archive for Clinical and Experimental Ophthalmology by Willem Hoe and colleagues.

The study involved individuals aged 18 to 75 who had undergone phaco-vitrectomy or phaco after vitrectomy using the AT LARA EDOF IOL. Patients completed a questionnaire evaluating overall visual quality, near vision quality, visual disturbances, based on established survey models like Catquest, NAVQ, and APPLES.

  • Participant Demographics: Out of 89 respondents (average age 56.7 years), 53.9% received a unilateral EDOF IOL.

  • Indications for Vitrectomy: Common reasons for vitrectomy included retinal detachments, floaters, and epiretinal membranes.

  • Satisfaction Scores: The Catquest and NAVQ scores indicated high overall satisfaction, good intermediate vision, and moderate near vision.

  • Visual Disturbances: The APPLES score suggested acceptable levels of visual disturbances post EDOF IOL implantation.

  • Comparison Between Groups: No significant differences were observed in satisfaction rates between unilateral and bilateral EDOF IOL groups, except for higher spectacle dependence in the unilateral group (40% vs. 10.6%).

  • Impact of Floaters: Participants who underwent vitrectomy for floaters reported comparatively lower satisfaction rates.

  • Effect of Pre-operative Refraction: Pre-operative refraction did not impact satisfaction or visual disturbances significantly.

The study indicates that both unilateral and bilateral AT LARA EDOF IOL implantations post vitrectomy resulted in high satisfaction levels among participants. Despite a slight disparity in spectacle dependence between unilateral and bilateral groups, overall satisfaction remained comparable. This suggests that AT LARA EDOF IOLs could be a viable option for younger individuals undergoing vitrectomy, even for unilateral use.

Reference:

Van Hoe, W., Van Calster, J., Jansen, J., Vander Mijnsbrugge, J., Delbecq, A.-L., Fils, J.-F., & Stalmans, P. Patient satisfaction after EDOF intraocular lens implantation in vitrectomized eyes. Graefe s Archive for Clinical and Experimental Ophthalmology,2023;261(12):3465–3474. https://doi.org/10.1007/s00417-023-06204-z

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individuals with genetic predisposition to low alcohol metabolism susceptible to incident AF after alcohol consumption

In a recent study found the relationship between alcohol consumption, genetic predisposition and the risk of incident atrial fibrillation (AF). The findings of this study were published in the BMC Medicine Journal.

The study encompassed 399,329 subjects from the database of UK Biobank who were enrolled from 2006 to 2010. The study utilized genetic data to explore the  interplay between alcohol consumption and AF risk. The participants were followed until 2021 with the genetic predisposition to alcohol metabolism stratified based on polygenic risk score (PRS) tertiles.

During the median follow-up of 12.2-year, a total of 19,237 cases of AF was observed. The data revealed a significant association between genetic predisposition to alcohol metabolism and actual alcohol consumption habits (P < 0.001). Mild-to-moderate drinkers expressed a decreased risk of AF (HR 0.96, 95% CI 0.92–0.99), while heavy drinkers faced an increased risk (HR 1.06, 95% CI 1.02–1.10) compared to non-drinkers.

After stratifying the results according to PRS tertiles uncovered that mild-to-moderate drinkers had equivalent AF risks across all PRS tertiles, while the heavy drinkers expressed increased AF risk in the low PRS tertile group. In the middle/high PRS tertile groups the mild-to-moderate drinkers experienced reduced AF risks and heavy drinkers faced similar risks.

The findings highlight the critical interplay between alcohol consumption, genetic predisposition to alcohol metabolism and the risk of incident AF. The individuals with a genetic predisposition to low alcohol metabolism were observed to be more susceptible to AF by highlighting personalized risk factors for this common cardiac condition.

Source:

Park, C. S., Choi, J., Choi, J., Lee, K.-Y., Ahn, H.-J., Kwon, S., Lee, S.-R., Choi, E.-K., Kwak, S. H., & Oh, S. (2023). Risk of newly developed atrial fibrillation by alcohol consumption differs according to genetic predisposition to alcohol metabolism: a large-scale cohort study with UK Biobank. In BMC Medicine (Vol. 21, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12916-023-03229-3

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Maternal grief in the third trimester tied to increased risk of ischemic heart disease in offspring: JAMA

Sweden: A recent study published in JAMA Network Open suggests no association between maternal stress during pregnancy and risk of ischemic heart disease (IHD) and stroke up to middle age in the offspring.

