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How to Apply for US Residency: A Guide for USMLE Aspirants and IMGs Written By: Dr Nandini L Applying for a US medical residency can feel overwhelming, especially for USMLE aspirants and International Medical Graduates (IMGs). Let’s break down the process, highlight the role of research, and cover the essentials like LORs (Letters of Recommendation) and the Match. Understanding the US Residency Application Process The main pathway into US residency is the National Resident Matching Program (NRMP), commonly called “the Match.” This system pairs applicants (US graduates and IMGs) with residency programs based on mutual preferences. The process involves several steps: Completing your medical degree from an accredited institution. Passing the USMLE Step 1 and Step 2 exams. Applying to programs via the Electronic Residency Application Service (ERAS). Submitting Letters of Recommendation (LORs), a personal statement, and other required documents. Attending interviews if selected. Ranking your preferred programs and participating in the Match algorithm. Why Research Matters for USMLE Aspirants and IMGs Research is increasingly essential for residency applications, especially in competitive specialties and university-based programs. Here’s why: About 41% of program directors consider research involvement when offering interviews, and nearly 30% factor it into their rank list decisions. Research demonstrates your commitment to medicine, ability to contribute to the field, and willingness to surpass the minimum requirements. Publications, poster presentations, and research projects can help IMGs stand out, especially if clinical experience in the US is limited. Real-life Example: Imagine two IMGs with similar USMLE scores. The one with research publications and conference presentations is likelier to get an interview, especially from academic programs that value scholarly activity. Key Components of a Strong Residency Application USMLE Scores: High scores open more doors, but are not the only factor. Research: A small project or case report can enhance your profile, especially if you aim for competitive specialties or university hospitals. Letters of Recommendation (LORs): Strong LORs from US physicians or faculty who know your work well are crucial. These should speak to your clinical skills, work ethic, and character. Personal Statement: Tell your story about how you chose your specialty, what motivates you, and what you bring to the table. Clinical Experience: US clinical rotations (if possible) help you get LORs and understand the US healthcare system. Interview Performance: Be prepared to discuss your experiences, research, and motivations. Actionable Steps for USMLE Aspirants and IMGs Start Early: Begin preparing for the USMLE exams and researching potential programs at least 1-2 years before you plan to apply. Engage in Research: Seek out research opportunities, even remotely. Aim for publications, posters, or case reports. Network: Connect with mentors, attend conferences, and reach out to alums who have matched. Secure LORs: Build relationships with faculty and supervisors who can write strong, personalized recommendations. Stay Organized: Track deadlines for ERAS, USMLE, and NRMP. Missing a deadline can jeopardize your application. Apply Broadly: Especially for IMGs, applying to a wide range of programs increases your chances of matching. Final Thoughts The US residency application process is competitive. However, with strong USMLE scores, solid research experience, compelling LORs, and a well-crafted personal statement, USMLE aspirants and IMGs can maximize their chances in the Match. Remember, research isn’t just a checkbox; it’s a way to show dedication and stand out in a crowded field. If you’re starting, focus on building your profile step by step. Every publication, connection, and bit of clinical experience counts! Keywords: USMLE Aspirants, Match, Research, LOR, IMGs https://www.uscis.gov/green-card/how-to-apply-for-a-green-card https://www.youtube.com/watch?v=xEqwoS5CGpU https://usmlestrike.com/residency-match-program/

Can Probiotics potentially prevent or treat food allergies in Children? Written By: Dr.Neha Bahri Food allergies in the Pediatric population The incidence of food allergies among the pediatric population has been surging globally in the last few decades. Data shows almost 8% of children below the age of 5 in the USA have food allergies. A meta-analysis conducted from worldwide studies showed significant variation, with the prevalence of food allergies ranging between 3-and 35% in the overall population. Can it be attributed to genetics, lesser environmental allergen exposure, late introduction of common food allergens in the early years of life, or a combination of all the above factors? – is a question that remains deprived of a definitive answer. Food allergy OR Food intolerance? Food allergy is an unwanted reaction of one’s immune system to something ingested orally – food protein specifically. The reaction can be mild in the form of hives, nausea/vomiting, or severe and even life-threatening in some cases, manifesting as throat tightness, facial swelling, trouble breathing/wheezing, and/or low blood pressure, eventually leading to circulatory failure and death. Henceforth, there is a need to pay attention to the causes and potential preventive and treatment modalities for food allergies in children. Although food allergies can develop to any food, some of the most commonly implicated food allergens are Peanuts, tree nuts, Shellfish, Fish, Soy, Wheat, Diary protein, Eggs, and Sesame—the first four cause severe allergic reactions in most cases. It’s important not to confuse food allergy with food intolerance. The latter is milderand caused by digestive issues without the immune system’s involvement. Therefore, allergy testing is recommended to confirm the diagnosis of food allergy. What is the current available therapy for food allergy? There isn’t any cure for food allergy. For decades, the go-to advice was to avoid the allergen.In case of accidental exposure, Oral antihistamines, and Epinephrine Inj are recommended depending on the severity of the allergic reaction. However, is it practical? Imagine the life of a child with a food allergy not being able to eat out, be it at a restaurant, a birthday party, or a picnic, without worrying about getting an allergic reaction, which could be life-threatening. Counting how many food items are labeled as May Contain these days is impossible. The only way to avoid a food allergen is to isolate a child socially and always provide home-cooked food with known ingredients. Nonetheless, it is easier said than done. Food allergies