Kerala Medical Journal

Advances in the Management of Type 2 Diabetes Mellitus

Cyriac Thomas — 2025-03-28

Diabetes mellitus is a chronic metabolic disorder of the endocrine system, characterized by a complex and varied pathophysiology. Worldwide, there is a dramatic increase in the number of patients with type 2 diabetes, and hence it is becoming a serious threat to the health of mankind. Commercially, a large number of drugs belonging to different classes, such as the Insulins, biguanides, sulfonylureas, meglitinides, and thiazolidinediones, DPP-4 inhibitors, SGLT2 INHIBITORS, and GLP1 AGONISTS are available to control and treat type 2 diabetic patients. However, none of these drugs are known to cure the diabetic phenotype completely. Furthermore, some of these agents can cause weight gain and have a limited role in the later stages of the disease. Newer formulations are reaching the market, which will help manage T2DM and improve patient outcomes.

Kerala’s Perinatal Health Model: A Beacon for Mental Health

Neethu S Cherian — 2025-03-28

Kerala has remarkable healthcare achievements, particularly in perinatal care which is lauded internationally. The Kerala model of perinatal health has been hailed as a success story which has not only improved physical health but also mental health. Perinatal mental health refers to the psychological well-being of women during pregnancy and the first year postpartum. This period is marked by significant physiological, psychological, and social changes that can predispose women to various mental health disorders. Common conditions include depression, anxiety, postpartum psychosis, and post-traumatic stress disorder, all of which can have profound effects on both maternal and infant outcomes. Early identification, appropriate screening, timely intervention, and multidisciplinary care are essential to prevent adverse consequences. Increasing awareness and integrating perinatal mental health services into routine obstetric care can improve maternal well-being and promote healthy child development. Perinatal mental health is a crucial yet often under-recognized aspect of maternal healthcare, encompassing mental health during pregnancy and the postpartum period. Women in the perinatal period experience multiple biological, emotional, and social transitions that can increase their vulnerability to mental health problems. Promoting maternal mental health ultimately fosters healthier families and strengthens child development.

Challenges in Delivering Care for Hematolymphoid Disorders during the COVID-19 Pandemic : Insights from a Tertiary Center in Kerala, India

Manju Rosy Jose — 2025-03-28

Background: The COVID-19 pandemic led to significant reallocation of healthcare resources toward emergency care, often at the cost of patients with non-COVID conditions. Individuals with haemato-lymphoid diseases, many of whom are immunocompromised and require continuous, intensive therapy, were particularly at risk. This study aimed to evaluate the impact of the pandemic on the care of patients with hematological diseases in a resource-limited setting in India.
Methods: A cross-sectional study was conducted at the Regional Advanced Centre for Transplantation, Haemato-Lymphoid Oncology and Marrow Diseases (RACTHAM), Believers Church Medical College Hospital, Kerala. All patients who received care between April 1st 2020 and December 31st 2020 were included. Data were gathered through structured interviews during outpatient visits or via telephone. Information on diagnosis, care access, treatment disruptions, follow-up delays, and COVID-19-related outcomes was collected and analysed descriptively.
Results: Among the 505 patients interviewed (mean age 47.95 ± 20.5 years; 50.6% male), 74.3% had benign hematological disorders and 25.7% had malignant conditions. Care disruptions due to the pandemic were reported by 13.5%, while 31.3% reported shifting their primary treatment center. Follow-up visits were affected in 4.9% and investigations were deferred in 2.4%. Treatment modification or discontinuation occurred in only 0.6%. Transfusion services remained uninterrupted. Telemedicine was accessed by just 2.9% of patients. Eight patients (1.5%) tested positive for COVID-19, and the overall mortality was 3.9%, largely unrelated to COVID.
Conclusion: While core hematology services such as chemotherapy and transfusion were largely maintained, logistical and access-related disruptions were common during the COVID-19 pandemic. The findings underscore the importance of strengthening decentralized care models, formalizing transition systems, and expanding telemedicine in hematology to ensure continuity of care during public health crises.

Prevention of Nutritional Anaemias in India

PK Sasidharan — 2025-06-19

Nutritional anaemias attributable to iron, B12 and folic acid deficiency in the Indian context is more often due to decreased consumption rather than due to all the other causes put together. In developed countries these deficiencies often are due to physiologically increased need for these micronutrients or pathological situations of malabsorption or increased loss, which are our concern too. Besides B12, iron and folic acid, regular consumption of a complete protein (containing all essential amino acids) is also absolutely essential for haemoglobin syntheses and even that is compromised in Indian scenario. Therefore nutritional anaemias in the Indian subcontinent is not an issue of iron deficiency alone, but it represents the tip of the iceberg of clinical and subclinical malnutrition. There are several myths and wrong ideas on nutrition and balanced diet which need to be changed and people should be empowered to consume proper diet. To make a beginning, we need to work for creating awareness on proper balanced diet and to remove all false beliefs and wrong practices, regarding food items, which are rooted in cultural, religious, regional factors and influence of consumerist forces using good primary education and well trained primary care doctors. Equally important is to empower the people by social, economic, and agricultural reforms, and policy changes, for consuming a balanced diet, for a sustainable solution to nutritional anaemias besides other nutritional deficiencies/disorders. The concept of balanced diet has to be taught in primary schools with school health programs, using the health team in PHCs, coordinated by dedicated primary care doctors. The practical tips and pitfalls of practising healthy eating and lifestyle habits are to be given through the PHCs by the primary care doctors. Besides that policy changes are needed to promote decentralised integrated farming to make available all the components of a balanced diet locally and afresh. The social aspects of malnutrition, including poor management of resources, wrong influences on the people by advertisements and the growing fast food culture all need to be addressed to achieve anaemia free India.

