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: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pneumonia are challenging lower respiratory tract infections (LRTIs) commonly encountered in clinical practice. The oral extended-spectrum cephalosporin cefpodoxime proxetil is highly active against the bacterial pathogens commonly associated with LRTIs.

AIM: To assess the role of cefpodoxime in the management of infections in Indian patients with AECOPD and LRTIs in a real-world setting, based on expert opinions.

METHODOLOGY: The expert consensus meeting was convened according to an a priori protocol. Physicians were invited to participate in the discussion to frame opinion statements based on their clinical experience. A structured questionnaire was prepared regarding the role of cefpodoxime in the management of infections in patients with AECOPD and LRTIs.

RESULTS: Streptococcus pneumoniae was the most common pathogen causing infections in patients with chronic bronchitis and pneumonia. Good penetration of cefpodoxime into lung tissues, high concentrations in lung tissues, and rapid resolution of symptoms make cefpodoxime the first-choice drug for treating LRTIs. Cefpodoxime is a step-down therapy of choice when switching hospitalized patients with LRTIs from parenteral antibiotics to oral antibiotics. Cefpodoxime is safe in patients with comorbid diseases and in elderly patients on polypharmacy.

CONCLUSION: Cefpodoxime is the preferred first-line empiric antibiotic of choice for the treatment of community-acquired LRTIs in the real-world setting in India. Cefpodoxime has been preferred by 99% of expert chest physicians to treat infections in patients with chronic obstructive pulmonary disease (COPD), considering its broad spectrum of activity. Ninety-seven percent of experts reported that cefpodoxime, as a step-down therapy, gives satisfactory patient recovery and prevents recurrent infections.

Prediabetes (PD) is a bridge between normoglycemia and hyperglycemia or diabetes mellitus (DM) characterized by higher than normal blood glucose but not fulfilling the criteria for type 2 DM (T2DM). PD is defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and/or hemoglobin A1c (HbA1c) above 5.7% but <6.4%. Individuals with PD are at increased risk of progressing to T2DM at a pace of 5-10% every year and other micro- and macrovascular complications, including cardiovascular diseases. Prevalence of IGT and IFG in 2021 was 9.1% (about 464 million), which is projected to increase to 10.0% (638 million) in 2045; that of IFG was 5.8% (about 298 million), projected to increase to 6.5% (414 million) in 2045 globally. That is why we must seriously take aggressive steps to prevent progression to T2DM and to reduce the morbidity and mortality associated with DM, its complications, and healthcare burden. Why PD is important? Why PD to be treated? Individuals with PD have a 5-10% annual risk of progressing to T2DM and are associated with increased risk of micro- and macrovascular complications like nephropathy, retinopathy, neuropathy, and cardiovascular risks, myocardial infarction, and stroke. To prevent progression or conversion of PD to DM, we must be very aggressive. These are sufficient reasons for treatment of PD by lifestyle intervention or pharmacotherapy, as intensive lifestyle modifications, dietary modification, and enhanced physical activity have been shown to reduce the progression of PD to T2DM by 40-70%. These measures also lead to weight loss and better cardiovascular health. PD develops due to insulin resistance, impaired insulin secretion, and increased hepatic glucose production. Therefore, pharmacotherapy with metformin, pioglitazone, α-glucosidase inhibitors (AGIs), dipeptidyl peptidase IV (DPP IV) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP1 RA) targeting these defects are efficacious in preventing T2DM in PD. Diabetes Prevention Program (DPP) has shown 31% reduction in DM incidence with metformin. There is increasing evidence for prevention of DM in adults with PD by pharmacotherapy, but options other than metformin have adverse effects, and there is no unanimity for their use in PD. The role of pharmacotherapy is still debatable, and no consensus is made. We recommend that patients who are at high risk, having a strong family history of DM, signs of severe insulin resistance like acanthosis nigricans, severe obesity, or associated comorbidities, must be considered for disease-modifying pharmacotherapy like SGLT2 inhibitors, DPP IV inhibitors, and GLP1 RA. Those who do not have the above risk factors should be followed up at regular intervals, at least every year. Why PD not to be treated? When we treat DM, our "treat to target" is HbA1c of 7% or less, and organizations like the European Association for the Study of Diabetes (EASD) recommend a stricter target of 6.5%, which is above the diagnostic criteria for PD. Then the million-dollar question arises: are we justified in treating PD, as diagnostic criteria for PD are lower than the DM treatment target of 7% or less? There is another issue of overdiagnosis and overmedication; labeling individuals as PD and treating them with pharmacotherapy may lead to increased medication and healthcare costs, as well as stigma associated with a chronic disease and its treatment. Long-term studies are required to evaluate the risk-benefit of pharmacotherapy. We suggest that persons identified to have PD must be under vigilance and investigated at regular intervals. If they are found to have incremental blood glucose and HbA1c and a high risk of progression or conversion to DM, it is logical to treat. Those who are stable in the prediabetic range without associated comorbidities should be observed regularly and advised lifestyle modification (diet and exercise) and weight reduction.

BACKGROUND: Rural areas continue to grapple with a lack of access to healthcare despite the development of technologies like telehealth, artificial intelligence (AI), virtual and mixed reality, nanotechnology, and robotics. However, there are encouraging ways to get beyond these obstacles with the advent of AI tools. To close the healthcare gap in rural India, the research explores the viability and effectiveness of implementing AI solutions.

METHODS: A scoping review was used in the study to help define its objectives and parameters as well as to examine the efficacy and potential of AI tools in bridging the gap in rural healthcare. The information was taken from a number of databases such as PubMed, ScienceDirect, and Google Scholar that contained English-language publications from January 2020 to December 2023. The data were recorded and screened with the help of electronic data processing software called "Rayyan," and the results were displayed thematically.

FINDINGS: The study shows how AI-driven solutions could be used to address and overcome healthcare access gaps, highlighting the potential for implementing AI technologies in rural healthcare settings. In order to successfully incorporate AI tools, the report also identifies barriers to their acceptance in rural healthcare and suggests joint efforts by healthcare providers, policymakers, and technology developers. In order to adopt AI in rural areas, this study requires supporting investments in capacity-building programs, digital infrastructure, and supportive legislative frameworks.

CONCLUSION: The paper emphasizes how AI is transforming healthcare in rural India and closing the gap in access. Healthcare professionals and legislators can overcome obstacles, provide local healthcare staff with better infrastructure, and enhance health outcomes for rural regions by utilizing AI technologies. The conclusions and suggestions help to advance the body of knowledge on using AI to provide appropriate healthcare, which will direct similar projects in the future.

Rheumatoid arthritis (RA) is a common autoimmune disorder characterized by inflammation in the joints, affecting around 0.24-1% of the population. RA can develop through a variety of paths, resulting in a nonspecific clinical appearance. It progresses from preclinical to chronic disease, with pathogenic mechanisms that may differ across people, confounding therapy efforts. Numerous factors have been found to be associated with RA, including lifestyle-related risk factors like smoking and obesity, which are modifiable, as well as advancing age and female gender, which are nonmodifiable. RA pathophysiology is an intricate interaction between different genetic and immunological variables resulting in disease progression. With a better knowledge of the pathophysiology of RA, new therapeutic approaches are being developed for effective management of RA. This review article summarizes epidemiology, pathogenesis, and diagnostic options for RA.

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.

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.

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.