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

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and an increased chronic inflammatory response in the airways to noxious particles and gases. More than 10 million individuals in the United States (US) are affected with COPD, the fourth largest cause of mortality. Globally 250 million individuals are affected by COPD. D-dimer, C-reactive protein (CRP), acute physiology and chronic health evaluation (APACHE) II score, and hypoalbuminemia have significant correlation with morbidity, mortality, and risk stratification of hospitalized COPD patients with acute respiratory failure (ARF). The purpose of this study is to assess how well D-dimer, CRP, APACHE II score, and hypoalbuminemia predict death in COPD with ARF.

Materials and methods: A hospital-based prospective research (observational study) was conducted in a tertiary care center. The research was carried out from 1st February 2021, until 1st November 2022. The patients (sample size = 60; 35 survived and 25 died) were taken for detailed personal history, occupational history, chest X-ray, arterial blood gas (ABG) analysis, and thorough clinical examination to identify evidence of COPD. Our study included D-dimer, CRP, APACHE II score, and hypoalbuminemia in hospitalized COPD patients.

Results: In our study, the median D-dimer levels for patients who lived and died were 1,012.34 and 7,222.64, respectively, with a p-value < 0.001. Patients who survived had a mean CRP of 3.56, whereas those who were dead had a value of 12.62. The mean serum albumin levels among survived and dead patients were 3.23 and 2.22, respectively. The mean APACHE II score in survived and dead patients were 9.91 and 28.48, respectively. The APACHE II score has sensitivity and specificity of 96 and 91.4%, respectively, with a critical cutoff of >19. Hypoalbuminemia has sensitivity and specificity of 96 and 65.7%, with a critical cutoff of <3.

Conclusion: High levels of CRP, an elevated APACHE II score, elevated levels of D-dimer, and lower levels of serum albumin are all independently related to an increased risk of in-hospital mortality.

A 13-year-old girl was referred to the endocrinology outpatient clinic with chief complaints of significant hair loss leading to balding and poor height gain noted since the age of 5 years. She was born full term with a normal birth weight and had achieved all appropriate developmental milestones. Physical examination (Fig. 1) revealed a pulse of 56 beats per minute, height of 102 cm [<3rd percentile, height standard deviation score (Ht SDS) = -6.92], and weight of 22 kg. She had dry skin, facial puffiness, and a protuberant abdomen. There was diffuse hair loss involving the frontal, temporal, and occipital areas of the scalp with no scarring. Hair loss was noted in the lateral one-third of the eyebrows as well. Her thyroid function tests showed a thyroid stimulating hormone (TSH) level above 100 mIU/mL with low T4 and T3. The bone age was suggestive of 5 years. Antithyroid peroxidase (anti-TPO) testing was not done as it was not available at our center. She was diagnosed with juvenile hypothyroidism and was initially treated with 25 µg of levothyroxine, which was escalated to a full replacement dose after 2 weeks. Two months later, during the follow-up visit (Figs 2A and B), the child was more active and cheerful, facial puffiness had reduced, and there was substantial improvement in hair growth as well. Repeat thyroid function tests showed a TSH level of 1.51 mIU/mL with normal T4 and T3.

A 54-year-old female was evaluated in 2012 for management of hypertension and dyslipidemia. Clinical examination was unremarkable except for blood pressure (BP) 160/90 mm Hg and a grade 2/6 ejection systolic murmur along the left sternal border. A skiagram of the chest (posterior-anterior view) revealed a cardiothoracic ratio (CTR) of 0.5, clear lung fields, and extensive calcification outlining the dilated ascending and thoracic aorta (arrows, Fig. 1A), prompting the diagnosis of porcelain aorta (PA). Two-dimensional transthoracic echocardiography (TTE) demonstrated concentric left ventricular hypertrophy (LVH), thickening of aortic valve, dilation of the ascending aorta without any aortic regurgitation (AR) or gradient across the valve, its outflow, and in the supravalvular region. Computed tomography (CT) aortogram showed asymmetric extensive calcification of the wall of dilated thoracic and descending aorta and mild calcification of the ascending aorta (Fig. 1B). Biochemical tests were normal except for deranged lipid profile. During the last 10-year follow-up, she has remained asymptomatic with well-controlled BP and lipids on amlodipine, ramipril, statins, and aspirin. Follow-up X-ray shows a CTR of 0.6, further dilation of the ascending aorta, and extensive calcification in ascending, aortic arch, thoracic, and descending aorta (arrow, Fig. 2A). CT aortogram revealed extension of calcification in the ascending aorta with its aneurysmal dilation as well as ectasia in descending aorta and extension of calcification up to the origins of the renal arteries and celiac trunk (Figs 2B to D). Serial TTE did not demonstrate any AR or hemodynamic alteration.

The suppression of gastric acid secretion has long been the cornerstone of treatment for acid peptic disorders (APDs). Proton pump inhibitors (PPIs) have played a central role in managing these conditions, but their effectiveness can be hindered by notable limitations such as refractoriness or treatment failure due to inadequate acid suppression in some gastroesophageal reflux disease (GERD) patients, nonadherence to prescribed regimens due to the complexity of dosing, variability of response, and nocturnal acid breakthrough, etc. Vonoprazan is a first-in-class potassium-competitive acid blocker (P-CAB), recently introduced in India and also approved in several countries such as Japan, South Korea, and the USA. Extensive clinical evidence suggests that vonoprazan offers more potent acid suppression than PPIs. This consensus from the Association of Physicians of India (API) has been developed with the objective of providing key recommendations for the appropriate clinical usage of vonoprazan across various subsets of APDs, thereby optimizing the existing therapeutic options and improving the care and management of APD patients.

