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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The Indian Public Health Standards (IPHS) 2022: Opportunity for Obesity Management
This communication reviews the Indian Public Health Standards (IPHS), a comprehensive coverage of health care standards across levels of care. It highlights the multiple opportunities available to integrate obesity care in the existing framework. A focused approach on innovation and integration can enhance efficacy and efficiency of existing health care systems.
Pragmatic Considerations in Switching to Semaglutide for Obesity Management: Real- World Perspectives
Incretin-based therapies have transformed the management of obesity and related cardiometabolic diseases. With the increasing availability of agents such as semaglutide and tirzepatide, switches between therapies are occurring in clinical practice despite the absence of formal randomized evidence guiding such transitions. This review outlines pragmatic, experience-based considerations for switching from tirzepatide to semaglutide including clinical rationale, dose conversion approaches, titration strategies, and cost-sensitive implementation. These practical insights aim to support clinicians in optimizing individualized, safe, and cost-effective obesity management.
Herpes Zoster Ophthalmicus in Healthy 13-month Infant: An Unforeseen Scenario
Herpes zoster (HZ) as well as varicella are caused by varicella-zoster virus. It is uncommon in children. Cases have been reported in literature among all ages from neonate to old age. We report this case of HZ ophthalmicus in a healthy child born to healthy mother with a history of varicella infection in the third trimester (7th month of gestation). Early diagnosis and treatment reduce complications. Preconceptional varicella-zoster vaccine is also a matter of concern.
Vaginal Estrogen Therapy in Postmenopausal Overactive Bladder
To assess the efficacy of vaginal estrogen therapy in postmenopausal overactive bladder (OAB). Study design: It is an OPD (outpatient department) based prospective study. Postmenopausal women attending gynecology OPD with complaint of OAB were enrolled for the study. Women fulfilling the criteria for the study were given estradiol 2 mg vaginal tablet everyday for 2 weeks, then weekly twice for 10 weeks. Patients were assessed by 3-day bladder diary, Patient Global Impression scale, before and after the therapy. Results: Ninety-three patients completed the study. Increased frequency of micturition was cured in 92.5% cases; urgency and urge incontinence was cured in 74.2% cases. Patient’s subjective feeling of improvement scale revealed only 12.9% women felt either no change or little better; rest all were happy. Conclusion: Local estrogen therapy in postmenopausal women with OAB resulted in a good outcome.
Uses of Antithyroid Antibodies in Nonvascular Hemisensory Impairment
To find out the uses and correlation of antithyroid antibodies in patients with hemisensory impairment. Background: In day-to-day clinical practice, we have difficulties in managing patients with hemisensory impairment, where the diagnostic tests are not supporting clinical localization. Material and methods: All patients, aged 18 years and above, who came to the Neurology Department between February 2018 and August 2019 with either right or left persistent hemisensory impairment with or without facial involvement, were included. After the clinical assessment, appropriate investigations (complete blood counts, urea, creatinine, electrolytes, thyroid-stimulating hormone [TSH], serum B12, antinuclear antibodies [ANA] profile, perinuclear antineutrophil cytoplasmic antibodies [pANCA], cytoplasmic antineutrophil cytoplasmic antibodies [cANCA], neurolaboratory tests, carotid vertebral arterial Doppler study, magnetic resonance imaging [MRI] brain with magnetic resonance angiogram [MRA]/MRI brain with contrast) were done to confirm the diagnosis or to treat accordingly. Patients with acute stroke, demyelination, hemiplegic migraine and transient ischemic attack (TIA) were excluded. Rest of them were advised to undergo serum antithyroid antibodies and psychiatric assessment. Patients with positive antithyroid antibodies were treated with prednisolone 1 mg/kg/day for 6 weeks and reviewed. Psychiatric follow-up was done in patients with negative antithyroid antibody reports. Uses and correlation of antithyroid antibodies were analyzed. Results: A total of 33 patients were studied. Among them, 28 (85%) were females, 5 (15%) males and the mean age of presentation was 41.6 years. Out of 33 patients, 27 (82%) had subjective feeling of subacute onset persistent tingling sensation or numbness or tightness or hypo-/hyperesthesia or uneasiness on either side of the body with or without face involvement. Rest of the 6 patients (18%), had numbness with feeling weak on one side with no demonstrable sensory motor deficit. Antithyroid antibodies (antithyroglobulin and antithyroid peroxidase antibodies) were positive in 21 (64%) patients with hemisensory impairment. In this study, 28 (85%) were in euthyroid, 3 patients (9%) in hypothyroid and 2 (6%) were in hyperthyroid groups. Antithyroid antibodies were positive in 61%, 66% and 100%, respectively in the thyroid groups. None of our study patient had psychiatric illness or brain lesions on MRI study. Conclusion: Autoimmune thyroiditis can present with new onset persistent hemisensory impairment in young adults, which is more common in females. Both antithyroid antibodies are clinically useful in the diagnosis and management of nonvascular hemisensory impairment. Hence, the strong clinical judgment not supported by the diagnostic tests might alert the physician to rule out autoimmune thyroiditis in neuroaxis.
