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

Lyme disease (LD) is a multisystem inflammatory zoonosis affecting the skin, heart, nervous system, and joints, transmitted by ticks and caused by infection with species of the Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex. It is the most common emerging vector-borne disease in the United States. The Centers for Disease Control and Prevention (CDC) estimated the annual occurrence of 3,29,000 cases of LD in the United States during 2005-2010, and it increased to 4,76,000 during 2010-2018. The incidence of various clinical manifestations of LD differs among countries or regions based on the prevalent genospecies of the B. burgdorferi s.l. complex responsible for infection. Ticks of Ixodes spp. are the main vectors involved in the transmission of LD, which occurs mainly during the spring season. However, in North America and Europe, there is a rise in temperature due to global warming, leading to the extension of tick habitats toward northern areas. These ticks now stay active for an extended period of the year, increasing the chances of transmission to humans, and it is postulated to be one of the reasons responsible for the rising cases of LD. Early diagnosis and treatment with appropriate antibiotics can resolve the early manifestations of LD and prevent subsequent complications, which are known to occur if not treated appropriately. The disease is most common in rural areas and is difficult to differentiate clinically from other tropical infections such as rickettsial infections. The literature on LD in India is limited; however, LD has been reported from at least 12 states of India. A recently concluded study by the Indian Council of Medical Research (ICMR) has documented the seroprevalence of this disease in eight sites situated in areas of North (Himachal Pradesh and Haryana) and Northeast India (Meghalaya, Assam, Mizoram, and Tripura). LD remains grossly underdiagnosed in India. The lack of awareness among clinicians regarding the prevalence of LD and the limited availability of diagnostic investigations may have contributed toward it. LD should no longer be confined to textbooks, but it should find a place in the list of differential diagnoses in clinical practice. This review is an endeavor to sensitize physicians regarding LD and its impending rise worldwide due to global warming.

Three decades after the landmark Diabetes Control and Complications Trial (DCCT), type 1 diabetes (T1D) care in India continues to face systemic, socioeconomic, and technological challenges. Despite a relatively lower incidence compared to high-income countries, India bears a disproportionate burden of T1D-related morbidity and premature mortality due to late diagnoses, fragmented care, limited access to insulin, and underutilization of glucose-monitoring technologies. This editorial explores the current landscape of T1D management in India through the lens of the T1D Index, highlighting critical disparities in care quality, life expectancy, and health-adjusted life years lost. We reflect on the need for a national T1D registry, improved access to advanced therapies such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, and the establishment of multidisciplinary pediatric diabetes centers. The manuscript emphasizes systemic reforms, including public-private partnerships, indigenous manufacturing of diabetes technologies, and expanded education and psychosocial support frameworks. By integrating global best practices with localized solutions, India can bridge the care gap and redefine T1D outcomes for future generations.

Background: The global incidence of fatty liver (FL) [alcoholic and nonalcoholic FL disease (NAFLD)] is increasing. Imaging-based elastography techniques, being noninvasive, may eliminate the need for more invasive techniques for the diagnosis and staging of liver fibrosis in FL disease.

Objective: Our study aims to address the gap in the current research by exploring the correlation between mean liver stiffness measurement (LSM) as obtained through magnetic resonance elastography (MRE) and transient elastography (TE), and two commonly used clinical scores, fibrosis-4 index (FIB-4) score and aspartate aminotransferase to platelet ratio index (APRI) score.

Materials and methods: In this hospital-based cross-sectional study, 62 patients diagnosed with FL on ultrasound were recruited. The patients were further subjected to MR liver elastography and TE, and LSM using both modalities was recorded. A history of diabetes mellitus and alcohol intake was taken. Moreover, noninvasive fibrosis scores such as FIB-4 and APRI were calculated using standard formulas.

Results: The correlation analysis revealed a strong positive correlation between LSM values obtained from MRE and TE (r = 0.88) (Cohen's κ = 0.87), a moderate correlation between MRE and FIB-4 score (r = 0.44), and weak positive correlations involving MRE and APRI (r = 0.34), TE and FIB-4 score (r = 0.36), and TE and APRI (r = 0.29). Additionally, significantly higher fat fractions were quantified [median (IQR)] in grade III FL [23.6 (15.9-29.5)] as compared to grades I [8.45 (2.25-13.9)] and grade II [13.1 (8.4-19.7)].

Conclusion: MRE shows a strong positive correlation with TE for LSM and stage of fibrosis. Our findings suggest that MRE could be a valuable tool in the diagnostic armamentarium of FLD.

Background: International Academy of Cytology (IAC) introduced a breast category to produce comprehensive standardized guidelines for reporting breast cytopathology. IAC Yokohama System for Reporting Breast Cytopathology highlights the indications for getting breast cytology, procedural techniques, preparation of smear, material yielded, uniform system of reporting, use of ancillary investigations and prognostic tests, and correlation with clinical workup algorithms. The triple approach that includes clinical examination, radiological and pathological workup aims to maximize the preoperative detection of malignancy for early, definitive, appropriate treatment to the patient.

Materials and methods: The present study characterized the cytomorphological features of breast lesions ranging from inflammatory, benign to malignant. The lesions encountered were assigned a specific category on the basis of IAC Yokohama System. Histopathological correlation of cytomorphological findings was done wherever possible.

