J Assoc Physicians India [JOURNAL]
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200 papers
Indian Expert Consensus on Allergic Rhinitis in Women: A Modified Delphi Survey.
Kameswaran M, Kapre M, Gupta N … +12 more , Pandit GS, Jain S, Khanna V, Latoo MA, Sengupta A, Kasyapi VV, Irudhayarajan A, Kapre G, Gupta R, Kalsotra P, Somu L, Karadkhele A
J Assoc Physicians India · 2026 Apr · PMID 42003159 · Publisher ↗
INTRODUCTION: At present, there are many significant gaps in understanding the clinical needs of Indian women with allergic rhinitis. To address a critical gap in clinical practice, the consensus group created an innovat...
INTRODUCTION: At present, there are many significant gaps in understanding the clinical needs of Indian women with allergic rhinitis. To address a critical gap in clinical practice, the consensus group created an innovative questionnaire tailored to assist Indian clinicians in the diagnosis and management of allergic rhinitis among female patients. METHODS: The modified Delphi survey utilized a systematic approach to group communication in addressing research questions and resolving conflicting viewpoints through detailed evaluation of various arguments. In total, 80 statements were developed focusing on disease burden, risk factors, clinical presentation, comorbidities, symptoms, and treatment of allergic rhinitis. RESULTS: Out of 61 statements reviewed by the expert panel, around 38 statements received over 80% agreement, leading to a consensus. CONCLUSION: Allergic conditions are more common among Indian women, impacting them disproportionately. A high level of consensus indicates that many Indian women spend most of their time indoors, which can result in heightened exposure to indoor allergens and pollutants, consequently increasing their vulnerability to allergies. The experts also offered real-world clinical recommendations while assessing and managing modifiable and nonmodifiable allergens in Indian women with allergic rhinitis.
Systematic Review of Topical Capsaicin 0.075% for the Treatment of Neuropathic Pain: Efficacy, Safety, and Tolerability.
Mohan V, Tiwaskar M, Jayapaul M … +4 more , Menon S, Nene A, Gokhalay S, Wakchoure V
J Assoc Physicians India · 2026 Apr · PMID 42003158 · Publisher ↗
BACKGROUND: Neuropathic pain, characterized by nerve damage, can significantly impact quality of life. Traditional treatments often fall short, prompting the exploration of topical therapies such as capsaicin. This syste...
BACKGROUND: Neuropathic pain, characterized by nerve damage, can significantly impact quality of life. Traditional treatments often fall short, prompting the exploration of topical therapies such as capsaicin. This systematic review aims to evaluate the efficacy, safety, and tolerability of topical capsaicin in treating neuropathic pain. METHODS: A systematic review of clinical studies assessing the topical use of capsaicin for neuropathic pain of different etiologies, including painful diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN), was conducted. Data were extracted regarding pain relief and adverse effects. A systematic review of literature identified through database searches, including PubMed and ScienceDirect, was conducted using the search term "topical capsaicin." RESULTS: A total of 22 studies were included (placebo-controlled: = 13; active-controlled: = 4; uncontrolled: = 4; comparison of two capsaicin formulations: = 1). Topical capsaicin demonstrated significant efficacy in reducing pain intensity and improving quality of life across various neuropathic pain conditions. Localized adverse effects were reported but were generally tolerable and occurred more often in the first week of treatment. Comparisons between 0.025% and 0.075% formulations indicated that the higher concentration is generally more effective. The development of a new roll-on formulation of capsaicin retains efficacy while reducing adverse effects. CONCLUSION: Topical capsaicin 0.075% is a promising and effective option for neuropathic pain management, providing meaningful pain relief and improved quality of life with a manageable and favorable safety profile. Further research is needed to evaluate long-term efficacy and explore combination treatment approaches.
Sodium-Glucose Cotransporter 2 Inhibitors in Kidney Diseases Other Than That Due to Diabetes: Benefits in Composite Renal Outcomes Driven by Immunoglobulin A Nephropathy.
Roy S, Basu M, Mukhopadhyay P … +1 more , Ghosh S
J Assoc Physicians India · 2026 Apr · PMID 42003157 · Publisher ↗
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a well-established treatment for managing diabetic kidney disease (DKD). Clinical trials, including DAPA-CKD and EMPA-KIDNEY, indicate that these drugs a...
