Internal Medicine Research Articles

AMNOG 2.0 for 'special therapeutic situations'

'Innovations under pressure: Do cutting-edge research & medicine have a future?' This was the title of this year's press dinner organised by the research-based pharmaceutical company Roche on the occasion of the Capital City Congress 2024 - once again at the Austrian restaurant Ottersbach zu Berlin with probably the best veal cutlets west of Vienna. This time, the speakers were Prof Wolfgang Schütte, Medical Director, Clinic for Internal Medicine II - Pneumology at the Martha-Maria Halle-Dölau Hospital, who addressed the topic of 'Clinical research: Is Germany losing touch?', and Friedrich Fichtner, Access Lead Strategic Pricing & Reimbursement at Roche Pharma AG, who explained in his presentation why an AMNOG 2.0 is needed. Fichtner's presentation is the focus of this report.

Patients as an additional safety barrier when administering chemotherapeutic agents

Chemotherapeutic agents are high-risk drugs with a high potential for error and serious harm. International studies show that 5-15% of all chemotherapy patients are affected by medication errors. 60% of these errors had the potential to cause harm to patients, 13% resulted in harm and 1% of patients were seriously harmed1. The most common medication errors in the administration of chemotherapy drugs are administration errors and can therefore be observed by the patients themselves. Chemotherapy patients in particular, who often experience the same treatment steps due to their longer treatment duration, often recognise deviations from the usual routine and notice when something is different than usual. They have time to look at the identifying features of chemotherapy and recognise mistakes. In the best case scenario, they communicate these observations, changes or uncertainties to the healthcare professional in charge. In this way, the active involvement of patients provides an additional safety barrier that can be used to support the medical staff. With this in mind, the Quality Management and Clinical Risk Management department has initiated a project together with the Department of Internal Medicine (tumour research), the oncological care experts at Essen University Hospital, the patient networking and self-help officer and other important interfaces such as the LVR Clinic to make the administration of chemotherapeutic agents even safer and to actively involve patients in their treatment.

Association Between Glycated Hemoglobin (HbA1c) Levels in Patients With Iron Deficiency Anemia in a Tertiary Care Hospital in Central India.

Background Iron deficiency anemia (IDA) and diabetes are prevalent health concerns, especially in regions like India. While previous studies have explored the relationship between glycated hemoglobin (HbA1c) levels and IDA, there is still inconsistency in the findings, particularly in the Indian population. Understanding this association is crucial for accurate diagnosis and management of both conditions. Materials and methods A case-control study was conducted at the Department of General Medicine at Acharya Vinoba Bhave Rural Hospital (AVBRH),Wardha, India, from May 2022 to October 2022. A total of 141 non-diabetic patients with IDA (study group) and 141 age- and gender-matched non-anemic controls were included. HbA1c levels were measured at baseline and after three months of IDA treatment. Statistical analysis was performed using SPSS software, including the Kolmogorov-Smirnov test, Chi-square test, Mann-Whitney test, and Pearson correlation coefficient. Results In the study group, HbA1c levels significantly increased from a mean of 4.63% at baseline to 5.82% after IDA treatment (p < 0.0001). However, there was no significant correlation between changes in hemoglobin (Hb) levels and HbA1c levels post-correction (r = 0.056, p = 0.510). In addition, all cases and controls were labeled non-diabetic based on a cutoff HbA1c level of 6%. After three months of IDA treatment, 80.85% of cases recovered from IDA. Conclusion The study highlights that HbA1c levels are lower in patients with IDA and may increase with the correction of IDA. However, there is no significant direct correlation between IDA correction and HbA1c increase. Therefore, when interpreting HbA1c levels, clinicians must consider the presence of IDA, especially in regions with high prevalence rates of both IDA and diabetes, like India. This understanding can improve management strategies for both conditions, ensuring better patient health outcomes.

Accuracy of lung ultrasound performed with handheld ultrasound device in internal medicine: an observational study.

