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

{"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":"https://doi.org/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":"<i>PLA2G6</i>-associated Neurodegeneration: A Rare Case Report of Dystonia-Parkinsonism Phenotype with a Novel Genotypic Variant.","authors":"Surya Prakash, D Srilekha, P S Naga Srinivas, Lakshmanan Sankaranarayanan, P R Sowmini, Sakthi Velayudham, Malcolm Jeyaraj, V Kannan, R Viveka Saravanan, Mugundhan Krishnan","doi":"10.59556/japi.73.0836","DOIUrl":"10.59556/japi.73.0836","url":null,"abstract":"<p><p><i>PLA2G6</i>-associated neurodegeneration (PLAN) is a complex heterogenous group of neurodegenerative diseases that results from mutations in a gene known as <i>PLA2G6</i>. PLAN comprises three phenotypes with overlapping clinical and radiologic features: (1) Infantile neuroaxonal dystrophy (INAD), (2) Atypical neuroaxonal dystrophy (ANAD), and (3) <i>PLA2G6</i>-related dystonia-parkinsonism complex (PLAN-DPC). The onset of <i>PLA2G6</i>-related DPC occurs in adulthood, and patients often have normal birth and development. These patients show clinical manifestations of Parkinsonian syndrome, characterized by bradykinesia and tremors with dystonia, in addition to cognitive regression as well as gait instability. Here, we report a case of PLAN-DPC phenotype in a 20-year-old girl. This case report highlights the detection of a novel variant of <i>PLA2G6</i> gene mutation, c.757G>A, which has an allelic frequency of 0.001% in the gene database.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383360","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":"Human Metapneumovirus-Is It a Cause for Concern?","authors":"Shobha Manish Itolikar, Milind Nadkar","doi":"10.59556/japi.73.0852","DOIUrl":"https://doi.org/10.59556/japi.73.0852","url":null,"abstract":"<p><p><i>\"Infectious disease is one of the few genuine adventures left in the world…. however secure and well regulated civilized life may become, bacteria, protozoa, viruses, infected fleas, lice, ticks, mosquitoes and bedbugs will always lurk in the shadows and pounce upon us when our defenses are down.\"</i>¹ These words by microbiologist Hans Zinsser in 1934 could be considered even more relevant and relatable today, nearly a century after he made these observations. Emerging infectious diseases continue to be a threat to our progress even though civilization and mankind have taken giant leaps toward development.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"11-12"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383100","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":"Steroid Induced Dialated Cardiomyopathy.","authors":"Meenaxi Sharda, B G Gokul, Dheeraj Krishna, Setu Jain, Nisa Susan Thomas","doi":"10.59556/japi.73.0831","DOIUrl":"https://doi.org/10.59556/japi.73.0831","url":null,"abstract":"<p><p>A 37-year-old male patient presents with complaints of progressively increased shortness of breath, pedal edema, puffiness of the face, distension of the abdomen, generalized swelling of the body, and oliguria for the last 15 days. There is no history of chest pain, palpitations, or cough. The patient gives a history of inhalational therapy prescribed at his local place and oral steroids (tab Betnesol) from a local medical store for the past 3 years for his attacks of breathlessness. The patient is a chronic smoker and alcoholic for the past 10 years.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383215","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":"Therapeutic Outcomes of Mucormycosis Patients: A Retrospective Cohort Study.","authors":"Nikhil Gupta, Ritu Karoli, Pankaj Verma, Shobhit Shakya, Mridu Singh, Anurag Pathak, Ariya Tripathi","doi":"10.59556/japi.73.0853","DOIUrl":"https://doi.org/10.59556/japi.73.0853","url":null,"abstract":"<p><strong>Introduction: </strong>Of all the cases of mucormycosis across the world, India has the largest number, probably because of the large number of uncontrolled diabetes mellitus and its climate, which favors mucormycosis. There is still scarce data in India regarding the duration of treatment required and factors associated with the outcome, such as the extent of disease, glycemic control, hematological, and biochemical parameters. Therefore, this study aims to study any association between the extent of disease and outcome, and the association of hematological and biochemical parameters with the outcome of the disease.</p><p><strong>Materials and methods: </strong>It was a retrospective cohort study. Study patients were all mucormycosis patients admitted from May 2021 to October 2021 in the Department of Medicine in a tertiary care teaching hospital. Diagnosis was made by direct KOH microscopy, histopathology, or fungal culture from nasal tissue. Patients who showed mixed infections or were on iron supplementation were excluded.