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Thyroid storm is a rare entity and can be fatal if not properly managed on time. A 75 year old lady reported to the emergency room with agitation, restlessness, breathlessness. On further evaluation she was found to have atrial fibrillation with a heart rate of 180 beats per minute. She was carrying a blood report indicative of thyrotoxicosis, which was confirmed subsequently. The patient was diagnosed as a case of thyroid storm and managed accordingly. On taking the detail history it was found that the patient had palpitation since last 2 years and had been taking levothyoxine 75 microgram/day after consulting a paramedical health worker in a hospital. The dose had been escalated to one and half tablet of 75mcg strength, in July 2021 as per the advice of the same health care worker after seeing the report. But the lab report of July 2021, the patient had, indicated thyrotoxicosis. Ideally the dose of levothyroxine should have been reduced or discontinued.

Thyroid storm is a rare entity and can be fatal if not properly managed on time. A 75 year old lady reported to the emergency room with agitation, restlessness, breathlessness. On further evaluation she was found to have atrial fibrillation with a heart rate of 180 beats per minute. She was carrying a blood report indicative of thyrotoxicosis, which was confirmed subsequently. The patient was diagnosed as a case of thyroid storm and managed accordingly. On taking the detail history it was found that the patient had palpitation since last 2 years and had been taking levothyoxine 75 microgram/day after consulting a paramedical health worker in a hospital. The dose had been escalated to one and half tablet of 75mcg strength, in July 2021 as per the advice of the same health care worker after seeing the report. But the lab report of July 2021, the patient had, indicated thyrotoxicosis. Ideally the dose of levothyroxine should have been reduced or discontinued.

To determine the prevalence of Vitamin D deficiency among COVID-19 patients. The present study was conducted at Rural Tertiary Care Centre Designated COVID Care Hospital, MMIMSR Mullana Ambala, Haryana, India. The duration of the study was 1.5 months (Aug 2020 to Sep 2020). Those who tested positive in RT-PCR were taken from the wards and Flu clinic of the hospital. To calculate the sample size for cross-sectional study, enough literature for Vitamin D and COVID-19 in India was not available. Therefore, all patients were enrolled consecutively over 1.5 months. Data were collected on a pre-validated Case Recording Form. The demographic data of all the COIVD-19 patients were recorded. Comorbid conditions like diabetes and hyper- tension were also recorded. History of alcohol consumption and smoking was recorded. The sample for Vitamin D along with routine investigations was sent and the level of Vitamin D was estimated using chemiluminescence-based immunoassay analyzer. To understand the Vitamin D status among the different groups, deficiency, and insufficiency were calculated separately and compared. This study included 200 COVID-19 patients. Among total patients, males (57.5%) were represented more than females (42.5%). The mean age of the patients was 45.56 ± 26.23 years.

An elderly male presented with symptoms suggestive of anemia. During workup for the same he was found to have very high levels of serum Ferritin along with a normocytic, normochromic peripheral blood film and no other apparent cause for hyperferritinemia .A swelling which incidentally found on his shin was further investigated by FNAC confirmed presence of soft tissue sarcoma.

Objective: Heart failure with preserved ejection fraction (HFPEF) is fast becoming animportant public health issue. Nearly fifty percent of all heart failure cases are due to HFPEF.There are many associated comorbidities has been associated with this condition which maybe pathophysiologically related. There is no specific treatment yet. The focus remains onsymptomatic treatment of heart failure along with carefully managing the associated conditions.The present study was aimed at analyzing the comorbidities in HFPEF in a tertiary care centre. Method: Patient diagnosed with heart failure wereechocardiographically analyzed. Thoseshowing diastolic dysfunction on tissue Doppler imaging were diagnosed as HFPEF. Patientswith chronic obstructive pulmonary disease, valvular heart disease, constrictive pericarditis,restrictive/ hypertrophic cardiomyopathy and sepsis related diastolic dysfunction were excluded.One hundred such patients fulfilling the inclusion and exclusion criteria were enrolled. Plasma Btype natriuretic peptide(BNP) level was assayed in all participants. Institutional Ethics Committeeapproval was taken beforehand. Written informed consent was taken from each patient. Result: The mean age of the patients in the study group was 63.06yrs. HFPEF was more commonin females(62%). The common comorbidities observed were hypertension(82%), high bodymass index (80%),anaemia (76%), hyperlipidemia (30%) diabetes mellitus(28%). The plasmaBNP was elevated in all except 2 patients. The BNP level was higher in those with higherleft atrial size and those showing more severe diastolic dysfunction on tissue doppler imaging.Conclusion- HFPEF can be diagnosed clinically with the help of echocardiography. Plasma BNPlevel assay may be done when diagnosis is in doubt. The patients with HfpEf are heterogeneousand treatment need to be individualized depending on the associated comorbidities. Furtherstudies with larger sample size are required to define the profile of this disease. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.39-44

