Homelessness during pregnancy linked to worse maternal outcomes including hypertension and diabetes: JAMA

Homelessness during pregnancy linked to worse maternal outcomes including hypertension and diabetes: JAMA

Homelessness during pregnancy linked to worse maternal outcomes including hypertension and diabetes suggests a study published in the JAMA.

Homelessness has significant implications for maternal, infant, and child health (MCH) and health inequities.Studies using International Classification of Diseases codes indicate that the number of postpartum people recorded as being affected by homelessness at the time of delivery is increasing over time. A multistate study using self-reported housing status demonstrated that experiencing homelessness is associated with behaviors known to affect pregnancy health (eg, smoking), but used data from 2000 to 2007.

In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a multi-state cross-sectional survey designed to be representative of individuals with live births. Through mail and telephone questionnaires, and linked birth certificate data, PRAMS collects information on health, sociodemographic characteristics, and behavior. Results: In a weighted sample of 146 943 postpartum people representing a population of 8 249 272, 2.4% (95% CI 2.3%-2.5%) reported homelessness in the year before birth. Compared with those without homelessness experiences, postpartum people who experienced homelessness were more likely to report their race as Black (34.0% [95% CI, 31.8%-36.2%] vs 14.9% [95% CI, 14.7%-15.1%]), be unmarried, and have high school education or less

This cross-sectional analysis found associations between homelessness and MCH. While PRAMS data are only representative of included states, applying the 2.4% homelessness rate to all US births in 2023 implies 70 000 babies would be born within 12 months of maternal homelessness.

Reference:

McGovern ME, Treglia D, Eliason EL, Spishak-Thomas A, Cantor JC. Homelessness and Maternal and Infant Health. JAMA Netw Open. 2024;7(11):e2442596. doi:10.1001/jamanetworkopen.2024.42596

Keywords:

Homelessness, during, pregnancy, linked, worse, maternal, outcomes, including hypertension, diabetes, JAMA, McGovern ME, Treglia D, Eliason EL, Spishak-Thomas A, Cantor JC.

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Operating microscope use during alveolar ridge preservation tied to improved healing: Study

Operating microscope use during alveolar ridge preservation tied to granulomatous tissue removal and improved healing suggests a study published in the Journal of Periodontology.

The use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP. Forty non-molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone-beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16-week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient-reported outcome measurements (PROMs) were assessed. Results: All patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p = 0.01) and a better healing score at 2-week (p = 0.04) and 4-week (p = 0.01) time points. There were no significant differences in 12-week crestal bone healing by histology (p = 0.1), US (p = 0.85), and CBCT healing (p = 0.64) at 12 weeks, as well as PROMs (p > 0.1). Within the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US-derived-crestal bone quality did not show a difference between the 2 group

Reference:

Sirinirund B, Zalucha J, Rodriguez Betancourt AB, et al. Clinical outcomes of using operating microscope for alveolar ridge preservation: A randomized controlled trial. J Periodontol. 2024; 1-11. https://doi.org/10.1002/JPER.24-0081

Keywords:

Operating, microscope, use, during, alveolar, ridge, preservation, tied, granulomatous, tissue, removal, improved healing, Study, Sirinirund B, Zalucha J, Rodriguez Betancourt AB

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Relugolix Combination Therapy Improves Pain, Functioning, and Quality of Life in Women with Endometriosis: Study

USA: Recent research published in the journal Fertility and Sterility has highlighted the significant benefits of relugolix combination therapy (CT) in treating endometriosis-associated pain, demonstrating its ability to improve functioning and quality of life (QoL) for affected women.

The findings of a new study extended the evaluation of relugolix CT up to 104 weeks, showcasing its potential to provide sustained relief from the pain associated with endometriosis. The study showed that women receiving relugolix CT experienced a significant reduction in pain symptoms, including dysmenorrhea (painful periods), non-menstrual pelvic pain (NMPP), and dyspareunia (pain during intercourse). This marks a substantial improvement in managing one of the most debilitating aspects of endometriosis.

Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside the uterus, causing severe pain, irregular bleeding, and potential fertility issues. For many women, endometriosis-associated pain severely impacts daily functioning and overall well-being.

Against the above background, Sawsan As-Sanie, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, and colleagues aimed to evaluate the impact of relugolix combination therapy (relugolix CT; 40 mg relugolix, 1 mg estradiol, and 0.5 mg norethisterone acetate) over up to two years in the SPIRIT long-term extension study. They focused on its effects on functioning and health-related quality of life (QoL), as measured by the Endometriosis Health Profile (EHP)-30 questionnaire, and examined how changes in QoL domains correlated with improvements in dysmenorrhea and nonmenstrual pelvic pain.

For this purpose, the researchers conducted a long-term extension study of the SPIRIT phase 3 trials involving premenopausal women with moderate-to-severe endometriosis pain who had previously completed the randomized SPIRIT trials. The women enrolled in an 80-week extension, receiving relugolix combination therapy (40 mg relugolix, 1 mg estradiol, 0.5 mg norethindrone acetate).

The study assessed changes in health-related quality of life using the EHP-30 questionnaire, with results analyzed through a mixed-effects model. The researchers also examined how improvements in dysmenorrhea and nonmenstrual pelvic pain (NMPP) correlated with changes in QoL scores.

The following were the key findings of the study:

  • In the 277 women treated with relugolix combination therapy, the least squares (LS) mean EHP-30 pain domain scores improved by 57.8% at week 24 (LS mean change: −32.8), 66.4% at week 52 (LS mean change: −37.7), and 72.2% at week 104 (LS mean change: −41.3).
  • At weeks 24, 52, and 104, respectively, clinically meaningful improvements in pain were seen in 75.9%, 83.6%, and 88.6% of women. Non-pain EHP-30 domain and total scores also showed improvement.
  • A positive correlation was observed between changes in dysmenorrhea/NMPP and all EHP-30 domain scores.
  • Similar results were seen in the delayed relugolix CT and placebo → relugolix CT groups.

The findings showed that sustained reduction in endometriosis-associated pain observed with relugolix combination therapy over 104 weeks was accompanied by improvements in functioning and health-related quality of life.

“These results further support the findings of the pivotal SPIRIT trials, which demonstrated that relugolix CT significantly reduced dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia compared to placebo in premenopausal women with endometriosis-related pain,” the researchers concluded.

Reference:

As-Sanie, S., Abrao, M. S., Reznichenko, G., Wilk, K., Zhong, Y., Perry, J., Hunsche, E., Soulban, G., & Becker, C. M. (2024). Impact of relugolix combination therapy on functioning and quality of life in women with endometriosis-associated pain. Fertility and Sterility, 122(4), 687-695. https://doi.org/10.1016/j.fertnstert.2024.06.009

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Constipation linked to survival of patients with idiopathic interstitial pneumonias, finds study

A new study published in the journal of Respiratory Investigation showed that constipation may have therapeutic value since it is an independent predictive factor for individuals with idiopathic interstitial pneumonias (IIPs). Idiopathic pulmonary fibrosis (IPF), the most common phenotype of IIPs, has a prognosis that is influenced by a number of clinical variables, including age, sex, dyspnea, body mass index (BMI), smoking status, pulmonary function, and radiological abnormalities. The prognosis of many chronic illnesses is impacted by constipation that lowers quality of life. According to reports, people who have constipation are more likely than those who do not to suffer from coronary heart disease, ischemic stroke, and all-cause death. According to a meta-analysis, children who had constipation were more likely to acquire asthma later on.

The impact of constipation on the prognosis of IIPs is yet unknown, though. Basic research has indicated that the gut microbiota may have an impact on pulmonary fibrosis, despite the fact that IIPs are chronic inflammatory illnesses with an uncertain cause. As with other chronic conditions, constipation may have a correlation with the prognosis of IIPs. Thus, Sho Takuma and colleagues used a time-dependent multivariate analysis that was controlled for clinical variables in the current investigation to examine the relationship between constipation and the prognosis of patients with IIPs.

