The Journal Of The Association Of Physicians Of India[JOURNAL]
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200 papers
The Weight of the Matter in Diabetes Care.
Bhattacharyya S
J Assoc Physicians India · 2025 Nov · PMID 41277213 · Publisher ↗
The weight of the matter in diabetes care challenges the traditional glucose-centric model of diabetes management and argues for a paradigm shift toward prioritizing weight-specifically fat reduction-as the central lever...
The weight of the matter in diabetes care challenges the traditional glucose-centric model of diabetes management and argues for a paradigm shift toward prioritizing weight-specifically fat reduction-as the central lever in achieving metabolic health. Drawing insights from landmark trials such as SURMOUNT and Diabetes Remission Clinical Trial (DiRECT), as well as real-world Indian experience with agents like oral semaglutide, the article emphasizes that visceral adiposity is a root cause driving insulin resistance, beta-cell dysfunction, and multiorgan complications. Addressing weight early can lead to improved glycemic control, cardiorenal protection, and even disease remission-outcomes that far exceed glucose lowering alone. In the Indian context, where the "thin-fat" phenotype and central obesity present unique challenges, this weight-first approach demands culturally sensitive strategies and redefined success metrics beyond body mass index (BMI) or hemoglobin A1c (HbA1c). With the advent of incretin-based therapies, clinicians now have the tools to treat upstream rather than manage symptoms downstream. The piece calls for a unified therapeutic strategy that targets excess adiposity to deliver both glycemic and vascular legacy benefits-reframing weight not merely as a number but as a powerful determinant of risk, response, and recovery.
Clinician's Health?
Agrawal R
J Assoc Physicians India · 2025 Nov · PMID 41277212 · Publisher ↗
Usually, people are under stress because of their own health issues, but clinicians are under stress because of others' (patients') health, and for them, they put their own health at stake. Here, by clinician, we mean ev...
Usually, people are under stress because of their own health issues, but clinicians are under stress because of others' (patients') health, and for them, they put their own health at stake. Here, by clinician, we mean every specialty of healthcare professionals (HCPs), physicians and surgeons. Clinicians are precious and their health is equally important. Unfortunately, most of the clinicians are not in good health because of the challenging and demanding needs of the profession, such as reading a lot while dealing with difficult cases and competition to cope with others. Most of the clinicians have a false belief that they are doing well, so they will not get any problem, or they themselves will take care of their health, and another very important fact is that most of them have little faith in their own colleagues, and this bitter truth must be accepted. Doctors need their own clinicians because despite their medical knowledge, they face a unique set of challenges such as exposure to high-stress, long working hours, altered sleep due to shift duties and irregular eating habits and non-nutritious diet, less time for self-care, and imbalance between family, professional and social life as well as stigma around mental health and treatment are sufficient to neglect their own health. They must have a sensitive physician to manage their health, like their patients, as family members of the doctors do not know whom to contact in case of emergency or the doctor's ill health. Doctors are not immune to health issues such as mental health, physical strain, burnout or infectious diseases, and various chronic diseases. Having their own doctor helps ensure they receive the unbiased healthcare they need, allowing them to continue caring for others effectively. Doctors play an essential role in maintaining the health of society, yet their own health is often compromised due to the stress of the demanding profession. Chronic conditions such as obesity, diabetes, hypertension (HT), coronary artery disease (CAD), thyroid disorders, and cancer are highly prevalent among HCPs, and the reasons are long working hours, sleep deprivation, emotional strain, and lack of time for self-care. By prioritizing regular health check-ups, stress management, physical activity, and a healthy working environment, and a balance between social, familial, and professional life, doctors can improve their own health. The key takeaway is adopting a holistic approach to doctors' well-being, which includes physical, mental, and emotional support, combining individual responsibility with institutional backing. Doctors should be empowered with the tools, resources, and cultural support they need to prioritize their own health to make society healthy. Large-scale surveys are required to find out the exact prevalence of various acute and chronic conditions among HCPs and how they are tackling them. : By clinician, we mean every specialty of doctors (HCPs), physicians, and surgeons. Terms such as physician, clinicians, doctors, and HCPs are used synonymously in this write-up.
A Review of the Efficacy of Nanodrug Delivery Systems: Is It Worth the Hype?
Pugazhenthi DP, Ramya A, Murugavel D … +2 more , Krishnan K, Palani S
J Assoc Physicians India · 2025 Nov · PMID 41277211 · Publisher ↗
Nanodrug delivery systems are gradually becoming the current "talk of the town" due to their efficiency in treating different diseases in a more advanced manner when compared to conventional drug-delivery systems. It is...
