Tobacco use and its smoke produces oxidative stress in the body, which eventually triggers cell damage by lipid peroxidation. Smokers report lower levels of omega-3 fatty acids (FAs) in their serum as compared to nonsmokers. Omega-3 deficiency impairs neurotransmission, resulting in hypofunctioning of the mesocortical system, which is a reward and dependency system that can raise tobacco cravings, disrupting tobacco quitting efforts. Omega-3 polyunsaturated fatty acid (PUFA) regulates stress, anxiety, and negative emotions that are associated with tobacco urges. Limited research has assessed the supplementation effect of omega-3 PUFA [in the form of alpha-linolenic acid (ALA)] on tobacco craving. We aimed to explore the effects of omega-3 PUFA (ALA) on the frequency of tobacco use per day, tobacco dependence, and tobacco craving when compared to placebo in regular tobacco users. Regular tobacco users (n = 83) recruited from the Tobacco Cessation Clinic were randomly allocated to two groups. Group I was the omega-3 PUFA group, supplemented with 10 mL/day of omega-3 PUFA in the form of ALA (5.1 gm) for 180 days, and the other group received a placebo for the same duration. The outcome was evaluated by means of a case record form (for demographic parameters), self-reports of tobacco use (for frequency of tobacco use per day), as well as psychometric measures (for tobacco dependence and tobacco craving). The evaluations were carried out at baseline and after 180 days of intervention. The frequency of tobacco use per day, tobacco dependence, and tobacco craving were found to be significantly decreased (p < 0.0001) in the group receiving omega-3 PUFA (ALA) at the end of supplementation. This is a novel approach that ALA supplementation reduces tobacco cravings in regular tobacco users in comparison to a placebo. Thus, omega-3 FAs may be an adjuvant tool in quitting tobacco use by reducing nicotine dependence and tobacco craving. Further studies are necessary with large samples to understand the possible association and explore the probable nonpharmacological approaches for tobacco cessation.

Aluminum phosphide (AlP) poisoning is a medical emergency with an alarmingly high mortality rate, primarily due to its rapid cardiotoxic effects. To identify and evaluate key prognostic indicators-clinical, electrocardiographic, echocardiographic, and biochemical-in patients with AlP poisoning. A cross-sectional observational study was conducted on 100 patients with confirmed AlP ingestion. ECG changes, cardiac biomarkers (troponin-I, CPK-MB, LDH, and CPK-NAC), 2D echocardiography findings, and acid-base disturbances were analyzed in relation to survival outcomes. ECG abnormalities and decreased ejection fraction were significantly associated with mortality. Elevated cardiac biomarkers and profound acidosis were strong independent predictors of poor prognosis. AlP poisoning causes critical cardiovascular compromise. Early identification of high-risk patients may guide aggressive intervention and resource allocation in intensive care settings.

We present a case of a 60-year-old male with a fever of unknown origin (FUO) who was ultimately diagnosed with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)-associated microscopic polyangiitis (MPA) and aortitis. This case underscores the diagnostic intricacies and therapeutic challenges of managing such rare and severe multisystem involvement. It also highlights the critical importance of clinician awareness for prompt recognition and effective management of similar presentations.

Electrolyte abnormalities are frequent in systemic infections such as enteric fever but remain under-recognized in clinical practice. These disturbances may worsen morbidity if not identified and corrected early. To determine the prevalence and pattern of serum electrolyte alterations in adult patients hospitalized with enteric fever at a tertiary care center in New Delhi. This retrospective observational study analyzed records of 128 adult patients (59 males, 69 females) with laboratory-confirmed enteric fever between January 2023 and March 2024. The first admission values for sodium, potassium, chloride, and bicarbonate were extracted from the hospital laboratory system. Results were categorized as low, normal, or high using standard clinical reference ranges. Descriptive statistics were applied, and gender-based comparisons were performed using Chi-square tests for categorical variables and t-tests for continuous measures. Hyponatremia was present in 58.6% (75/128) of patients, while 57.8% (74/128) had low bicarbonate levels consistent with a trend toward metabolic acidosis. In contrast, potassium and chloride values were predominantly normal, with abnormalities occurring in <10% of patients. The mean ± standard deviation (SD) values (mmol/L) were: sodium 132.7 ± 6.2, potassium 4.3 ± 0.6, chloride 101.1 ± 3.7, and bicarbonate 20.3 ± 4.7. No significant gender differences were detected for mean values or abnormality prevalence (all p > 0.17). Hyponatremia and reduced bicarbonate were the most common electrolyte abnormalities in enteric fever, whereas potassium and chloride disturbances were uncommon. Routine electrolyte monitoring should be incorporated into the management of hospitalized enteric fever patients to enable early correction and improved clinical outcomes.

Low or abnormal plasma concentrations of anti-tuberculosis drugs can be a major reason for treatment failure or the emergence of drug resistance. Acetylator status, which affects drug metabolism, plays a key role in determining drug bioavailability. This study aimed to perform therapeutic drug monitoring (TDM) of rifampicin and isoniazid and to evaluate the correlation between plasma drug concentrations and acetylator status among Indian patients receiving first-line antituberculosis therapy. Plasma concentrations of rifampicin and isoniazid were measured using in-house standardized high-performance liquid chromatography methods, while acetylator status was determined by conventional PCR of NAT2 gene. Peak concentrations were estimated from 125 patients on first-line tuberculosis (TB) treatment. Among these, 56% exhibited subtherapeutic rifampicin concentrations and 28% had subtherapeutic isoniazid concentrations. Conversely, above normal (potentially toxic) concentrations were seen in 2% and 21% for rifampicin and isoniazid, respectively. Despite receiving the standard TB treatment regimen, only 62% of patients improved clinically, while 38% of patients continued harboring TB signs and symptoms, among which 6 patients (5%) developed rifampicin resistance during the treatment course. About 44% were slow acetylators, followed by 40% intermediate and 16% rapid acetylators. The acetylator status significantly influenced the plasma concentrations of both drugs. Slow acetylators had significantly higher isoniazid concentrations (p = 0.004) and lower rifampicin concentrations (p = 0.01) as compared to rapid acetylators. Abnormal concentrations of rifampicin and isoniazid are prevalent and a major concern. Acetylator status influences plasma concentrations of rifampicin and isoniazid. Hence, determining acetylator status and performing TDM could be instrumental in optimizing and improving TB outcomes.

