The Indian Practitioner

Tuberculosis in India – Evolution of National Programmes and Treatment Regimens

2025-04-14T09:16:12+00:00

Tuberculosis (TB) has been one of the most important infectious diseases in India, and National Programs to streamline its diagnosis and management have been evolving and improving over time. With the highest TB burden in the world, India has been striving towards its goal of eliminating TB with greater awareness, involving physicians all over the country, improving patient access, introducing new drugs and diagnostic modalities for resistant TB, and also now creating a robust web-based platform. These commendable and immense strides keep the hope alive of India being TB-free in the future.

Medi Matters

2025-04-14T09:16:13+00:00

Diagnostic Accuracy in the Emergency Department: A Comparative Analysis of Initial and Final Diagnoses at Discharge

2025-04-14T09:16:13+00:00

Background: The accuracy of initial diagnoses in the emergency department (ED) is crucial for optimizing patient outcomes, minimizing unnecessary investigations, and ensuring cost-effective healthcare. This study evaluates the diagnostic accuracy of the ED by comparing the provisional diagnosis at presentation with the final diagnosis at discharge.

Methods: A retrospective observational study was conducted at an EMS of a hospital’s emergency department in Mumbai. The study included 403 patients admitted through the ED for 1 month duration. Cases were categorized as a full match (complete agreement between initial diagnosis in ED and final diagnosis), partial match (some variation but within the same system), or unmatched (significant deviation between initial and final diagnosis). Statistical analysis was performed using SPSS Version 21.0 to determine diagnostic accuracy across different specialties and triage priorities.

Results:Full match, Partial match, and Unmatched cases were 215 cases (53.34%), 155 cases (38.46%) and 33 cases (8.1%) respectively. Highest diagnostic accuracy was observed in pediatrics (100%), ophthalmology (100%), and neurosurgery (80.95%).Lowest accuracy was noted in hematology (0%), vascular surgery (60%), and chest medicine (31.82%).Trauma cases had higher diagnostic accuracy (69.76%) compared to non-trauma cases (51.38%).Triage-wise accuracy: Priority 1 cases had a diagnostic accuracy of 93.15%, while Priority 3 had 28.57%.

Conclusion: A significant proportion (53.34%) of ED diagnoses were fully accurate, with an additional 38.46% being partially matched. Specialty-based variations in accuracy highlight the need for targeted improvements in certain departments, particularly neuro-medicine and chest medicine. The findings support ongoing training and quality improvement measures in-ED triage and diagnosis.

Right Patient to Revascularize in Chronic Coronary Syndrome

2025-04-14T09:16:13+00:00

Concept of chronic coronary syndrome (CCS) is changing from epicardial obstructive lesion causing ischemia to a systemic pathophysiologic disorder involving the whole coronary vasculature including dysfunction in microvasculature.Non-invasive imaging is now more often used for diagnosisthan invasive angiography and functional significance of obstructive lesions is now more often determined.Landmark trials have established the role of optimal medical therapy (OMT) as the mainstay of treatment in CCS to decrease symptom, improve survival and overall quality of life. Revascularisation plays an important role in the management of select patients with CCS, particularly those with refractory angina despite optimal medical therapy, left main coronary disease, three vessel disease, left ventricular systolic dysfunction and diabetes. While percutaneous coronary intervention (PCI) provides a less invasive option, coronary artery bypass grafting (CABG) remains the preferred strategy for extensive coronary disease, particularly in high-risk populations. The choice between PCI and CABG depends on various factors, including anatomical complexity of coronary lesions, eligibility for surgery and individual preference. Determination of physiological significance of anatomical obstructive lesions by both invasive and non-invasive methods are increasingly used for management decision.Shared decision-making between the patient and their healthcare team is crucial to ensure that revascularisation is used appropriately and effectively.

The Importance of a Philosophical Construct in Evaluating Psychiatric Symptoms Part 3

2025-04-14T09:16:13+00:00

This article, the author’s part 3 of continuing series, explores the aims of family therapy, focusing on the therapist's role in navigating mutual blame, conflicting narratives, and emotional tensions within families. It contrasts two models—the therapist as Freud, who applies specialized psychological knowledge, and the therapist as Socrates, who fosters open dialogue. Additionally, it examines ethical concerns such as neutrality, truth, and manipulation. The discussion extends to human values, questioning their adaptability in light of evolving societal and technological changes.

The Expanding Waistline: Obesity, A Major Concern in India, Now

2025-04-14T09:16:13+00:00

Obesity has become a pressing health issue in India, shifting from being primarily a Western concern to a widespread national challenge. The Indian Practitioner sought expert opinions on key aspects of obesity - including its diagnosis, rising prevalence, associated co-morbidities, and the latest treatment advancements. Dr. Anoop Misra, Chairman of the Fortis - CDOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology has provided his views on obesity and its management, reproduced below:

India’s Healthcare Infrastructure Scenario

2025-04-14T09:16:14+00:00

India’s healthcare system faces several challenges, from inadequate infrastructure to rising treatment costs. While corporate hospitals offer advanced care, their affordability remains a concern, and government hospitals struggle with overburdened resources. To understand the current scenario, its implications, and possible solutions, The Indian Practitioner sought the views of leading doctors and healthcare professionals. The views of three doctors, Dr. Soham D. Bhaduri, Dr. Jayesh Sheth and Dr. Regi M. George are shared below.

Medical Ethics, Then and Now

2025-04-14T09:16:14+00:00

Nutraceuticals

2025-04-14T09:16:14+00:00

AYUSH / Alternative Medicine

2025-04-14T09:16:14+00:00

It’s A Tech World - Now!

2025-04-14T09:16:14+00:00

News

2025-04-14T09:16:14+00:00