Zydus Hospital

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low-and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively]. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

BACKGROUND:Iron deficiency anemia (IDA) is a persistent complication in cancer patients and may result from chronic inflammation, poor nutritional intake, and myelosuppressive therapies. Intravenous (IV) iron preparations, such as iron isomaltoside 1000, allow rapid iron repletion. This study evaluated the drug utilization patterns and safety profile of IV iron isomaltoside 1000 in cancer patients with IDA in a real-world setting. METHODS:This retrospective observational study included 100 adult cancer patients diagnosed with IDA who received IV iron isomaltoside 1000 at two participating centers between January 2024 and September 2025. Demographic data, laboratory parameters (hemoglobin, serum ferritin, total iron-binding capacity (TIBC), and transferrin saturation (TSAT)), dosing details, and adverse events (AEs) were recorded. Continuous variables were expressed as mean ± standard deviation (SD), and paired t-tests were used to compare pre- and post-treatment laboratory values. A p-value less than 0.05 was considered statistically significant. RESULTS:The mean age of patients was 49.5 ± 17.9 years, and 51% were female individuals. The mean baseline hemoglobin was 8.8 ± 1.9 g/dL and improved to 11.68 g/dL (p < 0.001) after one month of treatment. Among the 92 patients with paired baseline and one-month follow-up data, serum ferritin increased from 10.24 ng/mL to 133.16 ng/mL and TSAT improved from 13.28% to 21.98% (p < 0.001), while TIBC decreased from 441.62 µg/dL to 278.00 µg/dL (p < 0.001). AEs occurred in 7% of patients, including Fishbane reaction in 6% and mild musculoskeletal pain in 1%; all were mild and self-limiting. CONCLUSION:IV iron isomaltoside 1000 was associated with significant improvement in hematologic parameters and demonstrated a favorable safety profile in cancer patients with IDA. It can be considered a safe and practical option for rapid iron repletion in cancer management.

Abstract Postprandial glucose (PPG) is an important determinant of glycaemic control. Changes in postprandial levels may precede changes in fasting glucose levels, and postprandial hyperglycemia is an independent determinant of diabetic complications. The management of diabetes should aim to achieve overall glycaemic control, addressing both fasting and postprandial hyperglycemia. A multitude of variables, including demographics, differences in diet and lifestyle, and varied physiological factors, have been described which can alter and influence PPG levels. Therefore, inclusion of PPG in management planning is imperative. This can be done by identifying modifiable factors that positively influence PPG levels and adjusting treatment accordingly, made possible by frequent feedback and monitoring of PPG using practical approaches and individualizing the use of available technologies to achieve better overall glycaemic control.

Introduction: Primary membranous nephropathy (pMN) is a leading cause of nephrotic syndrome (NS) in adults. Cyclophosphamide (CYC) with glucocorticoids (GCs) is recommended for high and very high-risk patients, but the optimal treatment duration and cumulative dose remain unclear. This study aimed to compare the effectiveness and safety of short-duration (SD) versus long-duration (LD) oral CYC regimens in pMN patients with NS. Methods: We conducted a multicenter retrospective cohort study of 54 adult patients with biopsy-proven pMN treated with oral CYC in the USA and India between 2010 and 2022. Patients received either SD-CYC (≤3 months) or LD-CYC (>3 months). The primary outcome was overall remission (complete or partial) at 12 months. Secondary outcomes included complete remission (CR) rates and adverse events. Analyses were stratified by treatment duration and cumulative CYC dose. Results: Overall remission at 12 months was similar between SD and LD groups (73% vs. 83%, p = 0.088), with a trend toward higher CR in the LD group (47% vs. 23%, p = 0.077). The SD group had more baseline chronic kidney changes, which may have impacted outcomes. By cumulative dose, patients receiving >3 g CYC had significantly higher overall remission and CR after adjustment for baseline characteristics and cumulative GC dose. Serious adverse events occurred in 18.5% of patients, with no significant differences between groups. Conclusion: Short-term oral CYC combined with GC may be a safe alternative to LD-CYC regimens for achieving clinical remission in pMN. Although these findings align with recent evidence supporting the efficacy of low-dose CYC in pMN, well-designed clinical trials are still needed for more robust clinical validation.

Gloniopsis spp. are emerging dematiaceous fungi implicated in subcutaneous infections. Its phylogenetically close relation to Rhytidhysteron rufulum based on internal transcribed spacer (ITS) region alone often leads to misidentification of Gloniopsis spp. as R. rufulum. The study aimed to decipher clinical spectrum, molecular characterization, and antifungal susceptibility of Indian R. rufulum and Gloniopsis isolates. We retrieved 13 isolates identified as either R. rufulum or Gloniopsis from subcutaneous lesions in our culture collection and confirmed identification by Sanger sequencing. Phenotypic and genotypic characterization (targeting ITS, TUB, and LSU) was performed, followed by antifungal susceptibility testing (AFST). We also performed systematic review of all cases of 'Rhytidhysteron' or 'Gloniopsis' reported till date. Of 13 patients, majority were male with diabetes or renal transplantation. Diabetes mellitus was particularly noted in all patients infected with G. calami. Microscopic examination showed pigmented septate aerial hyphae in G. calami and septate hyphae with swellings in G. percutanea. All our isolates belonged to genus Gloniopsis rather than Rhytidhysteron. We report G. calami in human infection, for the first time. Molecular identification based on ITS, TUB, and LSU sequencing accurately differentiates among the species; however, TUB GenBank database needs to be expanded. AFST is challenging, but available data elucidate role of triazoles as potent therapy, along with surgical excision. This is the first study delineating clinical and microbiological characteristics and antifungal susceptibility of Gloniopsis species from India. Globally, maximum reports of infection by Gloniopsis spp. are from India, possibly due to its tropical temperature conducive for fungal growth, and warrants epidemiological investigation.