Archive for month: June, 2024

New Delhi- Armed Forces Medical Services (AFMS) released a notice for Dental Officers sponsored by Paramilitary Organisations and other Organisations of the Government of India for Postgraduate Courses for MDS through the National Eligibility-Entrance Test-Master of Dental Surgery (NEET-MDS) 2024 exam at AFMS Institute for the year 2024.

AFMS primarily conducts postgraduate training for doctors (Dental Officers) of the Armed Forces Medical Services, to meet the specialist requirements of the Armed Forces Medical Services. On this, additional seats, if any, are offered to sponsored candidates from friendly foreign countries, paramilitary organisations/other organisations of the Government of India, ex-SSC officers of AFMS and civilian doctors.

As per the notice, the ‘Sponsorship Certificate’ of the candidates along with required supporting documents duly endorsed by the competent authority is to be consolidated and forwarded by the concerned Ministry/Headquarters of Paramilitary Organisations/Headquarters of other Government of India Organisations to DGAFMS Office. Only correspondence received through official channels will be accepted and personal correspondence from candidates will not be accepted.

Meanwhile, the Sponsorship Certificate is to be filled as per the guidelines mentioned below-

1 Original ink signed by the Competent Authority (not below the rank of Director or equivalent) in the respective Ministry of Govt of India/ HQ of the Para Military organisation/ Head office of other GoI organisations in which the individual is employed.

2 Duly affixed with the rubber stamp & office seal of the Competent Authority.

3 It is mandatory to specify the subjects for which the candidate (Dental Surgeon) is being sponsored. The candidates are advised to select, during counselling, only the subjects for which they have been sponsored by their respective Ministry/ HQ of Para Military organization/ Head office of other GoI organizations. Under no circumstances will admission be granted in a subject which has not been sponsored by the sponsoring authority.

4 For the upcoming NEET MDS exam, the last date for the sponsorship certificate, from the respective Ministry/ HQ of Para Military organisation/ Head office of other GoI organisations, to reach this office is 05 Jul 2024.

5 Online counselling, consisting of registration, payment, choice filling/ locking and provisional seat allotment for Priority-III, IV & V candidates, for the academic session 2024-27, will be conducted by MCC through their web portal/ website. Seat allotment during counselling by MCC is provisional and subject to fulfilment of all eligibility criteria. The list of candidates eligible for counselling will be forwarded to MCC by this office for counselling and provisional seat allotment.

6 Priority-III candidates will be considered eligible for admission in AFMS Institutions only for those subjects, which are mentioned in their sponsorship certificate as forwarded by the respective sponsoring authority. In case a Priority-III candidate is allotted a seat, during the counselling conducted by the MCC, which is not mentioned in the Sponsorship Certificate forwarded by the sponsoring organization, admission to AFMS PG Teaching Institutes would not be granted and the candidate would be liable to suffer the consequences.

However, the official address to which the sponsorship certificates are to be submitted by the respective Ministry/ HQ of the Para Military organizations/ Head office of other GoI organizations and the email ID for communication and queries are mentioned in the notice.

To view the notice, click the link below

https://medicaldialogues.in/pdf_upload/need-mds-2024-afms-issues-notice-for-sponsored-dental-officers-seeking-pg-dental-admissions-242448.pdf

Today, findings from the CATALYST study reveal that hypercortisolism may be a significant factor for why type 2 diabetes (T2D) remains difficult to control for many patients. This study found that 24% of individuals with difficult-to-control type 2 diabetes have hypercortisolism, a condition characterized by high cortisol levels. The results were presented as a late-breaking symposium today at the 84th Scientific Sessions of the American Diabetes Association® (ADA) in Orlando, FL.

Currently, 38.9 to 76.9% of patients with type 2 diabetes have uncontrolled diabetes. Additional research is needed to understand how hypercortisolism may be an underlying contributing cause for difficult-to-control type 2 diabetes. Symptoms of hypercortisolism can include weight gain, high blood pressure, muscle weakness, and mood changes, which can further complicate diabetes management.

The CATALYST study, the largest prospective trial of its kind, screened over 1,000 patients with hemoglobin A1c levels between 7.5% and 11.5% despite multiple diabetes therapies. Researchers used an overnight 1-mg dexamethasone suppression test (DST) to detect hypercortisolism, indicated by a post-DST morning cortisol level above 1.8 μg/dL and a dexamethasone level of 140 ng/dL or higher.

Findings showed presence of hypercortisolism in 24% of the screened patients. Notably, among those taking three or more hypertension medications, the prevalence of hypercortisolism was approximately one in three. Additionally, CT scans revealed adrenal abnormalities in about one-third of these patients, with a quarter having an adrenal tumor, suggesting that surgical intervention could potentially resolve their hypercortisolism and improve diabetes control.