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a well-established treatment for managing diabetic kidney disease (DKD). Clinical trials, including DAPA-CKD and EMPA-KIDNEY, indicate that these drugs are probably protective for the kidneys even in cases of chronic kidney disease (CKD) without diabetes, and secondary analysis of trials suggests that the overall outcome may be driven by the benefits of IgA nephropathy (IgAN). We aimed to evaluate whether benefits in composite renal outcomes in CKD, other than those due to diabetes, are observed beyond those with IgA nephropathy. METHODS: Data were extracted from the clinical trials DAPA-CKD and EMPA-KIDNEY, including patients with and without diabetes and CKD. Kidney diseases were classified as hypertensive/renovascular nephropathy or glomerular diseases, further subdivided into IgAN, focal segmental glomerulosclerosis (FSGS), and other glomerulonephritis. The heterogeneous group labeled as other/unknown was excluded from all analyses. The composite renal outcome was analyzed from pooled data using the Mantel-Haenszel risk ratio with a random-effects model and analyzed for all groups and then reanalyzed excluding the IgAN subgroup. RESULTS: The first pooled analysis, including all groups, demonstrated a 22% reduction in composite renal outcomes (RR 0.78, 95% CI 0.63-0.96, = 0.02). However, when the IgAN group was excluded, the analysis revealed that the renoprotective benefits were no longer significant (RR 0.84, 95% CI 0.67-1.04, = 0.11). CONCLUSION: The overall benefit of SGLT2i in CKD due to causes other than diabetes, in patients with or without diabetes, may be predominantly driven by the benefits of IgAN.
Diagnosed by Upper Gastrointestinal Endoscopy.
Ahammed SM, Paul D, Basu A … +2 more , Ray Y, Begam NN
J Assoc Physicians India · 2026 Apr · PMID 42003156 · Publisher ↗
A 36-year-old male patient from rural South Bengal, India, presented to our hepatology outpatient department (OPD) with upper abdominal discomfort, anorexia, indigestion, and chronic diarrhea with passage of loose stools...
A 36-year-old male patient from rural South Bengal, India, presented to our hepatology outpatient department (OPD) with upper abdominal discomfort, anorexia, indigestion, and chronic diarrhea with passage of loose stools 3-4 times per day for 6 weeks. He was afebrile without any weight loss. He did not give any history of skin changes, arthralgia, or oral ulceration. He gave a history of consumption of water chestnuts. He had no history of travel or intake of alcohol or any medications. Physical examination did not reveal any lymphadenopathy, thyroid mass, organomegaly, or abdominal mass. Blood reports showed anemia with a hemoglobin of 78 gm/L (normal range 130-170 gm/L), and total leukocyte count showed eosinophilia (12%). Liver function test showed mild hypoalbuminemia. Human immunodeficiency virus, hepatitis B virus surface antigen, and antihepatitis C virus antibody were nonreactive. Abdominal ultrasonography was normal. Initial stool examination was normal. On upper gastrointestinal (GI) endoscopy, multiple flat, leaf-like, fleshy structures attached to duodenum were found, which were extracted endoscopically (Fig. 1 and Supplementary Video S1). They were morphologically identical to adult form of (3.5 cm × 1.5 cm × 0.5 cm) (Figs 2 and 3). He was treated with tablet praziquantel (75 mg/kg, in three divided doses for 1 day). The next day, stool examination showed eggs of (morphologically, eggs of , , and are similar) (Fig. 4). A few adult worms of were also expelled through feces for 2 days. From the 3rd day onward, stool examination did not show any eggs or adult forms of , and he was asymptomatic for a 6-month follow-up period.
"Academic Overdose" among Healthcare Professionals.
Agrawal R
J Assoc Physicians India · 2026 Apr · PMID 42003155 · Publisher ↗
INTRODUCTION: "Academic overdose (AO) leads to a state of mental and emotional saturation with constant academic input, to the point that learning and productivity decline and may lead to mental exhaustion and burnout, a...
INTRODUCTION: "Academic overdose (AO) leads to a state of mental and emotional saturation with constant academic input, to the point that learning and productivity decline and may lead to mental exhaustion and burnout, affecting quality of life (QOL)." Medical conferences (MC) are essential for knowledge dissemination, academic recognition, and professional transformation. This AO stems from the pressure to present research, networking, and demanding clinical and academic responsibilities. Adding to this are unlimited, exhaustive, and irritating queries from patients and attendants arising from internet searches. DISCUSSION: In recent years, the frequency of MCs and continuous medical educations (CMEs) has increased across local, national, and international levels. While this growth offers educational opportunities, it has also led to content redundancy, extended sessions, and a lack of audience engagement. The healthcare professionals (HCPs) have high academic expectations to be achieved in multiple domains, such as position, sustainability, promotions, and excellence in clinical practice; they also maintain scholarly, educational, and administrative responsibilities, and balancing these is highly challenging and may lead to emotional exhaustion and burnout, exacerbated by academic preparation for MC presentations. MCs have various advantages and disadvantages and require structural reforms to attract more participants and to be recognized as being of very high standards. Restructuring of MCs seems logical, and MCs must remain accessible, affordable, and academically oriented. CONCLUSION: MCs offer learning, innovations, professional networking, and knowledge and experience sharing, while at the same time needing to be more inclusive, ethical, cost-effective, and image-building opportunities. Associated risks of exhaustion, sleep deprivation, burnout, and financial constraint necessitate restructuring of MCs.
