Publications

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.

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.

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: 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.

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.

OBJECTIVES: (1) To know the contributions of bronchoscopy in intensive care units (ICUs) in terms of therapeutic benefits and diagnostic purposes. (2) To know the safety of the bronchoscopy procedure in ICUs in critically ill patients.

MATERIALS AND METHODS: This is a retrospective observational study that included 41 patients who underwent bronchoscopy in the ICU of a tertiary care center. Data collected included the patient's clinical profile, vitals, cause of ICU admission, indication for bronchoscopy, and complications.

RESULTS: There were 41 ICU patients who required and underwent bronchoscopy. A number of 15 patients (36.5%) were on mechanical ventilation, and 10 patients (24.3%) were on noninvasive ventilation (NIV) support. The most common indication was lung collapse in 23 (56%) patients. Out of 41 patients who underwent the procedure, 28 patients (68.2%) showed postprocedure improvement, which shows the utility of the procedure. Minor complications occurred in 18 patients (43%) and included hypoxia, bleeding, and bronchospasm. Zero mortality was reported during or after the procedure.

CONCLUSION: Bronchoscopy provides excellent diagnostic yield and therapeutic benefits in ICU patients with respiratory conditions, and it is relatively safe even in high-risk patients when done by trained consultants.

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.

INTRODUCTION: India harbors the second-largest population with diabetes, with over 100 million, and type 2 diabetes mellitus (T2DM) constitutes the major share. Metformin remains the first-line pharmacotherapy for T2DM due to its safety profile, cost-effectiveness, and beneficial metabolic effects.

MATERIALS AND METHODS: The aim of the study was to assess the frequency of vitamin B12 deficiency in patients with T2DM on metformin therapy and compare it with their cohabiting family members who are not on metformin but share similar dietary habits.

RESULTS: This study included 180 participants with 90 cases and controls each, and we enrolled 89 females (49.4%) and 91 males (50.6%). The mean age was 57 (± 4.88) years, and overall gender distribution and dietary pattern were nearly balanced among cases and controls. The mean duration of diabetes among cases was 7.69 ± 4.35 years, and duration of metformin use was 5.22 ± 3.77 years, ranging from 1-16 years. The mean daily dose of metformin was 1238.89 ± 586.50 mg/day, with a median dose of 1000 mg/day. The mean serum vitamin B12 level in metformin users was significantly lower than in controls (206.66 ± 59.09 pg/mL vs 301.44 ± 72.28 pg/mL, p < 0.001). Vitamin B12 deficiency was present in 40.0% of metformin users versus 11.1% of controls, yielding an odds ratio of 5.33 (95% CI: 2.44-11.65), which was a highly significant difference between the two groups (t = -9.631, p < 0.001), strongly suggesting an association between metformin use and reduced B12 levels. Neurological symptoms were observed in 14.4% of cases (OR 4.896, 95% CI: 1.345-17.827; p = 0.009).

CONCLUSION: Long-term metformin use in T2DM patients is strongly associated with both biochemical vitamin B12 deficiency and an increased likelihood of neurological symptoms.

An immediate need exists for a safe, quick, and effective reversal agent in patients who present with anticoagulant-induced major bleed. Dabigatran, a newer oral anticoagulant and a direct thrombin inhibitor (DTI), can also induce bleeding risk. Idarucizumab is a specific dabigatran reversal drug that the United States Food and Drug Administration (US FDA) has approved in the event of a significant bleeding caused by this drug. In this particular drug-related bleeding, it can be challenging to precisely dose alternative reversal agents like prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs) depending on coagulation characteristics. Additionally, they may result in thromboembolic problems. Despite these drawbacks, the inability to get idarucizumab may necessitate the use of these medications in cases of life-threatening bleeding. We describe the case of a 65-year-old male who reported to the hospital with coagulopathy, anemia, and fresh bleeding per rectum (Hb: 5.8 gm/dL, PT 20.02 seconds, INR: 1.55). He was on dabigatran for the past 1 month. Even after stopping dabigatran, injection of vitamin K, 4 units of blood transfusion, and 8 units of fresh frozen plasma (FFP), he was still bleeding, with fall in hemoglobin level. Following the administration of PCC, he significantly improved, and no additional transfusion products were needed. He could be sent home after 4 days. After 1 month, he returned for follow-up with no further complications.