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

{"title":"Skin Deep and Lung Bound: A Tale of Disseminated Kaposi's Sarcoma.","authors":"Sanjana Pant, Mrudula Prasanna, Vishal Keerthy Kumar, Vimi Rewari, Manish Soneja, Amandeep Singh","doi":"10.59556/japi.73.0972","DOIUrl":"https://doi.org/10.59556/japi.73.0972","url":null,"abstract":"<p><strong>Background: </strong>We present the case of an Indian man in his 40s with acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS), involving the skin, oral mucosa, and lungs. Fewer than 30 cases of KS have been reported in India to date. This case report emphasizes the challenges and confounding factors in diagnosing pulmonary KS, as well as the complexities involved in initiating treatment.</p><p><strong>Case description: </strong>The patient presented with multiple skin lesions, worsening dyspnea, and chest pain. A skin biopsy confirmed KS, and chest imaging revealed bilateral infiltrates. Pulmonary KS was diagnosed through polymerase chain reaction test from bronchoalveolar lavage fluid. Despite the initiation of antiretroviral therapy, the patient's condition deteriorated, leading to his demise.</p><p><strong>Conclusion: </strong>Diagnosing pulmonary KS remains a complex and nuanced process, often hindered by overlapping symptoms and confounding factors that can obscure its presentation. Early recognition and prompt intervention are essential but challenging, underscoring the need for a high index of suspicion and a multidisciplinary approach to optimize patient outcomes.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969998","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":"Severe Alopecia caused by Azathioprine in Systemic Lupus Erythematosus.","authors":"Vijay Kr Rao, Thanushree N, Manasa Rs","doi":"10.59556/japi.73.0958","DOIUrl":"https://doi.org/10.59556/japi.73.0958","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is an autoimmune disorder with heterogeneous phenotypes. The symptoms range from mild to life-threatening features. Azathioprine (AZA) is a routinely used immunosuppressive agent in mild to moderate SLE. Although bone marrow suppression is reported in AZA usage, severe alopecia is not very common with AZA.</p><p><strong>Case description: </strong>We report a 45-year-old female with stable clinical and serological lupus maintained on mycophenolate mofetil 500 mg twice per day and hydroxychloroquine 200 mg once per day. She was lost to follow-up with us for >1 year. Since her disease was stable, we switched to AZA 25 mg twice per day to start with and escalated to 50 mg in the morning and 25 mg at night after 2 weeks, with an advice for 4-week follow-up after starting AZA. Hydroxychloroquine was continued at 200 mg once per day. No corticosteroids were used at this time as it was not deemed necessary. Monitoring blood tests for AZA were planned at 4 weeks. She presented at 6 weeks with severe leukopenia as summarized in the table of investigations below and the graph summarizing the trend in leukocyte counts after AZA usage. She was managed in the hospital with intravenous dexamethasone, antibiotic prophylaxis, and hematology consultation, who opined as AZA-induced severe bone marrow suppression and severe alopecia due to AZA. Bone marrow examination was not deemed necessary by the hematologist. AZA was stopped in the hospital and mycophenolate mofetil was prescribed in the immediate follow-up after discharge, as she had previously responded to this drug. Hydroxychloroquine continued throughout her hospital stay. Although her blood counts responded very well after AZA withdrawal, it took nearly 3 months for her to have her normal scalp hair. One of the major differentials that was considered was SLE flare-up, but her clinical features and serology did not support a lupus flare.</p><p><strong>Conclusion: </strong>Bone marrow suppression is a severe complication of AZA in SLE. Leukopenia and hair loss are the major adverse effects reported during the therapy of AZA. It is sensible to recognize this relationship as prompt diagnosis and treatment is crucial.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969975","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":"Bilateral Abducens Nerve Palsy: An Unusual Manifestation of Subdural Collection in Invasive Breast Cancer with Dural Metastasis.","authors":"Vijo Wilson, Thomas Vt, Arjun Pr","doi":"10.59556/japi.73.0986","DOIUrl":"https://doi.org/10.59556/japi.73.0986","url":null,"abstract":"<p><p>Dural metastases from breast cancer are uncommon, with fewer than 5% of secondary intracranial tumors. As a presentation, bilateral abducens nerve palsy is extremely rare, making this case clinically significant. This case report emphasizes the need to recognize the unusual neurological manifestations in patients with advanced malignancies and to provide timely diagnosis and management. A 53-year-old woman with advanced breast cancer presented with progressive headaches, vomiting, and vision changes. On neurological examination, bilateral lateral rectus palsy and papilledema were observed. Magnetic resonance imaging (MRI) revealed subdural collection, pachymeningeal thickening, and brain metastases. After symptomatic relief through corticosteroid treatment, the patient was planned for palliative chemotherapy along with supportive treatment. Factors delaying diagnosis, with an emphasis on issues of socioeconomic barriers, pose major challenges to effectively managing such cases. This case focuses on the challenges of diagnosing rare manifestations of metastatic breast cancer like bilateral abducens nerve palsy. Limited access to healthcare, delayed presentations, and the socioeconomic factors influencing patient decisions played a significant role in this case. The early recognition of atypical symptoms, particularly in cases with a malignancy history, will improve patient outcomes. Similarly, multidisciplinary management by oncologists, neurologists, and palliative care specialists will help optimize the management of these cases and enhance the quality of life.