Indian Journal of Clinical Practice
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Editor: Dr. KK Aggarwal
ISSN: 0971– 0876
Frequency: Monthly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.ijcpgroup.com/
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Item A Controlled Clinical Study to Evaluate the Comparative Effect of Anuloma DS Tablet and Lactitol + Ispaghula Powder in Functional Constipation(IJCP Group, 2025-02) RAKESH; JADHAV, LAKSHMIPRASAD L; GOPAN, YADU; KJ, GIRISH; MUTTAPPA, TOTAD; B, VASANTHABackground: The International Classification of Diseases (ICD) has described constipation as decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool (ICD10- CM-K59). Overall, the average prevalence of constipation in adults has been estimated as 16% worldwide (varies between 0.7% and 79%); in adults aged 60 to 110 years, the prevalence has been estimated to be 33.5%. Objective: To evaluate and compare the efficacy of tablet Anuloma DS and lactitol + ispaghula powder in constipation. Materials and methods: Sixty-two subjects with constipation were divided into two groups: Group A with 32 subjects and Group B with 30 subjects. Group A received 1 Anuloma DS tablet at bedtime and Group B received lactitol + ispaghula powder 5 g at bedtime for 15 days. Results: Twenty-eight patients in Group A showed significant improvement in stool consistency, whereas just 8 patients showed improvement in consistency of stool in Group B. Twenty patients showed improvement in frequency of stool in Group A, whereas only 3 patients showed this improvement in Group B. Twenty-nine patients in Group A reported good improvement in feeling after defecation compared to 9 patients in Group B. Pain in abdomen improved in 21 patients in Group A versus 9 patients in Group B. Improvements were also seen in scores on the Constipation Assessment Scale, Patient Assessment Scale, and Quality of Life Questionnaire. Conclusion: Anuloma DS showed significant clinical benefits in the treatment of constipation compared to lactitol + ispaghula powder.Item Effectiveness and Safety of Fixed-Dose Combination of Dapagliflozin and Linagliptin in Patients not Controlled on Glimepiride and Metformin in Real-World Settings in India: LEAD INDIA Study(IJCP Group, 2025-02) BASU, D; PATRA, SK; BOKADIA, VK; KAPURE, NL; MAYABHATE, MM; SHARMA, ADBackground: Glimepiride/metformin is commonly used in India for its cost-effectiveness and efficacy, but one-third of patients may not achieve adequate glycemic control. Dapagliflozin/linagliptin fixed-dose combination (FDC) could be an effective alternative. Methods: A retrospective study of type 2 diabetes patients aged >18 years, not meeting glycated hemoglobin (HbA1c) goal <7% on glimepiride and metformin. Patients received dapagliflozin (10 mg)/linagliptin (5 mg) FDC. Changes in HbA1c, fasting plasma glucose (FPG)/postprandial plasma glucose (PPG), blood pressure, and body weight were analyzed over 3 months. Results: The study included patient (n = 114) with a mean age of 55.15 years and mean duration of 8.5 years. Adjunct to dietary/lifestyle modifications, up-titration of metformin-glimepiride along with FDC of dapagliflozin/linagliptin demonstrated significant reduction in HbA1c (from mean 8.8 ± 1.12 to 6.92 ± 0.23; p < 0.001), FPG (157.8 ± 28.86 mg/dL to 113.6 ± 9.24 mg/dL; p < 0.001), and PPG (237.21 ± 40.58 mg/dL to 161.39 ± 12.76 mg/dL; p < 0.001) indicating improved glycemic control. Additionally, there was a marginal decrease in body weight (73.19 to 72.12 kg), systolic blood pressure (137.6 to 129.11 mmHg), and diastolic blood pressure (84.26 to 78.68 mmHg) largely attributed to dapagliflozin. Treatment was well-tolerated. Conclusion: FDC of dapagliflozin/linagliptin is an attractive therapeutic option for patients with type 2 diabetes mellitus not controlled with ongoing glimepiride and metformin.Item Rare Adverse Effect of a Commonly Used Drug in Chronic Kidney Disease(IJCP Group, 2025-01) JOSHI, ARUN; DUA, ARUN; DOGRA, PAVITRA MANU; SOOD, VIVEKChronic kidney disease (CKD) and hypertension can lead to each other. Majority of the patients with CKD have hypertension. Sympathetic overactivity has been suggested as one of the important etiologies of hypertension in CKD patients. Clonidine is used as a central sympatholytic to control hypertension in CKD patients. Drug-induced sialadenitis has been reported with multiple drugs including antihypertensives. We report a case of clonidine-induced sialadenitis, which has been rarely seen despite the widespread use of this drug among CKD patients requiring multiple antihypertensive drugs.Item Hormonoids and Hormones(IJCP Group, 2025-01) KALRA, SANJAY; BHATTACHARYA, SAPTARSHI; KAPOOR, NITINThe field of endocrinology is ever expanding. With a rapid increase in the understanding of different hormones and hormone-like substances, there is a need to update the nomenclature of these chemical messengers. The authors