Publications

A 46-year-old man presented with pain in his left lower limb for the past 2 months. He was taking herbal medications for diabetes, which he had for the past 3 years. He had a history of alcohol dependence for the last 12 years, but recently he was able to overcome his addiction with the help of counseling. He had no history of recurrent abdominal pain and had no complaints of steatorrhea. Clinical examination revealed his body mass index (BMI) was 18 kg/m2, pulse 110 beats per minute, blood pressure 124/78 mm Hg, and absence of icterus. The blood tests showed hemoglobin 11.5 gm/dL, blood sugar (fasting) 440 mg/dL (reference range 60-110), and glycated hemoglobin (HbA1c) 9.5% (good control <6.5), serum calcium 8.9 mg/dL (reference value 8.5-10.5) and vitamin D3 16 ng/mL (reference range 20-50), serum creatinine 1.2 mg/dL (reference value 0.7-1.4), alanine transaminase 35 U/L (reference range 5-45). For pain in the lower limb, a radiograph of the lumbosacral vertebral spine (Fig. 1) was taken; however, numerous dense calcifications were noted across the 12th dorsal and 1st lumbar vertebrae, more so on the right side. Unenhanced abdominal computed tomography (CT) scans (Figs 2A and B) were obtained. The patient received an oral dosage of 500 mg of metformin twice a day, along with 10 units of human regular insulin delivered via subcutaneous injection in the morning and 8 units in the evening. His glucose levels were monitored at regular intervals. In a week's time, the patient's fasting blood glucose level decreased to 110 mg/dL. He was also prescribed calcium supplementation alongside weekly oral administration of vitamin D3 (60,000 IU). Additionally, oral pregabalin at a dosage of 75 mg was administered twice a day.

Human metapneumovirus (hMPV) is a leading cause of acute respiratory tract infections (ARTIs), with severe cases predominantly affecting immunocompromised individuals, such as transplant recipients, cancer patients, and those with chronic illnesses. In these high-risk populations, hMPV pneumonia often leads to prolonged hospitalization and elevated mortality rates. While supportive care remains the cornerstone of hMPV management, targeted therapies are urgently needed. Ribavirin, a broad-spectrum antiviral, combined with intravenous immunoglobulin (IVIG), has shown potential in reducing disease severity and improving outcomes in immunocompromised patients. This manuscript synthesizes the clinical evidence for ribavirin-IVIG therapy, discusses its mechanisms of action, and highlights its relevance in the Indian healthcare context, where respiratory infections impose a significant burden. Despite its promise, challenges such as high costs, limited awareness among clinicians, and logistical barriers restrict the adoption of ribavirin-IVIG in India. This review emphasizes the need for multicenter trials to establish efficacy, optimize dosing, and evaluate cost effectiveness in resource-limited settings. By addressing these gaps, ribavirin-IVIG therapy could play a transformative role in reducing the morbidity and mortality associated with severe hMPV pneumonia.

Hypertension is a leading global health concern that significantly contributes to cardiovascular (CV) and renal diseases. In India, its prevalence is rising, often coexisting with comorbidities such as type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), coronary artery disease (CAD), and metabolic syndrome (MetS). Effective hypertension management in these populations is challenging due to variations in blood pressure (BP) targets, the need for combination therapy, and the complexity of treating associated conditions such as albuminuria, nephropathy, CKD, CAD, and acute coronary syndromes (ACS). Despite advancements in treatment options, inconsistencies in clinical practice highlight the need for standardized, evidence-based recommendations. This expert consensus aims to address these gaps by guiding BP targets, optimal antihypertensive strategies, and individualized treatment approaches for high-risk patients. Key considerations include the role of renin-angiotensin-aldosterone system blockers, calcium channel blockers (CCBs), beta-blockers (BBs), sodium-glucose cotransporter-2 inhibitors, and combination therapies in improving CV and renal outcomes. By establishing clear, consensus-driven recommendations, this statement seeks to enhance hypertension management, promote early intervention, and improve patient outcomes in India.

INTRODUCTION: Tuberculosis (TB) has been a leading killer of mankind since time immemorial. There are four key components in the TB elimination approach. They are known as "Detect-Treat-Prevent-Build". Under the preventive strategy, scaling up of airborne infection control measures is an important step in controlling the global disease burden.

METHODS: This is a narrative review for which we used online databases such as PubMed, Embase, and CINAHL from inception to July 2024. The search terms used include TB, transmission, aerosols, cough, droplet nuclei, Wells-Riley equation, and ultraviolet germicidal irradiation (UVGI). All types of articles were selected.

RESULTS: The primary mechanism of transmission of Mycobacterium tuberculosis (M. tb) is the inhalation of small infected droplet nuclei (1-5 µm in diameter) consisting of a few mycobacteria that have the capacity to reach the alveoli. The transmission dynamics of TB can be influenced by various human, environmental, and pathogenic factors. Several mechanisms such as coughing, sneezing, talking, laughing, singing, and normal tidal breathing can produce droplet nuclei.

