The Journal of the Association of Physicians of India最新文献

Background: Following the outbreak of coronavirus in Wuhan, China in 2019, there has been multiple waves of different variants of COVID-19 throughout the world in the continuum of a pandemic. This study aims to compare different clinical and laboratory parameters of hospitalized patients in Omicron-driven 3rd wave vs Delta-driven 2nd wave in India. Materials and methods: This was a retrospective cross-sectional observational study that was done in the Department of General Medicine, Mahatma Gandhi Hospital, Dr S N Medical College, Jodhpur (Rajasthan). It included 100 patients of 3rd wave and 2nd wave respectively who were hospitalized. The primary outcome of the study was patient's survival and condition at discharge and secondary outcomes included length of hospital stay and mode of oxygenation. Results: The presence of cough, shortness of breath, and loss of taste are more common symptoms in 2nd wave vs 3rd wave with p-value being 0.0002, 0.004, and < 0.0001 respectively. The severity of illness, need for intensive care unit (ICU), and outcome in terms of discharge with oxygen or without oxygen were also statistically significant in the 2nd wave vs 3rd wave with p-value being < 0.0001 for all three variables. A total of 67% of patients were vaccinated in 3rd wave group compared to 11% in 2nd wave group (p-value < 0.0001). Comparison of laboratory parameters also revealed statistically significant results with D-dimer, quantitative C-reactive protein (CRP), normal (NL) ratio, and serum lactate being more deranged in the 2nd wave compared to the 3rd wave with p-value being < 0.05. Comparison of involvement of lung parenchyma based on computed tomography (CT) severity score revealed p-value < 0.0001 that is statistically relevant. Conclusion: Omicron-driven 3rd wave was associated with significantly less severity, less inflammatory response, and better outcome compared to Delta-driven 2nd wave. More vaccination and probably less intrinsic virulence during 3rd wave has a major role in the better outcome.

Balancing the risks of ischemic and bleeding events in patients who have undergone coronary angioplasty with drug-eluting stents (DES) is a delicate task. Individuals recovering from myocardial infarction are at increased risk of recurrent ischemic events, highlighting the potential benefits of rigorous secondary prevention measures.¹ Dual antiplatelet therapy (DAPT), combining aspirin with P2Y12 inhibitors such as clopidogrel or ticagrelor, forms the cornerstone of post-percutaneous coronary intervention (PCI) care aimed at preventing stent thrombosis and lowering the risk of ischemic events. Current medical guidelines recommend a 6-month duration of DAPT for stable coronary disease and 12 months for acute coronary syndrome (ACS).

Background: Common cold is a highly prevalent acute upper respiratory tract infection (URTI) leading to at least 4-6 episodes in adults annually. Persistent common cold infections can have a significant economic impact. Very few studies assess the efficacy of fixed-dose combination (FDC) therapies for the symptomatic treatment of common cold in Indian adults. This study assesses the efficacy and safety of FDC of paracetamol 500 mg, phenylephrine 10 mg, and chlorpheniramine maleate 2 mg for treating Indian adults with common cold symptoms. Methods: A total of 420 patients aged between 18 and 65 years were recruited for this study. Patients were evaluated for efficacy and safety using an FDC of paracetamol 500 mg, phenylephrine 10 mg, and chlorpheniramine maleate 2 mg per tablet. The study duration was 5 days, and the patients had to visit the clinical trial site for the baseline visit on the 1st day, the reevaluation visit on the 3rd day, and the conclusion visit on the 5th day. Efficacy was measured by total symptom score (TSS), and safety assessments were made using adverse events reported by patients. Results: A total of 318 out of 420 patients completed the study. On the first visit, the mean TSS was 9.016, which reduced to 5.011 and 0.495 on the second and third visits, respectively. By the third visit, 268 (84.276%) patients had no symptoms of common cold. The one-way ANOVA test showed a statistically significant reduction in TSS from the 1st to the 5th day of treatment (p < 0.0001). Additionally, there were no severe adverse drug reactions reported during the study; only 13 nonserious adverse events were reported, including hyperacidity and drowsiness. Conclusion: The FDC of paracetamol 500 mg, phenylephrine 10 mg, and chlorpheniramine maleate 2 mg was efficacious and safe for symptomatic treatment of common cold in adults.

