Journal of the Association of Physicians of India

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Quadrivalvular Heart Disease Complicated by Fatal Infective Endocarditis of Pulmonary Valve: A Case Report
(Journal of Indian Medical Association, 2025-04) Machigar, SY; Shah, A; Sharma, S.
A middle-aged sick male with rheumatic heart disease and prior mitral and aortic prosthesis was admitted for tricuspid valve replacement. Preoperative assessment revealed a hitherto undiagnosed pulmonic condition. This unusual case is reported not only to highlight the quadrivalvular disease with possible coexisting rheumatic and congenital etiology but also the fulminant endocarditis of pulmonary valve.
An Atypical Presentation of Pituitary Neurosarcoidosis as Massive Weight Loss and Failure to Thrive in a Young Female
(Journal of Indian Medical Association, 2025-04) Deshmukh, P; Deogaonkar, A; Deshmukh, V.
Neurological involvement accounts for <5% of patients with sarcoidosis. Manifestations are often those of the concerning site of affection such as hydrocephalus, transverse myelitis, neuropathy, and neuroendocrine dysfunction. We present a case of a 41-year-old female who presented to the endocrine clinic with complaints of fatigue, weight loss, anorexia, and absent menses for 6 years. She had no other comorbidities or chronic diseases. On examination, she was frail and cachectic [body mass index (BMI): 16.8 kg/m 2 ]. Laboratory assessments revealed anemia, leukocytosis, and eosinophilia. Hormone levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), 8 am cortisol, thyroid-stimulating hormone (TSH), and estradiol were low while erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and angiotensin-converting enzyme (ACE) levels were raised. Antinuclear antibody (ANA) titers were normal along with a negative tuberculin skin test. Magnetic resonance imaging (MRI) of the brain revealed features suggestive of empty sella with a 3 mm pituitary. She was diagnosed provisionally to have panhypopituitarism and failure to thrive secondary to granulomatous changes due to sarcoidosis as a possible etiology. She was treated with oral preparations of corticosteroids (prednisolone), ethinylestradiol, levonorgestrel, and thyroxine. At the subsequent visit, after 6 months, she reported improved general condition, weight gain (18 kg), increased appetite, and resumption of menses. Neurosarcoidosis with selective hypophyseal involvement, although a rare affliction, should be considered while investigating possible endocrinopathies among middle-aged females. Additionally, clinical evidence in the absence of tissue evidence also requires precedence, especially in cases where histopathology and imaging may not suffice to prove the existence of a disease.
Ventilator-associated Pneumonia: A Prospective Observational Study
(Journal of Indian Medical Association, 2025-05) Natarajan, K; Bahulikar, A; Phalgune, DS.
Background: The danger of ventilator-associated pneumonia (VAP) is maximum in the early course of a hospital stay. The published Indian data on VAP are limited. Objectives: The primary objectives were to find the occurrence and clinical outcome of VAP in the intensive care unit (ICU), whereas the secondary objectives were to find risk factors and microbiological profile of VAP. Materials and methods: About 138 patients admitted to ICU who were intubated for >48 hours were enrolled in this prospective observational study. Risk factors such as age, chronic lung disease, length of mechanical ventilation (MV), clinical outcome, presence of nasogastric tube, previous antibiotic exposure, reintubation or intubation ?7 days, change in the ventilator circuit, and use of sedatives/paralytic agents were noted. The endotracheal aspirate was sent to the laboratory for species identification and sensitivity testing. Discrete and continuous variables were compared by Fisher’s exact test and Mann–Whitney U test, respectively. Multiple logistic regression analysis was done to explore the significant risk factors linked with VAP. Results: The occurrence of VAP was 34.7/1,000 MV days, whereas 21.7% of MV patients developed VAP. Mortality was 50% in VAP patients. Age >55 years, prolonged ventilation, and chronic lung disease were significantly associated with VAP. The most common isolate was Acinetobacter baumannii, followed by Klebsiella pneumoniae. Multidrug resistance (MDR) and extensive drug resistance were observed in 13.3 and 66.7% of isolates, respectively. Conclusion: There was a high incidence and mortality of VAP in ICU patients. Strict implementation of VAP bundles and adherence to infection control protocols are needed.
Rare Presentation of Rituximab-induced Interstitial Lung Disease in a Patient with Pemphigus Vulgaris
(Journal of Indian Medical Association, 2025-04) Kalyankar, PP; Bhalla, RS; Alla, D; Gupta, N; Sirineni, S; Vulisha, A; Mekhail, M; Mrudula, ASS; Kattamreddy, AR.
