The Journal Of The Association Of Physicians Of India[JOURNAL]
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200 papers
The Interplay of Age, Obesity Measures, and Micronutrient Deficiencies in PCOS-associated Metabolic Dysfunction Findings from a Retrospective Postobservational Cohort Study.
Tumbi Z, Tumbi M, Tailor V … +1 more , Temkar G
J Assoc Physicians India · 2025 Dec · PMID 41391087 · Publisher ↗
BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine-metabolic disorder with significant age-related, anthropometric, and metabolic variations. Understanding the interplay between age, body composition, an...
BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine-metabolic disorder with significant age-related, anthropometric, and metabolic variations. Understanding the interplay between age, body composition, and micronutrient status can help identify predictors of metabolic dysfunction and long-term complications in women with PCOS. Most studies assess these factors in isolation, resulting in fragmented evidence and inconsistent conclusions. OBJECTIVES: This study aimed to evaluate the predictive associations of age, anthropometric parameters, and micronutrient levels (vitamin B12 and vitamin D3) with key metabolic, cardiovascular, and nutritional markers in women diagnosed with PCOS. MATERIALS AND METHODS: A cross-sectional analysis was conducted among women with PCOS, divided into two age-groups: group I (15-30 years) and group II (31-40 years). One-way analysis of variance (ANOVA) and linear regression analyses were performed to investigate age- and obesity-related differences in metabolic parameters. Pearson's correlations and regression models were applied to assess the predictive strength of age, body mass index (BMI), waist circumference (WC), vitamin B12, and vitamin D3 on metabolic outcomes. The Benjamini-Hochberg method was applied to control the false discovery rate (FDR) for multiple comparisons and ensure conclusions account for the increased risk of type I error due to multiple comparisons, thereby supporting the validity of the study's observations. RESULTS: The PCOS cohort exhibited generalized overweight (BMI 23.0-24.9 kg/m) and obesity (BMI ≥25.0 kg/m) in 40 and 54% of subjects, respectively; notably, visceral obesity (WC ≥80 cm) was present in 97% of the cohort, underscoring a marked predominance of central adiposity even among those with lower BMI thresholds. The PCOS cohort demonstrated high metabolic risk, with frequent insulin resistance, dyslipidemia, and hypertension; notably, 25% had nonalcoholic fatty liver disease (NAFLD), predominantly mild steatosis, indicating a substantial risk for future cardiometabolic complications. Advancing age was significantly associated with higher fasting blood sugar (FBS) ( = 0.019) and glycated hemoglobin (HbA1c) ( = 0.048), while fasting insulin declined with age ( = 0.048). BMI and WC were strong predictors of metabolic risk, positively impacting fasting insulin, FBS, HbA1c, and blood pressure ( < 0.05), while showing significant negative associations with high-density lipoprotein cholesterol (HDL-C) ( < 0.001). Vitamin B12 and D3 levels showed no significant impact on metabolic parameters. Vitamin B12 was predicted only by age ( < 0.001) and vitamin D3 ( < 0.001), while vitamin D3 was influenced by age ( < 0.001) and vitamin B12 levels ( = 0.041). CONCLUSION: Central obesity markers-particularly WC and BMI-are robust predictors of metabolic dysfunction in PCOS, offering greater prognostic value than micronutrient levels such as vitamin B12 or D3, which showed limited association with metabolic disturbances in this population. These findings highlight the primacy of early detection and intervention targeting adiposity and insulin resistance to reduce long-term cardiometabolic risk among women with PCOS. Integrated, multifactorial risk assessment remains essential, as age, nutritional deficits, and obesity-related factors independently and collectively drive adverse metabolic outcomes in PCOS, emphasizing the need for comprehensive preventive and management strategies.
Audit of Admissions and Discharges of Intensive Care Unit at a Tertiary Care Center of Northern India with American Critical Care Medicine-2016 Recommendations.
Bhushan D, Kumar V, Sinha SK … +2 more , Roy R, Agarwal M
J Assoc Physicians India · 2025 Dec · PMID 41391086 · Publisher ↗
BACKGROUND: The intensive care unit (ICU) is an area within a medical facility equipped with advanced technologies such as ventilators and personnel trained to provide intensive, advanced life-supportive care to critical...
