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

{"title":"Progressive Disseminated Histoplasmosis with Primary Adrenal Insufficiency in Immunocompetent Person: A Case Report.","authors":"Harshita Singh, Manas Das, Rohan Shrama, Sourav Kumar, Sagar M Sindagi, Neeraj Chaudhary, Mukul P Bhat, Aakash Pandey, Mayanglambam Sonika, Anil Gurtoo, Kritirupa Sarkar","doi":"10.59556/japi.73.0876","DOIUrl":"10.59556/japi.73.0876","url":null,"abstract":"<p><p>Histoplasmosis, also referred to as Darling's disease, is mainly caused by the thermally dimorphic fungus Histoplasma capsulatum. It is usually contracted by inhaling fungal spores found in soil contaminated with bat or bird droppings, often during activities like cave exploration. Although endemic in certain regions of India, such as the eastern part, and sporadically in southern and northern states, histoplasmosis can manifest with varied clinical presentations, ranging from asymptomatic to severe disseminated disease affecting multiple organs. Adrenal involvement, though relatively uncommon, can lead to adrenal insufficiency, especially in immunocompetent individuals, with bilateral adrenal enlargement being a characteristic feature in imaging studies. This report discusses the case of a 51-year-old farmer from Haryana, India, who was diagnosed with progressive disseminated histoplasmosis (PDH) resulting in primary adrenal insufficiency. Although tuberculosis or malignancy was initially suspected, imaging studies and biopsy results confirmed histoplasmosis as the root cause. This case emphasizes the necessity of including histoplasmosis in the differential diagnosis of primary adrenal insufficiency, especially in endemic areas, and highlights the importance of early detection and appropriate management of this potentially life-threatening disease.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633596","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":"Cellulitis that was NOT Cellulitis.","authors":"Aditi D Punwani, Keyur K Dave, Yuti Sheth, Rahul Shah, Tejas Parekh","doi":"10.59556/japi.73.0865","DOIUrl":"10.59556/japi.73.0865","url":null,"abstract":"<p><p>Cellulitis is a common bacterial skin infection characterized by erythema, swelling, and pain of the affected skin and subcutaneous tissues. The lower limbs are a commonly affected area due to microtrauma and gravity-dependent stagnation of blood. We describe a case of a male patient with an extensive travel history who presented with left lower limb cellulitis, hyperbilirubinemia, and acute kidney injury. When workup for the usual causes of cellulitis did not provide a clearer picture, we had to consider the unusual. Considering his travel history, an exotic tropical zoonotic disease was considered, and an eschar was searched for. Upon further investigation, he tested positive for the Weil-Felix test and responded very well to doxycycline. Our case emphasizes the need to suspect scrub typhus in travelers, even with unusual presentations, for timely diagnosis and treatment to prevent the development of various complications and ensure earlier recovery of patients. It usually presents as an acute febrile illness, but the diagnosis is often missed due to similarities with other tropical febrile infections.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"99-100"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634681","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":"To Assess Prevalence of Thyroid Dysfunction in Patients with Heart Failure and Impact on Its Prognosis.","authors":"Anubha Srivastava, Dheeraj Kumar Yadav","doi":"10.59556/japi.73.0882","DOIUrl":"10.59556/japi.73.0882","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence of thyroid dysfunction in patients with heart failure (HF) and its impact on prognosis, specifically regarding hospital stay duration.</p><p><strong>Methods: </strong>One hundred eighty-five HF patients aged >18 years were enrolled, and the study was conducted at Swaroop Rani Nehru Hospital between 21^st July 2021, and 20^th July 2022. All patients diagnosed with HF underwent demographic, clinical, hematological, biochemical, and thyroid function test (TFT) evaluations. Thyroid stimulating hormone (TSH) > 4.94 mIU/L was diagnosed as hypothyroidism, and TSH < 0.5 mIU/L was taken as hyperthyroidism, whereas those with normal TFT were defined as euthyroidism. Patients were monitored until discharge or final outcome. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software 21.</p><p><strong>Results: </strong>Thyroid disorders were seen in 28.6% of patients, with 6.5% having hyperthyroidism and 22.2% hypothyroidism. Thyroid disorders were significantly associated with higher New York Heart Association (NYHA) class (3/4), serum urea, serum creatinine, and lower hemoglobin levels. However, age, sex, or brain natriuretic peptide (BNP) were not significantly associated with thyroid disorders. There was no significant difference in HF patients' length of hospital stay with or without hypothyroidism. Though 6.5% of HF patients died during the course of the study, this was not statistically significant.