propose a novel term “Hormonoids”, defined as endogenous or exogenous substances that lead to hormone-like effects in the body. These may refer to various neurotransmitters, minerals, alkalis, acids, and vitamins that are not conventionally classified as hormones, but act upon receptors in target areas and are regulated by complex interlinked processes. These are required for homeostasis, and an imbalance in their concentration or activity may lead to dysfunction and disease. They may also be used as pharmacotherapy for these associated disorders.Item Accuracy, Precision, Sensitivity, and Patient Preferences of Accu-Chek® Self-Monitoring Blood Glucose Meters: A Targeted Literature Review(IJCP Group, 2025-02) KALRA, SANJAY; KAPOOR, NITIN; SOORAGONDA, BASAVARAJ; SHUKLA, RISHI; SHEIKH, SHEHLA; CHANDRASEKARAN, SRUTI; SHINDE, SURESH N; UNNIKRISHNAN, AG; MAYOR, REGINA; PRESENTI, CATERINA; ROETSCHKE, JULIA; GALA, VISHAL; AUGUSTINE, ABINSelf-monitoring of blood glucose (SMBG) using blood glucose monitoring (BGM) devices is recommended for people with diabetes to improve glycemic control and to detect and prevent episodes of hypoglycemia in these patients. The International Organization for Standardization (ISO) and World Health Organization (WHO) have defined specific criteria for accuracy, precision, user evaluation, and interfering agents for the quality of these devices. In this targeted literature review, Accu-Chek® devices (Instant®, Guide®, Active® ) were found to have stable results with appropriate accuracy and precision and did not respond to interfering agents. The devices were also found to be cost-effective and ranked high on patient preference.Item Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India(IJCP Group, 2025-01) AGGARWAL, HK; JAIN, DEEPAK; BHUTIA, PEMA WANGYAL; DAHIYA, SHAVETA; JAIN, PROMILIntroduction: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are prone to opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs, particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and even in different areas within the same country. Little information is available about the prevalence of OI in HIV patients from developing countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy among infected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies and spectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materials and methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in North India. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemical investigations, and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were included in the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis (TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and the third most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low-income, illiteracy, low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poor ART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is the commonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs across different patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status of patients can influence the occurrence and outcome of these deadly infections.Item The Usefulness of Ultrasound Guidance in Fresh Embryo Transfers: A Retrospective Study(IJCP Group, 2025-03) GAHLOT, ALKA; SWARANKAR, ML; SONI, RAVIKANTObjective: To evaluate retrospectively the efficacy of ultrasound-guided embryo transfer method on pregnancy and implantation rate and compare with clinical touch method. Material and methods: The results of 582 cycles from our in vitro fertilization and embryo transfer (IVF-ET) program conducted at Jaipur Fertility Centre, an Infertility Unit of Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan were analyzed retrospectively and comparison was made between those carried out using ultrasound guidance and those by clinical touch method. Results: Higher pregnancy and implantation rates (37.19% and 19.66%, respectively) were found in the group using the transabdominal ultrasound guidance during ET compared with those in the group using the clinical touch method (30.92% and 16.22%, respectively). The difference was not statistically significant. Conclusion: Older women (>35 years) and in the subgroup when the clinician rated the transfer procedure as easy with some difficulty, there appeared to be a substantial improvement in the pregnancy rate and the difference was statistically significant. We believe that ultrasound-guided ET should be used in these subgroups.Item Role of Beta-Blockers in Prevention of Hepatopulmonary Syndrome in Chronic Liver Disease: An Observation(IJCP Group, 2025-01) GAUTAM, ASHISH; AGRAWAL, PRABHAT; NIGAM, ASHWINIAim: Study was initiated to study the presence of hepatopulmonary syndrome (HPS) in chronic liver disease patients, and role of beta-blockers in its occurrence. Methods: Patients admitted in Dept. of Medicine and patients attending the Medicine OPD were examined and investigated