“These results are significant as they highlight a previously underrecognized factor contributing to the barriers when it comes to managing type 2 diabetes,” said John Buse, MD, PhD, from the University of North Carolina School of Medicine Diabetes Center and Translational and Clinical Sciences Institute and lead author of the study. “By identifying hypercortisolism in these patients, we can target treatments more effectively and potentially improve their outcomes.”

The first part of the CATALYST study underscores the importance of screening for hypercortisolism in patients with difficult-to-control type 2 diabetes The ongoing second part of the study aims to evaluate whether treating hypercortisolism medically can enhance diabetes management and alleviate related health issues.

A large analysis of data from nearly 400,000 healthy U.S. adults followed for more than 20 years has found no association between regular multivitamin use and lower risk of death. The study, led by researchers at the National Institutes of Health’s National Cancer Institute, was published in JAMA Network Open.

Many adults in the United States take multivitamins with the hope of improving their health. However, the benefits and harms of regular multivitamin use remain unclear. Previous studies of multivitamin use and mortality have yielded mixed results and been limited by short follow-up times.

To more deeply explore the relationship between long-term regular multivitamin use and overall mortality and death from cardiovascular disease and cancer, the researchers analyzed data from three large, geographically diverse prospective studies involving a total of 390,124 U.S. adults who were followed for more than 20 years. The participants included in this analysis were generally healthy, with no history of cancer or other chronic diseases.

Because the study population was so large and included lengthy follow-up and extensive information on demographics and lifestyle factors, the researchers were able to mitigate the effects of possible biases that may have influenced the findings of other studies. For example, people who use multivitamins may have healthier lifestyles in general, and sicker patients may be more likely to increase their use of multivitamins.

The analysis showed that people who took daily multivitamins did not have a lower risk of death from any cause than people who took no multivitamins. There were also no differences in mortality from cancer, heart disease, or cerebrovascular diseases. The results were adjusted for factors such as race and ethnicity, education, and diet quality.

The researchers noted that it is important to evaluate multivitamin use and risk of death among different kinds of populations, such as those with documented nutritional deficiencies, as well as the potential impact of regular multivitamin use on other health conditions associated with aging. 

Reference:

Loftfield E, O’Connell CP, Abnet CC, et al. Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts. JAMA Netw Open. 2024;7(6):e2418729. doi:10.1001/jamanetworkopen.2024.18729.

People with prediabetes are advised to reduce their weight in order to prevent manifest diabetes. Researchers from the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, a partner in the German Center for Diabetes Research (DZD), together with US colleagues in the renowned ”Diabetes Prevention Program (DPP),” have now been able to show for the first time that people achieve the best diabetes protection when they reduce their weight and at the same time normalize blood sugar regulation.

In the specialist journal Diabetologia, the authors argue that the normalization of blood sugar levels in prediabetes should be included as a therapeutic goal in the guidelines in order to improve the prevention of type 2 diabetes.

Diabetes is widespread and is associated with an increased risk of a number of life-threatening complications such as stroke, heart attack and kidney failure. “In order to prevent the development of the disease, early therapies are already important in the prediabetes stage, a preliminary stage of type 2 diabetes. Our results can be used to change the goals of these early lifestyle interventions in order to reduce the overall development rates of diabetes,” explains first author Reiner Jumpertz-von Schwartzenberg.

Prediabetes drastically increases the risk of diabetes

Prediabetes is diagnosed when there is no manifest type 2 diabetes yet, but the fasting blood sugar is already elevated and glucose tolerance is impaired. To prevent prediabetes from becoming diabetes, affected patients are advised to reduce their weight. US guidelines from the American Diabetes Association (ADA), for example, recommend reducing body weight by at least 7 percent. This recommendation is based on the DPP study.

The research team from the Department of Internal Medicine IV, Diabetology, Endocrinology and Nephrology at the Medical University Hospital of Tübingen, the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich in Tübingen and the Phoenix Epidemiology and Clinical Research Branch at the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, USA, investigated whether this weight loss is sufficient, or whether it is not better to prevent diabetes by also reducing blood sugar levels such that prediabetes goes into remission.

Prevention through one-year lifestyle intervention

They analyzed data from 480 people with prediabetes who participated in the US Diabetes Prevention Program (DPP) and had lost at least 7 percent of their body weight through a one-year lifestyle intervention. In 114 of them, prediabetes also went into remission during the intervention, meaning that their fasting blood sugar, glucose tolerance and HbA1c had normalized. However, the majority of the 366 study participants had not managed to significantly improve their blood sugar regulation despite successfully losing weight. Their prediabetes was not in remission at the end of the intervention.

