Journal, Indian Academy of Clinical Medicine最新文献

{"title":"Post-diphtheritic Polyneuropathy in Children with Diphtheria: A Prospective Observational Study","authors":"Deepa Barla, Chandrakanta Kumar, Manisha Verma, Vineet Kumar Singh, Sanjeev Kumar Verma, Rajesh Verma","doi":"10.1177/26339447231194446","DOIUrl":"https://doi.org/10.1177/26339447231194446","url":null,"abstract":"This study aimed to determine the proportion of diphtheria patients who develop post-diphtheritic polyneuropathy (DP) later on and also to study the clinical features and outcomes of children with post-DP. This prospective observational study was conducted at the Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India. Children under 14 hospitalized with clinically diagnosed diphtheria and post-DP were recruited (n = 81). Detailed clinical examination with appropriate investigations was conducted, including throat swabs for staining and culture for Corynebacterium diphtheria, nerve conduction studies, electrocardiography, and echocardiography. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. Seventy-four cases of diphtheria and seven cases of post-DP were enrolled, 56.8% were male, and the most prevalent age group afflicted was two to five years. Fifty-three children (65.4%) were partially immunized for diphtheria. Neck swelling, voice change, difficulty breathing, noisy breathing, respiratory involvement, and stridor were significantly more common in the unimmunized group. Voice change, heart rate irregularity, and hypotension were substantially more common in patients who developed clinical neuropathy than those who did not. Early administration of antibiotics in children with diphtheria before hospital admission was found to be significant in those children who did not develop clinical polyneuropathy, 38.5% of diphtheria survivors had abnormal nerve conduction study at six weeks of illness. Neck swelling and change in voice were significantly more common in patients with abnormal nerve conduction velocity (NCV) than in normal nerve conduction studies, 87.5% of children who had taken antibiotics before hospital admission had no clinical neuropathy, and NCV was also normal. Clinical neuropathy developed in just 20% of diphtheria patients with impaired NCV. Any child diagnosed with diphtheria should be followed for three to six months in anticipation of neurological complications. DP carries a good prognosis; hence, timely diagnosis and differentiation from other neuropathies is a prerequisite for rational management.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136295503","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":"Post Varicella Neurological Complication: A Case of Transverse Myelitis","authors":"Kavadisseril Vivekanandan Vysakha, C. P. Reshmi, Mathews Cyriac, Raina Thankappan Pillai","doi":"10.1177/26339447231192264","DOIUrl":"https://doi.org/10.1177/26339447231192264","url":null,"abstract":"Longitudinal extensive transverse myelitis is defined as a spinal cord lesion that extends over three or more spinal segments. Varicella zoster virus is an exclusively human neurotropic virus that reactivates following the weaning of cell-mediated immunity as age advances, resulting in herpes zoster. We report the case of a 61-year lady presenting with dorsal cord longitudinally extending transverse myelitis following herpes zoster infection that resolved with immunomodulation and antivirals.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135395638","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":"Dominant Optic Atrophy With Varied Phenotype in a Family of Eastern India: A Case Report of a Rare Mutation","authors":"Camelia Porey, B. Jaiswal","doi":"10.1177/26339447231176651","DOIUrl":"https://doi.org/10.1177/26339447231176651","url":null,"abstract":"Autosomal dominant optic atrophy (ADOA) can present with a varied phenotype in the form of pure ADOA, ADOA with sensorineural hearing loss, or the extended spectrum of DOA plus syndrome. Multiple genes have been identified over the years and majority of the cases are attributed to OPA1 gene mutation. Here we present an index case of DOA plus syndrome with affection of multiple family members across 2 generations with a rare mutation detection. A middle-aged female presented with onset of bilateral progressive visual blurring in the first decade followed by progressive sensorineural hearing loss since the second decade and onset of lower limb predominant cerebellar ataxia since the third decade. Routine parameters, imaging and electrophysiological studies were negative. Next generation clinical exome sequencing (NGCES) revealed an unique OPA1 gene mutation with worldwide evidence of only 3 such cases in database. DOA suspicion should be made in early onset visual defects with multiaxial involvement with a significant family history.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83489425","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":"Fatal Invasive Trichosporonosis in a Patient with Advanced Retroviral Infection and Diffuse Large B Cell Lymphoma","authors":"Meera S. N., A. Reghukumar","doi":"10.1177/26339447231175234","DOIUrl":"https://doi.org/10.1177/26339447231175234","url":null,"abstract":"","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78916019","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":"On the Path to Wellbeing for Everyone","authors":"P. Indu","doi":"10.1177/26339447231185979","DOIUrl":"https://doi.org/10.1177/26339447231185979","url":null,"abstract":"History of medicine has in its initial pages, long chapters on the havocs caused by communicable diseases, such as the small pox and plague. Improvement in living conditions along with specific measures like the vaccination enabled us to tackle many communicable diseases. Latest in the series, the SARSCoV-2 changed the priorities in public health globally, and became the leading cause of death among infectious diseases. Tuberculosis is the the second leading infectious killer and 13th leading cause of death. Multidrug-resistant TB (MDR-TB) poses a health security threat, since only 1 in 3 people with drug