Sourya Acharya

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Amongst the myriad neuropathic variants of diabetes mellitus, Diabetic Amyotrophy (DA) and neuropathic cachexias are rare complications. DA was first defined in the year 1980 and goes by the name ‘Bruns-Garland syndrome and diabetic lumbosacral radiculoplexopathy’. Diabetic Neuropathic Cachexia (DNC) is a rare form of peripheral neuropathy. It is characterised by weight loss, sleep disorders, severe muscle wasting involving the femoral regions bilaterally associated with burning pain and allodynia.

Background: In critical care, comorbidities significantly influence outcomes, but they are often underutilized in real-time decision-making. The Charlson Comorbidity Index (CCI), a widely validated tool for quantifying comorbid burden, offers a practical way to assess prognosis in intensive care unit (ICU) patients. This study was planned to explore the predictive utility of CCI alone in determining patient outcomes in a rural Indian ICU setting. Methodology: This prospective, cross-sectional study was conducted from April 2023 to March 2025 at a tertiary care center in central India. A total of 700 adult patients admitted to the medical ICU were included, excluding those with 3 were significantly older (mean age: 58.9 years) compared to those with CCI p < 0.001). The receiver operating characteristic (ROC) analysis revealed a fair predictive capacity of CCI for in-hospital mortality, with an area under the curve (AUC) of 0.635. At an optimal cutoff of 3.5, the CCI demonstrated good sensitivity (80.9%) but limited specificity (29.6%). Conclusion: The CCI is a valuable, easy-to-use tool for assessing the prognostic outlook of ICU patients, especially in low-resource settings. Although its standalone predictive power for mortality is moderate, its high sensitivity makes it a useful screening tool to identify high-risk patients early during ICU admission. The findings underscore the need to incorporate structured comorbidity assessment into critical care workflows, particularly where advanced physiological scoring systems may not be readily available.

Background: Spondyloarthritis is divided into axial and peripheral subtypes. The axial subtype is further divided into ankylosing spondylitis (AS) or radiographic axial spondyloarthritis and nonradiographic axial spondyloarthritis (nr-axSpA). Although AS and nr-axSpA share some common features, nr-axSpA lacks X-ray–based sacroiliitis as defined by the modified New York criteria, that is, the presence of either bilateral grade 2 sacroiliitis or unilateral grade 3 sacroiliitis, which is present in AS. Disease activity in either of them is measured via C-reactive protein (CRP) levels or magnetic resonance imaging (MRI) of the pelvis showing sacroiliitis due to the presence of bone marrow edema. A person with active disease can have normal CRP and MRI findings, especially in nr-axSpA. Immune system activation during inflammation has been shown to alter platelet maturation and morphology, as reflected by platelet indices. These platelet indices have been studied in the past in various autoimmune diseases, such as psoriatic arthritis, AS, and rheumatoid arthritis, and have been correlated with disease activity. Particularly, in spondyloarthritis, platelet indices are more central to the pathology of sacroiliitis, and CRP, which is currently used, is a generalized marker of inflammation. Therefore, platelet indices can provide a better understanding of inflammation, particularly in patients with sacroiliitis. Objective: This study aims to investigate whether platelet indices can be better markers of inflammation in patients with nr-axSpA. We will determine whether platelet indices are reliable biomarkers for measuring disease activity in patients with nr-axSpA. Methods: All patients who are classified as having axial spondyloarthritis as per the Assessment of Spondylarthritis International Society criteria will be included in this study. Patients will be divided into 2 case groups: group A (patients without radiographic sacroiliitis [nr-axSpA]) and group B (patients with radiographic sacroiliitis [AS]). Healthy individuals will be enrolled as controls to compare and correlate platelet indices such as platelet count, plateletcrit, mean platelet volume, and platelet distribution width with CRP, erythrocyte sedimentation rate, and MRI findings in patients with AS and nr-axSpA. Results: This is a nonfunded study. The data collection started on February 1, 2025, and we expect to complete the study by December 2027. As of July 2025, 7 individuals had been enrolled in groups A and B, respectively, and 5 individuals had been included in the control group. At the end of the study, we will be able to correlate whether platelet indices are trustworthy biomarkers of active disease in patients with nr-axSpA. Conclusions: If platelet indices prove to be better markers of active disease in patients with nr-AxSpA, then these markers should be included in the routine evaluation of these patients. International Registered Report Identifier (IRRID): DERR1-10.2196/71909

