Higher Likelihood of Tympanostomy Tube Replacement in Children with Cleft Palate Post-Surgery, Study Finds

USA: Tympanostomy tubes, commonly known as ear tubes, are a standard treatment for children with recurrent ear infections or persistent fluid buildup in the middle ear. However, the longevity and necessity for replacing these tubes vary among patients. A recent study has shed light on the risk factors influencing the need for tube replacement after surgical removal, aiming to enhance understanding and management in pediatric ear care.

The majority of children undergoing tympanostomy tube removal and myringoplasty do not require replacements. The new study, published in Otolaryngology-Head and Neck Surgery, identified that cleft abnormality increased the need for replacement tubes. Additionally, prolonged tube durations exceeding three years were linked to reduced success rates for myringoplasty.

“It is recommended that tympanostomy tube removal be considered within 2 to 3 years after placement for most patients, with longer durations potentially considered for children who have undergone cleft palate repair,” the researchers wrote.

The surgical procedures of ear tube removal and patch myringoplasty are commonly performed, with varying indications and timing recommended by otolaryngologists. Tympanostomy tubes are typically designed to stay in place temporarily, aiding in ventilation and drainage until natural healing occurs. However, in some cases, new tubes may be required due to persistent issues.

Against the above background, John Faria, Department of Otolaryngology, University of Rochester, Rochester, New York, USA, and colleagues identified risk factors associated with the need for replacing tympanostomy tubes after tube removal and myringoplasty.

The study utilized a case series approach with a chart review conducted within a single institution’s academic otolaryngology practice. The research focused on pediatric patients under 12 years old who underwent tympanostomy tube removal and myringoplasty at the University of Rochester Medical Center between March 2011 and September 2019. Patients who had tympanostomy tube removal, specifically due to chronic otorrhea, were excluded from the study criteria.

The study led to the following findings:

  • One hundred sixty-one patients (230 ears) met the inclusion criteria and had sufficient follow-up.
  • Myringoplasty success after tube removal was 94.8%.
  • Successful myringoplasty was associated with shorter tube duration (32 months) versus unsuccessful myringoplasty (40 months).
  • Replacement tympanostomy tubes after myringoplasty occurred in 9.6% of ears.
  • There was no difference in average patient age or duration of tubes in patients who required replacement of tympanostomy tubes versus patients who did not require tube replacement.
  • Patients with a cleft abnormality were more likely to require tympanostomy tube replacement.

“The study on risk factors for tympanostomy tube replacement provides valuable insights into optimizing care for children with ear conditions, highlighting the importance of tailored management approaches and regular follow-up to mitigate the need for further interventions,” the researchers concluded.

Reference:

Wie K, Shaw S, Allen P, Castle M, McKenna M, Faria J. Risk Factors for Replacement of Tympanostomy Tubes After Surgical Removal for Pediatric Patients. Otolaryngol Head Neck Surg. 2024 Jul 17. doi: 10.1002/ohn.909. Epub ahead of print. PMID: 39015070.

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Bipolar disorder & alcohol: It’s not as simple as ‘self-medication’ suggests JAMA study

Bipolar disorder and alcohol problems seem to go hand-in-hand, leading to a widespread belief that drinking acts as a kind of “self medication” to ease bipolar’s life-altering symptoms of mania, depression, anxiety, sleep disturbances and more.

But a new study suggests a much more complex interaction between the two.

Using ten years of data from nearly 600 people with bipolar disorder who volunteered for a long-term University of Michigan study, researchers show that even short-term increases in drinking can have lasting effects, even among those who drink fewer drinks than experts consider problematic.

But the opposite wasn’t true: those who experienced an uptick in their symptoms didn’t go on to have increased drinking that would indicate self-medication. The study was published in JAMA Network Open.

The researchers, based at the Heinz C. Prechter Bipolar Research Program, say this can be important knowledge for people with bipolar disorder and for the clinicians involved in their care.