Nanodrug delivery systems are gradually becoming the current "talk of the town" due to their efficiency in treating different diseases in a more advanced manner when compared to conventional drug-delivery systems. It is well known that drugs can be given through various routes of administration, such as the popular oral, subcutaneous, and intravenous routes. It is quite surprising that formulating these same drugs as nanoparticles (NPs) and administering them to the patient could produce better results. Different studies have shown the effects of nanodrug delivery systems in targeting cancer cells, ameliorating pulmonary arterial hypertension, and providing improved treatments for ophthalmic conditions such as glaucoma. In most studies, nanodrug delivery systems have been shown to exhibit targeted action at the desired site or organ, low toxicity, and fewer systemic side effects. These new insights can provide an enhanced understanding of the benefits of NP formulations of drugs, as well as open up new pathways for future creative techniques in addressing emerging medical conditions. Furthermore, these formulations generally consist of polymer- or liposome-based or coated NPs, as they are easily biodegradable, meaning they have a higher ability to disintegrate and, at the same time, are not harmful to living tissues, thereby displaying greater compatibility. New connections can be established through the utilization of NPs in the treatment of emerging diseases worldwide. Data from these studies could provide a foundation for groundbreaking and innovative strategies in coping with or fighting even the recent COVID-19 pandemic.
Expanding the Diagnostic Horizon in COPD: Insights from GOLD 2025 on Early Detection and Comprehensive Assessment.
Samajdar SS, Chatterjee R, Pal J … +3 more , Chatterjee N, Haldar I, Tiwaskar M
J Assoc Physicians India · 2025 Nov · PMID 41277210 · Publisher ↗
The 2025 update to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines redefines the chronic obstructive pulmonary disease (COPD) diagnostic framework by recognizing earlier-stage conditions like...
The 2025 update to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines redefines the chronic obstructive pulmonary disease (COPD) diagnostic framework by recognizing earlier-stage conditions like "pre-COPD" and "PRISm" (preserved ratio impaired spirometry). This new approach captures patients who display early symptoms or structural changes in the lungs but do not yet meet traditional COPD criteria, marking a shift toward early detection and personalized management. By broadening the diagnostic criteria and promoting advanced imaging and biomarker use, GOLD 2025 offers pulmonologists a more precise, individualized approach to assessing COPD. This article examines the implications of these diagnostic updates for clinical practice, emphasizing the importance of proactive intervention to improve outcomes, slow disease progression, and tailor treatment to the unique profiles of at-risk patients. By embracing diverse pathophysiological profiles, the new GOLD framework underscores the necessity for comprehensive diagnostic tools, including imaging and biomarker analyses, to redefine COPD as a preventable and manageable condition.
Hemophilia: Reducing Treatment Burden with Pen Devices.
Shanmukaiah C, Bhatt P, Mishra K … +9 more , Joshi V, Sharma S, Panjwani S, Katewa V, Shah S, Radhika KK, Bafna V, Gente VK, Upase D
J Assoc Physicians India · 2025 Nov · PMID 41277209 · Publisher ↗
Hemophilia is a coagulation disorder caused by deficient or absent clotting factors. It is a chronic disease that starts from birth and requires lifelong intravenous administration of antihemophilic factors. Healthcare p...
Hemophilia is a coagulation disorder caused by deficient or absent clotting factors. It is a chronic disease that starts from birth and requires lifelong intravenous administration of antihemophilic factors. Healthcare professionals (HCPs), patients living with hemophilia, and their caregivers have reported concerns regarding the challenges associated with the intravenous route and the deterioration in their quality of life (QoL) due to the frequently repeated infusions necessary to maintain the desired levels of clotting factors. Patients with hemophilia and their caregivers have often voiced their need for easier methods of treatment administration, similar to the way insulin is delivered subcutaneously using a pen. Subcutaneous injection using a pen device is a known way to improve treatment compliance and adherence in patients with chronic diseases. The recent introduction of pen devices for hemophilia treatment administration is expected to reduce the administration burden and improve QoL. The narrative review presents the advantages of pen devices and patient and caregiver attitudes toward these newly introduced pen devices in hemophilia.
Prevalence and Antimicrobial Resistance of Nontyphoidal Salmonellosis in a Tertiary Care Hospital in South India.
Srividhya M, M JF, As SP … +3 more , Ganesan V, Arunagiri R, Rajendran T
J Assoc Physicians India · 2025 Nov · PMID 41277208 · Publisher ↗
INTRODUCTION: Nontyphoidal (NTS) is a significant cause of food- and water-transmitted illness in the world, with the burden amplified in low-socioeconomic countries such as India. While most infections present as self-...
