Archive for month: May, 2024

A study was done to evaluate the efficacy of topical ivermectin 1% ointment, for the treatment of Demodex blepharitis. A retrospective study was designed to review electronic medical records of patients seen between January 2017 and December 2022, who had a diagnosis of Demodex blepharitis, treated with topical ivermectin 1% with at least 6 months of follow-up (Centro de Ojos Quilmes, Buenos Aires, Argentina). The presence of collarettes was graded from 0 to 4. An imaging system (Keratograph) was used, to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NIKBUT), and degree of conjunctival redness. In addition, the ocular surface disease index (OSDI) test was performed. Results were compared before and after ivermectin treatment, which was performed once a day for 2 months. Results: A total of 2157 patients (4314 eyes) were included. The mean age was 50.43 ± 15.3 years, and the follow-up time was 26.1 ± 8.5 months. No one discontinued treatment due to intolerance, although 14 cases (0.6 %) reported occasional discomfort. The grade of collarettes decreased with statistical significance, from 3.37 ± 0.7 to 0.1 ± 0.3 (p < 0.01), as well as conjunctival redness from 1.32 ± 0.3 to 0.94 ± 0.4 (p < 0.01) and OSDI score from 58.74 ± 17.9 to 17.1 ± 10.5 (p = 0.02). TMH and NIKBUT improved without statistical difference. Treatment with ivermectin 1% topical ointment, once daily for 2 months, was effective in reducing the presence of collarettes and in improving symptoms in patients with Demodex blepharitis.

Reference:

Valvecchia, F., Greco, L., Perrone, F. et al. Topical ivermectin ointment treatment of Demodex blepharitis: a 6-year retrospective study. Graefes Arch Clin Exp Ophthalmol 262, 1281–1288 (2024). https://doi.org/10.1007/s00417-023-06281-0

Keywords:

Local application, Ivermectin, ointment, safe, effective therapy, patients Demodex blepharitis, study, Graefe’s Archive for Clinical and Experimental Ophthalmology, Valvecchia, F., Greco, L., Perrone, Demodex, Ivermectin, Blepharitis, Ocular surface

Despite advances in stroke care, understanding the influence of UI on stroke outcomes, especially in patients with milder strokes, remains limited. Identifying predictors of poor outcomes, such as UI, is crucial for improving patient care and resource allocation.

Data were prospectively collected from the Sentinel Stroke National Audit Programme, including 1593 men and 1591 women admitted to four UK hyperacute stroke units (HASUs) from 2014 to 2016. Patients were stratified based on stroke severity using the National Institutes of Health Stroke Scale (NIHSS) scores ranging from 0 to 42. Multivariable logistic regression analysis was performed to assess the relationship between UI and various health outcomes, adjusting for confounding factors.

Key Findings:

• Among patients with mild strokes (NIHSS scores of 0-4), those with UI had significantly higher risks of in-hospital mortality, disability at discharge, pneumonia, urinary tract infection, prolonged hospital stay, palliative care by discharge, and discharge to care home compared to those without UI.

• Similar associations were observed in patients with moderate strokes (NIHSS scores of 5-15), with UI patients being at greater risk for poor outcomes, except for palliative care and activity of daily living (ADL) support.

• In patients with the most severe strokes (NIHSS scores of 16-48), UI was still associated with poor outcomes, although the odds ratios decreased as stroke severity increased.

The study highlights UI as a significant predictor of poor short-term outcomes in stroke patients, irrespective of stroke severity. Healthcare professionals should consider UI as an indicator of increased risk and tailor interventions accordingly to improve patient outcomes. This research provides valuable insights for identifying at-risk individuals and implementing targeted interventions in stroke care.

Reference:

Fry, C. H., Fluck, A., Affley, B., Kakar, P., Sharma, P., Fluck, D., & Han, T. S. Urinary incontinence indicates mortality, disability, and infections in hospitalised stroke patients. BJU International,2024. https://doi.org/10.1111/bju.16320

Knee osteoarthritis is a common condition among older adults, causing pain, stiffness, and limited mobility. While antiplatelet therapy is recommended for acute ischemic stroke, new approaches such as acupressure are being explored to provide additional symptom relief. Acupressure, a practice based on traditional Chinese medicine, involves applying pressure to specific points on the body. This study was published in JAMA Network Open by Yeung and colleagues.

The study included 314 patients aged 50 and older, who were randomly assigned to perform twice-daily acupressure on themselves or receive an educational program on knee health. The acupressure group targeted eight recognized acupressure points, while the education group received information on exercise, weight loss, drug treatments, and traditional Chinese therapeutic diets.

The primary outcome was self-reported pain scores on a 10-point scale after 12 weeks. Secondary outcomes included changes in the Western Ontario-McMaster Universities Osteoarthritis Index (WOMAC), Short Form-6 Dimensions (SF-6D), Timed Up and Go results, and fast gait speed.

The key findings of the study were:

• The acupressure group experienced a reduction in pain scores with a mean difference of -0.54 points after 12 weeks (95% CI -0.97 to -0.10 points, P=0.02).

