Background: Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are two of the most common acid-related gastrointestinal conditions in India. They are associated with significant morbidity and impaired quality of life. Vonoprazan has demonstrated clinical efficacy in clinical trials and offers rapid and sustained acid suppression. However, there is still a dearth of empirical data on its therapeutic application and efficacy in Indian patients. Methods: This multicentre, retrospective, observational real-world evidence study examined medical records from 8,325 patients prescribed Vonoprazan in outpatient settings across India during a 6-month period. Demographic details, indications, dose patterns, symptom improvement, treatment satisfaction, and safety outcomes were assessed using descriptive and comparative statistical methods. Results: GERD (55.98%) and acid peptic disorders (APD; 33.07%) as diagnosed by the treating physicians were the most common indicators for Vonoprazan treatment. The majority of patients (93.14%) received 20 mg of Vonoprazan once daily. Symptoms improved significantly, with heartburn relief reported in 97.53% of patients and acid regurgitation improvement in 91.80%. Severe heartburn dropped from 44.06% at baseline to 1.93% after treatment (p<0.05), while acid regurgitation decreased from 31.95% to 6.56% (p<0.05). Overall treatment satisfaction was high, with 73.44% of patients reporting being extremely satisfied. Conclusions: Vonoprazan demonstrated clinically meaningful real-world effectiveness, improvement in symptom control, favourable tolerability, and high patient satisfaction in Indian patients with GERD and other acid-related disorders, supporting its role as an effective therapeutic option in routine clinical practice.
Pheochromocytomas are uncommon adrenal tumors that can present considerable clinical difficulties because of their ability for catecholamine release and hypertensive crises. We report a case of a pheochromocytoma treated effectively with laparoscopic adrenalectomy. A 36-year-old woman was presented with secondary hypertension. Preoperative IV fluids, IV PPI’s, blockade was initiated with antihypertensive drugs to optimize hemodynamic control. The patient had a laparoscopic adrenalectomy. Histopathological analysis confirmed the diagnosis of pheochromocytoma with presence of Zellballan pattern and pheochromocytoma of the adrenal gland scaled score (PASS). Complications were minimal, with low hemoglobin, and 1 unit of PRBC was transfused. Post operatively, blood pressure and electrolytes levels were normalized. Laparoscopic adrenalectomy shown to be a reliable and efficient method for treating pheochromocytoma, resulting in improved blood pressure regulation and quality of life for the patient. This case highlights the significance of a multidisciplinary strategy, encompassing preoperative medical optimization and diligent postoperative observation, in the management of pheochromocytomas, and contributes to the increasing evidence favouring laparoscopic adrenalectomy for these adrenal tumors.
Caroli disease is a rare congenital hepatobiliary disorder characterized by non-obstructive dilatation of the intrahepatic bile ducts and classified as Todani type V choledochal cyst. Although congenital in origin, the disease is often diagnosed in adulthood due to its indolent course and nonspecific symptoms, frequently after complications such as recurrent cholangitis have occurred. We report a case of a 46-year-old male presenting with recurrent epigastric pain, abdominal distension, fever, jaundice, nausea, vomiting, and bowel movement disturbance. Laboratory findings revealed leukocytosis, direct hyperbilirubinemia, and cholestatic liver enzyme elevation consistent with acute cholangitis. Abdominal radiography demonstrated features of partial small bowel obstruction. Magnetic resonance cholangiopancreatography (MRCP) with contrast revealed multifocal cystic dilatation of the intrahepatic bile ducts without extrahepatic obstruction, consistent with Caroli disease. The patient was managed conservatively with intravenous antibiotics, ursodeoxycholic acid, bowel decompression, and supportive care, resulting in gradual clinical improvement. This case highlights the diagnostic value of MRCP and demonstrates that conservative management can be effective in adult Caroli disease complicated by recurrent cholangitis and secondary small bowel obstruction.
