A Study of Cardiac Dysfunction in Patients of Hypothyroidism

Introduction: Thyroid disorders are probably the mostcommon endocrinal disorders affecting the populationworldwide. Hypothyroidism is associated with obesity,dyslipidemia and increased atherosclerotic cardiovasculardisease. Hypothyroidism are associated with increasedcardiovascular morbidity and mortality. The present study wasplanned to study the cardiac dysfunction in hypothyroidismcases by using non-invasive method ECG and 2 D ECHO.Material and methods: A total of 100 patients withhypothyroidism were enrolled in the study.They were clinicallyevaluated and underwent relevant investigations,includingthyroid profile, ECG and 2D ECHO for cardiac abnormalities.Results: Mean age of patients was 40.45±13.03 years.Majority of patients were females (71%). There were only29% males. Male to female ratio of study population was0.41:1. Among 100 patients,on ECG abnormal findings wereseen in 57% cases. Bradycardia alone was the most commonECG abnormality affecting 27% of patients. 25% patientsshowed low voltage complexs. A total of 5% patients showedboth bradycardia and low voltage complex. On 2D ECHO,62% patients had normal findings. Abnormal findings wereseen in 38%. Among abnormal findings, the most commonwas mild pericardial effusion (18%) followed by LVDDGrade 1 (16%), LVDD Grade 1 with mild pericardial effusion(2%) and LVDD Grade 2 respectively.Conclusion: Cardiac dysfunction was found in hypothyroidpatients.

Systematic Evaluation of Published Research Studies Conducted Among Medical Undergraduate Students on Learning Environment in Medical Colleges of India Using the DREEM Inventory Tool

Objective: To evaluate original studies conducted among medical undergraduate students to assess education and learning environment in India using DREEM (Dundee Ready Educational Environment Measure) tool. Material & Methods: The online search engine PUBMED and Google scholar were utilized to short list original published research studies on learning environment. The eligibility criteria included: study conducted in India upon medical students using DREEM tool; information on sample size, total, and sub-domain DREEM score available. Fourteen original research publications with a total sample size of 4215 medical students were considered. Results: Total DREEM score (range, 0-200) was 119.5 that indicated that there was more positive education environment in selected medical colleges of country. The average score of different sub domains of DREEM also supported the positive environment. Sub-domain DREEM mean scores derived through this analysis was SPL-28.7 (range, 0-48); SPA-28.4 (range, 0-48); SPT-25.8 (range, 0-44); SASP-20.2 (range, 0-32); and SSSP-16.4 (range, 0-28). The scores of all the studies were in the similar range except two. Mean score of most (80%) of the items (40/50) lied between 2 and 3 (range, 0-4) indicating that these areas were ‘neither strong nor weak’ but could be ‘enhanced’. Some aspect of the learning and education environment with average score of less than 2 include inherent challenges of the extensive medical course; the teaching over-emphasizes factual learning (item-25); students are able to memorize all the matter (item-27); and rarely feel bored (item-14) require attention. However, issues like teaching is too teacher centered (item-48); the teachers are authoritarian (item-9); and the teachers get angry in class (item-39) requires sensitization and introspection by the esteem faculty members. Conclusion: Overall students perceived progressive and positive developmental milieu in the learning environment in the selected medical colleges of India.

Histogenesis of salivary gland neoplasms.

Salivary gland tumors are one of the most complex and relatively rare group of lesions encountered in oral pathology practice. Their complexity is attributed to heterogeneity of the cells of origin of these lesions. The problem is compounded by the ability of these cells to differentiate and modify into various morphological subtypes resulting in a myraid of histomorphological patterns. This also leads to a frequent overlap of microscopic features among various neoplasms and sometimes even between benign and malignant lesions causing significant diagnostic dilemma which sometimes may even not be resolved by immunohistochemical studies. Despite this the knowledge of histogenesis and morhogenetic concepts of salivary gland tumorigenesis greatly helps the pathologist in classifying these lesions as well as determining the prognosis. It will also help in development of newer strategies for differentiating these lesions and making an early diagnosis. The present article is aimed at reviewing and summarizing the current concepts regarding the histogenesis of salivary gland tumors and their relevance to routine diagnosis and classification of these lesions.

Accidental isoniazid poisoning--a report.

Eight patients who had taken accidental overdose of Isoniazid were followed in relation to its clinical manifestations, EEG changes and management. All cases survived without any residual effect.

Neuromuscular respiratory failure in Guillain-Barre Syndrome: evaluation of clinical and electrodiagnostic predictors.

