Publications

INTRODUCTION: Recently, there is an upsurge of splenic abscess due to typhoidal Salmonella in India.

METHODS: We present a case of splenic abscess caused by Salmonella paratyphi A in an immunocompetent male and conducted a systematic review of splenic abscess cases attributed to typhoidal Salmonella described between January 2001 and May 2024.

RESULTS: Of 33 cases reviewed, 26, 2, and 1 case each were reported from India, Sri Lanka, Turkey, Qatar, and Pakistan, respectively. S. typhi and S. paratyphi A were reported from 29 and 4 cases, respectively. Mean age was 21 years, with 13 children and 8 females. About 28 were immunocompetent and two had diabetes mellitus. Blood, pus, stool, and pleural fluid grew the isolate in 13, 20, 1, and 1 case, respectively. Ultrasonography (USG) abdomen was diagnostic in 28 cases and normal in two cases. Computed tomography (CT) abdomen was diagnostic in all the 27 cases tested. About 17, 12, and 1 patient showed multiple abscesses, solitary lesion, and multiloculated lesion, respectively. USG/CT-guided percutaneous drainage and splenectomy were performed in 25 and 7 cases, respectively. All 33 patients recovered from the infection.

CONCLUSION: We aspire to raise acquaintance among health professionals regarding this uncommon entity and foresee it in pertinent contexts.

OBJECTIVE: The current management of osteoporosis has several unmet needs. Consequently, the newer and upcoming agents and targets are being expectantly looked at. We aim to appraise the evidence examining the efficacy of the newer therapies for the management of osteoporosis.

METHODS: Scopus, Embase, and MEDLINE databases were screened from January 2013 to December 2023 to identify clinical trials that evaluated the efficacy of newer agents for the treatment of osteoporosis in men and postmenopausal women (PMO). Changes in bone mineral density (BMD) and incidences of vertebral fractures (VFs) and nonvertebral fractures (NVFs) or relative risk reduction (RRR) for VF and NVF were retrieved. The Oxford quality scoring system was applied to evaluate the methodological quality of the included clinical trials.

RESULTS: Eighteen randomized controlled trials (RCTs) that had enrolled 22,868 PMO and 473 male participants were included. Anabolic agents abaloparatide and romosozumab exhibited significant BMD gain and relative RRR for fractures and greater efficacy than teriparatide. Blosozumab was reported to exhibit substantial BMD gains. The efficacy of a sequential therapeutic strategy with anabolic agent followed by antiresorptive agents was superior to the reverse sequence.

CONCLUSION: Newer therapies for osteoporosis exhibited significant BMD gain and fracture risk reduction in men and PMO. The newer anabolic agents demonstrated greater efficacy than any of the previously available therapeutic options.

A 34-year-old female, a diagnosed case of chronic liver disease, presented to the emergency department with yellowish discoloration of the skin, abdominal distension, and bilateral lower limb swelling for 1 week. She also complained of painless swelling over her umbilicus for the last 6 months. On examination, she was conscious, oriented, and hemodynamically stable. General physical examination revealed icterus and bilateral pitting pedal edema up to the knees. On abdominal examination, the abdomen was distended and shifting dullness was present. A large swelling of approximately 7 × 5 cm was present over the anterior abdominal wall with a palpable thrill and an audible Cruveilhier-Baumgarten murmur (Figs 1A and B). The swelling was not reducible and had no signs of inflammation. The rest of the systemic examination was normal.