Myocardial Infarction has left an imprint on the heart in the form of left ventricular remodeling, which is the most important factor in the progression of heart failure and the gaining or losing of long-term cardiovascular prognosis. Traditional risk assessment has a narrow vision on metabolic factors which are most influential in the process of cardiac repair after the event. The cardiometabolic index, a composite of central adiposity along with dyslipidemia, is being recognized as a very easy and simple to use marker that reflects the metabolic stress situation. Observational studies have reported that increased cardiometabolic index is associated with unfavorable left ventricular structural changes such as concentric remodeling and hypertrophy along with decreased diastolic function indicating its use in predicting post-myocardial infarction outcomes. However, the majority of the data available so far come from studies of the general population rather than myocardial infarction-specific groups; yet the reasoning behind the mechanistic pathway is strong enough to support its presence in the post-infarction context where it provides a biologically plausible link between metabolic dysregulation and unfavorable changes in ventricle remodeling. This review presents the current evidence regarding cardiometabolic index and left ventricular remodeling, discusses its role in risk stratification and recognizes the lack of research in this regard. In order to prove cardiometabolic index as a predictor to assess its application in directing personalized interventions aimed at enhancing myocardial recovery, and to increase the associated life span of patients with heart problems, future clinical trials focusing on post-myocardial infarction patients are absolutely necessary.
Background: Cervical spine surgery is associated with significant morbidity and mortality, particularly in low-resource settings. Identifying predictors of adverse outcomes is essential for preoperative risk stratification and informed patient counselling. Methods: A retrospective cohort study was conducted on patients who underwent cervical spine surgery for traumatic and degenerative conditions between January 2018 and December 2024 at NOH, Dala Kano. Data extracted included demographics, clinical presentation, neurological status using Frankel grading, comorbidities, injury level, surgical details and postoperative outcomes. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of complications and mortality. Results: A total of 156 patients (124 males, 32 females) with a mean age of 44.8±14.2 years underwent cervical spine surgery. Major indication was trauma (71.8%). Overall complication rate was 31.4% and mortality rate was 9.6%. The commonest complication was respiratory tract infection (17.3%). The independent predictors of complications were: ASIA grade A injury (p<0.001), high cervical injury (C1-C4) (p=0.002), associated chest injury (p=0.008) and delayed surgery >7 days (p=0.012). Independent predictors of mortality were: ASIA grade A injury (p<0.001), high cervical injury (p=0.001), age >60 years (0.014) and presence of respiratory complications (p<0.001). Conclusions: ASIA A, high cervical level, associated chest trauma, delayed surgery and advanced age are significant predictors of adverse outcomes. These findings highlight the need for early referral, intensive perioperative respiratory support and targeted risk mitigation strategies in high-risk patients.
Over past decades, insulin therapy has been a cornerstone in reshaping diabetes care from a chronically morbid disease into a manageable condition. Despite availability of multiple pharmacological therapies, diabetes patients still suffer from optimum glycaemic control especially fasting hyperglycaemia which further increase the risk of developing vascular complications. Basal insulin is a choice of medication when patients require fasting blood glucose control to achieve desired glycaemic goal. With such crucial need of basal insulin therapy for controlling fasting hyperglycaemia, it remains inaccessible for majority of patients in need. This challenge is more prevalent in low- and middle-income countries where need for insulin is rising as prevalence of diabetes increases. Biosimilar insulin has arisen as an important strategy to bridge this gap. This review addresses the outline of evolution of basal insulin therapy, especially biosimilar insulin glargine as a solution to overcome fasting hyperglycaemia. One such illustration is of biosimilar insulin glargine (BASALOG®, BIOCON) for which evidence from global clinical trials and real-world studies has demonstrated its safety, efficacy and immunogenicity comparable to the reference insulin glargine available. This has further led to the approval for biosimilar insulin glargine overseas including interchangeability designation by USFDA. Further this review underlines the Indian perspective regarding biosimilar insulin glargine affordability and adoption with emphasis on patient education, cold-chain management to increase access and real-world data generation. Collectively, biosimilar insulin glargine offers a scalable and sustainable model which has potential to expand access of basal insulin therapy to patients who are in need.
