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

{"title":"Myasthenic Crisis Unmasking Myocardial Infarction with Nonobstructive Coronary Arteries in a Patient with Undiagnosed Myasthenia Gravis.","authors":"Abdeali Ginwala, Vihita Kulkarni, Varun Nivargi","doi":"10.59556/japi.74.1351","DOIUrl":"https://doi.org/10.59556/japi.74.1351","url":null,"abstract":"<p><p>We present a case of a patient with undiagnosed myasthenia gravis presenting in myasthenic crisis. In this case, the patient presented primarily with myocardial infarction with nonobstructive coronary arteries and respiratory failure and was later diagnosed to be in myasthenic crisis. The myasthenic crisis was treated with intravenous immunoglobulin (IVIg) and corticosteroids. Given the inadequate response to IVIg and glucocorticoids, the patient was subsequently administered an anti-CD20 monoclonal antibody in the form of rituximab. The patient responded well to rituximab, and her cardiac function subsequently improved.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"16-17"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445240","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":"Unilateral Facial and Vestibulocochlear Nerve Palsy: A Case Report of a Rare Adverse Effect of Warfarin Therapy.","authors":"Hardik Sheth, Aditya Davhale, Santwana Chandrakar, Priyanka Jadhav, Prashant Purkar, Smita Patil","doi":"10.59556/japi.74.1397","DOIUrl":"https://doi.org/10.59556/japi.74.1397","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial hemorrhage, most often intraparenchymal hemorrhage, is an increasingly common and fatal complication of warfarin-induced coagulopathy. Warfarin remains the anticoagulant of choice in valvular atrial fibrillation. However, warfarin has a narrow therapeutic index. Extra axial hemorrhage due to warfarin-induced coagulopathy is a rare adverse event. We present a rare case of right vestibulocochlear and lower motor neuron (LMN) facial palsy secondary to an intracranial bleed along the cerebellopontine angle.</p><p><strong>Case description: </strong>A 36-year-old woman presented with headache, giddiness, sudden onset of right-sided hearing loss, and left-sided deviation of the angle of the mouth. Symptoms had developed acutely over 4 hours. She was diagnosed with mitral stenosis at 8 years of age and had undergone mitral valve repair 2 years before presentation, after which she was started on warfarin. She was lost to follow-up for over a year and on presentation had right-sided sensorineural hearing loss along with features such as difficulty raising her right eyebrow, inability to close her right eye, and water drooling from the right side, all consistent with a right LMN facial palsy and vestibulocochlear nerve palsy. MRI brain showed an extra-axial hemorrhage at the right cerebellopontine angle cisterns.</p><p><strong>Conclusion: </strong>Warfarin-induced intracranial bleeds without involving the parenchyma are a rare event, and through this case, we would like to highlight the importance of timely monitoring of the international normalized ratio (INR) of patients on warfarin therapy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"39-41"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445203","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":"Atherogenic Indices in Newly Diagnosed Obese and Lean Patients of Type 2 Diabetes Mellitus: A Comparative Study.","authors":"Edelbert Anthonio Almeida, Mohit Mehndiratta, Shanmuga Priya Kirubalenin, S V Madhu, Rajarshi Kar","doi":"10.59556/japi.74.1440","DOIUrl":"https://doi.org/10.59556/japi.74.1440","url":null,"abstract":"<p><strong>Background: </strong>Dyslipidemia is one of the driving forces in the pathogenesis of atherosclerosis and its resultant cardiovascular disease. Both these conditions are characterized by an increase in proatherogenic lipids compared to anti-atherogenic lipids. Atherogenic Indices have been developed to predict CVD risk without increasing the cost of testing; however, most of the studies done to date have used these indices in patients who have already suffered a coronary event. Dyslipidemia is most prevalent in cases of type 2 diabetes mellitus (T2DM). Therefore, this study was designed to assess atherogenic risk (via atherogenic indices) in newly diagnosed treatment-naïve obese and lean patients of T2DM.</p><p><strong>Materials and methods: </strong>Treatment-naïve, newly diagnosed patients of T2DM were recruited and grouped into obese (BMI ≥ 25 kg/m²) and lean (BMI <18.5 kg/m²) groups. Blood was collected in a fasting state for the estimation of glycemic parameters and fasting lipid profile. Atherogenic indices (LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and atherogenic index of plasma (AIP)) were calculated using predefined formulas.