The Journal Of The Association Of Physicians Of India[JOURNAL]
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200 papers
Consensus Recommendations on Home Maintenance Nebulization with Focus on Obstructive Airway Diseases: An Update on Best Practices and Future Directions.
Guleria R, Salvi S, Ish P … +17 more , Vora AC, Ghoshal A, Saraf AA, Mukhopadhyay A, Taneja AK, Singh DP, Jash D, Mathur G, Satish K, Tewary K, Tiwaskar M, Nadkar MY, Abhyankar N, Singal RK, Dhar R, Maturu VN, Ramanathan RP
J Assoc Physicians India · 2025 Oct · PMID 41100338 · Publisher ↗
Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases (OADs) that contribute significantly to the burden on healthcare systems in low- and middle-income countries like India. Inhaler the...
Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases (OADs) that contribute significantly to the burden on healthcare systems in low- and middle-income countries like India. Inhaler therapy (primarily involving pressurized metered-dose inhalers and dry powder inhalers) remains the cornerstone of maintenance therapy; however, not all patients can use them effectively. Home maintenance nebulization (HMN) has been increasingly used as an alternative in appropriately identified patients, particularly those with advanced disease, physical or cognitive limitations, or suboptimal inspiratory flows. This expert consensus is an update from the 2017 recommendations, which provide evidence-informed recommendations on the use of HMN in OADs. By incorporating recent research findings and clinical expertise, the updated consensus , optimizes therapeutic protocols, and supports healthcare providers in delivering high-quality, patient-centered care. It is aimed at aiding clinicians involved in the management of OADs, including asthma and COPD, and evaluating the suitability of nebulization therapy as long-term maintenance treatment in home care settings.
Leveraging Artificial Intelligence Tools to Bridge the Healthcare Gap in Rural Areas in India.
Kerketta A, Balasundaram S
J Assoc Physicians India · 2025 Oct · PMID 41100337 · Publisher ↗
BACKGROUND: Rural areas continue to grapple with a lack of access to healthcare despite the development of technologies like telehealth, artificial intelligence (AI), virtual and mixed reality, nanotechnology, and roboti...
BACKGROUND: Rural areas continue to grapple with a lack of access to healthcare despite the development of technologies like telehealth, artificial intelligence (AI), virtual and mixed reality, nanotechnology, and robotics. However, there are encouraging ways to get beyond these obstacles with the advent of AI tools. To close the healthcare gap in rural India, the research explores the viability and effectiveness of implementing AI solutions. METHODS: A scoping review was used in the study to help define its objectives and parameters as well as to examine the efficacy and potential of AI tools in bridging the gap in rural healthcare. The information was taken from a number of databases such as PubMed, ScienceDirect, and Google Scholar that contained English-language publications from January 2020 to December 2023. The data were recorded and screened with the help of electronic data processing software called "Rayyan," and the results were displayed thematically. FINDINGS: The study shows how AI-driven solutions could be used to address and overcome healthcare access gaps, highlighting the potential for implementing AI technologies in rural healthcare settings. In order to successfully incorporate AI tools, the report also identifies barriers to their acceptance in rural healthcare and suggests joint efforts by healthcare providers, policymakers, and technology developers. In order to adopt AI in rural areas, this study requires supporting investments in capacity-building programs, digital infrastructure, and supportive legislative frameworks. CONCLUSION: The paper emphasizes how AI is transforming healthcare in rural India and closing the gap in access. Healthcare professionals and legislators can overcome obstacles, provide local healthcare staff with better infrastructure, and enhance health outcomes for rural regions by utilizing AI technologies. The conclusions and suggestions help to advance the body of knowledge on using AI to provide appropriate healthcare, which will direct similar projects in the future.
Unveiling the Complexities of Rheumatoid Arthritis: A Comprehensive Pathoepidemiological Review.
Raj N, Rautela A, Gupta RK … +4 more , Singh R, Singh M, Agarwal J, Garg J
J Assoc Physicians India · 2025 Oct · PMID 41100336 · Publisher ↗
Rheumatoid arthritis (RA) is a common autoimmune disorder characterized by inflammation in the joints, affecting around 0.24-1% of the population. RA can develop through a variety of paths, resulting in a nonspecific cli...
Rheumatoid arthritis (RA) is a common autoimmune disorder characterized by inflammation in the joints, affecting around 0.24-1% of the population. RA can develop through a variety of paths, resulting in a nonspecific clinical appearance. It progresses from preclinical to chronic disease, with pathogenic mechanisms that may differ across people, confounding therapy efforts. Numerous factors have been found to be associated with RA, including lifestyle-related risk factors like smoking and obesity, which are modifiable, as well as advancing age and female gender, which are nonmodifiable. RA pathophysiology is an intricate interaction between different genetic and immunological variables resulting in disease progression. With a better knowledge of the pathophysiology of RA, new therapeutic approaches are being developed for effective management of RA. This review article summarizes epidemiology, pathogenesis, and diagnostic options for RA.
