SUT Academy of Medical Sciences

Objective: To estimate the effect of Tolvaptan on serum sodium levels in hyponatremic patients. Methods: This was a prospective observational study conducted in the Department of Internal Medicine, Govt Medical College, Thiruvananthapuram, involving thirty consecutive patients, both sexes, ≥18 y, with hyponatremia, prescribed 15 mg Tolvaptan once daily. On day 1 and day 4, serum sodium levels were recorded. The data was analyzed using SPSS version 25. Quantitative variables were expressed as mean and standard deviation and qualitative variables as proportion with 95% confidence interval. Change in Serum sodium was analyzed using Paired‘t’ test. Results: The mean age of the study population was 66.27±8.38 y with female preponderance mean increase in serum sodium was 6.33± 3.68mEq/l (p<0.001) by day 4 with Tolvaptan therapy in all grades of hyponatremia. Conclusion: Tolvaptan produced significant increase in serum sodium levels.

Objective: Male infertility is a multifactorial condition often linked to oxidative stress and apoptosis. Key molecular regulators, such as NRF2 (antioxidant defense) and p53 (cell cycle and apoptosis), are influenced by hormonal and inflammatory pathways; however, their combined role in infertility remains underexplored. This study investigates the integrated expression of NRF2 and p53 genes and their association with hormonal, inflammatory, and biochemical markers in infertile males. Methods: A case-control study was conducted on 300 males (150 infertile, 150 fertile controls). Gene expression (NRF2, p53) was analyzed using RT-PCR. Hormonal (FSH, testosterone, estradiol), inflammatory (IL-6), and biochemical (SOD, PSA) markers were measured via ELISA. Statistical analysis included t-tests, ROC, scatter plot, and multiple regression. Results: Infertile men showed significantly reduced NRF2 expression and SOD levels, with elevated FSH, estradiol, IL-6, PSA, and p53 expression (p<0.001). ROC analysis identified FSH and NRF2 as strong predictors of infertility. Regression revealed IL-6 and PSA as significant positive predictors of p53 expression, while SOD positively correlated with NRF2. Scatterplots highlighted contrasting biomarker associations for NRF2 and p53. Conclusions: Combined dysregulation of NRF2 and p53, driven by oxidative, hormonal, and inflammatory factors, plays a critical role in male infertility. These genes hold promise as both diagnostic biomarkers and therapeutic targets.

Background – Acute encephalitis syndrome (AES) is now being used for surveillance in all encephalitis endemic zones irrespective of the etiology. Numerous viral pathogens possess the ability to invade the CNS and produce neurologic dysfunction. Methods - We performed a hospital-based descriptive study between January 2019 to January 2020 in the Department of Microbiology, GMC, Thiruvananthapuram taking samples from 193 AES patients admitted under the Departments of Internal Medicine, Neurology & Paediatrics. The samples were proceeded with PCR/ELISA depending on the clinical history. Findings - A viral etiology was established in 48 cases (24.9%) & most were caused by EBV (5.7%). MRI revealed temporal lobe involvement in 9 patients. 20% cases had post-encephalitic sequelae - focal neurological deficits and persistent seizures. Interpretation – Most number of patients were found to have infected with Epstein- Barr virus. Identification of the causative agent is of great importance in AES, as rapid detection and confirmation of etiological agent will have a tremendous impact on the management of outbreaks as well as patient’s disease. Funding – Indian Council of Medical Research (ICMR)

Kerala reports one of the highest case fatality rates and high prevalence of comorbidities and risk factors among persons with tuberculosis (PwTB). We developed a comprehensive care model (CCp-K) focusing on triaging persons with tuberculosis for severe illness, uncontrolled diabetes, alcohol and nicotine dependence at diagnosis, and ensuring inpatient care and follow-up. In the pre-implementation phase, we explored the barriers, facilitators, and perceived suggestions in the design and implementation of CCp-K from various interest holders for sustainable implementation. We conducted an interest holder mapping and using the Power-Interest matrix of Mendelow, we purposively selected key interest holders at the district and state level. In-depth interviews were conducted using an interview guide by trained interviewers until data saturation was achieved. The audio recordings were transcribed, translated, and analysed using a framework-guided thematic analysis approach. Twelve interest holders participated in the interview, which included nine men and three women. The interviews lasted for a mean duration of 74 min (SD = 22). A total of 33 codes were generated and categorized under five themes: (i) perception on TB deaths (ii) relevance of CCp-K differentiated TB care model, (iii) perceived feasibility and enablers of implementing CCp-K, (iv) perceived barriers, and (v) perceived suggestions for the model and its delivery. The interest holders perceived that while delayed diagnosis contributes to TB mortality, the CCp-K model can bridge critical gaps in post-diagnosis care, particularly through early triaging and comorbidity management to reduce TB deaths. The robust healthcare infrastructure of Kerala, local governments and community involvement, and cross-adaptation opportunities from previous successful models were perceived as facilitators. The lack of nodal treatment centres, stigma among healthcare workers, social vulnerability, and competing priorities were perceived as major barriers. The interest holders perceived the CCp-K model to be relevant and feasible. However, Kerala should overcome the barriers of inadequate inpatient referral centers by establishing designated TB care facilities, leveraging existing collaboration with private partnerships, and strengthening the social support system.