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

{"title":"Prevalence and Predictors of Neurocognitive Impairment, Fatigue, and Health-related Quality of Life in Patients with HIV/AIDS.","authors":"Arpita Raj, Pulin Kumar Gupta, Akhilesh Kumar, Anshit Budhiraja","doi":"10.59556/japi.74.1441","DOIUrl":"https://doi.org/10.59556/japi.74.1441","url":null,"abstract":"<p><strong>Background: </strong>People living with human immunodeficiency virus (PLHIV) are known to have decreased quality of life (QoL), increased fatigue, and neurocognitive dysfunction. In India, the prevalence and predictors of the same are not explored. We aim to determine the prevalence and predictors of neurocognitive impairment (NCI), fatigue, and health-related QoL among PLHIV in India.</p><p><strong>Setting: </strong>The study was conducted among people attending an antiretroviral therapy center in a tertiary care hospital in New Delhi after ethical approval.</p><p><strong>Materials and methods: </strong>We enrolled consented patients and used the Montreal Cognitive Assessment (MoCA), Multidimensional Assessment of Fatigue (MAF) scale, and 36-item Short Form (SF-36) survey to assess NCI, fatigue, and health-related QoL (HRQoL), respectively.</p><p><strong>Results: </strong>A total of 100 PLHIV with a mean age of 42.0 ± 9.6 years were enrolled, with 48% females. 47 patients (47%) had NCI with a MoCA score <26. Male gender, PLHIV with <5 years of treatment, and <50 years of age had higher MoCA scores. MoCA scores had a negative correlation with age and MAF scores and a positive correlation with SF-36 scores. 55 patients (55%) suffered from fatigue, with lesser fatigue scores for males. Fatigue scores had a negative correlation with SF-36 scores. 71 patients (71%) had total SF-36 scores >50 with males having higher scores. Fatigue had a negative correlation on QoL, <i>r</i> = -0.831.</p><p><strong>Conclusion: </strong>In India, the prevalence of NCI, fatigue, and decreased QoL is higher compared to other populations. Management strategies in HIV require interventions to improve NCI, fatigue, and QoL along with antiretroviral therapy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445172","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":"Infective Myositis with Guillain-Barré Syndrome in <i>Enterococcus</i> Infection.","authors":"Amit K Singh, Anwesha Sohrab, Arnab Bhattacharjee, Alamgir Shaikh","doi":"10.59556/japi.74.1140","DOIUrl":"https://doi.org/10.59556/japi.74.1140","url":null,"abstract":"<p><p>Acute myositis and Guillain-Barré syndrome (GBS) occurring together in a single patient is a rare clinical phenomenon that poses both diagnostic and therapeutic challenges. This article discusses the pathophysiology and clinical presentation of these two neuromuscular disorders. The simultaneous occurrence of infectious myositis and GBS is uncommon, and the identification of Enterococcus as the causative agent is even rarer. In this report, we describe a case involving a middle-aged female who presents with both acute infectious myositis and GBS.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445217","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 Prospective 1-Year Study of Renal Recovery in Pigment Nephropathy: Insights Beyond the Acute Phase.","authors":"Prem Shankar Patel, Archana, Pinki Kumari, Prit Pal Singh, Om Kumar","doi":"10.59556/japi.74.1413","DOIUrl":"https://doi.org/10.59556/japi.74.1413","url":null,"abstract":"<p><strong>Background: </strong>Pigment nephropathy is an underrecognized cause of acute kidney injury. Data from northern India is scarce. The present study aims to assess the clinical characteristics and outcomes of pigment nephropathy in this region.</p><p><strong>Materials and methods: </strong>We analyzed the demographics, etiology, and outcomes of 20 patients with biopsy-proven pigment nephropathy.