Antithyroid antibodies (antithyroglobulin and antithyroid peroxidase antibody),
Effect of Alcohol on Clinical Outcomes and Its Relationship with Semen Parameters
The incidence of infertility is 10%-15% globally and this has risen in recent years. Alcohol has been consumed in India for centuries, both in rural and urban areas, with prevalence rates ranging from 20% to 38% in males, according to various reports. Studies in northern India found the 1 year prevalence of alcohol use to be between 25% and 40%. In southern India, the prevalence of current alcohol use varies between 33% and 50%, with a higher prevalence among the lesser educated and the poor. Aim: To determine the effect of alcohol on seminal parameters. Design: Retrospective study. Setting: Morpheus Lucknow Fertility Center, Lucknow, Uttar Pradesh. Time duration: From January 2017 to December 2020. Sample size: Total 130 patients consisting of 57 patients as nonalcoholic control and 73 patients as alcoholic. Main outcome measure(s): The outcome of interest was seminal parameters, including count, motility, volume and morphology. Method: The study included two subject groups, controls and alcoholics. Subjects in the control group were volunteers who were free from any disease and who had never consumed alcoholic drinks and who had never smoked. Subjects in the alcoholic group were nonsmokers who had consumed a minimum of 180 mL of alcohol (brandy and whisky, both 40%-50% alcohol content) per day for a minimum of 5 days per week in the past year. Semen samples were collected after at least 48 hours but no more than 7 days of sexual abstinence. Semen parameters - volume, count, motility and morphology - were analyzed. Results: In the alcoholic group, volume (p < 0.005), count (p < 0.005), percentage of rapid progressively motile sperm (p < 0.005), were statistically significantly decreased, while percentage of nonprogressive sperm and percentage of immotile sperm (p < 0.005) were statistically significantly increased, compared with the control group. The percentages of slow progressively motile sperm and morphology were not statistically significant. Conclusions: The present study found statistically significant results that chronic alcoholism suppresses semen quality, at the seminiferous tubular level. Alcohol decreases semen volume, total sperm concentration, motility of sperm and viability of sperm. This study has proved beyond doubt that chronic alcohol consumption has a detrimental effect on the quality of semen, which in turn, may have effect on their reproductive outcomes.
Evaluation and Prediction of Cardio- Cerebrovascular Disease in End-Stage Renal Disease Patients on Hemodialysis Using Carotid Doppler Scan
The global prevalence of advanced chronic kidney disease (CKD) was more than 10 million, with an associated astronomical increase in morbidity and mortality of about 41.5%. The major reasons for fatality are usually due to carotid vessel diseases leading to stroke and ischemic heart diseases, accounting for a prevalence of about 15.1%. This study aims to evaluate the changes in carotid diameter (CD), carotid intima-media thickness (CIMT), and the presence of plaque using a noninvasive method like Doppler ultrasound in predicting cardiovascular and cerebrovascular disease outcomes to aid early interventions. Methods: One hundred and thirty-four patients with end-stage renal disease (ESRD), who were on dialysis for different durations, were consecutively recruited for the research. Details of the lipid profile, blood glucose, smoking, alcohol consumption, body mass index (BMI), and duration on dialysis were documented. A skilled radiologist used Doppler ultrasound to determine the CD, CIMT, and presence of plaque. Data were analyzed using the Statistical Package for the Social Sciences (IBM SPSS), version 23. A p-value of <0.05 was considered statistically significant for all analyses. Results: The cumulative prevalence of carotid artery diseases was 44.8%. The prevalence of patients with CD and abnormal CIMT was 41.8% and 6.7%, respectively. There was a positive correlation between CIMT and duration of dialysis (r = 0.174, p = 0.045), but it was inverse for CD (r = –0.145, p = 0.094). Alcohol, smoking, and the etiology of CKD have no significant association with carotid vessel disease. Conclusion: We conclude that carotid artery disease is highly prevalent among ESRD patients, and it is therefore imperative to identify these risks early and treat them to prevent fatal cerebrovascular and cardiovascular outcomes.
