Moderate and large volume nonmalignant pleural effusions independently associated with AKI: Study

Moderate and large effusion volume nonmalignant pleural effusions independently associated with acute kidney injury suggests a study published in the BMC Nephrology.

Nonmalignant pleural effusion (NMPE) is common and remains a definite healthcare problem. Pleural effusion was supposed to be a risk factor for acute kidney injury (AKI). The incidence of acute kidney injury in NMPE patients and whether there is a correlation between the size of effusions and acute kidney injury is unknown. A study was done to assess the incidence of acute kidney injury in NMPE inpatients and its association with effusion size. They conducted a retrospective cohort study of inpatients admitted to the Chinese PLA General Hospital with pleural effusion from 2018-2021. All patients with pleural effusions confirmed by chest radiography (CT or X-ray) were included, excluding patients with a diagnosis of malignancy, chronic dialysis, end-stage renal disease (ESRD), community-acquired acute kidney injury, hospital-acquired AKI before chest radiography, and fewer than two serum creatinine tests during hospitalization. Multivariate logistic regression and LASSO logistic regression models were used to identify risk factors associated with AKI. Subgroup analyses and interaction tests for effusion volume were performed and adjusted for the variables selected by LASSO. Causal mediation analysis was used to estimate the mediating effect of heart failure, pneumonia, and eGFR < 60 ml/min/1.73m2 on AKI through effusion volume.

Results: NMPE was present in 7.8% of internal medicine inpatients. Of the 3047 patients included, 360 (11.8%) developed AKI during hospitalization. After adjustment by covariates selected by LASSO, moderate and large effusions increased the risk of acute kidney injury compared with small effusions (moderate: OR 1.47, 95%CI 1.11-1.94 p = 0.006; large: OR 1.86, 95%CI 1.05-3.20 p = 0.028). No significant modification effect was observed among age, gender, diabetes, bilateral effusions, and eGFR. Volume of effusions mediated 6.8% (p = 0.005), 4.0% (p = 0.046) and 4.6% (p < 0.001) of the effect of heart failure, pneumonia and low eGFR on the development of acute kidney injury respectively.

The incidence of acute kidney injury is high among NMPE patients. Moderate and large effusion volume is independently associated with acute kidney injury compared to small size. The effusion size acts as a mediator in heart failure, pneumonia, and eGFR.

Reference:

Wang, D., Niu, Y., Chen, D. et al. Acute kidney injury in hospitalized patients with nonmalignant pleural effusions: a retrospective cohort study. BMC Nephrol 25, 118 (2024). https://doi.org/10.1186/s12882-024-03556-4

Keywords:

Moderate, large effusion volume, nonmalignant, pleural effusions, independently, AKI, BMC Nephrology, Nonmalignant pleural effusion, Acute kidney injury, Risk factor, Prognosis

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Hyperbaric Oxygen Therapy Reduces Mortality in Necrotizing Soft Tissue Infections: Study

Necrotizing soft tissue infections are life-threatening conditions that require immediate medical attention usually leading to high mortality rates and significant morbidity among survivors. A recent analysis unveiled promising outcomes for the application of Hyperbaric Oxygen Therapy (HBO) in treating Necrotizing Soft Tissue Infections (NSTI) which is a severe bacterial infection that destroys tissues under the skin. The key findings of this study were published in the World Journal of Emergency Surgery.

The conventional treatment approach includes aggressive surgical debridement, antibiotics and supportive care. The potential of HBO therapy, which involves breathing pure oxygen in a pressurized room or chamber, has been a subject of medical interest for enhancing recovery and outcomes in NSTI patients. The comprehensive meta-analysis drew data from PubMed, Embase, Web of Science and the Cochrane Library to ascertain the effectiveness of HBO when compared to standard treatments.

The study meticulously examined several observational trials which encompassed the data from a total of 49,152 patients, including 1,448 who underwent HBO therapy and 47,704 who received conventional care. The findings showed a significant reduction in the mortality rates among the patients treated with HBO, with a relative risk (RR) of 0.522 by indicating a 47.8% decrease in death rates when compared to those who did not receive HBO.

While the HBO group required a increased number of debridements to remove dead tissue, there was no significant difference in amputation rates that dispel concerns about the therapy leading to increased limb loss. The incidence of multiple organ dysfunction syndrome (MODS), a lethal complication of NSTI, was markedly lower in the HBO-treated group that suggests a substantial benefit in preventing critical complications.

These encouraging outcomes caution the evidence which primarily derived from retrospective studies that necessitates further validation through prospective research. The availability of HBO therapy which is not universally accessible across all healthcare facilities also poses a limitation to its widespread adoption. The study underscore the importance of individual patient assessment and timely surgical intervention to optimize treatment outcomes. Overall, the outcomes from this comprehensive analysis suggests a potential shift in the management of NSTI by advocating for the integration of HBO therapy as a complementary treatment strategy.