INTRODUCTION: Nontyphoidal (NTS) is a significant cause of food- and water-transmitted illness in the world, with the burden amplified in low-socioeconomic countries such as India. While most infections present as self-limiting gastroenteritis, vulnerable populations may develop invasive nontyphoidal salmonellosis (iNTS). This study aimed to determine the prevalence, clinical spectrum, serotype distribution, and antimicrobial resistance patterns of NTS isolates in a tertiary care hospital. MATERIALS AND METHODS: A total of 61 NTS isolates were recovered from clinical samples, including stool, blood, pus, and urine. Identification was performed using the VITEK-2 system, and serotyping of fifteen isolates was done at the National and Center, Central Research Institute (CRI), Kasauli, Himachal Pradesh. Antimicrobial susceptibility testing was performed using the VITEK-2 compact system. RESULTS: The prevalence of NTS among 1,08,468 samples was 0.056%. Most isolates were from stool samples, followed by blood, pus, and urine. Most patients presented with acute gastroenteritis (56%), often associated with outside food consumption. . Enteritidis and . Typhimurium were the most common serovars isolated. Extraintestinal manifestations included diabetic cellulitis, sepsis, and a rare case of generalized lymphadenopathy in a child, later diagnosed with Mendelian susceptibility to mycobacterial diseases (MSMD), and a case of neonatal meningitis in a 15-day-old infant. All isolates were susceptible to piperacillin-tazobactam, imipenem, and meropenem (100%). However, resistance to ceftriaxone was 22.9%, ciprofloxacin 31.1%, ampicillin 14.7% and trimethoprim-sulfamethoxazole 3.27%. CONCLUSION: Nontyphoidal Salmonella continues to pose a public health threat in India, particularly with the rise of antimicrobial resistance. These findings underscore the importance of prudent antibiotic usage, robust surveillance systems, and public health interventions focused on food safety, sanitation, and targeted education.
A Study of Ambulatory Blood Pressure Monitoring in Undergraduate Medical Students in a Tertiary Care Hospital in North India.
Sharma A, Sawlani KK, Yadav A … +4 more , Chaudhary SC, Usman K, Khattri S, Atam V
J Assoc Physicians India · 2025 Nov · PMID 41277207 · Publisher ↗
BACKGROUND: Hypertension, a prevalent health issue worldwide, is a leading risk factor for cardiovascular disease and often coexists with other metabolic conditions. Despite its treatability, the specific mechanisms lead...
BACKGROUND: Hypertension, a prevalent health issue worldwide, is a leading risk factor for cardiovascular disease and often coexists with other metabolic conditions. Despite its treatability, the specific mechanisms leading to organ damage from hypertension are not fully understood. This study aimed to evaluate blood pressure (BP) patterns among medical students using 24-hour ambulatory blood pressure monitoring (ABPM) and examine the relationship between these patterns and various associated factors. METHODOLOGY: This study was conducted at a tertiary care center in North India and involved 75 undergraduate medical students. Data collected included demographic details, height, weight, body mass index (BMI), smoking history, alcohol intake, physical activity, and family history of hypertension. A structured questionnaire was used to gather information, and BMI was calculated for each participant. Office BP measurements were taken, followed by ABPM the next day. RESULTS: The results revealed that 41 (54.6%) of the participants were male and 34 (45.3%) were female, with most students aged 20-22 years. BMI distribution showed 30.67% had normal BMI, 30.67% were overweight, and 38.6% were obese. Office BP measurements identified only 13.3% as hypertensive. ABPM identified 38.6% of participants as hypertensive by at least one criterion (24-hour mean BP, daytime mean BP, or nighttime mean BP). White coat hypertension was present in 6 (8.5%) participants, and 25 (33.3%) participants had masked hypertension. There was no significant correlation of hypertension with gender, BMI, exercise, or family history of hypertension. Normal dipping was seen in 23 (30.67%) participants, 46 (61.3%) were nondippers, and 3 (4%) each were reverse and extreme dippers. There was no significant correlation of dipping patterns with gender, BMI, exercise, or family history of hypertension. Hypertensive individuals, along with nondippers and reverse dippers, were referred for further evaluation. CONCLUSION: In our study, 29 participants were found to be hypertensive on ABPM, and 49 participants had abnormal dipping patterns. This increase in BP or abnormal dipping observed at such a young age is alarming. This was a single-center study with a small sample size, and therefore the results cannot be generalized to larger population sizes. Further multicenter studies in young patients with a larger sample size are required.
Evaluating the Real-world Effectiveness and Safety of Formoterol Fumarate and Fluticasone Propionate Combination in Asthma: A Prospective, Multicenter Study.
Patil S, Venkitakrishnan R, Behera SK … +6 more , Jalan RK, Jain MK, Dutta S, Panwala R, Nivangune K, Patel K
J Assoc Physicians India · 2025 Nov · PMID 41277206 · Publisher ↗
BACKGROUND: India bears a significant burden of asthma, and asthma in India is characterized by high mortality rates. Poor adherence to treatment guidelines is observed. Several inhaled corticosteroid (ICS) with long-act...