Whether they decide to drink or not, keeping alcohol consumption levels consistent and including discussions of drinking habits in mental health appointments could be key.

“Our study shows that when an individual with bipolar disorder drinks more than typical for them, regardless of how much more, they are more likely to show an increase in depressive and/or manic symptoms over the following six months, even if they did not have a co-occurring alcohol use disorder,” says first author Sarah Sperry, Ph.D., a psychologist and assistant professor at Michigan Medicine’s Department of Psychiatry who specializes in bipolar disorder care and research. “Contrary to the self-medication hypothesis, there was no evidence that having increased mood symptoms predicted lasting changes in alcohol use over the following six months.”

Sperry notes that previous studies have shown that more than half of people who have a bipolar disorder diagnosis also experience alcohol use disorders sometime in their lives, and that many report using alcohol to help them get to sleep.

But few studies have explored the interaction between the two or sought to address them together.

Study volunteers’ data makes a big difference

Thanks to the massive amounts of data available from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), Sperry and her colleagues are making headway on understanding the interaction.

The PLS-BD is a unique and detailed longitudinal study that has engaged over 1,500 individuals with and without bipolar disorder who are helping scientists identify biological, genetic, psychological, and environmental causes of bipolar disorder and its trajectory over time. All of them complete measures of mood symptoms, life functioning, alcohol use and more every 2 months throughout their involvement in the study.

“This is exactly the type of data needed to test how mood symptoms impact an individual’s alcohol use and conversely, how changes in alcohol use impact mood symptoms” says Sperry, the Prechter Program’s associate director.

Using sophisticated computational approaches needed for this type of intensive longitudinal data, doctoral candidate Audrey Stromberg, Sperry and their collaborators examined the bi-directional relationships between alcohol use and mood symptoms over 10 years in 584 individuals with a bipolar disorder.

They also looked at the impact of alcohol use on functioning across domains of family, friend, work, and home life and found that drinking more than typical amounts of alcohol was linked with a higher likelihood of problems in work functioning over the following six months. This was true for individuals with both of the most common forms of the condition, called bipolar I disorder and bipolar II disorder, although it was even more pronounced in individuals with bipolar II disorder.

The findings were seen even in people who were not engaging in binge drinking, drinking with high intensity or frequency, or experiencing impairment related to their alcohol use. As a result, they suggest that clinics should use a standardized measurement tool such as the Alcohol Use Disorder Identification Test (AUDIT) to gauge alcohol use patterns at any level over time, and guide conversations between patients and providers.

Advice for today – research for tomorrow

Sperry and her team at her EmoTe Laboratory have already begun following up on the new findings to try to identify psychological and neurophysiological factors that contribute to alcohol use and symptom changes in bipolar disorder. Ultimately, they hope to develop new interventions that target both.

For now, the key message about alcohol use for people with bipolar disorder seems to be to keep things consistent over time – – just like clinicians advise them to do with sleep schedules, medication schedules, and eating patterns.

For instance, patients who see alcohol as a tool to get to sleep or calm anxiety may be best off focusing on keeping their alcohol use low and stable, and avoid bingeing. Others may see the new findings as important for resisting peer pressure to binge drink during social situations. Findings may aid patients and their clinicians to have conversations about abstaining from alcohol vs. engaging in harm reduction strategies, Sperry notes.

“The reasons behind our findings likely have more to do with what alcohol and social situations involving alcohol do to a person’s circadian rhythms and brain-based reward circuits, not just the action of the substance in the brain,” says Sperry.

For instance, the brains of people with bipolar disorder may be more sensitive to disruptions in communications that alcohol can cause, and slower to recover from those impacts. Sperry and her colleagues are preparing to study this and other aspects of brain activity using EEG, or electroencephalogram, as well as mobile and wearable technologies to measure real-world behaviors.

Reference:

Sperry SH, Stromberg AR, Murphy VA, et al. Longitudinal Interplay Between Alcohol Use, Mood, and Functioning in Bipolar Spectrum Disorders. JAMA Netw Open. 2024;7(6):e2415295. doi:10.1001/jamanetworkopen.2024.15295.

