Background: Vigorous training, practice-related injuries coupled with inadequate resting time puts athletes at risk of bacterial infections, which begets the use of antimicrobial agents. The present study was planned to observe and assess the antimicrobial utilization among footballers from various professional clubs in Eastern India. Materials and methods: A cross-sectional observational study was conducted to probe the professional footballers regarding the information on their AMA usage during the last 6 months. Data like name of AMAs, whether prescribed by physicians or taken up as over-the-counter (OTC) drugs, indications for consuming AMAs and consuming AMA for the recommended duration or not were taken into consideration. To assess the AMA utilization pattern, prescriptions and medical records available in respective clubs were thoroughly studied. Antimicrobial agent utilization was assessed based on AWaRe classification as laid down by the WHO. Results: Azithromycin (19.1%), ofloxacin plus ornidazole fixed-dose combination (17.3%) and amoxicillin plus clavulanic acid fixed-dose combination (11.1%) were the top three antibiotics consumed by them. Access, Watch, and Reserve (AWaRe) classification conferred 74% to be under “Watch” group, 22% “Access” and 4% “Reserve.” 62% (n = 68) of the total AMA consumers were prescribed an AMA, with a sore throat, upper and lower respiratory tract infection, effusion in the joint, cellulitis, prophylactic use in case of cut injury, loose motion, enteric fever, and skin infections being the common indications. And 71% of the AMA users were found not completing the AMA therapy as per the recommended/advised dosage schedule and duration. Conclusion: The knowledge on completing the recommended AMA course requires effective information dissemination. Antimicrobial agent prescribing pattern seen in this study revealed a high chance of development of resistance. Application of knowledge and principles of AWaRe classification thus need to be followed strictly by practitioners.

Background: In India, the problems of underweight and overweight/obesity runs hand in hand. As the age increases from childhood to adolescent, the burden of overweight/obesity is found to be increased than underweight. Objectives: To evaluate the level of physical activity (PA) among school-going adolescents and explore its association with body mass index (BMI). Methods: Descriptive study with cross-sectional design was conducted in Government Higher Secondary Schools in Siliguri sub-division, Darjeeling district, from May 2019 to September 2020. Multistage random sampling was done. Sample size was 1,012. International Physical Activity Questionnaire (IPAQ) self-administered questionnaire was used. Collected data were entered into Microsoft Excel and analyzed by SPSS (version 22). Results: Mean BMI was 21.02 (SD ± 3.59) kg/m². The majority (71.2%) had normal BMI, 19.4% were overweight, and 9.4% were underweight. Most (54.45%) do moderate PA, and 34.98% do high PA. The proportion of overweight people was highest among those with low PA (89.7%) and lowest among those with high PA (4%). This association was statistically significant (p < 0.001). The low PA category as compared to moderate PA had significantly higher odds of being overweight than normal BMI. But the high PA as compared to moderate PA had significantly lesser odds of being overweight than normal BMI. Conclusions: The prevalence of both overweight and underweight was higher among rural participants. Physical activity level was moderately negatively correlated with BMI. Study findings would be helpful to take proper planning and actions to prevent such problems.

Aim and background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse neuropsychiatric manifestations which are classified and diagnosed under ACR 1999 guidelines and contribute significantly to overall disease morbidity and mortality. Data are scarce regarding neuropsychiatric manifestations of SLE in Eastern India as well as the utility of psychiatric rating scales for classifying, assessing disease severity, and prognostication. This study focuses on deriving the prevalence of psychiatric manifestations among SLE patients and their correlation with disease severity using several psychiatric rating scales and markers of disease severity. Methods: This is a single center-based cross-sectional study involving 50 consented adult SLE patients fulfilling Systemic Lupus Erythematosus International Collaboration Committee (SLICC) criteria at NRS Medical College & Hospital over 18 months using a pretested questionnaire that includes psychiatric rating scales as well as disease severity assessment tools. Patients with drug abuse, pre-existing psychiatric disorders, dyselectrolytemia, and ongoing infection were excluded from the study. Results: All the participants had anxiety disorder (100%) followed by depression (80%), psychosis (58%), mood disorders (54%), and cognitive dysfunction (8%). Systemic lupus activity measure, revised (SLAM-R) score had a positive correlation with General Health Questionnaire (GHQ) (r = 0.518, p < 0.05) and brief psychiatric rating scale (BPRS) (r = 0.589, p < 0.05). Brief psychiatric rating scale and GHQ had a positive correlation between them (r = 0.774, p < 0.05). Conclusion: Psychiatric manifestations of SLE are quite prevalent in the study niche and their clinical severity is comparable to that estimated using screening questionnaires and disease severity tools used in this study. Clinical significance: This study showed positive implications of implementing psychiatric rating scales as a screening tool in SLE patients for early diagnosis of psychiatric manifestations and use as corroborative measures of disease severity.

