INTRODUCTION:The occurrence of dual primary malignancies is an uncommon clinical phenomenon. This case report details a 65-year-old female presenting with both uterine leiomyosarcoma (LMS) and pulmonary adenocarcinoma, initially misdiagnosed as a metastatic spindle cell tumor. CASE DESCRIPTION:The patient presented with foul-smelling vaginal discharge, irregular menses, lower limb swelling, and a nonproductive cough. Imaging and biopsies revealed a necrotic uterine mass diagnosed as LMS and a left upper lobe lung mass identified as adenocarcinoma. Genetic testing of the lung tumor showed an epidermal growth factor receptor (EGFR) exon 19 deletion mutation. Treatment included chemotherapy targeting both malignancies, surgical resection of the uterine tumor, and targeted therapy for the lung adenocarcinoma. CONCLUSION:This case underscores the importance of thorough diagnostic evaluation in patients with multiple tumors to distinguish between metastatic disease and dual primary malignancies, as treatment strategies differ significantly.
BACKGROUND:India is witnessing a rapid rise in metabolic dysfunction-associated steatotic liver disease (MASLD), driven by the country's expanding population with obesity, type 2 diabetes (T2D), and other metabolic comorbidities. Despite this growing burden, structured liver disease screening is absent from routine noncommunicable disease (NCD) services at the primary care level. PROBLEM:A majority of MASLD diagnoses in India occur only after progression to advanced fibrosis or cirrhosis, even among individuals regularly engaged with healthcare systems for diabetes or hypertension. Primary health centers (PHCs) and community health centers (CHCs) currently lack standardized protocols for liver risk stratification, leading to critical missed opportunities for early intervention. APPROACH:This article outlines a scalable, systems-integrated model for community-based liver care, piloted at the All India Institute of Medical Sciences (AIIMS), Rishikesh. The model incorporates noninvasive fibrosis scoring tools (FIB-4, APRI), selective deployment of nurse-led FibroScan services, maternal hepatitis B virus screening, lifestyle modification strategies, and digital follow-up systems-seamlessly embedded within existing maternal health and NCD platforms. Insights: A real-world vignette from an urban diabetes outreach program in Kolkata illustrates the diagnostic gap: a high-risk patient remained undiagnosed for MASLD despite multiple healthcare encounters. International experiences, such as the Gwent model in Wales, further reinforce the feasibility of decentralized hepatology through community triage, nurse-led services, and simplified biochemical tools. CONCLUSION:India stands at a pivotal moment in redefining hepatology as a preventive, public health-oriented discipline. By embedding liver screening within existing NCD frameworks, leveraging task-sharing, and mobilizing digital infrastructure and public-private partnerships, India can develop a replicable model for early MASLD detection and intervention. This community hepatology framework-if scaled nationally-has the potential to position India as a global leader in MASLD prevention for low- and middle-income countries.
BACKGROUND:Among ischemic stroke patients, prehospital delay is the most common reason for underutilization of thrombolysis. AIMS:The study assessed prehospital factors contributing to delay and timely arrival among study participants. SETTINGS AND DESIGN:A cross-sectional study was carried out at the casualty department of Government Stanley Medical College and Hospital, South India. MATERIALS AND METHODS:We selected 212 study participants by consecutive sampling. Data were collected by interviewing patients or accompanying family members using a semistructured questionnaire. STATISTICAL ANALYSIS:Univariate analysis was followed by multivariate logistic regression to examine prehospital factors contributing to delay and timely arrival. Follow-up of eligible study participants for thrombolysis was performed using the National Institutes of Health Stroke Scale (NIHSS) and American Heart Association (AHA)-2019 checklist. RESULTS:The most common factors contributing to prehospital delay and timely arrival were found to be "unawareness regarding benefits of timely arrival among patients/relatives (48.7%)" and "apprehension of some serious health issue (50%)," respectively. The distance between the hospital and the place of onset of symptoms, stroke during sleep, mode of transport, National Institutes of Health Stroke Scale (NIHSS), and slurring of speech were found to have significant odds for timely arrival for intravenous thrombolysis (IVT). Among those who arrived on time (n = 60), 13 study participants could not undergo thrombolysis. The most common reason for this was refusal of thrombolysis (4, 6.7%), and other criteria, such as minor neurological deficits (4, 6.7%), rendered them ineligible for it. CONCLUSION:The study highlights factors associated with timely arrival at the hospital and further reasons for not undergoing IVT despite timely arrival among cases of acute ischemic stroke (AIS). There is also a need to generate awareness and disseminate information on the benefits of IVT, timely arrival, and prehospital factors; provide training in stroke preparedness; and strengthen the referral system to ensure maximum eligibility and utilization.