BACKGROUND: The intensive care unit (ICU) is an area within a medical facility equipped with advanced technologies such as ventilators and personnel trained to provide intensive, advanced life-supportive care to critically ill patients. These units can be general or specialized. Intensive care beds are always in demand in any tertiary care center. Getting ICU beds is a challenging task. In 2008, the cost of critical care was 17-39% of hospital costs and 5.2-11% of the total healthcare budget. On one hand, where needy patients do not get ICU beds, there are instances when patients are kept just for observation in intensive care. So, we planned this study to analyze our status regarding the effective utilization of medical intensive care beds. AIMS AND OBJECTIVES: To audit our admissions and discharges on the grounds of the criteria laid by the American Critical Care Medicine (ACCM) in the year 2016, and to strengthen our admission and discharge policies with standard protocols to make the best utilization for society. MATERIALS AND METHODS: Retrospectively, we analyzed the medical records of 6 months (July 1-December 31, 2021). We analyze admission criteria and discharges in those patients. We recorded the sequential organ failure assessment (SOFA) score, the quick sequential organ failure assessment (qSOFA) score, the length of stay in ICU, the total length of stay, and the outcomes of the patients. The analysis was done with SPSS. RESULTS: We collected records of 355 patients admitted in the medicine ICU during the defined period. There was a male preponderance in our study. The mean age of patients admitted was 54.75 ± 17.53 (range 16-82). Most patients were transferred in from the ward (53.5%), and the rest (46.5%) were directly from the emergency department. When we categorized the patients' admission according to ACCM Guidelines, 39.4% of patients were in category I, 11.3% patients in category II, 36.6% in category III, 7% in category IV, and 5.6% in category V. When we compared the SOFA score along with the admissions category, there was no significant association. Mean ICU length of stay was 6.11 ± 4.99. There was no association found between the category of admission and the mean ICU length of stay. Overall, out of 355 patients, 255 patients (71.8%) transferred out, 20 patients (5.6%), and 80 patients (22.6%) could not be saved. In our study, 80.3% of transfers out were unplanned (this also includes the death of patients). There was a significant association between the admission category of patients and their outcome in the ICU. CONCLUSION: The intensive care unit is an expensive setup. It is yet to be used in its maximum capacity for those who really need it. Triaging patients for the ICU is a must for better utilization of resources. Admissions and discharge policies should be followed stringently for optimum utilization of facilities.
Clinicopsychological Profile of Geriatrics Patient Visiting the Outpatient Department of a Tertiary Care Center of Western Uttar Pradesh: A Cross-sectional Study.
Sharma S, Gupta A, Chaudhary G … +2 more , Rishi VK, Pal T
J Assoc Physicians India · 2025 Dec · PMID 41391085 · Publisher ↗
BACKGROUND: The geriatric population is highly vulnerable to both clinical and psychological comorbidities; the psychological health of geriatric patients remains underassessed, particularly in government outpatient depa...
BACKGROUND: The geriatric population is highly vulnerable to both clinical and psychological comorbidities; the psychological health of geriatric patients remains underassessed, particularly in government outpatient department (OPD) settings where multiple chronic illnesses, low socioeconomic status, and hospitalization disrupt emotional well-being. AIMS AND OBJECTIVES: To evaluate the prevalence and association of chronic diseases with depression, anxiety, cognitive impairment, and sleep quality in elderly patients. MATERIALS AND METHODS: A cross-sectional study was conducted on 100 patients aged ≥60 years attending the medicine OPD. Geriatric depression scale (GDS-15), generalized anxiety disorder scale (GAD-7), mini-mental state examination (MMSE), and Pittsburgh sleep quality index (PSQI) scales were used to assess psychological status. Clinical parameters and recent hospitalization history were also recorded. RESULTS: Hypertension (45%), diabetes (35%), and osteoarthritis (25%) were the most prevalent chronic illnesses. Mild depression (56%), mild anxiety (45%), cognitive impairment (45%), and poor sleep quality (78%) were common. Coronary artery disease (CAD) was significantly correlated with depression ( = 0.008), diabetes with cognitive decline ( = 0.002), and recent hospitalization with cognitive scores ( = 0.006). CONCLUSION: The study underscores the need for integrated psychological assessment and intervention in geriatric medicine, even in resource-constrained OPD environments. Chronic illnesses such as CAD and diabetes significantly affect psychological well-being in elderly patients. Routine psychological screening is essential in OPDs.
Quantification of Liver Stiffness Using Magnetic Resonance Elastography in Comparison with Transient Elastography and Noninvasive Fibrosis Score in Fatty Liver.
M PS, Peer S, Raj A … +5 more , Kaushal G, Kaur H, Wander A, Singh S, Singh P
J Assoc Physicians India · 2025 Dec · PMID 41391084 · Publisher ↗
BACKGROUND: The global incidence of fatty liver (FL) [alcoholic and nonalcoholic FL disease (NAFLD)] is increasing. Imaging-based elastography techniques, being noninvasive, may eliminate the need for more invasive techn...
BACKGROUND: The global incidence of fatty liver (FL) [alcoholic and nonalcoholic FL disease (NAFLD)] is increasing. Imaging-based elastography techniques, being noninvasive, may eliminate the need for more invasive techniques for the diagnosis and staging of liver fibrosis in FL disease. OBJECTIVE: Our study aims to address the gap in the current research by exploring the correlation between mean liver stiffness measurement (LSM) as obtained through magnetic resonance elastography (MRE) and transient elastography (TE), and two commonly used clinical scores, fibrosis-4 index (FIB-4) score and aspartate aminotransferase to platelet ratio index (APRI) score. MATERIALS AND METHODS: In this hospital-based cross-sectional study, 62 patients diagnosed with FL on ultrasound were recruited. The patients were further subjected to MR liver elastography and TE, and LSM using both modalities was recorded. A history of diabetes mellitus and alcohol intake was taken. Moreover, noninvasive fibrosis scores such as FIB-4 and APRI were calculated using standard formulas. RESULTS: The correlation analysis revealed a strong positive correlation between LSM values obtained from MRE and TE ( = 0.88) (Cohen's κ = 0.87), a moderate correlation between MRE and FIB-4 score ( = 0.44), and weak positive correlations involving MRE and APRI ( = 0.34), TE and FIB-4 score ( = 0.36), and TE and APRI ( = 0.29). Additionally, significantly higher fat fractions were quantified [median (IQR)] in grade III FL [23.6 (15.9-29.5)] as compared to grades I [8.45 (2.25-13.9)] and grade II [13.1 (8.4-19.7)]. CONCLUSION: MRE shows a strong positive correlation with TE for LSM and stage of fibrosis. Our findings suggest that MRE could be a valuable tool in the diagnostic armamentarium of FLD.
