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

{"title":"Echocardiographic Manifestations in Chronic Obstructive Pulmonary Disease Patients with a History of Chronic Smoking: A Cross-sectional Study.","authors":"Anshul Kumar Mittal, Yogita Singh, Pavneet Kaur Soni, Santosh Mittal, Dheeraj Soni","doi":"10.59556/japi.74.1688","DOIUrl":"https://doi.org/10.59556/japi.74.1688","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the clinical profile and its association with spirometry and two-dimensional (2D) echocardiographic findings in patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methodology: </strong>A cross-sectional study was carried out at LLRM Medical College, Meerut, which included 144 COPD patients over 40 years of age, selected after informed consent and ethical approval. Patients with other respiratory or cardiac diseases, immunocompromised status, or poor echocardiographic imaging were excluded. Each participant underwent clinical evaluation, which included a history of respiratory symptoms and comorbidities, along with comprehensive investigations such as blood tests, spirometry, chest X-ray, sputum analysis, electrocardiography (ECG), arterial blood gases, and 2D echocardiography. Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 29. A <i>p</i>-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The data reveal that most COPD patients fall into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3 (severe), with a significant number also in stage 2 (moderate), indicating a high prevalence of advanced disease. COPD predominantly affects individuals over 50, with peak occurrence in the 60-69 age-group. Disease duration increases with severity, ranging from 2.38 years in stage 1 to 16.74 years in stage 4, showing a clear link between duration and progression. ECG abnormalities such as P-pulmonale, right ventricular hypertrophy (RVH), arrhythmias, and low QRS voltage were more frequent in severe stages, especially stage 3, highlighting the cardiovascular burden in advanced COPD. Echocardiographic findings, including pulmonary hypertension, right atrial enlargement, right ventricular dysfunction, and tricuspid regurgitation, showed significant association with disease severity (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>This study demonstrates a strong link between COPD severity and cardiovascular complications, especially right heart involvement. Significant associations between GOLD stages and 2D echocardiographic findings highlight the importance of routine cardiac screening in COPD patients. Pulmonary hypertension, right ventricular dysfunction, and tricuspid regurgitation were the most common complications, underscoring the need for close monitoring and targeted treatment. Early intervention and integrated cardiac evaluation in COPD management can help prevent right heart failure and improve patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"63-66"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotics in Heart Failure: A Narrative Review.","authors":"Taranpreet Kaur, Ritu, Pranus Kohli, Sumeet Angral, Boudhayan Das Munshi, Kirandeep Kaur","doi":"10.59556/japi.74.1702","DOIUrl":"https://doi.org/10.59556/japi.74.1702","url":null,"abstract":"<p><strong>Abstract: </strong>Infections commonly cause acute decompensation and poor outcomes in heart failure (HF), a major global health burden. Patients with heart failure are particularly vulnerable to infections related to the respiratory, urinary, skin, and devices because of systemic inflammation, immune dysfunction, changes in the gut barrier, and repeated exposure to healthcare facilities. The use of empirical antibiotics without confirmation due to overlapping symptoms between infection and heart failure is frequently associated with extended hospital stays, drug toxicity, and antibiotic resistance. While early targeted therapy improves outcomes in confirmed infections, evidence points to limited benefit and possible harm from unnecessary antibiotics. To maximize management in this susceptible population, careful diagnostic evaluation, stewardship, and customized prescribing are crucial.