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

Objectives: We present a rare case of Poncet's disease, a sterile reactive arthritis associated with active tuberculosis (TB), mimicking seronegative spondyloarthritis in a young diabetic male. We aim to highlight the diagnostic challenges and emphasize the importance of considering Poncet's disease in patients with inflammatory arthritis, especially in the context of subclinical TB.

Methods: We present a detailed case report of a 28-year-old male with poorly controlled diabetes mellitus type 2 [glycated hemoglobin (HbA1c) 13.9%] who presented with a 3-week history of bilateral ankle pain, swelling, and redness. The pain progressed to involve multiple small joints of the hands, wrists, elbows, and knees, significantly impacting his mobility, with no history of trauma, fever, rash, or urinary symptoms. Physical examination revealed tenderness and swelling in the affected joints with limited range of motion. Laboratory investigations showed an elevated erythrocyte sedimentation rate (ESR) of 74 mm/hour and C-reactive protein (CRP) of 104 mg/L. Chest X-ray revealed bilateral hilar lymphadenopathy, and computed tomography (CT) scan confirmed multiple enlarged lymph nodes in the mediastinum and bilateral hilar regions, suggestive of pulmonary TB. Despite the absence of acid-fast bacilli in bronchoalveolar lavage (BAL), the clinical presentation, imaging findings, exclusion of other causes of reactive arthritis, and a dramatic response to anti-TB therapy within days of initiation strongly supported the diagnosis of Poncet's disease. The patient completed 6 months of anti-TB therapy and achieved complete resolution of joint pain and swelling, regaining his full range of motion.

Results: The patient's symptoms, including joint pain, swelling, and inflammatory markers, significantly improved within weeks of starting anti-TB therapy. Serial CRP and ESR readings showed a downward trend, confirming the response to treatment.

Conclusion: This case report highlights the importance of considering Poncet's disease in the differential diagnosis of seronegative spondyloarthritis, particularly in patients with underlying TB. A high index of suspicion and prompt initiation of anti-TB therapy can lead to rapid improvement in symptoms and prevent unnecessary investigations and potentially harmful immunosuppressive medications.

A high risk of thrombosis is linked to myeloproliferative neoplasm (MPN) and antiphospholipid syndrome (APS). The systemic autoimmune disorder known as APS is characterized by persistently positive antiphospholipid antibodies [anticardiolipin (aCL), lupus anticoagulant, and antibeta 2 glycoprotein 1 IgG and IgM antibodies] in conjunction with obstetrical complications or thrombosis (Chayoua et al.). Polycythemia vera (PV) is a MPN that causes too many red blood cells (RBCs) in the blood and proinflammatory cytokines. In this report, we present a case of a 25-year-old lady with a history of second-trimester abortion who presented with abdominal pain and hepatosplenomegaly. Owing to erythrocytosis, thrombocytosis, and moderate hepatosplenomegaly, workup for MPN was done along with prothrombotic workup including APS, and she turned out to be positive for both. Coexistence of MPN and APS is rare in the literature. The optimal management of patients with coexistent APS and MPN has not been defined so far. Immediate anticoagulation with specific treatment for MPN is essential to prevent further thromboembolic episodes and progression to catastrophic APS.

Background: High-intensity statins are recommended in patients experiencing acute coronary syndrome (ACS) to lower low-density lipoprotein cholesterol (LDL-C) levels, but evidence-based recommended LDL-C goals often remain unmet. We assessed the therapeutic benefit of early LDL-C lowering and the safety of high-intensity atorvastatin and ezetimibe combination versus high-intensity atorvastatin alone in ACS.

Methods: In this investigator-initiated trial, 254 patients admitted with ACS were randomized 1:1 to either atorvastatin 80 mg once daily (group A) or a combination of atorvastatin 80 mg and ezetimibe 10 mg once daily (group B). The first dose was administered orally immediately after diagnosis and then continued daily. The primary and secondary endpoints were percentage reductions in direct LDL-C measurements over the initial 4-week period and at 12 weeks, respectively.

