Introduction: Among all the risk factors for atherosclerosis, diabetes is one that has a direct causal association with it, so it has been a focus in major primary prevention studies. The prediabetic population is considered at the same risk as non-diabetics as per the latest guidelines. By using the Coronary artery calcium score (CACS) which is a predictor of cardiovascular events, in this subset of people authors tried to analyse whether prediabetics can be treated the same as non-diabetics. Methods: Patients undergoing CT coronary angiography with no major epicardial coronary artery obstruction were in-cluded and divided into three subgroups of non-diabetic, pre-diabetic and diabetic. Their CACS were measured and compared for any significance. Results: A total of 300 patients were part of the study with 100 patients in each subgroup. The mean age of the population was 48 years. Lipid profile was significantly deranged in the non-diabetic and pre-diabetic subgroup as they were not on any therapy. CACS was 5.4 ± 37.37, 98.02 ± 300.89, 209.47 ± 277.61 in non-diabetic, pre-diabetic and diabetic subgroups respectively. The CACS was much higher in the pre-diabetic subgroup of people missing statistical significance by only a small margin. Conclusion: From this observational study authors conclude that prediabetics are at much higher risk of adverse cardio-vascular events than non-diabetics and so when it comes to primary prevention therapy, they should not be considered in the same risk category as non-diabetics.
The current drug discovery paradigm has a high attrition rate, postmarketing withdrawals, and costly development. Drugs have been emerging serendipitously “from the bedside,” without an organized approach. Drug discovery, at the bedside, is followed in reverse pharmacology (RP) by the relevant science of drug development for safety, efficacy, and mechanistic understanding. Such a transdisciplinary structured path can explore the large potential for novel drugs. The phytoactives can be novel scaffolds for new drugs. Ayurveda and other living traditional systems of medicine have a rich reservoir of pharmacotherapeutics. The documented therapeutic experience defines the nature of the drug targets to be studied in vitro and in vivo models. The phytomolecules may lead to newer dimensions of drug actions. Reserpine and Atremisinin exemplify such a potential. The delay in drug discovery can be eliminated by reverse pharmacology (RP). A well-structured multisystem and functionally multidisciplinary organization is needed for RP; it also needs an appropriate locus for academic growth, development, and intellectual appeal. A close and continuous collaboration between academia and industry is needed. In the future, RP can differentiate into unique specialities: Ayurvedic pharmacoepidemiology, observational therapeutics, pharmacodynamic methods, advanced pharmacokinetics, and biosynthesis. Early attention to RP is a prerequisite for achieving this. The medical pluralism in India offers observational opportunities for the bedside hits and leads for several unmet medical needs. Such leads can be facilitated by RP as drug discoveries for integrative medicine.
Lynch syndrome, is one of the most common hereditary colorectal cancer predisposition conditions, is characterised by an increased risk to a spectrum of cancers, primarily colorectal and endometrial cancers. We highlight the urgent need to diagnose, explain diagnostic methodologies and several cancer risks reducing interventions in these patients and their rela-tives. We highlight the role of aspirin as a potent chemo preventive agent in Lynch syndrome patients and discuss patient groups where the dose and duration of the intervention may require personalisation. With new genetic technologies on the horizon, early detection of these patients coupled with targeted chemo preventive intervention could potentially lead to the reduction of the cancer burden in India.
Aim: To evaluate the performance of chest computed tomography (CT) scan in the preliminary diagnosis of suspected coronavirus disease 2019 (COVID-19).Material and methods: Suspected 1149 COVID-19 patients who underwent both chest CT and RT-PCR tests were included. Considering RT-PCR as a reference standard, the performance of chest CT in diagnosing COVID-19 was evaluated. Obtained data was statistically analysed for sensitivity, specificity and accuracy for the diagnosis of COVID-19 cases.Results: Out of 1149 patients RTPCR was positive in 188 (16.36%) of patients and CT findings were positive in 368 (32.03%) of patients. The majority (21.15%) of the patients’ CT scan revealed sub-pleural ground-glass opacities (GGO), consolidation was seen in 76 (6.61%), pleural effusion in 73 (6.35%) and interstitial oedema in 41 (6.35%) respectively. Considering RT-PCR results as the reference standard, the chest CT revealed a sensitivity of 73.40%, specificity of 76.07% and accuracy of 75.63% in identifying COVID 19.Conclusion: Chest CT revealed diagnostic accuracy (75.63%) in diagnosing COVID-19 and it could be considered as a basic modality for detecting COVID-19 cases early. This can be valuable to initiate early triage and infection control practices and appropriate isolation strategies in Emergency Department.