affect the quality of life on a mental,social, and emotional level for both parents and Children. Evolving current therapiesfor food allergies include Oral immunotherapy (OIT), which is desensitizing an individual’s immune system to a food allergen by giving it orally in fractional amounts initially and then gradually increasing the dose until the individual stops reacting to a certain amount of the allergen.Oral food challenges may be given during the therapy to see how much allergen a person can tolerate without having an allergic reaction.OIT isn’t a mainstream practice and involves some risk of life-threatening reactions occurring during OIT. The inconvenience of daily dosing remains another hurdle, and the exact duration of treatment and whether an individual will remain desensitized to the food allergen after stopping OIT needs further research and studies. The first oral immunotherapy drug, Peanut Allergen Powder (Palforzia), has also been approved to treat children ages 4 to 17 with a confirmed peanut allergy. The U.S. Food and Drug Administration (FDA) recently approved omalizumab (Xolair) to help reduce allergic reactions to multiple foods in certain adults and children 1 year old or older. Omalizumab is a monoclonal antibody that is given as an injection. Therefore, it prevents an allergic reaction in case of accidental exposure to the food allergen as long as the patient is on it. The implausible cost of these drugs is only one barrier to providing a sustainable long-term benefit with improved quality of life for patients with food allergies.   What are Probiotics, and how can they help with food allergies? Simply put, Probiotics are friendly live microorganisms.Since they are friendly, they benefit us by co-residing with other beneficial microorganisms in our body and fighting off the non-friendly microorganisms that cause infections.They can be taken as an oral supplement or topical product where normal microbiomes reside in our body, such as the nose and genitals. Probiotics can stimulate primarily the innate immune system, thereby improving one’s defenses and supporting a balance between pro- and anti-inflammatory cytokines, which is our body’s messenger system. This decreases allergic inflammation and promotes epithelial integrity and permeability in the intestines. Many studies have shown that gut microflora and probiotic intake can support immune system maturity during the early years of life due to different physiological and metabolic reactions in the host. Lactobacillus and Bifidobacterium genera have shown the most encouraging results. As we advance, can probiotics be a potential savior in the Pediatric population with Food allergies? Promising results have been observed in studies with the use of probiotics in pregnancy as well as early years of life in preventing Atopic Dermatitis- a recurrent and chronic skin condition causing rashes and itching believed to be due to the ineffective skin barrier and dysregulated local and systemic immune responses. A Meta-analysis of 9 trials involving a Pediatric population with cow milk allergy (CMA) showed moderate certainty in improving CMA symptoms. However, individual factors such as age, immune status, and gut microbiomebefore initiating probiotics must be taken into account before anticipated benefits are expected. Last but not least, further studies and evidence remain pivotal in establishing the beneficial role of probiotics in food allergies.  References: Food allergies in children and babies. (2025, March 20). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/food-allergies-in-children#:~:text=Peanuts%2C%20tree%20nuts%2C%20fish%20and,5%20years%20have%20food%20allergies. Wong G. W. (2024). Food allergies around the world. Frontiers in nutrition, 11, 1373110. https://doi.org/10.3389/fnut.2024.1373110 Food allergy – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095 Food allergy – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/food-allergy/diagnosis-treatment/drc-20355101 Professional, C. C. M. (2025, May 9). Probiotics. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/14598-probiotics Lopez-Santamarina, A., Gonzalez, E. G., Lamas, A., Mondragon, A. D. C., Regal, P., & Miranda,

Modern Medicine Meets Women’s Health: The New Era of Fibroid Management Written By: Dr. Aida Feda Vanderpuye,MD,MPH Candidate Meet Elizabeth, G0 P0, a middle-aged White woman who had struggled with heavy vaginal bleeding and pelvic pain secondary to uterine fibroids. Like many women, her initial consultations led to discussions about hysterectomy as a first-line treatment to return to optimal health. The news left her emotionally gutted, as she did not feel comfortable losing her uterus. She was eager to explore alternative options. Was there another option? She discovered MRI-guided focused ultrasound (MRgFUS), a cutting-edge non-invasive procedure. After one outpatient procedure, she experienced significant relief from her symptoms and returned to her normal activities without the need for invasive surgery. Her story reflects the value of patient counselling and shared decision-making and the availability of less invasive treatment options for uterine fibroids. Uterine fibroids occur in about 25% of women in their reproductive age and more than 40% of women after menopause. Studies show that over 60% of African American women and nearly 40% of White women have fibroids by age 35. Fibroids are known to be the most common indication for hysterectomy. Clinicians manage asymptomatic uterine fibroids conservatively, whereas symptomatic uterine fibroids are an indication for treatment. A national survey of 968 affected women between 29 and 59 years with fibroids conducted in the USA and published by the American Journal of Obstetrics and Gynecology revealed that 79% expressed a desire to avoid invasive surgery or long recoveries, and more than half reported a preference for uterine preservation, regardless of future fertility. Current treatment: Minimally invasive alternatives to hysterectomy exist. They include Uterine Artery Embolization (UAE), Magnetic Resonance-Guided Focused Ultrasound Surgery (MRgFUS), and MR-guided High-Intensity Focused Ultrasound (MR-HIFU) Radiofrequency Ablation. According to ACOG guidelines (2022), office hysteroscopy is an outpatient procedure performed on an outpatient basis. It is a simple and cost-effective treatment modality for optimizing the care of patients with submucosal uterine fibroids. Hysteroscopy is considered a safe procedure and has the advantage of diagnosing and treating these fibroids with a single minimally invasive procedure in women who present with abnormal uterine bleeding. Recovery is quicker, and complications (such as intrauterine scarring, infections, and injury to adjacent structures) occur in less than 1% of cases. Endometrial ablation is used to manage abnormal uterine bleeding. It entails permanent destruction of the endometrial lining. It reduces the bleeding and, in some cases, stops it altogether. However, it is not used for bulk symptoms caused by large fibroids and is also not suitable for candidates seeking to preserve their fertility. There are various types, such as radiofrequency energy, heated balloon (balloon therapy), microwave energy, cryoablation, heated fluid(hydrothermal), and electrosurgery with a roller-ball-tipped microscope.  