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.

Implementation of a self-directed learning module for undergraduate medical students in biochemistry: sharing of an experience

Self-directed learning SDL is a process where learners take the initiative for their own learning, become sensitive to personal learning needs, formulate the learning objectives, search for the resources and use them judiciously and finally evaluate the learning outcome.

Risk factors including prothrombotic work up in young ischemic stroke Indian patients

Background: Stroke in young poses a major health problem. Various Indian studies have shown the incidence of stroke to be 10-15%. Cerebral venous thrombosis and rheumatic heart disease are the leading causes of stroke in the young in India. Thrombophilic factors have been implicated in 4-8% of the young strokes worldwide. Protein C deficiency is the most common thrombophilia marker followed by a deficiency of protein S, Factor V Leiden mutation, and antithrombin (AT) deficiency. Aims and objectives was the study of stroke in young is important for various reasons. The etiology and risk factors are more diverse and different as compared to the elderly. Therefore, these may indicate separate therapeutic approaches. The aim is to study the profile of ischemic stroke cases among the young.Methods: The study was carried out at a tertiary care defence hospital between December 2018 to December 2019. All cases of fresh ischemic stroke who were more than 15 and less than 45 years of age were included. Following clinical evaluation, patients underwent complete haemogram, blood sugar levels, lipid profile and other metabolic parameters. All patients were subjected to chest radiography, 12 lead ECG, and 2D echocardiography, Non-contrast CT head and MRI brain. Prothrombotic work up was also done.Results: A total of 41 patients (12.69%) presented with ischemic stroke before 45 years of age. Out of these 10 (24%) were females and 31 (76%) were male. None of the women smoked or consumed alcohol. Among the males, 19 (47%) smoked more than 10 cigarettes or bidis per day and 9 (22%) were moderate-to-heavy drinkers of alcohol. Hypertension was present in 7 (18%) and diabetes mellitus in 3 (7%) patients. Serum cholesterol was elevated in 7 (18%) patients and triglycerides in 17 (42%). Protein S deficiency was found in 28.8% patients, while protein C deficiency was detected in 21% patients and antithrombin III deficiency in 12% patients.Conclusions: Although traditional risk factors, such as hypertension, diabetes, and smoking, are associated with stroke in both elderly and young, this study shows that other modifiable risk factors such as alcohol consumption were also prevalent. The most common etiological cause was found to be venous infarction followed by cardio embolic cause. Deficiency of Protein S was the most common prothrombotic defect followed by deficiency of Protein C.

A Study of HbA1c, fasting and 2 hour plasma glucose levels in current smokers presenting at a tertiary care hospital in North India

Background: There is a concern that smokers are at increased risk of diabetes and this association has received surprisingly little attention. This study aims to study the relationship of smoking with three glycaemic variables (HbA1c, fasting and 2 hour post prandial plasma glucose levels) in current smokers and describe the potential impact of smoking in the context of screening for diabetes by using one of these glycaemic variables.Methods: 150 patients attending the OPD of Santosh Medical College were part of this Cross sectional population based study. One hundred were smokers and fifty non-smokers and non-diabetics. All participants were subjected to fasting plasma glucose level, 2 hour plasma glucose level and HbA1c testing.Results: Mean values of all three variables are substantially higher in smokers as compared to non-smokers. HbA1c levels show an increasing trend with increasing age among both groups. Mean plasma glucose levels show increasing values with increasing age but the trend is not uniform. Among females, only HbA1c levels whereas among males all three variables show a strong correlation with smoking. No correlation was observed between the number of cigarettes smoked daily or smoking index and the glycaemic variables. All variables show an increasing trend as the number of years of smoking increases.Conclusions: A higher prevalence of diabetes is seen in current smokers when we consider HbA1c levels indicating the beneficial effect of using HbA1c levels for identifying current smokers at risk of diabetes mellitus.