BACKGROUND:Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated efficacy in improving glycemic control and reducing cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). However, real-world evidence from Indian populations remains limited. This study aimed to assess the effectiveness and safety of semaglutide on glycemic control, body weight, and metabolic parameters in patients with T2DM in a real-world clinical setting. METHODS:This retrospective observational study was conducted at a tertiary care hospital in Jharkhand, India, between February 2023 and August 2024. A total of 60 patients with T2DM (44 males and 16 females), including treatment-naïve individuals and those with inadequate glycemic control (HbA1c >7%) despite ongoing therapy, were enrolled. Clinical and biochemical parameters were evaluated at baseline and after six months of semaglutide therapy. Statistical analysis was performed using paired t-tests, with a p-value <0.05 considered statistically significant. RESULTS:Significant improvements were observed following semaglutide therapy. Mean HbA1c decreased from 9.21% at baseline to 7.35% after six months (p <0.001). Mean body weight decreased by 2.6 kg (p <0.001). LDL cholesterol levels declined significantly from 92.03 mg/dL to 78.93 mg/dL (p <0.05). Renal parameters, including serum creatinine and urine albumin-to-creatinine ratio, showed numerical improvement; however, these changes did not reach statistical significance (p >0.05). Thyroid function remained stable throughout the study period. Improvements in diabetic retinopathy and neuropathy were also observed, although these findings were not statistically significant. CONCLUSION:Semaglutide was effective and well tolerated in patients with T2DM in routine clinical practice. Treatment was associated with significant reductions in HbA1c, body weight, and LDL cholesterol without adverse effects on renal or thyroid function. These findings support the use of semaglutide as an effective therapeutic option for the management of T2DM in real-world settings.
A 70-year-old male presented with dyspnea New York Heart Association (NYHA) class II since 1994. Dyspnea was not progressive. There was no history of cough, fever, chest pain, or palpitation. He was investigated and was told to have some abnormality in his heart and was advised surgery. Since patient was not very symptomatic, he did not undergo surgery. He did not have any record of his ailment. This time he was referred to us for fitness for noncardiac surgery. His electrocardiogram (ECG) showed normal sinus rhythm and right atrial (RA) enlargement. His echocardiography showed large cystic mass in his RA, occupying almost three-fourth of RA (Fig. 1). His noncontrast contrast-enhanced computed tomography (NC CECT) of thorax was done. It showed well defined cystic lesion with internal heterogeneous contents and calcification along its wall in RA, measuring 8.1 × 8.3 × 8.4 cm, suggestive of hydatid cyst of RA (Fig. 2).
BACKGROUND:Metastatic colorectal cancer (mCRC) remains a major contributor to cancer-related mortality worldwide. Real-world data from low- and middle-income countries remain limited. MATERIALS AND METHODS:This bidirectional observational study included 60 patients with histologically confirmed mCRC treated at a tertiary care center between January 2019 and December 2025. Demographic, clinicopathological, molecular, treatment, and survival data were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify prognostic factors. RESULTS:The median age was 48.5 years, and 63.3% of patients were male. Extensive metastatic disease was present in 96.7% of patients. Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were detected in 20.7% of patients, whereas microsatellite instability-high (MSI-high) status was identified in one patient. Median PFS and OS were 10.6 and 22.3 months, respectively. On multivariable analysis, peritoneal metastasis independently predicted inferior PFS [hazard ratio (HR) 4.45, 95% confidence interval (CI) 2.16-9.19; p < 0.001] and OS (HR 2.83, 95% CI 1.13-7.07; p = 0.026). Poorly differentiated histology independently predicted worse OS (HR 3.05, 95% CI 1.03-9.06; p = 0.045). CONCLUSION:This study highlights the substantial burden of advanced disease in Indian patients with colorectal cancer. Peritoneal metastasis and poor differentiation were associated with adverse outcomes. Improved early detection and wider access to targeted therapies may improve survival outcomes in resource-limited settings.