Diagnostic Accuracy of Fine Needle Aspirates Using International Academy of Cytology Yokohama System in Categorizing and Diagnosis of Lesions of the Breast: A Clinicopathological Experience.
Jairajpuri ZS, Fatima F, Trisal M … +7 more , Khetrapal S, Rana S, Abbas S, Mohroo R, Jetley S, Prasad D, Nawab S
J Assoc Physicians India · 2025 Dec · PMID 41391083 · Publisher ↗
BACKGROUND: International Academy of Cytology (IAC) introduced a breast category to produce comprehensive standardized guidelines for reporting breast cytopathology. IAC Yokohama System for Reporting Breast Cytopathology...
BACKGROUND: International Academy of Cytology (IAC) introduced a breast category to produce comprehensive standardized guidelines for reporting breast cytopathology. IAC Yokohama System for Reporting Breast Cytopathology highlights the indications for getting breast cytology, procedural techniques, preparation of smear, material yielded, uniform system of reporting, use of ancillary investigations and prognostic tests, and correlation with clinical workup algorithms. The triple approach that includes clinical examination, radiological and pathological workup aims to maximize the preoperative detection of malignancy for early, definitive, appropriate treatment to the patient. MATERIALS AND METHODS: The present study characterized the cytomorphological features of breast lesions ranging from inflammatory, benign to malignant. The lesions encountered were assigned a specific category on the basis of IAC Yokohama System. Histopathological correlation of cytomorphological findings was done wherever possible. RESULTS: Out of a total of 450 cases included in our study, 98% (441/450) were females, male to female ratio of 1:49, mean age being 32.6 ± 12.5 years. Majority of cases were in Yokohama category benign comprising 345 breast aspirates (76.66%), followed by 40 cases (8.8%) malignant, 28 cases (6.22%) in Yokohama atypical category. Category suspicious for malignancy consisted of 17 (3.7%) cases. A good inter-kappa agreement was found between cytological impression and histopathology diagnosis (>0.5). A sensitivity and specificity of 100 and 92.96% respectively was seen along with positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.24%, 100%, and 0.98 respectively. Diagnostic accuracy of 98.57% was seen. CONCLUSION: The IAC Yokohama System is a high-quality reporting system used for diagnosing breast fine needle aspirates accurately with greater reproducibility of reports and better communication between the pathologist and clinician.
Serum Calcium Levels as a Marker of Dengue Severity: A Clinical Observational Study.
Deshwal R, Sharma A
J Assoc Physicians India · 2025 Dec · PMID 41391082 · Publisher ↗
BACKGROUND: Dengue fever continues to pose a major global health challenge. Electrolyte disturbances, particularly hypocalcemia, are frequently observed in dengue but are underutilized for prognostication. OBJECTIVE: To...
BACKGROUND: Dengue fever continues to pose a major global health challenge. Electrolyte disturbances, particularly hypocalcemia, are frequently observed in dengue but are underutilized for prognostication. OBJECTIVE: To evaluate the relationship between corrected serum calcium levels and dengue severity. MATERIALS AND METHODS: A prospective observational study of 210 adult patients with confirmed dengue was conducted at Shiv Ram Hospital. Serum calcium was measured within 24 hours of admission and corrected for albumin. Severity was classified per World Health Organization (WHO) 2009 criteria. Correlation analyses and multivariate logistic regression were used to assess associations with clinical and laboratory parameters. RESULTS: Mean corrected serum calcium declined with increasing severity (group A: 8.39 ± 0.59 mg/dL, group B: 8.05 ± 0.62 mg/dL, group C: 7.61 ± 0.67 mg/dL; < 0.001). Hypocalcemia (<8.5 mg/dL) was observed in 91.3% of severe cases. Calcium levels negatively correlated with hematocrit, platelet count, and hospitalization duration ( < 0.01). Hypocalcemia independently predicted severe dengue (aOR: 3.94; 95% CI: 1.98-7.84; < 0.001). CONCLUSION: Hypocalcemia is a frequent and significant predictor of severe dengue. Serum calcium offers a simple, cost-effective tool for early triage and management in dengue-endemic regions.
Correlation between Serum Uric Acid Level and Left Ventricular Ejection Fraction in Patients with Heart Failure.
