Bengal Physician Journal

Register      Login

Table of Content

2023 | May-August | Volume 10 | Issue 2

Total Views

EDITORIAL

Nandini Chatterjee

Sudden Cardiac Death: Time to Pay Heed to the Warning Bells

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:27 - 28]

   DOI: 10.5005/jp-journals-10070-8015  |  Open Access |  How to cite  | 

159

Original Article

Shambo S Samajdar, Shatavisa Mukherjee, Sourya Ghosh, Santanu Munshi, Santanu K Tripathi, Saibal Moitra, Pudupakkam Vedanthan

Component-resolved Diagnostics in Allergy Practice Focusing on Food Allergy: A Systematic Review

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:14] [Pages No:29 - 42]

Keywords: Component-resolved diagnostics, Food allergy, Sensitization, Specific immunoglobulin E

   DOI: 10.5005/jp-journals-10070-8016  |  Open Access |  How to cite  | 

Abstract

In this systematic review, we have discussed the role of component-resolved diagnostics (CRD) in the diagnosis of immunoglobulin E (IgE)-mediated food allergies; IgE-mediated food allergies are adverse reactions to food caused by an immunologic mechanism involving specific IgE (sIgE) antibodies. While self-reported food adverse reactions are common, the prevalence of confirmed food allergies through oral food challenge (OFC) is estimated to be around 1%. The conventional diagnostic process for food allergies involves clinical history, in vivo and/or in vitro tests, and OFC. However, many components used in these tests are irrelevant to the diagnostic process. Component-resolved diagnostics is a diagnostic technique that uses purified allergens to detect sIgE antibody responses against individual allergenic molecules. It aims to enhance the specificity of IgE testing and differentiate between genuine sensitization and cross-reactivity-induced sensitization. Component-resolved diagnostics also helps in stratifying the clinical risk associated with sensitization patterns and predicting OFC outcomes. However, CRD cannot replace the OFC as the gold standard due to insufficient sensitivity and specificity levels. Proper interpretation is crucial to avoid unnecessary elimination diets and auto-injector prescriptions that may impact patients’ quality of life. Component-resolved diagnostics plays a significant role in the diagnostic work-up of food allergies by identifying and characterizing allergenic compounds causing allergic responses. It enables differentiation between primary and secondary sensitization, predicts disease progression and clinical risk, and aids in stratifying OFC results. However, there are gaps in research and clinical practice. Commercial diagnostic tests are only available for a limited number of allergens, CRD is costly compared to other tests, and it lacks sufficient sensitivity and specificity to replace the OFC. Further research and initiatives are necessary to address these gaps and improve the use of CRD in food allergy diagnosis.

612

Original Article

Debraj Chattopadhyay, Surajit Das, Kripasindhu Gantait

Monitoring Methotrexate-induced Increased Liver Stiffness and Significant Liver Fibrosis in Rheumatoid Arthritis Patients: A Cross-sectional Controlled Study with Real-time Two-dimensional Shear Wave Elastography

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:43 - 46]

Keywords: Elastography, Hepatic fibrosis, Methotrexate, Rheumatoid arthritis

   DOI: 10.5005/jp-journals-10070-8017  |  Open Access |  How to cite  | 

Abstract

Objective: To explore the significance of the association between treatment with methotrexate (MTX) and liver stiffness in rheumatoid arthritis (RA) patients by transient elastography (TM). Methodology: In this cross-sectional study, a total of 100 adult patients of RA were selected randomly as the study population, and 50 were the control population. Out of the total study population, half of them were taking MTX for >2 years to 5 years, and the rest for >5 years. Hepatic fibrosis was determined by measuring the hepatic stiffness by TE method (by FibroScan) in kilopascal unit (kPa), where >9 kPa value was considered to be significant for developing hepatic fibrosis. The hepatic stiffness of the patient group was compared with that of healthy controls. Result: The mean BMI value between the two groups taking methotrexate therapy for < 5 years and >5 years was 22.37 ± 2.67 kg/m2 and 25.13 ± 3.09 kg/m2, and the control population was 20.71 ± 2.06 kg/m2. P-value came to be < 0.0001, which was statistically significant, and the effect of mean BMI on liver stiffness was also found significant (p = 0.04). The mean (mean ± SD) kPa value among the study population and control group is 6.04 ± 0.95, 6.67 ± 1.68, and 3.83 ± 0.52. Having compared among three groups, p-value was < 0.0001. A significant association was also found regarding the duration of MTX therapy with increased liver stiffness (p = 0.018). SDAI has been found to be positively correlated with increased hepatic stiffness (r = 0.077). Conclusion: The long-term use of methotrexate therapy in RA patients has been found to be significantly associated with progressive liver fibrosis and increased hepatic stiffness.