Respiratory Examination for Postgraduate Residents: Unrevealing Expert's Questions and Answers.
Rai DK, Vora A, Ish P … +1 more , Mittal S
J Assoc Physicians India · 2026 Apr · PMID 42003154 · Publisher ↗
Physical examination is pivotal for getting a clue about the disease and making a provisional diagnosis. The respiratory examination is considered to be one of the toughest systemic examinations by undergraduate and post...
Physical examination is pivotal for getting a clue about the disease and making a provisional diagnosis. The respiratory examination is considered to be one of the toughest systemic examinations by undergraduate and postgraduate residents. No well-defined literature is available regarding the ideal method and interpretation of respiratory examination findings. There are many questions asked by experts that are hardly found in the literature. This review included a total of 30 important questions and the best possible answers, including expert questions from top institutes that are important for respiratory examination and would help all students (MBBS/MD/DNB/DM) to excel in their practical examination.
Modern Device-based Renal Denervation Approach for the Management of Uncontrolled Hypertension.
Gopi A, Rao S, Sinha N … +3 more , Mehta N, Nadkar M, Tiwaskar M
J Assoc Physicians India · 2026 Apr · PMID 42003153 · Publisher ↗
Uncontrolled hypertension can result from untreated high blood pressure (BP) or the inefficacy of established antihypertensive therapeutic regimens. Renal denervation (RDN) is a nonpharmacologic catheter-based interventi...
Uncontrolled hypertension can result from untreated high blood pressure (BP) or the inefficacy of established antihypertensive therapeutic regimens. Renal denervation (RDN) is a nonpharmacologic catheter-based intervention that achieves targeted renal sympathetic nerve ablation to modulate sympathetic activation. RDN is suitable for those with uncontrolled primary hypertension, resistant to therapy or intolerant to drugs, and who have a favorable renal artery anatomy. Long-term data demonstrate RDN's efficacy in significantly reducing elevated BP. RDN procedures have shown a good safety profile, and no significant difference in adverse events has been reported between RDN-treated and control groups in most clinical trials. Thus, RDN offers an effective and safe approach for sustained BP control.
Neck Circumference: A Screening Tool for Predicting Metabolic Syndrome in Obese Children.
Thiagarajan S, Tharanidharan SP
J Assoc Physicians India · 2026 Apr · PMID 42003152 · Publisher ↗
BACKGROUND: In recent days, neck circumference (NC) has been suggested as a screening technique for overweight individuals because it is easy to measure, does not require instruments such as a stadiometer or weighing sca...
BACKGROUND: In recent days, neck circumference (NC) has been suggested as a screening technique for overweight individuals because it is easy to measure, does not require instruments such as a stadiometer or weighing scale, and does not require calculations as in body mass index (BMI). Moreover, NC correlates with many fat-related anthropometric measurements and cardiovascular risk factors. AIMS: The objective of this study was to find the association of higher NC with metabolic syndrome (MetS), insulin resistance (IR), and other metabolic complications. SETTINGS AND DESIGN: Tertiary care teaching hospital, cross-sectional study. METHODS AND MATERIALS: A total of 211 overweight and obese children aged between 5 and 13 years were recruited. Anthropometric parameters such as weight, height, NC, and waist circumference (WC) were measured. Fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, aspartate transaminase (AST), and alanine transaminase (ALT) were estimated. Homeostasis model assessment of insulin resistance (HOMA-IR) and MetS were derived. STATISTICAL ANALYSIS USED: Independent -test and Chi-square analysis were applied for continuous and categorical variables, respectively, to find the association. RESULTS: Out of 79 children in the high-NC group, 11 had MetS, whereas only 4 had MetS in the low-NC group of 132 children, which was statistically significant (X = 8.87; = 0.003). Logistic regression analysis showed a significant association between high neck circumference and waist circumference ( = 0.00; AOR = 1.164). CONCLUSIONS: High NC reflects high BMI and can predict MetS in overweight and obese children.
A Study Comparing Tuberculosis-related Stigma in Healthcare Providers and Receivers.
Abbas Ali M, Bhavana S, Induri V … +2 more , Khan I, Valluri P
J Assoc Physicians India · 2026 Apr · PMID 42003151 · Publisher ↗
BACKGROUND: Global efforts to reduce tuberculosis (TB) are severely hampered by stigma. With a high number of TB infections, India struggles with the widespread stigma surrounding the illness, which makes it difficult to...
