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

{"title":"Unlocking the Future of Alzheimer's Disease: Innovations in Diagnosis and Therapy.","authors":"Man Mohan Mehndiratta, Monika Singla, Abhishek Dixit","doi":"10.59556/japi.73.1075","DOIUrl":"10.59556/japi.73.1075","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is one of the most common forms of dementia, making up around two thirds of all dementia cases globally. Despite its high prevalence, it is estimated to remain undiagnosed in 41 million people with dementia, and with only about 25% of dementia individuals being clinically identified. AD is the major neurodegenerative disorder leading to dementia, characterized by neuronal atrophy and loss. The accumulation of toxic amyloid-beta (Aβ) oligomers, protein aggregates, along with the formation of neurofibrillary tangles (NFTs) within neurons, is the key pathological feature of AD. NFTs are composed of hyperphosphorylated tau protein. These abnormalities contribute to a decline in cerebral glucose metabolism in the brain, synaptic dysfunction, and mitochondrial impairment. The progression of AD occurs in three stages: (1) the presymptomatic stage, (2) mild cognitive impairment (MCI), and (3) the clinical stage of AD. Many biomarkers have been identified for diagnosing AD and differentiating it from atypical AD. It has emerged as a key area of research, offering significant potential for early detection of AD, prognostication, as well as planning drug therapy and monitoring.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"92-97"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070656","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":"From Barriers to Best Practices: Enhancing Oral Rehydration Therapy Utilization for Diarrhea Management in India.","authors":"Janani Shankar, Rahul Nagpal, Amol Patil, Harshad Malve, Vijay Chamle","doi":"10.59556/japi.73.1091","DOIUrl":"10.59556/japi.73.1091","url":null,"abstract":"<p><p>Diarrheal diseases are the third leading cause of childhood mortality in India. Oral rehydration therapy (ORT) remains the cornerstone of diarrheal disease management, especially as first-line treatment for acute diarrhea. However, ORT faces significant barriers that compromise its effectiveness in India. Children with diarrheal dehydration frequently fail to receive recommended treatment, primarily due to knowledge gaps among caregivers and preparation inaccuracies. These are further compounded by water safety concerns, poor palatability of home-based preparations, and the practical challenges of handling 1 L volumes. A critical factor determining ORT effectiveness is osmolarity optimization, with current World Health Organization (WHO) [also known as the reduced-osmolarity oral rehydration solution (ORS)]-recommended low-osmolarity ORS demonstrating superior efficacy than the earlier standard-osmolarity formulations that increased risks of hypernatremia and stool output. However, many caregivers deviate from the recommended osmolality in ORS solutions. Creating awareness among caregivers and healthcare providers and training them on proper reconstitution of ORT is essential for optimizing ORT outcomes and reducing preventable dehydration-related morbidity and mortality, especially in resource-constrained settings. Ready-to-drink ORS (RTD-ORS) can be considered as a viable alternative, especially in specific scenarios where convenience and adherence are prioritized. This review aims to examine the challenges and barriers impeding diarrheal disease management in India and address the identified gaps in healthcare delivery and improve treatment outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8S","pages":"28-33"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070684","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":"Diagnosis of Cardiac Amyloidosis in South Asia: Need for a Collaborative Approach from Researchers and Clinicians.","authors":"Shreya Ghosh, Dibbendhu Khanra, Chayanika Kala, Vinay Krishna, Ashwani Kumar Thakur","doi":"10.59556/japi.73.1050","DOIUrl":"https://doi.org/10.59556/japi.73.1050","url":null,"abstract":"<p><p>Recent developments in diagnostic approaches for cardiac amyloidosis (CA) have augmented the possibility of its accurate diagnosis. Rising cardiovascular diseases in South Asian countries along with many undiagnosed cases make it important for cardiologists to screen patients for CA. Besides, the increasing susceptibility of amyloidosis patients to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection needs prompt diagnosis and management of CA in the COVID-19 era. With this focus in mind, a review of recent diagnostic approaches and treatment options adapted for CA is outlined in this article. In addition, a layout of different initiatives to diagnose such patients in the future has also been depicted. These approaches, if collaboratively adopted by the researchers and clinicians, would aid in the accurate diagnosis of CA patients in the South Asian population including India.