Adenomyosis has relatively high long-term recurrence rate after conservative surgery, finds study

Adenomyosis, a prevalent non-cancerous condition, is characterized by the erroneous presence of endometrial tissue within the myometrium. Symptoms include dysmenorrhea, abnormal uterine bleeding, and dyspareunia, adversely affecting patients’ quality of life. Diagnostic methods rely heavily on clinical judgment and imaging techniques like ultrasonography or magnetic resonance imaging due to the absence of definitive physical or laboratory indicators for adenomyosis. Recent retrospective study aimed to determine the recurrence rate after conservative surgery for adenomyosis and identify the risk factors for recurrence. Data from 133 eligible patients who underwent conservative surgery for adenomyosis between January 2013 and April 2023 were analyzed. The recurrence rate after conservative surgery was 39.1% (52/133) during a mean follow-up of 52 months. 2. Cox proportional hazards analysis identified several risk factors for recurrence: – Adenomyosis involving the posterior uterine wall (hazard ratio [HR] 6.505, p=0.018) – Two or more adenomyotic lesions (HR 6.310, p=0.030) – Laparotomy approach (HR 2.490, p=0.029) – Concomitant endometriosis (HR 2.313, p=0.036) – Higher number of abortions (HR 1.578, p=0.001) – Higher preoperative visual analog scale (VAS) pain score (HR 1.181, p=0.036) 3. In contrast, postoperative combined progestogen therapy (HR 0.126, p<0.001) or gonadotropin-releasing hormone agonist (GnRHa) therapy (HR 0.237, p=0.004) were found to protect against recurrence of adenomyosis.

Conclusion

The authors conclude that adenomyosis has a relatively high long-term recurrence rate after conservative surgery. Patients with adenomyosis involving the posterior uterine wall, multiple lesions, and concomitant endometriosis are at high risk of recurrence. Postoperative hormonal therapy with progestogens or GnRHa may reduce the risk of recurrence. Larger prospective studies are needed to confirm these findings.

Key Points

1. The recurrence rate after conservative surgery for adenomyosis was 39.1% during a mean follow-up of 52 months.

2. Several risk factors for recurrence were identified, including: – Adenomyosis involving the posterior uterine wall (hazard ratio [HR] 6.505) – Two or more adenomyotic lesions (HR 6.310) – Laparotomy approach (HR 2.490) – Concomitant endometriosis (HR 2.313) – Higher number of abortions (HR 1.578) – Higher preoperative visual analog scale (VAS) pain score (HR 1.181)

3. Postoperative combined progestogen therapy (HR 0.126) or gonadotropin-releasing hormone agonist (GnRHa) therapy (HR 0.237) were found to protect against recurrence of adenomyosis.

4. The authors conclude that adenomyosis has a relatively high long-term recurrence rate after conservative surgery.

5. Patients with adenomyosis involving the posterior uterine wall, multiple lesions, and concomitant endometriosis are at high risk of recurrence.

6. Larger prospective studies are needed to confirm these findings.

Reference –

Lu, K., Zhong, G., Lian, B. et al. Recurrence rates and associated risk factors after conservative surgery for adenomyosis: a retrospective study. BMC Women’s Health 24, 619 (2024). https://doi.org/10.1186/s12905-024-03457-6

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SC holds doctor guilty of medical negligence for surgery on wrong leg

New Delhi: Upholding the order of the National Consumer Disputes Redressal Commission (NCDRC) finding a surgeon liable for medical negligence while conducting surgery on the wrong foot of a patient, the Supreme Court recently dismissed the appeal filed by the doctor.

Challenging the NCDRC ruling, the concerned doctor, who worked as an Orthopaedic Surgeon at the Fortis Hospital in 2016, filed a plea before the Supreme Court.

After considering the doctor’s appeal, the top court bench comprising Justice PS Narasimha and Manoj Misra dismissed the same while noting, “Having considered the matter in detail, we are of the opinion that the National Consumers Disputes Redressal Commission, New Delhi has not committed any error in law or fact. In this view of the matter, the Civil Appeal is dismissed.”

