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Deep vein thrombosis (DVT) is a serious and potentially life-threatening condition due to the occurrence of pulmonary embolism (PEs) in the acute phase. DVT can be provoked or unprovoked. Provoked DVT can be associated with transient or persistent causes. Iron deficiency anemia (IDA) with reactive thrombocytosis can act as a prothrombotic condition. We present two case reports of lower limb DVT which was associated with moderate anemia. Association between IDA and thrombosis has been reviewed.

Assessment of diabetes with daily blood glucose fluctuations including peaks and nadirs forms the crux of the modern management. Use of glycemic variability (GV) as a parameter to assess these fluctuations is emerging. It is important to determine the hyperglycemic and hypoglycemic episodes which are the culprits for increasing glycemic variation. Diabetes mellitus patients follow different clinical trajectories which can be traced by the ambulatory glucose profile (AGP) obtained from flash glucose monitoring system (FGMS).This comparative observational study enrolled 106 adult (gt;18 years) type 2 diabetes patients with HbA1clt;8%. Patients were divided into two groups (group Aamp; group B) with 53 patients each. Group A included patients on OAD's (oral antidiabetic drug) with insulin and Group B included patients on OAD's without insulin. The patients were put on FGMS for 14 days and their AGP was analysed. Hyperglycemic episodes (level 1-gt;180 mg/dl, level 2-gt;250 mg/dl) and hypoglycemic episodes (level 1- 54-70 mg/dl, level 2-lt;54 mg/dl) were determined between the groups.Group A patients had significantly higher (29.99%) total number of hyperglycemic episodes (Level 1+ Level 2) as compared with group B (9.08%) (plt;0.0001). Amongst group A, proportion of patients with total number of hyperglycemic episodes was significantly higher in insulin only subgroup (58.11%) followed by insulin +metformin+ 1 OAD (29.14%)amp; insulin+ metformin (26.82%) (plt;0.0001). Amongst group B, total number of hyperglycemic episodes were found to be significantly higher with metformin only subgroup (10.19%) followed by metformin + 1 OAD (9.72%)amp; metformin +gt;1 OAD (8.1%) (plt;0.0001). Amongst the add on OAD's, sulfonylurea contributed to 61.07% hyperglycemic episodes in group Aamp; 11.63% in group B which was statistically more than DPP-4 inhibitors with 14.91%amp; 2.84% respectively (plt;0.0001). Total number of hypoglycemic episodes seen in group A patients (8.66%) were significantly less as compared with group B (13.27%) (plt;0.0001). Sulfonylurea contributed to 7.5% hypoglycemic episodes in group Aamp; 13.2% in group B which was statistically more than DPP-4 inhibitors with 6.49%amp; 12.35% respectively when added to metformin (plt;0.0001).Amongst the OAD's used in type 2 diabetes mellitus patients in this study, total number of hyperglycemic and hypoglycemic episodes were found to be more in patients taking sulfonylurea as compared with DPP4 inhibitors when used in combination with metformin with or without insulin.

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).

Brucella is the most common zoonosis in the world and is also included among the neglected endemic zoonoses by the World Health Organization. Its clinical presentation is often vague and it is not frequently suspected. A thorough history of social-economic status and animal exposure is often missed. We present a case of abdominal cocoon in a young patient residing at a dairy farm who tested positive for Brucella serology. Timely diagnosis and management prevented the progression of this debilitating condition to intestinal obstruction.

As India recovers from the two waves of the Covid-19 pandemic, its sequelae are posing a new challenge to the physician. These may vary from fatigue and myalgia to persistent, and even worsening breathlessness, due to pulmonary fibrosis. Management of post-COVID-19 pulmonary fibrosis is currently limited to symptomatic management and largely an unexplored aspect.To draw attention to the imminent threat of post-COVID-19 interstitial lung disease (PC-ILD) in COVID survivors through a case series.A retrospective analysis of data was done in patients admitted with severe COVID in December 2020 at our tertiary care hospital, and who had a prolonged stay with symptoms and signs suggestive of pulmonary fibrosis. HRCT was done to make a diagnosis of pulmonary fibrosis or ILD. Three such patients were identified.All the three cases were laboratory proven SARS CoV-2 positive cases and had developed pulmonary fibrosis, with traction bronchiectasis, termed here as PC-ILD (Post Covid-Interstitial Lung Disease). Two of them survived and had improved oxygen saturation on room air at three-month follow-up, while one patient had developed arrhythmia and died.PC- ILD is one of the emerging complications of COVID-19 pneumonia. A proactive follow-up programme should be undertaken to identify and manage this looming epidemic.

