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

Background: Contrast-induced nephropathy (CIN) is an iatrogenic impairment to the kidneys that can occur in susceptible persons after intravascular injections of contrast agents. Individuals undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) often bear the risk of developing CIN. The likelihood of CIN can be predicted using several techniques, although none of them are very accurate. CHA₂DS₂-VASc score is used to predict unfavorable clinical outcomes in patients with ACS and atrial fibrillation. The score comprises preprocedural variables and is simple to calculate and can be used for predicting CIN. This study aims to validate CHA₂DS₂-VASc score to predict occurrence of CIN among patients undergoing PCI.

Materials and methods: This cross-sectional research has been carried out at a tertiary care hospital. The study comprised a total of 182 patients who were admitted with ACS and underwent PCI. CIN incidence was computed. The study population was divided into two groups (the CIN group and the non-CIN group) based on the incidence of CIN. The CHA₂DS₂-VASc score was computed for every patient. The best cutoff values of the CHA₂DS₂-VASc score to predict the development of CIN were found using receiver operating characteristic (ROC) curve analysis. The incidence of CIN was computed both above and below the CHA₂DS₂-VASc score's optimal cutoff point.

Results: The incidence of CIN among patients undergoing PCI was 14.3%, and the ROC value for the CHA₂DS₂-VASc score was 0.896. Statistically significant increases in the incidence of CIN were observed in patients undergoing PCI who had a CHA₂DS₂-VASc score of >2. Additionally, a significant relationship was discovered between CIN and age, diabetes, hypertension, prior coronary artery disease (CAD), and Killip class ≥2.

Conclusion: Patients with CHA2DS2-VASc score of >2 had higher incidence of CIN. CHA2DS2-VASc score was found to be useful in predicting contrast nephropathy among patients with acute myocardial infarction undergoing angiography.

Introduction: Acanthosis nigricans (AN), a commonly encountered condition in clinical practice, is linked with numerous systemic disorders. Currently, there is a dearth of literature on the correlation of clinical and dermoscopic features of AN with nailfold capillaroscopy (NFC) changes. This study intended to evaluate patients with AN who have underlying microvascular complications as a consequence of metabolic diseases.

Objectives: Primarily to study the association of clinical and dermoscopic findings of AN with NFC and to elucidate the spectrum of NFC changes in patients of AN.

Materials and methods: This was a cross-sectional, hospital-based study with a sample size of 97. Clinical Burke's grading and dermoscopy were performed in clinically diagnosed AN patients. NFC was performed on all 10 fingernails. The fourth and fifth fingernails of each hand were considered for studying the association.

Results: NFC changes seen were tortuous, dilated, cross-linked, ramified capillaries, and dropouts. There was a positive association of clinical Burke's grading (p-value = 0.002) and duration (p-value = 0.003) of AN with dermoscopic features such as depth of sulci cutis, number of hyperpigmented dots, and shape of papillary projections. Tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN (p-value < 0.05). Ramified and cross-linked capillaries showed a significant association with the duration of AN (p-value < 0.05).

Conclusion: Dermoscopy in AN showed gradation in changes corresponding to the clinical Burke's grading and duration. Ramified and cross-linked capillaries showed a significant association with the duration of AN, while tortuous, cross-linked capillaries showed a significant association with the clinical scale of AN. The present study aids in the early detection of microvascular changes in AN, such as tortuous, ramified, and cross-linked capillaries, and proves helpful in referring the patient for screening of diabetic retinopathy and nephropathy at the earliest.

Objective: To assess the prevalence of guideline-directed medical therapy (GDMT) and identify reasons for nonprescription and dose optimization in heart failure patients with reduced ejection fraction (HFrEF) in a tertiary care hospital in southern India.

Methods: A cross-sectional study was conducted in a tertiary care hospital involving HFrEF patients. Patients with heart failure were categorized based on GDMT prescriptions. Reasons for nonprescription and suboptimal dosing were identified.