Unmasking Spinal Osteochondromas: A Comprehensive Review of an Enigmatic Entity

Suresh Sivadasan Pillai — 2025-03-28

Spinal osteochondromas are rare benign bone tumours that can cause significant morbidity through compression of spinal cord, nerve roots or major vascular structures. This review provides a comprehensive overview of spinal osteochondromas, covering incidence, prevalence, clinical presentation, management strategies, potential complications, aetiology and future research directions. Osteochondromas are more frequent in the cervical spine.1,2 Diagnosis is based on clinico-radiographic correlation using CT and MRI1. Surgical treatment is indicated for symptomatic patients with pain and/or neurovascular deficits.1 When surgery is contemplated, complete resection of the mass along with the cartilaginous cap is essential to minimize recurrence.3 The outcome of surgical treatment is generally favourable but it tends to be less favourable for thoracic osteochondromas.4 Future research maybe focused on understanding the genetic factors predisposing to osteochondroma formation, identifying and developing targeted therapies to prevent growth and recurrence.

Tofacitinib - A Short Review

Arun Njanappilly Madhavan — 2025-03-28

JAK inhibitors are a drug class that is showing promising clinical outcomes in a variety of conditions. This review article is about Tofacitinib the most frequently prescribed drug among JAK inhibitors.

A Case Report of Vector change Defibrillation in Cardiac Arrest Category: Case Report

Gayathri Mohan — 2025-06-19

Ventricular fibrillation (VF) is a life-threatening arrhythmia that requires immediate interventions like defibrillation and advanced resuscitation techniques. However, some cases of VF become refractory to standard interventions. Refractory Ventricular fibrillation (RVF) is defined as ventricular fibrillation that does not respond to three or more standard defibrillation attempts.1 Here, further defibrillation is usually unsuccessful. Vector change defibrillation (VCD) the technique of switching defibrillation pads from the anterior-lateral to the anterior-posterior position, helps to defibrillate a portion of the ventricle that may not be completely defibrillated by pads in the standard defibrillation.

A Perplexing Case of Recurrent Erythema Multiforme

M Radhamony — 2025-03-28

Erythema multiforme (EM) is a rare mucocutaneous hypersensitivity reaction with various etiological factors. Most common cause is infection by Herpes simplex virus. Characteristic clinical finding is development of Target lesions. We report a rare case of Recurrent Herpes associated erythema multiforme (HAEM) diagnosed by positive serology for herpes simplex virus and managed with systemic Acyclovir.

Catastrophic Medical Expenses: A Comorbidity Requiring Multilevel Intervention

Rajeev Jayadevan — 2025-03-28

Catastrophic medical expenses are a significant yet often overlooked comorbidity, particularly in low- and middle-income countries like India. This article examines the causes, consequences, and potential solutions to mitigate the financial burden of healthcare.
Hospitalisation costs, especially for uninsured individuals, can lead to severe financial distress, pushing families into poverty. High-interest loans, often taken to settle medical bills, further exacerbate the crisis, compromising the nutritional, educational, and healthcare needs of vulnerable family members. This sets off a vicious circle of poverty and ill-health.
Public awareness and sensitisation of healthcare providers are critical, as uncompromising adherence to expensive investigation and treatment protocols may inadvertently contribute to financial ruin among vulnerable patients.
Motor vehicle accidents, a major public health issue, are a leading cause of catastrophic expenses. Young adults are frequent victims. Unfortunately they are often uninsured due to perceived low risk. Human error accounts for over 80% of road injuries, underscoring the need for public education on safe road behaviour. Lifestyle factors like tobacco and alcohol use also contribute to severe health conditions, emphasising the importance of preventive measures such as regular exercise, balanced diets, and early detection through screening.
The dilemma of ICU admissions for patients with poor prognosis highlights the need for ethical and financial sensitisation among healthcare providers. Social pressure often leads to futile ICU admissions and unaffordable treatments. Doctors must balance clinical guidelines with families’ financial realities, guiding them toward cost-effective alternatives when appropriate.
Inadequate insurance coverage and frequent claim rejections further compound the issue. Government-sponsored schemes like Ayushman Bharat Yojana aim to provide financial protection, but challenges persist. Strategies to reduce claim rejections include enhancing data accuracy, verifying eligibility, and leveraging technology.
In conclusion, addressing catastrophic medical expenses requires multilevel interventions, including public awareness, provider sensitisation, preventive healthcare, and robust insurance systems, to ensure financial protection and universal health coverage.

Stamped into Sleep: The Story of Anesthesia

Rajeev Jayadevan — 2025-03-28

Pain is nature’s early warning system, alerting us to harm and healing. Without pain, injury would go unnoticed and damage unchecked. The earliest echoes of pain relief are found in Ramayana, written by sage-poet Valmiki in 3 BC. Therein lies a timeless injunction: “Let the wounded be swiftly lifted from the battlefield, carried to shelter, their bleeding staunched and upon their wounds, let soothing oil be poured, enriched with the essence of healing herbs.”