Background: Palliative care aims in reducing suffering and improving the well-being of patients suffering from serious life-limiting illnesses. Edmonton symptom assessment score (ESAS) is used to assess distress and life's quality of patients. Aims and objectives: To analyze the response of introducing palliative care earlier in course of illness. Materials and methods: This prospective study was using ESAS score in a tertiary care hospital. Results: The mean age of patients was 36.4 ± 5.4 in patients receiving palliative care and 37.2 ± 7.2 in patients not receiving early palliative care. All symptoms had p value < 0.05 except tiredness. Conclusion: The study concluded that when palliative care was given early during illness, we have observed better patient outcomes.

Background and aim: The most prevalent endocrine disorder in developing countries is related to thyroid imbalance. Hypothyroidism is a common endocrine disorder with reduced production of thyroid hormones. Primary hypothyroidism is defined by TSH concentrations above the reference range and free thyroxine concentration below the reference range. We tried to ascertain the prevalence of vitamin B₁₂ deficiency (<200 pg/mL) among patients with hypothyroidism. Materials and methods: A hospital-based study was done on patients of hypothyroidism fitting in inclusion and exclusion criteria attending the OPD/IPD of Mahatma Gandhi Hospital, Jaipur. Results: Most of the hypothyroid patients are <50 years of age; out of these, 24.5% of patients had vitamin B₁₂ deficiency. While in the age-group >50 years, 27.3% of patients had vitamin B₁₂ deficiency. Conclusion: Vitamin B₁₂ deficiency is common in hypothyroid patients. Screening for vitamin B₁₂ deficiency should be undertaken routinely in the diagnosis of hypothyroidism and regularly thereafter.

Introduction: Assessing the clinical severity of coronavirus disease-2019 (COVID-19) and triaging to appropriate levels of care is certainly one of the key elements in the success of managing COVID-19 patients. During the concluded wave of the pandemic, cases were categorized and cared for with set criteria prescribed by authorities. Other triaging criteria were included in contemporary international guidelines, but this hypothesis was never tested if anyone set is ever better than the other. Materials and methods: This is a case series of 165 deceased patients of COVID-19. All patients were categorized as per clinical disease severity and admitted to the designated care area after confirmation of SARS-CoV-2 infection as decided by the admitting doctors. We collected retrospective data from patient medical records and analyzed for medical history, comorbidity profiles, hematology investigations, organ function tests, computed tomography of the thorax, and point-of-care biomarker test (D-dimer, procalcitonin, NT-proBNP, Trop-T). These data were analyzed to compare the differences between the variables of ward and ICU patients by using XLstat software. Results: In this analysis of deceased patients’ case series, we found that there was no significant difference among the patients admitted to ward and ICU for initial demographic and biomarker variables and risk factors. Diabetes was the most commonly found comorbidity. The mortality rate among the ward and ICU (5.89 vs 6.67%, p value: 0.44) was also similar among both the cohorts. Conclusion: In this case series, we could conclude that both the cohorts were comparable at admission on demographic and laboratory parameter profile. Clinical significance: This analysis led us to the conclusion that our existing “triage criteria” for COVID-19 patients will need appropriate modification before the second wave sets in the region.

Introduction: Incidence of skin manifestations in diabetes mellitus (DM) varies from 11.3 to 70.6% and may manifest once the primary disease has already developed, but may also occur coincidently with its onset or may even precede DM in some of the cases. Our study is an attempt to analyze the pattern of various types of skin manifestations seen in DM. Aims and objectives: To study and analyze the various skin manifestations in patients of DM. Materials and methods: Two hundred patients of DM were enrolled. A detailed history was taken, investigations like preprandial and postprandial capillary plasma glucose and HbA1c were done. Diabetes was considered controlled when preprandial capillary plasma glucose 3.9–7.2 mmol/L (70–130 mg/dL), postprandial capillary plasma glucose <180 mg/dL, and HbA1c <7.0%. Results: Infections were the commonest skin manifestation present in a total of 81% of patients (56% fungal, 19% bacterial, and 6% viral) followed by conditions associated with DM present in 67% of patients (skin tag 33% was the commonest). Miscellaneous skin conditions were present in 62% of patients (discoloration of nails was the commonest 11%). Conclusion: Various skin manifestations may appear early and remain undetected till DM is diagnosed. The majority of patients do not take regular treatment and follow dietary restrictions in early diabetes leading to a persistent hyperglycemic state which predisposes to infections and other skin manifestations. The presence of easily visible skin manifestations can heighten the suspicion for early diagnosis of DM and thus, may very well be taken as a clinical marker of DM.