</p><p><strong>Results: </strong>One hundred patients were included, of which 82 were cured and 18 expired. Of the 18 expired, 12 had rhino-orbito-cerebral mucormycosis (ROCM) and 6 had rhino-orbital mucormycosis. The mean age was 51.12 years and the mean body mass index (BMI) was 25.02 kg/m². The most common comorbidity was diabetes mellitus (85%). The mean duration of antifungals given until the cure of the patient was 30.05 ± 8.34 weeks. Mean hemoglobin and serum iron were low, and serum ferritin was elevated. Facial pain, facial swelling, nasal discharge, decreased vision, and periorbital swelling were the most common presenting symptoms of mucormycosis, and these persisted for a mean duration ranging from 16 to 28 days.</p><p><strong>Conclusion: </strong>Rhino-orbital mucormycosis was the most common type of mucormycosis. Uncontrolled diabetes mellitus was the most common comorbidity associated with mucormycosis, so it should be treated properly. The mean duration of antifungals given until the cure of the patient was 30.05 ± 8.34 weeks. There was no significant association between the duration of antifungals and glycated hemoglobin (HbA1C), serum ferritin, or type of mucormycosis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"e5-e8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383262","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":"Typhoid Fever Complicated by Sepsis and ARDS in Pregnancy: A Rare Case.","authors":"Jayanta Datta, Dip Kumar Chowdhury","doi":"10.59556/japi.73.0824","DOIUrl":"https://doi.org/10.59556/japi.73.0824","url":null,"abstract":"<p><p>A woman in her thirties and in her second trimester of pregnancy presented with fever, shaking chills, and shortness of breath of 5-6 days duration. She developed progressive hypoxemia and tachypnea, leading to the development of acute respiratory distress syndrome (ARDS). An aerobic blood culture showed positivity for Salmonella typhi. Her worsening respiratory distress was treated with oxygenation through a high-flow nasal cannula. She was stabilized with intravenous (IV) antibiotics and other supportive measures and was discharged home with a live fetus in utero.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383268","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":"Urinary Levels of Neutrophil Gelatinase-associated Lipocalin and Cystatin C in Patients with Hepatitis B on Tenofovir Treatment.","authors":"Shivani Rani, Himanshu Dandu, Ambuj Yadav, Mahak Lamba, Amit Goel, Wahid Ali, Virendra Atam, Sumit Rungta, Medhavi Gautam, Atin Singhai","doi":"10.59556/japi.73.0828","DOIUrl":"https://doi.org/10.59556/japi.73.0828","url":null,"abstract":"<p><strong>Introduction: </strong>Tenofovir disoproxil fumarate (TDF) is a third-generation nucleoside analogue commonly used as a first-line therapy for chronic hepatitis B virus (HBV) infection. However, it is associated with nephrotoxicity, which can occur through mechanisms such as mitochondrial deoxyribonucleic acid (DNA) depletion and damage to renal tubules. This nephrotoxic effect typically manifests as a mild increase in serum creatinine and a decrease in serum phosphate, usually within 4-12 months after starting treatment. Recent studies suggest that novel biomarkers, such as urinary neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, may predict acute kidney injury (AKI) earlier and more accurately than traditional markers like serum creatinine. In line with this, we investigated NGAL and cystatin C levels in HBV patients receiving TDF therapy to assess their potential in monitoring kidney function.</p><p><strong>Materials and methods: </strong>The study included 350 cases in total. Each participant underwent a thorough assessment, including a detailed medical history, clinical examination, and routine blood tests, as outlined in the study's working proforma. Based on the above details, 226 cases fulfilling the inclusion criteria were enrolled for the second step of the study, where a 5 mL urine sample from each case was taken and sent to the pathology laboratory for estimation of cystatin C and NGAL by the ELISA method with the help of a kit.</p><p><strong>Results: </strong>The average age of the participants was 37.93 years, with 124 individuals falling within the 18-35-year age-group. After accounting for confounding factors, 87 cases were identified, predominantly young males, who exhibited elevated levels of both urinary NGAL and cystatin C.</p><p><strong>Conclusion: </strong>In this cross-sectional study, after controlling for confounding factors, we observed that TDF treatment was linked to elevated levels of urinary NGAL and cystatin C in 87 (38.4%) of the cases. Notably, increased levels of these biomarkers were also found in the younger age-group (18-35 years). These findings suggest the need for further prospective studies with larger sample sizes to better understand the direct impact of TDF on kidney function in hepatitis B patients.