BACKGROUND:Hyponatremia is a common and important electrolyte imbalance seen both in isolation and more commonly, as a complication of other medical illnesses. With a wide spectrum of presentations, the prognostic implications are grave and far-reaching if not addressed meticulously. Despite the knowledge of hyponatremia since the mid-20th century, data on the prevalence and clinical profile of hyponatremia are scarce, to say the least, from the Indian subcontinent. We took up this hospital-based observational study to explore the clinicoetiological profile of hyponatremia. RESULTS:Mean serum sodium level was 122.24 ± 6.10. Most of the patients had severe hyponatremia (63.3%). The most common cause of hyponatremia, as well as severe and euvolemic hyponatremia, was syndrome of inappropriate antidiuretic hormone secretion (SIADH) (21.9%). Most patients with SIADH had tubercular meningitis (TBM). The most common type of hyponatremia was hypovolemic hyponatremia (42.4%), of which sepsis was the most common cause. CONCLUSION:Further prospective studies are required as hyponatremia remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, its causation by multiple etiologies with differing pathophysiological mechanisms, and marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of hyponatremia; also, optimal treatment strategies have not been well defined for these reasons.
BACKGROUND:Central nervous system (CNS) infections remain a major cause of morbidity and mortality in people living with HIV (PLHIV), particularly in the setting of advanced immunosuppression and recent initiation of antiretroviral therapy (ART). While individual opportunistic CNS infections are well-documented, simultaneous infections with multiple pathogens are rare and diagnostically challenging. METHODS:We report a case series of 11 HIV-positive individuals aged 25-50 years, presenting within 3 months of ART initiation to two tertiary centers over a 2-year period. All patients exhibited clinical features of meningitis and underwent cerebrospinal fluid (CSF) analysis, PCR testing, neuroimaging, and comprehensive microbiological workup. RESULTS:All 11 patients were diagnosed with triple-pathogen CNS infections. The most common combination was Mycobacterium tuberculosis, Cryptococcus neoformans, and herpes simplex virus type 1 (HSV-1). Additional pathogens included Toxoplasma gondii, Treponema pallidum, and CMV. Median CD4 count was <70 cells/µL. Coinfections were frequently unmasked shortly after ART initiation, suggestive of immune reconstitution inflammatory syndrome (IRIS). Despite aggressive treatment, mortality was 45%. One complex case included CNS vasculitis, ischemic stroke, pulmonary embolism, and multiple systemic infections. CONCLUSION:This series underscores the diagnostic and therapeutic complexities of managing CNS coinfections in PLHIV, especially in the context of IRIS. A high index of suspicion, early multiplex diagnostic testing, and multidisciplinary management are crucial. Furthermore, the presence of noninfectious complications such as stroke and thromboembolism highlights the broader spectrum of HIV-related neurological disease. Early recognition and targeted treatment can improve outcomes in this high-risk population.
Often referred to as the diabetes capital of the world, new-wave urbanization and westernization of lifestyle have rendered India vulnerable to the so-called lifestyle diseases, especially diabetes mellitus. Arguably the most characterized of diseases, diabetes somehow still has a few tricks up its sleeve. Diabetic striatopathy (DS), also known as hyperglycemic nonketotic hemichorea/hemiballism, chorea/hemichorea associated with nonketotic hyperglycemia, diabetic hemiballism/hemichorea, or chorea-hyperglycemia-basal ganglia syndrome, is a long-known disease of many names but sparse characterization. With an estimated prevalence of 1 in 100,000 (Ondo, 2011), DS is, in our opinion, greatly underestimated and is often misdiagnosed as intracerebral hemorrhage (ICH), which is a travesty given the excellent prognosis DS carries, even with just the control of blood sugar levels. Here, we describe the case of a 73-year-old male, previously undiagnosed diabetic, who presented with an acute-onset movement disorder, initially thought to have had a stroke, but was later diagnosed as DS. We also discuss in brief the pathophysiology and treatment options.
