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Hyderabad: Medical experts have stressed the urgent need to address pediatric nephrology and urology issues promptly, urging parents to seek medical attention at the first signs of such conditions to ensure timely treatment and prevent complications.

According to a UNI report, to tackle bedwetting problems in children, KIMS Cuddles has introduced a special Bedwetting Clinic, operating every Tuesday. Many children continue to wet the bed beyond the age of five but do not disclose it due to embarrassment, leading to persistent issues. The clinic aims to provide effective solutions and eliminate the social stigma surrounding the condition.

As part of the Continuing Medical Education (CME) program, a Nephro-Uro Summit 2025 was organized under the leadership of Dr Mounika Motamarri, Consultant Pediatric Nephrologist on Sunday. The event saw the participation of over 250 pediatric nephrology and urology specialists from Telangana, Andhra Pradesh, and Karnataka.

Also Read:KIMS Cuddles Doctors treat 18-Month-Old girl for Chemical Pneumonitis after mosquito repellent Ingestion

Experts highlighted that even young children can develop kidney stones, and symptoms such as persistent pain or blood in the urine should never be ignored. Some children may exhibit reddish-colored urine, requiring specific diagnostic tests.

Additionally, doctors emphasized that children with protein levels exceeding 2 mg per kg of body weight should be closely monitored. Pediatric hypertension, if untreated, can lead to kidney damage, and some cases may require surgical intervention for narrow urinary tracts, reports UNI.

Dr Mounika Motamarri, the event’s organizing Secretary, announced that the Bedwetting Clinic would be available at KIMS Secunderabad and Kondapur Hospitals every Tuesday. Several renowned doctors, including Dr Babu S. Madarkar, Dr Yog Nagendar, Dr Parag Dekate, D Aparna C., Dr VS Reddy, and Dr Nitin Chawla, attended the summit to discuss advancements in pediatric nephrology and urology care.   

Also Read:KIMSHEALTH Doctors perform posterior scoliosis correction surgery on 23-year-old Maldivian

The issue came to light after
a Kozhikode couple filed a complaint with the Human Rights Commission, alleging that the city corporation refused to issue a birth certificate for their baby girl due to a lack of formal proof of birth. According to the complainant, she gave birth at her rented home
in November 2024, but officials refused to issue the certificate as no formal
records of the delivery existed. Dr Prathibha has invoked Article 226 of the
Constitution, calling for judicial intervention to prevent further tragedies.

According to Onmanorama, Dr Prathibha, currently
serving as a medical officer in Tanur, Malappuram, has expressed serious
concerns about the rights of newborns, emphasizing that every child is entitled
to medical care and legal recognition. Malappuram, which records the highest
number of home births in the state, has also seen a rise in neonatal
complications, she noted in her petition. The reasons behind choosing home
births vary, but lack of medical supervision puts both mothers and infants at
grave risk. “Some mothers fear hospitals and C-sections, others adhere to
conventional beliefs, while some are reluctant to expose their bodies to
medical staff. Financial constraints also play a role. Surprisingly, many of
these women are well-educated, holding graduate or even postgraduate degrees,
yet they continue to make conservative choice,” the petition stated. 

Babies born at home face survival
challenges, seizures, and nervous system disorders, while mothers are
vulnerable to severe bleeding, cardiac arrest, infections, and complications
such as retained placenta. “Often, when home births lead to complications,
families rush the mother and baby to the hospital, claiming the birth happened
suddenly on their way. Some even keep a vehicle on standby in case of
emergencies, falsely assuring themselves of preparedness,” she says.

According to the Daily, despite the widespread
practice of home births in Malappuram, families often conceal their plans,
making it difficult for authorities to intervene.”Expectant mothers attend
routine check-ups, undergo scans, and follow medical advice, but when the time
comes, they secretly give birth at home. These deliveries often occur at night,
and when questioned, families claim the birth happened too quickly to reach a
hospital. However, many of these cases are premeditated. Some women are
influenced by past home birth experiences in their families, while others feel
emboldened after witnessing similar cases within their circles,” Dr
Prathibha says.