</p><p><strong>Conclusion: </strong>Thyroid disorders are highly prevalent among HF patients and have a significant clinical impact on their prognosis. Patients with thyroid disorders exhibited anemia, higher NYHA class, greater renal dysfunction, and longer hospital stays. Future studies are needed in this field. Clinicians should consider screening HF patients for thyroid dysfunction to improve patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"50-52"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634422","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":"Navigating the Artificial Intelligence Revolution: The Future of General Practice in India.","authors":"Amit Kumar Dey","doi":"10.59556/japi.73.0856","DOIUrl":"10.59556/japi.73.0856","url":null,"abstract":"<p><p>This article explores the integration of artificial intelligence (AI) into general medical practice in India. It discusses global AI healthcare trends and India's strategic approach of leveraging AI for societal benefit through public service applications. The article examines Indian practitioners' skepticism and optimism regarding AI in enhancing diagnostics vs replicating nuanced clinical judgment. It highlights patients' data privacy concerns related to India's expanding digital health initiatives. Additionally, it identifies limitations in using AI for administrative tasks due to data constraints and the need for greater involvement of clinical users. Looking ahead, the article outlines future directions and challenges, including strengthening infrastructure, upskilling providers in AI, bolstering investment in translational research, and balancing technological innovation with ethical, human-centered healthcare delivery.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"84-85"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634747","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":"Plastic Pollution and One Health Crisis: A Burning Issue in Environmental Medicine.","authors":"Gouranga Santra","doi":"10.59556/japi.73.0840","DOIUrl":"10.59556/japi.73.0840","url":null,"abstract":"<p><p>Awareness of plastic pollution is poor among the general population and medical professionals. It is impossible to understand the detrimental effects of plastics without knowing basic facts about plastics and their additives and sorbents. As the topic of plastics is vast, it is difficult to grasp by a physician. So, I have tried first to concise the basic facts of plastics in this article, followed by detailing its impacts on health and the ecosystem. As plants, animals, and humans are interdependent, the impact of plastic pollution on one group affects the others. So, a healthy balance of all components is essential. For controlling pollution, basic needs are reduction of plastic production, reuse and recycling of plastics, and safe disposal of wastes. Considering the nature of pollution, global intervention is essential. Physicians should spread awareness, take preventive measures, and plan mitigation strategies against health hazards and environmental impacts of plastics.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"73-83"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634773","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":"Sample Size Calculation for Paired <i>t</i>-test Using <i>p</i>-value and Confidence Intervals When Standard Deviation of Difference is Not Given.","authors":"Shyam Vayyat, Nilotpal Chowdhury, Manish Goyal","doi":"10.59556/japi.73.0854","DOIUrl":"10.59556/japi.73.0854","url":null,"abstract":"<p><p>Sample size calculation is an important step for carrying out any research. Most of the sample size estimating utilities/applications use the standard deviation of differences in their formula for paired design, which usually is not reported in the published articles. Researchers are left to use the pooled standard deviation (SDp) instead of using the standard deviation of differences. The standard deviation of differences gives a more accurate estimate of sample size for a paired design. The standard deviation of differences can be determined from the <i>p</i>-value or confidence intervals (CI), which are usually reported in the published articles. In this paper, we have described and illustrated with an example how to determine sample size from the <i>p</i>-value or CIs. Readers may follow the given example using scripts for software R.