General Medicine Department Research Articles

A cross sectional study to analyse the ADR reported in a hospital during the past three years

Introduction: Cross sectional study is a type of observational study that analyzes data from apopulation, or a representative subset, at a specific point in time-that is, cross sectional data. The causality appraisal is assessment of the probability that the detected adverse event is produced by a specific medication. The most commonly used causality assessment scales are Naranjo Probability Scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality scales. The study is to analyze the adverse drug reaction reported in a hospital for the past three years. Aim: A cross sectional study to analyze the ADR reported in a hospital during the past three years. Methodology: A cross sectional observational study was conducted at Nirmala medical centre, Muvattupuzha. ADR reported in the past three years in this hospital were analyzed. Drug leading to ADR, department .gender, observed reaction, severity, Naranjo probability scale and WHO UMC causality assessment were done. Classification of drugs according to their drug class, classification of ADR according to the system, based on severity, sex, Naranjo score, WHO UMC criteria were done. The datas were analysed and represented into graphs. Result: A total of 342 ADR reports were analyzed in this study. The key findings of this study include: Skin-related ADRs were the most frequently reported, affecting 27.83% of cases. The majority of reported ADRs were of moderate severity (56.7%).Naranjo probability scale and WHO-UMC causality assessment indicated that most cases were in the probable category, with 63% and 76%, respectively. The general medicine department had the highest number of reported ADRs. Males accounted for the majority of reported ADRs (57.18%).Cardiovascular agents and antibiotics were the drug classes most commonly associated with reported ADRs, at 25.6% and 22.28%, respectively. Among cardiovascular agents, diuretics were found to be the primary culprits, causing 38.66% of reported ADRs. Conclusion: This study highlights the importance of monitoring, assessing, and documenting ADRs in healthcare facilities, as it provides valuable insights into the prevalence, severity, and causality of adverse drug reactions. This information can contribute to improving patient safety and the rational use of medications in clinical practice.

1869. Knowledge about and Perceptions of Latent Tuberculosis Infection (LTBI) among Physicians and Advanced Practice Providers at Tufts Medical Center

Abstract Background Mycobacterium Tuberculosis (TB) is a leading cause of infectious disease mortality worldwide. Most active TB cases result from reactivation of latent tuberculosis infection (LTBI). A large reservoir of latent TB is a major public health problem worldwide and in the United States. A better understanding of provider perspectives on LTBI could improve a sub-optimal LTBI care cascade. Methods A 13-question survey was fielded to attending physicians, fellows, and advanced practice providers working in the infectious disease, pulmonary/critical care, and general medicine departments at Tufts Medical Center (TMC), an academic tertiary care center in Boston, Massachusetts. Results The response rate of the survey was 33% (62/186). Only 17 (30.9%) providers were able to correctly identify all indications for screening. When asked how they decide who to treat, 26.8% (15/56) of providers selected that they would refer their patient to another specialist. Overall, provider confidence in LTBI management decreased along the care cascade (Figure 1). Infectious disease providers expressed more confidence in management than general medicine and pulmonary/critical care providers. The two most observed issues/barriers to care for patients were language, reported by 39 (76.5%) providers, and lack of knowledge or understanding about TB, reported by 39 (76.5%) providers. The two most selected interventions to improve LTBI care at TMC were use of in-person language interpreters, chosen by 37 (71.2%) providers, and information pamphlets available in patients’ preferred languages, chosen by 36 (69.2%) providers. Providers were asked “On a scale of 1-5, (“1” = not at all, and “5” = perfectly) “How confident are you in your ability to do the following” for the listed management tasks. Conclusion Results suggest that providers believe the largest barriers to patient LTBI treatment completion are due to a lack of patient comprehension about their infection. Improving patient understanding could be accomplished through in-person interpreters, information pamphlets about LTBI in patients’ preferred languages, and forming community partnerships to improve awareness and understanding of the risks of LTBI. Additionally, ensuring that providers feel confident in their ability to manage LTBI, are updated on screening guidelines, and have referral resources when needed, could help close the gaps in the LTBI care cascade. Disclosures All Authors: No reported disclosures

