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

Hemophilia is a coagulation disorder caused by deficient or absent clotting factors. It is a chronic disease that starts from birth and requires lifelong intravenous administration of antihemophilic factors. Healthcare professionals (HCPs), patients living with hemophilia, and their caregivers have reported concerns regarding the challenges associated with the intravenous route and the deterioration in their quality of life (QoL) due to the frequently repeated infusions necessary to maintain the desired levels of clotting factors. Patients with hemophilia and their caregivers have often voiced their need for easier methods of treatment administration, similar to the way insulin is delivered subcutaneously using a pen. Subcutaneous injection using a pen device is a known way to improve treatment compliance and adherence in patients with chronic diseases. The recent introduction of pen devices for hemophilia treatment administration is expected to reduce the administration burden and improve QoL. The narrative review presents the advantages of pen devices and patient and caregiver attitudes toward these newly introduced pen devices in hemophilia.

Systemic amyloid light chain (AL) amyloidosis is a rare but potentially fatal disorder caused by deposition of misfolded immunoglobulin light chains, often presenting with vague, nonspecific symptoms that delay diagnosis. We report a diagnostically striking case of a 65-year-old male presenting with progressive tongue enlargement, periorbital purpura, submandibular swelling, and a prior history of carpal tunnel syndrome-classic yet under-recognized features of AL amyloidosis. Despite negative urine immunofixation and Bence-Jones proteinuria, the markedly elevated free lambda light chains and an abnormal kappa/lambda ratio raised clinical suspicion. Bone marrow biopsy revealed 25% plasma cells with lambda restriction and t(11;14) translocation, confirming AL amyloidosis associated with plasma cell myeloma. Treatment with a daratumumab-, bortezomib-, and dexamethasone-based regimen led to dramatic clinical improvement. This case emphasizes the importance of recognizing subtle external manifestations as early diagnostic clues in AL amyloidosis, especially in the absence of classical laboratory markers. Timely recognition can significantly improve outcomes in a condition where therapeutic delay can be devastating.

The weight of the matter in diabetes care challenges the traditional glucose-centric model of diabetes management and argues for a paradigm shift toward prioritizing weight-specifically fat reduction-as the central lever in achieving metabolic health. Drawing insights from landmark trials such as SURMOUNT and Diabetes Remission Clinical Trial (DiRECT), as well as real-world Indian experience with agents like oral semaglutide, the article emphasizes that visceral adiposity is a root cause driving insulin resistance, beta-cell dysfunction, and multiorgan complications. Addressing weight early can lead to improved glycemic control, cardiorenal protection, and even disease remission-outcomes that far exceed glucose lowering alone. In the Indian context, where the "thin-fat" phenotype and central obesity present unique challenges, this weight-first approach demands culturally sensitive strategies and redefined success metrics beyond body mass index (BMI) or hemoglobin A1c (HbA1c). With the advent of incretin-based therapies, clinicians now have the tools to treat upstream rather than manage symptoms downstream. The piece calls for a unified therapeutic strategy that targets excess adiposity to deliver both glycemic and vascular legacy benefits-reframing weight not merely as a number but as a powerful determinant of risk, response, and recovery.

Background: Dyslipidemia is an imbalance of lipids-total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL). The aim of this observational electronic medical records (EMR)-based study was to evaluate the prevalence, comorbidities, and treatment pattern in dyslipidemia patients.

Methodology: This was a retrospective, EMR-based longitudinal study that used anonymized data. Data were analyzed for dyslipidemia patients of either gender, age ≥18 years, prescribed lipid-lowering agents. Follow-up data were captured at 3 months (±30 days) from the baseline visit. There were records of 77,57,513 adult patients in the EMR database from January 2018 to 2023. Of these, 15,20,319 (19.6%) patients were diagnosed with dyslipidemia, of which 90,933 (5.98%) were treatment-naïve patients, that is, newly diagnosed, and 65,535 (72.07%) patients had follow-up within 3 months (±1 month).

