Kasturba Hospital

Abstract Growing evidence suggests that early-life stress history can shape biological aging, yet the pathways through which this lifelong vulnerability manifests remain unclear. Using a maternal separation (MS) rodent model of early-life stress, we show that MS history evokes persistent cognitive, inflammatory, neurovasculature and bioenergetic changes that can accelerate aging trajectories. MS animals exhibit premature decline in object recognition memory in middle-aged life, accompanied by elevated peripheral inflammation, blood-brain barrier (BBB) compromise, heightened neuroinflammasome and microglial reactivity, and deteriorated mitochondrial health in the hippocampus. Notably, we demonstrate that adult-onset systemic supplementation with Nicotinamide (NAM), a NAD + precursor, prevents the emergence of peripheral and central inflammatory signatures, protects BBB integrity, maintains hippocampal mitochondrial health and mitigates cognitive decline in middle-aged MS animals. Collectively, these findings provide mechanistic insights into how early-life stress shapes brain aging, while highlighting NAM supplementation as a gerotherapeutic strategy to prevent premature aging driven by early adversity.

Vata is one of the three Doshas in Ayurveda, responsible for movement and neurological functions within the body. An imbalance of Vata can lead to a variety of disorders, both physical and psychological, such as Sandhivata (osteoarthritis), Pakshaghata (paralysis), Anidra (insomnia), Apasmara (epilepsy) and many more. In the present era, factors like sedentary lifestyle, irregular dietary patterns, stress, and environmental changes significantly contribute to the vitiation of Vata. Ayurveda emphasizes the concept of Swasthavritta—the discipline of health preservation and disease prevention—as a vital approach to maintaining Doshic equilibrium and promoting overall well-being. Ayurveda includes daily regimen (Dinacharya), seasonal regimen (Ritucharya), ethical conducts (Sadvritta), Vega Dharana (suppression of natural urges), proper regulation of Ahara(food) and Nidra(sleep). These guidelines are particularly effective in managing Vata disorders by promoting Guru (heaviness), Sheeta (cold), Snigdha (smoothness), which are opposite to qualities of Vata like Laghu (lightness), Ushna (hot nature), Ruksha (roughness). Practices like Abhyanga (oil massage), Snigdha Ahara (unctuous diet), Nidra (adequate sleep), and mental rest help counteract the aggravation of Vata at both preventive and early therapeutic stages. Moreover, mental health practices based on Sadvritta—such as truthfulness, compassion, and emotional stability—support psychological health, reducing the risk of neuro-psychiatric manifestations related to Vata imbalance. Thus, Ayurveda offers a comprehensive, cost-effective, and sustainable framework for the prevention and management of Vata-related disorders. Encouraging lifestyle modifications based on Ayurvedic principles can significantly contribute to reducing the burden of chronic diseases and improving public health outcomes.

Traditional Indian cereal-based breakfast items have high glycemic index (GI) contributing to postprandial (PP) glucose spikes. Use of diabetes-specific protein supplement (DSPS) may reduce glycemic excursions. The study aimed to evaluate the effect of partially replacing breakfast with DSPS (Protinex Diabetes Care) on PP glycemic response. Forty-two persons with type2 diabetes mellitus (T2DM) participated in this randomized, controlled, open-label, crossover study. Participants consumed a test breakfast (DSPS in 200ml milk + reduced portion of popular Indian savory breakfast (upma/poha)) or isocaloric control breakfast (upma/poha) for 5days, with 3-day washout. PP glucose and insulin were assessed on the first day of intervention at baseline, 30, 60, 90, 120, 150, and 180min after breakfast to calculate incremental area under the curve (iAUC0-3h) and delta peak (ΔCmax). During in-home use, macronutrient intake was assessed using dietary recalls, and glycemic variability (GV) was assessed using continuous glucose monitoring (CGM). Glucose iAUC0-3h and ΔCmax were 59% and 46% lower in test vs control, respectively. Insulin iAUC0-3h and ΔCmax did not differ significantly. During the test period, protein intake was significantly higher by 8.8g; mean amplitude of glycemic excursions (MAGE)-a GV metric-was significantly lower. There were no gastrointestinal or adverse events. DSPS was well accepted by participants. DSPS as a partial breakfast replacement improves blood glucose control without significantly impacting insulin response. In a real-world setting, DSPS enhances protein intake and reduces GV. These findings support DSPS as a practical, well-tolerated strategy for improving glycemic control and macronutrient intake balance in people with T2DM. The trial was registered with Clinical Trials Registry India (CTRI) CTRI/2024/08/072006 and has been registered in the International Clinical Trials Registry Platform (ICTRP).

Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is often associated with elevated liver enzymes.Objective: To assess the impact of metformin use on liver function tests in diabetic patients with clinically suspected NAFLD.Methods: This was a cross-sectional analytical study conducted at Jinnah Hospital, Lahore, Pakistan, from July 2024 to December 2024. A total of 185 adult patients were enrolled in the study. Non-probability consecutive sampling was used to recruit participants who met the inclusion criteria. Demographic data, including age, gender, body mass index (BMI), and duration of diabetes, were recorded. Clinical records were reviewed to document metformin use (yes/no), dosage, and duration.Results: Out of 185 patients, 115 (62.2%) were metformin users and 70 (37.8%) were non-users. Metformin users had significantly lower mean alanine aminotransferase (ALT) (41.3 ± 14.6 IU/L vs. 54.7 ± 18.2 IU/L; p < 0.001) and aspartate aminotransferase (AST) levels (35.2 ± 12.4 IU/L vs. 44.6 ± 15.7 IU/L; p = 0.002) compared to non-users. No significant differences were observed in alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels. Elevated ALT and AST were significantly less frequent in metformin users (p < 0.01). A weak inverse correlation was observed between metformin dose and ALT levels (r = -0.19, p = 0.043).Conclusion: It is concluded that metformin use is associated with improved liver enzyme profiles in diabetic patients with suspected NAFLD. These findings suggest a potential hepatoprotective role for metformin, warranting further longitudinal studies to explore its impact on liver histology and long-term hepatic outcomes.

One of the most prevalent liver conditions in the world, fatty liver, is typically brought on by lipid build-up, primarily triglycerides in hepatocytes. Although the liver naturally contains fat, fatty liver can develop if the amount of fat exceeds 5–10% of the liver’s total weight. Yakrit (liver) is considered as a crucial organ responsible for digestion, metabolism, detoxification in body. In Ayurveda non-alcoholic grade 2 fatty liver disease can be related with Yakrit Vikara primarily caused by imbalance of Pitta Dosha leading to conditions such as jaundice, fatty liver, liver cirrhosis and hepatitis etc. this case study examines the clinical presentation, diagnosis and treatment of a male patient aged 60 years with complaint of gaseous abdomen, increased body weight, pain in right side of abdomen, and incomplete bowel evacuation since last 2 months. Diagnostic ultrasound report confirmed grade 2 fatty liver in both lobes.

Abstract Introduction Screening with PAPs smear for screening of cervical cancer has been the gold standard for many years in high-income countries but has still not been successful in low- and middle-income country like India due to unavailability at public ground level. Thus, a simple, effective, and low-cost alternative to cervical cytology for cervical cancer prevention is urgently needed for high-risk, low-resource settings. Objectives The aim was to compare the efficacy of visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) with the PAP smear for screening precursor intraepithelial lesions and early signs of cervical cancer, and to evaluate their potential as alternative screening methods to the PAP smear in a semiurban population in Delhi. Material and Method A total of 127 married, nonpregnant patients between 18 and 65 years were randomly selected from gynecology outpatient department. Then, PAP smear samples were taken from all patients followed by VIA and VILI. Biopsies were then taken from those who showed positive findings in either of the screening methods. Out of these, 50 PAP and VIA-negative women were included as a control group. The diagnostic accuracy of VIA and VILI was compared with PAP smear, for diagnosis of precancerous lesions. Results VIA and VILI results were positive in 22 patients out of 127 (17.3%). PAP cytology report showed epithelial cell abnormality in 13 cases (10.2%) with atypical squamous cells of undetermined significance in 1 case, atypical glandular cells of undetermined significance in 4 cases, low-grade squamous intraepithelial lesion in 3 cases, and high-grade squamous intraepithelial lesions in 5 cases. PAP smear had showed better specificity (90.79%) and less sensitivity (85.71%) as compared with VIA and VILI method. Sensitivity of VIA was 100% and specificity was 80.26%. Similar parameters were seen with the VILI method also. The overall p-value for all the parameters of either screening method was &gt; 0.05; hence, both methods are comparable for screening. Conclusion VIA and VILI can be employed as initial screening tools in place of PAP smear, particularly in countries with limited resources or developing regions.