Results: The study included 102 HFrEF patients with a mean age of 54 ± 11.7 years, predominantly male (89%). Only 10.8% of patients received GDMT at optimal doses. Although 62% were on triple therapy, many had one or more medications at suboptimal doses. Additionally, 26% of patients were not prescribed all recommended drug classes. Notably, the majority of patients with renal impairment fail to receive triple therapy. Barriers identified included hemodynamic issues and renal dysfunction.

Conclusion: GDMT adherence in HFrEF patients is significantly lower than expected, with only 10.8% receiving therapy at recommended doses. Key issues include suboptimal dosing and incomplete prescription of drug classes, influenced by patient-specific factors and systemic barriers.

Type 2 diabetes mellitus (T2DM) remission has emerged as a critical area of research and clinical interest, especially in India, where diabetes prevalence is rising at an alarming rate. Achieving remission through pharmacologic, dietary, and surgical interventions is now an attainable goal for a subset of patients. This systematic review synthesizes evidence from clinical trials, emerging pharmacologic interventions, and current guidelines for diabetes remission. We explore the mechanisms of diabetes reversal, highlighting novel agents such as glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. This review also addresses the long-term sustainability of remission, epidemiological trends in India, and current treatment recommendations, integrating data from major studies. The findings underscore the need for a patient-centered, evidence-based approach to diabetes management. Additionally, we discuss the role of continuous glucose monitoring (CGM), dietary interventions, and the benefits of millet consumption in diabetes remission.

Rheumatoid arthritis (RA) is a common autoimmune disorder characterized by inflammation in the joints, affecting around 0.24-1% of the population. RA can develop through a variety of paths, resulting in a nonspecific clinical appearance. It progresses from preclinical to chronic disease, with pathogenic mechanisms that may differ across people, confounding therapy efforts. Numerous factors have been found to be associated with RA, including lifestyle-related risk factors like smoking and obesity, which are modifiable, as well as advancing age and female gender, which are nonmodifiable. RA pathophysiology is an intricate interaction between different genetic and immunological variables resulting in disease progression. With a better knowledge of the pathophysiology of RA, new therapeutic approaches are being developed for effective management of RA. This review article summarizes epidemiology, pathogenesis, and diagnostic options for RA.

Background: Metabolic syndrome (Met-S) is a major threat to human health all over the world due to a rise in obesity and sedentary lifestyle. It is associated with many cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia, and hypertension. This study was conducted to determine the correlation of serum liver enzymes, especially serum gamma-glutamyl transferase (GGT), in Met-S and non-Met-S patients.

Objectives: To determine the correlation of serum liver enzymes, especially serum GGT, in Met-S and non-Met-S patients.

Materials and methods: An observational case-control study was carried out on a total of 100 patients-50 cases of Met-S as defined by the International Diabetes Federation (IDF) 2005 and 50 age- and gender-matched controls (non-Met-S patients) aged >18 years-at a tertiary care hospital of Western India. Patients' history taking, general anthropometric, and systemic examination were done. Liver function tests [serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), GGT, alkaline phosphatase (ALP)], C-reactive protein (CRP), and ultrasonography (USG) for visualizing liver involvement were done.

Results: The maximum number of patients with Met-S were >50 years of age, with male predominance (78%) and a high prevalence of diabetes, hypertension, and central obesity among them as major components of Met-S. Liver function tests such as GGT, SGPT, SGOT, and CRP were significantly raised in Met-S patients compared to non-Met-S patients. The majority of the Met-S patients with deranged liver function tests had fatty liver on USG abdomen.

Conclusion: This study showed a significant association between elevated levels of GGT, SGPT, SGOT, CRP, and fatty liver in Met-S patients compared to non-Met-S patients.

Aim: To ascertain the function of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers in evaluation of disease activity in rheumatoid arthritis (RA) patients.

Materials and methods: This cross-sectional research was performed in a hospital and included 381 patients who met the 2010 ACR/EULAR criteria for RA. The clinical disease activity assessment (CDAI) was used to evaluate activity of disease in addition to demographic and disease-related variables. Based on preestablished CDAI cutoff values, the participants were categorized into four groups. For each patient, laboratory analysis included the following: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and complete blood count (CBC). The conventional procedure was followed in the appropriate computation of PLR and NLR. The four patient groups' NLR and PLR values were compared, and the relation among disease activity indices and NLR and PLR was investigated using Pearson correlation analysis.

