SummaryA young lady with a history of repeated episodes of generalised weakness and fatigue presented to our hospital with similar symptoms and was found to have severe hypokalaemia. She had been previously diagnosed as hypokalaemic periodic paralysis but during this presentation she had also started complaining of the classic sicca-complex of Sjogren's syndrome, which was not present previously. On subsequent investigations she was found to have normal anion-gap metabolic acidosis with positive urine anion gap consistent with the diagnosis of distal renal tubular acidosis (RTA). It was thus concluded that the distal RTA secondary to Sjogren's syndrome was the cause of severe hypokalaemia in our patient. By presenting this case we aim to not only highlight one of the rare presentations of Sjogren's syndrome but also the favourable response of our patient to potassium replacement alone.
BACKGROUND
A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension (PAH). Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature. All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of Grave's disease. The treatment of Grave's disease, initially by medications and subsequently by radioiodine therapy, was associated with a significant reduction in the pulmonary artery systolic pressure. The purpose of this case report is to highlight one of the unusual and underdiagnosed presentations of Grave's disease.
SUMMARYA 76 -year-old lady with a recent diagnosis of rheumatic heart disease (RHD), and a history of repeated lower respiratory tract infections, came with symptoms of gastritis unrelated to the primary disease but further diagnostic study in the hospital revealed poorly controlled atrial fibrillation, grossly dilated left atrium with two large left atrial thrombi and mitral valve area<1 cm 2 . It was decided that the best approach in our patient would be mitral valve replacement with mechanical prosthesis. Despite the usual trend of using bioprosthesis in the elderly, our decision was influenced by the fact that the patient would need chronic anticoagulation for atrial fibrillation in any case. The purpose of our case presentation is to illustrate a late-presenting case of RHD with unusual associations and the challenges to choose the best possible management.
BACKGROUND
Background: The purpose of this study was to introduce modified form of conventional problem-based learning (PBL) i.e. “Tutor less PBL” in educating medical students about type 2 diabetes mellitus (T2DM). Medical students are future physicians and can be effective healthcare professionals to screen and manage diabetes at community level. Poor levels of awareness as well as lacunae in teaching diabetes have been reported among medical students. The study aimed to assess the knowledge of undergraduate medical students about T2DM by using “Tutorless PBL” method.Methods: Sixty-two 8th semester medical students from one of the private medical colleges in Mumbai city attained knowledge about T2DM through “Tutorless PBL” and “conventional PBL”. “A structured set of engagements triggers” (SET) was used in Tutorless PBL. Students responded through pre and post-test questionnaires and ‘student’s unpaired t test’ compared their test scores. Fourteen item questionnaires with Likert scale evaluated students’ feedback about both methods.Results: The post test scores were more for students in “Tutor less group” than in “tutored group” (15.37 vs. 14.01). The difference was statistically significant (t=5.87, p<0.001). All (100%) students appreciated both methods for enhancing their knowledge about T2DM. “Tutor less PBL” was found to be more effective than “conventional PBL” in promoting self-learning and critical thinking abilities.Conclusions: Both methods were beneficial to students in terms of clarifying the topic, improving group interaction and yielding self-directed learning. Tutorless problem-based learning can be an effective option especially in resource (faculty) limited setting.
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