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Switching from eculizumab to ravulizumab safely preserves renal function in atypical hemolytic uremic syndrome: Study

Switching from eculizumab to ravulizumab safely preserves renal function in atypical hemolytic uremic syndrome suggests a study published in the BMC Nephrology.

The complement factor 5 (C5)-inhibitor eculizumab has been established as standard-of-care for the treatment of atypical hemolytic uremic syndrome (aHUS). In 2021, the long-acting C5-inhibitor ravulizumab was approved, extending intervals of intravenous treatment from two to eight weeks resulting in improvement of quality of life for patients and lowering direct and indirect therapy associated costs. This multicenter, retrospective data analysis of 32 adult patients with aHUS (including 10 kidney transplant recipients) treated with eculizumab for at least three months and switched to ravulizumab aims to evaluate the safety and efficacy of switching medication in the real-world setting. Hematologic parameters, kidney function, concurrent therapy and aHUS associated events were evaluated three months before and until up to 12 months after switching to ravulizumab. Results: Mean age (range) at ravulizumab initiation was 41 years (19–78 years) and 59% of the patients were female. Genetic analysis was available for all patients with 72% showing a pathogenic variant. Median time (range) on eculizumab before switching was 20 months (3–120 months). No new events of TMA or worsening of renal function were reported during up to 12 months of follow-up during ravulizumab treatment. This is the largest, non-industry derived, multi-center retrospective analysis of adult patients with aHUS switching C5-inhibitor treatment from eculizumab to ravulizumab in the real-world setting. Switching to ravulizumab was safe and efficient resulting in sustained hematological stability and preservation of renal function.

Reference:

Schönfelder, K., Kühne, L., Schulte-Kemna, L. et al. Clinical efficacy and safety of switching from eculizumab to ravulizumab in adult patients with aHUS– real-world data. BMC Nephrol 25, 202 (2024). https://doi.org/10.1186/s12882-024-03638-3

Keywords:

Switching, eculizumab, ravulizumab, safely, preserves, renal function, atypical, hemolytic uremic syndrome, Schönfelder, K., Kühne, L., Schulte-Kemna, L, BMC Nephrology

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AFMS MBBS Admissions 2024: Know Eligibility Criteria, Selection Process, Seat Matrix, All Details Here

New Delhi- Armed Forces Medical College (AFMS) is inviting online applications from candidates interested in admission to MBBS courses in AFMS. On this, AFMS released an Information Brochure detailing the MBBS programme for the candidates.

A total of 150 candidates (including 05 Govt. sponsored candidates from Friendly Foreign Countries) will be selected in the year 2024, of which 145 candidates (115 boys and 30 girls) will be selected as Medical Cadets for undergoing MBBS at the Armed Forces Medical College, Pune with liability to serve in the Armed Forces Medical Services as Medical Officers. The candidates selected in addition to becoming doctors will also be commissioned as officers of the Indian Armed Forces, wherein they have to be both physically and psychologically robust to be able to undergo the rigors of life in the Armed Forces. The selected candidates need to have leadership qualities, effective communication skills, and exacting physical standards, as the same are prime requisites, as per AFMS brochure.

for serving officers of the Armed Forces.Eligible candidates who are interested in joining AFMC, Pune to pursue the MBBS course will have to mandatorily register and apply for AFMC, Pune on DGHS’s official website during the registration window provided by the DGHS. Candidates seeking admission to the MBBS course at AFMC Pune will have to mandatorily qualify the NEET UG 2024 Examination conducted by the National Testing Agency (NTA).

Also Read: NEET PG Admissions 2024: AFMS Extends Document Submission Deadline for Medical Officers, Priority IV Candidates

As per the information brochure, in AFMS the MBBS course is 4 ½ years followed by compulsory rotating internship training of one year. All medical cadets commissioned into the AFMS will undergo internship training in selected service hospitals recognized by the National Medical Commission (NMC).