Lung ultrasound (LUS) is increasingly used in Internal Medicine to complement medical examination, documenting pleural and lung conditions. This study aimed to compare the accuracy of handheld ultrasound device (HHUSD) with high-end ultrasound device (HEUSD) in patients with heart failure or pneumonia, also including the assessment of costs and time-savings. In this observational study 72 patients (aged ≥ 18) admitted to Internal Medicine Unit for heart failure or pneumonia underwent LUS plus evaluation of inferior cava vein (ICV) when indicated, using both HHUSD and HEUSD. Each evaluation, independently performed by 2 different experienced operators, included B-lines number, pleural effusion, lung consolidations, ICV ectasia and its respiratory excursions. Concordance between HHUSD and HEUSD findings was 79.3% ± 17.7 (mean ± SD) for B-lines, 88.6% for pleural effusion, 82.3% for consolidations and 88.7% and 84.9% for ICV ectasia and its respiratory excursions respectively. BMI didn't significantly influence concordance between the two methods. Moreover, examination time (as mean ± SD) was shorter with HHUSD (8 ± 1.5min) compared to HEUSD (10 ± 2.5min). HHUSD demonstrated high accuracy in detecting B-lines, pleural effusions, lung consolidations and ICV evaluation when compared to HEUSD. Thus, HHUSD, not only is characterized by accessibility, portability, and easy handling due to its small size, but it also offers advantages in terms of saving costs and time, ultimately contributing to faster patient assessment compared to HEUSD.

Incidental pulmonary embolism: A Case Report

Pulmonary embolism (PE) is a common clinical condition that generally presents with acute dyspnea, pleuritic chest pain, cough, hemoptysis, tachypnea, tachycardia and hypoxia. Incidental pulmonary embolism (IPE) is defined as an unsuspected filling defect in the pulmonary arteries identified on CT imaging performed for another indication. This report describes a case of Incidental pulmonary embolism (IPE) detected by CT imaging during the follow-up of a 34-year-old male patient who applied to the internal medicine outpatient clinic with weight loss and gastrointestinal system complaints

Internal medicine in the 21st century: Back to the future

Healthcare systems face multiple challenges arising from demographic factors (population aging) and epidemiological factors (rise of chronic diseases and patients with multimorbidity) as well as threats to their financial sustainability when maintaining equitable access to medical and technological advances. Current healthcare models, based on specialized medical care, lead to fragmented care that can be harmful to the patient and is inefficient for the system due to the overuse of redundant, low-value medical acts. Internal medicine is the hospital-centered general medical specialty par excellence, providing a comprehensive and holistic vision that is centered on the patient and not on the disease. Internists should be the leading physicians in the hospital setting for complex patients with or those with an uncertain diagnosis. Internists must play a key role, as hospitalists do, in the continued care of acute patients hospitalized for medical or surgical diseases, establishing shared care models in multidisciplinary teams. Likewise, to guarantee continuity of care for chronic patients, internists must establish mechanisms for collaboration with primary care and nursing, participating in the development of new out-of-hospital care models that use the available technological resources. Internal medicine should play a leading role in graduate and postgraduate medical education to promote a holistic vision among medical students and residents in medical subspecialties.

Value-based healthcare as an opportunity for patient management at the individual and system level

Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with afocus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest. This paper aims to illustrate how VBHC principles are currently being implemented in the field of internal medicine in Germany and to identify the potential that can be derived from VBHC pioneering examples from the Netherlands. Selected case studies are presented to illustrate how VBHC principles are already being applied in internal medicine, focusing on where PROMs are utilized and how value-based reimbursement supports VBHC implementation-both in Germany and the Netherlands. In Germany, various cross-provider initiatives and individual providers implement the VBHC element of PROMs measurement. In addition, the Baden-Württemberg selective contract in cardiology demonstrates how financing VBHC elements in regular care was already made possible in Germany. Pioneers such as the Dutch center of excellence Diabeter and the multidisciplinary care network Netherlands Heart Network provide further inspiration for the implementation of VBHC in internal medicine. While various initiatives support the measurement of PROMs in the German context, the use of these results in care practice is not apparent. The utilization of PROMs and strategies identified in Dutch examples could be initial steps toward fostering VBHC in Germany.

