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Item Evaluation of Prescription Pattern of Antihypertensives and Its Compliance with Joint National Committee 8 Guidelines in Hospital Setting(Journal of Indian Medical Association, 2024-12) Damania, H; Kolhe, D; Kadam, S; Rajput, J; Devarshi, SP; Shaikh, A; Badani, R.Globally, hypertension is a major noncommunicable disease that contributes to significant fatalities and morbidity. Evaluation of trends in the prescription of antihypertensives and their adherence to the Joint National Commission 8 (JNC 8) recommendations can provide perspective on the dissemination of local and international guidelines in real-world clinical practice. An ambispective observational study was conducted over a duration of 6 months. Among the three- drug combinations, angiotensin receptor blockers (ARB) + beta-blocker (BB) + calcium channel blocker (CCB) (10%), followed by ARB + CCB + diuretic (DU) (8%), were primarily prescribed. BB + diuretic (DU) (20%) was the most prescribed in two-drug combination therapy, followed by ARB + BB (19%). BB (46%) were the most prescribed drugs, followed by diuretics (25%) as monotherapy. Combination therapy is as efficient as single-drug therapy. Among patients with hypertension and heart failure with reduced ejection fraction (HFrEF), the ARNI/ARB combination is effective in HFrEF patients. ARNI/ARB + antihypertensives were most commonly prescribed (40%), followed by ARNI/ ARB + ivabradine + antihypertensives (35%). Adherence to the JNC 8 guidelines varied between 71 and 92%. Ninety-two percent of the prescriptions were adherent to initiating pharmacological treatment in patients aged over 60 years with a BP goal of <140/90, with thiazide/loop diuretics, CCB, and ACEI/ARB as first-line therapy. The pattern of prescribed drugs was in accordance with clinical guidelines. Compliance with JNC 8 guidelines was optimal. However, studies including larger patient populations, drug dosages used, and physician perspectives on prescribing need to be studied further.Item A Study Correlating the Effects of Subclinical Hypothyroidism on the Known Modifiable Risk Factors of Coronary Artery Disease in Indian Adults(Journal of Indian Medical Association, 2024-12) Chowdhury, SR; Mandal, TK; Mukhopadhyay, P.Background: Subclinical hypothyroidism (SCH) is synonymous with thyroid failure (a milder form). It is a condition characterized by normal laboratory ranges of serum FT4 and FT3 levels, but serum thyroid stimulating hormone (TSH) levels are slightly increased above the normal range. Objective: The leading aims and objectives of the study were: (1) establishing a correlation between the presence of modifiable risk factors of ischemic heart disease in subjects with SCH. (2) Quantification of the economic markers of ischemic heart disease in patients with SCH. Methods: This study was accomplished at the Department of Internal Medicine, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, for the duration of 1 year, from March 2020 to February 2021. The study variables included history, physical examination, clinical examination, and investigations. The individuals who met the inclusion criteria set for the study were included. All the participants were informed about the study, and their informed consent was obtained. Data were analyzed using Microsoft Excel spreadsheet, followed by Statistical Package for the Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5. Results: Of the total 80 subjects enrolled in the study, 54 were females and 26 were males. In the study sample, the mean age was 47.8 (+9) years. Different variables were analyzed, and the values obtained were recorded for statistical analysis. Conclusion: According to the study, there is a positive correlation between established coronary artery disease (CAD) risk factors, such as hypertension, abnormal lipid profiles, and elevated body mass index (BMI), and SCH. We also noted a strong correlation between SCH and elevated levels of uric acid, fasting blood sugar (FBS), postprandial glucose test (PPBS), and hemoglobin A1c (HbA1c). As a result, early detection and management of SCH may have cardiac preventive benefits.Item Proposed Algorithm for the Diagnosis and Management of Functional Dyspepsia in India(Journal of Indian Medical Association, 2024-12) Zargar, SA; Mohan, VG; Shankar, RB; Pratap, N; Rai, RR; Goyal, O.Disorders of gut–brain interaction (DGBI), formerly known as functional bowel disorders, encompass a diverse array of conditions and symptoms that may manifest in different parts of the gastrointestinal tract. Some of the most prevalent DGBIs include functional dyspepsia, irritable bowel syndrome, functional constipation, functional diarrhea, and functional bloating and distension. Around 