The Journal Of The Association Of Physicians Of India[JOURNAL]
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200 papers
Alterations in Serum Electrolytes among Adults with Enteric Fever: A Retrospective Observational Study from a Tertiary Center in New Delhi.
Mishra S, Budhiraja S
J Assoc Physicians India · 2026 Mar · PMID 41818091 · Publisher ↗
BACKGROUND: Electrolyte abnormalities are frequent in systemic infections such as enteric fever but remain under-recognized in clinical practice. These disturbances may worsen morbidity if not identified and corrected ea...
BACKGROUND: Electrolyte abnormalities are frequent in systemic infections such as enteric fever but remain under-recognized in clinical practice. These disturbances may worsen morbidity if not identified and corrected early. OBJECTIVE: To determine the prevalence and pattern of serum electrolyte alterations in adult patients hospitalized with enteric fever at a tertiary care center in New Delhi. MATERIALS AND METHODS: This retrospective observational study analyzed records of 128 adult patients (59 males, 69 females) with laboratory-confirmed enteric fever between January 2023 and March 2024. The first admission values for sodium, potassium, chloride, and bicarbonate were extracted from the hospital laboratory system. Results were categorized as low, normal, or high using standard clinical reference ranges. Descriptive statistics were applied, and gender-based comparisons were performed using Chi-square tests for categorical variables and -tests for continuous measures. RESULTS: Hyponatremia was present in 58.6% (75/128) of patients, while 57.8% (74/128) had low bicarbonate levels consistent with a trend toward metabolic acidosis. In contrast, potassium and chloride values were predominantly normal, with abnormalities occurring in <10% of patients. The mean ± standard deviation (SD) values (mmol/L) were: sodium 132.7 ± 6.2, potassium 4.3 ± 0.6, chloride 101.1 ± 3.7, and bicarbonate 20.3 ± 4.7. No significant gender differences were detected for mean values or abnormality prevalence (all > 0.17). CONCLUSION: Hyponatremia and reduced bicarbonate were the most common electrolyte abnormalities in enteric fever, whereas potassium and chloride disturbances were uncommon. Routine electrolyte monitoring should be incorporated into the management of hospitalized enteric fever patients to enable early correction and improved clinical outcomes.
Distinct Risk Profiles in Posterior vs Anterior Circulation Strokes: A Prospective Study from Western India.
Chinthamaduka K, Makwana PV
J Assoc Physicians India · 2026 Mar · PMID 41818090 · Publisher ↗
BACKGROUND: Anterior (ACS) and posterior circulation strokes (PCS) differ in clinical presentation, vascular pathology, and associated risk factors. OBJECTIVES: The aim of the study was to compare vascular risk profiles,...
BACKGROUND: Anterior (ACS) and posterior circulation strokes (PCS) differ in clinical presentation, vascular pathology, and associated risk factors. OBJECTIVES: The aim of the study was to compare vascular risk profiles, clinical characteristics, neuroimaging findings, and outcomes between ACS and PCS patients in a hospital-based cohort. METHODS: A prospective observational study was conducted at a tertiary care hospital, from January to December 2021. Consecutive patients with confirmed anterior or posterior circulation stroke were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) scores, vascular risk factors (hypertension, diabetes, dyslipidemia, smoking, metabolic syndrome), presenting symptoms, computed tomography (CT) imaging findings, and outcomes [modified Rankin Scale (mRS) at discharge, mortality] were recorded. Univariate and multivariate logistic regression analyses were performed. RESULTS: Among 376 stroke patients analyzed, 274 (72.9%) had ACS and 102 (27.1%) had PCS. PCS patients were significantly younger (54.6 vs 61.2 years; = 0.003), with a higher prevalence of hypertension (78.4 vs 62.8%; = 0.008), current smoking (45.1 vs 28.8%; = 0.002), metabolic syndrome (41.2 vs 28.5%; = 0.02), and poor glycemic control (HbA1c >8% in 51.2 vs 38.6%; = 0.04). PCS presented more often with vertigo (78.4%), ataxia (62.7%), and visual symptoms (54.9%), while ACS typically presented with hemiparesis and aphasia. Despite lower NIHSS scores, brainstem infarcts in PCS accounted for most in-hospital deaths. Multivariate analysis identified hypertension, smoking, age <55, and metabolic syndrome as independent predictors of PCS. CONCLUSION: PCS affect a younger demographic and are independently associated with modifiable metabolic and vascular risk factors. Their atypical presentation and distinct risk profile call for targeted screening and prevention strategies, particularly in younger Indian adults.