CONCLUSION: It is crucial to thoroughly understand the mechanisms of TB transmission for a better understanding of TB dynamics. TB is mainly transmitted by droplet nuclei, and preventive strategies should incorporate this mechanism.

Sarcopenia and cachexia are two crucial geriatric problems that largely pass unrecognized, and their presence is a harbinger of a bad outcome. With the growing older of the human body, there is a gradual loss of muscle tissue and an increase in fat mass, leading to increased abdominal circumference. Sarcopenia is described as the progressive and generalized loss of skeletal muscle mass, strength, and physical function, leading to reduced workout capacity. It needs to be differentiated from cachexia, wherein the weight loss is because of an underlying sickness like cancer, chronic obstructive pulmonary disease (COPD), and immunodeficiency disorder, leading to loss of fat and muscle tissues, and starvation, which is a reversible situation on proper nutrient supplementation. Skeletal muscle tissue loss due to sarcopenia is resistant to dietary vitamin supplements. Even with many commonalities between these two situations, these are considered separate clinical entities. Aging may be described as the time-associated deterioration of the physiological functions critical for survival and fertility. The traits of growing older-as distinguished from ailments of growing old (together with cancer and coronary artery disease)-affect all the humans of a species. A massive loss of muscle tissue and strength (sarcopenia), a reduced regenerative capacity, and a compromised physical performance are hallmarks of aging skeletal muscle. It is prudent to outline the distinction between the two conditions within the aging population so that a therapeutic method may be targeted toward the skeletal muscle loss and strength in aged humans. The treatment consists of appetite stimulants, dietary and nutritional supplementation, tailored exercise, and anti-inflammatory drugs. Megestrol acetate, an appetite stimulant, and dronabinol (Marinol), a narcotic drug used to treat nausea and vomiting in patients with cachexia.

INTRODUCTION: Recently, there is an upsurge of splenic abscess due to typhoidal Salmonella in India.

METHODS: We present a case of splenic abscess caused by Salmonella paratyphi A in an immunocompetent male and conducted a systematic review of splenic abscess cases attributed to typhoidal Salmonella described between January 2001 and May 2024.

RESULTS: Of 33 cases reviewed, 26, 2, and 1 case each were reported from India, Sri Lanka, Turkey, Qatar, and Pakistan, respectively. S. typhi and S. paratyphi A were reported from 29 and 4 cases, respectively. Mean age was 21 years, with 13 children and 8 females. About 28 were immunocompetent and two had diabetes mellitus. Blood, pus, stool, and pleural fluid grew the isolate in 13, 20, 1, and 1 case, respectively. Ultrasonography (USG) abdomen was diagnostic in 28 cases and normal in two cases. Computed tomography (CT) abdomen was diagnostic in all the 27 cases tested. About 17, 12, and 1 patient showed multiple abscesses, solitary lesion, and multiloculated lesion, respectively. USG/CT-guided percutaneous drainage and splenectomy were performed in 25 and 7 cases, respectively. All 33 patients recovered from the infection.

CONCLUSION: We aspire to raise acquaintance among health professionals regarding this uncommon entity and foresee it in pertinent contexts.

OBJECTIVE: The present meta-analysis compares the effectiveness of cyclophosphamide (CYC) as an immunosuppressant in systemic sclerosis-associated interstitial lung disease (SSc-ILD) with placebo, and other immunosuppressants.

METHODOLOGY: The study involved randomized trials and observational studies identified through a systematic literature search using various databases, such as Elton B Stephens Company (EBSCO) Medline/PubMed, Scopus, Web of Science, Google Scholar, PubMed Central, Cochrane Library, and ScienceDirect. These studies compared the effectiveness of CYC with placebo or other immunosuppressants in terms of lung parameters. Meta-analysis and network meta-analysis were conducted to evaluate the effectiveness of the treatments.

RESULTS: Upon comparison, azathioprine (AZA) was favored over CYC for forced vital capacity (FVC) (d = 1.02, p = 0.00) and diffusing capacity of the lungs for carbon monoxide (DLCO) (d = 0.88, p = 0.00). No significant difference in FVC between CYC and mycophenolate mofetil (MMF) was found, although CYC was slightly preferred (d = -0.12, p = 0.60). CYC was beneficial over placebo in reducing the Dyspnea Index score (d = 0.78, p = 0.00) but not in improving DLCO. Network analysis revealed that CYC had the highest FVC outcome p-scores (0.6559), while rituximab (RTX) had the lowest (0.3410). For DLCO, AZA had the highest p-score (0.5707), followed by placebo (0.5180).

