Hashimoto's encephalopathy versus catatonia: A diagnostic dilemma.

Hashimoto's encephalopathy is a rare life-threatening disease entity with clinical presentation like psychiatric as well as neurological diseases, thus making it a challenging clinical scenario for physicians leading to delay in diagnosis and management of the patient. The incidence overall is under-estimated because of low overall awareness about the disease. Here, we report a 44-year-old female who was being treated for psychiatric disorders because of clinical presentation like catatonia but ultimately was diagnosed with Hashimoto's encephalopathy and responded very well to steroids.

Mini clinical evaluation exercise (Mini-CEX): A tool for assessment of residents in department of surgery.

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) is a formative assessment tool designed to provide feedback on skills essential to good medical care by observing an actual clinical encounter. However, the bigger advantage of mini-CEX is the structured feedback that it provides to the students as well as the faculty, thus helping them to make better decisions. MATERIALS AND METHODS: This study was a cross-sectional observational study. Sixteen surgery residents volunteered for participation and five professors conducted sessions; hence, 80 mini-CEX encounters. Seven core clinical skill assessments were done, and the performance was rated on a 9-point scale (grouped into unsatisfactory, satisfactory, and superior). Immediate feedback to the residents was given by the faculty. Delayed feedback from faculty and residents regarding the perception of mini-CEX was taken. Statistical analysis was done using SPSS version 20 and analysis of variance (ANOVA) for inferential statistics. RESULTS: As planned, 80 (100%) mini-CEX encounters were conducted. Surgery residents showed improvement that was statistically significant in the competencies of medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. Most of the faculty (80%) were able to identify the gaps in the knowledge of students and areas of improvement for their teaching. However, 60% of the faculty felt that it required more effort than traditional methods. The mean time taken by the assessor for observation and feedback to residents was 12.51 min and 5.68 min, respectively. The mean scores of evaluator satisfaction and resident satisfaction with mini-CEX sessions were 6.04 and 7.49, respectively. CONCLUSIONS: Mini-CEX improves the learning environment in residency and also leads to improvement in medical interviewing skills, physical examination skills, humanistic qualities/professionalism, and counseling skills. It is done in the actual patient encounter and hence prepares the resident better for dealing with patients in the future.

Spectrum of malignancies among human immunodeficiency virus-infected patients at a tertiary level human immunodeficiency virus-anti-retroviral therapy center in a North Indian hospital.

INTRODUCTION: Human immunodeficiency virus (HIV)-infected individuals have a higher risk of some types of cancer. A chronic immunodeficiency state, increased survival in the highly active antiretroviral therapy (HAART) era and predisposition to certain oncogenic viral infections have been postulated as the main reasons. While, the incidence of acquired immunodeficiency syndrome (AIDS) defining cancers (ADCs) is declining in the post-HAART era, non-AIDS-defining cancers (NADCs) are becoming an important cause of mortality in these patients. MATERIALS AND METHODS: Analysis of the data of HIV-infected patients registered at an apex centre was done for 7 years. All patients were subjected to routine investigations on presentation (baseline) and during follow-up for the occurrence of any malignant disease. CD4 cell counts before starting anti-retroviral therapy and before the diagnosis of malignancy were noted. The date of the last review and the current status/outcome were recorded. RESULTS: Out of 1258, 17 patients were diagnosed with various malignancies. Seven patients (41.2%) had ADCs and the remaining 10 (58.8%) had NADCs. The mean duration between diagnosis of HIV infection and diagnosis of malignancy was 59.53 months. The mean survival duration from the diagnosis of malignancy for all cases was 21 months. The mean survival duration was 29 months and 15 months for ADC and NADC group respectively. CONCLUSIONS: NADCs are on the rise in the era of effective use of HAART and increasing life span of HIV patients. The index of suspicion for cancer should be higher in such patients, especially compared to opportunistic infections in view of good immunovirologic status.

Hypertension and Obesity Among Civil Aviation Pilots.

BACKGROUND: Raised blood pressure (BP) is a risk factor for cardiovascular disease, which is a common cause of sudden in-flight incapacitation among pilots. Prevalence of hypertension (HT) among pilots as per new criteria is largely unknown. This study aims to understand the prevalence of hypertension and obesity in civil aviation pilots and their correlation.METHODS: Enrolled were 1185 civilian pilots reporting for medical evaluation to a regulatory medical establishment in India. Their height, weight, and blood pressure (BP) were measured. Pilots were categorized as hypertensive or normotensive as per JNC VIII criteria and hypertensive, having elevated BP, or normotensive as per new ACC/AHA criteria of 2017. Data were analyzed for prevalence of obesity and overweight as per both WHO and Asia Pacific criteria. Results were analyzed using SPSS version 17.RESULTS: Prevalence of hypertension was 4.1%. Maximum hypertensives were in the 26-35 yr age group. Under the new ACC/AHA guidelines, prevalence of HT was 18.7%. Prevalences of overweight and obesity as per WHO criteria were 39% and 7.3% and as per Asia Pacific guidelines were 23.3% and 46.3%, respectively. As BMI increased above 23, risk of developing hypertension or white coat hypertension as per JNC VIII criteria increased by 6.86 times (OR 6.86, 95% CI 0.9-52.58).CONCLUSIONS: Prevalence of HT rose from 4.1% to an alarmingly high 18.7% when new criteria were applied. Prevalence of obesity was 7.3% but increased to 46.3% when Asia Pacific guidelines were applied. Risk of hypertension increased as BMI increased above 23 kg · m-2.Bhat KG, Verma N, Pant P, Marwaha MPS. Hypertension and obesity among civil aviation pilots. Aerosp Med Hum Perform. 2019; 90(8):703-708.