Objectives Type 2 diabetes mellitus (T2DM), a global epidemic, requires sustained glycemic control to prevent acute and chronic complications. Because of their weight neutrality and safety, dipeptidyl peptidase-4 (DPP-4) inhibitors are frequently used; however, daily dosage may restrict adherence. One possible remedy is Trelagliptin, a once-weekly DPP-4 inhibitor that increases compliance without sacrificing effectiveness. Material and Methods During the course of 24 weeks (April-September 2025), 117 patients with well-controlled or nearly controlled T2D who were already taking DPP-4 inhibitors participated in this real-world, prospective, interventional, comparative study at a tertiary teaching hospital in North India. Once-weekly Trelagliptin was administered to eligible participants who were taking stable doses of vildagliptin, sitagliptin, linagliptin, or teneligliptin. Fasting plasma glucose (FPG), postprandial glucose (PPG), and HbA1c levels were measured at baseline and at follow-up. The student’s t-test was used for statistical analysis, and a p <0.05 was deemed significant. Results The mean age of each group was 43.1 ± 5.7 years, and their BMI was 24.1 ± 3.1 kg/m 2 . Trelagliptin and other DPP-4 inhibitors did not significantly differ in HbA1c values at baseline, 12 weeks, or 24 weeks ( p >0.38). Trelagliptin caused a mean HbA1c reduction from baseline of -0.08%, while daily DPP-4 inhibitors caused a reduction of -0.09%, suggesting non-inferiority. PPG stayed similar ( p >0.65), and a slight increase in FPG with Trelagliptin ( p = 0.03–0.04 vs vildagliptin/sitagliptin) was not clinically significant. There were no reports of hypoglycemia or adverse events. Conclusion Trelagliptin showed comparable safety and non-inferior efficacy to daily gliptins, with the added benefit of weekly dosing for greater convenience. It is an affordable, adherence-boosting solution for long-term glycemic control in T2D.
The management of non-infectious uveitis and scleritis continues to evolve. These conditions are often characterized by recurrent, uncontrolled inflammatory flare-ups that can progressively damage the eye’s structure and function in a “sawtooth” pattern, potentially leading to irreversible vision loss and even blindness. As such, treatment should aim to provide sustained control of inflammation while minimizing the long-term adverse effects of therapy. The success of tumor necrosis factor-alpha (TNF-α) inhibitors in treating rheumatologic inflammatory diseases marked the beginning of a new “biologic era” in medicine. Biologic therapies are designed to target inflammation at the molecular level, offering effective immunomodulation with a relatively low risk of serious side effects. This article reviews the current understanding of biologic treatments for non-infectious uveitis and scleritis, highlighting recent pharmacological developments and clinical research findings.
Diabetic retinopathy (DR), a microvascular complication of diabetes, is a leading cause of vision loss worldwide, characterized by progressive damage to the retinal vasculature due to nonperfusion, resulting in retinal ischemia, increased vascular permeability, and pathological angiogenesis (neovascularization). Hence it endorses the importance of regular retinal screening and timely intervention in individuals with diabetes. Advances in imaging modalities like optical coherence tomography (OCT) and OCT-angiography have improved the clinical understanding of the pathophysiology of DR and enabled early detection. Moreover, emerging therapies such as anti-vascular endothelial growth factor (VEGF) agents and sustained-release steroid implants have transformed DR management, offering enhanced visual outcomes and reduced treatment burden. The surgical management of DR has undergone an absolute transformation in the last decade, thereby revolutionizing the functional outcome. The recent advances in treatment modalities, like gene therapy, open new horizons to prevent blinding complications of DR. As the diabetic population grows, staying updated on DR diagnosis, treatment, and prevention is crucial to mitigate vision-threatening complications.