Uterine Artery Embolization blocks the blood supply to fibroids, causing shrinkage, reducing bleeding, and preserving the uterus. According to ACOG (2020), about 3 in 4 women who had UAE got relief from fibroid symptoms, and about 1 in 5 women who had UAE later needed another surgery for their fibroids (including a second UAE, myomectomy, or hysterectomy). Also, greater than 85% of patients would recommend the procedure to a friend or family member, which speaks for itself. Some of its disadvantages are complications like post-embolization syndrome, ovarian failure, and reduced fertility. The non-invasive MR-guided focused ultrasound ablation has been available to women in the U.S. It was approved by the Food and Drug Administration (FDA) in 2004. It uses MRI to guide ultrasound waves that target fibroid tissue. Recovery is speedy, and patients can return to daily work and lifestyle the next day. It preserves fertility, and many achieve successful pregnancies.  HIFU is a safe, non-invasive, and highly effective standard treatment with a broad indication range for fibroids of varying sizes. It involves delivering concentrated ultrasound energy to induce thermal coagulation and necrosis of fibroid tissue—research into HIFU dates back to the early 1900s, with significant breakthroughs in recent decades. While the treatment has high efficacy and minimal complications, it is time-intensive and limited by availability at specialized centers. Despite these limitations, HIFU remains a promising option for preserving fertility and avoiding invasive surgery. Radiofrequency ablation is a safe, versatile, and minimally invasive outpatient procedure that involves the thermal destruction of fibroids through radiofrequency. It is done through the cervix (Sonata) or laparoscopically (Acessa) and is ideal for small fibroids. RFA is used for small intramural fibroids. It preserves the uterus, and recovery time is short. Unlike myomectomy, techniques like Sonata do not involve entering the myometrium, which may protect uterine integrity. However, there is limited data on fertility outcomes following RFA. For many women, the emotional and psychological weight of undergoing hysterectomy is profound. The potential loss of fertility triggers deep feelings of depression and a sense of loss. It also underscores the importance of offering fertility-preserving or uterus-sparing alternatives. These options empower women to make informed decisions that honor their reproductive goals and personal values without undergoing invasive surgery or sacrificing their future fertility.  With increasing awareness and technological leaps, women like Elizabeth are embracing their autonomy and exploring alternatives to hysterectomy. The evolving standard of care in fibroid management must prioritize clinical outcomes and the voices and values of the women most affected. References  Orlando, Megan S. MD; Bradley, Linda D. MD. Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology. Obstetrics &Gynecology 140(3):p 499-513, September 2022. | DOI: 10.1097/AOG.0000000000004898  Inbar Y, Rabinovici J, Sverdlove R, Ziv-Baran T, Machtinger R. Long-term outcomes and re-intervention rates in women undergoing mri-guided focused ultrasound (mrgfus) for uterine fibroids: a 7-year follow-up study. J Assist Reprod Genet. 2025 Apr;42(4):1191-1196. doi: 10.1007/s10815-025-03405-9. Epub 2025 Feb 3. PMID: 39899259; PMCID: PMC12055703. Vo NJ, Andrews RT. Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids. Semin InterventRadiol. 2008 Sep;25(3):252-60. Doi: 10.1055/s-0028-1085923. PMID: 21326515; PMCID: PMC3036449. Mahmoud MZ, Alkhorayef M, Alzimami KS, Aljuhani MS, Sulieman A. High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study. Pol J Radiol. 2014 Oct 30; 79:384-90. Doi: 10.12659/PJR.891110.

Should I burn that excess fat or freeze it? Written By: Dr Pragya Pandey Obesity and the weight loss market With global obesity rates rising, the demand for weight loss products and services has increased. The weight management industry was worth USD 232.4 billion in 2023 and is anticipated to show an 8.6% compound annual growth rate from 2024 to 2032. The weight loss market can be broadly categorized into supplements, prescription medicines, noninvasive procedures, and surgical procedures. Unlike traditional Liposuction or other surgical procedures, supplements, medications, and noninvasive fat reduction techniques are gaining popularity because of convenience and cost 1,2. Types of fat (Visceral, subcutaneous) Visceral fat is beneath the abdominal muscles and cushions the internal organs, such as the liver, pancreas, and intestines. High visceral fat level is strongly linked with insulin resistance and associated pathologies 3. Subcutaneous fat lies underneath the skin and is distributed throughout the body. While this kind of fat is less metabolically active and provides insulation and energy storage, excessive amounts can lead to aesthetic dissatisfaction and even health risks 3. What are ‘fat burners’? ‘Fat burners’ are topical and consumable supplements that claim to promote fat metabolism. Some popular fat burners include caffeine, carnitine, green tea, conjugated linoleic acid, forskolin, chromium, kelp, and fucoxanthin. While the role of topical fat burners is limited to subcutaneous fat metabolism, evidence suggests that consumable fat burners increase overall fat metabolism. However, the benefit of adding thermogenic dietary supplements appears to be limited in reducing body mass index and improving cardiometabolic health for overweight individuals 4, 5. How does ‘fat freezing’ work? ‘Fat freezing’ or Cryolipolysis uses controlled cold temperatures for targeted destruction of subcutaneous fat cells. Since Lipid-rich tissues are more susceptible to cold injury than water-rich tissues, the skin and other surrounding structures remain safe during the procedure. This is one of the most popular nonsurgical subcutaneous fat reduction treatments, with over 450,000 procedures performed worldwide. Various Cryolipolytic devices such as CoolSculpt, CoolContour, Zeltiq, CoolTech, and Pleasanton are FDA approved for subcutaneous fat reduction from the flanks, thighs, and abdominal region 6, 7, 8.  