Thymoma is a mediastinal tumour with malignant potential, which has a recurrence rate after complete resection ranging from 5 to 50%. It is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Here we present an interesting case of a 58 year old female patient on treatment for Myasthenia Gravis for the past 26 years. She had undergone thymectomy with dissection of pericardium and adjacent pleura 26 years back. Now she had presented with worsening myasthenia symptoms, underwent treatment comprising of steroid pulse therapy and plasmapheresis along with regular medications. She was evaluated for left lung collapse, which revealed a thymoma involving left lung and a solitary deposit on the right side probably metastasis. Though the recurrence rate of thymoma is high, this case is unique as it recurred as malignant thymoma after 26 years.
Background: Polycystic Ovary Syndrome (PCOS) diagnosis is very complex and due to overlapping presentation of symptoms, women with PCOS may approach various practitioners, who might be using varied definitions to diagnose and manage PCOS.Objectives: To assess knowledge about PCOS diagnosis and management by Dermatologists, Gynecologists, Endocrinologists and Family Physicians (FPs).Methods: This cross-sectional study was done among 529 health care providers (HCPs) practicing in Mumbai metropolitan region using a convenient sample. A self-administered pretested questionnaire was filled by the HCPs after obtaining informed consent. Pearson’s Chi-square test and Analysis of Variance (ANOVA) was used to study the differences within each group.Results: All HCPs reported that women with PCOS consulted them with a varied spectrum of symptoms. Among FPs, Allopaths had better knowledge about diagnosis and Homeopaths were more confident about PCOS management. Among Specialists, Endocrinologists were more stringent in diagnosing cases as per defined criteria, along with screening and comprehensive management of the metabolic syndrome. Although the need for multidisciplinary management was perceived, in practice holistic management was not common.Conclusions: This study reveals the need for training and disseminating algorithms for comprehensive PCOS management across disciplines. It highlights women’s preferences in seeking health care for symptom complex of PCOS. These findings would help health policymakers to develop community-based awareness modules and India-specific management guidelines for early screening and a continuum of care for PCOS patients.Conflict of Interest: The authors have no conflicts of interest to declare that are relevant to the content of this manuscript.Source of Support: This study was conducted as an Intramural project of ICMR-NIRRH and hence there was no sourced funding agency and no financial conflicts.
Surgery is usually considered a treatment for acquired benign esophageal perforation but in sick patients’ surgery is not possible. We report a case of mid esophageal perforation, detected during side-viewing endoscopy. As the surgery was difficult considering her age and comorbidities, a fully covered, a self-expandable metallic stent (FC-SEMS) was placed over perforation, which was tied by plastic wire from the proximal end of FC-SEMS and anchored to the tooth (canines) to prevent inward migration. FCSEMS was removed after three months and complete closure of esophageal perforation was achieved. This is probably the first case report in which one end of the plastic thread was tied to FC-SEMS (proximal end) endoscopically and another end of plastic thread tied to teeth to prevent inward migration after stent deployment.
The diabetic foot is one of the most feared complications of diabetes. The diabetic foot also requires offloading of the foot after medical or surgical management. To understand the offloading of the foot, one has to understand the biomechanics of the foot. Especially the altered biomechanics which occurs in the diabetic foot. If the biomechanics is understood properly, it helps in the wound healing of diabetic foot ulcer. Also, it helps in the prevention of recurrence of the ulcer. An attempt is made in this article to focus on the assessment and various approaches to taking care of altered biomechanics for comprehensive management of diabetic foot.
The second wave of the COVID pandemic has had a sudden and severe impact on India. This grueling period was associated with the shortage of healthcare resources like hospital beds, oxygen supply, and medicines along with overburdening of health workers, and a very high toll of community suffering and loss. A combination of highly infective viral variant strains with the backdrop of premature complacency, removal of restrictions and abandonment of COVID appropriate behaviour may be responsible factors in hindsight. However, important learnings and action points acquired from the COVID resurge, can be valuable to avert such situations in future. These include focusing on maximizing population vaccination; continuing enforcement of safety norms with the graded lifting of restrictions; using data tools and medical research for prediction, analysis and timely decisions; ramping up healthcare resources and production of medicines, lifesaving equipment and vaccines; and having regulations and mechanisms in place to tackle misuse and illegal activities. Above all selflessness and unity at the level of the administration, community and individual are the needs of the hour in such a challenging situation.
Violence against women remains terribly pervasive and affects 1 in 3 (roughly 736 million) women across their lifetime. This violence can be from an intimate or non-intimate partner and have been fairly unchanged over that last decade since the onset of the COVID-19 pandemic, there has been emerging data from front line workers that violence of all forms against women and girls has intensified. Addressing this shadow pandemic is a health care crisis of global proportions, but of special significance in the patriarchal Indian scenario and needs to be prioritized amidst the COVID care issues. The first step forward is awareness, followed by access and availability of services. This cannot be achieved overnight but by a step-wise approach. There is an urgent need to adapt our approach, integrate these issues into our health care systems so that survivors can access appropriate medical and social services.
