The Journal Of The Association Of Physicians Of India[JOURNAL]
Sun
200 papers
A Rare Occurrence of Microscopic Polyangiitis and Aortitis.
Sahai A, Bhasin A, Gopinath C … +2 more , Anand G, Singal RK
J Assoc Physicians India · 2026 Mar · PMID 41818111 · Publisher ↗
We present a case of a 60-year-old male with a fever of unknown origin (FUO) who was ultimately diagnosed with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)-associated microscopic polyangiitis (MPA) and aort...
We present a case of a 60-year-old male with a fever of unknown origin (FUO) who was ultimately diagnosed with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)-associated microscopic polyangiitis (MPA) and aortitis. This case underscores the diagnostic intricacies and therapeutic challenges of managing such rare and severe multisystem involvement. It also highlights the critical importance of clinician awareness for prompt recognition and effective management of similar presentations.
Complicated Kartagener Syndrome Presenting as Type II Respiratory Failure: A Case report.
Gupta P, Chaurasia AK, Gupta SK
J Assoc Physicians India · 2026 Mar · PMID 41818110 · Publisher ↗
We report a case of a 22-year-old male who was previously treated for asthma from childhood, and his repeated respiratory infections prompted the physician to start antitubercular therapy (ATT) thrice, suspecting pulmona...
We report a case of a 22-year-old male who was previously treated for asthma from childhood, and his repeated respiratory infections prompted the physician to start antitubercular therapy (ATT) thrice, suspecting pulmonary tuberculosis despite being sputum acid-fast bacillus (AFB) negative every time. Diagnosis of Kartagener syndrome (autosomal recessive inheritance having a triad of bronchiectasis, chronic sinusitis, situs inversus, and strongly associated with infertility) was made in this case at our tertiary care referral hospital, but it was already too late when he presented with life-threatening bilateral pneumonia, bilateral pleural effusion with type II respiratory failure, and associated cystitis warranting mechanical ventilation, and he succumbed because of extremely and irreversibly damaged lungs.
iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity: Focus on Prevention and Treatment of Cardiometabolic Disease.
Anker SD, Ji L, Kindel T … +59 more , Coats AJ, Ojji D, Barragán AP, Rossing P, Zieroth S, Ahmad S, Usman S, Appannah G, Bailey AL, Bennis A, Brandao A, Butler J, Davies MJ, Fabryova L, Guo YL, Itoh H, Jadhav UM, Le Roux CW, Pinto FJ, Rosenstock J, Saboo B, Sabbour H, Tiwaskar M, Watson KE, Wei Tham K, Wyss FS, Abhayaratna WP, Abraham WT, Al Mahmeed W, Argirò A, Atherton JJ, Belardo D, Campuzano R, Chatterjee N, Chopra V, Cornier MA, Davies S, de Rueda Panadero C, Dzudie A, Gluckman TJ, Khan MS, Khunti K, Lopatin Y, Ma Z, Ogah OS, Oomman A, Lopez ESP, Li P, Poirier P, Redfern J, Rosano GM, Saraf A, Shaheen S, Verma S, von Haehling S, Zhang Y, Gulati M, Sattar N, Zamorano JL
J Assoc Physicians India · 2026 Mar · PMID 41818109 · Publisher ↗
There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints, and diverse local practices restrict their global applicability. This und...
There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints, and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and-most importantly-also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such "economic adjustment" recommendations aim to guide situations when "Resources are somewhat limited" or when "Resources are severely limited." Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.
Letter to the Editor Regarding "A Clinicoradiological and Bacteriological Profile of Community-acquired Pneumonia in a Tertiary Care Center in Eastern India".
Anand A, Nilgiri M
J Assoc Physicians India · 2026 Mar · PMID 41818108 · Publisher ↗
Abstract loading — click title to view on PubMed.
Semaglutide Hype or Hope: Evidence-based Review in Diabesity.
Gupta S, Makkar BM, Kesavadev J … +1 more , Kumar A
J Assoc Physicians India · 2026 Mar · PMID 41818107 · Publisher ↗
India is struggling with the twin epidemics of diabetes and weight issues, holding the second position globally in the former and third in the latter. Despite multiple advancements with therapies that offer glycemic cont...
India is struggling with the twin epidemics of diabetes and weight issues, holding the second position globally in the former and third in the latter. Despite multiple advancements with therapies that offer glycemic control and weight benefits, there has remained a gap for a comprehensive drug for the management of "diabesity." Semaglutide, since its global approval in 2017, has become a blockbuster, owing to the popularity of "Ozempic." While Ozempic has been traditionally approved for glycemic control in type 2 diabetes mellitus (T2DM), it does offer significant other benefits powerful weight loss, cardiovascular benefits, renal protection benefits, and functional improvement in peripheral arterial disease. The drug is approved in India for first-line use in adults with T2DM as an adjunct to diet and exercise. The long use of semaglutide globally and in India has ensured adequate data on efficacy and safety, ensuring confidence and trust. Gastrointestinal side effects are the most common adverse events seen with the molecule, as with other GLP-1 drugs. This review highlights the global clinical data and practicalities of the use of Ozempic in diabesity in the Indian context.
