No risk of birth defects: Use of Progesterone safer in first trimester than Dydrogesterone, claims DEBC Study

China: A recent study, known as the Maternal Drug Exposure Birth Cohort (DEBC), has been conducted in China to examine the effects of maternal drug use on newborn health. In the study, the researchers determined how medications taken by pregnant women can influence birth outcomes, potentially guiding future public health policies and clinical practices.

The study, published in Nature Communications, found that progesterone is safe, whereas dydrogesterone increases the risk of birth defects.

Exposure to dydrogesterone during the first trimester is associated with increased rates of stillbirth, preterm birth, low birth weight, and birth defects, while also correlating with a reduced incidence of miscarriage or abortion, the researchers reported. However, they noted that due to the limitations inherent in this cohort study, definitive causal conclusions cannot be established.

Global data on fetal safety related to drug exposure during pregnancy is limited. To address this gap, the Maternal Drug Exposure Birth Cohort (DEBC) study has been launched as a prospective longitudinal investigation. Lu Li, National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China, and colleagues aimed to examine the relationship between maternal drug use and pregnancy outcomes while also establishing a human biospecimen biobank for future research. They check the use of drugs in pregnancy, especially in the first trimester, and the risk of birth defects.

The researchers detailed the establishment of the DEBC study, revealing that 30.70% of the 112,986 pregnant women involved reported drug use during the first trimester. Among these drugs, dydrogesterone and progesterone were the most frequently used, with exposure rates of 11.97% and 10.82%, respectively. Overall, the study observed an incidence rate of 13.49% for adverse pregnancy outcomes.

The researchers stressed the importance of weighing the risks of using medication against the potential dangers of not using it. They explained, “For example, untreated preeclampsia in pregnant women significantly increases the risk of seizures, which can harm both the mother and fetus. In contrast, careful use of anti-epileptic medication can lower this risk. Similarly, our study found that dydrogesterone use was associated with a lower risk of miscarriage or abortion.”

They also mentioned the importance of balancing the risks and benefits when considering medication accounting for the timing and dosage. However, research on how different medication regimens (including various drugs, doses, and durations) affect maternal and fetal outcomes is still limited. Future studies will explore these aspects more thoroughly, using data from this cohort.

“Future studies should focus on stratified analysis based on specific maternal diseases and investigation of the connections between medications during pregnancy and adverse pregnancy outcomes, accounting for exposure timings, durations, routes, and doses,” the researchers concluded.

Reference: https://doi.org/10.1038/s41467-024-49623-0

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Already 30 minutes of exercise increases proportion of tumor-killing white blood cells in blood, reveals study

A new Finnish study from University of Turku shows that already a 30-minute exercise can increase the proportion of tumor-killing white blood cells in the bloodstream of breast cancer patients.

White blood cells, the cells of our immune system, fight against cancer, bacteria, and viruses. However, not all white blood cells destroy cancer cells and some can even promote cancer growth. The most important cell types that destroy cancer cells are cytotoxic T cells and natural killer cells. Cell types that support cancer growth include, for example, regulatory T cells and myeloid derived suppressor cells.

“The balance of different types of white blood cells determines whether the immune system works to destroy cancer or to support it. If there are more cancer-destroying cells than cancer-promoting cells in the tumor area, the body is more capable of fighting cancer,” says lead author, Doctoral Researcher Tiia Koivula from the University of Turku, Finland.

Twenty breast cancer patients who had just been diagnosed and therefore had not yet started their cancer treatments participated in the study. During the study, the patients pedaled a bicycle ergometer for 30 minutes at a resistance of their own choosing. Blood samples were taken from the patients at rest before the pedaling, during the exercise, and after the exercise.

Blood samples were analysed to calculate the amount of many different types of white blood cells, and the amounts measured during the exercise were compared to those at rest.

During the exercise, the amount of several different white blood cell types increased in the bloodstream. The number of cancer-destroying cytotoxic T cells and natural killer cells increased the most. On the other hand, the number of cancer-promoting regulatory T cells and myeloid derived suppressor cells did not change.

The researchers also examined the proportions of different white blood cell types relative to the total white blood cell count, and found that the proportion of natural killer cells increased significantly, while the proportion of myeloid derived suppressor cells decreased.

