Effect of physical stress on platelet aggregation was evaluated in thirty patients with ischemic heart disease (IHD) – After collecting fasting blood samples, they were subjected to treadmill test up to stage III, and blood samples were again collected. All the blood samples were subjected for the study of platelet aggregation using ADP and collagen as aggregating agents. The study demonstrated that ADP induced platelet aggregation is variably affected by physical stress while collagen induced platelet aggregation was significantly (p< 0.05) and consistently increased after physical exercise, in patients with IHD.

01-11

Hypothyroidism is a very serious and common health issue that results from a deficiency of thyroid hormone. The prevalence of hypothyroidism increases with an increase in age. There is a mutual relationship between the thyroid gland and the kidney. Cystatin C (Cys-C) is well known reliable and specific parameter commonly used for the assessment of kidney function in general people but this test is prejudiced by thyroid status. For this study, we performed serum Cys-C test and TSH test in a group of patients who are suffering from hypothyroidism. For this study, thirty hypothyroid patients and 30 normal individuals were recruited. Serum Cys-C was measured by Latex Enhanced immunoturbidometric method and TSH was measured by electrochemiluminescent technology for the comparative study. High concentrations of serum Cystatin C were found in hypothyroid patients when compared to normal healthy individuals. This indicates that thyroid dysfunction affects serum Cystatin C concentration and there might be a mechanism, possibly the increased production rate of the protein which causes an increase in Cystatin C level in case of hypothyroidism. This limits the use of Cystatin C as a marker for renal dysfunction.

12-23

Neuromyelitis Optica (NMO) is an infrequently encountered autoimmune demyelinating condition that predominantly affects central nervous system. NMO is often found to be associated with Sjogren's syndrome (SS) which is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands. Here we report a case of 45 years old female who suffered from recurrent nausea and vomiting. She consulted multiple gastroenterologists for her complaints and even underwent cholecystectomy. But there was no relief in her symptoms. She later developed quadriparesis and MRI showed demyelinating changes suggestive of Neuromyelitis Optica. She was screened for ANA profile which was positive for SSa/ Anti-Ro, confirmatory for Sjögren's syndrome, despite having no glandular symptoms.

24-27

Catatonia is a complex disease that is commonly seen in patients suffering from acute neuropsychiatric disorders. With respect to Major Depressive Disorder (MDD), in particular, catatonic features are frequently disregarded. In this condition once neuropsychiatric examination is done catatonia features should be evaluated and if left untreated; it can have life-threatening effects. Here, we describe a case of a 25-year-old woman who presented with diagnostic dilemma of having the MDD with the features of catatonia. However, she received psychiatric treatment for MDD only. On 3rd day patient was brought to emergency and after the comprehensive evaluation, the patient was finally diagnosed with MDD with catatonic characteristics. Subsequently, she was given pharmacological treatment of Inj. lorazepam, 1-2 mg/day intramuscular, and improvement was noticed within the first ten minutes. We believe that adding benzodiazepines (BZDs) to a psychotropic regimen would be beneficial to treat mixed features of catatonia and depression that is required to continue for a period of three to six months in order to prevent relapses.

28-30

BACKGROUND Chikungunya fever is an endemic viral disease spread by arbovirus. It presents as an acute febrile illness with severe debilitating joint pains. Recently, there have been few reports of striking pigmentation over nose, termed as “chik sign” which develops few weeks after chikungunya. CASE REPORT A 40 years old male patient presented to dermatology out patient department of dermatology with complaints of hyper-pigmentation over bridge of nose and ala of nose, 20 days after an acute febrile illness with joint pain. On examination mucosa and other body sites were normal. He had been diagnosed clinically as a case of dengue fever by the physician on the basis of clinical suspicion. A dermatological diagnosis of 'chik sign' was made which led to the retrospective diagnosis of chikungunya fever.

31-32

Cysticercosis is caused by Cysticercus cellulose, which is the larva of Taenia solium, the pork tapeworm. The larvae are carried in the blood stream after penetrating the walls of the alimentary tract and they lodge in different tissues like the skin, skeletal muscles, brain, fundus and heart, to cause disseminated cysticercosis. Cases of disseminated cysticercosis, that too involving tongue musculature have rarely been reported in the literature.

33-36

This case study demonstrates how extreme anxiety caused by a variety of conflicting features of worry and obsessions can make it difficult to diagnose Generalized Anxiety Disorder (GAD) and Obsessive-compulsive disorder (OCD) and how to make the appropriate final diagnosis. GAD is characterized by unrelenting, excessive anxiety over everyday issues, such as how others will see you, your accomplishments, danger, and safety. Obsessions, compulsions, and other intrusive, pointless, and distressing desires are traits of OCD, as are rigorously prescribed activities that must be carried out in order to calm anxiety. However, excessive rumination and worry are features of both illnesses.

37-40

The newly identified refractory adult-onset autoinflammatory syndrome known as VEXAS (Vacuoles, E1 enzyme, Xlinked, autoinflammatory, and somatic) is brought on by somatic mutations in the ubiquitin-like modifier-activating enzyme 1 (UBA1) gene in hematopoietic stem and progenitor cells that change the expression of the UBA1 isoform. As a result, patients have a variety of hematologic and systemic inflammatory symptoms. Except for high-dose glucocorticoids, patients currently respond poorly to immune suppressive medications, and no clear treatment guidelines exist. All medical disciplines need to treat patients with VEXAS syndrome seriously because of the high fatality rate. To better understand the targeted therapy and enhance the prognosis of VEXAS syndrome, this article seeks to discuss the essential characteristics, pathophysiology, and clinical symptoms of VEXAS syndrome.

41-53

The Medical Council of India has outlined the fundamental skills needed by an Indian medical graduate and created a competency-based module on a doctor's attitudes and interpersonal abilities. Globally, competency-based medical education (CBME) is gaining ground. A competency-based approach is becoming increasingly popular, which would represent a paradigm change from the existing traditional approach to medical education. The logic for CBME and its specific components — competency, entrustable professional activity, and milestones — will be covered in this article. To implement CBME successfully, one must take into account the approach taken, the difficulties encountered, and the constraints.

54-57

58-59