Atherogenic Indices in Newly Diagnosed Obese and Lean Patients of Type 2 Diabetes Mellitus: A Comparative Study.
Almeida EA, Mehndiratta M, Kirubalenin SP … +2 more , Madhu SV, Kar R
J Assoc Physicians India · 2026 Mar · PMID 41818089 · Publisher ↗
BACKGROUND: Dyslipidemia is one of the driving forces in the pathogenesis of atherosclerosis and its resultant cardiovascular disease. Both these conditions are characterized by an increase in proatherogenic lipids compa...
BACKGROUND: Dyslipidemia is one of the driving forces in the pathogenesis of atherosclerosis and its resultant cardiovascular disease. Both these conditions are characterized by an increase in proatherogenic lipids compared to anti-atherogenic lipids. Atherogenic Indices have been developed to predict CVD risk without increasing the cost of testing; however, most of the studies done to date have used these indices in patients who have already suffered a coronary event. Dyslipidemia is most prevalent in cases of type 2 diabetes mellitus (T2DM). Therefore, this study was designed to assess atherogenic risk (via atherogenic indices) in newly diagnosed treatment-naïve obese and lean patients of T2DM. MATERIALS AND METHODS: Treatment-naïve, newly diagnosed patients of T2DM were recruited and grouped into obese (BMI ≥ 25 kg/m) and lean (BMI <18.5 kg/m) groups. Blood was collected in a fasting state for the estimation of glycemic parameters and fasting lipid profile. Atherogenic indices (LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and atherogenic index of plasma (AIP)) were calculated using predefined formulas. RESULTS: LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and AIP were higher in the obese group compared to the lean group. However, these calculated indices were above the recommended cutoffs in both obese and lean patients with T2DM. CONCLUSION: This study is the first to document increased atherogenic risk in both obese and lean patients (newly diagnosed) with T2DM. Although CVD risk is higher among the obese patients, aggressive control of plasma lipids is required in all patients with T2DM, irrespective of BMI.
Chronic Kidney Disease with Risk Factor Diabetes: Need for Change in Nomenclature Reflecting Heterogeneity of Kidney Disease in Diabetes.
Basu M, Ghosh S
J Assoc Physicians India · 2026 Mar · PMID 41818088 · Publisher ↗
The International Diabetes Federation estimates that 537 million individuals around the globe currently have diabetes, and this number is anticipated to rise to approximately 783 million by 2045. About 30% or more of ind...
The International Diabetes Federation estimates that 537 million individuals around the globe currently have diabetes, and this number is anticipated to rise to approximately 783 million by 2045. About 30% or more of individuals diagnosed with diabetes are more prone to developing chronic kidney disease (CKD), and a considerable portion progresses to renal impairment that requires renal replacement therapy..
National Consensus on Semaglutide in Cardiology: From Clinical Evidence to Clinical Translation.
Chopra HK, Mehta A, Ponde CK … +23 more , Nanda NC, Wander GS, Oomman A, Kerkar P, Routray SN, Ratnaparkhi GP, Advani P, Shinde R, Agarwal R, Mahajan A, Shah J, Verma G, Mittal S, Prabhakar D, Ramesh D, Kochar A, Sidana S, Badani R, Sinha A, Parashar SK, Ramakrishnan S, Hazra PK, Grover A
J Assoc Physicians India · 2026 Feb · PMID 41818087 · Publisher ↗
Obesity is increasingly recognized as a chronic, relapsing, and progressive disease that acts as a major upstream driver of cardiovascular, kidney, and metabolic disorders, with South Asians experiencing heightened vulne...