</p><p><strong>Results: </strong>The mean age was 27.75 years (range: 13-52), with a male-to-female ratio of 18:2. The average peak serum creatinine was 12.09 mg/dL (range: 0.84-22.3). Rhabdomyolysis was identified in 14 (70%) and hemolysis in 6 patients (30%). The rhabdomyolysis was attributed to hypokalemia, infection, strenuous exercise, physical trauma, inflammatory myositis, neuroleptic malignant syndrome, and heat stroke. The hemolysis was caused by paroxysmal nocturnal hemoglobinuria, thrombotic microangiopathy, transfusion reaction, rifampicin, and physical stress. The majority of patients (85%) required hemodialysis, with a mean of 6 sessions (range: 3-17). The mean duration of hospitalization was 15.3 days (range: 4-30), and the average time to renal recovery was 3.1 weeks (range: 2-6). All 20 patients survived and achieved complete renal recovery. Of the 20 patients, 13 completed at least 1 year of follow-up, 4 were lost to follow-up, and 3 remain under observation. At 1 year, all 13 patients had normal serum creatinine. None progressed to chronic kidney disease.</p><p><strong>Conclusion: </strong>Of 20 patients (4.1%) with pigment-induced acute kidney injury (AKI), 70% had myoglobin- and 30% hemoglobin-induced nephropathy. Common causes included hypokalemia, infection, strenuous activity, and paroxysmal nocturnal hemoglobinuria. Hemodialysis was required in 85%, with an average hospital stay of 15.3 days. Among 13 patients with a 1-year follow-up, none developed chronic kidney disease. Overall prognosis appears favorable; however, larger studies with extended follow-up are needed to better characterize long-term outcomes in pigment nephropathy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445274","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":"iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity: Focus on Prevention and Treatment of Cardiometabolic Disease.","authors":"Stefan D Anker, Linong Ji, Tammy Kindel, Andrew Js Coats, Dike Ojji, Adriana Puente Barragán, Peter Rossing, Shelley Zieroth, Shaaf Ahmad, Shariq Usman, Geeta Appannah, Alison L Bailey, Ahmed Bennis, Andrea Brandao, Javed Butler, Melanie J Davies, Lubomira Fabryova, Yuan-Lin Guo, Hidetaka Itoh, Uday M Jadhav, Carel W Le Roux, Fausto J Pinto, Julio Rosenstock, Banshi Saboo, Hani Sabbour, Mangesh Tiwaskar, Karol E Watson, Kwang Wei Tham, Fernando Stuardo Wyss, Walter P Abhayaratna, William T Abraham, Wael Al Mahmeed, Alessia Argirò, John J Atherton, Danielle Belardo, Raquel Campuzano, Nandini Chatterjee, Vijay Chopra, Marc-André Cornier, Sarah Davies, Clemencia de Rueda Panadero, Anastase Dzudie, Ty J Gluckman, Muhammad Shahzeb Khan, Kamlesh Khunti, Yuri Lopatin, Zhiyi Ma, Okechukwu S Ogah, Abraham Oomman, Emilio S Peralta Lopez, Ping Li, Paul Poirier, Julie Redfern, Giuseppe Mc Rosano, Amit Saraf, Sameh Shaheen, Subodh Verma, Stephan von Haehling, Yuhui Zhang, Martha Gulati, Naveed Sattar, Jose Luis Zamorano","doi":"10.59556/japi.74.1445","DOIUrl":"10.59556/japi.74.1445","url":null,"abstract":"<p><p>There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints, and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and-most importantly-also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such \"economic adjustment\" recommendations aim to guide situations when \"Resources are somewhat limited\" or when \"Resources are severely limited.\" Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3E","pages":"e1-e16"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445218","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":"Clinicomycological Profile and <i>In Vitro</i> Antifungal Activity of Terbinafine and Griseofulvin against Clinical Isolates of Dermatophytes in a Tertiary Care Hospital.","authors":"Rajni J Jaishma, S Pramodhini, Sheela Kuruvila, R Latha, K Kavitha, Sherief Shebeena","doi":"10.59556/japi.74.1412","DOIUrl":"https://doi.org/10.59556/japi.74.1412","url":null,"abstract":"<p><strong>Background: </strong>Dermatophytes, primarily <i>Epidermophyton</i> spp., <i>Trichophyton</i> spp., and <i>Microsporum</i> spp., are responsible for superficial cutaneous mycoses, estimated to affect 20-25% of the people worldwide. The rise of antifungal resistance, especially to terbinafine, has made treating dermatophytosis increasingly difficult. This study aims to assess the clinical and mycological characteristics of dermatophytosis cases and evaluate the <i>in vitro</i> susceptibility of dermatophyte isolates to terbinafine and griseofulvin.