The Essential Role of Bedside Training in Undergraduate Medical Education: A Systematic Review.
Mathew C, Mathew JC, Philip SS
J Assoc Physicians India · 2026 Mar · PMID 41818106 · Publisher ↗
This systematic review examined the role of bedside teaching (BST) in undergraduate medical education, focusing on its impact on clinical competence and professional growth. The review included 15 studies that investigat...
This systematic review examined the role of bedside teaching (BST) in undergraduate medical education, focusing on its impact on clinical competence and professional growth. The review included 15 studies that investigated the effects of BST on physical examination skills, diagnostic abilities, communication skills, and confidence among medical students. The results showed that BST significantly improved physical examination skills, diagnostic abilities, and communication skills, and increased confidence among students. BST was also found to enhance empathy and professionalism among students. However, the review highlighted several challenges in implementing BST, including time constraints, lack of trained faculty, and declining opportunities for BST. To address these challenges, the review recommended integrating BST into the medical curriculum, providing faculty development programs, and utilizing technology-enhanced learning tools. The findings of this systematic review underscore the importance of BST in undergraduate medical education, emphasizing its potential to enhance clinical competence and professional growth among future healthcare professionals.
Happy Heart Syndrome: A Review of Takotsubo Cardiomyopathy Triggered by Positive Emotional Stressors.
Garg R
J Assoc Physicians India · 2026 Mar · PMID 41818105 · Publisher ↗
Takotsubo cardiomyopathy, or "broken heart syndrome," is a condition characterized by transient left ventricular dysfunction, typically triggered by intense emotional or physical stress. While initially thought to follow...
Takotsubo cardiomyopathy, or "broken heart syndrome," is a condition characterized by transient left ventricular dysfunction, typically triggered by intense emotional or physical stress. While initially thought to follow primarily negative life events, such as grief or fear, a subset of cases now recognized as "happy heart syndrome" occur instead after positive emotional triggers, such as celebrations, romantic moments, or good news. This review summarizes the current understanding of takotsubo syndrome (TTS) precipitated by joyful events, focusing on novel insights from the largest registry analysis to date of 37 "happy heart" cases from the international, multicenter GEIST registry. Compared with the more common negative emotional trigger group, these patients had a higher prevalence of men and atypical midventricular ballooning patterns. While event rates trended lower, likely due to the small sample size, acute complications, such as pulmonary edema, and long-term mortality did not definitively differ. The pathophysiology of "happy heart syndrome" remains unclear but implicates differences in central autonomic processing and peripheral catecholamine responses to positive vs negative emotional stimuli. Several key outstanding questions are highlighted, including understanding susceptibility factors, confirming prognostic differences, and leveraging insights into underlying brain-heart circuitry. Ultimately, dedicated research into this rare but fascinating condition could provide broader mechanistic insights and therapeutic opportunities for the prevention and management of all takotsubo phenotypes at the nexus of mind, brain, and heart.
Thyrotropin Controversy in Subclinical Thyroid Disorders.
Agrawal R
J Assoc Physicians India · 2026 Mar · PMID 41818104 · Publisher ↗
AIM: The thyrotropin controversy in subclinical thyroid disorders (STDs) is among the most common endocrine disorders globally. In India, approximately 42 million people suffer from thyroid disorders, with subclinical hy...
AIM: The thyrotropin controversy in subclinical thyroid disorders (STDs) is among the most common endocrine disorders globally. In India, approximately 42 million people suffer from thyroid disorders, with subclinical hypothyroidism (SCH) affecting about 9.4% of the population. SCH is more prevalent in females (11.4%) compared to males (6.2%). DISCUSSION: The diagnosis and treatment of SCH and subclinical hyperthyroidism (SHT) are controversial. SCH is often diagnosed based on biochemical markers, as patients may be asymptomatic or exhibit vague symptoms. Thyrotropin (TSH) levels may be elevated or decreased, while triiodothyronine (T3) and thyroxine (T4) remain within the normal reference range or near the lower or upper limits. STDs refers to an abnormal TSH with normal thyroxine (FT4) and free triiodothyronine (FT3) levels. It includes STDs and individuals at high risk for disease progression or adverse outcomes, with unclear prognosis. Progression of SCH to overt hypothyroidism depends on initial serum TSH levels, thyroid peroxidase antibodies (TPO), family history of thyroid disorders, previous radiation, and smoking. Controversies surround SCH and its association with cardiovascular diseases (CVD), pregnancy outcomes, neuropsychiatric issues, metabolic syndrome, dyslipidemia, and diabetes. Assay interference is a problem in interpreting thyroid function tests (TFTs), occurring in 1% of cases. The health package investigation systems often overlooks the impact of drug intake and assay interference. Various methods for measuring TFTs, such as radioimmunoassay, immunometric assay, and ELISA, differ in sensitivity, specificity, and standardization, leading to methodological variability. Common causes of assay interference include human antimurine antibodies (HAMA), thyroid hormone autoantibodies (THAAbs), rheumatoid factor, antistreptavidin, and antiruthenium antibodies. When diagnosing SCH, it is crucial to rule out other causes of elevated TSH, such as autoantibodies, goiter, and rare conditions such as thyroid hormone resistance (THR), diagnosed by serum glycoprotein alpha subunit (α-GSU) and family history. Biotin, a common supplement, can affect TFT assays, leading to spurious results. It can cause falsely high T4 and T3 levels and low TSH, leading to misdiagnosis of SCH. CONCLUSION AND RECOMMENDATIONS: The timing of TFTs, whether fasting, postprandial, or random, remains a debated issue. Assay interference and biotin intake should be considered when analyzing TFTs. The role of iodine and iodine supplementation during pregnancy and its impact on STDs are not yet fully conceptualized. Large randomized clinical and epidemiological studies are needed to establish a consensus on the diagnostic threshold for TSH. These studies should include diverse populations and medical conditions to improve our understanding of the disease and patient outcomes. In practice, avoid rushing to treat elevated TSH levels between 4 and 10 mIU/L or low TSH between 0.5 and 0.1 mIU/L without confirming the diagnosis with additional tests (T3, T4, FT4, FT3, and TPO). TSH alone should not be the sole decision-maker; consider other TFTs and sequential testing from the same laboratory and time to make more informed decisions. While TSH levels can be affected by time and prandial state, FT3 and FT4 levels remain stable, suggesting all three TFTs may aid in accurate diagnosis and treatment decisions.
