Archive for month: December, 2024

Polycystic Ovary Syndrome (PCOS) remains one of the most challenging health concerns for women in India today, impacting both physical and emotional well-being. In a recent multi-specialty crosstalk on PCOS care, leading experts in endocrinology, gynecology, and dermatology shared insights that underscored the complexity of this condition and offered guidance on managing it effectively. The panel included Dr. Madhavi Latha, a Gynecologist practicing at Kalyan Hospital, Payakaraopet, Andhra Pradesh; Dr. Smita Ghate, Professor and Head of Department in Department of Dermatology, H.B.T. M. C. And R. N. C. G.H. Mumbai; and Dr. Tejal Lathia, an Endocrinologist at Cloud 9 Hospital, Mumbai.

Each specialist provided unique insights into PCOS management through their area of expertise. Here, we delve into the top 10 takeaways from this enlightening discussion.

1. Making a PCOS Diagnosis Prudently in Young Patients (Gynecology)

Diagnosing PCOS, particularly in adolescents, presents challenges due to its wide range of symptoms, from menstrual irregularities to metabolic issues like insulin resistance. To avoid premature labeling in young patients, it is recommended to adopt a “probable PCOS” status and revisit the diagnosis after a few years. This approach helps manage symptoms while reducing anxiety and social stigma.

2. Cost-effective and Focused Testing for PCOS Diagnosis – Practical Pearls (Endocrinology)

Efficient and economical testing is key in managing PCOS. Diagnostic criteria include irregular menstrual cycles lasting more than 35 days, signs of hyperandrogenism, and ultrasound findings of ovarian volume over 10 cc or more than 20 follicles. Adolescents should not be diagnosed based on ultrasound findings alone. Avoiding unnecessary follow-up ultrasounds or tests reduces costs and keeps care accessible, especially for young patients, and is relevant in Indian socio-economic settings

3. Addressing Mental Health as an Essential Component of PCOS Care (Dermatology)

PCOS brings significant psychological burdens, with high rates of anxiety, depression, and body image concerns among patients. Visible symptoms like acne and hirsutism can exacerbate these issues. Positive and supportive communication is essential in reducing stigma, while incorporating mental health support, such as professional therapy, can foster better coping strategies, enhancing overall care quality in these patients.

4. Awareness of Dietary Adjustments & Environmental Factors (Dermatology)

Lifestyle and environmental factors play significant roles in PCOS management. A dietary approach emphasizing whole foods, fiber, and probiotics helps maintain gut health and support hormonal balance. Additionally, reducing exposure to endocrine disruptors found in plastics and processed foods contributes to long-term health and may help alleviate PCOS symptoms.

5. Dermatological Symptoms: Recognizing Hyperandrogenic Indicators (Dermatology)

PCOS frequently manifests through dermatological issues, such as resistant acne, hirsutism, and pigmentation around the knuckles and neck (acanthosis nigricans). Recognizing these symptoms early can guide diagnosis and treatment with a combination of metformin, lifestyle modifications, and skin-specific therapies like topical treatments like salicylic acid peels. Managing these symptoms can boost patient confidence and overall quality of life.

6. Dealing with PCOS & Pregnancy (Gynecology)

PCOS can complicate pregnancy, increasing risks of gestational diabetes, hypertension, and miscarriage. Pre-pregnancy counseling and annual screenings for blood glucose and blood pressure are recommended to identify risks early. In pregnancy, careful monitoring through continuous glucose monitoring and metformin under professional guidance & physician discretion can help mitigate risks, improving outcomes for both mother and child.

7. Insulin Resistance: Addressing the Core Metabolic Challenge (Endocrinology)

Insulin resistance is a central issue in PCOS, making the management of insulin sensitivity essential for alleviating symptoms. Metformin, commonly used to reduce androgen levels, helps regulate menstrual cycles and can lessen acne. A balanced diet, reduced in processed carbohydrates and higher in protein, alongside regular exercise, supports effective insulin resistance management in PCOS.

8. Lifestyle Modifications as the Foundation of PCOS Management (Gynecology)

Lifestyle interventions remain a foundational approach to PCOS management. For women with PCOS, maintaining a healthy weight through balanced nutrition and regular physical activity can significantly improve metabolic parameters and fertility outcomes. Weight reduction of even 5-10% positively impacts menstrual regularity and general health, while lean PCOS patients benefit from waist circumference monitoring and stress reduction techniques.

9. Metformin as a Treatment Option in Adolescents and Adults (Endocrinology)

Metformin is often recommended, especially for adolescent patients dealing with insulin resistance and weight management challenges. Beyond metabolic benefits, metformin can aid in regulating menstrual cycles without introducing hormonal pills, which are often avoided in younger patients due to potential impacts on bone health. Initiation of metformin at doses of 500 mg, gradually increased, supports both weight loss and balance androgenic hormones effectively.

10. Compassionate Communication and Simplified Patient Education (Gynecology)

Effective communication is essential in PCOS management. Using positive, empathetic language and avoiding words that may shame or blame patients can significantly improve their mental well-being. Educating patients in a supportive manner empowers them and instills confidence to manage their condition effectively, fostering trust and adherence to treatment plans.

Ballari: In the wake of five maternal deaths reported within a month at Ballari Institute of Medical Sciences (BIMS), several private hospitals in the state have reportedly begun exploiting patients by raising their charges for admitting pregnant women. This price hike has sparked concerns among families already grappling with financial hardships. 

In the past month, five deaths have been reported after patients at BIMS were administered a banned IV fluid by the hospital’s doctors and staff. As a result, many patients previously admitted to BIMS and other government hospitals have begun shifting to private hospitals over the past 15 days, seeking to avoid the health risks associated with the incident. 

