Bystander CPR up to 10 minutes after cardiac arrest may protect brain function, reveals study

The sooner a lay rescuer (bystander) starts cardiopulmonary resuscitation (CPR) on a person having a cardiac arrest at home or in public, up to 10 minutes after the arrest, the better the chances of saving the person’s life and protecting their brain function, according to preliminary research to be presented at the American Heart Association’s Resuscitation Science Symposium 2024.

The meeting will be held Nov. 16-17, 2024, at the Hilton Chicago Hotel in Chicago and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

Cardiac arrest, which occurs when the heart malfunctions and abruptly stops beating, is often fatal without quick medical attention such as CPR to increase blood flow to the heart and brain. More than 357,000 out-of-hospital cardiac arrests happen each year in the U.S. with a 9.3% survival rate. “Our findings reinforce that every second counts when starting bystander CPR and even a few minutes delay can make a big difference,” said Evan O’Keefe, M.D., the study’s first author and a cardiovascular fellow at Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City. “If you see someone in need of CPR, don’t dwell on how long they’ve been down, your quick actions could save their life.”

The study analyzed nearly 200,000 cases of witnessed out-of-hospital cardiac arrest to determine whether initiating CPR within different time windows, compared to outcomes with no bystander CPR administered, made a difference in survival and brain function after hospital discharge.

“We found that people who received bystander CPR within the first few minutes of their cardiac arrest were much more likely to survive and have better brain function than those who didn’t,” O’Keefe said. “The longer it took for CPR to start, the less survival benefit one received. However, even when CPR was started up to 10 minutes after cardiac arrest, there was still a significant survival benefit compared to individuals who did not receive CPR from a bystander.”

Results also found:

People who received CPR within two minutes of out-of-hospital cardiac arrest had an 81% higher rate of survival to release from the hospital and 95% higher rate of surviving without significant brain damage compared to people who did not receive bystander CPR.

Even people who received bystander CPR up to 10 minutes after cardiac arrest were 19% more likely to survive to hospital discharge and 22% more likely to have a favorable neurological outcome than those who did not receive bystander CPR at all.

For those who did not receive bystander CPR, about 12% survived to be released from the hospital, and more than 9% survived without significant brain damage or major disabilities. When bystander CPR was initiated more than 10 minutes after cardiac arrest, bystander CPR, compared to not receiving the lifesaving assistance, was no longer associated with improved survival.

“These results highlight the critical importance of quick action in emergencies. It suggests that we need to focus on teaching more people how to perform CPR, and we also need to emphasize ways to get help to those suffering cardiac arrest faster,” O’Keefe said. “This might include more widespread CPR training programs, as well as better public access to automated external defibrillators (AEDs) and improved dispatch systems.”

O’Keefe noted that future research could explore how technology (like apps that alert nearby trained bystanders or alert dispatchers to likely cardiac arrest) may help to reduce the time to first intervention, information that could be important for emergency dispatchers and policymakers in the development of public interventions for cardiac arrest.

“This study highlights the need for prompt recognition and treatment of cardiac arrest by bystanders. Time is of the essence when a cardiac arrest occurs, and late interventions can be as ineffective as no intervention. Community education and empowerment are critical for us to save lives,” said American Heart Association volunteer expert Anezi Uzendu, M.D., an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas and a cardiac arrest survivor.

The American Heart Association urges everyone learn the lifesaving skills of CPR and join its Nation of Lifesavers®, a movement to double survival rates from sudden cardiac arrest by 2030. Being ready to act quickly could be the difference of life or death for someone experiencing a cardiac arrest.

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Study Finds Higher Risk of Acne, Alopecia, and Hirsutism with Levonorgestrel IUDs

USA: A recent study has shown that levonorgestrel intrauterine devices (IUDs) are linked to a higher incidence of acne, alopecia, and hirsutism compared to copper IUDs, with variations observed between different types of levonorgestrel IUDs. The findings were published online in the Journal of the American Academy of Dermatology.

In an analysis of the FDA Adverse Events Reporting System database, Lydia Cassard and colleagues from the Cleveland Clinic Lerner College of Medicine in Cleveland, OH, aimed to determine the frequency of androgenic cutaneous side effects associated with levonorgestrel intrauterine devices.

For this purpose, the researchers reviewed the US Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS) up to December 2023 to identify adverse events associated with levonorgestrel intrauterine devices (IUDs), specifically focusing on acne, alopecia, and hirsutism where the IUDs were the only suspected cause. The analysis included 139,348 reports related to levonorgestrel IUDs (Mirena, Liletta, Kyleena, and Skyla) and 50,450 reports for the copper IUD (Paragard).