A Study of Diabetes in Young Individuals with Special Reference to Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) in young individuals is a serious concern for the society. Literature suggests that the incidence of T2DM is not only increasing, but also there is a shift of age of onset of T2DM toward younger age groups in India and worldwide. However, data about the frequency of T2DM among young subjects below 25 years of age are sparse in the Indian subcontinent. Hence, the current study was undertaken to find out the frequency and clinical profile of young individuals with T2DM in the departments of internal medicine and pediatrics in a tertiary care hospital. Aims and Objectives: The aim of the study was to study the frequency and clinical profile of T2DM among young individuals with diabetes mellitus. Materials and Methods: The study was a cross-sectional observational study conducted in the Departments of General Medicine and Pediatrics at JSS Hospital, Mysuru, Karnataka, India, over a 2-year period. The subjects with age of onset of diabetes mellitus below 25 years were included in the study. They were categorized according to the C-peptide values as type 1 diabetes mellitus (T1DM) and T2DM. Maturity-onset diabetes of the young (MODY) was diagnosed with the age of onset of diabetes below 25 years with a strong family history of diabetes for three generations and no insulin requirement for metabolic control for 5 years after diagnosis. The statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS version 25). Results: Of the 250 patients included in the study, 208 (83.2%) subjects were T1DM, 38 (15.2%) T2DM, and 4 (1.6%) with MODY. The mean age of onset of T1DM was 13.7 ± 6.201 years and T2DM was 23.28 ± 3.68 years. Body mass index (BMI) and waist circumference of young T2DM patients were more compared to T1DM, which were statistically significant P < 0.0001, and family history showed strong positivity in patients with young T2DM compared to T1DM. Low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and total cholesterol (TC) were more in young T2DM patients compared to T1DM which were statistically significant with P = 0.003 (LDL), P = 0.0015 (TG), and P = 0.03 (TC), respectively. Conclusions: T2DM, previously considered a middle-aged or elderly condition, is now commonly occurring in young adults and children, probably due to a growing epidemic of childhood obesity and lifestyle. Obesity and dyslipidemia were more in T2DM compared to T1DM among young diabetics.

Approach to non-compressive myeloneuropathy through a rendezvous of 11 cases from an Indian backdrop

IntroductionMyeloneuropathy is a diagnosis ascribed to disorders that concomitantly affect the spinal cord and peripheral nerves. Recognizing this syndrome may sometimes be arduous, even for the most consummate clinicians, because symptomatology can mimic either spinal cord or peripheral nerve disease. Besides, examination findings suggest a predominantly myelopathic or neuropathic picture. This article reports a rendezvous of rare cases of clinically diagnosed myeloneuropathy with different etiological backgrounds and therapeutic responses. MethodsEleven cases of non-compressive myeloneuropathy were admitted to the Department of General Medicine of Burdwan Medical College and Hospital, Burdwan, West Bengal, India, between May 2018 and May 2022. ResultsWe report the cases of 11 patients (6 men and 5 women) who presented with myeloneuropathy of different etiologies (vitamin B12, copper, and vitamin E deficiencies, organophosphate poisoning, chronic alcohol abuse, illicit substances abuse, anti-thyroid peroxidase/anti-thyroglobulin antibody-related neurologic disorder responsive to steroids, Sjögren syndrome, chikungunya infection, paraneoplastic, and hereditary). ConclusionMeticulous historical analysis, careful clinical examination, and apposite utilization and interpretation of biochemical, electrophysiological, and neuroimaging findings are sine-qua-non for an accurate and consistent approach to evaluating a suspected case of myeloneuropathy, facilitating early treatment and recovery. Differential identification of these disorders needs an in-depth perception of the mode of onset of symptoms, the course of progression of the disease, the pattern of myelopathic/neuropathic findings, and recognition of other neurological or systemic manifestations. For untroubled understanding, etiologies of myeloneuropathies should be subdivided into a few broad categories, e.g., metabolic (nutritional), toxic (toxin-induced), infectious, inflammatory (immune-mediated), paraneoplastic, and hereditary disorders.