BACKGROUND: Global efforts to reduce tuberculosis (TB) are severely hampered by stigma. With a high number of TB infections, India struggles with the widespread stigma surrounding the illness, which makes it difficult to diagnose and treat patients promptly. To shed light on an important but often ignored component of TB management, we calculate the prevalence of TB-related stigma and variability in the manifestation in different groups. METHODS: After calculating the sample size, we stratified them into different groups: patients with TB, healthcare workers providing TB services, and family members living with the patients. A validated, predesigned questionnaire was employed to assess stigma across various domains. MS Excel was used to compile the data, and Epi Info 7 to analyze it. RESULTS: Health professionals made up the largest percentage of those who experienced stigma (11.78%), followed by family members (8.91%), and patients (6.05%). The association of stigma with different groups of study participants was statistically significant, implying that stigma exists variably in the other groups. The majority of the patients (3.50%) perceived stigma at their home, whereas the majority of the family members faced stigma in the community (5.41%). Healthcare workers face stigma majorly in the community (7.96%). CONCLUSION: Stigma related to TB lays its foundation in varied perceptions by society. Societal norms determine acceptable and undesirable behaviors. Our study reveals major roadblocks on the way to TB eradication in the country and reveals a picture that can be extrapolated to most communities throughout. Aiming to reduce stigma will, in turn, improve treatment-related outcomes in TB and pave the way for smoother management and eradication.
Risk of Tuberculosis with the Use of Inhaled Corticosteroids in Delhi/NCR.
Kurri N, Chitkara S, Gadpayle A
J Assoc Physicians India · 2026 Apr · PMID 42003150 · Publisher ↗
BACKGROUND: Tuberculosis (TB) is a global health concern caused by Mycobacterium tuberculosis, primarily affecting the lungs. In addition to TB, chronic respiratory conditions like Chronic Obstructive Pulmonary Disease (...
BACKGROUND: Tuberculosis (TB) is a global health concern caused by Mycobacterium tuberculosis, primarily affecting the lungs. In addition to TB, chronic respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) and asthma are becoming more prevalent globally. Inhaled corticosteroids (ICS) are commonly used for COPD and bronchial asthma management, but some recent studies suggest a potential association between ICS usage and an increased risk of TB, raising concerns that they may lower lung immunity and enhance tuberculosis infection. AIMS AND OBJECTIVES: This research study was performed with an aim to investigate whether there is a link between inhaled corticosteroids (ICS) use and the risk of developing tuberculosis (TB) in COPD patients. The primary objective is to study whether the use of inhaled corticosteroids increases the risk of tuberculosis infection. The secondary objective is to compare the risk of TB in vulnerable populations with underlying comorbidities using inhaled corticosteroids. MATERIALS AND METHODS: This is an observational, analytical study conducted over 2 months in patients with COPD who have been receiving inhaled corticosteroids for more than 2 years. RESULTS: A total of 97 COPD patients on ICS were recruited and categorized into TB ( = 4) and non-TB ( = 93) groups based on final outcomes. The mean ICS duration for the non-TB and TB groups was 24.8 and 48.0 months, respectively. CONCLUSION: Despite being on ICS for more than 2 years, there was no significant correlation between ICS usage and TB infection. However, the study highlighted the significance of a prior TB history as a risk factor for increased reactivation (p < 0.001). Additionally, anemia was observed in reactivated TB cases, suggesting potential implications for identifying underlying chronic diseases in COPD patients.
Effects of Omega-3 Fatty Acids on Tobacco Craving in Tobacco Users: A Single-blind, Randomized, Placebo-controlled Study.
Singh A, Verma N, Kant S … +3 more , Verma AK, Tripathi A, Bhardwaj K
J Assoc Physicians India · 2026 Apr · PMID 42003149 · Publisher ↗
BACKGROUND: Tobacco use and its smoke produces oxidative stress in the body, which eventually triggers cell damage by lipid peroxidation. Smokers report lower levels of omega-3 fatty acids (FAs) in their serum as compare...
BACKGROUND: Tobacco use and its smoke produces oxidative stress in the body, which eventually triggers cell damage by lipid peroxidation. Smokers report lower levels of omega-3 fatty acids (FAs) in their serum as compared to nonsmokers. Omega-3 deficiency impairs neurotransmission, resulting in hypofunctioning of the mesocortical system, which is a reward and dependency system that can raise tobacco cravings, disrupting tobacco quitting efforts. Omega-3 polyunsaturated fatty acid (PUFA) regulates stress, anxiety, and negative emotions that are associated with tobacco urges. Limited research has assessed the supplementation effect of omega-3 PUFA [in the form of alpha-linolenic acid (ALA)] on tobacco craving. AIM: We aimed to explore the effects of omega-3 PUFA (ALA) on the frequency of tobacco use per day, tobacco dependence, and tobacco craving when compared to placebo in regular tobacco users. MATERIALS AND METHODS: Regular tobacco users ( = 83) recruited from the Tobacco Cessation Clinic were randomly allocated to two groups. Group I was the omega-3 PUFA group, supplemented with 10 mL/day of omega-3 PUFA in the form of ALA (5.1 gm) for 180 days, and the other group received a placebo for the same duration. The outcome was evaluated by means of a case record form (for demographic parameters), self-reports of tobacco use (for frequency of tobacco use per day), as well as psychometric measures (for tobacco dependence and tobacco craving). The evaluations were carried out at baseline and after 180 days of intervention. RESULTS AND CONCLUSION: The frequency of tobacco use per day, tobacco dependence, and tobacco craving were found to be significantly decreased (p < 0.0001) in the group receiving omega-3 PUFA (ALA) at the end of supplementation. This is a novel approach that ALA supplementation reduces tobacco cravings in regular tobacco users in comparison to a placebo. Thus, omega-3 FAs may be an adjuvant tool in quitting tobacco use by reducing nicotine dependence and tobacco craving. Further studies are necessary with large samples to understand the possible association and explore the probable nonpharmacological approaches for tobacco cessation.