Results: In patients, the mean PLR was 132.8 ± 127.7 and the mean NLR was 3.66 ± 2.6. Patients with low disease activity had a substantially lower mean PLR (p = 0.021) in comparison to those with higher disease activity. The mean NLR in relation to CDAI was not observed to be statistically significant (p = 0.69) across the four groups. While there was a weak positive association between PLR and the physician visual analog scale (VAS) (r = 0.22), patient VAS (r = 0.12), and CDAI (r = 0.17), there was no correlation among CDAI and specific disease indices with NLR, according to Pearson correlation analysis.

Conclusion: PLR, but not NLR, may be an effective biomarker for evaluating the disease activity level in RA patients, particularly higher disease activity.

Background: The safety and efficacy of proton-pump inhibitors (PPIs) in gastroesophageal reflux disease (GERD) patients on polypharmacy is challenging to manage. Rabeprazole's unique metabolism reduces drug-drug interactions (DDI), making it beneficial for patients with polypharmacy. This study aimed to explore the safety and effectiveness of rabeprazole in Indian comorbid GERD patients on polypharmacy.

Methods: A cross-sectional survey was conducted (November, 2024 and January, 2025), which included healthcare professionals (HCPs) with experience in prescribing PPIs. The survey included 10 questions addressing issues faced in polypharmacy settings.

Results: Around 91.9% preferred prescribing rabeprazole over other PPIs in polypharmacy patients. CYP450 enzyme interactions are considered by 73.3% HCPs when prescribing PPIs, with a strong emphasis on minimizing DDI in polypharmacy contexts. Rabeprazole was chosen by a major share of HCPs for its unique nonenzymatic metabolism and minimal interaction with the cytochrome P450 system, suggesting suitability in polypharmacy patients. Furthermore, 70% HCPs suggested rabeprazole could improve cardiovascular (CV) outcomes by optimizing antiplatelet therapy, and 74.4% supported its safety in patients on antiplatelet therapy.

Conclusion: Rabeprazole appears to be the preferred PPI in managing GERD among patients on polypharmacy, primarily due to its favorable safety profile and minimal DDI, and may be advantageous in clinical practice.

Background: Cirrhosis, a major cause of global morbidity and mortality, necessitates early detection and accurate staging for optimal management. Traditional reliance on liver biopsy is being challenged by noninvasive techniques such as transient elastography (FibroScan^®), which measures liver stiffness to estimate fibrosis severity. The potential for FibroScan^® as a point-of-care (POC) tool supports rapid clinical decision-making in multiple clinical settings and scenarios.

Materials and methods: A prospective observational study was conducted from December 2024 to February 2025 at a tertiary center in Western India, enrolling adult patients with suspected liver disease, metabolic risk factors, or excessive alcohol consumption. Liver fibrosis was assessed using the Echosense FibroScan mini+430 device, applying the Metabolic Dysfunction-Associated Steatohepatitis (MASH) scoring system (F0-F4). At least 10 valid liver stiffness measurements (LSM) were obtained per patient. Data analysis included t-tests, analysis of variance (ANOVA), Chi-squared tests, and receiver operating characteristic (ROC) curve analysis for diagnostic accuracy.

Results: Of the 93 patients (mean age 52.3 years; 69.9% male), 41.9% had advanced fibrosis, and 30.1% demonstrated cirrhosis. Alcohol intake and diabetes were significantly associated with fibrosis stage (p = 0.002 and p = 0.008, respectively). FibroScan^® showed excellent diagnostic accuracy for cirrhosis (AUROC = 0.91) and good accuracy for significant fibrosis (AUROC = 0.82); the optimal LSM cutoff for F4 was 12.5 kPa. Body mass index (BMI) correlated weakly but significantly with CAP values.

Conclusion: Bedside FibroScan® offers a highly accurate, rapid, and noninvasive method for quantifying liver fibrosis and cirrhosis in clinical practice. Its integration into routine care could substantially improve management for patients at risk of liver disease.