The original consumer complaint was filed against the treating doctor and hospital based on the allegation that the surgery was performed on the left leg of the patient instead of his injured right leg. Later, the patient got himself admitted to another hospital for surgery.

The history of the case goes back to 2016 when the patient slipped from the stairs and sustained injuries. Thereafter he was taken to Fortis Hospital, Shalimar Bagh, where the treating doctor, after conducting X-rays, informed that the patient had suffered fracture on his right foot. The patient was also asked to get a CT Scan of his right foot and an X-ray of his left foot and spine and was asked to undertake physiotherapy.

As per the patient, despite the fact that the patient had undergone a hairline fracture on his spine, he was administered anaesthesia in his spinal cord before the surgery and in spite of operating on the right foot, the petitioner’s left foot was operated!

The Delhi Medical Council had taken suo motu cognizance of the issue and the Disciplinary Committee of the DMC, which after considering the justifications given by the doctors for conducting the surgery on the left foot noted that no written consent was taken from the patient for the change of plan of surgery being carried out on the left side. Further, the DMC Committee also noticed attempted tampering of records.

Accordingly, DMC had recommended removing the names of two treating doctors from the State Medical Register for 180 days. When the DMC order was challenged before the erstwhile Medical Council of India (MCI), it exonerated one doctor on the ground that he was not present in the operation theatre when the surgery was performed on the petitioner. However, MCI had sustained the punishment granted to the other doctor- Dr. Kakran, who filed this plea before the Supreme Court.

While considering the matter, the Apex Consumer Court back in June 2024 awarded the patient a total compensation of Rs 1.10 crores. Among this amount, the treating hospital was asked to pay Rs 90 lakhs and two treating doctors including the surgeon were directed to pay Rs 10 lakhs each.

Also Read: Negligence in Ankle Surgery: Doctor, hospital ordered to pay Rs 3 lakh compensation

Challenging the NCDRC order, the surgeon in his plea before the Supreme Court claimed that an injury was found in the left leg of the patient as well in the operation room and he was advised to take surgical treatment for the same. The doctor claimed that the patient gave oral consent for the surgery. 

Previously, the NCDRC bench had found that there was gross medical negligence after noting that all the pre-surgery tests (X-Ray, scan etc.) were taken for the right leg even though the consent was taken for the right leg.

“The Complainant appears to have virtually escaped from the Hospital and ran for his life on account of this mess having been created by the Opposite Parties in proceeding to perform a surgery of the left leg when the surgery was planned to rectify and treat the fracture of the right leg,” NCDRC had observed in its order, Live Law has reported. Further, the consumer court had found that the protocol regarding the consent was not followed before operating on the left leg.

Even though the NCDRC order was challenged by the surgeon, the Supreme Court bench affirmed the findings of the NCDRC by rejecting the surgeon’s appeal.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/supreme-court-order-medical-negligence-263671.pdf

Also Read: Surgery undertaken without necessary skill, records manipulated! Delhi Doctors, Hospital slapped Rs 48 lakh compensation for misconduct, negligence

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Deaths of Pregnant Women After Administration of Contaminated Ringer’s Lactate Solution: CDSCO Under Scanner

New Delhi: The Central Drugs Standard Control Organisation (CDSCO) is under scrutiny as the Karnataka government seeks clarification regarding reports linking the deaths of pregnant women at Ballari District Hospital to bacterial and fungal contamination in the Ringer’s Lactate solution administered to them.

Health Department Principal Secretary Harsha Gupta has formally addressed the issue in a letter to the Drugs Controller General of India, Rajeev Singh Raghuvanshi.

The controversy has raised serious concerns about drug safety and regulatory oversight. The key point of contention lies in the conflicting reports from the state drug control department and the Central Drug Laboratory (CDL) in Kolkata. While the state department flagged several batches of the Ringer Lactate solution as substandard, the CDL cleared them, leading to questions about regulatory oversight and the reliability of quality assurance processes.

The fatalities occurred between November 9 and 11, 2024 post-caesarean operations at the Ballari District Hospital, with initial investigations linking the tragedies to a suspected substandard batch of Ringer Lactate solution—a commonly used intravenous fluid for hydration and electrolyte balance.