Examination and Validation of Neutrophil-Lymphocyte Ratio as a Perioperative Risk Assessment Biomarker in Major Noncardiac Surgical Patients: An Observational Cross-sectional Study.
Nangalia S, Dasgupta S, Choudhury A … +1 more , Pathak KK
J Assoc Physicians India · 2026 Apr · PMID 42003148 · Publisher ↗
BACKGROUND AND AIMS: Neutrophil-lymphocyte ratio (NLR) can predict prognosis of disease in patients suffering from cerebrovascular accidents, ischemic heart disease, infectious diseases, sepsis, etc., that can cause incr...
BACKGROUND AND AIMS: Neutrophil-lymphocyte ratio (NLR) can predict prognosis of disease in patients suffering from cerebrovascular accidents, ischemic heart disease, infectious diseases, sepsis, etc., that can cause increased postoperative morbidity and prolonged stay in hospital. So, NLR can be a potential preoperative risk assessment and stratification biomarker. Our study aims to estimate any correlation between preoperative NLR and coexisting medical and surgical disease and to validate NLR against American Society of Anesthesiologists Physical Status (ASA PS) Classification System, Revised Cardiac Risk Index (RCRI), Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, and Gupta's postoperative respiratory failure risk in Indian patients. MATERIALS AND METHODS: This observational, cross-sectional study was conducted in the preanesthesia check-up clinic. Information regarding sociodemographic profile, primary surgical disease, hematological investigations, that is, complete blood count, neutrophil count, lymphocyte count, NLR, and coexistent medical disease was collected, and ASA PS, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk were calculated for each study subject. Data were analyzed using standard statistical tests. RESULTS: Age, congestive cardiac failure, smoking, malignancy, and beta blockers usage were associated with elevated NLR. NLR was found to have a significant relationship with anesthesia risk indices: ASA PS, RCRI, ARISCAT, and Gupta's postoperative respiratory failure risk. CONCLUSION: Significant association has been observed between increased NLR and occurrence of systemic illness. NLR also has a significant association with ASA PS Classification System, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk. So, NLR may serve as a valuable biomarker in preoperative risk stratification.
A Clinical Profile of Transverse Myelitis with Special Reference to Outcomes: A 5-Year Retrospective Study.
Pendem H, Sureddy D, Dhanaraj M
J Assoc Physicians India · 2026 Apr · PMID 42003147 · Publisher ↗
INTRODUCTION: Transverse myelitis (TM), a rare inflammatory condition affecting the spinal cord, presents with a rapid onset of bilateral motor and sensory symptoms with or without bladder/bowel and sexual dysfunction. R...
INTRODUCTION: Transverse myelitis (TM), a rare inflammatory condition affecting the spinal cord, presents with a rapid onset of bilateral motor and sensory symptoms with or without bladder/bowel and sexual dysfunction. Recent studies are attempting to identify its improvement, worsening, or conversion to multiple sclerosis, and the factors that determine these outcomes. The present study aims to assess the immediate and long-term outcomes of TM and to determine the factors associated with them. MATERIALS AND METHODS: The study involved a retrospective review of hospital records of 30 patients diagnosed with TM between 2018 and 2022, followed by a telephonic interview to assess their present outcomes. RESULTS: Median age of the patients was 40 years [Interquartile range (IQR) = 30-48.5], with 53% males. About 76.7% had longitudinally extensive transverse myelitis (LETM). Onset was acute in 63.3%. Half (50%) of the patients had paraparesis. MRI spine showed involvement of the long segment in 65.5% and the short segment in 24.1%. At the end of treatment, 43.3% patients improved partially, and 16.7% improved completely. At follow-up, nearly 30% of the respondents reported complete recovery, while 8.3% reported worsening. One patient (3.33%), with an acute onset of TM, quadriparesis, bowel involvement, sexual dysfunction, and long spinal segment involvement, converted to multiple sclerosis at follow-up. 25% of patients with initial partial improvement showed complete improvement at follow-up. CONCLUSIONS: Acute onset LETM cases can potentially convert to multiple sclerosis. Patients who show early improvement, whether partial or complete, have higher chances of complete recovery at follow-up.
