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: Understanding Indian healthcare professionals' (HCPs) perceptions of beta (β)-blockers is critical, given the high burden of hypertension (HTN) and cardiovascular (CV) diseases in the country.

MATERIALS AND METHODS: A cross-sectional survey was conducted among 1,000 Indian HCPs, including consulting physicians, cardiologists, and specialists in diabetes/metabolism experienced in managing adult patients across the HTN and CV disease continuum. Conducted between April 2023 and March 2024, the survey employed a 26-item structured questionnaire, developed through literature review and expert consultation, to assess β-blockers utilization patterns, prescribing preferences, and perceived barriers.

RESULTS: Responses from 855 HCPs were analyzed. Consulting physicians (431; 50.4%) and cardiologists (342; 40.0%) formed the majority. β-blockers were prescribed to 25-50% of patients with HTN by 489 (57.2%) HCPs. Approximately 429 (50.2%) observed a systolic BP reduction of 10-15 mm Hg, while 465 (54.4%) reported a diastolic BP reduction of 5-10 mm Hg. β-blockers were commonly prescribed for heart failure (381; 44.6%), postmyocardial infarction (214; 25%), and chronic coronary syndrome (309; 36.1%). Metoprolol was the preferred BB in 75% of HTN, post-MI, chronic coronary syndrome (CCS), and AF cases, and in 66.2% for HF management.

CONCLUSION: This survey highlights real-world prescribing patterns and perceptions of β-blockers in India, with metoprolol emerging as the most preferred agent across multiple CV indications, reflecting its strong clinical acceptance and perceived efficacy.

Obesity is increasingly recognized as a chronic, relapsing, and progressive disease that acts as a major upstream driver of cardiovascular, kidney, and metabolic disorders, with South Asians experiencing heightened vulnerability at lower adiposity thresholds. Despite this, effective metabolic therapies remain underutilized in cardiology practice. Semaglutide, a GLP-1 receptor agonist, has emerged as a multisystem, disease-modifying agent with benefits that extend well beyond glycemic control. Accumulating evidence from the STEP (Semaglutide Treatment Effect in People with Obesity) program, the SELECT cardiovascular outcomes trial, the SOUL trial, heart failure with preserved ejection fraction (HFpEF) studies, and real-world cohorts underscores its relevance for cardiometabolic risk reduction and symptom improvement. Recognizing the need for India-specific guidance, a panel of cardiologists from across the country reviewed pivotal randomized trials, including STEP 1-8, STEP-HFpEF, STEP-HFpEF DM, STEP TEENS, SELECT, SOUL, SUSTAIN-6, and PIONEER-6, along with meta-analyses, observational data, and international recommendations to formulate practical, context-appropriate guidance for cardiology practice. Across diverse studies, semaglutide consistently produces substantial reductions in body weight and visceral fat, accompanied by improvements in blood pressure, glycemic control, inflammatory markers, and hepatic steatosis. SELECT demonstrated a significant reduction in major adverse cardiovascular events in adults with overweight or obesity and established atherosclerotic cardiovascular disease (ASCVD), independent of diabetes status. Benefits of obesity-related HFpEF include meaningful gains in symptoms, exercise tolerance, and quality of life. Emerging data also support renal and hepatic protection across CKM domains. Findings from high-dose 7.2 mg studies highlight a dose-response continuum but call for careful assessment of tolerability. As international guidelines increasingly position GLP-1 receptor agonists as cardiometabolic therapies, Indian data emphasize the importance of early, phenotype-driven intervention. Semaglutide represents a practice-changing therapy that addresses core pathophysiological drivers of ASCVD and HFpEF through integrated modulation of adiposity and metabolic dysfunction. Its cardiovascular efficacy, multisystem benefits, and suitability for South Asian phenotypes support broader incorporation into contemporary cardiology. This consensus offers a framework for evidence-based patient selection, contraindications, monitoring, maintenance strategies, and coordinated multidisciplinary implementation to ensure safe and effective use in Indian clinical practice.

The International Diabetes Federation estimates that 537 million individuals around the globe currently have diabetes, and this number is anticipated to rise to approximately 783 million by 2045. About 30% or more of individuals diagnosed with diabetes are more prone to developing chronic kidney disease (CKD), and a considerable portion progresses to renal impairment that requires renal replacement therapy.1,2.

BACKGROUND: Dyslipidemia is one of the driving forces in the pathogenesis of atherosclerosis and its resultant cardiovascular disease. Both these conditions are characterized by an increase in proatherogenic lipids compared to anti-atherogenic lipids. Atherogenic Indices have been developed to predict CVD risk without increasing the cost of testing; however, most of the studies done to date have used these indices in patients who have already suffered a coronary event. Dyslipidemia is most prevalent in cases of type 2 diabetes mellitus (T2DM). Therefore, this study was designed to assess atherogenic risk (via atherogenic indices) in newly diagnosed treatment-naïve obese and lean patients of T2DM.

