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

{"title":"Optimizing Screening Strategies for Hypertension in India: A Consensus Statement.","authors":"Jagdish S Hiremath, Gurpreet S Wander, Arup Dasbiswas, R R Mantri, Aziz Khan, Neil Bardoloi, S S Iyengar, B C Kalmath, Khrusheed Aslam, P R Vaidyanathan, M Vishwanathan, Anand Ahuja, Rajeev Garg, Mukul Misra, Neeraj Prasad, Preeti Sharma, Chinmoy Mazumder, M Kathiresan, Madhusudan Asawa, Mohit Bhagwati, Chandra K Das, Manish Ganwani, Harpreet S Gilhotra, Rajeev Kumar Gupta, Imran Hafeez, K Jaishankar, Mahadevappa Manjappa, Bijay Prasad, Bhanu Kiran Reddy, S Shilanjan Roy, Pratik Sane, Mahesh K Shah, Bipin Sinha, Muthiah Subramanian, Hariom Tyagi, Prashant Vazirani, Kumar Bagish, Bikash Rai Das, Prasad Deshmukh, Shailesh Gandhi, Sushil Indoria, Khurshid Iqbal, Rohit Kapoor, Bharat Kukreja, R Manjunath, Anil Minocha, Anil Modak, D Prabhakar, Deepak Rai, Y P Raju, M Ravichandran, Anindya Sengupta, Joyal Shah, Ashok Sharma, Priyank Shah, Sanjay Jain, Onkar C Swami","doi":"10.59556/japi.73.0926","DOIUrl":"https://doi.org/10.59556/japi.73.0926","url":null,"abstract":"<p><p>Hypertension is a highly prevalent issue worldwide. The prevalence of underdiagnosed hypertension in India calls for the need for this consensus article, which aims to optimize screening strategies. In this article, a modified Delphi approach was used to develop consensus statements. Key recommendations include the adoption of standardized screening protocols across diverse healthcare settings, incorporating both office-based and out-of-office blood pressure measurements (OBPM). By implementing these evidence-based strategies, the consensus aims to improve the early detection of hypertension, ultimately reducing the burden of cardiovascular disease and enhancing patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"e40-e46"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812291","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 Elusive Diagnosis Hiding in Plain Sight.","authors":"Aadesh K Hande, Yashvi M Shah, Sushil Kumar Patil, S Divyashree","doi":"10.59556/japi.73.0914","DOIUrl":"https://doi.org/10.59556/japi.73.0914","url":null,"abstract":"<p><p>This case report highlights the diagnostic and therapeutic challenges faced in the management of a middle-aged female patient presenting with persistent left gluteal pain and a history of remote pulmonary tuberculosis. Despite multiple hospital admissions and diagnostic procedures, the cause of her debilitating symptoms remained elusive. The diagnosis was clinched when a repeat investigation, including bone biopsy and bone marrow aspirate, revealed the growth of Salmonella Typhi (S. Typhi). The patient's symptoms markedly improved following treatment with appropriate antibiotics, underscoring the importance of considering atypical clinical presentations of common organisms.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812468","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":"Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica Spectrum Disorder.","authors":"Mukesh K Sarna, Mansi Setia, Puneet Rijhwani, Rishabh Parakh, Gourav Goyal","doi":"10.59556/japi.73.0911","DOIUrl":"https://doi.org/10.59556/japi.73.0911","url":null,"abstract":"<p><p>A 17-year-old male patient presented with frequent hiccups, nausea, and vomiting. He was initially treated for a hiatus hernia and gastritis with partial relief; however, symptoms recurred and worsened, necessitating a thorough assessment that included upper gastrointestinal endoscopy. Neuroimaging was ordered to look for a central cause of vomiting. The results showed a demyelinating lesion in the area postrema (AP), indicating neuromyelitis optica spectrum disorder (NMOSD). It typically affects the optic nerves and causes inflammatory demyelination of the spinal cord. Anti-aquaporin 4 (AQP4) autoantibodies in cerebrospinal fluid (CSF) were positive and validated the diagnosis. Intravenous methylprednisolone, intravenous immunoglobulin (IVIg), and rituximab were administered, and the patient responded well to the treatment. Regular follow-up and adherence to treatment guidelines are crucial for optimal patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"93-96"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811942","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":"Consensus to Reduce Withdrawal and Improve Adherence with SGLT2i: Consensus TWO SGLT2i Adherence Group.","authors":"Nagendra K Singh, Akash Kumar Singh, Bijay Patni, Prabhat Agarwal, Manohar Kathige Nageshappa, Manish Kumar Prasad, Meena Chhabra, Noni G Singha, Minakshisundaram Shunmugavelu, Arvind Gupta, Sanjeev Phatak, Mangesh Tiwaskar, Sanjay Kalra, Manash Pratim Baruah, Thamburaj Anthuvan, Abhijit Pednekar, Ashish Prasad, Smriti Gadia","doi":"10.59556/japi.73.0887","DOIUrl":"https://doi.org/10.59556/japi.73.0887","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a class of medications that have shown significant efficacy in regulating blood glucose levels and providing additional benefits, such as cardiorenal protection. This study aims to analyze the factors leading to nonadherence and discontinuation of SGLT2i treatment and to identify strategies that can enhance patient compliance and reduce withdrawal rates.