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Introduction: Cushing syndrome is a rare endocrine disorder caused by a variety of underlying etiologies. It can be due to exogenous or endogenous high cortisone levels (ACTH-dependent or ACTH-independent). We herein report a case of ACTHdependent Cushing syndrome caused by pituitary and adrenal hybrid adenoma. Case report: A 42-year-old female presented with a complaint of hematemesis. She had hirsutism, central obesity and violaceous striae on her abdomen and thigh. On detailed clinical examination and relevant investigation, we found that the cause of hematemesis was esophagitis with necrotic gastric ulcer due to Cushing syndrome caused by the pituitary and adrenal hybrid adenoma. Discussion: Cushing syndrome is a rare endocrine disorder characterized by increased exogenous or endogenous serum cortisol levels, which lead to various clinical presentations. Early identification of the disease and its cause is critical. The entire clinical presentation must be considered for correct diagnosis, which is generally delayed due to the overlapping symptoms of the disease with various specialities. Conclusion: Diagnosis and management of Cushing’s syndrome continues to present considerable challenges and necessitates referral to higher centers. Its diverse presentation warrants a complete clinical, physical, radiological and endocrine examination.

Introduction: Laurence-Moon-Bardet-Biedl syndrome (LMBBS) is a rare autosomal-recessive disorder, which is characterized principally by cardinal symptoms of marked central obesity, retinal dystrophy, polydactyly, mental retardation, hypogonadism and renal dysfunction. Case presentation: We report a case of a 20-year-old male who presented to us with history of fever, vomiting and dizziness. He was incidentally diagnosed as a case of LMBBS as the patient was having polydactyly, retinitis pigmentosa, central obesity, hypogonadism and low IQ. Conclusion: Laurence-Moon-Bardet-Biedl syndrome is a very rare syndrome with very low incidence; hence, we are reporting this case. In addition, we advice more diligent approach from various specialties, so that this syndrome can be picked up at an early age.

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Introduction: Laurence-Moon-Bardet-Biedl syndrome (LMBBS) is a rare autosomal-recessive disorder, which is characterized principally by cardinal symptoms of marked central obesity, retinal dystrophy, polydactyly, mental retardation, hypogonadism and renal dysfunction. Case presentation: We report a case of a 20-year-old male who presented to us with history of fever, vomiting and dizziness. He was incidentally diagnosed as a case of LMBBS as the patient was having polydactyly, retinitis pigmentosa, central obesity, hypogonadism and low IQ. Conclusion: Laurence-Moon-Bardet-Biedl syndrome is a very rare syndrome with very low incidence; hence, we are reporting this case. In addition, we advice more diligent approach from various specialties, so that this syndrome can be picked up at an early age.

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Introduction: Erectile dysfunction (ED) constitutes a large burden on society given its high prevalence and impact on quality of life. Diabetes is a common cause of organic ED. Prevalence of ED in diabetes ranges from 35% to 85% depending on the study, versus 26% in general population. Platelet-lymphocyte ratio (PLR) has been detected as an important marker for inflammation. Some studies have identified its role in ED but more research is needed. Material and methods: It was a hospital-based prospective observational study. According to International Index of Erectile Function (IIEF)-5 questionnaire, patients were divided into 4 categories: mild ED with score 17 to 21, mild-to-moderate ED with score 12 to 16, moderate ED with score 8 to 11 and severe ED with score 1 to 7. Presence of ED and its severity was correlated with age, residence, duration of diabetes, glycemic status, lipid profile, PLR, complications, body mass index (BMI), etc. Results: Prevalence of ED in male diabetes patients was found to be 72.4%. Among 110 cases with ED, 8 had mild ED (7.2%), 27 had mild-to-moderate (24.5%), 27 had moderate ED (24.5%) and 48 had severe ED (43.6%). Prevalence of ED was found to be proportional to age. Majority of cases in ED group were those with long-standing diabetes. Correlation of ED with complication of diabetes, like nephropathy and retinopathy, was significant, whereas it was not significant with neuropathy. Significant correlation of ED was found with BMI and PLR. Conclusion: ED prevalence was high among the diabetes patients and it increased with age and duration of the disease. Presence of diabetic complications was significantly associated with ED. BMI was significantly associated with development of ED. PLR was significantly higher in ED group and closely related to severity of ED.

Scrub typhus, also called bush typhus, is a zoonotic disease a Gram-negative bacterium. Its presentation may range from nonspecific febrile illness to severe disease, with cardiovascular, renal, hepatic and neurological involvement. Myocarditis is one of the rare complications of scrub typhus. Hence, we are reporting a case of a 50-year-old male, farmer by occupation, presenting to us in multiorgan dysfunction syndrome who developed myocarditis during second week of his illness.

Introduction: Rasmussen’s encephalitis (RE) is an inflammatory encephalopathy characterized by progressive refractory focal seizures, cognitive deterioration and focal neurological deficit that occur with gradual atrophy of one brain hemisphere. Case presentation: We report a case of an 18-year-old male with a history of abnormal body movements involving the right half of the body without loss of consciousness for the last 15 years. Noncontrast computed tomography (NCCT) head and magnetic resonance imaging (MRI) revealed hemiatrophy of the left cerebral hemisphere. Conclusion: RE is a rare disease; hence, diagnosing and managing such patients may be challenging. Our aim is to draw attention of the treating physicians towards this disease with the help of this case report.

Introduction: Rasmussen’s encephalitis (RE) is an inflammatory encephalopathy characterized by progressive refractory focal seizures, cognitive deterioration and focal neurological deficit that occur with gradual atrophy of one brain hemisphere. Case presentation: We report a case of an 18-year-old male with a history of abnormal body movements involving the right half of the body without loss of consciousness for the last 15 years. Noncontrast computed tomography (NCCT) head and magnetic resonance imaging (MRI) revealed hemiatrophy of the left cerebral hemisphere. Conclusion: RE is a rare disease; hence, diagnosing and managing such patients may be challenging. Our aim is to draw attention of the treating physicians towards this disease with the help of this case report.

Scrub typhus, also called bush typhus, is a zoonotic disease a Gram-negative bacterium. Its presentation may range from nonspecific febrile illness to severe disease, with cardiovascular, renal, hepatic and neurological involvement. Myocarditis is one of the rare complications of scrub typhus. Hence, we are reporting a case of a 50-year-old male, farmer by occupation, presenting to us in multiorgan dysfunction syndrome who developed myocarditis during second week of his illness.

Introduction: Rasmussen’s encephalitis (RE) is an inflammatory encephalopathy characterized by progressive refractory focal seizures, cognitive deterioration and focal neurological deficit that occur with gradual atrophy of one brain hemisphere. Case presentation: We report a case of an 18-year-old male with a history of abnormal body movements involving the right half of the body without loss of consciousness for the last 15 years. Noncontrast computed tomography (NCCT) head and magnetic resonance imaging (MRI) revealed hemiatrophy of the left cerebral hemisphere. Conclusion: RE is a rare disease; hence, diagnosing and managing such patients may be challenging. Our aim is to draw attention of the treating physicians towards this disease with the help of this case report.

Introduction: Erectile dysfunction (ED) constitutes a large burden on society given its high prevalence and impact on quality of life. Diabetes is a common cause of organic ED. Prevalence of ED in diabetes ranges from 35% to 85% depending on the study, versus 26% in general population. Platelet-lymphocyte ratio (PLR) has been detected as an important marker for inflammation. Some studies have identified its role in ED but more research is needed. Material and methods: It was a hospital-based prospective observational study. According to International Index of Erectile Function (IIEF)-5 questionnaire, patients were divided into 4 categories: mild ED with score 17 to 21, mild-to-moderate ED with score 12 to 16, moderate ED with score 8 to 11 and severe ED with score 1 to 7. Presence of ED and its severity was correlated with age, residence, duration of diabetes, glycemic status, lipid profile, PLR, complications, body mass index (BMI), etc. Results: Prevalence of ED in male diabetes patients was found to be 72.4%. Among 110 cases with ED, 8 had mild ED (7.2%), 27 had mild-to-moderate (24.5%), 27 had moderate ED (24.5%) and 48 had severe ED (43.6%). Prevalence of ED was found to be proportional to age. Majority of cases in ED group were those with long-standing diabetes. Correlation of ED with complication of diabetes, like nephropathy and retinopathy, was significant, whereas it was not significant with neuropathy. Significant correlation of ED was found with BMI and PLR. Conclusion: ED prevalence was high among the diabetes patients and it increased with age and duration of the disease. Presence of diabetic complications was significantly associated with ED. BMI was significantly associated with development of ED. PLR was significantly higher in ED group and closely related to severity of ED.