This study looked back at the relationship between constipation and survival outcomes in patients with idiopathic interstitial pneumonias (IIPs) in this single-centre observational analysis. To do this, they employed a marginal structural model (MSM) analysis, controlling for lung function measures (percent predicted forced vital capacity and diffusing capacity for carbon monoxide), age, sex, body mass index, and treatment type (including immunosuppressants, corticosteroids, and antifibrotic agents).

The study comprised 433 individuals with IIPs, including 148 and 285 patients with idiopathic pulmonary fibrosis [IPF] and those without IPF. Constipation struck 238 people throughout the monitoring period. Constipation was substantially linked to a worse overall survival rate, according to the MSM analysis. Constipation was substantially linked to a worse survival rate when the use of antifibrotic medications was weighted individually as nintedanib or pirfenidone. Additionally, independent of the severity of the disease, a subgroup analysis revealed that constipation was linked to a worse survival rate in both IPF and non-IPF patients. Overall, this study clearly indicates the independent occurrence of constipation from that of idiopathic interstitial pneumonias.

Reference:

Takuma, S., Mori, K., Karayama, M., Inoue, Y., Yasui, H., Hozumi, H., Suzuki, Y., Furuhashi, K., Fujisawa, T., Enomoto, N., Inui, N., & Suda, T. (2024). Association of constipation with the survival of patients with idiopathic interstitial pneumonias. In Respiratory Investigation (Vol. 62, Issue 6, pp. 1204–1208). Elsevier BV. https://doi.org/10.1016/j.resinv.2024.10.010

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T-Tube versus Choledochoscopy: Equally Effective for Post-Surgical Bile Duct Stone Detection, Study Finds

China: A recent study investigated the effectiveness of two diagnostic techniques—T-tube cholangiography and choledochoscopy—in identifying residual bile duct stones following biliary surgery. Residual calculi can lead to severe complications, making accurate detection essential for patient management.

The results, published in BMC Gastroenterology, revealed no significant difference in diagnostic accuracy between the two techniques, with a p-value of 0.82, indicating comparable performance. Both methods demonstrated a high consistency in their findings, reflected by a Kappa value of 0.70, which signifies a strong agreement between the two diagnostic approaches.

The findings imply that the selection of a diagnostic method for detecting postoperative residual bile duct stones should be tailored to the individual patient’s circumstances.

T-tube cholangiography and choledochoscopy are methods for identifying residual bile duct stones after biliary surgery. However, the effectiveness of routine cholangiography before T-tube removal requires further exploration. With this in mind, Yamin Zheng, Capital Medical University, Xicheng District, Beijing, China, and colleagues set out to assess the diagnostic efficacy of different techniques for detecting residual calculi following biliary procedures.

For this purpose, the researchers retrospectively analyzed the clinical data of 287 adult patients who underwent common bile duct exploration with T-tube drainage, followed by T-tube cholangiography and choledochoscopy at the Department of General Surgery, Xuanwu Hospital, Capital Medical University, from 2017 to 2022. Patients were excluded if they had bile duct tumors, incomplete medical records, were lost to follow-up, or had contraindications to T-tube or choledochoscopy. The McNemar and Kappa tests were utilized to compare the results and consistency between the two diagnostic methods. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage. T-tube cholangiography and choledochoscopy findings were documented, analyzed, and compared for each patient.

The study led to the following findings:

  • Out of 287 patients, T-tube cholangiography identified residual stones in 38 cases. Choledochoscopy confirmed residual stones in 29 cases.
  • Among the 249 patients who showed no signs of residual stones on T-tube cholangiography, 11 were later found to have retained stones via choledochoscopy.
  • There was no significant difference in the results between T-tube cholangiography and choledochoscopy.
  • The two methods demonstrated a high level of agreement, with a Kappa value of 0.70.

