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

{"title":"High Altitude De-acclimatization Syndrome: A Case Report.","authors":"Rajesh Mishra, Saurabh Debnath, Ahsina Jahan, Gaurav Mishra","doi":"10.59556/japi.73.0826","DOIUrl":"10.59556/japi.73.0826","url":null,"abstract":"<p><p>High altitude de-acclimatization syndrome (HADAS) is a clinical entity that arises when individuals return abruptly from high-altitude environments to lower altitudes without undergoing the necessary acclimatization processes. While altitude-related illnesses have been extensively studied, HADAS remains relatively underreported and may pose diagnostic challenges due to its varied and nonspecific clinical presentation. This case report aims to shed light on the importance of recognizing HADAS as a potential consequence of inadequate acclimatization, emphasizing the need for a thorough understanding of altitude-related disorders in individuals with a history of rapid altitude changes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"83-84"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383090","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":"Biomarkers of Gestational Diabetes Mellitus: Mechanisms, Advances, and Clinical Utility.","authors":"Thyparambil Aravindakshan Pramodkumar, Wesley Hannah, Ranjit Mohan Anjana, Uma Ram, Mangesh Tiwaskar, Kuppan Gokulakrishnan, Polina V Popova, Viswanathan Mohan","doi":"10.59556/japi.73.0849","DOIUrl":"10.59556/japi.73.0849","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) continues to pose a significant challenge to maternal and fetal health, driving the need for advanced diagnostic and therapeutic strategies. Biomarker discovery has proven essential for early detection, mechanistic insights, and targeted interventions. This review provides an in-depth examination of biomarkers related to GDM, focusing on glucose metabolism, insulin resistance, inflammatory signaling, adipokines, oxidative stress markers, and genetic/epigenetic determinants. We also evaluate novel biomarkers emerging from omics technologies and their translational potential in clinical practice. Additionally, we explore the role of microRNAs and extracellular vesicles as emerging biomarkers that could offer new perspectives on GDM pathophysiology. Integration of these biomarkers into predictive models holds the potential to improve risk assessment and patient health outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"56-67"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383384","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":"Diagnostic Accuracy of World Health Organization Case Definitions for Acute Febrile Illness: A Tertiary Care Hospital-based Study.","authors":"Safdar Aftab Aslam, Khateeja Afrah, Gopika Kamal, Santosh R Goudar","doi":"10.59556/japi.73.0792","DOIUrl":"10.59556/japi.73.0792","url":null,"abstract":"<p><strong>Background: </strong>The causes of acute febrile illness (AFI) in South India have been challenging to identify. As health care facilities in many endemic areas lack good laboratory support for the diagnosis of AFI, there is difficulty in ascertaining the causes of AFI, resulting in a delay in the initiation of treatment. This study aimed to evaluate the sensitivity and specificity of surveillance criteria and rapid diagnostic tests in the diagnosis of patients presenting with AFI and thrombocytopenia.</p><p><strong>Materials and methods: </strong>Our study enrolled 225 participants presenting with AFI who fulfilled the predetermined inclusion and exclusion criteria. The study was conducted in the medical wards of YMCH from January 2018 to January 2019, after obtaining institutional ethics clearance. The patients were selected according to the inclusion criteria after obtaining informed consent. The collected data were analyzed using SPSS v23.0 operating on Windows 10 to determine the diagnostic characteristics, such as sensitivity and specificity of surveillance criteria and rapid diagnostic tests.</p><p><strong>Results: </strong>Our study enrolled 225 participants, with a majority (71.3%) falling within the 20-40 age range, and a significant male predominance. Around 68% of patients had a fever lasting <5 days. The clinical diagnosis was made using surveillance criteria in all 225 participants, of which 44% of cases were dengue, 35% were malaria, 12% were leptospirosis, and 7% were scrub typhus. However, when a definitive diagnosis was made using more specific tests (ELISA for dengue, leptospirosis, and scrub typhus; MP smear for malaria), it was found that 32% had dengue, 26% had malaria, 7% had leptospirosis, 5% had scrub typhus, 27% had undifferentiated fever, and 1.8% had coinfection. The overall accuracy of the surveillance criteria in diagnosing dengue is 66.37%, malaria is 76.91%, leptospirosis is 84.07%, and scrub typhus is 89.46%.</p><p><strong>Conclusion: </strong>This study validates the effectiveness of the surveillance case definition in identifying AFI with thrombocytopenia, demonstrating high sensitivity and moderate specificity. It should be followed by routine rapid diagnostic tests and more specific investigations to arrive at a definitive diagnosis of AFI.