“We found that during the exercise, the number and proportion of cancer-destroying cells increases in the bloodstream, while the proportion of cancer-promoting cells either stays the same or decreases. However, it is still unclear whether these changes seen in the bloodstream also lead to changes in the white blood cell counts in tumor area,” says Koivula and continues:

“In this study, it was seen that the number of almost all white blood cell types decreased back to resting values one hour after the exercise. With the current knowledge, we cannot say where the white blood cells go after the exercise, but in preclinical studies, cancer-destroying cells have been seen to migrate into the tumor area.”

The researchers also analysed whether different types of breast cancer affect the exercise responses of white blood cells. The researchers found that the larger the tumor, the less the number of natural killer cells increased, and if the breast cancer was estrogen and/or progesterone receptor-positive, the number of cytotoxic T cells increased less than in hormone receptor-negative cancers.

“In our previous study, we found small indications that the type of breast cancer might affect the effects of exercise on white blood cells, which is why we wanted to examine it further. However, the correlations we found were not very strong and therefore, no decisive conclusions can be drawn from the results. According to current knowledge, it is beneficial for all cancer patients to exercise, and our recent study supports this notion,” Koivula encourages.

Reference:

Tiia Koivula, Salla Lempiäinen, Joona Neuvonen, The effect of exercise and disease status on mobilization of anti-tumorigenic and pro-tumorigenic immune cells in women with breast cancer, Frontiers in Immunology, https://doi.org/10.3389/fimmu.2024.1394420.

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PAD Patients Less Likely to Receive Statins, Despite Increased Cardiac Event Risk: Study

India: A retrospective study published in the Journal of the Association of Physicians of India revealed that patients with Peripheral Arterial Disease (PAD) are often underprescribed to appropriate statin therapy, even though they are at high risk for future cardiac events. 

The study found that the involvement of more vascular beds increased the likelihood of initiating high-intensity statin therapy. The findings highlight the need for greater awareness among healthcare providers to start high-intensity statin treatment in PAD patients, regardless of cholesterol levels, similar to the approach used for acute coronary syndrome (ACS) patients.

Atherosclerotic cardiovascular disease (ASCVD) events are frequent in patients with PAD, which impacts over 202 million individuals globally. Previous research has indicated that statin use among PAD patients remains low.

Given this context, Shweta Agrawal, Associate Professor, Department of Cardiology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India et. al. aimed to assess the proper use of statins in PAD patients and examine statin usage among those with PAD and involvement in other vascular beds.

To conduct this retrospective cross-sectional study, researchers reviewed data from patients with a confirmed PAD diagnosis based on invasive or noninvasive imaging. Demographic, clinical, laboratory, and treatment information was summarized using descriptive statistics. Multiple logistic regression analysis was performed to identify predictors for prescribing high-intensity statins. According to American College of Cardiology and American Heart Association guidelines, high-intensity statin therapy was defined as atorvastatin ≥40 mg per day, rosuvastatin ≥20 mg per day, or simvastatin ≥80 mg per day.

The key findings of the research were as follows:

  • Statins were used by 82% of patients; however, only 39% were on high-intensity statins.
  • Patients with cerebrovascular disease (CVD) had lower odds of receiving lower extremity revascularization (LIS) therapy, with an odds ratio of 0.19).
  • Those on oral anticoagulants (OAC) also had lower odds of receiving LIS therapy (OR = 0.16).
  • Patients on dual antiplatelet therapy (DAPT) were less likely to receive LIS therapy (OR = 0.20).

The researchers concluded that patients with PAD are less likely to receive appropriate statin therapy, despite having a high risk of future adverse cardiac events. Involvement of more vascular beds was associated with higher chances of initiating high-intensity statin.

Reference

Agrawal S, Batta SA, Kamath D, et al. Statin Usage in Peripheral Arterial Disease Patients. J Assoc Physicians India 2024;72(6):54-56.

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Pondicherry University Postpones MBBS Exams Following Question Paper Leak, no revised schedule yet

Puducherry: Medical students are in a dilemma as the first-year MBBS examinations of Pondicherry University, which were
scheduled to start last week, have been postponed due to a question paper leak.
The university has not yet announced a revised schedule.

This postponement affects students enrolled in over a dozen
government and private medical colleges affiliated with the university in Puducherry and the Andaman and Nicobar Islands.