A Right to Information
(RTI) request filed by Kulathur Jaisingh revealed that between 2019 and
September 2024, Kerala recorded 2,931 home deliveries, with Malappuram alone
accounting for 1,244 births. In the same period, the state reported 18 neonatal
deaths, four of which occurred in Malappuram. Advocate R Gopan,
representing Dr Prathibha in court, argued that children have fundamental
rights, including access to proper medical attention at birth. He pointed out a
legal loophole that allows parents to escape accountability if complications
arise from unsafe home deliveries. While birth certificates include
“delivered at home” as an option, families exploit this provision to
obtain official documentation without medical verification.

The petition highlights
multiple past incidents of home births leading to severe complications and
fatalities in Kerala. In February 2024, a mother and baby died during delivery
in Nemom, Thiruvananthapuram. Another case in October 2024 in Thanaloor,
Malappuram, saw a woman critically injured when the baby’s head emerged before
she was rushed to a hospital. A Chalakudy, Thrissur case ended with the infant’s
death and the mother requiring intensive care, while in October 2022, a mother
and child in Chadayamangalam, Kollam, did not survive a home delivery, reports the Daily.

She further alleged the
existence of illegal birthing facilities, where women from various parts of Kerala
and beyond—including Kollam, Alappuzha, and Lakshadweep—stay for weeks to
deliver their babies in Malappuram under unsupervised conditions. “Some of
these centres have been shut down by authorities following local complaints.
Additionally, organised groups coordinate home deliveries through secret
WhatsApp chats or groups, frequently changing numbers to avoid detection. Some
agents charge as little as ₹5,000 to facilitate home births, while others offer
costlier packages lasting up to a month,” she says.

With eight years of
service, Dr Prathibha started her career as an assistant medical officer at a
Public Health Centre in Tanur. As the number of home births rises, medical
professionals like her face mounting pressure from the government to address
the issue. “Each public health centre monitors expectant mothers through a
team comprising a junior public health nurse, staff nurse, and ASHA workers,
ensuring regular health updates. However, when home births go unreported, these
records remain incomplete, leaving medical officers without answers.” She
believes that stricter legal measures are essential to address this concern. The
High Court has scheduled the next hearing for March 17, awaiting a response
from the state government on the matter.

The study examined the effects of IF on platelet activation and thrombotic risk in two models: patients with coronary artery disease and Apolipoprotein E knockout (ApoE−/−) mice, a general model for studying atherosclerosis. Scientists examined the way IF influences gut microbiota composition, promoting the production of IPA. The research then investigated how high IPA levels influence platelet function by binding to PXR on platelets, thus modulating intracellular signaling pathways in thrombosis. Furthermore, myocardial and cerebral ischemia-reperfusion injury models were employed to evaluate the protective effects of IF against cardiovascular events.

Key Findings

• Platelet Activation Reduction: IF significantly repressed platelet activation in models of humans and animals.

• Increased IPA Production: IF produced elevated plasma levels of IPA, which inhibited platelet activation directly.

• PXR Pathway Activation: IPA has occupied the platelet PXR receptor and reduced activity in key signaling pathways (Src/Lyn/Syk and LAT/PLCγ/PKC/Ca2+), which are key players in platelet activation.

• Thrombosis Prevention: IF lowered thrombosis risk in ApoE−/− mice, potentially indicating cardiovascular protective effects.

• Protection from Ischemia-Reperfusion Injury: IF reduced myocardial and cerebral ischemia-reperfusion injury in ApoE−/− mice, further indicating its cardiovascular protective role.

Researchers concluded that intermittent fasting decreases platelet activation and the risk of thrombosis through enhanced IPA production, which engages PXR-associated pathways in platelets. The incorporation of IF into therapeutic plans can potentially bring about better patient outcomes compared to standard pharmacologic treatment.

Reference:

This phase 2b double-blind placebo-controlled randomized clinical trial occurred from January 2019 to January 2023 at the Baltimore Veterans Affairs (VA) Medical Center. Patients had to be diabetic veterans with a risk for diabetic foot complications but without an acute foot infection. They were ambulatory and had intact feet. A total of 175 participants (97% male, mean age 68 years) were randomly assigned in a 1:1 ratio to receive either 2% chlorhexidine wipes (n = 88) or soap-and-water wipes (n = 87). The intervention lasted for one year, during which participants were instructed to use the assigned wipes daily, followed by the application of a standardized foot lotion.