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"e1-e4"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382994","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":"Barbara McClintock and Cytogenetics.","authors":"J V Pai-Dhungat","doi":"10.59556/japi.73.0832","DOIUrl":"10.59556/japi.73.0832","url":null,"abstract":"<p><p>Barbara McClintock (1902-1992) was born in Hartford, Connecticut. She completed her undergraduate course in genetics at Cornell's College of Agriculture in 1919. The botany department was then involved in the study of maize genetics work. She found she could identify individual maize chromosomes under the microscope, and the 10 chromosomes of maize led to plant breeding experiments with chromosomal analysis. Within a few weeks, Barbara applied new staining techniques, identified the part of the embryo most suitable for cytological studies, and launched the new science of cytogenetics. McClintock earned her PhD in 1927, and from 1928 to 1935, she continued working with a small committed group of researchers at various institutions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"107"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383381","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":"Concomitant Fat Embolism Syndrome and Pulmonary Embolism in an Orthopedic Trauma Patient.","authors":"Arun Agarwal, Madhawi Sharma, Rahul Gahlot, Shubham Agarwal, Mala Airun","doi":"10.59556/japi.73.0848","DOIUrl":"10.59556/japi.73.0848","url":null,"abstract":"<p><p>Simultaneous acute pulmonary embolism (PE) and fat embolism syndrome (FES) in a trauma patient is very rare. Acute PE is a frequent complication and, at times, a fatal disease. Its most common presenting symptom is dyspnea, followed by chest pain and cough. FES is a rare clinical syndrome defined by the presence of fat globules in the pulmonary circulation. It can occur in a vast variety of clinical conditions, especially in those where fat is manipulated. Almost all cases of FES are due to long bone and pelvic fractures. It is essential to differentiate between FES and PE, as the management of both these conditions is altogether different. PE and FES are usually seen separately, and it is rare to have concomitant FES and PE in the same patient. There is a paucity of case reports in the literature wherein patients developed concomitant FES and PE. We present a case of a roadside traffic accident (RTA) with long bone fractures, who developed this unusual and rarer clinical entity of concomitant FES and PE in the perioperative period. Its presentation, diagnosis, and successful management are discussed, along with a literature review.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383436","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":"Nonislet Cell Tumor Hypoglycemia: A Rare Paraneoplastic Syndrome.","authors":"Aishwarya Gaur, Shyam Sunder, Prabhat Narain Sharma","doi":"10.59556/japi.73.0837","DOIUrl":"10.59556/japi.73.0837","url":null,"abstract":"<p><p>Nonislet cell tumor hypoglycemia (NICTH) is a rare and underreported cause of hypoglycemia due to excessive production of insulin-like growth factor 2 (IGF-2) and its intermediate forms, which activate the insulin receptor. Typically, certain malignancies can cause NICTH, usually as a paraneoplastic syndrome. Diagnosis requires a raised IGF-2/IGF-1 ratio. Surgery forms the cornerstone of management, while glucocorticoids are an alternative when surgery is not possible. We present a unique case of a 27-year-old male, who was a follow-up case of chronic hepatitis B infection and presented with a gall bladder fossa mass and recurrent, severe episodes of hypoglycemia. Workup revealed low insulin and C-peptide and suppressed IGF-1 with normal pituitary function. Clinicians should consider the possible diagnosis of NICTH when laboratory and immunohistochemical (IHC) data do not support more common causes, such as insulinoma.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"94-96"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383193","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":"Safety and Efficacy of Biosimilar Insulin Glargine (Basaglar) in Indian Patients with Type 2 Diabetes Mellitus: Results from a Multicenter, Open-Label, Single-Arm, Phase 4 Trial (ABEX).","authors":"Banshi Saboo, Deepak Khandelwal, Piyush Desai, Keyur Brahme, Paramesh Shamanna, Parag Shah, Indranil Bhattacharya, Rohit Arora, Erik Spaepen","doi":"10.59556/japi.73.0842","DOIUrl":"10.59556/japi.73.0842","url":null,"abstract":"<p><strong>Background: </strong>Basaglar^®, a biosimilar of glargine, was approved in India for the treatment of diabetes in patients aged >2 years. The efficacy and safety of biosimilar insulin glargine (Basaglar) have been previously established in Phase 3 clinical trials, ELEMENT-1, -2, and -5. This study assessed the safety and efficacy of Basaglar in Indian patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Materials and methods: </strong>This multicenter, open-label, single-arm, phase 4 trial included Indian patients with insulin-naïve T2DM with glycated hemoglobin A1c (HbA1c) ≥7.0 to <11.0% who were receiving ≥2 oral antihyperglycemic drugs and/or a glucagon-like peptide-1-receptor agonist. Patients received Basaglar once daily for 24 weeks, excluding 4 weeks of safety follow-up. The primary endpoint was the incidence of total hypoglycemic events [blood glucose (BG) ≤54 mg/dL (≤3.0 mmol/L)] at week 24.