BACKGROUND: India bears a significant burden of asthma, and asthma in India is characterized by high mortality rates. Poor adherence to treatment guidelines is observed. Several inhaled corticosteroid (ICS) with long-acting beta (β) 2 agonist (LABA) combinations are commercially marketed in India, formoterol fumarate-fluticasone propionate being one of them. Real-world Indian studies on fluticasone-formoterol from India are scarce. This study aims to evaluate the effectiveness and safety of formoterol fumarate (6 µg) and fluticasone propionate (250 µg) administered through a dry powder inhaler (DPI) or metered-dose inhaler (MDI) in Indian asthma patients. MATERIALS AND METHODS: This 24-week prospective, multicenter study (CTRI/2023/08/056250) evaluated Formoflo 250 (formoterol fumarate 6 µg with fluticasone propionate 250 µg) transcaps (DPI), and Formoflo 250 transhaler (MDI) in adults aged 18-65 years. The primary endpoint was the mean change in trough forced expiratory volume in 1 second (FEV1) at week-24. Secondary endpoints included changes in trough forced vital capacity (FVC), asthma control test (ACT), and asthma quality of life questionnaire (AQLQ) scores. Safety was assessed through adverse events (AEs) and asthma exacerbations, with appropriate statistical analyses conducted on the modified intention-to-treat (mITT) population. RESULTS: A total of 503 patients were enrolled, with 495 included in the mITT analysis and all 503 in the safety analysis. At week-24, a mean increase of 312.2 ± 121.1 mL was observed in trough FEV1, while trough FVC improved by 279.3 ± 147.3 mL ( < 0.0001). The mean ACT score increased by 11.6 ± 3.7 ( < 0.0001), while the mean AQLQ score improved by 2.5 ± 1.2 ( < 0.0001) at week-24. Adverse events were reported in 7.0% of patients, primarily mild, with no serious AEs or fatalities. The findings were consistent across both Formoflo DPI and MDI formulations. CONCLUSION: The combination of formoterol fumarate and fluticasone propionate significantly improved lung function, asthma control, and quality of life, demonstrating marked effectiveness and safety with both DPI and MDI in Indian asthma patients.
Community-based Estimates of the Prevalence of Hepatitis B and C Infections and their Correlates in Two Districts of West Bengal, India.
Sarkar A, Bhattacharya P, Das S … +8 more , Bandyopadhyay S, Gupta P, Mandal A, Saren S, Biswas AK, Adhikary RS, Roy P, Ghosh P
J Assoc Physicians India · 2025 Nov · PMID 41277205 · Publisher ↗
OBJECTIVES: This study was conceptualized to estimate the prevalence and correlates of hepatitis B and C infections among the adult population of West Bengal and review the progress made so far toward the stated goal of...
OBJECTIVES: This study was conceptualized to estimate the prevalence and correlates of hepatitis B and C infections among the adult population of West Bengal and review the progress made so far toward the stated goal of controlling these infections in the state. MATERIALS AND METHODS: A population-based cross-sectional study was conducted during February 2023 to April 2024 in two districts of the state in adults. Participants were recruited from subdistrict clusters using the population-proportion-to-size sampling method. Sociodemographic information, along with laboratory parameters of hepatitis B and C infections, was collected from individuals. RESULTS: Information from 22,320 individuals revealed that the prevalence of hepatitis B and C infections was 0.47 and 0.02%, respectively. Hepatitis B infection was higher in males (0.5%) and daily laborers (0.8%). In the population, 80.2% was considered susceptible to hepatitis B infection. A significant association of hepatitis B infection was found with a history of dialysis (AOR 21.1), multiple sex partners (AOR 7.3), and a family history of jaundice (AOR 3.4). CONCLUSION: Prevalences of hepatitis B and C were lower than earlier estimates done in 2015-2016. A higher proportion of susceptible individuals among young adults remains a point of concern. As the prevalence is low among adults, West Bengal should focus on the triple elimination of mother-to-child transmission (EMTCT) of human immunodeficiency virus (HIV), syphilis, and hepatitis B virus (HBV) to progress further toward the elimination of hepatitis B.
Optimizing Management Beyond Triple Therapy in Stable Severe Chronic Obstructive Pulmonary Disease: Efficacy of Adjunctive Oral Doxophylline in a Randomized Controlled Trial.
Thimmapuram B, Suriyan S, Sakthivel N … +1 more , Nagesh NJ
J Assoc Physicians India · 2025 Nov · PMID 41277204 · Publisher ↗
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition commonly managed with triple inhaler therapy comprising long-acting beta-agonist (LABA), long-acting muscarinic antagonist...
