Lung ultrasound score easy and effective bedside tool for assessing lung parameters in mechanically ventilated patients: Study

Lung ultrasound is a developing and beneficial method for identifying compromised alveolar air and the presence of interstitial and alveolar fluid. It assesses lung aeration beyond the pleura and can reveal underlying lung issues. Recent study aimed to investigate the relationship between lung ultrasound score (LUSS) and oxygenation, as well as respiratory mechanics, in mechanically ventilated patients. The researchers performed 101 lung ultrasounds in 50 patients aged 18-60 years requiring at least 24 hours of mechanical ventilation. The key findings of the study are: 1. LUSS showed a strong negative correlation with the ratio of arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2) (ρ = -0.827, p<0.001), indicating that higher LUSS values are associated with worse oxygenation. 2. LUSS also had a moderate negative correlation with lung compliance (ρ = -0.634, p<0.001), suggesting that higher LUSS is associated with decreased lung compliance. 3. Conversely, LUSS had a strong positive correlation with lung resistance (ρ = 0.735, p<0.001), meaning higher LUSS values correspond to increased lung resistance. 4. Using receiver operating characteristic (ROC) curve analysis, the researchers determined that a LUSS greater than 12 can predict a PaO2/FiO2 ratio less than 200 with 97.37% sensitivity and 85.7% specificity.

Conclusion

The authors concluded that LUSS is an easy and effective bedside tool for assessing lung parameters in mechanically ventilated patients. It correlates significantly with oxygenation, lung compliance, and lung resistance, providing valuable information about the underlying lung pathology. LUSS may be useful for monitoring disease progression and guiding treatment in these critically ill patients.

Key Points

1. Lung ultrasound score (LUSS) showed a strong negative correlation with the ratio of arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2), indicating that higher LUSS values are associated with worse oxygenation.

2. LUSS had a moderate negative correlation with lung compliance, suggesting that higher LUSS is associated with decreased lung compliance.

3. LUSS had a strong positive correlation with lung resistance, meaning higher LUSS values correspond to increased lung resistance.

4. Using receiver operating characteristic (ROC) curve analysis, the researchers determined that a LUSS greater than 12 can predict a PaO2/FiO2 ratio less than 200 with 97.37% sensitivity and 85.7% specificity.

5. The authors concluded that LUSS is an easy and effective bedside tool for assessing lung parameters in mechanically ventilated patients.

6. LUSS correlates significantly with oxygenation, lung compliance, and lung resistance, providing valuable information about the underlying lung pathology, and may be useful for monitoring disease progression and guiding treatment in these critically ill patients.

Reference –

Nishant Kumar et al. (2024). Relationship Of Lung Ultrasound Score With Oxygenation And Pulmonary Mechanics In Mechanically Ventilated Patients: An Observational Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_771_24.

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10-Day Vonoprazan-Amoxicillin Regimen Matches 14-Day Standard Treatment in H. pylori Eradication, reveals research

China: A large-scale study published in the American Journal of Gastroenterology demonstrated that a 10-day regimen of vonoprazan 20 mg twice daily combined with amoxicillin 1000 mg three times daily was equally effective as the traditional 14-day treatment in eradicating Helicobacter pylori.

“The eradication rates were 89.6% for the 10-day regimen and 91.2% for the 14-day regimen, establishing the shorter course as noninferior. Both treatment durations exhibited comparable adverse event profiles,” the researchers reported.

It remains unclear whether the 10-day short-course vonoprazan-amoxicillin dual therapy (VA-dual) is noninferior to the standard 14-day bismuth-based quadruple therapy (B-quadruple) for Helicobacter pylori eradication. Considering this, Yi Chen, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, and colleagues aimed to evaluate and compare the eradication rates, adverse events, and patient compliance between the 10-day VA-dual regimen and the standard 14-day B-quadruple regimen as first-line treatment for H. pylori.

For this purpose, the researchers conducted a prospective randomized clinical trial across three institutions in eastern China. Three hundred and fourteen treatment-naive patients with H. pylori infection were randomly assigned in a 1:1 ratio to receive either a 10-day VA-dual regimen or a 14-day B-quadruple regimen. Eradication success was assessed using the ^13C-urea breath test at least four weeks post-treatment. The study compared eradication rates, adverse events, and compliance.

