MKCG Medical College Hospital doctors perform laparoscopic bilateral adrenalectomy on 9-year-old girl

Berhampur: Doctors at the government-run MKCG Medical College and Hospital recently achieved a milestone by performing a laparoscopic bilateral adrenalectomy on a 9-year-old girl suffering from Cushing syndrome, an exceptionally rare condition. This marked the first instance of such a procedure in the state. 

Cushing syndrome is caused due to a rare genetic disease called primary pigmented nodular adrenocortical disease (PPNAD), an extremely rare disorder with a prevalence of less than one in two lakh. The doctors took around three hours to perform the laparoscopic on April 9, said a doctor.

According to a PTI report, “This might be the first case in the state and our doctors successfully treated the girl. The condition of the girl is now good and will be in the hospital for some days for observation,” said Suchitra Dash, superintendent of the medical college and hospital.

Also Read:Odisha Govt to set up 11 cancer care units, Rs 1001 crore boost for cancer care

The medical college’s principal, Santosh Kumar Mishra, and superintendent extended their gratitude to the dedicated team of doctors who tackled this challenging procedure.

Cushing syndrome manifests with small to normal-sized adrenal glands containing multiple pigmented nodules, leading to excessive cortisol hormone secretion from both glands. Left untreated, it can precipitate severe cardiac complications, strokes, and premature mortality.

The prescribed treatment involves the removal of both adrenal glands, followed by lifelong steroid supplementation at low doses, as elucidated by Professor P. Ravi Kumar from the endocrinology department.

This was a very challenging operation performed by a team of doctors consisting of paediatric surgeons, urologists, anaesthesia, and paediatrics departments.

Besides, parent department endocrinology provided support for steroids throughout the surgery, said Manas Ranjan Dash, associate professor, of paediatrics surgery, who led the team, news agency PTI reported.

Ravi Kumar said the patient from Khandadeuli village in Ganjam district was admitted to the endocrinology department on April 4. She was suffering from excessive weight, acne and high blood pressure. After thoroughly investigating, she was diagnosed to be a case of Cushing syndrome, he said.

Also Read:Fetus in Fetu: Doctors at UP hospital remove foetus from 7-month-old boy’s stomach

Powered by WPeMatico

Himcare Payment Delay: Health services hit at IGMC Shimla

Shimla: Himcare and Ayushman cardholders are facing difficulties obtaining essential medicines at the Indira Gandhi Medical College and Hospital’s (IGMC) Jan Aushadhi store, where they are entitled to receive them free of cost.

Sources reveal that the outstanding payments under these schemes at IGMC have soared to over Rs 65 crore, contributing to a cumulative debt of approximately Rs 300 crore statewide.

Furthermore, certain departments have ceased providing free surgeries to cardholders, creating a need to purchase costly equipment such as stents and pacemakers. Patients availing treatment under the Himcare and Ayushman health schemes at the Indira Gandhi Medical College (IGMC) and Hospital, Shimla, find themselves in a predicament as pending payments under these schemes lead to disruptions in services, reports the Daily. 

Also Read:Committe to address grievances, demands of doctors: Himachal CM Sukhu

The repercussions of these payment delays extend beyond the medical institution, affecting drug distributors who have suspended supplies to the hospital’s Jan Aushadhi store due to unpaid dues. Consequently, patients are compelled to procure medicines not available at the Jan Aushadhi store from the open market at full price. Anuj Jain, secretary of the Shimla Chemists and Druggists Association, expressed disappointment over the prolonged non-payment, stating that their dues have remained outstanding for nearly a year. Despite their efforts to sustain supplies, they were compelled to halt operations. 

“Our payments have not been released for almost a year now. We kept supplying medicines for as long as we could but eventually, we had to stop it about a month back. The companies are not supplying medicines without the payment now,” he told The Tribune. “We have been assured by the hospital administration that payments will be released by April 15,” he added.

Rajeev Saizal, the former Health Minister has alleged that the pending payments might indicate the government’s reluctance in continuing these schemes. “The suppliers have stopped the delivery of medicine and equipment. As a result, several departments have stopped the free-of-cost surgeries,” he added. Acknowledging the severity of the situation, an official from the state health authority affirmed that they are actively engaging with the government to address the issue of payment delays. 

