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

Objectives: Vitamin D deficiency has become a global epidemic in the past 2 decades. The present review has enlightened us about the etiopathogenesis of this epidemic. Materials and methods: A search of the literature and our previous studies were analyzed, and a conclusion was created. Results and analysis: It has been seen that the upsurge of obesity, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), and vitamin D deficiency are going hand in hand in all countries of the world. Probably downregulation of the gene Cyp2R1, whose product is 25-hydroxylase, may be the causative factor, as the enzyme 25-hydroxylase produces 25-hydroxy vitamin D from both ergocalciferol and cholecalciferol in the liver. Conclusion: Obesity, MetS, insulin resistance, and NAFLD are the causative factors of ubiquitous vitamin D deficiency.

Background: Idiopathic Parkinson's disease (IPD) is associated with a spectrum of nonmotor symptoms (NMS) that contribute as much to the burden of the disease as the more obvious motor abnormalities. There is a paucity of literature determining the association between NMS and the severity of IPD, especially in rural eastern parts of India.

Aims of study: This study explores the frequency of NMS in patients with IPD and determines the association between NMS and the severity of IPD.

Materials and methods: A cross-sectional observational study involving 65 serially enrolled IPD patients (diagnosed as per United Kingdom Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria) was conducted over a period of 18 months. The patients were evaluated for disease severity as per the Hoehn and Yahr scale (original) and were subsequently evaluated with a predesigned and validated Parkinson's Disease Non-Motor Symptoms Questionnaire. Pearson's Chi-squared test for independence of attributes or Fisher's exact test was used for comparison of categorical variables across the groups. Continuous variables were compared using a one-way analysis of variance (ANOVA) test.

Results: The most common presenting NMS of IPD was low mood (n = 61; 93.85%), followed by apathy (n = 59; 90.77%), impaired concentration (n = 58; 89.23%), restless leg (n = 54; 83.08%), and tenesmus (n = 54; 83.08%). A majority of the neuropsychiatric symptoms, autonomic dysfunctions, sleep abnormalities, gastrointestinal manifestations, and sensory abnormalities individually showed a statistically significant relation with the severity of IPD.

Conclusion: Common presenting NMS include neuropsychiatric manifestations, autonomic symptoms, sleep-related symptoms, and gastrointestinal manifestations. Most of the NMS are significantly related to disease severity.

India contributes to 26% of the global tuberculosis (TB) burden, with very high mortality and morbidity. The exact incidence of disseminated TB cannot be established among the general population but accounts for <2% of cases among immunocompromised hosts and constitutes 20% of all extrapulmonary TB cases. Disseminated TB has a very high mortality rate of around 25-30%. Miliary TB, a disseminated form, is another entity of TB that poses a health burden due to its difficulty in diagnosis. This entity usually presents with subclinical symptoms and poses a diagnostic challenge in the absence of specific diagnostic tests. We present a case of a young female with epistaxis and thrombocytopenia who was diagnosed with disseminated TB [miliary, bone cyst, bone marrow (BM) involvement].

Climate change has led to global warming since the last century, which has adverse health consequences. Heat stress nephropathy (HSN) is such a disorder that is emerging as an epidemic because of heat exposure, dehydration, and shortage of drinking water. HSN has been suspected to occur in different parts of the world. Many cases of chronic kidney disease of unknown etiology (CKDu) such as Mesoamerican nephropathy and Sri Lankan nephropathy are now being considered as HSN. Influences of agrochemicals (e.g., pesticides), heavy metals (e.g., cadmium, lead, arsenic, and fluoride), and genetic polymorphism were suspected for causation of CKDu in those cases, but results were inconsistent in different studies from different locations. Drinking water with high silica and strontium was also found in a region with high CKDu in South India.¹ Malnutrition and infections such as leptospirosis can also cause CKDu. It is not clear whether CKDu in different hot locations studied represents a single disease or a group of different disorders, but the common factors found are heat and related dehydration. However, combined effects may also be possible. Dehydration from heat stress increases toxin exposure of different organs because of higher blood and urine concentration, as chronically dehydrated patients may not excrete toxic substances effectively. Also, the wells and water reservoirs are more concentrated with toxic substances because of hot weather due to evaporation.