Optimizing Proton-pump Inhibitor Therapy in Patients with Comorbidities Receiving Polypharmacy Treatment: Insights from Clinical Practice in India.
Juneja HT, Gambhir S, Junaidy KH
J Assoc Physicians India · 2025 Oct · PMID 41100335 · Publisher ↗
BACKGROUND: The safety and efficacy of proton-pump inhibitors (PPIs) in gastroesophageal reflux disease (GERD) patients on polypharmacy is challenging to manage. Rabeprazole's unique metabolism reduces drug-drug interact...
BACKGROUND: The safety and efficacy of proton-pump inhibitors (PPIs) in gastroesophageal reflux disease (GERD) patients on polypharmacy is challenging to manage. Rabeprazole's unique metabolism reduces drug-drug interactions (DDI), making it beneficial for patients with polypharmacy. This study aimed to explore the safety and effectiveness of rabeprazole in Indian comorbid GERD patients on polypharmacy. METHODS: A cross-sectional survey was conducted (November, 2024 and January, 2025), which included healthcare professionals (HCPs) with experience in prescribing PPIs. The survey included 10 questions addressing issues faced in polypharmacy settings. RESULTS: Around 91.9% preferred prescribing rabeprazole over other PPIs in polypharmacy patients. CYP450 enzyme interactions are considered by 73.3% HCPs when prescribing PPIs, with a strong emphasis on minimizing DDI in polypharmacy contexts. Rabeprazole was chosen by a major share of HCPs for its unique nonenzymatic metabolism and minimal interaction with the cytochrome P450 system, suggesting suitability in polypharmacy patients. Furthermore, 70% HCPs suggested rabeprazole could improve cardiovascular (CV) outcomes by optimizing antiplatelet therapy, and 74.4% supported its safety in patients on antiplatelet therapy. CONCLUSION: Rabeprazole appears to be the preferred PPI in managing GERD among patients on polypharmacy, primarily due to its favorable safety profile and minimal DDI, and may be advantageous in clinical practice.
Review of Safety and Efficacy of Polmacoxib: A Novel Dual Inhibitor of Cyclo-oxygenase 2 and Carbonic Anhydrase in Osteoarthritis and Acute Painful Conditions.
Gunjal VS, Pawar RR, Sharma AD
J Assoc Physicians India · 2025 Oct · PMID 41100334 · Publisher ↗
Osteoarthritis (OA) is a chronic degenerative joint disorder and a leading cause of pain and disability among the elderly. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs), though effective in symptom relief, po...
Osteoarthritis (OA) is a chronic degenerative joint disorder and a leading cause of pain and disability among the elderly. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs), though effective in symptom relief, pose significant risks of gastrointestinal, cardiovascular, and renal complications, especially in long-term use. Polmacoxib (CG100649) is a newer NSAID with its dual inhibitory role on cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA), planned to offer higher therapeutic efficacy and safety. This review critically examines the pharmacodynamic and pharmacokinetic properties of polmacoxib, along with its clinical efficacy and safety in OA and acute pain conditions. Clinical trials across phases I-III consistently show polmacoxib to be well tolerated and effective in pain relief and efficient improvement of the joint, with a safety profile comparable to or better than traditional COX-2 inhibitors like celecoxib. Recent trials also explore its role in combination therapies for acute pain management, including dental and postoperative settings, showing noninferiority to standard regimens and fewer adverse events. Its innovative mechanism and pharmacological profile support its potential as a next-generation NSAID for OA and pain management, particularly in populations at high risk for NSAID-induced adverse effects. Further larger long-term studies are warranted to confirm its medical benefits and broader therapeutic applications.
Achieving Diabetes Remission: Current Guidelines and Emerging Pharmacotherapies in India.
Arpan, Singh N, Bali K … +1 more , Singh T
J Assoc Physicians India · 2025 Oct · PMID 41100333 · Publisher ↗
Type 2 diabetes mellitus (T2DM) remission has emerged as a critical area of research and clinical interest, especially in India, where diabetes prevalence is rising at an alarming rate. Achieving remission through pharma...
Type 2 diabetes mellitus (T2DM) remission has emerged as a critical area of research and clinical interest, especially in India, where diabetes prevalence is rising at an alarming rate. Achieving remission through pharmacologic, dietary, and surgical interventions is now an attainable goal for a subset of patients. This systematic review synthesizes evidence from clinical trials, emerging pharmacologic interventions, and current guidelines for diabetes remission. We explore the mechanisms of diabetes reversal, highlighting novel agents such as glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. This review also addresses the long-term sustainability of remission, epidemiological trends in India, and current treatment recommendations, integrating data from major studies. The findings underscore the need for a patient-centered, evidence-based approach to diabetes management. Additionally, we discuss the role of continuous glucose monitoring (CGM), dietary interventions, and the benefits of millet consumption in diabetes remission.
Fosfomycin Tromethamine: A Urinary Antibiotic.
Trailokya AA, Tiwaskar M
J Assoc Physicians India · 2025 Oct · PMID 41100332 · Publisher ↗
Urinary tract infection (UTI) is the second most common type of infection in the human body. It is one of the most prevalent conditions in medical practice, with approximately 150 million cases occurring globally each ye...
