Publications

Nocturnal hypertension, characterized by high blood pressure (BP) during nighttime, is a critical but often overlooked contributor to heart disease and organ damage. Globally, nocturnal hypertension is estimated to affect 6-20% of the population. Data indicating the prevalence of nocturnal hypertension in India is not available. Detection of nocturnal hypertension typically involves 24-hour ambulatory BP monitoring, which is a trusted method for detecting nocturnal BP variations such as nondipping and reverse-dipping that increase cardiovascular risk. Despite its clinical significance, nocturnal hypertension remains underdiagnosed due to various factors, and there are no specific Indian guidelines addressing its management. This expert consensus highlights key strategies for identifying and managing nocturnal hypertension in India. Lifestyle changes, such as reducing salt intake, managing stress, and improving sleep, are essential for treatment. Long-acting antihypertensive medications, including angiotensin receptor blockers, calcium channel blockers, and β-blockers, are recommended for better 24-hour BP control and reducing health risks. Additionally, newer therapies such as sodium-glucose cotransporter 2 inhibitors and angiotensin receptor-neprilysin inhibitors are promising options for patients with difficult-to-control BP or other conditions, such as diabetes or kidney disease. The consensus emphasizes the importance of tailored treatment strategies, regular BP monitoring, and integration of innovative therapies to address nocturnal hypertension effectively. These strategies aim to reduce the associated risks and improve health outcomes for patients in India.

In Indian primary care settings, cough is the second most common presenting symptom, only after fever. Despite cough being just a symptom of an underlying condition, it can be distressing and impact quality of life (QoL). Hence, symptomatic treatment of cough may be prudent along with definitive treatment directed at the underlying etiology. In patients with nonproductive cough, antitussives satiate this role for symptomatic management. On this accord, levodropropizine, a nonopioid, peripheral antitussive, is a valuable agent compared to traditional central antitussives. It demonstrates comparable efficacy in reducing cough severity and frequency while exhibiting a superior safety profile, with minimal central nervous system (CNS) side effects. Moreover, it has also been extensively studied in diverse age-groups and in multiple etiologies. This comprehensive review aims to summarize the drug aspects, clinical evidence, and place in therapy with levodropropizine.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has become a significant public health issue worldwide, with a pronounced impact in India due to the escalating rates of obesity and type 2 diabetes mellitus (T2DM) driving its prevalence. This condition spans a range of hepatic disorders, from uncomplicated steatosis to metabolic dysfunction-associated steatohepatitis (MASH), accompanied by differing levels of hepatic fibrosis, heightening the likelihood of progression to cirrhosis, liver cancer, and cardiovascular complications. While lifestyle modification remains the cornerstone of MASLD management, pharmacologic therapies are increasingly recognized as essential for patients with progressive disease or those at higher risk of complications. Recent insights into the pathogenesis of MASLD have led to the development of innovative therapies targeting key mechanisms such as hepatic steatosis, insulin resistance, inflammation, and hepatic fibrosis. Several pharmacological agents have shown encouraging results in clinical trials, including thyroid hormone receptor-β agonist resmetirom, glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide, peroxisome proliferator-activated receptor (PPAR) agonists such as pioglitazone and saroglitazar, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and vitamin E. Furthermore, emerging therapies, including the dual incretin agonist tirzepatide and fibroblast growth factor (FGF) analogs, hold the potential to transform future treatment strategies. This review provides a comprehensive overview of current and evolving pharmacologic options for MASLD, with a focus on practical recommendations tailored for Indian physicians. A structured treatment algorithm for noncirrhotic MASLD (F0-F3 fibrosis) is presented, incorporating only drugs currently available in India and stratified based on diabetes status and hepatic fibrosis severity. Given India's vast and diverse patient population, ensuring access to cost-effective therapies remains a challenge, necessitating a pragmatic approach that balances efficacy, affordability, and real-world feasibility. This review serves as a practical clinical guide, equipping physicians with evidence-based recommendations to optimize MASLD management in routine practice.

This review assesses the current landscape of hemophilia management, focusing on identifying unmet clinical needs. Hemophilia, a rare genetic bleeding disorder, requires continuous and comprehensive care to improve patients' life expectancy and quality of life (QoL). Despite advancements in treatment, challenges persist, including suboptimal bleed protection with current prophylactic options, the development of inhibitory alloantibodies, and the resulting joint damage leading to hemophilic arthropathy (HA). Additionally, the review highlights the significant physical and psychological burden on patients, impacting their education, employment, and overall QoL. Addressing these unmet needs through innovative therapies, improved access to care, and individualized treatment strategies is crucial for enhancing outcomes and reducing the overall burden of hemophilia, particularly in high-prevalence regions like India.

