The Journal of the Association of Physicians of India最新文献

{"title":"An Atypical Presentation of Pituitary Neurosarcoidosis as Massive Weight Loss and Failure to Thrive in a Young Female.","authors":"Paulami Deshmukh, Anushka Deogaonkar, Vaishali Deshmukh","doi":"10.59556/japi.73.0912","DOIUrl":"https://doi.org/10.59556/japi.73.0912","url":null,"abstract":"<p><p>Neurological involvement accounts for <5% of patients with sarcoidosis. Manifestations are often those of the concerning site of affection such as hydrocephalus, transverse myelitis, neuropathy, and neuroendocrine dysfunction. We present a case of a 41-year-old female who presented to the endocrine clinic with complaints of fatigue, weight loss, anorexia, and absent menses for 6 years. She had no other comorbidities or chronic diseases. On examination, she was frail and cachectic [body mass index (BMI): 16.8 kg/m²]. Laboratory assessments revealed anemia, leukocytosis, and eosinophilia. Hormone levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), 8 am cortisol, thyroid-stimulating hormone (TSH), and estradiol were low while erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and angiotensin-converting enzyme (ACE) levels were raised. Antinuclear antibody (ANA) titers were normal along with a negative tuberculin skin test. Magnetic resonance imaging (MRI) of the brain revealed features suggestive of empty sella with a 3 mm pituitary. She was diagnosed provisionally to have panhypopituitarism and failure to thrive secondary to granulomatous changes due to sarcoidosis as a possible etiology. She was treated with oral preparations of corticosteroids (prednisolone), ethinylestradiol, levonorgestrel, and thyroxine. At the subsequent visit, after 6 months, she reported improved general condition, weight gain (18 kg), increased appetite, and resumption of menses. Neurosarcoidosis with selective hypophyseal involvement, although a rare affliction, should be considered while investigating possible endocrinopathies among middle-aged females. Additionally, clinical evidence in the absence of tissue evidence also requires precedence, especially in cases where histopathology and imaging may not suffice to prove the existence of a disease.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"90-92"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Role of Sitagliptin in the Management of Type 2 Diabetes Mellitus for the Elderly: A Narrative Review.","authors":"Bipin Sethi, Mathew John, Bharadwaja Pendurthi, Shruti Dharmadhikari, Neeraj Markandeywar, Chintan Khandhedia, Amey Mane, Suyog Mehta","doi":"10.59556/japi.73.0922","DOIUrl":"https://doi.org/10.59556/japi.73.0922","url":null,"abstract":"<p><p>The prevalence of diabetes has risen considerably among older adults around the globe. It is the primary contributor to death from cardiovascular (CV) disease and other medical comorbidities, as well as a major contributor to complications, deterioration in quality of life (QoL), and decline in physical and mental well-being in the elderly. One of the main challenges with aging is that islet cells become dysfunctional, and their glucose metabolism changes with increasing age. Dipeptidyl peptidase-4 (DPP-4) inhibitors are an effective treatment option for older patients with type 2 diabetes mellitus (T2DM) because they demonstrate better effects on glycated hemoglobin (HbA1c) within this age-group. Sitagliptin, a highly selective DPP-4 inhibitor, is effective both as a monotherapy and in conjunction with other oral hypoglycemic agents (OHAs) for managing T2DM. Sitagliptin treatment in the elderly has demonstrated lowering HbA1c levels by 0.5-1.1% while having beneficial effects on pancreatic β-cells and no significant incidence of hypoglycemia, compared to studies in which oral antidiabetic medications were administered. It has little to no effect on body weight, renal function, or lipid profiles. This narrative review aimed to gather and assess data from trials investigating the use of sitagliptin in the elderly.