Urinary tract infection (UTI) is the second most common type of infection in the human body. It is one of the most prevalent conditions in medical practice, with approximately 150 million cases occurring globally each year. Approximately 50% of women will experience at least one episode of UTI during their lifetime, and between 20 and 40% will have recurrent episodes. The discovery of a broad-spectrum antibiotic, fosfomycin tromethamine, occurred in Spain in 1969 and is prominently used in the management of uncomplicated UTIs. As a phosphonic acid derivative, fosfomycin acts by disrupting bacterial cell wall synthesis by inhibiting the enzyme MurA, demonstrating effective activity against a wide variety of gram-negative and gram-positive pathogens, comprising multidrug-resistant strains such as and . Fosfomycin is not metabolized and is predominantly excreted unchanged in the urine through glomerular filtration. Mean peak urinary concentrations of fosfomycin ranging from 1053 to 4415 mg/L occur within 4 hours of administration of a single oral dose of fosfomycin tromethamine correspondent to fosfomycin 3 gm. Urinary concentrations >128 mg/L, which are adequate to inhibit most urinary pathogens, are maintained for 24-48 hours following a single oral dose of fosfomycin tromethamine. This makes it particularly advantageous for uncomplicated UTIs, where it offers a convenient and effective single-dose treatment option. Clinical trials and observational studies have consistently shown high cure rates and patient compliance, attributing this to its minimal side effects and broad-spectrum efficacy. A single oral dose of fosfomycin tromethamine, equivalent to 3 gm of fosfomycin, is indicated for treating acute uncomplicated lower UTIs in adults. It is classified as pregnancy category B. Various clinical guidelines, such as the Infectious Diseases Society of America (IDSA), European Association of Urology (EAU), and National Institute for Health and Care Excellence (NICE), also recommend fosfomycin tromethamine for the treatment of UTI. In conclusion, fosfomycin tromethamine remains a robust and indispensable antibiotic in the management of uncomplicated UTIs, with a distinct pharmacological profile that ensures both efficacy and safety, and patient compliance due to its single-dose regimen.
Comparative Study of Deep Relaxation Technique and Aum Kara on Autonomic Nervous System Variables in Hypertensive Indians.
Chacko AK, Valsakumar A, Verghese S … +1 more , Shetty SP
J Assoc Physicians India · 2025 Oct · PMID 41100331 · Publisher ↗
BACKGROUND: Hypertension is a chronic condition that progressively worsens. Lifestyle modifications and antihypertensive medications are among the strategies recommended to manage it. Nonpharmacological interventions lik...
BACKGROUND: Hypertension is a chronic condition that progressively worsens. Lifestyle modifications and antihypertensive medications are among the strategies recommended to manage it. Nonpharmacological interventions like deep relaxation, Aum Kara chanting, and tuning have been found to help lower blood pressure, enhance cardiovascular function, reduce stress, and promote mental tranquility. This study examines the effects of Aum Kara and the deep relaxation technique (DRT) on autonomic variability in individuals with primary hypertension. METHODS: From a pool of 200 individuals screened for hypertension at SDM Hospital in Dharmasthala, 60 participants aged 25-50 were selected according to the study's inclusion and exclusion criteria. The enrolled participants were assigned to one of two groups: group 1 (DRT) or group 2 (Aum Kara) based on randomization tables. Each group underwent a 20-minute session, after which their data were evaluated. RESULTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) decreased immediately after the interventions in both groups. The Aum Kara group demonstrated a decrease in heart rate and the LF/HF ratio compared to the DRT group ( < 0.05). Specifically, in the Aum Kara group, LF decreased and HF increased, showing statistical significance in comparison to the DRT group. A significant difference was noted in all HRV components between the groups upon comparison. CONCLUSION: In the comparison of the two therapies' effects, Aum Kara chanting demonstrated a more significant immediate beneficial impact on the sympathovagal system balance compared to DRT.
Frailty and the Fall: Unveiling the Burden of Falls among the Elderly in the Urban Slums of Siliguri.
Pandey S, Mukherjee A, Bhattacherjee S … +1 more , Datta S
J Assoc Physicians India · 2025 Oct · PMID 41100330 · Publisher ↗
BACKGROUND: Falls among the elderly are a significant public health concern, particularly in socioeconomically disadvantaged urban settings. Beyond physical injuries, falls contribute to psychological effects such as fea...