Prevalence of target organ disease and its relation with HbA1c at the point of detection of type 2 diabetes mellitus – A cross sectional study from a tertiary care hospital in Odisha

Introduction and Aim: HbA1c is not only a valid indicator of chronic hyperglycaemia but also coincides with the increased risk of diabetic complications in the long term. This study focuses on the prevalence of target organ disease (TOD) and its relation with HbA1c at the point of detecting Type 2 Diabetes Mellitus(T2DM). Materials and Methods: This is a single-centre cross-sectional study done in the Department of General medicine at IMS and SUM Hospital, Odisha, between November 2020 and June 2022, including all newly diagnosed Type-2 Diabetes Mellitus patients aged > 30 years. Besides all the biochemical parameters, the demographic profile was noted in an excel sheet, and later on, using SPSS version 26, the data was analysed categorically. Results: 148 newly diagnosed Type 2 DM patients were enrolled in the study with male predominance (54.72%). The mean age was found as 52.49±9.40 years. There were 29 (19.5%) cases of diabetic retinopathy, 39 (26.3%) diabetic neuropathy, 32(21.6%) diabetic nephropathy and 23(15.54%) left ventricular diastolic dysfunction, with a minimal number of RWMA [7 (4.72%)], Concentric left ventricular hypertrophy [9 (6.08%)] and Ischemic DCM [1(0.67%)] found as complications of newly diagnosed Diabetes mellitus patients. The prevalence of coronary artery disease (CAD) is higher in our study than in other diabetic complications, i.e., 40 (27.02%).A statistically significant (p<0.05) correlation exists between newly diagnosed Diabetes patients with higher HbA1C and serum creatinine, serum urea, microalbuminuria, and positive monofilament test. Conclusion: This study underscores the significance of assessing target organ damage (TOD) prevalence for Type 2 Diabetes Mellitus (T2DM) detection, highlighting the utility of HbA1c testing. HbA1c, a rapid and precise diagnostic tool, holds promise, especially in resource-limited settings, aiding in timely T2DM diagnosis and improved patient care amid the global diabetes epidemic.

CLINICAL AND HEMATOLOGICAL PROFILE OF PATIENTS WITH DENGUE FEVER AT A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

Objectives: The objective of this study was to analyze the clinical and hematological profile and studying outcome of patients having dengue fever (DF). Methods: This was an observational study conducted in the Department of General Medicine, Basveshwar Teaching and General Hospital, Kalaburagi, India. One hundred patients with DF were included in this study. Demographic details were obtained, detailed history was taken, and clinical examination was done. The cases were classified into dengue without warning signs, dengue with warning signs, and severe dengue as per world health organization classification of dengue. Clinical features, hematological profile, and outcome were assessed in studied cases. SSPE 21 software was used for statistical analysis. P value less than 0.05 was taken as statistically significant. Results: Out of these 100 cases, there were 62 (62.00 %) males and 38 (38 %) females with a M: F ratio of 1: 0.61. The mean age of male and female patients was found to be comparable with no statistically significant difference in the age group (p=0.391). Out of 100 studied cases, non-severe dengue was seen in 56 (56%) patients whereas 31 (31.00%) patients had non-severe dengue with warning signs and remaining 13 (13.00%) patients had severe dengue. The most common presenting complaint was fever which was present in all patients (100%). The other complaints included headache (82%) nausea and vomiting (74%). Positive torniquet test was seen in 7 (7%) patients and hypotension, decreased pulse pressure, and altered sensorium were seen in 5 (5%) patients each. In cases of dengue with warning signs or severe dengue out of 44 patients, 21 (21%) patients required blood component therapy and 5 (5%) patients landed up in shock despite fluid therapy. Two (2%) succumbed to complications of severe dengue. Conclusion: Comprehensive understanding of clinical features, hematological profile, and warning signs in DF is essential for timely diagnosis and effective management. With early diagnosis and proper management, the outcome of patients is usually good.

Serum uric acid level in chronic liver disease and its correlation with Child-Pugh score in a tertiary care hospital from South India.

