Indian Physicians Research Articles

Celebrating culture in American dermatology part I: A special tribute to Dr E. A. (Billy) Hankins III, dermatologist with American Indian heritage as a minor part of his ethnic background

This contribution honors the life of Dr E. A. (Billy) Hankins III, a board-certified dermatologist and dermatopathologist with 40 years of practice experience, now retired, having American Indian heritage as a minor part of his ethnic background. Hankins spent many years as a physician volunteer for an indigent clinic serving the urban American Indian community of the city and county of Los Angeles, California (the American Indian Free Clinic). He is a Vietnam era war veteran as well as a master sculpture taxidermist and wildlife recreation artist. He has been active for many years with the Association of American Indian Physicians, of which he is a member. Hankins is the founder and curator of vertebrate zoology and chief preparator for the World Museum of Natural History, an international, nonprofit public museum of natural history located on the campus of La Sierra University in Riverside, California. Dr Hankins’ life story offers insight into American Indian culture as it relates to dermatology, and hopefully it will inspire more American Indian medical students to pursue a career in that specialty.

Current practice toward the use of antihypertensive agents in the management of hypertension – A cross-sectional study among Indian physicians

Objective: The objective of this study was to assess current practices and usage patterns of antihypertensive medications in managing hypertension (HTN) in India. Materials and Methods: A cross-sectional, observational digital study was conducted among health-care practitioners (HCPs) across India (November 2022–March 2023). Results: A total of 792 HCPs (cardiologists, consulting, and general physicians) participated in this study. According to 63.38% of HCPs, 20–50 essential HTN patients seek consultation weekly. The majority of patients were in the age range of 40–60 years (84.09%). A total of 67.55% of HCPs mentioned that systolic blood pressure (BP) ranged between 140 and 160 mmHg. Type 2 diabetes mellitus was the most common comorbidity among hypertensive patients (84.09%). In total, 53.79% and 37.37% of HCPs preferred angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme and calcium channel blockers (CCBs) as the first choice of antihypertensive agents. The majority of HCPs (>69%) preferred prescribing a triple-drug fixed-dose combination (FDC) of CCBs + ARB + diuretics in hypertensive patients with coronary artery disease (CAD) and resistant HTN. The majority (89.90%) of HCPs preferred prescribing FDC of CCBs over monotherapy. Amlodipine (>55%) followed by cilnidipine (>32%) were preferred CCBs for young and older hypertensive patients. In patients with essential HTN without any CVD, amlodipine (72.85%) was the preferred CCB. Vascular selectivity (59.09%) and longer half-life (54.55%) were important factors for prescribing CCBs. Resistant HTN, inadequate BP control with monotherapy, and the presence of CAD were all (62.63%) important considerations for FDC with CCBs. The underutilization of CCBs in managing HTN (63.88%) was highlighted. Conclusion: Overall responses provide a comprehensive overview of the prevailing perception and the usage patterns of antihypertensive agents employed by HCPs in India.

Pioneering family physicians and the mechanisms for strengthening primary health care in India-A qualitative descriptive study.

India has one of the most unequal healthcare systems globally, lagging behind its economic development. Improved primary care and primary health care play an integral role in overcoming health disparities. Family medicine is a subset of primary care-delivered by family physicians, characterized by comprehensive, continuous, coordinated, collaborative, personal, family and community-oriented services-and may be able to fill these gaps. This research aims to understand the potential mechanisms by which family physicians can strengthen primary health care. In this qualitative descriptive study, we interviewed twenty family physicians, identified by purposeful and snowball sampling, who are among the first family physicians in India who received accredited certification in FM and were identified as pioneers of family medicine. We used the Contribution of Family Medicine to Strengthening Primary Health Care Framework to understand the potential mechanisms by which family medicine strengthens primary health care. Iterative inductive techniques were used for analysis. This research identifies multiple ways family physicians can strengthen primary health care in India. They are skilled primary care providers and support mid and low-level health care providers' ongoing training and capacity building. They develop relationships with specialists, ensure appropriate referral systems are in place, and, when necessary, work with governments and organizations to access the essential resources needed to deliver care. They motivate the workforce and change how care is delivered by ensuring providers' skills match the needs of communities and engage communities as partners in healthcare delivery. These findings highlight multiple mechanisms by which family physicians strengthen primary health care. Investments in postgraduate training in family medicine and integrating family physicians into the primary care sector, particularly the public sector, could address health disparities.