Specialty economies of scope in English hospitals: Cost Arguments for colocation

ObjectiveCurrent policy responses to COVID-19 disruption and care backlogs suggest potential changes to the location and structure of hospital healthcare supply. However, few studies investigating the cost effects of hospital reorganisation consider changes in the mix of outputs or test for the existence of economies of scope in hospital healthcare. Attempts to create dedicated hubs to address healthcare demand backlogs could have unintended adverse cost effects where these are provided outside existing hospital arrangements. To evaluate this, we investigate the existence and size of economies of scope in English hospital healthcare. DataWe use cost and activity data from the English NHS, linked to aggregated staff wage information and information taken from hospital financial statements. Cost and activity data was obtained from NHS England's Costing Publications. Wage data was extracted from the NHS's Electronic Staff Record via the NHS England Workforce Statistics Team, and published hospital financial accounts were aggregated and linked together at the organisation level. ResultsGeneral Surgery exhibited positive economies of scope when provided alongside other healthcare, as to a lesser extent did General Medicine and Obstetric/Gynaecology healthcare. There was little evidence for economies of scope in Diagnostic and Pathology services, Orthopaedics, or Emergency Care. Few (2/28) output cross-products (cost complementarities) were statistically significant, but Baumol's wider definition of scope economies demonstrates that scope economies are present in some specialties. ConclusionPolicymakers seeking to maximise the amount of healthcare provided and minimise the costs of doing so may wish to consider retaining General Surgery, General Medicine and Obstetric/Gynaecology healthcare supply alongside the provision of other clinical specialties. There is limited evidence that reconfiguring supply by centralizing other specialty groups into fewer providers would increase costs.

Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study.

Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]). Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30). Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses' perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints. The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.

Persistent Gastrointestinal Bleeding after Aortic Valve Replacement in Heyde's Syndrome.

Heyde's syndrome (HS) represents an association between aortic stenosis and intestinal angiodysplasias, and it has been demonstrated that acquired von Willebrand disease plays a pivotal role in the pathophysiology of this syndrome. In patients with HS, von Willebrand factor deficiency represents an additional risk factor, further contributing to the risk of bleeding and anemia. We present the case of an 86-year-old patient diagnosed with HS and von Willebrand deficiency in 2018. Four years prior, the patient underwent surgical aortic valve replacement. Since then, she has been receiving chronic oral anticoagulation therapy with a vitamin K antagonist. The patient was admitted to the Internal Medicine Clinic due to semi-solid dark stools, diffuse abdominal pain, and asthenia. Upon examination, the patient presented with an altered general status and clinical signs suggestive of anemia. Laboratory findings revealed anemia with elevated INR and aPTT values. Colonic angiodysplasias were identified during a colonoscopy, although no sources of active bleeding were detected. On the 9th day of hospitalization, the patient experienced an episode of lower gastrointestinal bleeding. The pharmacological management was adjusted, and argon plasma coagulation was recommended. Following treatment of the angiodysplastic lesions, the patient's clinical evolution was favorable, with the correction of the anemia.