</p><p><strong>Materials and methods: </strong>A total of 118 samples were studied from patients with clinical suspicion of dermatophytosis. The samples were processed for KOH mount and fungal culture for further speciation. Susceptibility to terbinafine and griseofulvin was assessed using the microbroth dilution technique, following the guidelines established by the Clinical and Laboratory Standards Institute (CLSI).</p><p><strong>Results: </strong>Tinea corporis (57.6%) appeared as the leading symptomatology in our study, followed by tinea cruris (10.2%). KOH positivity was higher (70.3%) compared to positivity by culture (16.9%). <i>Trichophyton mentagrophytes</i> was the predominant species (85%) isolated, followed by <i>Trichophyton violaceum</i> (10%) and <i>Microsporum gypseum</i> (5%). Terbinafine resistance was observed in over 60% of <i>T. mentagrophytes</i> isolates, with moderate resistance detected in <i>T. violaceum</i>. Griseofulvin showed moderate resistance in <i>T. mentagrophytes</i> and higher resistance in <i>T. violaceum</i>.</p><p><strong>Conclusion: </strong>This study highlights the increased resistance of T. mentagrophytes to terbinafine and T. violaceum to griseofulvin, stressing the critical role of routine susceptibility profiling. The findings highlight the growing challenge of antifungal resistance in dermatophytes and the importance of optimizing diagnostic and treatment strategies to improve patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445023","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":"Complicated Seronegative Neuromyelitis Optica Longitudinally Extensive Transverse Myelitis in Elderly: A Diagnostic Dilemma.","authors":"Sudipto Chakraborty, Samya Sengupta, Sanjay Bhaumik, Dhiman Sen","doi":"10.59556/japi.74.1431","DOIUrl":"https://doi.org/10.59556/japi.74.1431","url":null,"abstract":"<p><p>A 69-year-old gentleman without any previous comorbidities presented with complaints of acute-onset low-grade fever, one episode of loss of consciousness, and weakness of both legs with urinary and stool retention for 1 day. He had an episode of generalized tonic-clonic seizure 3 hours after admission. On examination, he had tachycardia and hypotension; Glasgow Coma Scale (GCS) was E3V2M4, and neurological examination was suggestive of bilateral lower limb upper motor neuron lesion in the shock stage. Blood investigation revealed severe hyponatremia, and magnetic resonance imaging (MRI) with contrast of the dorsolumbar spine revealed longitudinally extensive transverse myelitis (LETM). Blood investigation for antineuromyelitis optica (anti-NMO) antibody was negative. Other investigations revealed low serum osmolality, raised urine osmolality, and spot sodium. Cerebrospinal fluid (CSF) viral panel detected human herpesvirus 6 (HHV6). He was treated with a pulse dose of IV methylprednisolone, hypertonic saline, and IV levetiracetam. He had symptomatic improvement and was discharged with a tapering dose of oral prednisolone. He had a complete recovery after 3 months of regular follow-up. Thus, we report a case of HHV6-induced LETM complicated with cerebral salt wasting syndrome and hyponatremic seizures.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"48-50"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445085","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":"Implications of Acetylator Status and Therapeutic Drug Monitoring of Plasma Rifampicin and Isoniazid Concentrations among Indians.","authors":"Prerna R Arora, Rohan V Lokhande, Prasad R Naik, Alpa J Dherai, Zarir F Udwadia, Lancelot Pinto, Ayesha Sunavala, Rajeev Soman, Jignesh Patel, Camilla Rodrigues, Tester F Ashavaid","doi":"10.59556/japi.74.1425","DOIUrl":"https://doi.org/10.59556/japi.74.1425","url":null,"abstract":"<p><strong>Introduction: </strong>Low or abnormal plasma concentrations of anti-tuberculosis drugs can be a major reason for treatment failure or the emergence of drug resistance. Acetylator status, which affects drug metabolism, plays a key role in determining drug bioavailability. This study aimed to perform therapeutic drug monitoring (TDM) of rifampicin and isoniazid and to evaluate the correlation between plasma drug concentrations and acetylator status among Indian patients receiving first-line antituberculosis therapy.</p><p><strong>Methods: </strong>Plasma concentrations of rifampicin and isoniazid were measured using in-house standardized high-performance liquid chromatography methods, while acetylator status was determined by conventional PCR of NAT2 gene.