Is it safe? While Cryolipolysis is considered a low-risk procedure, some minor and self-limited adverse events include bruising, swelling, redness, pain or discomfort, and skin discoloration. Cold burn, which was considered to be an unlikely complication, has also been reported recently. Certain contraindications for the procedure are cold-sensitive, severe varicose veins, dermatitis, and a history of hernias. One of the most distressing and common adverse effects of Cryolipolysis is paradoxical adipose hyperplasia (PAH), where the treated area paradoxically grows larger instead of shrinking. This condition typically develops two to five months after Cryolipolysis and may need surgical alleviation. A higher incidence of PAH is observed among men, Hispanics, treatment of the abdominal region, and the use of larger handpieces 7, 8. Has Cryolipolysis replaced Liposuction? Though Cryolipolysis is a nonsurgical option for targeted fat reduction, Liposuction remains a preferred choice for larger volumes of fat removal, more significant body contouring, and faster turnaround time. However, Liposuction, being invasive, comes with a longer recovery time and the potential for more complications 9. Do we still need bariatric surgeries? Bariatric surgeries are weight-loss procedures for individuals with significant obesity. The goal of such procedures is to aid in shedding overall weight and treat obesity-related conditions. Fat freezing and Liposuction are aesthetic procedures that don’t target overall weight or underlying health issues 10. So, burn or freeze the excess fat? The choice between burning or freezing excess fat depends on the individual and their goals. The old-school way of burning fat, through diet and exercise, is a holistic approach that can lead to overall weight loss and improved health. Fat freezing, an FDA-approved noninvasive procedure for localized subcutaneous fat reduction, has more of a cosmetic role for targeting specific stubborn subcutaneous fat that doesn’t respond to traditional methods. While consumable “fat burners” are often promoted for weight loss, including visceral fat, the most effective strategies for reducing visceral fat involve a combination of lifestyle changes, including diet, exercise, and stress management, rather than relying solely on supplements.    References Global Market Insight. Weight Loss and Obesity Management Market [Internet]; 2024May. Available from: https://www.gminsights.com/industry-analysis/weight-loss-and-obesity-management-market[cited 2025 May 07] Obesity and Overweight [Internet]. Geneva: World Health Organization; March 2024. Available from: URL https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [cited2025 May 07]. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obesity reviews. 2010 Jan;11(1):11-8. Clark JE, Welch S. Comparing effectiveness of fat burners and thermogenic supplements to diet and exercise for weight loss and cardiometabolic health: Systematic review and meta-analysis. Nutrition and health. 2021 Dec;27(4):445-59. Escalante G, Bryan P, Rodriguez J. Effects of a topical lotion containing aminophylline, caffeine, yohimbe, l‐carnitine, and gotu kola on thigh circumference, skinfold thickness, and fat mass in sedentary females. Journal of cosmetic dermatology. 2019 Aug;18(4):1037-43. American Society of Plastic Surgeons. Nonsurgical fat reduction [Internet];Available from: https://www.plasticsurgery.org/cosmetic-procedures/nonsurgical-fat-reduction/cryolipolysis#:~:text=Cryolipolysis%2C%20commonly%20referred%20to%20as,structures%20are%20spared%20from%20injury.[cited2025 May 07]. Kania B, Goldberg DJ. Cryolipolysis: A promising nonsurgical technique for localized fat reduction. Journal of Cosmetic Dermatology. 2023 Nov;22:1-7. Krueger N, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clinical, Cosmetic and Investigational Dermatology. 2014 Jun 26:201-5. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plastic and reconstructive surgery. 2015 Jun 1;135(6):1581-90. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obesity surgery. 2015 Oct;25:1822-32.

Can Immunosuppressants Prevent PAH in Systemic Sclerosis? A New Study Investigates Written By: Dr. Nandini MANCHESTER, England — A new analysis presented at the British Society for Rheumatology (BSR) 2025 Annual Meeting suggests that while early immunosuppression does not prevent the onset of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc), it may improve survival in those who do develop the condition. Study Background and Key Investigators Dr. Christopher Denton, professor of experimental rheumatology at UCL Medical School and head of the Centre for Rheumatology at the Royal Free Hospital, noted that PAH in SSc is typically considered non-inflammatory. However, preliminary data indicated a potential protective effect of hydroxychloroquine in reducing PAH risk—an unexpected finding given the drug’s reputation as relatively mild in immunosuppressive action. “Hydroxychloroquine stood out. Patients on this drug seemed less likely to develop PAH,” Dr. Denton said, suggesting immunomodulation may still play a role in disease progression. PAH: A Severe SSc Complication Dr. Stefano Rodolfi, who presented the findings, emphasized that PAH remains one of the most devastating complications of SSc, affecting roughly 8–13% of patients. The 3-year survival rate remains poor, hovering around 50%. He described PAH’s pathogenesis as beginning with pulmonary vascular injury, leading to a fibroproliferative response, vascular remodeling, and, ultimately, right heart failure. Despite its vascular basis, Rodolfi highlighted mounting evidence pointing to immune dysregulation, including autoantibodies, inflammatory cytokines, and activated immune cells in affected patients. Study Design: Who Was Studied? The retrospective analysis included 629 patients with well-documented SSc. After exclusions based on significant interstitial lung disease (ILD) or low lung function, 607 patients were analyzed. Of these, 320 had received immunosuppressive therapy at some point, while 287 had not. Patients were grouped based on the timing of treatment: Early immunosuppression (within 5 years of diagnosis) – n = 206 Late immunosuppression (after 5 years) – n = 144 No immunosuppression – n = 287 Immunosuppression was defined as the sustained use of glucocorticoids, conventional DMARDs, or biologic agents. Findings: PAH Risk and Survival Outcomes Over a 21-year median follow-up, 77 patients developed PAH. Incidence by the group was: Early immunosuppression: 5.3% Late immunosuppression: 14.6% No immunosuppression: 15.7% At first glance, early