Background: Guillain-Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy with various subtypes, including the acute motor axonal neuropathy (AMAN) variant. Distal muscle weakness is typically rare in AMAN. Myositis, an inflammatory muscle condition, is infrequently documented in GBS. This case report presents an unusual presentation of GBS with unilateral claw hand and myositis.

Case description: A 55-year-old male presented with bilateral limb pain and weakness, progressing to significant motor impairment over 5 days. Symptoms began after a brief febrile illness with gastrointestinal distress. Upon examination, the patient exhibited decreased muscle strength in all limbs, dysphagia, and partial clawing of the left hand. Neurological assessment showed cranial nerve involvement and dysautonomia. Blood tests revealed elevated creatine phosphokinase (CPK) levels, and cerebrospinal fluid (CSF) analysis showed high protein without cellular abnormalities. Diagnosed with the AMAN variant of GBS, the patient was treated with intravenous immunoglobulin (IVIG) and antibiotics. Physiotherapy for speech, limbs, chest, and swallowing was initiated. Gradual improvement was observed, with increased limb power by the third week, although swallowing difficulties persisted longer.

Conclusion: This case highlights a rare presentation of the AMAN variant of GBS with unilateral claw hand and myositis. The findings suggest that elevated CPK levels in GBS may not directly indicate myositis but could be secondary to the syndrome. Prompt diagnosis and treatment of the patient for recovery have been emphasized. This report underlines the need to consider GBS in patients presenting with atypical motor impairments and elevated CPK levels.

Background and objective: Long coronavirus disease 2019 (COVID-19) has emerged as an important consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To identify its incidence 12-18 months following hospitalization in patients with COVID-19, we performed a prospective study.

Methods: Virologically confirmed successive patients with moderate-to-severe COVID-19, hospitalized during the delta wave in India, were recruited. Data on clinical features, investigations, and outcomes were obtained. Long COVID-19 was diagnosed using the European quality of life questionnaire (EQ-5D) and Birmingham symptom burden questionnaire (SBQ) at 12-18-month follow-up.

Results: During the study period (January-July 2021), we evaluated 8,680 suspected COVID-19 patients, of whom 1,641 were confirmed virologically and 388 were hospitalized. Men accounted for 64.4%, individuals aged >60 years for 41.5%, hypertension for 42.8%, diabetes for 38.4%, and cardiovascular disease for 17.3%. At admission, there was a high prevalence of cough (71.1%), fever (86.6%), and oxygen requirement (38.6%). Proning was deployed in 89.2% of cases, nasal cannula in 36.3%, nonrebreather masks in 15.7%, noninvasive ventilation in 14.4%, and invasive ventilation in 16.2%. In-hospital deaths totaled 75 (19.3%), with 310 discharged for home care and eligible for follow-up. At a median follow-up of 15 months, 9 patients had died, 40 were lost to follow-up, and 264 were evaluated. The incidence of Long COVID-19 was 45 [17.0%, 95% confidence of interval (CI) 12.6-21.9%]. The median EQ-5D score was 5.0, with >5 observed in only 11 patients (0.6%). Using the SBQ, new-onset dyspnea on exertion was noted in 13 (4.9%), rest dyspnea in 7 (2.6%), fatigue in 31 (11.7%), feverishness in 18 (6.8%), and low energy in 16 (6.1%). Long COVID-19 was significantly more prevalent in women and older individuals. In Long COVID-19 compared to controls, the mean duration of oxygen requirement (5.46 ± 9.8 vs 2.46 ± 4.5 days, p = 0.002), use of nonrebreather masks (17.8 vs 7.3%, p = 0.026), noninvasive ventilation (11.1 vs 3.2%, p = 0.020), and duration of intensive care unit (ICU) stay (13.5, 8.7-17.3 vs 8.0, 5.0-11.0 days, p = 0.028) were significantly higher.