Study of anemia among adolescent school girls and young adults

Background: The world’s adolescent population (age 10–19 years) is estimated to stand at more than 1 Billion, yet adolescents remain largely neglected, difficult-to-measure, and hard-to-reach. Population in which the needs of adolescent girls, in particular, are often ignored. Anemia during adolescence limits growth and delays the onset of menarche, which in turn may later lead to cephalopelvic disproportion. In armed forces young serving soldiers make the backbone of forces, anemia in this group affects man hour badly. So, study was planned to assess prevalence of anemia in these two groups.Methods: A prospective study was carried out with 340 girls and 500 serving adults and prevalence of anemia was carried out with respect to different prevailing factors.Results: The prevalence of severe, moderate and mild anemia in girls was 0.5%, 10.6% and 27.9% respectively and in serving soldiers prevalence of anemia was 1.8%, 2.8% and 3.4 % respectively.Conclusions: In the present study, the prevalence of anemia was found to be 39% in adolescent girls and 8% in serving soldiers. Strongest predictor to anemia in adolescent girls was history of excessive menstrual bleeding and vegetarian diet. Age group, age at menarche and BMI did not affect anemia prevalence. Strongest predictor to anemia in soldiers was age.

Role of yoga therapy on lipid profile in patients of hypertension and prehypertension

Background: Hypertension and dyslipidemia are one of the most prevalent cardiovascular disorders affecting 20% of world抯 population. There is emerging data that yoga therapies may be useful in managing modest elevations in BP. Yoga, specific yogic exercise (Sudarshan kriya) taught as a training protocol under Art of living course (AOL), is especially attractive as a candidate therapy in the management of elevated BP because of its combination of gentle physical activity. Hence, this study was undertaken to compare the effects of SDK on blood lipid levels.Methods: A total of 300 patients of hypertension and prehypertension were taken in the study where control group were given drugs treatment and life style modification and yoga group additionally had undergone yoga training. Lipid levels were estimated in both groups at entry, 06 months and 12 months and analyzed.Results: Lipid levels at entry were same in both while the yoga therapy group showed decrease in TG, LDL and VLDL at six months and 12 months but decrease was not significant. HDL levels showed significant increase in yoga group (P<0.05) at six months which was maintained at 12 months more so in diabetic patients.Conclusions: Yoga therapy has beneficial effect on serum lipid levels and should be included in therapy along with other measures.

Markers of inflammation following percutaneous coronary intervention (PCI) and its effect on adverse events

Background: Number of markers of inflammation has been associated with coronary artery disease and various studies have shown increased levels during chronic stable angina, acute myocardial infarction, and percutaneous coronary intervention. However, co-relation to final outcomes of percutaneous coronary intervention with these markers has not been studied. Aim of this study was to try and find a correlation between markers of inflammation released during percutaneous coronary intervention and incidence of restenosis on follow up at 06 moths on patients undergoing percutaneous coronary intervention with Bare Metal Stent (BMS).Methods: 36 consecutive only Bare Metal Stent (BMS) angioplasties done at our centre between July 2015 and June 2016 were analysed for markers of inflammation from peripheral venous sample before the procedure and coronary sinus sample after the procedure. Pts were kept on follow up for 6 months and assessed as per their clinical symptoms and Coronary Angiogram was done where indicated and results tabulated.Results: There was increase in the studied markers of inflammation post percutaneous coronary intervention but they did not correlate with or predict possible restenosis.Conclusions: This study showed that markers of inflammation are elevated during percutaneous coronary intervention but none of these markers correlates with subsequent restenosis.

Echocardiographic evaluation of diastolic dysfunction in diabetes mellitus without covert cardiac involvement

Background: Diabetic patients develop systolic and diastolic dysfunction without even associated coronary artery disease. But diastolic dysfunction is more prevalent in diabetic patients than systolic dysfunction and usually occurs before onset of symptoms. Recognition of early diastolic dysfunction is likely to make management better and avoids progression of cardiac dysfunction. This study was conducted in patients of Diabetes mellitus without other comorbidities.Methods: The present study which is cross sectional and was carried out among outpatients and inpatients of tertiary care hospital of Armed forces and involved army personnel and their dependents and sample size was 100 patients.Results: The prevalence of diastolic dysfunction among our study participants was found to be 36%. Diastolic dysfunction was found to be significantly higher among elderly individuals (60%) when compared to young study participants. (p<0.0001). Prevalence of diastolic dysfunction was found to be non-significantly higher among males and with longer duration of diabetes as compared to lesser duration and female gender.Conclusions: Diastolic dysfunction, evaluated by echocardiography, was found to be fairly prevalent (36%; 95% CI = 27-45%) among individuals with type 2 diabetes mellitus. Poor Glycaemic control and increasing age were found to be significantly associated with presence of diastolic dysfunction among individuals with diabetes mellitus.