MATERIALS AND METHODS: Treatment-naïve, newly diagnosed patients of T2DM were recruited and grouped into obese (BMI ≥ 25 kg/m2) and lean (BMI <18.5 kg/m2) groups. Blood was collected in a fasting state for the estimation of glycemic parameters and fasting lipid profile. Atherogenic indices (LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and atherogenic index of plasma (AIP)) were calculated using predefined formulas.

RESULTS: LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and AIP were higher in the obese group compared to the lean group. However, these calculated indices were above the recommended cutoffs in both obese and lean patients with T2DM.

CONCLUSION: This study is the first to document increased atherogenic risk in both obese and lean patients (newly diagnosed) with T2DM. Although CVD risk is higher among the obese patients, aggressive control of plasma lipids is required in all patients with T2DM, irrespective of BMI.

BACKGROUND: People living with human immunodeficiency virus (PLHIV) are known to have decreased quality of life (QoL), increased fatigue, and neurocognitive dysfunction. In India, the prevalence and predictors of the same are not explored. We aim to determine the prevalence and predictors of neurocognitive impairment (NCI), fatigue, and health-related QoL among PLHIV in India.

SETTING: The study was conducted among people attending an antiretroviral therapy center in a tertiary care hospital in New Delhi after ethical approval.

MATERIALS AND METHODS: We enrolled consented patients and used the Montreal Cognitive Assessment (MoCA), Multidimensional Assessment of Fatigue (MAF) scale, and 36-item Short Form (SF-36) survey to assess NCI, fatigue, and health-related QoL (HRQoL), respectively.

RESULTS: A total of 100 PLHIV with a mean age of 42.0 ± 9.6 years were enrolled, with 48% females. 47 patients (47%) had NCI with a MoCA score <26. Male gender, PLHIV with <5 years of treatment, and <50 years of age had higher MoCA scores. MoCA scores had a negative correlation with age and MAF scores and a positive correlation with SF-36 scores. 55 patients (55%) suffered from fatigue, with lesser fatigue scores for males. Fatigue scores had a negative correlation with SF-36 scores. 71 patients (71%) had total SF-36 scores >50 with males having higher scores. Fatigue had a negative correlation on QoL, r = -0.831.

CONCLUSION: In India, the prevalence of NCI, fatigue, and decreased QoL is higher compared to other populations. Management strategies in HIV require interventions to improve NCI, fatigue, and QoL along with antiretroviral therapy.

INTRODUCTION: Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes mellitus and is the most common cause of severe vision loss in adults. Diabetic retinopathy may lead to vision-threatening damage to the retina, eventually leading to blindness.

AIM: To study the effect of 12 weeks of intensive lifestyle intervention program on diabetic retinopathy using OCT and VEP.

SETTING AND DESIGN: Quasi-experimental study conducted in the Department of Physiology in collaboration with the Department of Ophthalmology at AIIMS, Nagpur.

MATERIALS AND METHODS: 75 patients of type 2 diabetes mellitus with a duration of >5 years were recruited as per the inclusion and exclusion criteria. After taking clinical history and anthropometry parameters, visual evoked potential and optical coherence tomography were done. Then, a 1.5-hour lifestyle intervention session was conducted. Followed by follow-up visits on 15th, 30th, and 45th days, done with biweekly follow-up in between through telephonic/ WhatsApp group.

RESULTS: Modification in dietary pattern, regular exercise, healthy sleep schedule, and stress management showed a reduction in latencies and no major changes in amplitudes, but overall mild improvement was observed in PRVEP and FVEP. Also, in the retinal nerve fiber layer, mild changes along with a reduction in the severity of thickening of the retinal nerve fiber layer (RNFL) of both eyes were seen, but no major changes in central macula thickness were observed.

CONCLUSION: Lifestyle modifications play a crucial role in the improvement of diabetic retinopathy.

AIM: The thyrotropin controversy in subclinical thyroid disorders (STDs) is among the most common endocrine disorders globally. In India, approximately 42 million people suffer from thyroid disorders, with subclinical hypothyroidism (SCH) affecting about 9.4% of the population. SCH is more prevalent in females (11.4%) compared to males (6.2%).