Objectives Metabolic disturbances, including insulin resistance and overweight, are significantly linked to pre-diabetes. These are believed to impact the serum levels of sex steroid hormones. The alteration in both glucose and sex steroid hormone metabolism is an important aspect in the pathogenesis of cardiovascular diseases (CVD). Studies on these associations are scarce in Africa. This research evaluated the correlation between sex steroid hormones and cardiovascular risks amongst pre-diabetic men and compared the same to other degrees of glycemia. Material and Methods It was a cross-sectional comparative research. A total of 191 adult men (75 with prediabetes (PD), 58 with diabetes, and 58 with normal glucose), who presented at the study center within the study period, were recruited. The recruitment was done by a systematic random sampling method, using interviewer-administered designed questionnaires. The mean and standard deviations, as well as numbers and percentages, were estimated for the numerical and categorical variables, respectively. The Fisher’s test was used in comparing the numerical variables, while the categorical variables were compared via the Chi-square test. The level of independent association among the dependent and independent variables was analyzed using logistic regression. The strength of these associations was tested using the odds ratio (OR) at a confidence interval (CI) of 95%. The statistically significant level was considered at a p <0.05. Results The associations between the age, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the glycemic levels were statistically significant. The patient with PD was more likely to be obese with a higher CVD risk. However, the BMI, WC, HC, WHR, SBP, and DBP were independent risk factors for the development of PD on the elimination of cofounders. There was age-dependent significantly lower free testosterone (FT) among PD compared to normal glucose tolerance (NGT) at all BMI levels, and significantly lower total testosterone (TT) and FT values among PD compared to other groups as the WHR rises. Conclusion The association between major CVD risks and some abnormal reproductive hormones with PD shows the need to screen all men within the reproductive age group, regular re-evaluation of all identified cases, lifestyle changes aimed at weight reduction, regular exercise, healthy eating habit, and intensifying the campaign on the dangers of PD, as it is always done for diabetes. These hormone abnormalities may worsen the incidence of PD, and by extension, diabetes mellitus (DM).
A chronic illness like tuberculosis (TB) is still rampant in developing nations like India. Although it is primarily a pulmonary disease, extrapulmonary manifestations can impact any organ system. Oral cavity involvement is not very common, and sometimes, it may clinically mimic oral cancer. We are going to discuss a situation where ulcers in the oral cavity looked like cancer. Medical history is crucial, and diseases that could present with similar symptoms should be considered in differential diagnosis before treatment. This is the case of a 25-year-old female in our department complaining of non-healing, painful oral ulcers. We hereby present a rare case of primary oral TB in a young female, diagnosed by histopathology and successfully treated with anti-tubercular therapy (ATT).
Chronic obstructive pulmonary disease (COPD) presents unique clinical challenges in elderly populations, where age-related physiological changes and multiple comorbidities complicate diagnosis and management. Elderly patients typically present through four distinct patterns: characteristic respiratory symptoms, non-respiratory complaints, comorbidity-related manifestations, or acute exacerbations. Cardinal symptoms include dyspnea, chronic cough, sputum production, wheezing, and chest tightness, though presentation may be atypical with predominant systemic features such as cognitive impairment, falls, or weight loss. Physical examination findings reflect disease severity and complications, including accessory muscle use, barrel chest, pursed-lip breathing, and signs of hypercapnia or cor pulmonale. Diagnostic challenges arise from symptom attribution to normal aging, overlapping comorbidities, and cognitive impairment affecting symptom reporting. Comprehensive assessment incorporating functional status evaluation and recognition of circadian symptom patterns is essential for optimal management. Understanding these diverse clinical presentations enables earlier diagnosis and individualized treatment approaches in this vulnerable population.
