Annals of Geriatric Education and Medical Sciences

9-10

Authors: Amit Beheti,Sunil Kumar*,Ayan Husain,Parth Godhiwala,Nitin Raisinghani

Gangrene is ischemic necrosis of limbs or its parts, without involvement of proximal arterial obstruction or vasculitis, often associated with disseminated intravascular coagulation and septic shock. This rare clinical syndrome are usually caused by infectious or non infectious causes, among them tuberculosis as a cause is rarely associated. We here report a case of 68 year old lady, who initially was diagnosed as tubercular meningitis and later developed peripheral gangrene in all four limbs.

13-15

Authors: Shreya Gattani*,Sourya Acharya,Roopesh Yarappa,Sakshi Gagneja

Dementia is a commonly encountered problem in the aging population. The cardinal manifestations of Vitamin B12 deficiency are dementia, delirium, cognitive impairment, confusion, memory losses, depression, acute psychosis, and rarely mania or schizophrenia. The neuropsychiatric manifestations due to Vitamin B12 deficiency are often accompanied by hematological abnormalities. We report a 68-year-old female who presented with complaints of behavioral changes, intermittent episodes of acute confusional state, memory deficits, inability to identify family members, lethargy and easy generalized fatigability. The laboratory investigations of the patient revealed macrocytic anemia with decreased Serum Vitamin B12 levels, Normal folate levels and elevated Serum Homocysteine levels based on which the patient was diagnosed with Hypovitaminosis of Vitamin B12 with Hyperhomocysteinemia. The patient showed dramatic improvement in the neuropsychiatric manifestations after receiving adequate supplementation of cobalamin.

18-19

Authors: Sourya Acharya*,Samarth Shukla,Sakshi Gagneja

Liddle’s syndrome is a rare cause of secondary hypertension. Identification of this disorder is important as treatment differs from other forms of hypertension. We report a case of a 68 year old male who presented with acute confusion state and hypertensive urgency with features of encephalopathy. Investigations confirmed Liddle’s syndrome.

61-68

Authors: Sharan Badiger*

Introduction: Isolated systolic hypertension is the commonest cause of raised blood pressure in the older population. As the age progresses more and more persons will be hypertensive. It is a disease, which is definitely the most prevalent, remediable risk factor for cardiovascular diseases and cerebrovascular diseases. Objective: To study the clinical profile of hypertension in elderly, to find out associated risk factors, especially on cardiac through echocardiography. Materials and Methods: A total number of sixty elderly hypertensive patients of ?60 years with systolic blood pressure ? 140 and diastolic blood pressure ? 90 mm of Hg were included in this study. A detailed history with general and systemic examination with fundus examination was carried out. Complete blood count, urine analysis, blood sugar, renal profile, lipid profile, chest x-ray, electrocardiogram, and echocardiogram were done in all patients. Results: Sixty patients were evaluated, and the mean age was 67.72±7.004 years of which 35 (58.33%) were males and 25 (41.67%) females and the common age group was 60-65 years. Chest pain in 45% and breathlessness in 38.33% were commonest clinical presentation. Family history, smoking history and total cholesterol were associated risk factors of hypertension. Hypertensive retinopathy was observed in 38.33% patients. Ischemic changes in 31.67% followed by left ventricular hypertrophy in 20% were most common electrocardiographic findings. The echocardiographic evaluation showed left ventricular dysfunction in 63.33% was common entity in the form of left ventricular hypertrophy in 30%, left ventricular dilatation in 15% and left ventricular diastolic dysfunction in 48.33%. Ischemic heart disease was diagnosed in 55% patients. Out of these 18 (54.55%) had anterior, 4 (12.12%) lateral, 3 (9.09%) inferior and 4 (12.12%) septal infarcts. One patient had global hypokinesia, and three patients had more than one segment involvement. There was strong co relation between left ventricular hypertrophy, ischemia and systolic blood pressure. Conclusion: The elderly hypertensive patients tend to have isolated systolic hypertension. Smoking history, family history and dyslipidemia are important determinants of hypertension. Left ventricular hypertrophy and other associated risk factors are responsible for coronary artery disease.

72-73

Authors: Sourya Acharya*,Nakul Kadam,Akash Daswaney

Silent mitral stenosis (MS) is an occult clinical entity. It remains hidden because of absence of clinical signs. Left atrial thrombus in mitral stenosis is usually common with atrial fibrillation (AF). We present a case of a 63 year old man who presented with acute stroke and found to have silent mitral stenosis in sinus rhythm with LA thrombus.

77-78

Authors: Ayush Dubey,Sunil Kumar*,Anuj Chaturvedi,Akshay Daphal

Paroxysmal dyskinesia (PD) as a first manifestation of hyperthyroidism is an extremely rare entity. We here report a case pf 65-year-old female presented with the features of PD, whose investigations revealed hyperthyroidism. Her dyskinesia responded with the anti-thyroid drug carbimazole.