Sakhuja M, Pendse M, Patil S
J Assoc Physicians India · 2025 Dec · PMID 41391081 · Publisher ↗
BACKGROUND: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with t...
BACKGROUND: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with the severity of systolic dysfunction. However, the relationship between SUA and left ventricular ejection fraction (LVEF) remains unclear. METHODOLOGY: A cross-sectional study was conducted at DY Patil University School of Medicine, Navi Mumbai, involving 60 patients diagnosed with HF. Patients were categorized based on LVEF into HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). SUA levels were measured, and patients were classified into hyperuricemia or normal uric acid level groups. Demographics, comorbidities, and clinical symptoms were also recorded. Statistical analysis was performed to determine the correlation between SUA and LVEF. RESULTS: Of the 60 patients enrolled, 65% were female, with a mean age of 61-70 years. The majority had HFrEF (70%), followed by HFmrEF (26.67%) and HFpEF (3.3%). Hyperuricemia was observed in 38.3% of patients. A weak negative correlation was found between LVEF and SUA ( = -0.070), which was not statistically significant ( = 0.599). Although hyperuricemia was more prevalent in HFrEF, no significant relationship was established between SUA levels and severity of systolic dysfunction. CONCLUSION: The study found a weak and statistically insignificant correlation between SUA levels and LVEF in HF patients. This suggests that SUA may not be a reliable biomarker for assessing the severity of systolic dysfunction. Further studies involving larger, more diverse populations are needed to clarify the prognostic role of SUA in HF.
Hand Grip Strength as a Functional Marker of Sarcopenia in Liver Cirrhosis: Evidence from an Indian Cohort.
Sunder S, Yadav NL, Sharma PN
J Assoc Physicians India · 2025 Dec · PMID 41391080 · Publisher ↗
BACKGROUND: Sarcopenia is a frequent and prognostically significant complication of liver cirrhosis. Hand grip strength (HGS) has emerged as a simple, noninvasive tool for assessing muscle function, yet limited data exis...
BACKGROUND: Sarcopenia is a frequent and prognostically significant complication of liver cirrhosis. Hand grip strength (HGS) has emerged as a simple, noninvasive tool for assessing muscle function, yet limited data exist on its utility in Indian cirrhotic populations. AIM: To evaluate the association of HGS with established prognostic scores and biochemical parameters in Indian patients with cirrhosis. MATERIALS AND METHODS: In this cross-sectional observational study, 100 adult cirrhotic patients were assessed between August 2022 and December 2023. HGS was measured using a validated hand-held dynamometer. Correlations between HGS and clinical scores of severity of cirrhosis [Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD)] and biochemical markers were analyzed using appropriate statistical methods. RESULTS: Mean patient age was 59.2 ± 8.46 years; 85% were male. The most common etiologies were alcohol (46%) and viral hepatitis (26%). HGS declined significantly with increasing liver disease severity: CTP A (34.0 ± 1.48 kg), B (21.63 ± 1.07 kg), and C (13.5 ± 2.87 kg) ( < 0.0001). HGS was inversely correlated with MELD score ( = -0.820) and showed strong positive correlations with serum albumin ( = +0.872) and hemoglobin ( = +0.59). Age, international normalized ratio (INR), and bilirubin were negatively correlated with HGS. CONCLUSION: HGS is strongly associated with liver disease severity and key biochemical indicators. As a bedside, radiation-free tool, it offers a practical method for assessing sarcopenia in cirrhosis, especially in resource-limited settings.
Surgical Antimicrobial Prophylaxis Appropriateness and Its Impact on Surgical Site Infection Rate.
Karuppiah Y
J Assoc Physicians India · 2025 Dec · PMID 41391079 · Publisher ↗
OBJECTIVES: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appr...
OBJECTIVES: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates. METHODS: A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols. RESULTS: The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use. CONCLUSION: The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.
A Study of the Etiology, Clinical Profile, and Outcome of Nontraumatic Cases of Impaired/Altered Sensorium in Patients Attending the Emergency Department in a South Indian Tertiary Care Hospital.
Budumuru U, Sowmini PR, Pramod KS … +5 more , Jeyaraj M, Velayutham S, Vellaichamy K, Raju SV, Krishnan M
J Assoc Physicians India · 2025 Dec · PMID 41391078 · Publisher ↗
INTRODUCTION: Nontraumatic cases of impaired/altered sensorium continue to be one of the most frequent emergencies that casualties encounter. The patient's overall prognosis may depend on early clinical evaluation and et...
