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New Delhi: Lt Gen Sadhna Saxena Nair, on August 01, 2024, assumed the office of Director General Medical Services (Army), becoming the first woman to be appointed to this prestigious position.
Prior to this, she was the first woman to hold the post of DG Hospital Services (Armed Forces) on promotion to the rank of Air Marshal.
Lt Gen Nair graduated from the Armed Forces Medical College, Pune with a distinguished academic record and was commissioned into the Army Medical Corps in December 1985. She holds a Post Graduate degree in Family Medicine, Diplomas in Maternal & Child Health and Health Care Management, and has undergone a two-year training programme in Medical Informatics at AIIMS, New Delhi.
She was trained in Chemical, Biological, Radiological and Nuclear Warfare with the Israeli Defence Forces and in Military Medical Ethics with the Swiss Armed Forces in Spiez. She is also the first woman Principal Medical Officer of Western Air Command, and Training Command, Indian Air Force (IAF).
Lt Gen Nair was nominated as an expert member of Dr Kasturirangan Committee for drafting part of the medical education component of the National Education Policy. For her meritorious service, she has been awarded the Air Officer Commanding-in-Chief, Western Air Command and Chief of the Air Staff Commendations as well as Vishisht Seva Medal by the President of India.
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CHINA: In a recent systematic review and meta-analysis of cardiovascular outcome trials, SGLT2 inhibitors significantly reduce the risk of various cardiac arrhythmias, including tachycardia, supraventricular tachycardia (SVT), atrial fibrillation (AF), and atrial flutter (AFL) in patients with type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD). The analysis also suggests that these medications may reduce the risk of cardiac arrest in CKD patients.
The findings were published online in Reviews in Cardiovascular Medicine.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the hypoglycemic agents widely used for T2D treatment. In addition to lowering blood glucose, SGLT2i protects the kidney and heart, significantly reduces cardiovascular (CV) events, and delays progression to HF and CKD.
In addition to lowering blood glucose, SGLT2i protects the heart and kidney, significantly reduces cardiovascular events, and delays the progression of heart failure and chronic kidney disease. However, prior research has not thoroughly explored the link between SGLT2 inhibitors and the risk of developing cardiac arrhythmias.
Against the above background, Xujie Wang, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China, and colleagues aimed to assess the association of SGLT2i with cardiac arrhythmias in patients with type 2 diabetes and without T2DM in cardiovascular outcome trials (CVOTs).
For this purpose, they performed a meta-analysis and systematic review of CVOTs that compared SGLT2 inhibitors with placebo. Online databases were systematically searched from their inception through December 2022. The review focused on CVOTs that reported on cardiovascular or renal outcomes and had a follow-up period of at least six months.
The meta-analysis included 12 CVOTs with 77,470 participants (42,016 SGLT2i versus 35,454 control), including patients with T2DM, heart failure, or chronic kidney disease. Follow-up duration ranged from 9 months to 5.65 years.
The researchers reported the following findings:
“These results offer strong support for the use of SGLT2 inhibitors in lowering the risk of cardiovascular disease in patients with type 2 diabetes mellitus, heart failure, and chronic kidney disease. Further prospective trials are necessary to verify the antiarrhythmic effects of SGLT2 inhibitors and to understand their underlying mechanisms better,” the researchers concluded.
Reference:
Wang, Xujie, et al. “Association of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) With Cardiac Arrhythmias: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials.” Reviews in Cardiovascular Medicine, vol. 24, no. 9, 2023, p. 258.
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China: A recent cohort study has shed light on the critical link between glycated hemoglobin (HbA1c) levels and long-term outcomes in patients grappling with diabetes and triple-vessel coronary disease (TVD). The research, conducted across diverse age brackets, underscores significant variations in prognosis based on age, challenging conventional medical wisdom on diabetes management.
The study, published in Diabetes Research and Clinical Practice, revealed variations in the relationship between HbA1c levels and endpoint events among patients with triple-vessel coronary disease and diabetes of different ages.
“In younger patients, increased HbA1c levels were associated with a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) and death, while in older patients, excessively low HbA1c levels (HbA1c < 6 %) tied to a higher risk of death and MACCE,” the researchers reported.
Lei Song, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China, and colleagues aimed to investigate the correlation between HbA1c and adverse prognostic events in patients with diabetes and TVD.
This study included 2,051 patients with TVD and diabetes. Based on their HbA1c levels, the researchers categorized patients into five groups: <6.0 %, 6.0–6.4 %, 6.5–6.9 %, 7.0–7.9 %, and ≥ 8.0 %. The primary endpoint was all-cause death, and the secondary endpoint was MACCE.
The following were the key findings of the study:
· The median follow-up time was 5.88 years. During this period, the researchers recorded 15.7 % of all-cause deaths and 26.2 % MACCEs.
· The relationship between HbA1c and the risk of endpoint events showed a J-shaped pattern; the lowest risk was between 6.0 % and 6.4 %.
· Further analysis revealed a significant interaction between HbA1c and age.
· In the subgroup with age < 70 years, as HbA1c increased, the risk of endpoint events gradually rose.
· In the subgroup with age ≥70 years, there was an L-shaped relationship between HbA1c and endpoint events, with the highest risk observed in patients with HbA1c < 6.0 %.
The results suggest a need for age-specific glycemic targets in diabetic patients with extensive coronary artery disease. Younger patients may require stricter control to mitigate long-term risks, whereas older patients could benefit from more lenient targets to avoid hypoglycemic episodes.