Diabetic Retinopathy: Does 12 Weeks of Intensive Lifestyle Intervention Cause Any Improvement?
Talmale PM, Phatak M, Bang P
J Assoc Physicians India · 2026 Mar · PMID 41818103 · Publisher ↗
INTRODUCTION: Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes mellitus and is the most common cause of severe vision loss in adults. Diabetic retinopathy may lead...
INTRODUCTION: Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes mellitus and is the most common cause of severe vision loss in adults. Diabetic retinopathy may lead to vision-threatening damage to the retina, eventually leading to blindness. AIM: To study the effect of 12 weeks of intensive lifestyle intervention program on diabetic retinopathy using OCT and VEP. SETTING AND DESIGN: Quasi-experimental study conducted in the Department of Physiology in collaboration with the Department of Ophthalmology at AIIMS, Nagpur. MATERIALS AND METHODS: 75 patients of type 2 diabetes mellitus with a duration of >5 years were recruited as per the inclusion and exclusion criteria. After taking clinical history and anthropometry parameters, visual evoked potential and optical coherence tomography were done. Then, a 1.5-hour lifestyle intervention session was conducted. Followed by follow-up visits on 15th, 30th, and 45th days, done with biweekly follow-up in between through telephonic/ WhatsApp group. RESULTS: Modification in dietary pattern, regular exercise, healthy sleep schedule, and stress management showed a reduction in latencies and no major changes in amplitudes, but overall mild improvement was observed in PRVEP and FVEP. Also, in the retinal nerve fiber layer, mild changes along with a reduction in the severity of thickening of the retinal nerve fiber layer (RNFL) of both eyes were seen, but no major changes in central macula thickness were observed. CONCLUSION: Lifestyle modifications play a crucial role in the improvement of diabetic retinopathy.
Study of Thyroid Function in Newly Diagnosed Human Immunodeficiency Virus Patients and Effect of Antiretroviral Therapy on Thyroid Function.
Kumar S, Gupta P, Chaurasia AK … +2 more , Mathur MK, Varma S
J Assoc Physicians India · 2026 Mar · PMID 41818102 · Publisher ↗
BACKGROUND: Thyroid dysfunction is a frequently overlooked yet clinically significant comorbidity in human immunodeficiency virus (HIV)-infected individuals. The introduction of antiretroviral therapy (ART) has improved...
BACKGROUND: Thyroid dysfunction is a frequently overlooked yet clinically significant comorbidity in human immunodeficiency virus (HIV)-infected individuals. The introduction of antiretroviral therapy (ART) has improved life expectancy but has also been associated with metabolic and endocrine disturbances, including thyroid abnormalities. Thyroid dysfunctions such as subclinical hypothyroidism, sick euthyroid syndrome, and overt hypothyroidism are increasingly recognized in both treatment-naïve and ART-experienced patients. However, limited data are available on thyroid function at the time of HIV diagnosis and its evolution following ART initiation, especially in the Indian population. MATERIALS AND METHODS: This prospective observational study was conducted at Moti Lal Nehru Medical College, Prayagraj, including 100 newly diagnosed HIV patients aged ≥18 years. Baseline free T3, free T4, TSH, and CD4 were measured prior and 3 months after the start of ART. Statistical analysis was performed using SPSS version 27.0, with paired -tests, analysis of variance (ANOVA), and Pearson correlation test to assess the changes and associations between thyroid parameters and ART, CD4 count, and demographic variables. RESULTS: The study focused on measuring serum free T3, free T4, and TSH levels at baseline and after ART initiation and analyzing their relationship with immunological status as indicated by CD4 count. The study population consisted of 100 individuals with a mean age of 37.29 ± 13.01 years, predominantly male (70%). At baseline, 62% of patients were euthyroid, while the remaining 38% showed thyroid dysfunction, primarily subclinical hypothyroidism and subclinical hyperthyroidism. Following 3 months of ART, the prevalence of thyroid dysfunction increased: euthyroid patients decreased to 41%, and cases of subclinical hypothyroidism, clinical hypothyroidism, and subclinical hyperthyroidism rose noticeably. This shift in thyroid status distribution was statistically significant (Chi-squared test, = 0.028), suggesting a potential impact of ART on thyroid physiology. In terms of hormone levels, the study observed a statistically significant increase in mean TSH values (from 4.23 ± 4.13 µIU/mL to 7.50 ± 7.85 µIU/mL, < 0.001) and a significant decrease in free T3 levels (from 2.92 ± 0.88 pg/mL to 2.45 ± 1.00 pg/mL, = 0.005) post-ART. Free T4 levels did not show a significant change ( = 0.337). These results align with existing literature suggesting that ART may unmask or exacerbate subclinical thyroid dysfunction, possibly through immune reconstitution or direct effects on thyroid metabolism. Correlation analysis demonstrated a significant negative association between CD4 count and TSH levels both before and after ART ( = -0.28 and -0.34, respectively), and a positive correlation between CD4 and both free T3 and free T4. CONCLUSION: This study establishes that ART is associated with significant changes in thyroid hormone profiles, particularly an increase in TSH and a decline in free T3 levels, reflecting emerging thyroid dysfunction. The results underscore the importance of regular thyroid function monitoring in HIV patients, particularly after initiating ART, to facilitate early detection and management of evolving endocrine disturbances.