Obesity is increasingly recognized as a chronic, relapsing, and progressive disease that acts as a major upstream driver of cardiovascular, kidney, and metabolic disorders, with South Asians experiencing heightened vulnerability at lower adiposity thresholds. Despite this, effective metabolic therapies remain underutilized in cardiology practice. Semaglutide, a GLP-1 receptor agonist, has emerged as a multisystem, disease-modifying agent with benefits that extend well beyond glycemic control. Accumulating evidence from the STEP (Semaglutide Treatment Effect in People with Obesity) program, the SELECT cardiovascular outcomes trial, the SOUL trial, heart failure with preserved ejection fraction (HFpEF) studies, and real-world cohorts underscores its relevance for cardiometabolic risk reduction and symptom improvement. Recognizing the need for India-specific guidance, a panel of cardiologists from across the country reviewed pivotal randomized trials, including STEP 1-8, STEP-HFpEF, STEP-HFpEF DM, STEP TEENS, SELECT, SOUL, SUSTAIN-6, and PIONEER-6, along with meta-analyses, observational data, and international recommendations to formulate practical, context-appropriate guidance for cardiology practice. Across diverse studies, semaglutide consistently produces substantial reductions in body weight and visceral fat, accompanied by improvements in blood pressure, glycemic control, inflammatory markers, and hepatic steatosis. SELECT demonstrated a significant reduction in major adverse cardiovascular events in adults with overweight or obesity and established atherosclerotic cardiovascular disease (ASCVD), independent of diabetes status. Benefits of obesity-related HFpEF include meaningful gains in symptoms, exercise tolerance, and quality of life. Emerging data also support renal and hepatic protection across CKM domains. Findings from high-dose 7.2 mg studies highlight a dose-response continuum but call for careful assessment of tolerability. As international guidelines increasingly position GLP-1 receptor agonists as cardiometabolic therapies, Indian data emphasize the importance of early, phenotype-driven intervention. Semaglutide represents a practice-changing therapy that addresses core pathophysiological drivers of ASCVD and HFpEF through integrated modulation of adiposity and metabolic dysfunction. Its cardiovascular efficacy, multisystem benefits, and suitability for South Asian phenotypes support broader incorporation into contemporary cardiology. This consensus offers a framework for evidence-based patient selection, contraindications, monitoring, maintenance strategies, and coordinated multidisciplinary implementation to ensure safe and effective use in Indian clinical practice.
Role of β-Blockers Across the Cardiovascular Continuum: A Real-World Perception Survey (ROBUST).
Hiremath JS, Dasbiswas A, Sawhney J … +4 more , Chandra S, Mohanan PP, Srivastava S, Nath B
J Assoc Physicians India · 2026 Feb · PMID 41818086 · Publisher ↗
BACKGROUND: Understanding Indian healthcare professionals' (HCPs) perceptions of beta (β)-blockers is critical, given the high burden of hypertension (HTN) and cardiovascular (CV) diseases in the country. MATERIALS AND M...
BACKGROUND: Understanding Indian healthcare professionals' (HCPs) perceptions of beta (β)-blockers is critical, given the high burden of hypertension (HTN) and cardiovascular (CV) diseases in the country. MATERIALS AND METHODS: A cross-sectional survey was conducted among 1,000 Indian HCPs, including consulting physicians, cardiologists, and specialists in diabetes/metabolism experienced in managing adult patients across the HTN and CV disease continuum. Conducted between April 2023 and March 2024, the survey employed a 26-item structured questionnaire, developed through literature review and expert consultation, to assess β-blockers utilization patterns, prescribing preferences, and perceived barriers. RESULTS: Responses from 855 HCPs were analyzed. Consulting physicians (431; 50.4%) and cardiologists (342; 40.0%) formed the majority. β-blockers were prescribed to 25-50% of patients with HTN by 489 (57.2%) HCPs. Approximately 429 (50.2%) observed a systolic BP reduction of 10-15 mm Hg, while 465 (54.4%) reported a diastolic BP reduction of 5-10 mm Hg. β-blockers were commonly prescribed for heart failure (381; 44.6%), postmyocardial infarction (214; 25%), and chronic coronary syndrome (309; 36.1%). Metoprolol was the preferred BB in 75% of HTN, post-MI, chronic coronary syndrome (CCS), and AF cases, and in 66.2% for HF management. CONCLUSION: This survey highlights real-world prescribing patterns and perceptions of β-blockers in India, with metoprolol emerging as the most preferred agent across multiple CV indications, reflecting its strong clinical acceptance and perceived efficacy.
Can the Dying Clinical Medicine be Resuscitated?
Rayate AS, Nagoba BS
J Assoc Physicians India · 2026 Feb · PMID 41818085 · Publisher ↗
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Black Pleura Sign in Silicosis.
Dixit R
J Assoc Physicians India · 2026 Feb · PMID 41818084 · Publisher ↗
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"The Cancer that Carried the Chalk"-NXP2+ Paraneoplastic Dermatomyositis Unleashing Calcinosis Cutis and Peripheral Neuropathy.