Chronic liver disease (CLD) is one of the important causes of morbidity and mortality in our country, and since the damage to the liver is irreversible, we have to look for many severity markers or predictors for the prognosis of the patient. In this study, we have tried to correlate the level of serum uric acid (UA) with the severity of CLD presented as a Child-Pugh score. A cross-sectional observational study was conducted at Vijayanagar Institute of Medical Science (VIMS), Ballari, Karnataka, from October 2015 to June 2017 in the Department of General Medicine. Fifty patients diagnosed with CLD, aged between 18 and 65 years, of either gender, were enrolled in the study. Serum UA levels were measured, and liver function and coagulation parameters were assessed. A statistical analysis was performed to evaluate the association between serum UA levels, liver function test, and coagulation parameters. In our study, the mean serum UA level was 6.52 mg/dl and was raised in patients with CLD in correlation to its severity. Alcoholic liver disease (ALD) was the most common etiology for CLD (80%) followed by hepatitis B (Hep B) virus infection (12%) and hepatitis C (Hep C) virus infection (6%). Serum UA levels increased as the Child-Turcotte-Pugh (CTP) score increased. The mean UA level in CTP class C was 8.29 mg/dl. Various parameters such as serum aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase, total bilirubin, international normalized ratio (INR), calcium, and albumin were significantly associated with serum UA levels in CLD patients. The correlation between rising blood UA levels and the Child-Pugh score shows that UA estimate may be a valid and affordable indicator for assessing the extent of liver cirrhosis in CLD.

GNRI, PLR and Stroke-Associated Pneumonia: From Association to Development of a Web-Based Dynamic Nomogram.

Discussing the relationship between geriatric nutritional risk index (GNRI) and platelet-to-lymphocyte ratio (PLR) on stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients, developing and validating a web-based dynamic nomogram. A total of 996 AIS patients admitted to the Department of General Medicine and Neurology at Xuzhou Medical University Affiliated Hospital were collected. They were divided into Non-SAP group and SAP group based on the occurrence of SAP. The data was randomly divided into training set and validation set in a ratio of 7:3. LASSO regression and multivariable logistic regression analysis were used to screen for independent risk factors and develop a dynamic nomogram. Area under the receiver operating characteristic curve (AUC-ROC), calibration curve, and decision curve analysis (DCA) curve were used to validate the model's discriminative ability, calibration, and clinical value, respectively. Among AIS patients, a total of 221 cases (22.19%) developed SAP. Age, NIHSS score, comorbid atrial fibrillation, dysphagia, PLR, and GNRI were identified as independent factors influencing the occurrence of SAP in AIS patients. A web-based dynamic nomogram was developed based on these six variables. The training set showed an AUC-ROC of 0.864 (95% CI: 0.828-0.892), while the validation set showed an AUC-ROC of 0.825 (95% CI: 0.772-0.882), indicating good predictive ability and discrimination of the model. The calibration curve demonstrated good calibration of the model, and the DCA curve showed its clinical value. This model can be accessed and utilized by anyone on the website (https://moonlittledoctor.shinyapps.io/ANADPG/). PLR and GNRI are independent factors influencing the occurrence of SAP in AIS patients, and a dynamic nomogram was constructed to predict the risk of SAP in AIS patients. It can guide clinical decision-making and improve patient prognosis.

EVALUATION OF CLINICAL AND BIOCHEMICAL PROFILE IN TYPE 2 LEAN DIABETES MELLITUS

Background and objectives: Various studies in India have documented Type 2 diabetes mellitus in low body weight/lean individuals. This present study was planned to assess the clinical, biochemical profile and complications in lean patients (BMI < 18.50 Kg/m2) with T2DM. Methodology: This single centre hospital based descriptive study was undertaken in the Department of General Medicine, Father Muller Medical College, Mangaluru, Karnataka. A total of 28 patients diagnosed to have T2DM with BMI <18.50 Kg/m2 were enrolled. Patients were investigated for clinical, biochemical profile and complications. Results: Equal number of patients (50% each) were males and females with male to female ratio of 1:1. The mean age was 48.61±7.31 and 50% of the patients were aged from 41 to 50 years. The mean duration of diabetes was being 3.55±2.39 years and treatment with oral hyperglycaemic agents was noted in 50% of the patients. Majority of the patients (75%) had higher waist circumference and presented with diabetic complications that is, diabetic neuropathy and nephropathy in 75% of the patients each, diabetic retinopathy in 67.86% of the patients while lipid abnormalities that is, 82.14% had hypercholesteolaemia and 89.29% had hypertriglyceridaemia. Conclusion and interpretation: Lean T2DM poses phenotypically a separate type of T2DM which is characterized by younger age at presentation with central obesity, overt hyperglycaemia leading to lipid abnormalities resulting early onset of microvascular complications.

