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

Background: Comprehensive reviews on the use and utility of point-of-care tests (POCs) in public health programs in relation to infectious disease and nutrition are limited. Point-of-care technologies have potential to improve the management of infectious diseases particularly in settings where healthcare infrastructure and timely access to quality medical care are limited.

Methods: We aim to describe POC tests currently used or under evaluation in the Indian national programs for communicable diseases and nutrition, and to identify the barriers and facilitators. Scoping review methodology was followed to search databases such as MEDLINE, EPPI (evidence for policy and practice information), CINAHL (Cumulative Index to Nursing and Allied Health Literature), JBI Evidence Synthesis, and Google Scholar. Descriptive statistics were applied to identify the utility, barriers, and facilitators of POCs in context of Indian public health program from patients' and physicians' perspectives.

Conclusion: Rapid results, appropriate case management, and accuracy of testing in remote areas are perceived to be the major benefits of using POCs. Lack of awareness about POCs and lack of regulations leading to spurious products on the market are obstacles to their optimal use.

Globally, hypertension is a major noncommunicable disease that contributes to significant fatalities and morbidity. Evaluation of trends in the prescription of antihypertensives and their adherence to the Joint National Commission 8 (JNC 8) recommendations can provide perspective on the dissemination of local and international guidelines in real-world clinical practice. An ambispective observational study was conducted over a duration of 6 months. Among the three-drug combinations, angiotensin receptor blockers (ARB) + beta-blocker (BB) + calcium channel blocker (CCB) (10%), followed by ARB + CCB + diuretic (DU) (8%), were primarily prescribed. BB + diuretic (DU) (20%) was the most prescribed in two-drug combination therapy, followed by ARB + BB (19%). BB (46%) were the most prescribed drugs, followed by diuretics (25%) as monotherapy. Combination therapy is as efficient as single-drug therapy. Among patients with hypertension and heart failure with reduced ejection fraction (HFrEF), the ARNI/ARB combination is effective in HFrEF patients. ARNI/ARB + antihypertensives were most commonly prescribed (40%), followed by ARNI/ARB + ivabradine + antihypertensives (35%). Adherence to the JNC 8 guidelines varied between 71 and 92%. Ninety-two percent of the prescriptions were adherent to initiating pharmacological treatment in patients aged over 60 years with a BP goal of <140/90, with thiazide/loop diuretics, CCB, and ACEI/ARB as first-line therapy. The pattern of prescribed drugs was in accordance with clinical guidelines. Compliance with JNC 8 guidelines was optimal. However, studies including larger patient populations, drug dosages used, and physician perspectives on prescribing need to be studied further.

A 31-year-old gentleman, hailing from West Bengal, a farmer by occupation, with no known prior comorbidities, presented with a history of multiple painful swellings over the abdomen, thorax (back and front), and suprapubic region of 6 months' duration. The swelling started in the abdomen and subsequently involved the thorax. It also progressively increased in size over the 6 months. He had used analgesics for the management of the pain. He also reported significant weight loss and loss of appetite.

Background: Subclinical hypothyroidism (SCH) is synonymous with thyroid failure (a milder form). It is a condition characterized by normal laboratory ranges of serum FT4 and FT3 levels, but serum thyroid stimulating hormone (TSH) levels are slightly increased above the normal range.

Objective: The leading aims and objectives of the study were: (1) establishing a correlation between the presence of modifiable risk factors of ischemic heart disease in subjects with SCH. (2) Quantification of the economic markers of ischemic heart disease in patients with SCH.

Methods: This study was accomplished at the Department of Internal Medicine, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, for the duration of 1 year, from March 2020 to February 2021. The study variables included history, physical examination, clinical examination, and investigations. The individuals who met the inclusion criteria set for the study were included. All the participants were informed about the study, and their informed consent was obtained. Data were analyzed using Microsoft Excel spreadsheet, followed by Statistical Package for the Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5.

Results: Of the total 80 subjects enrolled in the study, 54 were females and 26 were males. In the study sample, the mean age was 47.8 (+9) years. Different variables were analyzed, and the values obtained were recorded for statistical analysis.

Conclusion: According to the study, there is a positive correlation between established coronary artery disease (CAD) risk factors, such as hypertension, abnormal lipid profiles, and elevated body mass index (BMI), and SCH. We also noted a strong correlation between SCH and elevated levels of uric acid, fasting blood sugar (FBS), postprandial glucose test (PPBS), and hemoglobin A1c (HbA1c). As a result, early detection and management of SCH may have cardiac preventive benefits.

