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

A 65-year-old man was admitted with left lower-limb cellulitis and an impending abscess. He was a known case of type 2 diabetes mellitus, with hemoglobin A1c (HbA1c) 7.6%, and was started on intravenous piperacillin-tazobactam. Wound debridement was carried out under local anesthesia. At admission, he had stage 1 acute kidney injury as per Kidney Disease: Improving Global Outcomes (KDIGO) criteria, which improved with supportive measures. On the 6th day of therapy, his relatives noticed a black discoloration over his tongue (Fig. 1). Examination revealed a dark coating confined to the dorsal surface of the tongue, with sparing of the tip and lateral borders. There was no associated pain or burning sensation. A diagnosis of black hairy tongue (BHT) was considered, possibly related to piperacillin-tazobactam. The antibiotic was discontinued, and the patient was advised to maintain good oral hygiene and to brush the tongue gently. The discoloration resolved completely within 1 week of these measures.

Objectives: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates.

Methods: A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols.

Results: The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use.

Conclusion: The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.

Artificial intelligence (AI) is universally adopted in our day-to-day life, including medical science, and transforming healthcare in various ways, like scientific discovery, collecting and interpreting large data, and gaining insights that might not have been possible by traditional scientific tools. AI also helps learning by geometric understanding, leveraging knowledge, enhanced accuracy and efficiency in diagnostics, imaging, clinical decisions, predictive analysis, drug discovery, virtual assistance, administrative automation, telemedicine, and precision medicine. However, AI lacks emotional consciousness, moral understanding, spiritual insight, and human psychology. AI is a tool to help us and not a human being. Humanity, sociality, spirituality, and emotions are difficult to define. Human emotions are internal, subjective experiences such as happiness, sadness, anger, fear, love, empathy, and sympathy, deeply rooted in our biological systems, memories, and personal experiences, and AI can simulate these emotions but cannot feel or experience them, while spirituality involves meaning, purpose, and belief in something more than oneself (e.g., God or supreme power). AI has no soul or belief and spiritual practices. However, concerns persist, including biases ingrained in AI algorithms, lack of transparency in decision-making, potential compromises of patient data, privacy, and safety of AI implementation in clinical settings. Artificial intelligence has enormous potential in choosing complex regimes, faster calculations, streamlining workflows, and expanding access to healthcare. Nevertheless, AI cannot experience emotions, exercise moral reasoning, or offer genuine spiritual companionship, and successful integration requires AI to function strictly as an assistant to healthcare professionals (HCPs). "AI has vast potential, but it cannot be human, social, emotional, and spiritual."

Background: Dengue fever continues to pose a major global health challenge. Electrolyte disturbances, particularly hypocalcemia, are frequently observed in dengue but are underutilized for prognostication.

Objective: To evaluate the relationship between corrected serum calcium levels and dengue severity.

Materials and methods: A prospective observational study of 210 adult patients with confirmed dengue was conducted at Shiv Ram Hospital. Serum calcium was measured within 24 hours of admission and corrected for albumin. Severity was classified per World Health Organization (WHO) 2009 criteria. Correlation analyses and multivariate logistic regression were used to assess associations with clinical and laboratory parameters.

Results: Mean corrected serum calcium declined with increasing severity (group A: 8.39 ± 0.59 mg/dL, group B: 8.05 ± 0.62 mg/dL, group C: 7.61 ± 0.67 mg/dL; p < 0.001). Hypocalcemia (<8.5 mg/dL) was observed in 91.3% of severe cases. Calcium levels negatively correlated with hematocrit, platelet count, and hospitalization duration (p < 0.01). Hypocalcemia independently predicted severe dengue (aOR: 3.94; 95% CI: 1.98-7.84; p < 0.001).

Conclusion: Hypocalcemia is a frequent and significant predictor of severe dengue. Serum calcium offers a simple, cost-effective tool for early triage and management in dengue-endemic regions.

Nanodrug delivery systems are gradually becoming the current "talk of the town" due to their efficiency in treating different diseases in a more advanced manner when compared to conventional drug-delivery systems. It is well known that drugs can be given through various routes of administration, such as the popular oral, subcutaneous, and intravenous routes. It is quite surprising that formulating these same drugs as nanoparticles (NPs) and administering them to the patient could produce better results. Different studies have shown the effects of nanodrug delivery systems in targeting cancer cells, ameliorating pulmonary arterial hypertension, and providing improved treatments for ophthalmic conditions such as glaucoma. In most studies, nanodrug delivery systems have been shown to exhibit targeted action at the desired site or organ, low toxicity, and fewer systemic side effects. These new insights can provide an enhanced understanding of the benefits of NP formulations of drugs, as well as open up new pathways for future creative techniques in addressing emerging medical conditions. Furthermore, these formulations generally consist of polymer- or liposome-based or coated NPs, as they are easily biodegradable, meaning they have a higher ability to disintegrate and, at the same time, are not harmful to living tissues, thereby displaying greater compatibility. New connections can be established through the utilization of NPs in the treatment of emerging diseases worldwide. Data from these studies could provide a foundation for groundbreaking and innovative strategies in coping with or fighting even the recent COVID-19 pandemic.

We describe an uncommon instance of a female patient, age 35, with type 1 diabetes mellitus who developed DKA (diabetic ketoacidosis) that was exacerbated by acute pancreatitis and severe hypertriglyceridemia. The patient had abdominal pain, vomiting, and biochemical evidence of DKA upon admission. Physical examination was notable for xanthomas, and laboratory tests showed extremely high triglyceride levels and milky plasma. Clinical improvement resulted from the patient receiving IV insulin treatment and lipid-lowering medications. This example emphasizes the significance of early diagnosis and treatment when hypertriglyceridemia-induced pancreatitis complicates DKA.

Cystic lung disease is a rare and underrecognized manifestation of pulmonary tuberculosis (TB), often masquerading as other diffuse cystic lung disorders and complicating timely diagnosis. We present the unusual case of a 25-year-old woman who developed progressive dyspnea and pleuritic chest pain shortly after initiating antituberculous therapy. Initial imaging revealed classical miliary nodules without cystic changes. However, within a month of treatment, follow-up high-resolution CT unveiled an unexpected transformation of numerous thin-walled cysts clustered in the upper lobes, accompanied by ground-glass opacities, septal thickening, and a tree-in-bud pattern suggestive of active endobronchial spread. This radiological evolution, occurring posttreatment initiation, points to a dynamic pathophysiological process likely involving immune-mediated airway obstruction, necrosis, and structural remodeling of the parenchyma. This case reveals a rare form of pulmonary TB that mimics other cystic lung diseases. In TB-endemic areas, early recognition of cystic transformation, especially with recurrent pneumothorax or atypical imaging, is vital. Though uncommon, it highlights TB's chameleon-like nature and the value of serial imaging in guiding timely, effective management. Radiologists and clinicians should remain vigilant for such rare yet reversible complications in TB-endemic settings.