The candidate should have attained the age of 17 years at the time of admission or should be completing that age on or before 31 Dec of the year of admission of the first year of the MBBS course but must not have attained the age of 24 years on that date, i.e., must have been born not earlier than 01 January 2001 and not later than 31 December 2007.

Below are the other details including Eligibility, method of selection, etc regarding the admission to MBBS courses in AFMS.

Also Read: Applying for AFMS NEET PG 2024, NEET MDS 2024 admissions this year, know eligibility criteria, required documents, counselling details

ELIGIBILITY

A candidate seeking admission to the MBBS Course in AFMC is eligible if he/she fulfils the following criteria-

1 The candidate should be a citizen of India. Foreign nationals of Indian origin may be admitted into AFMC only after they have acquired Indian Citizenship or in respect of whom the Ministry of Home Affairs issues a certificate of eligibility. This however does not apply to 05 Govt Sponsored Candidates from Friendly Foreign Countries.

2 Must be unmarried. Marriage during the course is not permitted.

3 Should be medically fit.

Meanwhile, the following categories of candidates are not eligible to apply

1 Candidates who have passed in Domestic Science, Domestic Arithmetic, and Lower Math separately or in combination with other subjects like General Science / Social studies in High School / Higher Secondary (Multipurpose) or equivalent examination.

2 Candidates who have passed only Pre-University / Pre-Degree (one-year course) or PreProfessional in Agriculture / Veterinary / Dental Examination.

3 Candidates who have passed the Pre-professional or equivalent qualifying examination as a private candidate or from Open schools.

4 Candidates who have secured the requisite percentage but in subsequent attempts or compartment examination.

ACADEMIC QUALIFICATIONS

Candidates must have passed one of the qualifying examinations listed at sub-para (a) to (j) below in the first attempt with English, Physics, Chemistry and Biology/ Bio-technology taken simultaneously and securing not less than 60% of the aggregate marks in these three science subjects taken together and not less than 50% marks in English and 50% marks in each of the science subjects. They must have also passed an examination in Mathematics of the tenth standard. The examinations are-

1 The Higher Secondary (10+2) or equivalent examination in science of a statutory Indian University/Board or other recognised examination body with English, Physics, Chemistry & Biology/ Bio-technology which will include practical tests in all of these science subjects.

2 The Pre-professional/Pre-Medical examination with English, Physics, Chemistry and Biology/ Bio-technology (after passing either the Higher Secondary School examination or pre-university or equivalent examination) which shall include practical tests in these science subjects.

3 1st year of three years of Degree courses at a recognised University with English, Physics, Chemistry, and Biology/ Bio-technology including practical tests in science subjects provided the examination is a University Examination.

4 Senior Secondary of a statutory Examination Board of Indian School Certificate examination of 12 years of study, last two years of study comprising of Physics, Chemistry, Biology/ Bio-technology and Mathematics or any other elective subject with English at a higher level.

5 Higher Secondary School Certificate examination of Maharashtra State Board of Higher Secondary Education with English at a Higher level, anyone of the Modern Indian or Modern Foreign or Classical Languages, Physics, Chemistry, Biology/Biotechnology and Mathematics or any other elective subject.

6 Any other examination which in scope and standard is found to be equivalent to the Higher Secondary Science/Pre-Professional/Pre-medical Examination of Indian University/ Board with English, Physics, Chemistry and Biology/ Bio-technology including practical test in each of these Science subjects.

7 B.Sc. Examination of a recognized Indian University provided that he/she has passed the B.Sc. Examination in not less than two of the subjects Physics, Chemistry, Botany, Zoology / Bio-technology and further that he/she has passed the qualifying examination with Physics, Chemistry, Biology and English.

8 Candidates who have appeared or will be appearing in the qualifying examination may also apply. Admission, if selected, however, will be subject to passing and meeting the eligibility criteria.