</p><p><strong>Results: </strong>LDL-C/HDL-C, non-HDL-C, TC/HDL-C, atherogenic coefficient, lipoprotein combined index, and AIP were higher in the obese group compared to the lean group. However, these calculated indices were above the recommended cutoffs in both obese and lean patients with T2DM.</p><p><strong>Conclusion: </strong>This study is the first to document increased atherogenic risk in both obese and lean patients (newly diagnosed) with T2DM. Although CVD risk is higher among the obese patients, aggressive control of plasma lipids is required in all patients with T2DM, irrespective of BMI.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"14-16"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445320","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 Occurrence of Microscopic Polyangiitis and Aortitis.","authors":"Akshat Sahai, Atul Bhasin, Chittimalla Gopinath, Gagan Anand, Rajinder K Singal","doi":"10.59556/japi.74.1138","DOIUrl":"https://doi.org/10.59556/japi.74.1138","url":null,"abstract":"<p><p>We present a case of a 60-year-old male with a fever of unknown origin (FUO) who was ultimately diagnosed with perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)-associated microscopic polyangiitis (MPA) and aortitis. This case underscores the diagnostic intricacies and therapeutic challenges of managing such rare and severe multisystem involvement. It also highlights the critical importance of clinician awareness for prompt recognition and effective management of similar presentations.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"12-15"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445334","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":"Alterations in Serum Electrolytes among Adults with Enteric Fever: A Retrospective Observational Study from a Tertiary Center in New Delhi.","authors":"Shubham Mishra, Sandeep Budhiraja","doi":"10.59556/japi.74.1332","DOIUrl":"https://doi.org/10.59556/japi.74.1332","url":null,"abstract":"<p><strong>Background: </strong>Electrolyte abnormalities are frequent in systemic infections such as enteric fever but remain under-recognized in clinical practice. These disturbances may worsen morbidity if not identified and corrected early.</p><p><strong>Objective: </strong>To determine the prevalence and pattern of serum electrolyte alterations in adult patients hospitalized with enteric fever at a tertiary care center in New Delhi.</p><p><strong>Materials and methods: </strong>This retrospective observational study analyzed records of 128 adult patients (59 males, 69 females) with laboratory-confirmed enteric fever between January 2023 and March 2024. The first admission values for sodium, potassium, chloride, and bicarbonate were extracted from the hospital laboratory system. Results were categorized as low, normal, or high using standard clinical reference ranges. Descriptive statistics were applied, and gender-based comparisons were performed using Chi-square tests for categorical variables and <i>t</i>-tests for continuous measures.</p><p><strong>Results: </strong>Hyponatremia was present in 58.6% (75/128) of patients, while 57.8% (74/128) had low bicarbonate levels consistent with a trend toward metabolic acidosis. In contrast, potassium and chloride values were predominantly normal, with abnormalities occurring in <10% of patients. The mean ± standard deviation (SD) values (mmol/L) were: sodium 132.7 ± 6.2, potassium 4.3 ± 0.6, chloride 101.1 ± 3.7, and bicarbonate 20.3 ± 4.7. No significant gender differences were detected for mean values or abnormality prevalence (all <i>p</i> > 0.17).</p><p><strong>Conclusion: </strong>Hyponatremia and reduced bicarbonate were the most common electrolyte abnormalities in enteric fever, whereas potassium and chloride disturbances were uncommon. Routine electrolyte monitoring should be incorporated into the management of hospitalized enteric fever patients to enable early correction and improved clinical outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"22-25"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445339","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":"Atypical Presentation of Multiple Myeloma as Acute Renal Failure of Unknown Etiology: Two Case Reports.","authors":"Soumya Saxena, Prawash K Chowdhary, Sanjeev A Kale, Manish Agrawal, Anuj