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e26-e32"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Cardiorenal Safety of Sitagliptin in Type 2 Diabetes Mellitus: A Literature Review.","authors":"Parag Shah, Mangesh Tiwaskar, Ameya Joshi, Bharadwaja Pendurthi, Shruti Dharmadhikari, Prachi Ahire, Chintan Khandhedia, Neeraj Markandeywar, Amey Mane, Suyog Mehta","doi":"10.59556/japi.73.0924","DOIUrl":"https://doi.org/10.59556/japi.73.0924","url":null,"abstract":"<p><p>Type 2 diabetes (T2D) is a major public health problem globally, with significant socioeconomic ramifications for healthcare systems. Diabetes unquestionably contributes to both cardiovascular disease (CVD) and chronic renal disease. Hospitalization, low quality of life, and high mortality rate are inevitable in patients with this dual burden. As a result, the emphasis in diabetes care should also be on cardiorenal health. Glycemic control, as well as optimal management of cardiorenal risk factors and comorbidities, is required to eliminate cardiovascular (CV) morbidity and mortality related to T2D. Sitagliptin is a highly efficient and selective dipeptidyl peptidase-4 inhibitor (DPP-4i) that improves glycemic control while having a low risk of hypoglycemia. It has neutral effects on body weight, low proclivity for pharmacokinetic interactions, and a favorable safety profile. Numerous clinical trials have proven that sitagliptin is CV- and renal-safe in T2D patients, even in those with obesity, old age, renal impairment (RI), and preexisting CVD. It also corrects hyperglycemia-induced osmotic diuresis and excessive filtration. In people with T2D who are at high CV risk or moderate-to-severe renal insufficiency, sitagliptin is documented as a well-tolerated treatment that does not augment the risk of CV and renal complications. Sitagliptin may effectively manage CV and renal complications in diabetes patients, considering its CV and renal safety.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e19-e25"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revolutionizing Treatment Strategies through Inhibition of Tissue Factor Pathway Inhibitor: A Promising Therapeutic Approach for Hemophilia Management.","authors":"Naresh Gupta, Tulika Seth, Sunita Aggarwal, Sudhir Atri, Bilal Ahmed Shaikh, Rajendra K Nigam, Ankur Jain, Avriti Baveja, Sanjeev Kumar Digra, Bhadresh Vyas, Vishnu Sharma","doi":"10.59556/japi.73.0928","DOIUrl":"https://doi.org/10.59556/japi.73.0928","url":null,"abstract":"<p><p>Hemophilia, an X-linked genetic bleeding disorder, is caused by the deficiency of coagulation factors VIII (hemophilia A) or IX (hemophilia B). Regular replacement therapy with the missing clotting factor is an effective standard-of-care treatment. However, it comes with a significant fallout of frequent intravenous dosing with poor compliance, the risk of inhibitor development, and a substantial treatment burden. Research has progressed from missing clotting factors and factor VIII mimetics to the most recent rebalancing therapy that suppresses tissue factor pathway inhibitor (TFPI). Thrombin generation is restricted by TFPI, which inhibits the tissue factor-mediated activation of factor VII. This promising therapeutic approach rebalances hemostasis by inhibiting TFPI, a critical regulator of the extrinsic coagulation pathway, thereby increasing thrombin generation. Novel monoclonal antibodies (concizumab and marstacimab) enhance thrombin generation by blocking TFPI to restore hemostasis. Clinical trials have demonstrated good clinical efficacy and safety of these anti-TFPI, besides their convenient subcutaneous administration using pen devices. These innovative therapies have the potential to enhance the quality of life (QoL) of people with hemophilia. This review provides a comprehensive overview of the clinical development, therapeutic potential, challenges, and prospects of anti-TFPI in the management of hemophilia.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e47-e54"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Sequential Approach to Sample Collection in Microbiological Diagnosis of Smear Negative Pulmonary Tuberculosis.","authors":"Kirti Kadian, Aditya Chaudhary, Geetika Arya, Aman Ahuja, Krishan B Gupta, Dhruva Chaudhry, Pawan K Singh","doi":"10.59556/japi.73.0906","DOIUrl":"https://doi.org/10.59556/japi.73.0906","url":null,"abstract":"<p><strong>Background: </strong>The current diagnostic tools for pulmonary tuberculosis (PTB) fail in detecting up to 43% of cases, leading to inappropriate use of antibiotics and delayed diagnosis. Induced sputum and bronchoalveolar lavage (BAL) are more accurate samples, but their use is not clearly recommended. This study evaluates the real-world feasibility and effectiveness of using a sequential collection of respiratory samples to diagnose PTB.</p><p><strong>Materials and methods: </strong>PTB cases with sputum-scarce or smear-negative status were included. Sputum induction (SI) and BAL samples were collected. We used a composite reference standard (CRS) method as the reference.