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"79-87"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970073","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":"Tri-Gunas in Medicine: A Spiritual Framework for Education, Empathy, and Ethics.","authors":"Shambo Samrat Samajdar, Jyotirmoy Pal, Nandini Chatterjee, Mrinal K Roy, Udas Ghosh, Rupak Chatterjee, Mangesh Tiwaskar, Shashank R Joshi","doi":"10.59556/japi.73.1046","DOIUrl":"https://doi.org/10.59556/japi.73.1046","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969922","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":"Exciting Discovery of a New Maturity-onset Diabetes of the Young Subtype from India (MODY 15).","authors":"Viswanathan Mohan, Ranjit Unnikrishnan, Venkatesan Radha","doi":"10.59556/japi.73.1060","DOIUrl":"https://doi.org/10.59556/japi.73.1060","url":null,"abstract":"<p><p>Maturity-onset diabetes of the young (MODY) was first described by Tattersall and Fajans in their classic paper published in 1975.¹ At that time, the classification of diabetes was based purely on the age at onset of diabetes. Those diagnosed with diabetes below 40 years of age were labeled as \"growth onset diabetes,\" while those with onset at or above the age of 40 years were referred to as \"maturity onset diabetes.\" At that time, these types were believed to be equivalent to what are known as type 1 diabetes (T1D) and type 2 diabetes (T2D) today.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"11-13"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969933","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 Unusual Case of Asymmetrical Limb Spasticity in Tetanus.","authors":"Sahana Gv, Ananya Varshney, Mary George K, Chandramouli Ks","doi":"10.59556/japi.73.0974","DOIUrl":"https://doi.org/10.59556/japi.73.0974","url":null,"abstract":"<p><p>Tetanus, a serious bacterial infection by toxin-producing anaerobe <i>Clostridium tetani</i>, is a major public health concern in India, which causes significant morbidity and mortality with case fatality rates ranging from 16.5 to 53.6% (Surabhi et al., 2022; Sodha et al., 2018; Masthi et al., 2008). A classical presentation of tetanus is of a descending pattern of muscle spasms, with the initial symptom being lockjaw and risus sardonicus, followed by stiffness of the neck and limbs (Abrahamian et al., 2000). However, this patient showed initial lower limb spasticity, progressing asymmetrically, which, combined with trauma history and hypertonicity, raised strong suspicion of tetanus. The improvement in the patient's clinical status with tetanus immunoglobulin further confirmed the diagnosis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"7-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970024","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":"Total Anomalous Pulmonary Venous Connection: A Case Series.","authors":"Rekha Gupta, Lipi Uppal, Malvika Gupta, Sanjeev Jindal, Jeet R Kashyap","doi":"10.59556/japi.73.0984","DOIUrl":"https://doi.org/10.59556/japi.73.0984","url":null,"abstract":"<p><p>Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart disease with abnormal drainage of pulmonary veins (PVs) into a systemic vein or right atrium (RA). It is divided into four types on the basis of anatomical pattern of drainage: supracardiac, cardiac, infracardiac, and mixed type. The mixed variant is further divided into the \"3 + 1\" and \"2 + 2\" patterns. Our series illustrates three of these subtypes, that is, \"3 + 1\" mixed type, cardiac type, and obstructive infracardiac type with PVs draining into portal vein.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"50-53"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970030","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 Comparative Analysis of Sepsis Outcomes in Patients with Autoimmune Diseases: Sequential Organ Failure Assessment Scores, Mortality, and Disease Response.","authors":"Ram Bhat, Adarsh Sangathi","doi":"10.59556/japi.73.1033","DOIUrl":"https://doi.org/10.59556/japi.73.1033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis results from the body's extreme response to pathogens and is associated with high mortality rates. Autoimmune diseases, treated with immunosuppressive medications, can weaken immune responses and increase susceptibility to sepsis. While older studies linked autoimmune disease and immunosuppressive treatment with higher mortality and longer hospital stays in sepsis patients, recent research suggests that these patients may not always have worse outcomes, in fact, they might have better outcomes, highlighting the need for further investigations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;(1) To investigate predictive factors of sepsis outcomes in individuals with underlying autoimmune diseases. (2) To quantify the severity of sepsis in the context of autoimmune diseases using the Sequential Organ Failure Assessment (SOFA) scoring system. (3) To evaluate the influence of autoimmune disease therapy on sepsis outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A 6-month prospective, observational cohort study was conducted with 83 participants at a single center. Patients were nearly evenly divided into autoimmune and nonautoimmune groups. Key variables including SOFA score at admission, sex distribution, mortality, and effect of autoimmune treatment regimens were analyzed using statistical methods such as Chi-squared tests, &lt;i&gt;t&lt;/i&gt;-tests, analysis of variance (ANOVA), and &lt;i&gt;post hoc&lt;/i&gt; Bonferroni tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A comparison between patients with autoimmune conditions and those without revealed a significant difference in sex distribution, with 73.2% of autoimmune