The advantages and disadvantages of combining antileukotrienes with H1-antihistamines for the treatment of urticaria (hives, itch, and/or angioedema) remain unknown. As a result, in this study aimed to comprehensively compare the treatment results of antileukotrienes in conjunction with H1-antihistamines to H1-antihistamines alone for chronic and acute urticaria.

As part of updating the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, multiple databases (MEDLINE, CENTRAL, Embase, WPRIM, LILACS, IBECS, CBM, ICTRP, VIP, CNKI,FDA, Wanfang and EMA) were meticulously searched until December 18th, 2023. This included randomized controlled trials (RCTs) which evaluated antileukotrienes and H1-antihistamines versus H1-antihistamines.

Out of 34 RCTs  that involved a total of 3,324 participants (both children and adults), the study found that the combination of a leukotriene receptor antagonist (LTRA) with H1-antihistamines probably provides a modest reduction in urticaria activity. The primary metric used was the 7-day Urticaria Activity Score, where the combination therapy showed a mean difference of -5.04 points when compared to just H1-antihistamines with a confidence interval (CI) ranging from -6.36 to -3.71.

Similar modest improvements were observed for itch and wheal severity, as well as the quality of life for patients. Also, the study found no significant difference in the overall adverse events between the two treatment groups, also with moderate certainty.

Overall, the finding suggest that the combination of LTRAs and H1-antihistamines would modestly improve urticaria symptoms with little to no increase in overall adverse events. While the combination appears to offer some improvement in urticaria symptoms, the benefits are modest. This extensive review underline the need for more comprehensive studies that measure symptomatic relief and also monitor for less obvious side effects.

Source:

Rayner, D. G., Liu, M., Chu, A. W. L., Chu, X., Guyatt, G. H., Oykhman, P., Cao, D. J., Moellman, J., Ben-Shoshan, M., Baker, D. R., Waserman, S., Lang, D., Sheikh, J., Mathur, S. K., Beck, L. A., Khan, D. A., Oliver, E. T., Asiniwasis, R. N., Cole, E. F., … Chu, D. K. (2024). Leukotriene receptor antagonists as add-on therapy to antihistamines for urticaria: a systematic review and meta-analysis of randomized clinical trials. In Journal of Allergy and Clinical Immunology. Elsevier BV. https://doi.org/10.1016/j.jaci.2024.05.026

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Porsche crash case: Medical council seeks official documents to act against forensic headNo action has been taken so far against the head of the Forensic Medicine department and Chief Medical Officer (CMO) of Pune-based Sassoon General Hospital by the Maharashtra Medical Council (MMC) in connection with the alleged manipulation of the blood sample of the teen driver involved in the May 19 Porsche car crash case.Medical Dialogues on May 28 reported that the MMC issued notices to both doctors after taking suo moto cognizance of the matter. In the notice, the council had demanded a written explanation within seven days from the two doctors providing details for their alleged negligence following which actions were said to be taken accordingly.For more information click on the link below:Porsche Crash Case: Need Official Documents To Initiate Action Against Forensic Head, CMO Of Sassoon Hospital, Says Medical CouncilChandipura virus: six children die in Gujarat since July 10Since July 10, six children have died from a suspected outbreak of the Chandipura virus in Gujarat, with the total number of cases rising to 12, according to state Health Minister Rushikesh Patel. The virus, which causes fever, flu-like symptoms, and acute encephalitis, is transmitted by vectors such as mosquitoes, ticks, and sand flies. Samples from the 12 patients have been sent to Pune's National Institute of Virology (NIV) for confirmation.Among the cases, four were from Sabarkantha district, three from Aravalli, one from Mahisagar, and one from Kheda in Gujarat, with additional cases from Rajasthan and Madhya Pradesh. Five of the six deaths occurred at the civil hospital where paediatricians initially suspected the virus and sent samples to the NIV for testing.Supreme Court issues notice on pleas filed by NTA in NEET UG 2024 caseConsidering a batch of pleas filed by the National Testing Agency (NTA) seeking transfer of cases pending against it in various high courts on the NEET 2024 row to the top court to avoid multiplicity of litigations, the Supreme Court has issued notices to the private parties in the matter.The tagged petitions will now be heard together with the main batch on July 18th 2024, Thursday.