Use of adjuvant bisphosphonate therapy in breast cancer by Indian oncologists: An implementation science study.

e13667 Background: Several clinical trials, expert consensus and guidelines have recommended the use of bisphosphonates (BP) in reducing the breast cancer recurrence risk in postmenopausal women. The 2019 St. Gallen Panel voted 83.7% in favour of the routine use of bisphosphonates in postmenopausal women. Similarly, the 2022 ASCO-Ontario Health guidelines for breast cancer supports the recommendation. However, the uptake of these recommendations in routine clinical practice is poorly studied. We aimed to investigate the use of adjuvant BP therapy by Indian oncologists (implementation science study). Methods: A cross sectional survey study design was used to investigate our research question. Physicians in India who treat patients with breast cancer were presented with a clinical vignette of a young woman with postmenopausal (induced) non-metastatic high risk hormone receptor-positive breast cancer. A snowball sampling strategy was employed to avoid sampling bias. Participants were requested to state their gender, primary qualification, practice setting, number of years of practice as an oncologist and proportion of patients with breast cancer in their practice. Instead of providing the option of BP therapy, we asked an open-ended question whether they would recommend any additional therapy other than surgery, radiation, chemotherapy and anti-estrogen therapy. We asked them to write in the name or class of drug if they would prescribe an additional therapy to the patient. Results: The survey was completed by 74 Oncologists. The response rate is unknown as a snowball sampling strategy was employed. Majority of the respondents were male (74%), were non-teaching private practitioners (42%), medical oncologists (62%) with up to 10 years of experience (65%), and breast cancer patients make up to 50% of their patients (84%). Most of the oncologists responded no to our question on additional therapy (76%). Of those who responded yes, only 8 suggested BP therapy (11%). Conclusions: Despite strong evidence and guidelines, adjuvant BP therapy in high-risk early breast cancer was only recommended by very few oncologists in our survey study. Steps to bridge this gap between academic research and clinical application is urgently warranted. Implementation of clinical guidelines has to be monitored routinely which may be facilitated by provider and patient surveys. This can also assist in identifying and addressing the concerns with newer recommendations.

A Newer Approach in the Management of Cough: A Review on Levodropropizine

Safe and effective antitussive therapy remains a significant area of unmet need for cough management. Antitussive drugs are commonly used cough suppressants and include centrally acting (opioids and non-opioids) cough suppressants and peripherally acting antitussives. Authors searched PubMed, Google Scholar and additional studies from reference lists via cross-referencing to identify studies assessing levodropropizine for the treatment of cough. Of the 748 studies identified, 13 were included. Recent clinical evidence, guideline recommendations and findings from this review suggest that levodropropizine is a peripheral antitussive which reduces cough intensity, frequency, and nocturnal awakenings in children and adults and provides better efficacy outcomes with a more favourable risk/benefit ratio compared to centrally acting antitussive agents which pose greater safety concerns and present an unacceptable risk–benefit profile. This review is aimed at Indian primary care physicians for making effective cough management decisions where the clinical evidence needs to be translated to clinical practice. Key messages The usage of currently available centrally acting antitussive agent is greatly limited by their central depressing action and frequent side effect. The findings of this review indicate that levodropropizine is an effective antitussive agent and well tolerated in the management of cough in patients of all ages.

Knowledge, Attitudes, and Practices regarding Oral Fluid, Electrolyte, and Energy Management in Acute Nondiarrheal Illnesses among Physicians in India.

Fluid, electrolytes, and energy (FEE) management is important in the treatment of acute nondiarrheal illnesses. However, the use of FEE drinks in managing such illnesses is not well-documented. This study aimed to understand physicians' knowledge, attitude, and practices (KAP) and perceived patient outcomes in treating FEE deficits in acute nondiarrheal illnesses using FEE drinks in India. A cross-sectional respondent-blinded survey was designed and administered among practicing physicians across various specialties and prescribing statuses in India. KAP among groups of physicians was assessed, and the correlations between knowledge- attitudes, knowledge-practice, and knowledge-perceived outcomes were explored. A total of 494 physicians participated in the study from September to October 2021. Overall, knowledge scores were moderate. Prescribers had a higher average knowledge score and more proactive attitudes and practices as compared to nonprescribers. Most physicians agreed that FEE management recommendations could improve patients' recovery speed. There were significant positive correlations between knowledge scores and physicians' attitudes toward the importance of FEE management awareness, the importance of FEE management for patient recovery, and a physician's perception that FEE drinks improved patients' recovery time. There was no significant correlation between knowledge score and practices. There may be benefits from improving the knowledge of physicians in India in FEE management and developing guidelines for the use of FEE drinks in acute nondiarrheal illnesses. Further research exploring the knowledge-practice gap and evaluating the clinical benefit of FEE drinks in acute nondiarrheal illnesses should also be undertaken to develop such guidelines.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

BackgroundAwareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Materials and methodsAs part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. ResultsA total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. ConclusionThe survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.

Knowledge Attitude and Practices about Neuromodulation Techniques for Management of Refractory Diabetic Neuropathy Pain Among Physicians in India

Knowledge Attitude and Practices about Neuromodulation Techniques for Management of Refractory Diabetic Neuropathy Pain Among Physicians in India

Perceptions of Indian Physicians towards Deprescribing of Medications for Chronic Diseases in Elderly: A Questionnaire-based Study

Abstract: Deprescribing is the process of reconstructing multiple medications use by review and analysis, which concludes with the modification, replacement or elimination of drugs. Medications that were once appropriate may become inappropriate due to age-related physiological changes that increase the risk of harm from medications eliminated by the liver and kidneys and other co-morbidities. In India, with a steadfast rise in the elderly population paralleled with an augmented necessity for chronic disease management, the essence of deprescribing is rarely known and less practiced by physicians. Hence, a questionnaire-based interventional study was conducted to assess their perception and attitude towards implementing the deprescribing process. The study included 75 physicians from the departments of General Medicine and Nephrology, who were initially educated on deprescribing through a self-developed and validated educational video of three minutes duration, following which they were asked to fill the Perceptions, Attitudes and Challenges of Physicians towards Deprescribing Questionnaire. About 76% of the physicians felt that deprescribing was needed to reduce medication-related problems in older patients. Involvement of multiple prescribers (54.6%) was the main challenge stated by physicians; 92% stated deprescribing to be beneficial in current clinical scenario, and 85.3% showed a positive attitude towards integrating deprescribing into their day-to-day clinical practice. Physicians below 40 years with an experience of 0 to 10 years had a significantly positive perception and attitude towards deprescribing. In view of reducing potential medication-related adverse events in the elderly, daily practice of the deprescribing process should become a norm, thereby improving the quality of life. Keywords: Comorbidities, Polypharmacy, Deprescribing, Elderly patients.

Hepatitis in India: challenges, efforts, and recommendations

Hepatitis in India: challenges, efforts, and recommendations

Oncofertility awareness among primary care physicians in India.

Primary carephysicians not only coordinate referrals tooncologyservicesbut can play a crucial role in successful fertility preservation referrals in cancer-diagnosed patients. Hence, it is important to assess their knowledge and attitudes towards fertility preservation. An eighteen-itemoncofertilitysurvey was administered toprimary carephysicians between May 2019 to September 2020. Results: A total of forty-six responses were received and analysed.About 60% of primary carephysicians did not have adequate knowledge about available fertility preservation options and only 26-32% were aware ofinternational guidelines recommending fertility preservation in cancer patients. Conclusions: Impartingawareness and knowledge of fertility preservation and its optionsto primary care physicians could enable an integrated cancer care model while also facilitating successfuloncofertilityreferralsin countries like India.

PS-C10-10: AWARENESS AND RECOMMENDATION OF HOME BLOOD PRESSURE MEASUREMENT AMONG PHYSICIAN IN INDIA - RESULTS FROM ASIA HBPM SURVEY 2020