Prevalence and Predictors of Neurocognitive Impairment, Fatigue, and Health-related Quality of Life in Patients with HIV/AIDS.
Raj A, Gupta PK, Kumar A … +1 more , Budhiraja A
J Assoc Physicians India · 2026 Mar · PMID 41818101 · Publisher ↗
BACKGROUND: People living with human immunodeficiency virus (PLHIV) are known to have decreased quality of life (QoL), increased fatigue, and neurocognitive dysfunction. In India, the prevalence and predictors of the sam...
BACKGROUND: People living with human immunodeficiency virus (PLHIV) are known to have decreased quality of life (QoL), increased fatigue, and neurocognitive dysfunction. In India, the prevalence and predictors of the same are not explored. We aim to determine the prevalence and predictors of neurocognitive impairment (NCI), fatigue, and health-related QoL among PLHIV in India. SETTING: The study was conducted among people attending an antiretroviral therapy center in a tertiary care hospital in New Delhi after ethical approval. MATERIALS AND METHODS: We enrolled consented patients and used the Montreal Cognitive Assessment (MoCA), Multidimensional Assessment of Fatigue (MAF) scale, and 36-item Short Form (SF-36) survey to assess NCI, fatigue, and health-related QoL (HRQoL), respectively. RESULTS: A total of 100 PLHIV with a mean age of 42.0 ± 9.6 years were enrolled, with 48% females. 47 patients (47%) had NCI with a MoCA score <26. Male gender, PLHIV with <5 years of treatment, and <50 years of age had higher MoCA scores. MoCA scores had a negative correlation with age and MAF scores and a positive correlation with SF-36 scores. 55 patients (55%) suffered from fatigue, with lesser fatigue scores for males. Fatigue scores had a negative correlation with SF-36 scores. 71 patients (71%) had total SF-36 scores >50 with males having higher scores. Fatigue had a negative correlation on QoL, = -0.831. CONCLUSION: In India, the prevalence of NCI, fatigue, and decreased QoL is higher compared to other populations. Management strategies in HIV require interventions to improve NCI, fatigue, and QoL along with antiretroviral therapy.
Early LDL-C Lowering Efficacy of High-intensity Atorvastatin and Ezetimibe Combination Compared with High-intensity Atorvastatin Alone in Acute Coronary Syndrome: The LAI EARLY ACS Study.
Mehta V, Agarwal N, Mehra P … +12 more , Mehta N, Yusuf J, Dabla PK, Sukhija S, Safal S, Gupta M, Kumar S, Kathuria S, Kumar A, Duell PB, Pareek KK, Puri R
J Assoc Physicians India · 2026 Mar · PMID 41818100 · Publisher ↗
BACKGROUND: High-intensity statins are recommended in patients experiencing acute coronary syndrome (ACS) to lower low-density lipoprotein cholesterol (LDL-C) levels, but evidence-based recommended LDL-C goals often rema...
BACKGROUND: High-intensity statins are recommended in patients experiencing acute coronary syndrome (ACS) to lower low-density lipoprotein cholesterol (LDL-C) levels, but evidence-based recommended LDL-C goals often remain unmet. We assessed the therapeutic benefit of early LDL-C lowering and the safety of high-intensity atorvastatin and ezetimibe combination versus high-intensity atorvastatin alone in ACS. METHODS: In this investigator-initiated trial, 254 patients admitted with ACS were randomized 1:1 to either atorvastatin 80 mg once daily (group A) or a combination of atorvastatin 80 mg and ezetimibe 10 mg once daily (group B). The first dose was administered orally immediately after diagnosis and then continued daily. The primary and secondary endpoints were percentage reductions in direct LDL-C measurements over the initial 4-week period and at 12 weeks, respectively. RESULTS: The mean percentage reduction in LDL-C was 8.12% in group A vs 14.43% in group B ( < 0.001) at week 1, 16.62% in group A vs 28.34% in group B at 2 weeks ( < 0.001), 29.43% in group A vs 45.15% in group B at 4 weeks ( < 0.001), and 41.88% in group A vs 60.76% in group B ( < 0.001) at 12 weeks. Adverse events were similar in both groups. CONCLUSION: Ezetimibe added to high-intensity statin therapy was well tolerated and resulted in an immediate and robust additional decrease in circulating LDL-C concentrations, with a markedly higher proportion of participants achieving LDL-C goals at 4 and 12 weeks. These promising results show that dual therapy started immediately at the diagnosis of ACS has the potential to improve cardiovascular outcomes in ACS.