BACKGROUND: Falls among the elderly are a significant public health concern, particularly in socioeconomically disadvantaged urban settings. Beyond physical injuries, falls contribute to psychological effects such as fear of falling, which may limit mobility and increase dependency. The concept of fall efficacy, or the confidence in performing daily activities without falling, has emerged as a key psychological indicator in understanding fall risk. However, limited data exist on these aspects among older adults living in urban slums in India. OBJECTIVES: To determine the prevalence of falls among older adults residing in urban slums of Siliguri, West Bengal, and to explore the association between fall efficacy and the occurrence of falls. METHODS: A descriptive cross-sectional study was conducted among 207 adults aged ≥60 years selected two-stage cluster sampling from 30 urban slum clusters in Siliguri. Data were collected a pretested, semi-structured questionnaire capturing sociodemographic information, medical history, fall episodes, and fall efficacy, assessed using the Fall Efficacy Scale (FES). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 with multivariable logistic regression to identify predictors of falls. RESULTS: The prevalence of falls in the past 6 months was 41.1%, and the distribution of falls was nearly equal between indoor and outdoor settings. Significant predictors of falls included advanced age [≥80 years; adjusted odds ratio (AOR) = 4.25], presence of comorbidities (AOR = 8.16), physical disabilities (AOR = 2.50), and residence in pucca houses (AOR = 3.38). Although higher concern about falling (as indicated by higher FES scores) was associated with increased fall risk (AOR = 1.88), the association was not statistically significant. CONCLUSION: Falls among the elderly in urban slums are prevalent and influenced by a complex interplay of age, health status, and living conditions. Integrating physical, environmental, and psychological interventions is critical for fall prevention among older adults, especially in underserved urban slums.
Bedside FibroScan as a Point-of-care Tool for Quantification for Cirrhosis: A Single-center Prospective Observational Study from Western India.
Shelke PR, Padole SV, Deshmukh P … +3 more , Lalge P, Patil SR, Ingole J
J Assoc Physicians India · 2025 Oct · PMID 41100329 · Publisher ↗
BACKGROUND: Cirrhosis, a major cause of global morbidity and mortality, necessitates early detection and accurate staging for optimal management. Traditional reliance on liver biopsy is being challenged by noninvasive te...
BACKGROUND: Cirrhosis, a major cause of global morbidity and mortality, necessitates early detection and accurate staging for optimal management. Traditional reliance on liver biopsy is being challenged by noninvasive techniques such as transient elastography (FibroScan), which measures liver stiffness to estimate fibrosis severity. The potential for FibroScan as a point-of-care (POC) tool supports rapid clinical decision-making in multiple clinical settings and scenarios. MATERIALS AND METHODS: A prospective observational study was conducted from December 2024 to February 2025 at a tertiary center in Western India, enrolling adult patients with suspected liver disease, metabolic risk factors, or excessive alcohol consumption. Liver fibrosis was assessed using the Echosense FibroScan mini+430 device, applying the Metabolic Dysfunction-Associated Steatohepatitis (MASH) scoring system (F0-F4). At least 10 valid liver stiffness measurements (LSM) were obtained per patient. Data analysis included -tests, analysis of variance (ANOVA), Chi-squared tests, and receiver operating characteristic (ROC) curve analysis for diagnostic accuracy. RESULTS: Of the 93 patients (mean age 52.3 years; 69.9% male), 41.9% had advanced fibrosis, and 30.1% demonstrated cirrhosis. Alcohol intake and diabetes were significantly associated with fibrosis stage ( = 0.002 and = 0.008, respectively). FibroScan showed excellent diagnostic accuracy for cirrhosis (AUROC = 0.91) and good accuracy for significant fibrosis (AUROC = 0.82); the optimal LSM cutoff for F4 was 12.5 kPa. Body mass index (BMI) correlated weakly but significantly with CAP values. CONCLUSION: Bedside FibroScan® offers a highly accurate, rapid, and noninvasive method for quantifying liver fibrosis and cirrhosis in clinical practice. Its integration into routine care could substantially improve management for patients at risk of liver disease.
Analysis of Anticancer Drugs Used to Treat Brain Cancer Using the Cheapest and Costliest Drugs in India: A Cost-comparison Health Economics Study.
Simon P, Krishna A, Baby NK … +3 more , Baruah P, Srinivasan S, Kuttykandathil JJ
J Assoc Physicians India · 2025 Oct · PMID 41100328 · Publisher ↗
BACKGROUND: Brain tumors are among the most aggressive malignancies requiring multimodal therapy, including chemotherapy. In India, where healthcare is predominantly financed out of pocket, the cost of anticancer medicat...
BACKGROUND: Brain tumors are among the most aggressive malignancies requiring multimodal therapy, including chemotherapy. In India, where healthcare is predominantly financed out of pocket, the cost of anticancer medications poses a significant barrier to treatment adherence. A wide disparity exists between the costliest branded drugs and their lower-cost alternatives, raising concerns about affordability and equity in care. This study aimed to perform a cost-minimization analysis (CMA) to quantify cost differences (CDs) among the most expensive, least expensive, and generic chemotherapy drugs used for brain tumor treatment. MATERIALS AND METHODS: This descriptive pharmacoeconomic study compared the costs of eight chemotherapy agents-temozolomide, procarbazine, lomustine, carmustine, vincristine, bevacizumab, irinotecan, and carboplatin. Drug prices were sourced from the Current Index of Medical Stores (CIMS) and government databases. Dosages were standardized based on average Indian adult body surface area (BSA). Cost metrics included CD, cost ratio (CR), and percentage cost variation (PCV). Regimen-wise costs were calculated per cycle and overall. RESULTS: Significant cost variation was observed across all formulations. Temozolomide 250 mg showed the highest fold difference (8.94×), while bevacizumab displayed a 3.3× difference. Adjuvant temozolomide over 12 months ranged from ₹32,220 (generic) to ₹3,90,000 (costliest brand). PCV values ranged from 27.7% (carboplatin) to over 700% (temozolomide). Most CDs were statistically significant ( < 0.05). CONCLUSION: This study highlights substantial pricing disparities in chemotherapy for brain tumors in India. Cost-effective alternatives can significantly reduce treatment-related financial toxicity. Incorporating pharmacoeconomic evidence into prescribing decisions is essential to improve equitable access to neuro-oncology care.
