Ruby Hall Clinic

Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

BackgroundBlood eosinophils have become an invaluable tool in the assessment, management, and prognostication of patients with asthma and chronic obstructive pulmonary disease (COPD). Historically, the understanding and application of blood eosinophil counts (BEC) have been primarily based on data from high-income countries, with limited information available from developing regions, including the Indian subcontinent.Research QuestionThis study aims to assess the distribution and clinical relevance of BEC among patients with asthma and COPD as well as healthy volunteers across India, to determine if patterns observed in Western studies hold true in an Indian setting.Study Design and MethodsA multi-centre cross-sectional study was conducted at 16 clinics across India. Participants included patients diagnosed with asthma or COPD and healthy volunteers who were identified from referrals to these clinics. Comprehensive data collection involved demographics, medication use, smoking status, and pre- and post-bronchodilator spirometry. All participants underwent a laboratory full blood count.ResultsThe study comprised 4782 adults, including 1,332 patients with asthma (571 males, 761 females), 1,001 patients with COPD (691 males, 310 females), and 2,449 healthy volunteers (1,399 males, 1,050 females). Among patients with asthma, the mean BEC was higher at geometric mean 173.9 [156.2, 193.6]; patients with COPD had a mean BEC of 198.4 [178.6, 220.4] which was significantly higher than that of healthy volunteers (144.7 [134.5, 155.5]).InterpretationThe range of eosinophils in the contemporary Indian population aligns with data from Europe, affirming the validity of using BEC as a biomarker in obstructive lung disease within the Indian demographic. This insight challenges the prevailing assumption of distinct eosinophil count profiles in different geographical regions and underscores the global applicability of eosinophil-based management strategies for asthma and COPD.

Abstract Arteriovenous malformations (AVMs) present significant treatment challenges due to their hemorrhage risk and associated neurological deficits. Stereotactic radiosurgery (SRS) is a technique designed to obliterate AVMs while minimizing complications.This study aims to evaluate the obliteration rate and clinical outcomes of patients undergoing SRS using linear accelerators (LINAC) for the treatment of brain AVMs.This retrospective and prospective study included 56 consecutive patients who underwent SRS for AVMs between 2008 and 2021, with the study period till 2023. The mean patient age was 29.21 years (range: 8–67 years). Complete obliteration rates and clinical improvements were assessed, and statistical analysis was conducted using SPSS.The mean planning target volume was 11.39 cc (median: 7.74 cc) and the average modified AVM score was 1.79 (median: 1.56). The obliteration rate was 83.92%, with 7.1% of patients exhibiting residual AVM and 5.3% requiring surgical excision. Post-radiation hemorrhage occurred in 7.14% of cases.LINAC-based SRS proves to be a highly effective and safe treatment modality for small or surgically inaccessible brain AVMs.

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction‐associated steatotic liver disease (MASLD), formerly known as non‐alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high‐risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high‐risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non‐invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well‐planned study design that could enhance the scientific value of these statements.

Abstract INTRODUCTION: The incidence of Crytogenic Organising pneumonia (COP) differs among populations, it is estimated to be 1.97-7/100000.The classical form of COP is usually subacute, and does not manifest as severe disease. Organizing pneumonia (OP)is a type of inflammatory and fibroproliferative process of the lung leading to a clinico-pathological syndrome. Commonly, present in multifocal form, diffuse interstitial form. Sometimes may present as cavitatory nodules, micronodular pattern, isolated nodular form, nodules with air bronchogram.Here we present 4 cases with different manifestations. All 4 cases were diagnosed based on histopathological features. DISCUSSION: There is no age or sex predilection. Radiologically common picture of COP is diffuse patchy peripheral based consolidation surrounded with Ground glass opacities. Atoll sign is noted in 20% of COP. Our all four cases have shown localized, unilateral involvement which is the less common form. OP is histopathologically characterized by balls of organized fibrin conglomerates in the alveoli and respiratory ducts, patchy distribution in the absence of vitreous membranes, inflammatory granulomas, eosinophilic pneumonia, and bronchiolitis with abscess formation. The first case shows secondary OP as an extraintestinal manifestation of Crohn's disease. There is a dilemma in these cases whether its an opportunistic infection such as Tuberculosis. An awareness about this rare manifestation and early histology is the key here. Also this was acute fribrinous organizing pneumonia form of OP. The second case shows a patient presenting with less common pattern i.e a left upper lobe mass lesion with spiculated margins, suspicious of malignancy. The diagnosis of COP requires exclusion of infection as we saw in first case and malignancy here in second case. The third case shows recurrence of organizing pneumonia in a diabetic, after 8 years at a site different than previous, which required a repeat course of corticosteroid. one of the reasons proposed for relapse is delayed onset of initial treatment and evidence of cholestasis on laboratory testing is shown to be associated with multiple relapses. The fourth case shows a 62-year-old smoker who has only minimal dry cough. Smoking is however, not considered as a risk factor for COP. This case also shows the less common presentation in form of unilobar mass with irregular margins – Unifocal COP.