Closing the Gaps in Hepatitis C Knowledge Among Internal Medicine Residents in the United States

BackgroundThe introduction of direct-acting antivirals (DAA) has revolutionized Hepatitis C virus (HCV) treatment but has not translated into an appreciable decline in HCV prevalence, which is estimated to be 2.4 million in the United States. Efforts are thought to be limited by the lack of experience among non-specialist providers in managing HCV. However, there have been no comprehensive surveys assessing HCV knowledge among medical trainees to determine if trends have shifted since the discovery of DAA. MethodsWe performed a retrospective observational study of internal medicine (IM) residents in the United States (n = 1763) who completed the Physician Education and Assessment Center HCV learning module between 2021-2022. Participant pre- and post-test performance was compared with further stratified analysis by training year, geography, training program type, and local HCV prevalence using ANOVA and Chi-squared tests of proportions, respectively. ResultsIM residents universally lacked baseline HCV knowledge (average score ± standard deviation, 43% ± 19); less than 50% of participants answered correctly in the majority of tested domains. There were no consistent trends in performance regardless of resident characteristic used to stratify the participants. Knowledge gaps improved after completing an online educational training module (p < 0.001). ConclusionsHCV knowledge remains limited among IM residents despite expansion of treatment options. Addressing these gaps during clinical training may substantially increase the availability of HCV treatment in the community, and online modules may be one means by which to integrate these efforts into medical training.

Recommendations and quality criteria to improve the early diagnosis of primary biliary cholangitis

ObjectiveThe study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. Patients and methodsIt was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. ResultsSeven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient’s quality of life. Consider their point of view and agree on recommendations and care» and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually», respectively. ConclusionsThe implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

Evidence of Neutralizing Antibodies Indicating the Cure of Patients Infected with COVID-19 Within one Month of Infection

Background: During COVID-19 pandemic a major conflict facing the clinician where to prove cure of the patients. Aims: The idea of confirming curability is based on clinical evaluation of the symptoms, laboratory investigations, and specific IgM, IgG anti-SARS-CoV2 antibodies. Patients and Methods: All patients had presented with clinical features of COVID-19 positive PCR attended private clinic doctors consultant in internal medicine and infectious diseases, they did investigations in Lagash land private medical laboratory in Baghdad investigated and screened for COVID-19 by S. ferritin, D-dimer, Complete blood picture and LDH. All were reevaluated in the first month of infection by clinical examination, retesting, and screening for COVID-19 IgM IgG later to prove cure or evidence of viral infection in PCR negative cases. Results: All patients are of different ages with maximum years affected from adulthood till the age of one hundred years. Male were 170(54.3%) patients and females were 143 (45.7%) total 313 patients (100%). Most are moderate socioeconomic status, with a significant number having comorbidities. Conclusion: SARS COVID-19 IgM, IgG levels can be used to confirm a cure of the infection

Efficacy of intrauterine device procedural analgesics.

Nearly half of all pregnancies worldwide are unintended. Intrauterine devices are an effective, long-acting form of pregnancy prevention that require minimal maintenance, and also can be used in patients with menorrhagia. However, they are underused because of pain associated with their insertion. Topical and local anesthesia are good options for reducing procedural pain in select patients. IUD placement falls within the scope of practice for physician associates/assistants (PAs) practicing in family medicine, internal medicine, and women's health. PAs should be aware of these additional analgesia options available to patients in order to increase use of effective contraception.

Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study

IntroductionWe analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients. MethodsThis was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain. ResultsA total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis. ConclusionsIn a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.

Surgical patients’ assessment of healthcare encounters after elective surgery: A descriptive study

IntroductionA Norwegian-Danish research team identified a gap in research regarding how surgical patients felt about their post-operative care needs being met in hospitals. A study was subsequently developed to understand their subjective assessments of how they value the perceived fulfilment of their actual care needs. The study was further informed by international calls to focus on the fundamentals of care practice. Our aim was to determine the extent to which surgical patients receiving elective treatment experience the physical environment, atmosphere and collaboration with staff as supportive of their care and treatment, and what this means for them after treatment. In addition, we aimed to document the extent to which patients experienced being understood and having influence in their care. MethodsA descriptive observation study using a cross-sectional design. The validated Perioperative User Participation Perspectives (POUP) questionnaire was completed on the day of discharge by 194 adult (male and female) patients (mean age: 56 years) who had undergone elective surgery on gynaecological, internal medicine or orthopaedic wards. Agreement between the subjective importance of nursing care for patients and the perceived reality was determined. ResultsAgreement regarding the physical environment, a clean bed and clean surroundings was between 91.7 and 96.2%, and agreement with regard to a good relational atmosphere with staff it was 94.2 to 96.7%. In terms of the relational aspects of care, being understood and having influence the agreement was calculated to be 89.4 to 94.4%. However, 42.6% of the patients reported they were involved in drawing up a care plan. For those patients who valued collaborating in their care planning the congruency was 80%. ConclusionA conducive atmosphere and a keen eye for the patients’ wishes and needs is of particular importance at the time of discharge after elective surgery.

