International Journal of Advances in Medicine

Reactive arthritis linked to Abiotrophia defectiva: expanding the spectrum of post-infectious arthritis

Imran Yousaf — 2026-02-21

Reactive arthritis is a form of sterile inflammatory oligoarthritis that occurs days to weeks following a genitourinary or gastrointestinal infection presenting with joint pain and swelling. Extra-articular manifestations include uveitis, oral ulcers, urethritis, and skin rashes. It is commonly due to gram negative bacteria such as Chlamdyia, Campylobacter, Salmonella, Shigella, and Yersinia. Recently, rare pathogens such as Streptococci, Clostridium difficile, Escherichia coli, Mycoplasma pneumoniae have also been implicated. However, Abiotrophia defectiva, a gram-positive bacterium, is not listed among them. We present to the best of our knowledge the only case of Abiotrophia defectiva as a causative agent of reactive arthritis.

Acute rheumatic fever and multiple drug hypersensitivity: a case report

Cindy Fahira — 2026-02-21

Acute rheumatic fever (ARF) is an autoimmune-mediated inflammatory disorder precipitated by infection with group A Streptococcus (GAS) infection. The underlying pathogenesis is attributed to molecular mimicry, wherein antibodies directed against GAS antigens cross-react with host tissues. Diagnosis is established based on clinical evaluation using the revised Jones criteria in conjunction with laboratory evidence of recent GAS infection. Management involves antibiotic therapy, anti-inflammatory agents, and long-term prophylactic strategies to prevent recurrence. One of the potential adverse effects associated with these pharmacologic agents is drug hypersensitivity reactions (DHR). The recommended diagnostic approach to DHR is a graded challenge by introducing drugs safely and optimally under a threshold dose until the usual daily dose is reached. In the present case, due to the patient’s documented history of multiple drug hypersensitivities, a graded drug challenge was performed to ensure medication tolerance and minimize the risk of hypersensitivity.

Clinical and epidemiological characteristics of a hepatitis E outbreak in an internally displaced persons camp in Kassala, Sudan

Barakat M. Bakhit — 2026-02-21

Background: Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis in humanitarian settings. In March 2025, a large HEV outbreak occurred in an internally displaced persons (IDP) camp in Kassala, Sudan. The aim of the study was to evaluate the epidemiological and clinical characteristics of the outbreak to inform public health response.

Methods: We conducted a descriptive cross-sectional study using secondary data from the Kassala State Ministry of Health for all reported HEV cases between March and June 2025. Data were analyzed for demographic, clinical, and temporal characteristics.

Results: A total of 1,041 HEV cases were reported. The mean age was 20.3 years, with the highest attack rates in children and young adults (0-19 years). Females were disproportionately affected (60.7% of cases). The most common clinical presentations were dark urine (83.8%), fever (80.1%), and jaundice (74.4%). The epidemic curve peaked in late March, suggesting a common-source exposure. Only 1.6% of cases were laboratory-confirmed, revealing a significant diagnostic gap.

Conclusions: The 2025 Kassala HEV outbreak highlights the vulnerability of IDP populations to waterborne diseases. The findings underscore the urgent need for specific, actionable interventions, including the deployment of rapid diagnostic tests, implementation of point-of-use water treatment, and targeted health education for women and children to prevent future outbreaks.

Assessing the dual challenge of hypertension and dyslipidemia comorbidity: a real-world need gap analysis on diagnosis, management, drug therapy and patient related factors

Satish Rameshrao Chirde — 2026-02-21

Background: Hypertension and dyslipidemia frequently coexist and significantly elevate the risk of cardiovascular disease (CVD) through shared mechanisms. Despite clear evidence supporting integrated management, real-world gaps persist in diagnosis, monitoring, and patient adherence.

Methods: This nationwide cross-sectional survey was conducted among 842 healthcare professionals (HCPs) across India to evaluate current clinical practices, challenges, and educational needs in managing this dual comorbidity. A structured 20-item questionnaire captured insights on comorbidity prevalence, diagnostic approaches, therapeutic practices, and barriers to optimal care.

Results: The survey revealed substantial coexistence of hypertension and dyslipidemia, with 40.2% of HCPs reporting dyslipidemia in 10-20% of hypertensive patients and 38.8% observing hypertension in 20-30% of dyslipidemic cases. Comorbidity was most prevalent in adults aged 45-60 years (51.9%). Lifestyle factors were the leading contributors (38.3%), followed by age-related factors (25.4%). Despite routine lipid panel use, early diagnosis was hindered by poor follow-up (24.6%), asymptomatic presentation (23.3%), and inadequate screening guidelines (23.0%). Poor patient adherence was identified as the major treatment challenge (54.7%), while guideline sufficiency was divided, with 45.5% rating them adequate and a similar proportion finding them only somewhat sufficient.

Conclusions: Overall, the findings highlight substantial unmet needs in the real-world management of hypertension with dyslipidemia. Strengthened patient education, structured lifestyle support programs, regular lipid testing, and enhanced clinician training may improve early detection and long-term outcomes. A more unified, patient-centered approach is essential to reducing the growing cardiometabolic burden in India.

Effects of comorbidities on COVID-19 biomarkers: a retrospective study

Pradnya M. Bagalkote — 2026-01-09

Background: This retrospective investigation aimed to assess the effects of comorbidities on COVID-19 biomarkers at admission and during the post-discharge recovery period.