Saibaba J, Chandra N, Amalnath D … +1 more , Subrahmanyam D
J Assoc Physicians India · 2026 Feb · PMID 41818083 · Publisher ↗
Saibaba J, Chandra N, Amalnath D, "The Cancer that Carried the Chalk"-NXP2+ Paraneoplastic Dermatomyositis Unleashing Calcinosis Cutis and Peripheral Neuropathy. J Assoc Physicians India 2026;74(2):102-103.
Saibaba J, Chandra N, Amalnath D, "The Cancer that Carried the Chalk"-NXP2+ Paraneoplastic Dermatomyositis Unleashing Calcinosis Cutis and Peripheral Neuropathy. J Assoc Physicians India 2026;74(2):102-103.
A Young Male with Five Kidneys.
Abraham G, Kovilazhikam DS, Jaikumar S … +1 more , Mathew M
J Assoc Physicians India · 2026 Feb · PMID 41818082 · Publisher ↗
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Catheter-induced Left Main Dissection: A Minefield in Interventional Cardiology.
Prakash VR, Sujith MA, Prakash SR
J Assoc Physicians India · 2026 Feb · PMID 41818081 · Publisher ↗
Coronary angiography is an invasive diagnostic procedure used to assess the coronary anatomy. Although rare, iatrogenic coronary artery dissection during coronary catheterization is a dreaded complication. Here we report...
Coronary angiography is an invasive diagnostic procedure used to assess the coronary anatomy. Although rare, iatrogenic coronary artery dissection during coronary catheterization is a dreaded complication. Here we report the case of an 89-year-old patient diagnosed with acute coronary syndrome-Non-ST-segment elevation myocardial infarction, who underwent coronary angiography. During the coronary angiogram, he sustained a fatal left main coronary artery dissection. Here we discuss the interventions attempted to tackle the situation and a review of the approach to managing iatrogenic left main dissections.
Study of Platelet Indices as Markers of Retinopathy in Patients with Diabetes Mellitus.
Maheshwari S, Kulkarni HS, Yadav YR … +4 more , Kumar P, Mathur R, Bansal RK, Gupta S
J Assoc Physicians India · 2026 Feb · PMID 41818080 · Publisher ↗
BACKGROUND: Diabetes mellitus poses a substantial global health burden, with diabetic retinopathy (DR) being a prevalent and potentially devastating microvascular complication. Platelet activation has been implicated in...
BACKGROUND: Diabetes mellitus poses a substantial global health burden, with diabetic retinopathy (DR) being a prevalent and potentially devastating microvascular complication. Platelet activation has been implicated in the pathogenesis of DR, suggesting platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and plateletcrit (PCT) as potential noninvasive markers for predicting its onset. MATERIALS AND METHODS: We conducted a cross-sectional study involving 300 patients diagnosed with type 2 diabetes mellitus (T2DM) attending a tertiary care center. Demographic data, duration of diabetes, and HbA1c levels were recorded. Platelet indices were measured using complete blood counts, and DR was diagnosed based on fundus examination findings. RESULTS: Among the study participants, group B ( = 140) comprising patients with DR had significantly higher levels of MPV (13.28 ± 2.14 fL), PDW (14.56 ± 2.37), P-LCR (29.59 ± 6.018%), and PCT (0.29 ± 0.06) compared to group A ( = 160) without DR (MPV: 9.99 ± 1.64 fL, PDW: 12.81 ± 2.28, P-LCR: 27.64 ± 8.36%, PCT: 0.26 ± 0.09) ( < 0.001 for all comparisons). Subgroup analysis within poorly controlled diabetics (HbA1c > 7%) also showed significantly higher platelet indices in those with DR compared to those without. CONCLUSION: Our findings underscore a significant association between elevated platelet indices and the presence of DR in patients with T2DM, independent of glycemic control status. These indices could serve as valuable surrogate markers for identifying individuals at risk of developing DR, facilitating early intervention strategies in clinical practice.
Bedaquiline-related QTc Prolongation in Multidrug Resistant Tuberculosis Patients: A Prospective Study.