Background and aim: The normal level of serum uric acid (SUA) is generally 6.5–7 mg/dL for males and 6–6.5 mg/dL for females. The prevalence of hypertension and complications has rapidly increased worldwide, leading to significantly increased morbidity and mortality. Serum uric acid is one of the emerging recognized laboratory markers for cardiovascular diseases (CVD) in recent years. Thus, we conducted the present study to assess whether there exists an association of SUA with CVD in hypertensive patients. Materials and methods: This case–control study was conducted in 75 hypertensive patients with 25 cases having cardiovascular disease and 50 hypertensive control attending the OPD and IPD of the Department of General Medicine, Mahatma Gandhi Medical College, Jaipur. Results: In this study, mean uric acid in CVD patient was 5.89 + 1.66 mg/dL and in controls, it is 4.31 + 1.07 mg/dL. This difference was a statistically significant (p value < 0.001) negative correlation between uric acid and ejection fraction. It shows with the increment of uric acid levels ejection fraction decreases proportionately. As the severity of cardiovascular disease increases, uric acid levels also increase. Conclusion: According to our study, it seems that UA is a real risk factor for the development of CVD. We have shown that serum uric acid levels are negatively associated with ejection fraction. Under these conditions of reduced ejection fraction, serum uric acid is an independent risk factor for CVD, respectively, in individuals with hypertension.

Introduction: 2D echo is a non-invasive, rapid, investigation that enables us to visualize the heart directly in real-time using ultrasound and can help in such situations in diagnosing AMI by detecting any regional wall motion abnormality. The diagnosis of ST-elevation in myocardial infarction (STEMI) is usually based on patient's history and ECG findings, but it should be taken into account that patients may present with atypical symptoms, also it takes cardiac enzymes some time to elevate above the normal range after the onset of chest pain. Materials and methods: A total of 100 diagnosed patients with the first episode of acute ST-elevation myocardial infarction who reported in the emergency were included in the study and who have given written informed consent. On admission, patients with typical or atypical ischemic symptoms and ECG changes of ST-segment elevation of >0.1 mV (1 mm) in leads 2, 3, avF, V4, V5, V6, 1, and avL, and in leads V2, V3 > 0.2 mV (2 mm) in males >40 years, >0.25 mV in males 0.15 mV in females, in 2 contiguous leads were diagnosed as acute STEMI. Observation and results: In our study, mechanical complications of AMI were detected on 2D echo, of which, mitral regurgitation was found in 23 patients (23%), the ventricular septal rupture was found in 3 patients (3%), ventricular free wall rupture in 2%, papillary muscle rupture in 11%, pericardial effusion was found in 13%, and LV clot was found in 11% patients. Conclusion: Acute myocardial infarction is seen more commonly in the age-group of 61–70 years and it is more common among males. Killip classification of patients has prognostic value and helps in accessing the severity of myocardial infarction. Mechanical complications of AMI can be detected by 2D echo and can aid accordingly in treatment.