Also Read: PGI Chandigarh, HIMCARE join hands for cashless treatment

Powered by WPeMatico

USFDA accepts for review GSK 5-in-1 meningococcal ABCWY vaccine candidate

London: GSK plc has announced that the US Food and Drug Administration (FDA) has accepted for review a Biologics License Application (BLA) for its 5-in-1 meningococcal ABCWY (MenABCWY) vaccine candidate. The Prescription Drug User Fee Act (PDUFA) action date for a regulatory decision by the US FDA on this application is 14 February 2025.

GSK’s 5-in-1 MenABCWY vaccine candidate combines the antigenic components of its two well-established meningococcal vaccines with demonstrated efficacy and safety profiles, Bexsero (Meningococcal Group B Vaccine) and Menveo (Meningococcal [Groups A, C, Y, and W-135] Oligosaccharide Diphtheria CRM197 Conjugate Vaccine). The MenABCWY combination will target the five groups of the bacteria Neisseria meningitidis (Men A, B, C, W and Y) that cause most invasive meningococcal disease (IMD) cases globally.

According to the Company, combining the protection offered by these vaccines into fewer shots aims to reduce the number of injections, simplifying immunisation. This can help increase series completion and vaccination coverage and help reduce the overall burden of IMD, with unvaccinated adolescents being at particular risk of infection and potential outbreaks.

IMD is an unpredictable but serious illness that can cause life-threatening complications. Despite treatment, among those who contract IMD one in six will die, sometimes in as little as 24 hours. One in five survivors may suffer long-term consequences such as brain damage, amputations, hearing loss and nervous system problems. Although anyone can get IMD, those who are in their late teens and early adulthood are amongst the groups at higher risk of contracting it.

In the US, while meningococcal vaccine recommendations for all five serogroups have been in place since 2015, annual immunisation rates for IMD have remained low overall, due in part to a complex schedule. MenB is the most common group of IMD-causing bacteria in US adolescents and young adults, accounting for more than half of the IMD cases among this age group in the US from 2017-2021. For protection against MenB, which is subject to the shared clinical decision-making recommendation of the CDC, just under 12% of US adolescents have had the two required doses.

In the phase III trial , all primary endpoints were achieved for the MenABCWY vaccine candidate, including immunological non-inferiority to one dose of GSK’s Meningococcal Groups A,C,Y and W Vaccine, and non-inferior immune responses against 110 diverse MenB invasive strains (representing 95% of MenB strains circulating in the US) as compared to two doses of GSK’s Meningococcal Group B Vaccine. The vaccine was well tolerated with a safety profile consistent with both vaccines.

Read also: CDSCO Panel grants GSK’s Updated Prescribing Information for Antibiotic FDC of Amoxicillin, Clavulanic acid

Powered by WPeMatico

Higher levels of arm and trunk fat tied to greater CVD, mortality risk in people with type 2 diabetes: Study

China: Arm fat and trunk fat are positively associated with the risk of cardiovascular disease (CVD) and mortality among people with type 2 diabetes (T2D), a recent study has revealed. However, leg fat was shown to be inversely associated with the risk of CVD and mortality.

The findings, published in The Journal of Clinical Endocrinology & Metabolism highlight the importance of considering body fat amount and location for CVD and mortality risk assessment among individuals with T2D.

The intricate relationship between body fat distribution and health outcomes has been the subject of considerable research, particularly in individuals with type 2 diabetes. Recent studies have delved into the associations of regional body fat with the risk of CVD and mortality in this population, shedding light on crucial aspects of diabetes management and prevention strategies.

One of the focal points of investigation has been adipose tissue distribution, particularly visceral fat versus subcutaneous fat. Visceral fat, located around internal organs, has been implicated in metabolic disturbances, insulin resistance, and a higher risk of CVD events. Subcutaneous fat, found beneath the skin, has traditionally been considered less harmful. However, emerging evidence suggests that its distribution and characteristics also play a significant role in cardiometabolic health.

