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

Hyperthyroidism can sometimes mimic Guillain-Barré syndrome (GBS). Polyneuropathy, paraplegia, and thyrotoxic periodic paralysis presenting as hypokalemia can be the presentation of hyperthyroidism. This case highlights the similar presentation of two clinical conditions that can occur simultaneously, or one of them may precipitate the other. A high index of suspicion is essential for the diagnosis.

Erasmus syndrome is a rare clinical syndrome characterized by the development of systemic sclerosis (SSc) following chronic exposure to silica; however, the presence of silicosis is not a prerequisite for this diagnosis. It is infrequently reported in the literature, and recognizing the association between occupational silica exposure and SSc is crucial for timely diagnosis and management in workplace settings. We report a case of Erasmus syndrome in a stone cutter in his late 30s, who presented with gangrene in both feet, Raynaud's phenomenon, without any evidence of other organ involvement. Anti-Scl-70 antibody was positive on the line immunoassay, supporting the diagnosis. The patient was started on a combination therapy including calcium channel blockers, phosphodiesterase 5 inhibitors, and wound care. At 6-month follow-up, he had no further disease progression with stabilization of gangrene.

Hypertrophic osteoarthropathy (HOA), also known as pachydermoperiostosis is an unusual cause of digital clubbing. It is a rare osteo-arthro-dermopathic syndrome which is associated with clubbing of fingers, thickening of skin in the face and scalp, seborrhea, and subperiosteal new bone genesis. It is divided into two types: Primary (PHOA) and secondary HOA, with the latter being common. PHOA accounts for a very meager portion of HOA cases. PHOA is usually inherited in an autosomal dominant fashion and rarely follows autosomal recessive inheritance pattern. We report a case of a male who presented with a history of progressive and painful enlargement of distal phalanges of hands and feet for 6 years. After all examinations and tests ruled out the secondary causes for HOA, genetic sequencing was performed to confirm the diagnosis of PHOA. Sequencing revealed homozygous nonsense mutation in SLCO2A1 gene. This mutation is postulated to impair the degradation of prostaglandin E2 (PGE2), leading to its elevated levels. PHOA is an atypical cause of clubbing which usually poses a challenge in diagnosis. This report also underscores the importance of genetic sequencing in appropriate diagnosis and management of the PHOA.

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a complication of type 2 diabetes mellitus that can progress to coma and death if left untreated. Focal hyperglycemic seizures are still an uncommon but noteworthy association of HHNS and most commonly involve the occipital and parietal lobes. Gerstmann syndrome, also called angular gyrus syndrome, consists of a tetrad of finger agnosia, acalculia, left-right disorientation, and agraphia that is usually accompanied by aphasia and most commonly presents in parietal lobe pathology. Here we report a case of a 50-year-old right-handed male with complaints of focal right-sided upper limb and facial seizures and findings of acalculia, finger agnosia, left-right disorientation, semantic aphasia, and loss of comprehension. Laboratory reports suggested HHNS seizures that presented clinically as Gerstmann syndrome. Magnetic resonance imaging (MRI) of the brain revealed dominant (left in our case) parietal lobe pathology. Although it is understood that HHNS is linked with focal neurological deficits, the exact mechanism by which this happens is still unknown, and Gerstmann syndrome associated with hyperglycemic seizures is still underreported, necessitating additional research.

Tuberculosis involving the parotid lymph nodes is rare and can clinically and radiologically mimic benign neoplasms such as Warthin tumor, particularly when bilateral. We present the case of a 72-year-old male with bilateral parotid swellings, initially suspected to be Warthin tumors based on magnetic resonance imaging (MRI) findings showing well-defined, cystic lesions with focal solid components and central necrosis. Histopathological examination following ultrasound-guided biopsy revealed caseating granulomas consistent with tuberculous lymphadenitis. This case highlights the importance of including infectious etiologies such as tuberculosis in the differential diagnosis of bilateral parotid lesions, especially in endemic regions.