Reference:

Huang, C., Zhong, Y., Yue, C., He, B., Li, Y., & Li, J. (2023). The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis. In World Journal of Emergency Surgery (Vol. 18, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13017-023-00490-y

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Botulinum toxin improves quality of life and self-esteem in Rosacea patients, reveals study

Rosacea is characterized by the proliferation and dilation of dermal blood vessels primarily in the central areas of the face, has long been a challenge to treat effectively. A recent study unveiled efficacy of botulinum toxin (BTX) in reducing symptoms and improving the overall quality of life for rosacea patients. This study published in the International Journal of Dermatology revealed the promising new treatment avenue for patients with rosacea, a prevalent chronic inflammatory skin condition.

The results of this interventional study which was conducted at a single center included a total of 33 individuals who were diagnosed with rosacea. These patients were treated with standard therapeutic options along with superficial injections of BTX and were closely monitored for 90 days.

The findings suggest that the treatment with BTX lead to improvements in the clinical signs of rosacea, and an overwhelming 94% of participants reported marked enhancements. Importantly, the study demonstrated a statistically significant increase in both quality of life and self-esteem scores among the treated individuals.

Also, this study also highlighted the safety profile of BTX in this context, with rare adverse events observed throughout the trial period. These results offer hope for individuals affected by rosacea that could provide a potential solution in addressing the physical manifestations of the condition and also enhances overall well-being.

While acknowledging some limitations, the outcomes of this study demonstrates the positive impact of BTX treatment on both quality of life and self-esteem in rosacea patients. Further research and clinical validation is imperative which could help BTX therapy to emerge as a transformative option in bringing relief and confidence to individuals worldwide.

Reference:

Takahashi, K. H., Utiyama, T. O., Bagatin, E., Picosse, F. R., & Almeida, F. A. (2024). Efficacy and safety of botulinum toxin for rosacea with positive impact on quality of life and self‐esteem. In International Journal of Dermatology. Wiley. https://doi.org/10.1111/ijd.17040

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Bimekizumab bests Guselkumab in psoriatic arthritis, reveals new study

Bimekizumab bests Guselkumab in psoriatic arthritis, reveals new study published in the Rheumatology and Therapy.

Matching-adjusted indirect comparisons (MAIC) were used to assess the relative efficacy of bimekizumab 160 mg every 4 weeks (Q4W) compared to guselkumab 100 mg Q4W or every 8 weeks (Q8W) at 48/52 weeks in patients with psoriatic arthritis (PsA) who were biologic disease-modifying antirheumatic drug-naïve (bDMARD-naïve) or with previous inadequate response or intolerance to tumor necrosis factor inhibitors (TNFi-IR). Relevant trials were identified as part of a systematic literature review. For patients who were bDMARD-naïve, individual patient data (IPD) from BE OPTIMAL (N = 431) was matched to summary data from DISCOVER-2 (Q4W, n = 245; Q8W, n = 248). For patients who were TNFi-IR, IPD from BE COMPLETE (n = 267) and summary data from COSMOS (Q8W, N = 189). Trial populations were re-weighted using propensity scores. Unanchored comparisons of recalculated bimekizumab and guselkumab 48- or 52-week non-responder imputation outcomes for 20/50/70% improvement in American College of Rheumatology score (ACR20/50/70) and minimal disease activity (MDA) index were analyzed. Results: In patients who were bDMARD-naïve, bimekizumab was associated with a greater likelihood of ACR50 (odds ratio [95% confidence interval] 1.62 [1.07, 2.44]; p = 0.021), ACR70 (2.20 [1.43, 3.38]; p < 0.001), and MDA (1.82 [1.20, 2.76]; p = 0.005) compared to guselkumab Q4W at week 52. Bimekizumab also had a greater likelihood of ACR70 response (2.08 [1.34, 3.22]; p = 0.001) and MDA (2.07 [1.35, 3.17]; p < 0.001) compared to guselkumab Q8W at week 52. In patients who were TNFi-IR, bimekizumab had a greater likelihood in achieving all evaluated outcomes compared to guselkumab Q8W at week 48/52 (ACR20, 1.77 [1.15, 2.72]; p = 0.010; ACR50, 1.56 [1.03, 2.36]; p = 0.037; ACR70, 1.66 [1.05, 2.61]; p = 0.028; and MDA, 1.95 [1.27, 3.02]; p = 0.003). According to MAICs, bimekizumab demonstrated greater or comparable efficacy on ACR50/70 and MDA outcomes than guselkumab in patients with PsA who were bDMARD-naïve and TNFi-IR at week 48/52. Bimekizumab had a more favorable likelihood than guselkumab in achieving more stringent treatment outcomes.

