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

{"title":"Biologics and Tuberculosis Preventive Therapy.","authors":"Aloke G Ghoshal, Arup Halder","doi":"10.59556/japi.73.0847","DOIUrl":"10.59556/japi.73.0847","url":null,"abstract":"<p><p>Biologics have revolutionized the management of systemic inflammatory disorders in the last few decades. The most common side effect associated with these agents is increased susceptibility to infection. Increased risk of tuberculosis (TB) reactivation in patients with latent tuberculosis infection (LTBI) has been recorded for anti-tumor necrosis factor (TNF) agents and, to a lesser extent, for the nonanti-TNFα targeted biologics. Use of both biologic agents and Janus kinase (JAK) inhibitors is associated with increased risk of TB disease. LTBI screening prior to initiation of a biologic agent or JAK inhibitor and treatment of positive cases significantly reduces the incidence of TB disease, though it does not eliminate it. Several recommendations and guidelines have been published, but none of them apply globally due to variable socioeconomic conditions and endemicity of TB in different countries. At present, we have a national guideline in India from the National Tuberculosis Elimination Programme (NTEP) in the form of Guidelines for Programmatic Management of Tuberculosis Preventive Therapy in India (PMTPT), which mandates TB screening and treatment for patients on immunosuppressive therapy and anti-TNF treatment. However, PMTPT is essentially a general recommendation. Clinicians need to be abreast of the integration of this approach with the variable risks of TB reactivation associated with different biologics in clinical practice.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"67-72"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634680","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":"Kidney and Lungs: Do they Cross-talk?","authors":"Sanchit Mohan, Pranav Ish, Pallavi Prasad, Sourabh Sharma, Nupoor Vaghasia, Vidushi Rathi, Himanshu Verma, Vivek Kute","doi":"10.59556/japi.73.0860","DOIUrl":"10.59556/japi.73.0860","url":null,"abstract":"<p><p>The kidneys and lungs, often studied in isolation, are integral organs in maintaining homeostasis within the human body. However, the lung and kidney have multiple shared physiological and pathological pathways. It is important to understand these complex interactions and the cross-talk to manage patients, especially in critical care. This review delves into the intricate relationship between the kidneys and lungs, shedding light on how dysfunction in one organ can profoundly impact the other. It explores shared mechanisms, molecular mediators, and clinical implications, demonstrating the significance of understanding this cross-talk. By elucidating the nuanced interplay between the kidneys and lungs, we hope to pave the way for more holistic approaches to the diagnosis and treatment of diseases, ultimately enhancing patient care.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634740","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":"Management of Vasodilatory Shock: A Concise Review.","authors":"Utkarsh Shah, Shahnawaz Siddiqui, Shivam Chopra, Amit Shrawankar, Sajal Bansal","doi":"10.59556/japi.73.0880","DOIUrl":"10.59556/japi.73.0880","url":null,"abstract":"<p><p>Vasodilatory shock is a severe circulatory disorder characterized by excessive vasodilation, resulting in impaired tissue perfusion and organ dysfunction. The condition arises from dysregulated vasodilation and reduced vascular responsiveness to endogenous vasoconstrictors, disrupting normal vasoregulatory mechanisms. This review delves into the complex pathophysiology, clinical significance, and treatment approaches for vasodilatory shock. It offers a comprehensive summary of established and emerging pharmacological and nonpharmacological therapies. Designed for clinicians and researchers, this article consolidates critical insights to improve the understanding and management of vasodilatory shock.