Mehta","doi":"10.59556/japi.74.1395","DOIUrl":"https://doi.org/10.59556/japi.74.1395","url":null,"abstract":"<p><p>Multiple myeloma (MM) is a clonal plasma cell proliferative disorder that accounts for 1% of all cancers (Rajkumar). It is a disease of older adults, presenting with anemia, bone pain, and end-organ damage in the form of CRAB features. With increasing awareness regarding this entity and the availability of more-sensitive diagnostic modalities, involvement of younger age-groups with atypical presentations is becoming more common. Newer case series report that nearly 50% of MM cases present initially with renal failure of unknown etiology (Shankar et al.), highlighting the unique role of the nephrologist in the diagnosis of this condition. In these two case reports, we wish to highlight two cases presenting with acute renal failure of unknown etiology, who were subsequently diagnosed to have occult MM with light chain deposition disease (LCDD).</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"29-31"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147443920","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":"Autoimmune Hepatitis and Pregnancy: A Case Report.","authors":"Sayali Tulpule, Vinit Shah, Chaitanya Ganapule, Anuprita Burande, Deepak Phalgune","doi":"10.59556/japi.74.1325","DOIUrl":"https://doi.org/10.59556/japi.74.1325","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) is a long-lasting liver ailment. It causes hepatocellular necrosis and inflammation, leading to fibrosis. It can develop into cirrhosis and liver failure. The disease predominantly affects young to middle-aged women more than men. AIH flares up during gestation and is linked with a high rate of embryonic and maternal problems. With maternal and antenatal care becoming advanced, this disorder should be identified and managed for successful maternal and embryonic outcomes. We present a case report of a primigravida diagnosed with AIH at 14 weeks antenatally. Our main aim in reporting this case is to create general awareness for healthcare professionals and thereby for patients and caregivers about this condition in pregnancy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"18-19"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444162","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":"Dabigatran-induced Gastrointestinal Bleed Treated by 4-factor Prothrombin Complex Concentrate in a Tertiary Care Hospital in Sikkim.","authors":"Mona Dhakal, Om Prakash Dhakal, Nilay Dhakal, Kartikeya Ojha","doi":"10.59556/japi.74.1324","DOIUrl":"https://doi.org/10.59556/japi.74.1324","url":null,"abstract":"<p><p>An immediate need exists for a safe, quick, and effective reversal agent in patients who present with anticoagulant-induced major bleed. Dabigatran, a newer oral anticoagulant and a direct thrombin inhibitor (DTI), can also induce bleeding risk. Idarucizumab is a specific dabigatran reversal drug that the United States Food and Drug Administration (US FDA) has approved in the event of a significant bleeding caused by this drug. In this particular drug-related bleeding, it can be challenging to precisely dose alternative reversal agents like prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs) depending on coagulation characteristics. Additionally, they may result in thromboembolic problems. Despite these drawbacks, the inability to get idarucizumab may necessitate the use of these medications in cases of life-threatening bleeding. We describe the case of a 65-year-old male who reported to the hospital with coagulopathy, anemia, and fresh bleeding per rectum (Hb: 5.8 gm/dL, PT 20.02 seconds, INR: 1.55). He was on dabigatran for the past 1 month. Even after stopping dabigatran, injection of vitamin K, 4 units of blood transfusion, and 8 units of fresh frozen plasma (FFP), he was still bleeding, with fall in hemoglobin level. Following the administration of PCC, he significantly improved, and no additional transfusion products were needed. He could be sent home after 4 days. After 1 month, he returned for follow-up with no further complications.