The cohort study involving 6.8 million participants from Sweden and Denmark revealed no association between maternal stress during pregnancy, defined as the loss of a close relative, and the risk of stroke and IHD up to middle age in the offspring. However, maternal grief in the third trimester was associated with an increased IHD risk.

Stroke and ischemic heart disease are two major types of cardiovascular diseases (CVDs) that are the leading causes of mortality and morbidity worldwide. The incidence rates of these two diseases have generally remained stable or even increased slightly in younger individuals despite the substantial decrease in age-adjusted mortality due to stroke and IHD in the Western world. The aetiology of stroke and IHD in younger people is considered to be different from older people, and traditional cardiovascular (CV) risk factors such as hypertension, dyslipidemia, obesity, and smoking do not fully account for stroke and IHD in the younger population.

Considering the important societal and personal socioeconomic impact of a stroke or IHD diagnosis in younger people, including costs related to long-term health care and productivity loss, there is a need for a better understanding of their aetiology. Therefore, Fen Yang, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, and colleagues aimed to examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring.

For this purpose, the researchers conducted a cohort study using data from Swedish and Danish registries. The final analysis included live singleton births in calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021).

Prenatal stress was defined as the maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy.

The study led to the following findings:

  • The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 years, 0.1% of offspring were diagnosed with IHD and 0.2% with stroke.
  • Maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98) or stroke (AHR, 1.04) in offspring.
  • No associations were observed when exposure was classified by the mother’s relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85 for IHD and 0.98 for stroke) or loss of parent or sibling (HR, 1.03 for IHD and 1.06 for stroke).
  • Associations between loss in the third trimester and IHD (AHR, 1.50), and loss due to cardiovascular disease and stroke (AHR, 1.22) were identified when exposure was classified by the time of loss or the relative’s cause of death.

“The study findings provide little support for the hypothesis that prenatal stress is associated with risks of stroke and IHD in the first 5 decades of life,” the researchers wrote.

“However, further investigation is warranted for the association observed between stress in the third trimester and IHD,” they concluded.

Reference:

Yang F, Janszky I, Roos N, Li J, László KD. Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring. JAMA Netw Open. 2023;6(12):e2349463. doi:10.1001/jamanetworkopen.2023.49463

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Dexmedetomidine and midazolam equally effective sedative agents for third molar surgery

A recent study explored the efficacy of two common sedative agents, midazolam and dexmedetomidine, in third molar surgery – a prevalent minor oral surgical procedure in dentistry. The study findings suggest that both dexmedetomidine and midazolam are effective sedative agents for third molar surgery. This study was published in the journal Cureus by Alden Jason and colleagues.

The aim of the study was to evaluate their effectiveness and potential advantages in managing sedation during these procedures.

Sixty young adult patients, aged 18 to 50 years, without comorbidities, participated in the study. These individuals underwent third molar surgery, and their responses to sedation were observed and compared using the Observer’s Assessment of Alertness/Sedation scale. Patients were randomly assigned to receive either midazolam or dexmedetomidine. The effects of these sedatives on intraoperative vitals and sedation levels were assessed at 15-minute intervals.

The key findings of the study were:

  • Sedation Depth: Both midazolam and dexmedetomidine were equally effective in achieving the desired level of sedation during third molar surgery. No significant differences were observed in the depth of sedation between the two groups.

  • Heart Rate: Dexmedetomidine demonstrated a more efficient reduction in pulse rate compared to midazolam during the surgical procedure. However, this difference was not statistically significant.

  • Blood Pressure: Dexmedetomidine exhibited a statistically significant decrease in mean diastolic blood pressure in comparison to midazolam. This suggests a potential advantage in maintaining lower blood pressure levels during the procedure.

  • Arousal: Patients administered with dexmedetomidine showed quicker arousal post-surgery, indicating a favorable recovery profile compared to midazolam.

Dexmedetomidine displayed advantages in reducing diastolic blood pressure and promoting quicker arousal post-procedure. Its cardio-protective nature, anti-sialagogue properties, and potential analgesic effects highlight its potential for enhancing the management of minor oral surgical procedures like third molar surgery. The use of dexmedetomidine, with its unique properties, could offer additional benefits in minor oral surgeries, potentially improving patient outcomes and post-operative recovery.

Reference:

Jason, A. S., Sundaram, G. A., Preethi, Kumar, S. P., & Krishnan, M. Comparison of the efficacy of midazolam and dexmedetomidine as sedative agents in third molar surgery. Cureus,2023;15(11):e49477. https://doi.org/10.7759/cureus.49477

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