A Study on Prevalence of Malarial Retinopathy among Malaria Cases and to Determine Its Presence as a Marker of Severe Malaria: Observations from Eastern India.
Chatterjee R, Bhadra TR, Chatterjee N … +8 more , Mukherjee S, Halder P, Sarkar K, Chatterjee I, Saha B, Karmakar PS, Pramanik N, Samajdar SS
J Assoc Physicians India · 2026 Mar · PMID 41818099 · Publisher ↗
BACKGROUND: Malarial retinopathy refers to a constellation of changes seen in severe or complicated malaria cases. These include: retinal whitening, vessel changes-whitening, tramlining, retinal hemorrhages, and papilled...
BACKGROUND: Malarial retinopathy refers to a constellation of changes seen in severe or complicated malaria cases. These include: retinal whitening, vessel changes-whitening, tramlining, retinal hemorrhages, and papilledema. There are very few Indian studies on this entity. Since retina can be easily visualized by direct ophthalmoscopy, this study was done to determine prevalence of malarial retinopathy among malaria cases and to determine relationship between malarial retinopathy and severity of the disease. MATERIALS AND METHODS: The study was done at Indoor and Outdoor Departments of Tropical Medicine, School of Tropical Medicine (STM), Kolkata, with the support of the Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Medical College, Kolkata. Adult malaria cases, both complicated/severe and uncomplicated, were included. Patients unable or unwilling to cooperate with eye examination, contraindications to tropicamide eye drops (angle closure glaucoma or known allergy to product), severe corneal scarring or cataracts hindering view by ophthalmoscopy, diabetes mellitus, hypertension, intracranial space occupying lesions, epilepsy, alcohol use, chronic renal failure, age > 60 years and any other known ocular/systemic disease that can cause retinopathy changes were excluded. Severe malaria was diagnosed as per the WHO criteria. Cases with acute febrile illness of other causes were taken in control arm, and normal population subjects were taken as controls. All patients were assessed clinically, followed by appropriate laboratory investigations and then direct ophthalmoscopic examination was done. Ocular findings were be collaborated with severity of illness. RESULTS: A total of 71 malaria cases were included in our study. Among them, 12 cases were of severe malaria, and rest of the cases were uncomplicated. Of the 12 severe malaria cases, 8 were , 3 were , and 1 was mixed. Uncomplicated malaria cases were mostly (35 out of 59). Features suggestive of malarial retinopathy were noted in 9 out of 12 cases of severe malaria (75%) and 2 out of 59 cases of uncomplicated malaria (3.4%). We noted two cases of retinal changes-one case of retinal whitening in falciparum malaria and one case of vivax malaria with retinal hemorrhage in the uncomplicated group. Both of the cases subsequently needed admission for recurrent vomiting, reduced urine output, and severe weakness 40 dengue cases were included in control arm of AFI cases-20 DHF cases and 20 cases of DF with warning signs. Among them, retinal hemorrhage was noted in one case of DHF (2.5%). Out of 40 sepsis cases, retinal hemorrhage was seen in one case (2.5%). No retinal changes were noted among 40 other AFI cases which included scrub typhus, enteric fever, chikungunya, and acute viral hepatitis. Also, no abnormality was detected on ophthalmoscopy in 40 healthy individuals. The presence of retinopathy was suggestive of severe malaria ( < 0.05). We found the sensitivity and specificity of malarial retinopathy as a marker of severe malaria to be 75% and 96.6% with a positive predictive value of 81.8%. CONCLUSION: Malarial retinopathy may serve as an important clinical biomarker for predicting severe malaria. All clinicians should be appropriately trained in performing direct ophthalmoscopy to detect the retinopathy changes.
Hospital Hyperglycemia is Associated with Adverse Short-term Metabolic and Mortality Outcomes.
Ojha A, Aggarwal R, Prakash A … +3 more , Ghotekar LH, Gogoi P, Bansal P
J Assoc Physicians India · 2026 Mar · PMID 41818098 · Publisher ↗
INTRODUCTION: Stress hyperglycemia has been implicated in acute illnesses, but the risk of future diabetes is seldom studied. Hospital hyperglycemia, as defined by in-hospital random blood glucose (RBG) >140 mg/dL, is mu...
