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

{"title":"Extensive Disseminated Cysticercosis: A Rare Case Report in North India.","authors":"Suryakamal Verma, Nimish Gupta, Manoj Kumar Malav","doi":"10.59556/japi.73.0982","DOIUrl":"https://doi.org/10.59556/japi.73.0982","url":null,"abstract":"<p><p>Neurocysticercosis (NCC) is the most common parasitic infection of central nervous system; however, disseminated cysticercosis is a very rare presentation of cysticercosis. Less than 120 cases have been reported in the world till now. Here, we report the case of a 40-year-old female, presented to the emergency department of SN Medical College, Agra, on August 10, 2024, with multiple episodes of partial seizure of the right side. History taken and the patient was thoroughly investigated. Imaging showed an infinite number of larvae in all the muscles of the body. The patient was managed, and seizures were controlled with medical therapy. A country such as India where the majority of the population is vegetarian still suffers as an endemic region for NCC. This is due to poor sanitation management and food processing. We expect this case to raise attention toward serious complications of the disease and plan strategies for its prevention, control, and establish proper management guidelines.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"24-26"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969980","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":"Efficacy and Safety of Edaravone in Amyotrophic Lateral Sclerosis: It is Safe but Does Not Stop Progression.","authors":"Salil Gupta, Sunny Tomar, Rahul Soni, Ravi Anadure, Manoj Somashekhar, Anuj Singhal","doi":"10.59556/japi.73.1044","DOIUrl":"https://doi.org/10.59556/japi.73.1044","url":null,"abstract":"<p><strong>Background: </strong>Edaravone is recommended for amyotrophic lateral sclerosis (ALS) based on a study showing an effect on a defined subset of patients.</p><p><strong>Aim: </strong>To document the effect of edaravone in a cohort of ALS patients from India to find out if, after starting edaravone, there is a plateau period or significant slowing from baseline to compare results with existing literature.</p><p><strong>Methods: </strong>This was a single-center, prospective observational study with no control arm (due to ethical reasons). ALS patients >18 years of age, not requiring respiratory support or tube feeding, were included. All patients were given edaravone infusion in addition to standard of care and oral riluzole 50 mg twice daily. This consisted of giving the drug in monthly cycles over 6 months. The first cycle consisted of daily infusion of the drug for 14 days followed by a drug-free interval for the remaining part of the month. From cycle 2 to cycle 6, the patients received the drug for the first 10 days of the month followed by a drug-free interval for the remaining part of the month. The primary outcome was a significant change in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score from baseline at 6 months. Secondary outcomes were monthly change in ALSFRS-R scores when compared with the previous month and baseline, change in the first 3 months compared to the change in the next 3 months, adverse drug effects, and number of deaths. The study was registered with the Indian Council of Medical Research Clinical Trial Registry of India with the trial number CTRI/2019/11/021838. Paired <i>t</i>-test was used for statistical analysis.</p><p><strong>Results: </strong>Thirty patients received the drug along with riluzole. Twenty-three patients completed all six monthly infusions. Two died (3 months), two developed adverse reactions (3 months) and did not want further infusions (one had breathing difficulty and the other had hypotension during infusion). Two withdrew consent due to perceived poor effectiveness of the drug. The mean ALSFRS-R at baseline was 35.17 [standard deviation (SD) 8.01; range 20-46]. The primary outcome showed a significant decline in the mean last available ALSFRS-R score 6 months by -4.9 (SD 1.21) (<i>p</i> < 0.01). For the secondary outcome measure, mean monthly ALSFRS-R score was calculated before each infusion after excluding dropouts. There was a significant monthly decline in ALSFRS-R score: -0.93 (SD 0.58), -1.0 (-0.52), -0.90 (SD 0.71), -0.87 (SD 0.61), -0.82 (SD 0.57), -0.95 (SD 0.63), respectively (<i>p</i> < 0.001). There was also a progressive monthly decline when compared to baseline. The rate of decline in the first 3 months was the same as in the remaining 3 months: -2.5 (SD 0.73) vs -2.6 (SD 0.98) (<i>p</i> = 0.3).</p><p><strong>Conclusion: </strong>Edaravone infusion does not stop or significantly slow progression of disease from baseline but is safe.