</p><p><strong>Materials and methods: </strong>This consensus involved an expert committee comprising 14 leading opinion leaders, chosen for their profound expertise and experience in type 2 diabetes mellitus (T2D) and SGLT2i therapy. Prior to the meeting, a comprehensive document-developed through an extensive literature review on current challenges, best practices, and potential strategies for improving adherence and reducing withdrawal of SGLT2i-was distributed to the committee members. This allowed ample time for thorough review and preparation. The expert committee convened virtually multiple times to engage in in-depth discussions on various aspects of SGLT2i adherence and compliance. The finalized manuscript encapsulates the consensus achieved by the experts, presenting actionable recommendations aimed at enhancing adherence and reducing withdrawal rates in SGLT2i therapy.</p><p><strong>Results: </strong>Based on the literature, several factors contribute to the nonadherence of SGLT2i, including being of Black race, older age (>65 years), high unemployment rate, lower income levels, extended duration of diabetes, a greater number of baseline comorbidities, genital infections, and limited access to healthcare facilities. To maintain good adherence, appropriate patient selection and education are essential. Healthcare practitioners should be well-informed about the drug's indications, interactions, and side effects.</p><p><strong>Conclusion: </strong>Regular monitoring, lifestyle adjustments, and open communication between healthcare practitioners and patients are crucial. Developing personalized care plans, educating patients, promptly addressing their concerns, and cultivating a collaborative healthcare relationship are critical in maintaining adherence.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"75-84"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812409","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":"Prehyperuricemia Deserves More Attention in this Era of Metabolic Explosion: A Review.","authors":"G R Subbu, Mangesh Tiwaskar, A Muruganathan, R Rajasekar","doi":"10.59556/japi.73.0905","DOIUrl":"https://doi.org/10.59556/japi.73.0905","url":null,"abstract":"<p><p>The global population is experiencing a metabolic explosion, with the prevalence of hyperuricemia (HU) as a metabolic disorder and a causal factor for noncommunicable diseases (NCD) increasing rapidly worldwide over the last 2 decades. This rise is attributed to diets high in purine, alcohol, red meat, high-fructose foods, and lifestyle changes. The connection between HU and various NCDs is now stronger than ever. As HU progresses, systemic inflammation arises, leading to endothelial dysfunction and end-organ damage-molecular changes that were previously unrecognized. HU is increasingly seen as a metabolic disorder, particularly a vascular disorder rather than just a crystallization disease. Asymptomatic HU is no longer considered benign, and it should not be equated with gout. It is crucial to diagnose HU early, at a high normal level, and manage it to prevent the development and complications of related extra-articular diseases. For broader recognition and significance, this high normal level of serum uric acid (UA) should be termed prehyperuricemia (PHU). Like prediabetes and prehypertension, PHU should be identified early, regardless of age and sex, with preventive actions implemented to maintain UA at a safer level.