80% of patients with dyspepsia have no identifiable organic cause and are labeled as functional dyspepsia. Globally, functional dyspepsia prevalence ranges from 11 to 30%. In India, physicians encounter 20–40% of patients with functional dyspepsia, with variations attributed to diagnostic criteria and regions. However, Indian clinical guidelines for functional dyspepsia are currently lacking. Fifty gastroenterologists participated in focus group discussions to create an India-specific algorithm for the diagnosis and management of functional dyspepsia. After several national and regional discussions among groups of gastroenterologists across India, an algorithm was finalized for careful and thorough clinical evaluation of patients presenting with chronic dyspeptic symptoms. This guidance document highlights the role of endoscopic evaluation and Helicobacter pylori infection in the diagnosis of functional dyspepsia, along with the role of proton pump inhibitors (PPIs) and prokinetics in its treatment. The experts also reviewed the use of several prokinetics and provided their views on the choice of drugs for varied clinical presentations of functional dyspepsia. Among prokinetics, the experts believed that itopride was the preferred and relatively safer option for the treatment of functional dyspepsia.Item DiSi Survey: Use of Generic DPP4i–SGLT2i Fixed-dose Combinations in Indian Clinical Practice(Journal of Indian Medical Association, 2024-12) Saboo, B; Prajapati, C; Muralidharan, P; Qamra, A.India has a high burden of patients with diabetes mellitus (DM). Challenges to managing type 2 diabetes (T2DM) in India are unique. Indian T2DM patients do not just present with DM alone, but with clustering of cardiovascular (CV) risk factors like hypertension (HTN), dyslipidemia, and obesity. Furthermore, Indian patients also have lesser baseline beta-cell function compared to global reference populations. In India, various cost-effective, generic, fixed-dose combinations (FDC) of dipeptidyl peptidase 4 inhibitors (DPP4i) with sodium-glucose cotransporter 2 inhibitors (SGLT2i) are available for the management of T2DM. However, to the best of our knowledge, scant surveys have studied the clinical practice nuances regarding the use of these FDCs in Indian settings. Hence, we designed and conducted a knowledge, attitude, and practice (KAP) survey to study the attitude and practice of Indian physicians with regard to patient population and placement of generic DPP4i–SGLT2i FDCs. Our survey showed that in India, patients often present with a high baseline HbA1c. From a glycaemic control perspective, DPP4i-SGLT2i FDCs are preferred in treatment-naïve patients with HbA1c >8% and those with HbA1c >8.5% despite metformin monotherapy. Also, 85% physicians observed a reduction in SGLT2i associated GUTIs with use of DPP4i-SGLT2i FDCs or concomitant use of these agents. Part of these survey findings were presented at the American Diabetes Association (ADA) 2024 Congress held in Orlando, Florida.Item Conventional Synthetic Disease-modifying Drugs Remain the Mainstay of Therapy for Rheumatoid Arthritis in India(Journal of Indian Medical Association, 2024-12) Dhir, V; Chiu, SM; Gupta, R; Phillip, SS; Shenoy, P; Taksande, B; Rawal, D; Kumar, K; Singh, G; Kumar, S; Dhuria, S; Manovihar, A; Bhagat, A; Soni, C; Jain, S; Shobha, V.Background: There are limited data on the real-world utilization of disease-modifying antirheumatic drugs (DMARDs) in Indian patients with rheumatoid arthritis (RA). Methods: This was a cross-sectional study of a multicentric observational cohort of RA patients across rheumatology clinics at six centers across India. Patients who met the American College of Rheumatology (ACR) 2010 criteria for RA were included. The demographics, disease-related parameters, and current therapy in terms of DMARDs were analyzed using a structured paper or electronic case record form. Results: This study included 4,061 patients with RA across six centers in India. A majority were female (female-to-male ratio, 6:1), and their mean [standard deviation (SD)] age at the time of enrollment was 51 (12.2) years. Rheumatoid factor and/or anti-CCP were positive in 79 and 77%, respectively. Data on DMARDs were available for 3,550 RA patients. Conventional synthetic DMARDs alone were being used in 3,289 (93%), targeted synthetic DMARDs in 203 (6%), and biological DMARDs in 67 (2%). A total of at least 18 separate types or combinations of DMARDs were being prescribed, with the most common being a combination of methotrexate and hydroxychloroquine (22%), methotrexate monotherapy (17%), and a combination of methotrexate and leflunomide (16%). Overall, the most common DMARD prescribed (as monotherapy or in combination) was methotrexate (86%), followed by hydroxychloroquine (52%) and leflunomide (37%). Conclusion: Cs-DMARDs remain the mainstay in the treatment of Indian patients with RA in this study, with the majority being treated with methotrexate alone or in combination with other DMARDs.Item Unmasking the Perils of Heroin: A Compelling Case Report on Acute Respiratory Distress Syndrome(Journal of Indian Medical Association, 2024-12) Lohar, R; Chaudhari, A; Bohare, SM; Shriwastav, UK; Haldhar, A; Kant, R.This case report discusses an interesting instance of acute respiratory distress syndrome (ARDS) induced by heroin abuse. Heroin, a potent opioid, has been linked to this life-threatening condition. A young man in his early twenties was found unconscious, displaying atypical symptoms such as tachycardia and tachypnea; later he landed up in ARDS. The diagnosis was challenging due to the absence of classical signs of opioid intoxication. The case emphasizes the importance of considering opioid intoxication in patients presented with altered sensorium, tachycardia, and tachypnea, as well as the need for timely consideration of antiopioid treatment along with ARDS management for a successful recovery.Item Peak Inspiratory Flow Rate as a Prerequisite for Prescription of Inhaler Devices: A Cross-sectional Study(Journal of Indian Medical Association, 2024-12) Biswas, S; Karahyla, JK; Singhal, S; Nehra, T; Yadav, A.Inhaler therapy has become the mainstay of treatment in obstructive airway diseases. Although patients, and to a certain extent doctors also, were not initially comfortable with inhalation devices, they have now become the standard of care in chronic obstructive pulmonary disease (COPD) and asthma. However, the choice of inhaler device prescribed in different subsets of patients is still not clear. Prescription of a device depends upon age, dexterity, hand–mouth coordination, and peak inspiratory flow rates (PIFR). Prescription of wrong inhaler and wrong technique is not uncommon. In our study, 52.6% cases had prescription of wrong inhaler device, as per their PIFR. Physicians often do not consider the PIFR and the respiratory effort of the patient, while advising inhaler device. Only 43% patients with asthma had an adequate asthma control [asthma control test (ACT) > 19]. One of the main causes of a general inability to use an inhaler device properly results from the generation of an inadequate PIFR. It is more pronounced in those using dry powder inhalers (DPI), as it requires a higher effort-dependent inspiratory flow rate. PIFR of patients was divided into four groups, ?30, 31–60, 61–90, and >90 L/minute. The required PIFR was taken as 30–60 L/minute for metered dose inhaler (MDI) and >60 L/minute for DPI. A positive correlation was noted for PIFR and advice to change the device as per the readings (p = 0.05). A positive correlation was also noted with PIFR compared to smoking/biomass use (p = 0.002). Thus, clinicians should advise inhalers as per PIFR and also continue to monitor PIFR on subsequent visits.Item Spinocerebellar Ataxia-6 Associated with Sleep Behavior Disorder(Journal of Indian Medical Association, 2024-12) Gitay, A; Dubey, P; Rohatgi, S; Nirhale, S; Rao, P; Naphade, P.Spinocerebellar ataxia (SCA)-1, 2, 3, 6, and 31 are associated with sleep behavior disorder. We had a 66-year-old male who presented with late-onset cerebellar ataxia. Before 2 years, the onset of cerebellar symptoms, he had a history of sleep behavior disorder. He had a strong family history of similar symptoms in his younger sister. Whole exome sequencing of the patient and Sanger sequencing of his sister confirmed the diagnosis of SCA-6.Item To Establish the Utility of Neck Circumference as a Novel and Simple Risk Marker for Detection of Metabolic Syndrome and Cardiometabolic Risk Factors in Indians(Journal of Indian Medical Association, 2024-12) Sahay, N; Acharya, RV; Sahay, K; Sahay, M.Introduction: Waist circumference (WC) is used as a measure of metabolic syndrome (MeS); neck circumference (NC) can predict MeS. It is simpler to measure and may provide an indication of obstructive sleep apnea (OSA). Materials and methods: NC was measured. The mean NC was correlated with the markers of MeS and sleep apnea. Results: A total of 183 participants were recruited in the study. The average age was 48.13 ± 13.3 years in men and 48.09 ± 11.1 years in women. The mean body mass index (BMI) was 26.42 ± 4.69 kg/m 2 in men and 28.25 ± 4.92 kg/m 2 in women. The mean WC in men and women were 91.1 ± 12.92 cm and 90.86 ± 12.7 cm, respectively, while the NC was 38.4 ± 6.60 cm in men and 33.9 ± 2.40 cm in women. MeS was diagnosed in 17.6% of men and 12.7% of women. Sleep apnea was noted in 33.1% of males and 29.2% of females. There was a positive correlation between