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

{"title":"Blood Biomarkers of Fibrosis as Alternatives to FibroScan^® in Metabolic Dysfunction-associated Fatty Liver Disease: A Single-center Comparative Analysis.","authors":"Abhinav Gupta, Ranjana Duggal, Deepanjali Gupta, Anil K Gupta","doi":"10.59556/japi.73.1114","DOIUrl":"10.59556/japi.73.1114","url":null,"abstract":"<p><strong>Background: </strong>Liver fibrosis worsens prognosis in metabolic dysfunction-associated fatty liver disease (MAFLD). FibroScan® is the most widely used noninvasive tool for evaluating fibrosis, but performing this assessment requires specialized equipment and expertise. This study aimed to assess the potential of four additional noninvasive techniques for diagnosing liver fibrosis that rely on routine laboratory measurements, that is, fibrosis (FIB)-4 score, FIB-5 score, aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, and the aspartate aminotransferase to platelet ratio index (APRI).</p><p><strong>Methods: </strong>This study was performed following a cross-sectional observational design at a tertiary care hospital in India. The study included adult patients who were observed to have elevated serum AST and ALT levels and fatty deposition on ultrasonography, as these indicate a risk for liver fibrosis, that is, MAFLD or metabolic dysfunction-associated steatohepatitis. The specificity and sensitivity of FIB-4, FIB-5, APRI, and AST/ALT ratio were compared with those of FibroScan® (FibroScan® 502, Echosens, Paris, France).</p><p><strong>Results: </strong>Among the alternative noninvasive methods, FIB-4 had the highest specificity (78%) and sensitivity (85%) that were closest to the specificity (88%) and sensitivity (92%) of FibroScan®. FIB-5 and APRI demonstrated moderate sensitivity (80% and 76%, respectively) and specificity (75 and 70%, respectively). The AST/ALT ratio had relatively poor diagnostic capability, with a specificity of 60% and sensitivity of 65%. The area under the curve (AUC) for the methods being compared was 0.82 (FIB-4), 0.79 (FIB-5), 0.74 (APRI), and 0.65 (AST/ALT ratio).</p><p><strong>Conclusion: </strong>FibroScan® is the preferred option for evaluating liver fibrosis in patients with MAFLD. However, when unavailable, FIB-4 may be the next most reliable alternative for identifying or excluding advanced fibrosis. Other methods (FIB-5, APRI, and AST/ALT) are less accurate.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"e1-e4"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070360","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":"Issues Related to Academic Success and Mental Health: A Cross-sectional Study among Medical Students of Sangli District, Maharashtra, India.","authors":"Alka D Gore, Vivek B Waghachavare, Randhir V Dhobale, Meenakshi R Sawant, Aniket A Muley, Vinayak A Jadhav","doi":"10.59556/japi.73.1096","DOIUrl":"10.59556/japi.73.1096","url":null,"abstract":"<p><strong>Introduction: </strong>Medical students often experience high levels of stress, anxiety, and depression due to the demanding nature of their studies. Academic pressure can be a significant factor in the development of stress, depression, and anxiety among medical students. The situation may deteriorate if these students have personal, academic, or institutional problems. Hence, this study was planned to identify the prevalence of mental health problems among medical students and their association with personal, academic, and institutional issues.</p><p><strong>Materials and methods: </strong>We conducted a cross-sectional study among medical students from Sangli District, Maharashtra, India. Data were collected using a predesigned and pretested questionnaire. Chi-square and multivariate regression analysis were used for the statistical analysis. Microsoft Office 365 and SPSS 22 were used for analysis purposes.</p><p><strong>Results: </strong>A significant proportion of medical students reported experiencing symptoms of mental health challenges: 50.0% depression, 73.6% anxiety, and 22.2% stress. The significant predictors for depression were birth order, physical health, and religiosity; for anxiety-age, upbringing, and stress; gender, year in which they are studying, upbringing, birth order, and physical health. By using binary logistic regression, it was found that personal issues are significant predictors related to depression, anxiety, and stress.