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

{"title":"Revisiting Treatment-free Remission: A Case of Late Molecular Recurrence in Chronic Myeloid Leukemia.","authors":"Vishnu Sharma, Arpita Digwal, Vansh Bagrodia, Madhav Sharma","doi":"10.59556/japi.73.1123","DOIUrl":"10.59556/japi.73.1123","url":null,"abstract":"<p><p>We present the case of a woman in her early 70s with chronic-phase chronic myeloid leukemia (CML-CP), initially diagnosed in 2002. After achieving deep molecular response (DMR) with imatinib for over a decade, the patient discontinued treatment, entering treatment-free remission (TFR) for around 7 years. She later presented with fever, fatigue, and abnormal blood counts. Restarting imatinib led to a near-complete molecular response, emphasizing the potential for late molecular recurrence (LMRec) in TFR, and underscoring the importance of long-term monitoring in CML patients who discontinue tyrosine kinase inhibitor (TKI) therapy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"21-22"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070623","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":"Acute Cerebellar Ataxia in a Case of Enteric Fever.","authors":"Vivek Kumar Soni, Tanvi Batra, Atul Kakar","doi":"10.59556/japi.73.1122","DOIUrl":"10.59556/japi.73.1122","url":null,"abstract":"<p><p>Isolated acute cerebellar ataxia is a rare neurological complication of enteric fever. It usually presents with speech and gait abnormalities. Cerebellar ataxia is generally masked by various other neurological complications, such as delirium. Here, we report a case of a 24-year-old male with no known comorbidities, who presented with complaints of high-grade fever, slurred speech, and unsteady gait, which was broad based. He also had abnormal cerebellar signs. Initial laboratory investigations showed thrombocytopenia, and blood cultures detected Salmonella Typhi. cerebrospinal fluid (CSF) examination and brain imaging were unremarkable. The patient recovered with ceftriaxone, and a final diagnosis of enteric fever with encephalopathy was made.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"33-34"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070618","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 Unusual Presentation of IgM Myeloma.","authors":"Ankur Jain, Paras Gupta, Ankita Jaiswal Govil, Sumita Chaudhry","doi":"10.59556/japi.73.1129","DOIUrl":"10.59556/japi.73.1129","url":null,"abstract":"<p><p>Immunoglobulin M (IgM) paraproteinemia is usually associated with either lymphoplasmacytic lymphoma (LPL) or Waldenström's macroglobulinemia (WM). Manifestations due to IgM paraprotein include hyperviscosity, acquired coagulopathy, cryoglobulinemia, vasculitis, and cold antibody-mediated autoimmune hemolytic anemia. These manifestations are seen in variable percentage of patients with LPL/WM. IgM myeloma constitutes only 0.5-1% of all myeloma cases. We describe a middle-aged female who presented with 5C's: cryoglobulinemia, coagulopathy (acquired von Willebrand disease), cold autoimmune hemolytic anemia, clot (thrombosis due to vasculitis), and cloudy vision (hyperviscosity syndrome) attributable to IgM paraprotein, but was diagnosed later with IgM myeloma. IgM is an important differential diagnosis of WM. The current case highlights such diagnostic challenges and their therapeutic considerations.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"46-48"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070643","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":"Preventing Premature Coronary Artery Disease: The Synergistic Role of Biomarker Screening and Physical Activity.","authors":"Gobardhan Kathariya, Jyoti Aggarwal, Rajesh Nandal, Mayank Madan, Sreenivas Reddy","doi":"10.59556/japi.73.1105","DOIUrl":"10.59556/japi.73.1105","url":null,"abstract":"<p><strong>Objective: </strong>With the increasing prevalence of premature coronary artery disease (CAD), early detection and risk stratification are crucial. While physical inactivity is linked to CAD risk, its impact in the early stages remains underexplored. This study aims to identify biomarkers for early CAD diagnosis and their association with physical activity (PA), ultimately reducing morbidity and mortality rates.