the NC and systolic blood pressure (SBP) (r = 0.316 in males), fasting blood glucose (FBG) (r = 0.522 in males and 0.263 in females), triglyceride (TG) (r = 0.172 in males; 0.320 in females), while high- density lipoprotein cholesterol (HDL-C) showed a negative correlation in males and females. There was a positive correlation of NC with sleep duration in both males and females (r = 0.346 in males and 0.344 in females). Those with a NC of <35 cm had a sleep score of 7, while those with a NC of >35 cm had a score of 15, showing poor sleep quality. Conclusion: NC was comparable to WC and waist-hip ratio (WHR) for cardiometabolic risk factors and also showed a good association with sleep apnea.Item An Interesting Case of Alcohol-related Myelopathy(Journal of Indian Medical Association, 2024-12) Jose, EM; Thangaraj, M; Shriranjani, SS.The most accurately described causes of alcohol-related myelopathy are cases of hepatic myelopathy, which is myelopathy in the setting of either liver cell failure or portosystemic failure resulting in toxic myelopathy in the absence of liver failure. One of the few descriptions of myelopathy completely attributed to toxic effects of alcohol or its metabolites alone is by Sage et al., who reported five patients with the condition who had no evidence of hepatic involvement, portal hypertension, or nutritional deficiency. We report one of the first cases from India where an alcoholic presented with acute onset myelopathy with sphincter disturbances in the absence of liver cell involvement or portosystemic shunting.Item Gallbladder Polyp—An Incidental Finding of a High-grade B-cell Lymphoma: A Case Report(Journal of Indian Medical Association, 2024-12) Nino, S; La Ossa, MD; Principe, J; Castaneda, I; Pasha, AR; Jose, AM.Introduction and importance: High-grade B-cell lymphoma (HGBCL) is a highly aggressive form of B-cell non-Hodgkin lymphoma. Lymphoma involvement of the gallbladder is rare, with a reported incidence of 0.1–0.2%. Case description: In this report, we introduce the first case of a high-grade lymphoma presented as an asymptomatic gallbladder polyp in a 78-year-old woman. A preoperative computed tomography (CT) scan showed findings consistent with a possible mass-like lesion measuring 10 × 10 mm adjacent to the gallbladder and a cirrhotic liver. According to those findings, the decision was made to perform a laparoscopic cholecystectomy with an intraoperative cholangiogram. Histological examination of the excised mass showed a neoplastic proliferation of lymphocytes consistent with HGBCL. Discussion: This rare entity can present as common symptomatic cholecystitis or an asymptomatic mass with insidious growth. In this case, it was an incidental finding on imaging, which leads us to emphasize the importance of imaging studies as the first approach in the diagnosis of this uncommon extranodal lymphoma located within the gallbladder. Surgical excision with subsequent histopathological evaluation is the gold standard for a correct and prompt diagnosis. Conclusion: Gallbladder lymphoma is a rare condition with a challenging diagnosis. Although the prognosis is favorable in most cases, chemotherapy or radiotherapy may be necessary for remission of the disease.Item Bilateral Thoracic Herpes Zoster in a 62-year-old Immunocompetent Woman(Journal of Indian Medical Association, 2024-12) Koul, HP.Herpes zoster (HZ), caused by the reactivation of varicella-zoster virus (VZV), typically presents as a unilateral dermatomal erythematous vesicular rash. Bilateral HZ is rare and usually associated with immunocompromise. We report the case of a 62-year-old female with no evident immunocompromise who developed bilateral thoracic HZ. The patient was treated with antivirals and pain medications. Our case highlights the rarity of bilateral HZ and its implications for diagnosis and management. We also review the literature on bilateral HZ in the English literature.Item Syringomyelia Mimicking as Bibrachial Variant of Motor Neuron Disease(Journal of Indian Medical Association, 2024-12) Ralot, T; Jatav, VS; Karimji, S; Sharma, V.Introduction: Syringomyelia is a slowly progressive degenerative disorder of the spinal cord. Clinical features of syringomyelia vary from weakness in limbs to positive sensory symptoms and dissociative sensory loss. Thus, early and prompt diagnosis becomes crucial for reducing the morbidity associated with the disease. Case description: Here, we present a case of 52-year-old male presenting with progressive weakness in bilateral upper limbs without any sensory involvement which is an atypical presentation for syringomyelia. Conclusion: Motor neuron disease (MND) like presentation in syringomyelia is a rare entity. This can make diagnosis of syringomyelia difficult. Hence, any