Publications

In everyday life, we must adapt our behavior to a continuous stream of tasks and time motor responses and periods of resting accordingly. To mimic these challenges, we used a continuous interception computer game (Pong) on an iPad. This allowed us to measure the coordination of eye, hand, and head movements during natural sequential behavior while maintaining the benefits of experimental control. Participants intercepted a moving ball by sliding a paddle at the bottom of the screen so that the ball bounced back and moved toward the computerized opponent. We tested (i) how participants adapted their eye, hand, and head movements to this dynamic, continuous task, (ii) whether these adaptations are related to interception performance, and (iii) how their behavior changed under different conditions and (iv) over time. We showed that all movements are carefully adapted to the upcoming action. Pursuit eye movements provide crucial motion information and are emphasized shortly before participants must act; a strategy associated with better performance. Participants also increasingly used pursuit eye movements under more difficult conditions (fast targets and small paddles). Saccades, blinks, and head movements, which would lead to information loss, are minimized at critical times of interception. These strategic patterns are intuitively established and maintained over time and across manipulations. We conclude that humans carefully orchestrate their full repertoire of movements to aid performance and finely adjust them to the changing demands of our environment.

BACKGROUND: Cirrhosis, a major cause of global morbidity and mortality, necessitates early detection and accurate staging for optimal management. Traditional reliance on liver biopsy is being challenged by noninvasive techniques such as transient elastography (FibroScan®), which measures liver stiffness to estimate fibrosis severity. The potential for FibroScan® as a point-of-care (POC) tool supports rapid clinical decision-making in multiple clinical settings and scenarios.

MATERIALS AND METHODS: A prospective observational study was conducted from December 2024 to February 2025 at a tertiary center in Western India, enrolling adult patients with suspected liver disease, metabolic risk factors, or excessive alcohol consumption. Liver fibrosis was assessed using the Echosense FibroScan mini+430 device, applying the Metabolic Dysfunction-Associated Steatohepatitis (MASH) scoring system (F0-F4). At least 10 valid liver stiffness measurements (LSM) were obtained per patient. Data analysis included t-tests, analysis of variance (ANOVA), Chi-squared tests, and receiver operating characteristic (ROC) curve analysis for diagnostic accuracy.

RESULTS: Of the 93 patients (mean age 52.3 years; 69.9% male), 41.9% had advanced fibrosis, and 30.1% demonstrated cirrhosis. Alcohol intake and diabetes were significantly associated with fibrosis stage (p = 0.002 and p = 0.008, respectively). FibroScan® showed excellent diagnostic accuracy for cirrhosis (AUROC = 0.91) and good accuracy for significant fibrosis (AUROC = 0.82); the optimal LSM cutoff for F4 was 12.5 kPa. Body mass index (BMI) correlated weakly but significantly with CAP values.

CONCLUSION: Bedside FibroScan® offers a highly accurate, rapid, and noninvasive method for quantifying liver fibrosis and cirrhosis in clinical practice. Its integration into routine care could substantially improve management for patients at risk of liver disease.

BACKGROUND: Falls among the elderly are a significant public health concern, particularly in socioeconomically disadvantaged urban settings. Beyond physical injuries, falls contribute to psychological effects such as fear of falling, which may limit mobility and increase dependency. The concept of fall efficacy, or the confidence in performing daily activities without falling, has emerged as a key psychological indicator in understanding fall risk. However, limited data exist on these aspects among older adults living in urban slums in India.

OBJECTIVES: To determine the prevalence of falls among older adults residing in urban slums of Siliguri, West Bengal, and to explore the association between fall efficacy and the occurrence of falls.

METHODS: A descriptive cross-sectional study was conducted among 207 adults aged ≥60 years selected via two-stage cluster sampling from 30 urban slum clusters in Siliguri. Data were collected via a pretested, semi-structured questionnaire capturing sociodemographic information, medical history, fall episodes, and fall efficacy, assessed using the Fall Efficacy Scale (FES). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 with multivariable logistic regression to identify predictors of falls.

RESULTS: The prevalence of falls in the past 6 months was 41.1%, and the distribution of falls was nearly equal between indoor and outdoor settings. Significant predictors of falls included advanced age [≥80 years; adjusted odds ratio (AOR) = 4.25], presence of comorbidities (AOR = 8.16), physical disabilities (AOR = 2.50), and residence in pucca houses (AOR = 3.38). Although higher concern about falling (as indicated by higher FES scores) was associated with increased fall risk (AOR = 1.88), the association was not statistically significant.

CONCLUSION: Falls among the elderly in urban slums are prevalent and influenced by a complex interplay of age, health status, and living conditions. Integrating physical, environmental, and psychological interventions is critical for fall prevention among older adults, especially in underserved urban slums.

BACKGROUND: Hypertension is a chronic condition that progressively worsens. Lifestyle modifications and antihypertensive medications are among the strategies recommended to manage it. Nonpharmacological interventions like deep relaxation, Aum Kara chanting, and tuning have been found to help lower blood pressure, enhance cardiovascular function, reduce stress, and promote mental tranquility. This study examines the effects of Aum Kara and the deep relaxation technique (DRT) on autonomic variability in individuals with primary hypertension.

METHODS: From a pool of 200 individuals screened for hypertension at SDM Hospital in Dharmasthala, 60 participants aged 25-50 were selected according to the study's inclusion and exclusion criteria. The enrolled participants were assigned to one of two groups: group 1 (DRT) or group 2 (Aum Kara) based on randomization tables. Each group underwent a 20-minute session, after which their data were evaluated.

RESULTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) decreased immediately after the interventions in both groups. The Aum Kara group demonstrated a decrease in heart rate and the LF/HF ratio compared to the DRT group (p < 0.05). Specifically, in the Aum Kara group, LF decreased and HF increased, showing statistical significance in comparison to the DRT group. A significant difference was noted in all HRV components between the groups upon comparison.