Coronary artery anomalies are rare, and the incidence is around 1% to 2% in the general population. Majority of the patients are asymptomatic and detected while investigating another clinical issue. A few anomalies may be life-threatening due to the malignant course with potential for ischemia and even sudden death. Multidetector computed tomography (MDCT) has high accuracy in detecting these anomalies because of volume rendering (VR) and multiplanar reconstruction (MPR). ‘High take-off’, origin of the coronary artery from the opposite or noncoronary cusp with anomalous course and coronary artery fistula are three most frequent anomalies. MDCT can be a useful screening tool in the study of coronary anomalies.
Endometriosis Mimicking Upper Gastrointestinal Symptoms in Women
Governing Longevity: Ethical and Social Trade- offs in Singapore’s State-Led Health
This paper examines the ethical implications of Singapore’s emergence as the first engineered “Blue Zone 2.0,” where public health outcomes are shaped through deliberate state-led policies rather than organic cultural practices. Drawing on theories of governmentality, liberty, and public health ethics, the paper develops a framework to assess how Singapore’s policies simultaneously preserve formal freedoms and subtly guide citizens toward state-preferred behaviors. Through four tensions—non-interventionism, soft coercion, collective welfare, and the expansion of state authority—the analysis finds that Singapore’s model blurs boundaries between governance and daily life. While policies improve population health and reduce preventable disease, they also rely on environmental nudges and moralized expectations that complicate individual autonomy and expand the cultural role of the state. The paper concludes that Singapore’s engineered longevity challenges traditional ethical limits on state intervention and raises broader questions about autonomy, equity, and the political nature of designing health at scale.
SGLT2 Inhibitors in the Primary Health Care Setting: Consensus, Challenges, and Clinical Use
Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a major advancement in the pharmacological management of type 2 diabetes mellitus (T2DM), with robust evidence demonstrating benefits beyond glycemic control. They offer additional health benefits such as lowering the risk of heart failure hospitalizations, slowing chronic kidney disease (CKD) progression, and improving cardiovascular, renal, and metabolic health. The effective use of SGLT2 inhibitors also relies on comprehensive patient education and counseling. Patients must understand the medication's benefits, such as reducing blood sugar and preventing complications, and be instructed to stop the medication during acute illnesses or surgeries. It is vital to advice against discontinuing use without medical guidance due to potential risks. Routine check-ups for clinical status, blood glucose, and kidney-heart function are essential for safety and effectiveness. However, the application of SGLT2 inhibitors in primary care settings in rural India, specifically in Jharkhand, is low due to high costs, lack of provider awareness, insufficient monitoring systems, and treatment hesitance. Furthermore, no peer-reviewed data is available to assess their use in this region. Hence, a structured questionnaire was created by expert groups and distributed to endocrinologists, cardiologists, and general physicians. Using the DELPHI methodology, consensus statements were formed based on evidence and reviewed by 12 experts from India. Statements that garnered over 65% agreement in discussions were included in the final consensus. The consensus emphasized that SGLT2 inhibitors benefit T2DM, heart failure, and CKD, with safe, structured use and integration into primary care being key to maximizing cardio-renal-metabolic outcomes.