The following were the key findings of the study:

  • Based on intention-to-treat (ITT) analysis, the eradication rate was 86.0% in the VA-dual group and 89.2% in the B-quadruple group.
  • Based on modified ITT analysis, the eradication rate was 88.2% in the VA-dual group and 91.5% in the B-quadruple group.
  • Based on per-protocol (PP) analysis, the eradication rate was 90.8% in the VA-dual group and 91.3% in the B-quadruple group.
  • The efficacy of VA-dual was noninferior to B-quadruple therapy across ITT, modified ITT, and PP analyses.
  • The incidence of adverse events was significantly lower in the VA-dual group compared to the B-quadruple group.
  • Poor compliance was a contributing factor to eradication failure in the VA-dual group but did not significantly impact the B-quadruple group.

The authors acknowledge several limitations in their study. First, antimicrobial susceptibility testing was not conducted, though amoxicillin resistance is rare in China, minimizing its impact on the VA-dual regimen’s effectiveness. Second, patients allergic to penicillin or those in regions with high amoxicillin resistance may not benefit from VA-dual. Lastly, the open-label design may have introduced treatment bias, affecting adverse event reporting.

“Despite these limitations, the study found a high H. pylori eradication rate of 90.8% with 10-day VA-dual therapy in Eastern China, demonstrating lower adverse event rates than the 14-day B-quadruple regimen. The VA-dual regimen shows promise as a cost-effective option for H. pylori screening and eradication strategies,” the authors concluded.

Reference:

Yan, Tian-Lian MD1,*; Wang, Jing-Hua PhD1,*; He, Xin-Jue MD1; Zhu, Ya-Bi BD2; Lu, Lin-Jie MS3; Wang, Yan-Jiao MS2; Wang, Zi-Wei MS1; Gao, Jian-Guo PhD1; Xu, Cheng-Fu MD1; Ma, Han MD1; Luan, Shuang-Mei BD2; Li, Lan MD1; Chen, Yi MD1. Ten-Day Vonoprazan-Amoxicillin Dual Therapy vs Standard 14-Day Bismuth-Based Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Multicenter Randomized Clinical Trial. The American Journal of Gastroenterology 119(4):p 655-661, April 2024. | DOI: 10.14309/ajg.0000000000002592

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Laparoscopic Davydov-Moore vaginoplasty tied to satisfactory anatomic and sexual outcomes in MRKH syndrome: Study

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is defined as
a congenital absence or hypoplasia of the uterus, cervix, and vagina due to
malformations in the Müllerian ducts’ development, despite the presence of
typical external genitalia. It affects 1 out of 5000 women with normal phenotypes
and karyotypes (46, XX). Most of the cases are diagnosed between 15–17 ages due
to primary amenorrhea. It is subdivided into two types, type 1 (MRKH I),
related only to organs developing from the Müllerian ducts, and type 2, where
additional malformations including renal and skeletal systems occur (MRKH II). The
diagnostic process includes 3D ultrasonography or MRI of the pelvis along with
hormonal assay.

The diagnosis of MRKH is not only connected to physical
ailments, but also may have psychological impact related to an absence of
menstruation, challenges with sexual activity along with the inability to
conceive. In women with MRKH and desire for sexual activity, the treatment is a
vaginal reconstruction. Treatment options include form non-invasive methods
using dilators in case of the presence of a rudimentary vagina, to more
invasive ones such as an operative creation of a neovagina or uterus
transplantation, as the first true infertility treatment. Taking into account
that no standardized treatment is maintained, the surgical approach is based on
the operating surgeon’s experience. One of the most common surgical procedures
used to create neovagina is Davydov vaginoplasty, which includes the use of
peritoneal graft. It can be performed separately or combined with the procedure
described by Moore et al., where vaginoplasty includes the reconstruction
of the posterior vaginal canal and introitus together with the modification of
the final diameter and caliber of the vagina.

Given the clinical significance of MRKH, author
Magdalena Piróg and team investigated the postoperative outcomes and
sexual satisfaction in women with MRKH following neovaginal creation after
Davydov Moore vaginoplasty.

In the case-series study, authors described seven women, at
a median age of 22.6± and BMI 22.8±2.3 kg/m2. They measured peri- and
postsurgical parameters, including surgery-related neovaginal length and sexual
initiation time. Sexual outcomes were measured using the Female Sexual Function
Index (FSFI) before and 6 months after vaginoplasty.

