搜索结果：The Journal of the Association of Physicians of India

The clinical manifestation of drug-induced ataxia (DIA) is well established clinically but often becomes unrecognized until actual ataxia occurs. DIA may include ataxia as its primary clinical symptom or may be one of multiple manifestations. This study aimed to characterize the development of DIA types and the timing of clinical resolution. Between January 2016 and March 2025, a prospective observational study of subjects diagnosed with DIA based on the development of ataxia after starting a drug and no prior history of ataxia was conducted. Collected data included the drug involved, timing to onset of symptoms, type of DIA (cerebellar vs sensory), and time required for resolution of symptoms. A total of 63 subjects met the criteria for inclusion in this analysis. Ataxia was most commonly attributed to antiepileptic drugs (AED) (44 subjects, 69.8%), with the remaining 19 subjects having ataxia after the use of chemotherapeutic or other drugs (30.2%). The most frequent drug associated with ataxia was phenytoin (22 subjects). The majority of ataxia experienced by the subjects was of the cerebellar variety (58.7%), whereas only 41.3% experienced a sensory form of ataxia. Symptoms of ataxia following the use of a drug were most commonly noted >72 hours after starting the drug (79.4%). In subjects with symptomatic improvement after intervention, 39.7% of subjects demonstrated improvement within 72 hours after intervention. DIA may typically be caused by AEDs and chemotherapeutic drugs, with symptoms commonly manifesting >72 hours after initiation of drug therapy. Early recognition and treatment of DIA may improve clinical outcomes for individuals diagnosed with DIA.

Thrombotic events are a major morbidity among Philadelphia chromosome-negative myeloproliferative neoplasm (Ph-MPN) patients. There is a lack of data from Kerala regarding the profile of Ph-MPN and the prevalence of thrombosis among these patients. To study the clinical profile, driver mutations, incidence of thrombotic events among Ph-MPN patients, and the response to hydroxyurea therapy. We reviewed the medical records of 84 Ph-MPN patients who were on follow-up from April 2019 to June 2023 in a tertiary care hospital in Kerala. There were 48 polycythemia vera (PV), 16 essential thrombocythemia (ET), 14 primary myelofibrosis (PMF), and six unclassifiable MPN (MPN-u) patients. The incidence of Janus kinase 2 (JAK2) mutation was 96, 62.5, and 79% among PV, ET, and PMF patients, respectively. The incidence of calreticulin (CALR) mutation was 37.5 and 21% among ET and PMF patients, respectively. The incidence of thrombotic events was 23/48 (48%), 7/16 (43.5%), and 6/14 (42.8%) among PV, ET, and PMF patients, respectively. All ET and PMF patients with thrombotic events were JAK2V617F-mutated. Eighty-seven percent of the evaluable patients on hydroxyurea for PV achieved freedom from therapeutic phlebotomies. ET patients who were on hydroxyurea achieved a median platelet count of 4.3 lakhs/µL (3.16-6.08). There is a higher incidence of thrombosis among Ph-MPN patients from Kerala, which needs to be ascertained in a population-based study. JAK2V617F mutation is the major determinant of thrombotic episodes in ET and PMF. Hydroxyurea is an effective cytoreductive therapy in PV and ET.

