Publications

We describe a case of a 32-year-old nondiabetic lady who presented to our hospital with episodes of recurrent hypoglycemia. Investigations revealed suppressed insulin-like growth factor-1 (IGF-1) and elevated IGF-2 to IGF-1 ratio in the absence of hyperinsulinemia, which favored a diagnosis of nonislet cell tumor hypoglycemia (NICTH). Imaging revealed multiple lesions in the liver and a mesenteric nodal mass. Liver biopsy was suggestive of metastatic well-differentiated neuroendocrine tumor (NET) [World Health Organization (WHO) grade 3]. Our patient had a fairly aggressive progression of disease. She was given chemotherapy for the tumor, but the anatomic site of the primary malignancy could not be determined despite extensive imaging and diagnostic workup. This case highlights NICTH, which is a rarely encountered but life-threatening cause of hypoglycemia, and underlines the importance of tumor localization for effective treatment.

Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes, also known as MELAS, is an uncommon genetic disorder of mitochondrial inheritance. It presents as variable neurological and systemic manifestations. Here, we present a case of a young male who was a known case of seizure disorder and multiple neurological deficits. His clinical presentation included progressive hearing loss, diminution of vision, and recurrent headaches with vomiting. Neurological examination showed asymmetric limb weakness. Young-onset stroke was evaluated, and a magnetic resonance imaging (MRI) scan showed bilateral parieto-occipital hyperintensities. Serum lactate levels were high, which increased the suspicion of MELAS. m.3243A>G mutation was detected in mitochondrial DNA, confirming the diagnosis. Treatment involved the adjustment of antiepileptic therapy and the initiation of mitochondrial supplements. Our case emphasizes the heterogeneous clinical presentation and diagnostic challenges of MELAS as an important cause of young-onset stroke, highlighting the importance of early suspicion and confirmatory investigations for personalized management strategies to optimize patient outcomes.

Cystic lung disease is a rare and underrecognized manifestation of pulmonary tuberculosis (TB), often masquerading as other diffuse cystic lung disorders and complicating timely diagnosis. We present the unusual case of a 25-year-old woman who developed progressive dyspnea and pleuritic chest pain shortly after initiating antituberculous therapy. Initial imaging revealed classical miliary nodules without cystic changes. However, within a month of treatment, follow-up high-resolution CT unveiled an unexpected transformation of numerous thin-walled cysts clustered in the upper lobes, accompanied by ground-glass opacities, septal thickening, and a tree-in-bud pattern suggestive of active endobronchial spread. This radiological evolution, occurring posttreatment initiation, points to a dynamic pathophysiological process likely involving immune-mediated airway obstruction, necrosis, and structural remodeling of the parenchyma. This case reveals a rare form of pulmonary TB that mimics other cystic lung diseases. In TB-endemic areas, early recognition of cystic transformation, especially with recurrent pneumothorax or atypical imaging, is vital. Though uncommon, it highlights TB's chameleon-like nature and the value of serial imaging in guiding timely, effective management. Radiologists and clinicians should remain vigilant for such rare yet reversible complications in TB-endemic settings.

Hypertrophic osteoarthropathy (HOA), also known as pachydermoperiostosis is an unusual cause of digital clubbing. It is a rare osteo-arthro-dermopathic syndrome which is associated with clubbing of fingers, thickening of skin in the face and scalp, seborrhea, and subperiosteal new bone genesis. It is divided into two types: Primary (PHOA) and secondary HOA, with the latter being common. PHOA accounts for a very meager portion of HOA cases. PHOA is usually inherited in an autosomal dominant fashion and rarely follows autosomal recessive inheritance pattern. We report a case of a male who presented with a history of progressive and painful enlargement of distal phalanges of hands and feet for 6 years. After all examinations and tests ruled out the secondary causes for HOA, genetic sequencing was performed to confirm the diagnosis of PHOA. Sequencing revealed homozygous nonsense mutation in SLCO2A1 gene. This mutation is postulated to impair the degradation of prostaglandin E2 (PGE2), leading to its elevated levels. PHOA is an atypical cause of clubbing which usually poses a challenge in diagnosis. This report also underscores the importance of genetic sequencing in appropriate diagnosis and management of the PHOA.

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.

Stress is a part of life. Stress impacts persons living with chronic disease and those who care for them. Thus, coping with stress becomes an integral part of diabetes self-management education. This opinion piece describes useful ways of coping with stress. It uses a simple 4 × 3 model, designed in an alliterative manner. Four trigonal pillars, or the four As-approach/attitude, analysis, activity, and adjuvant methods-determine the efficacy of coping with stress. Each of these domains includes various attitudes, behaviors, and choices (ABC), which are described in a pleasing manner as 12 Ps. This list reinforces strategies, styles, and systems that can be used to ensure positive, productive coping.

INTRODUCTION: Nontyphoidal Salmonella (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 Salmonella and Escherichia 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. S. Enteritidis and S. 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.

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.

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.