Also Read:Delhi Court Denies Anticipatory Bail to Puja Khedkar in Alleged UPSC Fraud Case

Students arrived at their
respective examination halls on Friday morning only to learn that the exams
were postponed. This decision was made after faculty members at a private
medical college alerted the authorities about the leak, reports Times of India.

The assistant registrar
(medical) sent a circular to the deans and directors of the affiliated
colleges, notifying them of the postponement. However, the circular did not
specify the reason for the delay. “…I am
directed to inform that the examinations scheduled for the MBBS course for August
2024 session…are postponed due to administrative exigencies. The revised
schedule will be intimated shortly. This may be brought to the notice of the students
concerned,” the circular said.

A university official,
speaking on condition of anonymity, mentioned that the examination wing has
frequently been in the news for negative reasons, hinting at ongoing
administrative issues, reports the daily. “It has a lackadaisical approach in scheduling,
conducting exams, and declaring results on time. On a couple of occasions, it
didn’t declare results of UG even after the last date for admission into
postgraduate courses,” he added.

Also Read:NEET case updates: CBI conducts searches at 7 locations in Gujarat

This year’s NEET UG 2024
exam was also mired in controversies after a paper leak scam came to light.
Medical Dialogues had earlier reported that around 13 people, including four
examinees and their family members, were arrested in Bihar for their alleged
involvement in the paper leak of the NEET-UG exam. Patna police sources had
previously claimed that the NEET-UG question papers along with their answers
were provided to around 20 aspirants a day before the date of the exam i.e. May
5, 2024.

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CBI arrests first-year MBBS student of Rajmata Vijaya Raje Scindia Medical College in NEET paper leak case

In the latest update on the NEET paper leak case, the Central Bureau of Investigation (CBI) in its ongoing investigation recently arrested a first-year MBBS student of Rajmata Vijaya Raje Scindia Medical College in Bhilwara, Rajasthan in connection.
According to the agency, the accused student, Sandeep Kumar, admitted to his alleged involvement in solving the question paper of NEET-UG after being summoned to Patna by the CBI for interrogation on Saturday.
For more information, click on the link below:

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Drugs not yet marketed in India, Submit PSUR Data: CDSCO Panel Tells Novo Nordisk on Semaglutide injection

New Delhi: Noting that proposed drug products Semaglutide Injection 0.25mg/0.5mg/1mg/1.7mg/2.4mg (Wegovy) and Semaglutide Injection 0.25mg/0.5mg/1mg/1.7mg/2.4mg (Wegovy FlexTouch) are not yet marketed in India, the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) has opined the drug major Novo Nordisk to submit periodic safety update reports (PSUR) to establish the safety in the Indian population for further review by the committee in the presence of pediatrician.

This came after Novo Nordisk presented the proposal for a grant of permission for the additional indication of the drug products Semaglutide Injection 0.25mg/0.5mg/1mg/1.7mg/2.4mg (Wegovy)and Semaglutide Injection 0.25mg/0.5mg/1mg/1.7mg/2.4mg (Wegovy Flextouch), i.e., indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management in adolescents aged 12 years and above with obesity and body weight above 60 kg.

The committee mentioned that the medicine is not currently available for purchase in India.

The medication available in India is Novo Nordisk’s Rybelsus pill, which is a pill that has the same components as Wegovy. Recently, the FDA authorized Wegovy, a once-weekly injectable prescription medication, to help adults who are obese or who weigh too much, in addition to having medical issues related to their weight, lose weight. Wegovy is a brand name for semaglutide.

Semaglutide is a glucagon-like peptide 1 receptor agonist used to improve glycemic control in type 2 diabetes mellitus, treat obesity, and reduce the risk of major adverse cardiovascular events in selected adults.

GLP-1 is a physiological hormone that promotes glycemic control via several different mechanisms, including insulin secretion, slowing gastric emptying, and reducing postprandial glucagon secretion. The homeostasis of glucose is dependent on hormones such as insulin and amylin, which are secreted by the beta cells of the pancreas. Semaglutide is 94% similar to human GLP-1. Analogs of this hormone, such as semaglutide, stimulate the synthesis of insulin3 by stimulating pancreatic islet cells and reducing glucagon secretion.3 They directly bind with selectivity to the GLP-1 receptor, causing various beneficial downstream effects that reduce blood glucose in a glucose-dependent fashion.