</p><p><strong>Conclusion: </strong>Various academic, personal, and institutional issues were contributing to mental health problems among medical students. A robust support system is required to identify and alleviate these problems, which can empower them to cope with challenges and succeed in their academic challenges.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"e10-e14"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070581","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":"Trapped in the Vasculature: Delving into Intravascular B-cell Lymphoma.","authors":"Shrinath Kshirsagar, Namrata Singh, Shaikhali Barodawala, Sanjay Gohil, Abhay Bhave","doi":"10.59556/japi.73.1171","DOIUrl":"10.59556/japi.73.1171","url":null,"abstract":"<p><p>Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive variant of diffuse large B-cell lymphoma (DLBCL) in which neoplastic lymphoid cells proliferate within the lumen of small blood vessels involving any organ. The rarity and intravascular involvement of this lymphoma make this diagnosis difficult. Only 5% of these cases show atypical cells in peripheral blood. Some cases may present with hemophagocytic syndrome. Here, we report a case of IVLBCL diagnosed in a 65-year-old male who presented with vague symptoms of fever and fatigue. Peripheral blood smear showed approximately 5% atypical blast-like cells, which led to bone marrow examination. Flow cytometry immunophenotyping was done on aspirate followed by immunohistochemistry on trephine biopsy, and a diagnosis of IVLBCL was made (IVLBCL). Radiological evaluation was done by positron emission tomography (PET) scan, and cerebrospinal fluid (CSF) examination was done as part of the workup. Six cycles of R-CHOP chemotherapy were given with intrathecal methotrexate, and minimal residual disease (MRD) assessment was done twice. No recurrence of the disease was seen till 1-year follow-up post diagnosis. The case emphasizes that IVLBCL, being rare and aggressive, requires complete diagnostic workup in terms of laboratory and radiological studies, which play an important role in differential diagnosis and deciding the prognosis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"67-70"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070653","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 Novel Mutation of Fanconi-Bickel Syndrome: A Case Report.","authors":"Mythri Shankar, Damini Shankar, Varalaxmi Shetty K, C G Sreedhara","doi":"10.59556/japi.73.1005","DOIUrl":"https://doi.org/10.59556/japi.73.1005","url":null,"abstract":"<p><p>A 19-year-old girl from a consanguineous marriage showed signs of delayed motor developmental milestones since infancy, a protuberant abdomen, and failure to thrive. She suffered from cor pulmonale as a result of restrictive lung disease, pulmonary hypertension, and chronic interstitial lung disease. Diagnosed with resistant rickets elsewhere, she was on treatment with Joulie's solution. Physical examination revealed an undernourished state and features of rickets. Laboratory results were suggestive of proximal renal tubular acidosis (RTA), dyslipidemia, postprandial hyperglycemia, and elevated alkaline phosphatase. Skeletal X-rays confirmed rickets, and an abdominal ultrasound showed hepatomegaly. Whole-exome sequencing identified a homozygous missense variant in the <i>SLC2A2</i> gene (p.Glu486Gly), confirming Fanconi-Bickel syndrome (FBS). Management included phosphorus, bicarbonate, vitamin D supplementation, dietary changes, and conservative care. Follow-up showed improvement in height. Fanconi and Bickel (1949) initially reported the rare disorder known as FBS, which is attributed to mutations in the glucose transporter 2 (GLUT2) transporter gene. Due to its autosomal recessive inheritance, genetic counseling and prenatal diagnosis are essential. To the best of our knowledge, this is the first reported case in the world of a novel genetic mutation causing FBS.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"58-60"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070676","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":"Unmasking Addison's Disease: A Case of Acute Adrenal Crisis.","authors":"Mohammed Mufeeth, E Neethu, Deepak Muraleedharan, R Jayadevan, Dinesh Poonia","doi":"10.59556/japi.73.1131","DOIUrl":"10.59556/japi.73.1131","url":null,"abstract":"<p><p>Addison's disease is a rare endocrine disorder causing adrenal insufficiency and inadequate cortisol production. A 56-year-old chronic smoker presented with recurrent vomiting, abdominal pain, and severe hyponatremia. He had a 20 kg weight loss over 2 months, generalized weakness, dizziness, and hyperpigmentation. Laboratory tests