7-10

Authors: Sukhpal Kaur, Riponjot Singh

A dentist is also a healthcare professional providing oral care to the patient, as does a physician. It is responsibility of dentist while practicing, to maintain a certain standard of service he or she is providing. For this, there is set of principles of professional conduct and all dentists should adhere to these priniciples when fulfilling their duties to patients, public, profession and colleagues.

15-20

Authors: Anand P. Ambali

The seniors in India now constitute 9% of total population, and the prevalence of dementia is also rising. There is very less research happening in people with dementia. The approach to research quality of life in people with dementia especially their lived experiences, differs from general population. Involving the people with dementia itself is a challenging task. The main objectives of doing the research will be to know the person living with dementia, secondly their lived experiences and thirdly its impact on their quality of life. The multidimensional approach using interview method will be suitable especially in early stage of dementia. In developing countries, factors like illiteracy, superstition and low awareness about research hampers research work in people with dementia. The various approaches in understanding the persons lived experiences requires skills and patience in researcher. This review is an attempt to share the issues that are to be faced while doing research on people with dementia especially those living in developing countries and that too in rural areas. The challenges are the ethical, communication, understanding local factors that influence quality of life and involving person with dementia along with family members. Various studies which have overcome these challenges has been mentioned here so that it will assist in research process.

25-27

Authors: Manjunath F. V., Girish I, Taruni Ng

Anaemia is one of the most important public health problem in developing countries like India, and is more prevalent in older population. Anaemia of any degree in elderly patients leads to significant morbidity and mortality, so the main purpose of the present study is to determine the clinical profile of anaemia in elderly. Materials and Methods: An observational was conducted on a cohort of 100 elderly patients of both sexes aged more than 60 years, admitted to wards of general medicine at Basaweshwara medical college and hospital (BMCHRC), Chitradurga hospital from July 2016 to May 2017. A detailed history, through clinical examination and relevant blood investigations such as peripheral smear and biochemical investigations were done in all patients. The severity of anaemia was graded according to the WHO classification. Results: Among 100 patients, 68 were male patients and 32 were females. Most of the patients (n=67) patients were between the age of 60 to 69 years, 20 patients between 70 to 79 years, very few (n=13) were above 80 years. Majority of patients had microcytic anaemia (43%) about 32% had normocytic anaemia and about 24% had macrocytic/ dimorphic anaemia and 1 patients had AML on peripheral smear. Out of 32 normocytic anaemia, 22 patients had anaemia of chronic disease, 7 patients had acute blood loss, 1 patient was diagnosed to have MDS and 2 had aplastic anaemia. Majority of anaemia of chronic disease were due to CKD (45%) and rest were due to tuberculosis, chronic liver disease and malignancy. Out of 43 Patients with microcytic anaemia 18 patients had anaemia due to chronic blood loss, 10 patients had anaemia of chronic disease and 15 patients were due to nutritional deficiencies. Conclusion: Anaemia in elderly population is a common problem and it is usually underdiagnosed, so a systematic approach in diagnosis and evaluation of anaemia in elderly population helps in better management and improve the quality of life of the elderly persons.

33-35

Authors: Jahnabi Bhagwati, Sourya Acharya, Samarth Shukla, Ritesh Gupta, Amit Baheti

Electrolyte imbalances are common in elderly population. Ageing alters the milieu interior and impairs homeostatic mechanisms in such a way that geriatric population have a prolong and exaggerated response to stress. Thus, an event--pathological or traumatic--which produces a trivial change in plasma electrolytes of young people may produce major oscillations of plasma levels in the elderly, in clinical practice most electrolyte disturbances in old age are iatrogenic in origin. Adaptation to dehydration in elderly are impaired. So events like vomiting or diarrhea can acutely precipitate electrolyte levels and can cause serious manifestations in elderly. We present a case of 72 year old male who presented with severe hypokalemia, hypomagnesimia, cardiac rhythm disturbancs and generalized tonic clonic seizures (GTCS).

38-43

Authors: Thavanati Parvathi Kumara Reddy, Aurora Escoto de Dios, Maria Elena Aguilar Aldrete, Jorge Alberto G

Introduction: To study the Perspectives of longevity among Kurichia Tribe (Indian hunter-gatherers), Kerala, India. Materials and Methods: Kurichian Tribe, Descriptive and Case study analysis. Results: The full zodiac life cycle provided though Indian scriptures defines more than hundred years for a human individual, but it is not so evidenced completely. Consequently, it is important to note that, all the nearest kith and kin of centenarians of Kurichia tribe (Indian hunter-gatherers) of Kerala State, sucessfully lead their life more than 100 years among whom these tribal are free from specific disease during their life eventhough they look weak and fragile. They have active life and sometimes they are accustomed to walk for a longer distance in their earlier times. But the only draw back noticed is poor visión. At present, the older generations are very much worried about the younger generation wherein translating themselves to the modernization of acculturation which may affect the good health of their community. Atleast one member in a family lived more than 95 years either in three generation which appeared as a heredity of longevity. The ratio of women is more than the men. The centenarians are living alone with out their spouses and no one is under poor economic status. Majority of them had domestic relationships. The findings of the present study revealed the culture and the nature of some parameters were culture-specific determining factors of longevity. Conclusion: All variables played a relatively interactive, in the continued biological process and psychological health for longevity.