Introduction: Globally, besides being the second largest consumer of tobacco, India is also the second largest tobacco producer. There are very few studies that give data on economic burden of tobacco consumption. We estimated the prevalence of tobacco consumption along with monthly expenditure for the same among adult males. Methodology: A community-based cross-sectional study was conducted among males aged ≥18 years residing in an urban area of Raipur city. Simple random sampling technique was applied and a total of 292 adult males participated in the study. Analysis was done on Statistical software package (STATA) software version 12. Results: The mean age [standard deviation (SD)] was 41 (13) years. The prevalence of tobacco consumption (smoke and/or smokeless) was 73.6%, where use of smokeless tobacco was 60.6% and use of smoke tobacco was 33.6%. Beedi was the most common type of smoke used (11%), followed by a mix of cigarette and beedi (10.4%). Among occasional smokers, mean (SD) number of days of occasional smoking in a month was 7.8 (5.1) whereas among smokeless tobacco users, nearly 83% use them daily with 2-5 times in a day (66%). Nearly 67% of them had seen someone smoking and/or chewing tobacco in public places in the last 7 days. Mean [interquartile range (IQR)] monthly expenditure on tobacco products among study participants was INR 367 (0-355). Mean (IQR) monthly expenditure on smoking tobacco products and smokeless tobacco products was INR 244 (0-150) and INR 123 (0-225), respectively. Conclusion: This study gives insight to both consumer prospects about how much money they are spending on something that is going to harm in future (health problems due to tobacco use) and also to the policymakers of tobacco control programs to implement stringent rules on tobacco sale.

Corneille Heymans (1892-1968) was born in 1892 in Ghent, Belgium. Heymans received his doctor's degree in 1920 from the University of Ghent. He studied physiology in Paris, Lausanne, Vienna, and London under EH Starling and in the United States after graduation. He took up a lectureship in pharmacodynamics at the University of Ghent (1922) and was promoted to professor of pharmacology (1930).

Background: The prevalence of hypertension is on the rise, with approximately 200 million individuals affected by this condition in India. Epidemiological studies suggest that one in every three adults in India has hypertension. Fixed-dose combinations (FDCs) present a potential strategy to address the challenge of effective blood pressure control. They are now recommended for the initiation in most hypertensive patients by the guidelines. However, studies evaluating the safety and effectiveness of FDCs in large Indian populations with hypertension are few. Aim: The aim of this real-world study is to evaluate the safety and effectiveness of the fixed-dose combination of telmisartan and amlodipine in managing hypertension in Indian patients. Materials and methods: This prospective, multicenter, observational, real-world evidence study is designed to enroll 10,000 eligible participants from 1,000 study sites across India. Adult patients with newly diagnosed or uncontrolled hypertension on monotherapy would be eligible for enrollment in the study. The study participants would be administered the study treatment per the treating physician's routine clinical practice and followed up after 8 weeks. The primary endpoint is to measure the change in systolic blood pressure (SBP) from baseline to week 8, while secondary endpoints include determining the percentage of patients who reach their blood pressure targets., description of demographic characteristics of the Indian hypertensive population, and reporting of safety outcomes. Conclusion: The TACT India study will provide longitudinal, real-world data on the effectiveness and safety of telmisartan and amlodipine FDC among a large cohort of the Indian population with hypertension.