Sodium-glucose cotransporter 2 inhibitors,
IRACON 2025: 40th Annual Conference of Indian Rheumatology Association
Physician Preferences and Clinical Experience with Rabeprazole–Domperidone in Acid-Related Disorders: Insights from the Power Physician Survey 3.0 in India
Gastroesophageal reflux disease (GERD) is a common and chronic acid-related disorder that significantly affects quality of life. Proton pump inhibitors (PPIs) remain the cornerstone of therapy, often prescribed in combination with prokinetics such as domperidone to enhance symptomatic relief. This survey aimed to assess physician perceptions, prescribing patterns, and key factors determining the choice of PPI–domperidone combinations in India. Methods: A cross-sectional, perception-based digital survey (Power Physician Survey 3.0) was conducted among 3,260 physicians across India. A structured questionnaire captured information on patient load, preferred treatment strategies, time to symptom relief, recurrence rates, and factors guiding the selection of specific PPI–domperidone combinations. Responses were analyzed using descriptive statistics. Results: Over half of the respondents (51.6%) preferred prescribing a PPI–domperidone combination rather than PPI monotherapy. The rabeprazole–domperidone (RD) combination emerged as the most preferred regimen (80.1%), primarily for its rapid acid inhibition (46.6%), better tolerability (18.3%), and cost-effectiveness (13%). About half of the physicians observed symptomatic relief within 2 to 3 days (50.6%), with 82.8% perceiving lower recurrence rates and 88.7% reporting improved patient adherence. On preference ranking, RD was selected as the first choice by 80.1% of physicians, followed by pantoprazole– domperidone (10.4%), omeprazole–domperidone (4.8%), and esomeprazole–domperidone (4.7%). The combination was also rated most effective for night-time heartburn (90%) and preferred for patients with comorbidities (86.3%). Conclusion: The findings highlight a strong real-world preference for the RD combination in GERD management, driven by its rapid action, safety, and patient-centered benefits including improved adherence, symptom control, and reduced recurrence. These insights emphasize the importance of balancing efficacy, tolerability, and affordability in clinical decision-making for acid-related disorders in India.
Self-Monitoring of Blood Glucose for Gestational Diabetes Mellitus: A Nationwide Survey of Perspectives and Clinical Practices among Clinicians in India
Self-monitoring of blood glucose (SMBG) is an essential part of gestational diabetes mellitus (GDM) management. However, there is still a lack of adherence to SMBG in India, and it is unclear how actual clinician practices affect its uptake. This study evaluated the knowledge, attitudes, and practices of gynecologists and endocrinologists/diabetologists in India towards SMBG. Methods: A cross-sectional, digital knowledge, attitude, and practice (KAP) survey was conducted from May to July 2025 among 588 clinicians (311 endocrinologists/diabetologists and 277 gynecologists). Two validated, structured questionnaires captured awareness of guideline recommendations, attitudes toward SMBG, perceived patient barriers, and routine clinical practices. Responses were summarized using descriptive statistics. Results: A strong adherence to national guidelines was shown by both gynecologists and endocrinologists/diabetologists. Gynecologists identified patient noncompliance and lack of motivation, psychological resistance, and discomfort from repeated finger pricks as major obstacles, while endocrinologists emphasized on cost associated with glucose monitoring devices and strips, lack of acceptance, and limited knowledge on SMBG techniques. SMBG was widely recommended for insulin-treated GDM, but attitudes toward its role in lifestyle-controlled GDM varied. Although postpartum follow-up and referral patterns remained uneven, the majority of clinicians concurred that SMBG supports timely therapy decisions. Conclusion: Initiating SMBG at the level of gynecologists itself promotes earlier glycemic stabilization, which is essential for improving perinatal outcomes and reducing the burden of future diabetes and metabolic complications.
SMART-DM: Simplified Diabetes Management for Primary Care Physicians
Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and declining beta-cell function, often leading to chronic hyperglycemia and associated complications. Despite the availability of various pharmacological agents, glycemic control remains suboptimal in a significant proportion of patients, particularly when relying solely on monotherapy or delayed combination strategies. This review explores the current challenges in diabetes management within primary care settings, highlighting the limitations of monotherapy and dual therapy approaches. It emphasizes the role of early, individualized treatment intensification using triple combination therapy involving metformin, dapagliflozin, and sitagliptin. This combination targets complementary pathophysiological pathways - hepatic glucose production, renal glucose reabsorption, and incretin hormone regulation - offering superior glycemic control, reduced risk of hypoglycemia, weight management, and cardiorenal benefits. The SMART-DM framework is introduced as a simplified and actionable approach to guide physicians in optimizing diabetes care. In alignment with global and national clinical guidelines, this review supports the timely adoption of fixed-dose triple therapy to overcome clinical inertia and improve treatment adherence. Additionally, the review discusses evidence from key clinical trials, patient selection considerations, and safety profiles, thereby providing a comprehensive guide for health care practitioners aiming to enhance long-term outcomes in patients with T2DM.
Obesity Clinic Model: A Ramrajya Approach
Air Pollution: An Emerging Threat for Lung Cancer
Accuracy of the Ultrasound Sliding Sign for Predicting Intraperitoneal Adhesions
FROM THE DESK OF GROUP EDITOR-IN-CHIEF
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.