Female genital tuberculosis (FGTB) is asymptomatic or may present with a few symptoms among which infertility is the most common. The diagnosis of FGTB is challenging, as there is no single diagnostic test available.We researched 50 infertile patients by various special investigations and found 50% had tuberculosis, by various means. Endometrial biopsy and Hystero-laparoscopy are complementary procedures, and Cartridge Based Nucleic Acid Amplification Test is a useful new addition to the diagnostic armamentarium for endometrial and peritoneal samples.

Myelodysplastic syndromes (MDS) are due to defective hematopoiesis in bone marrow characterized by cytopenia and dysplasia of blood cells, with a varying degree of risk of acute myeloid leukemia (AML). Currently, the only potentially curative strategy is hematopoietic stem cell transplantation (HSCT). Many patients are ineligible for HSCT, due to late diagnosis, presence of co-morbidities, old age and complications likely due to graft-versus-host disease (GvHD). As a consequence, patients with MDS are often treated conservatively with blood transfusions, chemotherapy, immunotherapy etc. based on the grade and manifestations of MDS. The development of chimeric antigen receptor (CAR)-T cell therapy has revolutionized immunotherapy for hematological malignancies, as evidenced by a large body of literature. However, resistance and toxicity associated with it are also a challenge. Hence, there is an urgent need to develop new strategies for immunological and hematopoetic management of MDS. Herein, we discuss current limitations of CAR T-cell therapy and summarize novel approaches to mitigate this. Further, we discuss the in vivo activation of tumor-specific T cells, immune check inhibitors (ICI) and other approaches to normalize the bone marrow milieu for the management of MDS.

Background The majority of complications and deaths related to childbirth are concentrated in developing and disadvantaged nations, where the rates are unacceptably elevated. These incidents predominantly occur in the vicinity during the intrapartum period and immediately after childbirth. The peripartum period is especially critical for expectant mothers, as it represents the time when a significant number of complications and deaths occur.This study aimedto develop, validate, and assess theefficacy ofthe maternal morbidityscreening(MMS) toolfor predictingperipartum morbidity. Methodology The study was conducted in two phases: Phase one involved developing, validating, and piloting the MMS tool, while Phase two focused on evaluating and comparing the MMS tool with the modified early obstetric warning system (MEOWS) chart for predicting peripartum morbidity. An observational analytical clinical study design was utilized. Result In Phase one, theMMS tool was developedand validated by subject experts, resulting in a reliability score of 0.90. Therefore, the tool was deemed reliable and valid. Phase two results revealed that obstetric morbidity in the maternal morbidity group was 66.66%, higher than the 32% observed with the MEOWSchart. The MMStool demonstrated significantly higher sensitivity at 95.24%, specificity at 89.50%, and predictive value at 98.50%, yielding an overall accuracy of 90.50%. In comparison, theMEOWSchart exhibited a sensitivity of 70.51%, specificity of 86.81%, predictive value of 92.94%, and accuracy of 83.71%. Conclusion The occurrence of maternal morbidity in the trigger zone was significantly higher than in the non-trigger zone in the MMStool. The MMS tool was significantly more effective as a predictor of peripartum morbidity compared to the MEOWSchart.

Potential competing interests: No potential competing interests to declare.The case report is written well, but the authors should also rule out angioedema caused by amiodarone and look deeper into drug-drug interactions.The case report, "Ramipril-Induced Angioedema in a Patient With Basal Ganglia Bleed: A Case Report," shows intense knowledge of the case and tries to connect all points, but pharmacotherapy could have been connected more specifically.