All surgical procedures were performed successfully, with
one minor perioperative bleeding. The mean time of vaginoplasty was
82.1 min and the mean duration of hospitalization was six days. After a
6-month follow-up, vaginal length was 8.1-times longer than before surgery (10
vs. 81 mm). The time from the surgery to the initiation of vaginal
intercourse was between 17 to 22 weeks. The mean FSFI score indicated good
results, with no women below 23 score, and was 4.3- times higher when compared
with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before
surgery, the post-surgical FSFI revealed higher scores in all six different
domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times),
orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times).

This study is the first to show that neovaginal creation
with the Davidov-Moore approach is a safe treatment in women with MRKH. Authors
also demonstrated the high effectiveness of the procedure reflected by
prolonged vaginal length and good sexual function after this surgery.

In conclusion, laparoscopic Davydov-Moore vaginoplasty may
be considered as a safe procedure with satisfactory anatomic and sexual
outcomes, however, women need to be aware of possible complications. Further
research is needed to investigate possible long-term outcomes and their
clinical consequences.

Source: Magdalena Piróg, Magdalena Bednarczyk,
Katarzyna Barabasz; Archives of Gynecology and Obstetrics

https://doi.org/10.1007/s00404-024-07830-6

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Paternal weight may influence size of baby at birth, study finds

A study in Brazil involving 89 father-mother-baby triads points to an association between paternal overweight and newborn birth weight: the higher the father’s body mass index (BMI, weight divided by height squared), the lower the baby’s birth weight.

An article on the study is published in the International Journal of Obesity.

The findings reinforce the idea that anthropometric issues are not the sole responsibility of the mother and that the father should also strive to maintain a healthy lifestyle during a partner’s pregnancy.

“There is a great deal of discussion and research regarding the link between fetal development and maternal health, including issues such as overweight before and during pregnancy, but the fact is that the father’s health also has a significant impact on the development of the baby both during pregnancy and after birth. Our study was the first involving Brazilian families to show that the higher the father’s BMI, the lower the baby’s birth weight, evidencing the father’s importance to the baby’s health and development,” said Mariana Rinaldi Carvalho, first author of the article and a researcher at the University of São Paulo’s Ribeirão Preto Medical School (FMRP-USP). She was supported by FAPESP via a PhD scholarship.

Birth weight is considered a key predictor of health not just in early childhood but for life. A great deal of research has shown that babies born with low (or high) weight run a higher risk of death and of developing non-transmissible diseases later in life, such as type 2 diabetes, cancer and cardiovascular disorders.

The study by researchers at FMRP-USP was a follow-up to a clinical trial that investigated the effect of nutritional counseling intervention on weight gain for 350 overweight pregnant women attending public primary health clinics. The trial was supported by FAPESP.

“Having noticed that most studies involving fetal and neonatal health fail to take the parents’ lifestyle into account, we set out to include paternal anthropometry as a factor affecting fetal development,” said Carvalho’s thesis advisor, Daniela Saes Sartorelli, last author of the study and a professor in the Department of Social Medicine at FMRP-USP.

The group plans to analyze the effect of paternal diet on neonatal anthropometry and adiposity, focusing on consumption of ultra-processed foods and fat quality.

Public health

Maternal overweight is considered a public health problem. Many studies have shown that excessive weight gain during pregnancy is a major short- and long-term health hazard for both mother and baby. In the case of the mother, it heightens the risk of gestational diabetes, hypertension and preeclampsia, often making a cesarean section inevitable. For the baby, it increases the likelihood of low or high birth weight and the risk of obesity and associated disorders such as type 2 diabetes and hypertension at an early age.

While in the case of the mother there is a direct link via the placenta and other cells between obesity and fetal development, paternal overweight can lead to epigenetic alterations (biochemical changes to DNA that reprogram gene expression). According to Carvalho, previous studies involving animals showed that some genes expressed by the father can affect fetoplacental growth.

The fetus can suffer growth restrictions influenced by paternal overweight and fail to realize its genetic growth potential, she explained. Briefly, preconception paternal exposure to environmental stressors such as an unhealthy diet, a sedentary lifestyle and smoking, for example, can lead to metabolic disorders in offspring via epigenetic alterations.