treatment may reduce PAH risk. However, after adjusting for confounders (such as gender, autoantibody profile, renal involvement, and diffuse cutaneous SSc), the time to PAH onset was statistically similar across all groups (P = .581). Interestingly, when individual drugs were analyzed, mycophenolate mofetil (MMF) showed significantly lower odds of PAH (OR 0.12; P = .048). Other risk factors included: ILD (OR 3.01; P = .006) Scleroderma renal crisis (OR 6.54; P = .035) Anticentromere antibodies (OR 2.94; P = .026) Conversely, the anti–scl–70 antibody appeared protective (OR 0.15; P = .009). Survival Benefits Of Immunosuppression In a separate analysis focusing on 72 SSc-PAH patients, researchers compared those who had ever received immunosuppressants (n = 30) to those who had not (n = 42). Though baseline characteristics varied (e.g., more diffuse disease and ILD in the immunosuppressed group), the results showed: Median survival from PAH diagnosis was 7 years (treated) vs 4 years (untreated) Immunosuppression reduced mortality risk (OR 0.41; P = .045) Most striking was the impact of hydroxychloroquine. Of 9 patients on the drug, only 2 died, and both more than 17 years post-PAH diagnosis (HR 0.04; P = .004). Rodolfi noted that preclinical studies support these findings, with hydroxychloroquine demonstrating vascular protective effects and anti-remodeling properties in animal models. Clinical Implications and the Road Ahead Commenting on the findings, Dr. Carmel Stober from Cambridge University Hospitals said the study may change clinical thinking, particularly regarding hydroxychloroquine use in patients with limited cutaneous SSc, where immunosuppression is not routine. “If there’s even modest benefit and low risk, clinicians may start rethinking hydroxychloroquine’s role,” she said. Still, experts agree that randomized controlled trials are needed. A UK multicenter RCT is already underway, investigating whether MMF plus standard care can slow SSc progression compared to standard care alone. Conclusion While early immunosuppression does not appear to prevent PAH onset in systemic sclerosis, specific agents—particularly MMF and hydroxychloroquine—may offer survival benefits and delay disease progression. These findings support a more nuanced, drug-specific approach and signal the need for further prospective studies.

Patient-Centered Care: Revolutionizing Healthcare for Better Outcomes Written By: Dr. Aida Vandepuye, MD, MPH Candidate Patient-centered care (PCC) is a healthcare model that entails a holistic approach to managing patients with dignity, respect, trust, and compassion and involving them in all decisions concerning their health. It is a partnership between practitioners, patients, and their families that ensures that the patient’s needs, wants, and preferences are central to decision-making. PCC is the cornerstone of modern medicine because it shifts the focus from traditional, disease-centered models to prioritizing patients as active participants in their care. In an era of cutting-edge technology in diagnostics and treatment of medicine, PCC ensures that healthcare remains compassionate, respectful, and responsive. It fosters strong trust between provider and patient, ensures a higher patient satisfaction rate, improves outcomes, and promotes better adherence to lifestyle modifications and treatment. It is cost-effective because it minimizes unnecessary interventions and promotes efficient care.PCC empowers individuals to participate in their health journey. As healthcare systems aim for higher quality, safety, and efficiency, embracing patient-centered principles is essential for delivering clinically effective and emotionally supportive care. A built environment is the physical design of a healthcare facility. Its key elements include accessibility, privacy, comfort, aesthetics, and flexible spaces that adapt to patients’ different needs. The built environment affects patients’ experience, comfort, and dignity, emphasizing its impact on PCC. The PCC Service Delivery Framework emphasizes timely and equitable access to care, flexible appointments, and prompt responses to patients’ concerns. It supports individualized care through comprehensive evaluations and coordinated treatment plans. Trust and rapport enrich open communication and respect for preferences. Care continuity achieves seamless transitions and strong follow-up support. Empowering patients through shared decision-making and education ensures they can make informed choices and actively manage their health.  Additionally, PCC includes caregiver engagement, emotional support services, and attention to patients’ physical and environmental needs—such as pain management, healing-centered facility design, and survivorship programs—to enhance the patient experience: safety and quality maintenance protocols, incident reporting, and continuous quality improvement based on patient feedback. Finally, the hospital’s organizational culture is grounded in a commitment to patient-centered principles, supported by ongoing staff training and a mission that reflects these values. Many key organizations in the USA regulate and assess PCC. The Centers for Medicare & Medicaid Services (CMS) support healthcare quality through payment policies, quality reporting programs, and the Meaningful Measures Initiative, which emphasizes patient engagement and feedback. The Joint Commission accredits healthcare organizations and sets standards that include patient rights, communication, and shared decision-making. The Agency for Healthcare Research and Quality (AHRQ) advances PCC by funding research and providing evidence-based resources for healthcare providers. Likewise, the National Committee for Quality Assurance (NCQA) accredits healthcare organizations and develops quality measures related to PCC. Professional organizations such as the American Medical Association (AMA) and the American Nurses Association (ANA) advocate for PCC and guide their members. The National Patient Advocate Foundation and the Picker Institute promote patient rights and offer resources to patients and families. Furthermore, state licensing boards regulate communication, informed consent, and patient rights within their guidelines. Together, these bodies define, measure, and promote PCC, collaborating to continually advance its role in the US healthcare system. These institutions often collaborate and build upon each other’s work to advance PCC in the US healthcare system. PCC has become a foundational goal of healthcare reform and quality improvement in the United States. National initiatives such as the Institute of Medicine’s landmark 2001 report “Crossing the Quality Chasm” emphasized patient-centeredness as one of six core