Indian Journal Of Clinical Practice

From Evidence to Practice: Denosumab in Osteoporosis and Joint Health

Fri, 24 May 2024 00:00:00 +0000

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.

Role of Sodium Alginate in Gastroesophageal Reflux Disease: An Overview

Dr JYOTI YADAV, Dr SHUBHRICA — Mon, 03 Jun 2024 00:00:00 +0000

Sodium alginate helps manage and treat heartburn and gastroesophageal reflux disease (GERD). This article discusses the
structure, mechanism of action and clinical application. A brief review of the literature is carried out.

Medicine Update

Dr Veena Aggarwal — Mon, 03 Jun 2024 00:00:00 +0000

EDITORIAL

Health and Harmony: Teamwork is the Key

Dr Sanjay Kalra, Dr Hitesh Punyani, Dr Suneet Verma, Dr Nitin Kapoor — Mon, 03 Jun 2024 00:00:00 +0000

GUEST EDITORIAL

Clinical Spectrum of Recurrent Urinary Tract Infections: A Single-Center Study

Mon, 03 Jun 2024 00:00:00 +0000

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs)
in a tertiary care hospital. Patients <18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnant
patients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigations
and treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acute
pyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-
producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonas
spp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patients
due to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs,
though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam,
cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure
(39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need for
per urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.

Navigating Choices: A Questionnaire-based Study on Usage of Antiplatelet Therapies in Management of Acute Coronary Syndrome in India

Mon, 03 Jun 2024 00:00:00 +0000

Percutaneous coronary intervention (PCI) is a common invasive cardiac procedure used to treat acute coronary
syndrome (ACS). The main objective of anticoagulant therapy in PCI is to minimize the risk of plaque rupture and decrease
the formation of blood clots. Understanding clinicians' prescription patterns is crucial for optimizing treatment strategies
for patients with ACS who have undergone PCI. Methods: It was a cross-sectional, questionnaire-based, noninterventional
study which included questionnaire responses from 136 cardiologists, regarding usage of antiplatelets in ACS management.
Results: Ticagrelor and aspirin dual antiplatelet therapy (DAPT) is favored by 54% cardiologists in managing ACS patients
who have undergone PCI, regardless of the presence or absence of type 2 diabetes mellitus (T2DM). Further, 78% of the
participants preferred long-term DAPT over short-term and medium-term alternatives. Forty percent respondents preferred
a 1-month triple antithrombotic therapy (TAT) for PCI patients with atrial fibrillation. Additionally, the study emphasized
the importance of considering factors like age, bleeding history, hemoglobin, and creatinine clearance in determining the
optimal antithrombotic strategy. Conclusion: This study contributes valuable insights into the real-world practices of health
care practitioners, paving the way for more informed and personalized ACS management strategies in Indian patients.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

Mon, 03 Jun 2024 00:00:00 +0000

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total live
births in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks of
pregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, the
risk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted from
June 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratified
block randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies and
Group 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was
4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p < 0.02). Sixty out of 64 newborns
regained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±
0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference per
week was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Mean
average length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,
the difference was statistically significant (p < 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1
while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Our
study supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

An Interesting Case of Pulmonary Tuberculosis with Hypoxemic Respiratory Failure Mimicking Interstitial Lung Disease

Dr SHRINATH V, Dr SIDDHARTHA CHAKRABORTY, Dr RAHUL TYAGI, Dr ASHOK NARAYANAN — Mon, 03 Jun 2024 00:00:00 +0000

Hypoxemic respiratory failure is a rare presentation of active pulmonary tuberculosis (TB). Though tuberculous acute
respiratory distress syndrome (ARDS) is well documented in medical literature, non-ARDS respiratory failure is seldom
reported in active pulmonary TB. We herein report a case, which posed a diagnostic dilemma as it clinically mimicked
interstitial lung disease. Imaging showed unilateral localized smooth interlobular septal thickening along with consolidation
without significant mediastinal lymphadenopathy. To the best of our knowledge, this rare radiological finding has not been
reported in medical literature as being associated with hypoxemic respiratory failure in pulmonary TB patients.

Arrhythmia in Adult Congenital Heart Disease

Dr DEVENDRA SINGH BISHT, Dr KAMAL KISHOR, Dr MOHIT JAIDKA — Mon, 03 Jun 2024 00:00:00 +0000

This case report highlights the significance of a multidisciplinary approach in the management of patients with repaired
membranous ventricular septal defect (VSD) who develop postoperative arrhythmias. We present the case of a young female
who experienced symptomatic episodes of supraventricular tachycardia following VSD repair. Through electrophysiological
study and radiofrequency ablation, multiple tachycardia substrates were identified and successfully ablated. This report
underscores the importance of combining surgical repair, electrophysiological evaluation and intervention to achieve optimal
outcomes in this specific patient population.

An Interesting Case of Chromonychia in an Immunosuppressed Individual

Dr RAJESH RAJAGOPALAN — Mon, 03 Jun 2024 00:00:00 +0000

IMAGES IN CLINICAL PRACTICE

Adolescent Obesity and Type 2 Diabetes Mellitus: Synaptics and Heuristics

Mon, 03 Jun 2024 00:00:00 +0000

The adolescent population is the foundation for a Nation’s progress. Their shoulders therefore must be emboldened with
health and dignity to ensure a developed Nation. However, the multitude of prevailing epidemics have left nostone unturned
to enfeeble their strength. Type 2 diabetes mellitus (T2DM) and obesity stand amongst the top shotguns. There is a dire need
to execute preventive as well as therapeutic actions to contain the epidemic, for which one must be well versed with the
attributable risk factors. In this article, we will understand the synaptics of adolescent obesity and T2DM and what strategies
are recommended by the health authorities to prevent and overcome this rising epidemic

Medicolegal Insights