“We now know that environmental stressors such as overweight can influence the structure and quality of the father’s sperm, altering gene expression and affecting the DNA of his children. This influence relates to epigenetics, the scientific field that studies how environmental stimuli can activate or silence genes,” Carvalho explained.

“The mother’s health is evidently a key factor, and research has shown the importance of a healthy diet during pregnancy, but more attention needs to be paid to paternal overweight in the period prior to conception. Our research findings show that just as maternal nutritional counseling is important, so is the need for a preconception change in paternal habits.”

The study involving 89 parents and babies also found that the higher the father’s BMI and waist circumference, the smaller the baby’s head circumference at birth. “We didn’t detect any anomalies or malformations, but the correlation is important because head circumference at birth is a key growth parameter. Nevertheless, more research is needed to evaluate the real significance of this finding,” Carvalho said, adding that previous studies of obesity found overweight to influence neonatal bone mineralization.

“A limitation of this study was lack of access to information on the time these women took to deliver their babies [in cases of vaginal birth]. We know head circumference at birth can be altered temporarily when the baby has spent a long time in the vaginal canal,” she said.

Reference:

Carvalho, M.R., Miranda, D.E.G.d.A., Baroni, N.F. et al. Relationship between paternal excessive weight and neonatal anthropometry in a clinical trial of nutritional counseling for pregnant women with overweight. Int J Obes 48, 1831–1838 (2024). https://doi.org/10.1038/s41366-024-01639-8

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Living in disadvantaged neighborhood linked to higher blood pressure and lower cognition, finds study

New research from Wake Forest University School of Medicine suggests that living in a disadvantaged neighborhood is associated with higher blood pressure and lower cognitive scores, even among people who do not have an existing diagnosis of mild cognitive impairment.

The study appears online today in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, a journal of the Alzheimer’s Association.

“We know that inequitable access to education, employment, income and housing increases the risk for Alzheimer’s disease and related dementias,” said James R. Bateman, M.D., assistant professor of neurology at Wake Forest University School of Medicine and principal investigator of the study. “However, more research is needed to better understand the impact of social determinants of health, including what this study analyzed with neighborhood disadvantage.”

Bateman said neighborhood disadvantage refers to the lack of social and economic resources in one’s environment. To assess neighborhood disadvantage, the research team used the highly recognized national Area Deprivation Index, which measures housing quality, education and income.

“Our goal of the study was to analyze the relationship of neighborhood disadvantage with measures of cardiometabolic health and cognition in individuals with and without diagnosed mild cognitive impairment,” said Bateman, who is also a neurologist at Atrium Health Wake Forest Baptist.

Bateman said it was important for the team to compare individuals with a diagnosis to those without one to better understand how a person’s current cognitive state impacts the relationship between their environment and their health.

Cognition refers to the mental process of thinking, learning, remembering, being aware of surroundings and using judgment. Mild cognitive impairment is a decline in memory and thinking skills that is greater than expected with normal aging and is a risk factor for dementia.

Bateman noted that many cardiometabolic diseases may increase the risk for cognitive impairment and dementia. Cardiometabolic health is the cardiovascular and metabolic health of an individual and involves the management of risk factors such as blood glucose, high blood pressure, high cholesterol and obesity.

For the study, Bateman and team analyzed data from 537 adults over the age of 55 from the Alzheimer’s Disease Research Center Healthy Brain Study at Wake Forest University School of Medicine from 2016 to 2021.

Individuals received clinical exams, neurocognitive testing and neuroimaging, in addition to cardiometabolic tests to screen for diabetes, high cholesterol and high blood pressure.

The neurocognitive testing included in the study evaluated constructs such as memory, executive function, language, visuospatial skills, concentration and attention.

“We found an association between neighborhood disadvantage and higher blood pressure and cardiometabolic index, as well as lower cognitive scores in individuals who did not have a diagnosed mild cognitive impairment,” said Sudarshan Krishnamurthy, a fifth-year M.D./Ph.D. student at Wake Forest University School of Medicine and first author of the paper.

Krishnamurthy said that neighborhood disadvantage was only associated with higher hemoglobin A1C, which measures blood sugar, in people with diagnosed mild cognitive impairment.