Background: In Asia Pacific region, 66% of deaths are caused from cardiovascular diseases (CVD) which are attributed to hypertension, and in India alone, ischemic heart disease and stroke are the top causes of death. Awareness of hypertension and blood pressure (BP) control rate are still low in India; therefore, physicians and patients hypertension education are important for increasing awareness and improving hypertension management. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including prevention of CVD and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Methods: As part of Asia HBPM Survey-2020, a cross-sectional survey was conducted among health care professionals from India between December 2020 to June 2021. The questionnaire consisted of 37 questions, including sub-questions, related to HBPM awareness and recommendations to patients. All analyses were performed using the proper statistical software and results were presented as descriptive data. Results: A total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. Among physicians who recommend HBPM in the morning, more than 60% of respondents are giving instruction to their patients in alignment with local Indian hypertension guidelines regarding the body position and time of rest before measurement. Nevertheless, only 31% of physicians instruct their patients to measure their BP before taking anti-hypertensive drugs, while around 30% of physicians gave no instructions. A noticeable percentage of the physicians gave no instructions related to home BP measurement to their patients. Reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34%) and home BP (15%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 29% of their patients own HBPM device and 35% of the patients measure their own BP at home. Conclusions: The survey reveals that awareness of HBPM amongst physicians in India is low and instruction to their patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM rate among patients. Considering the challenges and limitations physicians face in daily practice, clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.

A Prospective Observational Study on Changing Trends of Antiepileptics Prescription Amongst Physicians in India

Epilepsy is one of the common neurological disease affecting millions of people worldwide. Multiple class of antiepileptic drugs (AEDs) are available which makes it difficult to select an appropriate drug therapy for epilepsy. With introduction of newer generation of antiepileptics, the drug Pool has become wider. Factors which determine the selection of therapy includes seizure type, adverse effect, drug-drug interaction, age, pregnancy, cost of treatment and drug compliance. Though the older generation of antiepileptics were effective in controlling seizures, we found that newer generation of antiepileptics are gaining popularity among the prescriber. Reason for this shift being, better efficacy, fewer side effect and better compliance by the patients. We completed the study with the conclusion that newer antiepileptic especially levetiracetam, are more preferred by doctors in comparison with older antiepileptic drugs for control of seizures, though previous generation of antiepileptics has still role in management of epilepsy and individualistic approach is needed in choosing appropriate antiepileptics.

Suicide deaths among medical students, residents and physicians in India

Suicide deaths among medical students, residents and physicians in India

Physicians in India Are Not Adequately Equipped to Manage Non-alcoholic Fatty Liver Disease (NAFLD): A Preliminary Survey

Physicians in India Are Not Adequately Equipped to Manage Non-alcoholic Fatty Liver Disease (NAFLD): A Preliminary Survey

Current status and future readiness of Indian radiation oncologists to embrace prostate high-dose-rate brachytherapy: An Indian Brachytherapy Society survey.

This survey aimed to understand the practice pattern and attitude of Indian doctors towards prostate brachytherapy. A 21-point questionnaire was designed in Google form and sent to radiation oncologists practicing in India, using texts, mails, and social media. Responses were collated, and descriptive statistical analysis was performed. A total of 212 radiation oncologists from 136 centers responded to the survey questionnaire, with majority (66%) being post-specialty training > 6 years. We found that about 44.3% (n = 94) of respondents do not practice interstitial brachytherapy for any site, and majority (83.3%, n = 175) do not practice high-dose-rate (HDR) prostate brachytherapy. Only 2.8% (n = 6) of doctors preferred boost by brachytherapy compared with 38.1% (n = 80) of respondents, who favored stereotactic body radiation therapy (SBRT) boost. When asked about the indication of HDR prostate brachytherapy in Indian setting, 32.5% (n = 67) of respondents favored monotherapy, 46.1% (n = 95) of oncologists thought boost as a good indication, and 21.4% (n = 44) preferred re-irradiation/salvage setting. The most cited reason for prostate brachytherapy not being popularly practiced in India was lack of training (84.8%, n = 179). It was also noted that out of 80 respondents who practiced SBRT for prostate boost, 37 would prefer HDR brachytherapy boost if given adequate training and facilities. The present survey provided insight on practice of prostate brachytherapy in India. It is evident that majority of radiation oncologists do not practice HDR prostate brachytherapy due to lack of training and infrastructure. Indian physicians are willing to learn and start prostate brachytherapy procedures if dedicated training and workshops are organized.

10 important financial investments for orthopods in India

10 important financial investments for orthopods in India

Addressing Challenges in Insulin Storage: An Ethical Dilemma among Physicians.