The researchers found that significantly fewer people in the group that had lost weight and achieved prediabetes remission developed manifest diabetes thereafter. The additional remission of prediabetes resulted in a relative risk reduction for the development of diabetes of 76 percent compared to those who had not achieved normalization of their blood sugar levels. The absolute risk reduction was higher than 10%.

“In the group with additional remission of prediabetes, there was even no type 2 diabetes at all in the first 4 years after the lifestyle intervention,” reports last author Andreas Birkenfeld. “In the group that had ‘only’ lost weight, however, some study participants did develop manifest diabetes during that period.”

Jumpertz-von Schwartzenberg and Birkenfeld draw a clear conclusion: “Our results show that remission of prediabetes brings a further significant benefit in addition to weight reduction. We therefore advocate that the goal of prediabetes remission should be included in the objectives of the practice guidelines in order to significantly improve the prevention of type 2 diabetes.”

References: Jumpertz von Schwartzenberg, R., Vazquez Arreola, E., Sandforth, A. et al. Role of weight loss-induced prediabetes remission in the prevention of type 2 diabetes: time to improve diabetes prevention. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06178-5

Patient positioning is crucial for the successful administration of neuraxial blocks. Recently published study aimed to compare the ultrasonographic dimensions of the spine’s acoustic target window in four different sitting positions, namely cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP), and rider’s sitting position (RSP). The primary objective was to measure the neuraxial acoustic target window, specifically the interlaminar distance between L3-L4 lamina, while the secondary objective was to compare the depth of the ligamentum flavum from the skin, the diameter of the intrathecal space, and the comfort score in the different sitting positions.

The findings of the study revealed that there was no statistically significant difference in the interlaminar distance among the four sitting positions, with a mean interlaminar distance ranging from 1.40 cm to 1.44 cm. This suggests that all four positions are equally effective for spinal/epidural intervention. However, the classical sitting position (CSP) was identified as the most comfortable among the four positions, with a significantly better comfort score compared to the others. As a result, the study emphasized giving more importance to patient comfort during the procedure, as it can increase the success rate of the intervention.

The study also provided insights into the significance of patient positioning in the success of neuraxial blocks and highlighted the importance of ultrasonographic measurements for identifying various dimensions of the acoustic target window of the spine. Additionally, the study compared its findings with previous research and discussed the implications of the results in the context of the Indian population. The study acknowledged its limitations and recommended further research, particularly randomized control trials on the patient population, to provide additional evidence.

Summary and Implications –

In conclusion, the study found that all four sitting positions (CLP, HSP, CSP, RSP) are comparable in terms of the acoustic target window. However, the CSP was identified as the most comfortable position for the participants, indicating that patient comfort should be a crucial consideration in choosing a sitting position for neuraxial block procedures. The study’s comprehensive analysis and comparison of the different positions provide valuable insights for practitioners and researchers in the field of neuraxial anesthesia.

Key Points –

– The study compared the ultrasonographic dimensions of the spine’s acoustic target window in four different sitting positions: cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP), and rider’s sitting position (RSP). The primary objective was to measure the neuraxial acoustic target window, specifically the interlaminar distance between L3-L4 lamina, while the secondary objective was to compare the depth of the ligamentum flavum from the skin, the diameter of the intrathecal space, and the comfort score in the different sitting positions.

– The findings revealed that there was no statistically significant difference in the interlaminar distance among the four sitting positions, suggesting that all four positions are equally effective for spinal/epidural intervention. However, the classical sitting position (CSP) was identified as the most comfortable among the four positions, with a significantly better comfort score compared to the others. The study emphasized the importance of patient comfort during the procedure, as it can increase the success rate of the intervention. Additionally, the study highlighted the significance of patient positioning in the success of neuraxial blocks and the importance of ultrasonographic measurements for identifying various dimensions of the acoustic target window of the spine.

– In conclusion, the study found that all four sitting positions (CLP, HSP, CSP, RSP) are comparable in terms of the acoustic target window. However, the CSP was identified as the most comfortable position for the participants, indicating that patient comfort should be a crucial consideration in choosing a sitting position for neuraxial block procedures. The study’s comprehensive analysis and comparison of the different positions provide valuable insights for practitioners and researchers in the field of neuraxial anesthesia.

Reference –

Singh G, Sethi P, Kaur M, Bhatia P, Garg PK, Kumari K, et al. Comparison of neuraxial acoustic target window of the spine among rider sitting, cross leg, hamstring stretch, and classical sitting position:An observational study. J Anaesthesiol Clin Pharmacol 2024;40:318‑23.