As the global prevalence of diabetes continues to rise, fueled by lifestyle changes and aging populations, studies like this serve as crucial benchmarks for refining treatment guidelines. The researchers advocate for ongoing research to further elucidate the intricate interplay between glycemic control, age, and cardiovascular health, aiming to optimize outcomes for all diabetic patients facing complex coronary challenges.
Reference:
https://doi.org/10.1016/j.diabres.2024.111751
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Rajkot: The All India Institute of Medical Sciences (AIIMS) in Rajkot, Gujarat, has been recognized as a facility for Zika virus screening, reducing the need to send swab samples to the National Institute of Virology (NIV) in Pune, Maharashtra, an official said on Wednesday.
According to a PTI report, “Our centre has been recognised for the screening of Zika virus (by Indian Council of Medical Research). We have received kits from the NIV, and are going to begin the tests very soon,” said Ashwini Agarwal, professor and head of the department of microbiology at AIIMS Rajkot.
He said the new testing centre at AIIMS will become operational from next week.
Also Read:Zika virus advisory for states issued by Health Ministry
Agarwal informed that the central government has also sanctioned a biosafety laboratory at AIIMS Rajkot that deals with highly infectious and pathogenic organisms.
“BSL 3 (biosafety level 3) lab has been sanctioned, and its construction will begin next month,” he said.
After the centre for Zika virus testing at AIIMS Rajkot becomes operational, results of samples of suspected cases will be known within 24 hours. When samples from Gujarat were sent to the Pune-based NIV, it took from one week to up to a month for confirmation, adds PTI.
“The centre will make the test results of suspected Zika virus patients known within 24 hours. Samples collected for surveillance purpose will take some time,” he said.
The Zika virus disease is transmitted through the bite of an infected Aedes mosquito, which is also known to transmit infections like dengue and chikungunya. The virus was first identified in Uganda in 1947.
Thirteen cases of Zika virus –three from Karnataka and 10 from Maharashtra– were reported till July 22 this year, Minister of State for Health Anupriya Patel had said in the Rajya Sabha on Tuesday, news agency PTI reported.
In 2023, the country had witnessed 23 cases of Zika virus, while two infections were seen in 2022 and 234 in 2021.
Gujarat had last reported three cases of the disease in 2017.
Prime Minister Narendra Modi inaugurated Gujarat’s first AIIMS in Rajkot on February 25 this year. The facility, spanning 201 acres and costing Rs 1,195 crore, features 720 beds, including ICU facilities.
Also Read:Karnataka Govt urges Deputy Commissioners to monitor Zika Virus, Dengue Outbreaks
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Researchers have demonstrated that D-dimer concentration is a very sensitive but only moderately specific marker for the diagnosis of acute aortic syndrome, a possibly life-threatening emergency condition. The accuracy of D-dimer for diagnosis was inconclusive in most of the reviews conducted earlier, usually based on small data. Newly published studies give a clearer picture of this. A systematic review and meta-analysis was performed to get a better understanding of the diagnostic performance of D-dimer. The study was published in the Annals of Emergency Medicine by Munira E. and colleagues.
A comprehensive search was conducted in MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Other searches included lists of references of included studies and other systematic reviews. A review focusing on diagnostic cohort studies, either prospective or retrospective, assessing the use of D-dimer in diagnosing acute aortic syndrome against a reference standard test, such as computed tomographic angiography, ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy. Study selection, data extraction, and quality assessment were done by two independent reviewers. The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). The analysis will be conducted through a bivariate meta-analytic model.
Results
Out of 2017 potential citations, 25 cohort studies met the inclusion criteria, with 18 reporting the 500 ng/mL threshold included in the primary meta-analysis.
The risk of bias was mostly unclear due to limited study reporting.
The summary sensitivity was 96.5% (95% credible interval [CrI] 94.8% to 98%) and summary specificity was 56.2% (95% CrI 48.3% to 63.9%).
Specificity varied markedly between studies, ranging from 33% to 86%, indicating substantial heterogeneity.
Sensitivity analysis including seven studies with other thresholds showed a summary sensitivity of 95.7% (95% CrI 93.2% to 97.5%) and a summary specificity of 57.5% (95% CrI 50.1% to 64.6%).
A sensitivity of 96.5% denotes that D-dimer is very good as an initial test to exclude acute aortic syndrome, since it identifies almost all true cases. Meanwhile, its average specificity of 56.2% indicates that a reasonable percentage of patients without the disease will test positive, risking overinvestigation. This heterogeneity was suggested by the changing specificity across studies, which may be due to study design, population, and diagnostic criteria.
It could be that accuracy in test performance in earlier meta-analyses was overestimated since it comprised a large number of case-control studies. This systematic review, focused on cohort studies, provides a more realistic estimate of D-dimer performance in clinical practice.
Data support that the concentration of D-dimer has high sensitivity, 96.5%, with moderate specificity, 56.2%, for the diagnosis of acute aortic syndrome. Even with some uncertainty because of the risk of bias and heterogeneity among studies, findings support the role of D-dimer in the diagnostic pathway of acute aortic syndrome. D-dimer should be used by clinicians as an initial screening tool; those positive will need confirmatory testing.
Reference:
Essat, M., Goodacre, S., Pandor, A., Ren, S., Ren, S., & Clowes, M. (2024). Diagnostic accuracy of D-dimer for acute aortic syndromes: Systematic review and meta-analysis. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2024.05.001
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