OBJECTIVES: This study evaluates the effect of vitamin D with calcium supplementation on glycemic control and quality of life (QoL) in patients with diabetes. MATERIALS AND METHODS: A prospective, observational, open-label randomized, controlled study was conducted on 150 type-2 patients with diabetes. A total number of patients were divided into three groups (n= 50 in each group) i.e. group 1 (patient on oral hypoglycemic agents), group 2 (oral hypoglycemic agents with vitamin D 60.000 IU/week), and group 3 (oral hypoglycemic agents, vitamin D 60.000 IU/week along with daily calcium of 1.000 mg/day). Biochemical estimation of fasting/random blood glucose (RBG), hemoglobin A1c (HbA1c), serum insulin and patient’s QoL were analyzed using modified diabetes QoL (MDQoL)-17 questionnaire after 12 weeks of treatment. Data were analyzed using a student t-test (paired t-test). RESULTS: The majority of the patients were male (more than 50%) with an average age of 50 ± 6 years having a diabetic history of more than 10 years and HbA1c level >10% in all three groups. After 12 weeks supplementation, the mean value of vitamin D was 25.73 ± 6.2 ng/mL, 29.98 ± 5.3 ng/mL and 62.71 ± 7.8* ng/mL in groups 1, 2, and 3, respectively (p

As various physiotherapeutic approaches are available to improve either motor or non-motor symptoms, the study was conducted for evaluating the effectiveness of Institution based Rehabilitation protocol to improve quality of life in patients with Parkinson���s Disease (IRQOL-PD) to focus on both types of symptoms simultaneously. The non-randomized controlled trial pilot study recruited 42 participants with Parkinson���s disease (age between 35-80 years) for 5 weeks of treatment sessions to evaluate the validity, reliability, and effectiveness of the designed protocol. The Unified Parkinson���s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale (H&Y scale) were used as outcome measures. The IRQOL-PD with content validity index (0.9), intra-rater reliability (Intra-class Co-relation Coefficient = 1 and Cronbach���s alpha = 1) and inter-reliability (Pearson correlation coefficient > 0.90 and

Background: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy. Methods: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients’ neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance. Results: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p

COVID-19 mortality and spread have varied widely across countries. It has been quite difficult to explain this variability by restrictive strategies adopted in the different nations. A significant part of this variation may be dependent on biological and environmental factors. In early April we had predicted a low mortality due to COVID-19 in India based on several factors, cross-immunity to endemic coronaviruses being prominent among them. Cross-reactive antibodies as well as T-cells have been later demonstrated by several groups. The importance of this cross-immunity in modifying the spread of COVID-19 in a population and the development of herd immunity has been discussed by us, as well as other authors who in a recent review have elaborated several theoretical models. Other driving factors of this natural variation of COVID severity may be trained immunity and immune tolerance acquired by the innate immune system, both a result of recurrent infections by diverse pathogens. We hypothesize, that in countries like India, huge sections of population, living in crowded and unsatisfactory hygienic conditions, are subjected to repeated infections by viruses, bacteria, and eukaryotic parasites, and this probably leads to a state of 'immune tolerance' in them against a novel organism like SARS-CoV-2. Although at present the major focus is on the detection and containment of COVID-19, including the development of vaccines, it appears that a better understanding of the host's response to SARS-CoV-2 invasion may provide us clues to explain the epidemiology of this pandemic in different countries and formulate nation-specific management plans. This article is protected by copyright. All rights reserved.