9 Regarding the requirement of Mathematics, any candidate who has passed the Higher Secondary, Senior Cambridge or Indian School Certificate Examination and had not offered Mathematics in the final year will be deemed eligible if he/she had studied Mathematics up to the pre-final year stage (X Class) and had passed an examination in the subject provided it was at least of Tenth standard. A certificate signed by the Head Master or Principal of the school in which the candidate has studied should be produced at the time of the interview in such cases. A candidate who had not taken Mathematics at the Tenth or an equivalent examination but had subsequently passed in Mathematics as an additional subject in the ISc. / B.Sc. examination is also eligible.

Also Read: MCC to conduct NEET MDS Counselling of Priority- III, IV, V candidates into AFMS PG Teaching Institutes from this year, all details here

METHOD OF SELECTION

1 The shortlisted candidates will be called for screening which comprises of Test of English Language and Reasoning (ToELR), Psychological Assessment Test (PAT), Interview and Medical Examination at AFMC, Pune.

2 Test of English Language and Reasoning (ToELR) will be in the form of a Computer Based Test (CBT) consisting of 40 MCQs of 2.0 marks each amounting to a maximum of 80 marks and will be held at AFMC, Pune. There will be negative marks of 0.5 for every incorrect answer. These 40 questions will be required to be answered in 30 minutes. The marks obtained in ToELR will be added to the NEET score to give the final written examination score.

3 This will be followed by an interview of 50 marks. In addition to the core subject, the candidates will be interviewed on general awareness and knowledge, interests, hobbies and personality by a panel of judges. Weightage will be given to candidates for participation in NCC/Sports at various levels and for wards of Officers/JCOs/ORs who are serving/ex-servicemen/Killed in action. The final merit will be based on the final score thus obtained (Written examination score + Interview marks + ToELR). The psychological Assessment Test (PAT) is a qualifying examination and the PAT score will not be considered for preparing the final merit list.

4 All candidates will be subjected to medical examination as per the requirement of the Armed Forces and as per the laid down standards. The candidates who have been declared medically unfit by the Medical Board of AFMC will not figure in the final merit list for admission.

5 The final result of the selected Merit List and Wait-list candidates will be available on the DGAFMS official website, which is mentioned in the information brochure.

METHOD OF SELECTION FOR SC/ST CANDIDATES

For the SC/ST category candidates, up to 10 seats out of 145 will be offered subject to fulfilling the following criteria-

1 The SC/ST candidates must have applied for AFMC, Pune and also qualified in the NEET UG– 2024 written examination.

2 They must fulfil all other conditions/standards, as applicable to non-SC / ST candidates, like age eligibility, academic qualifications, medical fitness, etc.

3 These seats will be in addition to any vacancies secured by SC/ST candidates on the basis of their position in the main merit list (excluding waiting list).

4 In case of any SC / ST girl/boy, admitted against these vacancies the number of girls/boys to be admitted against the general seats will be reduced correspondingly.

5 All such candidates will have to sign a surety bond on the same lines and on the same conditions as Non-SC / ST candidates.

To view the information brochure, click the link below

https://medicaldialogues.in/pdf_upload/information-brochure-afmc-mbbs-2024-245149.pdf

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Karnataka Assembly adopts resolution against NEET

Karnataka- Amid the controversy over the National Eligibility and Entrance Test (NEET) this year, the Karnataka Cabinet has adopted a resolution against the exam.

The government said the NEET examination system is severely affecting the medical education opportunities of poor children from rural areas. It not only makes the school education system ineffective, but also takes away the rights of the state government to admit students in state government managed medical colleges and hence it is requested that this system should be abolished, as per PTI report.

The Karnataka Cabinet, headed by Chief Minister Siddaramaiah, in a meeting held recently, approved the proposal to scrap the NEET exam in Karnataka. Instead of the NEET exam, the Cabinet decided to hold another new medical entrance examination for undergraduate and postgraduate programmes or convert it into the Common Entrance Test (CET) for medical students.

