Atropine poisoning mimicking septicemia.

A young female was admitted in medical emergency room with fever, tachycardia and breathing difficulty. A provisional diagnosis of septicemia was made and empirical antibiotics were started. The patient required intubation and assisted ventilation. The patient recovered within 72 hours completely except bilateral mid-dilated fixed pupils. Atropine was not administered in the hospital. All blood investigations and infection screening tests were negative. After detailed history, examination and discussions, atropine poisoning was suspected which could explain all the signs and symptoms of the patient. This highlights the examination of pupillary reflexes in emergency room and meticulous clinical examination.

A study of sociodemographic clinical and glycemic control factors associated with co-morbid depression in type 2 diabetes mellitus.

CONTEXT: Diabetes affects 9.2% of adults in India. About 8-16% of its population also suffer from depression. Both diseases pose a serious health challenge at individual and system level. The prevalence of depression in diabetes is much higher than in the general population. Undiagnosed and untreated depression puts people at higher morbidity and mortality risk. AIM: To study the prevalence of depression in diabetes and to identify associated risk factors. SETTINGS AND DESIGN: Case control study carried out in an outpatient setting of a tertiary hospital in central India. MATERIALS AND METHODS: One hundred and nine type 2 diabetes patients and 91 healthy controls formed the subjects of the study. Sociodemographic data were obtained on seven parameters. Comprehensive clinical data were obtained by means of standard procedures. Blood sugar levels and glycosylated hemoglobin levels were measured to assess glycemic control. Data of diabetic patients and controls as well as that of depressed and nondepressed diabetics were subjected to statistical analysis. RESULTS: About 42.2% of diabetes patients and only 4.39% of controls had depression. About 19% of diabetics had peripheral neuropathy but had much higher neuropathic symptoms. Depression was not related to any sociodemographic or clinical factors but was strongly associated with poor glycemic control. CONCLUSION: Depression is highly prevalent in diabetes. Physical symptoms mask depression. Special attention needs to be paid to diagnose depression in diabetes and treat it appropriately along with effective glycemic control. Diabetes patients need to be treated collaboratively by physicians and psychiatrists.

Relationship of serum thyroid stimulating hormone with body mass index in healthy adults.

OBJECTIVE: To investigate any possible relationship between serum thyroid stimulating hormone (TSH) with body mass index (BMI) in healthy adults. MATERIALS AND METHODS: A total of 417 subjects aged 18-60 years who volunteered to get screened for thyroid illness with serum TSH have been enrolled from November 2012 to July 2013. Patients were divided into four groups based on BMI value: Underweight (BMI <18 kg/m(2)), normal (BMI: 18-22.9 kg/m(2)), overweight (BMI: 23-24.9 kg/m(2)), and obese (BMI ≥25 kg/m(2)). RESULT: In our study we found a significant variation (P < 0.001) in TSH with increasing BMI. As the BMI increased, mean TSH in the BMI range also increased. The individuals with higher BMI had higher TSH and this trend continued from underweight to Obese. The mean TSH of underweight group was 1.6036 mIU/L, normal weight group 2.1727 mIU/L, overweight group 2.2870 mIU/L and obese group 2.6416 mIU/L. CONCLUSION: In this study we found a significant relationship between serum TSH and BMI and mean TSH increased as BMI increased. Further large scale data from the population is required to confirm our findings.

Failure of siblings to thrive beyond 5 years of age.

We describe a family in which parents had consanguinity, being children of real sisters. They had given birth to five children. In their family, children remained healthy from birth to pre-school age and then started having symptoms around the age of 5 years and two of them succumbed to this illness. Polyglandular autoimmune syndrome Type-1 is a rare sporadic autosomal recessive disease. It is characterized by the existence of two or more endocrinal disorders. Patients may require lifelong hormone replacement therapy for survival.

Invasive cranial mycosis our experiences.

Fungi can cause serious cranial infections in immunocompromised and diabetic patients. Common pathogens mainly include Aspergillus and Mucor. These organisms cause tissue invasion and destruction of adjacent structures (e.g. orbit, ethmoid, sphenoid, maxillary & cavernous sinuses). Mortality and morbidity rate is high despite combined surgical, antifungal and antidiabetic treatment. We present our experience of six cases with such infection.

Relevance of ankle reflex as a screening test for diabetic peripheral neuropathy.

BACKGROUND AND OBJECTIVE: The primary objective of this study is to find out if testing ankle reflex (AR) alone is an effective screening tool for diabetic peripheral neuropathy and the secondary objective of this study is to compare its sensitivity and specificity with biothesiometer vibration perception threshold (VPT), which is the gold standard. MATERIALS AND METHODS: A total of 450 patients with diabetes mellitus attending endocrine out-patient department from year 2012 January to 2013 July were included in this study. All patients underwent clinical assessment of AR compared with VPT by biothesiometer. RESULTS: AR is sensitive (81.09%) specific (81.679%) with diagnostic accuracy of (81.22%) and agreement between biothesiometer and AR is significant (κ = 0.538 P < 0.0001). CONCLUSION: AR is at par the gold standard that is biothesiometer VPT.

Altered sensorium and multiple cranial nerve palsies in a recently diagnosed diabetic.

We report a recent diabetic who presented with hyperglycemic, hyperosmolar, non ketotic state with coma and multiple cranial nerve palsies due to an associated previously undetected sinus infection. This is a classic case revisited purely for its educational value in terms of clinical photographs, tissue biopsy and imaging findings. These findings reiterate the devastating neurological consequences of fungal sinusitis in diabetic patients.

Non-healing arm wound with a discharging sinus in an elderly patient with diabetes.

A 48-year-old Filipino female presented with unilateral acute onset painful red eye, blurred vision and yellow discharge. On examination she had a corrected visual acuity of 6/5 in the right eye and 6/18 in the left eye. There was a left-sided periorbital swelling, with chemosis involving the bulbar conjunctiva on the temporal aspect. Ocular motility showed limitation of left-sided abduction with mild limitation of laevoelevation and laevodepression. She was afebrile and systemic examination was unremarkable. Medical history included diagnosis of Crohn's disease since the age of 20. She was on oral mesalamine 1 g for mildly active colitis. Full blood count was normal but erythrocyte sedimentation rate and C reactive protein were raised. Blood culture and conjunctival swab were negative. Contrast-enhanced CT scan demonstrated enlargement of the lacrimal gland. She was managed conservatively with acetaminophen and codeine for pain and swelling. She recovered completely in 2 weeks with no sequelae.

First autochthonous case of Rhinocladiella mackenziei cerebral abscess outside the Middle East.

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is a severe infection in the middle east, resulting in nearly 100% mortality despite the application of combined surgical and antifungal therapy and occurring occasionally in otherwise healthy patients. We report the first case of brain infection in a middle-aged male in India, where R. mackenziei is not endemic.