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Introduction: Mass migration during the war, frenzy riots, famine, or due to compelling economic reasons are known to be associated with different health issues besides human distress and suffering. India has witnessed such a mass migration immediately before/during the independence (August 15, 1947) consequent to partition riots occurring in west and East Pakistan (present Bangladesh). Although many publications are there about the human and social tragedies associated with partition not much is known about the long-term cardiovascular related diseases of partition migrant individuals. The current communication is trying to address whether cardiovascular diseases in post-partition migrant subjects are any different from non-migrant individuals. Objectives: To evaluate cardiovascular morbidity pattern among partition migrants and non-migrant people. Materials and Methods: This is an observational study done at a tertiary care center from January 2016 to June 2019. The study population had migrant ethnic Indians (n = 30) from West Pakistan and non-migrant ethnic Indians based in Delhi (n = 30). Patients were asked about their demographic details, birthplace particularly the pre-independence place of birth/residence, a detailed pedigree analysis and cardiovascular risk was assessed. Statistical analysis was done to compare the proportion between the migrants and non-migrants subjects using Chi-square/Fisher’s exact test. Results: The mean age of migrants and non-migrants was found to be 78.46 ± 7.13 years and 78.16 ± 6.10 years respectively. Males (65%) were found to be more in both groups compared to females (35%). Both the migrants (83.33%) and non-migrants (73.33 %) were mostly from socioeconomic status (SES) I and II. Migrants (16.66%) showed more smoking habits compared to non-migrants (10%). Migrants were mostly suffering from hypertension alone (20%) or with two comorbidities (63.2%) like hypertension and diabetes, hypertension and coronary artery disease (CAD), diabetes and CAD, cardiovascular diseases (CVD) with stroke. In non-migrant patients hypertension alone was seen in 16.6% of cases which is not statistically significant. Two comorbid cardiovascular conditions in this group were seen in 36.8% of cases as compared to migrant population with two comorbid conditions and this difference was statistically significant (P = 0.039).

Measles is a vaccine-preventable disease that continues to be a major cause of morbidity and mortality in children and young adults across the world. Immunization efforts have reduced the incidence of measles over the last 3 decades, but outbreaks are seen in high-transmission areas with susceptible populations, as is seen in hospitals and student campuses. The protection offered by prior vaccination may wean off over time making vaccinated individuals susceptible to infection. Hence, catch-up immunization drives should be undertaken for vulnerable populations such as healthcare personnel, along with routine immunization programs, with the goal to eliminate measles in the future. This case series presents measles in two of our medical residents who got infected despite being vaccinated in childhood.

BACKGROUND: The study was conducted to assess the different components of communication skills and barriers to practicing good communication skills among resident doctors in a health care setting. MATERIALS AND METHODS: A web-based cross-sectional survey was performed, and data were collected using a pre-validated questionnaire with a Cronbach's alpha (0.88). A total of 431 responses were statistically analyzed. Chi-square test was used to associate the socio-demographics and communication skills. Regression analysis was conducted to analyze the association between various communication domains and barriers, which were adjusted for potential confounders such as age and gender. RESULTS: Resident doctors have differential levels of competencies in each domain of communication skills. Around two-thirds of the residents did not practice good communication skills while breaking the bad news and reported poor para-verbal skills. Some of the most common barriers to practicing good communication skills were found to be an infrastructural deficit, lack of time, and long working hours. These barriers significantly affected the communication skills such as para-verbal skills {[-0.32; P < 0.01; C.I (-0.54 to -0.09), [-0.27, P < 0.05, C.I (-0.54 to. 004)], [-0.32, P < 0.01, (0.07–0.56)]}, the ability to break bad news {[-0.42, P < 0.01, (-0.73 to -0.11)], [-0.35, P < 0.05, (-0.75 to -0.35)], [0.48, P < 0.01, (0.12–0.84)]}, and communication with patients/attendants {[0.39, P < 0.01, C.I (-0.71 to -0.06)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)]} after adjustment for confounding such as age and gender. CONCLUSION: There is a scope for improvement in practicing good communication skills with patients, among the residents doctors in India. Structured modules for training and evaluation should be implemented in the medical curriculum.