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970061","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":"Uncommon Allies: Van der Knaap Syndrome and Focal Segmental Glomerulosclerosis.","authors":"Jayaram Saibaba, Sibi S, Dks Subrahmanyam","doi":"10.59556/japi.73.0988","DOIUrl":"https://doi.org/10.59556/japi.73.0988","url":null,"abstract":"<p><strong>Background: </strong>Van der Knaap disease, or megalencephalic leukoencephalopathy with subcortical cysts (MLC), is a rare autosomal recessive leukodystrophy caused by mutations in the <i>MLC1</i> or <i>GLIALCAM</i> genes. It is characterized by macrocephaly, developmental delays, ataxia, spasticity, seizures, progressive neurodegeneration, and subcortical cysts, particularly in individuals from consanguineous populations.</p><p><strong>Objective: </strong>To report a unique case of a 26-year-old male with MLC who developed steroid-resistant focal segmental glomerulosclerosis (FSGS), an association not previously described. The study aims to highlight potential links between neurodegenerative and renal pathologies and underline the importance of multidisciplinary care.</p><p><strong>Materials and methods: </strong>The diagnosis of MLC was based on clinical presentation, magnetic resonance imaging (MRI) findings, and genetic testing that confirmed an MLC1 mutation. The patient's FSGS was resistant to standard steroid therapy, necessitating immunosuppressive treatment, including rituximab. A review of the literature was conducted to explore possible connections between the two conditions.</p><p><strong>Results: </strong>The patient exhibited hallmark features of MLC and developed concurrent FSGS. Management involved targeted immunosuppressive therapies, leading to partial control of symptoms. The cooccurrence of these conditions, though rare, suggests a potential shared genetic or mechanistic pathway, which remains to be elucidated.</p><p><strong>Conclusion: </strong>This case illustrates the complex interplay between neurodegenerative and renal disorders, emphasizing the need for multidisciplinary management. The rare association of MLC and FSGS raises questions about potential genetic links or shared molecular mechanisms, warranting further research to identify targeted therapies.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970104","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":"Assessment of Noncommunicable Disease Risk Factors among Midday Meal Cooking Staff in Vijayapura Schools: A Cross-sectional Study.","authors":"Mallikarjun C Yadavannavar, Bhoomika N, Tanuja P Pattankar","doi":"10.59556/japi.73.1045","DOIUrl":"https://doi.org/10.59556/japi.73.1045","url":null,"abstract":"<p><strong>Background: </strong>Noncommunicable diseases (NCDs), frequently called as lifestyle diseases, are a significant concern. According to World Health Organization (WHO) estimates, NCDs are to account for >60% of all deaths occurring in India. The study aimed to conduct a comprehensive assessment of the prevalence of these diseases, dietary habits, physical inactivity, and behaviors such as tobacco use among the cooking staff of midday meals (MDMs) in schools and in finding out their overall knowledge, perception, and practices concerning NCDs such as hypertension and diabetes mellitus.</p><p><strong>Methods: </strong>A cross-sectional study design was implemented with 290 cooking staff from schools in Vijayapura district, Karnataka. Their sociodemographic profiles, diet habits, physical activity, blood pressure, and anthropometric measurements were gathered using a prestructured questionnaire. A statistical test package for the social sciences (version 20) was used for the statistical study.</p><p><strong>Results: </strong>The study found that most of the participants (41.4%) were from 30 to 40 years age-group. Overall, 38.3% of the participants were overweight, while 24.1% were classified as obese. Hypertension was observed in 32.4%, and 10.7% of the research participants were prehypertensive. Diabetes was present in 3.4%, and 13.4% of the research participants were prediabetic.</p><p><strong>Conclusion: </strong>Substandard dietary habits, blood pressure, and physical inactivity were seen as the most prevalent modifiable risk factors within these cooking personnel. Increasing knowledge of NCDs can be imposed to implement health promotion programs among cooking staff of MDMs in schools, aiming to reduce the economic and social burdens associated with NCDs.