Background:The people residing in hills of this Sub-Himalayan region traditionally have a distinct lifestyle involving high level of physical activity. However, increased urbanization in the last two decades has led to changes in lifestyle of people. The present study was an endeavor to document changes in the pattern of stroke in people residing at moderate altitude.Aim:This study was aimed to study the evolving trends in clinical profile, risk factors, and outcome at 3 months in hospitalized patients of stroke in a Tertiary Care Hospital situated at moderate altitude.Setting and Design:This prospective, observational study was carried out in a Tertiary Care Hospital, situated at 2000 m mean sea level, from July 2014 to June 2015 in Sub-Himalayan region of India.Methods:The clinical features and risk factors profile of 235 patients of stroke consecutively admitted in hospital were analyzed, and findings were expressed in percentage. The profile was compared with a study conducted at this institute 15 years back. The outcome of patients at 3 months in terms of modified Rankin Scale >3 (mRS) and Barthel Index <60 (BI) was also studied.Results:The occurrence of stroke as a cause of hospitalization was decreasing. Ischemic stroke was noted in 74%, and 26% had hemorrhagic stroke (HS). There was male predominance (58%), but affliction of females with stroke increased from 34% to 42%. The altered sensorium (P = 0.00) and neurological weakness (P = 0.024) were significantly associated with poor outcome in stroke. The occurrence of hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among indoor patients of stroke in the last 15 years. Poor outcome of 203 patients at 3 months follow-up in terms of mRS >3 was 79 (IS-47, HS-32) but in term of BI, 63 (IS-32, HS-31) had poor outcome. Overall HS had poorer outcome. Age >70 years, female sex, altered sensorium, hypertension, and diabetes mellitus, were observed as poor prognostic factors, but the association was significant with advanced age, headache, and altered sensorium.Conclusion:The occurrence of stroke decreased among hospitalized patients. Hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among patients of stroke.

Background:HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse.Objective:The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB) in HIV-seropositive patients and their relationship to CD4 counts.Materials and Methods:It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB.Results:Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC) examination. All patients with AFB-positive lymph node had CD4 count below 200/cum.Conclusions:The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT) reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore, adequate knowledge of the manifestations of tuberculosis in HIV-infected patients is absolutely necessary for optimal management and to reduce mortality and morbidity.

We report a 22-year-old male patient with untreated seizure disorder, presenting with increased frequency of seizures followed by encephalopathy. Laboratory evaluation showed severe hypernatremia (175 meq/l sodium), rhabdomyolysis, and acute renal failure (ARF). Excessive insensible water loss in hot and humid weather, associated with an inability to obtain adequate water replacement, led to a hyperosmolar state (plasma osmolality, 398 mOsm/kg). He was vigorously treated with hypotonic fluid supplement and, further, needed dialysis therapy (peritoneal dialysis followed by hemodialysis) for acute renal insufficiency. The patient survived without any neurological sequelae, but the clinical course was complicated by acute deep vein thrombosis. This case represents what we believe is a unique report in the literature of severe hypernatremia developing via the pathogenic mechanism outlined above and the complication of acute peripheral venous thrombosis, which has not been reported in adults. The purpose of this report is to emphasize hyperosmolarity as a newly described cause of rhabdomyolysis, ARF, and a hypercoagulable state.

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. A spectrum of renal abnormalities of patients with situs inversus has been reported. Developmental anomalies, including agenesis, dysplasia, hypoplasia, ectopia, polycystic kidney, and horseshoe kidney, have been reported. The association of situs inversus with nephrotic syndrome is very rare. We report the first known case of situs inversus totalis with nephrotic syndrome caused by primary focal segmental glomerulosclerosis, and the possible mechanism of this association.

We report a case of dual infection of scrub typhus and malaria in a 48-year-old woman.