Leptospirosis presents in a biphasic manner: an early leptospiraemic phase and a late immune phase. In its severe form, it presents with multi-organ failure, also known as Weil's disease. Stevens-Johnson syndrome (SJS) is an autoimmune hypersensitive reaction leading to diffuse fluid filled vesicle formation with detachment of skin and mucous membrane. Though SJS is triggered by different infections and drugs, its association with leptospirosis is not frequently reported. Here we present such a case.

Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia, adult respiratory distress syndrome and respiratory failure. Amidst the rising number of cases and deaths, it is imperative to not forget Tuberculosis (TB) which is another pandemic existing since centuries. There could be dire consequences for tuberculosis patients globally especially in low and middle income countries with a high burden of disease and overwhelmed health care systems. Tuberculosis is still the leading infectious killer worldwide, and therefore, it is crucial to reflect on the interaction between the two diseases. Evidence suggests that both COVID-19 and tuberculosis have a synergistic relationship, boosting detrimental effect of each other, disrupting existing health care models, and also worsening the clinical outcomes in terms of morbidity and mortality. This review aims to draw attention towards this pertinent clinical issue, and tries to unravel the intricate relationship between COVID-19 and tuberculosis, as also the role of BCG vaccination to combat the COVID-19 pandemic.

Dextrocardia is one of the rare cardiac positional anomalies, in which heart is located in the right side of thorax with its base-to-apex axis positioned to the right side. Dextroposition is different than dextrocardia where the heart is displaced to the right secondary to extracardiac causes like eventeration of diaphragm and right lung hypoplasia. The term situs solitus is used when heart and abdominal viscera are normally placed with the cardiac apex, spleen, stomach, and aorta are placed on the left side and inferior vena cava and liver placed on the right side, whereas situs inversus has mirror-image of the organs relative to their position in situs solitus. Dextrocardia, cardiac dextroposition, and situs inversus generally remain asymptomatic and are detected incidentally by imaging studies done for reasons other than cardiovascular system related problems. This article shares our experience of five cases of cardiac malposition that presented with atypical features of common medical problems. It highlights the importance of basic clinical examination in these patients which helps in making a bed side diagnosis of cardiac malposition and also prevents any mishap which can arise if any emergency intervention is done in patients of dextrocardia with or without situs inversus.

Colorectal cancer is a major cause of morbidity and mortality worldwide. The Indian scenario also shows a similar trend, and this has been attributed to the changing dietary patterns. Recurrence in colorectal cancer is associated with many factors, some related to the tumor itself and some to the surgical principles applied. Understanding these factors and application of sound surgical principles can go a long way in decreasing the incidence of colorectal cancer. Here, we highlight the main biological and technical factors implicated in the recurrence of colorectal cancer.

Studies reporting on the recurrence rate after laparoscopic repair of large hiatal hernias (HH), including anatomical asymptomatic recurrence, are scarce. So far, the impact of telematic surgical approach in Gastroesophageal Reflux Disease (GERD) is still obscure. In this prospective study, we analyzed the da Vinci Intuitive Surgical robotic system for antireflux surgery. In August 2012, we set up a pilot study to evaluate the efficacy of laparoscopic telerobotic surgery using the three-arm da Vinci system. Optimal trocar positions, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity, as well as mortality rate, were analyzed.

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.

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.

Xanthelasma palpebrarum (XP) are yellow plaques that occur most commonly near the inner canthus of the eyelid and are often associated with atherosclerosis, dyslipidemia, and coronary artery disease. This study was planned to address the issue of associated cardiovascular morbidity in xanthelasma patients attending our cardiac clinic.Materials and Methods. A total of 61 patients were detected to be having xanthelasma and constituted the study group. The control group constituted of 130 apparently normal individuals. Each patient underwent detailed history, examination, and investigations.Results and Discussion. The most prevalent age group was 40 to 60 years. Males outnumbered females. A percentage of 39.3% of cases had concomitant nicotine addiction. Dyslipidemia was present in 60% of cases, hypertension in 37.7%, prehypertension in 8.77%, diabetes mellitus in 18.03%, and prediabetes in 26.3%. Smokers and obese patients with xanthelasma had a higher prevalence of hypertension. Coronary artery disease (CAD) was found in 6.56% of XP cases. The waist circumference and diastolic blood pressures were significantly higher in XP patients.Conclusion. A significant number of cases of xanthelasma palpebrarum are combined with smoking, central obesity, hypertension, diabetes mellitus, and dyslipidemia which are the major risk factors for CAD. Efforts should be made to rule out the same in high-risk xanthelasma subjects.