showed hyponatremia (108 mEq/L), hyperkalemia (6.1 mEq/L), low fasting cortisol (0.65 µg/dL), and elevated adrenocorticotropic hormone (ACTH) (705 pg/mL). Imaging revealed bilateral adrenal enlargement and lymphadenopathy, confirming Addison's disease with adrenal crisis. Immediate IV hydrocortisone led to clinical improvement, stabilizing blood pressure and electrolyte balance. He was transitioned to oral steroids and discharged in stable condition with counseling and an emergency medical information card. This case highlights the need for early recognition and prompt treatment of adrenal crisis to prevent fatal outcomes. Increased clinician awareness can facilitate timely diagnosis and intervention, improving patient prognosis and reducing mortality risk.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"40-42"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070677","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":"Tolosa-Hunt Syndrome: A Rare Case of Painful Ophthalmoplegia in a Young Female.","authors":"Vaishnavi M Rathod, Darshankumar Manubhai Raval, Gayatri Laha, Dipakkumar Lalitbhai Solanki, Minal Shastri","doi":"10.59556/japi.73.1127","DOIUrl":"10.59556/japi.73.1127","url":null,"abstract":"<p><p>Tolosa-Hunt syndrome (THS) is a syndrome of painful episodic ophthalmoplegia due to nonspecific inflammation around the superior orbital fissure or the cavernous sinus, sometimes associated with paralysis of one or more of the cranial nerves III, IV, or VI. It is usually idiopathic but may have triggers such as tumors, aneurysms, or trauma. Since it is a diagnosis of exclusion, all other differentials such as cavernous sinus thrombosis, carotid-cavernous fistulae, giant cell arteritis, diabetic ophthalmoplegia, or ophthalmoplegic migraines should be ruled out. Diagnosis is mainly based on characteristic findings on clinical and radiological examination. The importance of diagnosing this condition lies in its management with steroids. This is one of the few neurological conditions that can completely resolve upon treatment. Here, we have a case of a young female who presented with painful ophthalmoplegia and ptosis of the left eye. She was diagnosed with THS on the basis of clinical and radiological features and showed complete resolution without any relapse with the administration of glucocorticoids. Therefore, early recognition of the condition and appropriate treatment lead to complete resolution of THS, as can be seen in our patient.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"10-12"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070683","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":"Calcification at the Level of 12th Dorsal and 1st Lumbar Vertebrae.","authors":"Ranjan Kumar Singh","doi":"10.59556/japi.73.1074","DOIUrl":"10.59556/japi.73.1074","url":null,"abstract":"<p><p>A 46-year-old man presented with pain in his left lower limb for the past 2 months. He was taking herbal medications for diabetes, which he had for the past 3 years. He had a history of alcohol dependence for the last 12 years, but recently he was able to overcome his addiction with the help of counseling. He had no history of recurrent abdominal pain and had no complaints of steatorrhea. Clinical examination revealed his body mass index (BMI) was 18 kg/m², pulse 110 beats per minute, blood pressure 124/78 mm Hg, and absence of icterus. The blood tests showed hemoglobin 11.5 gm/dL, blood sugar (fasting) 440 mg/dL (reference range 60-110), and glycated hemoglobin (HbA1c) 9.5% (good control <6.5), serum calcium 8.9 mg/dL (reference value 8.5-10.5) and vitamin D₃ 16 ng/mL (reference range 20-50), serum creatinine 1.2 mg/dL (reference value 0.7-1.4), alanine transaminase 35 U/L (reference range 5-45). For pain in the lower limb, a radiograph of the lumbosacral vertebral spine (Fig. 1) was taken; however, numerous dense calcifications were noted across the 12th dorsal and 1st lumbar vertebrae, more so on the right side. Unenhanced abdominal computed tomography (CT) scans (Figs 2A and B) were obtained. The patient received an oral dosage of 500 mg of metformin twice a day, along with 10 units of human regular insulin delivered <i>via</i> subcutaneous injection in the morning and 8 units in the evening. His glucose levels were monitored at regular intervals. In a week's time, the patient's fasting blood glucose level decreased to 110 mg/dL. He was also prescribed calcium supplementation alongside weekly oral administration of vitamin D₃ (60,000 IU). Additionally, oral pregabalin at a dosage of 75 mg was administered twice a day.