Results: The mean percentage reduction in LDL-C was 8.12% in group A vs 14.43% in group B (p < 0.001) at week 1, 16.62% in group A vs 28.34% in group B at 2 weeks (p < 0.001), 29.43% in group A vs 45.15% in group B at 4 weeks (p < 0.001), and 41.88% in group A vs 60.76% in group B (p < 0.001) at 12 weeks. Adverse events were similar in both groups.

Conclusion: Ezetimibe added to high-intensity statin therapy was well tolerated and resulted in an immediate and robust additional decrease in circulating LDL-C concentrations, with a markedly higher proportion of participants achieving LDL-C goals at 4 and 12 weeks. These promising results show that dual therapy started immediately at the diagnosis of ACS has the potential to improve cardiovascular outcomes in ACS.

India is struggling with the twin epidemics of diabetes and weight issues, holding the second position globally in the former and third in the latter. Despite multiple advancements with therapies that offer glycemic control and weight benefits, there has remained a gap for a comprehensive drug for the management of "diabesity." Semaglutide, since its global approval in 2017, has become a blockbuster, owing to the popularity of "Ozempic." While Ozempic has been traditionally approved for glycemic control in type 2 diabetes mellitus (T2DM), it does offer significant other benefits powerful weight loss, cardiovascular benefits, renal protection benefits, and functional improvement in peripheral arterial disease. The drug is approved in India for first-line use in adults with T2DM as an adjunct to diet and exercise. The long use of semaglutide globally and in India has ensured adequate data on efficacy and safety, ensuring confidence and trust. Gastrointestinal side effects are the most common adverse events seen with the molecule, as with other GLP-1 drugs. This review highlights the global clinical data and practicalities of the use of Ozempic in diabesity in the Indian context.

Background: Drowning is the third leading cause of unintentional injury and death worldwide, accounting for 7% of all injury-related deaths. People who are at higher risk include those who have free accessibility to water and younger children lacking supervision. The common complications of drowning are mainly due to hypoxia. It mainly affects the respiratory, cardiac, and central nervous system. Rarely, drowning may cause acute kidney injury (AKI) secondary to rhabdomyolysis. Here, we present a case of near drowning with AKI, rhabdomyolysis, and elevated intracranial tension (ICT) with a false localizing sign (abducent nerve palsy).

Case description: A 21-year-old female patient was brought with a history of alleged drowning for about 3-5 minutes. The patient presented with loss of consciousness; she was gasping and had diffuse subcutaneous emphysema. On examination, the patient had bilateral coarse crepitations. She was started on mechanical ventilation. After 2 days, the patient developed elevated renal parameters and had an episode of ventricular tachycardia. After 10 days, the patient developed diplopia and blurring of vision. Ophthalmological examination revealed bilateral abducent nerve palsy with established papilledema and hemorrhagic retinopathy. The patient was treated with IV antibiotics, IV fluids, DC shock, inotropes, hemodialysis, and acetazolamide. After 15 days, the patient recovered from bilateral lateral rectus palsy and had no blurring of vision.

Conclusion: Drowning is a leading cause of accidental death. This patient had diffuse subcutaneous emphysema, rhabdomyolysis with AKI, ventricular tachycardia, and raised ICT. In drowning, raised ICT often has a poor outcome. However, with constant monitoring and timely intervention this patient survived.

The International Diabetes Federation estimates that 537 million individuals around the globe currently have diabetes, and this number is anticipated to rise to approximately 783 million by 2045. About 30% or more of individuals diagnosed with diabetes are more prone to developing chronic kidney disease (CKD), and a considerable portion progresses to renal impairment that requires renal replacement therapy.^1,2.