</p><p><strong>Methods: </strong>This case-control study enrolled 300 subjects aged 18-45 years. They were subdivided into three categories. Additionally, the 200 subjects in groups I and II were classified into active, moderate, and sedentary categories based on World Health Organization (WHO) criteria. Serum levels of high-sensitivity C-reactive protein (hs-CRP), lipoprotein (a) [Lp(a)], apolipoprotein A1 (Apo-A1), apolipoprotein B100 (Apo-B100), and oxidized low-density lipoprotein (oxidized LDL) were analyzed, whereas non-high-density lipoprotein cholesterol (non-HDL-C) was calculated. The comparison of these biochemical parameters was done in terms of mean ± standard error of the mean (SEM) and area under the receiver operating characteristic curve (AUROC), and their significance with PA was determined using one-way analysis of variance (ANOVA) and Bonferroni test.</p><p><strong>Results: </strong>Significant differences in hs-CRP, Apo-B100, Lp(a), non-HDL-C, and oxidized LDL were observed across groups. AUROC analysis confirmed their strong association with CAD risk. Additionally, the findings highlight that an active lifestyle is linked to a more favorable biochemical profile, which may help mitigate the risk of premature CAD.</p><p><strong>Conclusion: </strong>The study suggests including hs-CRP, Apo-B, Lp(a), non-HDL-C, and oxidized LDL in routine screening for early CAD detection. Despite their proven effectiveness, these biomarkers are not widely used. Therefore, integrating early biomarker screening with lifestyle modifications can enhance risk assessment and improve treatment outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070578","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":"Keloidal Dermatofibroma: A Rare Diagnostic Entity.","authors":"Vidya Viswanathan, Anoushka Sharma, Sushama Gurwale, Yaminy Pradeep Ingale","doi":"10.59556/japi.73.1134","DOIUrl":"10.59556/japi.73.1134","url":null,"abstract":"<p><p>Dermatofibroma, also referred to as benign fibrous histiocytoma, is a cutaneous tumor frequently occurring on the extremities. Its occurrence on the neck is linked to atypical clinicopathologic characteristics and a more aggressive clinical course compared to typical cases. Furthermore, prior studies have recognized benign fibrous histiocytoma as the predominant subtype, while the keloid variant is extraordinarily rare, constituting approximately 1% of documented cases. In this case study, the exhibited nodular lesion is on the neck region. Upon histopathological examination, the tumor demonstrated well-circumscribed features with keloid-like regions, occasional spindle cells with elongated nuclei and eosinophilic cytoplasm, and a prominent inflammatory infiltrate. The objective of this study was to report our experience with a case of keloidal dermatofibroma occurring on the neck, a condition frequently overlooked in clinical practice, and to critically examine the management strategies for keloidal dermatofibromas at this anatomical site.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"35-36"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070596","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":"A Raw Crabby Tale: Paragonimiasis Unmasked.","authors":"Syam Nandajan, Zil Parekh, Deepti Mishra, Shruti Parab, S Divyashree","doi":"10.59556/japi.73.1130","DOIUrl":"10.59556/japi.73.1130","url":null,"abstract":"<p><p>Paragonimiasis is a parasitic infection endemic in the northeastern states of India. Because the infection is largely restricted to endemic areas, suspecting and establishing a diagnosis are challenging in nonendemic areas. Here, we describe a rare case of paragonimiasis in a nonendemic area. We highlight the importance of meticulous history as well as the practical issues in establishing the diagnosis. We also describe the management and outcome of the patient.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"43-45"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070650","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":"Beyond the Norm: Recognizing Uncommon Presentations of Large Vessel Vasculitis.","authors":"Bishakha Swain, Girija Sachdev, Rohini Samant","doi":"10.59556/japi.73.1135","DOIUrl":"10.59556/japi.73.1135","url":null,"abstract":"<p><p>Large vessel vasculitis (LVV) is known to affect the aorta and its branches. Takayasu arteritis (TAK) is a well-recognized LVV. TAK typically manifests with limb claudication, syncope, angina, absent pulses and unequal blood pressure. These symptoms stem from fibrotic and irreversible processes like stenosis and contribute to morbidity and mortality. Early atypical presentations may lead to delayed diagnosis. This underscores the importance of early diagnosis to arrest inflammation and prevent permanent damage. We present three cases where LVV was identified in patients with unusual symptoms, emphasizing the necessity for a high index of suspicion among healthcare providers. This is especially crucial in the primary care setting where patients first encounter general practitioners.