CONCLUSION: In the comparison of the two therapies' effects, Aum Kara chanting demonstrated a more significant immediate beneficial impact on the sympathovagal system balance compared to DRT.

Urinary tract infection (UTI) is the second most common type of infection in the human body. It is one of the most prevalent conditions in medical practice, with approximately 150 million cases occurring globally each year. Approximately 50% of women will experience at least one episode of UTI during their lifetime, and between 20 and 40% will have recurrent episodes. The discovery of a broad-spectrum antibiotic, fosfomycin tromethamine, occurred in Spain in 1969 and is prominently used in the management of uncomplicated UTIs. As a phosphonic acid derivative, fosfomycin acts by disrupting bacterial cell wall synthesis by inhibiting the enzyme MurA, demonstrating effective activity against a wide variety of gram-negative and gram-positive pathogens, comprising multidrug-resistant strains such as Escherichia coli and Klebsiella pneumoniae. Fosfomycin is not metabolized and is predominantly excreted unchanged in the urine through glomerular filtration. Mean peak urinary concentrations of fosfomycin ranging from 1053 to 4415 mg/L occur within 4 hours of administration of a single oral dose of fosfomycin tromethamine correspondent to fosfomycin 3 gm. Urinary concentrations >128 mg/L, which are adequate to inhibit most urinary pathogens, are maintained for 24-48 hours following a single oral dose of fosfomycin tromethamine. This makes it particularly advantageous for uncomplicated UTIs, where it offers a convenient and effective single-dose treatment option. Clinical trials and observational studies have consistently shown high cure rates and patient compliance, attributing this to its minimal side effects and broad-spectrum efficacy. A single oral dose of fosfomycin tromethamine, equivalent to 3 gm of fosfomycin, is indicated for treating acute uncomplicated lower UTIs in adults. It is classified as pregnancy category B. Various clinical guidelines, such as the Infectious Diseases Society of America (IDSA), European Association of Urology (EAU), and National Institute for Health and Care Excellence (NICE), also recommend fosfomycin tromethamine for the treatment of UTI. In conclusion, fosfomycin tromethamine remains a robust and indispensable antibiotic in the management of uncomplicated UTIs, with a distinct pharmacological profile that ensures both efficacy and safety, and patient compliance due to its single-dose regimen.

Type 2 diabetes mellitus (T2DM) remission has emerged as a critical area of research and clinical interest, especially in India, where diabetes prevalence is rising at an alarming rate. Achieving remission through pharmacologic, dietary, and surgical interventions is now an attainable goal for a subset of patients. This systematic review synthesizes evidence from clinical trials, emerging pharmacologic interventions, and current guidelines for diabetes remission. We explore the mechanisms of diabetes reversal, highlighting novel agents such as glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. This review also addresses the long-term sustainability of remission, epidemiological trends in India, and current treatment recommendations, integrating data from major studies. The findings underscore the need for a patient-centered, evidence-based approach to diabetes management. Additionally, we discuss the role of continuous glucose monitoring (CGM), dietary interventions, and the benefits of millet consumption in diabetes remission.

Osteoarthritis (OA) is a chronic degenerative joint disorder and a leading cause of pain and disability among the elderly. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs), though effective in symptom relief, pose significant risks of gastrointestinal, cardiovascular, and renal complications, especially in long-term use. Polmacoxib (CG100649) is a newer NSAID with its dual inhibitory role on cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA), planned to offer higher therapeutic efficacy and safety. This review critically examines the pharmacodynamic and pharmacokinetic properties of polmacoxib, along with its clinical efficacy and safety in OA and acute pain conditions. Clinical trials across phases I-III consistently show polmacoxib to be well tolerated and effective in pain relief and efficient improvement of the joint, with a safety profile comparable to or better than traditional COX-2 inhibitors like celecoxib. Recent trials also explore its role in combination therapies for acute pain management, including dental and postoperative settings, showing noninferiority to standard regimens and fewer adverse events. Its innovative mechanism and pharmacological profile support its potential as a next-generation NSAID for OA and pain management, particularly in populations at high risk for NSAID-induced adverse effects. Further larger long-term studies are warranted to confirm its medical benefits and broader therapeutic applications.

BACKGROUND: The safety and efficacy of proton-pump inhibitors (PPIs) in gastroesophageal reflux disease (GERD) patients on polypharmacy is challenging to manage. Rabeprazole's unique metabolism reduces drug-drug interactions (DDI), making it beneficial for patients with polypharmacy. This study aimed to explore the safety and effectiveness of rabeprazole in Indian comorbid GERD patients on polypharmacy.

METHODS: A cross-sectional survey was conducted (November, 2024 and January, 2025), which included healthcare professionals (HCPs) with experience in prescribing PPIs. The survey included 10 questions addressing issues faced in polypharmacy settings.

RESULTS: Around 91.9% preferred prescribing rabeprazole over other PPIs in polypharmacy patients. CYP450 enzyme interactions are considered by 73.3% HCPs when prescribing PPIs, with a strong emphasis on minimizing DDI in polypharmacy contexts. Rabeprazole was chosen by a major share of HCPs for its unique nonenzymatic metabolism and minimal interaction with the cytochrome P450 system, suggesting suitability in polypharmacy patients. Furthermore, 70% HCPs suggested rabeprazole could improve cardiovascular (CV) outcomes by optimizing antiplatelet therapy, and 74.4% supported its safety in patients on antiplatelet therapy.

CONCLUSION: Rabeprazole appears to be the preferred PPI in managing GERD among patients on polypharmacy, primarily due to its favorable safety profile and minimal DDI, and may be advantageous in clinical practice.