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

{"title":"Proposed Algorithm for the Diagnosis and Management of Functional Dyspepsia in India.","authors":"Showkat A Zargar, V G Mohan, Ravi B Shankar, Nitesh Pratap, Ramesh R Rai, Omesh Goyal","doi":"10.59556/japi.72.0771","DOIUrl":"https://doi.org/10.59556/japi.72.0771","url":null,"abstract":"<p><p>Disorders of gut-brain interaction (DGBI), formerly known as functional bowel disorders, encompass a diverse array of conditions and symptoms that may manifest in different parts of the gastrointestinal tract. Some of the most prevalent DGBIs include functional dyspepsia, irritable bowel syndrome, functional constipation, functional diarrhea, and functional bloating and distension. Around 80% of patients with dyspepsia have no identifiable organic cause and are labeled as functional dyspepsia. Globally, functional dyspepsia prevalence ranges from 11 to 30%. In India, physicians encounter 20-40% of patients with functional dyspepsia, with variations attributed to diagnostic criteria and regions. However, Indian clinical guidelines for functional dyspepsia are currently lacking. Fifty gastroenterologists participated in focus group discussions to create an India-specific algorithm for the diagnosis and management of functional dyspepsia. After several national and regional discussions among groups of gastroenterologists across India, an algorithm was finalized for careful and thorough clinical evaluation of patients presenting with chronic dyspeptic symptoms. This guidance document highlights the role of endoscopic evaluation and Helicobacter pylori infection in the diagnosis of functional dyspepsia, along with the role of proton pump inhibitors (PPIs) and prokinetics in its treatment. The experts also reviewed the use of several prokinetics and provided their views on the choice of drugs for varied clinical presentations of functional dyspepsia. Among prokinetics, the experts believed that itopride was the preferred and relatively safer option for the treatment of functional dyspepsia.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829907","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":"The Association of Lipid Abnormalities with Complications in Severe Scrub Typhus.","authors":"Ravi Sarswat, Balraj Singh, Akash Singh, Sanjay Mahajan","doi":"10.59556/japi.72.0746","DOIUrl":"https://doi.org/10.59556/japi.72.0746","url":null,"abstract":"<p><strong>Aim: </strong>To study abnormalities of lipids in patients suffering from severe scrub typhus and their relationship with complications.</p><p><strong>Methods: </strong>This cohort study was conducted in patients of severe scrub typhus [immunoglobulin (IgM) positive by enzyme-linked immunosorbent assay (ELISA)] admitted to our institute from 1^st August 2020 through 31^st July 2021. The lipid profile was estimated initially at the time of hospitalization. Serum total cholesterol, serum triglyceride levels (TGs), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were estimated. The association (risk ratios) of lipids abnormalities was determined with mortality, multiple organ dysfunction syndrome (MODS), septic shock, and septic shock with MODS.</p><p><strong>Results: </strong>We studied 100 patients (mean age of 48.4 ± 16.3 years) of whom 73 (73%) were females. On presentation, fever (91%), myalgias (38%), abdominal pain (16%), shortness of breath (15%), and cough (12%) were main symptoms. On examination, tachypnoea (68%), tachycardia (65%), conjunctival suffusion (37%), icterus (29%), eschar (14%), abdominal tenderness (10%), splenomegaly (4%), and hepatomegaly (3%) were noted. In lipid abnormalities, 93 (93%) patients had low HDL-C (males <40 mg/dL, females <50 mg/dL), serum triglycerides (200 mg/dL) were elevated in 71 (71%) patients, serum total cholesterol (>240 mg/dL) was increased in 4 (4%) patients, and 4 patients had raised serum LDL-C levels (160-189 mg/dL). Sixty-two (62%) patients developed MODS, 16 (16%) had septic shock, 15 (15%) developed septic shock with MODS, and 4 (4%) patients died. High serum TGs (>200 mg/dL) were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, <i>p</i> = 0.008) and septic shock with MODS (RR = 4.2, 95% CI = 1-17.4, <i>p</i> = 0.022) and the serum LDL-C levels <50 mg/dL were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, <i>p</i> = 0.007).</p><p><strong>Conclusion: </strong>There was a significant association of increased severity of scrub typhus with high TGs (>200 mg/dL) levels and low levels of LDL-C (<50 mg/dL) in admitted patients of severe scrub typhus.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"e17-e21"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829919","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":"Barriers and Facilitators in the Use of Selected Point-of-care Diagnostics in Indian Public Health Programs.","authors":"Tintu Varghese, Dilip Abraham, Beula Subashini Panchatcharam, Gagandeep Kang","doi":"10.59556/japi.72.0766","DOIUrl":"https://doi.org/10.59556/japi.72.0766","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive reviews on the use and utility of point-of-care tests (POCs) in public health programs in relation to infectious disease and nutrition are limited. Point-of-care technologies have potential to improve the management of infectious diseases particularly in settings where healthcare infrastructure and timely access to quality medical care are limited.