A 42-year-old female with a history of pemphigus vulgaris was started on rituximab after an inadequate response to corticosteroids. One month following the second cycle of rituximab, she developed acute interstitial pneumonia, which was linked to rituximab since a thorough workup revealed no evidence of an infectious cause. We initiated her on broad-spectrum intravenous (IV) antibiotics and antifungals, but the patient responded significantly to pulse methylprednisolone therapy.
Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica Spectrum Disorder
(Journal of Indian Medical Association, 2025-04) Sarna, MK; Setia, M; Rijhwani, P; Parakh, R; Goyal, G.
A 17-year-old male patient presented with frequent hiccups, nausea, and vomiting. He was initially treated for a hiatus hernia and gastritis with partial relief; however, symptoms recurred and worsened, necessitating a thorough assessment that included upper gastrointestinal endoscopy. Neuroimaging was ordered to look for a central cause of vomiting. The results showed a demyelinating lesion in the area postrema (AP), indicating neuromyelitis optica spectrum disorder (NMOSD). It typically affects the optic nerves and causes inflammatory demyelination of the spinal cord. Anti-aquaporin 4 (AQP4) autoantibodies in cerebrospinal fluid (CSF) were positive and validated the diagnosis. Intravenous methylprednisolone, intravenous immunoglobulin (IVIg), and rituximab were administered, and the patient responded well to the treatment. Regular follow-up and adherence to treatment guidelines are crucial for optimal patient outcomes.
Zeroing in on Hepatic Steatosis Screening in Patients with Type 2 Diabetes Mellitus: A Retrospective Analysis of the Vicious Trifecta-Obesity, Nonalcoholic Fatty Liver Disease, and Diabetes
(Journal of Indian Medical Association, 2025-05) Saluja, KV; Pillai, D; Balachandran, P; S, M; Bhargava, G.
Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus commonly coexist and act synergistically to drive worse prognosis for each other. Insulin resistance, obesity, and metaflammation are some of the important underlying pathologies. Despite the overwhelming prevalence of NAFLD in type 2 diabetic patients, there exists neither a proper screening protocol nor any specific management guideline for the same. With our study, we focus on three major diseases: diabetes, obesity, and NAFLD. We established collinearity among hemoglobin A1C (HbA1c), body mass index (BMI), and liver stiffness [kilopascals (kPa)] using multivariate linear regression. We were able to express kPa as a weighted average of the other two variables. Moreover, using correlation plots, we calculated critical values for both HbA1c and BMI as 6.57 and 26, respectively, beyond which the risk of liver fibrosis is accentuated significantly. We used the same cutoff values in our data to veritably prove that patients had increasing severity and frequency of hepatic steatosis/fibrosis as they exceeded the critical limit. Patients with both BMI and HbA1c below the cutoff had predominantly no/mild steatosis, while patients with both values exceeding the cutoff had predominantly severe steatosis/fibrosis on ultrasonographic imaging. Patients who had either of the two variables above the said limit had steatosis severity somewhere in between the two groups, highlighting that even one uncontrolled variable would significantly worsen the prognosis.
Beyond Amlodipine—The Case for S-amlodipine as the First Choice Calcium Channel Blocker: An Expert Opinion from India
(Journal of Indian Medical Association, 2025-04) Hiremath, J; Mohan, JC; Abdullakutty, J; Bansal, S; Dalal, J; Hazra, PK; Rao, S; Shah, VT; Kubba, S.
Background: Calcium channel blockers (CCBs) have been recommended as the first-line treatment option for the management of hypertension. Amlodipine has been used to treat hypertension over the past 3 decades. However, the chief limitation of amlodipine is pedal edema; it is associated with poor adherence to therapy. Amlodipine is a racemic mixture of two stereoisomers [R(+), S(–)]. Only the S(–) isomer exerts vasodilating action. The R-amlodipine isomer is considered to cause adverse effects. Aim: To understand the place of S-amlodipine and its combinations in the management of hypertension and related cardiovascular (CV) disorders in the real-world setting in India. Methodology: A conclave of nine Indian cardiologists was formed to discuss the place of S-amlodipine in the management of hypertension in their clinical practice. Results: The antihypertensive efficacy of S-amlodipine is comparable to that of amlodipine. S-amlodipine does not cause pedal edema. In fact, switching patients on amlodipine who develop pedal edema to S-amlodipine is helpful in improving patient compliance. However, it would be prudent to initiate treatment with S-amlodipine itself rather than amlodipine, which causes pedal edema. S-amlodipine does not cause gingival hypertrophy, and this improves patient compliance. S-amlodipine consistently lowers blood pressure (BP) across different patient populations such as young, elderly, and patients with CV risk factors. Conclusion: S-amlodipine has antihypertensive, antianginal actions, and pleiotropic effects. S-amlodipine 2.5 mg is found to be equivalent in its efficacy and tolerability when compared to amlodipine 5 mg in the treatment of mild to moderate hypertension.