Aims and background: Data on the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for critically ill patients are conflicting. This study aimed to investigate the prognostic value of NT-proBNP in critically ill Indian patients. Materials and methods: This was a retrospective, record-based, observational study conducted in the medicine intensive care unit (ICU) of All India Institute of Medical Sciences, Rishikesh, from December 2023 to May 2024. All patients admitted to the medicine ICU during the study period were eligible for the study. Exclusion criteria included medicolegal cases, age < 18 or >80 years, and patients with missing baseline data. The NT-proBNP was measured on admission. The Mann−Whitney U-test was used to compare ranks, and the receiver operating characteristic curve was used to determine the area under the curve (AUC) and identify the best cut-off values to predict mortality. Results: A total of 137 participants were eligible for the study. The NT-proBNP levels were higher in nonsurvivors compared with survivors, but the difference was not significant (p = 0.121). However, in a subgroup of patients without heart failure and in another subgroup without renal failure, a significant difference was seen in the NT-proBNP values between survivors and nonsurvivors (p = 0.044 and 0.002, respectively). The AUC for predicting mortality was 0.57. Conclusion: The NT-proBNP measured at admission was predictive of in-hospital mortality in nonselective critically ill patients without heart failure and in a subgroup of patients without renal involvement.

Introduction: In India, diabetic nephropathy (DN) constitutes approximately 46% of chronic renal diseases in the elderly population, becoming the primary cause of end-stage renal disease (ESRD). Early detection of DN enables timely intervention and prevents progression to ESRD. Aim of study: To study serum cystatin C as a biomarker of early DN in comparison with urinary albumin-to-creatinine ratio (UACR). Materials and methods: This cross-sectional observational study was conducted in the Department of General Medicine of Employees’ State Insurance Corporation Medical College and Hospital, Faridabad, from 2021 to 2024 after obtaining clearance from our institutional ethical committee. The duration for the sample collection was 1 year. A total of 50 consenting diabetic patients who fulfilled the inclusion and exclusion criteria within the study period were included in the study. In diabetic patients with a glomerular filtration rate (GFR) of ≥30 mL/min/1.73 m², indicating early DN (stages I, II, and III according to Mogensen's classification), serum cystatin C and UACR were assessed. We conducted a comparative analysis of serum cystatin C and the UACR as biomarkers for early DN. Results: Among 50 patients, 68% of the patients were aged between 41 and 50 years. The mean age was 43.06 ± 6.9 years. Among total subjects, 52% were males and 48% were females. The most common complaints were polyuria (56%), fatigue (56%), polydipsia (38%), and weight loss (34%). Mean values of diabetic parameters for fasting blood sugar (FBS), postprandial blood sugar (PBS), random blood sugar, and HbA1c were 224.82 ± 79.02 mg/dL, 341 ± 90.1 mg/dL, 331.56 ± 76.98 mg/dL, and 9.85 ± 2.37%, respectively. Mean duration of diabetes was 4.4 ± 3.48 years. About 30% of the cases were classified as stage I, 22% as stage II, and 48% as stage III. Serum cystatin C levels were elevated in 78% of cases. The mean serum cystatin C levels was 1.19 ± 0.39 mg/L, UACR was 95.22 ± 102.15 mg/gm, and GFR was 102.62 ± 28.54 mL/min/1.73 m². Serum cystatin C levels showed a significant positive correlation with UACR with an r-value of 0.530 and significant p-value of < 0.001. Conclusion: This study suggests that serum cystatin C is a valuable biomarker for early detection of DN and its rise before the onset of microalbuminuria highlights its utility in clinical practice.

Introduction: This research paper examines the knowledge, attitudes, and practices (KAP) of adverse drug reactions (ADRs) among healthcare professionals in a teaching hospital in eastern India. The study aims to assess their understanding of ADR reporting and draw conclusions about their role in patient safety. Materials and methods: A cross-sectional study was conducted with medical undergraduate students, medical postgraduates, medical interns, and nursing personnel. Participants completed a questionnaire consisting of knowledge, attitude, and practice-based questions. Data analysis was performed using statistical software. Results: A total of 264 participants took part in the study. Medical undergraduates and postgraduates had higher knowledge scores compared to interns and nursing personnel. Attitudes towards ADR reporting were more positive among medical students and interns. Practice scores revealed a gap between identifying and reporting ADRs, with postgraduates exhibiting the highest reporting practices. Conclusion: There are variations in the KAP of ADRs among healthcare professionals. Continuous education and training programs are needed to improve pharmacovigilance practices, particularly among nursing personnel. Integrating ADR reporting into curricula can enhance patient safety and promote rational medication use.