Methods: A total of 369 confirmed and hospitalized COVID-19 patients were included in this study. Biomarkers including D-dimer, ferritin, C-reactive protein (CRP), and lactate dehydrogenase (LDH) were recorded at three time points: hospital admission, 15 days post-discharge, and 30 days post-discharge. Data were retrieved from hospital records, and comorbidities were classified using the Charlson comorbidity index (CCI). Study design was retrospective cohort study

Results: About 44.87% of patients had diabetes as a pre-existing comorbidity, followed by hypertension (HTN) (27.07%) and cardiovascular disease (CVD) (25.78%). About 79.95% patients had diabetes mellitus (DM)+CVD+HTN. The age (p=0.108) and gender (p=0.481) showed an insignificant association with the comorbidity of COVID-19 patients. The patients with diabetes as a comorbidity showed the highest levels of D-dimer, Ferritin and LDH, while patients with CVD showed the highest levels of CRP. The mean D dimer, ferritin and CRP levels at admission and after 15- and 30-days post-discharge did not differ significantly (p>0.05) with respect to comorbidities. However, the mean LDH differ significantly (p=0.00) for patients with diabetes and other comorbidities at admission and 15 days post-discharge.

Conclusions: The mean levels of COVID-19 biomarkers-D-dimer, ferritin, and CRP-measured at admission and at 15- and 30-days post-discharge showed no significant differences across comorbidity groups. In contrast, LDH levels at two time points differed significantly with respect to comorbidity. This significant variation in LDH suggests that it may serve as a useful indicator for assessing disease severity in patients with comorbid conditions.

Assessment of quality of life in tuberculosis patients at Aland Taluk in Kalaburagi district

Vanishree P. Babladi — 2026-02-21

Background: Tuberculosis (TB), a recalcitrant infectious disorder precipitated by Mycobacterium tuberculosis, continues to pose a formidable public health burden, exerting pervasive and long-standing detriments to health-related quality of life (HRQOL). Despite sustained implementation of national control initiatives such as the directly observed treatment, short-course (DOTS) program, TB prevalence in India remains disproportionately elevated, particularly within rural and socioeconomically marginalized populations. The disease’s multisystemic impact necessitates comprehensive evaluation beyond microbiological and clinical indices. The objective of the study was to critically appraise the quality of life among individuals diagnosed with TB in the Aland region of Kalaburagi district and to ascertain the contributory impact of structured pharmacist-led counselling on patient outcomes.

Methods: A six-month prospective observational study was conducted across selected areas of Aland Taluk. Of 416 enrolled participants, 409 completed the study. Individuals aged 16–80 years were randomly assigned to intervention and control cohorts. Baseline sociodemographic characteristics and HRQOL parameters were assessed using standardized WHOQOL instruments, with follow-up evaluation performed at three months. Data were subjected to appropriate inferential statistical analysis.

Results: Baseline assessment revealed a predominance of active TB cases in both cohorts. Post-intervention analysis demonstrated a substantial reduction in disease burden in the intervention group (29.61%) compared with the control group (10.34%). Significant improvements were observed across all HRQOL domains, with consistently superior outcomes in the pharmacist-intervention cohort.

Conclusions: Pharmacist-mediated counselling significantly enhanced HRQOL and attenuated TB-related burden, underscoring its strategic value within integrated tuberculosis management frameworks.

Cilnidipine antihypertensive efficacy, pleiotropic benefits and experiences by cardiologists: findings from a digital questionnaire-based study

Pavan S. Agrawal — 2026-02-21

Background: Cilnidipine, a fourth-generation calcium channel blocker with dual L- and N-type action, offers distinct benefits in hypertension, though varied cardiologist awareness and prescribing may limit optimal use.

Methods: A cross-sectional survey was conducted among 416 practicing cardiologists across India between 17 April and 15 July 2025 to assess knowledge, perceptions, and prescribing preferences for cilnidipine in essential hypertension. A validated 20-item self-administered multiple-choice questionnaire captured mechanistic understanding and clinical perspectives following e-consent. Items addressed comparative advantages over other calcium channel blockers, effects on target organs, therapeutic applications (including combinations and patient subgroups), and metabolic benefits in metabolic syndrome. Responses were collected electronically and analyzed using descriptive statistics to summarize awareness and prescribing trends.

Results: Most cardiologists (85.1%) identified cilnidipine’s dual L- and N-type blockade as its key differentiator from conventional CCBs. Over half recognized its superior nocturnal BP control (56.3%), reduced BP variability via autonomic stabilization (52.6%), and lowering of mean arterial pressure without reflex tachycardia (54.6%). A substantial proportion (64.2%) acknowledged reno-protective benefits over amlodipine, while 55.8% favored its use in elderly and resistant hypertensive patients. Notably, 61.0% recognized improved insulin sensitivity in metabolic syndrome. However, knowledge gaps remained regarding its effects on the RAAS and endothelial function.

Conclusions: The survey reveals strong cardiologist awareness of cilnidipine’s sympatholytic, reno-protective, and hemodynamic benefits, alongside partial misconceptions regarding RAAS and endothelial effects. These findings underscore the need for ongoing clinical education and support cilnidipine’s role as a well-tolerated, organ-protective antihypertensive.