Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Rasmussen’s Encephalitis

Introduction: Rasmussen’s encephalitis (RE) is an inflammatory encephalopathy characterized by progressive refractory focal seizures, cognitive deterioration and focal neurological deficit that occur with gradual atrophy of one brain hemisphere. Case presentation: We report a case of an 18-year-old male with a history of abnormal body movements involving the right half of the body without loss of consciousness for the last 15 years. Noncontrast computed tomography (NCCT) head and magnetic resonance imaging (MRI) revealed hemiatrophy of the left cerebral hemisphere. Conclusion: RE is a rare disease; hence, diagnosing and managing such patients may be challenging. Our aim is to draw attention of the treating physicians towards this disease with the help of this case report.

Effectiveness of self-designed dental storybook as behavior modification technique in 5 – 7 year-old children A randomized controlled study

Background: Dental anxiety is one of the key factors that prevent children from obtaining dental treatment and raises anxiety levels in children. The first dental visit is usually fearful for the child and contributes to managing the child patient in a dental operatory. A pediatric dentist's role is to perform effective treatment using various nonpharmacological behavior management techniques. Aims: The aim of the study was to evaluate and compare the effect of self-designed dental storybook on behavior and pulse rate before and after dental procedures in 57-year-old children. Settings and Design: The study was a prospective, randomized, controlled trial. Materials and Methods: The study was conducted on 380 aged 57 years. Children were randomly allocated into two groups, namely, Group A ? Behavior modification using a self-designed dental storybook and Group B – Behavior modification without storybook. Research was carried out in two dental visits (screening, examination, and preventive and restorative treatment) wherein, before and after intervention, pulse rate, Facial Image Scale (FIS), and Venham Scale (VS) were recorded. Descriptive statistical analyses followed by the paired t-test and Wilcoxon signed-rank test were applied and tabulated using the SPSS software version 23.0. Results: There was a significant difference observed in the interventional group as compared to the control group for pulse rate, FIS, and VS. Conclusion: Self-designed dental storybook as an adjuvant was found to be promising behavior modification technique for 57-year-old children.

A Study of Erectile Dysfunction in Male Diabetes Patients and its Correlation with Platelet-Lymphocyte Ratio

Introduction: Erectile dysfunction (ED) constitutes a large burden on society given its high prevalence and impact on quality of life. Diabetes is a common cause of organic ED. Prevalence of ED in diabetes ranges from 35% to 85% depending on the study, versus 26% in general population. Platelet-lymphocyte ratio (PLR) has been detected as an important marker for inflammation. Some studies have identified its role in ED but more research is needed. Material and methods: It was a hospital-based prospective observational study. According to International Index of Erectile Function (IIEF)-5 questionnaire, patients were divided into 4 categories: mild ED with score 17 to 21, mild-to-moderate ED with score 12 to 16, moderate ED with score 8 to 11 and severe ED with score 1 to 7. Presence of ED and its severity was correlated with age, residence, duration of diabetes, glycemic status, lipid profile, PLR, complications, body mass index (BMI), etc. Results: Prevalence of ED in male diabetes patients was found to be 72.4%. Among 110 cases with ED, 8 had mild ED (7.2%), 27 had mild-to-moderate (24.5%), 27 had moderate ED (24.5%) and 48 had severe ED (43.6%). Prevalence of ED was found to be proportional to age. Majority of cases in ED group were those with long-standing diabetes. Correlation of ED with complication of diabetes, like nephropathy and retinopathy, was significant, whereas it was not significant with neuropathy. Significant correlation of ED was found with BMI and PLR. Conclusion: ED prevalence was high among the diabetes patients and it increased with age and duration of the disease. Presence of diabetic complications was significantly associated with ED. BMI was significantly associated with development of ED. PLR was significantly higher in ED group and closely related to severity of ED.

Efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone-iodine in the treatment of otomycosis - A randomized controlled study

Introduction: Otomycosis is a term used to describe the epithelial infection caused by yeast and filamentous fungi, in the External Auditory Canal (EAC). It is one of the common infections seen in ENT OPD because of its prevalence in hot and humid climate. Due its high recurrence rate and different treatment modalities, it’s important to come out with ideal treatment modality. Aim: To compare efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone- iodine in the treatment of otomycosis. Materials and methods: Randomized control study was performed for 2 months on clinically diagnosed otomycosis patients. Total 60 patients were included in the study, which were randomly divided in 3 groups and treated by 1% clotrimazole drops, 1% clotrimazole cream and 10% povidone- iodine respectively. Patients were reviewed after 7 days on the basis of clinical response and symptoms of pain, ear blockage, pruritus and burning sensation. Results: After 7 days of treatment groups treated with 1 % clotimazole drops and cream had good response of 90% and 95% as compared to 10% povidone-iodine group which was 70%. Clotrimazole cream group had more ear blockage complain which was 75% and clotrimazole drops group had more burning sensation complain which was 55%.Conclusion: 1% clotrimazole drops and cream are equally effective in management of otomycosis but 10% povidone-iodine can be considered if patient has complain of ear blockage and burning sensation.

Does thyroid function have any relation with components of metabolic syndrome.

Background: Obesity, insulin resistance, physical inactivity, advanced age and hormonal disturbances have been suggested to be the underlying risk factors for the development of metabolic syndrome. Thyroid dysfunction can cause obesity, and can in turn lead to metabolic syndrome and can also be a cause of lipid abnormalities. Hence we tried to study the effect of thyroid function on the components of metabolic syndrome. Methods: Blood pressure, waist circumferences, HDL cholesterol and triglycerides were measured in all patients. TSH was measured and on its basis patients were divided in three groups: euthyroid, hypothyroid and subclinical hypothyroid. Results: There were 28 females and 22 males. Mean BMI was 31.51±5.21 kg/m2. The mean systolic blood pressure was 139.04±26.67 mm Hg and the diastolic pressure was 88.32±14.95 mm Hg. Mean waist circumference was 102±10.1 cm & mean waist: hip ratio was 0.97±0.094. HDL <50 in males and <40 in females in Euthyroid showed statistical significance (p value 0.05). Other components did not gain a statically significance. Comparing gender wise Subclinical hypothyroidism patients with Euthyroid patients, females having subclinical hypothyroidism are more likely to have metabolic syndrome (p value =0.03). This is not so in case of males. Conclusions: Female patients having subclinical hypothyroidism have higher chances of have metabolic syndrome as compared to males. Euthyroid patients with metabolic syndrome had low cholesterol. Other components of metabolic syndrome had no statically significance with thyroid function.

Is rotator cuff repair worthwhile in patients with co-morbidities.

Background: Rotator cuff tears are a common source of shoulder pain. The incidence increases with age and is most frequently due to degeneration of the tendon, rather than injury. This study is done to see whether in patients having established rotator cuff tears with co-morbidities like hypertension diabetes, epilepsy, etc. a surgical repair is worthwhile or whether it is better to leave such patients alone in order to give them a better quality of life. Methods: A total of 35 patients with co-morbidities, treated by a single surgeon of which 8 by open method, 19 with arthroscopic assisted mini open rotator cuff repair and 8 entire arthroscopically were evaluated retrospectively. Small tears (<1 cm), medium tears (1-3 cm); large tears (3-5 cm) were addressed by the same surgical procedure using bone tunnels, suture anchors, or a combination of both. The patients were evaluated by history, examination, pain scores and constant scores. Results: As compared to patients with no co-morbidities, these patients took longer time for healing especially diabetics. Despite that 27 patients had excellent pain relief, 5 good and 3 poor pain relief. Constant scores improved in all patients. Conclusion: Patients with co-morbidities take longer time to heal, yet the final outcome which is attained and relief of pain and relief in the form of activities of daily living that we could offer the patients makes the surgery worthwhile. It is well worth operating on patients with co-morbidities and a rotator cuff tear, giving them a better pain free life and better activities of daily living.