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"93-97"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Clinical Outcome in Dengue Fever: A Retrospective Cohort Modeling Study.","authors":"Santosh Kumar Singh, Suman Kumar, Sreejith Prathapachandran Vanajakumari, Mehek Khanuja, Sandeep Kumar, Parikshit Singh Chauhan, Shivank Kumar, Abhishek Kumar","doi":"10.59556/japi.74.1712","DOIUrl":"https://doi.org/10.59556/japi.74.1712","url":null,"abstract":"<p><strong>Background: </strong>Dengue fever demonstrates a broad spectrum of clinical severity, ranging from self-limiting illness to life-threatening complications. Early identification of patients at risk of progression remains a clinical challenge, particularly in high-burden settings. Although platelet count and World Health Organization (WHO) dengue classification are routinely used in clinical practice, reliance on individual parameters may not adequately capture the multifactorial nature of disease severity. Development of multivariable predictive models integrating clinical and laboratory markers available at admission may improve early risk stratification and support evidence-based triage decisions.</p><p><strong>Methods: </strong>This retrospective predictive analysis included 667 consecutively hospitalized patients with laboratory-confirmed dengue infection. This retrospective cohort study was conducted in a tertiary care teaching hospital in Western Maharashtra over a 1.5-year period. Data were extracted from hospital records of patients evaluated during their admission period. An ordinal logistic regression model was developed to predict clinical outcome. Internal validation was performed using bootstrap resampling.</p><p><strong>Results: </strong>Of 667 patients, 585 (87.7%) had uncomplicated recovery, 69 (10.3%) had complicated recovery, and 13 (1.9%) had adverse outcomes. WHO classification, platelet count, neutrophil-to-lymphocyte ratio (NLR), and warning sign count at admission independently predicted clinical outcome, with an optimism-corrected C-index of 0.820.</p><p><strong>Conclusion: </strong>Admission WHO classification, platelet count, NLR, and warning signs enable accurate early prediction of dengue severity and may assist in triage and monitoring decisions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of a Model-based HbA2 Prediction for Low-cost Screening of β-thalassemia Trait Using Blood-derived Indices: Opportunities and Challenges.","authors":"Ramadevi Peraka, Pradeep Kumar Reddy M, Vanajakshi S, Sumedha Avadhanam, Manimekhala Parsa, Aditya Koppula","doi":"10.59556/japi.74.1706","DOIUrl":"https://doi.org/10.59556/japi.74.1706","url":null,"abstract":"<p><strong>Background: </strong>β-thalassemia trait (β-TT) is a common genetic condition with significant public health implications, particularly in regions with high prevalence. Diagnosis conventionally relies on HbA2 quantification using high-performance liquid chromatography or Hemoglobin electrophoresis, which are costly and inaccessible in resource-limited settings. Developing low-cost screening/triage tools is therefore essential.</p><p><strong>Materials and methods: </strong>A retrospective single-center cross-sectional study was conducted at the Department of Pathology, Apollo Institute of Medical Sciences & Research, Hyderabad, between February 2023 and December 2025. Data from 129 patients with complete blood counts, iron profiles, and HbA2 measurements were analyzed. LASSO method was applied to identify salient predictors of HbA2 from demographic, hematological, and iron parameters. Two ordinary least squares regression models (OLS) were constructed: one excluding iron parameters (model 1) and another incorporating iron parameters (model 2). LASSO-then-OLS approach was used for both 5-fold cross-validation and final model development. ROC analysis was also done.</p><p><strong>Results: </strong>Of the 129 patients, 15 (11.6%) had β-TT (HbA2 >3.5%). The 5-fold cross-validation found lower root mean squared error (RMSE) and superior variable selection stability with an iron parameter-inclusive model. Salient predictors in the final model were age, RBC count, MCV, and RDW-CV in model 1, while model 2 additionally included serum ferritin, transferrin saturation, and total iron binding capacity (TIBC). Age and RBC count were positively associated with HbA2, while MCV, RDW-CV, serum ferritin, and TIBC were negatively associated. Model 1 explained 40% of HbA2 variance, while model 2 explained 47% variance. Model imprecision was more pronounced for β-TT cases. ROC analysis showed an area under the curve (AUC) value of 0.868 (0.766-0.969) for model 1 and 0.904 (0.829-0.98) for model 2. Optimal cutoff (3.31% from model 1 and 3.26% from model 2) for β-TT detection was lower than the conventional threshold.