DISCUSSION: The diagnosis and treatment of SCH and subclinical hyperthyroidism (SHT) are controversial. SCH is often diagnosed based on biochemical markers, as patients may be asymptomatic or exhibit vague symptoms. Thyrotropin (TSH) levels may be elevated or decreased, while triiodothyronine (T3) and thyroxine (T4) remain within the normal reference range or near the lower or upper limits. STDs refers to an abnormal TSH with normal thyroxine (FT4) and free triiodothyronine (FT3) levels. It includes STDs and individuals at high risk for disease progression or adverse outcomes, with unclear prognosis. Progression of SCH to overt hypothyroidism depends on initial serum TSH levels, thyroid peroxidase antibodies (TPO), family history of thyroid disorders, previous radiation, and smoking. Controversies surround SCH and its association with cardiovascular diseases (CVD), pregnancy outcomes, neuropsychiatric issues, metabolic syndrome, dyslipidemia, and diabetes. Assay interference is a problem in interpreting thyroid function tests (TFTs), occurring in 1% of cases. The health package investigation systems often overlooks the impact of drug intake and assay interference. Various methods for measuring TFTs, such as radioimmunoassay, immunometric assay, and ELISA, differ in sensitivity, specificity, and standardization, leading to methodological variability. Common causes of assay interference include human antimurine antibodies (HAMA), thyroid hormone autoantibodies (THAAbs), rheumatoid factor, antistreptavidin, and antiruthenium antibodies. When diagnosing SCH, it is crucial to rule out other causes of elevated TSH, such as autoantibodies, goiter, and rare conditions such as thyroid hormone resistance (THR), diagnosed by serum glycoprotein alpha subunit (α-GSU) and family history. Biotin, a common supplement, can affect TFT assays, leading to spurious results. It can cause falsely high T4 and T3 levels and low TSH, leading to misdiagnosis of SCH.

CONCLUSION AND RECOMMENDATIONS: The timing of TFTs, whether fasting, postprandial, or random, remains a debated issue. Assay interference and biotin intake should be considered when analyzing TFTs. The role of iodine and iodine supplementation during pregnancy and its impact on STDs are not yet fully conceptualized. Large randomized clinical and epidemiological studies are needed to establish a consensus on the diagnostic threshold for TSH. These studies should include diverse populations and medical conditions to improve our understanding of the disease and patient outcomes. In practice, avoid rushing to treat elevated TSH levels between 4 and 10 mIU/L or low TSH between 0.5 and 0.1 mIU/L without confirming the diagnosis with additional tests (T3, T4, FT4, FT3, and TPO). TSH alone should not be the sole decision-maker; consider other TFTs and sequential testing from the same laboratory and time to make more informed decisions. While TSH levels can be affected by time and prandial state, FT3 and FT4 levels remain stable, suggesting all three TFTs may aid in accurate diagnosis and treatment decisions.

BACKGROUND: Malarial retinopathy refers to a constellation of changes seen in severe or complicated malaria cases. These include: retinal whitening, vessel changes-whitening, tramlining, retinal hemorrhages, and papilledema. There are very few Indian studies on this entity. Since retina can be easily visualized by direct ophthalmoscopy, this study was done to determine prevalence of malarial retinopathy among malaria cases and to determine relationship between malarial retinopathy and severity of the disease.

MATERIALS AND METHODS: The study was done at Indoor and Outdoor Departments of Tropical Medicine, School of Tropical Medicine (STM), Kolkata, with the support of the Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Medical College, Kolkata. Adult malaria cases, both complicated/severe and uncomplicated, were included. Patients unable or unwilling to cooperate with eye examination, contraindications to tropicamide eye drops (angle closure glaucoma or known allergy to product), severe corneal scarring or cataracts hindering view by ophthalmoscopy, diabetes mellitus, hypertension, intracranial space occupying lesions, epilepsy, alcohol use, chronic renal failure, age > 60 years and any other known ocular/systemic disease that can cause retinopathy changes were excluded. Severe malaria was diagnosed as per the WHO criteria. Cases with acute febrile illness of other causes were taken in control arm, and normal population subjects were taken as controls. All patients were assessed clinically, followed by appropriate laboratory investigations and then direct ophthalmoscopic examination was done. Ocular findings were be collaborated with severity of illness.

RESULTS: A total of 71 malaria cases were included in our study. Among them, 12 cases were of severe malaria, and rest of the cases were uncomplicated. Of the 12 severe malaria cases, 8 were Plasmodium vivax, 3 were Plasmodium falciparum, and 1 was mixed. Uncomplicated malaria cases were mostly P. vivax (35 out of 59). Features suggestive of malarial retinopathy were noted in 9 out of 12 cases of severe malaria (75%) and 2 out of 59 cases of uncomplicated malaria (3.4%). We noted two cases of retinal changes-one case of retinal whitening in falciparum malaria and one case of vivax malaria with retinal hemorrhage in the uncomplicated group. Both of the cases subsequently needed admission for recurrent vomiting, reduced urine output, and severe weakness 40 dengue cases were included in control arm of AFI cases-20 DHF cases and 20 cases of DF with warning signs. Among them, retinal hemorrhage was noted in one case of DHF (2.5%). Out of 40 sepsis cases, retinal hemorrhage was seen in one case (2.5%). No retinal changes were noted among 40 other AFI cases which included scrub typhus, enteric fever, chikungunya, and acute viral hepatitis. Also, no abnormality was detected on ophthalmoscopy in 40 healthy individuals. The presence of retinopathy was suggestive of severe malaria (p < 0.05). We found the sensitivity and specificity of malarial retinopathy as a marker of severe malaria to be 75% and 96.6% with a positive predictive value of 81.8%.

CONCLUSION: Malarial retinopathy may serve as an important clinical biomarker for predicting severe malaria. All clinicians should be appropriately trained in performing direct ophthalmoscopy to detect the retinopathy changes.