The implicated solution, manufactured by Paschim Banga Pharmaceutical Ltd and supplied through the Karnataka State Medical Supplies Corporation Limited (KSMSCL), has raised serious concerns about drug quality control and regulatory oversight. Acting swiftly, the Karnataka government has suspended the state’s drugs controller and blacklisted the supplier. Additionally, Chief Minister Siddaramaiah announced an ex-gratia payment of Rs 2 lakh to each bereaved family, promising stringent action against those responsible.

Also Read: Maternal Deaths at Ballary District Hospital: Karnataka Drug Controller Suspended for Negligence

Health department officials revealed that, out of 34 caesarean operations performed over three days, seven patients developed complications, including acute kidney injury and multi-organ dysfunction, leading to four deaths. One patient is still undergoing treatment at Vijayanagar Institute of Medical Sciences (VIMS), while two have recovered and been discharged.

A confidential investigation into the maternal deaths, led by specialist doctors under the guidance of the Rajiv Gandhi University of Health Sciences and Karnataka’s Health and Family Welfare Department, found no evidence of negligence by the hospital staff. According to the review, protocols for patient care, caesarean procedures, and post-operative management were appropriately followed. Despite these efforts, complications in the ICU and dialysis unit proved fatal for four patients.

The complications were traced to the Ringer Lactate solution administered at the hospital.

“The onset of complications following caesarean operations is being suspected to the ringer lactate solution supplied by Paschim Banga Pharmaceutical Ltd to Karnataka State Medical Supplies Corporation Ltd (KSMSCL). Earlier, all 192 batches supplied by the said company were temporarily frozen by KSMSCL, even though two batches were declared not of standard quality on March 18, 2024, by the Drugs Control Department,” read a statement by the Karnataka Health Department as quoted by PTI.

“Later, following the certificate of standard quality by Central Drug Laboratories, the usage of ringer lactate of 84 batches was permitted by KSMSCL on August 13, 2024,” it said.

Also Read: Karnataka BJP Calls for Resignations After 5 Women Die Post-Delivery in 2 Govt Hospitals

Discrepancies in Drug Quality Certification

This tragedy has underlined inconsistencies in drug quality control. Karnataka’s Drugs Testing Laboratory had previously declared some batches of the Ringer Lactate solution as “not of standard quality” (NSQ). However, upon review by the Central Drug Laboratory (CDL) in Kolkata, the same batches were certified as “standard quality” (SQ). According to a recent media report in The Indian Express, despite these clearances, later testing revealed sterility and bacterial endotoxin failures in 22 batches, prompting a statewide recall of the implicated IV fluids.

A letter from Harsha Gupta, Karnataka’s Principal Secretary for Health, has urged the Drugs Controller General of India (DCGI) to investigate the CDL’s quality certification process. Gupta also requested assistance from West Bengal’s drugs controller to scrutinize the manufacturing facilities of Paschim Banga Pharmaceutical Ltd.

Political and Regulatory Fallout

Opposition leaders, including former Chief Minister Basavaraj Bommai, have criticized the state government for lapses in oversight. Bommai has called for Health Minister Dinesh Gundu Rao’s resignation, alleging negligence. Meanwhile, health experts have underscored the systemic vulnerabilities in India’s pharmaceutical supply chain, particularly in public healthcare settings.

The CDSCO, under increasing pressure, has been directed to provide an explanation for the lapses. Simultaneously, the DCGI has initiated its own probe to assess the accountability of manufacturers, regulatory bodies, and procurement agencies.

Precautionary Measures and Future Actions

As a preventive measure, the state has blacklisted all implicated batches of Ringer Lactate and halted their usage across hospitals. Samples of the IV fluid have been sent for further testing, with results expected by December 9. The government has promised corrective reforms to ensure such tragedies are not repeated.

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Abnormal prenatal blood test results could indicate hidden maternal cancers

Researchers at the National Institutes of Health (NIH) found previously undetected cancers in 48.6% of pregnant people who had abnormal results for prenatal cell-free DNA (cfDNA) testing used to screen for chromosomal disorders in the fetus.