Introduction: This real-life observational study from a diabetes centre in Western India reports the status of A1C (glycated hemoglobin), blood pressure, and cholesterol levels (ABC goals) currently achieved in type 2 diabetic patients. Research design and methods: A cohort of 497 patients of type 2 diabetes first seen at the Diabetes Endocrine Nutrition Management and Research Centre from the years 2014 to 2017 were followed for a median [interquartile range (IQR)] duration of 21.5 (7, 33) months. A minimum of two follow-up clinical evaluations and investigations were analyzed. Results: Hemoglobin A1C (HbA1c) dropped significantly in the whole cohort (HbA1c, Percent: initial 9.0 ± 1.98, follow-up 7.66 ± 1.73; p < 0.0001). Increasing duration of diabetes showed a significantly poorer achievement of HbA1c targets on follow-up (HbA1c 0-5 years vs 5.1-10 years and >10 years, p < 0.001). Pretreatment HbA1c of <6, 6.1-7, 7.1-7.5, 7.6-8, 8.1-9, and >9% was seen in 2, 15, 11, 8, 20, and 44%, respectively. The corresponding HbA1c values on follow-up were 5, 30, 14, 11, 17, and 23%, respectively. Sodium-glucose transport protein 2 inhibitor (SGLT2i) group was in poorer control (HbA1c 8.20 ± 1.71) at follow-up than non-SGLT2i group (HbA1c 7.55 ± 1.72), p < 0.001) probably due to significantly greater use of sulphonylurea as background therapy in SGLT2i group (SGLT2i group 72.2%, non-SGLT2i group 58.7%, p < 0.02). Initial ABC targets were at goal for HbA1c, high blood pressure, and low-density lipoprotein (LDL) cholesterol in 17, 40, and 33% of patients, respectively. On follow-up, percent of patients at goal were HbA1c 35%, hypertension 95.77%, and LDL cholesterol 75.85%. Conclusion: The study brings out the difficulties in achieving HbA1c goals as compared to blood pressure and LDL cholesterol goals. Additionally, it brings out the efficacy of sulphonylureas as a treatment modality. Longer duration of diabetes resulted in lower achievement of glycemic targets.

Background: Topiroxostat, a selective xanthine oxidase inhibitor, effectively reduces serum urate levels in hyperuricemia patients with or without gout. The present narrative review aims to evaluate the existing evidence regarding the effectiveness of topiroxostat on renal function in patients with and without kidney disease. Materials and methods: A systematic search was conducted to identify relevant studies on renal function and topiroxostat published between 2005 and 2023. Various electronic databases were searched using different combinations of medical subject headings (MeSH) terms, and cross-referencing was performed. A total of 3146 articles were retrieved, and 18 met the inclusion and exclusion criteria. Results: The review included 18 studies investigating the effectiveness of topiroxostat on renal function in patients with and without kidney disease. Topiroxostat demonstrated maintenance of renal function, as evidenced by stable levels of estimated glomerular filtration rate (eGFR), serum creatinine, urinary albumin, and urinary protein. Furthermore, topiroxostat led to improvements in renal function, including increased eGFR and decreased levels of urinary albumin, uric acid, urinary protein, urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), and liver-type fatty acid-binding protein (L-FABP) following treatment. The literature also supports the safety profile of topiroxostat. Conclusion: Topiroxostat shows promise as an efficient and safe renoprotective agent in patients, irrespective of renal disease status. However, further large-scale, long-term, and multicenter clinical studies are needed to generate high-quality evidence in different populations and settings.

The medical community recently endured a heartbreaking tragedy with the brutal rape and murder of a young medical student in Kolkata. The tragic event at R G Kar Medical College in Kolkata is particularly distressing. While the reasons behind it may be complex-whether linked to a drug racket, a personal vendetta, or even the accused's questionable history as a womanizer and porn addict-the fact remains that justice appears elusive. There is a troubling sense that evidence has been tampered with and political influence is shielding the guilty. It's time for society to awaken. She could have been anyone's daughter. How can a woman be treated this way, especially in a country like India, where it is said, "यत्र नार्यस्तु पूज्यन्ते रमन्ते तत्र देवताः" ("where women are honored, divinity blossoms")? This incident painfully reminds us of the disrobing of Draupadi in the Mahabharata. In that moment of distress, Lord Krishna intervened to save her.

We read with interest the article "Samajdar SS, Mukherjee S, Gupta S, et al. Effect of α-blockers on handgrip test response of diastolic blood pressure in hypertensive, benign hypertrophy of prostate patients in a therapeutics clinic, Kolkata: a cross-sectional study. J Assoc Physicians India 2024;72(4):21-23."¹.