INTRODUCTION: Nontraumatic cases of impaired/altered sensorium continue to be one of the most frequent emergencies that casualties encounter. The patient's overall prognosis may depend on early clinical evaluation and etiological diagnosis. In order to make a more accurate and timely diagnosis, it is crucial to understand the etiological profile of comatose patients who arrive at a tertiary care facility, which can successfully predict the outcome. MATERIALS AND METHODS: This prospective observational study was carried out in a South Indian tertiary care facility. A total of 126 patients with altered mental status of nontraumatic origin who arrived at the emergency room with Glasgow coma scale (GCS) scores below 10 were included in the study. RESULTS: Of the 126 patients, 48 (38.1%) were female and 78 (61.9%) were male. All patients were 52.65 ± 17.94 years old on average. The comorbidities observed in this study were hypertension (49.2%), diabetes mellitus (36.5%), alcoholism (33.3%), smoking (25.3%), coronary artery disease (CAD) (7%), chronic kidney disease (CKD) (9.5%), epilepsy (4.7%), and previous cerebrovascular accident (CVA) (9.5%). The presenting symptoms other than altered sensorium were fever (4%), vomiting (9.5%), headache (3%), motor weakness (16%), seizures (15.8%), and breathlessness (4.7%). About 36 patients (28.5%) had abnormal neurological examination, with motor weakness being the most common finding in 34 patients (27%). A brain magnetic resonance imaging (MRI) or computed tomography (CT) scan was performed on 104 patients (82.5%), and 50 patients (48%) had abnormal results. The commonest finding was cerebral and cerebellar infarction seen in 35 patients (33.6%). A number of 48 (38%) patients had abnormal electrocardiogram (ECG), 42 (33%) had nonspecific ischemic alterations, and six patients (4.7%) had atrial fibrillation. In our study, 46 patients (36.5%) had neurological causes of impaired/altered sensorium, 32 patients (25.4%) had metabolic causes, 18 patients (14.3%) had multifactorial causes, 14 patients (11.1%) had infections, and 16 patients (12.7%) had other causes [status epilepticus, drug overdose, organophosphate (OP) poisoning]. The commonest neurological cause was ischemic stroke, noted in 32 patients (69.5%), out of which 16 cases were posterior circulation strokes. About 14 cases had anterior circulation stroke. The remaining two cases presented with both anterior and posterior circulation strokes. The mortality rate was 36.5%. A number of 46 patients died out of 126 patients. Out of 46 patients, CVA was the most common cause of death, accounting for 20 cases (43.4%). CONCLUSION: In this study, the duration of altered mental status, GCS score, level of altered consciousness, and etiology were found to be significant prognostic markers that correlated with outcome in nontraumatic cases with impaired/altered sensorium. Factors that offer early prognostic information can help with resource allocation decisions because the cost of intensive care has increased significantly. The prognosis can be predicted using a simple clinical evaluation of neurological function, paying particular attention to the degree of consciousness, focal neurological signs, and brainstem reflexes.
Correlation of Conventional and Extended Lipid Profiles with Plaque Burden in Statin-naïve Patients with Acute Coronary Syndrome: A Prospective Observational Study from South India.
Periasamy M, Ramadoss R, Anantharaj A … +1 more , Vairappan B
J Assoc Physicians India · 2025 Dec · PMID 41391077 · Publisher ↗
BACKGROUND: Traditional lipid parameters like low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) are commonly used in evaluating cardiovascular risk. Recently, emerging biomarkers s...
BACKGROUND: Traditional lipid parameters like low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) are commonly used in evaluating cardiovascular risk. Recently, emerging biomarkers such as apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) are proposed to provide improved accuracy in assessing atherosclerotic risk. This study examined the association between conventional and novel lipid parameters and plaque burden in statin-naïve acute coronary syndrome (ACS) patients. METHODOLOGY: We enrolled 81 statin-naïve patients with ACS. Each underwent both standard and extended lipid profiling. Coronary angiograms were evaluated using the Gensini score to quantify plaque burden. All participants were followed for 28 days to monitor for major adverse cardiac events (MACE). RESULTS: The average age was 51 years, with males comprising 77%. The ST-segment elevation myocardial infarction (STEMI) was observed in 58% of cases, non-ST-segment elevation myocardial infarction (NSTEMI) in 31%, and unstable angina in 11%. There was a significant correlation between the Gensini score and TC/HDL ratio ( = 0.35), LDL/HDL ratio ( = 0.31), and ApoB levels ( = 0.24). LDL and the ApoB/ApoA1 ratio did not exhibit significant associations with plaque burden. STEMI patients had higher LDL/HDL and TC/HDL ratios compared to those with NSTEMI or unstable angina. MACE occurred in 16% of participants, with no significant difference across ACS subtypes. CONCLUSION: The ratios of TC/HDL, LDL/HDL, and ApoB levels were positively associated with coronary plaque burden. While conventional lipid parameters continue to serve well in cardiovascular risk assessment (CRA), ApoB presents a promising standalone marker for identifying atherogenic risk and may serve as a practical alternative in clinical practice.
Comparative Assessment of Cardiac Biomarkers and APACHE II Score for Prognostication in Septicemic Patients at a Tertiary Care Hospital.
Meena S, Nawal CL, Saini HL … +2 more , Chejara RS, Singh A
J Assoc Physicians India · 2025 Dec · PMID 41391076 · Publisher ↗
INTRODUCTION: Cardiac dysfunction is one of the major causes of mortality in patients with sepsis. The acute physiology and chronic health evaluation II (APACHE II), quick sequential organ failure assessment (qSOFA), and...
