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

{"title":"Stasis Ulcer and Its Possible Etiologies.","authors":"Vivek Soni, Tanvi Batra, Atul Kakar","doi":"10.59556/japi.73.1085","DOIUrl":"10.59556/japi.73.1085","url":null,"abstract":"<p><p>A 62-year-old female, a known case of hypothyroidism, diabetes mellitus, and varicose veins, presented with a complaint of swelling of both lower limbs and ulceration on the left leg for 2 months. She also complained of dyspnea on exertion. As per the history, ulcer began as a pea-sized blackish discoloration on the left lower limb just above the ankle joint on medial aspect (Fig. 1) and increased to 6 × 8 cm, with irregular and raised margins (Fig. 2). The base of ulcer had whitish-yellow exudate with no healthy granulation tissue. The surrounding skin revealed hyperpigmentation. On examination, she had bilateral lower limb pitting edema-grade IV (Fig. 3), extending from above ankle to mid-calf region. The skin appeared to be shiny. Investigations revealed microcytic hypochromic anemia and high fructosamine levels. There was no history of trauma. Anti-HIV was negative. A biopsy was taken, thus revealing it to be a stasis ulcer. Our initial assessment for the causes of this ulcer included anemia resulting in poor perfusion, venous insufficiency exacerbated by varicose veins, and hypothyroidism or diabetes mellitus contributing to poor wound healing.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"100"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070645","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":"\"Responsible Use of Artificial Intelligence in Clinical Medicine\" or \"Ethical Integration of Artificial Intelligence in India's Healthcare System\": A Framework for Responsible Innovation.","authors":"Shriram V Kulkarni, Alok Modi","doi":"10.59556/japi.73.1057","DOIUrl":"10.59556/japi.73.1057","url":null,"abstract":"<p><p>The rapid evolution of artificial intelligence (AI) has ushered in transformative changes in healthcare systems globally, and India stands at the threshold of leveraging this technology to address longstanding disparities in access, efficiency, and quality of care. While the potential of AI is undeniable, its integration into healthcare must be guided by a strong ethical framework that ensures equity, accountability, and trust. In this context, the synthesized framework for ethical AI integration in India's healthcare system presents a comprehensive and timely guide that aligns with both global standards and India's unique demographic and infrastructural realities.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"11-12"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070587","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":"<i>Viva Voce</i> Examination Using Unstructured Impromptu Questions and Structured <i>Viva Voce</i> Cards: A Comparative Study among Final Year MBBS Students in the Subject of Internal Medicine.","authors":"Abraham M Ittyachen, Binitha Baby, Meera B John, Neha M Baby, Sarath C Mathew","doi":"10.59556/japi.73.1083","DOIUrl":"10.59556/japi.73.1083","url":null,"abstract":"<p><strong>Background: </strong>In the medical curriculum, <i>viva voce</i> is a crucial component of formative and summative assessment. However, despite many advantages, it also has some pitfalls. The primary objective of this study is to ascertain whether there is a significant difference in assessment between <i>viva voce</i> conducted using extempore questions and <i>viva voce</i> conducted using structured <i>viva voce</i> cards.</p><p><strong>Methods: </strong>This prospective observational study took place over a period of 3 months. <i>Viva voce</i> was conducted by four examiners in internal medicine among final-year students pursuing MBBS, initially in an unstructured manner using extempore questions, and later using structured questions of increasing difficulty in the form of printed cards. A theory examination was conducted before the <i>viva voce.</i> In addition, a feedback survey using a Likert scale questionnaire was conducted among the students and examiners to assess their perception.</p><p><strong>Results: </strong>Students scored the best in unstructured <i>viva,</i> followed by theory and structured <i>viva.</i> There was a moderately positive correlation between unstructured and structured <i>viva</i> and theory scores. There was a poor correlation between <i>viva</i> and perception scores for both unstructured and structured <i>viva.</i> The examiners had a slightly more positive perception toward the unstructured <i>viva</i> method than the structured method.</p><p><strong>Conclusion: </strong>Unlike most studies in preclinical and paraclinical subjects, this study is a contradiction, with students scoring better in the unstructured method and faculty also showing a preference for the same. Further research is required on the effectiveness of both unstructured and structured viva in clinical settings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070556","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":"Letter to Editor in Response to Article \"Estimation of Predictors of Mortality in Patients with Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Admitted in Tertiary Care Center\" J Assoc Physicians India 2025;73(2):35-38.","authors":"Madhusudan Barthwal, Sachinkumar S Dole","doi":"10.59556/japi.73.1068","DOIUrl":"10.59556/japi.73.1068","url":null,"abstract":"<p><p>We read with interest an article titled \"Estimation of Predictors of Mortality in Patients with Acute Respiratory Failure Secondary to Chronic Obstructive Pulmonary Disease Admitted in Tertiary Care Center\" published in the Journal of the Association of Physicians of India.