India has a high burden of hypertension (HTN), which is often poorly controlled, leading to hypertension-mediated organ damage (HMOD). In the management of HTN, angiotensin receptor blockers (ARBs) assume prime importance, being first-line agents for most patient subgroups. Olmesartan is a highly efficacious ARB that demonstrates sustained blood pressure (BP) reduction over 24 hours. Moreover, it also assumes a protective role by reducing microvascular inflammation, left ventricular hypertrophy, proteinuria, vascular stiffness, central aortic BP, cardiocerebrovascular events and atrial fibrillation. To enhance therapeutic compliance and achieve BP goals, single-pill combinations with other antihypertensive agents are also available. This review holistically summarizes the evidence of olmesartan for HTN management for not only BP reduction but also organoprotective effects.

For decades, achieving glycemic control, target blood pressure, and renin-angiotensin-aldosterone system (RAAS) blockade remained to be the therapeutic interventions for retarding diabetic kidney disease (DKD) progression. The management of DKD showed major transformation when SGLT2 inhibitors were recommended to reduce the risk of progressive deterioration in estimated glomerular filtration rate (eGFR), end-stage renal disease (ESRD), and renal death following results of CREDENCE and DAPA-CKD trials. Despite currently available therapeutic approaches, the risk of cardiac death, progression to ESRD, and requirement of renal replacement therapy remains high. Finerenone is the newer potent selective nonsteroidal mineralocorticoid receptor antagonist (MRA) that showed reduction in primary composite renal and CV outcomes in FIDELIO-DKD and FIGARO-DKD studies, respectively. While SGLT2 inhibitors have direct effects on cellular and metabolic functions besides reduction in glomerular hyperfiltration, finerenone primarily inhibits mineralocorticoid pathway-dependent inflammation and fibrosis. The renal benefits of dapagliflozin in the DAPA-CKD trial were regardless of MRA, and likewise, the benefits of finerenone in FIDELIO and FIGARO studies were irrespective of SGLT2i. Moreover, the risk of serious hyperkalemia with MRA was significantly reduced by concomitant use of SGLT2 inhibitors, making this combination a safer choice. Even though available data support the fact that this duo possibly has distinct as well as complementary mechanisms in protecting renal and cardiac functions, strong evidence to recommend routine use of the combination of SGLT2 inhibitors and MRA in DKD is currently lacking. However, the results of the ongoing CONFIDENCE study evaluating superiority of dual therapy of empagliflozin and finerenone will be worthwhile to understand the benefits of this friendly duo.

Introduction: Syringomyelia is a slowly progressive degenerative disorder of the spinal cord. Clinical features of syringomyelia vary from weakness in limbs to positive sensory symptoms and dissociative sensory loss. Thus, early and prompt diagnosis becomes crucial for reducing the morbidity associated with the disease.

Case description: Here, we present a case of 52-year-old male presenting with progressive weakness in bilateral upper limbs without any sensory involvement which is an atypical presentation for syringomyelia.

Conclusion: Motor neuron disease (MND) like presentation in syringomyelia is a rare entity. This can make diagnosis of syringomyelia difficult. Hence, any patient presenting with pure motor weakness of bilateral upper limb should also be suspected of syringomyelia.

Frank Macfarlane Burnet (1899-1985) was born in Victoria, Australia, and obtained his MD in 1924 from the University of Melbourne. Burnet spent 2 years in England at the Lister Institute, where he studied bacteriophages and earned a PhD in 1928. Returning to Australia, he worked at the Walter and Eliza Hall Institute; as a bacteriologist, he continued his research on phages. Burnet then made a significant contribution by devising a method for cultivating viruses in a living chick embryo (1932-33).

The most accurately described causes of alcohol-related myelopathy are cases of hepatic myelopathy, which is myelopathy in the setting of either liver cell failure or portosystemic failure resulting in toxic myelopathy in the absence of liver failure. One of the few descriptions of myelopathy completely attributed to toxic effects of alcohol or its metabolites alone is by Sage et al., who reported five patients with the condition who had no evidence of hepatic involvement, portal hypertension, or nutritional deficiency. We report one of the first cases from India where an alcoholic presented with acute onset myelopathy with sphincter disturbances in the absence of liver cell involvement or portosystemic shunting.

The psycho-neuro-immuno-endocrine/enteric (PNIE) axis is a fundamental concept in neuroscience, integral to the neuroendocrine system (NES). It encompasses the interactions between behavior, neurology, endocrinology, gut biology, and the immune system. These interactions regulate crucial metabolic processes like glucose, lipid, and protein metabolism, blood pressure, and various homeostatic functions, including blood pressure regulation, thermogenesis and pulmonary hypoxia detection.