INTRODUCTION: Cardiac dysfunction is one of the major causes of mortality in patients with sepsis. The acute physiology and chronic health evaluation II (APACHE II), quick sequential organ failure assessment (qSOFA), and other prognostic scores for sepsis have established data regarding their accuracy in predicting mortality. We have assessed the prognostic role of cardiac biomarkers [creatine phosphokinase-myocardial band (CPK-MB), troponin I (Trop I), and probrain natriuretic peptide (proBNP)] in patients with sepsis and compared it with the APACHE II score. MATERIALS AND METHODS: A total of 126 patients (63 in each group) participated in this case-control study in a large tertiary care teaching hospital. Patients with sepsis who required hospitalization were enrolled in the case group and compared with another group of nonsepticemic patients. They were taken for detailed evaluation and investigation on day 1 and day 3. Our study included proBNP, CPK-MB, Trop I, and APACHE II score. RESULTS: Both the case and control groups comprised 63 patients each. It was observed that the cardiac biomarkers (proBNP, Trop I, CPK-MB) were markedly higher among cases than in controls. Similarly, these markers were also found markedly higher in fatal cases than survivors in the case group. Out of all three biomarkers, proBNP was correlated well with mortality as much as the APACHE II score. It was also observed that increasing trends in the levels of biomarkers depict prognosis more effectively than a single value. CONCLUSION: We conclude that cardiac biomarkers can be routinely used as dynamic markers for the prediction of mortality and prognosis in patients with sepsis. ProBNP may be useful in predicting mortality in patients with sepsis.
Knowledge, Attitudes, and Practices of Indian Cross-specialty Healthcare Professionals Managing Diabetes on Nondiarrheal Dehydration and Its Management in Persons with Diabetes.
Chawla M, Agarwal S, Kalra S … +1 more , Sreenivasamurthy L
J Assoc Physicians India · 2025 Dec · PMID 41391075 · Publisher ↗
BACKGROUND: Hydration plays a vital role in metabolic health, particularly in diabetes, where factors such as osmotic diuresis, polypharmacy, and comorbidities heighten the risk of dehydration. Effective management of fl...
BACKGROUND: Hydration plays a vital role in metabolic health, particularly in diabetes, where factors such as osmotic diuresis, polypharmacy, and comorbidities heighten the risk of dehydration. Effective management of fluid, electrolyte, and energy (FEE) deficits is crucial, yet gaps persist in current practices. This is the first study to assess the knowledge, attitude, and practices of cross-specialty healthcare professionals (HCPs) managing diabetes on such a unique issue in persons with diabetes. OBJECTIVES: This study assessed the knowledge, attitudes, and practices (KAP) of 525 cross-specialty HCPs managing diabetes in India regarding FEE management in diabetic patients with acute nondiarrheal illnesses to identify gaps and inform interventions. MATERIALS AND METHODS: An online cross-sectional survey evaluated physician perspectives on dehydration in diabetes using a 30-item questionnaire covering knowledge of dehydration in diabetes, attitudes toward the oral FEE formulations, and current practice. RESULTS: Most respondents (90%) identified osmotic diuresis as a key driver of dehydration in diabetes, with 75% highlighting Sodium-glucose cotransporter 2 (SGLT-2) inhibitors as a risk factor. Despite widespread recognition of the adverse effects of dehydration and energy deficits (86%), only 46.5% routinely assessed hydration status during acute illnesses in persons with diabetes. Slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, were favored by 68.9% of respondents for their metabolic benefits to address energy deficits. 84.2% of HCPs perceived ready-to-drink (RTD) FEE formulations supporting rehydration and enhanced recovery, with an average impact on recovery time of 4.1 days. CONCLUSION: This study highlights the gaps in understanding the role of hydration in persons with diabetes. It also underscores the need for standardized oral FEE management guidelines and innovative solutions, such as RTD FEE drinks, to improve outcomes in diabetic care.
Living Will and Advance Care Planning: The Need of the Hour.
Khanna U, Khanna S
J Assoc Physicians India · 2025 Dec · PMID 41391074 · Publisher ↗
Advance care planning (ACP) refers to the process through which patients, their families, and healthcare providers discuss and record preferences for end-of-life care. Internationally, ACP has been shown to reduce unnece...
Advance care planning (ACP) refers to the process through which patients, their families, and healthcare providers discuss and record preferences for end-of-life care. Internationally, ACP has been shown to reduce unnecessary interventions, align medical decisions with patient wishes, and provide dignity at the end-of-life. In India, however, structured ACP is virtually absent. Good end-of-life care is directly linked to the quality of death that Indians achieve, which has been consistently poor; in the 2021 Quality of Death Index report, India ranked 59 out of 81 countries that were studied..
MASLD-A Gateway for ASCVD: A Call for Early Intervention and Multidisciplinary Care.
Manoria PC, Manoria P
J Assoc Physicians India · 2025 Dec · PMID 41391073 · Publisher ↗
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has emerged as a significant public health concern, affecting approximately 25% of the global...