The study led to the following findings:

  • Levonorgestrel IUD users had significantly higher odds of reporting acne, alopecia, and hirsutism compared to copper IUD users, with odds ratios (OR) of 3.21 for acne, 5.96 for alopecia, and 15.48 for hirsutism.
  • Among the different levonorgestrel IUDs, the Kyleena 19.5 mg IUD was associated with the highest likelihood of acne reports (OR, 3.42), followed closely by the Mirena 52 mg IUD (OR, 3.40) and the Skyla 13.5 mg IUD (OR, 2.30), all of which were statistically significant.
  • For alopecia and hirsutism, the Mirena IUD was linked to the highest odds, with ORs of 6.62 and 17.43, respectively, followed by the Kyleena IUD (ORs of 2.90 for alopecia and 8.17 for hirsutism) and the Skyla IUD (ORs of 2.69 for alopecia and 1.48 for hirsutism), with all findings showing statistical significance.
  • There were no significant differences in the reporting of acne, alopecia, or hirsutism between the Liletta 52 mg levonorgestrel IUD and the copper IUD.

“Overall, we found significant associations between levonorgestrel IUDs and androgenic cutaneous adverse events,” the authors noted. “Counseling before the initiation of levonorgestrel IUDs should include a discussion of potential cutaneous side effects, such as acne, alopecia, and hirsutism, to inform shared decision-making regarding contraception,” the researchers concluded.

The study’s limitations include the inability to verify FAERS database reports and potential variations in reporting rates due to differences in FDA approval dates. Additionally, the lack of data on prior medications limits the ability to fully understand the causes of these adverse events.

Reference:

Cassard, L., Mitchell, J., & Piliang, M. (2024). Frequency of androgenic cutaneous adverse events associated with levonorgestrel intrauterine devices: An analysis of the Food and Drug Administration Adverse Events Reporting System database. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.10.045

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Faricimab reduces fluid in Neovascular Age-Related Macular Degeneration eyes

Age-related macular degeneration (ARMD) is the leading cause
of severe vision loss in the developed world for people over 55 years old.
Anti-vascular endothelial growth factor (anti-VEGF) therapies for macular
neovascularization have been pivotal in decreasing the number of individuals
visually impaired by neovascular age-related macular degeneration (nARMD).
Faricimab is a novel antibody for the treatment of nARMD that aims to
neutralize not only VEGF-A but also Angiopoietin-2 (Ang-2), thus targeting two
distinct pathways involved in nARMD pathogenesis. Faricimab was initially shown
to be non-inferior to aflibercept in terms of change in best corrected visual
acuity (BCVA) at one year for treatment-naïve individuals. Many patients were
also able to achieve long dosing intervals of 12 or 16 weeks on faricimab.

This study aimed to collect functional and optical coherence
tomography (OCT)-based morphological observations after faricimab treatment in
a particular subset of eyes that showed persistent subretinal and/or
intraretinal fluid despite previous treatment with at least two other anti-VEGF
agents. Authors hypothesized that eyes refractory to treatment with multiple
prior anti-VEGF agents may still be able to respond anatomically and/or
functionally to faricimab injections based on the novel mechanistic nature of
the antibody.

Retrospective chart review was conducted on eyes with nARMD
with persistent subretinal and/or intraretinal fluid despite previously
receiving ≥15 injections with ≥2 different anti-VEGF agents. Best corrected
visual acuity (BCVA) and optical coherence tomography (OCT) parameters were
collected at baseline, initial post-injection visit, and most recent visit with
OCT following last faricimab.

Nineteen eyes were included. Average logMAR BCVA was 0.47 ±
0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at
final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92
μm at baseline, 279 ± 88 μm at initial follow-up (p = 0.001), and 274 ± 100 μm
at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both
initial and final follow-up visits.

While many eyes with nARMD respond favorably to initial
anti-VEGF therapies, there is a significant subset of eyes that show persistent
signs of disease activity with non-resolving macular edema despite several
routine anti-VEGF treatments and thus may have worse visual outcomes. For this
subset of patients, switching anti-VEGF agents is often a consideration.
Authors hypothesized that faricimab may benefit eyes with previous incomplete
response or non-response to two or more traditional anti-VEGF agents due to the
novel mechanistic nature of the antibody. The results of the present study
suggest that faricimab may result in anatomic improvement in this subset of
patients without evidence of an associated functional benefit in terms of
improvement in BCVA. CST, which started at an average of 310 ± 92 μm, decreased
to 279 ± 88 μm by the initial follow-up visit, with minimal subsequent decrease
to a final average of 274 ± 100 μm at last follow-up. Additionally, 9 eyes
(47%) showed resolution of fluid at both initial follow-up and final follow-up
visits.