Inappropriate use of antibiotics can have a significant impact on health care costs, increasing the likelihood of adverse drug reactions (ADR) and acting as a primary contributor to the development of antimicrobial resistance (AMR). To get baseline data on the pattern and characteristics of antibiotic use among the inpatients at a particular tertiary care health facility in Kolkata. This point prevalence survey (PPS) was conducted in the study hospital as a part of the first multicentric survey at NACNET (National Antimicrobial Consumption Network) sites, India. Data from all indoor admitted patients (medical wards) were collected, using a pretested Google Form, at 9:00 AM on a single day in the month of December 2021. The total number of beds covered was 148. Antibiotic use was classified as empiric, definitive, or prophylactic. Cumulatively, 118 antibiotic prescribing encounters were documented among 84 surveyed patients. A total of 72.61% (n = 61) of admitted patients were on antibiotics. Out of these, 19.04% (n = 16) patients received one antibiotic, 46.42% (n = 39) patients received two antibiotics, and 7.14% (n = 6) patients received three or more antibiotics. The rest 27.38% (n = 23) of patients did not receive any antibiotics. The top two antibiotics prescribed were doxycycline and gentamicin, both from the "Access" category. When taking into account the total prescribing encounters of antibiotics, about 50.84% (n = 60), 42.37% (n = 50), and 6.77% (n = 8) were from the Access, Watch, and Reserve groups, respectively. The average number of antibiotics prescribed was 1.40 per eligible patient. The relatively high use of antibiotics observed can be attributed to the study site being a tertiary care hospital specializing in the treatment of infectious diseases. This study showed the feasibility of conducting a point prevalence survey in a tertiary care public facility hospital with a paper-based medical record system. The study results emphasized the need to implement activities such as prescription audit, hospital antibiotic policy, and antibiotic stewardship program in the future.

Hyponatremia is a common and important electrolyte imbalance seen both in isolation and more commonly, as a complication of other medical illnesses. With a wide spectrum of presentations, the prognostic implications are grave and far-reaching if not addressed meticulously. Despite the knowledge of hyponatremia since the mid-20th century, data on the prevalence and clinical profile of hyponatremia are scarce, to say the least, from the Indian subcontinent. We took up this hospital-based observational study to explore the clinicoetiological profile of hyponatremia. Mean serum sodium level was 122.24 ± 6.10. Most of the patients had severe hyponatremia (63.3%). The most common cause of hyponatremia, as well as severe and euvolemic hyponatremia, was syndrome of inappropriate antidiuretic hormone secretion (SIADH) (21.9%). Most patients with SIADH had tubercular meningitis (TBM). The most common type of hyponatremia was hypovolemic hyponatremia (42.4%), of which sepsis was the most common cause. Further prospective studies are required as hyponatremia remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, its causation by multiple etiologies with differing pathophysiological mechanisms, and marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of hyponatremia; also, optimal treatment strategies have not been well defined for these reasons.

One of the global epicenters of the diabetes mellitus pandemic is India. Over the past 40 years, there has been a sharp rise in the prevalence of diabetes mellitus in India due to rapid socioeconomic development, demographic shifts, and increasing susceptibility in the Indian population. Diabetes affects 74.2 million individuals in India, which places a significant strain on the country's economy and healthcare system. A patient's diet, lifestyle, medication, and glucose monitoring must all be customized for optimal diabetes control. The rates of glucose monitoring in India are abysmal. Most of the monitoring methods currently in use are based on single-point-in-time readings, which may not be totally indicative of the state of diabetes control. This presents problems. With advancements in technology, the new monitoring tool-continuous glucose monitoring (CGM)-provides visibility into the glycemic profile 24 × 7 with user-friendly reports that provide information much beyond glycated hemoglobin (HbA1c) and self-monitoring of blood glucose. This device also detects the time spent in range by the individual with diabetes. This review article discusses CGM in terms of its purposes, technologies, accuracy, clinical indications, benefits, and problems associated with it.