50-52

Authors: P. P. Dhakshayani, S. Umarani, M. Ahila Muthu Selvi

Gastric lymphoma is an RARE disease, may either represent primary malignancy confined to stomach or secondary involvement by systemic disease. Herin, we report a case of gastric lymphoma in a 63 years old male patient presenting with symptoms of upper abdominal pain , melena, vomiting ,loss of appetite for period of 6 months.

38-40

Authors: Sukhpal Kaur, Riponjot Singh, Sandeep Kaur

Register Everyone wants a beautiful face with a healthy and beautiful smile. Orthodontics is the branch of dentistry that helps patients to achieve pleasing face with beautiful smile by correcting skeletal and dental malocclusions which interfere with their facial esthetics. For achieving this facial esthetics along with structural and functional balance, an accurate diagnosis and treatment planning is necessary. In this article we will discuss some advancement in orthodontic diagnostic system

45-49

Authors: Sunil Kumar.

Frailty is associated with advanced chronological age and chronic disease but is a separate construct. The measurement of frailty has received significant attention in recent geriatric medicine literature, with various models proposed to predict the risk of poor outcomes. Here, in this article different assessment tools has been reviewed to the definition of frailty, focusing on the conceptualization of frailty index as the failure of a complex system. We explore how far it is feasible in India and what can be done.

54-55

Authors: Ankita Kapse, Sourya Acharya.

Pulmonary embolism (PE) usually has multiple presentations. Arrhythmias as sole manifestation of PE is usually rare. In elderly population arrhythmias with PE are usually blamed on concomitant coronary artery disease (CAD). We present a case of a 75 year old lady who presented with recurrent PSVT and was subsequently diagnosed as PE.

58-60

Authors: Sanika Kalambe, Shraddha Jain, Gargi Mudey, Sagar Gaurkar, Sunil Kumar.

Primary Laryngeal aspergillosis in an immunocompetent patient is rare and very few cases have been reported. Laryngeal aspergillosis due to secondary invasion from tracheobronchial tree is usually seen in an immunocompromised host. We report a case of a 65 year female who presented with 4 months history of breathlessness, hoarseness of voice and cough. She had ischaemic heart disease, hypertension, for which she was taking aspirin. She was known case of bronchial asthma on inhalational steroids. Video-laryngoscopy revealed greenish black debris in subglottic area, without any mucosal changes. Diagnosis of Aspergillus flavus was confirmed on culture. Ig E and absolute eosinophil count was within normal limits. Patient was started on oral itraconazole and has responded to treatment. Possibility of Primary fungal infection of larynx should be kept in mind, in elderly patients on inhalational steroids, without any known risk factors for immunocompromised states.

63-64

Authors: NS Neki, Jaswinder Singh2, Amandeep Singh Dhanju, Bhoj Raj Sharma, Jithesh S, Rohit Bhardwaj

Glucocorticoid hypersensitivity syndrome (GHS) is a rare clinical entity. It is characterised by clinical features of Cushing syndrome with normal or sometimes low levels of ACTH and cortisol, with poor response to corticotrophin releasing factor (CRH) and synacthen. We report a case of 18 years old female who presented with obesity and hypertension. A diagnosis of GHS was made and the patient was managed with ketoconazole and cabergoline.

5-8

Authors: NS Neki, Neeraj Joshi, Gurminder Singh Multani, Gagandeep Singh Shergill, Rubal Sharma

Takotsubo cardiomyopathy (TCM) is an uncommon form of acute cardiomyopathy showing left ventricular apical ballooning. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. It is a reversible cardiomyopathy, a rare variant that presents within a different patient profile and with its own hemodynamic considerations. Its recognition is important for prognostic, evaluation and treatment considerations.

12-17

Authors: NS Neki, Neeraj Joshi, Gagandeep Singh Shergill, Rubal Sharma, Gagandeep Singh, Gaurav Joshi.

Erectile dysfunction is defined as insufficiency in initiating, achieving and maintaining of penile erection necessary for satisfactory sexual intercourse. Its prevalence increases as the age progresses, but it is underestimated in routine clinical practice. An attempt is made to review the literature showing erectile dysfunction as silent risk factor for cardiovascular disease (atherosclerosis).

22-28

Authors: Kawa Amin.

Despite progress in our knowledge of the patho-physiological causes and treatment of syncope, management of this condition remains variable across healthcare sectors.

31-32

Authors: NS Neki, Satpal Aloona, Bhupinder Singh.

Gastroesophageal events remain an important factor in the pathogenesis of patients with asthma with the reported prevalance ranging from 32-82%. The esophageal bronchial reflux plays a greater role in the pathophysiology of reflex associated cough. Gastroesophageal reflux either singly or in association with postnasal drip and or asthma is a thought to be a cause of chronic cough. People with asthma are twice as likely to have GERD as those people who don’t have asthma. GERD may worsen asthma symptoms, however asthma and some asthma medications may worsen GERD symptoms. Although these two disorders often occur together, the relationship between GERD and asthma remains unclear.