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition commonly managed with triple inhaler therapy comprising long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA), and inhaled corticosteroid (ICS). Despite optimal inhalation therapy, many patients continue to experience persistent symptoms. Doxophylline, a novel xanthine derivative, offers bronchodilator and anti-inflammatory benefits with a more favorable safety profile than traditional methylxanthines. OBJECTIVE: To assess the efficacy, safety, and tolerability of oral doxophylline in addition to triple inhaler therapy in patients with stable severe COPD. MATERIALS AND METHODS: In this randomized controlled trial, 78 patients were allocated to group A (triple therapy + doxophylline 650 mg once daily) and group B (triple therapy alone). Assessment included the COPD assessment test (CAT score), C-reactive protein (CRP), spirometry parameters (FEV, FEV%, FEV/FVC), adverse events, and evaluations were performed on days 0 and 90. RESULTS: By day 90, group A showed greater improvement in CAT score (7.94 ± 4.17 vs 10.06 ± 3.99; = 0.033) and CRP (12.2 ± 4.47 vs 15.33 ± 5.37 mg/L; = 0.01). Spirometry gains were comparable: FEV (0.97 ± 0.23 vs 0.96 ± 0.26 L/minute; = 0.872), FEV% predicted (49.10 ± 8.73 vs 48.69 ± 9.72%; = 0.482), and FEV/FVC% (54.09 ± 6.57 vs 52.89 ± 6.95%; = 0.397). Mild adverse events including palpitations (14.29%), tremors (8.57%), and nausea (2.86%) were more frequent in group A but were generally tolerated. CONCLUSION: Adjunctive oral doxophylline significantly improved symptom burden and systemic inflammation in patients with stable severe COPD without conferring additional spirometric benefits. Although mild adverse effects were observed, doxophylline was overall well tolerated and may represent a viable adjunctive option in selected COPD patients with persistent symptoms despite optimized inhaler therapy.
Effect of Sleep Quality on Heart Rate Variability in Medical Students: A Cross-sectional Study.
Dawer P, Alam KK, Mishra G … +1 more , Gupta M
J Assoc Physicians India · 2025 Nov · PMID 41277203 · Publisher ↗
BACKGROUND: Globally, medical students had demonstrated poor sleep quality. Poor sleep can negatively affect cardiovascular functions. The autonomic nervous system (ANS) regulates cardiovascular function during the sleep...
BACKGROUND: Globally, medical students had demonstrated poor sleep quality. Poor sleep can negatively affect cardiovascular functions. The autonomic nervous system (ANS) regulates cardiovascular function during the sleep-wake cycle and can be monitored by heart rate variability (HRV). The primary objective was to determine any association between sleep quality and HRV parameters in medical students. MATERIALS AND METHODS: A cross-sectional study was conducted at a single institution in North India. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. HRV was recorded using Power Lab AD Instrument (Australia). The correlation between HRV variables and sleep parameters was estimated using Pearson's correlation coefficient and Spearman correlation based on the normality test. RESULTS: A total of 84 medical students (54 males and 30 females) participated in the study. The mean total PSQI score was 6.44 (SD = 2.62). There was a statistically significant negative correlation between PSQI global score and HRV indices high frequency (HF), root mean square successive difference (RMSSD), and the proportion of differences in consecutive RR intervals that are longer than 50 ms in % (pRR50). A statistically significant positive correlation between PSQI global score and low frequency (LF), and LF/HF ratio was found. CONCLUSION: The present study found that parasympathetic-related indices (RMSSD, pRR50, and HF) were inversely correlated to poor sleep quality and directly related to sympathetic indices (LF and LF/HF). This suggests that the poorer the sleep quality, the less is the parasympathetic activity and the more is the sympathetic activity.
Retrospective Observational Electronic Medical Records-based Real World Study to Assess the Prevalence and Treatment of Dyslipidemia in Indian Patients.
Kanuru VP, Dalal J, Christopher J … +8 more , Naqvi SMH, Katare S, Sanghavi A, Reddy BS, Kotak BP, Shah J, Shah S, Verma G
J Assoc Physicians India · 2025 Nov · PMID 41277202 · Publisher ↗
BACKGROUND: Dyslipidemia is an imbalance of lipids-total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL). The aim of this obser...
BACKGROUND: Dyslipidemia is an imbalance of lipids-total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL). The aim of this observational electronic medical records (EMR)-based study was to evaluate the prevalence, comorbidities, and treatment pattern in dyslipidemia patients. METHODOLOGY: This was a retrospective, EMR-based longitudinal study that used anonymized data. Data were analyzed for dyslipidemia patients of either gender, age ≥18 years, prescribed lipid-lowering agents. Follow-up data were captured at 3 months (±30 days) from the baseline visit. There were records of 77,57,513 adult patients in the EMR database from January 2018 to 2023. Of these, 15,20,319 (19.6%) patients were diagnosed with dyslipidemia, of which 90,933 (5.98%) were treatment-naïve patients, that is, newly diagnosed, and 65,535 (72.07%) patients had follow-up within 3 months (±1 month). RESULTS: The prevalence of dyslipidemia was 19.6% with a greater number of males. Diabetes and hypertension (HTN) were the top comorbidities. HDL was in the normal range (44.8 ± 9.7 mg/dL), LDL and TC were borderline high (140.5 ± 38.8 and 222.8 ± 42.8 mg/dL), TG were high (203.8 ± 94.7 mg/dL), and VLDL was close to the normal range (29.2 ± 8.5 mg/dL) at baseline. About >50% of dyslipidemia patients with diabetes, HTN, or diabetes and HTN with LDL >100 mg/dL at baseline achieved LDL <100 mg/dL at follow-up. In dyslipidemia patients with coronary artery disease (CAD), 47.54% of patients had LDL >100 mg/dL at follow-up, and only 4.92% of patients had LDL <55 mg/dL at follow-up. A number of 66.7% of dyslipidemia patients with chronic kidney disease (CKD) had LDL <100 mg/dL at follow-up. Low- to moderate-dose rosuvastatin and atorvastatin were the mostly prescribed drugs. CONCLUSION: Statins significantly reduced LDL, TC, and TG in patients with CAD and LDL in patients with CKD. Despite being on lipid-lowering drugs, probably due to low doses, a significant proportion of patients did not achieve the recommended LDL levels.
Trends in Glomerular Diseases in Northwest India: Has COVID-19 Altered the Diagnostic Landscape?
Singh AP, Damor JR, Beniwal P … +3 more , Sharma S, Malhotra V, Saxena P
J Assoc Physicians India · 2025 Nov · PMID 41277201 · Publisher ↗
BACKGROUND: Glomerular diseases are a major contributor to chronic kidney disease, with regional variability influenced by genetic, environmental, and healthcare factors. In Northwest India, minimal change disease (MCD)...
BACKGROUND: Glomerular diseases are a major contributor to chronic kidney disease, with regional variability influenced by genetic, environmental, and healthcare factors. In Northwest India, minimal change disease (MCD) was historically the most common primary glomerular disease (PGD). However, evolving diagnostic capabilities and the disruptions caused by the COVID-19 pandemic may have altered the landscape of glomerular disease presentations and biopsy practices. OBJECTIVES: To reassess the clinicopathologic spectrum of glomerular diseases from 2020 to 2024, compare it with data from 2008 to 2013, and evaluate the impact of the COVID-19 pandemic on biopsy activity and disease distribution. METHODOLOGY: We retrospectively analyzed 925 renal biopsies from 2020 to 2024 and compared them with 622 biopsies from 2008 to 2013. All samples underwent light microscopy (LM) and immunofluorescence (IF) staining (IgA, IgG, IgM, C3, and C4). Diagnoses were categorized into PGD, secondary glomerular disease (SGD), and others. Clinical presentations, including nephrotic syndrome (NS) and acute kidney injury (AKI), were recorded. Statistical comparisons were made using Chi-square (χ) and -tests (SPSS v29), with < 0.05 considered significant. RESULTS: Glomerulonephritis remained predominant (93.9%) with a significant shift in distribution (χ = 121.5, < 0.0001). IgA nephropathy increased from 7.4 to 15.4%, overtaking MCD (which declined from 21.1 to 8.1%) as the leading PGD. Focal segmental glomerulosclerosis (FSGS) rose to 12.4%, while diabetic nephropathy (DN) increased to 3.1%. Nephrotic syndrome was the most common presentation (59.3%). Biopsy volume declined by 60% in 2020 but rebounded by 2022. CONCLUSION: These findings highlight evolving diagnostic trends and underscore the need for broader biopsy access, enhanced diagnostic tools, and a national renal biopsy registry in India.
Oral Iron Absorption Test as a Predictor of Response to Oral Iron Therapy and Gastrointestinal Malabsorption Syndromes in Iron Deficiency Anemia.
Gaur S, Sharma V, Gaur V … +1 more , Bagrodia V
J Assoc Physicians India · 2025 Nov · PMID 41277200 · Publisher ↗
BACKGROUND: Iron deficiency anemia (IDA) affects approximately 2 billion individuals globally, yet optimal response to oral iron supplementation remains unpredictable. The oral iron absorption test (OIAT) represents a po...