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Evaluating long-term survival and cardiac efficacy of a gene therapy for Duchenne muscular dystrophy

A recent study published in the journal Human Gene Therapy evaluated the long-term survival and cardiac efficacy of the gene therapy delandistrogene moxeparvovec in a rat model of Duchenne muscular dystrophy (DMD).

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New hypothesis on chronic inflammation could lead to advances in disease treatment

A recently published study led by Wayne State University on a new approach to understanding chronic inflammation could lead to new advancements in the treatment of many debilitating medical conditions, including cancer.

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Overactive bladder diagnoses found to increase after guideline publication

An increase in overactive bladder (OAB) diagnoses was seen following publication of the first OAB guideline, and the rate of third-line therapy procedures also increased, according to a study published online Nov. 19 in Neurourology & Urodynamics.

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Symptom pattern of Meniere’s disease often changes over time, study finds

Meniere’s disease (MD) shows a complex disease course, with initial symptoms decreasing and others persisting and worsening over time, according to a study published online Nov. 7 in Frontiers in Neurology.

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22 New AIIMS, 75 GMCs Approved for Upgradation Under PMSSY: JP Nadda Health informs Lok Sabha

New Delhi: The upgradation of 75 Government Medical Colleges and Institutions (GMCIs), including Patliputra Medical College in Dhanbad and Rajendra Institute of Medical Sciences (RIMS) in Ranchi, along with the establishment of 22 new All India Institute of Medical Sciences (AIIMS) – including one at Deoghar in Jharkhand, have been approved under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) to offer super speciality healthcare facilities across the country.

Additionally, a total of 157 Medical Colleges have been approved in the country under the Centrally Sponsored Scheme for ‘Establishment of new Medical Colleges attached to existing district/referral hospitals’. The details in this regard were presented in the Lok Sabha by the Union Minister of Health and Family Welfare, Shri Jagat Prakash Nadda recently. 

The Minister was asked a series of questions by Parliament member Shri Dulu Mahato who sought to know whether the Government proposes to set up new Super Speciality Hospitals or to upgrade existing hospitals in all the important districts of the country including Dhanbad district in Jharkhand on the lines of AIIMS model, if so, the concrete steps taken so far by the Government to set up or to upgrade the said hospitals as Super Speciality in the said districts, State/UT-wise along with the future plans being formulated in this regard.

Also read- NHM offers Incentives, Honorariums to encourage doctors to practice in Rural Areas: MoS Health

Also, he enquired whether the Government is taking some other measures to improve the status of healthcare services in the said areas, if so, the details of the measures being implemented presently and whether the Government proposes to fix any timeline and allocate a budget for the improvement of healthcare services in Dhanbad and other districts of Jharkhand and if so, the details thereof?

Responding to these queries, the Minister informed, “Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), there is a provision for upgradation of existing Government Medical Colleges/Institutions (GMCIs) by way of setting up of Super Speciality Blocks (SSB)/Trauma Centers. So far, 75 such projects have been approved under the Scheme, including the upgradation of Patliputra Medical College, Dhanbad and Rajendra Institute of Medical Sciences (RIMS), Ranchi in Jharkhand. Further, the establishment of 22 new All India Institute of Medical Sciences (AIIMS), including AIIMS at Deoghar in Jharkhand, has been approved under the Scheme. All AIIMS have provisions for Super Speciality healthcare facilities.”

“Public health is a State subject. However, under Centrally Sponsored Scheme for ‘Establishment of new Medical Colleges attached with existing district/referral hospitals’, a total of 157 Medical Colleges have been approved in the country,” he added. 

According to the Minister, the Ministry of Health and Family Welfare under the National Health Mission (NHM) provides technical and financial support to the States/UTs to strengthen the public healthcare system towards the objective of providing accessible, affordable and quality healthcare to all those who access public health facilities. Support under NHM is provided to States/UTs based on the requirements posted by them in their Programme Implementation Plan (PIPs) and within their overall resource envelope.

The various initiatives carried out under NHM by the Government of India in various States including Jharkhand are operationalisation of Ayushman Arogya Mandir, National Ambulance Services, Mobile Medical Units, ASHAs, 24 x 7 Services and First Referral facilities, Prime Minister’s National Dialysis Programme, Free Diagnostics Service Initiative and Free Drugs Service Initiative, various activities under RCH, Anemia Mukt Bharat (AMB) strategy, Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA) and Universal Immunization Programme.