Conclusion: The incidence of Long COVID-19 at 12-18 months follow-up is 17.0%. It is significantly higher in women, older age groups, and patients requiring longer oxygenation, nonrebreather oxygen masks, noninvasive respiratory support, and extended stays in the ICU.

Introduction: Leptospirosis and tick-borne typhus are zoonotic diseases, rarely reported as coinfection. More specific molecular tests are not easily accessible for diagnosis of these diseases, thus resulting in delayed diagnosis and eventually considerable morbidity and mortality.

Case description: We report a case of leptospirosis with tick-borne typhus coinfection in an abattoir worker who presented with a short history of fever, myalgia, jaundice, nonoliguric renal failure, diffuse petechial rash, and altered sensorium. His lab investigations showed leukocytosis, raised C-reactive protein (CRP), elevated transaminases and creatinine, mild pleocytosis, and mildly raised proteins in cerebrospinal fluid (CSF). Serology for Leptospira IgM was positive by enzyme-linked immunosorbent assay (ELISA). A paired Weil-Felix test (WFT) showed a fourfold increase in OX19 and OX2 titers. The patient responded well to IV antibiotic therapy and was discharged. This is the first time that leptospirosis and Indian tick-borne typhus coinfection has been reported from western India.

Conclusion: Leptospirosis and Indian tick-borne typhus coinfection is a rare but important cause of tropical fever. Arduous efforts to establish a definitive diagnosis help not only in surveillance for epidemiological data of the disease entities but also in avoiding severe complications resulting from considerable delay in appropriate therapy.

Heart failure (HF) is a condition that can result in repeated hospitalizations every year and can result in worsening HF (WHF). Although current pharmacological treatment for HF is fairly effective, there is a need to lower the residual risk of cardiovascular events and hospitalizations. Vericiguat, a soluble guanylate cyclase (sGC) stimulator, a new entrant, seems to present a promising therapeutic option for HF with signs of worsening, and early initiation of this therapy may be beneficial in certain patient profiles. This article explores the potential benefits of early vericiguat initiation in four patient profiles who presented with WHF.

Background: In patients with chronic obstructive pulmonary disease (COPD), early detection of noninvasive ventilation (NIV) failure is a promising technique for decreasing mortality. The objective of this study was to evaluate the efficacy of heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) score in predicting NIV outcome in COPD-associated respiratory failure.

Methodology: A prospective observational study was conducted on 100 COPD patients with acute respiratory failure who were initiated on NIV. HACOR score was calculated at the start of NIV and after 1-2, 12, and 24 hours. NIV failure was defined as progression to invasive mechanical ventilation or death. NIV success was defined as liberation from NIV prior to hospital day seven and not meeting criteria for failure.

Results: In this study, 100 patients with COPD and respiratory failure were enrolled. Their mean age was 65.34 years [standard deviation (SD) 8.19]. Male patients were predominant (n = 81). Eighty-nine percent of patients were smokers, and the remaining had exposure to biomass fuel. At the initiation of NIV, the median HACOR score was 3 (interquartile: 2, 4). In 13% of patients, there was NIV failure. There were 17 (17%) patients whose HACOR score at initiation was ≥5. In patients with a HACOR score ≥5, the NIV failure rate was 76.4% and mortality was 41.1%. The area under the curve (AUC) for prediction of NIV failure by HACOR score at initiation was 0.980 (p-value < 0.05).

Conclusion: The HACOR score had high sensitivity as well as specificity at initiation in the prediction of NIV failure. A higher HACOR score predicts a high chance of NIV failure. Obtaining the HACOR score at the bedside makes it convenient for assessing the efficacy of NIV in patients with COPD.