Indian Journal of Clinical Practice is the flagship peer-reviewed journal of IJCP Group. A multispecialty journal, it provides clinicians with evidence-based updated information about a diverse range of common medical topics, including those frequently encountered by the Indian physician, to make informed clinical decisions. Indian Journal of Clinical Practice is a peer-reviewed journal that publishes original research, clinical reviews, case reports, expert viewpoints, clinical practice guidelines, Medilaw, Medifinance, Spiritual Update, Lighter reading including latest news and updates in medicine from around the globe. Indian Journal of Clinical Practice has been published regularly every month since it was first launched in June 1990 as a monthly medical journal. The journal is available in print and is also available online. The ISSN (print version) number is 0971-0876; RNI number is 50798/1990. Indian Journal of Clinical Practice is indexed with Indian Citation Index and IndMed (http://indmed.nic.in/). IJCP Group was founded in 1990 by Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal and was the pioneer of medical journalism in India. It was started with the basic objective of updating the knowledge of the medical professionals, which is the need of the hour. We began with a single monthly journal called ‘The Indian Journal of Clinical Practice’ launched in 1990 by Late Dr Shankar Dayal Sharma, the then Vice President of India. Since then we have now grown into various multispecialty journals, customized books and publications, events, consulting, branding, Continuing Medical Education (CME) activities, doctor meetings, Key Opinion Leader (KOL) interactions, etc. Aim & Mission Our Aim To help medical professionals both within India and abroad to stay updated with the latest advances in medicine and help improve patient outcomes and to provide a platform for doctors to share information Our Mission To be the leader in the field of medical communications and to make Indian medical literature vastly read within India and abroad. Our Vision To benchmark the kaleidoscope of medical information Our Guiding Principles Content is King, commitment, excellence, quality, timeline efficiency, creativity, innovation.
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Case of Limited Negligence on Part of the Doctor and Contributory Negligence by the Patient
Huge Denture Causing Acute Obstruction in Esophagus and Stridor
We report a rare case of an unusually long foreign body (denture) impacted in the mid esophagus of a 62-year-old man. He was illiterate and drank wine regularly. He came to me with some attendants with history of taking wine with lunch, followed by acute obstruction since lunch at 12:30 pm and reached Kota by 9:30 pm. Till then, he was nil by mouth (NBM). Following investigations, we made a diagnosis of foreign body esophagus and with the help of rigid esophagoscopy under general anesthesia, we removed the foreign body. Next morning, he could swallow food and water without any difficulty, and we discharged him.
Chromosome 3p Duplication: A Rare Chromosomal Anomaly
Partial trisomy 3p results from either unbalanced translocation or de novo duplication. Common clinical features consist of dysmorphic facial features, congenital heart defects, psychomotor and mental retardation, abnormal muscle tone and hypoplastic genitalia. In this paper, we report a case of partial trisomy 3p with rare clinical manifestations. A full-term, female newborn was admitted to our hospital with complaints of repeated seizures and developmental retardation. On evaluation, chromosome 3p duplication was detected.
The Usefulness of Ultrasound Guidance in Fresh Embryo Transfers: A Retrospective Study
Objective: To evaluate retrospectively the efficacy of ultrasound-guided embryo transfer method on pregnancy and implantation rate and compare with clinical touch method. Material and methods: The results of 582 cycles from our in vitro fertilization and embryo transfer (IVF-ET) program conducted at Jaipur Fertility Centre, an Infertility Unit of Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan were analyzed retrospectively and comparison was made between those carried out using ultrasound guidance and those by clinical touch method. Results: Higher pregnancy and implantation rates (37.19% and 19.66%, respectively) were found in the group using the transabdominal ultrasound guidance during ET compared with those in the group using the clinical touch method (30.92% and 16.22%, respectively). The difference was not statistically significant. Conclusion: Older women (>35 years) and in the subgroup when the clinician rated the transfer procedure as easy with some difficulty, there appeared to be a substantial improvement in the pregnancy rate and the difference was statistically significant. We believe that ultrasound-guided ET should be used in these subgroups.