Gupta A, Pais CC, Babu S
J Assoc Physicians India · 2026 Feb · PMID 41818079 · Publisher ↗
INTRODUCTION: Bedaquiline (BDQ) has revolutionized multidrug-resistant tuberculosis (MDR-TB) management in the Indian population with a high MDR-TB burden. However, its potential cardiotoxicity in the form of QTc prolong...
INTRODUCTION: Bedaquiline (BDQ) has revolutionized multidrug-resistant tuberculosis (MDR-TB) management in the Indian population with a high MDR-TB burden. However, its potential cardiotoxicity in the form of QTc prolongation warrants careful monitoring. This study aims to evaluate the prevalence, severity, and risk factors of BDQ-related QTc prolongation in MDR/rifampicin-resistant (RR)-TB patients. Given the genetic variability and diverse environmental factors, extrapolating foreign data to Indian patients is challenging; thus, local evidence is crucial. METHODS: A prospective analytical study was conducted over a period of 18 months on 55 adult patients with RR or MDR pulmonary or extrapulmonary TB initiated on BDQ-containing regimens. Electrocardiograms (ECGs) were performed at baseline, 1, 3, and 6 months. QTc intervals were calculated using Fridericia's formula at each time interval. Prevalence and severity of QTc prolongation were documented. Significant prolongation, defined as an absolute QTcF value ≥500 ms or a change from baseline of ≥60 ms, was also noted. RESULTS: The overall prevalence of QTc prolongation was 37.25%, with 13.7% of patients experiencing significant prolongation. The highest proportion of moderate to severe cases occurred at 3 months. Male gender and body mass index (BMI) >18.5 kg/m were identified as statistically significant risk factors. All patients with significant QTc prolongation were under 60 years old, contrasting with prior research. Temporary withdrawal of BDQ was required in 1.96% of patients due to severe QTc prolongation, but no serious cardiac events were observed, consistent with previous studies. CONCLUSION: This prospective study highlights that while QTc prolongation is a frequent occurrence in MDR/RR-TB patients receiving BDQ, severe cases necessitating treatment modification remain uncommon. These findings reaffirm the critical role of BDQ in MDR-TB management while emphasizing the necessity of stringent cardiac monitoring, particularly during the initial 3 months of therapy. LIMITATIONS: The study's small sample size and concomitant use of other QTc-prolonging medications may have influenced the results. Further large-scale studies are needed to confirm these findings and explore additional risk factors.
Interobserver Variability of Both Glasgow Coma Scale and Full Outline of Unresponsiveness Scores in Forecasting the Results of Critically Ill Patients with Altered Sensorium.
Chendke P, Shah L, Badave A … +1 more , Tamboli AA
J Assoc Physicians India · 2026 Feb · PMID 41818078 · Publisher ↗
BACKGROUND: Altered mental status (AMS) refers to changes in cognitive function or consciousness, encompassing cognitive, attention, arousal, and consciousness disorders. The Glasgow Coma Scale (GCS) and full outline of...
BACKGROUND: Altered mental status (AMS) refers to changes in cognitive function or consciousness, encompassing cognitive, attention, arousal, and consciousness disorders. The Glasgow Coma Scale (GCS) and full outline of unresponsiveness (FOUR) score are tools used to evaluate patients with altered consciousness. Few studies have compared the interobserver reliability of these scales. This study aimed to assess interobserver variability between GCS and FOUR scores in predicting outcomes of critically ill patients with altered sensorium. METHODOLOGY: This hospital-based forecasting experimental study included 200 patients who were admitted to the critical care unit at King Edward Memorial (KEM) Hospital, Pune. Patients were randomly selected and scored once within 24 hours of admission using both GCS and FOUR scores by two independent observers, a critical care resident (CCR) and a critical care consultant (CCC), with a 5-minute interval between assessments. Interrater reliability was measured using kappa values, with outcomes focused on agreement within ±1 score point for both scales. Statistical analysis was conducted using Epi Info. RESULTS: Demographics showed males (62%) outnumbered females (38%). The largest age-group was 51-70 years (38 %). GCS and FOUR scores showed no significant differences between CCR and CCC in mean GCS (CCR: 8.2 ± 2.9; CCC: 8.5 ± 3.0; = 0.249) or FOUR score (CCR: 10.74 ± 3.2; CCC: 10.9 ± 3.1; = 0.6118). A close to borderline difference was observed in GCS for females ( = 0.0423). Interrater agreement showed kappa values for GCS components eye-openings (0.78291), verbal responses (0.64858), and motor responses (0.38867). For FOUR scores, kappa values were eye-openings (0.81014), motor responses (0.77721), brainstem reflexes (0.89801), and respirations (0.91623). CONCLUSION: The study found very good interobserver reliability for GCS eye and verbal components but poor agreement for motor responses due to confusion with localization and abnormal movements. The FOUR score demonstrated good to excellent reliability across all components and provided more detailed neurologic assessments, especially in intubated patients and those with brainstem dysfunction. It is more efficient in predicting outcomes, making it a preferred tool in intensive care units (ICUs). Larger studies are recommended to incorporate the FOUR score as a standard neuromonitoring tool in the intensive care unit.