Among ischemic stroke patients, prehospital delay is the most common reason for underutilization of thrombolysis. The study assessed prehospital factors contributing to delay and timely arrival among study participants. A cross-sectional study was carried out at the casualty department of Government Stanley Medical College and Hospital, South India. We selected 212 study participants by consecutive sampling. Data were collected by interviewing patients or accompanying family members using a semistructured questionnaire. Univariate analysis was followed by multivariate logistic regression to examine prehospital factors contributing to delay and timely arrival. Follow-up of eligible study participants for thrombolysis was performed using the National Institutes of Health Stroke Scale (NIHSS) and American Heart Association (AHA)-2019 checklist. The most common factors contributing to prehospital delay and timely arrival were found to be "unawareness regarding benefits of timely arrival among patients/relatives (48.7%)" and "apprehension of some serious health issue (50%)," respectively. The distance between the hospital and the place of onset of symptoms, stroke during sleep, mode of transport, National Institutes of Health Stroke Scale (NIHSS), and slurring of speech were found to have significant odds for timely arrival for intravenous thrombolysis (IVT). Among those who arrived on time (n = 60), 13 study participants could not undergo thrombolysis. The most common reason for this was refusal of thrombolysis (4, 6.7%), and other criteria, such as minor neurological deficits (4, 6.7%), rendered them ineligible for it. The study highlights factors associated with timely arrival at the hospital and further reasons for not undergoing IVT despite timely arrival among cases of acute ischemic stroke (AIS). There is also a need to generate awareness and disseminate information on the benefits of IVT, timely arrival, and prehospital factors; provide training in stroke preparedness; and strengthen the referral system to ensure maximum eligibility and utilization.

Sometimes, drug names or their appearances create confusion among healthcare providers. These look-alike or sound-alike (LASA) drugs have the potential to cause medication errors leading to patient harm. Such errors can occur during prescribing, dispensing, and administration of drugs. Therefore, this study was conducted to assess the knowledge, attitudes, and practice of LASA drugs among healthcare providers at a tertiary care hospital in India. This cross-sectional, observational, single-center, questionnaire-based study was conducted among healthcare providers at a tertiary care hospital in India. The study was conducted over a duration of 2 months between November and December 2024. Out of the 400 participants, 81% were doctors, followed by 12.75% nurses, 3.25% pharmacists, and 3% interns. The majority of them were aware of the term LASA drugs. The majority of them were slightly concerned about the risks of LASA drugs. Whereas, only 10% of them had ever reported LASA errors, as the majority of them were unaware about medication error reporting form. This study suggests that lack of awareness about LASA drugs among healthcare providers contributes to medication errors. To address this, solutions can be implemented at different levels via a multidisciplinary approach.

Asthma remains a major public health challenge in India, characterized by high disease burden, poor adherence, and suboptimal control despite therapeutic advances. Fixed-dose combination therapy with indacaterol/glycopyrronium/mometasone furoate (IND/GLY/MF; DIFIZMA&#xae;), a single-inhaler triple therapy (SITT), offers the potential for improved symptom control and adherence through once-daily dosing. However, real-world and postmarketing surveillance data on the effectiveness and safety of IND/GLY/MF in Indian asthma patients remain limited, underscoring the need for local evidence to guide clinical practice. To evaluate the safety and effectiveness of once-daily IND/GLY/MF dry powder inhaler (DPI) in Indian adults with asthma inadequately controlled on inhaled corticosteroid (ICS)-long-acting &#x3b2;2-agonist (LABA) therapy. This was a prospective, open-label, multicenter, single-arm, phase IV postmarketing study conducted across multiple centers in India. Adults (18-65 years) with persistent asthma symptoms despite ICS &#xb1; LABA therapy received IND/GLY/MF DPI (160 &#xb5;g mometasone furoate, 46 &#xb5;g glycopyrronium bromide, 114 &#xb5;g indacaterol acetate) once daily for 24 weeks. The primary endpoint was safety, based on treatment-emergent adverse events (TEAEs), serious TEAEs, and discontinuations. Secondary endpoints included changes from baseline in the asthma control questionnaire (ACQ-7) score, FEV1, FVC, and FEV1/FVC ratio at weeks 4, 12, and 24. A total of 200 patients were enrolled (safety set), of whom 196 were included in the modified intent-to-treat (mITT) analysis and 189 in the per-protocol (PP) population. TEAEs occurred in 9.5% of participants, with 6.5% considered drug-related; all events were mild or moderate in severity. No serious adverse events, severe TEAEs, or deaths were reported. Clinically meaningful and progressive improvements were observed in asthma control and lung function over 24 weeks. The ACQ-7 score decreased from 3.00 &#xb1; 0.59 at baseline to 2.36 &#xb1; 0.54 at week 4, 1.86 &#xb1; 0.54 at week 12, and 1.39 &#xb1; 0.61 at week 24, corresponding to mean change of -0.64 &#xb1; 0.50, -1.14 &#xb1; 0.74, and -1.62 &#xb1; 0.89, respectively (all p < 0.0001). Mean FEV1 increased from 1.49 &#xb1; 0.51 L at baseline to 1.73 &#xb1; 0.60 L at week 4, 1.81 &#xb1; 0.53 L at week 12, and 1.95 &#xb1; 0.51 L at week 24, with corresponding mean changes of +0.24 L, +0.32 L, and +0.46 L (all p < 0.0001). Mean FVC improved from 2.13 &#xb1; 0.63 L at baseline to 2.30 &#xb1; 0.70 L, 2.33 &#xb1; 0.62 L, and 2.38 &#xb1; 0.59 L at weeks 4, 12, and 24, respectively (all p < 0.0001). The FEV1/FVC ratio increased from 71.63 &#xb1; 12.76 at baseline to 76.71 &#xb1; 11.33, 80.86 &#xb1; 12.67, and 84.00 &#xb1; 8.93 at weeks 4, 12, and 24, with mean changes of +4.99, +8.91, and +12.10, respectively (all p < 0.0001). No hospitalizations or rescue medication use were reported. Compliance with study medication was 100%, and both patients and physicians reported marked symptom improvement and high treatment satisfaction. Once-daily IND/GLY/MF DPI demonstrated a favorable safety profile and significant, sustained clinical benefits in adults with asthma inadequately controlled on ICS-LABA therapy. The triple combination provided rapid onset and sustained improvement in asthma control and lung function, with excellent adherence and tolerability in real-world Indian clinical practice. These findings support IND/GLY/MF as an effective and practical single-inhaler triple therapy option for optimized asthma management.