INTRODUCTION: Stress hyperglycemia has been implicated in acute illnesses, but the risk of future diabetes is seldom studied. Hospital hyperglycemia, as defined by in-hospital random blood glucose (RBG) >140 mg/dL, is much less studied. This study aimed to determine the profile and short-term outcome of hospital hyperglycemia patients. METHODS: A descriptive follow-up study was conducted in 50 patients with hospital hyperglycemia. Based on their HbA1c status, patients were categorized into known cases of diabetes (group A, = 12, 24%), undiagnosed diabetes (group B, = 13, 26%), prediabetes (group C, = 13, 26%), and normoglycemic (group D, = 12, 24%). Duration of hospital stay and in-hospital mortality were noted. At 4 weeks post-discharge, HbA1c, along with the glucose tolerance test, was performed for groups C and D, and outcomes were recorded. RESULTS: Half of the hospital hyperglycemia patients were diabetic, although 26% of the patients with hospital hyperglycemia were unaware of their diabetes status. Average age and BMI were found to be higher in diabetes patients (25.63 ± 5.25 kg/m) than prediabetes (22.98 ± 2.24 kg/m) and normoglycemic patients (21.38 ± 2.37 kg/m). Two deaths were encountered during hospital stay in the prediabetes group. At 4 weeks post-discharge, in group C, 2 (8.7%) developed diabetes, 4 (17.4%) had impaired fasting glucose, and 3 (13%) had impaired glucose tolerance. One prediabetes patient became normoglycemic. All 12 patients of group D remained normoglycemic. CONCLUSION: Hospital hyperglycemia in diabetics as well as prediabetes subjects is associated with a higher age and BMI compared to normoglycemic individuals. Hospital hyperglycemia in prediabetes subjects is associated with higher mortality and greater propensity to develop diabetes in the short-term, compared to normoglycemic individuals.
Clinicopathological Spectrum and Biomarker Profile of Male Breast Cancer: A Retrospective Study from a Tertiary Care Center in South India.
Potu SR, Gumdal V, Koppaka D … +3 more , Natti HS, Rapole PS, Syed TAH
J Assoc Physicians India · 2026 Mar · PMID 41818097 · Publisher ↗
INTRODUCTION: Male breast cancer (MBC) accounts for <1% of breast malignancies yet often presents at advanced stages, particularly in low- and middle-income countries where awareness is limited. This study sought to defi...
INTRODUCTION: Male breast cancer (MBC) accounts for <1% of breast malignancies yet often presents at advanced stages, particularly in low- and middle-income countries where awareness is limited. This study sought to define the clinicopathological spectrum, biomarker profile, and treatment outcomes of MBC in a South Indian tertiary cancer center. OBJECTIVES: To analyze the demographic features, clinical presentation, pathological characteristics, biomarker distribution, treatment modalities, and outcomes of MBC cases managed at our center between 2019 and 2025. MATERIALS AND METHODS: We retrospectively analyzed all male patients with histologically confirmed breast carcinoma managed between 2019 and 2025 at ESIC Medical College and Hospital, Hyderabad. Demographic, clinical, pathological, biomarker, and treatment data were retrieved from hospital records and supplemented by follow-up contact. RESULTS: A total of 15 patients (mean age 60 years, range 31-74) were identified. Median delay from symptom onset to diagnosis was 6 months. All presented with a retroareolar mass, frequently accompanied by nipple retraction or skin changes. Most patients had advanced disease: Stage III ( = 9, 60.0%) and Stage IV ( = 4, 26.7%). Invasive ductal carcinoma was universal. Hormone receptor positivity was seen in 80%, HER2 positivity in 40%, and a triple-positive phenotype in 26.7%. Treatment strategies were stage- and biomarker-driven: 86.7% underwent surgery, endocrine therapy was prescribed for all HR+ cases, HER2-directed therapy was delivered when feasible, and CDK4/6 inhibitors were used in selected advanced HR+ tumors. At last follow-up, 9 patients (60%) remained alive with disease control, while 2 succumbed to progression. CONCLUSION: MBC in this cohort was characterized by delayed diagnosis, advanced presentation, and a high prevalence of HER2-positive tumors. Multimodality, biomarker-guided therapy achieved durable control in many patients, underscoring the urgent need for awareness initiatives, earlier detection, and equitable access to targeted therapies in India.
Implications of Acetylator Status and Therapeutic Drug Monitoring of Plasma Rifampicin and Isoniazid Concentrations among Indians.
Arora PR, Lokhande RV, Naik PR … +8 more , Dherai AJ, Udwadia ZF, Pinto L, Sunavala A, Soman R, Patel J, Rodrigues C, Ashavaid TF
J Assoc Physicians India · 2026 Mar · PMID 41818096 · Publisher ↗
INTRODUCTION: Low or abnormal plasma concentrations of anti-tuberculosis drugs can be a major reason for treatment failure or the emergence of drug resistance. Acetylator status, which affects drug metabolism, plays a ke...