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"60-63"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970087","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":"Undiagnosed Marfan's Syndrome Presenting with Primary Spontaneous Pneumothorax in a Young, Short, Nonsmoker Adult at Emergency.","authors":"Harman Singh, Ankur Verma, Sanjay Jaiswal, Maheshwar Lal, Saumya Gupta, Nikit Mittal, Naman Singh","doi":"10.59556/japi.73.0975","DOIUrl":"https://doi.org/10.59556/japi.73.0975","url":null,"abstract":"<p><p>Marfan's syndrome is an autosomal dominant multisystem connective tissue disorder. It commonly presents with complications of aortic dissection, aortic root dilation, or mitral valve prolapse, or less likely with primary spontaneous pneumothorax (PSP) in the emergency department (ED). A 22-year-old male patient presented with undifferentiated chest pain to our ED. The patient was diagnosed with spontaneous pneumothorax, and further examination was suggestive of Marfan's syndrome. The patient was treated with intercostal tube placement and was advised to follow-up at a higher center for genetic testing. It would be prudent for ED physicians treating spontaneous pneumothorax to suspect, examine, and educate patients, guiding them to a confirmatory diagnosis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"44-46"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970118","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":"Tuberculosis and Mental Health: A Poorly Addressed Syndemic in India.","authors":"Sanjitha Muneeswaran, Chapal Mehra, Lancelot M Pinto","doi":"10.59556/japi.73.1049","DOIUrl":"https://doi.org/10.59556/japi.73.1049","url":null,"abstract":"<p><strong>Introduction: </strong>India bears a dual burden of tuberculosis (TB) and mental health (MH) disorders, both of which are underdiagnosed due to stigma and diagnostic challenges. These conditions frequently coexist, forming a syndemic that has significant implications for public health.</p><p><strong>Objective: </strong>To explore the bidirectional relationship between TB and MH disorders, highlighting the impact on TB treatment outcomes, including higher risks of nonadherence, loss to follow-up, and mortality. This review emphasizes the need for integrating MH screening and support into TB programs to improve patient outcomes and ensure holistic care.</p><p><strong>Conclusion: </strong>Despite the profound interplay between TB and MH disorders, MH remains inadequately addressed in TB care. Simple screening tools and community-based interventions can facilitate early detection and treatment. Integrating MH support, reducing stigma, and promoting collaboration between healthcare workers and MH professionals are vital to achieving World Health Organization (WHO)'s patient-centered care goals. Addressing this syndemic holistically is essential to improve outcomes for those affected and advance TB care standards in India.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"88-90"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969881","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":"Atypical Presentation of Envenomation.","authors":"Aswini S, Sivakumar K","doi":"10.59556/japi.73.0979","DOIUrl":"https://doi.org/10.59556/japi.73.0979","url":null,"abstract":"<p><p>Snake bite, bee, and wasp stings are common medical emergencies presenting to our hospitals in India. Usually, presentation of snake bite includes descending paralysis in the form of ptosis, dysphagia, and blurring of vision, in the form of cellulitis or bleeding from the site of bite. Cerebrovascular accident, angle-closure glaucoma, and brachial artery thrombosis are some of the rare complications of this medical emergency. A 32-year-old female and 48-year-old male presented with cerebrovascular accident as the initial complaints to the hospital. A 50-year-old male presented with blurring of vision and history of snake, which was later diagnosed to be angle-closure glaucoma. A 70-year-old male presented with cerebrovascular accident as well as thrombosis of brachial artery with history of multiple bee stings. Diagnosis was confirmed with radiological investigations and ophthalmic examination. Early treatment with antisnake venom was initiated in all four patients. All patients recovered with treatment and were discharged. Early identification of the complication and early initiation of treatment plays a key role in preventing mortality and morbidity.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"59-60"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969995","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":"Hiccups with a Twist: A Rare and Surprising Cause Behind Those Involuntary Spasms.","authors":"Vishal Mavuri, Jay Chudasama, Sanjay Jagdish Chandnani, Deepika Pandey, Pravin Rathi","doi":"10.59556/japi.73.0959","DOIUrl":"https://doi.org/10.59556/japi.73.0959","url":null,"abstract":"<p><p>Hiccups is a reflex consisting of a sudden spasmodic contraction of the diaphragm causing shaking of the inspiratory muscles of the chest and abdomen, followed by the sudden closure of the glottis.