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"53-57"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634744","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 Rare Presentation of Rheumatic Heart Disease: Severe Pulmonary Tricuspid and Mitral Stenosis Successfully Treated by Triple Balloon Valvuloplasty.","authors":"Jitendra K Rai, Vivek Tripathi, Neelesh Mehrotra, Dp S Rajput, Jai Gavli, Adarsh Bajpai","doi":"10.59556/japi.73.0873","DOIUrl":"10.59556/japi.73.0873","url":null,"abstract":"<p><p>This case report describes a unique occurrence of rheumatic heart disease (RHD) with severe mitral, tricuspid, and pulmonary stenosis in a 17-year-old female. The patient presented with progressive exertional dyspnea and dependent edema. She had a history of acute rheumatic fever and joint pain 5 years ago. Evidence of congestive heart failure, such as pitting pedal edema, hepatomegaly, and elevated jugular venous pressure, was noted on presentation. The electrocardiogram (ECG) revealed important diagnostic information and signs consistent with right ventricular and right atrial enlargement. Chest radiography revealed cardiomegaly with an uplifted cardiac apex and elongation of the right heart border (enlargement of the right atrium and right ventricle). Echocardiography was suggestive of severe pulmonary, tricuspid, and mitral stenosis with mild mitral and tricuspid regurgitation. The patient's prognosis remained challenging, but she had dramatic symptomatic improvement after percutaneous triple valve balloon valvuloplasty. She was discharged after 5 days without any complications.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"101-103"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634626","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":"ANCA Negative Vasculitis Manifesting as Pulmonary-Renal Syndrome in a Patient with Chronic Osteomyelitis.","authors":"Anjana Jangid, Rahul Kumar, Tanvi Batra, Atul Kakar","doi":"10.59556/japi.73.0866","DOIUrl":"10.59556/japi.73.0866","url":null,"abstract":"&lt;p&gt;&lt;p&gt;A man in his early 60s, with a history of obstructive airway disease and hypertension, had a fall from a height 1 year ago. He developed a fracture of the left distal tibia and fibula, for which open reduction and internal fixation (ORIF) was done. Since then, he has had persistent pain and discharge from the implant site, for which multiple antibiotics were given and debridement was done numerous times. Three months ago, he was admitted to an outside hospital with similar complaints, and a pus culture grew methicillin-resistant &lt;i&gt;Staphylococcus aureus.&lt;/i&gt; The patient gave a history of sudden onset right upper and lower limb weakness associated with slurring of speech, which recovered in &lt;24 hours. A magnetic resonance imaging (MRI) of the brain revealed multiple thromboembolic acute infarcts. The patient now presented with high-grade fever, cough with expectoration, and shortness of breath (grade 3 mMRC) for 5 days. On examination, he was febrile, tachycardic, with a saturation of 92% on room air. Systemic examination revealed bilateral infrascapular crepitations and a mid-ejection systolic murmur in the aortic area. Laboratory investigations revealed leukocytosis, raised creatinine, and inflammatory markers. A chest X-ray done on day 1 revealed cardiomegaly. An X-ray of the left lower limb revealed changes of chronic osteomyelitis (Fig. 1). Blood, urine, and sputum cultures were sterile. An ultrasonography (USG) of the whole abdomen showed a splenic infarct with 190cc liquefaction. A 2D echocardiography revealed severe aortic stenosis. A plain computed tomography (CT) of the chest/abdomen showed moderate pleural effusion bilaterally with collapse/consolidation in both lungs. There was evidence of hypodense fluid density with internal hyperdense content and lobulated margins seen in the spleen. An USG-guided splenic infarct aspiration was done, which was sterile. Sequestration and debridement of the lower limb wound were done, and the culture revealed &lt;i&gt;Acinetobacter baumannii.&lt;/i&gt; On day 12, the patient had an episode of macroscopic hematuria, which resolved spontaneously. The coagulation profile was normal. On day 14, a similar episode reoccurred. In view of hematuria, resistant hypertension, worsening fluid overload, rising 24-hour urinary protein, and creatinine, a differential of nephrotic vs nephritic syndrome was made. The patient was stabilized with antibiotics, blood transfusion, and dialysis, and we proceeded with a kidney biopsy. The kidney biopsy revealed crescentic glomerulonephritis (Figs 2A and (B). Mild tubular atrophy and inflammation, as well as fibrosis of the interstitium, were also seen. Immunofluorescence revealed IgM positivity, and the rest (mesangial, IgG, IgA, C3, C1q, Kappa, and Lambda) were negative. ANA (IF), ANA profile, c-ANCA, p-ANCA were negative, and ASO titers were normal. The patient then developed