Results: The prevalence of dyslipidemia was 19.6% with a greater number of males. Diabetes and hypertension (HTN) were the top comorbidities. HDL was in the normal range (44.8 ± 9.7 mg/dL), LDL and TC were borderline high (140.5 ± 38.8 and 222.8 ± 42.8 mg/dL), TG were high (203.8 ± 94.7 mg/dL), and VLDL was close to the normal range (29.2 ± 8.5 mg/dL) at baseline. About >50% of dyslipidemia patients with diabetes, HTN, or diabetes and HTN with LDL >100 mg/dL at baseline achieved LDL <100 mg/dL at follow-up. In dyslipidemia patients with coronary artery disease (CAD), 47.54% of patients had LDL >100 mg/dL at follow-up, and only 4.92% of patients had LDL <55 mg/dL at follow-up. A number of 66.7% of dyslipidemia patients with chronic kidney disease (CKD) had LDL <100 mg/dL at follow-up. Low- to moderate-dose rosuvastatin and atorvastatin were the mostly prescribed drugs.

Conclusion: Statins significantly reduced LDL, TC, and TG in patients with CAD and LDL in patients with CKD. Despite being on lipid-lowering drugs, probably due to low doses, a significant proportion of patients did not achieve the recommended LDL levels.

Objectives: This study was conceptualized to estimate the prevalence and correlates of hepatitis B and C infections among the adult population of West Bengal and review the progress made so far toward the stated goal of controlling these infections in the state.

Materials and methods: A population-based cross-sectional study was conducted during February 2023 to April 2024 in two districts of the state in adults. Participants were recruited from subdistrict clusters using the population-proportion-to-size sampling method. Sociodemographic information, along with laboratory parameters of hepatitis B and C infections, was collected from individuals.

Results: Information from 22,320 individuals revealed that the prevalence of hepatitis B and C infections was 0.47 and 0.02%, respectively. Hepatitis B infection was higher in males (0.5%) and daily laborers (0.8%). In the population, 80.2% was considered susceptible to hepatitis B infection. A significant association of hepatitis B infection was found with a history of dialysis (AOR 21.1), multiple sex partners (AOR 7.3), and a family history of jaundice (AOR 3.4).

Conclusion: Prevalences of hepatitis B and C were lower than earlier estimates done in 2015-2016. A higher proportion of susceptible individuals among young adults remains a point of concern. As the prevalence is low among adults, West Bengal should focus on the triple elimination of mother-to-child transmission (EMTCT) of human immunodeficiency virus (HIV), syphilis, and hepatitis B virus (HBV) to progress further toward the elimination of hepatitis B.

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition commonly managed with triple inhaler therapy comprising long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA), and inhaled corticosteroid (ICS). Despite optimal inhalation therapy, many patients continue to experience persistent symptoms. Doxophylline, a novel xanthine derivative, offers bronchodilator and anti-inflammatory benefits with a more favorable safety profile than traditional methylxanthines.

Objective: To assess the efficacy, safety, and tolerability of oral doxophylline in addition to triple inhaler therapy in patients with stable severe COPD.

Materials and methods: In this randomized controlled trial, 78 patients were allocated to group A (triple therapy + doxophylline 650 mg once daily) and group B (triple therapy alone). Assessment included the COPD assessment test (CAT score), C-reactive protein (CRP), spirometry parameters (FEV₁, FEV₁%, FEV₁/FVC), adverse events, and evaluations were performed on days 0 and 90.

Results: By day 90, group A showed greater improvement in CAT score (7.94 ± 4.17 vs 10.06 ± 3.99; p = 0.033) and CRP (12.2 ± 4.47 vs 15.33 ± 5.37 mg/L; p = 0.01). Spirometry gains were comparable: FEV₁ (0.97 ± 0.23 vs 0.96 ± 0.26 L/minute; p = 0.872), FEV₁% predicted (49.10 ± 8.73 vs 48.69 ± 9.72%; p = 0.482), and FEV₁/FVC% (54.09 ± 6.57 vs 52.89 ± 6.95%; p = 0.397). Mild adverse events including palpitations (14.29%), tremors (8.57%), and nausea (2.86%) were more frequent in group A but were generally tolerated.