BACKGROUND:Depression and insomnia are common yet under-recognized comorbidities in end-stage kidney disease (ESKD) patients on dialysis. Comparative data on their prevalence between hemodialysis (HD) and peritoneal dialysis (PD) are limited. OBJECTIVES:To compare the prevalence and severity of depression and insomnia in patients undergoing HD and PD and identify clinical and biochemical correlates. MATERIALS AND METHODS:A multicenter, cross-sectional study was conducted across armed forces hospitals in Northern India from November 2024 to January 2025. Adult ESKD patients on HD or PD were assessed using the Patient Health Questionnaire-9 (PHQ-9) for depression. Insomnia was assessed using a response to a battery of questions. Demographic, clinical, and laboratory data were analyzed. RESULTS:Of 188 patients screened (HD 105, PD 83), 51 HD (48.6%) and 37 PD (44.6%) patients had PHQ-9 scores ≥5, indicating depression. Most had mild depression (HD 25.7%; PD 22.6%). Moderately severe depression was present in a small number, with no difference between the dialysis modalities. Insomnia prevalence was comparable (HD 24.7%; PD 22.6%). Severe depression was associated with lower hemoglobin and albumin, especially in PD (albumin: 2.38 vs 3.10 gm/dL, p = 0.03). CONCLUSION:Depression and insomnia are highly prevalent but underrecognized in dialysis patients. Dialysis modality did not affect the prevalence of depression or insomnia. Lower hemoglobin and albumin correlate with severe depressive symptoms.
Leprosy, recognized as one of the ancient diseases, predominantly affects the integumentary system and peripheral nerves. Nevertheless, central nervous system (CNS) involvement is a rare occurrence, with cortical manifestations being exceedingly infrequent. We present a case that aligns with this rarity, showcasing diffuse hyperintensities on magnetic resonance imaging (MRI) within the cortical region of the brain. The patient's clinical presentation was marked by seizures, necessitating targeted therapeutic interventions.
BACKGROUND:Osmotic demyelination syndrome (ODS) presents as quadriplegia with pseudobulbar palsy, and most cases occur with rapid correction of hyponatremia. It is due to demyelination of the pons without any inflammation. Other causes include chronic malnutrition, alcoholism, and underlying medical illnesses such as post-liver transplant. Here, we present a case report of a patient with hypernatremia and hypokalemia leading to ODS, whose early diagnosis and effective treatment resulted in complete recovery of the patient. CASE DESCRIPTION:A 33-year-old female patient presented with vomiting followed by confusion and weakness of all four limbs. On admission, the patient was drowsy, obeying oral commands, mildly dyspneic, dehydrated, weakness of all four limbs. Deep tendon reflexes were present, and the bilateral plantar reflex showed no response. Her vitals were stable. On evaluation, arterial blood gas (ABG) showed hyperchloremic normal anion gap metabolic acidosis. Serum potassium level was very low, and serum sodium level was significantly high. MRI brain T2-FLAIR image showed hyperintensity in the central pons with peripheral sparing. Pons appeared swollen and edematous, suggestive of ODS. On further evaluation, she was found to have distal renal tubular acidosis. With this presentation and in the background of renal tubular acidosis, autoimmune disease was considered. It was negative in our case. In view of hypernatremia, after calculating the water deficit, she was given IV 5% dextrose and free water through the nasogastric tube, along with potassium supplements. She was also given steroids and other supportive measures. The patient recovered completely. CONCLUSION:There was no evidence of hyponatremia during admission. Here, we consider that the osmotic demyelination could have occurred due to hypernatremia. The cause for hypernatremia in this case would have been hypokalemia. Moreover, hypokalemia leads to hypernatremia through a combination of increased sodium reabsorption in the kidneys, aldosterone-mediated effects, impaired renal concentrating ability, cellular electrolyte shifts, and associated volume depletion and dehydration. These mechanisms explain the complex relationship between sodium and potassium. Early diagnosis with MRI brain imaging and treatment allowed our patient to recover completely.