In a subset of eyes with nARMD that showed persistent
intraretinal and/or subretinal fluid refractory to treatment with traditional
anti-VEGF agents, faricimab resulted in anatomic improvement in terms of mildly
decreased CST and resolution of fluid in several eyes. However, there was no
significant associated change in BCVA.

Source: Qaseem et al; Clinical Ophthalmology 2024:18
3097–3102

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Negligence in Diagnosis, Issued Erroneous Report- NCDRC upholds compensation order

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently upheld negligence charges against a Diagnostic Centre for giving erroneous reports to a patient, who had to undergo a series of unnecessary tests and suffer immense anxiety.

“…we find no illegality or material irregularity or jurisdictional error in the order of the State Commission, hence the same is upheld,” the Commission observed.

The history of the case goes back to 2019 when the patient who was suffering from stomach pain, consulted the doctor, she advised sonography at Shrivari Sono Scans. It was revealed in the report that there was serious illness in the liver and gallbladder. Thereafter, the treating doctor advised the patient to have expert medical treatment. 

Following this, the complainant went to Kasturba Medical College (KMC) for scanning and further treatment. After undergoing scanning at KMC, it was revealed that he was not suffering from any illness in the liver or gall bladder and that the first scanning centre had issued a wrong scan report, which suggested liver disease.

Therefore, the patient filed a complaint before the District Forum for undergoing mental agony and hardships. The District Consumer Court through the order dated 29.01.2021, partly allowed the complaint and directed the scan centre to pay Rs 25,000 as compensation for deficiency in service along with litigation cost of Rs 3000.

“Complainant did not adduce any evidence of actual financial loss suf ered by him in this regard. But still he managed to go over to Mangalore and conducted test by spending his hard earned money due to wrong mis-leading finding on test results by opposite party and therefore considering the nature and attended circumstance of the case forum finds that a sum of Rs. 25,000/- is found reasonable compensation to he paid by opposite party to complainant,” the District Consumer Court had ordered.

Aggrieved by this, the petitioner appealed to the State Commission, which dismissed the appeal and confirmed the order of the District Commission.

“Issuing of wrong scan report is as a result of the negligence by the Pathologist in scanning the patient. It is a clear case of deficiency in service and negligence in diagnosing ¯the illness of the patient and issuing an erroneous test result. Issuing wrong report which suggested serious problem with the liver naturally will cause much mental agony and hardship to the complainant,” the State Commission had held.

Thereafter, the Scan Centre challenged the State Commission’s order before the Apex Consumer Court, arguing that the State Commission erred in granting the order dated 18.04.2023 and upholding the order of the District Forum. 

It was submitted that the patient did not consult the scan centre and the centre did not provide any advice regarding any disease. Therefore, there was no breach of duty on their part. The Scan Centre further submitted that the Sono Scanning was conducted using standard procedures and techniques and there was no dispute regarding the same. Consequently, the patient was given the report, which mentioned the limitations of ultrasound scanning and suggested seeking a review scanning with investigations in case of a difference of opinion.

Meanwhile, the patient submitted that the petitioner was not a Sonologist as claimed by him in the affidavit. He was only an MBBS graduate and did not possess any Postgraduate qualification in medicine from any recognized institute or university to claim as a specialist like ‘Consultant Sonologist’ or Sonologist. 

It was argued that while the doctor at the Scan Centre could perform USG studies only in Pregnancy Cases, he was advertising his Genetic Clinic as Centre for General Sonology, USG, HRSG, Colour Doppler Imaging, Echo Cardiography (Foetal & Adult) and practicing and signing accordingly and signing USG reports as ‘Consultant Sonologist’/Sonologist.

Also Read: Stent not Removed After PCNL: Hospital, surgeon Slapped Rs 35 Lakh Compensation for Deficiency in Service

The Complainant also pointed out that TCMC-Kerala found the petitioner guilty of a continuing violation of the direction of the Council and had punished him by removing his name from the Register of Modern Medicine for two months. Following deregistering by TCMC on 11.08.2021, DMOH had strictly directed him not to do USG studies other than permitted by PC & PNDT Act. Later, the National Medical Commission (NMC) had also upheld the order of TCMC.

Therefore, the complainant claimed that due to the faulty and fraudulent report issued by the petitioner, he had to approach KMC, Mangalore, which is 100 Km away from his residence, for further investigation and treatment for which he suffered mental agony hardships, damages, sufferings, losses of huge money and time. Accordingly, he prayed for an increase in the quantum of compensation to the tune of Rs 5 lakh.

