Archive for month: August, 2024

Jabalpur: At a time when the resident doctors at RG Kar Medical College are still protesting over the brutal rape and murder of PG trainee doctor in Kolkata, the Madhya Pradesh High Court in Jabalpur has ordered the state government to submit a comprehensive report within 14 days on the actions it has taken to enhance the safety of doctors in medical colleges across the state.

The court, led by Acting Chief Justice Sanjeev Sachdeva, was addressing a public interest litigation (PIL) filed by RTI activist Ansul Tiwari. The petition highlighted the urgent need for improved safety measures for doctors, prompted by the disturbing incident in Kolkata.

Also read- Violence at Prayagraj Hospital: Senior doctor suffers vision loss in left eye after mob attack

Advocate Mahendra Pateria, representing the medical community, informed the court that the state must present a detailed strategy during the proceedings. The required blueprint should cover several critical areas, transport for duty doctors, the establishment of a state grievance committee, setting up police posts, securing campus areas, implementing an attendants policy, enforcing restrictions on photography and videography, and managing bed occupancy.

“HC has asked the state government to come up with a strategy and planning for the safety and security of women doctors in hospitals and medical colleges and how it is planning to ensure their safety. Fourteen days time has been given to the state government to submit the report,” said Pateria as quoted by Free Press Journal. 

Medical Dialogues had earlier reported that after taking suo motu cognisance of the incident of rape and murder of a PG trainee doctor at RG Kar Hospital, the Supreme Court constituted a National Task Force to frame effective recommendations to remedy the issues of concern regarding safety, working conditions, and well-being of medical professionals and other related matters.

This 15-member committee, comprising nine senior doctors and five ex-officio government officials, shall prepare an action plan to prevent violence against medical professionals and provide safe working conditions for them.

Further, it will provide an enforceable national protocol for dignified and safe working conditions for interns, residents, senior residents, doctors, nurses, and all medical professionals, the Union Ministry of Health and Family Welfare mentioned in an Office Memorandum issued yesterday.

To prevent violence against healthcare workers, the NTF’s job will be to ensure due security in medical establishments, provide a framework for infrastructural development- such as separate duty rooms and restrooms for male/female doctors, nurses, gender-neural common resting space, use of bio-metric or facial recognition for entry to sensitive areas, installing CCTVs, provision of transport from place of stay to place of duty and vice versa.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors used to treat type 2 diabetes might prevent dementia, providing greater benefits with longer treatment, suggests a large study from Korea published by The BMJ today.

As this study was observational, the researchers note that the effect size could have been overestimated and say randomised controlled trials are now needed to confirm these findings.

According to the World Health Organization, the number of people with dementia globally is expected to reach 78 million by 2030 and type 2 diabetes is associated with a greater risk of developing dementia.

A recent study of over 65s with type 2 diabetes suggested a decreased risk of dementia associated with SGLT-2 inhibitors versus another type of diabetes drug, dipeptidyl peptidase-4 (DPP-4) inhibitors. But the effects on younger people and specific types of dementia (eg, Alzheimer’s disease, vascular dementia) remains unclear.

To address this, researchers used the Korea National Health Insurance Service database to identify 110,885 pairs of adults with type 2 diabetes aged 40-69 years who were free of dementia and started taking either an SGLT-2 inhibitor or a DPP-4 inhibitor between 2013 and 2021.

All participants (average age 62; 56% men) were matched by age, sex, use of the diabetes drug metformin, and baseline cardiovascular risk and were followed up for an average of 670 days to see who developed dementia.

Potentially influential factors including personal characteristics, income level, underlying risk factors for dementia, other conditions and related medicine use, were also taken into account.

Over the follow-up period, a total of 1,172 participants with newly diagnosed dementia were identified.

Dementia rates per 100 person years were 0.22 for those using SGLT-2 inhibitors and 0.35 for those using DPP-4 inhibitors, corresponding to a 35% reduced risk of dementia associated with use of SGLT-2 inhibitors compared with DPP-4 inhibitors.

The researchers also found a 39% reduced risk for Alzheimer’s disease, and a 52% reduced risk for vascular dementia associated with SGLT-2 inhibitors compared with DPP-4 inhibitors.

What’s more, the effect of SGLT-2 inhibitors seemed more pronounced with longer treatment duration. A 48% reduced risk of dementia was seen for more than two years of treatment versus a 43% reduced risk for two years or less.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors note that details of health behaviours (eg, smoking and alcohol consumption) and duration of type 2 diabetes were not fully available.

However, they point out that this was a large study based on nationally representative data that included relatively younger people with type 2 diabetes, and results were highly consistent across subgroups.

As such, they say SGLT-2 inhibitors might prevent dementia, providing greater benefits with longer treatment, and they call for randomised controlled trials to confirm these findings.

This study reports promising results that have important implications for clinical practice as well as from a public health perspective, say researchers from Taiwan in a linked editorial.

They agree that further trials are needed to confirm these findings, and suggest that studies are also needed “to explore the underlying mechanisms of any neuroprotective effects of SGLT-2 inhibitors.”

As no cure currently exists for dementia and few effective treatment options are available, strategies that can potentially prevent onset are critically important, they write.

Given the substantial socioeconomic and public health burdens associated with both dementia and type 2 diabetes, they also recommend that clinical guidelines and healthcare policies should be updated regularly to incorporate latest best evidence on the potential benefits of SGLT-2 inhibitors, including reduced dementia risk.

Reference:

Shin A, Koo B K, Lee J Y, Kang E H. Risk of dementia after initiation of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors in adults aged 40-69 years with type 2 diabetes: population based cohort study BMJ 2024; 386 :e079475 doi:10.1136/bmj-2024-079475

USA: Topline results from the FINEARTS-HF trial have revealed that finerenone (Kerendia), a nonsteroidal selective mineralocorticoid receptor antagonist (nsMRA), can lower the risk of cardiovascular (CV) death and total heart failure (HF) events in patients with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF).