1. Menopause and Hypothyroidism

A Bhattacharya, C Patel, A Tanna
MP Shah Medical College, Jamnagar - 361 001, Gujarat.

Introduction : Menopausal hypothyroidism is becoming an increasing problem. Diet plays a key role to bridge the gap of all these nutrients to comprehend such a multifaceted condition. It is necessary to create awareness about hypothyroidism during menopause and to provide knowledge to consume multiple food rich in calcium, vitamin D, iodine, phytoestrogens like Sesame seeds and Fenugreek seeds.

Aim : To map the prevalence of hypothyroidism and menopause amongst women and to create awareness amongst them and by providing nutritional health education.

Materials and Method : The study was carried out in five zones of low socioeconomic group of Vadodara. Thousand women were scanned for the presence of symptoms of hypothyroidism in menopause and were subjected to undergo nutritional health counselling.

Results : It was found that prevalence of clinical symptoms of menopause and hypothyroidism was 10.4%. 12.5% were in 30-34 years, 6.7% were seen in > 50 years. Of 104 subjects, 36 were UIE positive. 91 subjects found to be deficient of calcium (20%).

Conclusion : Multiple foods based approaches were effective in combating menopausal symptoms. The level of knowledge, attitudes and practices revealed that the subjects followed cooking practices to save loss of Iodine.

2. Rhabdomyolysis and Acute Renal Failure in a Newly Detected Case of Hypothyroidism : A Case Report

V Acharya, GK Varghese
Kasturba Medical College, Manipal, Karnataka.

Introduction : A wide spectrum of reversible abnormalities of muscular function including few cases of rhabdomyolysis have been reported in hypothyroidism. We report a case of hypothyroidism, who developed rhabdomyolysis following statin therapy, which was corrected with thyroid hormone replacement.

Case Report : A 43 year old gentleman presented with body swelling and pain in calves since one week. He was on Atenelol, Indapamide and Atorvastastin since 5 days before presenting to us. On examination he had pedal edema and delayed relaxation of ankle jerks. His investigations revealed S. Creatinine 1.3 mg%, S. Sodium 115 meq/L, CK 18580 U/L and moderately elevated transaminases. His TSH was > 100 mU/ml with low T3 and T4 values. Atorvastatin was stopped and Thyroxine was started. However he continued to worsen in the form of further drop in Sodium, increase in CK (> 1 lakhU/L) and developed frank rhabdomyolysis with renal failure. He developed paralytic ileus, hypocalcemia and altered sensorium. At this point, we gave him intravenous Thyroxine (200 mcg) which resulted in dramatic response in the form of improvement in the features of rhabdomyolysis, S. Sodium and sensorium. Within 4 days of IV Thyroxine therapy his renal function, sodium, calcium returned to normal and CK level came to < 10,000 U/L. He was continued on 150 mcg of oral Thyroxine. He is doing well on follow up.

Rhabdomyolysis is considered a rare but definite complication of severe hypothyroidism. The common precipitating factors are to be kept in mind. Hypolipidemic drug therapy if indicated should be started only after correcting the hypothyroid state.

3. Efficacy and Safety of Pregabalin (300 mg) for Treatment of Painful Diabetic Peripheral Neuropathy

SK Sachdeva, HK Madaan
Government Medical College, Patiala, Punjab.

Painful diabetic peripheral neuropathy is one of the most commonly encountered neuropathic pain syndrome in clinical practice. Pregabalin is a FDA proved drug for its management.

Aims and Objective : To evaluate the efficacy, safety and tolerability of 300 mg pregabalin for pain relief in diabetic peripheral neuropathic pain.

Methodology : Fifty four patients of T2DM with painful diabetic peripheral neuropathy of 1-5 years duration with pain score ≥ 40 mm on SF-MPQ-VAS (Short form McGill pain Questionnaire Visual analogue scale, where 0 mm = no pain and 100 mm = worst pain) were administered pregabalin 300 mg/ day (150 mg BD) for eight weeks. Primary efficacy measure was end point mean pain score. Secondary efficacy measures included improvement in SF-MPQ-VAS, mean weekly sleep interference score, patient and clinical Global Impression of change. All other medicines for neuropathic pain wee discontinued. Patients were followed up at 1, 4 and 8th week.

Results : Pregabalin 300 mg showed significant improvement in end point mean pain score, mean sleep interference score, SFMPQ- VAS, patient and clinical global impression of change. Pain relief and improved sleep began during week 1 and remained significant throughout study period. The most common adverse events were dizziness and somnolence. Pregabalin was well tolerated with low discontinuation rate.

Conclusions : Pregabalin demonstrated early and sustained improvement in neuropathic pain and beneficial effect on sleep. Pregabalin 300 mg is safe and well tolerated.

4. Thyroid Ophthalmopathy - A Case Series

Sushmitha P Fernandes, G Bantwal, V Ayyar, JM Idiculla, K Yamini, S Kanjilal
Department of Medicine, St. John’s Medical College, Bangalore.

Thyroid eye disease is an autoimmune condition found in patients with thyroid autoimmunity. Though most commonly found in association with Graves disease, this can run a variable course discordant of thyroid illness. We present a case of series of six patients with varying presentations.

One of these patients with sub clinical hyperthyroidism developed disc edema which responded to high dose steroids. Two patients developed ophthalmopathy followed radioiodine therapy for graces disease. Two other patients were noted to have opthalmopathy while being treated for sub clinical hypothyroidism.

This series aims to highlight the presence of opthalmopathy in patients with different type of thyroid illness.

This paper reiterates the independent cause of eye disease in autoimmune thyroid disease. Prompt treatment is needed to prevent visual loss as disc edema can be sight threatening.

5. Study of Clinical Profile of Hypothyroidism

D Raju, S Soni, A Chaurasia, PK Baghel, OP Jatav, MK Jain
SS Medical College, Rewa, Madhya Pradesh - 486 001.

Aims and Objectives : To study clinical profile of hypothyroidism in Rewa, Madhya Pradesh.

Method : Study group comprised of newly detected cases of hypothyroidism. Detailed history, physical examination, thyroid profile, lipid profile, chest X-ray, ECG, 2-D echocardiography and tread mill test were done.
Result : Out of the 65 patients studied, male:female ratio was 1:8, 58.46% of patients were middle aged. The symptoms in decreasing frequency included tiredness (95.38%), weight gain (81.54%), dryness of skin (69.23%), loss of appetite (63.08%), change in voice (61.54%), body ache (52.31%), breathlessness (52.31%), constipation (46.15%), menstrual irregularities (43.58%), cold intolerance (38.46%), psychiatric manifestations (24.62%), infertility and abortion (7.69%), altered sensorium (6.15%), seizures (4.62%). Clinical signs included dermatological manifestation (80.00%), non pitting edema (78.46%), anaemia (76.92%), hypertension (52.30%), facial puffiness (49.23%), delayed relaxation of tendon reflexes (43.08%), madarosis (29.23%), goitre (26.16%), obesity (26.16%), alopecia (18.46%), macroglossia (10.77%), xanthelasma (4.62%). Lipid profile was abnormal in 73.17%. ECG abnormalities included non-specific ST-T changes in 52.31%, low voltage complexes (24.62%), LAHB (7.69%), QT prolongation (9.23%). 2-D echocardiography revealed pericardial effusion in 40.00% patients, early diastolic dysfunction in 23.08%, LV hypertrophy in (26.15%), asymmetric septal hypertrophy in 12.31%. Out of 21 patients subjected to TMT, inducible ischemia was seen in 23.80%. USG abdomen revealed cholelithiasis in 28.57% patients.

Conclusion : Hypothyroidism can have multitude of clinical presentation. There is higher incidence of dyslipidemia and cardiovascular disease among these patients.

6. A Comparatives Study on Lipid Profile in Obese and Non-obese Subjects

PD Khandelwal, S Massey, M Muddaraju
SMS Medical College, Jaipur.

The present study included 50 patients of obesity and 50 nonobese as controls to compare the lipid profile with age and sex match with other surrogate parameters of obesity.

It was observed that obese subjects with BMI from 25 to 30 showed increased level of triglycerides (185 ± 12.2) and VLDL (47.8 ± 4.8) as compared to normal subjects, further TGs (210 ± 16.8) was found to increase with increase in BMI (30-35), where it was significantly (p < 0.05) increased as comparison to normal subjects. The triglycerides was found to bestatistically significantly high in patients with increased waist-hip ratio (males > 1, females > 0.9). The HDL was consistently found to be high (56 ± 6.4) in non-obese subjects as compared to all obese group of patients. The total cholesterol and LDL-C did not show any significant correlation with surrogate parameters of obesity in obese as well as non-obese subjects. Therefore high TGs and low HDL-C seems to be a greater risk factor than total cholesterol and LDL-C in obesity for CAD.

7. A Rare Case of Hypoglycemia due to Paraneoplastic Manifestation of Carcinoma Lung

Shruthi Kulkarni, V Ayyar, SD Tarey, KS Chandramouli
Department of Medicine, St. John’s Medical College, Bangalore.

Non pancreatic tumors may cause recurrent hypoglycaemia known as non-islet cell tumour hypoglycaemia (NICTH). We present an 81 yr old man, non diabetic who was admitted with us with complaints of increased drowsiness and decreased activity which improved after food intake and also recurrent hypoglycaemia was documented during these episodes. He was evaluated and found to have a large mesenchymal tumour in the left lung which is typically seen in NICTH. The work up for hyperinsulinemic hypoglycaemia was NEGATIVE and was suggestive of NICTH.

It is prudent to view hypoglycaemia with an underlying malignancy in the light of paraneoplastic syndrome to manage the condition effectively.

8. A Rare Case Report : Auto Immune Polyglandular Syndrome Type 2B in an Adolescent Male

M Manjappa, SM Shetty, VH Naik, J Inbanathan, B Dinesha, G Hemamalini
Mysore Medical College and Research Institute, Mysore, Karnataka.

Autoimmune polyglandular syndromes (APS) are a group of rare immune mediated diseases, which mainly include APS-1, APS-2a and APS-2b.

A 17 year old male presented with one year history of forward protrusion of eyes left more than right insidious onset gradually progressing, six months history of decreased appetite, increased bowel habits and micturition. Born out of a grade II consanguineous marriage with full term home delivery, patient had delayed developmental milestones.

On examination patient had class IV opthalmopathy (Grave’s), thyroid enlargement, bilateral sensory neural deafness (771dBHL both ears), short stature with growth retardation. Cardio-vascular, respiratory and per-abdomen were normal. In CNS higher mental functions and sensory system could not be evaluated as patients was deaf and dumb, motor system normal.

CBC revealed Hb 9.5 gm%, ESR 61 mm/hour, AEC (180 cells/ cmm), with mild microcytic-hypochromic anaemia and other parameters normal. T3 2.80 ng/ml, T4 19.90 μG/dl, TSH 0.011 μ Iu/L, (Hyperthyroid). Thyroid FNAC- Toxic goiter, TSH receptor antibodies (TSHRAbs) positive. FBS 256 mg%, PPBS 272 mg%, electrolytes Na+ 139, K+ 4.4, Chloride 105.1 and bicarbonate 23.3 all in mmol/L. Serum Calcium 8.98 mg%, serum Phosphorous 4.39 mg%. CT scan revealed bilaeral orbital Pseudotumour/ Thyroid opthalmopathy with mild hydrocephalous, 8 AM cortisol estimation normal (14.3 mg/dL). LFT, RFT, urine Routine, ECG with rhythm strip, chest X-ray, X-ray skull normal. USG showed mild fatty infiltration of liver.

APS-2b is characterized by Grave’s disease or autoimmune hypothyroidism, type 1 diabetes mellitus and primary
hypogonadism, manifesting commonly in females in their adult life. In this case, APS 2b is noted in an adolescent male with growth retardation which is not common.

9. Chronic Abdominal Pain as a Masquerader of Hypercalcemia : A Case Report

S Sankar, S Kanjilal, F Pulikkan, JM Idiculla, G Singh
St. John’s Medical College, Bangalore.

Primary hyperparathyroidism is the commonest cause of parathyroid dependent hypercalcemia, mainly as a result of single adenomas. The annual incidence is only 0.1 to 0.3/1000 persons. Hypercalcemia is a known medical cause for abdominal pain but can easily vex an unsuspecting mind thus, subtending the patient to prolonged and unnecessary evaluation. We present an account of a 24 year old male in this case report, who had been extensively evaluated in many hospitals for complaints of abdominal pain and vomiting for a period of six months. He had even undergone a laparoscopic procedure outside during this elaborate diagnostic exercise. We found the patient to have hypercalemia with elevated parathormone levels. The patient immediately responded to treatment for hypercalemia. A Tc sestamibi scan revealed a large solitary para thyroid adenoma. Patient underwent parathyroidectomy but developed hungry bones syndrome post operatively which was managed effectively. Patient is at present totally symptom free on regular follow up with normal calcium levels.

10. Hermaphrodite with Hypertension

V Rohith, S Shubha, VR Pandit, JM Thomas, Arun Chawla
Kasturba Medical College, Manipal, Karnataka.

Nineteen year old boy was referred from ophthalmology department with history of blurring of vision over the past 6 years.

Patient parents have noticed presence of ambigious genitalia since birth. Our examination revealed short statured male with masculine facial hair distribution and voice, pubic hair of feminine distribution with labia and clitoromegaly. Blood pressures were found to be 170/110 mm of Hg and fundoscopic examination showed feature of grade 3 hypertensive retinopathy.

Baseline investigations were essentially normal except for hypokalemia with elevated Serum Testosterone, ACTH, Androstenedione, DHEA (Dehydroepiandrosterone), 24 hour urinary 17-ketosteroid levels and with low cortisol levels. CT abdomen showed bilateral enlarged adrenals, hypoplastic uterus with normal bilateral ovaries, empty scrotal sac with hypoplastic external phallus. Testis was not visualized in pelvis or abdomen, diagnosis of congenital adrenal hyperplasia with 11-β hydroxylase deficiency considered, chromosome karyotyping showed XX pattern which confirmed the diagnosis.

He was started on suppressive dose of steroids and antihypertensives, laparoscopic hysterectomy and bilateral oophorectomy was done by the uroloigst as per the patient and parents request. During review visits his blood pressure and serum potassium had come to normal.

11. Mc Ardles Diseases - A Case Report

XE George, G Singh, Sharma, B Ganapathi
Department of Medicine, St. John’s Medical College, Bangalore.

Mc Ardles disease or type V (glycogen storage disorder is an uncommon autosomal recessive defect in muscle phosphoroylase deficiency which presents with pain, cramps and myoglobinuria and elevative CPK levels. We present 16 years old boy who presented with H/o exertional calf pain since 1 year. He is born of second degree consanguineous marriage. No history suggestive of cramps myoglobinuria. He had normal calcium levels with hyperphosphatemia and elevated ALP levels, normal 21 HD-D levels, normal PTH levels. Lower limb Doppler, baseline CK and lactate were normal. Muscle biopsy showed partial deficiency of a myophospheylites. Diagnosis of type V glycogen storage disorder was made. On proper management, he improved. This underlies the importance of muscle biopsy in calf pains.

12. Wolfram’s Syndrome : A Case Report

K Sanjaykumar, ND Moulick, Namita Padwal, R Neeraj, J Pravin
LTMMC and LTMGH, Sion, Mumbai - 22.

Wolfram’s syndrome, a rare and complex genetic disorder, also called as DIDMOAD Syndrome, consists of Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness. The gene responsible for Wolfram’s syndrome is located on short arm of chromosome 4.

A 20 years female was diagnosed as type 1 diabetes mellitus at the age of 8 years, developed optic atrophy at 10 years diagnosed during evaluation of diminution of vision. Now presented with polyurea, detailed evaluation with well controlled diabetes, found to have central diabetes inspidus. Further pure tone audiometry showed bilateral sensory neural hearing loss. Constelling all components of DIDMOAD Syndrome. She has been advised genetic studies.

13. Inherited Childhood Obesity (Prader Willi Syndrome) – (P.W.S.) – Case Report

K Selvakumary, P Alagianambi, A Singaravelan, Jayalakshmi Natrajan
Shri Gokulam Hospital, Salem, Tamilnadu – 636 004.

Introduction : Obesity epidemic is out of control global health problem; which complications not only bankrupts the health care system but also leads on to premature deaths. As it is preventable its recognition should begin as early as in childhood. We are presenting one such important case of preventable childhood obesity i.e. Prader Willi syndrome.

Case Report : Sixteen year old boy was received in the emergency room (SGH, Salem) with C/o breathlessness at rest, he was obese, anasarca++, cyanosed, JVP raised, no pallor, CVS : S1S2+, RS : NVBS, Crepts+ : SaO2-92%, RR – 28/min. anti failure measures such as diuretics, Isosorbide dinitrate (Reduce the preload) oxygen supplementation, pressors were administered; with intensive intervention his general condition and vital signs were stabilized. He was reassessed and the cause for right heart failure was searched; Birth history : According to his mother: he was delivered normally underweight at birth had feeding problems with delayed milestones, hypotonia improved gradually with age; while there was day time somnolence, snoring with obstructive sleep apnoea, drooling of saliva, hyperphagia, viscous saliva and cursting mouth corners present. O/E : Short stature, morbid central obesity: height 132 cms, weight 82 kgs, waist circumference 133 cms, BMI : 48.2 kg/m2 he had mental retardation (MR)-(IQ 65), day time somnolence; Vital signs PR 88/min, afebrile, BP 130/70 mmHg, RR – 22/min, CVS : Heart sounds heard, RS : scattered rales+, PA – soft, CNS-MR present. Genital examination : Hypogonadisin, micropenis, micro scrotum. Bilateral atrophied tests. Salient Investigations: Complete haemogram: Normal, X-ray chest PA view: Cardiomegally, ECG: P Pulmonale with RVH, 2D Echo: Features of cor pulmonale, Lipid profile: normal. Pulmonary function test – Restrictive pattern; Chromosomal analysis – normal; growth hormone assay:0.09 ng/ml (0.06-5) i.e. lower side of normal range; Thyroid function test : normal, Sr. cortisol levels (8.30 am):6.93 micgm/dl, (4.30-22.40), (4.30 pm) : 8.93 micgm/dl (3.09-16.66) Sr. Prolactin – 5.7 ng/ml (1.5-19): testosterone: 0.2 ng/ml (3-10.6) Suggestive of hypogonadism DEXA – 65% fat. Osteoporosis, GTT-normal.

Discussion : Patient has satisfied the major diagnostic criteria with the presence of neonatal hypotonia gradually improved feeding problems, underweight-excessive weight gain with age, between 1-6 years. Delayed milestones with MR, Hypogonadism genital hypoplasia, hyperphagia. Minor criteria: H/o: Infantile lethargy with weak cry in infancy improved with age. Sleep disturbances OSA, short stature. Small hands and feet, thick viscous saliva, crusting at mouth corners, skin picking, speech articulation defects, osteoporosis. Diagnosis : It is based on points from major and minor criteria (each major criteria carries; 1 point: each minor criteria carries 0.5 point). Birth to 3 years – 5 points – 2 major + 6 minor criteria; 3 years to adults 8 points – 5 major + 6 minor criteria. Our patient satisfies 6 major criteria and 8 minor criteria, hence he secures a total score of 10 points to diagnose Prader Willi Syndrome.

Conclusion : It is presented because it is a preventable cause of childhood obesity, though there is no cure to this disease; early diagnosis can support the child, his diet and behavior needs of the child so as to avoid child hood obesity and its life threatening complications. It is commonly under diagnosed because of individual variation in symptoms (atypical). Awareness and early diagnosis and prevention of childhood morbid obesity can enable these children to live a normal life span.

14. Doctors and Asthenia

AP George
Lourdes Hospital, Kochin

Introduction : Asthenia and fatigue are very frequently encountered reasons for consultation in day-to-day clinical practice. Asthenia is a complex syndrome commonly expressed as a sense of generalized lassitude, fatigue, exhaustion and lack of energy. The various symptoms of asthenia are seen in patients recovering from surgery, post-infection, students during examination as well as among persons with excess workload and work related stress like night shift workers, busy executives and professionals etc. However, there is no data about the presence of asthenia in physicians who are treating such patients in their dayto- day clinical practice and are themselves exposed to excessive workload and related stress thereby.

Objective : To evaluate the prevalence of asthenia in physicians doing clinical practice and their choice of treatment for asthenia.

Method : A prospective, multi-national, multi-centre, clinicbased epidemiological survey was conducted across 18 countries including India, which aimed to evaluate the presence/absence of asthenia symptoms in physicians doing clinical practice. The survey was conducted from October 2006 till February 2007.

Results : Three thousand one hundred and ninety nine physicians from 18 countries participated in the survey. 86.2% of physicians who were interviewed experienced various symptoms of asthenia. The 2 major causes of asthenia were excess workload (73.6%) and work-related stress (73.3%) and the other less common reasons being lack of leisure time (49.4%); insufficient sleep (44.6%) and irregular sleep patterns (36.2%), all of which were also related to excess workload in clinical practice. Physicians in India work 65.4 hours per week, which is much higher than the overall overage of 57 hours per week as observed in other countries. The most common manifestations of asthenia are lack of energy (80.7%), irritability (78.2%), daytime sleepiness (68%), physical pain (65.8%), anxiety (65.1%) and insomnia (48.9%). The survey also showed that majority of physicians adopt lifestyle measures like slowing down work pace, spending more time with family, leisure activities, change in sleep habits, etc. to treat asthenia. 20% of the physicians take medications when they feel extreme asthenia. 67% of the physicians who take anti-asthenic treatment use an anti-asthenic agent, the most preferred being Arcalion® (51.3%).

Conclusion : The survey shows that symptoms of asthenia exist in practicing physicians due to long working hours. Lifestyle modification is the preferred method for management of asthenia in long run, however for short-term therapy, Sulbutiamine (Arcalion®) is the most preferred anti-asthenic agent used by majority of physicians across the world.

15. Prevalence of Obesity in Young Males and Females in Rural Punjab and Its Correlation with Socioeconomic Status and Activity Profile

Vitull K Gupta, Sonia Gupta, Jassi Yashpal
Kishori Ram Hospital and Diabetes Care Centre, Bhatinda, Punjab.

Obesity is becoming one of the most prevalent health problems in urban India. Obesity is an important modifiable risk factor for hypertension (HTN), diabetes (DM), sleep apnea syndrome and coronary artery disease (CAD). Prevalence of obesity is increasing day by day. But most of studies are conducted in urban population. A national survey carried out in 2000 showed that 25% Indian men and 36% of women above 20 years are overweight. The Human Nutrition Unit of AIIMS conducted a study among children in Delhi and found 13.4% to be obese judging by their body mass index (BMI). Similar studies have found the prevalence of obesity in young urban population to vary between 10 to 15%. We studied the young population both males (5-20 years) and females (5-30 years) in villages around Bhatinda. Anthropometric measurements i.e. weight, height, was recorded along with socioeconomic and activity profile. Our studied included 3099 females, 807 (26.2%) females in age group of 5-10 years 1425 (45.9%) in 10-20 years age group. Body mass index (BMI) was calculated as weight in kilograms divided by square of height in meters and childhood obesity was defined as a BMI at or above 95th percentile for children of the same sex and age. BMI was categorized into low (< 18.5 Kg/m2), normal (18.5-24.9 Kg/m2), high (25-29.9 Kg/m2) and obese (≥ 30 Kg/m2). Socioeconomic status (SES) was calculated according to the family income and activity profile according to sedentary, moderate and active lifestyle. Among all (n-3099) age group females low BMI was present in 80.4% (n- 2490), normal BMI in 15.9% (n-495), high BMI in 2.9% (n-91) and obese BMI in 0.8% (n-23). Similarly in all (n-1221) age group males low BMI was found in 81% (n-990), normal BMI in 13.5% (n-165), high BMI in 4.8% (n-59) and obese BMI in 0.6% (n-7). Among 5 to 10 years (n-807) females, 93.7% (n-756) had low BMI, 5.6% (n-45) had normal BMI, 0.5% (n-4) had high BMI and 0.2% (n-2) was found to have obese BMI. In 10 to 20 years (n- 1425) age group females 82.2% (n-1170), 14.4% (n-207), 2.8% (n- 39) and 0.6% (n-9) females had low, normal, high and obese BMI respectively. In age group of > 20 years (n-867) females, 65.0% (n-564), 28.3% (n-243), 5.6% (n-48) and 1.2% (n-12) females had low, normal, high and obese BMI respectively. Among males 85.4% (n-702), 9.8% (n-81), 4.6% (n-37) and 0.2% (n-2) had low, normal, high and obese BMI respectively in the age group of 5-10 years (n- 822). 72.1% (n-288), 21.1% (n-84) and 5.5% (n-22) and 1.3% (n- 5) had low, normal, high and obese BMI respectively in the age group of 10-20 years (n-399). These results show prevalence of high BMI both in males (4.8%) and females (2.9%) is low in rural Punjab similarly prevalence of obese BMI in both males (0.7%) and females (0.8%) was quite low in rural Punjab. Prevalence of high and obese BMI increases with increase in age. Obese and high BMI in both males and females is directly related to high socioeconomic status and sedentary life style. To conclude obesity is becoming major health problem in urban areas and still has low prevalence in rural Punjab. More detailed studies are needed to find out the prevalence of obesity in both urban as well as rural areas along with other risk factors for CAD, hypertension and diabetes (Table 1).

16. A Rare Case of Kearns-sayre Syndrome

UB Nayak
Kasturba Medical College, Mangalore.

Seventeen year old male patient presented with H/o progressive drooping of eyelids, restriction of ocular movement and proximal muscle weakness. There was no family history of similar complaints.

Systemic examination revealed bilateral ptosis with ophthalmoplegia, pigmentory retinopathy, dysdiadokokinesia
and limb ataxia.

Investigations showed evidence of diabetes mellitus and bilateral sensorineural deafness. EMG showed myopathic pattern. Muscle Biopsy revealed ragged red fibres.

Diagnostic criteria for kearn sayre syndrome was satisfied and a final diagnosis of Kearn-sayre syndrome was made.

17. Ellis Van Crevald Syndrome

J John Sahayo Bino, J Thirumalaikolundu Subramanium, M Jubilee, SE Dhanasekar, G Usha, Malarvizhi
Institute of Internal Medicine, GGH and MMC, Chennai – 600 003.

Ellis Van Crevald Syndrome is a rare form of skeletal dysplasia involving chondral and ectodermal tissue, characterized by medial postaxial polydactyly, disproportionate short stature, Cardiac anamoly, nail dystrophy and Genu valgum. From 1940 to 2007 (April) only 150 cases was reported worldwide. Among the reported cases, renal involvement was documented among few but vertebral involvement was not stated.

Here two females of age 20 and 37 years, with established EVC syndrome are reported in view of thoracic scoliosis in both of them and renal involvement in one case. The probable mechanisms for the same and its implications are discussed.

18. Etiological Spectrum of Metabolic Bone Diseases

NM Hindlekar, ND Moulick, S Kaminwar, N Raghani, D Korivi
Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai – 22.

Aim : To study the spectrum of etiological factors for metabolic bone disorders in young adults.

Materials and Methods : Young patients of either short stature, pathological fractures of unexplained bone pains; referred to endocrine division of a tertiary care medical institute over one year were evaluated for causes of bone diseases. The causes were classified as (a) genetic, (b) endocrine, (c) renal, (d) hepatic, (e) hematological, (f) others.

Discussion : Twenty eight patients were included in the study 68% were female and 32% were male. Age was between 14-25 years. Genetic disorders were 28% (Wilson’s disease 2 cases, Neiman Pick disease 2 cases, X-linked hypophosphatemia 1 case, Turner syndrome 2 cases, Coeliac disease 1 case). Amongst the 42% endocrine cases 4 were IDDM, 3 of parathyroid adenoma causing hyperparathyroidism, 2 of hypothyroidism, 2 of
osteomalasia were present. Amongst the 14% renal causes 1 was having oxalosis and 3 were having renal osteodystrophy. One patient was having chronic childhood cirrhosis. Two cases were of chronic iron deficiency anaemia. One case was mixed connective tissue disorder.

Conclusions : Bone diseases caused by above disorders were due to either lack of or to much of one of these three essential elements Vitamin D3, Calcium or phosphorus or failure to provide one or more of them in a bio available form leading to weakness of bones.

19. Psychiatric Morbidity among the Survivals of Methyl Isocyanate Gas Victims after 22 Years

VK Sharma, RN Sahu, TN Dubey, RK Jain, K Deopujari, AK Singh, N Nahar
Gandhi Medical College, Bhopal.

Aim : To study the psychiatric symptoms in gas victims during Bhopal gas disasters after 22 years,

Methods : We studied 150 patients affected by methyl isocyanate gas and equal numbers of 150 non-gas victim patients were taken as control group. DSM-IV criteria were used to assess the psychiatric disorder in both groups.

Results : Psychiatric symptoms were more common in age group of 22 to 50 years in gas victims (49 males, 101 females), as compared to 41 to 50 years in control group (43 males, 107 females). Twenty four gas victims of psychiatric morbidity had history of death in family or neighborhood in comparison to 2 patients in control group. Twenty four gas victims had suicidal tendency in comparison to 19 of control group. Depression was the most psychiatric illness found in 48 gas victims in comparison to 32 patients in control group. In gas victim patients 12 patients suffered from posttraumatic stress disorder in comparison to 2 patients in control group.

Conclusion : In gas victims, psychiatric illness was more common in females then males. Most patients were between 22- 50 years of age with low socioeconomic status. Death of family members had strong correlation with increased incidence in psychiatric illness. Neurotic depression was the most common psychiatric illness found in gas victims with increased suicidal tendencies.

20. Clinical Profile of Hypokalemic Paralysis

K Jeganniwas, K Mayilananthi, Sripriya V Haridoss, K Purusothaman, SP Thirukmalaikolundu
Madras Medical College, Chennai.

Aim of the Study : Evaluate the presenting features of hypokalemic paralysis (HP), mode of diagnosis, various methods of treatment and outcome and to compare with published reports from India and abroad.

Materials and Methods : A prospective study was undertaken after institutional ethical clearance and with in informed consent at a tertiary care hospital to screen a total of 40 patients who had unequivocal evidence for HP. Parameters considered for analysis were: age, sex, past history of simi9lar episodes, precipitating factors, serum potassium level on admission, electrocardiographic changes, treatment and outcome. The data were analyzed statistically.

Results : There were 30 males and 10 females. Their age ranged from 14 to 37 years with 60% in third decade. Among them 40% of patients had recurrence. Among the total one third (37.5%) had positive family history (first degree relative). The precipitating factors could not be demonstrable in 30 patients. 80% of patients presented with quadriparesis and the remaining with paraparesis. The mean serum potassium was 2.5 Meq/L. ECG changes were seen in 80% only. Patients were managed conservatively and with supportive measures. With oral potassium alone 32 out of 40 patients got recovered fully and the rest improved with intravenous potassium supplementation.

Comments : Remember and recognize HP by clinical examination and consider the same after ECG, confirm by serum potassium level and intervene as early as possible to prevent adverse complications. The present reports tallies with earlier work published from India and abroad.