Reference:

Warren RB, McInnes IB, Nash P, et al. Comparative Effectiveness of Bimekizumab and Guselkumab in Patients with Psoriatic Arthritis at 52 Weeks Assessed Using a Matching-Adjusted Indirect Comparison. Rheumatol Ther. Published online March 15, 2024. doi:10.1007/s40744-024-00659-0

Deodhar A. Mirror, mirror, on the wall, which is the most effective biologic of all? J Rheumatol. 2018;45(4):449–50.

Keywords:

Bimekizumab, bests, Guselkumab, psoriatic arthritis, Warren RB, McInnes IB, Nash P, Rheumatology and Therapy

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Initiation of medication for alcohol use disorder at discharge may reduce readmissions: JAMA

Researchers at Massachusetts General Hospital in Boston have found in a new cohort study that starting medication for alcohol use disorder (MAUD) at discharge among people with alcohol-related hospitalizations may reduce likelihood of readmission.

US Food and Drug Administration–approved medications for alcohol use disorder (MAUD) are significantly underused. Hospitalizations may provide an unmet opportunity to initiate MAUD, but few studies have examined clinical outcomes of patients who initiate these medications at hospital discharge. A study was done toinvestigate the association between discharge MAUD initiation and 30-day posthospitalization outcomes. This cohort study was conducted among patients with Medicare Part D who had alcohol-related hospitalizations in 2016. Data were analyzed from October 2022 to December 2023. The primary outcome was a composite of all-cause mortality or return to hospital (emergency department visits and hospital readmissions) within 30 days of discharge. Secondary outcomes included these components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. Propensity score 3:1 matching and modified Poisson regressions were used to compare outcomes between patients who received and did not receive discharge MAUD. Results There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 [46-62] years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 192 hospitalizations (2.0%) involved discharge MAUD initiation. After propensity matching, discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58 [95% CI, 0.45 to 0.76]; absolute risk difference, −0.18 [95% CI, −0.26 to −0.11]). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56 [95% CI, 0.43 to 0.73]) except for mortality, which was rare in both groups (incident rate ratio, 3.00 [95% CI, 0.42 to 21.22]). Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital. In this cohort study, discharge initiation of MAUD after alcohol-related hospitalization was associated with a large absolute reduction in return to hospital within 30 days. These findings support efforts to increase uptake of MAUD initiation at hospital discharge.

Reference:

Bernstein EY, Baggett TP, Trivedi S, Herzig SJ, Anderson TS. Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge. JAMA Netw Open. 2024;7(3):e243387. doi:10.1001/jamanetworkopen.2024.3387

Keywords:

Initiation, medication, alcohol use disorder, discharge, readmissions, Bernstein EY, Baggett TP, Trivedi S, Herzig SJ, Anderson TS

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Earlier menopause worsens impact of high CV risk on cognitive decline: Study

Canada: A recent study published in Neurology suggests that earlier menopause may worsen the effects of high cardiovascular risk on cognitive decline. 

“Earlier menopause combined with a higher risk of cardiovascular disease is linked to an increased risk of thinking and memory problems later,” the study stated. In the study, earlier menopause is defined as occurring before age 49.

As a person ages, blood vessels, including those in the brain, can be damaged by controllable cardiovascular risk factors such as high blood pressure, diabetes and smoking. These risk factors not only increase a person’s risk of cardiovascular disease, they increase the risk of dementia.

“While cardiovascular risk factors are known to increase a person’s risk for dementia, what is lesser known is why women have a greater risk for Alzheimer’s disease than men,” said study author Jennifer Rabin, PhD, of the University of Toronto in Canada. “We examined if the hormonal change of menopause, specifically the timing of menopause, may play a role in this increased risk. We found that going through this hormonal change earlier in life while also having cardiovascular risk factors is linked to greater cognitive problems when compared to men of the same age.”

The study involved 8,360 female participants and 8,360 male participants matched for age who were enrolled in the Canadian Longitudinal Study on Aging. Female participants had an average age at menopause of 50. All participants had an average age of 65 at the start of the study and were followed for three years.

Researchers divided female participants into three groups: those who experienced earlier menopause between ages 35 and 48; average menopause between ages 49 and 52; and later menopause between ages 53 and 65. Researchers also looked at whether they had used hormone therapy containing estrogens.

For all participants, researchers reviewed six cardiovascular risk factors: high LDL cholesterol, diabetes, obesity, smoking, high blood pressure, as well as prescriptions for medications to lower blood pressure.

Participants were given a series of thinking and memory tests at the start and the end of the study. Researchers calculated cognitive scores for each person.

Researchers then examined the associations of cardiovascular risk with cognitive scores in female participants in the three groups and compared them to the same association in male participants.

After adjusting for factors such as age and education, researchers found that female participants with both earlier menopause and higher cardiovascular risk had lower cognitive scores three years later. For each one standard deviation increase in cardiovascular risk score, female participants with earlier menopause showed a 0.044 standard deviation decrease in cognitive scores, compared to male participants in the same age group who showed a 0.035 standard deviation decrease in cognitive scores.