Results: Out of a total of 450 cases included in our study, 98% (441/450) were females, male to female ratio of 1:49, mean age being 32.6 ± 12.5 years. Majority of cases were in Yokohama category benign comprising 345 breast aspirates (76.66%), followed by 40 cases (8.8%) malignant, 28 cases (6.22%) in Yokohama atypical category. Category suspicious for malignancy consisted of 17 (3.7%) cases. A good inter-kappa agreement was found between cytological impression and histopathology diagnosis (>0.5). A sensitivity and specificity of 100 and 92.96% respectively was seen along with positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.24%, 100%, and 0.98 respectively. Diagnostic accuracy of 98.57% was seen.

Conclusion: The IAC Yokohama System is a high-quality reporting system used for diagnosing breast fine needle aspirates accurately with greater reproducibility of reports and better communication between the pathologist and clinician.

Advance care planning (ACP) refers to the process through which patients, their families, and healthcare providers discuss and record preferences for end-of-life care.¹ Internationally, ACP has been shown to reduce unnecessary interventions, align medical decisions with patient wishes, and provide dignity at the end-of-life. In India, however, structured ACP is virtually absent. Good end-of-life care is directly linked to the quality of death that Indians achieve, which has been consistently poor; in the 2021 Quality of Death Index report, India ranked 59 out of 81 countries that were studied.².

Cardiac rehabilitation (CR) is a critical component of secondary prevention in cardiovascular disease (CVD) management. In India, where CVD prevalence is rising rapidly, CR remains severely underutilized due to multiple systemic barriers. These include limited infrastructure, insufficient funding, low awareness, and inequitable access across urban and rural regions. This review assesses the current CR landscape in India, contrasts it with global benchmarks, and highlights key implementation gaps. It further explores scalable solutions such as telerehabilitation, community-based programs, and integrated multidisciplinary models. The paper emphasizes the need for robust policy frameworks, sustainable funding, infrastructure strengthening, and comprehensive workforce development. Achieving universal access to CR in India demands a multisectoral, collaborative approach involving government agencies, healthcare providers, academic institutions, nongovernmental organizations (NGOs), and private stakeholders. Enhancing CR services is not only a clinical necessity but also a national public health priority.

Background: Hydration plays a vital role in metabolic health, particularly in diabetes, where factors such as osmotic diuresis, polypharmacy, and comorbidities heighten the risk of dehydration. Effective management of fluid, electrolyte, and energy (FEE) deficits is crucial, yet gaps persist in current practices. This is the first study to assess the knowledge, attitude, and practices of cross-specialty healthcare professionals (HCPs) managing diabetes on such a unique issue in persons with diabetes.

Objectives: This study assessed the knowledge, attitudes, and practices (KAP) of 525 cross-specialty HCPs managing diabetes in India regarding FEE management in diabetic patients with acute nondiarrheal illnesses to identify gaps and inform interventions.

Materials and methods: An online cross-sectional survey evaluated physician perspectives on dehydration in diabetes using a 30-item questionnaire covering knowledge of dehydration in diabetes, attitudes toward the oral FEE formulations, and current practice.

Results: Most respondents (90%) identified osmotic diuresis as a key driver of dehydration in diabetes, with 75% highlighting Sodium-glucose cotransporter 2 (SGLT-2) inhibitors as a risk factor. Despite widespread recognition of the adverse effects of dehydration and energy deficits (86%), only 46.5% routinely assessed hydration status during acute illnesses in persons with diabetes. Slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, were favored by 68.9% of respondents for their metabolic benefits to address energy deficits. 84.2% of HCPs perceived ready-to-drink (RTD) FEE formulations supporting rehydration and enhanced recovery, with an average impact on recovery time of 4.1 days.

Conclusion: This study highlights the gaps in understanding the role of hydration in persons with diabetes. It also underscores the need for standardized oral FEE management guidelines and innovative solutions, such as RTD FEE drinks, to improve outcomes in diabetic care.

Background: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with the severity of systolic dysfunction. However, the relationship between SUA and left ventricular ejection fraction (LVEF) remains unclear.

Methodology: A cross-sectional study was conducted at DY Patil University School of Medicine, Navi Mumbai, involving 60 patients diagnosed with HF. Patients were categorized based on LVEF into HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). SUA levels were measured, and patients were classified into hyperuricemia or normal uric acid level groups. Demographics, comorbidities, and clinical symptoms were also recorded. Statistical analysis was performed to determine the correlation between SUA and LVEF.

Results: Of the 60 patients enrolled, 65% were female, with a mean age of 61-70 years. The majority had HFrEF (70%), followed by HFmrEF (26.67%) and HFpEF (3.3%). Hyperuricemia was observed in 38.3% of patients. A weak negative correlation was found between LVEF and SUA (r = -0.070), which was not statistically significant (p = 0.599). Although hyperuricemia was more prevalent in HFrEF, no significant relationship was established between SUA levels and severity of systolic dysfunction.

Conclusion: The study found a weak and statistically insignificant correlation between SUA levels and LVEF in HF patients. This suggests that SUA may not be a reliable biomarker for assessing the severity of systolic dysfunction. Further studies involving larger, more diverse populations are needed to clarify the prognostic role of SUA in HF.