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

{"title":"Clinical Characteristics Treatment Approaches and Survival Outcomes in Secondary Hemophagocytic Lymphohistiocytosis: A Retrospective Observational Study.","authors":"Amratansh Varshney, Pratibha Satish Phadke, Anusree Prabhakaran, Dipak Patade, Yash Bhalani, Abhishek Kumar","doi":"10.59556/japi.74.1607","DOIUrl":"https://doi.org/10.59556/japi.74.1607","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal syndrome characterized by immune hyperactivation and a cytokine storm, leading to fever, cytopenia, organomegaly, and multiorgan dysfunction. Given its high morbidity and mortality, prompt diagnosis and treatment are essential. Currently, there are no established markers to predict outcomes in secondary hemophagocytic lymphohistiocytosis (sHLH).</p><p><strong>Materials and methods: </strong>This retrospective study aimed to identify prognostic factors in patients with sHLH, specifically evaluating the prognostic role of absolute neutrophil count (ANC) and serum ferritin level. The study also examined the impact of dexamethasone and etoposide on the treatment of these patients.</p><p><strong>Results: </strong>HLH remission was achieved in 64 patients (71.1%). Forty-seven out of those 64 patients survived and were discharged home, while 17 patients died in the hospital. HLH remission was not achieved in 26 patients (28.9%), of whom 25 patients died in the hospital. ANC at diagnosis and lower nadir ANC during the hospital stay significantly correlated with mortality (<i>p</i> = 0.001 and 0.017, respectively). Serum ferritin levels, however, were not a significant prognostic marker (<i>p</i> = 0.396). Treatment with dexamethasone was associated with better outcomes in patients with sHLH.</p><p><strong>Conclusion: </strong>sHLH should be considered in patients with treatment-resistant bicytopenia or pancytopenia. Lower ANC at diagnosis and nadir ANC during hospitalization are associated with increased mortality, suggesting that ANC is a potential indicator for early immunochemotherapy. Serum ferritin level is not a significant prognostic marker. Early diagnosis and dexamethasone treatment help achieve HLH remission, which improves outcomes in sHLH. These findings highlight the need for prospective studies to better understand sHLH prognostic markers and therapeutic strategies, especially in intensive care settings, where mortality remains high.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7E","pages":"e18-e24"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664529","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 Bone Health in Epilepsy-A Detailed Review of Anticonvulsant-induced Osteomalacia: Its Mechanisms and Therapeutic Strategies.","authors":"Sundar Sri Mk, Karthickeyan Krishnan","doi":"10.59556/japi.74.1597","DOIUrl":"https://doi.org/10.59556/japi.74.1597","url":null,"abstract":"<p><p>Anticonvulsants are the drugs given for managing epilepsy and some other types of neurological disorders; however, their long-term use is increasingly suspected of causing adverse skeletal outcomes, including osteomalacia. Osteomalacia is a condition marked by defective mineralization of bone, leading to bone softening, bone pain, muscle weakness, and predisposition to fractures. The disruption of vitamin D metabolism, impaired calcium absorption, and altered bone turnover are mechanisms attributed to several commonly used anticonvulsants, especially enzyme-inducing agents such as phenytoin, carbamazepine, and phenobarbital, in contributing to osteomalacia. Hence, this review aims to provide detailed information about the pathophysiology, clinical manifestations, diagnosis, and treatment of anticonvulsant-induced osteomalacia. The review places further emphasis on the importance of regular monitoring of bone health in individuals receiving long-term antiepileptic treatment, supplementation, lifestyle interventions, and interprofessional care. A proper understanding of this preventable complication will certainly help healthcare providers to minimize the impact in these patients and improve outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"73-79"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664540","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":"Barriers to Timely Rheumatologic Care for Rheumatoid Arthritis: A Real-World Questionnaire-based Study from Karnataka Chapter of Indian Rheumatology Association (KRA).","authors":"Vineeta Shobha, R Subramanian, J Prakruthi, Sumithra Selvam, V Shaleni, Vikram Haridas, Mahabaleshwar Mamadapur, Ashwini Kamath, M N Arjun, Pramod Chebbi, Jacob Mathews Vahaneyil, Silas Vinay Vr, Abhishek Patil, Benzeeta Pinto, G C Yathish, Sachin R Jeevanagi, Sahana Baliga, A S Harshini, Shweta Singhai, Vijay K Rao, Veena Ramachandran, Matam Sri Anusha, S Chandrashekara, K M Mahendranath","doi":"10.59556/japi.74.1560","DOIUrl":"10.59556/japi.74.1560","url":null,"abstract":"<p><strong>Introduction: </strong>To assess referral timelines to rheumatologists in Karnataka, India, identify factors linked to delays, and to examine their impact on disease activity, functional disability, and economic burden.