BACKGROUND:Brucellosis remains an underdiagnosed zoonotic disease in India due to its nonspecific clinical presentation and limited diagnostic awareness. MATERIALS AND METHODS:A retrospective analysis of all culture-confirmed brucellosis cases between January 2019 and September 2025 was conducted in a tertiary care hospital in Madurai, Tamil Nadu. Demographic, clinical, laboratory, and outcome data were extracted from the medical records of affected patients. RESULTS:During the study period, 14 patients with culture-confirmed brucellosis were identified. The median age was 49.5 years, and 57% were male. Blood cultures accounted for 86% of isolates, followed by pus and ascitic fluid. Fever was the most common presenting symptom. Diabetes mellitus was the most frequent comorbidity. Clinical manifestations ranged widely, including epididymo-orchitis, spondylodiscitis, cellulitis, Acute demyelinating encephalomyelitis (ADEM), and complications in chronic liver disease. Treatment regimens varied but predominantly included doxycycline with an aminoglycoside. CONCLUSION:Brucella melitensis infection demonstrates diverse clinical presentations. Automated identification systems facilitate timely detection. Improved awareness among clinicians is essential for early diagnosis in endemic regions.
BACKGROUND:Artificial intelligence (AI) has emerged as a powerful tool for electrocardiogram (ECG) analysis, potentially surpassing conventional interpretation in detecting arrhythmias and metabolic disturbances such as hyperkalemia. This study evaluated the diagnostic performance and real-world applicability of an AI-powered ECG interpretation system for arrhythmia prediction and hyperkalemia detection. MATERIALS AND METHODS:In this prospective observational study, patients presenting to the emergency department or cardiology clinic between March 2024 and February 2025 were enrolled. Standard 12-lead ECGs were analyzed in parallel by a validated deep-learning AI model and board-certified cardiologists blinded to AI results and clinical data. Primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for arrhythmia and hyperkalemia detection. Secondary outcomes assessed the impact of AI-driven alerts on workflow efficiency and time to therapy. RESULTS:Among 4,200 patients (mean age 56, 39% female), the AI-ECG system demonstrated 97.2% sensitivity and 96.1% specificity for arrhythmia detection, outperforming manual interpretation for atrial fibrillation, atrial flutter, and ventricular ectopy (p < 0.001). For hyperkalemia, sensitivity and specificity were 83.5% and 87.3%, respectively, reliably flagging all critical potassium elevations within 1 minute. AI alerts reduced median time-to-therapy by 19 minutes. Subgroup analysis showed robust performance in patients with chronic kidney disease and acute cardiac conditions. CONCLUSION:AI-powered ECG analysis enables highly accurate, rapid detection of arrhythmias and hyperkalemia, supporting earlier clinical intervention and improving workflow efficiency. These findings advocate for broader multicenter validation and integration of AI-ECG tools in routine cardiology practice.
BACKGROUND:Rapid assessment of electrolytes and hemoglobin is crucial in emergency and critical care. Arterial blood gas (ABG) analyzers are widely used as point-of-care devices. However, their agreement with central laboratory measurements remains uncertain because of methodological differences. This study aimed to evaluate the reliability of sodium, potassium, chloride, and hemoglobin values obtained from an ABG analyzer compared with those from a central laboratory autoanalyzer and to assess analytical acceptability using US Clinical Laboratory Improvement Amendments (CLIA) 2025 allowable error limits. MATERIALS AND METHODS:In this prospective observational study, 200 paired arterial and venous samples from patients in the Emergency Department were analyzed. Arterial samples were processed on an ABG analyzer using direct ion-selective electrode (ISE) methodology, and venous serum electrolytes were measured on a central laboratory autoanalyzer using indirect ISE methodology. Hemoglobin was measured on a hematology analyzer. Paired comparisons were performed using the Wilcoxon signed-rank test, correlation was assessed with Spearman's coefficient, agreement was assessed with Bland-Altman analysis, and total error was compared with CLIA limits. RESULTS:ABG-derived sodium and potassium values were significantly lower than venous laboratory values, whereas chloride and hemoglobin values were significantly higher (p < 0.001). All analytes showed strong positive correlations. Bland-Altman analysis demonstrated acceptable agreement for sodium (bias, -2.8 mmol/L) and potassium (bias, -0.2 mmol/L), both within CLIA allowable limits. Chloride showed a total error of 6.43%, and hemoglobin showed a total error of 15.15%, indicating unacceptable analytical error. CONCLUSION:ABG-derived sodium and potassium values demonstrated acceptable agreement with central laboratory measurements and can be used for rapid clinical decision-making in emergency settings. However, chloride and hemoglobin values should not be used interchangeably without institution-specific validation and correction equations.