“These findings show that living in a disadvantaged neighborhood has a bigger impact on heart health and brain function in people without preexisting cognitive issues,” Bateman said. “Our study highlights the importance of implementing structural changes to address social determinants of health to mitigate cardiometabolic and cognitive risks.”

Krishnamurthy added that the study underscores the impact of a person’s living environment.

“This study confirms what we had hypothesized: Where you live and the resources and opportunities that are available to you as a result, have a tangible impact on your risk for dementia,” Krishnamurthy said.

Established in 2016, the Alzheimer’s Disease Research Center at Wake Forest University School of Medicine is one of only 35 research centers in the country funded by the National Institute on Aging. Its goal is to translate research advances into improved diagnosis and care for people with the disease, and to find a treatment or ways to prevent Alzheimer’s and other types of dementia. 

Reference:

Sudarshan Krishnamurthy, Lingyi Lu, Christian J. Johnson, Laura D. Baker, Xiaoyan Leng, Sarah A. Gaussoin, Timothy M. Hughes, Da Ma, Allison Caban-Holt, Goldie S. Byrd, Suzanne Craft, Samuel N. Lockhart, James R. Bateman, Impact of neighborhood disadvantage on cardiometabolic health and cognition in a community-dwelling cohort, Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring, https://doi.org/10.1002/dad2.70021.

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An inflatable gastric balloon could help people lose weight, reveals research

Gastric balloons-silicone balloons filled with air or saline and placed in the stomach-can help people lose weight by making them feel too full to overeat. However, this effect eventually can wear off as the stomach becomes used to the sensation of fullness.

To overcome that limitation, MIT engineers have designed a new type of gastric balloon that can be inflated and deflated as needed. In an animal study, they showed that inflating the balloon before a meal caused the animals to reduce their food intake by 60 percent.

This type of intervention could offer an alternative for people who don’t want to undergo more invasive treatments such as gastric bypass surgery, or people who don’t respond well to weight loss drugs, the researchers say.

“The basic concept is we can have this balloon that is dynamic, so it would be inflated right before a meal and then you wouldn’t feel hungry. Then it would be deflated in between meals,” says Giovanni Traverso, an associate professor of mechanical engineering at MIT, a gastroenterologist at Brigham and Women’s Hospital, and the senior author of the study.

Neil Zixun Jia, who received a PhD from MIT in 2023, is the lead author of the paper, which appears today in the journal Device.

An inflatable balloon

Gastric balloons filled with saline are currently approved for use in the United States. These balloons stimulate a sense of fullness in the stomach, and studies have shown that they work well, but the benefits are often temporary.

“Gastric balloons do work initially. Historically, what has been seen is that the balloon is associated with weight loss. But then in general, the weight gain resumes the same trajectory,” Traverso says. “What we reasoned was perhaps if we had a system that simulates that fullness in a transient way, meaning right before a meal, that could be a way of inducing weight loss.”

To achieve a longer-lasting effect in patients, the researchers set out to design a device that could expand and contract on demand. They created two prototypes: One is a traditional balloon that inflates and deflates, and the other is a mechanical device with four arms that expand outward, pushing out an elastic polymer shell that presses on the stomach wall.

In animal tests, the researchers found that the mechanical-arm device could effectively expand to fill the stomach, but they ended up deciding to pursue the balloon option instead.

“Our sense was that the balloon probably distributed the force better, and down the line, if you have balloon that is applying the pressure, that is probably a safer approach in the long run,” Traverso says.

The researchers’ new balloon is similar to a traditional gastric balloon, but it is inserted into the stomach through an incision in the abdominal wall. The balloon is connected to an external controller that can be attached to the skin and contains a pump that inflates and deflates the balloon when needed. Inserting this device would be similar to the procedure used to place a feeding tube into a patient’s stomach, which is commonly done for people who are unable to eat or drink.

“If people, for example, are unable to swallow, they receive food through a tube like this. We know that we can keep tubes in for years, so there is already precedent for other systems that can stay in the body for a very long time. That gives us some confidence in the longer-term compatibility of this system,” Traverso says.

Reduced food intake

In tests in animals, the researchers found that inflating the balloon before meals led to a 60 percent reduction in the amount of food consumed. These studies were done over the course of a month, but the researchers now plan to do longer-term studies to see if this reduction leads to weight loss.