Stress is a part of life. Stress impacts persons living with chronic disease and those who care for them. Thus, coping with stress becomes an integral part of diabetes self-management education. This opinion piece describes useful ways of coping with stress. It uses a simple 4 × 3 model, designed in an alliterative manner. Four trigonal pillars, or the four As-approach/attitude, analysis, activity, and adjuvant methods-determine the efficacy of coping with stress. Each of these domains includes various attitudes, behaviors, and choices (ABC), which are described in a pleasing manner as 12 Ps. This list reinforces strategies, styles, and systems that can be used to ensure positive, productive coping.

Introduction: Nontyphoidal Salmonella (NTS) is a significant cause of food- and water-transmitted illness in the world, with the burden amplified in low-socioeconomic countries such as India. While most infections present as self-limiting gastroenteritis, vulnerable populations may develop invasive nontyphoidal salmonellosis (iNTS). This study aimed to determine the prevalence, clinical spectrum, serotype distribution, and antimicrobial resistance patterns of NTS isolates in a tertiary care hospital.

Materials and methods: A total of 61 NTS isolates were recovered from clinical samples, including stool, blood, pus, and urine. Identification was performed using the VITEK-2 system, and serotyping of fifteen isolates was done at the National Salmonella and Escherichia Center, Central Research Institute (CRI), Kasauli, Himachal Pradesh. Antimicrobial susceptibility testing was performed using the VITEK-2 compact system.

Results: The prevalence of NTS among 1,08,468 samples was 0.056%. Most isolates were from stool samples, followed by blood, pus, and urine. Most patients presented with acute gastroenteritis (56%), often associated with outside food consumption. S. Enteritidis and S. Typhimurium were the most common serovars isolated. Extraintestinal manifestations included diabetic cellulitis, sepsis, and a rare case of generalized lymphadenopathy in a child, later diagnosed with Mendelian susceptibility to mycobacterial diseases (MSMD), and a case of neonatal meningitis in a 15-day-old infant. All isolates were susceptible to piperacillin-tazobactam, imipenem, and meropenem (100%). However, resistance to ceftriaxone was 22.9%, ciprofloxacin 31.1%, ampicillin 14.7% and trimethoprim-sulfamethoxazole 3.27%.

Conclusion: Nontyphoidal Salmonella continues to pose a public health threat in India, particularly with the rise of antimicrobial resistance. These findings underscore the importance of prudent antibiotic usage, robust surveillance systems, and public health interventions focused on food safety, sanitation, and targeted education.

Background: Among liver disorders, nonalcoholic fatty liver disease (NAFLD) is the most common and is associated with metabolic syndromes, particularly type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of pioglitazone in the management of T2DM with NAFLD.

Methods: This retrospective, single-center, observational study was carried out at Dr Panikar's Speciality Care Centre from 1^st September 2022 to 1^st February 2024. The data were collected from the medical records of diabetic patients with NAFLD who received pioglitazone. Patients aged between 18 and 80 years who had diabetes along with NAFLD were included in the study.

Results: A total of 3,350 patients were enrolled in this study, of whom 2,074 were male, with a mean age of 48.6 years. The mean estimated A1C (eA1C) showed a significant reduction at 6 months compared to baseline (6.87 vs 7.6%; mean difference (95% CI): 0.50% (0.39, 0.61); p < 0.001). At baseline, the mean controlled attenuation parameter (CAP) was significantly higher than at 6 months (p = 0.032). Similarly, the mean cholesterol level was significantly higher at baseline compared to 6 months (p = 0.020). A 25.7% decrease in grade 3 fatty liver was noted over the 6-month period from baseline. In terms of the decrease in fibrosis severity, a 37.5% reduction in F2, a 25.8% reduction in F1, and a 17.6% reduction in F4 were observed from baseline to 6 months.

Conclusion: In T2DM patients with NAFLD, pioglitazone improves glycemic control and reduces both fatty liver grades and fibrosis stages.