Assessment of WHO Core Drug Use Indicators in a Government Teaching Hospital of Assam: Evidence from Prescription Audit Data.
Hazarika L, Saikia H, Saikia AL
J Assoc Physicians India · 2026 Apr · PMID 42003146 · Publisher ↗
BACKGROUND: With the rise of irrational drug prescriptions, leading to polypharmacy, increased health care costs, drug interactions, and risks of adverse drug reactions, irrational antibiotic prescribing, overuse of inje...
BACKGROUND: With the rise of irrational drug prescriptions, leading to polypharmacy, increased health care costs, drug interactions, and risks of adverse drug reactions, irrational antibiotic prescribing, overuse of injections, and hospitalization, it has become important to monitor drug use patterns. MATERIALS AND METHODS: With the objective to assess the drug use indicators of a government teaching hospital of Assam using WHO Core Drug Use Indicators, 700 prescriptions from OPDs of various specialties were assessed prospectively from the hospital dispensary and details of core drug use indicators were noted and analyzed for each in a proforma as per WHO recommendation on investigating drug use in health care facilities. Descriptive statistics were used thereafter to express the results. RESULTS: The WHO core prescribing indicators analysis revealed that the average number of drugs per encounter was 3.6. The percentage of drugs prescribed by generic name was 37%, with only 6% being injectable drugs; however, 39.14% of prescriptions included one or more antibiotics. Only 37% of the drugs prescribed were from the NLEM. CONCLUSION: This study highlights that only prescriptions involving injectable drugs were in accordance with WHO recommendations, while the other parameters exceeded the WHO-recommended values.
A Study on Electrocardiography Echocardiography and Cardiac Biomarkers in Aluminium Phosphide Poisoning and Their Prognostic Correlation.
Tiwari H, Sharma D, Sharda M … +2 more , Bishnoi D, Garg H
J Assoc Physicians India · 2026 Apr · PMID 42003145 · Publisher ↗
BACKGROUND: Aluminum phosphide (AlP) poisoning is a medical emergency with an alarmingly high mortality rate, primarily due to its rapid cardiotoxic effects. OBJECTIVE: To identify and evaluate key prognostic indicators-...
BACKGROUND: Aluminum phosphide (AlP) poisoning is a medical emergency with an alarmingly high mortality rate, primarily due to its rapid cardiotoxic effects. OBJECTIVE: To identify and evaluate key prognostic indicators-clinical, electrocardiographic, echocardiographic, and biochemical-in patients with AlP poisoning. MATERIALS AND METHODS: A cross-sectional observational study was conducted on 100 patients with confirmed AlP ingestion. ECG changes, cardiac biomarkers (troponin-I, CPK-MB, LDH, and CPK-NAC), 2D echocardiography findings, and acid-base disturbances were analyzed in relation to survival outcomes. RESULTS: ECG abnormalities and decreased ejection fraction were significantly associated with mortality. Elevated cardiac biomarkers and profound acidosis were strong independent predictors of poor prognosis. CONCLUSION: AlP poisoning causes critical cardiovascular compromise. Early identification of high-risk patients may guide aggressive intervention and resource allocation in intensive care settings.
Factors Contributing to COVID-19 Mortality In-hospital and after Discharge: Results of an Ambivalent Cohort Study from a Tribal District of Kerala, India.
Pariyarath C, Sharahudeen A, Balarajan NS … +8 more , Sunny SP, Joy BM, Ajith A, Valli R, Ajitha BK, Gladson V, Radhakrishnan C, Anish ST
J Assoc Physicians India · 2026 Apr · PMID 42003144 · Publisher ↗
INTRODUCTION: The morbidity and mortality burden of the COVID-19 pandemic was high in socioeconomically deprived areas. Identifying the factors associated with in-hospital mortality in such settings will help physicians...