The Unexplored Link between Nailfold Capillaroscopy and Acanthosis Nigricans: A Cross-sectional Clinicodermoscopic Study.
Shete AP, Doshi BR, Goroshi M … +2 more , Jain JA, Ankad BS
J Assoc Physicians India · 2025 Oct · PMID 41100327 · Publisher ↗
INTRODUCTION: Acanthosis nigricans (AN), a commonly encountered condition in clinical practice, is linked with numerous systemic disorders. Currently, there is a dearth of literature on the correlation of clinical and de...
INTRODUCTION: Acanthosis nigricans (AN), a commonly encountered condition in clinical practice, is linked with numerous systemic disorders. Currently, there is a dearth of literature on the correlation of clinical and dermoscopic features of AN with nailfold capillaroscopy (NFC) changes. This study intended to evaluate patients with AN who have underlying microvascular complications as a consequence of metabolic diseases. OBJECTIVES: Primarily to study the association of clinical and dermoscopic findings of AN with NFC and to elucidate the spectrum of NFC changes in patients of AN. MATERIALS AND METHODS: This was a cross-sectional, hospital-based study with a sample size of 97. Clinical Burke's grading and dermoscopy were performed in clinically diagnosed AN patients. NFC was performed on all 10 fingernails. The fourth and fifth fingernails of each hand were considered for studying the association. RESULTS: NFC changes seen were tortuous, dilated, cross-linked, ramified capillaries, and dropouts. There was a positive association of clinical Burke's grading (-value = 0.002) and duration (-value = 0.003) of AN with dermoscopic features such as depth of sulci cutis, number of hyperpigmented dots, and shape of papillary projections. Tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN (-value < 0.05). Ramified and cross-linked capillaries showed a significant association with the duration of AN (-value < 0.05). CONCLUSION: Dermoscopy in AN showed gradation in changes corresponding to the clinical Burke's grading and duration. Ramified and cross-linked capillaries showed a significant association with the duration of AN, while tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN. The present study aids in the early detection of microvascular changes in AN, such as tortuous, ramified, and cross-linked capillaries, and proves helpful in referring the patient for screening of diabetic retinopathy and nephropathy at the earliest.
Prevalence of Cardiovascular Diseases in Young Human Immunodeficiency Virus-positive Patients in Western Uttar Pradesh.
Gautam S, Dhaka S, Mittal C … +3 more , Singh G, Verma S, Soni D
J Assoc Physicians India · 2025 Oct · PMID 41100326 · Publisher ↗
INTRODUCTION: Human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) is an important public health problem with almost 39.9 million people living with HIV (PLHIV) all over the world and 1.3 million ne...
INTRODUCTION: Human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) is an important public health problem with almost 39.9 million people living with HIV (PLHIV) all over the world and 1.3 million new cases being detected every year according to a report by the World Health Organization. Due to an increase in the treatment landscape for HIV-positive patients, a revolutionary transformation has occurred in the life expectancy of these people. HIV is a chronic viral infection that can cause suppression of the body's immune response, leading to inflammatory changes and elevation in markers of inflammation such as C-reactive protein (CRP), interleukin-6 (IL-6). These elevated inflammatory markers are associated with increased risk of atherosclerosis as well as cardiovascular diseases. METHODOLOGY: This was a cross-sectional observational study, which was conducted at LLRM Medical College. Sample size calculation was done, and considering inclusion and exclusion criteria, 100 patients were included for the study, and all the parameters (clinical, biochemical, radiological) were assessed. RESULTS: Out of 100 patients, almost half (53%) were in the 18-30 years age-group, and 47% were in the 31-40 years age-group. The male-to-female ratio was almost equal (45:55). The maximum patients in our study were graduates (42%), while only 5% were illiterate. The most common occupation in our study was semiskilled persons (38%). The most common electrocardiogram (ECG) finding was sinus tachycardia (27%), the second most common finding was low-voltage complexes, which were present in 10% of patients; diffuse ST-T changes were the third commonest finding (4%), while 54% of patients did not show any ECG abnormality. On echocardiography of the patients, 70% did not show any abnormality, while 12% had pericardial effusion, 7% had dilated cardiomyopathy (DCMP), 5% had concentric left ventricular hypertrophy (LVH) with left ventricular diastolic dysfunction (LVDD), 3% showed pulmonary hypertension, and 3% had grade 1 diastolic dysfunction. CONCLUSION: Cardiac abnormality was found in 30% of patients, which must be considered a risk factor for HIV patients. The most common cardiac abnormality was pericardial effusion, the cause of which should be investigated further for proper management of the patients. These results emphasize the importance of regular cardiovascular monitoring in HIV-positive patients.