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"30-32"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070668","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":"Head, Shoulders, Knees, and Toes: Unveiling Stroke in Leptospirosis Acute Respiratory Distress Syndrome.","authors":"Sonal P Karpe, K Sidharth, Vishwambar S Khadekar, Shivam S Gurme, Jairaj P Nair","doi":"10.59556/japi.73.1126","DOIUrl":"10.59556/japi.73.1126","url":null,"abstract":"<p><p>Leptospirosis is an infection caused by the bacteria Leptospira. The disease presentation varies from self-limited acute febrile illness to complications involving multiple organs such as the liver, kidney, lungs, and bleeding diathesis. We present a case of a middle-aged female admitted with acute febrile illness, thrombocytopenia, and respiratory failure. She was diagnosed with leptospirosis-induced acute respiratory distress syndrome (ARDS) and was on noninvasive mechanical ventilation (NIV). The patient developed a stroke during the course of her admission, which was due to a large cerebral infarction. The patient was treated for leptospirosis, respiratory failure, and the cerebral infarction with antibiotics, steroids, and antiplatelet agents. She eventually recovered from both her ARDS and stroke and was discharged. To the best of our knowledge, this is the first reported case from India of leptospirosis presenting with both ARDS and cerebral infarct. There is a dearth of literature wherein leptospirosis neurological involvement is in the form of ischemic stroke. This would further encourage research and guideline formulation for the management of both leptospirosis ARDS and ischemic stroke occurring as a complication.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070674","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":"Type 1 Diabetes Care: The West Bengal Model.","authors":"Masuma Yasmin, Sujoy Ghosh","doi":"10.59556/japi.73.1052","DOIUrl":"10.59556/japi.73.1052","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) management is complex and requires a multifaceted approach. This includes daily multiple insulin injections, home monitoring of blood glucose, screening for potential complications, and patient education and support. Many T1D patients face untimely death due to lack of structured and timely care.¹ India has the highest number of children and adolescents (aged 0-19 years) living with T1D,² but there is no national health program or policy targeting this population.³ The average life expectancy for a person diagnosed with T1D in India is only 29 years.².</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"11-12"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070499","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":"Neurophysiology of Acute Quadriparesis.","authors":"Ankkita S Bhandari, Laxmi Khanna, Praveen Kumar, Mandaville Gouriedevi","doi":"10.59556/japi.73.1145","DOIUrl":"10.59556/japi.73.1145","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure is a life-threatening emergency requiring intensive care. Nerve conduction and repetitive nerve stimulation studies are invaluable to solve dilemmas related to the diagnosis and management. The results of these tests are available immediately, and prompt treatment can be given as illustrated in this case.</p><p><strong>Clinical description: </strong>A 7-year-old boy presented in circulatory shock and impending respiratory failure to the casualty without any preceding illness.</p><p><strong>Management and outcome: </strong>The clinical picture, blood reports, and neurophysiological findings of repetitive compound muscle potentials on nerve conduction and a progressive decremental pattern on repetitive nerve stimulation were suggestive of acute organophosphate poisoning. This led to prompt institution of appropriate treatment comprising Ryle's tube aspiration, respiratory support, and administration of neostigmine and pralidoxime. The diagnosis was later confirmed by low serum pseudocholinesterase levels.</p><p><strong>Conclusion: </strong>This case exemplifies the importance of neurophysiological study in the diagnosis of organophosphate poisoning.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"13-14"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070690","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}