aims for a high-quality healthcare system. Organizations like the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission have since integrated patient-centered principles into their standards, accreditation, and payment models. Across hospitals, clinics, and community health programs, there is an intensifying focus on respecting the autonomy of patients’ individual preferences, promoting shared decision-making, respecting the autonomy of patients’ individual preferences,improving communication, and addressing social determinants of health. PCC is pivotal for optimizing clinical outcomes, building rapport and trust, decreasing disparities, and enhancing the healthcare experience for diverse populations in a complex US healthcare system. PCC has gained attention on the global stage. The International Beryl Institute is a global community of healthcare professionals and experience champions committed to transforming the human experience in healthcare. It was established in 2010. This institution advocates PCC, and it currently involves 49 countries, emphasizing PCC’s broad and evolving influence. In conclusion, PCC marks a revolutionary change in healthcare delivery. With the support of key regulatory bodies and healthcare professionals, PCC poses to shape the future of medicine.   References Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Isr J Health Policy Res. 2021 Mar 5;10(1):21. doi: 10.1186/s13584-021-00459-9. PMID: 33673875; PMCID: PMC7934513.  More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatientsChenhao Yu 1,†, Yun Xian 1,†, Tiantian Jing 1, Mayangzong Bai 1, Xueyuan Li 2, Jiahui Li 3, Huigang Liang 4,*, Guangjun Yu 1,5,*, Zhiruo Zhang 1,*2023 Oct 19; 11:1148277. doi: 10.3389/fpubh.2023.1148277Patient-Centered Care and Preference-Sensitive Decision MakingCarla C. Keirns, MD, MA, MS, PhD; Susan Dorr Goold, MD, MHSA, MAJAMA. 2009;302(16):1805-1806. doi:10.1001/jama.2009.15 https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.mayoclinic.org/patientcenteredcare&ved=2ahUKEwjdvLerw8OLAxUsg4kEHWWwCmgQFnoECBIQAQ&usg=AOvVaw06ZlDpZoeFJGNQetTjKMyi

The Role of Research in Getting a US Residency Written By: Dr. Nandini L Research experience plays a significant role in the US medical residency application process, although it is not strictly mandatory. Its impact varies by specialty, program competitiveness, and your interests and career goals.   Why Research Matters Differentiates Your Application Research experience adds depth and uniqueness to your application, especially in a highly competitive environment. It demonstrates mastery of the scientific method, critical thinking, and evidence-based practice—skills that residency programs value highly. Signals Commitment and Curiosity Engaging in research shows your dedication to advancing medical knowledge and your curiosity as a future physician. It can highlight your passion for a particular specialty or academic medicine. Develops Transferable Skills Through research, you build analytical, problem-solving, and time management skills. These are seen as proxies for qualities such as self-directed learning and commitment to the specialty.  Creates Networking and Mentorship Opportunities Working on research projects often connects you with mentors and peers, leading to strong letters of recommendation and further clinical or research opportunities.   How Residency Programs View Research Factor Importance Relative to Research USMLE Step 1 & 2 Scores are generally more important Letters of Recommendation are generally more important Clerkship Grades are usually more important Research Experience is Helpful, sometimes equally crucial in competitive specialties. Leadership, Service, and Honor Societies are often less important than research in top fields Research is often weighted more heavily in competitive specialties (e.g., dermatology, orthopedics, radiology) and may be essential to stand out. In less competitive fields, research is a bonus but not a requirement. The transition of USMLE Step 1 to a pass/fail format may increase the emphasis on research and other holistic factors in the application process.   Quality Over Quantity Programs prefer meaningful involvement in one or two quality projects rather than superficial participation in many. Dissemination of research (e.g., presentations, publications) can further strengthen your application. Is Research Required? Research is not a strict requirement for most residency programs. Many successful residents have little to no research experience, especially if they excel in other areas, such as clinical performance, leadership, or service. Pursue research if it aligns with your interests and career goals, not solely as a checkbox for your application. Actionable Steps If you enjoy research or aim for a competitive specialty, seek research opportunities early in medical school. Focus on quality projects and see them through to publication or presentation. Utilize your research experience to establish connections with mentors who can provide strong letters of recommendation. Be prepared to discuss your research during residency interviews, as it is often a topic that comes up and can help you stand out. Real-Life Example Imagine two applicants: Applicant A has strong clinical grades and no research, but has led impactful community service projects. Applicant B has average grades but has published research in their particular specialty. Both can match, but Applicant B’s research might give them an edge in a competitive specialty or academic program. At the same time, Applicant A’s leadership and service could be more valued in community-focused programs. Summary Research experience is highly valued for US residency applications, particularly in competitive specialties and academic medicine. It demonstrates crucial skills, signals commitment, and can open doors through networking. However, it is not universally required, and applicants should pursue research based on genuine interest and career alignment, rather than simply as a resume booster.   Citations: https://mdresearch.us/why-research-experience-is-your-fast-track-to-a-us-medical-residencydont-wait/ https://www.ama-assn.org/medical-students/preparing-residency/how-medical-student-research-can-resonate-residency-programs https://pmc.ncbi.nlm.nih.gov/articles/PMC10516175/ https://www.sgu.edu/blog/medical/why-pursue-research-opportunities-for-medical-students/ https://residentsmedical.com/benefits-of-research-when-trying-to-land-u-s-medical-residency/ https://www.ama-assn.org/medical-students/preparing-residency/residency-program-research-faqs-how-get-key-information https://www.reddit.com/r/medicalschool/comments/195vvbg/why_is_research_such_a_huge_thing_seeming/ https://forums.studentdoctor.net/threads/how-important-is-research-for-residency.1276039/