Posology of Antidiabetic Drugs and Insulins: A Review of Standard Textbooks
The aim of this bibliographic review is to assess whether standard pharmacology, endocrinology and diabetology textbooks adequately mention the details regarding timings of administration, frequency and dose of various oral and injectable antidiabetic drugs. Material and methods: Four standard textbooks of pharmacology, two of diabetology and three of endocrinology were assessed for the published information regarding dose, timing and frequency of antidiabetic drugs. Results: Various omissions and contraindications were found in the coverage of glucose-lowering drugs in standard textbooks. Proper timing and frequency of administration of sulfonylureas, thiazolidinediones, SGLT2 inhibitors, GLP-1 receptor agonists and DPP-4 inhibitors have been omitted in majority of the textbooks. Conclusions: This article stresses upon the need of a uniform source of information for providing adequate and standardized knowledge regarding timing, frequency and dose of antidiabetic drugs.
ALBI and Child-Pugh Score in Predicting Mortality in Chronic Liver Disease Patients Secondary to Alcohol: A Retrospective Comparative Study
The severity of liver dysfunction in chronic liver disease (CLD) is often estimated with Child-Pugh (CTP) classification or model for end‐stage liver disease (MELD) score. The albumin-to-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction, which is simple and more objective. In the present study, we aimed to retrospectively compare the performance of ALBI score with Child-Pugh score for predicting the mortality in patients with CLD. Material and methods: Data of patients with CLD, irrespective of etiology, were retrospectively reviewed. Child-Pugh score and ALBI score were calculated for the patients and results from receiver operating characteristic (ROC) curves were analyzed. Results: The study was conducted on 299 patients of CLD; age distribution was between 20 and 85 years with mean age of patients being 45.7 ± 10.94 years, sex ratio male: female 265:34 with mortality rate of 19.73%. The area under the curve (AUC) of ROC of ALBI and Child-Pugh were 0.586 and 0.549, respectively. Conclusion: Ability of ALBI score for predicting mortality was comparable with that of Child-Pugh score but Child-Pugh score of >10 had better performance of predicting mortality as compared to ALBI score.
Negative Pressure Wound Therapy in Infected Wounds – Indian Public Hospital Observational Study
Negative pressure wound therapy (NPWT) is a procedure in which vacuum is used to enhance wound healing. Vacuum-assisted closure (VAC) refers to wound dressing that uses pressure below normal continuously or intermittently to the surface of a wound. The negative pressure is maintained by an apparatus; this promotes healing in various kinds of wounds and also helps in wound debridement. Aims: This study was carried out with an aim to find out the rate of wound contraction, compare infection clearance, granulation tissue formation and to study postoperative pain after using NPWT. Material and methods: All types of infected wounds with slough were selected. Patients irrespective of sex between 18 and 70 years of age were included. The wounds included were traumatic, diabetic foot, varicose ulcer, infected wounds, carbuncle, etc. The procedure included surgical debridement as a preliminary procedure, followed by application of NPWT. The wound criteria: 1) size, 2) shape, 3) wound margin and floor, 4) edge and contraction were studied. Results and Discussion: Infected wounds can be treated by specific modalities like daily wound dressing, surgical debridement, hyperbaric oxygen therapy and NPWT. NPWT seems more efficient than standard wound care for infected wounds. In our study, the mean size of ulcer in diabetic patients before NPWT was found to be 6.33 × 4.52 cm; after application of NPWT, it was 4.7 × 2.95 cm. The mean size of ulcer in traumatic patients before NPWT was found to be 7.1 × 5.1 cm, while after application of NPWT, it was 5 × 3.63 cm. The mean size of ulcer in vascular patients was found to be 5.71 × 3.85 cm before NPWT, and after application of NPWT, it was 4 × 2.42 cm. NPWT dressings have been proven to be beneficial as a variant method of dressing, mainly by negative pressure which sucks out serous fluid and helps in the formation of granulation tissue. Used in various wounds, continuous suction over period of time and later intermittent suction depending on wound status enhance wound healing process and lead to faster recovery compared to conventional methods of dressing. Conclusion: The wound healing period for large traumatic wounds and chronic diabetic wounds is 123 days as per published data. In our study, where NPWT was used, the average wound healing period was 35 days, ranging between 10 and 62, which is statistically significant (p < 0.005). NPWT is cost-effective, reduces hospital stay of patient with minimal chances of limb amputation with better results than standard wound care.
