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

{"title":"Clinicopathological Features and Outcomes of Metastatic Colorectal Cancers Treated at a Tertiary Care Hospital: A Bidirectional Observational Study.","authors":"Hema Sireesha Natti, Vishesh Gumdal, Deepak Koppaka, Swapna Nuguri, Sanjana Reddy Potu, Rudra Sanjeev Rudra, Rajeena Moulasa Jaffer","doi":"10.59556/japi.74.1616","DOIUrl":"10.59556/japi.74.1616","url":null,"abstract":"<p><strong>Background: </strong>Metastatic colorectal cancer (mCRC) remains a major contributor to cancer-related mortality worldwide. Real-world data from low- and middle-income countries remain limited.</p><p><strong>Materials and methods: </strong>This bidirectional observational study included 60 patients with histologically confirmed mCRC treated at a tertiary care center between January 2019 and December 2025. Demographic, clinicopathological, molecular, treatment, and survival data were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify prognostic factors.</p><p><strong>Results: </strong>The median age was 48.5 years, and 63.3% of patients were male. Extensive metastatic disease was present in 96.7% of patients. Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were detected in 20.7% of patients, whereas microsatellite instability-high (MSI-high) status was identified in one patient. Median PFS and OS were 10.6 and 22.3 months, respectively. On multivariable analysis, peritoneal metastasis independently predicted inferior PFS [hazard ratio (HR) 4.45, 95% confidence interval (CI) 2.16-9.19; <i>p</i> < 0.001] and OS (HR 2.83, 95% CI 1.13-7.07; <i>p</i> = 0.026). Poorly differentiated histology independently predicted worse OS (HR 3.05, 95% CI 1.03-9.06; <i>p</i> = 0.045).</p><p><strong>Conclusion: </strong>This study highlights the substantial burden of advanced disease in Indian patients with colorectal cancer. Peritoneal metastasis and poor differentiation were associated with adverse outcomes. Improved early detection and wider access to targeted therapies may improve survival outcomes in resource-limited settings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664467","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":"Imeglimin in Type 2 Diabetes Mellitus: Expert Opinions and Consensus in Indian Context.","authors":"Jegan Duraiswamy, Nitin Chintaman Gawari, Tanvi Naik, Teja Achyut Deshpande","doi":"10.59556/japi.74.1567","DOIUrl":"10.59556/japi.74.1567","url":null,"abstract":"<p><p><i>Dear Editor,</i> We read with interest the expert consensus by Seshadri et al. on imeglimin for the management of type 2 diabetes mellitus (T2DM). The article is timely and informative, particularly in view of the increasing complexity of diabetes management in India. The debate around the novel mechanism of imeglimin, which addresses both insulin resistance and mitochondrial dysfunction through mitochondrial routes, is well summarized and is in line with the increasing emphasis on preserving the function of the beta cell.¹.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"94"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664428","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 Conversation with ChatGPT about Pleural Effusion.","authors":"Srinivas Sadanand Pai","doi":"10.59556/japi.74.1563","DOIUrl":"10.59556/japi.74.1563","url":null,"abstract":"<p><p><i>Dear Editor,</i> A conversation with ChatGPT (Chat Generative Pre-trained Transformer) about pleural effusion.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"97"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664362","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":"Clinical Presentations of Different Types of Nodopathies.","authors":"Laxmi Khanna, Ish Anand, Praveen Kumar, Mandaville Gourie-Devi","doi":"10.59556/japi.74.1604","DOIUrl":"10.59556/japi.74.1604","url":null,"abstract":"<p><strong>Background and objectives: </strong>Nodoparanodopathies are subtypes of inflammatory polyneuropathies that differ in clinical presentation, duration, and response to intravenous immunoglobulins. Antineurofascin antibodies are detected by cell-based assays from serum or cerebrospinal fluid. The aim of our study was to describe the clinical presentation, electrophysiology, antibody assay, and response to treatment in different types of nodopathies.</p><p><strong>Methods: </strong>During the last 1 year, we came across three patients with neurofascin 140/186 positivity and one patient with neurofascin 155 antibody positivity. The clinical features, electrophysiology, treatment response, and outcome were studied after obtaining informed consent from the patients.