Myasthenic crisis-induced Takotsubo cardiomyopathy: a case report.

Introduction and importance: Myasthenic crisis (MC) is characterized by severe weakness in the bulbar and respiratory muscles. Takotsubo cardiomyopathy (TC) is a rare clinical entity mainly associated with postmenopausal women. We report a case of both these conditions in a premenopausal woman. Case presentation: A 31-year-old woman with hypothyroidism presented with dyspnea. Bedside echocardiography in the ICU revealed an apical ballooning with an ejection fraction of 25%, and she was treated with losartan, furosemide, and spironolactone. She was intubated after 2 days as she developed respiratory distress and type II respiratory failure. Upon investigation, the patient tested positive for anti-acetylcholine receptor antibody. Treatment with five doses of IVIG (intravenous immunoglobulin) was given, and she made a remarkable recovery. Repeat echocardiography revealed her ejection fraction is normal and cardiac function is resolved. Clinical discussion: The association between TC and MC is unusual and not commonly observed. MC can be a natural progression of myasthenia gravis or due to stressors, such as infection, medicine, pregnancy, and surgery. Stressful events can lead to TC. This leads to the possibility of TC, along with other cardiac complications, in patients with MC. Conclusion: Patients with MC may be at potential risk of developing TC, thus careful cardiac monitoring is necessary while treating them for a better prognosis.

Diabetes Mellitus among Patients with Acute Ischemic Stroke Admitted to the Department of Medicine in a Tertiary Care Center.

Introduction: Diabetes mellitus is a major public health concern and a continuously growing chronic disease worldwide. Diabetes mellitus is one of the modifiable, independent, and major risk factors of ischemic stroke. This study aimed to find the prevalence of diabetes mellitus among patients with acute ischemic stroke admitted to the Department of Medicine in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients with acute ischemic stroke admitted to the Department of Medicine from 19 July 2023 to 19 November 2023 after obtaining ethical approval from the Institutional Review Committee. Detailed clinical history, random blood sugar and glycated haemoglobin were used to define diabetes mellitus. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 80 patients, diabetes mellitus was seen in 25 (31.25%) (21.09-41.41, 95% Confidence Interval). Among them, 19 (76%) had previously diagnosed and 6 (24%) had newly diagnosed diabetes mellitus. The poor glycemic control was seen in 11 (44%). Conclusions: The prevalence of diabetes mellitus among patients with acute ischemic stroke was found to be higher than in studies done in similar settings. Keywords: diabetes mellitus; glycated hemoglobin; ischemic stroke.

Severe Stress among Medical Students of Two Medical Colleges: A Descriptive Cross-sectional Study.

Introduction: Mental health problems are common in medical students and there is a high prevalence of psychological morbidity among them. The inability to use effective coping strategies affects the health and academic performance of students. The aim of this study was to find out the prevalence of severe stress among medical students of two medical colleges. Methods: A descriptive cross-sectional study was conducted among medical undergraduates of two medical colleges from 14 September to 14 October 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 0609202109). Three hundred fifteen students were selected for the study using the proportionate stratified random sampling technique. Perceived Stress Scale was used to assess the level of stress and the Brief Cope Inventory scale was used to assess the coping strategies employed by students during stress. Point estimate and 95% confidence interval was calculated. Results: Among 315 medical students, severe stress was found in 39 (12.38%) (8.76-16.04, 95% Confidence Interval). Conclusions: The prevalence of severe stress among medical students was higher when compared to similar studies done in similar settings. Keywords: coping strategies; medical students; psychological stress.