BACKGROUND: Iron deficiency anemia (IDA) affects approximately 2 billion individuals globally, yet optimal response to oral iron supplementation remains unpredictable. The oral iron absorption test (OIAT) represents a potentially valuable diagnostic tool for predicting therapeutic response and identifying underlying gastrointestinal malabsorption syndromes. MATERIALS AND METHODS: This prospective study enrolled 190 IDA patients at a tertiary care center. After collecting baseline hematological parameters, participants underwent OIAT by receiving 60 mg of elemental iron, with serum iron levels measured at baseline and after 2 hours. Patients with abnormal OIAT results underwent additional investigations to identify underlying malabsorption syndromes. RESULTS: Among the participants (mean age 32.34 ± 11.84 years, 90.5% female), 34.2% demonstrated abnormal OIAT results. Malabsorption was diagnosed in 19.5% of subjects, with infection (54.1%), autoimmune gastritis (27.0%), and celiac disease (18.9%) as the predominant etiologies. OIAT showed excellent sensitivity (89.2%), good specificity (79.1%), and exceptional negative predictive value (97.6%) for identifying malabsorption syndromes. CONCLUSIONS: OIAT demonstrates robust diagnostic performance for predicting response to oral iron therapy and identifying malabsorption syndromes in IDA. The high negative predictive value positions OIAT as an effective first-line screening tool, potentially reducing the need for invasive investigations in patients with normal test results.
Evaluating Pioglitazone for Managing Type 2 Diabetes Mellitus in Patients with Nonalcoholic Fatty Liver Disease.
Panikar V, Gupta A, Nasikkar N … +12 more , Joshi S, Walwalkar S, Sachdev I, Tiwaskar M, Panikar K, Mahajan A, Deogaonkar N, Vadgama J, Tuteja H, Lalwani D, Singh S, Kader P
J Assoc Physicians India · 2025 Nov · PMID 41277199 · Publisher ↗
BACKGROUND: Among liver disorders, nonalcoholic fatty liver disease (NAFLD) is the most common and is associated with metabolic syndromes, particularly type 2 diabetes mellitus (T2DM). This study aimed to assess the effe...
BACKGROUND: Among liver disorders, nonalcoholic fatty liver disease (NAFLD) is the most common and is associated with metabolic syndromes, particularly type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of pioglitazone in the management of T2DM with NAFLD. METHODS: This retrospective, single-center, observational study was carried out at Dr Panikar's Speciality Care Centre from 1 September 2022 to 1 February 2024. The data were collected from the medical records of diabetic patients with NAFLD who received pioglitazone. Patients aged between 18 and 80 years who had diabetes along with NAFLD were included in the study. RESULTS: A total of 3,350 patients were enrolled in this study, of whom 2,074 were male, with a mean age of 48.6 years. The mean estimated A1C (eA1C) showed a significant reduction at 6 months compared to baseline (6.87 vs 7.6%; mean difference (95% CI): 0.50% (0.39, 0.61); < 0.001). At baseline, the mean controlled attenuation parameter (CAP) was significantly higher than at 6 months ( = 0.032). Similarly, the mean cholesterol level was significantly higher at baseline compared to 6 months ( = 0.020). A 25.7% decrease in grade 3 fatty liver was noted over the 6-month period from baseline. In terms of the decrease in fibrosis severity, a 37.5% reduction in F2, a 25.8% reduction in F1, and a 17.6% reduction in F4 were observed from baseline to 6 months. CONCLUSION: In T2DM patients with NAFLD, pioglitazone improves glycemic control and reduces both fatty liver grades and fibrosis stages.
Including Kidney Health in the National Public Health Agenda: The Time is Now.
Vasishta S, Jha V
J Assoc Physicians India · 2025 Nov · PMID 41277198 · Publisher ↗
Abstract loading — click title to view on PubMed.
Recurrent Rusty Pipe Syndrome: A Case Report.
Chandra C, Sehgal S, Tripathi M
J Assoc Physicians India · 2025 Oct · PMID 41100342 · Publisher ↗
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Mental Health Lessons from a Stranded Space Mission: An Epitome of Hope, Human Resilience, and Mental Fortitude.
Inamdar AV
J Assoc Physicians India · 2025 Oct · PMID 41100341 · Publisher ↗
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What Makes Cefpodoxime an Empiric Drug of Choice to Treat Lower Respiratory Tract Infections, including Acute Exacerbation of Chronic Obstructive Pulmonary Disease, in the Real-world Setting in India?
Talwar D, Vora A, Tarke C … +3 more , Mehta A, Shah NN, Dalal S
J Assoc Physicians India · 2025 Oct · PMID 41100340 · Publisher ↗
BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pneumonia are challenging lower respiratory tract infections (LRTIs) commonly encountered in clinical practice. The oral extended-spect...
BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pneumonia are challenging lower respiratory tract infections (LRTIs) commonly encountered in clinical practice. The oral extended-spectrum cephalosporin cefpodoxime proxetil is highly active against the bacterial pathogens commonly associated with LRTIs. AIM: To assess the role of cefpodoxime in the management of infections in Indian patients with AECOPD and LRTIs in a real-world setting, based on expert opinions. METHODOLOGY: The expert consensus meeting was convened according to an a priori protocol. Physicians were invited to participate in the discussion to frame opinion statements based on their clinical experience. A structured questionnaire was prepared regarding the role of cefpodoxime in the management of infections in patients with AECOPD and LRTIs. RESULTS: was the most common pathogen causing infections in patients with chronic bronchitis and pneumonia. Good penetration of cefpodoxime into lung tissues, high concentrations in lung tissues, and rapid resolution of symptoms make cefpodoxime the first-choice drug for treating LRTIs. Cefpodoxime is a step-down therapy of choice when switching hospitalized patients with LRTIs from parenteral antibiotics to oral antibiotics. Cefpodoxime is safe in patients with comorbid diseases and in elderly patients on polypharmacy. CONCLUSION: Cefpodoxime is the preferred first-line empiric antibiotic of choice for the treatment of community-acquired LRTIs in the real-world setting in India. Cefpodoxime has been preferred by 99% of expert chest physicians to treat infections in patients with chronic obstructive pulmonary disease (COPD), considering its broad spectrum of activity. Ninety-seven percent of experts reported that cefpodoxime, as a step-down therapy, gives satisfactory patient recovery and prevents recurrent infections.
Prediabetes: To Be Treated or Not?
Agrawal R
J Assoc Physicians India · 2025 Oct · PMID 41100339 · Publisher ↗
Prediabetes (PD) is a bridge between normoglycemia and hyperglycemia or diabetes mellitus (DM) characterized by higher than normal blood glucose but not fulfilling the criteria for type 2 DM (T2DM). PD is defined by impa...
Prediabetes (PD) is a bridge between normoglycemia and hyperglycemia or diabetes mellitus (DM) characterized by higher than normal blood glucose but not fulfilling the criteria for type 2 DM (T2DM). PD is defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and/or hemoglobin A1c (HbA1c) above 5.7% but <6.4%. Individuals with PD are at increased risk of progressing to T2DM at a pace of 5-10% every year and other micro- and macrovascular complications, including cardiovascular diseases. Prevalence of IGT and IFG in 2021 was 9.1% (about 464 million), which is projected to increase to 10.0% (638 million) in 2045; that of IFG was 5.8% (about 298 million), projected to increase to 6.5% (414 million) in 2045 globally. That is why we must seriously take aggressive steps to prevent progression to T2DM and to reduce the morbidity and mortality associated with DM, its complications, and healthcare burden. Why PD is important? Why PD to be treated? Individuals with PD have a 5-10% annual risk of progressing to T2DM and are associated with increased risk of micro- and macrovascular complications like nephropathy, retinopathy, neuropathy, and cardiovascular risks, myocardial infarction, and stroke. To prevent progression or conversion of PD to DM, we must be very aggressive. These are sufficient reasons for treatment of PD by lifestyle intervention or pharmacotherapy, as intensive lifestyle modifications, dietary modification, and enhanced physical activity have been shown to reduce the progression of PD to T2DM by 40-70%. These measures also lead to weight loss and better cardiovascular health. PD develops due to insulin resistance, impaired insulin secretion, and increased hepatic glucose production. Therefore, pharmacotherapy with metformin, pioglitazone, α-glucosidase inhibitors (AGIs), dipeptidyl peptidase IV (DPP IV) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP1 RA) targeting these defects are efficacious in preventing T2DM in PD. Diabetes Prevention Program (DPP) has shown 31% reduction in DM incidence with metformin. There is increasing evidence for prevention of DM in adults with PD by pharmacotherapy, but options other than metformin have adverse effects, and there is no unanimity for their use in PD. The role of pharmacotherapy is still debatable, and no consensus is made. We recommend that patients who are at high risk, having a strong family history of DM, signs of severe insulin resistance like acanthosis nigricans, severe obesity, or associated comorbidities, must be considered for disease-modifying pharmacotherapy like SGLT2 inhibitors, DPP IV inhibitors, and GLP1 RA. Those who do not have the above risk factors should be followed up at regular intervals, at least every year. Why PD not to be treated? When we treat DM, our "treat to target" is HbA1c of 7% or less, and organizations like the European Association for the Study of Diabetes (EASD) recommend a stricter target of 6.5%, which is above the diagnostic criteria for PD. Then the million-dollar question arises: are we justified in treating PD, as diagnostic criteria for PD are lower than the DM treatment target of 7% or less? There is another issue of overdiagnosis and overmedication; labeling individuals as PD and treating them with pharmacotherapy may lead to increased medication and healthcare costs, as well as stigma associated with a chronic disease and its treatment. Long-term studies are required to evaluate the risk-benefit of pharmacotherapy. We suggest that persons identified to have PD must be under vigilance and investigated at regular intervals. If they are found to have incremental blood glucose and HbA1c and a high risk of progression or conversion to DM, it is logical to treat. Those who are stable in the prediabetic range without associated comorbidities should be observed regularly and advised lifestyle modification (diet and exercise) and weight reduction.
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