Ask-Upmark kidney was originally described as a congenital segmental hypoplasia of the kidney, but recent data suggest it to be a sequela of vesicoureteral reflux or pyelonephritis in early age. This segmental hypoplasia leads to hypertension in young people. This hypertension is treatable with a partial nephrectomy. This reported patient presented with hypertensive urgency in the OPD. On evaluation, he was found to have Ask-Upmark kidney. The patient was managed conservatively. In case of severe and progressive renal damage, surgical resection with or without transplant can be considered. If the disease is nonprogressive with normal kidney function, the patient can be managed with antihypertensive treatment alone. This is one of the rare causes of hypertension in young that should be kept in mind while evaluating such cases.
BACKGROUND:Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal syndrome characterized by immune hyperactivation and a cytokine storm, leading to fever, cytopenia, organomegaly, and multiorgan dysfunction. Given its high morbidity and mortality, prompt diagnosis and treatment are essential. Currently, there are no established markers to predict outcomes in secondary hemophagocytic lymphohistiocytosis (sHLH). MATERIALS AND METHODS:This retrospective study aimed to identify prognostic factors in patients with sHLH, specifically evaluating the prognostic role of absolute neutrophil count (ANC) and serum ferritin level. The study also examined the impact of dexamethasone and etoposide on the treatment of these patients. RESULTS:HLH remission was achieved in 64 patients (71.1%). Forty-seven out of those 64 patients survived and were discharged home, while 17 patients died in the hospital. HLH remission was not achieved in 26 patients (28.9%), of whom 25 patients died in the hospital. ANC at diagnosis and lower nadir ANC during the hospital stay significantly correlated with mortality (p = 0.001 and 0.017, respectively). Serum ferritin levels, however, were not a significant prognostic marker (p = 0.396). Treatment with dexamethasone was associated with better outcomes in patients with sHLH. CONCLUSION:sHLH should be considered in patients with treatment-resistant bicytopenia or pancytopenia. Lower ANC at diagnosis and nadir ANC during hospitalization are associated with increased mortality, suggesting that ANC is a potential indicator for early immunochemotherapy. Serum ferritin level is not a significant prognostic marker. Early diagnosis and dexamethasone treatment help achieve HLH remission, which improves outcomes in sHLH. These findings highlight the need for prospective studies to better understand sHLH prognostic markers and therapeutic strategies, especially in intensive care settings, where mortality remains high.
BACKGROUND:Asthma remains a major public health challenge in India, characterized by high disease burden, poor adherence, and suboptimal control despite therapeutic advances. Fixed-dose combination therapy with indacaterol/glycopyrronium/mometasone furoate (IND/GLY/MF; DIFIZMA®), a single-inhaler triple therapy (SITT), offers the potential for improved symptom control and adherence through once-daily dosing. However, real-world and postmarketing surveillance data on the effectiveness and safety of IND/GLY/MF in Indian asthma patients remain limited, underscoring the need for local evidence to guide clinical practice. OBJECTIVES:To evaluate the safety and effectiveness of once-daily IND/GLY/MF dry powder inhaler (DPI) in Indian adults with asthma inadequately controlled on inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) therapy. MATERIALS AND METHODS:This was a prospective, open-label, multicenter, single-arm, phase IV postmarketing study conducted across multiple centers in India. Adults (18-65 years) with persistent asthma symptoms despite ICS ± LABA therapy received IND/GLY/MF DPI (160 µg mometasone furoate, 46 µg glycopyrronium bromide, 114 µg indacaterol acetate) once daily for 24 weeks. The primary endpoint was safety, based on treatment-emergent adverse events (TEAEs), serious TEAEs, and discontinuations. Secondary endpoints included changes from baseline in the asthma control questionnaire (ACQ-7) score, FEV1, FVC, and FEV1/FVC ratio at weeks 4, 12, and 24. RESULTS:A total of 200 patients were enrolled (safety set), of whom 196 were included in the modified intent-to-treat (mITT) analysis and 189 in the