Pattern of Thyroid Dysfunction in Type II Diabetes Mellitus Patients in a Tertiary Care Center: A Cross-Sectional Study

Background: Early identification and intervention of thyroid dysfunction which occurs in association with type-II diabetes mellitus may significantly reduce the risk of adverse cerebrovascular and cardiovascular events in such patients. Hence, this study analyzed the pattern of thyroid dysfunction in T2DM (Type 2 Diabetes mellitus) patients. Methods: The present cross-sectional study was done on 250 T2DM patients, who visited the department of General Medicine in a tertiary care teaching center. Medical history was recorded and venous blood samples were collected for investigations (HbA1C (Hemoglobin A1C), FBS (Fasting blood sugar), PPBS (Postprandial blood sugar), TSH (Thyroid stimulating hormone), T4 (Tetraiodothyronine), anti-TPO (Thyroid peroxidase), and fasting lipid profile). Thyroid dysfunction in patients with T2DM was considered as the primary outcome variable. P value <0.05 was considered statistically significant. Data were analyzed using coGuide software, V.1.03. Results: Females (55.6%) outnumbered males (44.4%) in this study. The prevalence of thyroid dysfunction in our study was 23.6% (95%CI 0.184 to 0.293). Subclinical hypothyroidism was found in 67.79% (95%CI 0.543 to 0.793) participants, overt hypothyroidism in 27.11% (95%CI 0.163 to 0.402), and hyperthyroidism in 5.10% (95%CI 0.010 to 0.141). Females (84.6%) had significantly higher prevalence of anti-TPO positivity compared to males (15.4%)(p=0.013). Conclusions: Findings of this study showed that T2DM patients have higher prevalence of thyroid dysfunction with predominance of subclinical hypothyroidism. Hence, this study emphasizes the importance of annual investigation of TSH levels in all the patients with T2DM. Keywords: Autoimmune Diseases, Hyperthyroidism, Hypothyroidism, Thyroid­Stimulating Hormone, Type II Diabetes Mellitus

ChatGPT-Generated Differential Diagnosis Lists for Complex Case-Derived Clinical Vignettes: Diagnostic Accuracy Evaluation.

The diagnostic accuracy of differential diagnoses generated by artificial intelligence chatbots, including ChatGPT models, for complex clinical vignettes derived from general internal medicine (GIM) department case reports is unknown. This study aims to evaluate the accuracy of the differential diagnosis lists generated by both third-generation ChatGPT (ChatGPT-3.5) and fourth-generation ChatGPT (ChatGPT-4) by using case vignettes from case reports published by the Department of GIM of Dokkyo Medical University Hospital, Japan. We searched PubMed for case reports. Upon identification, physicians selected diagnostic cases, determined the final diagnosis, and displayed them into clinical vignettes. Physicians typed the determined text with the clinical vignettes in the ChatGPT-3.5 and ChatGPT-4 prompts to generate the top 10 differential diagnoses. The ChatGPT models were not specially trained or further reinforced for this task. Three GIM physicians from other medical institutions created differential diagnosis lists by reading the same clinical vignettes. We measured the rate of correct diagnosis within the top 10 differential diagnosis lists, top 5 differential diagnosis lists, and the top diagnosis. In total, 52 case reports were analyzed. The rates of correct diagnosis by ChatGPT-4 within the top 10 differential diagnosis lists, top 5 differential diagnosis lists, and top diagnosis were 83% (43/52), 81% (42/52), and 60% (31/52), respectively. The rates of correct diagnosis by ChatGPT-3.5 within the top 10 differential diagnosis lists, top 5 differential diagnosis lists, and top diagnosis were 73% (38/52), 65% (34/52), and 42% (22/52), respectively. The rates of correct diagnosis by ChatGPT-4 were comparable to those by physicians within the top 10 (43/52, 83% vs 39/52, 75%, respectively; P=.47) and within the top 5 (42/52, 81% vs 35/52, 67%, respectively; P=.18) differential diagnosis lists and top diagnosis (31/52, 60% vs 26/52, 50%, respectively; P=.43) although the difference was not significant. The ChatGPT models' diagnostic accuracy did not significantly vary based on open access status or the publication date (before 2011 vs 2022). This study demonstrates the potential diagnostic accuracy of differential diagnosis lists generated using ChatGPT-3.5 and ChatGPT-4 for complex clinical vignettes from case reports published by the GIM department. The rate of correct diagnoses within the top 10 and top 5 differential diagnosis lists generated by ChatGPT-4 exceeds 80%. Although derived from a limited data set of case reports from a single department, our findings highlight the potential utility of ChatGPT-4 as a supplementary tool for physicians, particularly for those affiliated with the GIM department. Further investigations should explore the diagnostic accuracy of ChatGPT by using distinct case materials beyond its training data. Such efforts will provide a comprehensive insight into the role of artificial intelligence in enhancing clinical decision-making.

