A 59-year-old woman with history of a recent cryptogenic stroke and long-standing, untreated erosive seropositive (+RF, +anti-CCP antibody) rheumatoid arthritis (Fig. 1) for over 20 years was admitted for a gastrointestinal bleed. During her hospitalization, she spiked a fever, and a murmur was detected on examination. Given these findings and her recent admission for a cryptogenic stroke, an echocardiogram was ordered to rule out a vegetation. The transthoracic echocardiogram revealed a mobile valvular vegetation on the mitral valve, consistent with endocarditis (Fig. 2A). A follow-up transesophageal echocardiogram was performed a few days after because it gives a more clear and precise view of the valve. It showed diffuse thickening of the mitral valve (Fig. 2B), which is significant because this is what is seen with nonbacterial (noninfectious) endocarditis. Her antiphospholipid antibody panel was negative. Cardiology, rheumatology, and infectious diseases specialists were consulted, and because multiple serial blood cultures and extensive infectious and malignant workup returned negative, she was ultimately diagnosed with marantic endocarditis (nonbacterial thrombotic endocarditis) secondary to her rheumatoid arthritis. The differential for marantic endocarditis includes advanced malignancy (most common), systemic lupus erythematosus, and rarely inflammatory conditions such as antiphospholipid syndrome, rheumatoid arthritis, sepsis, and burns. In rheumatoid arthritis, it is extremely rare to develop marantic endocarditis 1,2 ; however, this patient was found to have leg ulcers, severe erosive deformities, and marantic endocarditis due to her long-standing untreated inflammatory disease; this is extremely rare to see in the postmethotrexate era. Treatment for marantic endocarditis is systemic anticoagulation and treatment of the underlying associated disease; surgery is performed in select cases as well. 3
BACKGROUNDHypertension is a major public health problem in developing countries across the world, which is a leading cause of cardiovascular disorders worldwide. The prevalence of hypertension and its complications are increasing in developing countries due to economic development, changes in lifestyle and diet and increase in life expectancy. The prevalence will increase even further unless effective preventive measures are implemented. Epidemiological studies are urgently needed to assess the prevalence and risk factors contributing to Hypertension.The objectives of this study is to estimate the prevalence of hypertension among the outpatients attending a teaching hospital in Central Kerala, to assess the factors associated with hypertension and to determine co-existence of diabetes with hypertension.
BACKGROUND Breastfeeding is an extremely important and cost-effective intervention for the healthy growth and development of infants and young children. Physicians have an essential role in promoting breastfeeding as the ideal method of infant feeding. Medical students are also expected to have basic knowledge about breastfeeding practices so that they can guide the community to promote breastfeeding. This study was done to assess the knowledge regarding breastfeeding among medical students and to study the impact of the educational intervention. MATERIALS AND METHODS After getting approval from the research and ethical committee of the institution, an educational interventional study was conducted among the first year medical students. After obtaining informed consent, a baseline survey was conducted after their routine class hours using a pretested, semi-structured, self-administered questionnaire to assess the knowledge regarding breastfeeding. This was followed by an educational session regarding correct breastfeeding practices. Post-test survey was conducted after the educational intervention using the same questionnaire to assess the impact of education. RESULTS Out of the total 100 medical students studying in the first semester, 95 students who were present on the day of study participated. The female students constituted 69%. Their mean age was 19 years. The median score in knowledge improved from 14 to 20 after intervention and this was statistically significant Z= 8.234, p <0.001. CONCLUSION Overall knowledge of the students regarding breastfeeding was low before intervention, and there was a significant increase in knowledge after intervention. It is suggested to include integrated teaching for the first year medical students on the knowledge and importance of breastfeeding along with their anatomy and physiology classes related to this subject. This would improve their knowledge in this aspect, and this knowledge can be imparted to the community.
BACKGROUNDGestational Diabetes Mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Prevalence of gestational diabetes mellitus is reported to be between 2% -8%, distributed across all continents and cultures. In South India, the prevalence of GDM increased from 1% in 1998 to 16.55% in 2004. In a recent community based study conducted by Seshiah et al in South India, GDM was reported among 17.5% of women in urban, 13.8% in semi urban, 9.9% in rural areas based on two-hour 75 gm post glucose value greater than or equal to 140 mg/dL. Women with GDM are at increased risk for adverse obstetric and perinatal outcomes. Diabetes complicates between 1 and 20% of all pregnancies worldwide, which include pre-gestational diabetes and GDM. Hence, Research regarding GDM is essential to understand the burden of the problem and its impact.The objectives of this study is to estimate the prevalence of GDM among attendees of an Antenatal Clinic at a Teaching Hospital in Ernakulam district to assess factors associated with GDM and to determine the maternal and neonatal complications associated with GDM.
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