patients being female compared to 42.9% in the nonautoimmune group (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 7.818, &lt;i&gt;p&lt;/i&gt; = 0.005). Analysis of the SOFA scores showed that the nonautoimmune group had significantly higher mean scores (6.05) compared to autoimmune group (4.15) (&lt;i&gt;p&lt;/i&gt; = 0.006). Septic shock occurred less frequently in the autoimmune group (26.8%) than in the nonautoimmune group (42.9%) but was not statistically significant (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 2.345, &lt;i&gt;p&lt;/i&gt; = 0.126). Mortality was lower in individuals with autoimmune diseases (14.6%) compared to those without (23.8%), but lacked statistical significance (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 1.122, &lt;i&gt;p&lt;/i&gt; = 0.289). Different treatment types for autoimmune diseases did not significantly affect mean SOFA scores (&lt;i&gt;F&lt;/i&gt; = 1.918, &lt;i&gt;p&lt;/i&gt; = 0.144), indicating no major impact on sepsis outcomes. However, &lt;i&gt;post hoc&lt;/i&gt; analyses suggested that untreated autoimmune patients had higher average SOFA scores than those on disease-modifying antirheumatic drugs (DMARDs), warranting further investigation into treatment effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study showed significantly low SOFA scores and better sepsis outcomes in patients with autoimmune diseases, highlighting the mitigating effects of autoimmune diseases and their treatment in sepsis. Even though many observed differences","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"64-67"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970123","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":"White Coat Hypertension and Its Predictors in Newly Diagnosed Hypertensive Patients Attending a Tertiary Care Center.","authors":"Muzafar Naik, Junaid Altaf, Tariq Bhat, Azra Tariq, Khalid Mushtaq","doi":"10.59556/japi.73.1037","DOIUrl":"https://doi.org/10.59556/japi.73.1037","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of hypertension (HTN) is best achieved by ambulatory blood pressure monitoring (ABPM) as it helps differentiate sustained hypertension (SH) from white coat hypertension (WCH).</p><p><strong>Aim: </strong>To diagnose SH and WCH in newly diagnosed hypertensive patients.</p><p><strong>Materials: </strong>All newly diagnosed hypertensive patients with office blood pressure measurement (OBPM) ≥140/90 mm Hg, attending the medical outpatient department and not on any antihypertensive treatment, were included in the study.</p><p><strong>Objectives: </strong>To evaluate the clinical utility of ABPM in newly diagnosed hypertensive subjects by comparing OBPM with ABPM readings.</p><p><strong>Methods: </strong>This descriptive cross-sectional study was carried out on 196 newly diagnosed HTN patients over a period of 18 months. All hypertensive patients were subjected to ABPM. Patients with persistent HTN on ABPM were labeled as SH, whereas those with normal blood pressure on ABPM were labeled as WCH.</p><p><strong>Results: </strong>SH was diagnosed in 143 out of 196 (73%) patients. WCH was detected in 53 patients (27%). Patients with SH had a significant family history of HTN compared to patients with WCH (82.5 vs 45.3%, <i>p</i> = 0.00), higher office diastolic blood pressure (DBP) compared to WCH (96.56 ± 4.63 vs 94.13 ± 3.23, <i>p</i> = 0.000), and significant nondipping pattern compared to WCH (37.1 vs 18.9%, <i>p</i> = 0.015).</p><p><strong>Conclusion: </strong>ABPM should be performed in all newly diagnosed hypertensive patients, especially if they have no family history of HTN and DBP is <95 mm Hg, to rule out WCH.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969940","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":"Septic Arthritis due to <i>Salmonella</i> Paratyphi A in a Splenectomized Thalassemia Patient.","authors":"Sadia Khan, Sahil Gaba, Rohit Garg, Chanchal Yadav, Vibha Mehta, Sharmila Sengupta","doi":"10.59556/japi.73.0973","DOIUrl":"https://doi.org/10.59556/japi.73.0973","url":null,"abstract":"<p><p><i>Salmonella</i> bone and joint infections are unusual and account for <1% of cases of septic arthritis and osteomyelitis. We report the case of a patient with monoarticular septic arthritis with underlying beta thalassemia who had undergone splenectomy 17 years earlier. Ultrasound-guided aspiration of pus from the affected hip joint grew <i>Salmonella</i> Paratyphi A. The patient was started on sensitive antibiotics and responded well to treatment. <i>Salmonella</i> septic arthritis is more commonly observed in individuals with comorbid conditions, such as hemoglobinopathies (particularly sickle cell anemia), pre-existing joint disorders such as rheumatoid arthritis, hematologic malignancies, systemic lupus erythematosus (SLE), or other conditions associated with increased hemolysis. A limited number of cases of <i>Salmonella</i> septic arthritis have been reported in thalassemia patients. In typhoid endemic regions of the world, culture and susceptibility of joint fluids from septic arthritis cases can guide physicians in appropriate and timely diagnosis of this entity, especially in patients who are immunosuppressed.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"15-16"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969959","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}