Tacrolimus is a calcineurin inhibitor widely used as maintenance immunosuppression after renal transplantation. Although neurotoxicity is a well-recognized complication of tacrolimus therapy, manifesting as tremor, seizures, posterior reversible encephalopathy syndrome, and encephalopathy, the occurrence of choreiform movements—particularly hemichorea—is exceptionally rare. We report a 32-year-old male who developed acute-onset unilateral chorea one month after renal transplantation while receiving tacrolimus and prednisolone. Laboratory evaluation revealed a markedly elevated tacrolimus trough level, while magnetic resonance imaging (MRI) of the brain demonstrated an old right capsulo-ganglionic hemorrhage, providing a structural vulnerability. The patient improved promptly after reduction of tacrolimus dosing and symptomatic therapy. This case underscores the need to consider tacrolimus-induced neurotoxicity in the differential diagnosis of new-onset movement disorders in transplant recipients.
Most crucial stress for women in now days are having infertility issue. Successful healthy conception requires proper structure and function of entire reproductive system. Anti-mullerian hormone is an ovarian reserve marker that effects in ovulation and endometrium thickness. Low anti-mullerian hormone has become first choice for IVF centre. There is the great scope of Ayurveda research to find out appropriate and effective solution for this problem. Considering all these points the present study was planned according to Ayurvedic principles. A 29 years female presented with a 4-year history of inability to conceive and was diagnosed with poor ovarian reserve and anovulation based on her reports. Patient was treated with Virechana, Madhutailik Basti, Mustadi Yapana Basti, Uttarbasti and Shamana Aushadha. There was an improvement in endometrium thickness, ovulation occurred and the patient subsequently conceived and delivered a full term healthy male child. The administered therapy helped correct Dosha vitiation, which in turn promoted fertility restoration. The treatment led to ovarian function, restoration of ovulation and successful conception culminating in a full-term normal delivery.
Background: Open radical nephrectomy is a method of treatment of large malignant renal tumour. We aimed to review the open radical nephrectomies done in our centre with view of assessing the outcome. Methods: Patients with suspected malignant renal tumour who had open radical nephrectomies at the Benue State University Teaching Hospital within the study period of May 2019 to April 2024 were identified and information retrieved from the records. Statistical package for the social sciences (SPSS) version 25 was used for analysis using appropriate test statistics. Results: A total number of 23 patients had open radical nephrectomies (9 right and 14 left nephrectomies) based on clinico-radiological features of malignant renal tumours. The age range was between 9 months and 77 years. The male to female ratio was 1:1.5. The mean operating time was 2 hours 10 minutes and the average length of hospital stay was 5 days. The high-grade complication rate was 8.7%. The in-hospital mortality rate was 4.3% and the transfusion rate was 47.8%. The histology report showed 11 (47.8%) had nephroblastoma, 8 (34.8%) had renal cell carcinoma, 3 (13.0%) had oncocytoma and 1 (4.4%) had cystic nephroma. Conclusion: Although the transfusion rate is high, open radical nephrectomy remains an option for large renal tumour as it is beneficial and gives a favourable outcome.
Background: Conventional randomized controlled trial (RCTs) in cardiovascular medicine are expensive, ethically constrained, and logistically demanding. The synthetic control arm (SCA) methodology leverages real-world inspired simulated patient data and propensity score matching to construct an external comparator, enabling all enrolled participants to receive active treatment. Despite increasing regulatory acceptance, cardiovascular applications of this methodology remain methodologically under-characterized. Methods: A simulation study was conducted involving 75 patients: 40 in the treatment arm receiving a combined antihypertensive and lipid-lowering agent, and 35 in the SCA control arm derived by propensity score matching on ten baseline clinical covariates. Primary endpoint was MACE at 12 months. Secondary endpoints were change in LDL cholesterol and systolic blood pressure. Statistical analyses included independent samples t-tests, Chi-squared tests, Cohen's d, odds ratios, and Kaplan-Meier survival analysis. Results: Propensity score matching produced acceptable covariate balance across nine of ten variables (all SMD <0.3), with one residual imbalance in baseline systolic BP (SMD=0.54; p=0.024). Treatment significantly reduced LDL cholesterol (−29.4±10.3 versus −5.0±5.1 mg/dl; p<0.001; d=−2.94) and systolic blood pressure (−10.6±3.6 versus −3.3±3.5 mmHg; p<0.001; d=−2.06). MACE occurred in 32.5% of treated versus 40.0% of SCA control patients (OR=0.72; p=0.664), non-significant owing to insufficient power at this sample size. Conclusion: The SCA design successfully demonstrates the feasibility of SCA methodology under controlled simulation assumptions, with strong performance for surrogate endpoints but limited power for clinical endpoints in a cardiovascular simulation context, demonstrating robust detection of surrogate endpoint effects. The MACE non-significance is attributable to sample size limitations, not methodological failure. Adequate power for a 7.5 percentage-point MACE difference requires approximately 645 patients per arm. These findings provide a structured methodological framework for future SCA applications in cardiovascular pharmacoepidemiology.
