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

{"title":"Real-world Challenges and Predictors of Success in Glucagon-like Peptide-1 Receptor Agonist Therapy.","authors":"Nitin Mohaniraj Patankar, Sushma Jain Sanghvi","doi":"10.59556/japi.74.1627","DOIUrl":"https://doi.org/10.59556/japi.74.1627","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have revolutionized the management of type 2 diabetes mellitus (T2DM) and obesity, demonstrating robust efficacy in landmark trials for glycemic control, weight reduction, and cardiovascular protection. However, real-world discontinuation rates exceed trial-reported rates, highlighting a gap between clinical efficacy and practical outcomes.</p><p><strong>Objective: </strong>This review synthesizes evidence from 2018 to 2024, including trial data, population studies, and registry analyses, to identify and contextualize major real-world barriers. High rates of gastrointestinal side effects, substantial out-of-pocket costs, and patient aversion to injectable formulations often result in 1-year discontinuation rates ranging from 27 to 41%. These challenges are compounded by heterogeneity in patient response, with predictors of successful long-term use including higher baseline HbA1c, elevated body mass index (BMI), absence of severe gastrointestinal disorders, and robust early response to therapy.</p><p><strong>Methods: </strong>A proposed clinical scoring model is presented to improve patient selection and predict adherence, while digital health tools and emerging combination therapies offer additional avenues to enhance persistence and outcomes. Despite promising advances such as dual- and triple-incretin agents and oral GLP-1 RA formulations, cost and access remain major hurdles.</p><p><strong>Results: </strong>Key factors, including baseline HbA1c >8.0%, BMI >30 kg/m<sup>2</sup>, absence of severe gastrointestinal (GI) disorders, and prior adherence success, correlate strongly with higher persistence. Real-world data reveal that discontinuation rates for GLP-1 receptor agonists remain high, with 1-year discontinuation ranging from approximately 28% to around 41%, depending on the patient population and indication. Discontinuation is more common among patients using GLP-1 RAs for obesity without diabetes, reaching rates above 50% in some cohorts. The primary reasons for stopping therapy include gastrointestinal side effects, reported in over 25% of discontinuations, high medication costs, and issues with insurance coverage or medication access. Persistence is generally higher among patients with T2DM, those with higher baseline BMI, and those who experience greater early weight loss or favorable tolerability, while frequent adverse effects and logistical barriers contribute to poorer long-term adherence. Although emerging clinical tools and digital health interventions are proposed to help address these barriers, further prospective data are needed to quantify their impact on persistence at scale.</p><p><strong>Conclusion: </strong>Bridging trial evidence with real-world practice requires proactive candidate profiling and side-effect management. Combining predictive scoring, artificial intelligence (AI)-supported adherence tools, and emerging dual-incretin agen","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"74-76"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231179","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":"A Retrospective Study of Clinical, Microbiological, and Ulcer Severity Patterns of Diabetic Foot Presenting to a Tertiary Care Hospital.","authors":"Asif Dabeer Jafri, Srikant Kumar Dhar, Muktesh Singh, Ratender Kumar Singh","doi":"10.59556/japi.74.1675","DOIUrl":"10.59556/japi.74.1675","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) are a major complication of diabetes and are frequently associated with infection, antimicrobial resistance, and limb amputation. Regional Indian data on microbiological patterns and antimicrobial resistance remain limited.</p><p><strong>Methods: </strong>This retrospective observational study evaluated 40 patients with DFUs presenting to a tertiary care hospital over a 12-month period. Clinical and laboratory parameters, including glycated hemoglobin (HbA1c), C-reactive protein (CRP), total leukocyte count (TLC), and serum albumin, were analyzed. Ulcer severity was graded using the Wagner classification, and wound cultures with antibiotic susceptibility testing were performed.</p><p><strong>Results: </strong>Most patients were male (70%) and aged 40-60 years. Mean HbA1c was significantly higher in male than in female patients (13.99 ± 1.40 vs 10.45 ± 1.41; <i>p</i> < 0.05). Monomicrobial infections predominated, with Gram-negative organisms accounting for 70.3% of isolates, followed by Gram-positive bacteria (22.2%) and fungi (7.4%). Polymicrobial infections occurred in 12.5% of cases. Gram-negative isolates showed universal sensitivity to colistin, whereas <i>Acinetobacter</i> spp. demonstrated high resistance to other antibiotics. Higher Wagner grades were significantly associated with elevated HbA1c and CRP levels. All amputations occurred in male patients with polymicrobial infections.