“The deployment for traditional gastric balloons is usually six months, if not more, and only then you will see good amount of weight loss. We will have to evaluate our device in a similar or longer time span to prove it really works better,” Jia says.

If developed for use in humans, the new gastric balloon could offer an alternative to existing obesity treatments. Other treatments for obesity include gastric bypass surgery, “stomach stapling” (a surgical procedure in which the stomach capacity is reduced), and drugs including GLP-1 receptor agonists such as semaglutide.

The gastric balloon could be a good option for patients who are not good candidates for surgery or don’t respond well to weight-loss drugs, Traverso says.

“For certain patients who are higher-risk, who cannot undergo surgery, or did not tolerate the medication or had some other contraindication, there are limited options,” he says. “Traditional gastric balloons are still being used, but they come with a caveat that eventually the weight loss can plateau, so this is a way of trying to address that fundamental limitation.”

Reference:

Jia, Neil Zixun et al., OSIRIS: Oscillating satiety induction and regulation intragastric system, Device, DOI:10.1016/j.device.2024.100624 

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Novel radiological indicators may accurately predict difficult laryngoscopy in cervical spondylosis patients: Study

Recent study introduced novel radiological indicators from lateral cervical X-rays in the extended head position to improve the accuracy of predicting difficult laryngoscopy, which is crucial for preoperative assessment of patients with cervical spondylosis.

The study included 402 patients scheduled for elective cervical spine surgery. Patients were categorized into “easy laryngoscopy” and “difficult laryngoscopy” groups based on the Cormack-Lehane grading system. Demographic data, conventional bedside indicators, and four radiological indicators were analyzed. The radiological indicators were: 1) Mandibular Length (ML): Length between mentum and mandibular angle 2) Laryngeal Height (LH): Distance from anterior border of thyroid cartilage to mandible 3) Larynx-Mandibular Angle Test (LMAT): Angle formed by lines connecting mentum to mandibular angle, and mandibular angle to anterior border of thyroid cartilage 4) Larynx-Mandibular Height Test (LMHT): Vector from mandibular angle to intersection point of a perpendicular line from thyroid prominence to the line connecting mentum and mandibular angle.

Regression Analysis

A binary logistic regression model identified inter-incisor gap (IIG), upper lip bite test (ULBT), neck circumference (NC), and LMAT as independent predictors of difficult laryngoscopy.

Combined Predictive Model

A novel combined predictive model was derived: Ɩ = -0.969 – 1.33×IIG + 0.408×ULBT + 0.201×NC – 0.042×LMAT. This combined model had an AUC of 0.776, exceeding the individual AUC of 0.677 for LMHT.

Study Findings

The study findings suggest that LMHT and the combined predictive model incorporating LMAT are valuable predictors for anticipating difficult laryngoscopy in patients with cervical spondylosis. These radiological indicators can enhance airway management safety by improving preoperative assessment and informing anesthetic planning for this high-risk population.

Key Points

1. The study introduced novel radiological indicators from lateral cervical X-rays in the extended head position to improve the accuracy of predicting difficult laryngoscopy in patients with cervical spondylosis.

2. The radiological indicators analyzed were Mandibular Length (ML), Laryngeal Height (LH), Larynx-Mandibular Angle Test (LMAT), and Larynx-Mandibular Height Test (LMHT).

3. Binary logistic regression analysis identified inter-incisor gap (IIG), upper lip bite test (ULBT), neck circumference (NC), and LMAT as independent predictors of difficult laryngoscopy.

4. A novel combined predictive model was derived, which included IIG, ULBT, NC, and LMAT, and had an AUC of 0.776, exceeding the individual AUC of 0.677 for LMHT.

5. The study findings suggest that LMHT and the combined predictive model incorporating LMAT are valuable predictors for anticipating difficult laryngoscopy in patients with cervical spondylosis.

6. These radiological indicators can enhance airway management safety by improving preoperative assessment and informing anesthetic planning for this high-risk population.

Reference –

Li, J., Tian, Y., Wang, M. et al. Radiological indicators and a novel combined predictive model for anticipating difficult laryngoscopy in cervical spondylosis patients: a prospective cohort study. BMC Anesthesiol 24, 446 (2024). https://doi.org/10.1186/s12871-024-02826-w

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Elevated D-Dimer and Non-Glucocorticoid Therapies Risk Factors for Thromboembolic Events in Dermatomyositis: Study

A recent study found that the
prevalence of thromboembolic events is increased in individuals with Dermatomyositis
with elevated D-dimer levels and the lack of glucocorticoid therapy as per the
results that were published in the Journal of Inflammation Research.