Evaluation of Sepsis Outcomes Using SOFA, APACHE II, and SAPS Indices: A Retrospective Study in a Quaternary Care Hospital with Implications for Enhanced Mortality Prediction Models.
George M, Sriram DK, Rathakrishnan D … +3 more , Moka MK, Sahay MI, Jagadeeshwaran V
J Assoc Physicians India · 2025 Oct · PMID 41100325 · Publisher ↗
BACKGROUND: Sepsis is a leading cause of mortality globally, yet obtaining accurate population-level data remains challenging. According to a 2020 report, there were approximately 48.9 million cases of sepsis and 11 mill...
BACKGROUND: Sepsis is a leading cause of mortality globally, yet obtaining accurate population-level data remains challenging. According to a 2020 report, there were approximately 48.9 million cases of sepsis and 11 million sepsis-related fatalities worldwide, accounting for 20% of all deaths globally. This study aims to assess the diagnostic efficacy of patient evaluation in comparison with the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Simplified Acute Physiology Score (SAPS) indices, in a quaternary care hospital, and to analyze the impact of various clinical parameters and comorbidities on patient outcomes. MATERIALS AND METHODS: The study was conducted at Hindu Mission Hospital in Chennai and used a retrospective design to analyze septicemia patients' data from June 2018 to January 2020. The database included clinical presentation, vital signs, comorbidities, laboratory values, and septicemia features. Specimens underwent smear microscopic analysis of the mycobacterial culture. RESULTS: The study found that elevated SOFA and APACHE II scores, comorbidities, prompt antibiotic administration, and infection characteristics significantly impact sepsis patient outcomes, emphasizing the importance of timely intervention and comprehensive scoring systems. CONCLUSION: The study emphasizes the significance of a comprehensive approach to sepsis management, including early detection, prompt intervention, and managing comorbid conditions, and suggests future research should focus on accurate predictive models and personalized medicine approaches.
The Function of Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio in Assessing Disease Activity in Rheumatoid Arthritis Patients.
Mehta H, Dhaon P, Bohara S … +3 more , Tiwari S, Uraiya D, Verma R
J Assoc Physicians India · 2025 Oct · PMID 41100324 · Publisher ↗
AIM: To ascertain the function of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers in evaluation of disease activity in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS:...
AIM: To ascertain the function of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers in evaluation of disease activity in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS: This cross-sectional research was performed in a hospital and included 381 patients who met the 2010 ACR/EULAR criteria for RA. The clinical disease activity assessment (CDAI) was used to evaluate activity of disease in addition to demographic and disease-related variables. Based on preestablished CDAI cutoff values, the participants were categorized into four groups. For each patient, laboratory analysis included the following: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and complete blood count (CBC). The conventional procedure was followed in the appropriate computation of PLR and NLR. The four patient groups' NLR and PLR values were compared, and the relation among disease activity indices and NLR and PLR was investigated using Pearson correlation analysis. RESULTS: In patients, the mean PLR was 132.8 ± 127.7 and the mean NLR was 3.66 ± 2.6. Patients with low disease activity had a substantially lower mean PLR ( = 0.021) in comparison to those with higher disease activity. The mean NLR in relation to CDAI was not observed to be statistically significant ( = 0.69) across the four groups. While there was a weak positive association between PLR and the physician visual analog scale (VAS) ( = 0.22), patient VAS ( = 0.12), and CDAI ( = 0.17), there was no correlation among CDAI and specific disease indices with NLR, according to Pearson correlation analysis. CONCLUSION: PLR, but not NLR, may be an effective biomarker for evaluating the disease activity level in RA patients, particularly higher disease activity.
Assessment of Hemoglobinopathies in Antenatal Females.
Gore C, Agarwal M, Ratnakar P … +3 more , Deshpande H, Buch A, Dixit M
J Assoc Physicians India · 2025 Oct · PMID 41100323 · Publisher ↗
INTRODUCTION: Hemoglobinopathies, a group of inherited disorders characterized by abnormal hemoglobin (Hb) production or structure, pose significant health risks during pregnancy. This study aims to assess the prevalence...