Spectrum of Skin Manifestations in CKD: A Tertiary Care Center Experience from North India
Introduction: Dermal manifestations in chronic kidney disease (CKD) patients may range from mild ones, like xerosis, skin pallor, pruritus, coated tongue, superficial infections and hair and nail changes, to severe life-threatening ones, like nephrogenic systemic fibrosis, which is a rare entity in current times. The present study was done to evaluate the spectrum of mucocutaneous manifestations in patients with CKD and to look for an association between them and various biochemical parameters and inflammatory markers. Material and methods: This study was a 1 year prospective, observational study conducted on adult patients with CKD who presented to the Nephrology clinic in Pt. BD Sharma PGIMS, Rohtak. Patients between the ages of 17 and 75 years with CKD stages II or more with dermatological conditions were included in this study. Each participant was subjected to detailed clinical, biochemical, radiological and dermatological examination by same consultants in order to avoid interpersonal variations. Various skin, mucosal, nail and hair manifestations along with cutaneous infections were analyzed across the spectrum of CKD. Results: Among cutaneous infections, fungal infections predominated, amongst which, onychomycosis was the most common. Xerosis was the most common dermatological disease and the prevalence of xerosis, skin pallor and pruritus was found to increase significantly from Stage II to Stage V and VD of CKD in a statistically significant manner. An association was found between xerosis and decreasing levels of hemoglobin and while ferritin was not different between patients with and without xerosis, high-sensitivity C-reactive protein (hs‐CRP) was significantly higher in patients with xerosis. Similarly, hs-CRP levels were significantly elevated in patients with xerostomia and nail pallor as compared with those who did not have these conditions. Lastly, patients with nail pallor had significantly lower albumin. Conclusion: It was observed in our study that in CKD patients on hemodialysis and on conservative management, xerosis, pruritus, pigmentation, nail changes, oral mucosa changes and cutaneous infections were the predominant cutaneous manifestations. In patients with CKD, mucocutaneous manifestations progressively worsened as renal function deteriorated.
Humility and Hormones: The Hacks of Obesity Care
Uncovering Silent Hemoglobinopathies: Utility of HPLC in Outpatient Screening
Hemoglobinopathies are among the most common inherited red cell disorders globally and pose significant public health burden in India. Differentiating hemoglobinopathies from nutritional anemia, particularly in antenatal women, remains a diagnostic challenge. The aim was to determine prevalence and spectrum of undiagnosed hemoglobinopathies among patients attending outpatient clinics using high-performance liquid chromatography (HPLC). Methods: A cross-sectional observational study was conducted from January 2022 to December 2024. A total of 7,440 blood samples from patients attending general medicine, pediatrics, and antenatal OPDs were analyzed. Patients with a known diagnosis of hemoglobinopathy, recent blood transfusion (within 1 year) and patients with uncontrolled diabetes were excluded. Complete blood count (CBC), peripheral smear, sickling tests, and HPLC chromatograms were analyzed. Results: A total of 7,440 outpatient samples were analyzed and a female preponderance (81.2%) was seen in the study population. Among these, 162 cases (2.17%) were found to have abnormal hemoglobin (Hb) fractions suggestive of hemoglobinopathy on HPLC. The most common hemoglobinopathy identified was the heterozygous beta-thalassemia trait (1.37%), followed by heterozygous HbAE (0.32%), heterozygous HbAS or sickle cell trait (0.18%), and heterozygous HbAD Punjab (0.14%). Rare Hb variants included homozygous sickle cell disease (HbSS) (0.04%), hereditary persistence of fetal hemoglobin (HPFH) (0.05%), and 1 case each (0.01%) of homozygous HbEE, heterozygous HbAC, compound HbE/beta-thalassemia, and delta–beta thalassemia. Additionally, 5 cases (0.06%) showed unidentified abnormal peaks on HPLC that required further molecular testing. Peaks in the P03 and P04 retention windows were correlated with elevated HbA1c in individuals with diabetes and excluded from hemoglobinopathy classification. Conclusion: HPLC is a reliable, rapid, and sensitive tool for detecting both common and rare hemoglobinopathies in outpatient settings. Its integration into routine antenatal and general screening can facilitate early diagnosis, genetic counseling, and preventive interventions. Expanding access to HPLC testing can reduce the burden of transfusion-dependent hemoglobinopathies and improve long- term patient outcomes.
Lighter Side of Medicine HUMORSPRING FEVER
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Not Practising Accepted Protocols While Examining a Patient
Jainism: Inspiration and Insights for Obesity Care
An Unusual Case of Liver Abscess Caused by Trematodes
Liver abscess caused by trematodes is considered highly unusual. Here we present a case of an elderly female with no known comorbidities, who presented with fever and right upper quadrant pain. Upon evaluation, she was found to have features of liver abscess on abdominal ultrasound and 640-slice computed tomography (CT) of the abdomen. Ultrasound-guided needle biopsy of the liver showed features of trematode. Patient was treated with oral nitazoxanide. Patient’s fever and abdominal pain subsided after the treatment.