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812310","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":"Primary Hypertrophic Osteoarthropathy-A Rare Cause of Joint Pain.","authors":"Shivam Kumar Kasaudhan, Pooja Dhaon","doi":"10.59556/japi.73.0903","DOIUrl":"https://doi.org/10.59556/japi.73.0903","url":null,"abstract":"<p><p>A 48-year-old male displayed pain along with swelling of small joints of the hand and feet, along with low back pain, for the last 7-8 years. The joint pain was not associated with early morning stiffness or constitutional symptoms. On physical examination, all fingers and toes had bulbous enlargement and clubbing (Figs 1A and B). There were no skin changes and no motion restriction of any joint. Other systemic examination was normal. The routine investigations along with inflammatory markers and immunological tests were normal. A radiograph of bones showed periosteal changes in long bones as well as small bones of the hand and feet (Figs 1C to F) suggestive of hypertrophic osteoarthropathy (HOA). The patient was evaluated for secondary causes of HOA, and all his reports were within normal limits. The patient was diagnosed with incomplete primary hypertrophic osteoarthropathy (PHOA) on the basis of clinical and radiological features. The patient was given an infusion of 4 mg of zoledronic acid, along with etoricoxib, once daily. The patient responded to treatment with significant reduction in pain at 4 weeks and etoricoxib was stopped.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"97"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812322","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":"Implementation Strategies to Improve Survival Outcomes after Out-of-Hospital Cardiac Arrest: Global Challenges and Disparities.","authors":"Vemuri S Murthy, Srinivas Ramaka, Ashima Sharma","doi":"10.59556/japi.73.0888","DOIUrl":"https://doi.org/10.59556/japi.73.0888","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) is a major global public health problem, contributing to high mortality and morbidity. There is significant variability in OHCA incidence and survival rates across different countries and communities and in various geographical locations, even within the same country. Cardiopulmonary resuscitation (CPR) knowledge and skills are critical to achieving better survival outcomes during OHCA. Community CPR training rates vary widely from country to country. Most low-middle-income countries (LMICs) lack an organized prehospital care system and are relatively far from the acceptable standards recommended for better outcomes by international organizations. Several factors contribute to disparities in outcomes during the management of OHCA in a given community in any country. The key challenges are lack of OHCA awareness, community CPR training, well-trained medical personnel, first responders, essential emergency equipment, high-quality emergency medical services (EMS) and funding, as well as access to and provision of timely, evidence-based emergency cardiac care. It is important to understand the structure of a given geographical community before planning and implementing a sustainable program to enhance outcomes during OHCA globally. There is a need for ground-level research and surveillance to improve outcomes from OHCA. Addressing these challenges and disparities is critical in improving survival outcomes after OHCA.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"58-64"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811858","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 of Bedside Diagnosis of Bacterial Meningitis Using Urinary Strip Reagent for Semiquantitative Analysis of Cerebrospinal Fluid.","authors":"Bhavya Chadalavada, Ritesh R Baddam, Raja M Rao","doi":"10.59556/japi.73.0890","DOIUrl":"https://doi.org/10.59556/japi.73.0890","url":null,"abstract":"<p><strong>Background: </strong>Meningitis is an inflammatory disease of the leptomeninges and is defined by the abnormal number of white blood cells (WBCs) in the cerebrospinal fluid (CSF). Meningitis-related mortality and morbidity can be decreased with early diagnosis and antibiotic administration. The most reliable method of diagnosis is still CSF analysis. Yet, a straightforward bedside test would be helpful for early identification due to the absence of experienced staff, laboratory, and transport services at the primary health care level in developing countries.</p><p><strong>Materials and methods: </strong>Patients fitting the inclusion criteria were admitted to Gandhi Hospital, and a lumbar puncture was performed under aseptic conditions. Using the SEIMENS Multistix 10 SG reagent strip as the index test and CSF microscopy and biochemistry as the gold standard diagnostic test, CSF was examined for proteins, sugars, and leukocytes.