INTRODUCTION: The morbidity and mortality burden of the COVID-19 pandemic was high in socioeconomically deprived areas. Identifying the factors associated with in-hospital mortality in such settings will help physicians prioritize the scarce resources for the more needy individuals. OBJECTIVE: To study the demographic, clinical, and biochemical factors associated with in-hospital mortality in COVID-19 patients in Wayanad, Kerala, India. We also report the incidence of post-COVID symptoms and the mortality rate in the survivors of COVID-19 pneumonia. MATERIALS AND METHODS: The study design was a record-based retrospective cohort, and the study participants were 402 patients admitted with moderate to severe COVID-19 at the secondary care hospital of Wayanad, Kerala, India, during late 2020 and early 2021. In-hospital mortality was the major outcome variable, and we expressed the mortality risk in terms of relative risks (RRs). Factors associated with the same were assessed using Chi-square, Fisher's exact tests, and -tests depending upon the type of exposure variable. Dose-response relationships were assessed using Chi-square for trend. A subgroup of consented survivors ( = 156) was followed to study the post-COVID symptoms and mortality rate outside the hospital. We constructed binary logistic models to find out the independent predictors of mortality. RESULTS: The patient group ( = 402) was composed of individuals aged 18-95 years, and two-thirds ( = 258) were men. The in-hospital mortality rate was 17.7%. The risk of mortality increased with age, multimorbidity, and extent of hypoxia, peripheral oxygen saturation/fraction of inspired oxygen [SpO/FiO (SF)] ratio, D-dimer, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), serum creatinine, and blood urea. The case fatality rate (CFR) had a dose-response relationship with the number of comorbidities. Out of the individual comorbidities analyzed, systemic arterial hypertension [RR = 1.5 (1.16-1.83)], cancer [RR = 4.7 (1.38-15.6)], and neurological disorders [RR = 5.8 (1.6-21.16)] were significantly associated with mortality in the hospital. According to the binary logistic regression analysis, age, hypoxia at the time of admission, intensive care unit (ICU) admission, serum creatinine, and SF ratio were the significant predictors of mortality. Most of the patients (73%) complained of some symptoms during follow-up. Easy fatigability and tiredness were the most common post-COVID symptoms, followed by exertional breathlessness, myalgia, decreased sleep, weight loss, and cough. CONCLUSION: The physician should prioritize patients with multimorbidity and markers of organ involvement to save lives in resource-poor settings during pandemics and large infectious disease outbreaks affecting the community. The early diagnosis and management of comorbidities should be included in pandemic or outbreak preparedness to reduce morbidity and mortality.
Effectiveness of Simulation Training on Students' Confidence and Competence in Performing Basic Life Support.
Mishra SK, Challagolla SL, Reddy JRN … +1 more , Dash S
J Assoc Physicians India · 2026 Apr · PMID 42003143 · Publisher ↗
BACKGROUND: Basic life support (BLS) is a critical skill for healthcare professionals. Traditional teaching approaches may not sufficiently ensure retention or practical proficiency. Simulation-based training offers a dy...
BACKGROUND: Basic life support (BLS) is a critical skill for healthcare professionals. Traditional teaching approaches may not sufficiently ensure retention or practical proficiency. Simulation-based training offers a dynamic learning environment with opportunities for practice and feedback. OBJECTIVES: This study aimed to assess the effectiveness of simulation-based BLS training in improving (1) competence and (2) confidence among undergraduate medical students. MATERIALS AND METHODS: A quasi-experimental pre/posttest design was employed with two parallel groups (simulation vs traditional lecture-based instruction). Sixty undergraduate medical students were recruited and randomly assigned. Competence was assessed using an objective structured clinical examination (OSCE)-based performance checklist. Confidence was measured via a validated Likert-scale questionnaire. Pre- and post-training evaluations were conducted. RESULTS: Simulation-trained students demonstrated significantly higher posttest competence scores ( < 0.05) and reported increased confidence ( < 0.05) compared to the control group. Within-group comparisons also showed significant improvement from pre- to posttest in both metrics for the simulation group. CONCLUSION: Simulation-based training significantly enhances students' competence and confidence in performing BLS. These findings support its integration into medical curricula to foster critical life-saving skills.
Comparison of qSOFA Score and NEWS2 Score in Sepsis Patients Admitted in Emergency Department and ICU as Prognostic Markers of Patient Outcome.
Anupam K, Sawlani KK, Yadav A … +4 more , Chaudhary SC, Usman K, Sharma A, Atam V
J Assoc Physicians India · 2026 Apr · PMID 42003142 · Publisher ↗
BACKGROUND: Sepsis causes high short-term mortality in emergency and ICU settings. Quick sequential organ failure assessment (qSOFA) and national early warning score 2 (NEWS2) are bedside tools for early risk stratificat...
BACKGROUND: Sepsis causes high short-term mortality in emergency and ICU settings. Quick sequential organ failure assessment (qSOFA) and national early warning score 2 (NEWS2) are bedside tools for early risk stratification, yet comparative evidence remains limited. OBJECTIVES: To compare qSOFA and NEWS2 for predicting 7-day and 28-day mortality and length of stay in adult sepsis patients. METHODS: This prospective observational study was conducted over 1 year (March 2024-February 2025) at a tertiary care center in northern India. A total of 874 patients aged 18-65 years admitted with sepsis were enrolled. On-admission qSOFA and NEWS2 scores were recorded. Outcomes included 7-day, 28-day mortality and length of hospital stay. RESULTS: Among 874 patients, NEWS2 showed higher sensitivity than qSOFA for 7-day (63.1% vs 35.1%) and 28-day mortality (64.1% vs 37.3%), with comparable specificity (~86%). Area under receiver operating characteristic curve (AUROC) values favored NEWS2 for 7-day (0.627 vs 0.606) and 28-day mortality (0.629 vs 0.609). CONCLUSION: In adults with sepsis, the NEWS2 score showed higher sensitivity and marginally better prognostic accuracy than qSOFA for predicting short-term mortality and hospital stay. NEWS2 may therefore serve as a more reliable bedside tool for early identification of high-risk patients in emergency and ICU settings.