High prevalence of medication errors in a secondary-level Lithuanian hospital: A prospective cross-sectional observational study.

As the population continues to age, the occurrence of chronic illnesses and comorbidities that often necessitate the use of polypharmacy has been on the rise. Polypharmacy, among other factors that tend to coincide with chronic diseases, such as obesity, impaired kidney and liver function, and older age, can increase the risk of medication errors (MEs). Our study aims to evaluate the prevalence of MEs in the Internal medicine, Cardiology, and Neurology departments at the secondary-level university hospital. We conducted a prospective observational study of 145 patients' electronic or paper-based data of inpatient prescriptions and patients' pharmacokinetic risk factors, such as an impairment of renal and/or hepatic function, weight, and age. All included patients collectively received 1252 prescribed drugs. The median (Q1; Q3) number of drugs per patient was 8 (7;10). At least one ME was identified in 133 out of the 145 patients, indicating a significantly higher prevalence than hypothesized (91.7% vs. 50%; p < .001). There was moderate, positive correlation between the quantity of prescribed drugs and the number of MEs, meaning that the more drugs are prescribed, the higher the number of identified MEs (Spearman's ρ = 0.428; p < .001). These findings suggest that there is a need for continuous medication education activity for prescribing physicians, continuous evaluation of prescription appropriateness to objectively identify the MEs and to contribute to more rational patient treatment.

Predicting Factors of Worse Prognosis in COVID-19: Results from a Cross-sectional Study on 52 Inpatients Admitted to the Internal Medicine Department.

The initial phases of the COVID-19 pandemic posed a real need for clinicians to identify patients at risk of poor prognosis as soon as possible after hospital admission. The study aimed to assess the role of baseline anamnestic information, clinical parameters, instrumental examination, and serum biomarkers in predicting adverse outcomes of COVID-19 in a hospital setting of Internal Medicine. Fifty-two inpatients consecutively admitted to the Unit of Internal Medicine "Baccelli," Azienda Ospedaliero - Universitaria Policlinico of Bari (February 1 - May 31, 2021) due to confirmed COVID-19 were grouped into two categories based on the specific outcome: good prognosis (n=44), patients discharged at home after the acute phase of the infection; poor prognosis, a composite outcome of deaths and intensive care requirements (n=8). Data were extracted from medical records of patients who provided written informed consent to participate. The two study groups had similar demographic, anthropometric, clinical, and radiological characteristics. Higher interleukin 6 (IL-6) levels and leucocyte count, and lower free triiodothyronine (fT3) levels were found in patients with poor than those with good prognosis. Higher IL-6 levels and leucocyte count, lower fT3 concentration, and pre-existing hypercholesterolemia were independent risk factors of poor outcomes in our study population. A predicting risk score, built by assigning one point if fT3 < 2 pg/mL, IL-6 >25 pg/mL, and leucocyte count >7,000 n/mm3, revealed that patients totalizing at least 2 points by applying the predicting score had a considerably higher risk of poor prognosis than those scoring <2 points (OR 24.35 (1.32; 448), p = 0.03). The weight of pre-existing hypercholesterolemia did not change the risk estimation. Four specific baseline variables, one anamnestic (pre-existing hypercholesterolemia) and three laboratory parameters (leucocyte count, IL-6, and fT3), were significantly associated with poor prognosis as independent risk factors. To prevent adverse outcomes, the updated 4-point score could be useful in identifying at-risk patients, highlighting the need for specific trials to estimate the safety and efficacy of targeted treatments.