Against the above background, Gang Liu, Huazhong University of Science and Technology, Wuhan, China, and colleagues aimed to prospectively examine the association between regional body fat and CVD risk in individuals with type 2 diabetes, who often exhibit changes in relative fat distribution and have increased CVD risk.

The main analysis comprised 21,472 participants with T2D from the UK Biobank. Regional body fat was measured by bioelectric impedance assessment. Cox proportional hazard regression models were used to estimate hazard ratios (HRs).

The study led to the following findings:

  • Over a median of 7.7 years of follow-up, 3,976 CVD events occurred.
  • After multivariable adjustment, upper and lower body fat were independently and oppositely associated with CVD risk among patients with T2D.
  • Higher arm fat percentage was linearly associated with increased CVD risk, while higher trunk fat percentage was nonlinearly associated with increased CVD risk.
  • Higher leg fat percentage was nonlinearly associated with lower CVD risk.
  • When comparing extreme quartiles, the multivariable-adjusted HR of CVD was 0.72 for leg fat percentage, 1.63 for arm fat percentage, and 1.27 for trunk fat percentage.
  • Similar patterns of associations were observed for all-cause and CVD mortality.
  • Leg fat percentage, but not other regional fat percentage, was associated with CVD risk independently of traditional measures of obesity.

In conclusion, higher levels of arm and trunk fat were linked to greater CVD and mortality risks for people with T2D. In contrast, higher levels of leg fat were associated with reduced CV and mortality risks.

Reference:

Qiu, Z., Lee, D. H., Lu, Q., Li, R., Zhu, K., Li, L., Li, R., Pan, A., Giovannucci, E. L., & Liu, G. Associations of Regional Body Fat with Risk of Cardiovascular Disease and Mortality among Individuals with Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae192

Powered by WPeMatico

Maternal iron and vitamin D levels during mid-pregnancy independently linked to third-trimester depression symptoms: Study

Pregnant individuals often struggle to obtain adequate iron and vitamin D due to factors such as limited food access, nutrient bioavailability, dietary restrictions, location or seasonality, and medical conditions. These micronutrients are crucial for optimal fetal development and maternal health. Iron deficiency affects 20% of pregnancies globally, while the global prevalence of vitamin D sufficiency is unclear.

According to a study published in The Journal of Nutrition, researchers have concluded that Maternal iron and vitamin D levels during mid-pregnancy were found to be independently linked to third-trimester depression symptoms. Specifically, adequate levels of these nutrients during the second trimester were associated with fewer depression symptoms in the third trimester.
The Alberta Pregnancy Outcomes and Nutrition study enrolled pregnant women and their children from Calgary and Edmonton in Canada. The study measured iron biomarkers and vitamin D metabolites using various techniques. Four categories of iron and vitamin D status during the second trimester were identified based on SF(serum ferritin) and a total of 25(OH)D concentrations. EPDS scores during the third trimester and three months postpartum were obtained for 1920 and 1822 participants, respectively.
Key findings from the study are:
· During the second trimester, the Concentrations of maternal 25(OH)D3, 3-epi-25(OH)D3, and the ratio of both metabolites were higher than their status at three mo postpartum.
· Higher second-trimester maternal concentrations of SF, hepcidin and 25(OH)D3 predicted lower maternal EPDS scores during the third trimester.
· Pregnant individuals with a low iron (SF <15 μg/L) and replete vitamin D (25(OH)D ≥75 nmol/L) or low iron (SF <15 μg/L) and vitamin D (25(OH)D <75 nmol/L)status during midpregnancy had higher third-trimester EPDS scores compared with those that were replete in both micronutrients.
In conclusion, a higher mid-pregnancy maternal iron and vitamin D status, either alone or in combination, predicted fewer depression symptoms in the third trimester. Postpartum, maternal 25(OH)D3 and 3-epi-25(OH)D3 levels may be lower than in mid-pregnancy. This study is one of the first to examine the combined impact of maternal iron and vitamin D status on depression during pregnancy.
Reference:
Evanchuk JL et al. Maternal Iron and Vitamin D Status during the Second Trimester Is Associated with Third Trimester Depression Symptoms among Pregnant Participants in the APrON Cohort. J Nutr. 2024 Jan;154(1):174-184.