Background: Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive impairment, gait disturbances, and disability. Given its high burden and multifaceted clinical impact, CSVD has emerged as a critical public health concern. There is limited understanding of how radiological markers of CSVD correlate with clinical manifestations in Indian populations, which may differ from Western cohorts due to genetic, lifestyle, and environmental influences. Methods: This observational, cross-sectional study included 85 adults with magnetic resonance imaging (MRI) evidence of at least one CSVD marker. Clinical assessment included cognition, gait, Parkinsonism, vascular risk factors, and stroke subtypes. MRI markers were classified per STRIVE criteria, and cumulative burden quantified using the total SVD score. Associations between radiological markers and clinical outcomes were evaluated using appropriate statistical tests. Results: Lacunes (76.5%) and WMH (75.3%) were the most frequent markers, followed by CMB (42.4%), PVERSUS (30.6%), and RSSI (14.1%). Dementia was significantly more common in patients with lacunes (26.1% versus 5%; p=0.043) and WMH (25.6% versus 4.7%; p=0.034). CMB were strongly associated with Parkinsonism (36.1% versus 14.3%; p=0.019) and gait abnormalities (27.8% versus 10.2%; p=0.036). Higher SVD scores correlated with cerebral atrophy (68.9% versus 32.5%; p=0.001) and greater clinical impairment. Acute infarcts clustered with RSSI (50% versus 21.9%) and high SVD burden. Conclusion: This study demonstrates substantial CSVD burden in an Indian cohort and highlights strong clinical–radiological correlations. Findings reinforce CSVD as a whole-brain, cumulative microvascular disorder with significant cognitive and motor implications.
Alopecia areata (AA) is an autoimmune condition that causes round bald patches, usually on areas of the body where hair normally grows most commonly on the scalp. In Ayurveda, this condition is compared to indralupta. According to ayurvedic understanding, indralupta is caused by an imbalance of the three doshas (Vata, Pitta and Kapha) along with Rakta (blood). This is a case study of 28 years old male patient came to OPD having complaints of bald patches over scalp region for 6 months. Patient was diagnosed with indralupta and managed by Samana therapy. Treatment for 4 months along with the diet regimen mentioned in ayurvedic text was followed. The patient got speedy recovery with remarkable regrowth of scalp hair within 4 months of treatment. Classical indralupta chikitsa mentioned in ayurvedic classics is effective in the management of alopecia areata.
Porphyria cutanea tarda (PCT) is a rare form of enzymatic disorder of heme-biosynthesis pathway. Due to a defect of enzyme uroporphyrinogen decarboxylase (UROD) this disease occurs. Porphyria cutanea tarda can be sporadic and can be familial. Here, we are presenting a late cutaneous form of porphyria cutanea tarda in a 26-year-old male patient without any known triggers. The patient was diagnosed by genetic and laboratory testing and showed typical appearance of PCT. All the details of PCT from presentation of symptoms, complications, involvement of organs and diagnosis is discussed in this article. Furthermore, this article provides thorough discussion about PCT.