Researchers did not find a similar association for female participants with average or later menopause. Hormone therapy did not affect the results.

“Our study suggests that earlier menopause may worsen the effects of high cardiovascular risk on cognitive decline,” said Rabin. “Since our study followed participants for only three years, more research is needed over longer periods of time. Our findings highlight that age at menopause as well as cardiovascular risk should be considered when developing prevention strategies for cognitive decline.”

A limitation of the study was that the age of menopause was self-reported, and participants may not have remembered that age accurately. Another limitation was that researchers did not include participants who reported a hysterectomy since the age of the procedure was not available. Additionally, no data was available on whether participants had surgical removal of one or both ovaries.

Reference:

Madeline Wood Alexander, Che-Yuan Wu,  Priya Palta, Walter Swardfager, Mario Masellis, Liisa A.M. Galea, Gillian Einstein, Sandra E. Black, and Jennifer S. Rabin, Associations Between Age at Menopause, Vascular Risk, and 3-Year Cognitive Change in the Canadian Longitudinal Study on Aging, Neurology, https://doi.org/10.1212/WNL.0000000000209298.

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Contact with kids most important factor in the onward transmission of pneumococcal pneumonia to elderly: Study

Spain: A recent study has suggested the main benefit of adult pneumococcal vaccination is to directly protect older adults exposed to children who may still carry and transmit some vaccine-type pneumococcal strains despite successful national childhood vaccination programs.

New research being presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024) in Barcelona, Spain (27-30 April) finds that pneumonia-causing bacteria are common in the over 60s and that contact with pre-school and young school-aged children appears to be the most important factor in the onward transmission of Streptococcus pneumoniae (pneumococcus) to the over 60s.

Pneumococcus is the main bacterial pathogen involved in ear and sinus infections but is also a major cause of more severe diseases such as pneumonia, sepsis, and meningitis. Pneumococcal infections mainly affect children under two and the elderly and claim almost two million lives worldwide every year.

The US CDC estimates that pneumococci cause more than half of all cases of bacterial meningitis in the USA with around 2,000 cases of pneumococcal meningitis occurring each year. Over 150,000 hospitalizations from pneumococcal pneumonia occur every year in the USA, and pneumococci are also the most common bacterial cause of childhood pneumonia, especially in children under 5 years. In adults, pneumococci account for 10% to 30% of adult community-acquired pneumonia.

Since pneumococcal conjugate vaccines (PCV) were included in America’s childhood vaccination program in 2000, invasive disease caused by vaccine-type strains in children has decreased by over 90%, an effect that has not been seen in older adults. This suggests that pneumococci might be transmitted by age groups other than children.

Pneumococci commonly inhabit the respiratory tract of healthy persons and are transmitted via respiratory droplets. Rates of asymptomatic carriage vary-the CDC estimates that among school-age children, 20% to 60% may be colonised, while only 5% to 10% of adults without children are colonised.

Important questions remain about the sources of transmission of pneumococcus to older adults in the community. This information is vital for understanding the potential indirect effects of using PCVs in children and older adults.

“If substantial pneumococcal transmission occurs between adults, then vaccination of older adults could have the additional benefit of reducing transmission and potentially serious disease”, explains lead author Dr Anne Wyllie from the Yale School of Public Health, New Haven, USA.

To find out more about the importance of within-household transmission between adults aged 60 and older, and the risks associated with acquiring pneumococcus in the community, researchers conducted a longitudinal study in New Haven, Connecticut of household pairs (e.g. married couples) aged 60 and older without younger individuals living in the household.

Throughout autumn/winter 2020/2021 and 2021/2022, a total of 183 adults (average age 70 years; 51% female; 85% White) living in 93 households were enrolled.

Researchers collected saliva samples and data from questionnaires about social behaviours and health from participants every 2 weeks over six visits (over 10 weeks).

Quantitative PCR (qPCR) was used to test saliva samples for the presence of pneumococcal DNA and the diversity of pneumococcal strains. Usually, testing for pneumococcus in adults is assessed using nasopharyngeal swabs-taken from far back inside the nostril. Previous work by the same author established that this is insufficient to capture carriage in adults so sampling saliva is more effective at detecting pneumococcus in adults.

The analyses found that overall, 52/1,088 (4.8%) samples tested positive for pneumococcus, with 28/183 (15%) individuals colonised on at least one sampling visit.

Several individuals tested positive for pneumococcus at multiple timepoints including two participants who were colonized throughout the 10-week sampling period. Two other adults tested positive at five of the six time points-one of whom reported daily contact with children aged 2-59 months and 5-9 years.

In 5/93 (5.4%) households, both members were carriers, though not necessarily at the same time point.

Pneumococcal carriage point prevalence (at any sampled time) was substantially (six times) higher among older adults who had contact with children daily/every few days (10%) compared to those who had no contact with children (1.6%).