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"101-102"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070380","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":"Letter to Editor in Response to Article \"Clinical Phenotypes and Disease-specific Health-related Quality of Life in Patients of Chronic Obstructive Pulmonary Disease. J Assoc Physicians India 2025;73(3):36-39.\"","authors":"Sachinkumar S Dole, Geedhara H Reddy, Madhusudan Barthwa","doi":"10.59556/japi.73.1099","DOIUrl":"10.59556/japi.73.1099","url":null,"abstract":"<p><p>We read with interest an article titled \"Clinical Phenotypes and Disease-specific Health-related Quality of Life in Patients of Chronic Obstructive Pulmonary Disease\" published in JAPI.¹ We have the following comments to offer.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070518","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":"Effectiveness of Cyclophosphamide and Immunosuppressants in Systemic Sclerosis-associated Interstitial Lung Disease: A Meta-analysis.","authors":"Isha Anwar, Darryl Sony, Monika Chetry, Neha Hatti, S Chandrashekara","doi":"10.59556/japi.73.1124","DOIUrl":"10.59556/japi.73.1124","url":null,"abstract":"<p><strong>Objective: </strong>The present meta-analysis compares the effectiveness of cyclophosphamide (CYC) as an immunosuppressant in systemic sclerosis-associated interstitial lung disease (SSc-ILD) with placebo, and other immunosuppressants.</p><p><strong>Methodology: </strong>The study involved randomized trials and observational studies identified through a systematic literature search using various databases, such as Elton B Stephens Company (EBSCO) Medline/PubMed, Scopus, Web of Science, Google Scholar, PubMed Central, Cochrane Library, and ScienceDirect. These studies compared the effectiveness of CYC with placebo or other immunosuppressants in terms of lung parameters. Meta-analysis and network meta-analysis were conducted to evaluate the effectiveness of the treatments.</p><p><strong>Results: </strong>Upon comparison, azathioprine (AZA) was favored over CYC for forced vital capacity (FVC) (<i>d</i> = 1.02, <i>p</i> = 0.00) and diffusing capacity of the lungs for carbon monoxide (DLCO) (<i>d</i> = 0.88, <i>p</i> = 0.00). No significant difference in FVC between CYC and mycophenolate mofetil (MMF) was found, although CYC was slightly preferred (<i>d</i> = -0.12, <i>p</i> = 0.60). CYC was beneficial over placebo in reducing the Dyspnea Index score (<i>d</i> = 0.78, <i>p</i> = 0.00) but not in improving DLCO. Network analysis revealed that CYC had the highest FVC outcome <i>p</i>-scores (0.6559), while rituximab (RTX) had the lowest (0.3410). For DLCO, AZA had the highest <i>p</i>-score (0.5707), followed by placebo (0.5180).</p><p><strong>Conclusion: </strong>While suggesting the potential benefits of CYC and AZA, the study findings do not decisively support the superiority of CYC over other treatments for most SSc-ILD lung function parameters. This emphasizes the need for rigorous, ongoing research to refine treatment strategies and address unresolved questions regarding the efficacy and safety profile of CYC.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"e28-e37"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070494","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":"Treatable Neuropathies.","authors":"Satish Khadilkar, Jharna Mahajan, Hiral Halani, Raymond Rosales","doi":"10.59556/japi.73.1118","DOIUrl":"10.59556/japi.73.1118","url":null,"abstract":"<p><p>Peripheral neuropathy is one of the most common neurological problems encountered by physicians, and the broad diagnosis of neuropathy has a wide variety of underlying etiologies and varied clinical presentations. This review aims to cover the spectrum of treatable neuropathies, their etiologies, diagnostic criteria, and advances in treatment. Clinical pattern recognition and neuropathy characterization help narrow the list of differential diagnoses and thus direct the investigations. The list of treatable neuropathies is increasing and mainly includes metabolic, immune, infectious, toxic, and nutritional etiologies. Prompt recognition of treatable neuropathies with early treatment reduces morbidity and disability. In this review, we shall discuss the common treatable neuropathies in detail and tabulate the uncommon conditions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"73-84"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070497","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}