Several patients and their relatives have reported that private hospitals are exploiting the situation by inflating the costs of maternity care. This sharp price rise has left many families struggling to afford the necessary treatment. In response, patients and their families are urging the district administration to take immediate action against private hospitals charging exorbitantly.   

Also Read: AIIMS Rishikesh becoming pricey- Announces Rollback after public outcry

He claimed that although his daughter’s medical reports were normal, the hospital informed him that there were no vacant beds available due to the increased influx of pregnant women.  

Medical Dialogues team had earlier reported that a four-member panel has been constituted by the Karnataka government to investigate maternal deaths reported at Ballari Hospital and elsewhere across the state. 

Also Read: Private Hospitals in Kolkata set to revise charges citing inflation

A recent study published in the Hypertension journal highlights the cost-effectiveness of salt substitution over antihypertensive drug treatment in managing prehypertension among Chinese adults, particularly for the individuals aged 40 and above. The findings illuminate the potential for significant public health benefits and cost savings through early lifestyle interventions.

The research incorporated data from the China Kadoorie Biobank, using real-world information on cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs). By utilizing Markov cohort model, this study evaluated 3 interventions: salt substitution, antihypertensive drug treatment, and a combination of both. Costs and utilities were derived from published sources, and the interventions were assessed across different age groups and risk levels. Incremental cost-effectiveness ratios (ICERs) provided a measure of value for each intervention per QALY gained.

By replacing traditional salt with a salt substitute for prehypertensive individuals starting at age 40 proved to be the most cost-effective strategy. With an ICER of $6413.62/QALY, this intervention showed substantial benefits in reducing CVD risk without the high costs associated with drug treatments.

For individuals at high risk of CVD, combining salt substitution with antihypertensive drug treatment offered the greatest reduction in CVD events. Initiating this combined approach at age 40 was effective by achieving a 5.3% reduction in CVD events with an ICER of $2913.30/QALY. This represented a better value when compared to starting at older ages, where the cost per QALY gained increased significantly.

Across all interventions, younger starting ages yielded better outcomes and lower ICERs. For instance, initiating a combined intervention at age 40 reduced CVD events by 5.3% when compared to 4.9% at age 70. Further, the cost per QALY gained at age 70 ($32,635.33/QALY) was more than 10-times higher than at age 40. This emphasizes the importance of early intervention in managing prehypertension.

The sensitivity analyses confirmed the robustness of these findings by reinforcing the outcome that salt substitution when started early, is a highly cost-effective measure. Overall, the study found that replacing standard salt with a low-sodium salt substitute is a simple yet impactful intervention for prehypertensive adults in China by offering significant health benefits at a fraction of the cost of drug treatments.

Reference:

Sun, Z., Zhang, H., Ding, Y., Yu, C., Sun, D., Pang, Y., Pei, P., Yang, L., Chen, Y., Du, H., Hu, W., Avery, D., Chen, J., Chen, Z., Li, L., & Lv, J. (2024). Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults. In Hypertension (Vol. 81, Issue 12, pp. 2529–2539). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/hypertensionaha.124.23412

Single Arsenic and Cadmium exposure is positively associated with increased CKD risk, reports a study published in the Environmental Geochemistry and Health.

A new study published in the journal of BMC Pregnancy and Childbirth showed that continuous temperature deep learning might yield clinically useful pregnancy care solutions. Instead of being assessed in days, the average inaccuracy of the current clinical expected date of delivery, or EDD, is calculated in weeks. A “term” pregnancy lasts 5 weeks, ranging from 37 to 42 weeks. There are no clinical techniques that reliably indicate whether a pregnancy is likely to start on the earlier or later side of this range, despite considerable efforts to discover biomarkers of approaching labor. 

In many species, changes in body temperature predict the commencement of labor, although this idea has not been investigated in humans. So, Chinmai Basavaraj and colleagues looked into whether constant body temperature of women fluctuates in a similar way and whether these variations may be related to their hormonal state. Lastly, they created a deep learning model that forecasted the time until labor commencement each day by utilizing temperature patterning. 

Using a wearable smart ring, this research assessed trends in continuous skin temperature data from 91 pregnant women (n = 54 spontaneous labors). This research looked at daily steroid hormone samples before delivery in a subgroup of 28 pregnancies in order to evaluate the connections between hormones and the trajectory of body temperature. Also, the deep learning model called autoencoder long short-term memory (AE-LSTM) to produce a new daily estimate of the number of days till the start of labor.

Urinary hormones and the kind of labor were linked to characteristics of the temperature shift that preceded labor. When compared to pregnancies without spontaneous labor, those that had spontaneous labor had more stable circadian rhythms, lower body temperatures, and a higher estriol to α-pregnanediol ratio.

The AE-LSTM model was trained using skin temperature data from 54 pregnancies that had spontaneous labor between 34 and 42 weeks of gestation, and an additional 37 pregnancies that experienced artificial induction of labor or Cesarean without labor were utilized for additional testing.

5-minute skin temperature data from 240 days before the day of labor commencement served as the pipeline’s input. Regardless of gestational age, the AE-LSTM average error decreased below 2 days at 8 days before to labor during cross-validation. From the AE-LSTM output, labor onset windows were computed utilizing a probabilistic distribution of model error.

For these windows, 79% of spontaneous labors within a 4.6-day window at 7 days prior to actual labor and a 7.4-day window at 10 days prior to true labor had their labor start accurately predicted by AE-LSTM. Overall, constant skin temperature throughout pregnancy indicates the onset of labor and changes in hormones.

Reference:

Basavaraj, C., Grant, A. D., Aras, S. G., & Erickson, E. N. (2024). Deep learning model using continuous skin temperature data predicts labor onset. In BMC Pregnancy and Childbirth (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12884-024-06862-9