For more information click on the link below:

NEET 2024: Supreme Court Issues Notices On NTA's Pleas To Transfer HC Cases To SCNMC mandates tobacco cessation centers in all medical collegesAiming to reduce the practice of tobacco usage in the country, the National Medical Commission (NMC) has asked all the medical college hospitals across the country to set up "Tobacco Cessation Centres"The Commission has suggested setting up such centres as a special clinic operated by the Department of Psychiatry or other departments. Further, NMC has directed establishing such centres in the rural and urban health centres that the college has adopted for training.For more information click on the link below:All Medical Colleges To Have Tobacco Cessation Centres: NMC

Age-related Macular Degeneration presents one of the surfacing enormous reasons for blindness and generally occurs in older individuals. At this point, there is no treatment for the condition with regard to the AMD dry form. JAK inhibitors were licensed by the FDA in 2011, but have been primarily used in treating cancer and autoimmune disorders. There is some new evidence from recent studies showing that inflammation and immunological pathways could be associated with the development of AMD.

A study led by Dr. Nizar Smaoui of AbbVie assessed the insurance-claimed data for probes with respect to the incidence of AMD in patients with autoimmune disorders exposed to JAK inhibitors. This research used two large administrative databases, MarketScan and Optum, from 2010-2022.

Overall, two cohorts comprising more than 29,000 subjects were included from two databases. Each JAK inhibitor patient was matched on age, sex, race/ethnicity, geography, and autoimmune diagnosis, among other factors, to a patient treated with another type of immune-modulating drug. The demographic characteristics of the cohorts were matched for the MarketScan cohort with 18,252 patients,   % women, and for the Optum cohort, %. Moreover, more than % of the study subjects in both cohorts were 55 or older in age. The largest number among them was for rheumatoid arthritis treatment, with the others including psoriasis, psoriatic arthritis, and ulcerative colitis.

The key findings from the study are as follows:

• It was shown that the patients who used JAK inhibitors had a significantly lower rate of AMD compared to the ones using other drugs.

• With an aIRR of 0.51 and a 95% CI of 0.19 to 0.90, this represents a roughly 50% reduction in the MarketScan cohort.

• This was reflected in an adjusted incidence rate ratio of 0.27, with a 95% confidence interval of 0.03-0.74—nearly a 75 percent reduction—in the Optum cohort.

• The absolute risk reductions were 0.36% in the MarketScan cohort and 0.32% in the Optum cohort.

• AMD was a rare event in both cohorts. Among more than 18,000 patients in the MarketScan group, 53 new cases developed (10 in JAK inhibitor users and 43 in non-users).

• In the Optum group, 24 cases were diagnosed (three in users and 21 in non-users).

These findings permit the inference that a strong association might exist between JAK inhibitors and a reduced AMD incidence. remains there, the study could support the hypothesis that inflammation and immune pathways play a role in the pathogenesis or progression of AMD, he said. However, he then added that further clinical studies are required to confirm these results.

Dr. Sumit Sharma of the Cleveland Clinic, who was not involved in the study, found the results promising but said that the small population size and retrospective nature of the study necessarily limit the implications of such studies. He required well-designed clinical trials to explore the potential for JAK inhibitors to treat AMD, especially given both the high risk of side effects and FDA warnings about cardiovascular risks associated with these drugs.

The limitations of this study are that it was retrospective, nonrandomized, and observational. It did not educate regarding the severity of autoimmune diseases, distinguish between "wet" and "dry" forms of AMD, different JAK inhibitor products, or their indications. In addition, the data could not confirm that all patients received equivalent eye exams or that such exams were correctly coded.

Given that JAK inhibitors are associated with a risk of AMD among patients with autoimmune disorders, they could not be recommended for the treatment of AMD based on this research. Instead, solid clinical trials with less risk of side effects should be conducted in this respect.

Reference:

Hallak JA, Abbasi A, Goldberg RA, Modi Y, Zhao C, Jing Y, Chen N, Mercer D, Sahu S, Alobaidi A, López FJ, Luhrs K, Waring JF, den Hollander AI, Smaoui N. Janus Kinase Inhibitor Therapy and Risk of Age-Related Macular Degeneration in Autoimmune Disease. JAMA Ophthalmol. 2024 Jul 11. doi: 10.1001/jamaophthalmol.2024.2376. Epub ahead of print. PMID: 38990568. https://pubmed.ncbi.nlm.nih.gov/38990568/

Khanani, MD, MA, FASRS, discusses efficacy and safety data for the port delivery system ahead of its reintroduction.The data were derived from the SUMMIT study, which investigated real-world results in patients with neovascular age-related macular degeneration.“The port delivery system (Susvimo, Genentech) is an innovative sustained-delivery platform,” he said. “In the real world, what we have seen is maintenance of visual acuity and [central subfield thickness] with a

The head of Health Access California, one of the state’s most influential consumer groups, changed course only after he and his allies extracted a deal to increase subsidies for people in need.