Conclusion: Adjunctive oral doxophylline significantly improved symptom burden and systemic inflammation in patients with stable severe COPD without conferring additional spirometric benefits. Although mild adverse effects were observed, doxophylline was overall well tolerated and may represent a viable adjunctive option in selected COPD patients with persistent symptoms despite optimized inhaler therapy.

The 2025 update to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines redefines the chronic obstructive pulmonary disease (COPD) diagnostic framework by recognizing earlier-stage conditions like "pre-COPD" and "PRISm" (preserved ratio impaired spirometry). This new approach captures patients who display early symptoms or structural changes in the lungs but do not yet meet traditional COPD criteria, marking a shift toward early detection and personalized management. By broadening the diagnostic criteria and promoting advanced imaging and biomarker use, GOLD 2025 offers pulmonologists a more precise, individualized approach to assessing COPD. This article examines the implications of these diagnostic updates for clinical practice, emphasizing the importance of proactive intervention to improve outcomes, slow disease progression, and tailor treatment to the unique profiles of at-risk patients. By embracing diverse pathophysiological profiles, the new GOLD framework underscores the necessity for comprehensive diagnostic tools, including imaging and biomarker analyses, to redefine COPD as a preventable and manageable condition.

Osteoarthritis (OA) is a chronic degenerative joint disorder and a leading cause of pain and disability among the elderly. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs), though effective in symptom relief, pose significant risks of gastrointestinal, cardiovascular, and renal complications, especially in long-term use. Polmacoxib (CG100649) is a newer NSAID with its dual inhibitory role on cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA), planned to offer higher therapeutic efficacy and safety. This review critically examines the pharmacodynamic and pharmacokinetic properties of polmacoxib, along with its clinical efficacy and safety in OA and acute pain conditions. Clinical trials across phases I-III consistently show polmacoxib to be well tolerated and effective in pain relief and efficient improvement of the joint, with a safety profile comparable to or better than traditional COX-2 inhibitors like celecoxib. Recent trials also explore its role in combination therapies for acute pain management, including dental and postoperative settings, showing noninferiority to standard regimens and fewer adverse events. Its innovative mechanism and pharmacological profile support its potential as a next-generation NSAID for OA and pain management, particularly in populations at high risk for NSAID-induced adverse effects. Further larger long-term studies are warranted to confirm its medical benefits and broader therapeutic applications.

Poor nutritional status prior to surgery in cardiac patients is one of the risk factors for acute kidney injury (AKI), morbidity, and mortality. There is a lack of data in patients undergoing cardiac surgery with regard to nutritional status and risk of AKI. This study was conducted with the objective of assessment of the nutritional status of cardiac surgery patients using body composition measures (BCM) and other biochemical parameters. This study was conducted at Madras Medical Mission Hospital, Chennai. Before enrolling, informed consent from the patients and ethical authorization were obtained. All patients >18 years of age undergoing cardiac surgery had a BCM analysis done on the pre- and postoperative day 5. Paired t-test was used to compare the pre- and postoperative data. Preoperative body mass index (BMI) of the patients showed that the majority of them were overweight, with a mean BMI of ±26.55 kg/m². There were no significant changes in the BCM results for protein weight in either study group (no AKI group-preop: mean ± SD, 9.0316 ± 2.39, p = 0.67; postop: mean ± SD, 9.1919 ± 2.57, p = 0.77; AKI group-preop: mean ± SD, 9.57 ± 8.00, p = 0.67; postop: mean ± SD, 9.56 ± 8.07, p = 0.77). There was a significant loss of body fat in all patients, but it was higher in patients who developed AKI (preop: mean ± SD, 33.28 ± 10.96, p = 0.11 vs postop: mean ± SD, 31.83 ± 10.94, p = 0.53). The skeletal muscle mass in both groups showed no significant changes. Those who developed AKI postoperatively had a higher preoperative visceral fat area (VFA) (mean ± SD, 116.87) and percentage body fat (PBF) (33%) compared to patients who did not develop AKI (VFA ±102.36 and PBF 30%). We found that patients had lost body fat postsurgically. Those who were diagnosed with AKI had overhydration, high waist circumference, and VFA preoperatively.