patient presenting with pure motor weakness of bilateral upper limb should also be suspected of syringomyelia.Item Unveiling the Enigma: A Peculiar Encounter of Concurrent Anti-N-methyl-D-aspartate Receptor and Anti-Hu Antibody Positive Paraneoplastic Syndrome in Small Cell Lung Cancer(Journal of Indian Medical Association, 2024-12) Rajan, A; Sengupta, A.Paraneoplastic neurological syndromes (PNS) are mostly immune-mediated, tumor-associated disorders. Earlier the 2004 PNS criteria were used which are now partially outdated due to advances in PNS research and also identification of new phenotypes and antibodies that have transformed the diagnostic approach to PNS; hence, a new criterion was proposed in 2016. They can have multifarious presentations, ranging from behavioral abnormalities to altered sensorium and coma. They can precede, be synchronous with, or follow the diagnosis of malignancy. Treatment depends on the underlying antibody and malignancy. We hereby describe an unusual presentation with dual antibody positivity in a patient who was diagnosed with lung cancer in a hospital in the same presentation.Item Nutcracker Syndrome and its Exceptional Occurrence with Pulmonary Tuberculosis: A Case Report(Journal of Indian Medical Association, 2024-12) Jelia, SC; Ajmera, D; Airan, D; Meena, Y; Bairwa, R.Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome, is a condition resulting due to compression of LRV between the aorta and superior mesenteric artery (SMA), with dilatation of the distal portion of LRV. We present a case of an elderly female presenting with left lumbar pain for 1 year. Initial investigations revealed microscopic hematuria and mild ascites. Further investigations revealed compression of LRV between the aorta and SMA, with aorto- SMA angle reduced up to 12°, suggesting a diagnosis of NCS. Along with this, cystic bronchiectasis with multiple centrilobular nodules with tree-in-bud pattern was seen in bilateral lung fields, suggestive of pulmonary tuberculosis. Ziehl–Neelsen (ZN) staining and cartridge-based nucleic acid amplification test (CBNAAT) confirmed our diagnosis of NCS with pulmonary tuberculosis.Item The Vanishing Infarct: A Rare Presentation of MERS Due to Salmonella Infection in Middle-Aged Patient(Journal of Indian Medical Association, 2024-12) Lakhpatia, P; Revankar, V; Kelkar, S; Chincholkar, S; Dalal, K; Kadam, N; Jadhav, R.Enteric fever is caused by Salmonella typhi and Salmonella paratyphi A and B, which can present clinically with variety of symptoms. We report a case of a middle-aged gentleman with salmonella infection who developed reversible corpus callosum splenium infarcts, which is an unusual presentation of enteric fever. The condition was reversed with antibiotics routinely used to treat enteric fever in the country.Item Multiorgan Involvement: Is There a Relevant Pathogenetic Link?(Journal of Indian Medical Association, 2024-12) Rajapandian, J; Shanjitha, J; Thangavelu, S.Multisystem autoimmune disorders have different presenting symptoms with organ involvement phased over numerous years. We have a 56-year-old homemaker who is a known case of Graves’ disease—post-thyroidectomy performed 20 years ago—and developed a volume overload state with exertional dyspnea for a period of 1.5 years. She was evaluated elsewhere and diagnosed with pulmonary arterial hypertension (PAH), the cause of which had not been established at the time. She presented to us with progressive dyspnea and abdominal distension of 1-week duration. A further diagnosis of biopsy-proven autoimmune hepatitis, chronic parenchymal liver disease (CLD), and noninfiltrative restrictive cardiomyopathy (RCM) was made. At follow-up, the patient complained of thickening and dryness of skin with similar antinuclear antibody (ANA) profile results 6 months apart. In the background of immune-mediated organ manifestations and laboratory picture, systemic sclerosis was diagnosed. This case report highlights that one should have a high index of suspicion while dealing with subsequent autoimmune manifestations of isolated organs as they might be part of a multisystem autoimmune disorder.Item Barriers and Facilitators in the Use of Selected Point-of-care Diagnostics in Indian Public Health Programs(Journal of Indian Medical Association, 2024-12) Varghese, T; Abraham, D; P, BS; Kang, G.Background: Comprehensive reviews on the use and utility of point-of-care tests (POCs) in public health programs in relation to infectious disease and nutrition are limited. Point-of-care technologies have potential to improve the management of infectious diseases particularly in settings where healthcare infrastructure and timely access to quality medical care are limited. Methods: We aim to describe POC tests currently