INTRODUCTION: Hemoglobinopathies, a group of inherited disorders characterized by abnormal hemoglobin (Hb) production or structure, pose significant health risks during pregnancy. This study aims to assess the prevalence of hemoglobinopathies among antenatal females and establish guidelines for effective screening and management. MATERIALS AND METHODS: An observational cross-sectional study was conducted over 18 months at Dr DY Patil Medical College, Hospital and Research Centre, involving 800 antenatal women. Demographic data, medical history, and blood samples were collected for complete blood count (CBC) and Hb electrophoresis. Statistical analysis was performed using SPSS software. RESULTS: A study evaluated 800 antenatal females aged 20-39 years, with an almost equal distribution between age-groups 20-29 (49.23%) and 30-39 (50.77%) years. Peripheral blood smear analysis revealed 97.69% had microcytic hypochromic anemia, indicating a high prevalence of iron deficiency, while 2.31% exhibited normocytic normochromic anemia. Hb electrophoresis identified hemoglobinopathies in 1.72% of cases, with 1.53% cases identified as beta-thalassemia carriers, and 0.19% with sickle cell trait (SCT). Among the abnormal cases, beta-thalassemia (55.56%) was found to be the most common, followed by HbE heterozygous (11.11%), HbE homozygous (11.11%), and double heterozygous (11.11%), with a single case (11.11%) of sickle cell disease (SCD). Beta-thalassemia was the most prevalent hemoglobinopathy. CBC parameters showed significant variations among hemoglobinopathy types, with analysis of variance (ANOVA) -values of 0.0001 for Hb, mean corpuscular volume (MCV), and mean corpuscular Hb. These findings underscore the significance of microcytic hypochromic anemia and the relatively low prevalence of hemoglobinopathies in the antenatal population. DISCUSSION: The low prevalence of hemoglobinopathies in this region contrasts with higher rates reported elsewhere in India, indicating potential regional genetic factors. The predominant finding of microcytic hypochromic anemia underscores the urgent need for targeted interventions addressing iron deficiency in antenatal care. CONCLUSION: This study emphasizes the importance of routine screening for hemoglobinopathies in pregnant women, particularly in regions with known genetic predispositions. Increased awareness and follow-up molecular analysis are recommended for accurate diagnosis and management, ultimately improving maternal and fetal health outcomes. Future research should expand to larger, multicentric studies to further validate these findings.
A Cross-sectional Study of Medication Identification Patterns among Patients Attending the Medicine Outpatient Department in a Tertiary Hospital in Rural Gujarat.
Bhende P, Vadodaria DJ, Bhanderi DG … +2 more , Thacker BA, Patel UA
J Assoc Physicians India · 2025 Oct · PMID 41100322 · Publisher ↗
BACKGROUND: The number of people living with multiple chronic medical conditions has risen, and with it, the number of medications taken by them. In addition to adherence to medications, it is extremely important to corr...
BACKGROUND: The number of people living with multiple chronic medical conditions has risen, and with it, the number of medications taken by them. In addition to adherence to medications, it is extremely important to correctly identify the medications. Medication errors occur at all steps, with polypharmacy, low literacy, language barriers, old age, and lack of communication as contributing factors. Many of the patients may not be identifying medications themselves or may be doing so incorrectly. Hence, this study is aimed to check the methods used by patients to identify medications. MATERIALS AND METHODS: A total of 150 patients attending the outpatient department (OPD) of the medicine department were interviewed using a structured questionnaire, which had multiple-choice questions and one open-ended question. Sociodemographic data, level of education, data on type and number of clinical conditions, groups of medications taken, and methods used for identification of medications were collected. Statistical analysis was done using Stata 14.2. RESULTS: Most (85.33%) of the patients had a chronic medical condition, out of which 37.33% had two or more clinical conditions. Physical attributes of the tablets (60%) and packaging (39.33%) were used most commonly to identify medications. About 10.67% did not identify the medications themselves. Again 45.33% of the patients depended on the doctor's prescription for the dosing of medications. Patients felt that identification of medications would be easier if the content on packaging included indication, was written in the local language, and was in bold font. They also felt that healthcare professionals spending more time explaining would help them. CONCLUSION: Irrespective of the level of education, language known, and number of comorbidities, physical attributes and packaging were most commonly used to identify medications.
Usage of Guideline-directed Medical Therapy in Patients with Heart Failure and Reduced Ejection Fraction in a Tertiary Care Hospital.
George S, Selvaraj RJ, Satheesh S … +1 more , Karthikeyan B
J Assoc Physicians India · 2025 Oct · PMID 41100321 · Publisher ↗
OBJECTIVE: To assess the prevalence of guideline-directed medical therapy (GDMT) and identify reasons for nonprescription and dose optimization in heart failure patients with reduced ejection fraction (HFrEF) in a tertia...
OBJECTIVE: To assess the prevalence of guideline-directed medical therapy (GDMT) and identify reasons for nonprescription and dose optimization in heart failure patients with reduced ejection fraction (HFrEF) in a tertiary care hospital in southern India. METHODS: A cross-sectional study was conducted in a tertiary care hospital involving HFrEF patients. Patients with heart failure were categorized based on GDMT prescriptions. Reasons for nonprescription and suboptimal dosing were identified. RESULTS: The study included 102 HFrEF patients with a mean age of 54 ± 11.7 years, predominantly male (89%). Only 10.8% of patients received GDMT at optimal doses. Although 62% were on triple therapy, many had one or more medications at suboptimal doses. Additionally, 26% of patients were not prescribed all recommended drug classes. Notably, the majority of patients with renal impairment fail to receive triple therapy. Barriers identified included hemodynamic issues and renal dysfunction. CONCLUSION: GDMT adherence in HFrEF patients is significantly lower than expected, with only 10.8% receiving therapy at recommended doses. Key issues include suboptimal dosing and incomplete prescription of drug classes, influenced by patient-specific factors and systemic barriers.