A Study of Role of Bronchoscopy in Intensive Care Units.
Achhava MS, Gupta AM, Tripathi S … +3 more , Kapadia V, Chauhan BA, Pathan H
J Assoc Physicians India · 2026 Feb · PMID 41818077 · Publisher ↗
OBJECTIVES: (1) To know the contributions of bronchoscopy in intensive care units (ICUs) in terms of therapeutic benefits and diagnostic purposes. (2) To know the safety of the bronchoscopy procedure in ICUs in criticall...
OBJECTIVES: (1) To know the contributions of bronchoscopy in intensive care units (ICUs) in terms of therapeutic benefits and diagnostic purposes. (2) To know the safety of the bronchoscopy procedure in ICUs in critically ill patients. MATERIALS AND METHODS: This is a retrospective observational study that included 41 patients who underwent bronchoscopy in the ICU of a tertiary care center. Data collected included the patient's clinical profile, vitals, cause of ICU admission, indication for bronchoscopy, and complications. RESULTS: There were 41 ICU patients who required and underwent bronchoscopy. A number of 15 patients (36.5%) were on mechanical ventilation, and 10 patients (24.3%) were on noninvasive ventilation (NIV) support. The most common indication was lung collapse in 23 (56%) patients. Out of 41 patients who underwent the procedure, 28 patients (68.2%) showed postprocedure improvement, which shows the utility of the procedure. Minor complications occurred in 18 patients (43%) and included hypoxia, bleeding, and bronchospasm. Zero mortality was reported during or after the procedure. CONCLUSION: Bronchoscopy provides excellent diagnostic yield and therapeutic benefits in ICU patients with respiratory conditions, and it is relatively safe even in high-risk patients when done by trained consultants.
Prevalence of Vitamin D Deficiency in Pulmonary Tuberculosis: A Prospective Cross-sectional Study.
Sekhar V
J Assoc Physicians India · 2026 Feb · PMID 41818076 · Publisher ↗
OBJECTIVE: The current cross-sectional study examined the extent of vitamin D (Vit-D) deficiency among pulmonary tuberculosis (TB)-affected patients and explored the potential associations of demographic factors with Vit...
OBJECTIVE: The current cross-sectional study examined the extent of vitamin D (Vit-D) deficiency among pulmonary tuberculosis (TB)-affected patients and explored the potential associations of demographic factors with Vit-D status. METHODOLOGY: Conducted from 1 August 2014, to 1 February 2016, at a tertiary care center, the study included patients aged 18-60 years. Ethical approval was obtained, and exclusion criteria such as category II or multidrug-resistant TB, secondary immunodeficiency states, and extrapulmonary TB were applied. Clinical and laboratory data, including Vit-D levels, were collected. Statistical studies employed ANOVA, Chi-squared tests, and one-sample -tests. RESULTS: Among the 72 patients with TB, the majority were aged 50 years and above, with male preponderance (62%). Fifty-two (75%) TB patients had Vit-D deficiency, with an average Vit-D level of 16.68 ng/mL. The prevalence of Vit-D deficiency was significantly higher in women compared to men (92.6 vs 64.4%; = 0.026). All patients with bilateral lung lesions had Vit-D deficiency compared to 59.3% in unilateral lung lesion patients ( = 0.002). Sputum microscopy and culture contributed to 65.28% of TB diagnoses. Vit-D deficiency prevalence was 75%, with an average Vit-D level of 16.68 ng/mL. CONCLUSION: The study highlights gender- and lesion-associated vulnerabilities to Vit-D deficiency among pulmonary tuberculosis patients. Despite limitations, the findings suggest the need for Vit-D screening in TB care and further clinical trials to explore the role of Vit-D levels in management.