CONCLUSION: While suggesting the potential benefits of CYC and AZA, the study findings do not decisively support the superiority of CYC over other treatments for most SSc-ILD lung function parameters. This emphasizes the need for rigorous, ongoing research to refine treatment strategies and address unresolved questions regarding the efficacy and safety profile of CYC.

OBJECTIVES: To compare the efficacy and safety of biosimilar adalimumab injection manufactured by Enzene Biosciences Ltd. (biosimilar) with innovator adalimumab (iADA) in subjects with active ankylosing spondylitis (AS).

METHODS: The prospective, multicenter, randomized, double-blind, phase 3 study involved 192 subjects with active AS recruited at 20 centers across India. The subjects who fulfilled the eligibility criteria were randomized in a ratio of 2:1 (i.e., 125 subjects in the biosimilar adalimumab arm and 67 subjects in the iADA arm). The selected subjects were randomly assigned to receive either the biosimilar or iADA at a dose of 40 mg subcutaneously every other week for a total of 12 weeks. Efficacy assessment was done based on ASAS and BASDAI response criteria. Safety assessment was based on complete physical examination, adverse event (AE) monitoring, vital signs, electrocardiogram (ECG), anti-adalimumab antibody (ADA) assessment, and laboratory tests.

RESULTS: A total of 192 patients were randomized into two groups: biosimilar adalimumab (n = 125) and iADA (n = 67). Baseline demographics, including mean age (32.6 vs 32.4 years) and BMI (23.5 vs 23.2 kg/m1), were comparable between groups. At 12 weeks, ASAS 20/40/70 responses were achieved by 97.5, 94.1, and 68.9% in the biosimilar group and by 98.4, 96.7, and 77% in the iADA group. A total of 44 AEs were reported in 27 subjects (14.1%), with an AE rate of 0.264 per person in the biosimilar arm and 0.16 in the iADA arm. ADA positivity rates were statistically nonsignificant between groups (p = 0.3516). Pharmacokinetic analysis confirmed bioequivalence with comparable Cmax and AUC values.

CONCLUSION: The ASAS 20/40/70 response rates indicated the response to biosimilar at week 12 was similar to iADA. Both drugs had comparable safety and tolerability profiles. Trial registry name: The Clinical Trials Registry-India (CTRI), URL: http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=42640&EncHid=&u… Trial registration number: CTRI/2020/09/028070.

BACKGROUND: Diabetes mellitus is a global epidemic, with an increasing number of undiagnosed individuals, particularly those with type 2 diabetes mellitus (T2DM). However, there is limited data on treatment delays among drug-naïve patients in India. The present study aimed to ascertain the incidence of treatment delay among drug-naïve patients and the sequence of alternate treatments sought since diagnosis.

MATERIALS AND METHODS: This cross-sectional, multicentric, observational study was conducted across 10 primary and secondary care settings in Mumbai from October 2023 to April 2024. Adults of either gender, diagnosed with T2DM, who are drug-naïve, were included. Patient's demographic data, comorbidities, current medications, and medical history were recorded in an electronic case report form and analyzed.

RESULTS: Of the 625 patients enrolled, 591 completed the study. The mean age of the patients was 46.7 years. The proportion of male patients was 54.1%. Overall, 57% of patients had no treatment delays, while 43% experienced delays of ≥3 months. Patients with treatment delays of ≥3 months used alternative/traditional medicines (56.0%), with Ayurveda being preferred by 56.7% of these patients.

CONCLUSION: The study indicated considerable treatment delays among drug-naïve patients in India.

INTRODUCTION: Medical students often experience high levels of stress, anxiety, and depression due to the demanding nature of their studies. Academic pressure can be a significant factor in the development of stress, depression, and anxiety among medical students. The situation may deteriorate if these students have personal, academic, or institutional problems. Hence, this study was planned to identify the prevalence of mental health problems among medical students and their association with personal, academic, and institutional issues.

MATERIALS AND METHODS: We conducted a cross-sectional study among medical students from Sangli District, Maharashtra, India. Data were collected using a predesigned and pretested questionnaire. Chi-square and multivariate regression analysis were used for the statistical analysis. Microsoft Office 365 and SPSS 22 were used for analysis purposes.

RESULTS: A significant proportion of medical students reported experiencing symptoms of mental health challenges: 50.0% depression, 73.6% anxiety, and 22.2% stress. The significant predictors for depression were birth order, physical health, and religiosity; for anxiety-age, upbringing, and stress; gender, year in which they are studying, upbringing, birth order, and physical health. By using binary logistic regression, it was found that personal issues are significant predictors related to depression, anxiety, and stress.

CONCLUSION: Various academic, personal, and institutional issues were contributing to mental health problems among medical students. A robust support system is required to identify and alleviate these problems, which can empower them to cope with challenges and succeed in their academic challenges.