</p><p><strong>Conclusion: </strong>Regression-based machine learning models have the potential to estimate HbA2 using routine blood indices, offering a cost-effective screening/triage before specialized assays. Such models are particularly valuable in populations with prevalent iron deficiency anemia (serum ferritin <12 ng/ml), where fixed HbA2 cutoffs are unreliable. Larger studies incorporating peripheral smear image analysis are needed to improve the predictive accuracy of models before they can be deployed clinically.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone Usage Sleep Quality and Behavioral Health in Adolescents: A Cross-sectional Study from Eastern India.","authors":"Rupak Chatterjee, Subhajit Dey Sarkar, Shatavisa Mukherjee, Nandini Chatterjee","doi":"10.59556/japi.74.1618","DOIUrl":"https://doi.org/10.59556/japi.74.1618","url":null,"abstract":"<p><strong>Background: </strong>Widespread smartphone use has raised concerns regarding its effects on adolescent health, particularly sleep quality and behavioral outcomes. The associations between smartphone usage patterns, sleep disturbances, and markers of obesity and vision health have yet to be systematically evaluated in India.</p><p><strong>Objectives: </strong>To assess the prevalence of smartphone usage, bedtime usage patterns, and their association with sleep quality, overweight status, and visual acuity among adolescents in Eastern India.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 140 adolescents aged 13-19 years attending urban and rural schools in Eastern India. Participants completed a structured questionnaire covering demographics, daily and bedtime smartphone use, and sleep quality. Sleep quality was assessed using a modified Pittsburgh Sleep Quality Index (PSQI), and smartphone addiction was estimated using behavioral proxies. Chi-square tests were employed to assess associations, and logistic regression was used to identify predictors of poor sleep quality.</p><p><strong>Results: </strong>The mean age of participants was 16.8 ± 1.9 years, with 55% male participants and 70% from urban areas. Smartphone usage at bedtime was reported by 89.3% of participants, and 42.1% reported poor sleep quality. Longer bedtime smartphone use (>30 minutes) was significantly associated with poor sleep quality (<i>χ</i>² = 42.5, <i>p</i> < 0.001). Daily usage exceeding 2 hours was significantly associated with overweight status (<i>χ</i>² = 21.9, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>A high prevalence of bedtime smartphone use among adolescents in Eastern India is significantly associated with poor sleep quality. Excessive daily smartphone use is also linked with overweight status. Public health strategies should include digital hygiene awareness and school-based interventions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"72-76"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common Cold-An Update.","authors":"Prasanta Raghab Mohapatra, Baijayantimala Mishra","doi":"10.59556/japi.74.1613","DOIUrl":"https://doi.org/10.59556/japi.74.1613","url":null,"abstract":"<p><strong>Abstract: </strong>The common cold, a mild yet highly prevalent upper respiratory tract infection (URTI), imposes a substantial societal and economic burden through healthcare costs, lost productivity, and widespread morbidity. Primarily caused by diverse respiratory viruses (e.g., rhinoviruses, coronaviruses), it encompasses a spectrum of acute infections affecting the nasal passages, throat, larynx, and bronchi, manifesting as rhinitis, pharyngitis, or bronchitis. Framed by the \"iceberg concept\" of disease, most cases are mild or asymptomatic, yet severe outcomes (e.g., exacerbations of chronic conditions) contribute to rare mortality. Management focuses on symptom relief: decongestants and antihistamines alleviate nasal congestion and cough in adults, though cough suppressants are discouraged in children. Despite its self-limiting nature, the common cold underscores challenges in primary care due to viral diversity and a lack of targeted therapies. Annual influenza vaccination, while not preventing colds, mitigates flu-related complications, indirectly reducing overlapping URTI burdens. Public health strategies emphasizing prevention, symptom management, and judicious antibiotic use remain critical to curbing its widespread impact.