Publications

How to cite this article: Saibaba J, Chandra N, Amalnath D, et al. "The Cancer that Carried the Chalk"-NXP2+ Paraneoplastic Dermatomyositis Unleashing Calcinosis Cutis and Peripheral Neuropathy. J Assoc Physicians India 2026;74(2):102-103.

BACKGROUND: Diabetes mellitus poses a substantial global health burden, with diabetic retinopathy (DR) being a prevalent and potentially devastating microvascular complication. Platelet activation has been implicated in the pathogenesis of DR, suggesting platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and plateletcrit (PCT) as potential noninvasive markers for predicting its onset.

MATERIALS AND METHODS: We conducted a cross-sectional study involving 300 patients diagnosed with type 2 diabetes mellitus (T2DM) attending a tertiary care center. Demographic data, duration of diabetes, and HbA1c levels were recorded. Platelet indices were measured using complete blood counts, and DR was diagnosed based on fundus examination findings.

RESULTS: Among the study participants, group B (n = 140) comprising patients with DR had significantly higher levels of MPV (13.28 ± 2.14 fL), PDW (14.56 ± 2.37), P-LCR (29.59 ± 6.018%), and PCT (0.29 ± 0.06) compared to group A (n = 160) without DR (MPV: 9.99 ± 1.64 fL, PDW: 12.81 ± 2.28, P-LCR: 27.64 ± 8.36%, PCT: 0.26 ± 0.09) (p < 0.001 for all comparisons). Subgroup analysis within poorly controlled diabetics (HbA1c > 7%) also showed significantly higher platelet indices in those with DR compared to those without.

CONCLUSION: Our findings underscore a significant association between elevated platelet indices and the presence of DR in patients with T2DM, independent of glycemic control status. These indices could serve as valuable surrogate markers for identifying individuals at risk of developing DR, facilitating early intervention strategies in clinical practice.

How to cite this article: Abraham G, Kovilazhikam DS, Jaikumar S, et al. A Young Male with Five Kidneys. J Assoc Physicians India 2026;74(2):101.

BACKGROUND: Mycobacterium bovis, the causative agent of bovine tuberculosis, is a zoonotic pathogen capable of infecting cattle and humans. Human contraction of bovine tuberculosis, particularly pulmonary infection, remains a significant public health concern. The differentiation between Mycobacterium bovis and Mycobacterium tuberculosis is challenging due to limitations in conventional diagnostic methods, leading to an underestimated burden of M. bovis in human population. This study focuses on the prevalence of M. bovis in cases of pulmonary tuberculosis in a tertiary care teaching hospital located in Karamsad, Anand, a rural district of Gujarat.

METHODS: In this cross-sectional study, 1,000 sputum samples from patients clinically suspected of having pulmonary tuberculosis were collected at the Department of Respiratory Medicine from November 2017 to June 2018. All samples underwent Ziehl-Neelsen staining for Acid Fast Bacilli detection, followed by molecular testing using primers targeting the HupB gene (a histone-like protein), to differentiate between M. tuberculosis and M. bovis. Results: Of the 1,000 sputum samples, 100 (10%) tested positive for Acid Fast Bacilli. Molecular analysis revealed that 90% of these positive samples were M. tuberculosis. Among the remaining samples, 4% were positive for M. bovis, and 6% indicated a mixed infection with both M. tuberculosis and M. bovis. Conclusion: The study found the prevalence of M. bovis in 10% cases of pulmonary tuberculosis in the Anand district of Gujarat. The findings highlight the limitations of conventional diagnostic methods in identifying M. bovis infections and demonstrate the efficacy of molecular techniques, explicitly targeting the HupB gene, for accurate detection and differentiation of M. tuberculosis and M. bovis. The evidence of coinfection in 6% patients further emphasizes the complexity of tuberculosis diagnosis in endemic areas.

BACKGROUND: Anterior (ACS) and posterior circulation strokes (PCS) differ in clinical presentation, vascular pathology, and associated risk factors.

OBJECTIVES: The aim of the study was to compare vascular risk profiles, clinical characteristics, neuroimaging findings, and outcomes between ACS and PCS patients in a hospital-based cohort.

METHODS: A prospective observational study was conducted at a tertiary care hospital, from January to December 2021. Consecutive patients with confirmed anterior or posterior circulation stroke were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) scores, vascular risk factors (hypertension, diabetes, dyslipidemia, smoking, metabolic syndrome), presenting symptoms, computed tomography (CT) imaging findings, and outcomes [modified Rankin Scale (mRS) at discharge, mortality] were recorded. Univariate and multivariate logistic regression analyses were performed.