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"54-56"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970000","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 for the Risk of Allergy to COVID-19 Vaccines in People with History of Allergy Diathesis.","authors":"Dhruve Soni, Sunita C Shukla, Nithya J Gogtay, Sukant Pandit, Milind Y Nadkar","doi":"10.59556/japi.73.1041","DOIUrl":"https://doi.org/10.59556/japi.73.1041","url":null,"abstract":"<p><strong>Background and rationale: </strong>Vaccination has formed the mainstay for mitigation of the COVID-19 pandemic. Vaccine-induced allergic reactions, though rare, have made it difficult to ensure complete coverage of COVID-19 vaccination. Initial guideline issued by the Government of India contraindicated vaccination in those with food or drug allergies. Allergic reactions largely result from excipients such as polysorbate 80 (P-80) (present in COVISHIELD™) and polyethylene glycol (PEG) [present in the messenger ribonucleic acid (mRNA) vaccines]. The present study was carried out with the objective of allergy testing in those with a history of allergic diathesis to generate objective evidence to the extent of true allergies to COVID-19 vaccination.</p><p><strong>Materials and methods: </strong>After approval from the Institutional Ethics Committee, written informed consent was obtained for this prospective, open-label study in 100 participants. Allergic response assessment in participants with a history of any allergies, yet unvaccinated to COVID-19, or have taken the first dose and were due for second dose, or had taken the second dose and were due for the precautionary dose, was done by skin prick test (SPT) followed by intradermal testing (IDT) injection with COVISHIELD™ vaccine, P-80, and PEG individually. Based on the result of the skin test (either positive or negative), participants were given advice regarding vaccination.</p><p><strong>Results: </strong>Of the 100 enrolled participants, <i>n</i> = 75 had taken both doses of any COVID-19 vaccine, <i>n</i> = 15 had taken only the first dose of any COVID-19 vaccine, and <i>n</i> = 10 were yet unvaccinated. There was no [0/92 (0%) and 0/98 (0%)] positive test with PEG and P-80, respectively. Only 02/98 (2.04%) returned a positive test with full strength (1:1) COVISHIELD™ vaccine IDT but not with SPT.</p><p><strong>Conclusion: </strong>This study indicates a low risk of allergy to PEG, P-80, and COVISHIELD™. Where feasible, allergy testing and counseling can be offered to unvaccinated or partially vaccinated individuals with a history of allergic diathesis.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"44-46"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970121","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":"Overdiagnosis and Overtreatment: Boon or Bane?","authors":"Ananda Datta","doi":"10.59556/japi.73.1048","DOIUrl":"https://doi.org/10.59556/japi.73.1048","url":null,"abstract":"<p><p>With the help of modern medical technology, various neoplastic and nonneoplastic lesions are getting diagnosed in the subclinical stage. Also, by lowering the threshold of disease definition, a large number of at-risk individuals get reclassified to the disease category. Quite often, these conditions remain harmless throughout a lifetime. Overzealous management in these settings becomes therefore unnecessary and results in various treatment-related adverse effects.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"100-102"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969865","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":"True Tracheal Bronchus.","authors":"Ambika Sharma, Govind Singh Rajawat, Mahesh Gupta","doi":"10.59556/japi.73.1040","DOIUrl":"https://doi.org/10.59556/japi.73.1040","url":null,"abstract":"<p><p>A 35-year-old male nonsmoker presented with complaints of left-sided dull aching chest pain and dry cough for 20 days. A chest radiograph showed a left hilar mass. Computed tomography of the chest showed a heterogenous mass in the hilar region involving the left main bronchus. On multiplanar reconstruction coronal images, an incidental finding of tracheal bronchus or \"pig bronchus\" (white arrow, Fig. 1A) was noted. Flexible bronchoscopy was performed to biopsy the mass lesion where an accessory bronchial opening (white arrow) at the right tracheal wall just prior to the main carina (black arrow) was seen (Fig. 1B). This tracheal bronchus was serving the right upper lobe and had normal apical, posterior, and anterior segments. It is also known as \"pig bronchus\" (bronchus suis) or \"true tracheal bronchus.\" The right mainstem bronchus was the bronchus intermedius, which was further dividing into middle and lower lobe bronchi.