International Journal of Advances in Medicine

Impact of 90-day integrative therapy on ambulatory blood pressure parameters in patients with white coat effect: a preliminary retrospective observational study

2026-02-03T22:40:56+0530

Hypertension diagnosis based on clinic blood pressure measurements is often confounded by the white coat effect, leading to potential misclassification and overtreatment. Ambulatory blood pressure monitoring provides a more accurate assessment of true blood pressure patterns and therapeutic response. A retrospective, multicentric, observational study was conducted at Madhavbaug clinics across India from December 2022 to April 2025. Patients aged 18 years and above diagnosed with white coat effect on ambulatory blood pressure monitoring and participated in the Blood Pressure Management Program were studied. Data from day 1 was compared with data from day 90. A total of 12 patients were studied. Improvement in daytime ambulatory systolic blood pressure (day 1: 143.92±7.39 mmHg and day 90: 123.83±7.10 mmHg), nighttime ambulatory systolic blood pressure (day 1: 135.25±7.67 mmHg and day 90: 114.83±10.20 mmHg), daytime ambulatory diastolic blood pressure (94.42±5.87 mmHg and 79.83±6.91 mmHg), and nighttime ambulatory diastolic blood pressure (day 1: 86.50±8.07 mmHg and day 90: 72.00±10.53 mmHg) at 90 days were improved. Ayurveda and Panchakarma significantly decreased ambulatory blood pressure parameters and eliminated white coat effect in patients without adverse side effects. Controlled trials are needed to confirm the positive outcome of this promising alternative treatment for hypertension.

A contemporary review on combination therapy for hypertension management in India

2026-02-11T16:45:26+0530

Hypertension affects nearly one-third of Indian adults, yet only one in six patients achieve adequate blood pressure control. This narrative, evidence-informed review synthesizes data from PubMed, Scopus and Google Scholar (2000–2025) on antihypertensive combination therapy, with additional focus on Indian epidemiology and prescribing patterns. Evidence suggests that early initiation of combination therapy—particularly as single-pill combinations (SPCs)—may offer more rapid and sustained blood pressure reduction by targeting multiple pathophysiological pathways simultaneously. Indian patients have a unique cardiometabolic phenotype characterized by increased abdominal obesity, diabetes, dyslipidemia, heightened sympathetic tone, elevated resting heart rate, and enhanced renin-angiotensin-aldosterone system (RAAS) activation, resulting in higher cardiovascular risk at younger ages. This review evaluates clinical evidence from dual, triple, and quadruple combination trials, summarizes current global and regional guideline recommendations, and highlights gaps in Indian practice, including persistent underutilization of combination regimens in moderate- to high-risk patients. The objective is to review global evidence for Indian clinical practice and discuss strategies for optimizing risk-stratified hypertension management.

Influenza vaccination in discharge protocol for patients with comorbid conditions: an expert review

2026-03-05T18:57:33+0530

Influenza remains a significant global health challenge, contributing to substantial morbidity and mortality, particularly among individuals with chronic comorbidities such as cardiovascular disease, chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus, and chronic kidney disease (CKD). Despite strong recommendations, influenza vaccine uptake in India continues to be low. The aim of this consensus was to assess the role of influenza vaccination as part of hospital discharge protocols for patients with comorbidities in clinical settings. A focused expert advisory meeting was conducted with nine leading pulmonologists from India to evaluate the role of influenza vaccination as part of hospital discharge protocols in patients with comorbidities. The discussion was supported by a comprehensive literature review. Current national and international guidelines were also analyzed to provide contextual insights. Annual influenza vaccination significantly reduces complications, hospitalizations, and all-cause mortality among high-risk populations. Evidence demonstrates reductions in cardiovascular events, respiratory morbidity, and exacerbations in COPD and asthma. In patients with diabetes and CKD, vaccination is associated with decreased hospitalization rates, fewer ICU admissions, and slower progression of renal decline. However, barriers such as limited awareness, absence of standardized hospital protocols, and logistical constraints impede vaccine uptake. Incorporating influenza vaccination into discharge protocols and enhancing patient education can substantially improve coverage in these vulnerable groups. Hospital-based vaccination programs represent a feasible and effective strategy to mitigate influenza-related morbidity and mortality in India. Expert consensus strongly supports the inclusion of influenza vaccination in discharge protocols for patients with comorbidities.