STUDY CLINICAL, RADIOLOGICAL, ELECTROCARDIOGRAPHIC, AND ECHOCARDIOGRAPHIC CHANGES IN CHRONIC CORPULMONALE

Introduction: Chronic cor pulmonale accounts for 5–10% of all heart diseases and 20–30% of all admissions for heart failure. The development of pulmonary hypertension (PAH) and subsequent chronic cor pulmonale increases the risk of hospitalization and is associated with reduced survival. Echocardiography examination can quantify the extent of the right ventricular hypertrophy (RVH) and PAH noninvasively. Methods: This is a prospective and observational study conducted in 74 included cases admitted in the department of general medicine, NSCB Medical College Hospital, Jabalpur. On the basis of patient’s history, physical findings, radiological findings, and electrographic changes, the diagnosis of chronic cor pulmonale was made and was subjected to echocardiography examination. Results: Cor pulmonale was more common in smokers with male-to-female ratio of 2.52:1 and was more common in the 4th, 5th, and 6th decade of life. ECGshowed 58.10% of cases with RVH, 59.45% with right axis deviation, 48.64% right bundle branch block, and 66.21% with P pulmonale. Echocardiographic evaluation revealed right ventricular dilatation in 100% cases, RVH in 94%, tricuspid regurgitation in 52.70%, right atrial enlargement in 50%, PAH in 97.29%, diastolic septal flattening in 16.21%, paradoxical motion of the IV septum in 8.1%, reduced left ventricular end-diastolic volume in 8.1%, and left ventricular ejection fraction reduced in 22.97%. Conclusion: Detection of chronic cor pulmonale in the early stage is important for therapeutic and prognostic implication. Echocardiography is a non-invasive, affordable investigation for early diagnosis of chronic cor pulmonale.

SERUM FERRITIN LEVELS AS A PROGNOSTIC INDICATOR IN ACUTE ISCHEMIC STROKE: A COMPREHENSIVE CLINICAL STUDY

Objective: This clinical study investigates the potential of serum ferritin levels as a prognostic indicator in acute ischemic stroke. Methods: This cross-section study included 75 patients enrolled in our outpatient clinic, General Medicine Department, and SMS Medical College. The study enrolled all patients who had a new onset focal neurological deficit due to a stroke. A total of 75 patients (25 in each group (mild/moderate/ severe) as per the National Institute of Health Stroke Scale scoring) of >14 years old, presenting in the general medicine wards were enrolled for the study. The study assesses the correlation between serum ferritin levels and various clinical parameters, including stroke severity, consciousness status, and disability outcomes. Results: Severe group had the highest average blood ferritin level (408.48 with a standard deviation (SD) of 68.63). A significant relationship was observed between ferritin levels and loss of consciousness. In addition, the mean ferritin residue ratio (MRS) also correlated with ferritin levels, with MRS correlating to ferritin levels. A significant association between elevated serum ferritin levels and severe stroke, as well as unfavorable outcomes. Conclusion: The findings suggest that serum ferritin could serve as a promising prognostic index in acute ischemic stroke, aiding in patient risk stratification and clinical decision-making.