Breaking the Cycle: A Qualitative Study of Factors That Mitigate Impostor Phenomenon Among Internal Medicine Residents.

Background Impostor phenomenon (IP) describes feelings of inadequacy often experienced by individuals struggling to internalize success despite evidence to the contrary. IP is common in medicine and can be experienced as a cycle following exposure to an achievement-focused task, leading to fear of being found out as an impostor. Prior research describes IP characteristics, yet few studies have identified factors that mitigate IP among medical residents. Objective To understand factors that moderate IP among internal medicine (IM) residents. Methods We conducted a qualitative study using one-on-one semistructured interviews with 28 IM residents at a single academic health center from May to June 2020. To ascertain the prevalence of IP, informants completed a 20-item Clance Impostor Phenomenon Scale (CIPS) questionnaire. Using a constructivist thematic approach investigators independently coded transcripts to identify factors mitigating IP. Results Twenty-eight of 53 (53%) eligible residents participated in the study. Most informants were female (21 of 28, 75%) and in their second postgraduate year of training (12 of 28, 43%). The mean CIPS score was 63. When faced with an achievement-focused task, informants describe feelings of inadequacy, avoidance behaviors, distortion of feedback, and attribution beliefs. Internal factors found to moderate IP include (1) reframing attribution beliefs; (2) accepting feedback; and (3) acknowledging strengths. External factors include (1) mentors, coaches, and role models; (2) formal opportunities to share IP experiences; and (3) growth-oriented learning environments. Conclusions This qualitative study describes internal and external factors that potentially mitigate impostor feelings, thereby interrupting the cyclical nature of IP among IM residents.

Dr. Coluthur Gopalan: Father of Indian Nutrition Science.

Dr. Coluthur Gopalan, a towering figure in nutrition science in India, made seminal contributions that transformed public health and nutrition policy in the country. Born in Salem, Tamil Nadu, in 1918, Dr. Gopalan's illustrious academic journey began at the Christian College High School and Madras Medical College, where he earned his M.D. in General Medicine in 1943. The Bengal Famine of 1942 profoundly influenced his career, steering him towards nutrition research. Awarded the Nuffield Foundation Scholarship, he earned a Ph.D. in nutrition from the University of London in just 30 months. Upon his return to India, he joined the Nutrition Research Laboratories (NRL) in Coonoor in 1949, which later became the National Institute of Nutrition (NIN), where he significantly broadened the scope of nutrition research. Dr. Gopalan's work laid the foundation for pivotal national nutrition programs, such as the Integrated Child Development Services (ICDS) and the midday meal scheme for schoolchildren. His tenure as Director of NIN (1960-1974) and later as Director General of the Indian Council of Medical Research (ICMR) from 1974 to 1979 saw major advancements in addressing malnutrition and emerging issues like overnutrition. His dedication to improving women's and children's nutritional status left a lasting impact on public health in India. Dr. Gopalan's pioneering research on protein-calorie malnutrition, micronutrient deficiencies, and holistic approaches to nutritional problems provided critical insights and guided thenational policies. As an institution builder, he transformed NIN into a premier research center and during his tenure established new research institutes at ICMR, fostering a robust framework for future research. His advocacy ensured that nutrition was prioritized in national development plans, leading to significant health improvements. Internationally recognized, Dr. Gopalan's contributions included efforts to improve global nutrition, earning him numerous accolades. His legacy, encapsulated in the Nutrition Foundation of India, and his several contributionscontinueto be a vital resource for nutritionists and policymakers, ensuring lasting benefits for future generations. Dr. Gopalan's compassionate personality, visionary leadership, and holistic approach have indelibly advanced the nutritional status and health of millions globally.