Background: Folate has an important role in reducing risk of neural tube defects in fetus and megaloblastic anemia in women of reproductive age. This study assessed the knowledge and practice of periconceptional folate intake among pregnant women attending clinic at Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria. Methods: Two hundred and seventeen pregnant women were selected using simple random sampling technique. A semi-structured questionnaire was used for data collection. Descriptive and inferential statistics such as mean, frequency, percentage, standard deviation and Chi-square were used for data analysis. Results: The study showed that most respondents were young adults aged 19–30 years (63.6%) with a mean age of 28.32±5.05 years. Majority were married (92.2%), and had at least secondary education (53.5%). Very few (7.4%) of the pregnant women had a history of stillbirth or a baby with a congenital defect, whereas 3.2% had a history of a child with a neural tube defect. Nutritional knowledge of folate intake was low (25.8%) while practice of folate intake was high (88.0%). There was no significance association (p>0.05) between nutritional knowledge and practice of folate intake at (χ²=0.02, p=0.890). Key factors influencing folate rich food intake include lack of knowledge of folate rich food, poor economic status and pregnancy unplanned with mean scores (4.41), (3.22) and (3.50) respectively. Conclusion: The study revealed that the number of respondents that had good nutritional knowledge of folate intake was low, while those that had good dietary practices were high.
Background: Aloe vera has a long antiquity as a medicinal herb with varied therapeutic applications. It has been used as remedies in different form as gel, Elva, juice etc. Among the different forms, Elva is found to be as a constituent in several Ayurvedic formulations but still its standard operating procedure is not mentioned yet. Aim was to develops a standard operating procedure for Elva by preparing it with two different methods. Methods: The study was carried out by preparing Elva with two different methods, first by water extract (Elva sample I) of aloe vera leaves and secondly by pulp (Elva sample II) of the same. Results: Elva sample I and II have 4.65% and 2.2% yield respectively. Also, by HPTLC identification, Elva sample I found to be more genuine by taking British Pharmacopoeia as reference standard. Conclusions: Elva sample I have comparatively better yield and found to be more acceptable by HPTLC.
Background: The lipoproteins, endogenous lipids and apolipoproteins are formed in the liver and lipid metabolism, stages of lipid synthesis and transportation are also control by the liver. Degenerated serum lipoprotein pattern can be observed during the acute metabolic impairment in cirrhosis hence, it is reasonable to expect an abnormal lipid profile in those with severe liver dysfunction. Methods: This cross-sectional study was carried out at a tertiary care hospital, in central Rajasthan among 360 cases of cirrhosis of liver from all causes admitted in Medicine and Gastroenterology wards of Jawaharlal Nehru Medical College, Ajmer. Venous blood sample was collected after overnight fasting of 12 h in all the patients diagnosed with cirrhosis for estimation of hemoglobin, total white blood cell (WBC) count, total platelet count, erythrocyte sedimentation rate (ESR), random blood sugar, blood urea, serum creatinine, liver function tests and serum lipid profile. Results: The mean high-density lipoprotein (HDL) levels were decreasing statistically with increasing model for end stage liver disease (MELD) score while low-density lipoprotein (LDL) and triglyceride (TG) showed no significant association with increasing MELD score. The sensitivity of HDL in detecting the liver cirrhosis at cut off of 19.3 MELD score was estimated to be 93% and specificity of 82.1%. Conclusions: The mean HDL levels were significantly decreasing with increasing MELD score and the study of lipid profile of patients may be an alternate to assess the severity of liver cirrhosis.
Background: Type 2 diabetes mellitus (T2DM) is a major public health problem associated with chronic hyperglycemia and multiple metabolic disturbances. Magnesium plays an important role in insulin action and glucose metabolism and hypomagnesemia is frequently observed in diabetic patients, potentially contributing to poor glycemic control. To estimate serum magnesium levels in patients with T2DM and to assess their association with glycemic control measured by HbA1c. Methods: This hospital-based, single-centre, cross-sectional observational study was conducted in the General Medicine inpatient ward of a tertiary care hospital over 12 months. A total of 200 adults with T2DM were included after applying the inclusion and exclusion criteria. Clinical details and laboratory parameters, including fasting and postprandial blood glucose, serum magnesium, HbA1c, urea and creatinine, were measured. Data were analysed using SPSS. Chi-square test and correlation analysis were applied, with p<0.05 considered significant. Results: Hypomagnesemia (<1.8 mg/dl) was present in 68.0% of participants. The mean serum magnesium level was 1.46±0.58 mg/dL and mean HbA1c was 7.52±1.21%. A significant association was found between serum magnesium category and HbA1c group (Chi-square=7.85, p=0.010). Serum magnesium showed a significant negative correlation with HbA1c (r=−0.262, p=0.001). Conclusions: Hypomagnesemia is common in T2DM and is significantly associated with poorer glycemic control. Routine monitoring and correction of magnesium deficiency may support better diabetes management.