per-protocol (PP) population. TEAEs occurred in 9.5% of participants, with 6.5% considered drug-related; all events were mild or moderate in severity. No serious adverse events, severe TEAEs, or deaths were reported. Clinically meaningful and progressive improvements were observed in asthma control and lung function over 24 weeks. The ACQ-7 score decreased from 3.00 ± 0.59 at baseline to 2.36 ± 0.54 at week 4, 1.86 ± 0.54 at week 12, and 1.39 ± 0.61 at week 24, corresponding to mean change of -0.64 ± 0.50, -1.14 ± 0.74, and -1.62 ± 0.89, respectively (all p < 0.0001). Mean FEV1 increased from 1.49 ± 0.51 L at baseline to 1.73 ± 0.60 L at week 4, 1.81 ± 0.53 L at week 12, and 1.95 ± 0.51 L at week 24, with corresponding mean changes of +0.24 L, +0.32 L, and +0.46 L (all p < 0.0001). Mean FVC improved from 2.13 ± 0.63 L at baseline to 2.30 ± 0.70 L, 2.33 ± 0.62 L, and 2.38 ± 0.59 L at weeks 4, 12, and 24, respectively (all p < 0.0001). The FEV1/FVC ratio increased from 71.63 ± 12.76 at baseline to 76.71 ± 11.33, 80.86 ± 12.67, and 84.00 ± 8.93 at weeks 4, 12, and 24, with mean changes of +4.99, +8.91, and +12.10, respectively (all p < 0.0001). No hospitalizations or rescue medication use were reported. Compliance with study medication was 100%, and both patients and physicians reported marked symptom improvement and high treatment satisfaction. CONCLUSION:Once-daily IND/GLY/MF DPI demonstrated a favorable safety profile and significant, sustained clinical benefits in adults with asthma inadequately controlled on ICS-LABA therapy. The triple combination provided rapid onset and sustained improvement in asthma control and lung function, with excellent adherence and tolerability in real-world Indian clinical practice. These findings support IND/GLY/MF as an effective and practical single-inhaler triple therapy option for optimized asthma management.
Lateral medullary syndrome is a collection of different neurological symptoms after ischemic/hemorrhagic insult to either the posterior inferior cerebellar artery/vertebral artery or rarely the anterior inferior cerebellar artery, causing infarction of ipsilateral cerebellum and posterolateral medulla (Tiedt and Weidauer, 2013). Dizziness, nausea, vertigo, vomiting, nystagmus, ataxia, dysphagia, hoarseness of voice, ptosis, and sensory impairment of face and body are typical. Here we report an unusual presentation of a 47-year-old female who was hypertensive and diabetic and who complained of vertigo, nausea, vomiting, slurring of speech, facial deviation toward the left, and loss of pain and temperature over the right side of the face and body without any difficulty in swallowing or nasal regurgitation. The patient was eventually diagnosed with left lateral medullary syndrome, drawing attention to the rare and unusual presentation of the same.
BACKGROUND:Community-acquired pneumonia (CAP) carries substantial mortality. Common scoring tools such as CURB-65, A-DROP, and PSI have limitations. The expanded A-DROP incorporates clinical and biochemical markers, showing promise and requires validation in Indian settings. MATERIALS AND METHODS:This prospective observational study at a North Indian tertiary center (March 2024-June 2025) included 80 adults with CAP. Expanded A-DROP scores were calculated within 24 hours of admission, and patients were followed for ICU admission, in-hospital, and 14-day postdischarge mortality. Analyses used ANOVA, Chi-square, logistic regression, and receiver operating characteristic (ROC) curves (p < 0.05). RESULTS:Of 80 patients, 22 (27.5%) died within 14 days. Mortality was 1/23 (4.3%) in group I (0-2), 2/22 (9.1%) in group II (3-4), and 19/35 (54.3%) in group III (≥5) (p < 0.001). ICU admission rose with severity: 1/23 (4.3%), 8/22 (36.4%), and 25/35 (71.4%) (p < 0.001). Mean (SD) hospital stay increased: 4.0 (0.9), 7.0 (1.1), and 9.0 (1.3) days (p < 0.0001), with positive correlation to score (ρ = 0.53, p < 0.000001). ROC analysis gave an AUC of 0.871 (95% CI: 0.783-0.958). A score ≥5 predicted mortality with 86.2% sensitivity and 72.4% specificity. Multivariate regression identified Expanded A-DROP as the only independent predictor (OR 3.07, p < 0.001). CONCLUSION:Expanded A-DROP demonstrated strong predictive power for short-term mortality, ICU requirement, and hospital stay in CAP. It is a simple, clinically relevant, and effective tool for early triage, especially in resource-limited settings.
