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

Objective: The purpose of the study was to assess the amount of serum copper, zinc, and copper-to-zinc ratio in sickle cell anemia patients and healthy subjects and to relate the parameters with an objective disease severity score. Further, to see the correlation between copper and zinc levels with fetal hemoglobin level in sickle cell anemia (SCA) subjects in both stable state and during the crisis.

Materials and methods: Copper and zinc levels in serum of 100 SCA and 100 healthy subjects were measured using commercially available kits. The copper-to-zinc ratio was then obtained by dividing the copper and zinc levels. High-performance liquid chromatography (HPLC) was used to determine the fetal hemoglobin level of every participant. The data were compared between SCA subjects in a stable state, crisis state, and control subjects using the Student's t-test, and the variables were linked with disease severity levels using the Pearson's correlation coefficient.

Results: The levels of copper and the ratio of copper-to-zinc were notably elevated in SCA patients compared to controls, whereas zinc levels were lower in the SCA patients. Zinc level was associated negatively (r = -0.350; p < 0.001), while the ratio of copper to zinc was associated positively (r = 0.246; p = 0.014) with objective disease severity scores.

Conclusion: Copper levels were elevated, while zinc levels were reduced in sickle cell anemia patients, and the ratio of copper-zinc in these patients may predict the severity of the disease.

Objective: To identify factors causing prehospital delay in treatment of status epilepticus (SE).

Materials and methods: This is a prospective observational study done on 78 patients with SE in the Stanley Medical College, Chennai, over 2 years. Demographic SE-related data and treatment delay were entered and correlated with outcome.

Results: The delay in reaching tertiary care was more in patients who traveled by own vehicle, compared to emergency medical services (EMS). Only 4 patients (5.1%) received treatment at the onset site and only seven patients (9%) who traveled in EMS received antiepileptic drugs. There is a significant delay in reaching the tertiary center from the onset of seizures if the patient is taken to any health center before coming to tertiary center (132.352 minutes). All the patients who were taken to another health center before reaching the tertiary center had received their initial treatment and favorable outcomes. Patients with prior history of seizures or SE had a better outcome.

Conclusion: Early recognition of SE is necessary to initiate rapid treatment, preferably during the prehospital phase. EMS personnel should be prepared to treat SE promptly with the recommended first-line drugs.

Background: There are limited data on the real-world utilization of disease-modifying antirheumatic drugs (DMARDs) in Indian patients with rheumatoid arthritis (RA).

Methods: This was a cross-sectional study of a multicentric observational cohort of RA patients across rheumatology clinics at six centers across India. Patients who met the American College of Rheumatology (ACR) 2010 criteria for RA were included. The demographics, disease-related parameters, and current therapy in terms of DMARDs were analyzed using a structured paper or electronic case record form.

Results: This study included 4,061 patients with RA across six centers in India. A majority were female (female-to-male ratio, 6:1), and their mean [standard deviation (SD)] age at the time of enrollment was 51 (12.2) years. Rheumatoid factor and/or anti-CCP were positive in 79 and 77%, respectively. Data on DMARDs were available for 3,550 RA patients. Conventional synthetic DMARDs alone were being used in 3,289 (93%), targeted synthetic DMARDs in 203 (6%), and biological DMARDs in 67 (2%). A total of at least 18 separate types or combinations of DMARDs were being prescribed, with the most common being a combination of methotrexate and hydroxychloroquine (22%), methotrexate monotherapy (17%), and a combination of methotrexate and leflunomide (16%). Overall, the most common DMARD prescribed (as monotherapy or in combination) was methotrexate (86%), followed by hydroxychloroquine (52%) and leflunomide (37%).

Conclusion: Cs-DMARDs remain the mainstay in the treatment of Indian patients with RA in this study, with the majority being treated with methotrexate alone or in combination with other DMARDs.