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis (SREAT), or Hashimoto’s encephalopathy, is a rare autoimmune neurological disorder linked to elevated antithyroid antibodies and presenting various neurological symptoms. This report deals with a case of a 54-year-old female with a history of hypothyroidism who presented with hypertensive emergency and atypical neurological symptoms that deteriorated during the hospital stay. On testing, she was euthyroid. Initial investigations, including MRI and CSF analysis, were inconclusive, but high levels of antithyroid peroxidase (Anti TPO) antibodies confirmed the diagnosis of SREAT. The patient was managed with intravenous methylprednisolone, leading to rapid clinical improvement. SREAT, being a diagnosis of exclusion, presents with various neurological and neuropsychiatric symptoms that can be difficult to identify. This condition remains poorly understood, though autoimmune factors and antithyroid antibodies seem to play a role. Glucocorticoids remain the primary treatment choice. At the same time, other immunosuppressive agents are reserved for non-responders. This case highlights the critical importance of early diagnosis in SREAT, as early recognition and corticosteroid treatment can lead to significant recovery. Timely intervention is essential for improved patient prognosis, emphasizing the need for awareness of SREAT in patients with a history of hypothyroidism presenting with neurological symptoms.

BACKGROUND Spondyloarthritis is divided into axial and peripheral subtypes. The axial subtype is further divided into ankylosing spondylitis (AS) or radiographic axial spondyloarthritis and nonradiographic axial spondyloarthritis (nr-axSpA). Although AS and nr-axSpA share some common features, nr-axSpA lacks X-ray–based sacroiliitis as defined by the modified New York criteria, that is, the presence of either bilateral grade 2 sacroiliitis or unilateral grade 3 sacroiliitis, which is present in AS. Disease activity in either of them is measured via C-reactive protein (CRP) levels or magnetic resonance imaging (MRI) of the pelvis showing sacroiliitis due to the presence of bone marrow edema. A person with active disease can have normal CRP and MRI findings, especially in nr-axSpA. Immune system activation during inflammation has been shown to alter platelet maturation and morphology, as reflected by platelet indices. These platelet indices have been studied in the past in various autoimmune diseases, such as psoriatic arthritis, AS, and rheumatoid arthritis, and have been correlated with disease activity. Particularly, in spondyloarthritis, platelet indices are more central to the pathology of sacroiliitis, and CRP, which is currently used, is a generalized marker of inflammation. Therefore, platelet indices can provide a better understanding of inflammation, particularly in patients with sacroiliitis. OBJECTIVE This study aims to investigate whether platelet indices can be better markers of inflammation in patients with nr-axSpA. We will determine whether platelet indices are reliable biomarkers for measuring disease activity in patients with nr-axSpA. METHODS All patients who are classified as having axial spondyloarthritis as per the Assessment of Spondylarthritis International Society criteria will be included in this study. Patients will be divided into 2 case groups: group A (patients without radiographic sacroiliitis [nr-axSpA]) and group B (patients with radiographic sacroiliitis [AS]). Healthy individuals will be enrolled as controls to compare and correlate platelet indices such as platelet count, plateletcrit, mean platelet volume, and platelet distribution width with CRP, erythrocyte sedimentation rate, and MRI findings in patients with AS and nr-axSpA. RESULTS This is a nonfunded study. The data collection started on February 1, 2025, and we expect to complete the study by December 2027. As of July 2025, 7 individuals had been enrolled in groups A and B, respectively, and 5 individuals had been included in the control group. At the end of the study, we will be able to correlate whether platelet indices are trustworthy biomarkers of active disease in patients with nr-axSpA. CONCLUSIONS If platelet indices prove to be better markers of active disease in patients with nr-AxSpA, then these markers should be included in the routine evaluation of these patients. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/71909