FDA Authorizes First Prescription Digital Therapeutic for Migraine: A New Era in Headache Care Written By: Dr. Nandini L The Digital Revolution Hits Migraine Treatment Imagine managing your migraines not just with pills but with a smartphone app prescribed by your doctor. That’s now a reality. In a landmark move, the U.S. Food and Drug Administration (FDA) has authorized CT-132, the first-ever prescription digital therapeutic (PDT) designed to prevent episodic migraines in adults. What Is CT-132? CT-132 is a mobile app developed by Click Therapeutics, intended for adults 18 and older who suffer from episodic migraines. Unlike over-the-counter headache apps, CT-132 is clinically validated and must be prescribed by a healthcare provider. It’s designed to be used alongside standard migraine medications, not as a replacement. How Does It Work? ●     Behavioral and Cognitive Tools: The app delivers a 12-week program using evidence-based behavioral techniques, including elements of cognitive behavioral therapy, to help users manage migraine triggers and reduce brain hypersensitivity.  ●     Daily Engagement: Features include an eDiary tracker and short, daily lessons to encourage consistent use and self-awareness.   ●     Adjunctive Use: It’s meant to complement, not substitute, existing acute and preventive treatments, including newer medications like CGRP inhibitors. The Science Behind the App The FDA’s decision was based on robust clinical evidence: ●     ReMMi-D Trial: Involving over 500 adults, this phase 3 study compared CT-132 to a sham (placebo) digital therapeutic. Patients using CT-132 experienced a significant reduction in monthly migraine days, approximately three days per month after 12 weeks, along with improved quality of life and high adherence rates. ●  ReMMiD-C Study: This trial confirmed similar benefits for patients already taking advanced migraine medications, such as CGRP inhibitors. ●  Notably, CT-132 showed no device-related adverse events and carries no contraindications, making it a safe adjunct for most adults with episodic migraines. Why Is This a Big Deal? Expanding Access and Options For the 37 million adults in the U.S. living with migraines, many still struggle with frequent, debilitating attacks despite available medications. CT-132 offers: ● Accessibility: Imagine having your migraine care delivered right to your phone, anywhere, anytime. CT-132 offers this convenience, providing a sense of relief for those managing their condition. ● Personalization: For those who haven’t found relief with drugs alone, CT-132 offers a new tool. Its personalized approach makes users feel understood and catered to. ● Scalability: Digital therapeutics like CT-132 can reach patients who lack easy access to specialists or in-person care. This scalability offers hope for those in remote areas or with limited healthcare resources. Real-Life Impact Think of someone who’s tried every medication but still misses work or family events due to migraines. With CT-132, they can incorporate a clinically proven, non-invasive tool into their treatment plan, potentially increasing the number of headache-free days without additional side effects. What’s Next for Digital Therapeutics? CT-132’s FDA authorization marks more than just a win for migraine sufferers. It signals a shift in how we approach treating complex conditions—combining traditional medicine with intelligent, software-based interventions. Click Therapeutics is already exploring similar digital solutions for depression and diabetes, with more on the horizon. Quick Facts: CT-132 at a Glance Feature        Details Indication: Preventive treatment of episodic migraine in adults Platform       Smartphone app (prescription-only) Use    an Adjunct to standard migraine medications Clinical Results     ~3 fewer migraine days/month after 12 weeks Age Range: Adults 18+ FDA Pathway        De Novo (first-of-its-kind technology) Safety: No device-related adverse events; no contraindications Summary: The FDA’s authorization of CT-132 marks a significant milestone in migraine care, combining the benefits of digital health with proven medical therapies. For patients and clinicians alike, it opens the door to more personalized, accessible, and effective migraine management—right at your fingertips. If you or someone you know struggles with migraines, ask your healthcare provider about this new digital option. The future of headache relief may be just an app away. https://www.medscape.com/viewarticle/fda-authorizes-first-prescription-digital-therapeutic-2025a1000993 https://www.fiercebiotech.com/medtech/fda-clears-its-first-prescription-migraine-app-click-therapeutics https://www.neurologylive.com/view/fda-approves-ct-132-as-first-digital-therapeutic-preventive-treatment-episodic-migraine https://pharmatimes.com/news/fda-approves-clicks-digital-therapeutic-for-episodic-migraine/ https://www.linkedin.com/pulse/personal-milestone-fda-authorizes-ct-132-first-app-shaheen-e-3ar9e https://community.hlth.com/insights/the-talk-of-the-town/fda-authorizes-click-therapeutics-prescription-digital-therapeutic-for-migraine-prevention-2025-04-16 https://xtalks.com/fda-clears-ct-132-first-prescription-digital-therapeutic-for-migraine-prevention-4190/ https://www.epocrates.com/online/article/fda-approves-first-digital-therapeutic-for-migraine-prevention https://www.neurologylive.com/view/valtoco-gains-expanded-indication-fda-approves-digital-therapeutic-migraine-phase-1-study-amx0114-als-begins

Curing More Than Cancer: The Expanding Role of Bone Marrow Transplant in Pediatric Genetic Disorders – Copy Written By: Dr. Nandini k AORTIC STENOSIS: -a narrowing of the aortic valve opening due to thickening of the valve with fibrosis or calcium deposition. This restricts flow of blood from the left ventricle to the aorta, causing symptoms like-dyspnea, new found difficulty walking shorter distances or decline in regular activity, lightheadedness and palpitations. Some of the causes of Aortic Stenosis are aging , bicuspid aortic valve, congenital heart disease and rheumatic fever.  