Prevalence of Various Forms of Active Tuberculosis in Patients with Diabetes

A diabetic foot ulcer (DFU) is a persistent complication of diabetes mellitus. Diabetes is linked to a two to four-fold higher likelihood of developing peripheral arterial disease (PAD) when compared to individuals without diabetes. Objective: To determine the incidence of various forms of active tuberculosis in patients with diabetes. Methods: It was a cross-sectional study conducted at the Department of General Medicine from August 2022 to February 2023. 175 patients, including both males and females, participated in this study. Comprehensive demographic information was meticulously documented for each patient following the appropriate consent procedures. These patients had symptoms such as cough with or without phlegm, hemoptysis, persistent fever, and unexplained weight loss, and their ages ranged from 10 to 85 years. Comprehensive medical history, clinical examination, and TB screening tests were conducted and data analysis were done by SPSS version-24 for further analysis. Results: The mean age was 51.34 years with a standard deviation of 3.61. Among the patients, 107 (61.14%) were male, and 68 (38.85%) were female. The overall prevalence of active TB was 38 cases, accounting for 21.71% of the total. Among these cases, 18 were pulmonary TB, making up 47.36% of the active TB cases, while 13 were extra-pulmonary TB, constituting 34.21% of the total. Additionally, 5 cases were identified as multidrug-resistant TB, representing 13.15% of the active TB cases. Conclusions: In conclusion, our study reveals a higher prevalence of various forms of active tuberculosis in patients with diabetes with pulmonary tuberculosis accounting for 47.35% and extra pulmonary tuberculosis for 34.21% of cases.

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India.

Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin. Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. Severeiron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopeniaif common causes of pancytopenia are ruledout.

Addressing sexual assault in Pakistan: Insights from an analysis of female survivors at Lahore General Hospital

Background & objectiveRape is a severe kind of sexual violence that represents a significant violation of human rights. The objective was to investigate the demographic and clinical features of female survivors of sexual assault in Lahore, Pakistan. MethodA retrospective study was conducted at the Department of Forensic Medicine of Lahore General Hospital, analysing records of female sexual assault survivors investigated by affiliated police stations from November 2020 to November 2022. Data were collected from medicolegal certificates and medical notes and analysed using SPSS software. Result282 female survivors reported to Lahore General Hospital's Forensic Medicine Department, aged 5–55 years, with a mean age of 22.74 ± 8.30. A significant proportion (50.4%) were aged 16–25 years. Most survivors were examined between 6 and 24 h (34%) and 2–7 days (37.9%) after the assault, with the majority (95%) exhibiting well-developed secondary sexual characteristics. Sexual assault and physical abuse were both reported in 56.4% of cases. In 77% of cases, the perpetrator was known, and in 36.5% of cases, a weapon was used. No external body injury was observed in 74.8% of cases, and 2.8% showed signs of fresh hymen rupture. The study identified 92.2% of cases lost to follow-up. ConclusionThis study highlights the pressing need to implement effective measures to prevent and address rape in Pakistan. The findings emphasise the need for education, improved forensic infrastructure and policy reforms to address sexual assault effectively.

Prevalence of iron deficiency in non-anemic heart failure patients

Background: To study the prevalence of iron deficiency in non-anemic heart failure patients. Materials and methods: This is a single-center cross-sectional study done in the Department of General Medicine at the Institute of Medical Sciences and SUM Hospital, Odisha, between November 2020 and June 2022. The selection of participants was made based on Framingham criteria. An iron profile was used to detect iron deficiency anemia during the study period. According to the WHO, Anemia is defined as having a hemoglobin (Hb) level below 12 gm/dL in females and 13 gm/dL in males. Serum ferritin below 100 ng/mL is considered an absolute iron deficiency, and serum ferritin between 100 and 300 ng/mL with low transferrin saturation (TSAT <20%) is regarded as functional Iron deficiency. Results: A total of 100 individuals with non-anemic heart failure (53% men and 47% women) were included in the study. Most of the individuals were of class IV New York Heart Association (NYHA) (N=39). Iron deficiency was present in 60% of individuals, with 32% having absolute iron deficiency and 28% having functional iron deficiency. Men and women had almost the same prevalence of iron deficiency (62.2% vs 57.44%). The levels of mean Hb, ferritin, and transferrin saturation in the iron deficiency group (i.e., 13.2 gm/dL, 139.7 ng/mL, and 14.4%) were less when compared to the non-iron deficiency group (i.e., 13.3 gm/dL, 391.35 ng/mL and 36.1%). Conclusion: Our research emphasizes the impact of iron deficiency on heart failure patients in India, which is still underappreciated and ignored. This study recommends more in-depth analysis to define this manageable illness correctly and explore habitual testing in upcoming national recommendations.