Insulin is a temperature-sensitive protein; hence, its potency is highly dependent on appropriate storage. Ideally, insulin should be stored in the refrigerator, but when in use it can be stored at room temperature for up to four weeks. However, room temperatures vary widely across regions and countries, and all rural areas of developing countries like India are not electrified. This study explored physicians' perception of alternative methods for appropriate storage of insulin, such as indigenous storage methods like clay pots. A Study was conducted among 188 Indian physicians attending a diabetes conference in December 2018 to evaluate the feasibility of indigenous storage methods. It was observed that although the use of alternate indigenous methods like clay pots was recommended by them, the proportion was low. The awareness of literature on these methods for insulin storage validation was also less than 50%. Owing to the lack of validation studies on indigenous methods, nearly 80% of the physicians felt that they were not confident to recommend them. Besides, the study results highlighted the necessity of conducting an adequate number of validation studies on indigenous methods in the Indian setting, considering their scarcity. This is the first time we highlight ethical dilemmas through a study among physicians when they advise non-refrigerator methods for insulin storage, in the event of a lack of electricity supply. It is hoped that results from these studies would highlight ethical dilemmas among physicians and would motivate researchers in this field to conduct studies to validate alternative methods of insulin storage.

An Insight into the Elusive Healer Plant “Luffa echinata Roxb.”

Pharmacognosy Research,2023,15,1,26-41.DOI:10.5530/097484900254Published:December 2022Type:Review ArticleAuthors:Sumanta Mondal, Kausik Bhar, Renu Kumari, Prasenjit Mondal, Subhadip Chakraborty, and Nooka Yaswanth Teja Author(s) affiliations:Sumanta Mondal1,*, Kausik Bhar1, Renu Kumari1, Prasenjit Mondal2, Subhadip Chakraborty1, Nooka Yaswanth Teja1 1Department of Pharmaceutical Chemistry, GITAM School of Pharmacy, GITAM (Deemed to be University), Visakhapatnam, Andhra Pradesh, INDIA. 2Department of Pharmaceutical Technology, Brainware University, Ramkrisnapur Road, Kolkata, West Bengal, INDIA. Abstract:Recent years have seen a global rise in the use of herbal medicine. Many naturally occurring bioactive substances, especially those derived from plants, have been studied as potential cures for various diseases. Luffa echinata Roxb., a mysterious medicinal plant from the Cucurbitaceae family, has recently gained recognition as one of the most important medicinal herbs among them. Many phytochemicals found in this plant have been found to have therapeutic potential, including xanthones, alkaloids, phytosterols, flavonoids/isoflavonoids, chalcone, glycosides, terpenoids, saponins, carbohydrates, proteins, reducing sugars, fatty acids, tannins, and phenolic compounds. Other potent phytoconstituents of this plant include saponins, hentriacontane, gypsogenin, sapogenin, cucurbitacin (A, B, C, D, E, K, S, and I), β-sitosterol, echinatol (A and B), oleanolic acid, isoquercetin, quercimeritrin, and sitosterol glycoside. Cucurbitacin, a prominent class of triterpenoids found in L. echinata, has been proven effective in numerous reports. Recent research has shown that cucurbitacins can decapitate or inhibit the proliferation of cancer cells. Luffa echinacea's fruit and leaves have long been used as purgatives and to cure liver disease, hemorrhoids, jaundice, migraines, emesis, and other conditions by Indian and Chinese physicians. Ulcers and sores have also been expelled using them. During the field study, it was found that the tribal community (Tharus) of Khatima utilized extremely bitter, squeezed fruit stuff given to sufferers of dog bites in the morning on an empty stomach, and more than 500 people have been adequately treated thus far. The therapeutic potential and phytoconstituents of Luffa echinata have been clarified by pharmacological and phytochemical studies; further study is required to investigate these phytoconstituents and their structures. Keywords:Cucurbitaceae, Cucurbitacin, Ethnobotanical, Luffa echinata Roxb., Pharmacobotanical, Pharmacological Testimony, PhytomoleculesView:PDF (1.66 MB)

A Review on Detection of Pneumonia in Chest X-ray Images Using Neural Networks.

The health organisation has suffered from the lack of diagnosis support systems and physicians in India. Further, the physicians are struggling to treat many patients, and the hospitals also have the lack of a radiologist especially in rural areas; thus, almost all cases are handled by a single physician, leading to many misdiagnoses. Computer aided diagnostic systems are being developed to address this problem. The current study aimed to review the different methods to detect pneumonia using neural networks and compare their approach and results. For the best comparisons, only papers with the same data set Chest X-ray14 are studied.