For those participants who reported recent contact (within 2 weeks of sample collection): point prevalence was highest in those in contact with younger children, with those who reported recent contact with <5-year-olds and 5-9-year-olds having point prevalences of 14.8% and 14.1%, respectively; compared with those reporting contact with children aged 10 years and over that had a point prevalence of 8.3%. Looking in detail at the youngest children, the point prevalences were: for children up to age 1 year (14%), 1-2 years (11%) and 2-5 years (17%).

While the numbers were small, those who had contact with children daily or every few days had the highest prevalence (15.7% and 14.0%, respectively). Those who had contact once or twice a month or no contact had lower prevalence (4.5% and 1.8% respectively).

Recent (within 2 weeks of sample) contact with children aged under 10 years was associated with a significant (3-times) increase in acquisition rate compared with no contact. Likewise, those over-60s with contact with children daily or every few days had a 6-times higher risk of acquisition than those without contact with children.

“Our study found no clear evidence of adult-to-adult transmission even though there were households in which an individual was positive for pneumococcus across numerous sampling moments, and instances where both adults in the household carried pneumococcus around the same time”, says Dr Wyllie.

“Instead, we found that transmission was highest among older adults who had frequent contact with young children. This suggests that the main benefit of adult pneumococcal vaccination is to directly protect older adults exposed to children who may still carry and transmit some vaccine-type pneumococcal strains despite successful national childhood vaccination programmes.”

The authors note that the study period coincided with the COVID-19 pandemic, so they were able to explore risk factors for pneumococcal carriage when strict transmission mitigation measures were in place and eased over time. Interestingly, carriage rates remained consistent across both study seasons, despite a return to community activities in the second season and an increased circulation of respiratory viruses in the local community.

The authors note that the findings are based on a small community-based study (with comparatively few carriers detected) in one region of the USA involving mostly White individuals with higher education which might limit the generalisability of the findings to people from other racial or ethnic groups and countries. They also note that while saliva is generally more sensitive for the detection of pneumococcal carriage in adults, it is still possible that the overall carriage prevalence may have been underestimated since they did not sample other sites in the upper airway.

Reference:

Recent contact with young children linked to trebling of risk of over-60s acquiring pneumonia-causing bacteria, European Society of Clinical Microbiology and Infectious Diseases, Meeting: The European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024).

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Assistant Professors posted in Central University with MBBS degree as essential qualification entitled to NPA: Delhi HC

New Delhi: Granting relief to a group of doctors employed at Jawaharlal Nehru University (JNU), the Delhi High Court bench recently held that an individual holding the post of Assistant Professor in a Central University, requiring an MBBS degree as an essential qualification, would also be entitled to a Non-Practicing Allowance (NPA).

“The rationale behind grant of NPA appears to be in the form of an incentive to Medical Doctors in lieu of their private practice. This rationale apparently is predicated on the individual possessing a MBBS degree recognized by the Indian Medical Council Act, 1956 or the Dentists Act, 1948 as an essential qualification alone without anything further. Thus, an individual holding the post of Assistant Professor in Central University requiring MBBS degree as an essential qualification would also be entitled to NPA,” observed the HC bench comprising Justice Tushar Rao Gedela.

The Court made such an observation while considering the plea by a group of doctors, who challenged the University’s decision to stop the payment of Non-Practicing Allowance (NPA) to them from January 2017.

Challenging the University’s decision, the doctors approached the HC bench and filed a plea under Article 226 of the Constitution. Their prayers included the quashing of the University letter stopping NPA, quashing the clarification issued by the University Grants Commission (UGC) in this regard, and certain other letters and directives related to Non-Practicing Allowance.

It was argued by the petitioners that based on the resolution dating back to 1977, NPA was granted to faculties employed at the posts for which a medical qualification recognized under the Indian Medical Council Act, 1956 or under the Dentists Act, 1948 was prescribed as an essential qualification.

However, it was alleged the NPA payment was stopped to the petitioners back in January 2017. When the petitioners questioned the move, the University revealed that the NPA had been stopped in light of a letter dated 28.12.2016 sent by UGC to the University in response to a clarification sought by the University from UGC. Further, holding that NPA was not admissible in the case of one of the doctors employed at the University, an Assistant Professor at the Centre, the University sent a letter dated 05.07.2017 to him and sought to recover from the petitioners from the date of initial payment till December 2016, i.e. for a period ranging from 14 years to 31 years.

Approaching the HC bench for relief, the counsel for the petitioners submitted that the petitioners are aggrieved by the arbitrary and unjust withdrawal of the NPA by the letter dated 05.07.2017 and also the notice issued asking why the University should not recover the NPA paid to them with effect from 12.12.1990 till December 2016.

