Insomnia: A Current Review.

Insomnia is a prevalent sleep disorder with pervasive effects on quality of life. The deleterious effects of insomnia are largely preventable with appropriate therapeutic interventions. Pharmacotherapy should be initiated in patients with inadequate response to CBT-I and tailored to comorbidities. Referral to a sleep medicine specialist should be considered in patients with a suboptimal response.

Association of microalbuminuria with ischemic heart disease in non-diabetic Asian-Indians: A case control study.

CONTEXT: Microalbuminuria is a known indicator of atherosclerosis and its association with ischemic heart disease (IHD) has been extensively studied in the diabetic population. The significance of urine microalbumin in non-diabetics, however, is yet to be elucidated. AIM: To determine whether an independent association exists between microalbuminuria and IHD in non-diabetic Asian-Indians, and the level of microalbuminuria predictive of concomitant IHD. MATERIALS AND METHODS: A cross-sectional case-control study was conducted between July 2009 and June 2011. Non-diabetic patients undergoing evaluation for IHD were divided into cases and controls, based on the presence or absence of IHD, respectively. Fifty cases and 50 controls were included, and matched by age, sex, smoking habit, hypertension and body-mass index (BMI). Fasting blood glucose (FBG), fasting lipid profile, and urine microalbumin were recorded for all patients. RESULTS: Mean fasting glucose, mean low density lipoprotein (LDL)-cholesterol and mean urine microalbumin were all significantly higher in cases compared to controls. Urine microalbumin was independently associated with IHD, and microalbumin greater than 12.6 mg/g was predictive of IHD (OR: 13.5; 95% CI, 4.6-39.9; P < 0.001). CONCLUSION: Urine microalbumin is independently associated with IHD in non-diabetics and levels greater than 12.6 mg/g are predictive of IHD.

A simple score to predict fetal outcomes in gestational diabetes mellitus.

BACKGROUND: Strict glycemic control is critical in preventing adverse maternal and fetal outcomes with gestational diabetes mellitus (GDM), but frequently results in recurrent maternal hypoglycemia and is often impracticable. This study was done to determine whether a more lenient strategy might provide satisfactory outcomes and to formulate a glycemic score for prognostication of fetal outcomes. METHODS: A prospective non-interventional study was conducted on consecutive patients admitted with GDM between May 2007 and August 2009. Patients with pre-gestational diabetes were excluded. All patients received treatment at the discretion of treating consultants. Glycemic control was estimated by recording mean values of all glucose profiles performed. Fasting and postprandial blood glucose levels below 95 mg/dl and 120 mg/dl, respectively, were considered controlled. A glycemic score was calculated based on the number of mean blood glucose values controlled. Fetal outcomes were noted. RESULTS: Ninety-four patients with GDM were included. The glycemic score was significantly predictive of adverse fetal outcomes (p < 0.001). Analysis by receiver operating characteristic (ROC) curve showed good sensitivity and specificity for macrosomia (78.3% and 81.8%, respectively) and congenital anomalies (73.9% and 66.7%, respectively) with a glycemic score of 2 or less [area under curve (AUC) 0.768; odds ratio (OR), 11.17; 95% Confidence Interval (CI), 2.58-48.35; p < 0.001; and AUC 0.765; OR, 2.22; 95% CI, 0.71-6.92; p = 0.055, respectively]. Binomial logistic regression confirmed the glycemic score to be independently predictive of fetal outcome (p = 0.015). CONCLUSION: The glycemic score is a sensitive and specific prognostic marker. Tight control of three of four values of blood glucose within the glucose profile appears sufficient to prevent adverse fetal outcomes.

AS, DISH or something else?

A 68-year-old farmer presented with progressively worsening pain in multiple joints associated with stiffening for 9 months. Locomotor examination revealed grossly restricted movement of the axial skeleton. There were no neurological deficits. Radiological evaluation demonstrated diffuse bone densification and extraspinal calcification with bony ankylosis reminiscent of ankylosing spondylitis. Laboratory tests subsequently yielded the true diagnosis. The patient was counselled accordingly and started on appropriate therapy.

Community-acquired multidrug-resistant Gram-negative bacterial infective endocarditis.

We describe two cases of bacterial endocarditis secondary to multidrug-resistant Gram-negative organisms. In both cases, the diagnosis was made in accordance with the modified Duke's criteria and confirmed by histopathological analysis. Furthermore, in both instances there were no identifiable sources of bacteraemia and no history of contact with hospital or other medical services prior to the onset of symptoms. The patients were managed in similar fashion with prolonged broad-spectrum antibiotic therapy and surgical intervention and made complete recoveries. These cases highlight Gram-negative organisms as potential agents for endocarditis, as well as expose the dissemination of such multidrug-resistant bacteria into the community. The application of an integrated medical and surgical approach and therapeutic dilemmas encountered in managing these cases are described.

A young woman with seizures and psychosis.

We present a case of a 24-year-old woman with abnormal behaviour of recent onset. She had been diagnosed previously with epilepsy and had been started on antiepileptic medication. Clinical examination confirmed features of psychosis including paranoid delusions and auditory hallucination. Neurological examination showed nystagmus and dysmetria. Further evaluation revealed the underlying cause for her symptoms. She responded promptly to appropriate therapy with complete resolution of psychosis.