Neurocysticercosis (NCC) is the most common parasitic infection of central nervous system; however, disseminated cysticercosis is a very rare presentation of cysticercosis. Less than 120 cases have been reported in the world till now. Here, we report the case of a 40-year-old female, presented to the emergency department of SN Medical College, Agra, on August 10, 2024, with multiple episodes of partial seizure of the right side. History taken and the patient was thoroughly investigated. Imaging showed an infinite number of larvae in all the muscles of the body. The patient was managed, and seizures were controlled with medical therapy. A country such as India where the majority of the population is vegetarian still suffers as an endemic region for NCC. This is due to poor sanitation management and food processing. We expect this case to raise attention toward serious complications of the disease and plan strategies for its prevention, control, and establish proper management guidelines.

A 25-year-old previously healthy female presented with a week-long history of headache, fever, bilateral lower limb weakness, and urinary retention. Initial examination and investigations pointed toward an infectious cause, with magnetic resonance imaging (MRI) suggestive of leptomeningitis with myelitis, and cerebrospinal fluid (CSF) analysis revealing lymphocytic pleocytosis and a low glucose ratio. Empirical treatment for meningoencephalitis was initiated, including broad-spectrum antibiotics and high-dose steroids for myelitis. A diagnosis of glial fibrillary acidic protein (GFAP) autoimmune meningitis was confirmed by positive GFAP antibody titers. The patient showed significant recovery following immunosuppressive therapy and was discharged from the intensive care unit (ICU). This case underscores the importance of a multidisciplinary approach, prompt intervention, and the role of autoimmune testing in atypical presentation.

Acquired hemophilia A (AHA) is a rare autoimmune disorder (1.5 per million) caused by autoantibodies against factor VIII, leading to coagulopathy. Postpartum AHA is uncommon, accounting for only 1-5% of cases, and typically presents with mucocutaneous or vaginal bleeding, while deep vein thrombosis (DVT) is an extremely rare manifestation. We report a case of a 33-year-old postpartum female presenting with left lower limb DVT and spontaneous bleeding. Initial management with heparin and direct oral anticoagulants (DOACs) exacerbated bleeding, prompting treatment revision. Persistently elevated activated partial thromboplastin time (aPTT) with normal platelet count and prothrombin time (PT) raised suspicion of AHA. A Bethesda assay confirmed high-titer factor VIII inhibitor (35.2 BU/mL). Immunosuppressive therapy with rituximab, corticosteroids, and cyclophosphamide successfully led to remission. This case highlights an unusual presentation of AHA with DVT in a postpartum patient. The combination of thrombosis and bleeding necessitates careful diagnosis and individualized management. Prompt recognition of prolonged aPTT, uncorrected mixing study, and confirmatory Bethesda assay are crucial for early intervention. Postpartum AHA, though rare, should be considered in postpartum females presenting with coagulopathy or thrombosis. Early diagnosis and tailored treatment improve outcomes and reduce mortality.

BACKGROUND: We present the case of an Indian man in his 40s with acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS), involving the skin, oral mucosa, and lungs. Fewer than 30 cases of KS have been reported in India to date. This case report emphasizes the challenges and confounding factors in diagnosing pulmonary KS, as well as the complexities involved in initiating treatment.

CASE DESCRIPTION: The patient presented with multiple skin lesions, worsening dyspnea, and chest pain. A skin biopsy confirmed KS, and chest imaging revealed bilateral infiltrates. Pulmonary KS was diagnosed through polymerase chain reaction test from bronchoalveolar lavage fluid. Despite the initiation of antiretroviral therapy, the patient's condition deteriorated, leading to his demise.

CONCLUSION: Diagnosing pulmonary KS remains a complex and nuanced process, often hindered by overlapping symptoms and confounding factors that can obscure its presentation. Early recognition and prompt intervention are essential but challenging, underscoring the need for a high index of suspicion and a multidisciplinary approach to optimize patient outcomes.

Salmonella bone and joint infections are unusual and account for <1% of cases of septic arthritis and osteomyelitis. We report the case of a patient with monoarticular septic arthritis with underlying beta thalassemia who had undergone splenectomy 17 years earlier. Ultrasound-guided aspiration of pus from the affected hip joint grew Salmonella Paratyphi A. The patient was started on sensitive antibiotics and responded well to treatment. Salmonella septic arthritis is more commonly observed in individuals with comorbid conditions, such as hemoglobinopathies (particularly sickle cell anemia), pre-existing joint disorders such as rheumatoid arthritis, hematologic malignancies, systemic lupus erythematosus (SLE), or other conditions associated with increased hemolysis. A limited number of cases of Salmonella septic arthritis have been reported in thalassemia patients. In typhoid endemic regions of the world, culture and susceptibility of joint fluids from septic arthritis cases can guide physicians in appropriate and timely diagnosis of this entity, especially in patients who are immunosuppressed.