Association of metabolic syndrome with hypothyroidism and hyperuricemia: A cross-sectional study in a tertiary care hospital, Kolkata, West Bengal

Background: Metabolic Syndrome (MetS) (Syndrome X, insulin resistance syndrome, MetS) consists of a constellation of metabolic abnormalities which include central obesity, hyperglycemia, insulin resistance, high triglycerides, low high-density lipoprotein (HDL) cholesterol, and hypertension. Obesity is a critical component of MetS. It causes alteration in the thyroid hormones and hyperuricemia. Furthermore, insulin resistance seen in MetS causes decreased uric acid excretion. Aims and Objectives: To study the association of MetS with hypothyroidism and hyperuricemia. Materials and Methods: A cross-sectional study was conducted among patients from the outpatient department of General Medicine, IPGME and R, Kolkata from January 2012 to June 2013. A total of 112 patients, consisting of 53 patients with MetS and 59 patients without MetS were selected. Patients’ history, clinical and laboratory findings were recorded and data were analyzed. Results: Majority (66%) of the patients with MetS were female and the rest were male. The mean Body mass index of patients with MetS was 33.31±4.36 (Mean±SD) kg/m2 and without MetS was 25.21±2.62 (Mean±SD) kg/m2. A significant association was observed between weight, height, waist circumference, fasting blood sugar, HDL value, and MetS (P<0.05). About 39.6% of the patients with MetS had hyperuricemia. The association between MetS and hyperuricemia was found to be significant. Similarly, 45.3% of the patients with MetS had hypothyroidism. This association was also found to be significant. Serum thyroid-stimulating hormone had a minimal correlation with serum uric acid in patients with MetS (correlation coefficient r=0.344), while no correlation was observed between fT3, fT4 with serum uric acid. Conclusion: Increased prevalence of hyperuricemia and hypothyroidism was seen among patients with MetS. More extensive population-based research is needed to support this finding.

Peripheral Parenteral Nutrition and Activities of Daily Living in Hospitalized Older Frail Patients.

Frail older adults require nursing care following hospitalization for acute illnesses. Frailty is reversible, and appropriate nutritional management and rehabilitation during hospitalization are essential. However, optimal nutritional management for patients who are unable to obtain adequate nutrition via oral intake has not been established. We aimed to determine whether peripheral parenteral nutrition (PPN) promotes the recovery of activities of daily living (ADLs) in frail older patients. This was a retrospective, observational cohort study conducted at the General Medicine Department of Aomori Prefectural Central Hospital in Aomori, Japan. The primary outcome was recovery of the Barthel index (BI) from the beginning of rehabilitation to discharge, and the secondary outcomes were the proportion of patients transferred for rehabilitation and the nutritional status. In total, 342 patients hospitalized during the period of April 2018 to January 2022 were included, of whom 127 (37.1%) received PPN and 215 (62.9%) did not. Contrary to our expectations, recovery of the BI was lower in the PPN group than that in the non-PPN group (12.2 (95% confidence interval (CI): 8.5-16.0) vs. 22.4 (18.8-23.0); p < 0.01). Multivariable analysis revealed PPN as an independent risk factor for poor BI recovery (mean difference = -7.3 (95% CI = -12.7 to -1.9)). Nutritional management through PPN for frail older adults may not improve physical activity.The nutritional management of frail patients with inadequate oral intake remains challenging.

Frequency of Non-Alcoholic Fatty Liver Disease in Adults with Diabetes Mellitus

Objective: To compare the frequency of non-alcoholic fatty liver disease in patients with diabetes of different age groups, body mass indexes and duration of diabetes.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of General Medicine, Combined Military Hospital, Quetta Pakistan, from Jun to Nov 2019.&#x0D; Methodology: One hundred thirty-two patients of either gender with diabetes for more than one year were included. All patients underwent ultrasound to scan for fatty liver, and a consultant radiologist confirmed the findings. Non-alcoholic fatty liver disease was diagnosed as per operational definition.&#x0D; Results: Of the total 132, 89(67.5%) were males, and 43(32.5%) were females. The mean age of the patients was 49.34±5.76 years. The mean weight of the patients was 72.91±13.40 Kg, the mean height was 1.56±0.09 meters, and 6.35±2.99 years was the mean duration of diabetes. Most patients were 46-60 years (78.8%). NAFLD was seen in 58.5% of patients with diabetes with female preponderance.&#x0D; Conclusion: Non-alcoholic fatty liver disease was found to be more frequent in patients of the age group 46-60 years, and also it has a strong correlation with body mass index of &gt;25 kg/m2 and longer duration of diabetes. A significant proportion of patients with diabetes were also found to have ‘lean non-alcoholic fatty liver disease.