An Investigation of the Equivocal Relationship Between Daydreaming, Creativity and Well-Being
An extensive number of studies have been conducted on the relationship between daydreaming, creativity and well-being, with mixed results, nonetheless. Particularly, research has demonstrated both positive and negative effects of daydreaming on creativity and well-being, as well as of creativity on well-being. In addition, most studies have been conducted on adults. Therefore, the purpose of this survey-based study conducted in, Delhi University in May 2023 was to further explore the relationship among the aforesaid constructs on a sample of late adolescents. To this aim, 622 Indian were asked to complete three psychometrically validated scales. The following research hypotheses were proposed: H1) Daydreaming would be a statistically significant predictor of creativity; H2) Daydreaming would be a statistically significant predictor of overall distress, stress, anxiety and depression; H3) There would be a statistically significant difference in daydreaming among severity levels of stress, anxiety and depression; H4) Creativity would be a statistically significant predictor of overall distress, stress, anxiety and depression; and H5) There would be a statistically significant difference in creativity among severity levels of stress, anxiety and depression. Results showed that daydreaming was not a statistically significant predictor of creativity, but greater daydreaming was related to higher distress, stress, anxiety and depression. Furthermore, participants with higher creativity experienced greater anxiety. Nevertheless, creativity was not a statistically significant predictor of distress, stress and depression. Finally, participants with extremely severe depression displayed lower creativity than those with moderate depression. Further research is advised before practical implications are recommended.
The Effect of Phototherapy on Various Biochemical Parameters in Neonatal Hyperbilirubinemia
Phototherapy (PT) is the current modality of choice for treatment of unconjugated hyperbilirubinemia. The effects of PT on various biochemical parameters including serum calcium, bilirubin profile, serum total protein, albumin, urea, creatinine, serum electrolytes in neonates are a concern in current times. Like any other treatment, PT also has its own side effects. This hospital-based, prospective, comparative observational study was conducted with the objective to assess the level of various biochemical parameters like serum calcium, serum sodium, serum potassium, serum chloride, serum urea and serum creatinine, serum total protein and serum albumin in addition to serum bilirubin before PT and after completion of 48 hours of PT in full-term neonates with unconjugated hyperbilirubinemia at a tertiary care center. On comparing biochemical parameters, a statistically significant difference in parameters such as bilirubin, urea, creatinine, sodium, potassium, chloride, calcium, total protein and albumin was observed after PT. On the other hand, there was a statistically nonsignificant difference in corrected calcium (p = 0.945).
A Survey on Practice of Hygiene and Knowledge About Menstruation in Women of Pithoragarh, Uttarakhand, India
The Uttarakhand, India, is having many remote areas where traditional values are practiced in the society during menstruation. A structured study would help to understand the menstruation related traditional practices. Objective: To study the prevalent practice of hygiene, social taboos, and knowledge about menstruation (KAM) in young females, aged 18 to 25 years, living in the remote area, Pithoragarh district of Uttarakhand. Materials and methods: Institutional Ethics Committee has approved the study. The volunteer subjects were recruited from different villages and colleges. Six hundred fifty subjects were approached to volunteer and 400 subjects, who met inclusion criteria and given consent. The KAM and hygiene related questionnaire [HRQ] were questionnaires, were administered with basic demographic information sheet. Results: Eighty-seven percent of females follow traditional restrictions and taboos during menses. About 52.75% experiencing regular menses, while 47.25% having irregular menses. About 65.25% of respondents were using sanitary pads, while 13% were using old cloth during menstruation. Seventy-two percent women did not know anything about menstruation before menarche. Almost all participants follow social restriction irrespective of their level of education. Conclusion: There are many outdated customs are still practiced by all sections of the society. There is a need of mass awareness to educate the young women about menstruation related taboos and practice of hygiene to have a healthy society.
Role of Sodium Alginate in Gastroesophageal Reflux Disease: An Overview
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.
The Nine Resolves and Nephrology: An Eco‐Social Framework for Kidney Health in India
APAO 2025: The 40th Asia-Pacific Academy of Ophthalmology Congress
Patient Care and Medical Decision-Making