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Abstract Background Hypertension is a leading cause of premature mortality and morbidity. Recent guidelines advocate for out-of-office blood pressure monitoring, including ambulatory and home BP monitoring, to better identify hypertension phenotypes like masked hypertension, white coat hypertension, and sustained hypertension. However, clinical inertia persists due to a lack of robust evidence on the effectiveness of screening these phenotypes and their association with cardiovascular and all-cause mortality. This systematic review and meta-analysis aims to evaluate the relationship between various hypertension phenotypes and future cardiovascular events and all-cause mortality to support the broader implementation of out-of-office BP monitoring. Main body Following PRISMA, Cochrane, and MOOSE guidelines, we conducted a comprehensive search in Pubmed, OvidSP, and Cochrane Central databases up to October 17, 2023. Eligible studies reported associations between hypertension phenotypes and cardiovascular or all-cause mortality, with normotension as the reference group. Hazard ratios with 95% confidence intervals (CIs) were pooled using random-effects models. Eight studies with 15,327 participants were included. Masked hypertension was associated with increased cardiovascular mortality (pooled HR 2.05, 95% CI 1.69–2.48). Sustained hypertension also showed a higher risk (pooled HR 2.42, 95% CI 2.12–2.76). WCH did not significantly increase cardiovascular mortality risk (pooled HR 1.18, 95% CI 0.98–1.42). For all-cause mortality, neither masked hypertension (pooled HR 2.10, 95% CI 0.91–4.88) nor white coat hypertension (pooled HR 1.96, 95% CI 0.71–5.42) showed significant increases. Conclusion Masked hypertension and sustained hypertension are linked to higher cardiovascular mortality compared to normotension, highlighting the importance of out-of-office BP monitoring to identify and manage high-risk phenotypes effectively. Further high-quality studies are needed to generalize these findings and support policy changes.

Abstract Background and aim Continuing Medical Education (CME) is crucial for physicians to stay current in the rapidly advancing field of medicine. A WhatsApp (WA) based community of physicians was initiated in 2016 ‘WhatsApp CME India Group’ to facilitate learning, knowledge sharing, and discussion among physicians. Due to participant size constraints of the technology, it evolved into seven distinct WA groups, overseen by a central administrator. A survey undertaken in the group’s 7th year aimed to evaluate its effectiveness in achieving its goals, measure participant engagement, and uncover the primary factors driving its usage. Methods The survey questionnaire was distributed to 3500 members across the 07 WhatsApp CME groups for voluntary participation. Data collected was analysed using SPSS version 24.0 (SPSS Inc., Chicago, IL, USA) and reported using descriptive statistics. Results Among the 581 survey respondents, the study found 43% of physicians use the WhatsApp academic groups for CME content, with 32% accessing their group over four times daily. The primary motivation for 77% was to discuss challenging cases and to gain knowledge updates from fellow physician (70%). Medical websites (57%), referral books (49%), and Google (43%) were other significant resources. Every participant (100%) found the WhatsApp CME India group the most beneficial resource for daily medical science updates. A significant portion (57%) of the respondents found the group valuable for real-time information exchange. Over 78% stated it kept them current with knowledge and guidelines. Notably, 94% viewed WhatsApp CME as complementary to physical conferences, not a replacement. The post-conference/webinar summaries were appreciated by 81% participants. Case discussions (31%) and update posts from fellow physicians sharing their insights and learnings (24%) were noted as activities of great academic interest. Conclusion This study underscores the potential of digital platforms like WhatsApp in supplementing CME in India and potentially other comparable settings. The blend of digital and traditional resources suggests a balanced learning approach. While real-time engagement is a strength, challenges like information overload and privacy concerns require careful management. Striking a balance is crucial for ensuring content quality, structured discussions and privacy. As the digital age advances, professionals must critically assess shared information on these platforms to guarantee evidence-based and reliable knowledge dissemination. Trial registration ARK 001.