INTRODUCTION: Low or abnormal plasma concentrations of anti-tuberculosis drugs can be a major reason for treatment failure or the emergence of drug resistance. Acetylator status, which affects drug metabolism, plays a key role in determining drug bioavailability. This study aimed to perform therapeutic drug monitoring (TDM) of rifampicin and isoniazid and to evaluate the correlation between plasma drug concentrations and acetylator status among Indian patients receiving first-line antituberculosis therapy. METHODS: Plasma concentrations of rifampicin and isoniazid were measured using in-house standardized high-performance liquid chromatography methods, while acetylator status was determined by conventional PCR of NAT2 gene. RESULTS: Peak concentrations were estimated from 125 patients on first-line tuberculosis (TB) treatment. Among these, 56% exhibited subtherapeutic rifampicin concentrations and 28% had subtherapeutic isoniazid concentrations. Conversely, above normal (potentially toxic) concentrations were seen in 2% and 21% for rifampicin and isoniazid, respectively. Despite receiving the standard TB treatment regimen, only 62% of patients improved clinically, while 38% of patients continued harboring TB signs and symptoms, among which 6 patients (5%) developed rifampicin resistance during the treatment course. About 44% were slow acetylators, followed by 40% intermediate and 16% rapid acetylators. The acetylator status significantly influenced the plasma concentrations of both drugs. Slow acetylators had significantly higher isoniazid concentrations (p = 0.004) and lower rifampicin concentrations (p = 0.01) as compared to rapid acetylators. CONCLUSION: Abnormal concentrations of rifampicin and isoniazid are prevalent and a major concern. Acetylator status influences plasma concentrations of rifampicin and isoniazid. Hence, determining acetylator status and performing TDM could be instrumental in optimizing and improving TB outcomes.
Association between Androgenic Hair Patterns and Prostate Cancer Risk in South Indian Men: A Case-control Study from the Cauvery Delta.
Narayanan J, Sundar VE, Mathi SA
J Assoc Physicians India · 2026 Mar · PMID 41818095 · Publisher ↗
BACKGROUND: Prostate cancer (PCa) is one of the most common malignancies in men worldwide. Androgens influence both prostate growth and hair patterns. Androgenic alopecia (male-pattern baldness) and excessive male-patter...
BACKGROUND: Prostate cancer (PCa) is one of the most common malignancies in men worldwide. Androgens influence both prostate growth and hair patterns. Androgenic alopecia (male-pattern baldness) and excessive male-pattern body hair (hypertrichosis) have been hypothesized as clinical markers of long-term androgen exposure. Previous Western studies have reported mixed results on whether early-onset or severe androgenic alopecia correlates with increased prostate cancer risk. Data in South Indian (Dravidian) populations is lacking. OBJECTIVE: To examine the association between androgenic hypertrichosis, androgenic alopecia, and prostate cancer in Dravidian men from the Cauvery Delta region of Tamil Nadu, India. MATERIALS AND METHODS: We conducted an age-stratified, population-based case-control study among men in the Cauvery Delta. The cases consisted of 117 men with pathologically confirmed adenocarcinoma of the prostate (diagnosed 2010-2015). Controls were 123 men with benign prostatic hyperplasia (BPH) from the same hospital registries, frequency-matched by age. Individuals with incomplete data or non-Dravidian (North Indian) ancestry were excluded. Trained investigators performed face-to-face interviews, directly observing and recording postpubertal body hair growth (indicative of androgenic hypertrichosis) and scalp hair loss (androgenic alopecia classified by the Norwood scale). Statistical analysis included multivariate discriminant analysis (Wilks' Lambda), one-way ANOVA for continuous variables, chi-square cross-tabulation, and computation of Cramer's V statistic to assess association strength. A two-tailed -value of <0.05 was considered statistically significant. RESULTS: The age distributions of cases and controls were comparable. The prevalence of androgenic hypertrichosis and alopecia did not differ significantly between prostate cancer cases and BPH controls. Cramer's V analysis showed that prostate cancer status accounted for only 1.1% of the variance in hypertrichosis (Cramer's V ≈ 0.011) and 1.5% of the variance in alopecia (Cramer's V ≈ 0.015). CONCLUSION: In this case-control study of Dravidian men from Tamil Nadu, we observed no significant association between androgenic alopecia or hypertrichosis and prostate cancer. These findings contrast with data from Western cohorts, suggesting that interethnic variation in androgen receptor polymorphisms, follicular sensitivity, and environmental exposures may modulate prostate cancer risk differently. Further research is needed to elucidate how androgenic traits influence prostate carcinogenesis across different ethnic groups.
Clinicomycological Profile and Antifungal Activity of Terbinafine and Griseofulvin against Clinical Isolates of Dermatophytes in a Tertiary Care Hospital.
Jaishma RJ, Pramodhini S, Kuruvila S … +3 more , Latha R, Kavitha K, Shebeena S
J Assoc Physicians India · 2026 Mar · PMID 41818094 · Publisher ↗
BACKGROUND: Dermatophytes, primarily spp., spp., and spp., are responsible for superficial cutaneous mycoses, estimated to affect 20-25% of the people worldwide. The rise of antifungal resistance, especially to terbin...