A 62-year-old female, a known case of hypothyroidism, diabetes mellitus, and varicose veins, presented with a complaint of swelling of both lower limbs and ulceration on the left leg for 2 months. She also complained of dyspnea on exertion. As per the history, ulcer began as a pea-sized blackish discoloration on the left lower limb just above the ankle joint on medial aspect (Fig. 1) and increased to 6 × 8 cm, with irregular and raised margins (Fig. 2). The base of ulcer had whitish-yellow exudate with no healthy granulation tissue. The surrounding skin revealed hyperpigmentation. On examination, she had bilateral lower limb pitting edema-grade IV (Fig. 3), extending from above ankle to mid-calf region. The skin appeared to be shiny. Investigations revealed microcytic hypochromic anemia and high fructosamine levels. There was no history of trauma. Anti-HIV was negative. A biopsy was taken, thus revealing it to be a stasis ulcer. Our initial assessment for the causes of this ulcer included anemia resulting in poor perfusion, venous insufficiency exacerbated by varicose veins, and hypothyroidism or diabetes mellitus contributing to poor wound healing.

As exhorted by the Bhagavad Gita, physicians do their best karma to manage a patient. The uncertainties and chance can never be altogether eliminated from medical practice despite using best practices because of inherent human and environmental variations. No management is perfect with a 100% probability of success in all cases. The outcome remains with him. The physicians and the patients need to be reminded of this limitation all the time.

India faces a growing burden of type 2 diabetes mellitus (T2DM), necessitating innovative treatments that improve glycemic control, reduce glycemic variability (GV), and enhance patient adherence. Dipeptidyl peptidase 4 (DPP-4) inhibitors are established antidiabetic agents; however, once- or twice-daily dosing often limits long-term compliance. Trelagliptin, a novel once-weekly DPP-4 inhibitor, addresses this issue with an extended half-life and superior molecular stability, enabling sustained DPP-4 inhibition and significant GV reduction. Improved glycemic control with trelagliptin can potentially lower the risk of macrovascular and microvascular complications associated with T2DM. Trelagliptin, developed and launched in India by Zuventus Healthcare Limited under the brand name Trelaglip®, offers prolonged efficacy and high selectivity in inhibiting the DPP-4 enzyme, helping minimize side effects. Development began with in-house active pharmaceutical ingredient (API) synthesis, followed by successful formulation and stability studies. A bioequivalence study confirmed pharmacokinetic equivalence with the reference product by Takeda, Japan. In a randomized phase 3 clinical trial involving patients with glycated hemoglobin (HbA1c) ≥8%, trelagliptin showed greater HbA1c reduction (-1.25%) as compared to vildagliptin (-1.15%) and a similar safety profile. Mild adverse events occurred in 6.67% of trelagliptin users compared to 9.17% with vildagliptin. This article outlines the development and regulatory journey leading to trelagliptin's first approval in India by the Central Drugs Standard Control Organization (CDSCO) in December 2024. Phase 4 real-world evidence studies are currently ongoing in India to assess long-term safety and efficacy.

Hypertension (HTN) remains a leading contributor to global morbidity and mortality, often coexisting with major comorbidities such as diabetes, chronic kidney disease (CKD), coronary artery disease (CAD), heart failure (HF), and obesity. In India, a significant proportion of hypertensive individuals remain undiagnosed or inadequately treated. This multispecialty consensus provides comprehensive, evidence-based recommendations for individualized HTN management tailored to specific phenotypes and comorbidities. Developed through structured expert panel discussions and a review of international and national guidelines, the consensus emphasizes out-of-office blood pressure (BP) monitoring, phenotype recognition (e.g., white-coat, masked, nocturnal HTN), and early detection of target organ damage. The document outlines practical algorithms and a therapeutic wheel to guide antihypertensive therapy based on patient-specific factors, promoting use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers (BB), and diuretics, as per clinical context. Special considerations are provided for managing HTN in young adults, patients with tachycardia, stroke, and respiratory disorders. The consensus also advocates for lifestyle modifications, treatment adherence, and multidisciplinary care to improve BP control and long-term outcomes. By promoting a holistic, patient-centered approach, this consensus aims to bridge gaps in clinical practice and standardize the management of HTN in diverse healthcare settings.