Parkinson’s disease (PD) is the second most common neurodegenerative disorder of the elderly, presenting primarily with symptoms of motor impairment. The disease is diagnosed most commonly by clinical examination with a great degree of accuracy in specialized centers. However, in some cases, non-classical presentations occur when it may be difficult to distinguish the disease from other types of degenerative or non-degenerative movement disorders with overlapping symptoms. The diagnostic difficulty may also arise in patients at the early stage of PD. Thus, a biomarker could help clinicians circumvent such problems and help them monitor the improvement in disease pathology during anti-parkinsonian drug trials. This review first provides a brief overview of PD, emphasizing, in the process, the important role of α-synuclein in the pathogenesis of the disease. Various attempts made by the researchers to develop imaging, genetic, and various biochemical biomarkers for PD are then briefly reviewed to point out the absence of a definitive biomarker for this disorder. In view of the overwhelming importance of α-synuclein in the pathogenesis, a detailed analysis is then made of various studies to establish the biomarker potential of this protein in PD; these studies measured total α-synuclein, oligomeric, and post-translationally modified forms of α-synuclein in cerebrospinal fluid, blood (plasma, serum, erythrocytes, and circulating neuron-specific extracellular vesicles) and saliva in combination with certain other proteins. Multiple studies also examined the accumulation of α-synuclein in various forms in PD in the neural elements in the gut, submandibular glands, skin, and the retina. The measurements of the levels of certain forms of α-synuclein in some of these body fluids or their components or peripheral tissues hold a significant promise in establishing α-synuclein as a definitive biomarker for PD. However, many methodological issues related to detection and quantification of α-synuclein have to be resolved, and larger cross-sectional and follow-up studies with controls and patients of PD, parkinsonian disorders, and non-parkinsonian movement disorders are to be undertaken.

Objective: Diabetic cardiomyopathy (DC) is a myocardial disease characterized by myocyte hypertrophy, interstitial fibrosis, protein glycosylation and intra-myocardial micro-angiopathy due to prolonged exposure of myocardial tissues to hyperglycemia in diabetes mellitus (DM) patients. Alteration in cardiac function can be non-invasively assessed via echocardiography. The early recognition of cardiac dysfunction can prevent the symptomatic heart failure in DM patients. The study aimed at evaluating cardiac function in uncomplicated type 2 diabetes mellitus. Materials And Methods: Sixty Type 2 DM patients without any feature of the coronary arterial disease (CAD), hypertension, nephropathy and respiratory illness were enrolled in the study and compared with the sixty age matched healthy controls. Echocardiographic assessment was done in all subjects to evaluate the cardiac function. Results: Diastolic dysfunction was more common in diabetic patients when compared with normal healthy population. Systolic dysfunction progresses with age of the diabetic patient. Conclusion: Echocardiography is a simple noninvasive cost effective test for detecting cardiac dysfunction in Type 2 DM patients and should be applied to detect early Left ventricular(LV) dysfunction so that corrective measures may be initiated early and cardiac functions may be preserved for long. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.211-215

The development of neuroprotective drugs targeting mitochondria could be an important strategy in combating the progressive clinical course of Parkinson's disease. In the current study, we demonstrated that in SH-SY5Y cells (human dopaminergic neuroblastoma cell line), rotenone caused a dose-dependent (0.25-1 μM) and time-dependent (up to 48 h) loss of cell viability and a loss of cellular ATP content with mitochondrial membrane depolarization and an increased formation of reactive oxygen species; all these processes were markedly prevented by the mitochondrial permeability transition pore blocker cyclosporine A, which did not affect complex I inhibition by rotenone. The nuclear morphology of rotenone-treated cells for 48 h indicated the presence of both necrosis and apoptosis. We then examined the effects of cyclosporine A on the rotenone-induced model of Parkinson's disease in Wistar rats. Cyclosporine A significantly improved the motor deficits and prevented the loss of nigral dopaminergic neurons projecting into the striatum in rotenone-treated rats. Being a marketed immuno-suppressive drug, cyclosporine A should be further evaluated for its putative neuroprotective action in Parkinson's disease.