Objectives JN.1 was initially identified as a variant of Interest (VOI) by the World Health Organization (WHO), and was later recognized as a distinct VOI, after which the government of India issued an advisory to states for genome sequencing of COVID positive samples. Material and Methods A total of 335 throat/nasopharyngeal swabs of SARS-CoV-2 positive patients were received at Sawai Man Singh Medical College (SMSMC), Jaipur, from 19-12-23 till 18-04-24 for whole genome sequencing, of which 223 samples that were found positive for SARS-CoV-2 and having a Ct value <25 were further processed for sequencing. Results Out of 206 lineages identified, 62.14% (128) were JN.1 and 37.86%(78) were other lineages. Among the total 128 JN.1 cases identified, 60.16% were males and 39.84% were females. 14.84% were <18 years, 57.03% were in the age group 19-59 years, and 28.13% were ≥60 years of age. 22.65% cases were asymptomatic, while 77.34% cases were symptomatic. Re-infection was found in 23.44% (30) of cases. The maximum positive cases were from the Jaipur district. The majority (81.25%,104) of the JN.1 infected cases were already vaccinated, 3.91% (5) were unvaccinated, while 14.84% (19) were not eligible for vaccination. Co-morbidities/other conditions were present in 23.44% (30) of patients. Hospitalization was required in 18.75% (24) of cases. Only one patient had a history of international travel. Death due to COVID was reported in 2 cases. Conclusion Rapid spread of JN.1 variant implicates continuous evolution of the virus and emphasizes continuous monitoring for timely detection of new variants.
Objectives Hematopoietic stem cell transplantation (HSCT) is preferred for several malignant and non-malignant hematopoietic conditions. However, high diversity in the histocompatibility genes, i.e., human leukocyte antigen (HLA) , poses a challenge due to the unavailability of HLA-identical donors for most cases. This has increased haplo-identical HSCT in the last few years, which can lead to enhanced allorecognition and propensity for graft-versus-host disease (GvHD). The population-specific molecular diversity of peptide-binding domains (PBD) of HLA alleles defines allo-sensitivity. Therefore, we attempted to analyze reported Indian HLA diversity for their phylogenetic relatedness in PBD, towards plausible implications for population-specific donor selection for haplo-identical HSCT here. Material and Methods For this observational study, published literature, allelefrequencies.net, and immuno polymorphism database (IPD) - international ImMunoGeneTics information system (IMGT)/HLA databases were referred to cumulatively estimate the degree of reported HLA diversity in the Indian population for the PBD region, with reference to global diversity. CLUSTAL omega and interactive tree of life (iTOL) were used for estimating phylogenetic relatedness. Results Comprehensive analysis of reported HLA data for Indian population revealed a heterogenous distribution pattern representing the majority of globally present allelic groups (one field). At two fields, 114 HLA-A, 185 HLA-B and 68 HLA-C alleles for HLA class I are reported for Indian population. The dendrograms highlighted phylogenetic relatedness between small clusters usually having same allele group (one field level), though few exceptions were also observed. Conclusion The observed heterogeneity in distribution of class I and class II and their phylogenetic relatedness could be attributed to diverse microflora and environmental conditions. Our analyses could plausibly facilitate formulating algorithms guiding optimal selection of permissible histocompatible donor for transplantation.
Livedo reticularis (LR) is characterized by a mottled, lace-like pattern of reddish-blue to violaceous, cyanotic skin discoloration, most commonly involving the extremities and occasionally the trunk. LR may occur in the absence of systemic disease, as seen in physiological, primary, or idiopathic forms, or it may be secondary to underlying systemic conditions. Secondary LR is most often associated with hypercoagulable states, with antiphospholipid antibody syndrome (APS) being the most frequent etiology. In addition, LR has been reported in association with endocrine disorders, including hypercalcemia, hypothyroidism, and diabetes mellitus (DM). Hence, we report the case of an 18-year-old girl with type 1 DM who presented with LR. We investigated to rule out the secondary causes and concluded that in her case, LR was secondary to none other than underlying uncontrolled type 1 DM. This article aims to bring this rare complication of diabetes to light so that it can improve our understanding of the associations and complications of the disease.