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has emerged as a significant public health concern, affecting approximately 25% of the global population with its prevalence rising from 22% in 1991 to 37% in 2019. While the hepatic consequences of MASLD, such as steatohepatitis, fibrosis, and cirrhosis, are well documented, its systemic implications are increasingly coming to light. While traditionally viewed as a hepatic disorder, growing evidence highlights MASLD as a multisystem disease with profound implications on cardiovascular health. Atherosclerotic cardiovascular disease (ASCVD) has now been recognized as the leading cause of mortality in patients with MASLD, surpassing liver-related complications. MASLD is present in up to 75% of patients with type 2 diabetes mellitus (T2DM). Notably, MASLD is linked to a higher risk of cardiovascular diseases (CVD), including arrhythmia, atherosclerotic heart disease, heart failure, and CVD-related mortality. The association between MASLD and ASCVD is particularly alarming, positioning MASLD as a critical gateway for cardiovascular morbidity and mortality.
Exploring Etiologies of Hypokalemic Paralysis: A Case Series.
Chaudhary SC, Sinha S, Pal T … +1 more , Sawlani KK
J Assoc Physicians India · 2025 Nov · PMID 41296311 · Publisher ↗
BACKGROUND: Hypokalemic paralysis is a rare but potentially life-threatening neuromuscular emergency characterized by the sudden onset of flaccid weakness due to reduced serum potassium. While inherited channelopathies r...
BACKGROUND: Hypokalemic paralysis is a rare but potentially life-threatening neuromuscular emergency characterized by the sudden onset of flaccid weakness due to reduced serum potassium. While inherited channelopathies represent primary causes, secondary etiologies-particularly endocrine, renal, and metabolic disorders-are more frequently encountered and require timely recognition to avoid complications. CASE SUMMARY: We report four patients presenting with acute flaccid paralysis associated with documented hypokalemia (serum potassium <3.5 mmol/L). The first case involved a pregnant woman with primary hyperaldosteronism due to an adrenal adenoma, managed initially with spironolactone and subsequently cured by adrenalectomy. The second case was a normotensive female diagnosed with distal renal tubular acidosis (dRTA) in the setting of Sjögren's syndrome, treated with potassium citrate and sodium bicarbonate. The third case was a young male with thyrotoxic periodic paralysis (TPP) secondary to Graves' disease, who improved with antithyroid drugs and beta-blockers. The fourth case described a young male with primary hypokalemic periodic paralysis (HPP), presenting with exertion-induced weakness, successfully treated with intravenous potassium supplementation. CONCLUSION: This case series underscores the diverse etiologies of hypokalemic paralysis, spanning endocrine, renal, autoimmune, and genetic causes. A systematic diagnostic approach, guided by clinical and biochemical evaluation, is essential for timely treatment. Identifying the underlying cause not only ensures effective acute management but also prevents recurrence and reduces the risk of serious complications, including cardiac arrhythmias.
Pericardial Hydatid Cyst Causing Focal Right Atrial Tamponade: A Case Report.
Bantu R, Laddhad DS, Mahajan AU … +3 more , Agrawal SR, Gadge PS, Ibrahim F
J Assoc Physicians India · 2025 Nov · PMID 41296310 · Publisher ↗
Cystic echinococcosis (CE) caused by Echinococcus granulosus presents a significant public health concern globally, with varied clinical presentations ranging from asymptomatic to life-threatening complications. We repor...
Cystic echinococcosis (CE) caused by Echinococcus granulosus presents a significant public health concern globally, with varied clinical presentations ranging from asymptomatic to life-threatening complications. We report a case of a 58-year-old female with extensive hydatid disease involving multiple cysts in the abdominal, pelvic, and pericardial cavities, resulting in substantial morbidity. Despite the complexity of the case and the therapeutic dilemma it posed, a tailored management approach combining medical therapy with either surgical intervention or minimally invasive procedures was employed. This case highlights the challenges in managing advanced CE infections and underscores the importance of individualized treatment strategies guided by a comprehensive understanding of the disease and its potential complications.
Atypical Presentation of Myelin Oligodendrocyte Glycoprotein Antibody Disease as Pyrexia of Unknown Origin with Meningitis: A Case Report.
Padhiyar VN, Pahuja VJ, Maitra A … +2 more , Chaudhary NV, Singhal T
J Assoc Physicians India · 2025 Nov · PMID 41296309 · Publisher ↗
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune neuroinflammatory disorder. While it typically presents as optic neuritis, myelitis, or acute disseminated encephal...
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune neuroinflammatory disorder. While it typically presents as optic neuritis, myelitis, or acute disseminated encephalomyelitis (ADEM), its manifestation as pyrexia of unknown origin (PUO) with subsequent meningitis is extremely rare. CASE DESCRIPTION: We report a 17-year-old male who presented with persistent fever and headache, without focal neurological deficits. Extensive infectious workup was inconclusive. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, and empirical antibiotics were initiated without clinical improvement. A repeat CSF analysis demonstrated worsening pleocytosis, prompting an expanded autoimmune and neuroinflammatory panel. MOG-IgG antibodies were detected in both serum and CSF, confirming the diagnosis of MOGAD. The patient responded well to high-dose corticosteroids followed by mycophenolate mofetil for maintenance therapy. CONCLUSION: This case highlights the importance of considering MOGAD in patients with unexplained fever and headache with inflammatory CSF. Early recognition and prompt immunotherapy initiation are essential for optimal outcomes. A favorable outcome was observed following timely immunotherapy.