</p><p><strong>Methods: </strong>We aim to describe POC tests currently used or under evaluation in the Indian national programs for communicable diseases and nutrition, and to identify the barriers and facilitators. Scoping review methodology was followed to search databases such as MEDLINE, EPPI (evidence for policy and practice information), CINAHL (Cumulative Index to Nursing and Allied Health Literature), JBI Evidence Synthesis, and Google Scholar. Descriptive statistics were applied to identify the utility, barriers, and facilitators of POCs in context of Indian public health program from patients' and physicians' perspectives.</p><p><strong>Conclusion: </strong>Rapid results, appropriate case management, and accuracy of testing in remote areas are perceived to be the major benefits of using POCs. Lack of awareness about POCs and lack of regulations leading to spurious products on the market are obstacles to their optimal use.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"e42-e51"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829936","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 Study Correlating the Effects of Subclinical Hypothyroidism on the Known Modifiable Risk Factors of Coronary Artery Disease in Indian Adults.","authors":"Sujoy Roy Chowdhury, Tushar Kumar Mandal, Prabuddha Mukhopadhyay","doi":"10.59556/japi.72.0779","DOIUrl":"https://doi.org/10.59556/japi.72.0779","url":null,"abstract":"<p><strong>Background: </strong>Subclinical hypothyroidism (SCH) is synonymous with thyroid failure (a milder form). It is a condition characterized by normal laboratory ranges of serum FT4 and FT3 levels, but serum thyroid stimulating hormone (TSH) levels are slightly increased above the normal range.</p><p><strong>Objective: </strong>The leading aims and objectives of the study were: (1) establishing a correlation between the presence of modifiable risk factors of ischemic heart disease in subjects with SCH. (2) Quantification of the economic markers of ischemic heart disease in patients with SCH.</p><p><strong>Methods: </strong>This study was accomplished at the Department of Internal Medicine, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, for the duration of 1 year, from March 2020 to February 2021. The study variables included history, physical examination, clinical examination, and investigations. The individuals who met the inclusion criteria set for the study were included. All the participants were informed about the study, and their informed consent was obtained. Data were analyzed using Microsoft Excel spreadsheet, followed by Statistical Package for the Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5.</p><p><strong>Results: </strong>Of the total 80 subjects enrolled in the study, 54 were females and 26 were males. In the study sample, the mean age was 47.8 (+9) years. Different variables were analyzed, and the values obtained were recorded for statistical analysis.</p><p><strong>Conclusion: </strong>According to the study, there is a positive correlation between established coronary artery disease (CAD) risk factors, such as hypertension, abnormal lipid profiles, and elevated body mass index (BMI), and SCH. We also noted a strong correlation between SCH and elevated levels of uric acid, fasting blood sugar (FBS), postprandial glucose test (PPBS), and hemoglobin A1c (HbA1c). As a result, early detection and management of SCH may have cardiac preventive benefits.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"44-48"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829899","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":"Olmesartan: 360-degree Perspectives Befitting an Angiotensin Receptor Blocker.","authors":"Sadanand Shetty, Anil Bhoraskar, Banshi Saboo, Satyanarayan Routray, Mangesh Tiwaskar, L Sreenivasamurthy, Vijay Kumar Shrivas, Anooja Jose, Charmy Prajapati, Amit Qamra, Parthasarathy Muralidharan","doi":"10.59556/japi.72.0780","DOIUrl":"https://doi.org/10.59556/japi.72.0780","url":null,"abstract":"<p><p>India has a high burden of hypertension (HTN), which is often poorly controlled, leading to hypertension-mediated organ damage (HMOD). In the management of HTN, angiotensin receptor blockers (ARBs) assume prime importance, being first-line agents for most patient subgroups. Olmesartan is a highly efficacious ARB that demonstrates sustained blood pressure (BP) reduction over 24 hours. Moreover, it also assumes a protective role by reducing microvascular inflammation, left ventricular hypertrophy, proteinuria, vascular stiffness, central aortic BP, cardiocerebrovascular events and atrial fibrillation. To enhance therapeutic compliance and achieve BP goals, single-pill combinations with other antihypertensive agents are also available. This review holistically summarizes the evidence of olmesartan for HTN management for not only BP reduction but also organoprotective effects.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"59-72"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829904","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":"SGLT2 Inhibitors and Finerenone: A friendly Duo in the Treatment of Diabetic Kidney Disease?","authors":"Adlyne Reena Asirvatham, Arthur Joseph Asirvatham, Shriraam Mahadevan","doi":"10.59556/japi.72.0759","DOIUrl":"https://doi.org/10.59556/japi.72.0759","url":null,"abstract":"<p><p>For decades, achieving glycemic control, target blood pressure, and renin-angiotensin-aldosterone system (RAAS) blockade remained to be the therapeutic interventions for retarding diabetic kidney disease (DKD) progression. The management of DKD showed major transformation when SGLT2 inhibitors were recommended to reduce the risk of progressive deterioration in estimated glomerular filtration rate (eGFR), end-stage renal disease (ESRD), and renal death following results of CREDENCE and DAPA-CKD trials. Despite currently available therapeutic approaches, the risk of cardiac