While considering the appeal, the Apex Consumer Court perused the orders passed by both the State Commission and the District Consumer Court and opined that both the Forum had given well-reasoned orders. The NCDRC bench also perused various documents including the report dated 15.07.2019 of Kasturba Medical College, Mangalore, and other medical records placed on record, orders dated 30.08.208 and 17.05.2021 of Registrar of Travancore Cochin Medical Council, Certificate of Registration issued by D.M.O. Health, order dated 01.06.2022 of NMC and other relevant orders to hold that “State Commission has rightly come to a finding of negligence and deficiency in service on the part of Petitioner…”

At this outset, the Commission also referred to the Supreme Court orders holding that revisional jurisdiction of the National Commission is extremely limited and it should be exercised only in case as contemplated within the parameters specified in the provision i.e. when the State Commission had exercised a jurisdiction not vested in it by law or had failed to exercise jurisdiction so vested or had acted in the exercise of its jurisdiction illegally or with material irregularity.

Accordingly, the Apex Consumer Court held that there was no illegality or material irregularity or jurisdictional error in the State Commission’s order and upheld the same. 

“Accordingly, Revision Petition is dismissed with costs of Rs.15,000/- to be paid by Petitioner herein to the Respondent herein within 30 days of this order. As regards request of Respondent herein for enhancement of compensation to Rs.5.00 lakhs is concerned, the same cannot be considered as the Respondent has not challenged the orders of District Forum and State Commission and the same have become final as far as Respondent is concerned. Hence, in the Revision Petition filed by the Petitioner herein, request for enhancement of compensation cannot be considered,” the top consumer court observed in its order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/shrivarisonoscansvssureshan-260290.pdf

Also Read: TN Medical Council Files Complaint Against Doctor for Practicing with Cancelled License

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Study reveals best timing for getting the RSV vaccine during pregnancy to protect newborns

Current guidelines recommend that pregnant people receive a vaccine against respiratory syncytial virus (RSV)—which typically causes mild, cold-like symptoms in most adults but can be deadly for infants—during weeks 32–36 of pregnancy. New research led by investigators at Mass General Brigham suggests that vaccination earlier in that timeframe, closer to 32 weeks, could provide the best protection for newborns against RSV. The findings are published in the American Journal of Obstetrics and Gynecology.

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Study finds pandemic-era increase in alcohol use has persisted

Alcohol use increased during the COVID-19 pandemic and remained elevated even after the pandemic ended, according to a large nationally representative Keck Medicine of USC study published today in the Annals of Internal Medicine.

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Most effective way to communicate with Alzheimer’s patients identified

Research involving the UAB reveals the most effective way to talk to people with Alzheimer’s so that their emotional response and their levels of attention and understanding are the highest possible.

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Adequate sleep significantly reduces the risk of hypertension in adolescents, new study finds

Adolescents who meet the recommended guidelines of 9 to 11 hours of sleep per day were shown to have a significantly lower risk of hypertension in a new study from UTHealth Houston.

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The hidden burden of weight stigma in pregnant women and new mothers

People with larger bodies commonly face a pervasive, resilient form of social stigma, often facing discrimination in the workplace as well as in educational and health care settings.

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Salem doctor refuses to examine murder accused, Inquiry ordered

Salem: An inquiry has been launched against an on-duty government doctor for allegedly refusing to examine seven murder suspects and for reportedly engaging in a confrontation with the city police on Saturday night.

Karipatty police sources have revealed that seven murder case suspects were brought to the government hospital in Vazhapadi for a medical assessment on Saturday night before being presented before the judicial magistrate at the Attur sub-court. However, the on-duty doctor reportedly declined to examine the accused.

Also Read: Boy with fractured arm allegedly turned away by 2 Delhi Hospitals, Health Minister orders probe

As per the recent media report by the TOI, special sub-inspector of police Ramesh stated, “Dr Senthilkumar, who was on duty, insisted that they be taken to the Salem Govt Mohan Kumaramangalam Medical College and Hospital for the examination, stating that he was unable to assist them at his current location. When police requested him to examine the accused people, he confronted us and shouted at us for entering the hospital without his consent.”

Due to the Doctor’s refusal, the police transported the accused to the government hospital in Attur to complete the mandatory medical process.

Dr Malarvizhi Vallal, Joint Director of Health, took swift action and initiated a departmental inquiry just after the incident was reported. She stated that the department would submit its findings to higher authorities for further action.  

Meanwhile, the police sub-inspector present at the scene Ramesh has filed a complaint against the doctor with the Vazhapadi police, requesting appropriate action against the doctor for his unprofessional behaviour at the hospital. The Vazhapadi police have since launched an inquiry to investigate the complaint. 

Medical Dialogues team had earlier reported that government doctors including a Gynaecologist at a Sub-district hospital in Uri have been accused of medical negligence following the death of a woman patient in Kashmir’s Baramulla district. 

Also Read: Kerala: Govt Doctor allegedly denies treatment to wheelchair-bound ex-military officer

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