Powered by WPeMatico

Ascending- descending ultrafiltration may help stabilizethe blood pressure levels among hemodialysis patients, suggests study

Ascending- descending ultrafiltration may help stabilise blood pressure levels among hemodialysis patients, suggests study published in the BMC Nephrology.

Considering no previous research into the utilization of ascending/descending ultrafiltration and linear sodium profiles in improving blood pressure among hemodialysis patients, the present study aimed to explore the effect of the A/D-UF along with linear sodium profiles on HD patients with hypotension. Applying a crossover design, this clinical trial was fulfilled between December 2022 and June 2023 on 20 patients undergoing HD, randomized into two groups, each one receiving two intervention protocols, viz., (a) an intervention protocol in which the liquid sodium in the dialysis solution was linear and the UF profiling was A/D, and (b) a routine protocol or HD, wherein both liquid sodium and UF in the dialysis solution remained constant. The HD patients’ BP was then checked and recorded at six intervals, namely, before HD, one, two, three, and four hours after it, and following its completion, within each session. The data were further statistically analyzed using the IBM SPSS Statistics 20 and the related tests.

Results: In total, 20 patients, including 12 men (60%) and 8 women (40%), with the mean age of 58.00 ± 14.54 on HD for an average of 54 months, were recruited in this study. No statistically significant difference was observed in the mean systolic and diastolic BP levels in the group receiving the A/D-UF profile all through the desired hours (p > 0.05), indicating that the patients did not face many changes in these two numbers during HD. Our cross-over clinical trial demonstrated a statistically significant reduction in symptomatic IDH episodes from 55 to 15% with the application of the A/D-UF profile (p < 0.05). The study demonstrated that the A/D-UF profile could contribute to the stability of blood pressure levels among HD patients, with no significant fluctuations observed during treatment sessions.

Reference:

Arasnezhad, M., Namazinia, M., Mazlum, S.R. et al. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrol 25, 128 (2024). https://doi.org/10.1186/s12882-024-03554-6

Powered by WPeMatico

Masquelet technique and double plate fixation combo effectively treats large segmental bone defects of distal tibia: Study

Masquelet technique and double plate fixation combo effectively treats large segmental bone defects of the distal tibia suggests a study published in the BMC Surgery.

There is no effective consensus on the choice of internal fixation method for the Masquelet technique in the treatment of large segmental bone defects of the distal tibia. Thus, the study aimed to investigate the outcomes of the Masquelet technique combined with double plate fixation in the treatment of large segmental bone defects. This was a retrospective study involving 21 patients with large segmental bone defects of the distal tibia who were treated between June 2017 and June 2020. The length of bone defect ranged from 6.0 cm to 11 cm (mean, 8.19 cm). In the first stage of treatment, following complete debridement, a cement spacer was placed to induce membrane formation. In the second stage, double plate fixation and autologous cancellous bone grafting were employed for bone reconstruction. Each patient’s full weight-bearing time, bone healing time, and Iowa ankle score were recorded, and the occurrence of any complications was noted.

Results: All patients were followed up for 16 to 26 months (mean, 19.48 months). The group mean full weight-bearing time and bone healing time after bone grafting were 2.41 (± 0.37) months and 6.29 (± 0.66) months, respectively. During the treatment, one patient had a wound infection on the medial side of the leg, so the medial plate was removed. The wound completely healed after debridement without any recurrence. After extraction of iliac bone for grafting, one patient had a severe iliac bone defect, which was managed by filling the gap with a cement spacer. Most patients reported mild pain in the left bone extraction area after surgery. The postoperative Iowa ankle score range was 84–94 (P < 0.05). In this cohort, 15 cases were rated as “excellent”, and 6 cases as “good” on the Iowa ankle scoring system. The Masquelet technique combined with double plate fixation is a safe and effective method for the treatment of large segmental bone defects of the distal tibia.