</p><p><strong>Conclusion: </strong>Gram-negative pathogens predominated in DFUs in this setting, contrasting with the Gram-positive predominance reported in Western literature. Poor glycemic control and elevated inflammatory markers were associated with increasing ulcer severity and amputation risk.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231187","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":"Carotid Intimal Media Thickness as an Indicator of Ischemic Heart Disease in Male Patients with Type 2 Diabetes and Metabolic Syndrome.","authors":"Akshaya Janardhanan, Subrahmanyam Dks, Santhosh Satheesh","doi":"10.59556/japi.74.1669","DOIUrl":"https://doi.org/10.59556/japi.74.1669","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) increases cardiovascular disease risk due to accelerated atherosclerosis. Carotid intima-media thickness (CIMT) is an effective, noninvasive screening tool for atherosclerosis. Hence, we sought to measure the CIMT of male patients with type 2 diabetes and MetS and attempted to correlate the CIMT values between patients with and without evidence of ischemic heart disease.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study conducted on diabetic patients who met the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for MetS (specified for the Indian population), aged 45-60 years. Each participant completed the Rose questionnaire and was grouped as either symptomatic or asymptomatic. Further, all patients were subjected to biochemical tests, electrocardiography (ECG), CIMT, echocardiography (ECHO), and ankle-brachial pressure index (ABPI). Those who showed no evidence of ischemia on ECG and ECHO were subjected to exercise stress testing (treadmill test). Abnormal ECG, ECHO, and treadmill test results indicating ischemic heart disease were used to group patients into ischemic and nonischemic groups.</p><p><strong>Results: </strong>A total of 128 patients who met the inclusion criteria were recruited. The values of CIMT ranged from 0.62 to 0.76 mm. The CIMT values between the ischemic and nonischemic groups were found to be similar. However, CIMT values were consistently higher in patients with MetS compared to the general population CIMT values based on prior studies in India across all age-groups. The Rose questionnaire served as a good screening tool, with a negative predictive value of 86% for the detection of ischemia in asymptomatic patients. Among the other parameters, the critical value of ABPI was found to be higher in the ischemic group [1.1 (1-1.12) vs 1 (0.85-1.075), <i>p</i> = 0.004].</p><p><strong>Conclusion: </strong>While CIMT was not a reliable indicator of ischemic heart disease in patients with MetS, its consistently elevated values compared to those of the general population suggest that it could serve as a valuable marker of atherosclerosis. The ankle-brachial pressure index (ABPI) has consistently proven to be a reliable and repeatable indicator of ischemia. Due to the high incidence of silent ischemia in this study group (12.9%), further research on early markers of ischemia and atherosclerosis is warranted.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231226","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":"Updates in Rhinitis: A Comprehensive Review of Recent Advances.","authors":"Bhagyesh Lalitchandra Darji","doi":"10.59556/japi.74.1638","DOIUrl":"https://doi.org/10.59556/japi.74.1638","url":null,"abstract":"<p><strong>Abstract: </strong>Rhinitis is a common inflammatory condition of the nasal mucosa. It significantly impacts a person's health and quality of life. Traditionally, it is categorized as allergic rhinitis (AR) or nonallergic rhinitis (NAR). Recent advancements have led to a more nuanced understanding of its pathophysiology, classification, and management. This review emphasizes key updates over the last decade. The focus is on evolving concepts in phenotyping and endotyping, novel insights into disease mechanisms, advancements in diagnosis, and emerging therapeutic strategies, including biologics and targeted nerve interventions. The recognition of local allergic rhinitis (LAR), the role of innate immunity and epithelial barrier dysfunction, and the increasing array of precision medicine options underscore a paradigm shift toward personalized management. Despite these newer advances, challenges remain in fully characterizing NAR and optimizing therapeutic guidelines. This review aims to provide an overview of these transformative developments, guiding clinicians and researchers toward more effective and tailored approaches to treat rhinitis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"77-80"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231196","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":"Efficacy and Tolerability of Tenofovir/Lamivudine/Dolutegravir among Antiretroviral Therapy Naive Human Immunodeficiency Virus Infected Patients of a Tertiary Care Center in Eastern India.","authors":"Debroop Sengupta, Sandip Ghosh, Shantasil Pain, Nandini Chatterjee","doi":"10.59556/japi.74.1617","DOIUrl":"https://doi.org/10.59556/japi.74.1617","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"96"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231079","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":"Listing