Dermatomyositis (DM) is an
autoimmune disorder and is a common clinical subtype of Idiopathic inflammatory
myopathies. Clinically it presents with skin manifestations, which can affect
the lungs, joints, esophagus, and heart. DM is characterized by a
hypercoagulable state associated with endothelial dysfunction, leading to Thromboembolic
events (TEs). There is uncertainty about the risk factors that cause TEs in DM.
Hence Chinese researchers conducted a retrospective analysis to investigate the
prevalence of TEs in DM in Southeast China and identify the independent
predictors. 

Also Read: Use of elderberry as herbal supplement may exacerbate dermatomyositis and cutaneous lupus erythematosus: Study

A 10-year retrospective analysis included
patients aged ≥18 with at least one ICD code for DM. The European League
Against Rheumatism/American College of Rheumatology 2017 classification
criteria were used to identify a well-defined, relatively homogenous population
of individuals with DM. Individuals with a score ≥7.5 without a muscle biopsy
or ≥8.7 with a muscle biopsy, along with at least one of the three skin
criteria, were considered eligible for the study. TEs were determined by ultrasonography,
computed tomography, magnetic resonance imaging, or angiogram.

About 543 patients hospitalized
for DM within the past 10 years were analyzed retrospectively and compared with
patients with DM with and without TEs for demographic, clinical, and laboratory
characteristics. The independent predictors were analyzed using multivariate
logistic regression analysis. The diagnostic performance was calculated by a
receiver operating curve (ROC).

Findings:

  • Twenty-two (4.1%) patients with DM had TEs,
    including 12 (54.5%) with venous thromboembolism and 10 (45.5%) with arterial
    thromboembolism.
  • Multivariate logistic regression analysis revealed
    that glucocorticoid therapy was a protective factor for patients with DM
    developing TEs, whereas increased D-Dimer was a risk factor.
  • The combined ROC analysis of glucocorticoid
    therapy and D-Dimer indicated high diagnostic values in distinguishing patients
    with both DM and TEs from patients without TEs, with 86.4% sensitivity, 98.9%
    specificity, and 0.983 area under the ROC curve (95% CI 0.962– 1.000, P<
    0.001).
Also Read: A Protein-Based Gel Can Be Used for Higher Performance, More Sustainable Skincare Products: Study Reveals

Thus, the study concluded that
the prevalence of TE was less in DM. However, the lack of glucocorticoid
therapy and increased levels of D-dimer were risk factors for the development
of TEs in DM patients. Hence, the researchers suggested early screening of
thromboembolic events in all dermatomyositis individuals by evaluating the risk
factors. Physicians should also consider adding anticoagulants in DM patients
to prevent TEs.

Further reading: Prevalence
and Risk Factors of Thromboembolic Events in Dermatomyositis in China: A
10-Year Retrospective Analysis. Doi: https://doi.org/10.2147/JIR.S482055

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Selective Allocation of NRI Quota in PG Medical Courses- State Files response

Jabalpur: The Madhya Pradesh High Court has filed its reply to the plea challenging the selective allocation of the NRI quota reservation in medical admission to the private medical colleges of the State.

While considering the plea, the HC bench comprising Justices Sanjeev Sachdeva and Vinay Saraf asked for the distribution of copies of the State’s reply to all the parties in the case. The matter has been listed for further hearing on December 18, 2024.

Medical Dialogues had earlier reported that filing the plea before the High Court, a Bhopal-based doctor alleged that 15% of the seats in the private medical colleges of the State, which are reserved for the NRIs, are being allocated only to eight popular courses and not being evenly distributed.

The petitioner alleged that such selective allocation is against the rights of non-NRI students. Dr. Ojas Yadav, the petitioner, submitted before the Court that there are 22 branches in medical colleges. However, NRI quotas are allocated only to eight branches, which are high in demand, claimed the petitioner.