Objectives In India, disparities in orthopedic care arise from variability in healthcare infrastructure, access to specialized training, and modern medical technologies. To improve uniformity and quality of treatments, the Indian Council of Medical Research (ICMR) initiated the development of standard treatment workflows (STWs) for common orthopedic conditions. Material and Methods A multi-disciplinary panel of national experts guided the creation of STWs. The process involved reviewing the latest literature and international guidelines, which were then adapted to local healthcare contexts. Focus was placed on prevalent conditions such as fractures, back pain, and joint diseases. External peer reviews were conducted to refine and validate the guidelines. The workflows were designed in a user-friendly, graphical format for easy implementation in various healthcare settings. Results The STWs provide evidence-based protocols for managing a range of orthopedic conditions. For fractures, such as ankle and distal femur fractures, the workflows guide clinicians from initial assessment to definitive surgical techniques. For degenerative conditions like knee and hip osteoarthritis, the STWs detail conservative management, surgical indications, and postoperative care. Open fractures have a dedicated workflow to stress on early interventions in post-traumatic infection prevention. The STWs are presented as concise, single-page posters to enhance accessibility and practical use in clinical settings. Conclusion The ICMR’s STWs represent a proactive approach to standardizing orthopedic care across India. By providing easy-to-use, evidence-based protocols, this initiative is expected to improve care quality, especially in resource-limited settings, and support ongoing training of healthcare providers.
VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a rare and recently identified auto-inflammatory disorder that has emerged as a paradigm-shifting diagnosis that bridges the gap between unexplained inflammation and clonal hematologic disorders. Driven by a somatic mutation in the UBA1 gene, it presents with a perplexing mix of recurrent fevers, vasculitis, cytopenias, and steroid-refractory inflammation, often masquerading as classic autoimmune disease. While increasingly recognized in the West, VEXAS remains underdiagnosed in India, where such cases are frequently misattributed to infections like tuberculosis or seronegative vasculitis. With the advent of affordable genomic testing, there is a pressing need for heightened awareness among Indian clinicians. It demands a shift in diagnostic thinking, from serology to sequencing, and from pattern recognition to precision medicine. This article sheds light on its vexing presentations since its inception in 2020 to its long-term prognosis and available treatment modalities.
Objectives Tuberculosis (TB) poses a major global health concern, with drug-resistant strains posing significant treatment challenges. Drug-resistant TB (DR-TB) requires second-line anti-TB drugs, which often have severe side effects. This study focuses on evaluating adverse drug reactions (ADRs) in DR-TB patients to improve treatment outcomes by timely identification and management. Material and Methods This was a 2-year prospective observational descriptive study of 145 registered DR-TB patients initiated on treatment, among whom 79 developed ADRs. Demographic, clinical, and treatment data were collected from all 79 DR-TB patients. ADRs were assessed using statistical methods to determine any associations with factors such as age, sex, HIV status, and treatment regimen. Results The mean age of the study population having ADR was 38.5 years, with 67.0% male. Most patients (78.4%) were underweight, 77.2% were anemic, and 29.1% had comorbidities, mainly hypertension. About 74.6% of patients had a previous history of anti-TB treatment. Rifampicin (R)-mono resistance (64.5%) was the predominant resistance pattern. The overall ADR incidence was 54.5%, with peripheral neuropathy being the most frequent ADR (41.3%). Linezolid was the most commonly implicated drug, responsible for 58.6% of ADRs. Conclusion The study found a high incidence (54.5%) of ADRs in DR-TB patients, particularly peripheral neuropathy and anemia linked to linezolid. There were no significant associations between ADR occurrence and factors like age, sex, or HIV status. Vigilant monitoring and early intervention are critical for managing ADRs and improving treatment adherence among these patients.