Caroli disease presenting with recurrent cholangitis and secondary small bowel obstruction: a case report

2026-03-13T17:56:39+0530

Caroli disease is a rare congenital hepatobiliary disorder characterized by non-obstructive dilatation of the intrahepatic bile ducts and classified as Todani type V choledochal cyst. Although congenital in origin, the disease is often diagnosed in adulthood due to its indolent course and nonspecific symptoms, frequently after complications such as recurrent cholangitis have occurred. We report a case of a 46-year-old male presenting with recurrent epigastric pain, abdominal distension, fever, jaundice, nausea, vomiting, and bowel movement disturbance. Laboratory findings revealed leukocytosis, direct hyperbilirubinemia, and cholestatic liver enzyme elevation consistent with acute cholangitis. Abdominal radiography demonstrated features of partial small bowel obstruction. Magnetic resonance cholangiopancreatography (MRCP) with contrast revealed multifocal cystic dilatation of the intrahepatic bile ducts without extrahepatic obstruction, consistent with Caroli disease. The patient was managed conservatively with intravenous antibiotics, ursodeoxycholic acid, bowel decompression, and supportive care, resulting in gradual clinical improvement. This case highlights the diagnostic value of MRCP and demonstrates that conservative management can be effective in adult Caroli disease complicated by recurrent cholangitis and secondary small bowel obstruction.

Tacrolimus-associated hemichorea in a post–renal transplant patient: a case report

2026-02-03T08:18:37+0530

Tacrolimus is a calcineurin inhibitor widely used as maintenance immunosuppression after renal transplantation. Although neurotoxicity is a well-recognized complication of tacrolimus therapy, manifesting as tremor, seizures, posterior reversible encephalopathy syndrome, and encephalopathy, the occurrence of choreiform movements—particularly hemichorea—is exceptionally rare. We report a 32-year-old male who developed acute-onset unilateral chorea one month after renal transplantation while receiving tacrolimus and prednisolone. Laboratory evaluation revealed a markedly elevated tacrolimus trough level, while magnetic resonance imaging (MRI) of the brain demonstrated an old right capsulo-ganglionic hemorrhage, providing a structural vulnerability. The patient improved promptly after reduction of tacrolimus dosing and symptomatic therapy. This case underscores the need to consider tacrolimus-induced neurotoxicity in the differential diagnosis of new-onset movement disorders in transplant recipients.

Lipid profiles of patients as markers for the severity of liver cirrhosis

2026-02-16T20:26:33+0530

Background: The lipoproteins, endogenous lipids and apolipoproteins are formed in the liver and lipid metabolism, stages of lipid synthesis and transportation are also control by the liver. Degenerated serum lipoprotein pattern can be observed during the acute metabolic impairment in cirrhosis hence, it is reasonable to expect an abnormal lipid profile in those with severe liver dysfunction.

Methods: This cross-sectional study was carried out at a tertiary care hospital, in central Rajasthan among 360 cases of cirrhosis of liver from all causes admitted in Medicine and Gastroenterology wards of Jawaharlal Nehru Medical College, Ajmer. Venous blood sample was collected after overnight fasting of 12 h in all the patients diagnosed with cirrhosis for estimation of hemoglobin, total white blood cell (WBC) count, total platelet count, erythrocyte sedimentation rate (ESR), random blood sugar, blood urea, serum creatinine, liver function tests and serum lipid profile.

Results: The mean high-density lipoprotein (HDL) levels were decreasing statistically with increasing model for end stage liver disease (MELD) score while low-density lipoprotein (LDL) and triglyceride (TG) showed no significant association with increasing MELD score. The sensitivity of HDL in detecting the liver cirrhosis at cut off of 19.3 MELD score was estimated to be 93% and specificity of 82.1%.