</p><p><strong>Materials and methods: </strong>A multicenter, cross-sectional, observational questionnaire-based study was conducted across 17 rheumatology centers in Karnataka, India (June, 2023-July, 2024). Disease activity (DAS28, CDAI), disability (HAQ-DI), and healthcare expenditure prior to referral and during the past 1 year were analyzed in relation to self-reported referral time, categorized as early (≤3 months from symptom onset) and late (>24 months). Utilization of healthcare schemes available in Karnataka was captured.</p><p><strong>Results: </strong>Among 2,141 participants with RA, the median referral time to a rheumatologist was 18 (6-36) months, early referral (≤3 months) in 17% (<i>n</i> = 365), and late referral (>24 months) in 31% (<i>n</i> = 662). Older age [AOR = 1.01 (1.005-1.02)], being married [AOR = 1.48 (1.03-2.12)], resident of non-Bengaluru regions [AOR = 2.26 (1.60-3.19)], academic treating facility [AOR = 2.32 (1.68-3.18)], and longer duration of illness >120 months [AOR =2.84 (2.14-3.76)] had higher odds of late referrals. This group had significantly higher expenditure prior to referral [β = 3.57 (3.05-4.19)], higher total annual medical expenditure [β = 1.20 (1.09-1.32)], and catastrophic expenditure [β = 1.56 (1.22-2.01)]. 52 % (<i>n</i> = 1120) of participants reported out-of-pocket healthcare expenditure.</p><p><strong>Conclusion: </strong>Delayed referral to a rheumatologist was associated with increased disability and financial strain, including a significantly higher risk of catastrophic health expenditure.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7E","pages":"e1-e8"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664556","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":"Idiopathic Intracranial Hypertension Masquerading as Cerebral Venous Sinus Thrombosis: A Diagnostic Challenge.","authors":"Nikhil Gupta, Tanvi Batra, Atul Kakar, Ashima Abbott Chandra","doi":"10.59556/japi.74.1594","DOIUrl":"10.59556/japi.74.1594","url":null,"abstract":"<p><p>Idiopathic intracranial hypertension (IIH) is a syndrome identified by raised intracranial pressure (ICP), with absence of a mass lesion/hydrocephalus, typically affecting obese women of childbearing age.¹ It may present with similar symptoms such as headache, visual disturbances, and papilledema, making clinical differentiation challenging.¹ IIH primarily threatens vision, and treatment focuses on lowering ICP using medications like acetazolamide, serial lumbar punctures, or surgical interventions such as optic nerve sheath fenestration or CSF shunting in refractory cases.² Misdiagnosing IIH as CVST can lead to unnecessary anticoagulation, which may prove to be harmful for the patient.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"90-92"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664431","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":"Association of Hemoglobin-Albumin-Lymphocyte-Platelet Count (HALP) Score and Type 2 Diabetes Retinopathy.","authors":"Vijay Kumar, Kadiri Gururaj, Pratibha Modi, Sanjeev Kumar, Anil Balivada, Amit Raj","doi":"10.59556/japi.74.1605","DOIUrl":"https://doi.org/10.59556/japi.74.1605","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy (DR) represents a frequent microvascular consequence of type 2 diabetes mellitus (T2DM). Both inflammatory activity and nutritional status influence its development. The hemoglobin-albumin-lymphocyte-platelet (HALP) index is a composite marker that reflects these factors and has been explored in several diseases. This study assessed its association with the occurrence and severity of DR.