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"20-22"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445146","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":"Study of Thyroid Function in Newly Diagnosed Human Immunodeficiency Virus Patients and Effect of Antiretroviral Therapy on Thyroid Function.","authors":"Satyam Kumar, Poonam Gupta, Ajeet Kumar Chaurasia, Manoj Kumar Mathur, Sharad Varma","doi":"10.59556/japi.74.1429","DOIUrl":"https://doi.org/10.59556/japi.74.1429","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thyroid dysfunction is a frequently overlooked yet clinically significant comorbidity in human immunodeficiency virus (HIV)-infected individuals. The introduction of antiretroviral therapy (ART) has improved life expectancy but has also been associated with metabolic and endocrine disturbances, including thyroid abnormalities. Thyroid dysfunctions such as subclinical hypothyroidism, sick euthyroid syndrome, and overt hypothyroidism are increasingly recognized in both treatment-naïve and ART-experienced patients. However, limited data are available on thyroid function at the time of HIV diagnosis and its evolution following ART initiation, especially in the Indian population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This prospective observational study was conducted at Moti Lal Nehru Medical College, Prayagraj, including 100 newly diagnosed HIV patients aged ≥18 years. Baseline free T3, free T4, TSH, and CD4 were measured prior and 3 months after the start of ART. Statistical analysis was performed using SPSS version 27.0, with paired &lt;i&gt;t&lt;/i&gt;-tests, analysis of variance (ANOVA), and Pearson correlation test to assess the changes and associations between thyroid parameters and ART, CD4 count, and demographic variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study focused on measuring serum free T3, free T4, and TSH levels at baseline and after ART initiation and analyzing their relationship with immunological status as indicated by CD4 count. The study population consisted of 100 individuals with a mean age of 37.29 ± 13.01 years, predominantly male (70%). At baseline, 62% of patients were euthyroid, while the remaining 38% showed thyroid dysfunction, primarily subclinical hypothyroidism and subclinical hyperthyroidism. Following 3 months of ART, the prevalence of thyroid dysfunction increased: euthyroid patients decreased to 41%, and cases of subclinical hypothyroidism, clinical hypothyroidism, and subclinical hyperthyroidism rose noticeably. This shift in thyroid status distribution was statistically significant (Chi-squared test, &lt;i&gt;p&lt;/i&gt; = 0.028), suggesting a potential impact of ART on thyroid physiology. In terms of hormone levels, the study observed a statistically significant increase in mean TSH values (from 4.23 ± 4.13 µIU/mL to 7.50 ± 7.85 µIU/mL, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and a significant decrease in free T3 levels (from 2.92 ± 0.88 pg/mL to 2.45 ± 1.00 pg/mL, &lt;i&gt;p&lt;/i&gt; = 0.005) post-ART. Free T4 levels did not show a significant change (&lt;i&gt;p&lt;/i&gt; = 0.337). These results align with existing literature suggesting that ART may unmask or exacerbate subclinical thyroid dysfunction, possibly through immune reconstitution or direct effects on thyroid metabolism. Correlation analysis demonstrated a significant negative association between CD4 count and TSH levels both before and after ART (&lt;i&gt;ρ&lt;/i&gt; = -0.28 and -0.34, respectively), and a positive correlation between CD4 and both free T3 and free T4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conc","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"84-89"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445177","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":"Type 4 Woolly Hair-palmoplantar Keratoderma Syndrome with a Novel Phenotype.","authors":"Sharini Cadiravane, Vasudharini Ananthakrishnan, Shanmathi Sethumadhavan, Jeyashree Damodaran, Saritha Mohanan, Sathish Kumar Chockalingam, Vijhayapriya Thanasekar, C S Banushree, Udayashankar Carounanidhy","doi":"10.59556/japi.74.1396","DOIUrl":"https://doi.org/10.59556/japi.74.1396","url":null,"abstract":"<p><p>Woolly hair with palmoplantar keratoderma (WH-PPK) is a group of four autosomal recessive syndromes. Type 4 WH-PPK is usually associated with KANK2 mutation and does not have cardiac morbidity among its features. Here we report a 25-year-old woman with woolly hair, palmoplantar keratoderma without any cardiac morbidity. However, she had sensorineural hearing loss and maculopathy. Thus, we present a patient with type 4 WH-PPK with a novel phenotype to highlight the rare WH-PPK syndromes. The association of woolly hair and palmoplantar keratoderma without cardiomyopathy, and with macular deposits and sensorineural hearing loss, has not been reported before.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 3","pages":"37-38"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445201","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}