The researchers concluded that a study assessing the diagnostic value of T-tube cholangiography and choledochoscopy for detecting residual bile duct stones after biliary surgery revealed a strong agreement between the two methods, with no significant difference in their overall effectiveness.

“However, choledochoscopy identified some stones that were missed by T-tube cholangiography. Therefore, diagnostic technique selection should be customized based on the patient’s specific circumstances,” they wrote.

Reference:

Li, S., Wang, Z., Li, Z. et al. Diagnostic value of T-tube cholangiography and choledochoscopy in residual calculi after biliary surgery. BMC Gastroenterol 24, 383 (2024). https://doi.org/10.1186/s12876-024-03474-7

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Vitamin C and Dietary Antioxidants may Reduce Diabetes Risk, reveals research

Researchers have established that higher dietary antioxidant intake, particularly vitamin C, is inversely associated with the prevalence of diabetes mellitus. A recent study was published in the journal Frontiers in Nutrition conducted by Zhou L. and colleagues.

Diabetes mellitus is a chronic disease influenced by oxidative stress. This study fills the gap by examining the association between different levels of dietary antioxidant intake and risk of diabetes while also looking at the combined effect using the Composite Dietary Antioxidant Index among U.S. adults.

This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) data collected between 2011 and 2018. The dietary data for the participants was obtained from two 24-hour dietary recall interviews, which involved six critical dietary antioxidants to find the CDAI score. To explore the interaction between individual antioxidants and CDAI and diabetes, multifactorial logistic regression models were considered. Other subgroup analyses and restricted cubic spline curves also explored the relationship between CDAI and risk of diabetes.

Key Findings

  • The analysis included 7,982 adults, with a mean age of 47.32 years (±16.77), comprising 48.5% males and 51.5% females.

  • In the multivariate-adjusted single antioxidant model, vitamin C intake was significantly associated with a reduced risk of diabetes (p= 0.047), suggesting its powerful protective effect.

  • Although not reaching statistical significance, zinc intake exhibited a potential trend toward lowering diabetes risk (p= 0.088).

  • Composite Dietary Antioxidant Index (CDAI): CDAI was notably associated with a lower risk of diabetes in female participants (p= 0.046), emphasizing the combined effect of antioxidants in dietary intake on diabetes risk.

This study concludes that higher dietary antioxidant intake, particularly vitamin C, is related to reduced prevalence of diabetes, and that CDAI is valuable in reducing the risk of developing diabetes among women. The findings thus imply that dietary antioxidant intake is a viable approach in helping attenuate diabetes risk and hence holds gigantic implications for public health strategies based on nutrition.

Reference:

Zhou L, Xu X, Li Y, Zhang S and Xie H (2024) Association between dietary antioxidant levels and diabetes: a cross-sectional study. Front. Nutr. 11:1478815. doi: 10.3389/fnut.2024.1478815

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Long acting injection of Fluticasone promising in knee osteoarthritis, reveals research

Long acting injection Fluticasone promising in knee osteoarthritis suggests a new study published in the The Lancet Rheumatology.