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969917","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":"Functional Neurological Disorders: A Comprehensive Review.","authors":"Lakshmi Priya Lalitha, Purushottam T Acharya, Mahendra Javali, Anish Mehta, Pradeep Rangaiah","doi":"10.59556/japi.73.1051","DOIUrl":"https://doi.org/10.59556/japi.73.1051","url":null,"abstract":"<p><p>Functional neurological disorders (FNDs) are altered voluntary symptoms incompatible with recognized medical or neurological conditions, causing significant distress to the patient. It is not a diagnosis of exclusion, but positive signs must be used to make a confident diagnosis and initiate appropriate management at the earliest. The understanding of FNDs has evolved over decades from supernatural power in the Mesopotamian age to the current neurocircuitry dysfunction and yet continues to be an area of active research. The evolution of various theories and terminologies for these disorders has been highlighted in this article in addition to key clinical signs for the diagnosis of various subsets of these disorders. In this article, FNDs are grouped into functional limb weakness, functional seizures, functional movement disorders, functional gait disorders, functional pseudosyncope, and functional cognitive dysfunction, and important clinical clues of diagnosis are discussed. FNDs contribute to about 5-10% of outpatient neurological consultations, and identification of appropriate positive clinical signs plays a key role in early diagnosis and judicious use of investigations (Bennett et al., 2021).¹ Management of these disorders involves a multidisciplinary approach ranging from effective communication of the diagnosis and management of psychiatric comorbidities to individually tailored counseling and therapy sessions.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"e17-e23"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969890","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":"Levodropropizine: Comprehensive Review of the Peripheral Antitussive.","authors":"Sandeep Nayar, Agam Vora, Mangesh Tiwaskar, Anooja Jose, Charmy Prajapati, Amit Qamra, Parthasarathy Muralidharan","doi":"10.59556/japi.73.1056","DOIUrl":"https://doi.org/10.59556/japi.73.1056","url":null,"abstract":"<p><p>In Indian primary care settings, cough is the second most common presenting symptom, only after fever. Despite cough being just a symptom of an underlying condition, it can be distressing and impact quality of life (QoL). Hence, symptomatic treatment of cough may be prudent along with definitive treatment directed at the underlying etiology. In patients with nonproductive cough, antitussives satiate this role for symptomatic management. On this accord, levodropropizine, a nonopioid, peripheral antitussive, is a valuable agent compared to traditional central antitussives. It demonstrates comparable efficacy in reducing cough severity and frequency while exhibiting a superior safety profile, with minimal central nervous system (CNS) side effects. Moreover, it has also been extensively studied in diverse age-groups and in multiple etiologies. This comprehensive review aims to summarize the drug aspects, clinical evidence, and place in therapy with levodropropizine.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7","pages":"e35-e44"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969911","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 Rare Case of Postpartum-acquired Hemophilia A Presenting with Deep Vein Thrombosis.","authors":"Amitabha Saha, Md Abid Sarfaraz, Arjun Talapatra, Sushmita Basu, Nausheen Arshad","doi":"10.59556/japi.73.0983","DOIUrl":"https://doi.org/10.59556/japi.73.0983","url":null,"abstract":"<p><p>Acquired hemophilia A (AHA) is a rare autoimmune disorder (1.5 per million) caused by autoantibodies against factor VIII, leading to coagulopathy. Postpartum AHA is uncommon, accounting for only 1-5% of cases, and typically presents with mucocutaneous or vaginal bleeding, while deep vein thrombosis (DVT) is an extremely rare manifestation. We report a case of a 33-year-old postpartum female presenting with left lower limb DVT and spontaneous bleeding. Initial management with heparin and direct oral anticoagulants (DOACs) exacerbated bleeding, prompting treatment revision. Persistently elevated activated partial thromboplastin time (aPTT) with normal platelet count and prothrombin time (PT) raised suspicion of AHA. A Bethesda assay confirmed high-titer factor VIII inhibitor (35.2 BU/mL). Immunosuppressive therapy with rituximab, corticosteroids, and cyclophosphamide successfully led to remission. This case highlights an unusual presentation of AHA with DVT in a postpartum patient. The combination of thrombosis and bleeding necessitates careful diagnosis and individualized management. Prompt recognition of prolonged aPTT, uncorrected mixing study, and confirmatory Bethesda assay are crucial for early intervention. Postpartum AHA, though rare, should be considered in postpartum females presenting with coagulopathy or thrombosis. Early diagnosis and tailored treatment improve outcomes and reduce mortality.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"27-29"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969948","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":"Opalski Syndrome: Atypical Presentation of Lateral Medullary Syndrome.","authors":"Sounak Chabri, Priyanka V Kashyap","doi":"10.59556/japi.73.0971","DOIUrl":"https://doi.org/10.59556/japi.73.0971","url":null,"abstract":"<p><p>Lateral medullary syndrome (LMS) (Wallenberg syndrome) is a relatively uncommon stroke with classic presentation of crossed spinothalamic sensory deficit, same-side ataxia, and other findings. Hemiparesis is rare with LMS, and when associated, is termed Opalski syndrome. The author presents rarity in this less common posterior circulation stroke.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 7S","pages":"42-43"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969967","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}