RESULTS: Among 376 stroke patients analyzed, 274 (72.9%) had ACS and 102 (27.1%) had PCS. PCS patients were significantly younger (54.6 vs 61.2 years; p = 0.003), with a higher prevalence of hypertension (78.4 vs 62.8%; p = 0.008), current smoking (45.1 vs 28.8%; p = 0.002), metabolic syndrome (41.2 vs 28.5%; p = 0.02), and poor glycemic control (HbA1c >8% in 51.2 vs 38.6%; p = 0.04). PCS presented more often with vertigo (78.4%), ataxia (62.7%), and visual symptoms (54.9%), while ACS typically presented with hemiparesis and aphasia. Despite lower NIHSS scores, brainstem infarcts in PCS accounted for most in-hospital deaths. Multivariate analysis identified hypertension, smoking, age <55, and metabolic syndrome as independent predictors of PCS.

CONCLUSION: PCS affect a younger demographic and are independently associated with modifiable metabolic and vascular risk factors. Their atypical presentation and distinct risk profile call for targeted screening and prevention strategies, particularly in younger Indian adults.

BACKGROUND: Altered mental status (AMS) refers to changes in cognitive function or consciousness, encompassing cognitive, attention, arousal, and consciousness disorders. The Glasgow Coma Scale (GCS) and full outline of unresponsiveness (FOUR) score are tools used to evaluate patients with altered consciousness. Few studies have compared the interobserver reliability of these scales. This study aimed to assess interobserver variability between GCS and FOUR scores in predicting outcomes of critically ill patients with altered sensorium.

METHODOLOGY: This hospital-based forecasting experimental study included 200 patients who were admitted to the critical care unit at King Edward Memorial (KEM) Hospital, Pune. Patients were randomly selected and scored once within 24 hours of admission using both GCS and FOUR scores by two independent observers, a critical care resident (CCR) and a critical care consultant (CCC), with a 5-minute interval between assessments. Interrater reliability was measured using kappa values, with outcomes focused on agreement within ±1 score point for both scales. Statistical analysis was conducted using Epi Info.

RESULTS: Demographics showed males (62%) outnumbered females (38%). The largest age-group was 51-70 years (38 %). GCS and FOUR scores showed no significant differences between CCR and CCC in mean GCS (CCR: 8.2 ± 2.9; CCC: 8.5 ± 3.0; p = 0.249) or FOUR score (CCR: 10.74 ± 3.2; CCC: 10.9 ± 3.1; p = 0.6118). A close to borderline difference was observed in GCS for females (p = 0.0423). Interrater agreement showed kappa values for GCS components eye-openings (0.78291), verbal responses (0.64858), and motor responses (0.38867). For FOUR scores, kappa values were eye-openings (0.81014), motor responses (0.77721), brainstem reflexes (0.89801), and respirations (0.91623).

CONCLUSION: The study found very good interobserver reliability for GCS eye and verbal components but poor agreement for motor responses due to confusion with localization and abnormal movements. The FOUR score demonstrated good to excellent reliability across all components and provided more detailed neurologic assessments, especially in intubated patients and those with brainstem dysfunction. It is more efficient in predicting outcomes, making it a preferred tool in intensive care units (ICUs). Larger studies are recommended to incorporate the FOUR score as a standard neuromonitoring tool in the intensive care unit.

PURPOSE: To extend wavelet analysis of pattern electroretinography (PERG) from macular cone to retinal ganglion cell (RGC) dysfunction in optic nerve disease (OND) by validating Symlet-2 (sym2) discrete wavelet transform (DWT) features.

METHODS: From the open access PERG-Institute of Applied Ophthalmobiology (IOBA) dataset, 58 recordings from OND subjects and 262 recordings from healthy volunteers (HVs) were analyzed. Five pre-selected sym2 coefficients (D5-2, D6-2, D6-3, A6-3, A6-4) were quantified. Their correlations with canonical amplitudes (|P50-N35|, |N95-P50|) and group separation (rank-biserial effect size, |rrb|) were analyzed. We also assessed a previously defined DWT energy index based on the Daubechies 8 mother wavelet (7N), capturing RGC activity.