The advent of modern potent immunosuppression has significantly reduced the occurrence of rejection in renal allograft recipients but has increased the risk of infection, which remains the major cause of death in these patients. This single-center retrospective observational study was conducted at a tertiary care center in India. Data were collected from medical records of renal allograft recipients admitted for infection-related complications over a 10-year duration. Out of 238 admissions, 63 (26.47%) were due to infection-related complications involving 59 unique patients. The most common infections were urinary tract infections (UTIs) (n = 24) and pneumonia (n = 19). Of the two patients requiring multiple admissions, one patient had two episodes of pneumonia and one episode of UTI, and the other patient needed three admissions for diabetic foot. Six patients succumbed to their illness, resulting in a mortality rate of 10.16%, with sepsis due to UTI being the most common cause of death.

Osmotic demyelination syndrome (ODS) presents as quadriplegia with pseudobulbar palsy, and most cases occur with rapid correction of hyponatremia. It is due to demyelination of the pons without any inflammation. Other causes include chronic malnutrition, alcoholism, and underlying medical illnesses such as post-liver transplant. Here, we present a case report of a patient with hypernatremia and hypokalemia leading to ODS, whose early diagnosis and effective treatment resulted in complete recovery of the patient. A 33-year-old female patient presented with vomiting followed by confusion and weakness of all four limbs. On admission, the patient was drowsy, obeying oral commands, mildly dyspneic, dehydrated, weakness of all four limbs. Deep tendon reflexes were present, and the bilateral plantar reflex showed no response. Her vitals were stable. On evaluation, arterial blood gas (ABG) showed hyperchloremic normal anion gap metabolic acidosis. Serum potassium level was very low, and serum sodium level was significantly high. MRI brain T2-FLAIR image showed hyperintensity in the central pons with peripheral sparing. Pons appeared swollen and edematous, suggestive of ODS. On further evaluation, she was found to have distal renal tubular acidosis. With this presentation and in the background of renal tubular acidosis, autoimmune disease was considered. It was negative in our case. In view of hypernatremia, after calculating the water deficit, she was given IV 5% dextrose and free water through the nasogastric tube, along with potassium supplements. She was also given steroids and other supportive measures. The patient recovered completely. There was no evidence of hyponatremia during admission. Here, we consider that the osmotic demyelination could have occurred due to hypernatremia. The cause for hypernatremia in this case would have been hypokalemia. Moreover, hypokalemia leads to hypernatremia through a combination of increased sodium reabsorption in the kidneys, aldosterone-mediated effects, impaired renal concentrating ability, cellular electrolyte shifts, and associated volume depletion and dehydration. These mechanisms explain the complex relationship between sodium and potassium. Early diagnosis with MRI brain imaging and treatment allowed our patient to recover completely.