This systematic review examined the role of bedside teaching (BST) in undergraduate medical education, focusing on its impact on clinical competence and professional growth. The review included 15 studies that investigated the effects of BST on physical examination skills, diagnostic abilities, communication skills, and confidence among medical students. The results showed that BST significantly improved physical examination skills, diagnostic abilities, and communication skills, and increased confidence among students. BST was also found to enhance empathy and professionalism among students. However, the review highlighted several challenges in implementing BST, including time constraints, lack of trained faculty, and declining opportunities for BST. To address these challenges, the review recommended integrating BST into the medical curriculum, providing faculty development programs, and utilizing technology-enhanced learning tools. The findings of this systematic review underscore the importance of BST in undergraduate medical education, emphasizing its potential to enhance clinical competence and professional growth among future healthcare professionals.

Introduction: Stress hyperglycemia has been implicated in acute illnesses, but the risk of future diabetes is seldom studied. Hospital hyperglycemia, as defined by in-hospital random blood glucose (RBG) >140 mg/dL, is much less studied. This study aimed to determine the profile and short-term outcome of hospital hyperglycemia patients.

Methods: A descriptive follow-up study was conducted in 50 patients with hospital hyperglycemia. Based on their HbA1c status, patients were categorized into known cases of diabetes (group A, n = 12, 24%), undiagnosed diabetes (group B, n = 13, 26%), prediabetes (group C, n = 13, 26%), and normoglycemic (group D, n = 12, 24%). Duration of hospital stay and in-hospital mortality were noted. At 4 weeks post-discharge, HbA1c, along with the glucose tolerance test, was performed for groups C and D, and outcomes were recorded.

Results: Half of the hospital hyperglycemia patients were diabetic, although 26% of the patients with hospital hyperglycemia were unaware of their diabetes status. Average age and BMI were found to be higher in diabetes patients (25.63 ± 5.25 kg/m²) than prediabetes (22.98 ± 2.24 kg/m²) and normoglycemic patients (21.38 ± 2.37 kg/m²). Two deaths were encountered during hospital stay in the prediabetes group. At 4 weeks post-discharge, in group C, 2 (8.7%) developed diabetes, 4 (17.4%) had impaired fasting glucose, and 3 (13%) had impaired glucose tolerance. One prediabetes patient became normoglycemic. All 12 patients of group D remained normoglycemic.

Conclusion: Hospital hyperglycemia in diabetics as well as prediabetes subjects is associated with a higher age and BMI compared to normoglycemic individuals. Hospital hyperglycemia in prediabetes subjects is associated with higher mortality and greater propensity to develop diabetes in the short-term, compared to normoglycemic individuals.

Introduction: Anemia is considered to be a public health issue of serious concern universally. In the current era of advancing technology, electronic health (e-health) initiatives are being employed in various health programs for disease screening and management. This study was planned to screen for anemia and manage it through a multidimensional approach comprising iron folic acid (IFA) supplementation, deworming among children, and dietary guidance and health education through pop-up videos with the aid of e-health initiatives.

Methods: This was a prospective cohort study. An Android e-application (app) was used on tablets to identify anemia after hemoglobin estimation through the Hemoglobin Color Scale. Accredited Social Health Activists (ASHAs) managed anemia by providing health education and dietary guidance through pop-up videos and IFA supplementation. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 29. Tests of significance in the form of Cochran's Q, McNemar, chi-square, and repeated measures analysis of variance (ANOVA) and independent t-test were applied.

Results: The overall prevalence of anemia significantly declined from 46.08% at baseline to 14.65% at the 9th month. Males had a higher anemia prevalence (52.8%) compared to females (39.16%). An overall improvement of 68.2% was observed in the anemia status, with the maximum being in the 1-5-year age-group and females. Mean hemoglobin levels showed a consistent increase across all age-groups, with the maximum being in the 6-month-1-year age-group and females.

Conclusion: This study demonstrated that community-based, sustained, and targeted strategies through the use of e-health initiatives can effectively combat anemia and achieve significant improvements in hemoglobin levels across all age and gender groups.