Corticosteroids are among the few effective treatments for knee osteoarthritis, but short duration of action limits their utility. EP-104IAR, a long-acting formulation of fluticasone propionate for intra-articular injection, optimises the action of fluticasone propionate through novel diffusion-based extended-release technology. The SPRINGBOARD trial assessed the efficacy, safety, and pharmacokinetics of EP-104IAR in people with knee osteoarthritis. SPRINGBOARD was a randomised, vehicle-controlled, double-blind, phase 2 trial done at 12 research sites in Denmark, Poland, and Czech Republic. We recruited adults aged 40 years or older with primary knee osteoarthritis (Kellgren–Lawrence grade 2–3) who reported Western Ontario and McMaster Universities Osteoarthritis Arthritis Index (WOMAC) pain scores of at least 4 and no more than 9 out of 10. Participants were randomly assigned (1:1) to receive one intra-articular dose of 25 mg EP-104IAR or vehicle control. Randomisation was done via interactive web-based access to a central predefined computer-generated list with block size of six (allocated by clinical site). Participants and assessors were masked to treatment allocation. Participants were followed up for 24 weeks. The primary outcome was the difference between groups in change in WOMAC pain score from baseline to week 12, analysed in all participants who were randomly assigned and received treatment. Safety, including laboratory analyses, and pharmacokinetics from quantification of fluticasone propionate in peripheral blood were assessed in all participants who received a dose of randomly assigned treatment. A person with lived experience of knee osteoarthritis was involved in study interpretation and writing of the report. Findings: Between Sept 10, 2021, and Nov 16, 2022, 1294 people were screened for eligibility, and 319 were randomly assigned to EP-104IAR (n=164) or vehicle control (n=155). One participant in the EP-104IAR group was excluded from all analyses because treatment was not administered due to an adverse event. 318 participants (135 [42%] male and 183 [58%] female, 315 [99%] White) received randomly assigned treatment and were included in the primary analysis and safety analysis (EP-104IAR, n=163; vehicle control, n=155). At week 12, least squares mean change in WOMAC pain score from baseline was –2·89 (95% CI –3·22 to –2·56) in the EP-104IAR group and –2·23 (–2·56 to –1·89) in the vehicle control group, with a between-group difference of –0·66 (–1·11 to –0·21; p=0·0044); a significant between-group difference persisted to week 14. 106 (65%) of 163 participants in the EP-104IAR group had one or more treatment-emergent adverse event compared with 89 (57%) of 155 participants in the vehicle control group. Effects on serum glucose and cortisol concentrations were minimal and transient. There were no treatment-emergent deaths or treatment-related serious adverse events. Plasma concentrations of fluticasone propionate showed a blunted initial peak with terminal half-life of approximately 18–20 weeks. These phase 2 results suggest that EP-104IAR has the potential to offer clinically meaningful pain relief in knee osteoarthritis for an extended period of up to 14 weeks, longer than published data for currently marketed corticosteroids. There were minimal effects on glucose and cortisol, and stable fluticasone propionate concentrations in plasma. The safety and efficacy of EP-104IAR will be further evaluated in phase 3 trials, including the possibility of bilateral and repeat dosing with EP-104IAR.

Reference:

Efficacy and safety of a diffusion-based extended-release fluticasone propionate intra-articular injection (EP-104IAR) in knee osteoarthritis (SPRINGBOARD): a 24-week, multicentre, randomised, double-blind, vehicle-controlled, phase 2 trial

Malone, Amanda et al. The Lancet Rheumatology, Volume 0, Issue 0

Keywords:

Long, acting, injection, Fluticasone, promising, knee, osteoarthritis, The Lancet Rheumatology, multicentre, randomised, double-blind, vehicle-controlled

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Smoking and Alcohol Consumption Significantly Reduce efficacy of Psoriasis Treatment: Study

Researchers have identified that smoking, as well as alcohol consumption, alone or in combination, can significantly impair the effectiveness of therapeutic measures for psoriasis. An observational study in the Shanghai Skin Diseases Hospital demonstrated a much higher risk of failure to achieve a ≥ 75% improvement. This study was conducted by Shen F. and colleagues and was published in the journal Psoriasis.

Psoriasis is a chronic skin condition that affects more than 125 million people worldwide and cannot be cured; however, therapy can be used to reduce the manifestations of this disease. So far, limited attention in the literature has been paid to the combined influence of smoking and drinking on treatment for psoriasis.

This study treated 560 patients with psoriasis at the Shanghai Skin Diseases Hospital between 2021 and 2022. Their smoking and drinking behaviors were evaluated by questionnaires, and their psoriasis severity was evaluated through Psoriasis Area and Severity Index (PASI) scores at weeks 0, 4, and 8. Smoking was defined as smoking ≥ 100 cigarettes in a lifetime, and drinking was defined as the consumption of alcohol ≥ 2 times per week for ≥ 6 months.

Among the 560 patients, 43.8% (n = 245) smoked, 25.4% (n = 142) drank alcohol, and 19.6% (n = 110) both smoked and drank. The patients were categorized under four groups below.