of the Affective Domain in the AETCOM Module: An Issue Requiring Attention from the National Medical Commission of India.","authors":"Gitanjali Batmanabane, Rituparna Maiti","doi":"10.59556/japi.74.1666","DOIUrl":"https://doi.org/10.59556/japi.74.1666","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"94"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231073","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":"Comprehensive Approach to Detect Liver Fibrosis by Indirect Serum Biomarkers.","authors":"Harshit Garg, Deepti Sharma, Harshvardhan Tiwari, Dinesh Bishnoi","doi":"10.59556/japi.74.1668","DOIUrl":"https://doi.org/10.59556/japi.74.1668","url":null,"abstract":"<p><strong>Aim and objective: </strong>The diagnostic accuracy of three serum-derived markers-aspartate aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and the aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio-was investigated as noninvasive alternatives in this study for assessing liver fibrosis severity and correlating these scores with FibroScan-derived liver stiffness measurements in patients with chronic liver disease (CLD).</p><p><strong>Materials and methods: </strong>We enrolled 100 adult patients with a confirmed diagnosis of CLD for this cross-sectional analysis at GMC Kota. Consenting patients received clinical evaluations, ultrasound, and biochemical screenings [complete blood count (CBC), liver function tests (LFTs), glucose, and viral serology]. We staged liver stiffness (F0-F4) <i>via</i> FibroScan and computed indirect indices, including FIB-4, APRI, and AST/ALT, using validated equations.</p><p><strong>Results: </strong>The average participant age was 47 years, with males comprising 67% of the study population. FibroScan showed that 73% of patients had F4 fibrosis, followed by F3 (10%), F2 (12%), and F0-F1 (5%). Etiologies included alcohol-related liver disease (34%), hepatitis B (15%), hepatitis C (4%), autoimmune hepatitis (2%), and diabetes-associated nonalcoholic fatty liver disease (NAFLD) (38%). Significant positive correlations were found between liver stiffness and the AST/ALT ratio (<i>r</i> = 0.658), APRI (<i>r</i> = 0.639), and FIB-4 (<i>r</i> = 0.444), all with <i>p</i> < 0.0001. Diagnostic thresholds revealed that lower cutoff values (e.g., APRI > 0.5, FIB-4 ≥ 1) had high sensitivity, whereas higher cutoff values (e.g., AST/ALT > 1, APRI ≥ 1, FIB-4 ≥ 3.24) achieved excellent specificity. A stepwise diagnostic approach using these thresholds improved detection accuracy and reduced reliance on liver biopsy.</p><p><strong>Significance: </strong>The study validates simple, cost-effective biomarkers as reliable tools for fibrosis detection. Their integration into clinical practice may enhance early diagnosis, optimize resource use, and improve outcomes in patients with CLD, especially in low-resource settings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"44-46"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231096","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":"Beyond Fever-The Changing Face of Acute Leptospirosis: A Retrospective Observational Study from Western India.","authors":"Arun Agarwal, Sachin Choudhary, Aakanksha Agarwal, Hetashree Raval, Roshan Patel","doi":"10.59556/japi.74.1661","DOIUrl":"10.59556/japi.74.1661","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Leptospirosis is a zoonotic infection caused by pathogenic &lt;i&gt;Leptospira&lt;/i&gt; species and remains a significant cause of acute febrile illness in tropical regions. Its clinical spectrum ranges from mild, self-limiting illness to severe multi-organ dysfunction. The disease is broadly classified into anicteric and icteric (Weil's disease) forms, the latter associated with jaundice and increased morbidity. In India, diagnosis is often challenging due to overlapping features with other endemic infections such as dengue and scrub typhus. Coinfections and changing epidemiological patterns, including increasing urban cases, further complicate clinical assessment. This study evaluated the demographic profile, clinical characteristics, organ involvement, coinfections, severity, management, and outcomes of adults hospitalized with acute leptospirosis, with comparison between icteric and anicteric phenotypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective observational study included 78 adults with laboratory-confirmed acute leptospirosis admitted over 30 months to a tertiary care hospital in Rajasthan, India. Diagnosis was established by positive &lt;i&gt;Leptospira&lt;/i&gt;-specific immunoglobulin M (IgM) serology (&gt;11 NTU) and/or polymerase chain reaction (PCR). Data regarding demographics, comorbidities, clinical features, organ involvement, coinfections, treatment, and outcomes were extracted from medical records. Organ involvement was defined using predefined clinical and laboratory criteria across major systems. Severe disease was defined as dysfunction of two or more organ systems. Icteric leptospirosis was defined by clinical jaundice and/or serum