</p><p><strong>Results: </strong>Both groups improved with treatment; however, patients with neurofascin 140/186 positivity were older, with proximal weakness and a good response to intravenous immunoglobulins, while the patient with neurofascin 155 positivity was younger, with cranial and respiratory involvement, gait ataxia, high cerebrospinal fluid protein, a prolonged clinical course, and an inadequate response to intravenous immunoglobulins. The interesting observation made was that both groups of patients had varying conduction blocks without temporal dispersion on nerve conduction studies, which reversed rapidly with treatment.</p><p><strong>Conclusion: </strong>The spectrum of illness, electrophysiology, and treatment varied widely in affected patients. Ultimately, the outcome depended on one's clinical acumen, antibody levels, and prompt treatment, as illustrated in the patients mentioned. This patient series was small, but the results were illustrative of the complexities of the disorder and the necessity for testing for nodopathies in patients with atypical clinical presentations, a prolonged clinical course, or conduction blocks in nerve conduction studies.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"38-41"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664341","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":"Consensus Guidance for the Diagnosis and Management of Diabetic Kidney Disease: Executive Summary.","authors":"Kavita Yadav, Vivekanand Jha, Georgi Abraham, Alan Fernandes Almeida, Sandeep Bansal, Shyam Bihari Bansal, Dipankar Bhowmik, Sujoy Ghosh, Natarajan Gopalakrishnan, Sanjeev Gulati, Shashank R Joshi, Sanjay Kalra, Jothydev Kesavadev, Vijay Kher, Dinesh Khullar, Ajay Umakant Mahajan, V Mohan, Abraham Oomman, Sreejith Parameswaran, Uday Phadke, C K Ponde, Sathyanarayana Rao Prakash, Narayan Prasad, Sree Bhushan Raju, A Ramachandran, Manisha Sahay, Rakesh Kumar Sahay, Jps Sawhney, Bipin Kumar Sethi, Daljit Singh Sethi, Parag Shah, Raj Kumar Sharma, Shivendra Singh, Rajana Sreedhara, Mangesh Tiwaskar, Subhash K Wangnoo","doi":"10.59556/japi.74.1537","DOIUrl":"10.59556/japi.74.1537","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is becoming an increasingly common consequence of diabetes in India, where the number of affected individuals is rising at an alarming pace. The illness is often silent in its early stages, and many patients are diagnosed only when kidney damage is advanced, leading to high rates of kidney failure and cardiovascular complications. This consensus document was developed by a broad group of experts to provide practical, evidence-based recommendations tailored for Indian healthcare settings. It stresses the importance of timely screening using the urine albumin-to-creatinine ratio and estimated glomerular filtration rate, along with routine evaluation of cardiovascular risks. The guidance covers key management areas such as blood pressure and glycemic control, the use of renin-angiotensin system blockers, newer agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2) inhibitors and finerenone, as well as lifestyle and dietary measures. Equal attention is given to affordability, patient education, and integrating care into national health programs. By adapting international standards to local realities, this document aims to improve early detection, reduce inequalities in treatment, and support better long-term outcomes for people living with DKD in India.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7E","pages":"e24-e29"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664619","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":"Continuous Glucose Monitoring-Purposes, Benefits, and Problems: A Review of the Indian Scenario.","authors":"Anushtha Kushwaha, Aarti Niveditha Kodirekkala, Aruna Saharawat, Rashi Jaiswal","doi":"10.59556/japi.74.1615","DOIUrl":"https://doi.org/10.59556/japi.74.1615","url":null,"abstract":"<p><p>One of the global epicenters of the diabetes mellitus pandemic is India. Over the past 40 years, there has been a sharp rise in the prevalence of diabetes mellitus in India due to rapid socioeconomic development, demographic shifts, and increasing susceptibility in the Indian population. Diabetes affects 74.2 million individuals in India, which places a significant strain on the country's economy and healthcare system. A patient's diet, lifestyle, medication, and glucose monitoring must all be customized for optimal diabetes control. The rates of glucose monitoring in India are abysmal. Most of the monitoring methods currently in use are based on single-point-in-time readings, which may not be totally indicative of the state of diabetes control. This presents problems. With advancements in technology, the new monitoring tool-continuous glucose monitoring (CGM)-provides visibility into the glycemic profile 24 × 7 with user-friendly reports that provide information much beyond glycated hemoglobin (HbA1c) and self-monitoring of blood glucose. This device also detects the time spent in range by the individual with diabetes. This review article discusses CGM in terms of its purposes, technologies, accuracy, clinical indications, benefits, and problems associated with it.