Reference:

Wang, Z., Zou, C., Zhan, X. et al. Application of double plate fixation combined with Masquelet technique for large segmental bone defects of distal tibia: a retrospective study and literature review. BMC Surg 24, 103 (2024). https://doi.org/10.1186/s12893-024-02396-1

Powered by WPeMatico

IV iron therapy effectively improves anemia in pediatric patients with IBD: Study

A recent study published in the World Journal of Clinical Pediatrics unveiled the effectiveness and safety of intravenous (IV) iron therapy for treating iron deficiency anemia (IDA) in children with inflammatory bowel disease (IBD). Iron deficiency anemia is a common complication in pediatric patients with IBD, primarily due to chronic inflammation that disrupts iron absorption and metabolism. Despite the recognized need for aggressive treatment, there has been hesitance to prescribe IV iron, largely due to concerns over potential adverse reactions. The study by Krishanth Manokaran and team addressed these concerns by evaluating the safety and efficacy of IV iron therapy in this group.

This study spanned from September 2017 to December 2019 and included a cohort of 236 pediatric patients by underlining a major step forward in pediatric IBD management. Out of the total 236 patients admitted during the study period, 92 met the criteria for IDA. The treatment modalities were split where 57 patients received IV iron, 17 patients were given oral iron supplements and 18 patients were discharged before any iron therapy could be administered. The findings observed that patients receiving IV iron showed a significant improvement in their health outcomes.

These patients experienced an increase in mean hemoglobin (Hb) levels by 1.9 g/dL at their first outpatient follow-up which is markedly higher than the increases noticed in the individuals who received oral iron or no iron treatment, which were both only 0.8 g/dL. This study also highlighted the safety of IV iron therapy with only one reported adverse reaction among the 57 patients treated through this method which translated to an incidence rate of just 1.8%. This low rate of adverse events suggests that IV iron is both a safe and more effective alternative to oral iron supplements for managing IDA in pediatric IBD patients.

These results provide empirical support for clinicians who consider IV iron therapy for young patients. Improved hemoglobin and iron levels significantly improve the quality of life and overall health outcomes for children suffering from this chronic condition. Overall, the findings from this study pave the way for more standardized use of IV iron in pediatric IBD treatment to reduce the reluctance among healthcare providers to utilize this treatment.

Source:

Manokaran, K., Spaan, J., Cataldo, G., Lyons, C., Mitchell, P. D., Sare, T., Zimmerman, L. A., & Rufo, P. A. (2024). Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience. In World Journal of Clinical Pediatrics (Vol. 13, Issue 1). Baishideng Publishing Group Inc. https://doi.org/10.5409/wjcp.v13.i1.89318

Powered by WPeMatico

Unlocking Insights: The real-world BrIDGE study on brodalumab effectiveness in psoriasis patients

Greece: A large-scale study evaluating brodalumab for moderate-to-severe plaque psoriasis revealed significant improvements in patient outcomes.

The study of 638 patients showed that brodalumab led to substantial reductions in the Psoriasis Area and Severity Index (PASI) scores, with 74.0% achieving PASI ≤3 by week 12. In particular, 54.1% of patients achieved complete clearance (PGA0). The findings were published online in the Journal of the European Academy of Dermatology and Venereology on February 03, 2024.

In the psoriasis treatment landscape, it is crucial to understand the real-world effectiveness of medications for healthcare professionals to make informed decisions. The BrIDGE study in Greece offers valuable insights into brodalumab effectiveness in patients with moderate-to-severe plaque psoriasis.

Brodalumab, a human monoclonal antibody targeting the interleukin-17 receptor, has shown promising results in clinical trials for treating psoriasis. However, real-world data is essential to confirm its efficacy and safety in diverse patient populations. Therefore, Dimitrios Rigopoulos, 1st Department of Dermatology-Venereology, University of Athens, Athens, Greece, and colleagues conducted an observational, prospective, single-cohort, multicentre study (BrIDGE) that recruited patients with moderate-to-severe plaque psoriasis in Greece.

The primary objective was to assess the proportion of patients who achieved PASI 100 after 24 weeks. Other endpoints included: the short-term response [PASI75/90/100 and static Physician’s Global Assessment (sPGA) 0/1] to brodalumab at 12–16 weeks, the maintenance of PASI90/100 through to 104 weeks, and the time to complete clearance. Moreover, the researchers explored the change in the quality of life [Dermatology Life Quality Index (DLQI) 0/1] and adherence to brodalumab.

