Publications

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.

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.

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: 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: Brain tumors are among the most aggressive malignancies requiring multimodal therapy, including chemotherapy. In India, where healthcare is predominantly financed out of pocket, the cost of anticancer medications poses a significant barrier to treatment adherence. A wide disparity exists between the costliest branded drugs and their lower-cost alternatives, raising concerns about affordability and equity in care. This study aimed to perform a cost-minimization analysis (CMA) to quantify cost differences (CDs) among the most expensive, least expensive, and generic chemotherapy drugs used for brain tumor treatment.

MATERIALS AND METHODS: This descriptive pharmacoeconomic study compared the costs of eight chemotherapy agents-temozolomide, procarbazine, lomustine, carmustine, vincristine, bevacizumab, irinotecan, and carboplatin. Drug prices were sourced from the Current Index of Medical Stores (CIMS) and government databases. Dosages were standardized based on average Indian adult body surface area (BSA). Cost metrics included CD, cost ratio (CR), and percentage cost variation (PCV). Regimen-wise costs were calculated per cycle and overall.

RESULTS: Significant cost variation was observed across all formulations. Temozolomide 250 mg showed the highest fold difference (8.94×), while bevacizumab displayed a 3.3× difference. Adjuvant temozolomide over 12 months ranged from ₹32,220 (generic) to ₹3,90,000 (costliest brand). PCV values ranged from 27.7% (carboplatin) to over 700% (temozolomide). Most CDs were statistically significant (p < 0.05).

CONCLUSION: This study highlights substantial pricing disparities in chemotherapy for brain tumors in India. Cost-effective alternatives can significantly reduce treatment-related financial toxicity. Incorporating pharmacoeconomic evidence into prescribing decisions is essential to improve equitable access to neuro-oncology care.

INTRODUCTION: Acanthosis nigricans (AN), a commonly encountered condition in clinical practice, is linked with numerous systemic disorders. Currently, there is a dearth of literature on the correlation of clinical and dermoscopic features of AN with nailfold capillaroscopy (NFC) changes. This study intended to evaluate patients with AN who have underlying microvascular complications as a consequence of metabolic diseases.

OBJECTIVES: Primarily to study the association of clinical and dermoscopic findings of AN with NFC and to elucidate the spectrum of NFC changes in patients of AN.

MATERIALS AND METHODS: This was a cross-sectional, hospital-based study with a sample size of 97. Clinical Burke's grading and dermoscopy were performed in clinically diagnosed AN patients. NFC was performed on all 10 fingernails. The fourth and fifth fingernails of each hand were considered for studying the association.

RESULTS: NFC changes seen were tortuous, dilated, cross-linked, ramified capillaries, and dropouts. There was a positive association of clinical Burke's grading (p-value = 0.002) and duration (p-value = 0.003) of AN with dermoscopic features such as depth of sulci cutis, number of hyperpigmented dots, and shape of papillary projections. Tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN (p-value < 0.05). Ramified and cross-linked capillaries showed a significant association with the duration of AN (p-value < 0.05).

CONCLUSION: Dermoscopy in AN showed gradation in changes corresponding to the clinical Burke's grading and duration. Ramified and cross-linked capillaries showed a significant association with the duration of AN, while tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN. The present study aids in the early detection of microvascular changes in AN, such as tortuous, ramified, and cross-linked capillaries, and proves helpful in referring the patient for screening of diabetic retinopathy and nephropathy at the earliest.

BACKGROUND: Sepsis is a leading cause of mortality globally, yet obtaining accurate population-level data remains challenging. According to a 2020 report, there were approximately 48.9 million cases of sepsis and 11 million sepsis-related fatalities worldwide, accounting for 20% of all deaths globally. This study aims to assess the diagnostic efficacy of patient evaluation in comparison with the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Simplified Acute Physiology Score (SAPS) indices, in a quaternary care hospital, and to analyze the impact of various clinical parameters and comorbidities on patient outcomes.

MATERIALS AND METHODS: The study was conducted at Hindu Mission Hospital in Chennai and used a retrospective design to analyze septicemia patients' data from June 2018 to January 2020. The database included clinical presentation, vital signs, comorbidities, laboratory values, and septicemia features. Specimens underwent smear microscopic analysis of the mycobacterial culture.