for presence of HPS irrespective of its typical clinical features as explained in the literature. Patients having ascites or pleural effusion were managed by means of paracentesis and pleural tap first and then included in the study. Patients having any other primary pulmonary disease like bronchial asthma or chronic obstructive pulmonary disease were excluded from the study. Arterial blood gas analysis and contrast-enhanced echocardiography was done to confirm presence of arterial hypoxemia and pulmonary shunt, the diagnostic criteria. Results: During 1 year study, total 125 patients were enrolled in the study after appropriate selection criteria. Twenty-eight out of 125 patients were not taking propranolol. Propranolol is contraindicated in these patients for one or two reasons. Four out of these 28 patients developed HPS. One out of 97 patients who were on propranolol developed HPS. Total 5 patients were confirmed having HPS. The Fisher’s exact test statistic value is 0.008887. The result is significant at p < 0.01. Conclusion: Patients of cirrhosis with portal hypertension on treatment with propranolol were having significantly lower chances of development of HPS then those without propranolol. Propranolol may have preventive role for development of HPS.Item Unveiling the Eschar: A Mite’s Mark in Scrub Typhus(IJCP Group, 2025-01) RAO, BV NAGABHUSHANA; SRAVANTHI, T; SUNEETHA, R; MOUNICA, MSScrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a Gram-negative intracellular organism transmitted by Leptotrombidium mites, with wild rats serving as natural reservoirs. The disease is more common in the Tsutsugamushi Triangle, often afflicting travelers and creating diagnostic challenges in clinical practice. We present the case of a diabetic patient who acquired the infection while visiting an agricultural farm. Our discussion covers clinical manifestations, diagnostic markers and treatment modalities, emphasizing the significance of early recognition and the benefits of prompt treatment. The importance of searching for an eschar, a key physical sign, is underscored and potential serious outcomes are discussed. Recent advances and preventive measures are also highlighted. This synthesis of research and clinical insights aims to enhance global awareness, prompt diagnosis, and effective management of scrub typhus.Item Robot-Assisted Laparoscopic Surgery for Pheochromocytoma in a Dilated Cardiomyopathy Patient(IJCP Group, 2025-03) VERMA, ANKUR; SINGH, POOJA; BISWAS, SHUBHASHISH; PANIGRAHI, ABINASH; DABAS, SURENDER KUMARPheochromocytomas are rare endocrine tumors which secrete catecholamines leading to severe cardiovascular complications. Dilated cardiomyopathy (DCM) is known to exist in patients with pheochromocytomas. The presence of these two conditions makes the anesthetic management of such cases even more complex. In this article, we present the case of a young male who had both pheochromocytoma and DCM, and who underwent robotassisted laparoscopic surgery. The challenges in managing this case are discussed.Item Management of Diabetic End-Stage Renal Disease: Role of Hemodialysis(IJCP Group, 2025-03) BALLAL, H SUDARSHANDiabetes mellitus is now the most common cause of end-stage renal disease (ESRD) all across the globe, including India. In view of the alarming rise in numbers, renal failure due to type 2 diabetes has been termed a “medical catastrophe of worldwide dimensions”. When a patient develops uremic symptoms he needs renal replacement therapy. The renal replacement therapies available for all patients with ESRD are: hemodialysis, chronic ambulatory peritoneal dialysis (CAPD), and renal transplantation. Kidney transplantation is the best option for patients with diabetic ESRD. The 5-year survival of transplant patients of 75%-85% is far superior to the 5-year survival rate of around 25% on dialysis.Item An Unusual Presentation of Splenic Rupture in a Hemodialysis Patient(IJCP Group, 2025-02) AW, ADEYEMO; SHARMA, SOURABH; KA, BUSARI; AE, FAPONLE; OLALEKAN, OLATISE; IKEUGWOKE, ODINAKA; OJAH, OKOISplenic rupture, although rare in dialysis patients, can be life-threatening. In this case, a 45-year-old man with kidney failure on hemodialysis experienced sudden and severe abdominal pain in the left flank, without any history of trauma. He displayed symptoms of hypovolemic shock, characterized by pallor, hypotension, and tachycardia. Additionally, he had abdominal distension and tenderness. An abdominal CT scan revealed a splenic hematoma and intra-abdominal hemorrhage. The patient required a splenectomy to address the ongoing bleeding, but unfortunately, he succumbed to post-splenectomy sepsis 2 weeks later.Item Vonoprazan – A Potassium-Competitive Acid Blocker: An Overview(IJCP Group, 2025-02) SHUBHRICA; YADAV, JYOTIVonoprazan helps in management and treatment of heartburn, peptic ulcers and gastroesophageal reflux disease. The structure, mechanism of action, and