Revolutionizing Treatment Strategies through Inhibition of Tissue Factor Pathway Inhibitor: A Promising Therapeutic Approach for Hemophilia Management
(Journal of Indian Medical Association, 2025-04) Gupta, N; Seth, T; Aggarwal, S; Atri, S; Shaikh, BA; Nigam, RK; Jain, A; Baveja, A; Digra, SK; Vyas, B; Sharma, V.
Hemophilia, an X-linked genetic bleeding disorder, is caused by the deficiency of coagulation factors VIII (hemophilia A) or IX (hemophilia B). Regular replacement therapy with the missing clotting factor is an effective standard-of-care treatment. However, it comes with a significant fallout of frequent intravenous dosing with poor compliance, the risk of inhibitor development, and a substantial treatment burden. Research has progressed from missing clotting factors and factor VIII mimetics to the most recent rebalancing therapy that suppresses tissue factor pathway inhibitor (TFPI). Thrombin generation is restricted by TFPI, which inhibits the tissue factor- mediated activation of factor VII. This promising therapeutic approach rebalances hemostasis by inhibiting TFPI, a critical regulator of the extrinsic coagulation pathway, thereby increasing thrombin generation. Novel monoclonal antibodies (concizumab and marstacimab) enhance thrombin generation by blocking TFPI to restore hemostasis. Clinical trials have demonstrated good clinical efficacy and safety of these anti-TFPI, besides their convenient subcutaneous administration using pen devices. These innovative therapies have the potential to enhance the quality of life (QoL) of people with hemophilia. This review provides a comprehensive overview of the clinical development, therapeutic potential, challenges, and prospects of anti-TFPI in the management of hemophilia.
Exploring the Role of Sitagliptin in the Management of Type 2 Diabetes Mellitus for the Elderly: A Narrative Review
(Journal of Indian Medical Association, 2025-04) Sethi, B; John, M; Pendurthi, B; Dharmadhikari, S; Markandeywar, N; Khandhedia, C; Mane, A; Mehta, S.
The prevalence of diabetes has risen considerably among older adults around the globe. It is the primary contributor to death from cardiovascular (CV) disease and other medical comorbidities, as well as a major contributor to complications, deterioration in quality of life (QoL), and decline in physical and mental well-being in the elderly. One of the main challenges with aging is that islet cells become dysfunctional, and their glucose metabolism changes with increasing age. Dipeptidyl peptidase-4 (DPP-4) inhibitors are an effective treatment option for older patients with type 2 diabetes mellitus (T2DM) because they demonstrate better effects on glycated hemoglobin (HbA1c) within this age-group. Sitagliptin, a highly selective DPP-4 inhibitor, is effective both as a monotherapy and in conjunction with other oral hypoglycemic agents (OHAs) for managing T2DM. Sitagliptin treatment in the elderly has demonstrated lowering HbA1c levels by 0.5–1.1% while having beneficial effects on pancreatic ?-cells and no significant incidence of hypoglycemia, compared to studies in which oral antidiabetic medications were administered. It has little to no effect on body weight, renal function, or lipid profiles. This narrative review aimed to gather and assess data from trials investigating the use of sitagliptin in the elderly.