Acute Pancreatitis beyond Gallstones and Alcohol.
Bagepally RS, Rampally V, Rao GS … +4 more , Donapati VR, Adi RK, Mannava AK, Reddy V
J Assoc Physicians India · 2026 Apr · PMID 42003141 · Publisher ↗
BACKGROUND: Acute pancreatitis (AP) is a potentially grave abdominal condition where the pancreas gets inflamed and is associated with variable regional and systemic involvement. The inflammatory state is usually charact...
BACKGROUND: Acute pancreatitis (AP) is a potentially grave abdominal condition where the pancreas gets inflamed and is associated with variable regional and systemic involvement. The inflammatory state is usually characterized by acute abdominal pain with concomitant increase in serum pancreatic enzymes. Investigative workup includes serum amylase, lipase, liver function tests, triglycerides, serum calcium, and parathyroid hormone (PTH) assay; imaging includes ultrasonography, computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP), and/or endoscopic ultrasound in some patients. AIM: To identify the etiology and frequency of nonalcoholic and nonbiliary causes of AP in a hospital scenario, and analyze the severity and outcome of the disease. MATERIALS AND METHODS: A prospective, observational, hospital-based study was conducted on 150 consecutive AP patients in the Department of Gastroenterology at Yashoda Hospitals, Secunderabad, India. A total of 150 consenting patients who were hospitalized consecutively with AP were included, and subjects with chronic pancreatitis were excluded. RESULTS: Overall, 150 patients were included; 117 (72.9%) were men, and 37 (27.1%) women. Alcohol was the most common etiological factor noted in 54 (36%), followed by biliary tract disease 45 (30%), idiopathic 21 (14%), hypertriglyceridemia 7 (4.67%), endoscopic retrograde cholangiopancreatography (ERCP)-related 3 (2%), infection-related 5 (3%), hyperparathyroidism 3 (2%), and drug-induced 8 (5.33%). The most common presentation was abdominal pain (98.6%). Organ failure and mortality were low in the nonalcoholic/nonbiliary cause of pancreatitis. CONCLUSION: AP in our study reports a significant number of nonalcoholic/nonbiliary causes. The current study showed that the mortality rate in nonalcoholic/nonbiliary cases was low. Despite low mortality in this group, there is a need to identify these causes and treat on an urgent basis for limiting the hospital stay.
An Attempt to Achieve Holistic Health by Improving Spiritual, Emotional, and Psychological Wellbeing: A Clinical Trial Using an Eastern Spirituality-based Intervention in Indian Context.
Pal A, Mukhopadhyay P, Chattopadhyay M
J Assoc Physicians India · 2026 Apr · PMID 42003140 · Publisher ↗
BACKGROUND AND AIMS: Spirituality is an important fourth dimension of health. Spiritual wellbeing is a subconstruct of spirituality and an important contributor to overall wellbeing. Health cannot be conceived as "holist...
BACKGROUND AND AIMS: Spirituality is an important fourth dimension of health. Spiritual wellbeing is a subconstruct of spirituality and an important contributor to overall wellbeing. Health cannot be conceived as "holistic" without including "spiritual wellbeing." The researchers attempt to look at the effects of an Eastern spirituality-based intervention on spiritual, emotional, and psychological wellbeing to achieve holistic health. METHODS: A total of 140 participants were randomized to attend either 6 "spirituality" sessions (1 session each week) or "usual care" pseudo sessions. The outcome parameters were measured pre- and postintervention. The spiritual wellbeing was measured by Spiritual Wellbeing Scale (SWBS) and WHO quality of life: spirituality, religiousness, and personal beliefs scale (WHOQOL-SRPB). Emotional wellbeing was measured by Depression, Anxiety, and Stress Scale (DASS-21), and psychological wellbeing by WHO-5 Wellbeing Scale. Repeated measures ANOVA tests were used for statistical analysis. RESULTS: The spirituality sessions improved the SWBS scores (treatment effect size: medium, ηp = 0.1253) and WHOQOL-SRPB scores (treatment effect size: small, ηp = 0.04952) significantly. In addition, DASS-21 scores: S stress (treatment effect size: medium, ηp = 0.09784), A anxiety (treatment effect size: medium, ηp = 0.08542), and D depression (treatment effect size: medium, ηp = 0.0761), and WHO-5 wellbeing scores (treatment effect size: medium, ηp = 0.112) also improved. CONCLUSION: An Eastern spirituality-based intervention improved the spiritual, emotional, and psychological wellbeing of Indian participants. Addressing spiritual wellbeing will help one toward achieving the goal of "holistic" health. Future studies will help to corroborate the results.
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