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"70-72"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664449","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":"Profile of Philadelphia Chromosome Negative (Ph-) Myeloproliferative Neoplasm with Special Emphasis on Vascular Thrombotic Events and the Response to Cytoreductive Therapy in Polycythemia Vera and Essential Thrombocythemia Patients: A Single Center Study from Kerala.","authors":"Raghuveer Santhakumara Prabhu, Rahmathullah Sulaimankutty Nameera, Sayyid Muhammed Lukhmanulhakkim Thangal K, Priyanka R Nair","doi":"10.59556/japi.74.1583","DOIUrl":"https://doi.org/10.59556/japi.74.1583","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombotic events are a major morbidity among Philadelphia chromosome-negative myeloproliferative neoplasm (Ph-MPN) patients. There is a lack of data from Kerala regarding the profile of Ph-MPN and the prevalence of thrombosis among these patients.</p><p><strong>Aims: </strong>To study the clinical profile, driver mutations, incidence of thrombotic events among Ph-MPN patients, and the response to hydroxyurea therapy.</p><p><strong>Methods: </strong>We reviewed the medical records of 84 Ph-MPN patients who were on follow-up from April 2019 to June 2023 in a tertiary care hospital in Kerala.</p><p><strong>Results: </strong>There were 48 polycythemia vera (PV), 16 essential thrombocythemia (ET), 14 primary myelofibrosis (PMF), and six unclassifiable MPN (MPN-u) patients. The incidence of Janus kinase 2 (JAK2) mutation was 96, 62.5, and 79% among PV, ET, and PMF patients, respectively. The incidence of calreticulin (CALR) mutation was 37.5 and 21% among ET and PMF patients, respectively. The incidence of thrombotic events was 23/48 (48%), 7/16 (43.5%), and 6/14 (42.8%) among PV, ET, and PMF patients, respectively. All ET and PMF patients with thrombotic events were JAK2V617F-mutated. Eighty-seven percent of the evaluable patients on hydroxyurea for PV achieved freedom from therapeutic phlebotomies. ET patients who were on hydroxyurea achieved a median platelet count of 4.3 lakhs/µL (3.16-6.08).</p><p><strong>Conclusion: </strong>There is a higher incidence of thrombosis among Ph-MPN patients from Kerala, which needs to be ascertained in a population-based study. JAK2V617F mutation is the major determinant of thrombotic episodes in ET and PMF. Hydroxyurea is an effective cytoreductive therapy in PV and ET.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"24-27"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664577","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":"Expanding the Spectrum: Isolated Acute Diencephalitis as the Initial Manifestation of Neuromyelitis Optica Spectrum Disorder.","authors":"Jayaram Saibaba, Pushkar Pazhani, Vivek Venkataraman Iyer","doi":"10.59556/japi.74.1510","DOIUrl":"10.59556/japi.74.1510","url":null,"abstract":"<p><p>Diencephalic syndrome is a rare clinical variant of neuromyelitis optica spectrum disorder (NMOSD), observed in approximately 3.4% of presentations. Its hallmark features include endocrine and sleep-wake disturbances such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypothermia, narcolepsy, daytime somnolence, and appetite dysregulation.¹ We report a case of NMOSD presenting as an isolated acute diencephalic syndrome, a rare and diagnostically challenging initial manifestation. This case underscores the importance of considering NMOSD even in the absence of typical optic neuritis or longitudinally extensive transverse myelitis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 7","pages":"86-87"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664470","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":"AI-powered ECG Interpretation System for Arrhythmia Prediction and Hyperkalemia Detection Using Machine Learning.","authors":"Arvind Kumar, Tania Bansal, Salil Jaura","doi":"10.59556/japi.74.1526","DOIUrl":"https://doi.org/10.59556/japi.74.1526","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has emerged as a powerful tool for electrocardiogram (ECG) analysis, potentially surpassing conventional interpretation in detecting arrhythmias and metabolic disturbances such as hyperkalemia. This study evaluated the diagnostic performance and real-world applicability of an AI-powered ECG interpretation system for arrhythmia prediction and hyperkalemia detection.