bilirubin ≥3 mg/dL. Coinfections were confirmed through appropriate laboratory testing. Continuous variables were expressed as median (interquartile range) and categorical variables as frequency (%). Subgroup comparisons were performed using the Mann-Whitney &lt;i&gt;U&lt;/i&gt; test and Fisher's exact test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median age was 57 years (interquartile range 41-68), with slight male predominance (52.6%). Although 59% of patients were from rural areas, 41% were urban residents. Hypertension (25.6%) and diabetes mellitus (29.5%) were common comorbidities, while 42.3% had no prior illnesses. Anicteric disease predominated (84.6%), and 15.4% had icteric leptospirosis. Fever was present in 93.6% of patients. Hepatic (69.2%) and respiratory (66.7%) involvement were most frequent, and multi-organ dysfunction occurred in 61.5%. Coinfections were identified in 52.6% of cases, most commonly dengue (17.9%) and scrub typhus (14.1%). Coinfected patients were younger and had fewer comorbidities, with lower rates of renal, respiratory, and neurological involvement and reduced need for ventilatory support. Icteric patients were significantly younger (median 31.5 vs 58 years) and had longer hospital stays (10.5 vs 7 days). Hepatic involvement was universal in the ict","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"18-24"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231210","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":"Risk Factors and Emerging Therapies for Immune Checkpoint Inhibitor-related Myocarditis: A Narrative Review.","authors":"Ujjvala Kalluri, Maazen Naduthra Subair","doi":"10.59556/japi.74.1665","DOIUrl":"https://doi.org/10.59556/japi.74.1665","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) represent a groundbreaking development in immunotherapy, offering significant promise in the treatment of various malignancies previously considered incurable. However, despite their potential benefits, the increasing use of ICIs is associated with a spectrum of immune-related adverse events (irAEs). Myocarditis is a rare and potentially underestimated complication that represents the highest mortality rate among irAEs.</p><p><strong>Objective: </strong>The review aims to evaluate the current understanding of ICI-myocarditis (ICI-M) through providing a detailed overview of diagnostic challenges, screening strategies, and, in particular, the risk factors and evolving treatment agents beyond corticosteroids.</p><p><strong>Materials and methods: </strong>A comprehensive literature review was conducted on PubMed, analyzing data from relevant clinical studies, case reports, preclinical models, and expert consensus guidelines. In addition, data from one ongoing clinical trial (ATRIUM trial) not yet indexed in PubMed were included to reflect emerging therapeutic developments.</p><p><strong>Results: </strong>Despite the low incidence of ICI-M (0.06%-1%), which is likely underestimated, the mortality rate is the highest among irAEs; the most identifiable risk factors include combination therapy with ICI agents (anti-PD1 and anti-CTLA-4), preexisting cardiovascular and autoimmune diseases, use of ICIs alongside other anticancer treatments, certain tumor types, older age, and female sex. Diagnosis of the condition is faced with challenges such as nonspecific clinical features and often requires multimodal evaluation including biomarkers, imaging, and biopsy. High-dose corticosteroids remain the first-line treatment; however, steroid-refractory cases are increasingly reported. Promising second-line options include mycophenolate mofetil, antithymocyte globulin, abatacept, and tacrolimus; however, there is a lack of prospective data to support their efficacy. Studies conducted on various preclinical models highlight potential therapeutic targets such as CXCR3.</p><p><strong>Conclusion: </strong>ICI-M poses a significant challenge in cardio-oncology practice due to its underestimation, high mortality rate, and lack of robust clinical data evaluating standardized screening protocols and second-line treatment measures. Although several second-line agents show promise, the evidence supporting their usage is largely on the basis of expert consensus and case reports, hence representing a strong need for prospective studies offering direct comparisons. Likewise, preclinical studies show great promise in identifying the pathophysiology and potential therapeutic targets for ICI-M; however, translational studies are necessary to validate these findings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231182","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":"Atlantoaxial Dislocation Presenting with Quadriplegia after Local Neck Massage Therapy: A Unique Presentation.","authors":"Rishav Mukherjee, Kalyani Chakrawar, Debanjan Nandi, Chirantan Mandal, Boudhayan Das Munshi, Saikat Mondal, Anirban Ghosh","doi":"10.59556/japi.74.1663","DOIUrl":"https://doi.org/10.59556/japi.74.1663","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 8","pages":"90-91"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231213","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}