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"13-14"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634122","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":"Survival and Clinical Outcomes After Single-vessel Percutaneous Coronary Intervention Using Drug-eluting Stent: An Observational and Follow-up Study in a Tertiary Care Center in the Gangetic Plains of North India.","authors":"Soumik Ghosh, Rajpal Prajapati, Arjun Tandon, Amit K Gauraw, Kumar Amit, Om Shankar","doi":"10.59556/japi.73.0869","DOIUrl":"10.59556/japi.73.0869","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has transformed the management of coronary artery disease (CAD), particularly for single-vessel disease (SVD), by reducing restenosis rates. However, long-term survival data following PCI in North Indian populations are limited. This study aimed to evaluate survival and clinical outcomes after PCI with DES and identify factors associated with mortality and adverse events, such as chest pain, dyspnea, and bleeding.</p><p><strong>Materials and methods: </strong>This observational cohort study at Sir Sunder Lal Hospital, Banaras Hindu University, included 1,112 adult patients undergoing single-vessel PCI with DES. Patients were followed for 18 months <i>via</i> outpatient assessments and telephonic interviews to assess survival, chest pain, dyspnea, and bleeding. Data were analyzed using IBM SPSS Statistics (Version 25.0). Continuous variables were reported as mean ± SD, and categorical data as frequencies and percentages. Chi-square and independent <i>t</i>-tests were used, with a 5% significance level.</p><p><strong>Results: </strong>Of the 782 patients who were successfully followed up after 18 months, 740 (94.62%) were alive, and 42 (5.38%) had died. Significant factors associated with mortality included older age (<i>p</i> = 0.013), history of hospitalization (<i>p</i> < 0.001), chest pain (<i>p</i> < 0.001), dyspnea (<i>p</i> < 0.001), and bleeding (<i>p</i> < 0.001). Acute coronary syndrome (ACS) was the leading cause of death (52.3%), followed by post-PCI complications.</p><p><strong>Conclusion: </strong>PCI with DES demonstrated a high survival rate in North Indian patients with SVD. Key predictors of mortality were age, history of hospitalization, and post-PCI symptoms, emphasizing the need for long-term follow-up and aggressive management of symptoms to improve outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"21-24"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634178","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":"Scrub Saccadomania: An Enigma of Eye Movement in the Tropics.","authors":"Jayaram Saibaba, Chandni Chandramouli, Deepak Amalnath, Dks Subrahmanyam","doi":"10.59556/japi.73.0872","DOIUrl":"10.59556/japi.73.0872","url":null,"abstract":"<p><strong>Background: </strong>Opsoclonus myoclonus syndrome (OMS) is a rare neuro-ophthalmic disorder characterized by chaotic, multidirectional saccadic eye movements. It is associated with various etiologies, including infectious and immune-mediated encephalitis. Scrub typhus, caused by <i>Orientia tsutsugamushi,</i> is an uncommon but important, treatable cause of OMS. Here, we present a case of scrub meningoencephalitis presenting with saccadomania as the initial clinical manifestation.</p><p><strong>Objective: </strong>To highlight scrub meningoencephalitis as a potential cause of OMS and emphasize the importance of prompt recognition and early treatment to enhance patient outcomes.</p><p><strong>Materials and methods: </strong>We describe the case of a 32-year-old female presenting with fever, altered sensorium, and saccadomania, along with a characteristic eschar, diagnosed with scrub meningoencephalitis. Clinical, laboratory, and imaging findings, as well as treatment modalities, are presented.</p><p><strong>Results: </strong>The patient demonstrated generalized jerky movements and rapid eye movements in all directions, consistent with saccadomania. Diagnosis was confirmed through positive IgM enzyme-linked immunosorbent assay (ELISA) for scrub typhus and a characteristic eschar. Treatment with doxycycline and dexamethasone resulted in significant symptom improvement within days, with complete resolution by day 10.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering scrub meningoencephalitis as a potential cause of OMS, particularly in endemic regions. Prompt recognition and initiation of appropriate antibiotic therapy, along with adjunctive corticosteroids, are crucial for favorable patient outcomes. Increased awareness among clinicians can lead to timely diagnosis and management, preventing potential neurological sequelae associated with this treatable condition.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e39-e40"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634128","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":"Hypertension-mediated Organ Damage Care in India Go-Real (<u>G</u>uidelines t<u>O</u> <u>Real</u> World) Application: Expert Opinion.","authors":"Baishali Nath, Prabhakar Dorairaj, Tiny Nair, Ajay Aurora, Shantanu Sengupta, U P Sharma","doi":"10.59556/japi.73.0877","DOIUrl":"10.59556/japi.73.0877","url":null,"abstract":"<p><p>Hypertension is a global health concern. India alone is home to an estimated 220 million adults with hypertension. Only one in three Indians received a diagnosis for hypertension, less than one in five were treated, and only one in 12 achieved blood pressure control. Such patterns of