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

Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome, is a condition resulting due to compression of LRV between the aorta and superior mesenteric artery (SMA), with dilatation of the distal portion of LRV. We present a case of an elderly female presenting with left lumbar pain for 1 year. Initial investigations revealed microscopic hematuria and mild ascites. Further investigations revealed compression of LRV between the aorta and SMA, with aorto-SMA angle reduced up to 12°, suggesting a diagnosis of NCS. Along with this, cystic bronchiectasis with multiple centrilobular nodules with tree-in-bud pattern was seen in bilateral lung fields, suggestive of pulmonary tuberculosis. Ziehl-Neelsen (ZN) staining and cartridge-based nucleic acid amplification test (CBNAAT) confirmed our diagnosis of NCS with pulmonary tuberculosis.

Background: Previous research has suggested that the prevalence of risk factors for cardiometabolic diseases is higher in South Asians, with premature presentation common in this subpopulation.

Aim: To explore this further, we assessed the prevalence of metabolic syndrome (MetS) components and risk factors among young adults.

Methods: This was a cross-sectional, epidemiological, institution-based study conducted at the Medical College in Eastern India. The study aimed to assess the demographic, physical, and biochemical risk factors for MetS among first-year medical students using a predesigned, pretested, semistructured questionnaire. The relationship between socio-demographics and other characteristics of MetS was calculated by using Chi-squared tests and unpaired t-tests. A p-value ≤ 0.05 was significant with a 95% confidence interval (CI). The logistic regression method was applied to find out the strength of the association of sociodemographics and other characteristics with MetS.

Results: The study included 150 first-year medical undergraduate students (mean age of 18.5 ± 0.4 years), comprising 68% males. Among students who were smokers, consumed alcohol, and had excessive junk food, salt, and red meat, the risk of MetS was significantly greater (p < 0.00001). The logistic regression revealed that history of smoking [adjusted odds ratio (AOR) 5.32, 95% CI (3.31-9.02)] and history of alcohol intake [AOR 6.23, 95% CI (2.45-8.62)] were significantly associated with greater odds of MetS.

Conclusion: In young adults, the risk of premature cardiovascular disease can be reduced by focusing on the early identification and prevention of risk factors for MetS. Context-specific, cost-effective, and feasible interventions to reduce identified risk factors are the need of the hour.

Enteric fever is caused by Salmonella typhi and Salmonella paratyphi A and B, which can present clinically with variety of symptoms. We report a case of a middle-aged gentleman with salmonella infection who developed reversible corpus callosum splenium infarcts, which is an unusual presentation of enteric fever. The condition was reversed with antibiotics routinely used to treat enteric fever in the country.

A 52-year-old man with a 5-year history of diabetes mellitus and chronic renal disease presented with sudden onset left upper limb weakness and numbness at 5 pm, which progressed to quadriplegia by the next day at 2:30 am. He had dysarthria at admission. There were no sensory symptoms in the lower limbs. There were no bladder symptoms. Examination showed bilateral tongue weakness and quadriplegia, with the left side more affected than the right. Reflexes were sluggish bilaterally. Plantars were extensor bilaterally. The sensory system was normal in all four limbs, including joint position sense and vibration. Diffusion-weighted magnetic resonance imaging (MRI) of the brain showed diffusion restriction in the bilateral medial medulla simulating a heart sign, suggestive of a bilateral medial medullary infarct (Figs 1 and 2). MR angiography showed left vertebral artery stenosis. He was treated as per stroke protocol and made partial recovery at follow-up.

Overview: Parkinson's disease (PD) is a neurodegenerative disorder that is common in individuals over the age of 50 years, affecting about 1% of the population. Nonmotor symptoms (NMS) are a common occurrence in PD, but they are often ignored by motor symptoms. Studies have shown that NMS in PD show a significant impact on quality of life. The introduction of tools like nonmotor symptoms scale (NMSS) and unified Parkinson's disease rating scale (UPDRS) that have a specific nonmotor domain will assist in defining research and therapy to enhance the early identification and management of NMS in the affected population.