The researchers recruited two hundred patients initiating treatment with or switching to brodalumab. Analyses were conducted using the observed data and three imputation approaches were applied for the missing data.

The study led to the following findings:

  • Based on the ‘as observed data’, 42.0% of patients achieved PASI100 at Week 24 after 25.9 ± 3.5 weeks and 65% of patients attained PASI100 at Week 104.
  • In total, 70.2%, 47.5%, and 32.0% achieved PASI75/90/100, respectively, whereas 72.6% of patients achieved sPGA 0/1, at Weeks 12–16.
  • For sPGA status 82.8%, 89.2%, and 92.5% of patients achieved sPGA 0/1 at Weeks 24, 52, and 104, respectively.
  • The time to achieve PASI100 at Weeks 12–16 was 13.7 ± 1.3, 52.1 ± 3.4 weeks at Week 52 and 105.5 ± 4.8 weeks at Week 104.
  • Mean DLQI and Psoriasis Symptom Inventory (PSI) scores decreased by 11.4 ± 7.0 and 15.4 ± 6.5 points from baseline to Week 104, respectively. Treatment adherence was equal to 98.9%.

In conclusion, the study found that brodalumab confers rapid and durable responses and improvements in the quality of life of patients with moderate-to-severe psoriasis.

Reference:

Rigopoulos, D., Tampouratzi, E., Angelakopoulos, C., Apalla, Z., Barkis, I., Georgiou, S., Delli, F., Drosos, A., Zafiriou, E., Katsantonis, J., Lazaridou, E., Panagakis, P., Papadavid, E., Papakonstantis, M., Roussaki-Schulze, V., Sotiriou, E., Anastasiadis, G., Chasapi, V., Sfaelos, K., . . . Ioannides, D. Real-world data on the effectiveness of brodalumab in patients with moderate-to-severe plaque psoriasis in the Greek clinical setting (the BrIDGE study). Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.19816

Powered by WPeMatico

Endobronchial valve therapy for emphysema improves lung function and quality of life, finds research

A new study published in the Annals of the American Thoracic Society revealed the long-term efficacy of the Spiration Valve System (SVS) in treating severe heterogeneous emphysema. The EMPROVE study was conducted over a 24-month period that marks a significant advancement in understanding and managing this debilitating respiratory condition. EMPROVE trial is one of the first rigorous comparison between treatment and control groups over an extended follow-up period.

The findings from EMPROVE paint a promising picture for emphysema patients. The patients receiving SVS treatment demonstrated a remarkable and sustained improvement in lung function measured by the forced expiratory volume in 1 second (FEV1), even after 24 months. Also, significant enhancements in quality-of-life (QOL) measures were observed, including the marked improvements in respiratory symptoms and reduced dyspnea when compared to the control group.

The absence of significant adverse events associated with SVS treatment was a remarkable finding of this study. Despite the prevailing concerns about potential complications, the incidence of acute chronic obstructive pulmonary disease exacerbations and pneumothorax remained low and comparable between the treatment and control groups.

The durability of SVS treatment demonstrated in this study offers hope for the patients with emphysema who seek long-lasting relief from their symptoms. These results validate the effectiveness of endobronchial valve therapy, and also they highlight its safety and potential to transform the management of severe emphysema.

Research:

Criner, G. J., Mallea, J. M., Abu-Hijleh, M., Sachdeva, A., Kalhan, R., Hergott, C. A., Lazarus, D. R., Mularski, R. A., Calero, K., Reed, M. F., Nsiah-Dosu, S., Himes, D., Kubo, H., Kinsey, C. M., Majid, A., Hogarth, D. K., Kaplan, P. V., Case, A. H., Makani, S. S., … Shepherd, R. W. (2024). Sustained Clinical Benefits of Spiration Valve System in Patients with Severe Emphysema: 24-Month Follow-Up of EMPROVE. In Annals of the American Thoracic Society (Vol. 21, Issue 2, pp. 251–260). American Thoracic Society. https://doi.org/10.1513/annalsats.202306-520oc

Powered by WPeMatico