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Gastroesophageal Reflux Disease among Postgraduate Medical Students in North India: A Cross-sectional Study.","authors":"Divyanshi Chauhan, Shweta Mangal, Ashok Kumar, Disha Mangal","doi":"10.59556/japi.74.1701","DOIUrl":"https://doi.org/10.59556/japi.74.1701","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gastroesophageal reflux disease (GERD) is a persistent state due to the retrograde flow of acidic gastric contents, leading to symptoms such as heartburn, regurgitation, chest pain, and dysphagia. Postgraduate medical students are exposed to high stress and lifestyle factors that predispose them to gastrointestinal symptoms. Limited Indian data exist on GERD prevalence in this cohort.</p><p><strong>Materials and methods: </strong>A questionnaire-based cross-sectional study was conducted using the GERD-Q tool. Data were collected <i>via</i> an online Google Form and analyzed using Microsoft Excel. The Chi-square statistical test and univariate analysis were performed to identify associations between GERD and variables.</p><p><strong>Results: </strong>Among 324 participants (mean age, 28.1 years), 77.4% were aged 25-30 years; 52.5% were male. Most were hostellers or paying guests. GERD prevalence was 25.3%. The prevalence was higher among males (27.6%) compared with females (22.7%) and among participants with higher BMI (27.6%) compared with those with normal BMI (23.5%). GERD prevalence was highest among postgraduates in medicine and allied specialties (31.3%), followed by surgical (23.3%) and preclinical/paraclinical departments (19.2%).</p><p><strong>Conclusion: </strong>This study highlights a significant burden of GERD among postgraduate medical students. Identifying associated risk factors may help in designing targeted interventions to improve gastrointestinal health and overall well-being of healthcare providers.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"48-52"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Cyclosporine and Eltrombopag in Acquired Aplastic Anemia: Experience from a Tertiary Care Center in Eastern India.","authors":"Shuvraneel Baul, Abhishek Sharma, Kaustav Ghosh, Subhra Kamal Saha, Tuphan Kanti Dolai","doi":"10.59556/japi.74.1689","DOIUrl":"10.59556/japi.74.1689","url":null,"abstract":"<p><strong>Introduction: </strong>Acquired aplastic anemia (AAA) is an immune-mediated bone marrow failure syndrome traditionally treated with antithymocyte globulin (ATG)-based immunosuppressive therapy. However, many patients-particularly older adults and those with significant comorbidities-are unable to tolerate ATG. The combination of cyclosporine (CSA) and eltrombopag (EPAG) without ATG has emerged as a potential alternative, though real-world data from India remain limited.</p><p><strong>Materials and methods: </strong>This single-center, retrospective observational study included consecutive adult patients (<i>n</i> = 40; ≥18 years) with severe or very severe AAA treated with CSA and EPAG without ATG between January 2020 and December 2025, study ends December 2025. Patients had contraindications to ATG due to age and/or comorbidities. Hematologic responses were assessed at 3-6 months. Overall response rate (ORR) was defined as complete plus partial response. Safety was evaluated using CTCAE v5.0 criteria.</p><p><strong>Results: </strong>The median age was 56.5 years, with 72.5% having severe and 27.5% very severe AAA. At 6 months, complete response was observed in 17.5% and partial response in 45%, yielding an ORR of 62.5%. Notable improvements were observed in hemoglobin, absolute neutrophil count, and platelet count (all <i>p</i> < 0.001). Younger age (≤60 years), fewer comorbidities (≤1), higher baseline blood counts, and severe (vs very severe) disease were significantly associated with response. Treatment was well tolerated; hepatic adverse events were mild (grade ≤2), transient, and did not necessitate treatment discontinuation.