Gastrointestinal Beriberi as a prodrome of non-alcoholic Wernicke’s encephalopathy: a study of an emerging nutritional deficiency disorder from Kashmir, India

Background: Gastrointestinal manifestations of thiamine deficiency have not been well described in literature. Authors aimed to study the symptoms of gastrointestinal beriberi in a cohort of patients of non-alcoholic Wernicke’s encephalopathy and review the relevant literature.Methods: In a retrospective analysis, case records of 52 patients diagnosed with non-alcoholic Wernicke’s encephalopathy were analyzed for the nature of gastrointestinal symptoms, their duration, severity and associated findings, investigations and response to treatment. The available literature on gastrointestinal symptoms in thiamine deficiency disorders and gastrointestinal beriberi was reviewed.Results: Gastrointestinal symptoms were found in 46 of the 52 patients. The most common gastrointestinal symptom in our patients was recurrent vomiting in 42 patients. Eight patients had water brash. Ten patients had epigastric pain and 10 patients had anorexia. Based on the nature and severity of symptoms, patients were evaluated for their symptoms using endoscopy, ultrasonography, amylase and lactate levels, and routine laboratory studies and the results were normal in the majority of patients.  Gastrointestinal symptoms settled in all the patients after receiving intravenous thiamine. On reviewing the literature multiple studies were found to have reported prominent gastrointestinal symptoms in patients of Wernickes encephalopathy and other thiamine deficiency related disorders. However, the definition of gastrointestinal beriberi is not clearly stated.Conclusions: Gastrointestinal symptoms were prominent prodromal manifestations in our cohort of Wernicke’s encephalopathy and have also been amply reported in literature. Presence of gastrointestinal symptoms in individuals predisposed to thiamine deficiency without alternative explanation should be enough to label a patient as gastrointestinal beriberi. The study highlights the importance of recognizing gastrointestinal beriberi as a distinct syndrome that may precede the development of Wernicke’s encephalopathy.

A Case of True Hermaphroditism, 46, XY DSD

A 26 year old student reared as a female, presented with inability to menstruate and increased facial hair growth. On examination , patient had hyperandrogenic features including hirsutism, low pitched voice, microphallus with hypospadias. Investigations revealed a 46 XY karyotype with increased testosterone and imaging revealed both ovaries and testes with a hypoplastic uterus. The patient was managed with bilateral testicular gonadectomy, feminising genitoplasty and hormonal therapy.

Etiological analysis, morbidities and mortality that affect the young and middle aged admitted with altered mental status in a general hospital

Background: Authors conducted this study to find the profile of causes and diseases that affect patients of younger age group in altered sensorium admitted in a general hospital associated with Government Medical College Srinagar, in India.Methods: Authors conducted present study over a period of eight months. The patients of young and middle age who were admitted in their hospital ward with altered mental status were included. The study subjects were divided into two groups: group A included patients of age upto 30 years, and group B with patients in age group 31-50 years. The patients were studied for their diagnoses, comorbidities, gender distribution, duration of stay in hospital and mortality patterns.Results: Authors had a total of 112 patients of young and middle age admitted in their hospital ward with altered mental status during the study period. In group A, there were 42 patients or 37.5% (20 males and 22 females). In group B, there were 70 patients or 62.5% (30 males and 40 females). The most common cause of admission in these patients was infection (29.46%) followed by seizures (17.85%) and cardioembolic strokes (11.60%).The most common comorbidities in studied patients were underlying seizure disorder, psychiatric disease in the form of bipolar affective disorder or schizophrenia, hypertension, type 2 diabetes and chronic kidney disease.There were 14 deaths in group A and 30 deaths in group B. The most common cause of death was infections followed by seizures, Acute respiratory distress syndrome (ARDS) and severe diabetic ketoacidosis (DKA).Conclusions: The most common cause of admission in young and middle-aged patients in authors’ hospital was infection followed by seizures and cardioembolic strokes. The most common cause of death was again infections followed by seizures, acute respiratory distress syndrome and severe diabetic ketoacidosis.

A case of pheochromocytoma presenting as syncope due to long QT syndrome

Pheochromocytoma, a catecholamine secreting tumour, is rare and we are presenting such a case who presened with syncopal episodes due to arrhythmias associated with the tumour. The patient was managed with pharmacologic and surgical treatment.