</p><p><strong>Materials and methods: </strong>In this prospective observational study, patients presenting to the emergency department or cardiology clinic between March 2024 and February 2025 were enrolled. Standard 12-lead ECGs were analyzed in parallel by a validated deep-learning AI model and board-certified cardiologists blinded to AI results and clinical data. Primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for arrhythmia and hyperkalemia detection. Secondary outcomes assessed the impact of AI-driven alerts on workflow efficiency and time to therapy.</p><p><strong>Results: </strong>Among 4,200 patients (mean age 56, 39% female), the AI-ECG system demonstrated 97.2% sensitivity and 96.1% specificity for arrhythmia detection, outperforming manual interpretation for atrial fibrillation, atrial flutter, and ventricular ectopy (<i>p</i> < 0.001). For hyperkalemia, sensitivity and specificity were 83.5% and 87.3%, respectively, reliably flagging all critical potassium elevations within 1 minute. AI alerts reduced median time-to-therapy by 19 minutes. Subgroup analysis showed robust performance in patients with chronic kidney disease and acute cardiac conditions.</p><p><strong>Conclusion: </strong>AI-powered ECG analysis enables highly accurate, rapid detection of arrhythmias and hyperkalemia, supporting earlier clinical intervention and improving workflow efficiency. These findings advocate for broader multicenter validation and integration of AI-ECG tools in routine cardiology practice.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664347","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":"Assessing Body Fat in Obesity: Clinic and Home Monitoring Using a Portable Bioelectrical Impedance Analysis Device.","authors":"Ashish Kumar, Anil Arora, Praveen Sharma, Shayesta Jan, Monika Taneja, Tarun Rajput","doi":"10.59556/japi.74.1545","DOIUrl":"https://doi.org/10.59556/japi.74.1545","url":null,"abstract":"<p><strong>Introduction: </strong>With the rising burden of obesity in India, accurate assessment of body and visceral fat has become essential for risk stratification and monitoring treatment response, both in clinics and at home. Bioelectrical impedance analysis (BIA) offers a practical alternative to advanced imaging-based methods such as dual-energy X-ray absorptiometry (DEXA) or magnetic resonance imaging (MRI), which, while precise, are expensive and not widely accessible. Among BIA devices, the InBody 770 is regarded as a clinical reference standard, but its high cost and large size restrict routine use. Portable and affordable BIA devices provide a potential solution, but their accuracy requires validation against established methods.</p><p><strong>Patients and methods: </strong>This cross-sectional study was conducted at the Fatty Liver and Obesity Clinic, Sir Ganga Ram Hospital, New Delhi, which manages patients with obesity, diabetes, and related metabolic disorders, including metabolic dysfunction-associated steatotic liver disease (MASLD). A total of 343 consecutive adults underwent body and visceral fat measurement using both the portable Omron HBF-702T and the InBody 770 devices. Agreement between the two devices was assessed using Pearson correlation coefficients and Bland-Altman plots, with subgroup analyses by gender and body mass index (BMI).</p><p><strong>Results: </strong>The mean age of participants was 45 years, and 76.7% were male. Omron demonstrated excellent correlation with InBody 770 for total body fat percentage (<i>r</i> = 0.91). Subgroup analysis showed consistently high correlations in males (<i>r</i> = 0.87) and in patients with BMI ≥30 (<i>r</i> = 0.90). For visceral fat, Omron showed a good overall correlation (<i>r</i> = 0.73) but weaker performance in females (<i>r</i> = 0.68) and patients with BMI <30 (<i>r</i> = 0.40).</p><p><strong>Conclusion: </strong>The portable BIA device Omron HBF-702T provides reliable estimates of total body fat, comparable to the InBody 770, in individuals with obesity and diabetes. Visceral fat estimation shows variability in certain subgroups, particularly females and those with lower BMI. Despite these limitations, the Omron remains a practical and affordable tool for routine monitoring in both clinics and homes, especially relevant in the era of lifestyle interventions and glucagon-like peptide-1 (GLP-1)-based therapies.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6E","pages":"e9-e16"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664500","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}