• SF-6D utility scores improved significantly in the acupressure group compared to the control group (mean difference 0.03 points, 95% CI 0.003-0.01).

• Other measures, such as WOMAC and Timed Up and Go results, did not differ significantly between groups.

• Both groups showed improvements from baseline in most secondary measures.

The findings suggest that self-administered acupressure may offer a viable alternative or adjunctive treatment for knee osteoarthritis, providing moderate relief in symptoms such as pain and quality of life measures. Patients showed high acceptability and compliance with the self-administered acupressure training program, highlighting the potential for widespread adoption.

The study supports the use of self-administered acupressure as a cost-effective option for managing knee osteoarthritis. While limitations such as unblinded design and potential cultural predispositions may affect the results, acupressure remains a promising alternative for symptom relief in knee osteoarthritis.

Reference:

Yeung, W.-F., Chen, S.-C., Cheung, D. S. T., Wong, C. K.-H., Chong, T. C., Ho, Y. S., Suen, L. K. P., Ho, L. M., & Lao, L. (2024). Self-administered acupressure for probable knee osteoarthritis in middle-aged and older adults: A randomized clinical trial. JAMA Network Open, 7(4), e245830. https://doi.org/10.1001/jamanetworkopen.2024.5830

Appearing before a bench of Justices Hima Kohli and Ahsanuddin Amanullah, Senior Advocate Mukul Rohatgi, representing Patanjali, highlighted an interview given by IMA President Dr RV Ashokan to the press the previous day. In the interview, the IMA chief reportedly criticized the Supreme Court’s observations regarding IMA’s response to complaints of unethical practices by doctors.

Describing the interview as ‘disturbing’, Rohatgi quoted the IMA President’s comments where he termed the Supreme Court’s observations as “unfortunate” and “vague.” The bench requested Rohatgi to submit the interview for the record.

“He (the IMA President) says why has the Court turned its fingers at us…The court is making vague and irrelevant statements…The Court is taking a broadside at us…We have done a great job…Our people have died…This is direct interference with the course of proceedings in this case…he says that these are unfortunate comments…demoralizing private doctors. What is this?”, Rohatgi said.

Also Read: Is Your Apology The Same Size As Your Advertisement? SC Slams Baba Ramdev

In response to the submission, Justice Ahsanuddin Amanullah remarked, as quoted by Livelaw;

“This is more serious than what we have been doing till now…After all that is happening, you [IMA] do this. Be prepared for more serious consequences.”

Justice Hima Kohli, addressing IMA’s counsel, also commented;

“Self-certification does not help anybody. If what has been said by the other side is correct, you have not covered yourself with glory. There is something you will have to say to explain how would you decide which way we should be…”.

The bench recorded in its order;

“Mr. Rohatgi has also sought to bring attention of this court to an interview given by the current President of petitioner No.1 (IMA), which it is his submission is critical of this Court’s order dated April 23. He seeks leave to file a copy of the publication carrying the interview. Needful shall be done within 2 days.”

The Court was addressing a petition filed by the IMA, initiating a contempt case against Patanjali Ayurved, its MD Acharya Balkrishna, and Baba Ramdev for publishing misleading medical advertisements in violation of a court undertaking.

Medical Dialogues had earlier reported that issuing a caution to the petitioner medical association about the complaints of unethical practices by allopathic doctors, the Supreme Court bench of Justices Hima Kohli and Ahsanuddin Amanullah observed, “The petitioner (IMA) needs to put its own house in order regarding alleged unethical acts of the organisation where medicines are prescribed, which is expensive and unnecessary.”

The apex court said that wherever there is a misuse of the position by the IMA to prescribe expensive medicines and the line of treatment, it needs “closer examination”.

It further told IMA that while it is pointing fingers at Patanjali, four fingers are pointing back at them. The bench asked, “Your (IMA) doctors also endorsing medicines in the allopathic field, if that’s happening, why should we not turn the beam at you (IMA)?”

“Your (IMA) members also endorsed such products… your members are prescribing medicines,” the bench said, while hearing the case filed by IMA against an alleged smear campaign carried out by Patanjali Ayurveda Ltd and its founders against the COVID-19 vaccination drive and modern medicine

On April 16, the apex court had warned Ramdev and Balkrishna against any attempt to “degrade allopathy” and permitted them to tender a “public apology and show contrition” within a week in the contempt proceedings in the misleading advertisements case against Patanjali Ayurved Ltd.

Earlier, on two occasions, they tendered unconditional and unqualified apology with regard to the issue of advertisement. However, the bench refused to accept their affidavits, tendering apologies, and slammed them for the misleading advertisements carried out by them and the company. The apex court also slammed the Uttarakhand government for being “hand-in-glove” with errant licencing officers who failed to take action against Patanjali for publishing misleading advertisements.

The top court had earlier also directed Patanjali not to publish false advertisements in the future and later issued contempt of court notices to the company, Ramdev and Balkrishna.