Optimizing Screening Strategies for Hypertension in India: A Consensus Statement
(Journal of Indian Medical Association, 2025-04) Hiremath, J; Wander, G; Dasbiswas, A; Mantri, RR; Khan, A; Bardoloi, N; Iyengar, SS; Kalmath, BC; Aslam, K; Vaidyanathan, PR; Vishwanathan, M; Ahuja, A; Garg, R; Misra, M; Prasad, N; Sharma, P; Mazumder, C; Kathiresan, M; Asawa, M; Bhagwati, M; Das, CK; Ganwani, M; Gilhotra, HS; Gupta, RK; Hafeez, I; Jaishankar, K; Manjappa, M; Prasad, B; Reddy, BK; Roy, SS; Sane, P; Shah, MK; Sinha, B; Subramanian, M; Tyagi, H; Vazirani, P; Bagish, K; Das, BR; Deshmukh, P; Gandhi, S; Indoria, S; Iqbal, K; Kapoor, R; Kukreja, B; Manjunath, R; Minocha, A; Modak, A; Prabhakar, D; Rai, D; Raju, YP; Ravichandran, M; Sengupta, A; Shah, J; Sharma, A; Shah, P,; Jain, S; Swami, OC.
Hypertension is a highly prevalent issue worldwide. The prevalence of underdiagnosed hypertension in India calls for the need for this consensus article, which aims to optimize screening strategies. In this article, a modified Delphi approach was used to develop consensus statements. Key recommendations include the adoption of standardized screening protocols across diverse healthcare settings, incorporating both office-based and out-of-office blood pressure measurements (OBPM). By implementing these evidence-based strategies, the consensus aims to improve the early detection of hypertension, ultimately reducing the burden of cardiovascular disease and enhancing patient outcomes.
An Elusive Diagnosis Hiding in Plain Sight
(Journal of Indian Medical Association, 2025-04) Hande, AK; Shah, YM; Patil, SK; S, D.
This case report highlights the diagnostic and therapeutic challenges faced in the management of a middle-aged female patient presenting with persistent left gluteal pain and a history of remote pulmonary tuberculosis. Despite multiple hospital admissions and diagnostic procedures, the cause of her debilitating symptoms remained elusive. The diagnosis was clinched when a repeat investigation, including bone biopsy and bone marrow aspirate, revealed the growth of Salmonella Typhi (S. Typhi). The patient’s symptoms markedly improved following treatment with appropriate antibiotics, underscoring the importance of considering atypical clinical presentations of common organisms.
A Concise Review on Different Aspects of Influences of Coronavirus Disease 2019 on Liver and Metabolic Changes
(Journal of Indian Medical Association, 2025-01) Ghosh, R; Yarlagadda, LC; Mondal, C; Paruchuri, T; Ghosh, D; Rudra, A; Chattopadhyay, G; Sarkar, J.
Purpose: Coronavirus disease 2019 (COVID-19) is a viral disease, causing a deadly situation around the world. Significant cases need hospitalization and intensive care. Obese, diabetic, and immunosuppressed people have poor prognosis. Here, we are establishing the link between liver disease and COVID-19. Methods: A thorough investigation was performed across several articles and databases from 2020 to 2022 to assess the impact of COVID-19 on the liver. Results: As of June 2022, we identified 75 articles in electronic databases discussing the hepatic impact of COVID-19. Conclusion: This review delves into the impact of COVID-19 on liver metabolism, specifically how it exacerbates morbidity and mortality in individuals with preexisting chronic liver disease (CLD).
Revisiting the Cardiorenal Safety of Sitagliptin in Type 2 Diabetes Mellitus: A Literature Review
(Journal of Indian Medical Association, 2025-04) Shah, P; Tiwaskar, M; Joshi, A; Pendurthi, B; Dharmadhikari, S; Ahire, P; Khandhedia, C; Markandeywar, N; Mane, A; Mehta, S.
Type 2 diabetes (T2D) is a major public health problem globally, with significant socioeconomic ramifications for healthcare systems. Diabetes unquestionably contributes to both cardiovascular disease (CVD) and chronic renal disease. Hospitalization, low quality of life, and high mortality rate are inevitable in patients with this dual burden. As a result, the emphasis in diabetes care should also be on cardiorenal health. Glycemic control, as well as optimal management of cardiorenal risk factors and comorbidities, is required to eliminate cardiovascular (CV) morbidity and mortality related to T2D. Sitagliptin is a highly efficient and selective dipeptidyl peptidase-4 inhibitor (DPP-4i) that improves glycemic control while having a low risk of hypoglycemia. It has neutral effects on body weight, low proclivity for pharmacokinetic interactions, and a favorable safety profile. Numerous clinical trials have proven that sitagliptin is CV- and renal-safe in T2D patients, even in those with obesity, old age, renal impairment (RI), and preexisting CVD. It also corrects hyperglycemia-induced osmotic diuresis and excessive filtration. In people with T2D who are at high CV risk or moderate-to-severe renal insufficiency, sitagliptin is documented as a well-tolerated treatment that does not augment the risk of CV and renal complications. Sitagliptin may effectively manage CV and renal complications in diabetes patients, considering its CV and renal safety.
