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

Objectives: Hepatitis B virus (HBV) has a partially double-stranded circular deoxyribonucleic acid (DNA) that replicates through reverse transcription, producing an intermediate ribonucleic acid (RNA). This replication process has a high chance of error, leading to several mutations in the genome. According to several studies conducted worldwide, the classical basal core promoter (BCP) double mutation (A to T at nucleotide 1762 and G to A at nucleotide 1764) in the BCP region and the mutation in the precore (PC) region (G to A at nucleotide 1896) of HBV DNA have a strong correlation with advanced liver disease. The present study aims to compare the role of BCP and PC mutations among two groups of patients: monoinfected HBV (acute and chronic) and coinfected HBV-HIV patients.

Methodology: Thirty cases from each group of monoinfected (acute = 15 and chronic = 15) and coinfected patients were subjected to BCP and PC mutation identification by PCR-RFLP, confirmed by sequencing. The prevalence of BCP and PC mutations between the two groups was then compared statistically.

Results: The BCP mutation among chronic HBV and HBV-HIV coinfected patients was 66.67 and 19.23%, respectively, while the PC mutation among chronic HBV and HBV-HIV patients was 8.34 and 23.07%, respectively. Both mutations were higher among hepatitis B e antigen (HBeAg)-negative subjects. HBV/D was the major genotype among the BCP and PC mutant subjects.

Conclusion: The BCP mutants in our study had a high percentage of HBeAg negativity, low DNA levels, and mildly elevated ALT levels, mimicking inactive carriers. BCP mutants have a strong association with chronic liver diseases, so identifying chronic inactive HBV patients harboring the BCP mutant is necessary, and they require a close follow-up regimen.

Allergy is an important public health disorder. Common allergic disorders include asthma, rhinitis, conjunctivitis, atopic eczema, contact dermatitis, and food and drug allergies. In this article, allergic disorders are discussed comprehensively, along with their epidemiological trends, quality of care, and barriers in management. Allergic disorders have increased in prevalence throughout the world, except for a few foci (e.g., Spain) where asthma is decreasing. Prevention of allergen exposure, pharmacotherapy, and immunotherapy are different modes of controlling allergy. Extensive training, research, and awareness can improve the quality of allergy care.

Introduction: Waist circumference (WC) is used as a measure of metabolic syndrome (MeS); neck circumference (NC) can predict MeS. It is simpler to measure and may provide an indication of obstructive sleep apnea (OSA).

Materials and methods: NC was measured. The mean NC was correlated with the markers of MeS and sleep apnea.

Results: A total of 183 participants were recruited in the study. The average age was 48.13 ± 13.3 years in men and 48.09 ± 11.1 years in women. The mean body mass index (BMI) was 26.42 ± 4.69 kg/m² in men and 28.25 ± 4.92 kg/m² in women. The mean WC in men and women were 91.1 ± 12.92 cm and 90.86 ± 12.7 cm, respectively, while the NC was 38.4 ± 6.60 cm in men and 33.9 ± 2.40 cm in women. MeS was diagnosed in 17.6% of men and 12.7% of women. Sleep apnea was noted in 33.1% of males and 29.2% of females. There was a positive correlation between the NC and systolic blood pressure (SBP) (r = 0.316 in males), fasting blood glucose (FBG) (r = 0.522 in males and 0.263 in females), triglyceride (TG) (r = 0.172 in males; 0.320 in females), while high-density lipoprotein cholesterol (HDL-C) showed a negative correlation in males and females. There was a positive correlation of NC with sleep duration in both males and females (r = 0.346 in males and 0.344 in females). Those with a NC of <35 cm had a sleep score of 7, while those with a NC of >35 cm had a score of 15, showing poor sleep quality.

Conclusion: NC was comparable to WC and waist-hip ratio (WHR) for cardiometabolic risk factors and also showed a good association with sleep apnea.

Background: The coronavirus disease 2019 (COVID-19) pandemic contributed enormously to the psychosocial distress of Indian healthcare providers. The mental well-being of the healthcare community remains an underappreciated priority in India. The primary objective was to observe the results of an online brief mindfulness-based intervention on stress, anxiety, and depression, and the secondary objective was to examine its effects on mindfulness characteristics and World health Organization (WHO) quality of life among Indian healthcare providers during pandemic times.

Methods: The study population was randomized into two groups to attend either "mindfulness" sessions or "usual care" sessions. The outcome variables were stress (using the perceived stress scale: PSS), anxiety (generalized anxiety disorder scores: GAD7), depression (patient health questionnaire: PHQ9), mindfulness characteristics (Freiburg mindfulness inventory: FMI), and quality of life (WHO-QOL100). These variables were recorded pre- and postprogram. Statistical analysis included the use of unpaired and paired t -tests.