death, progression to ESRD, and requirement of renal replacement therapy remains high. Finerenone is the newer potent selective nonsteroidal mineralocorticoid receptor antagonist (MRA) that showed reduction in primary composite renal and CV outcomes in FIDELIO-DKD and FIGARO-DKD studies, respectively. While SGLT2 inhibitors have direct effects on cellular and metabolic functions besides reduction in glomerular hyperfiltration, finerenone primarily inhibits mineralocorticoid pathway-dependent inflammation and fibrosis. The renal benefits of dapagliflozin in the DAPA-CKD trial were regardless of MRA, and likewise, the benefits of finerenone in FIDELIO and FIGARO studies were irrespective of SGLT2i. Moreover, the risk of serious hyperkalemia with MRA was significantly reduced by concomitant use of SGLT2 inhibitors, making this combination a safer choice. Even though available data support the fact that this duo possibly has distinct as well as complementary mechanisms in protecting renal and cardiac functions, strong evidence to recommend routine use of the combination of SGLT2 inhibitors and MRA in DKD is currently lacking. However, the results of the ongoing CONFIDENCE study evaluating superiority of dual therapy of empagliflozin and finerenone will be worthwhile to understand the benefits of this friendly duo.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"e35-e41"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829908","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":"Syringomyelia Mimicking as Bibrachial Variant of Motor Neuron Disease.","authors":"Tarun Ralot, Vinod Singh Jatav, Sameera Karimji, Vishwesh Sharma","doi":"10.59556/japi.72.0721","DOIUrl":"https://doi.org/10.59556/japi.72.0721","url":null,"abstract":"<p><strong>Introduction: </strong>Syringomyelia is a slowly progressive degenerative disorder of the spinal cord. Clinical features of syringomyelia vary from weakness in limbs to positive sensory symptoms and dissociative sensory loss. Thus, early and prompt diagnosis becomes crucial for reducing the morbidity associated with the disease.</p><p><strong>Case description: </strong>Here, we present a case of 52-year-old male presenting with progressive weakness in bilateral upper limbs without any sensory involvement which is an atypical presentation for syringomyelia.</p><p><strong>Conclusion: </strong>Motor neuron disease (MND) like presentation in syringomyelia is a rare entity. This can make diagnosis of syringomyelia difficult. Hence, any patient presenting with pure motor weakness of bilateral upper limb should also be suspected of syringomyelia.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"93-94"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829915","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":"Sir Macfarlane Burnet-Immunologist.","authors":"Jayant Pai-Dhungat","doi":"10.59556/japi.72.0750","DOIUrl":"https://doi.org/10.59556/japi.72.0750","url":null,"abstract":"<p><p>Frank Macfarlane Burnet (1899-1985) was born in Victoria, Australia, and obtained his MD in 1924 from the University of Melbourne. Burnet spent 2 years in England at the Lister Institute, where he studied bacteriophages and earned a PhD in 1928. Returning to Australia, he worked at the Walter and Eliza Hall Institute; as a bacteriologist, he continued his research on phages. Burnet then made a significant contribution by devising a method for cultivating viruses in a living chick embryo (1932-33).</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"108"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829910","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 Interesting Case of Alcohol-related Myelopathy.","authors":"Eveline Maria Jose, M Thangaraj, S S Shriranjani","doi":"10.59556/japi.72.0761","DOIUrl":"https://doi.org/10.59556/japi.72.0761","url":null,"abstract":"<p><p>The most accurately described causes of alcohol-related myelopathy are cases of hepatic myelopathy, which is myelopathy in the setting of either liver cell failure or portosystemic failure resulting in toxic myelopathy in the absence of liver failure. One of the few descriptions of myelopathy completely attributed to toxic effects of alcohol or its metabolites alone is by Sage et al., who reported five patients with the condition who had no evidence of hepatic involvement, portal hypertension, or nutritional deficiency. We report one of the first cases from India where an alcoholic presented with acute onset myelopathy with sphincter disturbances in the absence of liver cell involvement or portosystemic shunting.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829916","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":"Empowering Physicians for Holistic Wellness in Diabetes Management through Mind-Body Medicine: Implications of the Psycho-Neuro-Immuno-Endocrine/Enteric Concept in Diabetes.","authors":"Vaishali Chetan Deshmukh, Manoj Chadha","doi":"10.59556/japi.72.0758","DOIUrl":"https://doi.org/10.59556/japi.72.0758","url":null,"abstract":"<p><p>The psycho-neuro-immuno-endocrine/enteric (PNIE) axis is a fundamental concept in neuroscience, integral to the neuroendocrine system (NES). It encompasses the interactions between behavior, neurology, endocrinology, gut biology, and the immune system. These interactions regulate crucial metabolic processes like glucose, lipid, and protein metabolism, blood pressure, and various homeostatic functions, including blood pressure regulation, thermogenesis and pulmonary hypoxia detection.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"72 12","pages":"11-12"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829695","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}