Renal stones are a common condition causing significant morbidity and economic burden. The prevalence of urinary tract stones in the developed nations ranges from 4–20%. Renal stones are of different types, the most common being the calcium oxalate stones. Various dietary, non-dietary, and urinary risk factors contribute to their formation. Their frequent association with systemic diseases (like hypertension, diabetes, and obesity) highlights the role of dietary and lifestyle changes in their occurrence, recurrence, and possible prevention. Non-contrast computed tomography (CT) identifies almost every stone and is the preferred investigation for identification. Ultrasound has its advantages, as it is low cost and requires no radiation, but is observer dependent. Metabolic profiles (including blood calcium, phosphate, magnesium, creatinine, uric acid, sodium, and potassium) should be measured and a detailed urinalysis should be done. This review further discusses the formation in depth, and covers risk factors and management of renal stones, and lays down the importance of preventive measures to avoid their recurrence.

Background. Vitamin D, a fat-soluble vitamin, has various extraskeletal effects, and several human and animal studies have suggested that vitamin D deficiency may be a contributory factor in the pathogenesis of coronary artery disease (CAD). However, such studies in the Indian subcontinent are either lacking or have shown conflicting results. Methods. This was a descriptive cross-sectional study involving 121 patients with CAD from a tertiary care center and their 80 age-matched healthy controls. Serum vitamin D levels along with serum and urine chemistries were measured in both the groups. The average duration of sun exposure/day and use of sunscreen were also considered in the study cohort using a questionnaire. Serum vitamin D levels were categorized into deficient (75 nmol/lit) groups. Results. Among the cases, 51.2% of the patients were vitamin D deficient and 44.6% patients had insufficient vitamin D levels, whereas among controls, 40% and 31% of the population had deficient and insufficient levels of vitamin D, respectively. However, the mean value of the serum vitamin D level was not statistically different in the cases as compared to that of the controls (34.06 vs 40.19 nmol/lit) (P=0.08). Corrected serum calcium (9.26 vs 9.59 mg%) (P≤0.0001) and serum albumin levels (4.21 vs 4.75 gm%) (P≤0.0001) were lower in the cases than those of the controls. The average sun exposure/day was higher among the cases than that among the controls (2.93 vs 1.85 hours) (P=0.001). Conclusion. Vitamin D deficiency is widely prevalent in Indian population despite abundant sunshine, and the duration of sun exposure is not correlated with serum vitamin D levels. Vitamin D deficiency is not associated with CAD. However, serum calcium is deficient in CAD patients as compared to the controls. Large-scale studies are required to explore the association further to evaluate the benefits of screening and correction of vitamin D deficiency in patients with CAD.

Coronary artery disease (CAD) has become the latest scourge of humankind and referred to in this article as CAD, is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries that supply the myocardium, a process also known as atherosclerosis and manifests mostly in the form of chronic stable angina or acute coronary syndrome. Vitamin D has attracted considerable interest recently due to its role in a number of extraskeletal disease processes including multiple sclerosis, malignancies, diabetes mellitus, and CAD. It is also known as sunshine vitamin due to its production in the body following exposure to ultraviolet rays, and it is a unique vitamin as it acts like a hormone with its receptor present in a wide range of tissues including endothelium, which is the important mediator of atherosclerosis and subsequent CAD. A large number of studies conducted in the past have provided the basic scientific framework and this article attempts to explore the role of Vitamin D deficiency in the pathogenesis of CAD and stresses the need for further research to fill up gap in our knowledge.

This article provides an insight towards diagnosing and managing thalassemias. It begins by describing the structure of normal hemoglobin and elaborates on our understanding of the pathophysiology of thalassemia. An overview of transfusion therapy and its complications including endocrinopathies and cardiomyopathy has also been discussed.