Nodoparanodopathies are subtypes of inflammatory polyneuropathies that differ in clinical presentation, duration, and response to intravenous immunoglobulins. Antineurofascin antibodies are detected by cell-based assays from serum or cerebrospinal fluid. The aim of our study was to describe the clinical presentation, electrophysiology, antibody assay, and response to treatment in different types of nodopathies. During the last 1 year, we came across three patients with neurofascin 140/186 positivity and one patient with neurofascin 155 antibody positivity. The clinical features, electrophysiology, treatment response, and outcome were studied after obtaining informed consent from the patients. Both groups improved with treatment; however, patients with neurofascin 140/186 positivity were older, with proximal weakness and a good response to intravenous immunoglobulins, while the patient with neurofascin 155 positivity was younger, with cranial and respiratory involvement, gait ataxia, high cerebrospinal fluid protein, a prolonged clinical course, and an inadequate response to intravenous immunoglobulins. The interesting observation made was that both groups of patients had varying conduction blocks without temporal dispersion on nerve conduction studies, which reversed rapidly with treatment. The spectrum of illness, electrophysiology, and treatment varied widely in affected patients. Ultimately, the outcome depended on one's clinical acumen, antibody levels, and prompt treatment, as illustrated in the patients mentioned. This patient series was small, but the results were illustrative of the complexities of the disorder and the necessity for testing for nodopathies in patients with atypical clinical presentations, a prolonged clinical course, or conduction blocks in nerve conduction studies.

Anticonvulsants are the drugs given for managing epilepsy and some other types of neurological disorders; however, their long-term use is increasingly suspected of causing adverse skeletal outcomes, including osteomalacia. Osteomalacia is a condition marked by defective mineralization of bone, leading to bone softening, bone pain, muscle weakness, and predisposition to fractures. The disruption of vitamin D metabolism, impaired calcium absorption, and altered bone turnover are mechanisms attributed to several commonly used anticonvulsants, especially enzyme-inducing agents such as phenytoin, carbamazepine, and phenobarbital, in contributing to osteomalacia. Hence, this review aims to provide detailed information about the pathophysiology, clinical manifestations, diagnosis, and treatment of anticonvulsant-induced osteomalacia. The review places further emphasis on the importance of regular monitoring of bone health in individuals receiving long-term antiepileptic treatment, supplementation, lifestyle interventions, and interprofessional care. A proper understanding of this preventable complication will certainly help healthcare providers to minimize the impact in these patients and improve outcomes.

Splenic abscess is a rare entity, with a reported incidence of 0.1-0.7%, often necessitating source control of infection with percutaneous drainage or even partial or complete splenectomy in refractory cases. It carries a high morbidity and mortality risk despite treatment, with immunocompromised states such as malignancy, immunosuppressive medications, acquired immunodeficiency syndrome (AIDS), end-stage kidney disease, cirrhosis, and contiguous sites of infection acting as predisposing factors. We report the case of a 19-year-old lady with lupus nephritis who presented with persistent high-grade fever and sepsis-associated acute kidney injury. After extensive evaluation for potential sources of infection, imaging revealed an abscess in the spleen measuring 6 &#xd7; 4 &#xd7; 3 cm. Percutaneous pigtail catheter drainage of the collection under ultrasonography guidance was done. Cultures from pus revealed nontyphoidal Salmonella. She also developed progressively worsening thrombocytosis, which was attributed to functional asplenia and was managed with prophylactic antiplatelet to alleviate thrombotic risk, in addition to hydroxyurea therapy. This is the first reported case of nontyphoidal Salmonella-associated splenic abscess and further complications in a case of lupus nephritis.