massive hemoptysis. The coagulation profile and platelet counts were repeated, which were normal. A ches","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634671","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":"Cola-colored Cerebrospinal Fluid: A Case of Reversible Cerebral Vasoconstriction Syndrome.","authors":"Abhishek Thakkar, Pradip Patel, Vipul Khandelwal, Dev Kumar Jain, Vipin Ola, Amit Mehta","doi":"10.59556/japi.73.0881","DOIUrl":"10.59556/japi.73.0881","url":null,"abstract":"<p><p>Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headache and multifocal cerebral arterial constriction, which can be associated with pregnancy and exposure to certain vasoactive agents. It is usually evoked by triggering agents in 80% of cases. RCVS can present with focal deficits or new-onset seizure in 8-43% and 1-17% of cases, respectively. RCVS is more common than it is thought to be. Thunderclap headaches can persist for a few weeks and occur daily, lasting for 1-3 hours. Potential complications are nonaneurysmal cortical subarachnoid hemorrhage (SAH), lacunar infarcts, posterior reversible encephalopathy syndrome, and intracranial hemorrhage. Diagnosis of RCVS requires a high level of suspicion. The RCVS2 score can be used even before angiographic changes are documented in suspected cases of RCVS. We report a case of a 35-year-old postpartum female patient with RCVS, ischemic stroke, and nonaneurysmal SAH before definite cerebral vasoconstriction documentation.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e41-e43"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634707","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":"Vonoprazan in Management of Refractory Gastroesophageal Reflux Disease: An Indian Expert Group Consensus Statements.","authors":"Philip Abraham, Gouradas Choudhuri, Sharad Deshmukh, Manish Kak, Mangesh Tiwaskar, Rakesh Kochhar, S K Sinha, S C Panigrahi, Rajeev Shandil, Molina Khanna, Ramesh Garg, G S Lamba, Monika Jain, Prateik Poddar, Ajay Mishra, Apurva Shah, Chetan Kantharia, Hardik Shah, Indraneel Saha, Khurshid Vazifdar, Lokesh Jain, Nitin Borse, Pallavi Garg, Manoj Kumar, Manoj Sahu, Preetam Nath, Rajdeep Singh, Vikram Sahu, Sanjay Bandyopadhyay, Saurabh Jaiswal, Dinesh Patil, Shripad Bodas, Smit Vaghasia, Sudeep Khanna, Onkar C Swami, Suneel Chakravarty, K Vamsi Murthy, Vinod Kumar","doi":"10.59556/japi.73.0878","DOIUrl":"10.59556/japi.73.0878","url":null,"abstract":"<p><strong>Background: </strong>Approximately, 40% of gastroesophageal reflux disease (GERD) patients experience insufficient symptom relief from proton-pump inhibitors (PPI), resulting in PPI-refractory GERD (rGERD).</p><p><strong>Objective: </strong>To review the existing literature and develop an Indian expert group consensus statement on the place of vonoprazan in the management of rGERD.</p><p><strong>Materials and methods: </strong>A panel of 35 leading Indian gastroenterologists extensively reviewed the literature to develop consensus statements for the management of rGERD in Indian patients, with a focus on the newly available potassium-competitive acid blocker (P-CAB), vonoprazan. This process involved two structured meetings in which experts deliberated on literature reviews and draft statements, which were further rigorously discussed and modified. Consensus was achieved through a voting process employing a five-point Likert scale, with results meticulously documented. The final statements unanimously approved by all participants and subsequently developed into a comprehensive manuscript.</p><p><strong>Results: </strong>Based on the evidence, 14 statements were developed and confirmed by expert panelists for the assessment and management of rGERD. Among these 14 statements, 5 obtained Level A evidence, 4 received Level B, 4 were classified as Level C, and 1 as Level D. The consensus highlights the importance of symptom assessment, lifestyle modifications, and medication adherence, followed by a diagnostic procedure with upper gastrointestinal (GI) endoscopy. If needed, manometry or 24-hour pH impedance may be considered. Vonoprazan, a novel and reversible potassium-competitive acid blocker (P-CAB), has emerged as a potential alternative to proton pump inhibitors (PPIs), offering rapid, potent, and sustained acid suppression. Based on current evidence, a daily dose of 20 mg vonoprazan for 4-8 weeks is recommended as an initial treatment strategy for rGERD.