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.

Acute Gastroenteritis Induced Adrenal Crisis in a patient with Congenital Adrenal Hyperplasia: A Case Report.

Congenital Adrenal Hyperplasia is a group of autosomal recessive diseases due to deficiencies of enzymes involved in steroidogenesis. If not diagnosed and treated adequately, Congenital Adrenal Hyperplasia can lead to an acute adrenal crisis with hemodynamic collapse. Acute stressors and steroid insufficiency precipitate an adrenal crisis. The major clinical features are hypotension and volume depletion. Nonspecific symptoms such as fatigue, lack of energy, anorexia, nausea, vomiting, and abdominal pain are common. We report a case of a 3-year male previously diagnosed with congenital adrenal hyperplasia in adrenal crisis secondary to medicine noncompliance and gastroenteritis. The diagnosis was based on the clinical history and biochemical investigations. After initial resuscitation was managed; lifelong oral prednisolone and fludrocortisone were prescribed. Keywords: adrenal insufficiency; gastroenteritis; glucocorticoids.

Multimorbidity in Diabetic Patients Admitted to a Tertiary Care Center: A Descriptive Cross-sectional Study.

Introduction: Multimorbidity is defined as the co-occurrence of two or more chronic conditions in the same individual. Type 2 Diabetes Mellitus rarely occurs without coexisting diseases. With an increasing elder population and longevity, elder adults have a higher prevalence of chronic morbidity, thus increasing the chances of experiencing more than one non-communicable chronic condition, where the impact of multimorbidity is greater than the cumulative effect of the single condition. The study aimed to find out the prevalence of multimorbidity in diabetic patients admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted utilising hospital records of patients with type 2 diabetes mellitus admitted to the Department of Medicine from 1 April 2021 to 1 April 2022. Ethical clearance was obtained from the Institutional Review Committee of the same institute (Reference number: 12082022/07). The diagnosed cases of type 2 diabetic patients aged more than 18 years and confirmed with serum glucose levels were included in the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of the 107 diabetic patients, multimorbidity was present in 75 patients (70.10%) (61.42-78.77, 95% Confidence Interval). Conclusions: The prevalence of multimorbidity is higher than the similar studies done in similar settings. Keywords: co-morbidity; diabetes mellitus; multimorbidity; osteoarthritis.

Left Chronic Otitis Media with Squamous Cell Carcinoma of the Middle Ear and Postauricular Mastoid Fistula: A Case Report.

Though squamous cell carcinoma is the commonest tumor, it rarely presents in the middle ear and follows a history of chronic ear discharge. Postauricular mastoid fistula is also a rare complication of chronic otitis media. These two pathological changes occurring simultaneously are even rarer. We report a rare case of a 37 years old male with a history of left-sided chronic ear discharge and conductive hearing loss. Squamous cell carcinoma along with postauricular mastoid fistula was diagnosed based on high-resolution computed tomography scan and histopathology. Left modified radical mastoidectomy with tympanic membrane grafting was done under general anesthesia. Often middle ear tumor is associated with long-standing ear discharge and this case is a very good example. The co-occurrence of the middle ear tumor with mastoid fistula is extremely rare as both the entities are rare in itself.

Appendicular and Caecal Fecalith causing Perforation: A Case Report.

Fecalith is a concretion of dry compact feces or hard stony mass of faeces in the intestinal tract. Though appendicular fecoliths are commonly encountered, caecal fecoliths are rare entities. Fecoliths are amenable to conservative management with laxatives and enemas but surgical management prevents recurrence. We present a case of 27 years old male who was diagnosed with acute appendicitis with peritonitis. He was intraoperatively diagnosed as gangrenous and perforated retrocaecal appendix with multiple small fecaliths and a large fecalith on cecum with perforation. Appendectomy and primary repair of caecal perforation done. Histological examination of perforated margin confirmed as an inflammatory lesion.

Congenital Adrenal Hyperplasia with Salt Wasting Crisis: A Case Report.

Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders due to deficiencies of enzymes involved in steroidogenesis. The most common form is a 21-hydroxylase deficiency which can be classical or non-classical. The severe form also called Classical Congenital Adrenal Hyperplasia is usually detected after birth to infant period. If Congenital Adrenal Hyperplasia is not diagnosed and treated early, neonates are susceptible to sudden death in the early weeks of life. We report a case of thirty-five days male with a salt-wasting variant of congenital adrenal hyperplasia. The diagnosis was based on an elevated level of 17-hydroxyprogesterone. He was managed and life long oral Prednisolone and Fludrocortisone were prescribed. Keywords: 21-hydroxylase, congenital adrenal hyperplasia, case report.

Posterior Reversible Encephalopathy Syndrome in a Patient with Post Streptococcal Glomerulonephritis: A Case Report.

Posterior reversible encephalopathy syndrome is a clinical-radiological syndrome neurological disorder with varied symptoms which include headache, visual field defects, seizures, altered consciousness. It is a rare complication of post-streptococcal glomerulonephritis and results in life-threatening manifestations if not managed on time. Although reversible by definition, complications like status epilepticus, intracranial hemorrhage, and ischemic infarction may lead to mortality and morbidity. We report a case of a 9-year-old female patient with posterior reversible encephalopathy syndrome who presented with multiple episodes of seizures and bilateral painless loss of vision for 1 day. Due to her severity, a computed tomography scan was sent which revealed a hypodense lesion in the brain. She was admitted to the pediatric intensive care unit and managed with supportive care for 6 days where she died on the 6th day. Vital signs are simple but important and if overlooked can lead to a series of complicated events.