Refractory hypothyroidism is characterised by persistently elevated thyroid-stimulating hormone (TSH) despite adequate or high-dose levothyroxine therapy. It presents a common clinical challenge, often requiring evaluation for causes such as poor adherence, drug interactions, or gastrointestinal malabsorption. Pseudomalabsorption due to inconsistent medication intake is the most frequent and reversible cause. Differentiating this from true malabsorption is crucial, as the latter may necessitate investigation for conditions like celiac disease, inflammatory bowel disease, or post-surgical states. The levothyroxine absorption test (LT4AT) is commonly used for this purpose, but conventional protocols are lengthy, costly, and inconvenient. Recently, simplified approaches using a single high oral dose with early measurement of serum free thyroxine (FT4) have been proposed. A rise in FT4 within a few hours indicates adequate intestinal absorption. We report a 54-year-old woman with refractory hypothyroidism in whom a short-duration LT4AT confirmed adequate absorption, suggesting pseudomalabsorption.
Background: A variety of musculoskeletal manifestations are commonly related with diabetes mellitus. This study is aimed at evaluating the prevalence and clinical spectrum of musculoskeletal manifestations in patients with diabetes mellitus in KJ Somaiya Hospital, Mumbai. Methods: A tertiary care centre based cross-sectional study was conducted with 82 patients from November 2018 to October 2020 to evaluate the pattern of musculoskeletal (MSK) manifestations in adult diabetic patients and to correlate them with duration and control of diabetes. A detailed history and clinical examination were noted in each patient with particular importance given on musculoskeletal examination and relevant investigations. Results: Most of the patients (35.6%) were aged between 51 and 60 years. Female patients accounted for 63.4% of the study population. 69 (84.2%) patients had HbA1c ≥7 (poor glycaemic control). The most common musculoskeletal manifestation was Frozen shoulder (18.3%) followed by Osteoarthritis (17.1%). Conclusions: Musculoskeletal manifestations are quite prevalent in patients with diabetes mellitus, and there is significant correlation between development of these manifestations and glycaemic control, age and duration of diabetes of patients.
Pregnancy complicated by pre-existing diabetes mellitus is associated with increased maternal and fetal morbidity. Hyperglycemia during the periconceptional period significantly increases the risk of congenital malformations, spontaneous abortions, and adverse perinatal outcomes. Preconception counseling plays a vital role in optimizing metabolic control and minimizing complications before pregnancy occurs. The aim of this review is to summarize current evidence and highlight practical clinical strategies for optimizing pregnancy outcomes in women with pre-existing diabetes. A literature search was conducted using PubMed and Google Scholar for articles published between 2000 and 2024 using keywords “preconception care,” “diabetes,” and “pregnancy outcomes”. Relevant literature was identified from international clinical guidelines and peer-reviewed publications using standard database searches. Optimal preconception care includes achieving strict glycemic control, screening for diabetic complications, reviewing medications, initiating folic acid supplementation, optimizing body weight, and ensuring effective contraception until glycemic targets are achieved. Multidisciplinary care involving obstetricians, endocrinologists, dieticians, and ophthalmologists is essential for comprehensive management. Evidence suggests that structured preconception programs significantly reduce congenital malformations, perinatal mortality, and maternal complications in diabetic pregnancies. Despite this, many pregnancies in women with diabetes remain unplanned, emphasizing the need for improved counseling and awareness. Early identification and management of reproductive-age women with diabetes should be incorporated into routine clinical care. Implementation of standardized preconception counseling protocols can substantially improve maternal and fetal outcomes.