clinical applications have been discussed in this article. A brief review of literature is carried out.Item To Study Endothelial Dysfunction by Brachial Artery Flow-mediated Dilatation and Its Relationship with Microalbuminuria in Hypertensive Individuals(IJCP Group, 2025-03) AHARWAR, SANDEEP; A, ARIF MOHAMMEDIntroduction: Hypertension remains a central pathophysiologic contributor to cardiovascular morbidity and mortality. In its earliest stage, the principal endothelial alteration is merely functional and addressed as “endothelial dysfunction”. Flow-mediated dilatation (FMD) of the brachial artery has been widely used as a noninvasive marker to vascular reactivity. Both microalbuminuria and endothelial dysfunction are expressions of an endothelial pathology; however, it is still uncertain whether they are interrelated, or if the two phenomena are caused in parallel by the cardiovascular risk burden. Aim: To study the relationship of brachial artery flow-mediated dilatation (BAFMD) with microalbuminuria in hypertensive subjects. Method: Total 120 subjects were included in the study comprising 80 hypertension cases and 40 controls. All subjects were subjected to anthropometric measurements and routine biochemical tests – hemogram, urea, serum creatinine, liver function test, lipid profile, BAFMD and urinary albumin to urinary creatinine ratio (30-300 mg/g Cr). Conclusion: Mean % FMD was lower in patients with abnormal microalbuminuria compared to normal and this was statistically verified, with p = 0.016, thereby verifying the central hypothesis of this study.Item Gender Inequity in Neurological Health Care in India: Socio-Cultural Influences, Clinical Challenges, and Potential Pathways to Equity(IJCP Group, 2025-01) Dubey, Souvik; Dewasi, Siladitya; Das, Shambaditya; Dubey, Mahua Jana; Ghosh, Ritwik; Santra, Arindam; Pandit, AlakThe issue of gender-based inequity in health care, particularly in neuromedicine, is indeed a matter of serious concern in India. From birth, girls often face discrimination, which can manifest in malnutrition, unequal access to education, and inadequate health care, all of which impact their neurological health. Neurological conditions such as epilepsy, stroke, psychosomatic disorders, and demyelinating disorders reveal stark disparities in diagnosis, treatment, and care based on gender. Key factors contributing to this gender-based inequity in neuromedicine are socio-cultural barriers (deep-rooted societal norms and cultural practices in India often prioritize the health of male family members over females. These norms can result in women delaying seeking medical attention or being denied care altogether. This contributes to late diagnoses and poor outcomes for women with neurological conditions; myths misconceptions and misbeliefs (neurological disorders, particularly epilepsy and psychosomatic disorders, carry significant stigma, especially for women). Misconceptions around conditions like epilepsy can lead to social isolation, exclusion from marriage prospects, and neglect in care. Additionally, women’s health issues are often dismissed as psychological or “hormonal”, leading to misdiagnoses; access to health care (women often face structural barriers, such as lack of autonomy in decision-making, lower financial independence, and restricted mobility), which limit their access to neuromedical care. Health care resources in rural and underserved areas are limited, and gender biases in treatment mean that women are less likely to receive timely and adequate interventions for neurological conditions; malnutrition (poor nutrition among women), starting from childhood, is a significant contributor to neurological health problems. Malnutrition during pregnancy, which affects fetal development, can result in a higher prevalence of developmental neurological disorders in children, with gender-based neglect often continuing into adulthood. Potential solutions include awareness campaigns, policy changes, health care provider training, and community empowerment. By delving into these areas, we can begin to understand the complexities of gender inequity in neuromedicine and work toward more equitable health care solutions.Item Extended Use of Ivabradine in Heart Failure with Preserved Ejection Fraction and Inappropriate Sinus Tachycardia(IJCP Group, 2024-02) Sathyamurthy; Srinivasan, Kanthallu NarayanamoorthyIvabradine has been used for over a decade in managing chronic coronary syndromes and heart failure (HF) with reduced ejection fraction (HFrEF). HF with preserved ejection fraction (HFpEF) accounts for 50% of the total HF cases carrying equal mortality and morbidity risk as HFrEF. Increased heart rate (HR) in such cases has been shown to be associated with poor clinical outcomes. Clinical conditions like inappropriate sinus tachycardia (IST) manifest with elevated HR without any specific triggers. Beta-blockers have been the preferred treatment