On the other hand, the counsel for Jawaharlal Nehru University submitted that when clarification was sought regarding the issue of NPA, UGC had forwarded the communication to MHRD (Ministry of Human Resource Department) and consequently, the Ministry by its letter dated 28.12.2016 had directed that such NPA was not admissible in the case of one of the doctors considering the fact that the Integrated Finance Division opined that the post of Assistant Professor in the Department of Social Medicine and Community Health, School of Social Sciences, JNU cannot be treated as Medical Post and therefore, does not qualify for NPA.

UGC submitted that decisions regarding whether the petitioners were or were not entitled to NPA or even whether any recoveries of the past payments on that account had to be recovered or not were to be taken by either MHRD or the Ministry of Finance, and UGC had absolutely neither any role nor any responsibility on that count.

However, to assist the Court in the matter, the counsel for UGC referred to various correspondences exchanged between the parties with UGC as a common party and informed that NPA, to the posts of Lecturers and some other staff of the Central Universities requiring MBBS degree as essential qualification, was introduced and continued by the Government of India from the year 1971 onwards. Revisions to such NPA were being notified from time to time and made applicable to all such entitled teachers.

It was further submitted that the controversy on the matter was initiated from the request/representation of a doctor employed at the University for admissibility of NPA in his case too being similarly situated as the petitioners. The matter was referred to UGC by the University and in response to this, UGC sought a few clarifications from the University regarding the non-payment ot NPA to the concerned doctor.

UGC sought to know from MHRD as to whether NPA was payable to the concerned doctor and whether the said post of Assistant Professor at Centre for Social Medicine and Community Health was to be treated as “Clinical” or “Non-Clinical” post. consequently, MHRD clarified that the post in question was purely academic (non-clinical) and that no prior approval was sought from the Ministry for such grant and also directed that the said doctor was not entitled to NPA.

Subsequently, on further clarification sought by UGC, MHRD re-considered the issue with its Integrated Finance Division which too opined that the said post cannot be treated as a Medical Post and does not qualify for NPA in terms of O.M. dated 30.08.2008. This clarification was conveyed to the University.

While considering the matter, the Court observed that the petitioners were qualified MBBS doctors having requisite qualifications to the post of Assistant Professor at the Centre for Social Medicine and Community Health, School of Social Sciences at the University. Further, the bench observed that all three petitioners were found entitled to NPA since their induction into the service and have been paid the same continuously till 31.12.2016.

Taking note of the sequence of events in how NPA was initiated for the medical faculties at the University, the Court observed,

“…it is apparent that the Government of India had fixed NPA for posts which required MBBS degree as an essential qualification recognized under the Indian Medical Council Act, 1956 or the Dentists Act, 1948. It is also clear that the respondent no.2/ UGC by the Notification/ Order dated 24.06.1976 had extended the admissibility of NPA even to the Lecturers and Readers in the Medical Faculties of the Central Universities … Undoubtedly, the same was put up before the EC in its 52nd meeting held on 13.04.1977 whereby under Clause 3.8, the revision of NPA rates were made applicable even to the Staff of respondent no.1/ University requiring MBBS degree as an essential qualification.”

Observing that the University and other authorities relied on the Office Memo dated 30.08.2008 to deny the continuance of payment of NPA and simultaneously sought recovery of the NPA paid previously to the petitioners till 31.12.2016, the Court perused the concerned OM that stated, “The NPA should be restricted only to those Medical posts for which a Medical qualification recognized under the Indian Medical Council Act, 1956 or under the Dentists Act, 1948 has been prescribed as an essential qualification.”

Taking note of the OM, the Court observed that the Central Government in the modification of the Order dated 15.04.1998 had revised the NPA in respect of medical posts attached to the other posts included in the Central Health Services (CHS). The interpretation sought to be put forward by the authorities on Clause 4 was that NPA cannot be granted to non-clinical posts which are purely academic posts.

At this outset, the Court opined,

“In the considered opinion of this Court, the aforesaid interpretation does not appear to be correct. This is for the reason that, had any such interpretation been sought to be projected by the Central Government, it would have also taken note of the previous OMs in this regard which have been referred to above, in extenso, by this Court. In that, there is no reference to the OMs of the years 1971, 1974, 1976 and other similar OMs granting NPA to posts which only required MBBS degree as an essential qualification. More particularly, the respondent no.2/ UGC neither modified nor rescinded its own Notification/ Order dated 24.06.1976, when it made the NPA applicable to Lecturers and Readers in the Central Universities. No such reference has been made even by the Central Government while issuing O.M. dated 30.08.2008. Thus, in the absence of such connecting material, it is not possible for this Court to conclude that the posts of Assistant Professor in Central Universities like the respondent no.1/ University, requiring MBBS degree as an essential qualification, has been included in the O.M. dated 30.08.2008 or that the said O.M. deprives or disentitles Teachers such as the petitioners from admissibility of NPA.”