Results: The postsession mean scores in the "mindfulness" group compared to the "usual care" group decreased significantly in PSS, GAD7, and PHQ9, with p < 0.0001, p = 0.0102, and p = 0.0462, respectively. There was an increase in FMI with p < 0.0001 and in WHO-QOL domains 1, 2, and 4, with p = 0.0008, p < 0.0001, and p = 0.0194, respectively.

Conclusion: The online brief mindfulness-based intervention created a positive effect on stress, anxiety, and depression. The postprogram mindfulness characteristics and WHO quality of life also improved in Indian healthcare providers during pandemic times. Further large-scale research will be needed to support these beneficial effects.

Multisystem autoimmune disorders have different presenting symptoms with organ involvement phased over numerous years. We have a 56-year-old homemaker who is a known case of Graves' disease-post-thyroidectomy performed 20 years ago-and developed a volume overload state with exertional dyspnea for a period of 1.5 years. She was evaluated elsewhere and diagnosed with pulmonary arterial hypertension (PAH), the cause of which had not been established at the time. She presented to us with progressive dyspnea and abdominal distension of 1-week duration. A further diagnosis of biopsy-proven autoimmune hepatitis, chronic parenchymal liver disease (CLD), and noninfiltrative restrictive cardiomyopathy (RCM) was made. At follow-up, the patient complained of thickening and dryness of skin with similar antinuclear antibody (ANA) profile results 6 months apart. In the background of immune-mediated organ manifestations and laboratory picture, systemic sclerosis was diagnosed. This case report highlights that one should have a high index of suspicion while dealing with subsequent autoimmune manifestations of isolated organs as they might be part of a multisystem autoimmune disorder.

Inhaler therapy has become the mainstay of treatment in obstructive airway diseases. Although patients, and to a certain extent doctors also, were not initially comfortable with inhalation devices, they have now become the standard of care in chronic obstructive pulmonary disease (COPD) and asthma. However, the choice of inhaler device prescribed in different subsets of patients is still not clear. Prescription of a device depends upon age, dexterity, hand-mouth coordination, and peak inspiratory flow rates (PIFR). Prescription of wrong inhaler and wrong technique is not uncommon. In our study, 52.6% cases had prescription of wrong inhaler device, as per their PIFR. Physicians often do not consider the PIFR and the respiratory effort of the patient, while advising inhaler device. Only 43% patients with asthma had an adequate asthma control [asthma control test (ACT) > 19]. One of the main causes of a general inability to use an inhaler device properly results from the generation of an inadequate PIFR. It is more pronounced in those using dry powder inhalers (DPI), as it requires a higher effort-dependent inspiratory flow rate. PIFR of patients was divided into four groups, ≤30, 31-60, 61-90, and >90 L/minute. The required PIFR was taken as 30-60 L/minute for metered dose inhaler (MDI) and >60 L/minute for DPI. A positive correlation was noted for PIFR and advice to change the device as per the readings (p = 0.05). A positive correlation was also noted with PIFR compared to smoking/biomass use (p = 0.002). Thus, clinicians should advise inhalers as per PIFR and also continue to monitor PIFR on subsequent visits.

The prevalence of Alzheimer's disease (AD) is rising with an aging population worldwide and is expected to surpass 130 million by 2050. India is no exception, but the true prevalence data on AD is not conclusive. By 2050, India will have almost 15% of the population aged 60 years or above. It is the need of the hour to have newer and more effective agents that can address various therapeutic needs of Alzheimer's viz., halt or delay disease progression, and offer better improvement in symptomatology. The most desirable would be to have an intervention that can prevent AD onset. The prime focus of the present review is to introduce to the readers the promising drug candidates across the world. We reviewed all the information available to us through a literature search. It is quite apparent that the developmental efforts are concentrated not only on disease-modifying therapies that can prevent the development but also on palliative therapies that improve the quality of life of AD patients. Several approaches including biological and small molecules are being explored to tap their potential in AD therapeutics using sound scientific research principles and execution. Besides conventional development approaches, the drug repurposing strategy has emerged as quick, cost-effective, and less risky and is being exploited to the fullest. The drugs in the pipeline and undergoing various phases of clinical trials for the past 5 years are taken from the ClinicalTrials.gov registry. It remains to be seen the advent of a successful disease-modifying agent for AD in future.

Background: The local antibiogram is essential to prevent the development of multidrug-resistant organisms. The aim of the study was to find out the synchronization of empirical antibiotics with the sensitivity pattern of the urine culture report and to study the differences in the organisms and sensitivity patterns in urinary tract infection (UTI) with and without other comorbidities.

Materials and methods: UTI, diagnosed by a positive urine culture report of 300 consecutive patients above the age of 18, was studied retrospectively. The data were processed using the statistical software STATA 14.

