Publications

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.

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: The National Medical Commission (NMC) of India requires medical postgraduate students to conduct research in the form of a thesis or dissertation. However, students often face challenges throughout the process, including topic selection, protocol approval, data collection, and thesis writing. This study aimed to assess the effectiveness of a 1-day focused thesis writing workshop in improving the knowledge and confidence of medical postgraduate students.

METHODS: A cross-sectional mixed-methods study was conducted involving 68 postgraduate students from various medical disciplines who participated in a thesis writing workshop. Participants were administered pre- and post-test questionnaires to assess their knowledge of key thesis writing components, including literature review, results, discussion, and conclusion. The workshop included interactive sessions on each of these topics. Descriptive and inferential statistics were used to analyze the results, and qualitative feedback was gathered to assess participant satisfaction and perceived improvements in confidence.

RESULTS: The pre- and post-test scores showed a significant improvement in knowledge, particularly in the areas of literature review, results, and discussion (p < 0.05). However, the improvement in knowledge regarding thesis conclusions was not statistically significant. Feedback from participants indicated high satisfaction with the workshop, with 85% reporting increased confidence in their thesis writing skills. The majority of students (78%) found the workshop relevant and helpful in enhancing their understanding of thesis writing.

CONCLUSION: A focused, 1-day workshop significantly improved the knowledge and confidence of medical postgraduate students in thesis writing. This suggests that such workshops can be an effective intervention to support postgraduate students in completing their research. The study advocates for the integration of similar workshops into postgraduate curricula. Further research with larger, multicenter studies is needed to evaluate the long-term impact and feasibility of institutionalizing such programs.

AIM: To study the perception of nonintensivists of Indian intensive care units (ICUs) about the role of intensivists as leaders of the ICU, their impact on patient outcomes, including length of stay on the ventilator, cost of care, and evidence-driven quality care using a survey questionnaire.

MATERIALS AND METHODS: This study employed an online survey conducted using a Google Form and distributed via WhatsApp to nonintensivists taking care of ICU/high dependency unit (HDU) patients in public and private hospitals all over India. It consisted of 24 questions related to perceptions about the role of an intensivist in the ICU, their impact on patient-driven outcomes, ICU processes, and ICU structure.

RESULTS: There was a statistically significant difference in responses from respondents working in closed and semi-open ICUs vs open ICUs. Overall, the presence of an intensivist was perceived to be associated with improvements in patient outcomes, smoother decision-making for complex cases, reduced costs by avoiding unnecessary tests, and reduced litigation by patient families, especially in closed and semi-open ICUs vs open ICUs.

CONCLUSION: This is the first-ever survey done to understand the role of an intensivist in the ICU in India in the eyes of a nonintensivist/admitting physician or surgeon. It shows that intensivists are considered to play a significant role in impacting patient outcomes, such as facilitating smoother decision-making in complex cases, improving decision-making efficiency, reducing costs associated with unnecessary tests, and preventing litigation by families. The survey results are very encouraging and should pave the way for conducting large-scale surveys in the developing world.

Poor nutritional status prior to surgery in cardiac patients is one of the risk factors for acute kidney injury (AKI), morbidity, and mortality. There is a lack of data in patients undergoing cardiac surgery with regard to nutritional status and risk of AKI. This study was conducted with the objective of assessment of the nutritional status of cardiac surgery patients using body composition measures (BCM) and other biochemical parameters. This study was conducted at Madras Medical Mission Hospital, Chennai. Before enrolling, informed consent from the patients and ethical authorization were obtained. All patients >18 years of age undergoing cardiac surgery had a BCM analysis done on the pre- and postoperative day 5. Paired t-test was used to compare the pre- and postoperative data. Preoperative body mass index (BMI) of the patients showed that the majority of them were overweight, with a mean BMI of ±26.55 kg/m2. There were no significant changes in the BCM results for protein weight in either study group (no AKI group-preop: mean ± SD, 9.0316 ± 2.39, p = 0.67; postop: mean ± SD, 9.1919 ± 2.57, p = 0.77; AKI group-preop: mean ± SD, 9.57 ± 8.00, p = 0.67; postop: mean ± SD, 9.56 ± 8.07, p = 0.77). There was a significant loss of body fat in all patients, but it was higher in patients who developed AKI (preop: mean ± SD, 33.28 ± 10.96, p = 0.11 vs postop: mean ± SD, 31.83 ± 10.94, p = 0.53). The skeletal muscle mass in both groups showed no significant changes. Those who developed AKI postoperatively had a higher preoperative visceral fat area (VFA) (mean ± SD, 116.87) and percentage body fat (PBF) (33%) compared to patients who did not develop AKI (VFA ±102.36 and PBF 30%). We found that patients had lost body fat postsurgically. Those who were diagnosed with AKI had overhydration, high waist circumference, and VFA preoperatively.

BACKGROUND/INTRODUCTION: The Indian subcontinent faces a substantial healthcare challenge with allergic bronchopulmonary aspergillosis (ABPA). While numerous investigations have explored ABPA's occurrence in the general asthmatic population, there remains a significant knowledge gap regarding its specific prevalence among individuals with severe asthma. Current Indian research demonstrates considerable variation in reported ABPA prevalence rates among severe asthmatics, highlighting the need for more comprehensive investigation.

OBJECTIVE: This research initiative aimed to determine the precise prevalence of ABPA among severe asthma patients seeking treatment at a tertiary healthcare institution in northwestern India, with the goal of enhancing our understanding of this complex condition's burden in this specific patient population.

METHODOLOGY: We conducted a comprehensive cross-sectional investigation spanning August 2022 through July 2023. The study encompassed 247 patients diagnosed with severe asthma. Each participant underwent thorough clinical evaluation and provided blood samples for comprehensive analysis, including absolute eosinophil count measurement, total IgE quantification, and specific testing for Aspergillus fumigatus-related IgE antibodies. When clinically indicated, additional diagnostic procedures included Aspergillus-specific IgG testing and detailed chest imaging through X-ray or high-resolution computed tomography (HRCT).

RESULTS: Our investigation revealed that 63.2% (156 out of 247) of severe asthma patients met the diagnostic criteria for ABPA. The affected population showed a mean age of 41.6 years, with a relatively balanced gender distribution (80 females, 76 males). Among those diagnosed with ABPA, we observed a notably higher prevalence of ABPA-B (92.3%, 144 patients) compared to ABPA-S (7.7%, 12 patients).

CONCLUSION: This research represents one of the most extensive investigations to date documenting such a high ABPA prevalence (63.2%) among severe asthma patients in northern India. These findings underscore the critical need for expanded research initiatives to investigate the underlying factors contributing to such elevated ABPA rates in this geographical region, ultimately aiming to develop and implement effective preventive strategies at the community level.

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.