A 69-year-old gentleman without any previous comorbidities presented with complaints of acute-onset low-grade fever, one episode of loss of consciousness, and weakness of both legs with urinary and stool retention for 1 day. He had an episode of generalized tonic-clonic seizure 3 hours after admission. On examination, he had tachycardia and hypotension; Glasgow Coma Scale (GCS) was E3V2M4, and neurological examination was suggestive of bilateral lower limb upper motor neuron lesion in the shock stage. Blood investigation revealed severe hyponatremia, and magnetic resonance imaging (MRI) with contrast of the dorsolumbar spine revealed longitudinally extensive transverse myelitis (LETM). Blood investigation for antineuromyelitis optica (anti-NMO) antibody was negative. Other investigations revealed low serum osmolality, raised urine osmolality, and spot sodium. Cerebrospinal fluid (CSF) viral panel detected human herpesvirus 6 (HHV6). He was treated with a pulse dose of IV methylprednisolone, hypertonic saline, and IV levetiracetam. He had symptomatic improvement and was discharged with a tapering dose of oral prednisolone. He had a complete recovery after 3 months of regular follow-up. Thus, we report a case of HHV6-induced LETM complicated with cerebral salt wasting syndrome and hyponatremic seizures.

Anemia is considered to be a public health issue of serious concern universally. In the current era of advancing technology, electronic health (e-health) initiatives are being employed in various health programs for disease screening and management. This study was planned to screen for anemia and manage it through a multidimensional approach comprising iron folic acid (IFA) supplementation, deworming among children, and dietary guidance and health education through pop-up videos with the aid of e-health initiatives. This was a prospective cohort study. An Android e-application (app) was used on tablets to identify anemia after hemoglobin estimation through the Hemoglobin Color Scale. Accredited Social Health Activists (ASHAs) managed anemia by providing health education and dietary guidance through pop-up videos and IFA supplementation. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 29. Tests of significance in the form of Cochran's Q, McNemar, chi-square, and repeated measures analysis of variance (ANOVA) and independent t-test were applied. The overall prevalence of anemia significantly declined from 46.08% at baseline to 14.65% at the 9th month. Males had a higher anemia prevalence (52.8%) compared to females (39.16%). An overall improvement of 68.2% was observed in the anemia status, with the maximum being in the 1-5-year age-group and females. Mean hemoglobin levels showed a consistent increase across all age-groups, with the maximum being in the 6-month-1-year age-group and females. This study demonstrated that community-based, sustained, and targeted strategies through the use of e-health initiatives can effectively combat anemia and achieve significant improvements in hemoglobin levels across all age and gender groups.

Amyloidosis is an extremely rare condition with a variety of symptoms that, in extreme situations, can be fatal. Basically a protein misfolding disorder, it is characterized by deposition of insoluble polymeric protein fibrils in tissues and organs. There are different types of amyloidosis; here, we see a case of secondary amyloidosis, which is usually a consequence of a chronic disease. The case is unique, as there are many research projects showing the link of tuberculosis (TB) and secondary amyloidosis, but it is rarely documented because of extrapulmonary TB, which here is tuberculous lymphadenitis, and also here the patient is younger than the mean age. The clinical manifestations of this disease are seen mainly in the renal system, gastrointestinal system, and reticuloendothelial system. For which the management is mainly supportive, along with treatment of the underlying cause.

An immediate need exists for a safe, quick, and effective reversal agent in patients who present with anticoagulant-induced major bleed. Dabigatran, a newer oral anticoagulant and a direct thrombin inhibitor (DTI), can also induce bleeding risk. Idarucizumab is a specific dabigatran reversal drug that the United States Food and Drug Administration (US FDA) has approved in the event of a significant bleeding caused by this drug. In this particular drug-related bleeding, it can be challenging to precisely dose alternative reversal agents like prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs) depending on coagulation characteristics. Additionally, they may result in thromboembolic problems. Despite these drawbacks, the inability to get idarucizumab may necessitate the use of these medications in cases of life-threatening bleeding. We describe the case of a 65-year-old male who reported to the hospital with coagulopathy, anemia, and fresh bleeding per rectum (Hb: 5.8 gm/dL, PT 20.02 seconds, INR: 1.55). He was on dabigatran for the past 1 month. Even after stopping dabigatran, injection of vitamin K, 4 units of blood transfusion, and 8 units of fresh frozen plasma (FFP), he was still bleeding, with fall in hemoglobin level. Following the administration of PCC, he significantly improved, and no additional transfusion products were needed. He could be sent home after 4 days. After 1 month, he returned for follow-up with no further complications.

There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints, and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and-most importantly-also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such "economic adjustment" recommendations aim to guide situations when "Resources are somewhat limited" or when "Resources are severely limited." Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.