India has a high burden of patients with diabetes mellitus (DM). Challenges to managing type 2 diabetes (T2DM) in India are unique. Indian T2DM patients do not just present with DM alone, but with clustering of cardiovascular (CV) risk factors like hypertension (HTN), dyslipidemia, and obesity. Furthermore, Indian patients also have lesser baseline beta-cell function compared to global reference populations. In India, various cost-effective, generic, fixed-dose combinations (FDC) of dipeptidyl peptidase 4 inhibitors (DPP4i) with sodium-glucose cotransporter 2 inhibitors (SGLT2i) are available for the management of T2DM. However, to the best of our knowledge, scant surveys have studied the clinical practice nuances regarding the use of these FDCs in Indian settings. Hence, we designed and conducted a knowledge, attitude, and practice (KAP) survey to study the attitude and practice of Indian physicians with regard to patient population and placement of generic DPP4i-SGLT2i FDCs. Our survey showed that in India, patients often present with a high baseline HbA1c. From a glycaemic control perspective, DPP4i-SGLT2i FDCs are preferred in treatment-naïve patients with HbA1c >8% and those with HbA1c >8.5% despite metformin monotherapy. Also, 85% physicians observed a reduction in SGLT2i associated GUTIs with use of DPP4i-SGLT2i FDCs or concomitant use of these agents. Part of these survey findings were presented at the American Diabetes Association (ADA) 2024 Congress held in Orlando, Florida.

Introduction and importance: High-grade B-cell lymphoma (HGBCL) is a highly aggressive form of B-cell non-Hodgkin lymphoma. Lymphoma involvement of the gallbladder is rare, with a reported incidence of 0.1-0.2%.

Case description: In this report, we introduce the first case of a high-grade lymphoma presented as an asymptomatic gallbladder polyp in a 78-year-old woman. A preoperative computed tomography (CT) scan showed findings consistent with a possible mass-like lesion measuring 10 × 10 mm adjacent to the gallbladder and a cirrhotic liver. According to those findings, the decision was made to perform a laparoscopic cholecystectomy with an intraoperative cholangiogram. Histological examination of the excised mass showed a neoplastic proliferation of lymphocytes consistent with HGBCL.

Discussion: This rare entity can present as common symptomatic cholecystitis or an asymptomatic mass with insidious growth. In this case, it was an incidental finding on imaging, which leads us to emphasize the importance of imaging studies as the first approach in the diagnosis of this uncommon extranodal lymphoma located within the gallbladder. Surgical excision with subsequent histopathological evaluation is the gold standard for a correct and prompt diagnosis.

Conclusion: Gallbladder lymphoma is a rare condition with a challenging diagnosis. Although the prognosis is favorable in most cases, chemotherapy or radiotherapy may be necessary for remission of the disease.

This case report discusses an interesting instance of acute respiratory distress syndrome (ARDS) induced by heroin abuse. Heroin, a potent opioid, has been linked to this life-threatening condition. A young man in his early twenties was found unconscious, displaying atypical symptoms such as tachycardia and tachypnea; later he landed up in ARDS. The diagnosis was challenging due to the absence of classical signs of opioid intoxication. The case emphasizes the importance of considering opioid intoxication in patients presented with altered sensorium, tachycardia, and tachypnea, as well as the need for timely consideration of antiopioid treatment along with ARDS management for a successful recovery.

Herpes zoster (HZ), caused by the reactivation of varicella-zoster virus (VZV), typically presents as a unilateral dermatomal erythematous vesicular rash. Bilateral HZ is rare and usually associated with immunocompromise. We report the case of a 62-year-old female with no evident immunocompromise who developed bilateral thoracic HZ. The patient was treated with antivirals and pain medications. Our case highlights the rarity of bilateral HZ and its implications for diagnosis and management. We also review the literature on bilateral HZ in the English literature.

A 62-year-old lady was referred with the diagnosis of hypertensive encephalopathy. She had episodes of paroxysms of hypertension while on the ventilator with normal saturations. She underwent a battery of tests to identify the cause of the paroxysms. Eventually, a very unusual cause was found that should have been identified if the label of hypertensive encephalopathy had not been put at the beginning. A diligent history and examination remain important even in the modern day with high-technology care.

Paraneoplastic neurological syndromes (PNS) are mostly immune-mediated, tumor-associated disorders. Earlier the 2004 PNS criteria were used which are now partially outdated due to advances in PNS research and also identification of new phenotypes and antibodies that have transformed the diagnostic approach to PNS; hence, a new criterion was proposed in 2016. They can have multifarious presentations, ranging from behavioral abnormalities to altered sensorium and coma. They can precede, be synchronous with, or follow the diagnosis of malignancy. Treatment depends on the underlying antibody and malignancy. We hereby describe an unusual presentation with dual antibody positivity in a patient who was diagnosed with lung cancer in a hospital in the same presentation.