</p><p><strong>Results: </strong>Peak concentrations were estimated from 125 patients on first-line tuberculosis (TB) treatment. Among these, 56% exhibited subtherapeutic rifampicin concentrations and 28% had subtherapeutic isoniazid concentrations. Conversely, above normal (potentially toxic) concentrations were seen in 2% and 21% for rifampicin and isoniazid, respectively. Despite receiving the standard TB treatment regimen, only 62% of patients improved clinically, while 38% of patients continued harboring TB signs and symptoms, among which 6 patients (5%) developed rifampicin resistance during the treatment course. About 44% were slow acetylators, followed by 40% intermediate and 16% rapid acetylators. The acetylator status significantly influenced the plasma concentrations of both drugs. Slow acetylators had significantly higher isoniazid concentrations (p = 0.004) and lower rifampicin concentrations (p = 0.01) as compared to rapid acetylators.</p><p><strong>Conclusion: </strong>Abnormal concentrations of rifampicin and isoniazid are prevalent and a major concern. Acetylator status influences plasma concentrations of rifampicin and isoniazid. Hence, determining acetylator status and performing TDM could be instrumental in optimizing and improving TB outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"46-50"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445156","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 the Editor Regarding \"A Clinicoradiological and Bacteriological Profile of Community-acquired Pneumonia in a Tertiary Care Center in Eastern India\".","authors":"Atulya Anand, Mithun Nilgiri","doi":"10.59556/japi.74.1416","DOIUrl":"https://doi.org/10.59556/japi.74.1416","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"108-109"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445174","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":"Two Syndrome Progressing to Nine Syndrome.","authors":"Somarajan Anandan, Sajeesh S Rajendran, Jyothish P Kumar, Joesni Joy, Sisira S Rajan","doi":"10.59556/japi.74.1146","DOIUrl":"https://doi.org/10.59556/japi.74.1146","url":null,"abstract":"<p><p>Internuclear ophthalmoplegia with ipsilateral horizontal gaze palsy is called one and a half syndrome. There are a number of numerical one and a half spectrum disorders. One such syndrome is nine syndrome, which is characterized by one and a half syndrome, ipsilateral lower motor neuron type facial palsy, and contralateral hemiparesis or hemihypesthesia or hemiataxia. Here we describe a case of nine syndrome with left one and a half syndrome, left lower motor neuron type facial palsy, and right hemiataxia.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"32-33"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445190","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 Unlikely Duo: Tuberculous Lymphadenitis Leading to Secondary Amyloidosis in a Young Patient.","authors":"Vraj D Bhatt, Abulkalam A Sirajwala, Minal Shastri, Rajvi D Raval","doi":"10.59556/japi.74.1398","DOIUrl":"https://doi.org/10.59556/japi.74.1398","url":null,"abstract":"<p><p>Amyloidosis is an extremely rare condition with a variety of symptoms that, in extreme situations, can be fatal. Basically a protein misfolding disorder, it is characterized by deposition of insoluble polymeric protein fibrils in tissues and organs. There are different types of amyloidosis; here, we see a case of secondary amyloidosis, which is usually a consequence of a chronic disease. The case is unique, as there are many research projects showing the link of tuberculosis (TB) and secondary amyloidosis, but it is rarely documented because of extrapulmonary TB, which here is tuberculous lymphadenitis, and also here the patient is younger than the mean age. The clinical manifestations of this disease are seen mainly in the renal system, gastrointestinal system, and reticuloendothelial system. For which the management is mainly supportive, along with treatment of the underlying cause.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"51-54"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445238","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}