  • Group A: None of them had ever smoked or drank, n = 283

  • Group B: Never smoked but drank alcohol, n = 32

  • Group C: Smoker but never drank, n = 135

  • Group D: Smoker and drinker, n = 110

Of subjects, male patients represented the majority (72.9%), with a mean age of 47 years (IQR, 36-61). The median PASI baseline scores for all groups were not significantly different from one another at the beginning of the study and ranged between 7.9 and 16.6 IQR.

Results

  • Those with a history of smoking were also significantly at higher risks for treatment failure at the end of 8 weeks of treatment when PASI75 was not achieved (OR, 7.78; 95% CI, 5.26-11.49).

  • More often, treatment failure was discovered among alcohol consumers (OR, 5.21; 95% CI, 3.29-8.27).

  • The combination of both behaviors had adverse effects on the results of treatment. The OR for failure to attain a threshold for PASI75 was highest in those who smoked and drank (12.74; 95% CI, 7.16-22.67).

The efficacy of the treatment was assessed at 8 weeks instead of at 12 weeks, which is a standard point in time for assessing outcomes of the treatment of psoriasis. Other limitations include a mismatched male: female ratio in patients and a lack of generalizability of the findings to other populations.

Smokers and alcohol drinkers therefore significantly weaken the treatment of psoriasis. It is much more likely for such patients to not respond suitably to treatments targeting their psoriasis. Dermatologists should base their approaches on such findings in the treatment of patients suffering from psoriasis. They should encourage such patients to adopt lifestyle changes that would positively influence the response to treatment.

Reference:

Shen F, Song Y, Qiang Y, et al. Tobacco Smoking Interacted with Alcohol Drinking Could Increase the Failure of PASI75 Achievement at Week 8 Among Patients with Psoriasis: Findings Based on a Psoriasis Cohort. Psoriasis (Auckl). https://doi.org/10.2147/PTT.S484609

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Quitting smoking after cancer diagnosis improves survival across wide variety of cancers: JAMA

Smokers who are diagnosed with cancer now have more incentive to quit, as researchers from The University of Texas MD Anderson Cancer Center have found survival outcomes were optimized when patients quit smoking within six months of their diagnosis.

Study results, published today in JAMA Oncology, found a 22%-26% reduction in cancer-related mortality among those who had quit smoking within three months after tobacco treatment began. The best outcomes were observed in patients who started tobacco treatment within six months of a cancer diagnosis and were abstinent from smoking three months later. Survival for these patients increased from 2.1 years for smokers to 3.9 years for abstainers.

“While smoking cessation is widely promoted across cancer centers for cancer prevention, it remains under-addressed by many oncologists in their routine care,” said principal investigator Paul Cinciripini, Ph.D., chair of Behavioral Science and Executive Director of the Tobacco Research and Treatment Program at MD Anderson. “Our research underscores the critical role of early smoking cessation as a key clinical intervention for patients undergoing cancer treatment.”

Tobacco use remains the leading preventable cause of death and disease in the U.S. According to the Surgeon General, smoking at or following a cancer diagnosis increases both all-cause and cancer-specific mortality, as well as risk for disease progression and tobacco-related second primary cancers. Each year, about 480,000 Americans die from tobacco-related illnesses.

The average smoker makes several attempts to quit before successfully beating the addiction. MD Anderson’s Tobacco Research and Treatment Program tackles the barriers to cessation at an individual and population level, and conducts research designed to change clinical practice by addressing knowledge gaps among health care providers on treating tobacco addiction.

In the current study, researchers followed a cohort of 4,526 current smokers who had been diagnosed with cancer and were receiving cessation treatment at MD Anderson. The patients included men and women aged 47 to 62. More than 95% of visits in the study were provided via telemedicine. Abstinence was defined as self-reported no smoking in the seven days before each assessment, at the three-, six- and nine-month follow-up marks. The primary outcome was survival recorded by the MD Anderson tumor registry.

