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

{"title":"Rare Case of Limited Systemic Sclerosis with Left Ventricle Aneurysm.","authors":"Amita Mason, Rahul Kumar Gupta, Vardhan Garg, Meghaa Vashishht, Rakhee Khanduri","doi":"10.59556/japi.72.0633","DOIUrl":"10.59556/japi.72.0633","url":null,"abstract":"<p><p>Scleroderma is a rare connective tissue disorder with multisystem involvement with unknown and complex etiopathogenesis. Scleroderma is classified based on clinical and serological criteria and can be divided into two forms: localized scleroderma or systemic sclerosis, which can further be classified into limited systemic sclerosis or diffuse systemic sclerosis. There are few cases of aortic aneurysm and left ventricle aneurysm in systemic sclerosis but no such case in limited scleroderma in available literature. Here, we describe a rare case of limited systemic sclerosis with left ventricular aneurysm.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"99-100"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401357","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":"Gluconephrotic Syndrome: A Comprehensive Review.","authors":"Sourabh Sharma, Sanjay Kalra","doi":"10.59556/japi.72.0687","DOIUrl":"https://doi.org/10.59556/japi.72.0687","url":null,"abstract":"<p><p>This article provides an overview of the diabetic kidney disease paradigm, explaining important aspects such as prognostic markers, clinical assessments, and therapeutic options. The importance of the term gluconephrotic syndrome (GlucoNS) is emphasized, highlighting its significant influence on clinical evaluations, research procedures, screening techniques, and patient care. This term encapsulates nephrotic syndrome (NS) within the diabetic milieu, shedding light on the intricate relationship between renal complications and diabetes. GlucoNS necessitates a refined approach, considering the unique challenges posed by diabetes in the context of NS. With this review, we want to highlight how important it is to assess diabetes in every case of NS and how important it is to assess albuminuria in every diabetic patient.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401332","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":"Multilevel Vertebral Body Osteonecrosis in an Adult Patient: A Rare Case with Review of Literature.","authors":"Sonal Saran, Akash Rauniyar, Bhumireddy Vijaya Madhuri, Pooja Kundu","doi":"10.59556/japi.72.0640","DOIUrl":"10.59556/japi.72.0640","url":null,"abstract":"<p><p>Osteonecrosis, characterized by ischemic bone injury leading to cell death and bone resorption, manifests in various anatomical sites due to multiple etiologies such as radiotherapy and medications. While certain sites like the femoral head and jaw have garnered attention, vertebral body osteonecrosis remains less explored and lacks a standardized classification system. This report presents a unique case of a 52-year-old woman undergoing chemotherapy for diffuse large B-cell lymphoma who developed multilevel vertebral body osteonecrosis, a rare occurrence in English medical literature. The patient presented with fever, abdominal pain, and lymphoid malignancy markers, initiating chemotherapy with the rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) regimen. During treatment, she experienced breathing difficulties and back pain, prompting imaging studies revealing extensive osteonecrosis affecting multiple vertebrae and other skeletal sites. Various factors, including chemotherapy, human immunodeficiency virus (HIV) therapy, trauma, and others, contribute to vertebral body necrosis. While osteonecrosis in lymphoma patients is rare, chemotherapy-induced marrow necrosis can lead to bone involvement. Vertebral bodies, especially their anterior portions, are susceptible due to limited blood supply. The presence of an intravertebral vacuum cleft on radiographs is pathognomonic for osteonecrosis, while magnetic resonance imaging (MRI) reveals hypointense areas and fluid collections. This case underscores the complexity of diagnosing and managing multilevel vertebral body osteonecrosis, exacerbated by the lack of standardized protocols. The interplay between disease processes and treatment modalities complicates decision-making, emphasizing the need for further research to establish optimal diagnostic and treatment guidelines. In conclusion, this case sheds light on a rare manifestation of osteonecrosis in a lymphoma patient, highlighting the challenges in diagnosis and management. Further research is warranted to enhance understanding and improve outcomes for patients with this debilitating condition.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"96-98"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401339","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":"Late Postpartum Eclampsia with \"Normal\" Blood Pressure.","authors":"Somarajan Anandan, Sajeesh S Rajendran, Jyothish P Kumar, Divine S Shajee","doi":"10.59556/japi.72.0661","DOIUrl":"10.59556/japi.72.0661","url":null,"abstract":"<p><p>Majority of the eclampsia or preeclampsia occur between 20 weeks of gestation and within 48 hours postpartum. Postpartum eclampsia usually occurs on a background of preeclampsia. Late postpartum eclampsia (LPE) without preeclampsia is a rarity. LPE with posterior reversible encephalopathy syndrome (PRES) and mild hypertension is extremely rare. We report a case of LPE with PRES without preeclampsia, at a blood pressure of 140/90 mm Hg. Seizures occurring late postpartum period could be due to LPE and this can occur even with mild hypertension.