¹ We have the following comments to offer.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"104"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070605","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":"Evaluation of the Anti-inflammatory, Phagocytic, and Antioxidant Potential of ORSL^® Immunity+ in Lipopolysaccharide-stimulated Human Peripheral Blood Mononuclear Cells.","authors":"Sanjay Kalra, Trupti Gilada, Ashwin Dabhi, Vijay Chamle, Deepanshi Dhar, Tarique Meer, Michael Southall, Ashok Godavarthi, Amol Patil, Harshad Malve, Ashley Barlow","doi":"10.59556/japi.73.1090","DOIUrl":"10.59556/japi.73.1090","url":null,"abstract":"<p><strong>Background: </strong>Maintaining optimal hydration and electrolyte balance is essential for immune function, as it supports cellular homeostasis and immune defense mechanisms. Electrolyte-based micronutrient drinks helps replenish essential nutrients, including zinc, selenium, and vitamin E, which play key roles in modulating immune responses, mitigating oxidative stress, and regulating inflammation. Lipopolysaccharide (LPS)-induced inflammation and oxidative stress are major contributors to immune dysfunction, necessitating interventions that enhance immune resilience.</p><p><strong>Objective: </strong>To evaluate the immunomodulatory potential of ORSL® Immunity⁺ in mitigating inflammation, enhancing phagocytic activity, and providing antioxidant protection in LPS-stimulated peripheral blood mononuclear cells (PBMCs) Materials and methods: PBMCs were isolated from human blood and stimulated with LPS to induce an inflammatory response. The effects of ORSL® Immunity+ on the immune function of treated cells were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay for cytotoxicity, enzyme-linked immunosorbent assay (ELISA) for inflammatory markers [tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin 6 (IL-6), interferon gamma (IFN-γ), nitric oxide (NO)], oxygen radical absorbance capacity (ORAC) assay for antioxidant capacity, and phagocytosis assay.</p><p><strong>Results: </strong>ORSL® Immunity+ demonstrated no cytotoxic effects on PBMCs. The treatment significantly reduced the levels of inflammatory markers, indicating an anti-inflammatory effect. Additionally, ORSL^® Immunity⁺ enhanced phagocytic activity in a dose-dependent manner against <i>Escherichia coli,</i> suggesting improved immune response. Antioxidant capacity was also significantly increased, as evidenced by the ORAC assay, highlighting its potential in mitigating oxidative stress.</p><p><strong>Conclusion: </strong>ORSL® Immunity+ exhibits promising immunomodulatory properties by reducing inflammation, enhancing phagocytosis, and improving antioxidant potential in LPS-stimulated PBMCs. These findings support a potential role in immune health alongside improving hydration status, warranting further clinical evaluation.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8S","pages":"21-27"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070678","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":"Dehydration with Nondiarrheal Illnesses in Adults and Older Adults: Insights from Retrospective, Real-world, Electronic Medical Record-based Data.","authors":"Harshad Malve, Sumit Bhatia, Manoj Chawla, Priti Thakor, Amol Patil","doi":"10.59556/japi.73.1087","DOIUrl":"10.59556/japi.73.1087","url":null,"abstract":"<p><strong>Introduction: </strong>Nondiarrheal dehydration, though a physiologically common condition, remains underreported. There are no specific guidelines for its treatment, and physicians usually rely on the guidelines for diarrheal dehydration. Until now, no study has reported the epidemiology of dehydration in nondiarrheal conditions.</p><p><strong>Materials and methods: </strong>This was an electronic medical record (EMR)-based retrospective observational study. Anonymized and aggregated data of patients meeting the eligibility criteria from January 2017 to March 2023 were retrieved from the EMR database. Analysis was done to evaluate the prevalence of dehydration and associated conditions in adults and older adults.</p><p><strong>Results: </strong>The EMR platform had 2,24,90,146 patients, including 1,57,13,317 (69.87%) adults and 44,43,851 (19.76%) older adults (≥60 years). A total of 1,84,89,088 patients had nondiarrheal illnesses, of which 1,43,56,271 (77.65%) were adults and 41,32,817 (22.35%) were older adults. Dehydration was reported only for 4,917 (0.026%), of which 3,451 (70.19%) were adults without diabetes, and 666 (13.54%) were older adults without diabetes. The diabetic adults and older adults with dehydration accounted for 547 (0.0035%) and 253 (0.0057%), respectively.</p><p><strong>Conclusion: </strong>The recorded prevalence of dehydration in patients with nondiarrheal illnesses is very low, highlighting the need for proactive screening for dehydration. There is a need to effectively diagnose nondiarrheal dehydration and highlight the significance of proactively documenting it in the prescriptions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8S","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070682","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":"Letter to the Editor: Human Metapneumovirus-How It Affects and Whom?","authors":"Prachee Ratre, Rahul Khera, Deepak Prajapat, Kanishka Kumar Singh, Deepak Talwar","doi":"10.59556/japi.73.1069","DOIUrl":"https://doi.org/10.59556/japi.73.1069","url":null,"abstract":"<p><p>We would like to highlight the clinical spectrum of human metapneumovirus (hMPV) infection in 11 patients diagnosed in the year 2024 at our center, clarifying that it is neither new nor does it resemble COVID-19. Our observations aim to provide insights and contribute to a clearer understanding of its role in respiratory diseases.