RESULTS: The macular cone-specific sym2-D6-2 correlated tightly with |P50-N35| in HVs (rcorr = 0.95) and OND subjects (rcorr = 0.97). In contrast, sym2-A6-4 (112-150 ms, 0-13 Hz) was best suited to capture differences between the HV and OND groups (|rrb| = 0.549), compared to |N95-P50| (|rrb| = 0.358). Bootstrap benchmarking confirmed that sym2-A6-4 outperformed |P50-N35| and |N95-P50| (Δ|rrb| = 0.362 and 0.187; Pboot = 0.005 and 0.036, respectively). The 7N feature failed to yield effective results on all measures (|rrb| = 0.084).

CONCLUSIONS: Sym2 DWT features provide compartment-specific, multidimensional biomarkers that outperform traditional canonical peaks for both macular cone (sym2-D6-2) and RGC (sym2-A6-4) assessment. Future work should validate these biomarkers in a large, diverse, genetically and phenotypically characterized external cohort to confirm generalizability and clinical utility.

TRANSLATIONAL RELEVANCE: Sym2 wavelet indices provide robust and sensitive PERG biomarkers that could serve as quantitative endpoints in clinical trials.

INTRODUCTION: The growth of the paramedic profession over recent years is reflected in the growing body of publications by paramedics or related to paramedics, ambulance services and pre-hospital care. Publications are not the only method by which new knowledge can be disseminated, and conferences represent another method of dissemination. Conference presentations may or may not be published, so studying these presents a different perspective on topics of interest and research happening within the profession. This study set out to report on material presented at large conferences relevant to UK paramedics between 2010 and 2023.

METHODS: The project comprised a bibliometric study describing presentations from UK conferences relevant to paramedics between 2010 and 2023. Conferences relevant to paramedic practice were selected by the study team based on pre-determined criteria. Standardised forms were used to extract data on presentations and presenters. Data are presented descriptively.

RESULTS: Six large conferences (999 EMS Research Forum, Ambulance Leadership Forum, Faculty of Pre-Hospital Care Conference, College of Paramedics National Conference, Research Conference and Student Conference) were selected, and data from 43 individual conferences were collected, representing 70% of the potential conferences during this time frame. The data include 690 presentations given by 551 individual presenters. Paramedics were the most common professional group presenting. The London Ambulance Service, North East Ambulance Service and University of Sheffield were the most common institutions represented. The most common topics under discussion were policy and practice, research and trauma. The most common methodologies were qualitative.

CONCLUSION: This study provides an overview of research presented at paramedic, ambulance service and pre-hospital conferences. A wide range of research was presented at the selected conferences by many individuals. A wide range of topics feature in the data, but high-impact, low-frequency clinical conditions, such as cardiac arrest and major trauma, feature highly.

INTRODUCTION: Ventilation with a bag-valve-mask is a standard part of cardiopulmonary resuscitation (CPR) performed by ambulance clinicians. Ventilation quality has received little attention until recently, when ventilation feedback devices (VFDs) became available. Evidence suggests that clinicians struggle to ventilate according to guidelines without feedback and that a VFD improves ventilation quality. This study explored the impact of regular VFD use compared with a single episode of VFD use and no VFD use on ventilation quality during simulated CPR across a six-month period.

METHODS: The study comprised a single-site, exploratory, randomised controlled trial conducted in North East Ambulance Service NHS Foundation Trust. Participants completed six-minute CPR scenarios, with ventilation quality recorded, repeated three times over six months. Participants were randomised 1:1:1 to ventilation feedback at each session, feedback at the first session only or no feedback (control). The primary outcome was ventilation quality (rate and volume) at the final study session.

RESULTS: The study ran from February to July 2025 and included 51 participants, mostly male (82%), with a median age of 39 years (IQR 33-45), who were primarily paramedics (92%). Participants completed 150 study sessions, generating 15.5 hours of ventilation data. There was a clear difference in ventilation quality (rate and volume) with VFD versus no VFD. The ventilation quality of the group that had feedback at only the first session declined sharply when feedback was removed, and by the third (final) study session this group was statistically no different from the control group. VFD use reduced instances of hyper- and hypoventilation.

CONCLUSION: This simulation-based, exploratory, randomised controlled trial demonstrated that VFD use improved the ability of ambulance clinicians to ventilate according to guidelines but when the VFD was removed, they rapidly reverted to a low level of compliance. Future work needs to study VFD use in clinical practice and to explore any impact on patient outcomes.