</p><p><strong>Results: </strong>Among 100 CSF specimens evaluated, 52 (52%) were normal and 48 (48%) were considered as having pleocytosis. The overall performance of the urine leukocyte strip when compared to CSF leukocytes had a sensitivity of 95.8%, specificity of 67.3%, negative predictive value (NPV) of 94.6%, and positive predictive value (PPV) of 73.1%. The protein portion of the urine strip was compared to quantitative CSF proteins and showed a sensitivity of 90%, specificity of 70%, PPV of 66.7%, NPV of 91.3%, and diagnostic accuracy of 78%. The glucose portion of the reagent strip also performed better than the standard test, with a sensitivity of 100%, specificity of 93.8%, PPV of 90%, NPV of 100%, and diagnostic accuracy of 96%. For the diagnosis of bacterial meningitis, the strip glucose showed a sensitivity of 100%, specificity of 69.7%, PPV of 35%, NPV of 100%, and diagnostic accuracy of 74%. The significance of the reagent strip test for leukocytes, proteins, and sugars, when compared to the standard test, was established at a 95% confidence interval (CI) using the Pearson Chi-squared test.</p><p><strong>Conclusion: </strong>The urinary reagent strip is a simple test for a semiquantitative assessment of CSF, which may help with the diagnosis of meningitis at the point of care. It can also assist in deciding whether to begin antimicrobial therapy in settings with limited resources.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 4","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812384","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":"Allergic Bronchopulmonary Aspergillosis, a Masquerader: Unveiling a Case of Nonresolving Pneumonia in an Asthmatic Patient.","authors":"K Manmadharao, Jyothi M Jose, Palash Shah","doi":"10.59556/japi.73.0858","DOIUrl":"https://doi.org/10.59556/japi.73.0858","url":null,"abstract":"<p><strong>Background: </strong>Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated hypersensitivity reaction to <i>Aspergillus,</i> a common environmental fungus. It is typically seen in asthmatic patients and those with cystic fibrosis. Lack of clinical suspicion and misdiagnosis often make the management of this condition difficult.</p><p><strong>Case description: </strong>We are reporting a case of ABPA that was diagnosed and managed at Divisional Railway Hospital, Kharagpur, South Eastern Railway. The patient was a 66-year-old female who presented with fever, cough, and shortness of breath. She had been asthmatic since childhood and was on treatment for the same. On initial evaluation, her clinical and radiological features were suggestive of community-acquired pneumonia and were treated with antibiotics. However, the patient did not show improvement, and asthma also remained poorly controlled despite treatment. This raised the possibility of ABPA in this patient. The International Society for Human and Animal Mycology-ABPA (ISHAM-ABPA) working group criterion was used for making the diagnosis. She was successfully managed with low-dose steroids and itraconazole.</p><p><strong>Conclusion: </strong>A high index of clinical suspicion is needed for timely detection of ABPA. Features of nonresolving pneumonia in the background of poorly controlled asthma raised the possibility of ABPA in this patient. Misdiagnosis and delay in initiating proper treatment can lead to permanent lung damage, such as bronchiectasis and lung fibrosis, which can even lead to life-threatening complications like cor pulmonale and respiratory failure.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"86-89"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634669","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":"Diabetic Striatopathy: A Treatable Movement Disorder.","authors":"Gurunathan Srinivasan, P Vishaal, M Chozhan, Lakshmanan Sankaranarayanan, Mugundhan Krishnan","doi":"10.59556/japi.73.0875","DOIUrl":"https://doi.org/10.59556/japi.73.0875","url":null,"abstract":"<p><strong>Background: </strong>Diabetic striatopathy (DS), marked by hemichorea-hemiballismus syndrome (HCHB) linked to hyperglycemia, presents as a rare complication of diabetes mellitus.</p><p><strong>Case description: </strong>This paper details a case study involving a 60-year-old woman with poorly regulated diabetes, outlining the evolution, clinical signs, imaging characteristics, and therapeutic interventions for DS. The patient exhibited persistent involuntary movements in her left upper and lower limbs, exacerbated by voluntary actions but relieved during sleep. Clinical evaluation revealed hyperkinetic movements, disrupted gait, and distinct imaging results. Treatment encompassed glycemic control and medication, resulting in notable improvement. Discussion focuses on the pathophysiology, differential diagnoses, and treatment strategies, underlining the importance of glycemic management.</p><p><strong>Conclusion: </strong>This study contributes to the comprehension and management of DS, emphasizing the significance of prompt identification and effective treatment approaches.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e44-e45"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634690","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}