There has been a surge of mucormycosis cases in India in the wake of the second wave of COVID-19 with more than 14000 cases reported. Mucormycosis in patients of COVID-19 in India is at variance to other countries where Aspergillus, Pneumocystis, and Candida have been reported to be the major secondary fungal pathogens. We discuss the probable causes of the mucormycosis epidemic in India. Whereas dysglycaemia and inappropriate steroid use have been widely suggested as tentative reasons, we explore other biological, iatrogenic, and environmental factors. The likelihood of a two-hit pathogenesis remains strong. We propose that COVID-19 itself provides the predisposition to invasive mucormycosis (first hit), through upregulation of GRP78 and downregulation of spleen tyrosine kinase involved in anti-fungal defense, as also through inhibition of CD8+ T-cell mediated immunity. The other iatrogenic and environmental factors may provide the second hit which may have resulted in the surge.

India has witnessed a high number of COVID-19 cases, but mortality has been quite low, and most cases have been asymptomatic or mild. In early April, we had hypothesized a low COVID-19 mortality in India, based on the concept of cross-immunity. The presence of cross-immunity is presumed to lead to a milder course of disease and allow the time necessary for the development of adaptive immunity by the body to eliminate the virus. Evidence supporting our hypothesis has started showing up. Multiple studies have shown the generation of different T cell subsets and B cells responding to epitopes of viral proteins, especially of the spike protein, as a part of adaptive immunity against SARS-CoV-2. Cross-reactive T-cells have been demonstrated in patients who have been previously exposed to endemic coronaviruses. The interplay of cross-immunity and herd immunity is apparent in the COVID-19 scenario in India by the presence of a large number of asymptomatic or mild cases, a low infection-fatality ratio and a generally flat curve of percentage positivity of cases with respect to total testing, both in periods of strict lock-down and step-wise unlocking. It seems that cross-immunity resulted in faster generation of herd immunity. Although the initial restrictive measures such as lockdown prevented the rapid spread of the outbreak, further extension of such measures and overly expensive ones such as enhanced testing in India will result in a huge burden on the health economics as well as the society. Hence, we propose a restructuring of the health services and approach to COVID-19. The restructured health services should move away from indiscriminate testing, isolation and quarantine, and instead, the emphasis should be on improving facilities for testing and management of only critical COVID cases and the replacement of complete lockdowns by the selective isolation and quarantine of the susceptible persons such as the aged and those with co-morbidities. In the process of describing India-specific plans, we emphasize why the development of country-specific plans for tackling epidemics is important, instead of adopting a “one policy fits all” approach.

Background: The worldwide epidemiology of dengue fever (DF) and dengue hemorrhagic fever (DHF) is changing fast. The Indian encounter with this disease is fascinating and captivating. In recent years the disease has distorted its course exhibiting in a severe form as DHF, dengue shock syndrome (DSS) and Expanded Dengue Syndrome. Methods: The present study is an observational prospective study conducted in a single unit of the department of Medicine of a tertiary care hospital. Institutional ethics committee approval was obtained prior to enrolment of any patient. Results: The work presented in this study expands the knowledge base of dengue clinical profile and management. Fever, thrombocytopenia, raised transaminases were the common findings in the 150 patients studied. Hemorrhagic manifestations were observed in 20 patients who had required platelet transfusion. Conclusion: Dengue fever is always the foremost of these arboviral infections with significant impact on socioeconomic and healthcare cost for the patient. The clinical picture can be non-specific viral prodrome to classical dengue fever to life threatening dengue shock syndrome(DSS)/dengue haemorrhagic fever(DHF). Early diagnosing and with aggressive management particularly for DHF and DSS remains the cornerstone strategy for good outcomes.

The ongoing Corona virus (COVID-19) pandemic has witnessed global political responses of unimaginable proportions. Many nations have implemented lockdowns that involve mandating citizens not to leave their residences for non-essential work. The Indian government has taken appropriate and commendable steps to curtail the community spread of COVID-19. While this may be extremely beneficial, this perspective discusses the other reasons why COVID-19 may have a lesser impact on India. We analyze the current pattern of SARS-CoV-2 transmission, testing, and mortality in India with an emphasis on the importance of mortality as a marker of the clinical relevance of COVID-19 disease. We also analyze the environmental and biological factors which may lessen the impact of COVID-19 in India. The importance of cross-immunity, innate immune responses, ACE polymorphism, and viral genetic mutations are discussed.

