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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 7 | Issue 3
Page Nos. 59-91

Online since Monday, July 15, 2019

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EDITORIAL  

Editorial p. 59
M Premanath
DOI:10.4103/AJIM.AJIM_21_19  
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GUEST EDITORIAL Top

A sneak peek into channelopathies p. 60
Pratibha Pereira
DOI:10.4103/AJIM.AJIM_15_19  
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REVIEW ARTICLES Top

Hyponatremia: A clinician's perspective p. 62
Sudha Vidyasagar
DOI:10.4103/AJIM.AJIM_12_19  
Hyponatremia is a commonly encountered clinical problem by all physicians. It is classified according to volume status as hypovolemic, euvolemic, or hypervolemic hyponatremia. The clinical presentation depends on the type of hyponatremia and the speed of onset. Acute hyponatremias can result in altered sensorium, convulsions, and coma, making it a medical emergency. Chronic hyponatremias can be due to drugs and several systemic illnesses. The syndrome of inappropriate secretion of antidiuretic hormone is common and can occur in several diseases as euvolemic hyponatremia. Its onset can be deceptively slow but needs attention to prevent complications. Investigations of serum and urine, osmolality and sodium, help in classification of this condition. Apart from intravenous correction with hypertonic saline, which may be urgently needed in acute hyponatremia to prevent mortality, vaptans offer an oral option in chronic hyponatremia. Care must be taken to avoid rapid correction of serum sodium, to prevent osmotic demyelination syndrome.
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Medical education in India: Past, present, and future p. 69
Praveen Kulkarni, K Pushpalatha, Deepa Bhat
DOI:10.4103/AJIM.AJIM_13_19  
Medical education in global context has evolved over a period of time and so in India. With changing community needs, educational advancements and technological revolutions, we need to update the method of imparting knowledge and skills to the students. Major components of hidden curriculum like communication skills, attitude, empathy, altruism, professionalism, humanities etc need to be uncovered and delivered in a more systematic way. Ever increasing demand of doctors in the country has forced to establish new medical colleges across the country but the quality of Indian Medical Graduates produced out of them needs a lot to think and work upon. Reforms in curriculum Medical Council of India is planning to bring should be taken seriously and all efforts should be made to bring them to reality. In order to bring a competent Indian Medical Graduate in par with global standards should be the MANTRA of every medical education institution.
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ORIGINAL ARTICLE Top

Secondary hypokalemic periodic paralysis: A study of a case series p. 74
Vasantha Kamath, Shreyashi Ganguly, BL Avinash, V Vinodh
DOI:10.4103/AJIM.AJIM_11_19  
Background: Periodic paralysis is a group of heterogeneous disorders of different etiologies, with episodic, short-lived, and hyporeflexic skeletal muscle weakness, with or without myotonia. There is neither sensory deficit nor loss of consciousness. They can be familial (primary) or acquired (secondary). Secondary periodic paralysis is due to demonstrably known causes. The interictal potassium level is abnormal in these cases. Hypokalemic paralysis is more common than hyperkalemic. Materials and Methods: This is a prospective observational study elucidating the clinical profile of the cases of secondary hypokalaemic periodic paralysis seen in our care over a period of 14 months. Results: In this study, we present nine patients with hypokalemic periodic paralysis, in which four were diagnosed with thyrotoxicosis and five with dengue. They were given potassium correction under judicious cardiac monitoring. Antithyroid drugs and beta-blockers were used in thyrotoxicosis. Dengue patient received adequate fluid and antipyretic cover. All the patients made complete recovery, without any neurological sequelae. Conclusion: Secondary hypokalemic periodic paralysis should always be kept in mind as a differential in the setting of acute, painless, flaccid motor paralysis, especially in young patients with no significant family history or risk factors for stroke or Guillain–Barre Syndrome. A clinician must be aware of causes of secondary periodic paralysis as recognition and diagnosis can completely prevent further attacks of periodic paralysis. Routine estimation of thyroid levels should be the initial line of investigation even if features of thyrotoxicosis are absent. In the presence of acute febrile illness, ordering serology for dengue, after ruling out thyrotoxicosis, is the preferred approach in India.
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CASE REPORTS Top

Peripheral limb ischemia with preserved pulses p. 80
Sangram Biradar, S Sumangala, Manne Nagaraj
DOI:10.4103/AJIM.AJIM_14_19  
Symmetric peripheral limb gangrene can occur with preserved arterial pulses due to the involvement of microcirculation, including small venules. Various representative disorders, including drug-induced vasculitis have been reported. Presenting a case of a 22-year-old female with symmetric ischemic changes of fingers with preserved pulses secondary to ergot alkaloid-induced secondary Raynaud's phenomena causing vasculitis. This case emphasizes on the importance of drug history and clinical examination and the need for high index of suspicion for drug-induced Raynaud's.
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A case of pulmonary thromboembolism secondary to hyperhomocysteinemia p. 82
Rishika Reddy, Sangram Biradar, Matta Rakesh
DOI:10.4103/AJIM.AJIM_19_19  
Hyperhomocysteinemia (HHcy) affects hemostasis and shifts its balance in favor of thrombosis. HHcy can be a potential cause of unprovoked pulmonary thromboembolism, which may be a sole manifestation rather than typical multisystem involvement of the disease. Here, we report a rare case of a 56-year-old male presented with sudden onset of breathlessness, unexplained tachycardia, hypoxemia, who was diagnosed as a case of pulmonary embolism secondary to HHcy without any evidence of deep vein thrombosis.
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An enigmatic case of pure neuritic leprosy with trophic ulcers p. 84
Mohd Zeeshan Ali, Sangram Biradar, S Sumangala
DOI:10.4103/AJIM.AJIM_20_19  
Leprosy is one of the most common diseases of peripheral nerves. In pure neuritic leprosy, skin along the distribution of the affected nerve is usually hypo-anesthetic or anesthetic, and as a rule, no classical leprosy skin lesions/patches should be present. However, depending on the severity of sensory and autonomic dysfunction, there could be a variable degree of hypo/anhidrosis, xerosis, fissuring, and ulcers along its distribution. Diagnosis of leprosy in the absence of typical dermatological features is difficult and requires histopathological confirmation using nerve biopsy. We report a case of leprosy with peripheral neuropathy without skin lesions. Nerve biopsy showed chronic inflammatory cell infiltration, epithelioid-cell granulomas, and the presence of Mycobacterium leprae on Modified Ziehl-Neelson stain. Hence, in leprosy prevalent countries like India, this form of leprosy should be thoroughly investigated, especially in patient without skin changes and presenting with trophic ulcers. It was a diagnostic challenge requiring high degree of clinical suspicion and thorough investigations.
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ECG DIAGNOSIS Top

Electrocardiographic diagnosis p. 87
Suresh V Sagarad, Ashwini , Malavika Rao
DOI:10.4103/AJIM.AJIM_16_19  
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RADIOLOGICAL DIAGNOSIS Top

Radiological diagnosis p. 88
Ragahavendra Bhat
DOI:10.4103/AJIM.AJIM_17_19  
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VIEW POINT Top

Leaders for the medical professionals: Need of the hour p. 90
B Sadanand Naik
DOI:10.4103/AJIM.AJIM_18_19  
There have been many eminent and leading practitioners of medicine who have received coveted awards from the State and the Union government. Unfortunately, there have been hardly any doctors who lead the medical fraternity at times of difficulty which affect the very existence of this noble profession. There is an urgent need for the eminent and all influential doctors to work for the dignity and the very existence of this great profession by taking up the mantle of the leadership.
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