A 54-year-old, nondiabetic male who had an ABOi spousal kidney transplant in May 2023 underwent graft nephrectomy elsewhere due to dysfunction. He was initially on hemodialysis (HD) from July 2023 and was switched over to continuous ambulatory peritoneal dialysis (CAPD) in January 2024 due to poor hemodynamic status. He had a Swan neck Tenckhoff catheter (Fig. 1A). He noticed intermittent reddish effluent (Fig. 1B) since March 15, 2024. He denied trauma to the abdomen and was not on anticoagulant or antiplatelet drugs. His complete blood count (CBC) and electrolytes were: Hemoglobin (Hb)-7.8 g/dL, white blood cell (WBC) count-10 × 10³ µL, platelet count-186 × 10³ µL, creatinine-10.01 mg/dL, sodium-139 mmol/L, potassium-4.08 mmol/L, bicarbonate-23.7 mmol/L with normal coagulation profile [prothrombin time (PT)-17 seconds, international normalized ratio (INR)-1.51 ratio] and normal liver function tests. Hepatitis B surface antigen (HBsAg) and anti-HCV Ab were negative.

Background: Acute kidney injury (AKI) is one of the poor prognosticating conditions in the intensive care unit (ICU). It increases mortality. Its pathophysiology involves various aspects, such as prerenal, renal, and postrenal components. Many times, it is a combination of one or more etiologies. Its management is a challenge, as no agent is approved for its prevention or treatment. It is the comprehensive treatment and timely institution of renal replacement therapy (RRT) that matter most. To understand the prognosis and outcome of patients with AKI, we conducted this observational analytical study.

Materials and methods: It was a observational study. To analyze the effect of loop diuretics, we grouped the patients into two: one group received furosemide, and the other did not.

Results: There was a male preponderance among AKI patients. Hypertension and diabetes were the most common comorbidities. About 44.1% of patients received diuretics. There was no significant difference among patients in the requirement for RRT or the need for vasopressors; however, the outcome of patients who received diuretics was worse.

Conclusion: The use of diuretics did not improve the outcome of acute kidney injury.

Introduction: An elevated defensive reaction of the body to a harmful stressor like infection, trauma, surgery, acute inflammation, ischemia, reperfusion, or malignancy to localize and eliminate the endogenous or exogenous source of the injury is known as systemic inflammatory response syndrome (SIRS). Sepsis is a term used for SIRS with suspected or documented sources of infection. It is characterized by the fulfillment of any two of the following conditions: white blood cell (WBC) count ≥4000/µL or >10% immature forms or bands; body temperature over 38°C or below 36°C; pulse rate above 90 beats per minute; tachypnea (respiratory rate greater than 20 breaths per minute); or partial pressure of CO₂ below 32 mm Hg. Procalcitonin (PCT) is one of the more complex and expensive lab indicators used to diagnose and prognosticate this disorder. Less expensive tests include total leukocyte count (TLC), neutrophil count, and neutrophil/lymphocyte ratio (NLR).

Objectives: To ascertain the correlation between procalcitonin and TLC, neutrophil count, and NLR in patients with SIRS without documented infection and SIRS with infection (sepsis), and to evaluate TLC, neutrophil count, and NLR ratios between SIRS without infection and sepsis.

Materials and methods: Acutely ill patients aged 18 years or older who fulfilled the criteria for SIRS were included in this study. The serum PCT value, TLC, and blood culture were done within 12 hours of admission. All other relevant investigations at the time of admission were also noted.

Results: Out of 282 patients with SIRS, 194 patients had no documented infection (group I), whereas 88 patients had a documented infection (sepsis group II). The difference in age and sex between both groups (p < 0.05) was found to be statistically significant. All four markers-PCT, TLC, neutrophils, and NLR-were significantly higher in the sepsis group.

Conclusion: PCT is the best biomarker to predict sepsis, and it correlated significantly with TLC, neutrophil count, and NLR in SIRS without infection, and with neutrophil count and NLR in sepsis in our study. Secondly, TLC and NLR are also good predictors of sepsis and can diagnose sepsis in resource-poor settings.

Inhospital ischemic stroke has more mortality, more disability, and greater severity compared to community-onset stroke. We present a case of a 40-year-old male who reported to the emergency room (ER) with breathlessness and later developed a stroke during the course of his stay in the hospital. We noted multiple comorbidities and risk factors that could have resulted in the stroke.

Real-world evidence (RWE) is rapidly becoming a crucial component in healthcare decision-making, complementing traditional clinical trial data. Randomized controlled trials (RCTs) are widely regarded as the most reliable method for assessing the efficacy and safety of medical treatments. RWE can enhance and support the results obtained from traditional RCTs. RWE is derived from real-world data (RWD). Understanding RWE is essential for clinicians as it helps in guiding treatment decisions, assessing the effectiveness of therapies, and monitoring drug safety in broader patient populations. This article explores what clinicians need to know about RWE, its sources, applications, challenges, and future implications in healthcare.

High altitude de-acclimatization syndrome (HADAS) is a clinical entity that arises when individuals return abruptly from high-altitude environments to lower altitudes without undergoing the necessary acclimatization processes. While altitude-related illnesses have been extensively studied, HADAS remains relatively underreported and may pose diagnostic challenges due to its varied and nonspecific clinical presentation. This case report aims to shed light on the importance of recognizing HADAS as a potential consequence of inadequate acclimatization, emphasizing the need for a thorough understanding of altitude-related disorders in individuals with a history of rapid altitude changes.