Background: In December 2019, a new respiratory tract infecting agent emerged in Wuhan city of China, known as the coronavirus. There are limited studies regarding coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). Therefore, the present study was aimed to determine the demographic profile, comorbidities, hydroxychloroquine as prophylaxis and outcomes of reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 HCWs.Material and methods: This study was an observational retrospective study carried out over a period of 10 months from 15th March, 2020 to 15th January, 2021 in 350 RT-PCR confirmed COVID-19 HCWs who were in home isolation or admitted in dedicated COVID hospital. Results: We observed that majority of HCWs were in the age group 20-39 years (66.58%), were males (69.14%) and from urban areas (72.86%). Only few had comorbidities (3.42%), took hydroxychloroquine as prophylaxis (5.71%) and mortality was 0.57%. About 46.29% of the HCWs were doctors and 28.40% of the doctors werefrom Medicine. Conclusion: From the present study, we conclude that HCWs affected by COVID-19 are mainly young adult male physicians from urban areas, without significant comorbidities. The outcome in COVID-19 positive HCWs is favorable due to better awareness, prompt diagnosis and treatment. The results of this study will be useful in knowing the most vulnerable section of HCWs.

Background: In December 2019, a new respiratory tract infecting agent emerged in Wuhan city of China, known as the coronavirus. There are limited studies regarding coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). Therefore, the present study was aimed to determine the demographic profile, comorbidities, hydroxychloroquine as prophylaxis and outcomes of reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 HCWs.Material and methods: This study was an observational retrospective study carried out over a period of 10 months from 15th March, 2020 to 15th January, 2021 in 350 RT-PCR confirmed COVID-19 HCWs who were in home isolation or admitted in dedicated COVID hospital. Results: We observed that majority of HCWs were in the age group 20-39 years (66.58%), were males (69.14%) and from urban areas (72.86%). Only few had comorbidities (3.42%), took hydroxychloroquine as prophylaxis (5.71%) and mortality was 0.57%. About 46.29% of the HCWs were doctors and 28.40% of the doctors werefrom Medicine. Conclusion: From the present study, we conclude that HCWs affected by COVID-19 are mainly young adult male physicians from urban areas, without significant comorbidities. The outcome in COVID-19 positive HCWs is favorable due to better awareness, prompt diagnosis and treatment. The results of this study will be useful in knowing the most vulnerable section of HCWs.

Background: In December 2019, a new respiratory tract infecting agent emerged in Wuhan city of China, known as the coronavirus. There are limited studies regarding coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). Therefore, the present study was aimed to determine the demographic profile, comorbidities, hydroxychloroquine as prophylaxis and outcomes of reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 HCWs.Material and methods: This study was an observational retrospective study carried out over a period of 10 months from 15th March, 2020 to 15th January, 2021 in 350 RT-PCR confirmed COVID-19 HCWs who were in home isolation or admitted in dedicated COVID hospital. Results: We observed that majority of HCWs were in the age group 20-39 years (66.58%), were males (69.14%) and from urban areas (72.86%). Only few had comorbidities (3.42%), took hydroxychloroquine as prophylaxis (5.71%) and mortality was 0.57%. About 46.29% of the HCWs were doctors and 28.40% of the doctors werefrom Medicine. Conclusion: From the present study, we conclude that HCWs affected by COVID-19 are mainly young adult male physicians from urban areas, without significant comorbidities. The outcome in COVID-19 positive HCWs is favorable due to better awareness, prompt diagnosis and treatment. The results of this study will be useful in knowing the most vulnerable section of HCWs.

Mirizzi syndrome was first described by Pablo Luis Mirrizi. The incidence of this syndrome ranges from 0.05% to 4%. Thisrare condition is caused by the obstruction of common hepatic duct or common bile duct due to compression caused byseveral impacted stones or a single large impacted gallstone in Hartmann’s pouch. The clinical presentations may vary fromno symptoms to severe cholangitis. It is a rare cause of obstructive jaundice and hence we are reporting a case to emphasizethat while evaluating a case of obstructive jaundice, one must consider Mirizzi syndrome as a differential diagnosis.

Congenital toxoplasmosis is caused by transmission of an intracellular obligate coccidian protozoan (Toxoplasma gondii) via vertical transmission during pregnancy. The clinical manifestations are wide ranging from asymptomatic to intracranial calcifications, seizures, developmental delay, chorioretinal lesions and even fetal death. Aplastic anemia is one of the rare presentations of congenital toxoplasmosis. Hence, we are reporting a case of a 23-year-old male who presented to us with aplastic anemia due to congenital toxoplasmosis. Thus, congenital toxoplasmosis should always be considered as a cause when evaluating a case of aplastic anemia.

Mirizzi syndrome was first described by Pablo Luis Mirrizi. The incidence of this syndrome ranges from 0.05% to 4%. Thisrare condition is caused by the obstruction of common hepatic duct or common bile duct due to compression caused byseveral impacted stones or a single large impacted gallstone in Hartmann’s pouch. The clinical presentations may vary fromno symptoms to severe cholangitis. It is a rare cause of obstructive jaundice and hence we are reporting a case to emphasizethat while evaluating a case of obstructive jaundice, one must consider Mirizzi syndrome as a differential diagnosis.