Publications

Physical examination is pivotal for getting a clue about the disease and making a provisional diagnosis. The respiratory examination is considered to be one of the toughest systemic examinations by undergraduate and postgraduate residents. No well-defined literature is available regarding the ideal method and interpretation of respiratory examination findings. There are many questions asked by experts that are hardly found in the literature. This review included a total of 30 important questions and the best possible answers, including expert questions from top institutes that are important for respiratory examination and would help all students (MBBS/MD/DNB/DM) to excel in their practical examination.

Uncontrolled hypertension can result from untreated high blood pressure (BP) or the inefficacy of established antihypertensive therapeutic regimens. Renal denervation (RDN) is a nonpharmacologic catheter-based intervention that achieves targeted renal sympathetic nerve ablation to modulate sympathetic activation. RDN is suitable for those with uncontrolled primary hypertension, resistant to therapy or intolerant to drugs, and who have a favorable renal artery anatomy. Long-term data demonstrate RDN's efficacy in significantly reducing elevated BP. RDN procedures have shown a good safety profile, and no significant difference in adverse events has been reported between RDN-treated and control groups in most clinical trials. Thus, RDN offers an effective and safe approach for sustained BP control.

BACKGROUND: Global efforts to reduce tuberculosis (TB) are severely hampered by stigma. With a high number of TB infections, India struggles with the widespread stigma surrounding the illness, which makes it difficult to diagnose and treat patients promptly. To shed light on an important but often ignored component of TB management, we calculate the prevalence of TB-related stigma and variability in the manifestation in different groups.

METHODS: After calculating the sample size, we stratified them into different groups: patients with TB, healthcare workers providing TB services, and family members living with the patients. A validated, predesigned questionnaire was employed to assess stigma across various domains. MS Excel was used to compile the data, and Epi Info 7 to analyze it.

RESULTS: Health professionals made up the largest percentage of those who experienced stigma (11.78%), followed by family members (8.91%), and patients (6.05%). The association of stigma with different groups of study participants was statistically significant, implying that stigma exists variably in the other groups. The majority of the patients (3.50%) perceived stigma at their home, whereas the majority of the family members faced stigma in the community (5.41%). Healthcare workers face stigma majorly in the community (7.96%).

CONCLUSION: Stigma related to TB lays its foundation in varied perceptions by society. Societal norms determine acceptable and undesirable behaviors. Our study reveals major roadblocks on the way to TB eradication in the country and reveals a picture that can be extrapolated to most communities throughout. Aiming to reduce stigma will, in turn, improve treatment-related outcomes in TB and pave the way for smoother management and eradication.

BACKGROUND: Aluminum phosphide (AlP) poisoning is a medical emergency with an alarmingly high mortality rate, primarily due to its rapid cardiotoxic effects.

OBJECTIVE: To identify and evaluate key prognostic indicators-clinical, electrocardiographic, echocardiographic, and biochemical-in patients with AlP poisoning.

MATERIALS AND METHODS: A cross-sectional observational study was conducted on 100 patients with confirmed AlP ingestion. ECG changes, cardiac biomarkers (troponin-I, CPK-MB, LDH, and CPK-NAC), 2D echocardiography findings, and acid-base disturbances were analyzed in relation to survival outcomes.

RESULTS: ECG abnormalities and decreased ejection fraction were significantly associated with mortality. Elevated cardiac biomarkers and profound acidosis were strong independent predictors of poor prognosis.

CONCLUSION: AlP poisoning causes critical cardiovascular compromise. Early identification of high-risk patients may guide aggressive intervention and resource allocation in intensive care settings.

BACKGROUND: Thyroid dysfunction of any magnitude is associated with dyslipidemia. But the relationship of thyroid hormones with lipid parameters among euthyroid population is still unclear.

MATERIALS AND METHODS: This is a cross-sectional study to assess relationship between measured [free T3 (fT3), free T4 (fT4), and TSH] and derived (free T3/free T4 ratio, and TSH index) parameters of thyroid profile with different components of lipid profile among euthyroid population.

RESULTS: We included 100 patients (60 men and 40 women) in this study. The mean free T3, free T4, and TSH levels of our study population were 2.4 ± 0.5 pg/mL, 1.2 ± 0.2 ng/dL, and 3.0 ± 1.6 µIU/mL, respectively. Overall, fT3 had a significant positive correlation with HDL cholesterol (r = 0.4, p = 0.01) and a negative correlation with total cholesterol levels (r = -0.3, p = 0.04). While fT4 (r = 0.3, p = 0.04) and fT3/fT4 ratio (r = 0.5, p = 0.001) showed positive correlation only with HDL levels. In subgroup analysis, positive association of fT3 (r = 0.6, p = 0.008), fT4 (r = 0.4, p = 0.04), and fT3/fT4 ratio (r = 0.8, p = 0.001) with HDL cholesterol was significant only in men. And only in the subgroup with TSH ≥ 3 µIU/mL (N = 48), we found a significant negative correlation of fT3 with total cholesterol (r = -0.5, p = 0.01) and LDL levels (r = -0.7, p = 0.001) and a positive correlation with HDL levels (r = 0.5, p = 0.02).

CONCLUSION: Among euthyroid subjects, fT3 seems to have a significant and consistent favorable association with lipid levels, especially with HDL cholesterol. This positive association of fT3 with HDL is more marked in men and in subjects with TSH ≥ 3 µIU/mL.

BACKGROUND: Sepsis causes high short-term mortality in emergency and ICU settings. Quick sequential organ failure assessment (qSOFA) and national early warning score 2 (NEWS2) are bedside tools for early risk stratification, yet comparative evidence remains limited.

OBJECTIVES: To compare qSOFA and NEWS2 for predicting 7-day and 28-day mortality and length of stay in adult sepsis patients.

METHODS: This prospective observational study was conducted over 1 year (March 2024-February 2025) at a tertiary care center in northern India. A total of 874 patients aged 18-65 years admitted with sepsis were enrolled. On-admission qSOFA and NEWS2 scores were recorded. Outcomes included 7-day, 28-day mortality and length of hospital stay.

RESULTS: Among 874 patients, NEWS2 showed higher sensitivity than qSOFA for 7-day (63.1% vs 35.1%) and 28-day mortality (64.1% vs 37.3%), with comparable specificity ( 86%). Area under receiver operating characteristic curve (AUROC) values favored NEWS2 for 7-day (0.627 vs 0.606) and 28-day mortality (0.629 vs 0.609).

CONCLUSION: In adults with sepsis, the NEWS2 score showed higher sensitivity and marginally better prognostic accuracy than qSOFA for predicting short-term mortality and hospital stay. NEWS2 may therefore serve as a more reliable bedside tool for early identification of high-risk patients in emergency and ICU settings.

INTRODUCTION: The morbidity and mortality burden of the COVID-19 pandemic was high in socioeconomically deprived areas. Identifying the factors associated with in-hospital mortality in such settings will help physicians prioritize the scarce resources for the more needy individuals.

OBJECTIVE: To study the demographic, clinical, and biochemical factors associated with in-hospital mortality in COVID-19 patients in Wayanad, Kerala, India. We also report the incidence of post-COVID symptoms and the mortality rate in the survivors of COVID-19 pneumonia.

MATERIALS AND METHODS: The study design was a record-based retrospective cohort, and the study participants were 402 patients admitted with moderate to severe COVID-19 at the secondary care hospital of Wayanad, Kerala, India, during late 2020 and early 2021. In-hospital mortality was the major outcome variable, and we expressed the mortality risk in terms of relative risks (RRs). Factors associated with the same were assessed using Chi-square, Fisher's exact tests, and t-tests depending upon the type of exposure variable. Dose-response relationships were assessed using Chi-square for trend. A subgroup of consented survivors (n = 156) was followed to study the post-COVID symptoms and mortality rate outside the hospital. We constructed binary logistic models to find out the independent predictors of mortality.

RESULTS: The patient group (n = 402) was composed of individuals aged 18-95 years, and two-thirds (n = 258) were men. The in-hospital mortality rate was 17.7%. The risk of mortality increased with age, multimorbidity, and extent of hypoxia, peripheral oxygen saturation/fraction of inspired oxygen [SpO2/FiO2 (SF)] ratio, D-dimer, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), serum creatinine, and blood urea. The case fatality rate (CFR) had a dose-response relationship with the number of comorbidities. Out of the individual comorbidities analyzed, systemic arterial hypertension [RR = 1.5 (1.16-1.83)], cancer [RR = 4.7 (1.38-15.6)], and neurological disorders [RR = 5.8 (1.6-21.16)] were significantly associated with mortality in the hospital. According to the binary logistic regression analysis, age, hypoxia at the time of admission, intensive care unit (ICU) admission, serum creatinine, and SF ratio were the significant predictors of mortality. Most of the patients (73%) complained of some symptoms during follow-up. Easy fatigability and tiredness were the most common post-COVID symptoms, followed by exertional breathlessness, myalgia, decreased sleep, weight loss, and cough.

CONCLUSION: The physician should prioritize patients with multimorbidity and markers of organ involvement to save lives in resource-poor settings during pandemics and large infectious disease outbreaks affecting the community. The early diagnosis and management of comorbidities should be included in pandemic or outbreak preparedness to reduce morbidity and mortality.

BACKGROUND: Tobacco use and its smoke produces oxidative stress in the body, which eventually triggers cell damage by lipid peroxidation. Smokers report lower levels of omega-3 fatty acids (FAs) in their serum as compared to nonsmokers. Omega-3 deficiency impairs neurotransmission, resulting in hypofunctioning of the mesocortical system, which is a reward and dependency system that can raise tobacco cravings, disrupting tobacco quitting efforts. Omega-3 polyunsaturated fatty acid (PUFA) regulates stress, anxiety, and negative emotions that are associated with tobacco urges. Limited research has assessed the supplementation effect of omega-3 PUFA [in the form of alpha-linolenic acid (ALA)] on tobacco craving.

AIM: We aimed to explore the effects of omega-3 PUFA (ALA) on the frequency of tobacco use per day, tobacco dependence, and tobacco craving when compared to placebo in regular tobacco users.

MATERIALS AND METHODS: Regular tobacco users (n = 83) recruited from the Tobacco Cessation Clinic were randomly allocated to two groups. Group I was the omega-3 PUFA group, supplemented with 10 mL/day of omega-3 PUFA in the form of ALA (5.1 gm) for 180 days, and the other group received a placebo for the same duration. The outcome was evaluated by means of a case record form (for demographic parameters), self-reports of tobacco use (for frequency of tobacco use per day), as well as psychometric measures (for tobacco dependence and tobacco craving). The evaluations were carried out at baseline and after 180 days of intervention.

RESULTS AND CONCLUSION: The frequency of tobacco use per day, tobacco dependence, and tobacco craving were found to be significantly decreased (p < 0.0001) in the group receiving omega-3 PUFA (ALA) at the end of supplementation. This is a novel approach that ALA supplementation reduces tobacco cravings in regular tobacco users in comparison to a placebo. Thus, omega-3 FAs may be an adjuvant tool in quitting tobacco use by reducing nicotine dependence and tobacco craving. Further studies are necessary with large samples to understand the possible association and explore the probable nonpharmacological approaches for tobacco cessation.

BACKGROUND AND AIMS: Neutrophil-lymphocyte ratio (NLR) can predict prognosis of disease in patients suffering from cerebrovascular accidents, ischemic heart disease, infectious diseases, sepsis, etc., that can cause increased postoperative morbidity and prolonged stay in hospital. So, NLR can be a potential preoperative risk assessment and stratification biomarker. Our study aims to estimate any correlation between preoperative NLR and coexisting medical and surgical disease and to validate NLR against American Society of Anesthesiologists Physical Status (ASA PS) Classification System, Revised Cardiac Risk Index (RCRI), Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, and Gupta's postoperative respiratory failure risk in Indian patients.

MATERIALS AND METHODS: This observational, cross-sectional study was conducted in the preanesthesia check-up clinic. Information regarding sociodemographic profile, primary surgical disease, hematological investigations, that is, complete blood count, neutrophil count, lymphocyte count, NLR, and coexistent medical disease was collected, and ASA PS, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk were calculated for each study subject. Data were analyzed using standard statistical tests.

RESULTS: Age, congestive cardiac failure, smoking, malignancy, and beta blockers usage were associated with elevated NLR. NLR was found to have a significant relationship with anesthesia risk indices: ASA PS, RCRI, ARISCAT, and Gupta's postoperative respiratory failure risk.

CONCLUSION: Significant association has been observed between increased NLR and occurrence of systemic illness. NLR also has a significant association with ASA PS Classification System, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk. So, NLR may serve as a valuable biomarker in preoperative risk stratification.

BACKGROUND: With the rise of irrational drug prescriptions, leading to polypharmacy, increased health care costs, drug interactions, and risks of adverse drug reactions, irrational antibiotic prescribing, overuse of injections, and hospitalization, it has become important to monitor drug use patterns.

MATERIALS AND METHODS: With the objective to assess the drug use indicators of a government teaching hospital of Assam using WHO Core Drug Use Indicators, 700 prescriptions from OPDs of various specialties were assessed prospectively from the hospital dispensary and details of core drug use indicators were noted and analyzed for each in a proforma as per WHO recommendation on investigating drug use in health care facilities. Descriptive statistics were used thereafter to express the results.

RESULTS: The WHO core prescribing indicators analysis revealed that the average number of drugs per encounter was 3.6. The percentage of drugs prescribed by generic name was 37%, with only 6% being injectable drugs; however, 39.14% of prescriptions included one or more antibiotics. Only 37% of the drugs prescribed were from the NLEM.

CONCLUSION: This study highlights that only prescriptions involving injectable drugs were in accordance with WHO recommendations, while the other parameters exceeded the WHO-recommended values.