</p><p><strong>Results: </strong>Of the 259 patients enrolled, 64.1% were males, had mean [standard deviation (SD)] age 52.1 (11.38) years, and had diabetes for mean (SD) 6.75 (5.16) years. The mean HbA1c (SD) levels significantly improved from baseline to week 24 [-1.03 (1.554); <i>p</i> <0.0001] and Basaglar titration doubled from baseline. Total hypoglycemic events were reported in 10 (3.86%), 7 (2.70%), and 4 (1.54%) patients during weeks 0-24, 0-12, and 12-24, respectively. Ten patients (3.90%) reported 12 adverse events (AE; 11 mild and moderate, one severe). One death, unrelated to Basaglar, was reported.</p><p><strong>Conclusion: </strong>Basaglar was well tolerated with few hypoglycemic events and significantly reduced HbA1c and BG from baseline in Indian insulin-naïve patients with T2DM.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383211","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":"Cryptococcal Meningitis Secondary to Immunosuppression in a Case of Lupus Nephritis and Antiphospholipid Syndrome: A Case Report.","authors":"Aishwarya Mohan, Charlene Carvalho, Akshaya Sawant, Kedareshwar Narvencar","doi":"10.59556/japi.73.0823","DOIUrl":"10.59556/japi.73.0823","url":null,"abstract":"<p><p>Infections are an important cause of hospital admission in systemic lupus erythematosus (SLE) due to the immunosuppressed state of these patients. Although cryptococcal meningitis is the most common fungal infection in SLE, it is relatively rare and thus often diagnosed late, causing considerable morbidity and mortality. The management of SLE in the setting of cryptococcal meningitis becomes difficult, as immunosuppressive agents used in SLE lead to difficulty in eradicating the infection. Here, we present a case report of a patient with SLE, lupus nephritis, and antiphospholipid syndrome (APS) who developed cryptococcal meningitis and was successfully managed.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"e14-e15"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383000","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":"An Interesting Case of Recurrent Ophthalmoplegic Neuropathy.","authors":"S Padmapriya, N Shobana, M Sacratis, V Sadeeshkumar, C J Selvakumar, Joby J Thomas","doi":"10.59556/japi.73.0829","DOIUrl":"10.59556/japi.73.0829","url":null,"abstract":"<p><p>Ophthalmoplegic migraine was previously defined as migraine associated with oculomotor palsy. The condition has recently been termed recurrent painful ophthalmoplegic neuropathy (RPON). There is a paucity in the literature reporting the incidence and treatment strategies for RPON. This case report describes a 19-year-old male diagnosed with RPON and the management strategies implemented for treatment.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"e16-e17"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383377","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":"Impact of Blood Glucose Level on Hematological Indices in Patients with Type 2 Diabetes Mellitus.","authors":"C L Nawal, Aradhana Singh, Hazari Lal Saini, Govind Rankawat","doi":"10.59556/japi.73.0851","DOIUrl":"10.59556/japi.73.0851","url":null,"abstract":"<p><strong>Background: </strong>The severity and complications of type 2 diabetes mellitus (T2DM) are the most important preventable health burdens. This study was undertaken to assess the impact of hyperglycemia on hematological indices in patients with T2DM.</p><p><strong>Materials and methods: </strong>This study was conducted on 300 patients with T2DM, which included group A having controlled diabetes [hemoglobin A1c (HbA1c) <7%] and group B having uncontrolled diabetes (HbA1c >7%). Information concerning medical history, physical examination, diabetic parameters, hematological indices, and laboratory findings was extracted for interpretation and association between both groups.</p><p><strong>Results: </strong>About 115 patients (38.33%) had HbA1c <7% and 185 patients (61.67%) had HbA1c >7%. Total leukocyte count (TLC), monocytes, basophils, red cell distribution width (RDW-CV), platelet distribution width (PDW), mean platelet volume (MPV), platelet large cell ratio (P-LCR), plateletcrit (PCT), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were significantly higher among patients with uncontrolled T2DM compared to those with controlled T2DM (<i>p</i> < 0.05), while red blood cells (RBC) count, hemoglobin, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) were significantly lower in the uncontrolled diabetic group compared to the controlled diabetic group (<i>p</i> < 0.05). HbA1c had a significant positive correlation coefficient with TLC, neutrophil count, basophil count, PDW, MPV, PCT, PLR, and NLR, while RBC count, hemoglobin, hematocrit (HCT), and MCV showed significant negative correlation coefficients (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>This study concluded that inflammation, tendency to coagulation, and thrombosis can be detected with easily accessible and inexpensive hematological indices. Therefore, hematological indices can be used as a direct measure to detect the severity of T2DM and its complications.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383110","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}