Doctors seem to be a soft target for the scamsters for cyber frauds. We are otherwise known for our intelligence and shrewdness, fall prey to these cyber criminals with ease. This is a short write-up on this very problem.

Introduction: Sjögren's syndrome is an autoimmune disorder which leads to chronic B-cell infiltration of the exocrine glands, most commonly salivary and lacrimal glands. This leads to xerostomia and keratoconjuctivitis sicca which are the most common clinical manifestations reported in literature. However, it can present in a wide range of clinical spectrum. Such patients may pose a diagnostic challenge for the treating physicians. Aim: The aim of the article is to establish the significance of autoimmune workup in any middle-aged female presenting with hypokalemic quadriparesis with hyperchloremic normal anion metabolic acidosis. Materials and methods: This case series was reported from a tertiary care center in North-West India from June, 2022 to July, 2024. Here we will discuss five middle-aged female patients who presented with sudden onset quadriparesis, as a result of severe hypokalemia, which was the initial manifestation of Sjögren's syndrome due to interstitial involvement of the kidneys, manifesting as distal (type I) renal tubular acidosis (RTA), thus leading to hypokalemia. In these patients, arterial blood gases (ABG) reveal hyperchloremic normal anion gap metabolic acidosis (NAGMA). Antinuclear antibodies (ANA) Hep-2 positivity was seen associated with a positive SSA antibody, thus making a diagnosis of Sjögren syndrome. Conclusion: Patients of Sjögren's syndrome may present with manifestations due to extraglandular involvement of kidneys. The most common renal manifestation is interstitial nephritis, presenting as distal (type I) RTA. Hypokalemia is the most common electrolyte abnormality, that causes sudden onset quadriparesis.

Drug-induced liver injury (DILI) is a condition characterized by acute or chronic liver damage following the use of hepatotoxic drugs. It can be classified based on clinical presentation (hepatocellular, cholestasis, or mixed), mechanism of hepatotoxicity, or histological appearance. Drug-induced liver injury also includes cases related to herbal-induced liver injury (HILI). Diagnosing DILI requires excluding other potential causes and identifying a consistent pattern of liver involvement. The pathogenesis typically involves the parent drug or its metabolites, which may directly impact cell biochemistry or trigger an immune response. The specific drug involved influences the pattern of liver function abnormalities, the latency period before symptom onset, the presence of immune-mediated hypersensitivity, and the response to drug discontinuation. The case discussed illustrates a DILI caused by an indigenous herbal drug, highlighting the complexities of identifying and managing liver injury in such scenarios.

Erasmus syndrome is a rare disease characterized by the development of systemic sclerosis (SSc) in the background of silica exposure or silicosis. Here we report a case of a 42-year-old male who presented with skin tightening for 2 years and progressive dyspnea for 1 year. Patient worked as a sandblaster for 6 months. On examination, there was sclerodactyly, fixed flexion deformity of the lower limbs, diffuse skin tightening and salt and pepper rashes on the chest wall and upper back and crepitations on the chest auscultation. Chest imaging and pulmonary function tests were suggestive of interstitial lung disease. The autoimmune profile showed Scl-70 +++. The diagnosis of erasmus syndrome was made based on specific clinical presentations and characteristic chest imaging findings in a male patient with a history of silica exposure.

Kala-azar, or visceral leishmaniasis, was once a widespread problem in the Bengal Presidency of British India, encompassing present-day Indian states such as Bengal, Bihar, Assam, and Odisha. The disease was prevalent along the Ganga and Brahmaputra River regions. Upendranath Brahmachari, born on December 19, 1873, emerged as a pioneering figure in the field of medicine, particularly noted for his groundbreaking work in combating Kala-azar in 1920. Upendranath Brahmachari discovered urea stibamine which revolutionized the treatment of Kala-azar. This discovery achieved a cure rate exceeding 90% with minimal side effects. His research also extended to identifying post-kala-azar dermal leishmaniasis, subsequently known as Brahmachari Leishmanoid. Despite nominations for the Nobel Prize in Medicine in 1929 and 1942, Brahmachari's enduring legacy in tropical therapeutics and biochemistry remains underappreciated.

Fibromuscular dysplasia (FMD) can present with renovascular hypertension with or without hypertensive emergency in mostly young patients. A 16-year-old girl presented with uncontrolled hypertension and features of posterior reversible encephalopathy syndrome (PRES). She had no features of large vessel vasculitis. Renal artery bruit could be auscultated on the right side. Blood examination showed hyperreninemic hyperaldosteronism. The USG renal artery doppler study and invasive renal angiogram showed unilateral right renal artery stenosis. She was provisionally diagnosed as a case of FMD and was treated accordingly.