“This is a call to action for experts, regulatory bodies and institutions to prioritize smoking cessation as an integral part of first-line cancer care,” Cinciripini said. “MD Anderson has made a significant investment in clinical care and research related to tobacco use, which at the individual patient level translates to a better quality of life and a longer one, for those who quit smoking. The earlier the engagement in tobacco cessation treatment the greater impact on a patient’s lifespan.”

Reference:

Cinciripini PM, Kypriotakis G, Blalock JA, et al. Survival Outcomes of an Early Intervention Smoking Cessation Treatment After a Cancer Diagnosis. JAMA Oncol. Published online October 31, 2024. doi:10.1001/jamaoncol.2024.4890

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Courts Should Exercise Caution While Issuing Orders to Keep Seats Vacant at Medical Colleges: SC

New Delhi: The Supreme Court recently held that even though courts have power to make orders directing to keep medical seats vacant at medical colleges, they should exercise great caution while doing so.

“If provisional admission seats are not to be given casually, the said principal should also apply for directions to keep seats vacant. Only if there is a cast iron case for the petitioner and the petitioner is bound to succeed in cases where the error of the respondent authorities is so gross as to negate any other conclusion, interim orders keeping seats vacant could be made,” opined the top court bench comprising Justices BR Gavai and KV Vishwanathan.

Further, the Court opined that even in rare and exceptional cases where orders are made to keep the seats vacant, the courts should make every possible endeavour to dispose of the matter before the completion of the counselling for admissions.

“Additionally, even if the Writ Petition/Appeal succeeds, but if the matter could not be disposed off before the deadline the seat may still go vacant. It should not be forgotten that while the recurring and non-recurring expenditure for a college remains the same, a vacant seat will deprive the college of the fees to that extent, not just for one year but for the whole course, which could be four, five or more years,” the Supreme Court bench pointed out.

Such observations were made by the Supreme Court while considering the cases of two medical colleges, which were ordered by the High Court to keep medical seats vacant. Ultimately, these institutes suffered losses due to the said seats remaining vacant.

However, while considering their cases, the Supreme Court recently paved the way for monetary reimbursement by adjusting the fees proposed by the colleges for successive batches.

Both these colleges were ordered by the Director of Medical Education to keep one MBBS seat vacant with a direction that the said seat would not be included in the College Level Counselling (CLC) Round for the academic year 2023-2024. These directions were issued based on an interim order dated 22.09.2023 passed by the High Court.

Later, both these pleas were dismissed denying relief to the petitioner students. Consequently, the colleges were caught in the crossfire in their attempt to intervene. Having failed in the High Court, the courts filed a plea before the Supreme Court seeking a compensatory seat in the subsequent academic year. Their case was that because the seat was kept on hold, they were deprived of the opportunity to fill that seat. Their grievance was that the consequential loss had befallen solely on them due to an act of the court.

The colleges contended that the seat which was directed to be kept vacant became wasted since the pleas could not be disposed of before the cut-off date for admissions. They contended that the vacant seat would result in underutilization of resources, wastage of resources causing financial harm to them and resulting in meritorious candidates being denied admission to that seat.

While the colleges prayed to the Supreme Court top grant a compensatory additional seat for the ensuing academic year, the authorities contended that the authorities did not have any role in the matter and it was the order of the Court which was duly carried out and no liability could be fastened on them.

While considering the matter, the Apex Court referred to the interim order directing one seat in the counselling to be kept vacant as “cryptic” noting that in both these matters, neither the prima facie case nor the balance of convenience and irreparable loss aspects were discussed.

“This Court had time and again reiterated that in cases where the court is inclined to grant interim relief, at least a brief prima-facie assessment as to why the case warranted an interim protection needs to be discussed. Equally, the balance of convenience and the irreparable harm aspects are also to be briefly discussed in the order. These are well settled principles for adjudication of interim reliefs. The High Court, in both the matters before us, has wholly ignored these principles,” noted the Supreme Court bench.