Also Read: More than 4 Lakh NEET candidates May Lose 5 Marks as SC Directs NTA to Re-Tally Results over ‘Ambiguous’ Physics Question

Previously, Karnataka deputy CM DK Shivakumar said “The NEET exam must be scrapped immediately and the union government must allow states to conduct their own exams. Karnataka has built colleges but the NEET exam is benefitting North Indian students and depriving our own students. We all have to unitedly fight against this”.

To scrap the NEET from Karnataka started after the Tamil Nadu Assembly unanimously passed a resolution against the NEET, urging the union government to scrap NEET and allow state governments to undertake medical admissions based on class 12 marks, as was done before NEET’s implementation.

Medical Dialogues had earlier reported that the resolution was introduced by Tamil Nadu Chief Minister MK Stalin amid uproar over a paper leak in the NEET-UG 2024 examination and the sudden postponement of the NEET-PG 2024 examination.

“Tamil Nadu has been consistently saying that we do not want NEET. Now it is proved that NEET is not a fair examination, and students are losing so much because of NEET. We want NEET to be abolished. We have passed a resolution in our Assembly, and it is still pending with the President for signature”, Kanimozhi said.

Also Read: Tamil Nadu Assembly unanimously passes resolution to scrap NEET

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Submit AE and SAE Data : CDSCO Panel Tells MSN Pharmaceuticals on Anti-cancer Drug MK-1084

New Delhi: Reviewing phase 3 clinical study protocol of the anti-cancer drug MK-1084, the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) has opined MSD Pharmaceuticals to submit details of AE (adverse event) and SAE (serious adverse event) data for further review.

This came after MSD Pharmaceuticals presented phase 3 clinical study protocol no. MK-1084-004 version 00 dated 15 December 2023.

MK-1084 is an investigational, potent, and specific KRAS G12C covalent inhibitor. Mutations in KRAS are among the most prevalent mutations found in cancer, occurring with high frequency in non-small cell lung cancer, and pancreatic, urogenital, and colorectal cancers. The KRAS G12C mutation is the most frequently observed KRAS mutation in patients, occurring in approximately 14% of non-small cell lung cancers (adenocarcinoma).

MK-1084 is an orally available inhibitor of the oncogenic KRAS substitution mutation G12C, with potential antineoplastic activity. Upon oral administration, KRAS G12C inhibitor MK-1084 selectively targets the KRAS G12C mutant and inhibits KRAS G12C-mediated signaling.

MK-1084 exhibits anticancer activity and can be used either alone or in combination with pembrolizumab for cancer research.

At the recent SEC meeting held on July 9, 2024, the expert panel reviewed phase 3 clinical study protocol no. MK-1084-004 version 00 dated 15 December 2023 presented by MSD Pharmaceuticals.

After detailed deliberation, the committee opined that the firm should submit details of AE (adverse event) and SAE (serious adverse event) data for further review by the committee.

Also Read: CDSCO may waive cough syrups from testing for export to specific countries

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Study debunks link between moderate drinking and longer life

Probably everyone has heard the conventional wisdom that a glass of wine a day is good for you—or you’ve heard some variation of it. The problem is that it’s based on flawed scientific research, according to a new report in the Journal of Studies on Alcohol and Drugs.

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Cancer risk from pesticides comparable to smoking in some cases, study finds

In modern day agriculture, pesticides are essential to ensure high enough crop yields and food security. These chemicals, however, can adversely affect plant and animal life as well as the people exposed to them.

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Wearing a face mask in public spaces cuts risk of common respiratory symptoms, suggests Norway study

Wearing a surgical face mask in public spaces reduces the risk of self-reported respiratory symptoms, finds a trial of adults in Norway published by The BMJ.

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Harm of prescribing NSAIDs to high-risk groups estimated to cost NHS £31 million over 10 years

Prescribing non-steroidal anti-inflammatory drugs (NSAIDs) to people at high risk of harm from them is estimated to cost the NHS in England around £31 million and cause more than 6,000 lost years of good health over 10 years, finds a study published by The BMJ.

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