The plan was ultimately blocked by Democrats who wanted the state to adopt a single-payer health care system instead. Yet the moment encapsulates classic Anthony Wright: independent-minded and willing to compromise if it could help Californians live healthier lives without going broke.

This summer, Wright will assume the helm of the health consumer group Families USA, taking his campaign for more affordable and accessible health care to the national level and a deeply divided Congress. In his 23 years in Sacramento, Wright has successfully lobbied to outlaw surprise medical billing, require companies to report drug price increases, and cap hospital bills for uninsured patients — policies that have spread nationwide.

“He pushed the envelope and gave people aspirational leadership,” said Jennifer Kent, who served as Schwarzenegger’s head of the Department of Health Care Services, which administers the state Medicaid program. The two were often on opposing sides on health policy issues. “There was always, like, one more thing, one more goal, one more thing to achieve.”

Recently, Wright co-led a coalition of labor and immigrant rights activists to provide comprehensive Medicaid benefits to all eligible California residents regardless of immigration status. The state funds this coverage because the federal government doesn’t allow it.

His wins have come mostly under Democratic governors and legislatures and when Republican support hasn’t been needed. That will not be the case in Washington, D.C., where Republicans currently control the House and the Senate Democratic Caucus has a razor-thin majority, which has made it extremely difficult to pass substantive legislation. November’s elections are not expected to ease the partisan impasse.

Though both Health Access and Families USA are technically nonpartisan, they tend to align with Democrats and lobby for Democratic policies, including abortion rights. But “Anthony doesn’t just talk to his own people,” said David Panush, a veteran Sacramento health policy consultant. “He has an ability to connect with people who don’t agree with you on everything.”

Wright, who interned for Vice President Al Gore and worked as a consumer advocate at the Federal Communications Commission in his 20s, acknowledges his job will be tougher in the nation’s capital, and said he is “wide-eyed about the dysfunction” there. He said he also plans to work directly with state lawmakers, including encouraging those in the 10, mostly Republican states that have not yet expanded Medicaid under the Affordable Care Act to do so.

In an interview with California Healthline senior correspondent Samantha Young, Wright, 53, discussed his accomplishments in Sacramento and the challenges he will face leading a national consumer advocacy group. His remarks have been edited for length and clarity.

Q: Is there something California has done that you’d like to see other states or the federal government adopt?

Just saying “We did this in California” is not going to get me very far in 49 other states. But stuff that has already gone national, like the additional assistance to buy health care coverage with state subsidies, that became something that was a model for what the federal government did in the American Rescue Plan [Act] and the Inflation Reduction Act. Those additional tax credits have had a huge impact. About 5 million Americans have coverage because of them. Yet, those additional tax credits expire in 2025. If those tax credits expire, the average premium will spike $400 a month.

Q: You said you will find yourself playing defense if former President Donald Trump is elected in November. What do you mean?

Our health is on the ballot. I worry about the Affordable Care Act and the protections for preexisting conditions, the help for people to afford coverage, and all the other consumer patient protections. I think reproductive health is obviously front and center, but that’s not the only thing that could be taken away. It could also be something like Medicare’s authority to negotiate prices on prescription drugs.

Q: But Trump has said he doesn’t want to repeal the ACA this time, rather “make it better.”

We just need to look at the record of what was proposed during his first term, which would have left millions more people uninsured, which would have spiked premiums, which would have gotten rid of key patient protections.

Q: What’s on your agenda if President Joe Biden wins reelection?

It partially depends on the makeup of Congress and other elected officials. Do you extend this guarantee that nobody has to spend more than 8.5% of their income on coverage? Are there benefits that we can actually improve in Medicare and Medicaid with regard to vision and dental? What are the cost drivers in our health system?

There is a lot we can do at both the state and the federal level to get people both access to health care and also financial security, so that their health emergency doesn’t become a financial emergency as well.

Q: Will it be harder to get things done in a polarized Washington?

The dysfunction of D.C. is a real thing. I don’t have delusions that I have any special powers, but we will try to do our best to make progress. There are still very stark differences, whether it’s about the Affordable Care Act or, more broadly, about the social safety net. But there’s always opportunities for advancing an agenda.

There could be a lot of common ground on areas like health care costs and having greater oversight and accountability for quality in cost and quality in value, for fixing market failures in our health system.

Q: What would happen in California if the ACA were repealed?

When there was the big threat to the ACA, a lot of people thought, “Can’t California just do its own thing?” Without the tens of billions of dollars that the Affordable Care Act provides, it would have been very hard to sustain. If you get rid of those subsidies, and 5 million Californians lose their coverage, it becomes a smaller and sicker risk pool. Then premiums spike up for everybody, and, basically, the market becomes a death spiral that will cover nobody, healthy or sick.

Q: California expanded Medicaid to qualified immigrants living in the state without authorization. Do you think that could happen at the federal level?

Not at the moment. I would probably be more focused on the states that are not providing Medicaid to American citizens [who] just happen to be low-income. They are turning away precious dollars that are available for them.

Q: What do you take away from your time at Health Access that will help you in Washington?

It’s very rare that anything of consequence is done in a year. In many cases, we’ve had to run a bill or pursue a policy for multiple years or sessions. So, the power of persistence is that if you never give up, you’re never defeated, only delayed. Prescription drug price transparency took three years, surprise medical bills took three years, the hospital fair-pricing act took five years.

Having a coalition of consumer voices is important. Patients and the public are not just another stakeholder. Patients and the public are the point of the health care system.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Santo Domingo, DR – The families living in “La Cueva,” in the Maquiteria sector of Villa Duarte, Santo Domingo East municipality, where, according to neighbors, three children have died of suspected dengue fever, live amidst accumulated water and garbage in a septic tank which reflects the poor hygiene.

The apparent sewage drain has a deteriorated metal cover with several holes. According to residents, the surrounding cement cover has a hole through which water comes out when it is completely full and overflows in times of downpours. The constant dripping of water from the “cave” produces a humidity that covers several of the zinc-roofed houses below.

“There are too many mosquitoes here, too many, too many mosquitoes, just that hole over there is full of water and mosquitoes,” said Franklin Ogando, a resident of the area.
Elainy Pérez’s neighbors and relatives attribute the death of her son and two other children in the area with suspected dengue fever to this calamitous situation.

Mauricio Perez, the father of the nine-year-old girl who died on July 2nd, says that the infant presented fever, vomited once, and had bruises and convulsions until she lost her life while she was being taken to a medical center.
Perez indicated that up to the moment, the information provided by the medical center where she was treated indicated that it could have been dengue fever. However, they are still waiting for the National Institute of Forensic Sciences (Inacif) to deliver the autopsy results.

She said that her daughter spent much time playing in the houses near the sewer.
“When it rains, it is a total mess, a lagoon,” said Perez when talking about the hole.
The last case registered in this sector, with suspicions, is about a girl who was one year and seven months old and died last Wednesday at the Robert Read Cabral Hospital.

Ercilia Hernandez, the infant’s great-grandmother, said that she had a high fever and that she immediately went to take her to the Los Mina maternity hospital. Still, when the fever went down, she was sent home.
Hernandez said that in the early hours of the morning, “she felt hot” again and vomited. She explains that at that moment, she decided to take her to the polyclinic of Villa Duarte, where she was assisted and put on oxygen until she was referred to the Robert Read Cabral Hospital.

Although the neighbors speculate about the situation, Hernandez expressed that he prefers to know the results of the autopsy that will be delivered in 45 days.
As of midday this Saturday, the Inacif had not delivered the body of the deceased to the relatives, who were desperately waiting outside the institution.

INTERVENTION OF THE AUTHORITIES

Some families go further and show their concern about the issue. Because of this, they ask Public Health to come to their aid, inspect the place, sanitize it, and carry out fumigation campaigns.

The Ministry of Health and Wellness strongly refutes a statement made in a section of the press that indicated Barbadians’ health was at risk during the recently concluded T20 Men’s Cricket World Cup.

The facts are as follows:

During Cricket World Cup, the Ministry of Health and Wellness, in conjunction with the Caribbean Public Health Agency (CARPHA), instituted a real-time surveillance system to capture all possible public health events that could have occurred. We received daily reports on the status of public health during all of the Cricket World Cup matches.

The surveillance started before, during, and a week after Cricket World Cup. At no time was there any infectious disease outbreak that warranted public health intervention.

The management of public health during the World Cup was commendable and the public remained safe at all times.

We deployed several environmental health and surveillance officers, along with public health nurses, to ensure our surveillance was strengthened throughout the Cricket World Cup.

With respect to Hill Milling Co. Ltd., the environmental health team in the Ministry of Health and Wellness is working with the management of Hill Milling to ensure the food supply remains safe.

There is no outbreak associated with Hill Milling Co. Ltd., and we will continue to work with the company to have outstanding matters resolved.

The Ministry encourages the public to use reputable sources and refrain from using unofficial and unverified sources to obtain their information.

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