resistant TB accessed treatment in 2021. Dengue and other arboviral infections have local, regional and country wide outbreaks in several places and half of the world’s population is now at risk of dengue with an estimated 100–400 million infections occurring each year. In India also, these communicable diseases are public health priorities for prevention and control. However, in terms of burden and mortality, the noncommunicable diseases (NCDs) outnumber the infectious diseases by manyfold. Noncommunicable diseases account for 74% of all deaths globally, out of which 77% are in lowand middle-income countries. Cardiovascular diseases account for most NCD deaths, followed by cancers, chronic respiratory diseases and diabetes. Together, these four groups of diseases account for over 80% of all premature NCD deaths. Health system not only gets overburdened by the NCDs, but they increase the morbidity and mortality due to communicable diseases, especially when there are outbreaks of dengue and leptospirosis. Prevention and control of noncommunicable diseases is the top public health priority for India; through interventions to reduce the tobacco use and harmful use of alcohol and to improve physical activity and healthy diets. Healthy diets are costlier and less appealing in general; hence proactive measures are needed from governments to improve health literacy and to strengthen and reorient the public distribution system, so that deserving population has access to healthy food. High blood pressure has the highest attributable risk for mortality, followed by raised blood glucose and overweight and obesity. We also need to have systems in place to screen for these to facilitate early diagnosis and treatment. In this issue of Indian Journal of Clinical Medicine, we have three original articles; viz COVID mortality in India, estimation based on civil registration; nutrition assessment in chronic kidney disease patients; and adrenal insufficiency associated with low high-density lipoprotein (HDL) in patients of chronic liver disease. Chronic diseases often necessitate long term medications. The 76th World Health Assembly (WHA), which concluded in Geneva in May 2023, expressed concern over out-of-pocket spending on health catastrophically, which affects a billion people and pushes hundreds of millions of people into extreme poverty. Another notable outc","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"57 1","pages":"5 - 5"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75336940","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 Psychosis Among COVID-19 Recovered Patients—Need for Attention","authors":"Shivangi Srivastava, Tarun Kumar Suvvari","doi":"10.1177/26339447231176647","DOIUrl":"https://doi.org/10.1177/26339447231176647","url":null,"abstract":"The COVID-19 pandemic, caused by SARS-CoV-2, has been extensively studied for both respiratory and extrapulmonary manifestations, including neuropsychiatric ones, which are a significant cause for concern. Although the direct effects of SARS-CoV-2 on psychiatric health have been extensively studied, the negative effects of medications on mental health are often underreported. There are concerns about the unrestricted use of steroids during COVID-19, as some studies have suggested that it may lead to psychological disturbances, cognitive impairment, and behavioural changes.1 Patients who have been treated with steroids may present with long-term symptoms such as fatigue, depression, anxiety, stress, and loneliness, which can impair their daily life. These symptoms may be related to the sustained production of cytokines, reactive oxygen species, and immune dysregulation, which can increase the risk of further inflammation.1 Patients with acute COVID-19 infection and postCOVID-19 syndrome are highly sensitive to steroid-induced psychosis due to the continued effects of the virus on brain tissues and hypoxic injury.2 According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), steroidinduced psychosis is classified as a form of substance or medication-induced psychotic disorder.3 To diagnose this disorder, the patient must exhibit symptoms of mania, impaired cognition, abnormal psychomotor behavior, and disorganized speech, as well as at least one symptom of delirium or hallucinations. Thus, a thorough history, physical examination, laboratory findings, and the presence of characteristic features such as delusions or hallucinations can aid in the diagnosis of this disorder.3 Steroid-induced psychosis can manifest as early as 1 to 2 weeks after starting treatment or even after discontinuing the drug. Higher doses of dexamethasone and prednisolone have been associated with an increased risk of psychosis. In a metaanalysis of psychiatric and neuropsychiatric presentations associated with various coronavirus infections, including COVID-19, a total of 25 studies were examined. One of these studies, conducted in Hong Kong, found that 13 out of 1744 COVID-19 patients suffered from steroid-induced psychosis.4 The pathophysiology of steroid-induced psychosis is related to an extreme imbalance between glucocorticoid receptors and mineralocorticoid receptors. The hypothalamicpituitary-adrenal axis is disrupted, resulting in distorted cortisol levels due to the activation of pituitary glucocorticoid receptors by exogenous steroids while depleting endogenous cortisol levels.5 Medication-induced psychosis is dosedependent, as evidenced during the COVID-19 pandemic, where the treatment protocol involved short-term, high-dose steroid therapy, which led to psychotic manifestations as a side effect unrestrained drug usage.5 Although rare, psychosis can occur in acute cases of COVID-19 and post-COVID-19 syndrome, highlighting the importance of unders","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"170 1","pages":"65 - 66"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77533996","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":"Proliferating Trichilemmal Tumor of Scalp—An Eye Opener for a Pathologist","authors":"Bhoomika Kaushik, S. Azad, Arvind Kumar, Sanjeev Kishore","doi":"10.1177/26339447231158247","DOIUrl":"https://doi.org/10.1177/26339447231158247","url":null,"abstract":"Proliferating trichilemmal tumor is a rare tumor of external root sheath of hair follicles, originating mainly from the scalp of middle-aged females. Grossly and microscopically, it mimics squamous cell carcinoma; hence, it is important to understand the cytological as well as histological features of this tumor diligently. In addition, there are no standard guidelines present for the treatment of these tumors and recurrence is not uncommon which make its management a challenge. Here we are reporting a case of a 65-year-old woman with proliferating trichilemmal tumor in a form of an ulcerated lobulated mass on her occipital area of the scalp.