Aim of the study: (1) To evaluate the prevalence of NMS in different stages of idiopathic Parkinson's disease. (2) To correlate the prevalence of NMS with the duration and severity of the disease.

Materials and methods: The study involved 80 individuals who visited the Movement Disorder Clinic at Stanley Medical College and Hospital in Chennai and were diagnosed with idiopathic Parkinson's disease, which was in agreement with the United Kingdom Parkinson's Disease (UK PD) Brain Bank criteria.

Results: Out of the 80 study participants, 63.7% (n = 51) were male and 36.3% (n = 29) were female. In our study, the mean age of patients was 63.1 ± 7.01 years. The study population was predominantly aged 50-60 years (n = 36), followed by 61-70 years (n = 30), which made up more than 80% of the population. Age group of >71 years constituted only 17.5% (n = 14). Majority of the patients, that is, 42.5% (n = 34) were in stage 3 of Hoehn and Yahr (H&Y) staging. The mean and mode of H&Y stage were 2.7 ± 0.9 and 3, respectively. The mean duration of disease was 4.7 ± 2.7 years. The mean UPDRS score was 66 ± 24.5. The mean NMSS score was 32 ± 10.18.

Conclusion: NMSs are found to be highly prevalent among Indian patients with PD according to this study. The nonmotor symptom questionnaire aids in early detection and recognition of nonmotor symptoms in PD patients.

Spinocerebellar ataxia (SCA)-1, 2, 3, 6, and 31 are associated with sleep behavior disorder. We had a 66-year-old male who presented with late-onset cerebellar ataxia. Before 2 years, the onset of cerebellar symptoms, he had a history of sleep behavior disorder. He had a strong family history of similar symptoms in his younger sister. Whole exome sequencing of the patient and Sanger sequencing of his sister confirmed the diagnosis of SCA-6.

Background: Participating in undergraduate research in research-focused countries enhances students' critical evaluation, innovation, and contribution skills. Medical research is essential for undergraduates as it develops their critical thinking and analytical skills for innovation and aids in their professional growth. Many Indian students might be unaware of research opportunities because of insufficient exposure and guidance within their academic programs and restricted access to research facilities and mentorship at their educational institutions. Hence, this study aimed to check the awareness of medical and allied undergraduate students regarding research work. Methodology: Four hundred twenty-six valid responses were collected through an online Google form using snowball sampling from various healthcare disciplines, such as medicine, dental, nursing, Ayurveda, and physiotherapy. Data was collected from all over Maharashtra. The questionnaire had two sections: the first was regarding sociodemographics, and the other was an awareness tool, prepared and scored. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 22. Results: Most students (82.6%) supported making research a compulsory part of their education. Medical students showed greater interest (69.2%) than paramedical students (64.2%). Non-English-medium and government institute students had significantly higher awareness scores (p < 0.001). The type of course and a lower socioeconomic status were strong predictors of awareness (β = 16.809, -2.365, respectively; p < 0.001). Conclusion: Over 80% of medical students supported mandatory research in their curriculum. The specific course type and lower socioeconomic status were the best predictors of research awareness.

In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival. The aim of this consensus paper is to identify patient profiles, initiation or up-titration of beta-blockers and benefits of chirally pure beta-blocker in patients with heart failure. This expert consensus will ensure precise implementation of beta-blockers in heart failure as a part of guideline-directed medical therapy.

We present a case of a 77-year-old female diagnosed with multidrug-resistant (MDR) pulmonary tuberculosis (PTB), on all oral longer regimen [according to Indian Programmatic Management of Drug Resistant Tuberculosis (PMDT) guidelines] for a month. She presented with nausea, vomiting, worsening of breathlessness for a week, pancytopenia, and gradually increasing lactate levels. Various causes of lactic acidosis including metabolic, septic, and hypoxic were ruled out. Despite our dedicated efforts, she tragically passed away due to severe lactic acidosis, a complication associated with linezolid treatment.