Ethics of bedside clinics.

Teaching at the bedside is a time-tested and traditional method of instilling the basics of medical practice in students. In fact every medical student looks forward to “clinics at the bedside.” The students see clinical signs, hear murmurs and palpate organs with excitement and enthusiasm. The teachers in turn demonstrate disease manifestations with zing and zeal. It is here that basic clinical skills as well as “bedside manners” are acquired by the students. Each patient is a chapter of a medical text book to be written in the grey matter of the student.

Microalbuminuria and low hemoglobin as risk factors for the occurrence and increasing severity of diabetic retinopathy.

Aim: To assess the influence of urinary microalbuminuria and hemoglobin concentration on the occurrence and severity of diabetic retinopathy (DR), clinically significant macular edema (CSME) and hard exudate formation. Materials and Methods: In this prospective cross-sectional study carried out over a period of 2 years, type 2 diabetic patients seeking ocular evaluation for DR were assessed for presence and severity of DR, presence of hard exudates and CSME. Retinal findings were correlated to severity of microalbuminuria, hemoglobin concentration and other systemic risk factors using linear regression analysis. Results: Three hundred and six patients were included in the study. DR of any grade was seen in 132 (43%) patients, hard exudate formation in 93/306 (30.4%) patients, CSME in 50/306 (16.3%) patients and proliferative DR in 26/306 (8.5%) patients. Duration of diabetes (P <0.001), microalbuminuria (P <0.001) and low hemoglobin (P = 0.001) were found to be highly significant risk factors for the development and increasing severity of DR as well as for CSME and hard exudate formation. Conclusion: Microalbuminuria and low hemoglobin are strong predictors for DR, CSME and hard exudate formation in type 2 diabetics even after correcting for duration of diabetes and other systemic risk factors. Although not directly involved in the pathogenesis, microalbuminuria can help in identifying patients at risk for more severe diabetic eye disease. Microalbuminuria warrants intensive monitoring of both retinal and renal status. The hemoglobin levels should be monitored regularly in diabetic patients to detect and treat anemia, thereby reducing one risk factor for DR.

Bilateral gonadoblastomas with a left sided dysgerminoma in a true hermaphrodite (disorder of sexual differentiation) with 46, XY karyotype.

Ovotesticular DSD is not an uncommon disorder. The presence of Y chromosome confers a high risk of neoplastic transformation in dysgenetic gonads. The neoplastic development in these patients is associated with the presence of Y chromosome and intra abdominal location of the abnormal gonad. We report histogenetic details of a rare occurrence of bilateral gonadoblastomas and left sided dysgerminoma in a XY ovotestes DSD (disorder of sexual differentiation) in an 18 year old with a female phenotype.

Diabetic amyotrophy: a brief review.

Bruns in 1890 was the first to recognize the main clinical features of 'diabetic amyotrophy'. The term itself was coined by Hugh Garland in 1955 when he reported 12 elderly patients with type 2 diabetes. The aetiology is controversial, and both ischaemic and metabolic hypotheses have been proposed. The current evidence, however, points to a vasculitic aetiology of ischaemia followed by axonal degeneration and demyelination. The main features of diabetic amyotrophy are weakness, wasting and pain, most commonly in the quadriceps muscle. Though the weakness starts on one side, it almost always spreads to the other side in an asymmetrical manner. Patients also complain of sensory symptoms in the thigh such as severe pain, dysaesthesiae and paraesthesiae. On examination, there is weakness in the involved muscles. Tendon jerks, especially the patellar, are absent. Extensor plantar responses may be elicited in some patients. The course of the disease is variable but good functional improvement can be expected in most patients though weakness, sensory symptoms and absent tendon jerks may persist. Some patients experience multiple episodes of the condition commencing mostly on the opposite side. Conservative treatment constitutes optimizing diabetic control along with active physiotherapy and analgesia. Recently, intravenous immunoglobulins have been found to produce dramatic improvement in both clinical and electrophysiological parameters in patients with diabetic polyradiculopathy.