“In case the Central Government had felt the necessity to do so, there was no impediment in it issuing any fresh notification or O.M. in that regard, restricting the admissibility of NPA only to medical practitioners. In the absence of any such notification having been placed on record by the respondents, this Court is unable to agree with the argument of the respondents. Moreover, the Notification/ Order dated 24.06.1976 of the UGC appears to have been specifically issued in terms of a notification of the Central Government extending NPA to faculty in Central Universities which has also not been referred to in the O.M. dated 30.08.2008. No document or Order or Notification regarding any modification in respect of admissibility of NPA to faculty of Central Universities has been placed on record by the respondents. Thus, looked at it any which way, the arguments of the respondents are unacceptable,” it further noted.

The bench observed that the rationale behind granting NPA appears to be an incentive to Medical Doctors in lieu of their private practice.

“This rationale apparently is predicated on the individual possessing a MBBS degree recognized by the Indian Medical Council Act, 1956 or the Dentists Act, 1948 as an essential qualification alone without anything further. Thus, an individual holding the post of Assistant Professor in Central University requiring MBBS degree as an essential qualification would also be entitled to NPA,” opined the Court.

“This was the basis of Notification/ Order dated 24.06.1976 of the respondent no.2/ UGC. The said notification was issued by UGC in consultation with the Central Government. Thus, it is clear that the Central Government has itself deemed such faculty to be entitled to NPA. Hence, unless there is an O.M. or a notification rescinding the primary notification of the Central Government or Notification/ Order dated 24.06.1976 of the UGC, no such interpretation, as sought to be put across by the respondents upon O.M. dated 30.08.2008, can at all be sanctified,” the bench mentioned.

With this opinion, the bench set aside the letter dated 05.07.2017 issued by the University, where it held that the petitioners were not entitled to NPA and simultaneously directed recovery of the NPA paid to the petitioners with effect from 12.12.1990 till 31.12.2016. The bench also quashed and set aside the UGC letter dated 28.12.2016, to the extent where the reference to the MHRD’s opinion/clarification was noted.

“Consequently, the respondent no.1/ University is directed to pay to the petitioners the arrears of the admissible NPA with effect 01.01.2017 till the dates of their entitlement. The said exercise be carried out within a period of 6 weeks from today, failing which, a simple interest of 6% per annum shall be payable by the respondent no.1/ University,” ordered the Court.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-hc-npa-235691.pdf

Also Read: Restoration of NPA: Himachal Pradesh Govt doctors go on mass leave

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Quality Care appoints Dr Hari Prasad as Group Chairman and Varun Khanna as Group Managing Director

Hyderabad: Quality Care, India’s largest emerging-cities focused healthcare provider, backed by marquee global investors Blackstone and TPG, has hired two industry veterans, Dr Hari Prasad as the Group Chairman & Non-Executive Director and Varun Khanna as the Group Managing Director to drive the platform’s rapid growth in South Asia.

Dr Hari Prasad, with over 30 years of experience, was most recently the President of Apollo Group Hospitals, where he played a pivotal role in shaping the journey of Apollo Hospitals having overseen the growth from c.1,200 beds to c.10,000 beds today.

He also serves as the Executive Chairman of Society for Emergency Medicine, India. He has been honored with a Fellowship by Royal College of Emergency Medicine, UK and International Federation of Emergency Medicine.

Also Read:Digital Certification for Empanelled Hospitals: NHA collaborates with Quality Council of India

He was also the campus Dean for global MD program of Macquarie University, Australia. He has helped establish Apollo Health City in Hyderabad, Asia’s first operational health city. Dr Hari Prasad brings to the organization his vast clinical expertise, unwavering focus on quality and learnings from many firsts in the field of medical science.

Varun Khanna has more than 14 years of experience in the healthcare sector and was most recently the Managing Director of Healthcare Business & Investments at Siloam Hospitals Group, Indonesia (a $2bn market cap hospital chain), where he grew EBITDA from c.$30m to c.$130m and the Chairman at Sahyadri Hospitals, India. He has been a key figure in growing mature multinational med-tech companies and healthcare organizations across India, South Asia and ASEAN.

In addition, he has served as a National Executive Board Member of AMCHAM, Chairman of the AdvaMed India Working Group and Executive Committee, Co-Chair of the FICCI Health Services Committee, and Secretary and Treasurer of NATHEALTH.

The three hospital chains within Quality Care comprising 4,500+ beds: KIMSHEALTH led by Chairman & Managing Director – Dr M. I. Sahadulla; CARE Hospitals led by Chief Executive Officer, Mr Jasdeep Singh; and Evercare Bangladesh led by CEO and Managing Director, Dr Ratnadeep Chaskar shall all continue to be driven by the existing leadership teams. The addition of Dr Hari Prasad and Varun Khanna will further strengthen Quality Care’s mission of bridging the quality healthcare gap in South Asia.

Dr Hari Prasad, Group Chairman & Non-Executive Director of Quality Care, said, “It is with great pleasure that I take on the Group Chair responsibility at a platform having an ethos of providing quality healthcare across underserved cities in India and South Asia.