At the recent SEC meeting for Endocrinology and Metabolism held on July 24, 2024, the expert panel reviewed the proposal for grant of permission for the proposed additional indication of the drug product, Semaglutide Injection.

The committee noted that the drug product is not yet marketed in India.

After detailed deliberation, the committee recommended the firm submit PSUR data to establish safety in the Indian population for further review of the present proposal by the committee in the presence of a pediatrician.

Also Read: Akums Drugs and Pharmaceuticals Gets CDSCO Panel Nod To study Norethindrone, Estradiol, Relugolix FDC

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6 doctors, 13 healthcare workers at RML Lucknow suspended

Altogether 6 doctors and 13 healthcare workers of Dr. Ram Manohar Lohia Institute of Medical Sciences (RMLIMS) were suspended recently in connection to a case of medical negligence.
Uttar Pradesh Deputy Chief Minister Brajesh Pathak ordered the suspension of these doctors and health workers after a patient was denied admission and was discharged from the Emergency Department with incomplete treatment.
For more information click on the link below:

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Srinagar-based student studying MBBS in Bangladesh dies, 2 others injured in car accident in Kashmir

Handwara: A medical student along with another individual tragically lost their lives in a car accident in the Mawer area of north Kashmir’s Kupwara district while two other passengers in the vehicle survived the crash sustaining injuries.

The medical student has been identified as a final-year MBBS student pursuing her studies at a medical college in Bangladesh. 

The incident took place when the car travelling to Bangus Valley in Handwara lost its control, skidded off the road near forest huts and fell into a deep gorge which resulted in the death of two individuals and injuries to two others. It was found that the group of four members including three girls and a man went on a trip to Bangus Valley. At approximately 5 PM, they decided to depart for Srinagar via the Mawer route. 

Also read- 3rd-year MBBS student of Kurnool GMC dies in road accident

Following the accident, locals reported the incident to the police. The police then rushed to the spot, conducted a rescue operation and evacuated the injured persons. They were immediately rushed to New Type Primary Health Centre (NTPHC) Qalamabad where doctors after initial treatment referred them to Government Medical College (GMC) Handwara for specialised treatment.

Station House Officer (SHO) Qalamabad Majid Khan told Greater Kashmir that the vehicle while coming back from Bangus via Mawer route skidded off the road near forest huts and fell into a deep gorge resulting in injuries to four individuals.

Deputy Superintendent Associated District Hospital GMC Handwara Dr Aijaz Ahmad told the daily, “The two young girls were brought dead while a girl and a male were injured who were later referred to Srinagar for better treatment. The male had received severe head injuries and his condition was critical while the condition of other injured was not worrisome.”

Also read- Tragic: Mumbai Ophthalmologist dies as iron gate falls on her head after being rammed by van

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Health Bulletin 06/ August/ 2024

Here are the top health stories for the day:

RML Lucknow suspends 6 doctors and 13 healthcare workers over incomplete patient treatment
Altogether 6 doctors and 13 healthcare workers of Dr. Ram Manohar Lohia Institute of Medical Sciences (RMLIMS) were suspended recently in connection to a case of medical negligence.
Uttar Pradesh Deputy Chief Minister Brajesh Pathak ordered the suspension of these doctors and health workers after a patient was denied admission and was discharged from the Emergency Department with incomplete treatment.
For more information, click on the link below:

Union Health Secretary reviews Dengue outbreak, urges states to heighten vigilance

Union Health Secretary Shri Apurva Chandra has advised States and municipalities to be vigilant for timely containing of any outbreak of Dengue. ”It is important for relevant stakeholders including the Urban Development Ministry, States, Municipal Corporations and local self-government bodies to cooperate and work in tandem to prevent and manage dengue cases in the country,” he stated while chairing a high-level inter-ministerial meeting (conducted in hybrid mode) to review the dengue situation in nine high-burden states and assess the preparedness of the public health system for the prevention, containment, and management of dengue, given the onset of the monsoon and the rise in dengue cases.
The meeting, included participation from the Ministry of Housing and Urban Affairs (MoHUA) as well as Secretaries and high-level officials from the nine states of Delhi, Gujarat, Karnataka, Maharashtra, Rajasthan, Tamil Nadu, Telangana, Uttar Pradesh, and West Bengal. Total of 18 municipal corporations including Ahmedabad, Bengaluru, Chennai, Delhi, Hyderabad, and Mumbai virtually participated in the meeting. The highest number of cases have been reported from Karnataka, Kerala, Tamil Nadu, and Maharashtra.
For more information, click on the link below:

NTA set to release NEET 2024 candidates data on UMANG, DigiLocker platforms
In order to address and resolve the requests and grievances of the candidates regarding their OMR sheets and other related documents, the National Testing Agency (NTA) has decided to upload the data of National Eligibility and Entrance Test-Undergraduate (NEET UG) 2024 candidates on UMANG and DigiLocker platforms of the Government of India.
As per the public notice in this regard, NTA has informed that the authority has received numerous complaints regarding the NEET OMR answer sheets. Therefore, to facilitate the candidates, NTA has decided to upload the candidate data of NEET (UG) – 2024 onto the UMANG and DigiLocker platforms of the Government of India.
For more information, click on the link below:


MBBS student from Rajmata Vijaya Raje Scindia Medical College arrested by CBI in NEET paper leak case

In the latest update on the NEET paper leak case, the Central Bureau of Investigation (CBI) in its ongoing investigation recently arrested a first-year MBBS student of Rajmata Vijaya Raje Scindia Medical College in Bhilwara, Rajasthan in connection.
According to the agency, the accused student, Sandeep Kumar, admitted to his alleged involvement in solving the question paper of NEET-UG after being summoned to Patna by the CBI for interrogation on Saturday.
For more information, click on the link below:

NCDRC confirms MD Medicine doctors can treat ICU patients without Extra Intensive Care Training
While considering an appeal alleging medical negligence in treatment, the National Consumer Disputes Redressal Commission (NCDRC) recently held that MD Medicine doctors are sufficiently qualified to treat ICU patients without the requirement of extra intensive care training.
“Every MD Medicine is competent to treat patient in ICU,” held the Apex Consumer Court bench, presided by Justice Ram Surat Maurya and Mr. Bharatkumar Pandya, while dismissing the complaint of medical negligence.
For more information, click on the link below:

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Union Minister Prataprao Jadhav inaugurates Cardiac catheterization lab at AIIMS Raipur

Raipur: The Union Minister of State (Independent Charge) for AYUSH and Health and Family Welfare, Prataprao Jadhav inaugurated a new cardiac catheterisation laboratory at the All India Institute of Medical Sciences (AIIMS) Raipur in Chhattisgarh on Sunday.

AIIMS Raipur, which had only one cath lab that performed approximately 25 to 30 angiographies per week, now has this advanced state-of-the-art facility and it is expected to significantly increase the number of such procedures, a statement issued by the hospital said.  

Also Read:AIIMS Raipur inks MoU with Defence Ministry for health services to ex-servicemen

According to a PTI report, “The second lab will not only reduce patient waiting times but also enhance the hospital’s capacity to provide timely and efficient cardiac care. The new lab will also serve as a critical training ground for medical students in the DM (Doctor of Medicine) Cardiology programme, fostering a new generation of highly skilled cardiologists,” it added.  

The Union Minister of State for AYUSH and the Ministry of Health and Family Welfare, who was accompanied by state’s health minister Shyam Bihari Jaiswal, also visited key departments, including the emergency paediatric department, the trauma and emergency department, and the AYUSH department. Jadhav held a meeting with the executive director, deans, and medical superintendent of AIIMS Raipur, the release said.  

Medical Dialogues team had earlier reported that in a significant development aimed at enhancing healthcare services for ex-servicemen, a Memorandum of Understanding (MoU) was signed between the All India Institute of Medical Sciences (AIIMS) Raipur and the Ex-servicemen Contributory Health Scheme (ECHS) wing of the Ministry of Defence. The agreement, inked during a ceremony at AIIMS Raipur, aims to facilitate ex-servicemen in availing health benefits at the facility in a “capless and cashless manner”.  

Also Read:Lt Gen Ashok Kumar Jindal appointed as new Executive Director and CEO of AIIMS Raipur

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