Evaluation of Knowledge, Attitudes, and Practices among Healthcare Professionals toward Role of Artificial Intelligence in Healthcare
(Journal of Indian Medical Association, 2025-04) Vanamali, DR; Gara, HK; Dronamraju, VA.
Background: Artificial intelligence (AI) is transforming healthcare by enhancing diagnostics, treatment planning, and patient management. However, the successful integration of AI depends on healthcare professionals’ (HCPs) knowledge, attitudes, and practices (KAP). The study aimed to evaluate the KAP of HCPs regarding the role of AI in healthcare. Additionally, the study aimed to identify key barriers, such as ethical concerns and technical limitations, that hinder AI adoption. Materials and methods: A cross-sectional study was conducted using an online structured questionnaire targeting doctors, medical students, and nurses. The survey, distributed via Google Forms, measured participants’ demographics, KAPs regarding AI. Purposive and snowball sampling methods were employed to recruit a total of 350 participants. Results: A total of 350 participants completed the survey, with the majority being medical students (52%) and younger professionals aged 18–27 years (73.1%). AI’s primary use was in diagnostics (71.1%), followed by treatment protocol development (45.4%) and drug development (33.1%). Most respondents rated their technical skills as low or very low, with medical students showing slightly higher proficiency compared to nurses and faculty members. Ethical concerns were prominent, with 46% of participants highlighting data privacy and security issues, followed by concerns about high costs (23.7%) and over-reliance on manual processes (16.6%). Significant differences were observed between professions: medical students and faculty were more open to AI’s role in making critical decisions (60.98% and 61.94%, respectively) than nurses (29.41%). Additionally, 97% of nurses expressed willingness to undergo AI training compared to 86% of faculty and 82% of medical students. However, confidence in AI’s ability to improve clinical outcomes was mixed, with 35.71% agreeing, 29.71% neutral, and 40% regularly using AI tools in practice. Conclusion: The findings highlight a positive attitude toward AI in healthcare, with substantial recognition of its benefits, especially in diagnostics. However, significant gaps in knowledge, technical skills, and awareness of ethical issues remain, particularly among nurses. Tailored education and training programs are needed to bridge these gaps and enhance AI readiness in healthcare practice.
Sitagliptin as an Add-on Therapy to Other Glucose-lowering Agents in Patients with Type 2 Diabetes Mellitus: A Narrative Review
(Journal of Indian Medical Association, 2025-04) Kalra, S; Singh, AK; Das, S; Pendurthi, B; Dharmadhikari, S; Ahire, P; Khandhedia, C; Markandeywar, N; Mane, A; Mehta, S.
The burden of type 2 diabetes mellitus (T2DM) is increasing in India, with increasing mortality and morbidity. In India, T2DM management is complicated by the presence of distinct clinical characteristics as well as certain socioeconomic factors of the patient population. These factors affect glycemic control and lead to poorer outcomes, necessitating the use of add-on treatments with safer medications, which can be used over the long term with minimal follow-up. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that inhibits the activity of DPP-4, a peptidase that degrades glucagon-like peptide 1 (GLP-1), a glucoregulatory hormone. Sitagliptin enhances glucoregulation in people with T2DM as monotherapy, as well as in combination with other antihyperglycemic drugs, and has a low risk of adverse side effects. This review focuses on assessing the efficacy and safety of sitagliptin as an add-on therapy to other antidiabetic agents and insulin.
Consensus to Reduce Withdrawal and Improve Adherence with SGLT2i: Consensus TWO SGLT2i Adherence Group
(Journal of Indian Medical Association, 2025-04) Singh, NK; Singh, AK; Patni, B; Agarwal, P; Nageshappa, MK; Prasad, MK; Chhabra, M; Singha, NG; Shunmugavelu, M; Gupta, A; Phatak, S; Tiwaskar, M; Kalra, S; Baruah, MP; Anthuvan, T; Pedenekar, A; Prasad, A; Gadia, S.
Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a class of medications that have shown significant efficacy in regulating blood glucose levels and providing additional benefits, such as cardiorenal protection. This study aims to analyze the factors leading to nonadherence and discontinuation of SGLT2i treatment and to identify strategies that can enhance patient compliance and reduce withdrawal rates. Materials and methods: This consensus involved an expert committee comprising 14 leading opinion leaders, chosen for their profound expertise and experience in type 2 diabetes mellitus (T2D) and SGLT2i therapy. Prior to the meeting, a comprehensive document—developed through an extensive literature review on current challenges, best practices, and potential strategies for improving adherence and reducing withdrawal of SGLT2i—was distributed to the committee members. This allowed ample time for thorough review and preparation. The expert committee convened virtually multiple times to engage in in-depth discussions on various aspects of SGLT2i adherence and compliance. The finalized manuscript encapsulates the consensus achieved by the experts, presenting actionable recommendations aimed at enhancing adherence and reducing withdrawal rates in SGLT2i therapy. Results: Based on the literature, several factors contribute to the nonadherence of SGLT2i, including being of Black race, older age (>65 years), high unemployment rate, lower income levels, extended duration of diabetes, a greater number of baseline comorbidities, genital infections, and limited access to healthcare facilities. To maintain good adherence, appropriate patient selection and education are essential. Healthcare practitioners should be well-informed about the drug’s indications, interactions, and side effects. Conclusion: Regular monitoring, lifestyle adjustments, and open communication between healthcare practitioners and patients are crucial. Developing personalized care plans, educating patients, promptly addressing their concerns, and cultivating a collaborative healthcare relationship are critical in maintaining adherence.
Prehyperuricemia Deserves More Attention in this Era of Metabolic Explosion: A Review
(Journal of Indian Medical Association, 2025-04) Subbu, GR; Tiwaskar, M; Muruganathan, A; Rajasekar, R.
The global population is experiencing a metabolic explosion, with the prevalence of hyperuricemia (HU) as a metabolic disorder and a causal factor for noncommunicable diseases (NCD) increasing rapidly worldwide over the last 2 decades. This rise is attributed to diets high in purine, alcohol, red meat, high-fructose foods, and lifestyle changes. The connection between HU and various NCDs is now stronger than ever. As HU progresses, systemic inflammation arises, leading to endothelial dysfunction and end-organ damage—molecular changes that were previously unrecognized. HU is increasingly seen as a metabolic disorder, particularly a vascular disorder rather than just a crystallization disease. Asymptomatic HU is no longer considered benign, and it should not be equated with gout. It is crucial to diagnose HU early, at a high normal level, and manage it to prevent the development and complications of related extra-articular diseases. For broader recognition and significance, this high normal level of serum uric acid (UA) should be termed prehyperuricemia (PHU). Like prediabetes and prehypertension, PHU should be identified early, regardless of age and sex, with preventive actions implemented to maintain UA at a safer level.
Implementation Strategies to Improve Survival Outcomes after Out-of-Hospital Cardiac Arrest: Global Challenges and Disparities
(Journal of Indian Medical Association, 2025-04) Murthy, VS; Ramaka, S; Sharma, A.
Out-of-hospital cardiac arrest (OHCA) is a major global public health problem, contributing to high mortality and morbidity. There is significant variability in OHCA incidence and survival rates across different countries and communities and in various geographical locations, even within the same country. Cardiopulmonary resuscitation (CPR) knowledge and skills are critical to achieving better survival outcomes during OHCA. Community CPR training rates vary widely from country to country. Most low-middle-income countries (LMICs) lack an organized prehospital care system and are relatively far from the acceptable standards recommended for better outcomes by international organizations. Several factors contribute to disparities in outcomes during the management of OHCA in a given community in any country. The key challenges are lack of OHCA awareness, community CPR training, well-trained medical personnel, first responders, essential emergency equipment, high-quality emergency medical services (EMS) and funding, as well as access to and provision of timely, evidence-based emergency cardiac care. It is important to understand the structure of a given geographical community before planning and implementing a sustainable program to enhance outcomes during OHCA globally. There is a need for ground-level research and surveillance to improve outcomes from OHCA. Addressing these challenges and disparities is critical in improving survival outcomes after OHCA.
A Retrospective Study of Clinical Characteristics and Serological Profile of Male Systemic Lupus Erythematosus Patients in India
(Journal of Indian Medical Association, 2025-04) Kumar, A; Vasdev, V; J, S; Kartik, S; Singh, R; Kishore, K; Kumar, MH; Hegde, A; Koshy, V; MN, A; Goel, N.