Conclusions: The mean HDL levels were significantly decreasing with increasing MELD score and the study of lipid profile of patients may be an alternate to assess the severity of liver cirrhosis.

A study of serum magnesium level and its association with glycemic control in patients with type 2 diabetes mellitus

2026-02-18T11:09:33+0530

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem associated with chronic hyperglycemia and multiple metabolic disturbances. Magnesium plays an important role in insulin action and glucose metabolism and hypomagnesemia is frequently observed in diabetic patients, potentially contributing to poor glycemic control. To estimate serum magnesium levels in patients with T2DM and to assess their association with glycemic control measured by HbA1c.

Methods: This hospital-based, single-centre, cross-sectional observational study was conducted in the General Medicine inpatient ward of a tertiary care hospital over 12 months. A total of 200 adults with T2DM were included after applying the inclusion and exclusion criteria. Clinical details and laboratory parameters, including fasting and postprandial blood glucose, serum magnesium, HbA1c, urea and creatinine, were measured. Data were analysed using SPSS. Chi-square test and correlation analysis were applied, with p<0.05 considered significant.

Results: Hypomagnesemia (<1.8 mg/dl) was present in 68.0% of participants. The mean serum magnesium level was 1.46±0.58 mg/dL and mean HbA1c was 7.52±1.21%. A significant association was found between serum magnesium category and HbA1c group (Chi-square=7.85, p=0.010). Serum magnesium showed a significant negative correlation with HbA1c (r=−0.262, p=0.001).

Conclusions: Hypomagnesemia is common in T2DM and is significantly associated with poorer glycemic control. Routine monitoring and correction of magnesium deficiency may support better diabetes management.

Musculoskeletal disorders in patients with diabetes mellitus: a neglected manifestation

2026-03-19T23:24:32+0530

Background: A variety of musculoskeletal manifestations are commonly related with diabetes mellitus. This study is aimed at evaluating the prevalence and clinical spectrum of musculoskeletal manifestations in patients with diabetes mellitus in KJ Somaiya Hospital, Mumbai.

Methods: A tertiary care centre based cross-sectional study was conducted with 82 patients from November 2018 to October 2020 to evaluate the pattern of musculoskeletal (MSK) manifestations in adult diabetic patients and to correlate them with duration and control of diabetes. A detailed history and clinical examination were noted in each patient with particular importance given on musculoskeletal examination and relevant investigations.

Results: Most of the patients (35.6%) were aged between 51 and 60 years. Female patients accounted for 63.4% of the study population. 69 (84.2%) patients had HbA1c ≥7 (poor glycaemic control). The most common musculoskeletal manifestation was Frozen shoulder (18.3%) followed by Osteoarthritis (17.1%).

Conclusions: Musculoskeletal manifestations are quite prevalent in patients with diabetes mellitus, and there is significant correlation between development of these manifestations and glycaemic control, age and duration of diabetes of patients.

Comparative pharmaceutico-analytical study of Elva prepared with two different methods

2025-06-10T12:13:34+0530

Background: Aloe vera has a long antiquity as a medicinal herb with varied therapeutic applications. It has been used as remedies in different form as gel, Elva, juice etc. Among the different forms, Elva is found to be as a constituent in several Ayurvedic formulations but still its standard operating procedure is not mentioned yet. Aim was to develops a standard operating procedure for Elva by preparing it with two different methods.

Methods: The study was carried out by preparing Elva with two different methods, first by water extract (Elva sample I) of aloe vera leaves and secondly by pulp (Elva sample II) of the same.

Results: Elva sample I and II have 4.65% and 2.2% yield respectively. Also, by HPTLC identification, Elva sample I found to be more genuine by taking British Pharmacopoeia as reference standard.

Conclusions: Elva sample I have comparatively better yield and found to be more acceptable by HPTLC.