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070686","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":"Introducing a Novel Once-weekly Dipeptidyl Peptidase 4 Inhibitor: Trelagliptin in India.","authors":"Bhupesh Dewan, Sanjaykumar Navale, Siddheshwar Shinde, Rishima Ganiga","doi":"10.59556/japi.73.1093","DOIUrl":"10.59556/japi.73.1093","url":null,"abstract":"<p><p>India faces a growing burden of type 2 diabetes mellitus (T2DM), necessitating innovative treatments that improve glycemic control, reduce glycemic variability (GV), and enhance patient adherence. Dipeptidyl peptidase 4 (DPP-4) inhibitors are established antidiabetic agents; however, once- or twice-daily dosing often limits long-term compliance. Trelagliptin, a novel once-weekly DPP-4 inhibitor, addresses this issue with an extended half-life and superior molecular stability, enabling sustained DPP-4 inhibition and significant GV reduction. Improved glycemic control with trelagliptin can potentially lower the risk of macrovascular and microvascular complications associated with T2DM. Trelagliptin, developed and launched in India by Zuventus Healthcare Limited under the brand name Trelaglip®, offers prolonged efficacy and high selectivity in inhibiting the DPP-4 enzyme, helping minimize side effects. Development began with in-house active pharmaceutical ingredient (API) synthesis, followed by successful formulation and stability studies. A bioequivalence study confirmed pharmacokinetic equivalence with the reference product by Takeda, Japan. In a randomized phase 3 clinical trial involving patients with glycated hemoglobin (HbA1c) ≥8%, trelagliptin showed greater HbA1c reduction (-1.25%) as compared to vildagliptin (-1.15%) and a similar safety profile. Mild adverse events occurred in 6.67% of trelagliptin users compared to 9.17% with vildagliptin. This article outlines the development and regulatory journey leading to trelagliptin's first approval in India by the Central Drugs Standard Control Organization (CDSCO) in December 2024. Phase 4 real-world evidence studies are currently ongoing in India to assess long-term safety and efficacy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070592","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 Dehydration and Use of Oral Electrolytes in Diabetic Adults and Older Adults with Nondiarrheal Conditions: A Retrospective, Real-world, Database Study.","authors":"Manoj Chawla, Sumit Bhatia, Priti Thakor, Harshad Malve, Amol Patil","doi":"10.59556/japi.73.1089","DOIUrl":"10.59556/japi.73.1089","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric and geriatric populations are at a greater risk of dehydration than the adult population. Diabetes plays a synergistic role and makes persons with diabetes more susceptible to dehydration. Nondiarrheal conditions like fever, infections, nausea, vomiting, heat-related illnesses, tropical illnesses like dengue, malaria, etc., increase the insensible fluid and electrolyte losses and make patients susceptible to dehydration. However, there is hardly any evidence on the incidence or prevalence of the same. There is no data available on nondiarrheal dehydration and the use of oral electrolytes in persons with diabetes.</p><p><strong>Methodology: </strong>This retrospective observational study was conducted using anonymized and aggregated data from the HealthPlix electronic medical records (EMR) database.</p><p><strong>Results: </strong>There was a large difference between the number of patients with dehydration documented in their prescriptions and those prescribed oral electrolytes, suggesting the underreporting of dehydration. ORSL Rehydrate^®, a low-sugar variant of ORSL^®, suitable for diabetic patients, was observed to be the preferred prescription choice for patients with symptoms like chills, vomiting, and others. However, for some of the conditions, other variants were the most prescribed. These variants were mostly prescribed for 1-3 days with twice daily (BID) or thrice daily (TID) regimen. Recovery from fever tends to be faster in the case of patients prescribed ORSL^® variants.</p><p><strong>Conclusion: </strong>There is a need to emphasize the documentation of dehydration in prescriptions and prescribe the most suited variant of oral electrolytes for diabetic patients. Prescription of oral fluid, electrolyte, and energy (FEE) drinks along with the standard of care treatment supports patients of nondiarrheal conditions for faster recovery.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8S","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070310","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":"Chance vs Probability in Medical Practice: Bhagavad Gita and Karma.","authors":"Abhaya Indrayan","doi":"10.59556/japi.73.1061","DOIUrl":"10.59556/japi.73.1061","url":null,"abstract":"<p><p>As exhorted by the Bhagavad Gita, physicians do their best karma to manage a patient. The uncertainties and chance can never be altogether eliminated from medical practice despite using best practices because of inherent human and environmental variations. No management is perfect with a 100% probability of success in all cases. The outcome remains with him. The physicians and the patients need to be reminded of this limitation all the time.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"98-99"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070506","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}