Molecular Identification of in Human Pulmonary Tuberculosis: Insights from a Tertiary Care Hospital in Gujarat, India.
Bhatt D, Singh S, Chudasama P
J Assoc Physicians India · 2026 Feb · PMID 41818075 · Publisher ↗
BACKGROUND: the causative agent of bovine tuberculosis, is a zoonotic pathogen capable of infecting cattle and humans. Human contraction of bovine tuberculosis, particularly pulmonary infection, remains a significant pu...
BACKGROUND: the causative agent of bovine tuberculosis, is a zoonotic pathogen capable of infecting cattle and humans. Human contraction of bovine tuberculosis, particularly pulmonary infection, remains a significant public health concern. The differentiation between and is challenging due to limitations in conventional diagnostic methods, leading to an underestimated burden of in human population. This study focuses on the prevalence of in cases of pulmonary tuberculosis in a tertiary care teaching hospital located in Karamsad, Anand, a rural district of Gujarat. METHODS: In this cross-sectional study, 1,000 sputum samples from patients clinically suspected of having pulmonary tuberculosis were collected at the Department of Respiratory Medicine from November 2017 to June 2018. All samples underwent Ziehl-Neelsen staining for Acid Fast Bacilli detection, followed by molecular testing using primers targeting the gene (a histone-like protein), to differentiate between and Results: Of the 1,000 sputum samples, 100 (10%) tested positive for Acid Fast Bacilli. Molecular analysis revealed that 90% of these positive samples were Among the remaining samples, 4% were positive for and 6% indicated a mixed infection with both and Conclusion: The study found the prevalence of M. bovis in 10% cases of pulmonary tuberculosis in the Anand district of Gujarat. The findings highlight the limitations of conventional diagnostic methods in identifying M. bovis infections and demonstrate the efficacy of molecular techniques, explicitly targeting the HupB gene, for accurate detection and differentiation of M. tuberculosis and M. bovis. The evidence of coinfection in 6% patients further emphasizes the complexity of tuberculosis diagnosis in endemic areas.
To Determine Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin Therapy.
Bhadade R, Dongare N, Harde M … +2 more , deSouza R, Patel A
J Assoc Physicians India · 2026 Feb · PMID 41818074 · Publisher ↗
INTRODUCTION: India harbors the second-largest population with diabetes, with over 100 million, and type 2 diabetes mellitus (T2DM) constitutes the major share. Metformin remains the first-line pharmacotherapy for T2DM d...
INTRODUCTION: India harbors the second-largest population with diabetes, with over 100 million, and type 2 diabetes mellitus (T2DM) constitutes the major share. Metformin remains the first-line pharmacotherapy for T2DM due to its safety profile, cost-effectiveness, and beneficial metabolic effects. MATERIALS AND METHODS: The aim of the study was to assess the frequency of vitamin B12 deficiency in patients with T2DM on metformin therapy and compare it with their cohabiting family members who are not on metformin but share similar dietary habits. RESULTS: This study included 180 participants with 90 cases and controls each, and we enrolled 89 females (49.4%) and 91 males (50.6%). The mean age was 57 (± 4.88) years, and overall gender distribution and dietary pattern were nearly balanced among cases and controls. The mean duration of diabetes among cases was 7.69 ± 4.35 years, and duration of metformin use was 5.22 ± 3.77 years, ranging from 1-16 years. The mean daily dose of metformin was 1238.89 ± 586.50 mg/day, with a median dose of 1000 mg/day. The mean serum vitamin B12 level in metformin users was significantly lower than in controls (206.66 ± 59.09 pg/mL vs 301.44 ± 72.28 pg/mL, < 0.001). Vitamin B12 deficiency was present in 40.0% of metformin users versus 11.1% of controls, yielding an odds ratio of 5.33 (95% CI: 2.44-11.65), which was a highly significant difference between the two groups ( = -9.631, < 0.001), strongly suggesting an association between metformin use and reduced B12 levels. Neurological symptoms were observed in 14.4% of cases (OR 4.896, 95% CI: 1.345-17.827; = 0.009). CONCLUSION: Long-term metformin use in T2DM patients is strongly associated with both biochemical vitamin B12 deficiency and an increased likelihood of neurological symptoms.
Exploring Hypovitaminosis B12 in New Onset Type 2 Diabetes Mellitus and Prediabetes.
