Thiamine deficiency-related neuropathy: A reversible entity from an endemic area.

Background And Purpose: Despite thiamine deficiency being a lesser-known entity in modern times, beriberi in various forms, including thiamine deficiency-related neuropathy, remains endemic in Kashmir due to the consumption of polished rice as a staple food. This observational study investigates cases of peripheral neuropathy of unknown etiology and their potential responsiveness to thiamine administration.

Methods: This prospective study enrolled adult patients presenting to the emergency department with weakness consistent with thiamine deficiency-related neuropathy and conducted a therapeutic challenge with thiamine on 41 patients.

Thiamine responsive high output heart failure of adults: an under-recognized entity.

Thiamine deficiency, commonly presenting as dry and wet beriberi, a lesser-known entity in the present era, is increasingly being reported from Kashmir, a north Indian state. The present study aims to present the clinical profile of patients presenting with high-output heart failure (HOHF). Subjects with a primary diagnosis of denovo heart failure and features suggestive of HOHF were recruited; those who responded to intravenous administration of thiamine alone (responders) were adults with no co-morbidities and those who required other medications particularly diuretics (non-responders) were elderly with co-morbidities and underlying heart disease.

Vitamin D status among Kashmiri tribal population: A cross-sectional community-based study.

Background & Objectives: Vitamin D deficiency (VDD) is prevalent across all age groups in general population of India but studies among tribal populations are scanty. This study aimed to evaluate the prevalence of VDD in the indigenous tribal population of the Kashmir valley and examine associated risk factors.

Methods: In this cross-sectional investigation, a total of 1732 apparently healthy tribal participants (n=786 males and n=946 females) were sampled from five districts of Kashmir valley by using probability proportional to size method.

Unusual presentations of primary head and neck tuberculosis and review of literature.

Background/purpose: The diagnosis of TB in the head & neck region is challenging due to diverse presentations and due to changing clinical pictures. The aim of this article is to report three unusual primary cases of head and neck tuberculosis in immunocompetent patients presenting to our hospital with description of their clinical presentation, appropriate diagnostic methods used and treatment response of these patients.

Methods: Three clinical cases were of primary tuberculosis of the lacrimal system, the thyroid gland and of the temporal space were clinically worked up.

A Study of Depressive Symptoms in Doctors Working at COVID-19 Hospitals: An Online Survey.

Objective: COVID19 outbreak has put a tremendous physical and mental burden on frontline doctors. A limited amount of literature is available in this area. The present study was done to assess the depressive symptoms and depression levels in doctors working at COVID-19 Hospitals.

Hyaluronic Acid in Dermatology.

Hyaluronic acid (HA) is a major component of the extracellular matrix of the skin and plays an important role in the metabolism of the dermis. It has a key position in wound healing and tissue repair processes owing to its ability to maintain a humid environment favorable to healing and the stimulation of growth factors, cellular constituents, and the migration of various cells essential for healing. This review aims to describe briefly the physical, chemical, and biologic properties of HA, together with some details of the dermatologic indications of this unique molecule.

Intraoperative Awareness and Recall: A Comparative Study of Dexmedetomidine and Propofol in Cardiac Surgery.

Background Awareness during general anesthesia is undesired and unanticipated patient wakefulness during surgery or recall of intraoperative events. Incidence of awareness in patients undergoing cardiac surgery is significantly higher than the overall incidence of 1% during general surgery. Awareness during cardiac surgery can be prevented by a number of methods.

Post Traumatic Isolated Ureteropelvic Junction Avulsion in a Child.

Isolated ureteropelvic junction injuries due to blunt trauma are very rare and are missed at initial presentation in more than 50% patients. Hence they need high index of suspicion for diagnosis which is the main aim of reporting this case.

A case report of suspected malignant hyperthermia where patient survived the episode.

Malignant hyperthermia is rare inherited disorder in our part of the world; there are only few cases reported in literature in India who were suspected of having this condition. The overall incidence of malignant hyperthermia during general anesthesia is estimated to range from 1: 5000 to 1: 50,000-100,000 and mortality rate is estimated to be <5% in the presence of standard care. In India, there is no center where halothane caffeine contraction test is performed to confirm diagnosis in suspected cases.

Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, affecting 5-10% of reproductive-aged women. The dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, androgenic alopecia, and acanthosis nigricans, are among the cardinal manifestations of PCOS.

Aim: To study the incidence and prevalence of various cutaneous manifestations in patients with PCOS and to correlate these skin manifestations with hormonal changes.

Spectrum of biliary abnormalities in portal cavernoma cholangiopathy (PCC) secondary to idiopathic extrahepatic portal vein obstruction (EHPVO)-a prospective magnetic resonance cholangiopancreaticography (MRCP) based study.

Objective: To characterize biliary abnormalities seen in portal cavernoma cholangiopathy (PCC) on MR cholangiopancreaticography (MRCP) and elucidate certain salient features of the disease by collaborating our findings with those of previous studies.

Methods: We prospectively enrolled 52 patients with portal cavernoma secondary to idiopathic extrahepatic portal vein obstruction, who underwent a standard MRCP protocol. Images were analyzed for abnormalities involving the entire biliary tree.

Correction: Generalized Tetanus Initially Presenting with Dysmasesis.

[This corrects the article DOI: 10.7759/cureus.644.

Vitamin E in dermatology.

Vitamin E is an important fat-soluble antioxidant and has been in use for more than 50 years in dermatology. It is an important ingredient in many cosmetic products. It protects the skin from various deleterious effects due to solar radiation by acting as a free-radical scavenger.

Generalized Tetanus Initially Presenting with Dysmasesis.

A 58-year-old male farmer, with no significant history of any chronic morbidity, was admitted via the Emergency Department of SMHS Hospital, Srinagar, with a history of an injury to the hand 20 days earlier followed by a three-day history of dysmasesis (difficulty chewing), progressing to trismus and generalized stiffness interfering with his daily activities. The patient was clinically managed as tetanus on grounds of high clinical suspicion. The patient was treated for a week and discharged without any sequelae to follow-up in the Neurology Outpatient Department of the SMHS Hospital and is currently doing well.

Transumbilical SILC Using Conventional Laparoscopic Instruments-Initial Experience in a Resource-Limited Setting.

In the era of minimal access, single-incision laparoscopic surgery is gaining popularity. Expensive ports, disposable hand instruments and flexible endoscopes have been utilised, but they increase the cost of operation. We report our initial experience of two-trocar single-incision laparoscopic cholecystectomy (SILC) in 70 patients using conventional instruments that can be adapted as a novel technique in achieving minimal trauma and aesthetic results in resource-limited hospitals.

Extra pontine osmotic demyelination syndrome.

The osmotic demyelination syndrome (ODS) has been identified as a complication of the rapid correction of hyponatremia for decades. However, in recent years, a variety of other medical conditions have been associated with the development of ODS, independent of changes in serum sodium which cause a rapid changes in osmolality of the interstitial (extracellular) compartment of the brain leading to dehydration of energy-depleted cells with subsequent axonal damage that occurs in characteristic areas. Slow correction of the serum sodium concentration and additional administration of corticosteroids seems to be a major prevention step in ODS patients.

Rabson-mendenhall syndrome.

Rabson-Mendenhall syndrome (RMS) is a rare genetic disorder characterized by growth retardation, dysmorphisms, lack of subcutaneous fat, acanthosis nigricans, enlarged genitalia, hirsutism, dysplastic dentition, coarse facial features, abnormal glucose homeostasis, hyperinsulinemia and pineal hyperplasia. Herein, we describe a 13-year-old girl with physical features of RMS who presented to us on account of acanthosis nigricans.

Non-Hyperammonemic valproate encephalopathy.

A 21-year-old male known case of primary hypothyroidism, Seizure disorder sequelae of an old trauma receiving sodium valproate, clobazam and phenobarbitone for control of Generalized tonic clonic seizures reported to neurology OPD with history of altered sensorium and gait unsteadiness for 1 week with history of hike in valproate dose 2 weeks before. On examination he was drowsy. Neurological examination was unremarkable except for gait unsteadiness and ataxia.