of choice for both HFpEF and IST but are often ineffective or present with side effects due to their negative ionotropic effects. Ivabradine, through its inhibitory action on funny current (Ifc), reduces HR without altering the inotropic mechanism. Few case reports and small case series have documented its extended use and efficacy in reducing HR in these cardiac conditions. In this article, we present two cases who needed HR control, one with HFpEF and another case of IST syndrome. Ivabradine was successfully used in both these cases to control the elevated HR.Item Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India(IJCP Group, 2024-02) Aggarwal, HK; Jain, Deepak; Bhutia, Pema Wangyal; Dahiya, Shaveta; Jain, PromilIntroduction: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are prone to opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/ AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs, particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and even in different areas within the same country. Little information is available about the prevalence of OI in HIV patients from developing countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy among infected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies and spectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materials and methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in North India. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemical investigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were included in the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis (TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and the third most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy, low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poor ART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is the commonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs across different patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status of patients can influence the occurrence and outcome of these deadly infections.Item A Case of Idiopathic Autoimmune Hemolytic Anemia: Every Anemia – First Type It and Then Treat It(IJCP Group, 2024-02) Kothia, Darpan; Mungalpara, Dhyey; Acharya, Hemang K; Mehta, Manish NAutoimmune hemolytic anemia (AIHA) is a medical disorder where the immune system erroneously targets and destroys red blood cells (RBCs), causing a reduction in their longevity. This results in an inadequate supply of RBCs to carry oxygen, leading to symptoms like fatigue, weakness and jaundice. AIHA is categorized into warm and cold types based on the optimal temperature for antibody activity. A comprehensive grasp of the immunological mechanisms involved is essential for accurate diagnosis and effective management of this autoimmune condition. AIHA is a frequently missed diagnosis as patient are not fully investigated, and treated with vitamin B12, folic acid and iron in outpatient department.Item Refractory Anemia in a Patient with Sickle Cell Nephropathy on Dialysis(IJCP Group, 2024-12) Sotomiwa, Sotubo; Sharma, Sourabh; Mumuni, Amisu; Ayoola, Odeyemi; Oluwole, Banjoko; Adebowale, Adekoya; Olugbenga, AwobusuyiThis case highlights a middle-aged female with sickle cell nephropathy (SCN) on maintenance hemodialysis who presented with refractory anemia despite initial erythropoiesis-stimulating agent therapy and dialysis. Intensifying dialysis frequency to alternate-day sessions and switching from erythropoietin to darbepoetin significantly improved the patient's management. This report underscores the critical role of adequate dialysis and optimized anemia management in SCN patients.Item Echoes of a Hidden Cardiac Tumor: Case Report of a Left Atrial Myxoma(IJCP Group, 2024-12) Rao, BV Nagabhushana; Rajasekharam, SN; Mahesh, G; Narayana, A SankarMyxomas are the most common primary cardiac tumors, predominantly arising in the left atrium and less frequently in the right atrium or ventricles. Although benign, myxomas can cause significant symptoms and complications due to embolization, obstruction, or vasoactive substance production. This case report describes a 37-year-old male presenting with intermittent palpitations, anxiety, and breathlessness. Clinical examination and routine investigations were unremarkable except for early finger clubbing. Echocardiography revealed a pedunculated left atrial mass, later confirmed as a myxoma via histopathological examination. The patient underwent successful surgical resection of the tumor. This case underscores the diagnostic challenges of myxomas, particularly in asymptomatic individuals, and highlights the importance of echocardiography for detection. Surgical excision remains the definitive treatment, with follow-up to monitor for recurrence. This case report emphasizes the need for awareness of varied presentations of myxoma and the role of comprehensive cardiac evaluation in symptomatic patients.