Indian Journal Of Clinical Practice

Medicine Update

Dr Veena Aggarwal — 2024-06-28

EDITORIAL

Silver Stewardship

Dr Sanjay Kalra — 2024-06-28

GUEST EDITORIAL

Birth Defects with the Use of Valproate: An Impact on the Prescribing Pattern amongst the Health Care Professionals in India

Dr V KALAISELVAN — 2024-06-28

Objective: The present study was carried out to evaluate the impact of Pharmacovigilance Programme of India (PvPI) initiative
to reduce the use of sodium valproate/valproic acid (SV/VA) in the women of childbearing age group. Methods: In our
questionnaire-based study, 251 health care professionals (HCPs) participated from 41 medical colleges across India, which are
also working as Adverse drug reaction Monitoring Centres (AMCs) under PvPI. Results: The data collected at the National
Coordination Centre (NCC) shows the significant decrease in the use of SV/VA in the women of childbearing age group after
the PvPI initiative on Information, Education, and Communication (IEC) materials for HCPs. However, it was found that
40% of HCPs of Gynecology and Neurology Department were still not aware of the initiative taken by the Government of
India to reduce the use of SV/VA in the women of childbearing age group. Conclusion: PvPI, therefore, needs to take more
measures to increase the reach of their resource materials to all HCPs.

Role of Beta-Blockers in Prevention of Hepatopulmonary Syndrome in Chronic Liver Disease: An Observation

Dr ASHISH GAUTAM — 2024-06-28

Aim: Study was initiated to study the presence of hepatopulmonary syndrome (HPS) in chronic liver disease patients, and role
of beta-blockers in its occurrence. Methods: Patients admitted in Dept. of Medicine and patients attending the Medicine OPD
were examined and investigated for presence of HPS irrespective of its typical clinical features as explained in the literature.
Patients having ascites or pleural effusion were managed by means of paracentesis and pleural tap first and then included
in the study. Patients having any other primary pulmonary disease like bronchial asthma or chronic obstructive pulmonary
disease were excluded from the study. Arterial blood gas analysis and contrast-enhanced echocardiography was done to confirm
presence of arterial hypoxemia and pulmonary shunt, the diagnostic criteria. Results: During 1 year study, total 125 patients
were enrolled in the study after appropriate selection criteria. Twenty-eight out of 125 patients were not taking propranolol.
Propranolol is contraindicated in these patients for one or two reasons. Four out of these 28 patients developed HPS. One out
of 97 patients who were on propranolol developed HPS. Total 5 patients were confirmed having HPS. The Fisher’s exact test
statistic value is 0.008887. The result is significant at p < 0.01. Conclusion: Patients of cirrhosis with portal hypertension on
treatment with propranolol were having significantly lower chances of development of HPS then those without propranolol.
Propranolol may have preventive role for development of HPS.

Hepatic Granulomas: A Clinician’s Perspective

Dr MAYANK JAIN — 2024-06-28

Hepatic granulomas are focal aggregates of transformed epithelioid histiocytes with or without multinucleated giant cells that are
cuffed by lymphocytes and plasma cells. They represent delayed-type specialized cell-mediated immunity to a wide-spectrum
of antigenic stimuli. Hepatic granulomas are found in up to 10% of liver biopsies and the causes are usually multifactorial.
Different antigens like infectious agent, medication, foreign body and malignancy can initiate granuloma formation. Hepatic
granulomas per se seldom cause architectural changes and often provide a clue to a systemic disease. Most often, to a practicing
clinician, it is a combination of clinical presentation, laboratory parameters with information on the typical localization and
characterization of the granuloma within the liver by the pathologist that often provides a clue to a definitive diagnosis.

A Rare Convergence: A Case Report on Bilateral Hypoglossal Schwannoma in a Patient with Charcot-Marie-Tooth Disease 2

Dr K SANKAVI GAUTHAM — 2024-06-28

This case presents a rare co-occurrence of Charcot-Marie-Tooth disease type 2 (CMT2) and schwannoma, shedding light on
the intricate relationship between two neurogenic disorders. CMT is a hereditary sensorimotor peripheral neuropathy while
schwannoma is a benign encapsulated tumor involving Schwann cells. The co-occurrence has been previously described in
2 patients in a family with CMT type 1A. Our case reports the first documented instance of the co-occurrence of bilateral
hypoglossal schwannoma in CMT2.

Unveiling the Nexus of Cognitive Impairment in Diabetes: Exploring the Enigmatic “Diabetic Melancholy”

Dr RITWIK GHOSH — 2024-06-28

Patients living with diabetes suffer from a spectrum of cognitive and mood disorders. To encompass the diverse
neuropsychological aspects of diabetes, the authors herein propose the new construct of “diabetic melancholy”, which
stands for memory impairments, executive dysfunctions, language impairments, psychomotor retardation, low mood, and
apathy. Authors have also described the underlying neural basis of cognitive dysfunction in diabetes.

Patient Care and Medical Decision-Making

IJCP — 2024-06-28

MEDICOLEGAL

64th Annual Conference of the Indian Society of Gastroenterology (ISGCON 2023)

IJCP — 2024-06-28

CONFERENCE PROCEEDINGS

News and Views

IJCP — 2024-06-28

AROUND THE GLOBE

The Lips of Truth shall be Recognized Forever, a Lying Tongue is but for a Moment

IJCP — 2024-06-28

SPIRITUAL UPDATE

How do we Affect Others

IJCP — 2024-06-28

INSPIRATIONAL STORY

Lighter Side of Medicine

IJCP — 2024-06-28

LIGHTER READING

From Evidence to Practice: Denosumab in Osteoporosis and Joint Health

Dr SANJAY AGARWALA — 2024-06-28

Osteoporosis and osteopenia are prevalent conditions in India, particularly among postmenopausal women and the elderly,
leading to increased fracture risks and morbidity. Denosumab, a monoclonal antibody, demonstrates superior efficacy
over other treatments in reducing fracture risk and enhancing bone mineral density (BMD). Clinical trials highlight its
effectiveness in preventing periprosthetic bone loss, improving implant stability, and mitigating femoral head collapse in
various conditions; combination therapies involving denosumab further amplify BMD gains and reduce fracture risk. The
article reviews the efficacy and safety of denosumab in managing osteoporosis, joint replacement therapy, and avascular
necrosis based on a review of clinical evidence and studies. Denosumab emerges as a cornerstone therapy for osteoporosis
management, offering multifaceted benefits in fracture prevention, joint replacement therapy, and avascular necrosis.