Under the Centrally Sponsored Scheme (CSS) component of the Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), administrative approvals amounting to Rs 20,451.31 crore have been granted to States and Union Territories for the period 2021-22 to 2024-25.

“CSS component of PM-ABHIM provides for the establishment of Critical Care Blocks (CCBs) in 602 districts with a population of more than 5 lakhs. In addition to support for establishment of 15 CCBs, an amount of Rs. 625.68 cr. has been approved for the State of Jharkhand for FY 2021-22 to FY 2024-25 for the establishment and strengthening of 893 Building-less Sub-centres Ayushman Arogya Mandirs (AAM), 100 Block Public Health Units (BPHUs) and 17 Integrated Public Health Labs (IPHL). Further, under the Central Sector component of PM-ABHIM, establishment of 150 bedded CCBs has been approved in 12 Central Institutions,” the Minister added. 

Under the Fifteenth Finance Commission (FC-XV) health sector grants, a provision of Rs.70,051 Crore, including Rs.2370.19 Crore for Jharkhand, has been made for strengthening health infrastructure, drugs, and diagnostics from FY 2021-22 to FY 2025-26

Details of allocation for funds during the current year for the State of Jharkhand are as follows:

Scheme

Allocation for 2024-2025
NHM 961.38

PM-ABHIM

 109.16

XV-FC Health Grant

 492.10

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HP Govt sets up advisory board for De-Addiction, Rehabilitation

Shimla: Himachal Pradesh Chief Minister Sukhvinder Singh Sukhu announced the formation of a state-level advisory board for de-addiction and rehabilitation. This decision was made during a state-level workshop on Maternal, Infant, and Young Child Nutrition and De-addiction held on Wednesday.

According to an ANI report, addressing a day-long state-level workshop on Maternal, Infant and Young Child Nutrition and De-addiction, CM Sukhu also declared the Centre of Excellence of Mental Health at Dr Rajendra Prasad Government Medical College, Tanda as State level nodal institution for De-addiction and rehabilitation.

He also said that Opioid Substitution Therapy Centre would be established at all medical colleges and district hospitals of the State.

CM Sukhu said that the state government would prepare an action plan for addressing the nutritional concerns of adolescent girls, pregnant and lactating mothers and children up to the age of six years besides drug abuse prevention, de-addiction and rehabilitation.

Also Read:Himachal Pradesh HC slams Govt for Delays in PHC Appointments

He also directed the Social Justice and Empowerment Department to formulate a mechanism to ensure the wellbeing of expectant women and their new born up to the age of one year.

“First one thousand days of new born babies are critical, therefore, their health is the priority for the State Government. Government was also contemplating to delegate the powers to the lower level for the procurement of nutritional supplements to ensure good quality of food items being provided to the eligible pregnant women, lactating mothers,” he said, according to a release, news agency ANI reported.

The Chief Minister emphasized that there was a need to create awareness at the school level regarding the ill effects of drug abuse. He said that the State Government has initiated a crackdown on drug mafia in the state and many of the culprits had been nabbed.

“It is concerning that young children are falling prey to the drug addiction. The state government is concerned about how to protect them and their families from this. We are also going to establish state of art de-addiction and rehabilitation centre in Kotla Barog of Sirmaur district spread over 150 bighas,” he added.

Dr VK Paul, Member of NITI Aayog, stressed the importance of monitoring, training and teamwork to tackle the malnutrition issues in children. He advocated for immediate breastfeeding within the hospital after childbirth and exclusive breastfeeding for the first six months.

He said that ASHA workers and Anganwadi workers have a critical role in guiding parents on proper nutrition practices for infants. “Training these workers is essential to ensure that children’s growth is monitored and supported effectively,” he said.

Dr Paul emphasized the critical role of parental awareness in ensuring child health, urging families to provide nutritious meals at home once a child reaches six months of age. He highlighted the importance of zinc supplementation for children experiencing diarrhoea to prevent nutrient deficiencies.

Also Read:Himachal Pradesh health institutions to be upgraded soon: CM Sukhvinder Singh Sukhu

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