BACKGROUND: In South Asian healthcare settings, certain symptoms described in local languages create unique challenges in medical practice. "Ghabrahat" is a commonly used term that lacks standardization in medical terminology and presents difficulties in translation and interpretation. This study aimed to comprehensively assess the knowledge, attitudes, and practices (KAP) regarding "ghabrahat" among healthcare professionals.

MATERIALS AND METHODS: A cross-sectional study was conducted among 107 healthcare professionals, including faculty members and postgraduate trainees, across multiple tertiary care centers. A structured questionnaire was used to evaluate their understanding, perceptions, and clinical approaches regarding "ghabrahat" as a medical term.

RESULTS: Of the 107 participants, 105 (98.1%) had encountered the term during their medical practice. The majority (77.6%) believed that "ghabrahat" requires further medical investigation, and 94.4% considered it treatable/manageable. Significant associations were found with cardiovascular (86%) and psychological (73.8%) systems. Gender differences in perception were noted by 67.2% of participants, while 88.8% believed that comorbidities influence its presentation. Notably, 54.2% of participants reported encountering mortalities directly attributed to "ghabrahat."

CONCLUSION: While "ghabrahat" is widely recognized among healthcare professionals, there exists substantial variation in its interpretation, perceived severity, and management approaches. This study highlights the urgent need for standardization in understanding and approaching this commonly reported symptom in South Asian medical practice.

INTRODUCTION: Gestational diabetes mellitus (GDM) is hyperglycemia diagnosed for the first time during the second or third trimester of pregnancy. It often leads to neonatal complications. Effective management of GDM is crucial to mitigate such risks. This study evaluates the effectiveness of ambulatory glucose profile (AGP) vs self-monitoring of blood glucose (SMBG) in managing GDM.

METHODS: This 18-month observational study was conducted at All India Institute of Medical Sciences, Raipur, India, involving 65 pregnant women diagnosed with GDM. Thirty-two patients wore the flash glucose monitoring system (AGP group) and 33 performed SMBG (SMBG group). Blood glucose levels were monitored using AGP and SMBG, with data collected on fasting, postprandial glucose levels, and hypoglycemic events till 15 days after enrollment. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 21.

RESULTS: The AGP group showed significant reductions in blood glucose levels across all measured times. Mean blood glucose concentrations decreased significantly in both groups from enrollment till 15 days, with no significant intergroup differences. The AGP group had a higher mean time in range (92 vs 90%) and lower time above range (4 vs 6%) compared to the SMBG group. Hypoglycemic events were fewer in the AGP group.

CONCLUSION: AGP demonstrated superior effectiveness in managing GDM by providing continuous glucose monitoring, improving glycemic control, and reducing hypoglycemic events compared to SMBG. AGP is recommended for better glucose management in GDM patients.

INTRODUCTION: Problem-based learning (PBL) is a student-centered learning approach in which students learn through analyzing and solving problems.

JUSTIFICATION: Traditional teaching program is in the form of a dictated lecture and is teacher-centered. A larger number of topics can be covered without active student participation. In PBL, which promotes deep learning, students learn to justify their knowledge with the help of cognitive skills and complex thinking.

METHODS: This retrospective study was done after obtaining Institutional Human Ethics Committee (IHEC) approval. Data collected from three internal assessment examinations (IAEs) written between the period of January 2017 and August 2017 by 151 students pursuing second-year MBBS training in the Department of Pharmacology. Examination papers for second-year MBBS students contain questions such as short notes, ultrashort, and PBL.

RESULTS: Wilcoxon Mann-Whitney test analysis of IAE-1 with IAE-2 and IAE-1 with IAE-3 in SPSS software gave p-value-0.393 and 0.020, respectively. Using analysis of variance (ANOVA), IAE-2 with PBL and IAE-3 with PBL showed p-value 0.001, which was statistically significant. There was an increase in the pass percentage [number of students who scored 40 and above in IAE-3 (with PBL) when compared to IAE-1 (without PBL)].

CONCLUSION: This audit showed definite knowledge improvement by the students using PBL as a tool along with a traditional teaching program.