</p><p><strong>Conclusion: </strong>Cyclosporine combined with eltrombopag is a relatively safe and effective ATG-free therapeutic option for selected patients with acquired aplastic anemia, particularly older individuals and those with comorbidities. This regimen offers meaningful hematologic recovery with acceptable toxicity and represents a pragmatic alternative in real-world and resource-limited settings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Epidemiological Study to Assess the Prevalence of Anemia and Its Determinants in Women of Reproductive Age Group (15-49 Years) in an Urban Slum of a Metropolitan City.","authors":"Kshitij Rajesh Deshmukh, Smita Santosh Chavhan, Sagar Dhondiram Tupe, Roshni Vakilna, Mahesh Rajguru","doi":"10.59556/japi.74.1690","DOIUrl":"https://doi.org/10.59556/japi.74.1690","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a serious public health concern among women of reproductive age (WRA) 15-49 years in India. The prevalence of anemia in WRA in Mumbai and the Mumbai suburban district was 45%-50%, respectively, as per National Family Health Survey-5 (NFHS-5) data. This study was done to assess the prevalence of anemia and its determinants in WRA in the urban slums of Mumbai.</p><p><strong>Materials and methods: </strong>A total of 1,500 WRA were enrolled in this community-based cross-sectional study by the convenience sampling method. A structured validated questionnaire was used to record sociodemographic variables and determinants. Hemoglobin (Hb) estimation was done with a digital hemoglobinometer. SPSS v.18, Chi-square test, and binary logistic regression were used for analysis. The study was approved by the Institutional Ethics Committee of HBT Medical College and Dr. RN Cooper Hospital (Approval No. HBTMC/IEC/025-2025/RP/0/330/07072025/26) on 07/07/2025, and written informed consent was obtained from all participants.</p><p><strong>Results: </strong>Prevalence of anemia in WRA was 57.9%. Significant associations were found between anemia and education level (<i>p</i> = 0.004), socioeconomic class (<i>p</i> < 0.001), gravida status (<i>p</i> < 0.001), spacing between pregnancies (<i>p</i> < 0.001), iron tablet consumption in the past 1 year (<i>p</i> = 0.014), duration of menses (<i>p</i> = 0.019), and pad changes per day (<i>p</i> = 0.013).</p><p><strong>Conclusion: </strong>Determinants such as education level, socioeconomic class, number of pregnancies, spacing between pregnancies, iron tablet consumption, duration of menses, and pad changes per day affect the Hb level of WRA.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"43-47"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Genomic Phenotypic and Host-response Analysis of Multidrug-resistant Diabetic Foot Infections: A Tertiary Center Study from Kerala India.","authors":"Mohammed Jaseem Ibrahim K","doi":"10.59556/japi.74.1693","DOIUrl":"https://doi.org/10.59556/japi.74.1693","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot infections (DFIs) are a primary driver of amputation, worsened by multidrug-resistant (MDR) organisms. The link between pathogen genomics, virulence (e.g., biofilm), and host immunity is poorly quantified. This study aimed to integrate these multi-omic data streams to identify predictors of treatment failure.</p><p><strong>Materials and methods: </strong>This prospective, single-center cohort study enrolled 150 DFI patients. Deep-tissue and autologous healthy-skin biopsies were collected. Pathogens were identified (culture/16S rRNA), with susceptibility and biofilm capacity tested. MDR isolates (<i>n</i> = 76) underwent whole-genome sequencing (WGS). Host response was quantified using an eight-gene quantitative reverse transcription polymerase chain reaction (qRT-PCR) panel, normalized to autologous controls. The primary outcome was \"healing failure\" (amputation or persistent ulcer) at 12 weeks. A least absolute shrinkage and selection operator (LASSO)-penalized regression model was developed and cross-validated.</p><p><strong>Results: </strong>The final analytical cohort included 112 culture-positive patients; 68/112 (60.7%) had an MDR infection. WGS identified high-risk clones (<i>Escherichia coli</i> ST131, <i>Klebsiella pneumoniae</i> ST258). Healing failure occurred in 34/112 (30.4%) patients. Strong biofilm production (adjusted OR 3.81, 95% CI 1.92-7.55) and a high host IL-10:TNF-α expression ratio (AOR 2.98, 95% CI 1.41-6.30) were independent predictors of healing failure. The LASSO model achieved an optimism-corrected area under the curve (AUC) of 0.79 (95% CI 0.71-0.87) with acceptable calibration (Brier score: 0.18; slope: 0.95).</p><p><strong>Conclusion: </strong>In this DFI cohort, pathogen biofilm capacity and a modulated host immune signature were independently associated with treatment failure, highlighting potential new diagnostic and therapeutic targets.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 9","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}