Alopecia Universalis is an autoimmune disorder which sometimes may be associated with other autoimmune diseases like vitiligo, atopic dermatitis and endocrine disorders like hypothyroidism. In less than 2% of cases it may be associated with nephrotic syndrome although the underlying etiology has not been reported. We report here one similar case that had alopecia universalis beginning at the age of 17 years and simultaneously developed hyperuricemia. His son also developed alopecia universalis and renal stones at an early age of 10 years. The case represents one of the rare forms of alopecia namely alopecia universalis in two generations of the same family. Apart from this the case highlights the presence of renal stones probably due to hyperuricemia in both the generations which invokes a need to investigate any association of hyperuricemia with alopecia universalis.

While infections are a major cause of neonatal mortality in India even in full-term neonates, this is an especial problem in the large proportion (~20%) of neonates born underweight (or small-for-gestational-age; SGA). One potential contributory factor for this susceptibility is the possibility that immune system maturation may be affected along with intrauterine growth retardation.In order to examine the possibility that differences in immune status may underlie the susceptibility of SGA neonates to infections, we enumerated the frequencies and concentrations of 22 leukocyte subset populations as well as IgM and IgA levels in umbilical cord blood from full-term SGA neonates and compared them with values from normal-weight (or appropriate-for-gestational-age; AGA) full-term neonates. We eliminated most SGA-associated risk factors in the exclusion criteria so as to ensure that AGA-SGA differences, if any, would be more likely to be associated with the underweight status itself.An analysis of 502 such samples, including 50 from SGA neonates, showed that SGA neonates have significantly fewer plasmacytoid dendritic cells (pDCs), a higher myeloid DC (mDC) to pDC ratio, more natural killer (NK) cells, and higher IgM levels in cord blood in comparison with AGA neonates. Other differences were also observed such as tendencies to lower CD4:CD8 ratios and greater prominence of inflammatory monocytes, mDCs and neutrophils, but while some of them had substantial differences, they did not quite reach the standard level of statistical significance.These differences in cellular lineages of the immune system possibly reflect stress responses in utero associated with growth restriction. Increased susceptibility to infections may thus be linked to complex immune system dysregulation rather than simply retarded immune system maturation.

Cutaneous drug reactions are frequent in hospitalized patients and vary from simple manifestations like rash and erythema to severe life threatening conditions like angio-oedema, erythroderma, Stevens-Johnson syndrome and toxic epidermal necrolysis. However drug eruptions with antitubercular drugs are largely unknown except few case reports. We highlight here one similar case which presented with pleomorphic cutaneous manifestations after taking anti tubercular therapy and closely mimicked vasculitis. But when the offending drugs were stopped the lesions disappeared and the patient improved.

Atypical neurological presentations of hypothyroidism include myelopathy which has been seldom reported as presenting feature in patients. This case was one of those atypical presentations of hypothyroidism in which patient presented with neurological complication viz myelopathy which was timely diagnosed and treated. The symptoms including neurological findings reversed with thyroxin replacement. The case highlights the varied and vivid manifestations of hypothyroidism which treating physicians should be aware of while treating patients.

A middle aged male patient came with multiple swellings over his body which were gradually increasing in number. He was asymptomatic for any other disease and was worried for cosmetic reasons. His examination was unremarkable except xanthelesma on all of his four eyelids and multiple swellings of varying size all over his body. His blood investigations including lipid profile, ECG and X-ray chest were normal. As this patient had xanthelesma it was presumed that the swellings on other parts of his body were a part of the same etiology namely xanthomas. However FNAC of the swellings surprisingly proved it to be lipoma. This case reports an uncommon distribution of lipomas all over the body in the presence of xanthelesma.

Despite availability of modern methods of various surgical techniques for treating complicated patients, there are still some unreported incidents in day to day practice where simple surgical procedure ends up in unwanted complications. This may be attributed sometimes to the negligence of treating doctors and sometime to the patient himself. We present here one such case where unnecessary morbidity added to the patient after surgery.