Objectives To examine the association between urinary bisphenol A (BPA) levels and infertility in both females and males using case-control data from Sarojini Naidu Medical College and Hospital. Material and Methods Case-control studies were conducted. Fifty women with anovulatory infertility were compared to 50 fertile female controls. Fifty men with abnormal semen parameters were compared to 50 fertile male controls. Urinary BPA concentrations were measured using high-performance liquid chromatography, mass spectrometry (HPLC-MS), adjusted for creatinine, and log-transformed. Logistic regression assessed the association between BPA and infertility. Results In females, each log-unit increase in BPA was associated with an 8.17-fold higher odds of ovulatory infertility (95% CI: 2.29-29.15, p = 0.002). In males, the odds of infertility increased 10.49-fold per log-unit increase in BPA (95% CI: 2.66-41.36, p = 0.001). In addition, infertile men had significantly higher urinary levels of BPA, bisphenol S (BPS), and bisphenol F (BPF), alongside impaired semen parameters and hormonal imbalances compared to controls. Conclusion Elevated urinary BPA levels are strongly associated with increased odds of infertility in both sexes. These findings reinforce international evidence and underscore the need for BPA exposure monitoring and reproductive health policy in India.
Objectives The objective of this study was to analyze the relation of patient health questionnaire (PHQ-9) scores with the extent of COVID-associated mucormycosis (CAM), the surgical approach used for treatment, the extent of surgery (structures removed), and to report the epidemiology of CAM in Eastern India, where the incidence of mucormycosis is rare. Material and Methods This is a cohort study done from May 2021 to July 2021, which was performed at a tertiary care institute in Eastern India. Forty patients of CAM who received surgical and pharmacological therapy were included. The PHQ-9 was administered after 6 weeks of the initiation of treatment. Results Statistical analysis regarding the demographics and relation of PHQ-9 scores with the extent of disease, surgical approach, and extent of surgery was performed. The mean age of presentation was 49 years, with a male-to-female ratio of 7:1. The most common presenting complaint was hemifacial pain. The most commonly involved sinus was maxillary sinus. There was no significant impact of intracranial and intraorbital extension of disease on the PHQ-9 scores. However, palatal removal had a significant impact on the PHQ-9 scores ( p = 0.03). Conclusion Hard palate should be preserved or reconstructed wherever possible. Orbital exenteration did not affect the scores significantly; hence, it should be performed wherever indicated to ensure better chances of survival for the patient. Other, more specific measures pertaining to CAM are required for determining the psychosocial impact of surgical management in CAM patients more accurately.
Research investigating connections between dietary intake and mental health has identified the gut-brain axis as a potentially important communication pathway. This review examines current understanding of how diet may influence mental health through intestinal microbiota, immune signaling, and neural pathways. While emerging evidence suggests associations between certain dietary patterns and mental health outcomes, the mechanisms underlying these relationships remain incompletely understood. Clinical applications of gut-brain axis research are still developing, with limited high-quality intervention studies available. This review summarizes established findings while acknowledging significant gaps in current knowledge and the need for more rigorous research.
Molecular diagnostics, which provide quick and precise detection of infectious agents, have completely changed clinical microbiology. To identify bacterial, viral, fungal, and parasitic infections, this review looks at the fundamentals and uses of molecular techniques such as polymerase chain reaction (PCR), nucleic acid sequencing, and microarray technologies. Molecular techniques provide several advantages over traditional culture-based methods, such as the capacity to identify species-level information, identify fastidious organisms, and identify antibiotic resistance genes directly from clinical specimens. There is also a discussion of difficulties, including assay standardization, cost, and technical know-how. Notwithstanding these difficulties, molecular diagnostics has dramatically improved pathogen detection speed and accuracy in clinical settings, leading to better patient outcomes through infection management and tailored therapy. Novel biomarkers and automation will be incorporated in the future to improve diagnostic capabilities and further expedite testing procedures.
Acute myocardial infarction (AMI) can present atypically, especially in elderly and diabetic patients. We report a 64-year-old diabetic ex-serviceman at high altitude who presented with dizziness and vomiting, without chest pain. Initial electrocardiogram (ECGs) were non-diagnostic, but serial tracings revealed inferior wall ST-elevation myocardial infarction (STEMI). Due to the unavailability of thrombolytics at the primary care level and challenging terrain, thrombolysis was delayed until transfer to a higher center. This case emphasizes the importance of high suspicion, serial ECGs, and preparedness for cardiac emergencies in resource-limited, high-altitude settings.