</p><p><strong>Materials and methods: </strong>We carried out a cross-sectional analysis of 150 individuals with T2DM (equal male-female distribution, mean age 58.9 ± 10.9 years). Retinal changes were graded through fundus examination. Laboratory values for calculating the HALP index were obtained. Statistical analysis included <i>t</i>-tests, Mann-Whitney <i>U</i> tests, and receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>DR was found in 43.4% of patients, predominantly in the moderate stage. The mean HALP index was 34.3 ± 36.6. Differences in HALP values between the DR and non-DR groups were not statistically significant (<i>p</i> = 0.249), although lower scores tended to appear in DR. ROC analysis showed modest discriminatory power (AUC 0.555 for DR; 0.599 for moderate-severe DR). Hemoglobin was significantly higher among those with moderate-severe DR (<i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>Although the HALP index did not independently predict DR, its downward trend in advanced stages suggests potential as part of a multifactorial risk assessment. Owing to its affordability and simplicity, the HALP index may complement existing tools for identifying patients at higher risk of vision-threatening DR.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664338","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":"Consultation Fees as a Barrier to Regular Follow-up.","authors":"Rajesh Agrawal","doi":"10.59556/japi.74.1569","DOIUrl":"https://doi.org/10.59556/japi.74.1569","url":null,"abstract":"<p><p>Regular follow-up visits are essential for effective management and prevention of complications of chronic diseases like hypertension (HT), diabetes mellitus (DM), cardiovascular disease (CVD), and coronary artery disease (CAD), and many more, for continuity of care and improved patient outcomes including quality of life. However, consultation fees act as a significant barrier, particularly in low- and middle-income populations, where out-of-pocket expenses deter patients from adhering to follow-up schedules. This article explores how consultation fees influence patient behavior, reduce compliance with medical advice, and ultimately compromise the quality of care and life. A review of current literature highlights the financial challenges faced by patients and allows us to think about potential policy solutions, including subsidized follow-ups, bundled care models, and extended free follow-up windows. Addressing this financial constraint is critical for ensuring equitable access to ongoing care and improving long-term health outcomes. Well-planned research on this issue is required for long-term planning.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"80-81"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664455","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":"When Febrile Seizures Are Not Benign: An Unusual Cause of Dyke-Davidoff-Masson Syndrome.","authors":"Jashir Ahammed, Syed Ahmed Zaki, Kiran Kumar Reddy","doi":"10.59556/japi.74.1588","DOIUrl":"https://doi.org/10.59556/japi.74.1588","url":null,"abstract":"<p><p>A 14-year-old girl presented with a history of recurrent seizures over the past year, varying in type-generalized tonic-clonic and right-sided focal seizures involving both upper and lower limbs. Birth and family history were unremarkable, and early developmental milestones were appropriate. However, her academic performance declined over the past 2 years, eventually leading her to drop out of school. At 7 months of age, she had an upper respiratory tract infection followed by febrile status epilepticus lasting 20 minutes and requiring 5 days of hospitalization. Neuroimaging, cerebrospinal fluid analysis, and blood cultures were normal. There were no focal neurological deficits at discharge. Antiepileptic medications were discontinued after two seizure-free years. Current examination showed mild right-sided spasticity with increased deep tendon reflexes and an extensor plantar response. Magnetic resonance imaging (MRI) revealed left frontal sinus hypertrophy, left calvarial thickening, left cerebral atrophy, and right-sided crossed cerebellar atrophy, suggestive of Dyke-Davidoff-Masson syndrome (DDMS) (Fig. 1). Electroencephalography (EEG) revealed intermittent sharp waves and background slowing over the left frontotemporal region. She was started on antiepileptic therapy, physiotherapy, and occupational and speech therapy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"88-89"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664560","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":"Evaluation of Presepsin as an Early Biomarker of Sepsis in Elderly Patients with Community-acquired Pneumonia.","authors":"Shreya Sharma, Anita Tahlan, Monica Gupta, Anshu Palta, Nidhi Singla","doi":"10.59556/japi.74.1603","DOIUrl":"https://doi.org/10.59556/japi.74.1603","url":null,"abstract":"<p><p>Pneumonia is the most prevalent cause of sepsis. Early detection of sepsis is essential. Presepsin is an emerging biomarker. To analyze the diagnostic efficacy of presepsin for identifying sepsis