Clinical Biochemical Profile and Outcomes of Cerebral Venous Thrombosis in Puerperal and Nonpuerperal Presentation: A Prospective Observation Study from Northwest India.
Kumar K, Dhankar K, Kumawat R
J Assoc Physicians India · 2025 Oct · PMID 41100320 · Publisher ↗
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare but treatable cause of stroke, predominantly affecting younger individuals, particularly women during the puerperal period. Despite increased recognition through adv...
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare but treatable cause of stroke, predominantly affecting younger individuals, particularly women during the puerperal period. Despite increased recognition through advanced imaging, clinical diagnosis remains challenging due to its diverse presentation and varying etiological factors. OBJECTIVE: To evaluate the clinical profile, etiological factors, treatment outcomes, and prognosis of CVT patients, with a focus on comparing puerperal and nonpuerperal cases in a tertiary care setting in Northwest India. MATERIALS AND METHODS: This prospective observational study included 80 adult patients diagnosed with CVT computed tomography venography (CTV) or magnetic resonance venography (MRV) over a 2-year period. Participants were categorized into male, puerperal female, and nonpuerperal female groups. Detailed clinical, laboratory, and radiological evaluations were performed. Modified Rankin Scale (mRS) was used to assess neurological outcomes. Statistical analyses were conducted using analysis of variance (ANOVA) and Chi-squared tests with significance at < 0.05. RESULTS: Puerperal females were younger than other groups. Common symptoms included headache (85%), seizures (45%), and focal deficits (47.5%). Hyperhomocysteinemia (65%) and vitamin B12 deficiency (51.25%) were prevalent, particularly among males and nonpuerperal females. Anemia was significantly more common in females. No significant difference was noted in clinical outcomes across groups. Poor prognosis was associated with Glasgow Coma Scale (GCS) <8, focal deficits, and low vitamin B12 levels. In-hospital mortality was 6.25%; 97% of survivors had favorable outcomes (mRS <3) at 3 months. CONCLUSION: CVT in Northwest India affects a significant number of males and nonpuerperal females. Nutritional deficiencies, particularly vitamin B12 and anemia, play a crucial role. Early diagnosis and appropriate anticoagulation therapy are critical for favorable outcomes.
Utility of CHADS-VASc Score in Predicting Contrast-induced Nephropathy in Patients with Acute Myocardial Infarction Following Percutaneous Coronary Angiography: A Cross-sectional Study in South India.
Bhat RR, Kulkarni A, Hegde AV … +2 more , Shaikh AM, Suhail MK
J Assoc Physicians India · 2025 Oct · PMID 41100319 · Publisher ↗
BACKGROUND: Contrast-induced nephropathy (CIN) is an iatrogenic impairment to the kidneys that can occur in susceptible persons after intravascular injections of contrast agents. Individuals undergoing percutaneous coron...
BACKGROUND: Contrast-induced nephropathy (CIN) is an iatrogenic impairment to the kidneys that can occur in susceptible persons after intravascular injections of contrast agents. Individuals undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) often bear the risk of developing CIN. The likelihood of CIN can be predicted using several techniques, although none of them are very accurate. CHADS-VASc score is used to predict unfavorable clinical outcomes in patients with ACS and atrial fibrillation. The score comprises preprocedural variables and is simple to calculate and can be used for predicting CIN. This study aims to validate CHADS-VASc score to predict occurrence of CIN among patients undergoing PCI. MATERIALS AND METHODS: This cross-sectional research has been carried out at a tertiary care hospital. The study comprised a total of 182 patients who were admitted with ACS and underwent PCI. CIN incidence was computed. The study population was divided into two groups (the CIN group and the non-CIN group) based on the incidence of CIN. The CHADS-VASc score was computed for every patient. The best cutoff values of the CHADS-VASc score to predict the development of CIN were found using receiver operating characteristic (ROC) curve analysis. The incidence of CIN was computed both above and below the CHADS-VASc score's optimal cutoff point. RESULTS: The incidence of CIN among patients undergoing PCI was 14.3%, and the ROC value for the CHADS-VASc score was 0.896. Statistically significant increases in the incidence of CIN were observed in patients undergoing PCI who had a CHADS-VASc score of >2. Additionally, a significant relationship was discovered between CIN and age, diabetes, hypertension, prior coronary artery disease (CAD), and Killip class ≥2. CONCLUSION: Patients with CHA2DS2-VASc score of >2 had higher incidence of CIN. CHA2DS2-VASc score was found to be useful in predicting contrast nephropathy among patients with acute myocardial infarction undergoing angiography.
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