</p><p><strong>Results: </strong>Of 220 cases screened, 156 were enrolled. Eighty cases underwent successful SI (group A), and 76 cases failed induction (group B). In group A, 53.75% of cases were positive for <i>Mycobacterium tuberculosis</i> (MTB) by cartridge-based nucleic acid amplification test (CBNAAT). Of the 112 cases that underwent flexible optic bronchoscopy (FOB), 85 were detected positive for PTB, of which eight were detected rifampicin-resistant by CBNAAT in BAL samples. The remaining cases were found to have an alternative diagnosis. Using the sequential approach, CBNAAT had a higher cumulative sensitivity (97.72%), specificity (100%), and diagnostic accuracy (DA) (98.08%) with a <i>p</i>-value < 0.001, as compared to either smear examination or culture. 27.56% of cases were able to avoid bronchoscopy using the sequential technique.</p><p><strong>Conclusion: </strong>The sequential technique of sample collection increased the bacteriological confirmation of PTB.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"52-57"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Efficacy and Safety of Dapagliflozin vs Basal Insulin in Stabilizing Glycemic Variability in Patients with Type 2 Diabetes Mellitus Inadequately Controlled on Triple Drug Combination Therapy.","authors":"Deepak S Bhosle, Bhakti Chandekar, Satish Shelke","doi":"10.59556/japi.73.0925","DOIUrl":"10.59556/japi.73.0925","url":null,"abstract":"<p><p>Wide variations in glucose levels may enhance oxidative stress and inflammation, sequentially resulting in endothelial cell damage. Insulin glargine, a basal insulin, is associated with good glycemic control with fewer events of hypoglycemia. Dapagliflozin is a selective inhibitor of sodium-glucose cotransporter 2 (SGLT-2) that reduces blood glucose by enhancing its urinary excretion. Continuous glucose monitoring (CGM) allows continuous assessment of interstitial glucose over time, allowing individualization of diabetes management.</p><p><strong>Objective: </strong>To compare the efficacy and safety of dapagliflozin vs basal insulin in stabilizing glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Materials and methods: </strong>A 1-year, prospective, randomized, open-label, single-center, double-arm, interventional clinical study was conducted at Deogiri Diabetes Care Centre, Aurangabad. About 100 patients with T2DM who were inadequately controlled on triple drug combination therapy were randomized into group A (<i>N</i> = 50), receiving dapagliflozin 10 mg once daily (OD), and group B (<i>N</i> = 50), receiving insulin glargine as the fourth glucose-lowering agent for 3 months. The \"FreeStyle Libre Pro®\" ambulatory glucose monitoring (AGM) sensor was used for the study to evaluate the coefficient of GV, time in range (TIR)%, time below range (TBR)%, time above range (TAR)%, and glucose management index (GMI).</p><p><strong>Results: </strong>A significant reduction in the values of GV parameters (TIR, TAR, TBR, GMI, and coefficient of GV) and glycemic parameters like fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1C), and change in body weight of patients was observed in both groups after 3 months of therapy.</p><p><strong>Conclusion: </strong>Insulin glargine, as the fourth glucose-lowering agent on the background of a triple drug regimen, has demonstrated a significant reduction in GV compared to that observed with dapagliflozin.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Henrik Dam and Vitamin K.","authors":"Jayant Pai-Dhungat","doi":"10.59556/japi.73.0904","DOIUrl":"https://doi.org/10.59556/japi.73.0904","url":null,"abstract":"<p><p>Carl Peter Henrik Dam (1895-1976), Danish biochemist, was born in Copenhagen; he obtained his doctorate in 1914 from the University of Copenhagen. During the course of his education, he studied under Pregl in Austria in 1925 and with Paul Karrer in Switzerland (1935).</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"100"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sitagliptin as an Add-on Therapy to Other Glucose-lowering Agents in Patients with Type 2 Diabetes Mellitus: A Narrative Review.","authors":"Sanjay Kalra, Awadhesh Kumar Singh, Sambit Das, Bharadwaja Pendurthi, Shruti Dharmadhikari, Prachi Ahire, Chintan Khandhedia, Neeraj Markandeywar, Amey Mane, Suyog Mehta","doi":"10.59556/japi.73.0923","DOIUrl":"https://doi.org/10.59556/japi.73.0923","url":null,"abstract":"<p><p>The burden of type 2 diabetes mellitus (T2DM) is increasing in India, with increasing mortality and morbidity. In India, T2DM management is complicated by the presence of distinct clinical characteristics as well as certain socioeconomic factors of the patient population. These factors affect glycemic control and lead to poorer outcomes, necessitating the use of add-on treatments with safer medications, which can be used over the long term with minimal follow-up. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that inhibits the activity of DPP-4, a peptidase that degrades glucagon-like peptide 1 (GLP-1), a glucoregulatory hormone. Sitagliptin enhances glucoregulation in people with T2DM as monotherapy, as well as in combination with other antihyperglycemic drugs, and has a low risk of adverse side effects. This review focuses on assessing the efficacy and safety of sitagliptin as an add-on therapy to other antidiabetic agents and insulin.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e13-e18"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Presentation of Rituximab-induced Interstitial Lung Disease in a Patient with Pemphigus Vulgaris.","authors":"Pravin Panditrao Kalyankar, Ravivir Singh Bhalla, Deekshitha Alla, Nikhil Gupta, Srija Sirineni, Abhinav Vulisha, Mario Mekhail, Alla Sai Santhosha Mrudula, Ananth Rupesh Kattamreddy","doi":"10.59556/japi.73.0916","DOIUrl":"https://doi.org/10.59556/japi.73.0916","url":null,"abstract":"<p><p>A 42-year-old female with a history of pemphigus vulgaris was started on rituximab after an inadequate response to corticosteroids. One month following the second cycle of rituximab, she developed acute interstitial pneumonia, which was linked to rituximab since a thorough workup revealed no evidence of an infectious cause. We initiated her on broad-spectrum intravenous (IV) antibiotics and antifungals, but the patient responded significantly to pulse methylprednisolone therapy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e55-e56"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Obstructive Sleep Apnea by Standard Recommended Tools and Its Associated Comorbidities in a Subset of Eastern Indian Surgical Population: An Observational Study.","authors":"Anisha Ghosh, Sugata Dasgupta, Arpita Choudhury, Atanu Chandra, Puspendu Biswas, Shrestha Ghosh","doi":"10.59556/japi.73.0889","DOIUrl":"10.59556/japi.73.0889","url":null,"abstract":"<p><strong>Background and aims: </strong>Obstructive sleep apnea/hypopnea syndrome (OSAHS) is underdiagnosed, and patients commonly have a lengthened and difficult hospital stay associated with cardiovascular, respiratory, and neurological complications. Therefore, timely diagnosis using screening tools, especially in resource-poor setups, is essential in preventing an adverse surgical course and delivering optimum patient care. Thus, we intended to highlight the proportion of patients with OSAHS presenting for various surgical procedures and compare the sensitivity of the screening tools when used individually and in various combinations.</p><p><strong>Methods: </strong>We conducted this prospective observational study with 527 subjects from January 2018 to January 2020. The prevalence of OSAHS was calculated by the simultaneous administration of the Berlin questionnaire, STOP-Bang score, American Society of Anesthesiologists (ASA) checklist, and Preoperative Sleep Apnea Prediction (PSAP) score. These screening tools were also used individually and in combinations of two and three to ascertain the most sensitive combination. Using bivariate logistic regression followed by multivariate logistic regression, associations between OSAHS and various anthropometric measurements were also established.</p><p><strong>Results: </strong>Four screening tools simultaneously detected the presence of OSAHS in the maximum number of subjects (74.95%), matched by the administration of STOP-Bang, Berlin, and PSAP screening tools in conjunction. Among combinations of any two tools, STOP-Bang and PSAP established OSAHS in 74.38% of respondents, whereas individually, the highest number of cases was observed using the PSAP score (67.17%).</p><p><strong>Conclusion: </strong>OSAHS is frequently encountered in surgical patients. The STOP-Bang and PSAP screening tools, in combination, are the most sensitive and convenient choice for detecting OSAHS.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"36-41"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}