232

REVIEW ARTICLE

Madhuchanda Kar, Jhilam Mukherjee

Artificial Intelligence is Poised to be a Premier Player in the Future of Health Care

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:47 - 49]

Keywords: Artificial intelligence, Chatbot, EMR, Health care, Precision medicine, Wearable sensors

   DOI: 10.5005/jp-journals-10070-8007  |  Open Access |  How to cite  | 

Abstract

The goal of artificial intelligence (AI) is to imitate cognitive processes in humans. Due to expanding availability of health care data and the quick advancement of analytics techniques, it is bringing about a paradigm shift in health care. Recent advancements in the digitized data-collecting process have allowed AI applications to expand into previously believed to be the sole domain of human experts. In this article, we discuss current developments in AI technology across a range of health care applications, as well as the challenges that must yet to be overcome to implement a precise medical AI system.

289

REVIEW ARTICLE

Gorky Guha

Motor Neuron Disease: The Contribution of TAR-43 Gene in Amyotrophic Lateral Sclerosis

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:5] [Pages No:50 - 54]

Keywords: Amyotrophic lateral sclerosis, Familial amyotrophic lateral sclerosis, Sporadic amyotrophic lateral sclerosis, TAR DNA-binding protein 43

   DOI: 10.5005/jp-journals-10070-8009  |  Open Access |  How to cite  | 

Abstract

Motor neuron diseases are a spectrum of neurodegenerative disorders, characterized by their physicochemical propinquity for the voluntary motor systems. The most notorious of these neurodegenerative disorders is amyotrophic lateral sclerosis (ALS), which is a multifocal disorder affecting both lower and upper motor neurons. Amyotrophic lateral sclerosis has been defined as a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control. Transactive response element (TAR) DNA binding protein 43 (TDP-43) is an ribonucleic acid (RNA)/DNA binding protein contributing to RNA-related metabolism. Hyperphosphorylated and ubiquitinated TDP-43 deposits function as inclusion bodies in the brain and spinal cord which causes ALS. Majority of the ALS cases are sporadic amyotrophic lateral sclerosis's (SALS's) and 5–10% of cases are familial amyotrophic lateral sclerosis (FALS), where mutations of the TDP-43 DNA binding protein (TARDBP) gene occur and the rest (90–95%) are due to mutations in other genes like C9ORF72, SOD1, etc. Whether the ALS is familial or sporadic it has been seen that there is a significant contribution of TDP43 protein in the ALS pathology. Thus, the modality of TDP43-based proteinopathies and its involvement in ALS has been the focal point in the study of ALS-mediated neurodegeneration.

330

CASE REPORT

Sivaroja Yellaturi, Mugundhan Krishnan, Sowmini Perumal, Sakthi Velayutham, Malcolm Jeyaraj, V Kannan, R Viveka Saravanan

A Rare Case of Optic Nerve Sheath Meningioma

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:55 - 58]

Keywords: Meningiomas, Neurofibromatosis, Optic nerve sheath

   DOI: 10.5005/jp-journals-10070-8001  |  Open Access |  How to cite  | 

Abstract

Optic nerve sheath meningiomas (ONSMs) are benign neoplasms originating from the arachnoid cap cells located in the dural sheath surrounding the orbital or intracanalicular portion of the optic nerve. Multiple meningiomas have most commonly been found to be associated with neurofibromatosis type 2 (NF2). Although optic nerve sheath meningiomas are benign and slow growing, they tend to cause severe vision loss at later stages. Patients with meningiomas at one site should be screened for meningiomas at other locations and also for the presence of neurocutaneous stigmata.

199

CASE REPORT

Anuradha Deuri, Asif Mohammed Oleeur Rahman Mazumder, Arup Kumar Sarma, Nasreen Kausar, Jithin J Chandran

Rare Mucocutaneous (Dermatological) Manifestations of Vitamin B12 Deficiency: A Case Series

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:10] [Pages No:59 - 68]

Keywords: Deficiency, Hyperpigmentation, Mucocutaneous, Vitamin B12

   DOI: 10.5005/jp-journals-10070-8008  |  Open Access |  How to cite  | 

Abstract

Vitamin B12 deficiency is widespread in developing countries, especially in Africa, India, South and Central America. It affects 1–2% of the general population and 10–15% of older adults and hospitalized patients. The evaluation includes a detailed history of associated conditions and symptoms; an examination for gastrointestinal, dermatological, neurological, and other findings, and laboratory testing, including complete blood count (CBC) and vitamin B12 and folate levels. The prevalence of vitamin B12 deficiency is higher in vegans. Less commonly mucocutaneous presentations usually Addisonian-like hyperpigmentation over knuckles palms, and soles, diffuse/symmetric or a few scattered macules can occur. The hypothesis regarding pathophysiology behind these includes the decrease in the reduced form of glutathione increasing the activity of tyrosinase; second defective melanin transfer between melanocytes and keratinocytes and finally disturbed melanin distribution due to megaloblastic changes in keratinocytes. Here we present a case series of eleven patients ages varying from 22 years to 71 years, who presented with a history of multiple blood transfusions with rare findings of mucocutaneous hyperpigmentation, very prominent in the hard and soft palate, tongue, buccal mucosa and accentuated hyperpigmentation in upper limb and lower limb, all over face. Few cases also presented with whole-body pigmentation. They all presented high mean corpuscular volume (MCV) (>120) with severe anemia with hypersegmented neutrophils, normal cortisol, and very low serum vitamin B12. All related investigations were done. They have previously tried treatment with oral vitamin B12 supplements, but they didn't respond. Now they were treated with intramuscular vitamin B12 and all patients started to respond with clinical and lab oratorical values. There were also improvements in hyperpigmentation also.

606

CASE REPORT

Arijit Kayal, Dipan Saha, Anindya Karmakar, Debarati Bhar, Pranesh Sarkar

Incretin-based Antidiabetic Therapy and Pancreatitis: A Case Series

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:69 - 70]

Keywords: Acute pancreatitis, Case report, Diabetes mellitus, GLP-1 agonist

   DOI: 10.5005/jp-journals-10070-8012  |  Open Access |  How to cite  | 

Abstract

Dipeptidyl peptidase-4 (DPP-4) inhibitors, commonly referred to as gliptins, are a class of oral antihyperglycemic agents used for the management of type 2 diabetes mellitus. They work by inhibiting the enzyme DPP-4, which leads to increased levels of incretin hormones such as glucagon-like peptide-1 (GLP-1). On the contrary, glucagon-like peptide 1 receptor agonists (GLP-1RA) are the newest treatment for diabetes mellitus (DM). Many of these incretin-based agents have shown positive results in their respective cardiovascular outcome trials (CVOT). Acute pancreatitis is a condition that has been a subject of concern in relation to incretin-based therapies, as reported in some randomized clinical trials. Here, we present three such cases of pancreatitis related to this antidiabetic therapy.

202

CASE REPORT

Moumana Das, Rimi Som Sengupta, JM Jeetendra Kumar, Sagnic Mandal, Anirban Ghosh

Immune Thrombocytopenic Purpura Secondary to Carcinoma Tongue: A Rare Case Presentation

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:71 - 72]

Keywords: Carcinoma tongue, Case report, Immune thrombocytopenic purpura, Thrombocytopenia

   DOI: 10.5005/jp-journals-10070-8014  |  Open Access |  How to cite  | 

Abstract

Immune thrombocytopenic purpura (ITP) secondary to carcinoma tongue, is a relatively rare manifestation. An association of ITP with lymphoproliferative disorder comprises about 30% of cases of secondary ITP. A clinical correlation between ITP and carcinoma tongue was never reported before. Case description: A 48-year-old female with infiltrating squamous cell carcinoma tongue was admitted with isolated severe thrombocytopenia, without signs of active bleeding. She was treated conservatively and discharged. Then again after 15 days, she was readmitted with thrombocytopenia. Bone marrow examination showed megakaryocytic hyperplasia with normal morphology of erythroid and myeloid series with no evidence of infiltration of bone marrow by tumor cells. Finally, the diagnosis of ITP related to carcinoma tongue was reached. Conclusion: Immune thrombocytopenic purpura is mostly primary but it can occur secondary to autoimmune disorders, infections, such as HIV, Hepatitis C, H. pylori, lymphoid neoplasms and occasionally solid tumors. This patient is an example of ITP secondary to a solid tumor with a clinical course concomitant to the course of carcinoma tongue. This case supports the relationship between carcinoma tongue and the immune disease.

254

SHORT COMMUNICATION

Shatavisa Mukherjee, Siddhartha Roy

Acute Psychosis Secondary to Isoniazid in a Patient with Pulmonary Tuberculosis

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:73 - 74]

Keywords: Acute psychosis, Drug induced psychosis, Isoniazid

   DOI: 10.5005/jp-journals-10070-8010  |  Open Access |  How to cite  | 

Abstract

Isoniazid (INH) is one of the first-line drugs used in the treatment of tuberculosis (TB). Though considered safe, mild to moderate adverse reactions secondary to INH has been noted in various patients. In some cases, though infrequent, INH may induce psychiatric reactions including delirium, hallucinations, paranoia, acute psychosis, etc., via acting as a monoamine oxidase (MAO) inhibitor or by decreasing pyridoxine. The present report details a case of acute psychosis secondary to INH use in a 47-year-old female patient with pulmonary tuberculosis.

221

LETTER TO THE EDITOR

Surendra Daga

A Review of Multimorbidity in Elderly

[Year:2023] [Month:May-August] [Volume:10] [Number:2] [Pages:1] [Pages No:75 - 75]

   DOI: 10.5005/jp-journals-10070-8013  |  Open Access |  How to cite  | 

191

© Jaypee Brothers Medical Publishers (P) LTD.