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"e37-e38"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401337","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":"An Uncommon Finding of Plasma Cell Invasion of the Kidney in a Patient with Plasma Cell Dyscrasia: Should It be Considered a Myeloma Defining Event?","authors":"Prem Shankar Patel, Archana, Om Kumar","doi":"10.59556/japi.72.0708","DOIUrl":"10.59556/japi.72.0708","url":null,"abstract":"<p><p>Plasma cell invasion of the kidney in plasma cell dyscrasia is rare. We are reporting a case of plasma cell infiltration in the kidney presenting as rapidly progressing renal failure. The patient presented with generalized weakness, anemia, and advanced renal failure. The kidney biopsy revealed multifocal atypical CD138-positive plasma cell-rich interstitial inflammation and severe acute tubular injury. In the present situation of clinically unexplained renal failure with suspicion of plasma cell dyscrasia, a kidney biopsy proved to be key to the diagnosis. Hence, malignant plasma cell infiltration in the kidney could indicate underlying plasma cell dyscrasia and may serve as a future myeloma defining event (MDE).</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"e28-e30"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401409","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":"Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India.","authors":"Raman Puri, Vimal Mehta, Manish Bansal, P Barton Duell, S S Iyengar, Sadanand Shetty, Ian Graham, J C Mohan, Upendra Kaul, Dayasagar Rao, Rajeev Agarwala, Gurpreet Singh Wander, Prakash Hazra, Soumitra Kumar, S K Wangnoo, Abdul Hamid Zargar, Banshi Saboo, Jamal Yusuf, Vinod M Vijan, Prem Aggarwal, Sarat Chandra, Ravi R Kasliwal, P C Manoria, M U Rabbani, Milan C Chag, D Prabhakar, Aziz Khan, Neil Bordoloi, Saravanan Palanippan, Kunal Mahajan, Akshay Pradhan, Dharmender Jain, A Murugnathan, Pradeep Kumar Dabla, Nagaraj Desai, Mangesh H Tiwaskar, Devaki R Nair, Charanjeet Singh, Jayant Panda, Vitull Gupta, Prashant Sahoo, Nathan D Wong","doi":"10.59556/japi.72.0692","DOIUrl":"https://doi.org/10.59556/japi.72.0692","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of &lt;50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research-India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for ","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"71-76"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401330","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":"Utility of Sonoelastography and Magnetic Resonance Imaging in Characterization of Thyroid Nodules.","authors":"Upinderjeet Singh, Rekha Gupta, Ashok K Attri, Nitin Gupta, Uma Handa","doi":"10.59556/japi.72.0709","DOIUrl":"https://doi.org/10.59556/japi.72.0709","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate thyroid nodules with sonoelastography and magnetic resonance imaging (MRI).</p><p><strong>Materials and methods: </strong>The study included 28 patients with 40 thyroid nodules. Clearance was obtained from the institute's ethical clearance committee. Patients with pure cystic nodules or nodules with eggshell calcification, diffuse thyroid pathology (such as Graves' disease, Hashimoto's thyroiditis, De Quervain thyroiditis, and Riedel's thyroiditis), inaccessible nodules <i>via</i> fine needle aspiration cytology (FNAC), or patients with a history of thyroid gland surgery were excluded from the study. Strain elastography was performed on a Phillips iU22 machine, producing qualitative color-coded strain maps (graded using the Rago 5-point system) and semiquantitative strain ratios. MRI was performed on a Phillips ACHIEVA 1.5T magnet with a head and neck coil.</p><p><strong>Results: </strong>Rago scores statistically correlated (<i>χ</i>² = 18.052, <i>p</i> < 0.001) with malignant nodules, and using the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUROC) for the mean strain ratio predicting malignant outcomes was 0.88 [95% confidence interval (CI): 0.767-0.992], which was also statistically significant (<i>p</i> < 0.001). A cutoff of mean strain ratio ≥2.48 predicted malignant outcomes with 100% specificity. T2 signal intensity ratio (SIR) and apparent diffusion coefficient (ADC) values were not statistically significant in predicting malignant outcomes. Kinetic curves were statistically significant for Rago scores (<i>χ</i>² = 11.356, <i>p</i> = 0.045); however, no significant difference was found in predicting malignant outcomes.</p><p><strong>Conclusion and clinical significance: </strong>We concluded that sonoelastography, along with grayscale ultrasound, is a useful noninvasive technique for predicting histological outcomes. However, MRI should largely be reserved as a problem-solving tool rather than a standalone imaging modality. The kinetic curves show some degree of overlap between histologically distinct diseases, and thus large-scale multicenter trials are needed for further standardization.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"e13-e17"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401360","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":"DC-CRP: Deep Cerebral Venous Thrombosis, Clinicoradiological Profile, and Treatment Outcome in Indian Population-A Tertiary Care Experience.","authors":"Sheetal Goyal, Vivek Murumkar, Karthik Kulanthaivelu, Nirmit Kailas Agrawal, Mahammad Samim Mondal, Priyanka Priyadarshini, Debjyoti Dhar, Raghavendra Kenchaiah, Jitender Siani","doi":"10.59556/japi.72.0610","DOIUrl":"https://doi.org/10.59556/japi.72.0610","url":null,"abstract":"<p><strong>Background: </strong>Deep cerebral venous thrombosis (DCVT) is an uncommon cause of stroke with diverse predisposing factors, clinical presentations, imaging findings, and functional outcomes, which makes the diagnosis of DCVT even more challenging.