Also Read: Selective allocation of NRI Quota for PG medical courses- HC Issues Notice

Earlier, the petitioner’s advocate Alok Bagrecha had argued that the excessive allocation of NRI Quota seats would affect the rights of the meritorious students due to the decrease in the number of available seats. The petitioner’s counsel pointed out that while there are altogether 545 seats available in these eight branches, 152 seats are allocated under the NRI quota.

Further, it was pointed out before the Court that instead of the stipulated 15% for the NRI quota, 40-50% of the seats have been reserved in various branches. It was also claimed that the choice-filling was being conducted without giving any time to the claims and objections as per the admission rules.

Therefore, the counsel argued that the NRI quota seats should have been distributed across all branches and further contended that the process adopted by the State Government was completely illegal.

As per the latest media report by the Times of India, the Madhya Pradesh High Court on Monday filed its response to the plea and the HC bench, while hearing the plea, asked for the distribution of copies of the reply to all the parties in the case and listed the matter for further hearing on December 18, 2024.

The issue was previously raised before the HC bench as a Public Interest Litigation. However, during the special sitting on the matter, the Division Bench of the HC had refused to hear the matter as a PIL. After this, the petitioner sought to withdraw the PIL and the HC bench accepted this prayer. It also granted liberty to the petitioner to use alternative legal remedies available to him.

Also Read: PIL Challenges NRI Quota in Medical Colleges, HC Denies Hearing

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NEET PG 2024: Srinagar Doctors Protest Against Reduction of Open Merit PG Medical Seats

Srinagar: Protesting against the reduction of Open Merit (OM) postgraduate medical seats, the doctors in Srinagar have urged the authorities to address their concerns by ensuring fairness in postgraduate admissions.

Several doctors gathered at the Government Medical College (GMC) campus in Srinagar on Tuesday and raised slogans in support of their demands. They also criticized Rule 17 of the reservation policy as “draconian and unique to J&K,” Daily Excelsior has reported.

Emphasizing the need for maximum reservation in specialty courses like NEET PG, the protesting doctors argued that during MBBS, all students study under the same conditions, accessing identical resources including books, faculties, and libraries. According to the doctors, getting access to identical resources allows them to compete on merit. 

They also argued that exams like NEET PG, which is the entrance test for admission to specialty courses, need to prioritize merit to ensure that the best candidates are selected.

Also Read: 25661 seats up for grabs in NEET PG Round 2 Counselling 2024- MCC Releases newly added seats, virtual, Clear Vacancies

As per the latest media report by Daily Excelsior, even though the SRO 49, which was issued on January 30, 2018m, allocated 75% of the seats to the Open Merit, this number was reduced to 40% by the amendments under SO 176, issued on March 15, 2024, and SO 305, issued on May 21, 2024. However, in reality, this quota effectively drops below 30% after applying the Horizontal Reservation and Rule 17.

Expressing their concerns over these recent changes in the reservation policies, the doctors gathered today at GMC Srinagar. Commenting on the issue, a doctor named Saqib told the Daily, “For NEET PG 2024, only 78-80 unreserved candidates secured seats out of 293 total seats in the state, a mere 27%, while the majority went to reserved categories.”

Pointing out how this significant reduction has caused anxiety and frustration among the unreserved candidates, he added that the unreserved “view it as a blow to merit-based admissions.”

Apart from protesting against the reduction of OM seats, the protestors also called for the removal of Rule 17 of the J & K Reservation Rules 2004-2005. They argued that the rule allows reserved category candidates who secure seats through Open Merit to claim an additional reserved seat upon upgrading to a higher specialty.

“The vacated OM seat does not revert to the OM category but is instead returned to the reserved pool, creating an imbalance and undermining the principle of merit-based selection,” said a doctor.

Additionally, the doctors demanded the implementation of a three-year bond system for the PG and DM courses, as is practiced in other states, to ensure equitable service provision.

Further, the doctors also referred to the disparities in the NEET PG 2024 and pointed out that of the 293 seats in Government Colleges, Open Merit initially accounted for 113 seats (38.5%). They mentioned that after applying Rule 17 and Horizontal Reservation, OM seats were reduced to 78, making up only 26.6^ of the total.

The doctors also noted that seven out of 28 EWS seats were filled. However, 21 vacant seats intended for the OM pool were allocated for the reserved category instead.

Also Read: NEET PG 2024: MP HC allows normalisation plea, tells NBE to Issue Fresh State Merit List of In-Service Candidates

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