Results: Out of 300 patients, 58.3% were females. The mean [standard deviation (SD)] age was 54.19 (19.06) years. The most common associated comorbidity was diabetes mellitus (DM) (34.7%). Lower urinary tract symptoms (LUTS) were the most common presenting symptom, followed by dysuria and fever. The most common organism was Escherichia coli in both nondiabetic and diabetic patients (67.3% and 60.6%). Comparing diabetics and nondiabetics, recurrent UTI (15.4 vs 5.1%), infection with extended-spectrum beta-lactamase (ESBL) organisms (67.3 vs 51.5%), and prolonged hospitalization (75 vs 61.2%) were observed more in diabetics. The most common empirical antibiotic chosen was cefoperazone-sulbactam in the diabetic group and levofloxacin in the nondiabetic group. Empirical antibiotics in diabetics matched with the sensitivity in 57.1% of ESBL cases and 47% of non-ESBL cases, while in nondiabetics, this alignment was 40.5% in ESBL cases and 61% in non-ESBL cases. Resistance to oral fluoroquinolone, cotrimoxazole, and nitrofurantoin was 78, 59.3, and 39.6%, respectively, while resistance to meropenem and amikacin was 35.6 and 25.6%.

Conclusion: The increasing prevalence of ESBL-positive strains and rising resistance to common antimicrobial drugs raise concerns for future therapeutic options.

Disorders of gut-brain interaction (DGBI), formerly known as functional bowel disorders, encompass a diverse array of conditions and symptoms that may manifest in different parts of the gastrointestinal tract. Some of the most prevalent DGBIs include functional dyspepsia, irritable bowel syndrome, functional constipation, functional diarrhea, and functional bloating and distension. Around 80% of patients with dyspepsia have no identifiable organic cause and are labeled as functional dyspepsia. Globally, functional dyspepsia prevalence ranges from 11 to 30%. In India, physicians encounter 20-40% of patients with functional dyspepsia, with variations attributed to diagnostic criteria and regions. However, Indian clinical guidelines for functional dyspepsia are currently lacking. Fifty gastroenterologists participated in focus group discussions to create an India-specific algorithm for the diagnosis and management of functional dyspepsia. After several national and regional discussions among groups of gastroenterologists across India, an algorithm was finalized for careful and thorough clinical evaluation of patients presenting with chronic dyspeptic symptoms. This guidance document highlights the role of endoscopic evaluation and Helicobacter pylori infection in the diagnosis of functional dyspepsia, along with the role of proton pump inhibitors (PPIs) and prokinetics in its treatment. The experts also reviewed the use of several prokinetics and provided their views on the choice of drugs for varied clinical presentations of functional dyspepsia. Among prokinetics, the experts believed that itopride was the preferred and relatively safer option for the treatment of functional dyspepsia.

Aim: To study abnormalities of lipids in patients suffering from severe scrub typhus and their relationship with complications.

Methods: This cohort study was conducted in patients of severe scrub typhus [immunoglobulin (IgM) positive by enzyme-linked immunosorbent assay (ELISA)] admitted to our institute from 1^st August 2020 through 31^st July 2021. The lipid profile was estimated initially at the time of hospitalization. Serum total cholesterol, serum triglyceride levels (TGs), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were estimated. The association (risk ratios) of lipids abnormalities was determined with mortality, multiple organ dysfunction syndrome (MODS), septic shock, and septic shock with MODS.

Results: We studied 100 patients (mean age of 48.4 ± 16.3 years) of whom 73 (73%) were females. On presentation, fever (91%), myalgias (38%), abdominal pain (16%), shortness of breath (15%), and cough (12%) were main symptoms. On examination, tachypnoea (68%), tachycardia (65%), conjunctival suffusion (37%), icterus (29%), eschar (14%), abdominal tenderness (10%), splenomegaly (4%), and hepatomegaly (3%) were noted. In lipid abnormalities, 93 (93%) patients had low HDL-C (males <40 mg/dL, females <50 mg/dL), serum triglycerides (200 mg/dL) were elevated in 71 (71%) patients, serum total cholesterol (>240 mg/dL) was increased in 4 (4%) patients, and 4 patients had raised serum LDL-C levels (160-189 mg/dL). Sixty-two (62%) patients developed MODS, 16 (16%) had septic shock, 15 (15%) developed septic shock with MODS, and 4 (4%) patients died. High serum TGs (>200 mg/dL) were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, p = 0.008) and septic shock with MODS (RR = 4.2, 95% CI = 1-17.4, p = 0.022) and the serum LDL-C levels <50 mg/dL were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, p = 0.007).

Conclusion: There was a significant association of increased severity of scrub typhus with high TGs (>200 mg/dL) levels and low levels of LDL-C (<50 mg/dL) in admitted patients of severe scrub typhus.