Diabetic kidney disease (DKD) is becoming an increasingly common consequence of diabetes in India, where the number of affected individuals is rising at an alarming pace. The illness is often silent in its early stages, and many patients are diagnosed only when kidney damage is advanced, leading to high rates of kidney failure and cardiovascular complications. This consensus document was developed by a broad group of experts to provide practical, evidence-based recommendations tailored for Indian healthcare settings. It stresses the importance of timely screening using the urine albumin-to-creatinine ratio and estimated glomerular filtration rate, along with routine evaluation of cardiovascular risks. The guidance covers key management areas such as blood pressure and glycemic control, the use of renin-angiotensin system blockers, newer agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2) inhibitors and finerenone, as well as lifestyle and dietary measures. Equal attention is given to affordability, patient education, and integrating care into national health programs. By adapting international standards to local realities, this document aims to improve early detection, reduce inequalities in treatment, and support better long-term outcomes for people living with DKD in India.

Rheumatoid arthritis (RA) is a systemic autoimmune disease with frequent extra-articular manifestations, of which pulmonary involvement is the most common and clinically significant. Combined pulmonary fibrosis and emphysema (CPFE) is a distinct clinic-radiological syndrome characterized by the coexistence of upper-lobe emphysema and lower-lobe fibrosis and is increasingly recognized in patients with connective tissue diseases, including RA. We describe the case of a 50-year-old nonsmoking woman who presented with a 3-year history of progressive exertional dyspnea and chronic dry cough, preceding the onset of inflammatory polyarthritis by nearly 2 years. She later developed symmetrical involvement of small and large joints with prolonged morning stiffness, along with constitutional symptoms including low-grade fever and weight loss. Physical examination revealed grade IV digital clubbing and bibasilar inspiratory crackles. Laboratory evaluation showed elevated inflammatory markers with negative rheumatoid factor and anticyclic citrullinated peptide antibodies, consistent with seronegative RA. High-resolution computed tomography of the thorax showed upper lobe emphysema and lower lobe honeycombing, confirming the diagnosis of CPFE. Pulmonary function testing showed relatively preserved airflow with mildly reduced diffusion capacity, along with severe exercise-induced desaturation. Echocardiography revealed mild pulmonary hypertension. This case highlights an uncommon presentation of rheumatoid arthritis-associated combined pulmonary fibrosis and emphysema (RA-CPFE), where pulmonary manifestations preceded articular disease, emphasizing the need for a high index of suspicion. Early recognition through high-resolution computed tomography (HRCT) and comprehensive pulmonary evaluation is crucial, as RA-CPFE is associated with significant morbidity, pulmonary hypertension, and poor prognosis. Multidisciplinary management incorporating immunosuppressive therapy, consideration of antifibrotics in progressive disease, and supportive care remains essential. Further studies are required to better define optimal treatment strategies and prognostic markers in RA-CPFE.

To explore undergraduate medical students' understanding and perceptions of empathy toward caregivers, within the framework of the Attitude, Ethics, and Communication (AETCOM) module. A qualitative cross-sectional study was conducted at a tertiary care academic medical institution following the Competency-Based Medical Education (CBME) curriculum. Second-year MBBS students (n = 113), having clinical exposure and AETCOM training, were selected through purposive sampling. Data were collected using a 15-item questionnaire. The questionnaire focused on students' understanding of empathy, perceived importance of caregiver involvement, personal observations, and suggestions for curriculum improvement. Students were allowed to interact with caregivers in clinical wards, present reflections in class, and view curated videos illustrating caregiver challenges. Group discussions and debriefings were conducted, which further enhanced reflection. Participant anonymity and confidentiality were maintained. Data were analyzed with GraphPad Prism 10. Descriptive statistics such as frequencies and percentages were used to summarize demographic information and closed-ended responses, as applicable. The role of empathy in holistic care, communication gaps with caregivers, emotional challenges faced by families, and recommendations for integrating empathy-focused training into the curriculum were assessed. A significant number of students were aware of the problems of the caregivers and components of empathy. This study provides insights into students' perspectives on empathy toward caregivers and highlights the need for structured, experiential learning approaches in medical education to foster compassionate care beyond the patient.