Intracranial IgG4-related Disease: Insights from Two Cases.
Khanna S, Yadav S, Balakrishnan C
J Assoc Physicians India · 2025 Nov · PMID 41296308 · Publisher ↗
INTRODUCTION: Immunoglobulin G4-related disease (IgG4-RD) is a rare autoimmune fibroinflammatory condition that can affect multiple organs. Central nervous system (CNS) involvement is seen in only 2-4% of cases. Due to i...
INTRODUCTION: Immunoglobulin G4-related disease (IgG4-RD) is a rare autoimmune fibroinflammatory condition that can affect multiple organs. Central nervous system (CNS) involvement is seen in only 2-4% of cases. Due to its rarity and heterogeneous presentation, it often mimics malignancies, infections, or other inflammatory conditions, leading to delayed diagnosis. We report two cases illustrating the spectrum of CNS IgG4-RD and highlight diagnostic and therapeutic considerations. Case 1: A 29-year-old male presented with new-onset generalized tonic-clonic seizures. Brain magnetic resonance imaging (MRI) revealed a left-sided, extra-axial dural-based enhancing lesion with vasogenic edema. Serum IgG4 was elevated (3.25 gm/dL), but whole body positron emission tomography-computed tomography (PET-CT) ruled out systemic involvement. Surgical resection of the lesion was performed. Histopathology revealed a lymphoplasmacytic infiltrate with fibrosis and an IgG4:IgG plasma cell ratio of 20%. The patient was treated with tapering corticosteroids and methotrexate, leading to complete radiological resolution and seizure control. Case 2: A 44-year-old woman with longstanding hypothyroidism presented with headache, tinnitus, polydipsia, and polyuria. Laboratory investigations revealed panhypopituitarism. Imaging revealed an enlarged pituitary with systemic fluorodeoxyglucose (FDG)-avid lesions on PET-CT. Serum IgG4 was elevated (3.01 gm/L). A diagnosis of probable IgG4-related hypophysitis with multisystem involvement was made. She was managed with pulse methylprednisolone followed by oral steroids, methotrexate, and desmopressin. Follow-up showed clinical and radiological improvement, and serum IgG4 levels normalized. DISCUSSION: These cases demonstrate the clinical heterogeneity of CNS IgG4-RD, ranging from isolated pachymeningitis mimicking neoplasia to multisystem hypophysitis with systemic uptake. While the 2020 diagnostic criteria emphasize an IgG4:IgG ratio ≥40%, case 1 underscores that lower ratios (e.g., 20%) may still be diagnostically relevant, particularly in meningeal disease. Both patients responded well to corticosteroids and methotrexate, supporting their role as effective first-line treatment. These cases add to the growing evidence base for CNS-specific IgG4-RD and emphasize the need for organ-specific diagnostic flexibility and long-term immunosuppressive strategies.
Post-Coronavirus Disease-2019-associated Multisystem Inflammatory Syndrome in Adults: A Case from India.
Dinkar A, Singh J, Bhavya J … +1 more , Kumar S
J Assoc Physicians India · 2025 Nov · PMID 41296307 · Publisher ↗
Multisystem inflammatory syndrome in adults (MIS-A) is a postacute hyperinflammatory condition associated with prior SARS-CoV-2 infection. While predominantly reported in children (MIS-C), MIS-A is increasingly recognize...
Multisystem inflammatory syndrome in adults (MIS-A) is a postacute hyperinflammatory condition associated with prior SARS-CoV-2 infection. While predominantly reported in children (MIS-C), MIS-A is increasingly recognized in adults and is characterized by multiorgan dysfunction, elevated inflammatory markers, and evidence of recent COVID-19. Timely diagnosis remains challenging due to clinical overlap with other infectious and inflammatory conditions. We report a case of a 36-year-old previously healthy male from Bihar, India, who presented with severe epigastric pain, progressive dyspnea, and systemic symptoms. Clinical examination revealed tachypnea, hypotension, pedal edema, ascites, and hemorrhagic rashes over the abdomen. Laboratory evaluation showed leukocytosis, thrombocytopenia, acute kidney injury, transaminitis, coagulopathy, markedly elevated inflammatory markers, and cardiac biomarkers. Chest imaging revealed bilateral subpleural opacities and mild pleural effusions, indicating pulmonary involvement. Despite a negative SARS-CoV-2 RT-PCR result, high antibody titers confirmed a recent COVID-19 infection. Imaging of the abdomen confirmed acute interstitial edematous pancreatitis. Extensive evaluation excluded tropical, autoimmune, and other infectious etiologies. The present case was managed with high-dose corticosteroids, vasopressors, mechanical ventilation, anticoagulation, and supportive therapy. He showed gradual improvement and was discharged after 6 weeks. MIS-A should be considered in patients with recent SARS-CoV-2 exposure presenting with systemic inflammation, including respiratory and extrapulmonary organ dysfunction. Early recognition and immunomodulatory therapy are essential for favorable outcomes.
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