Participants were supplied with lookalike wipes for blinding. The main outcome was time to first new foot complication, occurring after randomization and defined as chronic foot ulcer, foot infection, or amputation of a lower extremity. Data analysis was performed in an intention-to-treat fashion. Follow-up occurred over one year’s median duration, during which adverse effects and intervention compliance were closely observed.

Key Findings

• In a year, 12 (14%) and 14 (16%) participants in the chlorhexidine and soap-and-water groups, respectively, developed new foot complications.

• The time to the first new foot complication was 232 days (IQR: 115-315 days) in both groups.

• No significant hazard reduction of new foot complications in the chlorhexidine group was seen compared with the soap-and-water group (hazard ratio, 0.83; 95% CI, 0.39-1.80).

• 60 adverse events were documented throughout the study, but none of them resulted from the intervention. The adherence was very high with 145 participants (83%) sustaining the intervention during the entire study period.

The study authors concluded that daily use of 2% chlorhexidine wipes did not significantly influence prevention of new diabetic foot complications among diabetic veterans in comparison with soap-and-water wipes. These findings are valuable for future research regarding how to optimize preventive interventions for diabetic foot complications.

Reference:

Lydecker AD, Kim JJ, Robinson GL, et al. Chlorhexidine vs Routine Foot Washing to Prevent Diabetic Foot Ulcers: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(2):e2460087. doi:10.1001/jamanetworkopen.2024.60087

“High-dose vitamin D not only reduced disease activity in early MS and CIS compared to placebo but also prolonged the time to disease activity, with patients on vitamin D experiencing a delay of 432 days versus 224 days in the placebo group, without any severe adverse events associated with the supplementation,” the researchers reported in JAMA.

Clinically isolated syndrome, the first neurological episode suggestive of multiple sclerosis, requires early intervention to delay disease progression. Among potential risk factors, vitamin D deficiency has been linked to increased disease activity in MS, raising interest in its therapeutic role. However, while supplementation is considered a promising strategy, existing evidence on its effectiveness remains inconclusive.

Against the above background, Eric Thouvenot, CHU Nimes, Service de Neurologie, Univ Montpellier, Nimes, France, and colleagues aimed to assess the effectiveness of high-dose cholecalciferol as a standalone treatment in lowering disease activity in patients with clinically isolated syndrome indicative of MS.

For this purpose, the researchers conducted the D-Lay MS trial, a parallel, double-blind, randomized placebo-controlled study across 36 MS centers in France. From July 2013 to December 2020, they enrolled untreated CIS patients aged 18 to 55 years, with CIS duration under 90 days, serum vitamin D levels below 100 nmol/L, and MRI findings meeting 2010 criteria for dissemination in space or oligoclonal bands. Participants were randomized to receive either 100,000 IU of oral cholecalciferol (n=163) or placebo (n=153) every two weeks for 24 months. The primary outcome was disease activity, defined by relapses or MRI changes.

Key Findings:

• Among 316 enrolled participants (median age 34 years, 70% women), 303 (95.9%) received at least one dose, and 288 (91.1%) completed the 24-month trial.

 • Disease activity was observed in 60.3% of the vitamin D group vs. 74.1% of the placebo group (HR, 0.66).

• Median time to disease activity was longer in the vitamin D group (432 vs. 224 days).

• MRI outcomes favored vitamin D over placebo:

• MRI activity: 57.1% vs. 65.3% (HR, 0.71).

• New lesions: 46.2% vs. 59.2% (HR, 0.61).

• Contrast-enhancing lesions: 18.6% vs. 34.0% (HR, 0.47).

 • There was no significant difference in secondary clinical outcomes, including relapse (17.9% vs. 21.8%).

• There were similar results in 247 patients meeting the 2017 relapsing-remitting MS criteria.

• Severe adverse events occurred in 17 patients in the vitamin D group and 13 in the placebo group, with none linked to cholecalciferol.

“The trial demonstrated that high-dose oral cholecalciferol (100,000 IU every two weeks) effectively reduced disease activity in CIS and early RRMS with a low risk of adverse events. These findings support further research on its potential as an add-on therapy in MS management,” the researchers concluded.

Reference:

Thouvenot E, Laplaud D, Lebrun-Frenay C, et al. High-Dose Vitamin D in Clinically Isolated Syndrome Typical of Multiple Sclerosis: The D-Lay MS Randomized Clinical Trial. JAMA. Published online March 10, 2025. doi:10.1001/jama.2025.1604