RESULTS: The study found that elevated SOFA and APACHE II scores, comorbidities, prompt antibiotic administration, and infection characteristics significantly impact sepsis patient outcomes, emphasizing the importance of timely intervention and comprehensive scoring systems.

CONCLUSION: The study emphasizes the significance of a comprehensive approach to sepsis management, including early detection, prompt intervention, and managing comorbid conditions, and suggests future research should focus on accurate predictive models and personalized medicine approaches.

AIM: To ascertain the function of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers in evaluation of disease activity in rheumatoid arthritis (RA) patients.

MATERIALS AND METHODS: This cross-sectional research was performed in a hospital and included 381 patients who met the 2010 ACR/EULAR criteria for RA. The clinical disease activity assessment (CDAI) was used to evaluate activity of disease in addition to demographic and disease-related variables. Based on preestablished CDAI cutoff values, the participants were categorized into four groups. For each patient, laboratory analysis included the following: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and complete blood count (CBC). The conventional procedure was followed in the appropriate computation of PLR and NLR. The four patient groups' NLR and PLR values were compared, and the relation among disease activity indices and NLR and PLR was investigated using Pearson correlation analysis.

RESULTS: In patients, the mean PLR was 132.8 ± 127.7 and the mean NLR was 3.66 ± 2.6. Patients with low disease activity had a substantially lower mean PLR (p = 0.021) in comparison to those with higher disease activity. The mean NLR in relation to CDAI was not observed to be statistically significant (p = 0.69) across the four groups. While there was a weak positive association between PLR and the physician visual analog scale (VAS) (r = 0.22), patient VAS (r = 0.12), and CDAI (r = 0.17), there was no correlation among CDAI and specific disease indices with NLR, according to Pearson correlation analysis.

CONCLUSION: PLR, but not NLR, may be an effective biomarker for evaluating the disease activity level in RA patients, particularly higher disease activity.

BACKGROUND: The number of people living with multiple chronic medical conditions has risen, and with it, the number of medications taken by them. In addition to adherence to medications, it is extremely important to correctly identify the medications. Medication errors occur at all steps, with polypharmacy, low literacy, language barriers, old age, and lack of communication as contributing factors. Many of the patients may not be identifying medications themselves or may be doing so incorrectly. Hence, this study is aimed to check the methods used by patients to identify medications.

MATERIALS AND METHODS: A total of 150 patients attending the outpatient department (OPD) of the medicine department were interviewed using a structured questionnaire, which had multiple-choice questions and one open-ended question. Sociodemographic data, level of education, data on type and number of clinical conditions, groups of medications taken, and methods used for identification of medications were collected. Statistical analysis was done using Stata 14.2.

RESULTS: Most (85.33%) of the patients had a chronic medical condition, out of which 37.33% had two or more clinical conditions. Physical attributes of the tablets (60%) and packaging (39.33%) were used most commonly to identify medications. About 10.67% did not identify the medications themselves. Again 45.33% of the patients depended on the doctor's prescription for the dosing of medications. Patients felt that identification of medications would be easier if the content on packaging included indication, was written in the local language, and was in bold font. They also felt that healthcare professionals spending more time explaining would help them.

CONCLUSION: Irrespective of the level of education, language known, and number of comorbidities, physical attributes and packaging were most commonly used to identify medications.

OBJECTIVE: To assess the prevalence of guideline-directed medical therapy (GDMT) and identify reasons for nonprescription and dose optimization in heart failure patients with reduced ejection fraction (HFrEF) in a tertiary care hospital in southern India.

METHODS: A cross-sectional study was conducted in a tertiary care hospital involving HFrEF patients. Patients with heart failure were categorized based on GDMT prescriptions. Reasons for nonprescription and suboptimal dosing were identified.

RESULTS: The study included 102 HFrEF patients with a mean age of 54 ± 11.7 years, predominantly male (89%). Only 10.8% of patients received GDMT at optimal doses. Although 62% were on triple therapy, many had one or more medications at suboptimal doses. Additionally, 26% of patients were not prescribed all recommended drug classes. Notably, the majority of patients with renal impairment fail to receive triple therapy. Barriers identified included hemodynamic issues and renal dysfunction.

CONCLUSION: GDMT adherence in HFrEF patients is significantly lower than expected, with only 10.8% receiving therapy at recommended doses. Key issues include suboptimal dosing and incomplete prescription of drug classes, influenced by patient-specific factors and systemic barriers.