Obesity is an increasingly prevalent disease across the globe. Lifestyle modification though a cornerstone in management falls short of goal many times and hence the need for pharmacotherapy for Obesity. There have been many on and off label used medications and some medications have also been withdrawn from the market. However, the future looks exciting with many new treatments on the horizon. Current communication tries to look at existing and future possibilities in obesity treatment armamentarium.
Complex comminuted fractures of the base of the middle phalanx, proximal phalanx and proximal interphalangeal joint are a treatment challenge, as deformity, stiffness and loss of function are quite frequent and disabling, following surgical treatment. We present a case of a 31-year male who suffered from comminuted intra-articular fracture and dislocation of the middle phalangeal base of the little finger and middle finger of the same hand, a year apart. Both were closed injuries of the dominant hand. We used a modified dynamic Suzuki wire frame for treatment of both fractures in an acute setting and at late presentation for the middle finger and little finger respectively. Minimal soft tissue injury, capsulo-ligamentotaxis, early mobilisation with frame and early return to function were key aspects of this treatment. Modified dynamic Suzuki frame is a simple, minimally invasive, dynamic external fixation device, that allows early motion at PIPJ and eventually good remodelling and function at PIPJ and DIPJ, even in the long term. It can be used in modified forms for comminuted fractures of bases of distal and proximal phalanges as well.
Since the completion of the human genome project our understanding of the genes, and their function in various pathophysiological conditions, has advanced and revolutionized the medical field. From a simple chromosome study to complex DNA sequencing, array CHG, and Next-Generation sequencing technology has made it possible to diagnose many rare diseases which were thought of as nonexistence or difficult to diagnose. And many of these disorders can be treated if diagnosed early. The burden of genetic disorders seems to be high in India likely to be due to consanguinity practiced in many communities. The present article is a basic understanding of the field of genetics and when to suspect and, how to diagnose and manage in day-to-day clinical practice.Conflict of Interest: None declaredSource of Support: Ms. Aadhira Nair is a junior research fellow on a research project funded by Gujarat StateBiotechnology Mission (GSBTM), Govt of Gujarat, India.
With the second wave of COVID-19 hitting countries like India, the surgical community is fighting to evade getting infected by the virus as well as to continue giving surgical treatment to all the needy patients who need emergent surgical intervention. India faced few challenging problems during the second wave of COVID-19 like lack of hospital beds, live-saving medicines, and oxygen for all types of patients in this pandemic. With the third wave of covid being expected to hit India in October 2021, the surgeons need to make some homework.
Positive parent-child interactions are critical for effectively navigating the course of a child’s development. In children with developmental and behavioural disorders intervention plan needs to cater to both the child as well as the entire family, to ensure positive changes for both. Due to limited data, time and resource constraints, clinicians in India often are not able to optimally engage and optimize caregiver involvement in the treatment plan. A 2 years and 9-months-old boy presented to a multidisciplinary child development centre due to delayed speech and hyperactivity. In addition, he was found to be fidgety, restless, could not wait for his turn, stubborn, showed head banging when demands were not met and temper tantrums. A battery of developmental assessment led to a diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly hyperactive-impulsive type (DSV-IV-TR). The child received an individualized goal based multi-disciplinary intervention involvingparental counselling, occupational therapy and speech and language therapy over a period of 2 years. In addition, parents were actively engaged and coached to implement best practices i.e., reduced screen time, increase play time, home cooked food, sleep hygiene and parent diary. This collaborative approach with parents helped to accelerate and sustain the effectiveness of the multidisciplinary intervention. In a child with ADHD, predominantly hyperactive-impulsive type, caregiver-centred approach plays a vital role in augmenting and sustaining the desired outcomes achieved by a multidisciplinary intervention.
The response to the second surge of the pandemic brought out significant deficiencies in our healthcare delivery systems. The over-emphasis on a dysfunctional tertiary health care system undermined the necessity of building a robust primary health care network in India, in the last 75 years. This coupled with a lack of reliable epidemiological data saw our planners get caught off-guard which reflected in the response to this present wave of the pandemic. The absence of standard guidelines or the presence of ones that lacked adequate evidence prevented healthcare providers from providing evidence-based care to the people affected by the pandemic. Drugs or treatments that showed little or no efficacy in managing the disease were prescribed to millions due to poor regulatory oversight. The over-reliance on drugs and hospitals instead of the creation of a robust primary health care system has left even the so-called “pharmacy of the world” in a state of shock and despair. Primary health care is the most crucial component of any healthcare system in the world which can help fight pandemics like the present one as well as maintaining a healthy society. The presence of a strong and empowered force of general practitioners would have helped manage the pandemic much better than what we have seen in the past few months. The lessons learnt in the past year, tells us that decisions made in the wake of this current pandemic, to help strengthen our primary health care system will go a long way in creating a resilient and healthy India as envisaged in the “Alma Ata Declaration” on primary health care more than forty-three years back.