Apart from this, the Court also pointed out that it repeatedly held that a medical seat has life only in the year it falls due and that too till the cut-off date is fixed. It pointed out that there are stringent regulations of the National Medical Commission (NMC) providing that admission can only be made by the medical colleges within the sanctioned capacity for which permission/recognition has been granted.

“No doubt, in rare and exceptional circumstances, courts can direct increase in seats for the same academic year not exceeding one or two seats, if it finds that for no fault attributable to the candidate and for the fault on the part of the authorities, the candidate has suffered. This Court has also held that if in the same year, the candidate cannot be accommodated, the Court can mould the relief and direct the admission to be granted in the next academic year,” it observed.

Besides, the Court also noted that it has frowned upon the grant of provisional admission unless the court is fully satisfied that the petitioner has a cast iron case which is bound to succeed or the error is so gross or apparent that no other conclusion is possible, adding that “Even there, the court has opined that a short notice to the respondent ought to be given and after hearing the other side, in an exceptional case fulfilling the criteria prescribed necessary orders can be made.”

At this outset, the Court opined that seats should not be kept vacant casually and such interim orders keeping seats vacant should be made only if there is a cast iron case for the petitioner.

“Though courts have power to make orders directing seats to be kept vacant in such cases, great caution and circumspection should be shown in exercising the power. In appropriate cases, even where the said exceptional criterion as set out above is met, the court will be justified in directing the petitioner to provide security, to the concerned college-institution where the seat is ultimately directed to be kept vacant or on whom ultimately the liability of the vacant seat would fall. The security is to guarantee that in the event of the Writ Petition/Appeal being dismissed and the seat going unfilled for the academic year the Petitioner/Appellant would make good the loss which the college may incur financially,” noted the top court bench, adding that even when such orders are made to keep the seats vacant, the Courts should make every possible endeavour to dispose of the matter before completion of the counseling.

“…these safeguards are essential to restitute the colleges which may have suffered for no fault of theirs. It is well settled that if on account of an act of a party persuading the court to pass an order, which at the end has been held not sustainable and if in the process one party has gained an advantage which it would not have otherwise earned or the other party had suffered an impoverishment, restitution can be made. This Court had held that the principle of restitution is not excluded from its application to interim orders,” the Supreme Court bench further observed.

“This Court has also held that the maxim actus curiae neminem gravabit will apply in such a scenario, and orders of restitution can be passed directing the party which obtained the advantage to compensate the party which suffered the disadvantage,” noted the Court.

Applying these principles to the facts of the present case, the Supreme Court bench found that the vacant seat ordered could not be filled because by the time the pleas were disposed of, the counselling had concluded and the cut-off date for admissions was also over. Noting that the colleges will have to carry the vacant seat for the entire duration of the MBBS course, the Court observed that while in the first case, the plea was dismissed, in the second case, at the student’s behest, the High Court order was set aside and the student was accommodated for the succeeding academic year. However, even in that case, the seat could not be filled and continued to remain vacant.

Accordingly, to serve the justice, the Supreme Court bench granted liberty to the medical colleges to make a representation to the Fee Fixation Committee/Fee Fixation Authority of the State highlighting the vacancy caused due to the interim order of the High Court.

“If such a representation is made, the Fee Fixation Committee/Fee Fixation Authority shall, while fixing the fees for college (for future batches) reckon the deficit in fees that has resulted due to the single vacant seat and fix the fees by adding such amount to the total fees proposed to be fixed which will restitute the colleges monetarily,” it ordered.

“Considering that it is a single seat and since the fee will be spread over for a period of five years, the financial impact on whom the burden will fall will be marginal, in proportion to the total fee payable. On the current facts, we find that this is the best possible option, to neutralize the effect of the interim orders which have operated to the prejudice of the colleges,” noted the top court.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/supreme-courtjudgement07-nov-2024-260300.pdf

Also Read: Even a single Medical seat must not remain vacant: SC slams MCC, Centre over 1,456 vacant NEET PG seats

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