Objectives The primary objective of the study was to compare the effectiveness of different methods (broth microdilution [BMD], colistin agar test [CAT], colistin disc elution [CDE], and Vitek) in detecting colistin resistance among clinical isolates. The secondary objective was to analyze risk factors associated with colistin-resistant organisms in intensive care unit (ICU) and high-dependency unit (HDU) settings. Material and Methods A total of 65 colistin-resistant isolates from various clinical samples were utilized. The resistant organisms were predominantly found in ICUs and HDUs. Colistin minimum inhibitory concentration (MIC) was determined using BMD, CAT, CDE, and the Vitek system. The sensitivity of each method was compared. Additionally, risk factor analysis was conducted to identify factors contributing to MDRO infections. Results The analysis revealed that BMD and Vitek methods demonstrated 100% sensitivity in detecting colistin resistance. The CAT method showed 96.92% sensitivity, ranking it as the second-best method, while the CDE method exhibited 70.76% sensitivity. Among the resistant organisms, Klebsiella pneumoniae (n=51) was most frequently encountered. Risk factor analysis indicated that long-term hospital stays and immunocompromised conditions in ICU patients increased the susceptibility to multidrug-resistant organisms (MDROs) infections. Conclusion The emergence of colistin resistance poses a serious threat to public health, particularly in ICUs and HDUs. Accurate detection of colistin resistance is vital for appropriate antibiotic therapy and infection control. This study demonstrates that while BMD and Vitek methods offer the highest sensitivity, CAT also provides reliable results and can be used in clinical practice. The findings highlight the need for ongoing surveillance, stringent infection control measures, and robust antimicrobial stewardship programs (AMSP) to combat the spread of MDROs and improve patient outcomes. Implementing rigorous infection prevention and control practices, as recommended by the US Centers for Disease Control and Prevention (CDC), can significantly mitigate the risks associated with MDROs.
Mpox (formerly known as Monkeypox) is a zoonotic viral infection caused by the Orthopoxvirus , closely related to the variola virus (VARV) (smallpox). Initially endemic to Central and West Africa, Mpox has re-emerged as a significant global public health threat, particularly during the 2022 and 2024 outbreaks. The 2024 outbreak, caused by the Clade 1b strain, demonstrated increased transmissibility, shorter incubation periods, and more severe symptoms, especially in vulnerable populations such as children and immunocompromised individuals. This review comprehensively examines the epidemiology, virology, clinical manifestations, transmission dynamics, and public health implications of the evolving Mpox virus. Special attention is given to India’s response and preparedness in managing the current outbreak. The paper further analyzes vaccine efficacy, including JYNNEOS® and ACAM2000®, and explores emerging therapeutic interventions and containment strategies. By synthesizing the latest research, this review highlights the urgent need for international collaboration, enhanced diagnostic capabilities, and equitable vaccine distribution to mitigate the ongoing Mpox crisis.
Vulvar ciliated cysts are benign cysts lined with simple columnar ciliated epithelial cells that resemble MÜllerian tissue. They are usually associated with pregnancy and exogenous progesterone use and, as such, are rare. They are usually asymptomatic unless their size increases enough to cause pressure symptoms. Patients with these cysts usually come to the doctor with aesthetic concerns, as they cause disfigurement of the vulva. A 21-year-old female presented with a cystic structure arising from the right labia majora of the vulva, with a length of about 5-6 cm, without any significant symptoms, except for the disfigurement of the external genitalia. The cyst was surgically excised, and the histopathological report confirmed the features of a benign MÜllerian cyst lined by ciliated columnar epithelium. The cosmetic result was excellent, and the young patient felt relieved. MÜllerian cysts arising from the labia majora are a rare finding, and the treatment is surgical excision. The excision not only cured but also restored the normal anatomy of the vulva. It also confirmed the histological diagnosis.