Lateral medullary syndrome is a collection of different neurological symptoms after ischemic/hemorrhagic insult to either the posterior inferior cerebellar artery/vertebral artery or rarely the anterior inferior cerebellar artery, causing infarction of ipsilateral cerebellum and posterolateral medulla (Tiedt and Weidauer, 2013). Dizziness, nausea, vertigo, vomiting, nystagmus, ataxia, dysphagia, hoarseness of voice, ptosis, and sensory impairment of face and body are typical. Here we report an unusual presentation of a 47-year-old female who was hypertensive and diabetic and who complained of vertigo, nausea, vomiting, slurring of speech, facial deviation toward the left, and loss of pain and temperature over the right side of the face and body without any difficulty in swallowing or nasal regurgitation. The patient was eventually diagnosed with left lateral medullary syndrome, drawing attention to the rare and unusual presentation of the same.

Point-of-care ultrasound (POCUS) has become an essential bedside imaging tool in modern medical practice, enabling rapid, real-time, and cost-effective assessment for cardiac, pulmonary, abdominal, and vascular conditions, as well as guidance for invasive procedures. Its value is well established in emergency and critical care settings, yet formal POCUS training is currently absent from the undergraduate as well as postgraduate medical curriculum in India. This gap persists despite the widespread applicability of POCUS across clinical disciplines and its proven role in improving diagnostic accuracy and patient safety. Major barriers to POCUS integration in Indian medical education include limited awareness among physicians, inadequate infrastructure and equipment, lack of trained faculty, curriculum deficiencies, and regulatory challenges. Additional constraints, such as limited time during clinical rounds and the absence of standardized quality assurance, further hinder adoption. This article highlights the urgent need for structured and uniform POCUS education within the competency-based medical education (CBME) framework. It proposes the "POCUS Megaphone Strategy," a comprehensive approach encompassing problem identification, curriculum and faculty development, trainee-focused training programs, infrastructural strengthening, and policy-level advocacy. Integrating standardized POCUS training under the National Medical Commission will equip future Indian physicians with essential bedside imaging skills and significantly enhance the quality and safety of patient care.

The synthesis of blood cells, initiated during fetal development, transitions from the yolk sac to the liver and spleen, and finally to the bone marrow by 18 weeks of gestation, continuing throughout adulthood. Postnatally, hematopoiesis occurs exclusively in the bone marrow, but can be taken over by other organs in various hematological disorders. Extramedullary hematopoiesis (EMH) can involve numerous organs and lead to conditions such as hepatomegaly, splenomegaly, and paraspinal masses. Rarely, EMH occurs in atypical sites such as the gastrointestinal tract, lungs, or central nervous system, especially in patients with conditions such as thalassemias, myelofibrosis, hemolytic anemias, and hematological malignancies. This report describes a 26-year-old man with sickle beta-thalassemia and EMH, observed through serial imaging over 2 years. Initial imaging showed paravertebral masses and diffuse skeletal sclerosis on radiography and CT, with MRI revealing lobulated lesions without spinal canal extension. Treatment included radiotherapy and hydroxyurea, leading to fatty replacement in EMH masses, evidenced by changes in MRI characteristics over time. The case provides a longitudinal perspective on EMH. The observed transition from active EMH to fatty replacement underscores the dynamic response to treatment and highlights the importance of serial imaging in managing EMH. This case emphasizes the need for further studies to optimize treatment strategies and improve understanding of EMH progression in hematological disorders.