Stroke is a “Rapidly developing clinical signs of focal or global disturbances of cerebral functions lasting for more than 24 hours”.¹ One of the most important causes of high morbidity and mortality all over the world is stroke. The diseases of cerebral blood vessels and their related infarcts and hemorrhages occur in the elderly as well as the young. The various abnormalities in lipid profile have been reported in young patients with stroke. Both hypercholesterolemia and hypertriglyceridemia appear to be important risk factors for atherosclerosis. A total of 50 subjects were selected by non-probability convenient sampling method at the tertiary care center. Out of all patients fulfilling the inclusion criteria of the age-group of 15–45 years. Dyslipidemia was seen in 32% [90% CI (22.31–43.53%)] of patients. Cortical venous thrombosis in 9 (18%) [90% CI (10.78–28.50%)] patients all of them were women. All but one was in a postpartum state. There was a single case of antiphospholipid antibody syndrome. Ten percent [90% CI (4.95–19.15%)] and 4% [90% CI (1.33–11.39%)] of patients were found to have rheumatic heart disease and systemic lupus erythematosus, respectively. One of the ischemic and hemorrhagic strokes was undiagnosed [90% CI (0.5–8.8%)]. Dyslipidemia as in elevated LDL and decreased HDL was a common finding. Dyslipidemia was found as the most common etiology for stroke in the young. Diagnostic challenges are to be expected while evaluating these patients.

The concepts of happiness and related engagement practices have attracted common life since ancient times. Happiness is an emotional experience that has evolved over the millennia to accommodate the rapidly changing needs of the individual in particular and the environment at large. It mainly refers to people's subjective appraisals of their lives in terms of well-being and typically includes a global assessment of all aspects of a person's life. Mindfulness, on the other hand, refers to the self-regulation of attention to one's experiences in the present moment with curiosity, openness, and acceptance and thus promotes the adaptations of higher-order needs which in turn lead to positive emotions and ultimately happiness. Available literature points to a positive link between mindfulness and happiness, and this paper contributes to the existing body of knowledge by consolidating the findings. Widespread acceptance and dissemination of mindfulness practice represent the new emerging process of engagement with happiness that provides a beginning empirical foundation. Future research can attempt to throw some light on this relationship and to determine what facets may be correlating and mediating the mindfulness meditation–happiness relationship in terms of life satisfaction and well-being.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a rare anomaly of the urogenital system. The characteristic triad of this syndrome, which was initially reported in 1950, is didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis (Embrey¹). The prevalence of congenital Müllerian duct anomalies is reported to be 1%.² A 24-year-old girl got admission to MGH on 15.3.2019 with lower abdominal pain and difficulty in the passing of urine. Her menarche was established 6 months back with a regular cycle and associated with dysmenorrhea. Magnetic resonance imaging (MRI) established the diagnosis of OHVIRA. She underwent surgery for drainage of the hematocolpos and excision of the vaginal septum and urethral dilatation with cystoscopy followed by an uncomplicated recovery and the patient had normal menstrual cycles after surgery.

Folie a deux, or shared psychotic disorders, is an unusual psychiatric disorder in which delusional beliefs are transferred from one individual to one or more other susceptible persons in close connection. To date, it remains a rare, yet challenging psychiatric diagnosis. Here, we present a case report and discussion of folie a deux, involving two sisters.

Mucormycosis is a fungal infection, caused by fungi of the order Mucorales of subphylum Mucoromycotina. It is an aggressive, life-threatening infection that is common in immunocompromised patients and diabetics. COVID-19 infection and its treatment renders the patient severely immunocompromised and can increase the risk of such secondary infections. Here, we present a case of a 62-year-old man, a known case of diabetes who was recently diagnosed as COVID-19 positive. He then complained of left eye swelling and pain, with chemosis while being on steroids and remdesivir for the COVID-19 pneumonia. He was later diagnosed with orbital cellulitis, with a possible fungal infection which was later confirmed microbiologically. The patient was started on liposomal amphotericin B and high-grade antibiotics for orbital cellulitis. The patient later succumbed to sepsis-related complications. We conclude that prompt identification of symptoms and early initiation of therapy is necessary to have a better outcome in such cases, also this case can help us be more vigilant in diabetic patients with COVID-19, in whom therapeutic agents like steroids and monoclonal antibodies should be given at lowest recommended doses.