and evaluate its predictive accuracy, a study was conducted for 18 months involving 100 elderly (≥60 years) patients diagnosed with community-acquired pneumonia (CAP) and fulfilling the Systemic Inflammatory Response Syndrome (SIRS) criteria. Clinical details were recorded, and the quick Sequential Organ Failure Assessment (qSOFA) score was calculated. Presepsin values were determined and correlated with culture findings. All patients were divided into two groups: the diagnostic group (based on culture findings) and the prognostic group (based on clinical outcome). Subgroups of the diagnostic group were culture-proven and culture-sterile, and those of the prognostic group were survivors and nonsurvivors. Presepsin values were higher in culture-proven patients and nonsurvivors. Presepsin and qSOFA scores correlated positively. Presepsin can be used to predict mortality from sepsis in addition to being a superior biomarker for predicting bacteremia.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664463","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 Cross-sectional Study to Assess the Knowledge, Attitude, and Practice of Look-alike, Sound-alike Drugs among Healthcare Providers at a Tertiary Care Hospital.","authors":"Nancy Bansal, Akash Ashok Kumar Khobragade, Aditya R Bawne, Ajinkya Bavlecha, Balbir Singh Kohli","doi":"10.59556/japi.74.1593","DOIUrl":"https://doi.org/10.59556/japi.74.1593","url":null,"abstract":"<p><strong>Background: </strong>Sometimes, drug names or their appearances create confusion among healthcare providers. These look-alike or sound-alike (LASA) drugs have the potential to cause medication errors leading to patient harm. Such errors can occur during prescribing, dispensing, and administration of drugs. Therefore, this study was conducted to assess the knowledge, attitudes, and practice of LASA drugs among healthcare providers at a tertiary care hospital in India.</p><p><strong>Materials and methods: </strong>This cross-sectional, observational, single-center, questionnaire-based study was conducted among healthcare providers at a tertiary care hospital in India. The study was conducted over a duration of 2 months between November and December 2024.</p><p><strong>Results: </strong>Out of the 400 participants, 81% were doctors, followed by 12.75% nurses, 3.25% pharmacists, and 3% interns. The majority of them were aware of the term LASA drugs. The majority of them were slightly concerned about the risks of LASA drugs. Whereas, only 10% of them had ever reported LASA errors, as the majority of them were unaware about medication error reporting form.</p><p><strong>Conclusion: </strong>This study suggests that lack of awareness about LASA drugs among healthcare providers contributes to medication errors. To address this, solutions can be implemented at different levels via a multidisciplinary approach.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"20-23"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664367","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":"Incidence of Infections in Renal Allograft Recipients and Their Outcomes in a Tertiary Care Center in Northeast India.","authors":"Sudipta Hajong, M Sharma, A Hakmaosa, P K Doley, G Pegu","doi":"10.59556/japi.74.1614","DOIUrl":"https://doi.org/10.59556/japi.74.1614","url":null,"abstract":"<p><strong>Introduction: </strong>The advent of modern potent immunosuppression has significantly reduced the occurrence of rejection in renal allograft recipients but has increased the risk of infection, which remains the major cause of death in these patients.</p><p><strong>Materials and methods: </strong>This single-center retrospective observational study was conducted at a tertiary care center in India. Data were collected from medical records of renal allograft recipients admitted for infection-related complications over a 10-year duration.</p><p><strong>Results and conclusion: </strong>Out of 238 admissions, 63 (26.47%) were due to infection-related complications involving 59 unique patients. The most common infections were urinary tract infections (UTIs) (n = 24) and pneumonia (n = 19). Of the two patients requiring multiple admissions, one patient had two episodes of pneumonia and one episode of UTI, and the other patient needed three admissions for diabetic foot. Six patients succumbed to their illness, resulting in a mortality rate of 10.16%, with sepsis due to UTI being the most common cause of death.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"13-14"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664523","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}