Introduction: The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations. Methods: It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG). Results: This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P =

Dermatoglyphics is the scientific study of the pattern of dermal ridges on the palmar surface of digits, palm and sole. Characteristically, hair does not grow in this area. These ridges serve well to enhance contact. The development of these ridges and the development of the nervous system occur simultaneously in the intrauterine period. The pattern of dermal ridges begins to develop around the 13th week and is completed by the 19th week of intrauterine life. Once the fingerprint pattern develops, it does not change and persists throughout life. Unusual dermatoglyphic patterns often relate to genetic disorders. Dermatoglyphics may be used as an additional screening tool to identify early risk factors that may help prevent additional complications of various diseases. In this review, we will be discussing dermatoglyphics and its important role in the diagnosis of diseases which have some genetic basis.

Coronavirus disease (COVID-19) is an infectious disease caused by the newly discovered SARS-COV-2. Older people and people with pre-existing medical conditions, such as diabetes and obesity, appear to have the worst outcomes with the COVID-19 virus. In response to the COVID-19 pandemic, many countries enforced stringent lockdowns to prevent the spread of the disease. India had a lockdown of 68 days between 21st March and 31st May 2020. In this background, we undertook this study to assess the effect of the lockdown on the glycemic status and weight of people with diabetes, which was indirectly an opportunity to assess the self-care practices of people with diabetes. Material and Methods: The subjects included in the study were people with type 2 diabetes identified from electronic medical records who had attended the Jai Clinic and Diabetes Care Centre in Lucknow and were tested for HbA1c between 20th Feb 2020 and 20th March 2020. A total of 313 people with diabetes were identified meeting the inclusion criteria, out of which 171 were females and 142 were males. They were again tested for HbA1c between 1st June 2020 and 1st July 2020 after lockdown. Their pre- and post-lockdown HbA1c and weight were analyzed statistically. Results: HbA1c was increased in 195 patients, which was statistically significant. A total of 151 patients had an increase in weight compared to their prelockdown weights, but it was not statistically significant. Furthermore, an increase in weight correlated with an increase in HbA1c and a decrease in weight correlated with a decrease in HbA1c. Both were statistically significant. Conclusion: Optimum diabetes control and adherence to good self-care practices is the need of hour, and contingency plans for medicines and diabetes care supplies are of utmost importance in these testing times.

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes share a bidirectional relationship. NAFLD can increase the severity of diabetic microvascular and macrovascular complications. Ultrasonography, the most commonly used method of assessment of NAFLD in India, is associated with intra-operator variability and false positives. Transient elastography and Liver Stiffness Measurement (LSM) have emerged as one of the best modalities to screen NAFLD in people with diabetes. Aim: Screening for NAFLD in people with Type 2 Diabetes and its association with age, Body Mass Index (BMI) and duration of diabetes. Materials and Methods: This was a prospective crosssectional study conducted on patients with known Type 2 Diabetes Mellitus (T2DM) who visited the study center between July 2019 and November 2019 for consultation. A total of 287 people with diabetes were subjected to FibroScan test and LSM was done. The other variables-age, gender, duration of diabetes, height, weight, BMI and HbA1c were recorded for all subjects and the collected data was correlated using Spearman rho test. Results: The study population included 61% males and 39% females. The mean age was 46.96 years and the mean duration of diabetes was 10.98 years. The mean Glycated haemoglobin (HbA1c) value was 9.28%. The median value of LSM by M probe was 7.16. Out of the total, 78 (27.2%) were identified with advanced fibrosis with LSM >9.6. Advanced fibrosis was strongly correlated with HbA1c (r=0.820), age (r=0.562) and duration of diabetes (r=0.596) and moderately with BMI (r=0.375). Conclusion: The screening of people with type 2 diabetes for NAFLD using LSM revealed 27.2% subjects with advanced fibrosis, it correlated positively with age, BMI and duration of diabetes.