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"13-15"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383315","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":"Ischemic Stroke in a Young Individual as an Atypical Presentation of Polycythemia Vera.","authors":"Muskan Raina, Sahil Choudhary","doi":"10.59556/japi.73.0825","DOIUrl":"https://doi.org/10.59556/japi.73.0825","url":null,"abstract":"<p><p>Polycythemia vera represents a neoplastic proliferative disorder characterized by an abnormal overproduction of cells of myeloid lineage, especially erythrocytes. It can infrequently present as an acute ischemic stroke as the initial manifestation. This presentation is rarer in young patients; hence, it signifies the essence of a complete evaluation to elicit an accurate diagnosis to help prevent morbidity and mortality. In this report, we present a young male with acute onset hemiparesis who, on imaging, was found to have an ischemic infarct in the posterior limb of the internal capsule. On further investigation, the patient had a markedly elevated hematocrit and hemoglobin, and a mutation in JAK2 on genetic analysis. After confirming the diagnosis, phlebotomy was performed, which brought hemoglobin levels closer to the reference range and provided symptomatic relief.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383186","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":"The Effect of Clinical Decision Support Tools on Physicians' Practices.","authors":"Amrin Fakih","doi":"10.59556/japi.73.0706","DOIUrl":"https://doi.org/10.59556/japi.73.0706","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this research is to assess the impact of clinical decision support (CDS) tools on the practices of Indian physicians.</p><p><strong>Methods: </strong>Descriptive statistics and frequency distributions are used to assess the data.</p><p><strong>Results: </strong>Through a primary survey, it was found that about 69% of the physicians frequently use clinical decision tools in their practice. The author found that the clinical decision tools affect 1-5 decisions every week (for about 54% of the sample). Nonetheless, a great many (31%) stated that they do not use the tools frequently; therefore, none of their decisions are affected by the technology on a usual basis. There is a slight improvement in diagnosis post the use of the app. Although 46% of doctors stated that they have made zero errors in decision making post the use of the application, 54% admitted making errors in 1-5 decisions per week. This shows that the tool has not been able to address all the needs of the doctors. A great many agreed that the tool helped in reducing diagnostic tests. Although a majority of doctors stated that they order fewer than five diagnostic tests post the use of the application, a great many doctors agreed that they order >10 tests after using the application. This could be due to less faith in the technology or could be an attribute of a small sample. The author intended to assess whether clinical decision tools are cost-effective. The author found that not all decision tools are cost-effective. The variation could be due to differences in comprehensiveness of information, product features, and area of practice.</p><p><strong>Conclusion: </strong>This study exhibits that there is less faith in the technology and the application is favored by younger doctors. By and large, doctors agreed that the tool provides quicker diagnosis and is user-friendly.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"26-30"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383257","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":"Cerebral Neurotoxoplasmosis in a Newly Diagnosed Person Living with Human Immunodeficiency Virus at a Higher Cluster of Differentiation 4 Count.","authors":"Simi Tahiliani","doi":"10.59556/japi.73.0835","DOIUrl":"https://doi.org/10.59556/japi.73.0835","url":null,"abstract":"<p><p>Toxoplasma encephalitis is a well-known opportunistic infection in person living with human immunodeficiency virus (PLHIV). It is the most common cause of focal brain lesions among PLHIV. However, clinical disease is rare among patients with a cluster of differentiation 4 (CD4) count >200/mm³. Patients with a CD4 count <50/mm³ are at greatest risk. Here, we report a 20-year-old male with a history of fever for 4 months and altered sensorium for 3 days, who was found to have positive HIV serology and intracerebral neurotoxoplasmosis. His CD4 count at the time of diagnosis was 206/mm³. He was managed with sulfadiazine/pyrimethamine for 6 weeks and responded well to the same.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 2","pages":"e12-e13"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383388","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}