Chronic myeloid leukaemia (CML) is a clonal myeloproliferative disorder of haematopoietic stem cells characterised by increased proliferation of the granulocytic cell line without the loss of their...

Multiple myeloma is a neoplasm of plasma cells in the bone marrow. It is characterised by lytic lesions in the bones, marrow plasmacytosis and presence of M protein in serum and/or urine. Serum ?2 microglobulin is also raised and can be used for classification and prognostication of the disease. In the absence of M protein, the disease is known as non-secretory myeloma. It is proposed that raised ?2 microglobulin can be used for diagnosis and therapeutic guidance in the absence of M protein. A rare case of nonsecretory myeloma with neurocognitive impairment along with review of literature is being presented. The patient had multiple lytic lesions in bones with marked increase in plasma cells in bone marrow. M protein was not detectable in serum or urine but serum ?2 microglobulin was much elevated.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.142-145

Systemic Lupus Erythematosus (SLE) is a multisystem chronic inflammatory disease of autoimmune aetiology. It has a predilection for female gender and presence of photosensitive rash over the sun exposed area gives a clue to the diagnosis. Diagnosis in a male patient with atypical manifestations is unusual and difficult. A 25-year-old male presented with fever, fatigue, vomiting, abdominal pain and loss of weight. He had sustained injury on his right arm following which he developed abscess at the trauma site and severe anaemia. Further evaluation revealed pancytopenia and peritonitis. Though peritonitis is rare in SLE, it was considered in the differential diagnosis after ruling out bacterial and tubercular peritonitis. Positive anti-dsDNA and antiSm antibodies confirmed the diagnosis. While evaluating for microcytic anaemia it was found that iron studies were normal and A2 fraction was raised in haemoglobin electrophoresis. The symptoms and laboratory parameters improved remarkably with steroid therapy. Beta thalassaemia trait is rare in patients with SLE, but when they co-exist the manifestations can be severe. High degree of suspicion is required to diagnose SLE in male patients in absence of typical photosensitive rash. Beta thalassaemia trait often does not require any treatment except genetic counseling. However empirical treatment with iron should be avoided.

Background: A more general involvement of the nervous system in diabetes, affecting not only the peripheral but also the central nervous system has been increasingly suggested over the last two decades. Electrophysiological investigations in the form of visual evoked potentials (VEPs) can be very sensitive and valuable method in evaluating central neural conduction in diabetics before the overt manifestations of ophthalmologic involvement. Aims and Objectives: This study was planned to detect visual dysfunctions in type 2 diabetics at earlier stages by recording pattern reversal VEPs (PRVEPs). Materials and Methods: PRVEP was recorded in 100 subjects (50 patients with type 2 diabetes and 50 controls). Mean latencies of N75, P100 and N145 waves, interocular latency differences (for P100 waves) and N75-P100 amplitude were compared between diabetics and the controls by unpaired t-test. P < 0.05 was considered as significant. Results: A statistically significant increase in mean P100 latency (P < 0.0001) and interocular latency difference (P < 0.001) along with the reduction in N75-P100 amplitude (P < 0.0001) was revealed in diabetics as compared to the controls. Mean N75 and N145 latencies exhibited increase in diabetics but without statistical significance. Conclusion: Electrophysiological alterations in the form of abnormal VEPs are registered in type 2 diabetes before clinically detectable ophthalmologic impairment. VEPs should be employed for assessing the visual functions in diabetics to ameliorate the prognosis of the condition.

Acute myocardial infarction (AMI) is a common emergency which requires timely intervention. Traditionally, its diagnosis is based on symptoms, electrocardiogram and cardiac biomarkers. Symptoms may be nonspecific.

We congratulate the authors of the editorial, “What does it take to put an ugly fact through the heart of a beautiful hypothesis?”1 for …