</p><p><strong>Materials and methods: </strong>Retrospective observational study (December 2018 to January 2023). Cases with imaging data suggestive of DCVT were included. The neuroradiological assessment was performed using multimodality imaging to determine the location of parenchymal changes and the number of deep veins involved in isolation or with the superficial dural venous system. Clinical variables were tabulated.</p><p><strong>Results: </strong>Of the 206 cases with CVT in the study period, 27 had DCVT (13.1%), of which four (14.8%) had isolated DCVT (male-to-female ratio 13:14; mean age = 33.4 years). Hyperhomocysteinemia (<i>n</i> = 11) is the most common risk factor associated with it. The most common presentations were headaches (<i>n</i> = 27) and focal motor deficits (<i>n</i> = 13). Raised intracranial tension (ICT) was present in almost half of the study population (<i>n</i> = 14). Mean and median modified Rankins score (mRS) at the time of discharge were 2.0 and 1, respectively. The most common deep vein involved was the straight sinus (SS) (<i>n</i> = 25), followed by the internal cerebral vein (<i>n</i> = 23). The mean and median mRS after 3 months from discharge were 0.3 and 0, respectively.</p><p><strong>Conclusion: </strong>A knowledge of diverse clinical presentations in DCVT, its neurovascular anatomy, and imaging characteristics with prompt diagnosis and timely interventions can assist in attenuating the risk of acute complications and long-term sequelae. Extensive deep grey matter involvement in DCVT is associated with neurological manifestations like altered sensorium and motor deficits, with increased severity of illness as measured by the mRS score.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401328","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":"Brudziński and His Signs.","authors":"Jayant Pai-Dhungat, Aparna Verma","doi":"10.59556/japi.72.0697","DOIUrl":"https://doi.org/10.59556/japi.72.0697","url":null,"abstract":"<p><p>Many among us and some students have a personal idiosyncrasy to remember eponyms in clinical medicine and other subjects such as signs, tests, phenomena, and rules named after a person who originally described them. However, it is not always necessary as long as one knows what they mean. Józef Brudziński's name is given to four eponymous medical signs associated with reflexes observed in meningeal irritation along with Kernig's sign.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"108"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401413","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":"Coronavirus Disease-19-associated Mucormycosis: A Single-center Observational Study of 69 Patients.","authors":"Dhirendra Shivprasad Yadav, Swati Arvind Chavan, Niteen Dattatray Karnik, Chaya Ashok Kumar, Rupal Nilesh Padhiyar, Desma D'Souza","doi":"10.59556/japi.72.0684","DOIUrl":"https://doi.org/10.59556/japi.72.0684","url":null,"abstract":"<p><strong>Background and objectives: </strong>We studied the clinical presentation, risk factors, complications, and in-hospital outcomes of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM).</p><p><strong>Materials and methods: </strong>A retrospective study was done on 69 COVID-19 patients with microbiologically proven mucormycosis admitted over a period of seven months from March 2021 to September 2021.</p><p><strong>Results: </strong>All 69 mucormycosis patients (46 males, 23 females) had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection. Their mean age was 52.8 years, with mucormycosis developing in 51 patients (73.9%) within 30 days of COVID-19 infection; 7 (10.1%) were positive on admission. Rhino-orbital-cerebral mucormycosis (ROCM) was the most common (40.3%), followed by rhino-orbital (37.3%) and sinonasal (22.4%). Diabetes mellitus was present in 98.6% of patients. Common symptoms of mucormycosis were facial pain, headache, facial swelling, and vision loss. During COVID-19, 88.4 and 52.5% received immunosuppressive treatment and zinc sulfate, respectively; 34.7% needed intensive care unit (ICU) admission. The mortality rate was 26.1%. On multivariate logistic regression analysis, the presence of chronic kidney disease, leukocytosis, ophthalmoplegia, oral/palate ulceration, current need for invasive ventilation, and past duration of oxygen therapy and zinc supplementation were significantly associated with mortality. Patients with current COVID-19 infection had severe disease with increased need for intensive care (57.1 vs 14.5%) and higher mortality (57.1 vs 22.6%) compared to mucormycosis patients with previous COVID-19 infection.</p><p><strong>Interpretation and conclusion: </strong>Rhino-orbital-cerebral, rhino-orbital, and sinonasal were the most common presentations in cases of mucormycosis, with a mortality rate of 26.1%. COVID-19 coinfection predisposes patients with mucormycosis to severe disease with higher mortality.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 10","pages":"24-31"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401415","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}