Publications

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.

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.

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.

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 (p < 0.0001). The mean ACT score increased by 11.6 ± 3.7 (p < 0.0001), while the mean AQLQ score improved by 2.5 ± 1.2 (p < 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.

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 1st September 2022 to 1st 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); p < 0.001). At baseline, the mean controlled attenuation parameter (CAP) was significantly higher than at 6 months (p = 0.032). Similarly, the mean cholesterol level was significantly higher at baseline compared to 6 months (p = 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.

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 Helicobacter pylori 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.

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 (χ2) and Z-tests (SPSS v29), with p < 0.05 considered significant.

RESULTS: Glomerulonephritis remained predominant (93.9%) with a significant shift in distribution (χ2 = 121.5, p < 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.

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.

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.

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 (FEV1, FEV1%, FEV1/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; p = 0.033) and CRP (12.2 ± 4.47 vs 15.33 ± 5.37 mg/L; p = 0.01). Spirometry gains were comparable: FEV1 (0.97 ± 0.23 vs 0.96 ± 0.26 L/minute; p = 0.872), FEV1% predicted (49.10 ± 8.73 vs 48.69 ± 9.72%; p = 0.482), and FEV1/FVC% (54.09 ± 6.57 vs 52.89 ± 6.95%; p = 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.