¹ Persistent hiccups, i.e., lasting longer than 48 hours, usually signify an underlying organic cause and must be evaluated. Gastroesophageal disorders such as aerophagia, peptic ulcer disease, esophagitis, gastritis, and pancreatitis are the common causes of persistent hiccups. Distal esophageal spasm (DES) usually presents with dysphagia and chest pain.² There have been no case reports of DES presenting with hiccups as a primary complaint. Our patient presented with persistent hiccups as a primary complaint and was initially treated as gastroesophageal reflux disease-related hiccups. On further investigations, he was found to have DES, which completely resolved after peroral endoscopic myotomy procedure.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"61-62"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970004","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":"Histoplasmosis: A Rare Cause of Cervical Lymphadenopathy.","authors":"Mohammad Ahmad Husain, Shyam Chand Chaudhary, Tarun Pal, Shambhavi Sinha, Sunita Kumari, Kamal Kumar Sawlani, Shalini Bhalla","doi":"10.59556/japi.73.0978","DOIUrl":"https://doi.org/10.59556/japi.73.0978","url":null,"abstract":"<p><p>Over the past few years, there has been a significant rise in the prevalence of human fungal infections worldwide, largely due to factors such as the acquired immunodeficiency syndrome (AIDS) pandemic, widespread use of antibacterial agents, and the utilization of chemotherapeutic agents for treating neoplastic diseases. Histoplasmosis, attributed to the dimorphic fungus <i>Histoplasma capsulatum</i>, is one such opportunistic fungal infection. It is endemic to regions along the \"Ohio\" and \"Mississippi\" river valleys and is frequently located in soil tainted by bat or bird feces. Cases occurring outside these endemic areas are often due to imported diseases. Histoplasmosis is not considered endemic in India, but regions with high prevalence have been reported in the Gangetic plain, particularly in West Bengal and Uttar Pradesh. The prevalence of histoplasmosis in India, as determined by histoplasmin skin sensitivity testing, ranges from 0 to 12.3%. Infection typically occurs through inhalation of spores, with the majority of cases being asymptomatic or presenting with minimal symptoms in over 99% of patients. Symptomatic cases usually manifest as acute pulmonary histoplasmosis, which is a self-limiting illness resembling atypical pneumonia. However, immunocompromised individuals, particularly those with impaired T-cell immunity, may fail to elicit appropriate immunological responses, leading to the development of disseminated histoplasmosis. This form of infection can manifest with symptoms such as anorexia, pancytopenia, fever, weight loss, hepatosplenomegaly, as well as mucosal ulceration. Histoplasmosis resulting in isolated lymphadenopathy is uncommon, especially in India, where tuberculosis constitutes the primary etiology in the majority of instances. Diverse and ambiguous symptoms of histoplasmosis often lead to misdiagnosis or underreporting of infections. Thus, it is essential to include histoplasmosis in the list of potential causes for cervical lymphadenopathy, especially among immunocompromised individuals. Early medical intervention is essential to prevent dissemination of the disease. The presentation of histoplasmosis with cervical lymphadenopathy is uncommon, and we present a case of such occurrence here.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"17-19"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970011","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":"Hepatopulmonary Syndrome as First Presentation of Liver Cirrhosis.","authors":"Sundari Shrikant, Anshul Jain","doi":"10.59556/japi.73.0980","DOIUrl":"https://doi.org/10.59556/japi.73.0980","url":null,"abstract":"<p><p>A 46-year-old male nonsmoker presented to the outpatient department (OPD) with a history of progressively increasing breathlessness and central cyanosis since 1 month. He had a history of surgery for craniopharyngioma 6 years back and was on hormone replacement therapy. On evaluation, no cardiopulmonary cause was found for cyanosis. Patient was detected to have cirrhosis, possibly due to nonalcoholic fatty liver disease (NAFLD), and hepatopulmonary syndrome (HPS) was suspected as the cause for dyspnea and cyanosis, which was confirmed on workup. HPS as the first presentation of undiagnosed cirrhosis is relatively rare, although there are some case reports in the literature.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970020","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}