Guillain-Barre Syndrome (GBS) has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Successful management mandates anticipation, prompt recognition and optimal treatment of neuromuscular respiratory failure in GBS. AIMS: To identify clinical and electrodiagnostic predictors of neuromuscular respiratory paralysis in GBS. MATERIALS AND METHODS: Forty six patients of GBS were studied over a 6 year period, the study being 2 year retrospective and 4 year prospective. Clinical and electrodiagnostic data were compared between ventilated (28) and non-ventilated (18) patients. The clinical parameters assessed were median age, gender, antecedent infection, prior lung disease, time to peak disability, bifacial weakness, upper limb weakness, bulbar paralysis, neck weakness and autonomic dysfunction. Electrodiagnostic studies included motor nerve conduction studies in 11 ventilated and 13 non-ventilated patients, done prior to maximum disability in each group. Multiple logistic regression analysis was used to compare the two groups. RESULTS: Comparing the clinical data in the ventilated and non-ventilated groups, 'early peak disability', autonomic dysfunction and bulbar weakness predicted the onset of respiratory paralysis. Age, gender, neck or bifacial weakness, upper limb paralysis, or preceding infection did not influence the development of neuromuscular respiratory weakness. Electrodiagnostic testing revealed abnormal H reflex and F waves to be the commonest abnormality in either group. Although data was not sufficient for statistical analysis, the presence of markedly attenuated Compound Muscle Action Potentials inexcitable motor nerves and denervation changes on the electromyography, was commoner in the ventilated group. Thirty six patients received treatment with either plasmapheresis (12) or intravenous immunoglobulin (24). Overall mortality was 5, all 5 patients being on assisted ventilation. CONCLUSION: Early progression to peak disability, bulbar dysfunction and autonomic instability predicted the development of neuromuscular respiratory paralysis in GBS. Early electrodiagnostic studies in this series suggest axonopathic GBS as a predictor of respiratory paralysis, a finding that needs to be evaluated with sufficient data to permit statistical analysis.

Visual evoked responses in ethambutol induced optic neuritis.

Pattern evoked responses were recorded in 46 patients of tuberculosis on ethambutol and 16 healthy subjects. Deterioration in visual acuity was documented in two patients (4.3%). P100 latency was delayed in 16 cases (34.8%), while in 12 patients (26.1%) both latency and amplitude were affected. A cut off latency value of > or = 140 ms was associated with ophthalmological findings. The incidence of subclinical toxicity as detected by visual evoked response (VER) was higher in older subjects, patients on higher doses of ethambutol (> or = 20 mg/kg/day) and longer duration of treatment. Of two cases with objective ocular signs, one who reported for follow up after two months had recovered completely after stopping ethambutol. Recording of VER is an extremely useful objective test for subclinical optic nerve damage.

Myocarditis and hemiplegia from scorpion bite--a case report.

A 16 year old boy presenting with features of myocarditis and pulmonary oedema following scorpion sting developed hemiplegia with patchy vasculitic lesions on CT scan. The possible pathogenic mechanism is discussed.

Isoniazid induced neuropathy in slow versus rapid acetylators: an electrophysiological study.

Clinical, biochemical and nerve conduction studies were performed in 100 cases of tuberculosis taking isonicotinic acid hydrozide (isoniazid) for more than 12 weeks. Electro-physiological studies were carried out in a similar number of normal age and sex matched controls. In 16 percent of cases an abnormality was documented in the motor nerve conduction velocity, amplitude and terminal latency of the common peroneal, ulnar and median nerves; of these, only two patients had objective evidence of neuritis. The occurrence of isoniazid neuropathy was found to be more in the fourth decade of life (10 of 16), in those who had taken the drug for over six months (13 of 16), and in 'slow' inactivators (10 of 16).

Contrast computed tomography in epilepsy with special reference to intracranial ring or disc enhancing lesions.

We report the results of computed tomography (CT) in 170 patients who developed seizures. Localized signs could be demonstrated by neurologic examination in 23.5%. CT findings were normal in 64 patients (37.6%). The commonest abnormality was a focal ring or disc enhancing lesion in 66 patients (62.3%) followed by calcification (18 patients; 16.9%), cerebral atrophy (9; 8.5%), vascular lesions (7; 6.6%), tumours (4; 3.8%) and congenital hydrocephalus (2; 1.9%). The occurrence of abnormal CT was higher (74.3%) in patients with partial seizures.