Myopathies of endocrine origin: A review for physicians.

Myopathies are a common manifestation of endocrine disorders. Endocrine myopathies are often overlooked while considering differential diagnoses in patients with musculoskeletal symptoms. The hindrance to mobility and the musculoskeletal discomfort owing to these myopathies are important causes of disability and depreciated quality of life in these patients. Endocrine myopathies occur due to the effects of endogenous or iatrogenic hormonal imbalance on skeletal muscle protein and glucose metabolism, disrupting the excitation-contraction coupling. Abnormalities of the pituitary, thyroid, parathyroid, adrenal, and gonadal hormones have all been associated with myopathies and musculoskeletal symptoms. Endocrine myopathies can either be the complication of a secondary endocrine disorder or a presenting symptom of a missed underlying disorder. Therefore, an underlying endocrine abnormality must always be excluded in all patients with musculoskeletal symptoms. This review presents a compilation of various endocrine myopathies, their etiopathogenesis, clinical presentation, diagnostic modalities, and treatment protocols.

Rapid N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Kit as a Differentiating Tool for Acute Dyspnea in a Resource-Limited Setting.

Introduction Dyspnea is among the most prevalent symptoms experienced by patients presenting as an emergency. The underlying etiology is often a cardiovascular or pulmonary condition, of which heart failure is recognized as a major contributor. The differentials are primarily established based on the patient's clinical presentation and physical examinations but are not conclusive. Of the various investigations undertaken to determine the cause of dyspnea, the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) was found to be significantly associated with heart failure. Its level has been proven to be in direct correlation with the severity of the disease. This study demonstrates the usability of an economical rapid test kit in measuring NT-ProBNP levels to help differentiate the cause of dyspnea in the presenting patient in a resource-limited setting. Methodology We studied 115 participants from a tertiary care center in India, which included 70 males and 45 females aged ≤30 to ≥75 years, presenting with shortness of breath. Rapid NT-ProBNP tests were conducted alongside recording their symptoms, vitals, examination findings, and other parameters. They were also classified according to New York Heart Association (NYHA) Classification, and further investigated. Results The study elucidated the efficacy and accuracy of the rapid kits in determining NT-ProBNP levels, and its relation with the severity and prognosis of heart failure. The kits utilized had a sensitivity of greater than 93% for ruling out heart failure as a cause of dyspnea, and a sensitivity of greater than 96% for ruling out elevated NT-ProBNP levels in general. Other parameters such as presenting symptoms and vitals were also analyzed, establishing a correlation with NT-ProBNP levels.  Conclusion This study guided us in understanding the effective utilization of the rapid testing kits for emergency care, minimizing the burden on other limited resources. The lower cost and ease of use would serve as a quick means of reaching a conclusive diagnosis, especially in an emergency, which in turn would aid in receiving timely and specific treatment. These kits could act as a stepping stone in creating a sustainable and efficient healthcare system for patients as well as healthcare workers.

The Local Heroes Project: a youth-led pan-India hyperlocal crisis relief model during the COVID-19 pandemic.

Introduction: There was shortage of essential diagnostic and therapeutic supplies in public hospitals during the second wave of COVID-19 in India. Materials and methods: The Local Heroes Project, a hyperlocal project initiated by the World Youth Heart Federation (WYHF). Pilot project was conducted in six cities, and a nationwide project was scaled up to 58 city groups with 438 volunteers. Three-step model of needs assessment, fundraising, and establishment of the supply chain was undertaken. A national team was formed consisting of representatives from multiple international organizations and stakeholders. Local Volunteers were recruited and empowered in each city to conduct donation drives. The Qualitative Comparative Analysis (QCA) model was used to assess the impact of the intervention. Results: 48.2% of the city groups completed needs assessment and 37.9% completed their donations. Factors such as team strength more than 4, local needs assessment, regular reporting during monthly meeting, receptive local administration, donation to more than 2 health centers and donation of supplies worth >= Rs 5,000 in each city (raw coverage 0.44, consistency 1) were more important contributors for success of the outcome. Supplies worth INR 2.45 million were donated. Conclusion: Hyperlocal projects can effectively address essential supply shortages. A three-step model of needs assessment, fundraising, and supply chain establishment can be an effective approach. Community involvement and donations are crucial for the success and sustainability of such projects.

Apparent Dengue Fever Turned Out to be Hemophagocytic Lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is an extremely uncommon hematologic condition that is potentially fatal. It is a disease of histiocyte or lymphocyte hyperactivity, which can be inherited (primary) or acquired (secondary). Dengue fever and HLH both can present with fever, lethargy, and a blood profile of pancytopenia, which makes it difficult to diagnose HLH promptly in a region with dengue endemicity. Clinical and supportive biochemistry findings help clinicians to suspect and diagnose HLH. This article presents a case report of a patient who was diagnosed with dengue fever during initial presentation with subsequent swerves toward HLH. Diagnosing HLH associated with dengue can be difficult. However, it is of utmost importance to diagnose it early, as an early diagnosis and management can lead to significantly improved outcomes. How to cite this article: Gandhi A, Patel P, Shah D. Apparent Dengue Fever Turned Out to be Hemophagocytic Lymphohistiocytosis. J Assoc Physicians India 2023;71(11):96-99.

An Unusual Progression of Membranous Nephropathy.

Membranous glomerulopathy is one of the commonest causes of nephrotic syndrome and chronic renal insufficiency in adults. There has been documented evidence of a poorer prognosis with factors such as male gender, advanced age, increased blood pressure and persistent loss of proteins in the urine, but the overall prognosis of this condition is excellent. Herein, we present the case of a 20-year-old female patient who was diagnosed with primary membranous nephropathy. Normally, cases of primary membranous nephropathy have good outcomes with conservative management and immunosuppressants but our case had a worsening course and a delayed response even with immunosuppressive treatment. This case has been recorded due to its unusual presentation, unnatural course, and outcomes contrary to what is seen in routine clinical practice.

Retroperitoneal Ancient Neurilemmoma: A Nervous Rarity.

Neurilemmomas are tumors of neural origin that comprise Schwann cell proliferation in a characteristic pattern. They are benign in nature. Ancient neurilemmomas are usually longstanding growths that exhibit degenerative features that could be mistaken for malignancy. We report a case of ancient neurilemmoma in a 70-year-old male patient in the retroperitoneal area. Retroperitoneal schwannomas are extremely uncommon along with ancient neurilemmoma features making it worth reporting.