used or under evaluation in the Indian national programs for communicable diseases and nutrition, and to identify the barriers and facilitators. Scoping review methodology was followed to search databases such as MEDLINE, EPPI (evidence for policy and practice information), CINAHL (Cumulative Index to Nursing and Allied Health Literature), JBI Evidence Synthesis, and Google Scholar. Descriptive statistics were applied to identify the utility, barriers, and facilitators of POCs in context of Indian public health program from patients’ and physicians’ perspectives. Conclusion: Rapid results, appropriate case management, and accuracy of testing in remote areas are perceived to be the major benefits of using POCs. Lack of awareness about POCs and lack of regulations leading to spurious products on the market are obstacles to their optimal use.Item Current Update on Promising New Anti-Alzheimer’s Drugs in Different Phases of Clinical Development: Where Exactly Are We Lacking?(Journal of Indian Medical Association, 2024-12) Sharma, PK; Yadav, M; Mehta, N.The prevalence of Alzheimer’s disease (AD) is rising with an aging population worldwide and is expected to surpass 130 million by 2050. India is no exception, but the true prevalence data on AD is not conclusive. By 2050, India will have almost 15% of the population aged 60 years or above. It is the need of the hour to have newer and more effective agents that can address various therapeutic needs of Alzheimer’s viz., halt or delay disease progression, and offer better improvement in symptomatology. The most desirable would be to have an intervention that can prevent AD onset. The prime focus of the present review is to introduce to the readers the promising drug candidates across the world. We reviewed all the information available to us through a literature search. It is quite apparent that the developmental efforts are concentrated not only on disease-modifying therapies that can prevent the development but also on palliative therapies that improve the quality of life of AD patients. Several approaches including biological and small molecules are being explored to tap their potential in AD therapeutics using sound scientific research principles and execution. Besides conventional development approaches, the drug repurposing strategy has emerged as quick, cost-effective, and less risky and is being exploited to the fullest. The drugs in the pipeline and undergoing various phases of clinical trials for the past 5 years are taken from the ClinicalTrials.gov registry. It remains to be seen the advent of a successful disease-modifying agent for AD in future.Item Importance of Urine Culture and Antibiotic Sensitivity for Improving Clinicians’ Choice in Treating Urinary Tract Infections(Journal of Indian Medical Association, 2024-12) Mannari, JG; Kanjariya, G; Shah, MK; Modi, C; Ganjiwale, J.Background: The local antibiogram is essential to prevent the development of multidrug-resistant organisms. The aim of the study was to find out the synchronization of empirical antibiotics with the sensitivity pattern of the urine culture report and to study the differences in the organisms and sensitivity patterns in urinary tract infection (UTI) with and without other comorbidities. Materials and methods: UTI, diagnosed by a positive urine culture report of 300 consecutive patients above the age of 18, was studied retrospectively. The data were processed using the statistical software STATA 14. Results: Out of 300 patients, 58.3% were females. The mean [standard deviation (SD)] age was 54.19 (19.06) years. The most common associated comorbidity was diabetes mellitus (DM) (34.7%). Lower urinary tract symptoms (LUTS) were the most common presenting symptom, followed by dysuria and fever. The most common organism was Escherichia coli in both nondiabetic and diabetic patients (67.3% and 60.6%). Comparing diabetics and nondiabetics, recurrent UTI (15.4 vs 5.1%), infection with extended-spectrum beta-lactamase (ESBL) organisms (67.3 vs 51.5%), and prolonged hospitalization (75 vs 61.2%) were observed more in diabetics. The most common empirical antibiotic chosen was cefoperazone-sulbactam in the diabetic group and levofloxacin in the nondiabetic group. Empirical antibiotics in diabetics matched with the sensitivity in 57.1% of ESBL cases and 47% of non-ESBL cases, while in nondiabetics, this alignment was 40.5% in ESBL cases and 61% in non-ESBL cases. Resistance to oral fluoroquinolone, cotrimoxazole, and nitrofurantoin was 78, 59.3, and 39.6%, respectively, while resistance to meropenem and amikacin was 35.6 and 25.6%. Conclusion: The increasing prevalence of ESBL-positive strains and rising resistance to common antimicrobial drugs raise concerns for future therapeutic options.