BACKGROUND: Dermatophytes, primarily spp., spp., and spp., are responsible for superficial cutaneous mycoses, estimated to affect 20-25% of the people worldwide. The rise of antifungal resistance, especially to terbinafine, has made treating dermatophytosis increasingly difficult. This study aims to assess the clinical and mycological characteristics of dermatophytosis cases and evaluate the susceptibility of dermatophyte isolates to terbinafine and griseofulvin. MATERIALS AND METHODS: A total of 118 samples were studied from patients with clinical suspicion of dermatophytosis. The samples were processed for KOH mount and fungal culture for further speciation. Susceptibility to terbinafine and griseofulvin was assessed using the microbroth dilution technique, following the guidelines established by the Clinical and Laboratory Standards Institute (CLSI). RESULTS: Tinea corporis (57.6%) appeared as the leading symptomatology in our study, followed by tinea cruris (10.2%). KOH positivity was higher (70.3%) compared to positivity by culture (16.9%). was the predominant species (85%) isolated, followed by (10%) and (5%). Terbinafine resistance was observed in over 60% of isolates, with moderate resistance detected in . Griseofulvin showed moderate resistance in and higher resistance in . CONCLUSION: This study highlights the increased resistance of T. mentagrophytes to terbinafine and T. violaceum to griseofulvin, stressing the critical role of routine susceptibility profiling. The findings highlight the growing challenge of antifungal resistance in dermatophytes and the importance of optimizing diagnostic and treatment strategies to improve patient outcomes.
A Prospective 1-Year Study of Renal Recovery in Pigment Nephropathy: Insights Beyond the Acute Phase.
Patel PS, Archana, Kumari P … +2 more , Singh PP, Kumar O
J Assoc Physicians India · 2026 Mar · PMID 41818093 · Publisher ↗
BACKGROUND: Pigment nephropathy is an underrecognized cause of acute kidney injury. Data from northern India is scarce. The present study aims to assess the clinical characteristics and outcomes of pigment nephropathy in...
BACKGROUND: Pigment nephropathy is an underrecognized cause of acute kidney injury. Data from northern India is scarce. The present study aims to assess the clinical characteristics and outcomes of pigment nephropathy in this region. MATERIALS AND METHODS: We analyzed the demographics, etiology, and outcomes of 20 patients with biopsy-proven pigment nephropathy. RESULTS: The mean age was 27.75 years (range: 13-52), with a male-to-female ratio of 18:2. The average peak serum creatinine was 12.09 mg/dL (range: 0.84-22.3). Rhabdomyolysis was identified in 14 (70%) and hemolysis in 6 patients (30%). The rhabdomyolysis was attributed to hypokalemia, infection, strenuous exercise, physical trauma, inflammatory myositis, neuroleptic malignant syndrome, and heat stroke. The hemolysis was caused by paroxysmal nocturnal hemoglobinuria, thrombotic microangiopathy, transfusion reaction, rifampicin, and physical stress. The majority of patients (85%) required hemodialysis, with a mean of 6 sessions (range: 3-17). The mean duration of hospitalization was 15.3 days (range: 4-30), and the average time to renal recovery was 3.1 weeks (range: 2-6). All 20 patients survived and achieved complete renal recovery. Of the 20 patients, 13 completed at least 1 year of follow-up, 4 were lost to follow-up, and 3 remain under observation. At 1 year, all 13 patients had normal serum creatinine. None progressed to chronic kidney disease. CONCLUSION: Of 20 patients (4.1%) with pigment-induced acute kidney injury (AKI), 70% had myoglobin- and 30% hemoglobin-induced nephropathy. Common causes included hypokalemia, infection, strenuous activity, and paroxysmal nocturnal hemoglobinuria. Hemodialysis was required in 85%, with an average hospital stay of 15.3 days. Among 13 patients with a 1-year follow-up, none developed chronic kidney disease. Overall prognosis appears favorable; however, larger studies with extended follow-up are needed to better characterize long-term outcomes in pigment nephropathy.
E-health Initiatives for Screening and Management of Anemia in Rural Rajasthan.
Mangal S, Mangal D, Kumar A … +1 more , Panwar RB
J Assoc Physicians India · 2026 Mar · PMID 41818092 · Publisher ↗
INTRODUCTION: Anemia is considered to be a public health issue of serious concern universally. In the current era of advancing technology, electronic health (e-health) initiatives are being employed in various health pro...
INTRODUCTION: Anemia is considered to be a public health issue of serious concern universally. In the current era of advancing technology, electronic health (e-health) initiatives are being employed in various health programs for disease screening and management. This study was planned to screen for anemia and manage it through a multidimensional approach comprising iron folic acid (IFA) supplementation, deworming among children, and dietary guidance and health education through pop-up videos with the aid of e-health initiatives. METHODS: This was a prospective cohort study. An Android e-application (app) was used on tablets to identify anemia after hemoglobin estimation through the Hemoglobin Color Scale. Accredited Social Health Activists (ASHAs) managed anemia by providing health education and dietary guidance through pop-up videos and IFA supplementation. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 29. Tests of significance in the form of Cochran's Q, McNemar, chi-square, and repeated measures analysis of variance (ANOVA) and independent -test were applied. RESULTS: The overall prevalence of anemia significantly declined from 46.08% at baseline to 14.65% at the 9th month. Males had a higher anemia prevalence (52.8%) compared to females (39.16%). An overall improvement of 68.2% was observed in the anemia status, with the maximum being in the 1-5-year age-group and females. Mean hemoglobin levels showed a consistent increase across all age-groups, with the maximum being in the 6-month-1-year age-group and females. CONCLUSION: This study demonstrated that community-based, sustained, and targeted strategies through the use of e-health initiatives can effectively combat anemia and achieve significant improvements in hemoglobin levels across all age and gender groups.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe