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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 8 | Issue 1
Page Nos. 1-37

Online since Tuesday, January 14, 2020

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EDITORIAL  

Editorial p. 1
Manjunath Premanath
DOI:10.4103/AJIM.AJIM_87_19  
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GUEST EDITORIAL Top

Can waist circumference be a screening tool for obesity? p. 2
M Suresh Babu
DOI:10.4103/AJIM.AJIM_77_19  
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REVIEW ARTICLE Top

Rickettsial infections: Past and present perspectives p. 4
Vasantha Kamath, Shreyashi Ganguly, Jasmine Kaur Bhatia, R Himabindu
DOI:10.4103/AJIM.AJIM_22_19  
Rickettsial infections are reported from various parts of India. But despite the surging number of cases, these diseases are often under-diagnosed. Rickettsial diseases have re-emerged as some of the most covert infections of the present time. These diseases are generally incapacitating and notoriously difficult to diagnose. The greatest challenge lies in overcoming the difficult diagnostic dilemma posed by these infections early in their courses- when antibiotic therapy is most effective. Untreated cases have a fatality of up to 30% but when promptly and properly diagnosed, it is often easily treated. Clinical manifestations combined with a thorough history (travel, epidemiological environment, and place of residence) and knowledge of the distribution of rickettsial agents and their vectors may help clinicians to correctly diagnose a rickettsiosis. Weil Felix, although not sensitive, aids in initiating antibiotics when interpreted in the correct clinical context. Antibiotic treatment with doxycycline (including for children) must be started whenever a possible rickettsiosis is suspected, taking into consideration pregnant women and allergic patients. The factors that predispose to rickettsial infections are widely prevalent in this country hence the physicians and paediatricians need to include rickettsial infections in their differential diagnosis of febrile thrombocytopaenia or an acute febrile illness.
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ORIGINAL ARTICLES Top

Sensitivity and specificity of waist circumference as a screening tool for assessment of obesity in rural population p. 11
Jayaprakash S Appajigol, Manjunath S Somannavar, Ramesh R Araganji
DOI:10.4103/AJIM.AJIM_31_19  
Context: Prevalence of obesity increasing worldwide, including in the rural populations. Waist circumference (WC) and body mass index (BMI) are closely related in measuring obesity. Measuring WC is easier than measuring height and weight for calculating BMI. Therefore, WC measurement can be used as obesity detecting tool. Aims: The aim of the study is to estimate the prevalence of obesity in a rural population and to assess the sensitivity and specificity of WC values for identifying obesity. Settings and Design: It was a cross-sectional study conducted in rural places of North Karnataka. Material and Methods: Height, weight, and WC of each participant were measured. WC was measured at the midpoint between the inferior margin of the last rib and iliac crest. Statistical Analysis Used: Statistical analyses were performed using MedCalc for Windows. The area under the receiver operating characteristics derived by plotting 100 specificity along the X-axis and sensitivity along the Y-axis. Results: Abdominal obesity measured by WC showed that 114 participants were obese with a prevalence of 36.08%. Prevalence of obesity by taking BMI of ≥25 kg/m2 as cutoff showed 15.82%. We found that presently recommended WC cutoff value for males had 66.67% sensitivity and for females had 89.47% sensitivity to diagnose obesity. Conclusions: WC can be used as screening tool for identifying obesity. Considerable variation in sensitivity was found among different studies. Unlike BMI, universal cutoff may not be possible with WC. More studies are needed to assess the relationship of different obesity surrogates to cardiovascular morbidity and mortality.
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Study of atazanavir-induced hyperbilirubinemia among HIV patients on second-line anti-retroviral therapy p. 15
K Ravi, GN Devamsh, KJ Umesh, BC Prashant
DOI:10.4103/AJIM.AJIM_32_19  
Introduction: Ritonavir-boosted atazanavir (ATV/r) is the preferred second-line protease inhibitor option for HIV patients as per the NACO guidelines. Atazanavir is a protease inhibitor with several advantages including once-daily dosing, low pill burden, and favorable effect on lipid profile compared with other protease inhibitors. Atazanavir-induced hyperbilirubinemia is not widely studied in the Indian population. Aim: The aim is to study the occurrence of atazanavir-induced hyperbilirubinemia in HIV patients receiving second-line antiretroviral therapy (ART) and its outcome. Materials and Methods: One hundred and ten HIV patients treated with ATV/r-based second-line anti-retroviral regimen at a tertiary care hospital were included in the study and followed up for at least 12 months. Liver function tests were measured at baseline (at the time of initiation of ATV/r), at 6 months and 12 months of second-line ART. Results: The cumulative incidence of hyperbilirubinemia in the study population was 42.72% (n = 47). However, atazanavir-induced hyperbilirubinemia was self-limiting and did not mandate change in regimen. Conclusion: A significant number of patients on ATV/r-based second-line ART developed indirect hyperbilirubinemia. There was no significant elevation in liver enzymes. Most of the patients tolerated ATV/r-based regimen well and there was no need for discontinuation/change of regimen. Patients on ATV/r-based regimen must be followed up closely and counseled regarding adherence to therapy.
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CASE REPORTS Top

A rare case of tuberculosis along with abdominal aorto arteritis in young women p. 19
Amit Kamath, Sangram Biradar
DOI:10.4103/AJIM.AJIM_7_19  
Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic Takayasu's arteritis. Aortoarteritis is an inflammatory condition of the aorta, which has been rarely reported due to tuberculous infection. We are presenting a case of 28-year-old young female of abdominal aortoarteritis along with tuberculosis (TB). Patient was treated with anti-TB therapy and steroids.
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Systemic lupus erythematosus and beta-thalassemia trait p. 22
M Narayana Swamy, TA Shilpa, Stephen Benny
DOI:10.4103/AJIM.AJIM_10_19  
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that predominantly affects women of child-bearing age. The prevalence of beta-thalassemia in patients with SLE is lesser than the general population. When these two conditions coexist, however, SLE seems to have a more severe course. The following case report deals with a 34-year-old female who presented with severe dimorphic anemia and a positive direct Coombs test. On further evaluation, she was diagnosed with SLE based on a positive antineutrophilic antibody report and anti-Smith antibodies. A hemoglobin (Hb) electrophoresis was ordered for in view of the normal iron profile which revealed beta-thalassemia trait. An improvement in Hb and platelet counts was noted after initiating steroids. Although most hematological abnormalities are due to the disease (SLE) itself, it is important to remember that other causes such as thalassemia may coexist.
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An unusual presentation of non-hodgkin's lymphoma p. 24
Vishwaraj Baswaraj Tadakal, Sangram Biradar, Muddasir Indikar
DOI:10.4103/AJIM.AJIM_25_19  
Non-Hodgkin's lymphoma (NHL) causes many deaths worldwide. It represents a heterogeneous group of neoplasms originating from the lymphocytes. The etiology of this disease is still unclear. Some infectious agents have been associated more or less strictly with the development of an NHL as, i.e., the Epstein–Barr virus, the human herpesvirus-8, and the human T-cell lymphotropic virus Type I. Nearly 70% of lymphomas present a generally multilocalized, single, or multiple lymphoadenomegaly without pain, with involvement in almost 30%–40% of laterocervical lymphnodes. In 30% of patients, an extranodal localization is reported in Waldeyer's ring, in the stomach, and generally, in the gastrointestinal tract. The retroperitoneal localization is extremely rare and its diagnosis is often difficult. It often requires a time-consuming and costly diagnostic workup. Here, we present a rare case of NHL presented with retroperitoneal mass encasing the aorta.
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Management of autoimmune ear disease and idiopathic polyarthritis with adalimumab p. 27
Shiva Prasad, Jagadish R Malloli, A Sudhakar
DOI:10.4103/AJIM.AJIM_29_19  
Autoimmune inner ear disease (AIED) is a rare form of sensorineural hearing loss of autoimmune origin and responding to immunosuppressive therapy with corticosteroids or other immunosuppressants. Novel treatment approaches include intratympanic steroids and biological response modulators against tumor necrosis factor-α. We present a case of AIED, who concomitantly developed seronegative inflammatory polyarthritis (IPA). The treatment for IPA was initiated with methotrexate, hydroxychloroquine, and intra-articular methyl prednisolone. When there was no adequate response, the patient was started on adalimumab, which in addition to IPA also showed beneficial effects on AIED.
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ECG DIAGNOSIS Top

Interesting case of unaddressed palpitations p. 29
Mohammed Emad Hussain, Suresh V Sagarad
DOI:10.4103/AJIM.AJIM_47_19  
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RADIOLOGICAL DIAGNOSIS Top

The story of a “horrible looking chest X-ray” p. 30
Raghavendra Bhat
DOI:10.4103/AJIM.AJIM_74_19  
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BOOK REVIEW Top

Handbook on epilepsy for physicians p. 31
Manjunath Premanath
DOI:10.4103/AJIM.AJIM_76_19  
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LETTERS TO THE EDITOR Top

Anticalcitonin gene-related peptide monoclonal antibodies: An overview p. 33
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/AJIM.AJIM_70_19  
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Cell phone aggravating the morning sickness? p. 34
Sadananda B Naik, Krishna Mohan Prabhu, K Ramesha
DOI:10.4103/AJIM.AJIM_72_19  
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Training undergraduate medical students on research methodology in the competency-based curriculum p. 35
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/AJIM.AJIM_73_19  
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Management of asymptomatic coronary artery disease p. 36
Swetha Amaresh Biradar
DOI:10.4103/AJIM.AJIM_83_19  
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