undiagnosed, untreated, and uncontrolled hypertension all contribute to an increased risk of hypertension-mediated organ damage (HMOD). The presence of HMOD is related to increased vascular risk and mortality, further worsening the brunt of hypertension. HMOD can predominantly affect the heart, kidney, brain, and eye. An early and timely assessment of HMOD can help in appropriate cardiovascular risk stratification and applying effective treatment strategies. The international and national guidelines' recommendations for assessment of HMOD in hypertension are very comprehensive. While they are appropriate to be applied universally, there are challenges to following them for HMOD assessment in real-world practice settings in India. The aim of this expert opinion and review is to simplify the HMOD assessment modalities such that they are actionable and consistently applicable across diverse cardiology practice settings in a cost-effective way in India. The paper encompasses certain novel tools that may help in HMOD assessment in a larger hypertensive population, developed under the guidance of Indian cardiologists, nephrologists, neurologists, and ophthalmologists. The HMOD assessment for each organ-namely heart, kidney, brain, and eye-has been categorized into \"essential\" and \"optimal\" for practical purposes. The ultimate vision of this document is to simplify HMOD assessment and ensure that clinicians are able to conduct \"essential\" assessment in most eligible hypertensive patients and timely refer them to a specialist when more comprehensive assessment is needed, with an ultimate endeavor to reduce the burden of HMOD and its sequelae in the country.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e7-e21"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634724","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":"Spectrum of Clinical Manifestations in Patients of Scleroderma and Correlation between Cutaneous and Pulmonary Involvement.","authors":"Jyotsna Oak, Ojas Unavane, Rupali Mathur","doi":"10.59556/japi.73.0855","DOIUrl":"10.59556/japi.73.0855","url":null,"abstract":"<p><strong>Purpose: </strong>Our research aimed at characterizing the range of signs and symptoms observed in scleroderma patients at a tertiary care hospital and investigating potential correlations between pulmonary and cutaneous involvement.</p><p><strong>Materials and methods: </strong>We obtained informed consent from scleroderma patients for conducting a comprehensive clinical assessment, including detailed medical histories and physical examinations. Standard diagnostic investigations like complete blood counts, erythrocyte sedimentation rate, renal function, liver function, electrocardiograms (ECG), high-resolution computed tomography (HRCT) scans, and pulmonary function tests were performed. The modified Rodnan skin score (mRSS) was used to assess skin involvement.</p><p><strong>Results: </strong>About 74 (71.2%) patients had diffuse cutaneous systemic scleroderma (dcSSc), while 30 (28.8%) patients had limited cutaneous scleroderma (lcSSc). 96 (92.3%) patients had Raynaud's phenomenon. About 68 (65.4%) patients had mild mRSS, while 26 (25%) and 10 (9.6%) patients had moderate and severe mRSS, respectively. Skin tightening (88.4%) and sclerodactyly (88.4%) were the most common cutaneous manifestations, followed by digital ulcers and pits (57.7%), diffuse edema of hands and feet (38.4%), salt-and-pepper skin (38.4%), calcinosis (30.8%), telangiectasia (25%), and contractures (19.2%). Pulmonary manifestations showed interstitial lung disease (ILD) in 62 (59.6%) patients and pulmonary hypertension (PH) in 14 (13.5%) patients. 8 (7.7%) patients had ILD with PH. 48 (46.2%) and 18 (17.3%) patients with dcSSc had mild and moderate mRSS, respectively, while 8 (7.7%) patients had severe mRSS. About 20 (19.2%) and 8 (7.7%) patients with lcSSc had mild and moderate mRSS, respectively, while 2 (1.9%) patients had severe mRSS. There was no significant correlation of mRSS and subtypes of scleroderma patients. The mean mRSS score in ILD was low in comparison to the mRSS score in patients with PH (25.7 ± 8.90 vs 28.9 ± 7.62). There was a significant correlation of mRSS and pulmonary involvement as indicated by the Student's <i>t</i>-test (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>In systemic sclerosis (SSc) patients, the emergence of severe systemic complications such as pulmonary arterial hypertension and ILD can manifest regardless of disease duration or subtype. Symptoms might not consistently align with disease advancement. Therefore, a thorough evaluation that incorporates symptoms and specialized diagnostic tests, such as pulmonary function tests, echocardiography (ECHO), and HRCT, is crucial for early identification, timely treatment, and better prognosis. The mRSS serves as a valuable clinical instrument for monitoring scleroderma progression.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634221","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}