Karanth JB, Maribashetti K, Karanth GJ
J Assoc Physicians India · 2026 Feb · PMID 41818073 · Publisher ↗
BACKGROUND: Diabetics often develop vitamin B12 deficiencies, which are crucial for blood, nerve, cognitive, and cardiovascular functions. The impact of metformin on vitamin B12 levels, leading to complications such as p...
BACKGROUND: Diabetics often develop vitamin B12 deficiencies, which are crucial for blood, nerve, cognitive, and cardiovascular functions. The impact of metformin on vitamin B12 levels, leading to complications such as peripheral neuropathy and anemia, is well-known; yet no studies focus on deficiency status at diabetes diagnosis or the start of treatment. METHODS: A cross-sectional study was conducted at 2 tertiary care institutions in India, Command Hospital (Western Command), Haryana, and Civil Hospital in Sirsi, Karnataka, from July 2022 to November 2023. The study included 326 newly diagnosed type II diabetes mellitus (DM) patients and prediabetes individuals attending outpatient and inpatient departments, collecting data on substance use, dietary practices, fasting blood sugar, random blood sugar, HbA1c, and vitamin B12 levels (CLIA method). RESULTS: The study population of 326 individuals showed significant regional differences in mean age, gender distribution, and dietary preferences. Vitamin B12 deficiency (<200 pg/mL) was prevalent in 43.4% of prediabetic and 51.9% of type II DM patients. Significant differences in fasting blood sugar, postprandial blood sugar, and HbA1c levels were observed between regions. However, no significant correlation was found between vitamin B12 levels and HbA1c, age, or fasting glucose levels. Vegetarian individuals exhibited significantly higher vitamin B12 deficiency. CONCLUSION: This study revealed a high prevalence of vitamin B12 deficiency in newly diagnosed diabetes patients, emphasizing the need for early identification and treatment to prevent complications such as neuropathy. The study recommends incorporating initial vitamin B12 assessment into the diagnosis protocol for newly detected diabetes patients to improve patient care and prevent complications in the Indian population.
Different Methods of Low-density Lipoprotein Cholesterol Estimation and the Impact on Lipid-lowering Therapy in Patients with Coronary Artery Disease.
Bansal M, Kaushal P, Kasliwal RR … +5 more , Chandra P, Kapoor R, Chouhan N, Bhan A, Trehan N
J Assoc Physicians India · 2026 Feb · PMID 41818072 · Publisher ↗
BACKGROUND: Indirect estimation of low-density lipoprotein cholesterol (LDL-C) is a common clinical practice. The Friedewald equation is used most often but has inherent limitations. Clinical implications of such a pract...
BACKGROUND: Indirect estimation of low-density lipoprotein cholesterol (LDL-C) is a common clinical practice. The Friedewald equation is used most often but has inherent limitations. Clinical implications of such a practice have not been well defined, especially in the current era of targeting low (<50-70 mg/dL) or ultralow (<30-40 mg/dL) LDL-C levels. METHODS: Overall, 3,028 consecutive subjects with coronary artery disease (CAD) undergoing coronary revascularization were included. Four methods of LDL-C estimation were compared: direct estimation, the Friedewald, Martin, and Sampson equations. RESULTS: The mean age of the subjects was 61.3 ± 10.2 years, and 2,525 (83.4%) were men. Mean direct LDL-C was 78.9 ± 32.9 mg/dL. Compared with the direct estimation, all three indirect methods significantly underestimated LDL-C, but the Martin equation had the least bias (mean differences of -10.5 ± 9.7 mg/dL, -5.2 ± 7.6 mg/dL, and -7.2 ± 8.3 mg/dL with the Friedewald, Martin, and Sampson equations, respectively; -values <0.001 for all the comparisons). Among patients with LDL-C >70 mg/dL and >50 mg/dL, the Friedewald equation erroneously classified 24.6% and 19.9%, respectively, as having LDL-C below these thresholds. This error increased with increasing triglyceride levels. The Martin equation was the most accurate, whereas the Sampson equation had intermediate accuracy. CONCLUSION: Our study shows that the Friedewald equation underestimates LDL-C and can potentially result in significant undertreatment in patients with CAD in whom aggressive LDL-C lowering is crucial. Direct estimation is the preferred method, but the Martin equation could be a reasonable alternative if the direct estimation is not feasible due to logistical constraints.
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