AS treatment varies widely with asymptomatic patients managed medically and severe symptomatic patients treated surgically. So classifying becomes important and is done using Echocardiography. Echo is the main method used to assess severity of AS and the following 3 parameters are used.The peak velocity (PVel), the mean pressure gradient (MPG) and the aortic valve area (AVA). The first two parameters are directly measured using continuous wave Doppler, while the last one is calculated based on the continuity equation and measurement of the left ventricular outflow tract (LVOT) diameter, LVOT time-velocity integral (TVI) and aortic TVI. AVA is measured by assuming that the AV area is circular but in CT images show an oval valve area thus increasing the margin of error. Ideally, these parameters should be concordant, with severe AS being defined by a peak velocity >4 m/sec, an MPG >40 mmHg and an AVA <1 cm². Treatment options for AS are-Surgical Aortic Valve Replacement (SAVR) for low to moderate risk patients ,Transcatheter Aortic Valve Implantation (TAVI/TAVR) for high risk patients. This new england journal of medicine article discusses Managing Oral Anticoagulation in Patients Undergoing TAVI. Transcatheter aortic valve implantation—or TAVI—has become an established treatment option for patients with symptomatic severe aortic stenosis, especially those who are high-risk or inoperable for traditional surgery. Approximately one-third of patients undergoing TAVI also have a concomitant indication for oral anticoagulation, most commonly due to atrial fibrillation. This creates a clinical dilemma:1) Should we interrupt oral anticoagulation before the procedure to reduce bleeding risk?2)Or should we continue it to prevent thromboembolic events like stroke? To address this, a comparison was made between periprocedural continuation and interruption of oral anticoagulation during TAVI. The primary outcome evaluated was a composite of cardiovascular death, stroke, myocardial infarction, major vascular complications, or major bleeding within 30 days post-procedure.  Exclusion criteria for this evaluation included: Presence of a mechanical heart valve prosthesis Intracardiac thrombus Venous thromboembolism within the past 3 months Recent TIA or stroke within 6 months in patients with atrial fibrillation In the interruption group,  anticoagulation management followed established guidelines for high bleeding-risk procedures. Results showed that bleeding complications were more common in the continuation group than in the interruption group—highlighting the bleeding risk associated with uninterrupted therapy. However, continuation of oral anticoagulation may still be important for selected high-risk patients, such as those with a high CHA₂DS₂-VASc score or a history of stroke. These individuals are more vulnerable to thromboembolic events due to their underlying vascular or cerebrovascular disease. Ultimately, managing anticoagulation in TAVI patients requires a careful balance between bleeding and thrombotic risk, tailored to each patient’s clinical profile.

Revolutionizing Surgery with AI: The Future is Here Written By: Dr. Abhishek Thapa Artificial Intelligence (AI) is reshaping the world in a rapid way, including the medical field. Looking at the power of AI, it can make procedures safer, more precise, and highly efficient. From preoperative planning to post-surgical recovery, AI is no longer just an advanced tool instead it has the power to become essential partner for surgeons. AI has the capacity to handle a vast volume of data, aid in making decisions swiftly, and assist in improving surgical procedures. It is leading us towards a new dawn/era in healthcare. AI in Surgery: From Start to Finish AI can be present at every stage of a surgical procedure, enhancing care from pre-op to recovery. Here’s how: Smarter Preoperative Planning      Even before a patient enters the operating room, AI helps surgeons prepare by analyzing medical histories, image scans, and potential risks. Advanced AI models and algorithms can predict complications, allowing doctors to adjust their strategy. AI-generated 3D anatomical models also provide a clear view of the operation area, and surgeons can map out each stage of the procedure with accuracy. AI-Powered Assistance During Surgery      In surgery, AI plays a crucial role in ensuring everything is done precisely and safely. Robotic surgical systems use AI to provide real-time assistance, improve precision, and minimize risks. AI can also review images taken during surgery, highlighting key structures and even tracking tumors in real-time. This results in faster procedures with fewer complications than the traditional method. Personalized Postoperative Care After surgery, AI-driven systems also keep monitoring the patient to identify early warning signs for complications like infection or organ issues. Wearable sensors track vital health metrics, and AI platforms generate individualized recovery plans. Virtual reality (VR) therapy has been used to manage pain and support rehabilitation which has shown a promising result. AI in Surgical Education: Training the Next Generation      Not only is AI helping with surgeries, but it is also changing the process of surgical training for all trainees. Traditional surgical training depends a lot on hands-on experience, but AI is transforming that with: AI-driven simulations with instant feedback and surgical skills evaluation. Performance analysis toolthat tracks a trainee’s accuracy, effectiveness, and decision-making skills. Virtual reality training will allow future surgeons to practice complicated procedures in a risk-free setting. AI training techniques assist surgeons in acquiring the skills they require faster and better, which enhances patient care. This is quite amazing. The Challenges: Ethical and Practical Considerations AI offers tremendous advantages for surgery, yet it also has issues that need to be addressed: Moral concerns: Who do we blame when something goes wrong with AI-supported surgery? Accountability is essential here. AI model bias: AI models need to learn from diverse patient data to prevent biases that may result in variation in treatment. Regulatory and safety controls: AI technologies should be rigorously tested and approved to ensure they are effective and safe. Accessibility and affordability: Advanced AI tools may be expensive, making it essential to find ways to make them accessible to all. The Future of AI in Surgery: A Collaborative Approach The use of AI in surgery is only in the beginning stages; the future promises to be even more amazing. AI will continue to improve surgical accuracy, increase patient safety, and offer more innovative training resources for surgeons. However, its success relies on cooperation – surgeons, AI engineers, ethicists, and regulators who need to collaborate for AI to be effectively and responsibly used for better patient outcomes.AI is not here to replace surgeons—it’s here to empower them. With its abilities, we can build a future where operations are safer, recovery is quicker, and health care is more individualized than ever imagined. The future of surgery is here, and AI is at the forefront. Artificial intelligence in surgery—a narrative review – Byrd IV – Journal of Medical Artificial Intelligence