Objective: Systemic lupus erythematosus (SLE) is a female-preponderant disease, and a few studies from outside India have observed that the clinical characteristics of SLE in male patients vary from those of females. There is a lack of data about SLE in male patients in the Indian subcontinent. Hence, we have reported our observations on the various clinical characteristics of SLE in male patients in this retrospective 5-year cohort study. Methods: This was a retrospective case record-based study at a tertiary care rheumatology center in North India. Records of all the SLE patients of all age-groups maintained with the department over 5 years were perused. All the patients fulfilling either of the classification criteria, viz., American College of Rheumatology (ACR) 1997 criteria and Systemic Lupus International Collaborating Clinics (SLICC) 2012, were included in the study. Data on clinical features were retrieved at the presentation and during the follow-up, immunological profile, treatment received, and long-term complications. Results: Records of 45 patients were included in the study, of which two were juvenile lupus. Mucocutaneous manifestations were the most common clinical presentation and minor organ involvement. Among the major organs, renal involvement was the most common, followed by hematological manifestations. Two patients had thrombotic manifestations. Four patients had overlap with other connective tissue disorders. Hypertension was the most common complication developed during follow-up, followed by avascular necrosis (AVN) of the femoral head. Two patients died during follow-up. Eleven patients were tested for antiphospholipid syndrome (APS) antibodies, of which one lupus anticoagulant (LAC)-positive patient had thrombotic complications. All patients were antinuclear antibodies (ANA) positive, with a speckled pattern being common, and anti–double-stranded deoxyribonucleic acid (anti-dsDNA) was the common antibody. All patients received hydroxychloroquine and low-dose steroids, and up to 35% received steroid- sparing agents. Most patients with lupus nephritis (LN) took >1 year to achieve clinical remission. Conclusion: Our study showed that male SLE patients are at high risk of severe organ damage at an early age and are susceptible to various other complications during follow-up. This may differ from female SLE patients, and larger studies in the future can further enlighten tailored treatment approaches in male patients. Ethical consent was taken wide letter no. IEC Reg. no. 54/2024 AH RR.
Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease: Meta-summary of Case Reports
(Journal of Indian Medical Association, 2025-04) Juneja, D; Jain, R; Nasa, P.
Aim: The aim of this meta-summary was to identify the patient profile, symptomology, risk factors, and outcomes of chronic kidney disease (CKD) patients with posterior reversible encephalopathy syndrome (PRES) by reviewing published case reports and series. Methodology: For this meta-summary, we performed a methodical search of PubMed, Google Scholar, and Reference Citation Analysis databases. We used the following search terms: ”chronic kidney failure,” ”chronic renal insufficiency,” AND ”hypertensive encephalopathy,” ”PRES,” ”reversible posterior leukoencephalopathy syndrome,” OR ”posterior leukoencephalopathy syndrome” in combination. The obtained results were then filtered for case reports published in English and on adult (above 18 years) humans. The relevant literature pertaining to CKD and PRES was manually screened, and duplicate articles from different databases were removed. Results: A total of 19 case reports and 9 case series with 41 patients meeting the inclusion criteria were included in the final analysis. Commonly reported symptoms were seizures (65.9%) and headache (58.5%). Visual disturbances, varying from blurred vision to cortical blindness, were reported by 36.6% of cases. In two patients, PRES was the first manifestation of CKD. Underlying hypertension was reported in 51.2% of cases, but severe hypertension was reported by 70.7% of patients at the time of presentation. Only 14.6% of patients were posttransplant on immunosuppressive therapy. Along with supportive therapy, modification of antihypertensive therapy was reported in 78.1% of cases. The need for intensive care unit (ICU) admission was reported in 43.9% of cases, with 17.1% of patients requiring invasive mechanical ventilation. The majority of patients completely recovered by the time of discharge, with only 19.5% of cases reporting residual neurological deficit. The median time for reversal was 10.5 days, and only three deaths were reported. Conclusion: CKD patients may be particularly vulnerable to developing PRES. However, due to nonspecific symptomatology overlapping with several other more common causes of neurological dysfunction in these patients, PRES may be largely missed and underdiagnosed. It may also present without any associated severe hypertension or a background of immunosuppressive therapy, which makes the diagnosis even more difficult. Blood pressure management, along with anti- edema measures and supportive care, may lead to complete recovery.

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