I am delighted to work with the talented clinical and management team to drive the legacy of Quality Care forward with better clinical outcomes and build quality at scale. I look forward to collaborating with the Board, the existing leadership team and the 1,500 member strong clinical team at CARE to achieve the broader vision of providing quality healthcare.”

Commenting on his appointment, Varun Khanna said, “I am excited to lead Quality Care, a platform touching 2.5bn+ lives every year and built on values of clinical excellence and driven by a group of exceptional, proven leaders. The individual teams at CARE, KIM’S HEALTH and Evercare have built a strong legacy of delivering quality care to its patients and I look to carry forward the transformational healthcare journey and scaling the company to the next level. I remain committed to all stakeholders – patients, clinicians, nursing and administrative personnel, suppliers, and shareholders.”

Ganesh Mani, Senior Managing Director at Blackstone, said, “We are delighted to welcome Dr. Hari Prasad and Varun Khanna, two distinguished executives who bring a wealth of industry expertise, leadership experience, as well as a passion for delivering the best quality healthcare. Along with investments in infrastructure, talent and technology, this high pedigree leadership team will expand Quality Care to be a quality-focused healthcare leader.”

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Jaipur Kidney Transplant Racket: Donors, recipients lured from Bangladesh, FIR registered

Gurugram: In a significant breakthrough, a collaborative effort between the CM Flying Squad, the district health department, and Gurugram Police has uncovered an illegal kidney transplant racket operating across two private hospitals in Jaipur.

The racket allegedly facilitated illegal kidney transplants in exchange for monetary gains. After coming across a Facebook advertisement for selling a kidney, the donor got in touch with Ansari.

According to a PTI report, After the transplant, the gang allegedly used to make the patient and the donor stay in a guest house in Gurugram, said the police.

According to authorities, after the illegal transplants, both the recipients and the donors were reportedly accommodated in a guest house in Gurugram. Acting swiftly on intelligence inputs, a joint team conducted a raid on the aforementioned guest house, leading to the apprehension of two donors and three recipients. An FIR has been lodged at the Sadar police station, with efforts underway to apprehend the mastermind behind the illicit operation, identified as Mohammed Murtaza Ansari, hailing from Jharkhand.

Also Read:Delhi Apollo Hospital under scanner over alleged ‘cash-for-kidney’ scam

Ansari had allegedly taken Rs 10 lakh from the recipients and gave Rs 2 lakh to the donors in exchange for a kidney, they added.

As per a media report in The Indian Express, During interrogation, it was revealed that the racket was run by Murtaza Ansari from Ranchi, Jharkhand, and he facilitated kidney transplants at Fortis Hospital in Jaipur, said ASI Tarun Kumar, the investigating officer in the case.

According to the complaint filed by Gurugram Deputy Civil Surgeon Dr Pawan Chaudhary, the raid was conducted at M/S Babil Palace in Sector 39 following a tip-off that a nexus of organ transplant was being run by Ansari at the guest house, said police.

During the raid, it was discovered that five individuals, believed to be from Bangladesh, were residing in the guest house under Ansari’s arrangement. Further investigations revealed that they were involved in the illegal kidney transplant operation, having undergone the procedures at a hospital in Jaipur. Notably, the donors and recipients lacked any documented evidence of consent or authorization for the procedures, indicating a flagrant violation of the Transplantation of Human Organs and Tissues Act 1994.

“The donor and the recipient do not have any blood relation. When the donors and the recipients were inquired about the no objection certificate or any permission from the authority, neither the donors nor the recipients could produce any such document.

“A donor, Shamim Mehndi Hasan, revealed that he came to know about a person through Facebook advertisement regarding earning money by selling kidney and he contacted Mohammed Murtaza Ansari… It is a violation of the Transplantation of the Human Organs and Tissues Act 1994 and act of cheating”, as Dr Chaudhary said in his complaint.

The police said, Following the complaint, an FIR was registered against Ansari and others under sections 420 (cheating), 120-B (criminal conspiracy) of the IPC and section 19 of the Transplantation of the Human Organs and Tissues Act 1994 at the Sadar police station on Thursday, news agency PTI reported.

Fortis Healthcare, in a statement, said it would fully cooperate with any ongoing investigation.

“Fortis Healthcare is committed to the highest ethical standards in healthcare, strictly following the SOTTO (State Organ and Tissue Transplant Organisation) protocols for organ transplants…each case is thoroughly evaluated…by the State Authorization Committee and obtains necessary government approvals…We have a zero-tolerance policy towards procedural deviations and we are committed to patient safety, care and transparency and ethical practices,” the statement added. A spokesperson said that a transplant coordinator at the hospital was found to have been involved with the racket, and action was taken against him by authorities last week.

Also Read:Controversy: Apollo Hospital Embroiled in Illegal Kidney Racket accusations, Denies all claims

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