</p><p><strong>Conclusion: </strong>The consensus endorses the use of vonoprazan to improve patient outcomes and quality of life, highlighting its important place in therapy for controlling rGERD in Indian patients.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e29-e36"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634491","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 Stitch in Time Saves Nine.","authors":"Harsh Yadav, Kranti Garg, Vishal Chopra","doi":"10.59556/japi.73.0863","DOIUrl":"10.59556/japi.73.0863","url":null,"abstract":"<p><p>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure is nowadays routinely used for diagnostic sampling of mediastinal lymph nodes. Fracture of the needle during the procedure has rarely been reported in the past. This reports the successful retrieval of the broken fragment of the needle using a snare through a fiberoptic bronchoscope. The accidental breakdown of the needle was encountered while performing EBUS-TBNA from the subcarinal lymph node. The cardinal management in such emergencies in resource-constrained settings can be accomplished by maintaining calm, using multiple instruments judiciously in different combinations, and tapping the potential expertise of the team to the fullest.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"94-95"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634657","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":"Pseudomedian Claw Hand in Cortical Infarct: A Case Report.","authors":"Somarajan Anandan, Jyothish P Kumar, Divine S Shajee","doi":"10.59556/japi.73.0861","DOIUrl":"10.59556/japi.73.0861","url":null,"abstract":"<p><p>Isolated hand weakness due to stroke is rare and is often misdiagnosed as a peripheral lesion. Isolated central hand and finger weakness can present as pseudomedian, pseudoulnar, and/or pseudoradial nerve palsy. Here, we describe a patient who presented with a median claw hand due to cortical infarct.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"90"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633615","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":"Correlation of Cytomorphology Pattern in Tuberculous Lymphadenitis with Microbiological Studies.","authors":"Yasmeen Khatib, Vaz G Sheldon, Jayashri Chaudhari, Prajakta Gupte, Manisha Khare, Yogita Sable, Richa Patel, Vinaya Shah","doi":"10.59556/japi.73.0871","DOIUrl":"10.59556/japi.73.0871","url":null,"abstract":"<p><strong>Background: </strong>Fine needle aspiration cytology (FNAC) is commonly used in the primary workup of suspected tuberculous lymphadenitis. Microbiological studies are essential for confirmation of diagnosis and drug resistance. However, the sensitivity of individual microbiological tests is low. We undertook this study to analyze the different cytomorphological patterns of tuberculous lymphadenitis and to compare the role of Ziehl-Neelsen (ZN) stain, Auramine-Rhodamine (AR) stain, <i>Mycobacterium</i> Growth Indicator Tube Culture (MGIT), and Cartridge-Based Nucleic Acid Amplification Testing (CBNAAT) in the detection of <i>Mycobacterium tuberculosis</i> with the final outcome.</p><p><strong>Materials and methods: </strong>It was a prospective study of 100 clinically suspected cases of tuberculous lymphadenitis that underwent fine needle aspiration. Clinical details were noted. The material obtained was analyzed for cytology, ZN stain, AR stain, MGIT, and CBNAAT.</p><p><strong>Result: </strong>Out of 100 cases, 94 cases were of tuberculous lymphadenitis. In this group, 34 showed granulomatous pattern, 10 showed caseation, 41 showed necrotizing granulomas, 4 showed suppurative pattern, and 4 were reactive. The remaining five cases were reactive nodes, and one case was of metastatic squamous cell carcinoma. On microbiological studies, 16 (17.02%) were positive for AR staining, 7 for ZN staining, 43 (45.74%) cases for CBNAAT, and 56 out of 94 (59.57%) were positive for MGIT. Sensitivity increased to 94.7% after combining the results of cytomorphology and all four microbiological tests.</p><p><strong>Conclusion: </strong>The sensitivity of individual microbiological tests is low. Hence, a combination of cytomorphology with CBNAAT and MGIT is recommended for the diagnosis of tuberculous lymphadenitis, microbiological confirmation, and detection of resistance for optimum patient management.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 3","pages":"e1-e6"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634687","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}