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"37 1","pages":"60 - 62"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86726414","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":"Neurological Adverse Effects Following Administration of COVID-19 Vaccination: A Meta-Analysis","authors":"S. Ahmad, Yadgar N. Abbas, Jaafar O. Ahmed, Z. Mahmood, F. Kakamad, Hiwa O. Baba, Karzan M. Salih, S. Karim, S. Mohammed, M. N. Hassan, Rawezh Q. Salih, Suhaib H. Kakamad","doi":"10.1177/26339447221139021","DOIUrl":"https://doi.org/10.1177/26339447221139021","url":null,"abstract":"Introduction During the previous year, a variety of serious neurological problems associated with the COVID-19 vaccination have been documented, including encephalopathy, Guillain-Barré syndrome, transverse myelitis, and Bell’s palsy. Objective In the current study, neurological complications reported post-COVID-19 vaccination were systematically reviewed. The current meta-analysis aims to provide clinicians with a comprehensive understanding of this uncommon adverse event. Method Web of Science, MEDLINE on OVID, PubMed, and Google Scholar were searched for English-language papers published after January 1, 2020. Result Thirty articles were included in this study (21 case series and 9 cohort studies). The studies comprised 22,780 patients who got COVID-19 vaccinations and had at least 1 neurological adverse event. Across the majority of event types, females (54%) reported more adverse events than males (40%). The median duration from vaccination to the development of neurological symptoms was 12 days (0-41 days) in case series studies and 10 days (0-30 days) in cohort studies. Stroke is by far the most common neurological side effect of SARS-CoV-2 vaccines, followed by Bell’s palsy and seizures. Conclusion Concerns regarding the safety of COVID-19 vaccinations are being backed up by a growing number of studies that demonstrate neurological side effects.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"46 1","pages":"24 - 33"},"PeriodicalIF":0.0,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86073581","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":"Hives and Butterflies: A Curious Case of Urticaria","authors":"Meera S. N., Sreedevi S. Suresh, A. R.","doi":"10.1177/26339447221145815","DOIUrl":"https://doi.org/10.1177/26339447221145815","url":null,"abstract":"Mucocutaneous involvement is common in Systemic Lupus Erythematosus (SLE). Lupus specific lesions include acute, subacute, chronic lupus erythematosus lesions. Lupus nonspecific lesions are cutaneous leukocytoclastic vasculitis, bullous lesions, periungual erythema, livedo reticularis, livedo racemose, etc. Here we present a male who manifested with urticarial lesions and was subsequently diagnosed to have SLE.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"61 1","pages":"63 - 64"},"PeriodicalIF":0.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77775373","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":"Excess COVID-19 Mortality in India: An Estimation Using the Published Death Rate by the Civil Registration System","authors":"Hariprasad Thazhathedath Hariharan, A. T. Surendran","doi":"10.1177/26339447231158202","DOIUrl":"https://doi.org/10.1177/26339447231158202","url":null,"abstract":"Background An unbiased estimate of the COVID-19 deaths is essential to compare and contrast the public health actions adopted by governments from time to time. It also helps them in their policy-making in the future. But unfortunately, there is gross underreporting of COVID-19 deaths across the world, and also from India, as reported by many researchers, which can be estimated by modelling exercises only. Methods In this article, we estimated the number of COVID-19 deaths among the Indian states using a time series analysis approach with the mortality data published by the civil registration system since 2011. We excluded the trend in non-COVID mortality due to the prevailing causes to prevent it from being counted erroneously as due to COVID-19. Results Accordingly, the number of COVID-19 deaths in India is estimated as 25.8 lakh (95% confidence interval [CI]: 11.1L, 35.4L), with Bihar being the largest under-reporter of COVID-19 mortality (98.4% [95% CI: 98.0, 98.7] deaths not reported). On the contrary, there are states with zero underreporting (Kerala, Goa, Mizoram, Sikkim, and all the union territories). We also found out that the measures of social and economic development, like the multidimensional poverty index, infant mortality, literacy rate, per capita state domestic product, and the NITI Aayog Health Index, are significantly correlated to the proportion of underreporting. Discussion and Conclusion The underreporting of COVID-19 deaths in India is very much linked to its social and economic development. There is intentional nonreporting of the deaths of children, women, and the poor for a much longer period of time. Poor quality of data-grabbing mechanisms, the social stigma associated with the disease, inadequate testing of the population, the inefficiency of the administration, and omission of the socially and economically vulnerable groups had intensified the scenario.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"31 1","pages":"17 - 23"},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77826284","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}