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Chilaiditi’s sign is a rare radiological diagnosis characterized by colonic interposition between the diaphragm and the liver, and when symptomatic it is known as Chilaiditi’s syndrome. We report that the case of a 55-years-old male, who was referred to our institution as a case of colitis, with the symptoms of recurrent vomiting, pain abdomen, and altered bowel habit, was eventually diagnosed to have Chilaiditi’s syndrome with non-specific colitis, after carefully taking the history and clinically examining the patient.

Background: Seizure disorder is a common neurological disorder among the elderly population and is associated with increased morbidity and mortality due to underlying comorbidities, weaker immunity and drug-to-drug interaction, but it does not get the adequate attention it deserves. Methodology: In a hospital-based retrospective observational study, 78 patients above 60 years, presenting with non-traumatic seizure for the rst time, were included in this study. The mean age of the study population was 70 years, with a male-to Results: -female ratio of 1.84:1. The most common cause of seizure was a cerebrovascular accident (37%), followed by metabolic (24.3%) and infective causes (19.23%). Generalised type of seizure was more common than focal seizure (69% vs 25.5%). CVA was the most common cause of generalised seizure (38.16%) whereas, tubercular meningitis was the most common cause of focal seizure (10.2%). Hypertension was the most common comorbidity, followed by diabetes. The study emphasises the need for a holistic approach towards an e Conclusion: lderly with seizure disorder and the need to control the comorbidities and thereby, its complications, such as seizure.

Background: Chronic Myeloid Leukaemia (CML) is a myeloproliferative disorder of the haemopoietic clonal cells carrying the Philadelphia chromosome in 95% cases which results from the reciprocal translocation between long arms of chromosomes 9 and 21 t(9;22)(q34;11), leading to the formation of BCR-ABL fusion gene, that constitutively produces Tyrosine Kinase. Beyond normal activity of this enzyme is responsible for the carcinogenesis in CML. Imatinib, a tyrosine kinase inhibitor, inhibits the oncogenic pathway in CML. Imatinib has been a great success in terms of cytogenic and haematological response since its approval by FDA. Imatinib is well tolerated, but is associated with mild to moderate toxicity that can be managed by dose reductions or discontinuation. Common side effects include GI intolerance, rash and myalgia. Adherence to Imatinib is the key to complete therapeutic response but there are multiple compliance limiting factors, like unavailability, side effects and one of the recent factors being the COVID19 pandemic. This study highlights the challenges faced by the CML patients on Imatinib in terms of side effects and factors that limit the adherence to therapy. Materials and Methods: Study Design: Retrospective telephonic hospital based observational study Method: We reviewed the Chemotherapy register of Assam Medical College and Hospital and attempted to contact CML patients who have indented Imatinib in the last 5 months. Total 59 patients indented the drug in this time span, out which 27 patients could not be contacted. Remaining patients were asked regarding any complaints and compliance to the therapy after taking due consent. Result: The study involved 32 patients, 34.3% Female and 65% Male, with a median age of 48. While 37.5% patients didn’t have any side effect, most common side effect was Gastrointestinal intolerance, 31.25%(nausea, vomiting, loose stool and abdominal discomfort), followed by equal occurrence of other side effects (6.25%);myalgia, facial puffiness, weight gain, tingling sensation, skin rash, itching and one case of haematuria. Out of the 32 patients, 43.75% patients have been strictly adherent to the therapy. Among others 25%(8) patients could not take the medicine due to lockdown imposed in 2020 due to COVID19 pandemic;18.75%(6) concurrent illness; 12.5%(4) drug unavailability; 6.25%(2) poor quality of the drug and 1 patient switched to herbal medication temporarily. CONCLUSION: While one third patients didn’t have any complaint, GI intolerance is the most common among the rest. Among the other factors, the ongoing COVID19 pandemic has emerged out as an important adherence limiting factor in CML followed by concurrent illness and drug unavailability. This study emphasizes the need for ensuring the quantity, quality and delivery of the drug to an extent that is minimally affected by the pandemic and also highlights the importance of disease awareness to prevent less educated people switching to alternative treatment like herbal medications.

BACKGROUND As defined by World Health Organization (WHO), stroke is accountable for 5 million deaths and 5 million disabled patients throughout the world. The prevalence of stroke is in rising trend in Indian subcontinent and therefore is a source of socioeconomic concern. This study was conducted to evaluate the aetiological and clinical profile in stroke patients with special reference to baseline intracranial haemorrhage (ICH) score in haemorrhagic stroke in North East India. METHODS The study was carried out among in-patients of Medicine Department at Assam Medical College and Hospital, Dibrugarh in North East India from March 2019 to February 2020. A total of 112 patients who presented with symptoms suggestive of stroke were assessed. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by chi-square test (for 2 x 2 tables). P-value less than 0.05 was taken as statistically significant. RESULTS In our study stroke was common in 40 – 60 years age group which comprised 50 % of total patients. Stroke was more common in males with a sex ratio of 1.24:1. 73.2 % of patients suffered haemorrhagic stroke and 22.3 % suffered ischemic stroke whereas 4.5 % suffered cardio-embolic stroke. Hypertension was the most prevalent and an important risk factor with 80.3 % (P = 0.001), followed by smoking with 39 % (P = 0.021), chronic alcohol consumption with 37 % (P = 0.028) and diabetes with 22 %. The most common site of haemorrhage was basal ganglia (28 %) followed by thalamus (24 %). Patients presenting with intraventricular extension, infratentorial location, low Glasgow Coma Scale (GCS) score (< 4) or having high ICH score (≥ 3) at the time of presentation were associated with increased mortality in haemorrhagic stroke (P = 0.010). CONCLUSIONS Haemorrhagic strokes (73.2 %) are the most common type. Hypertension is the most prevalent and an important risk factor (80.3 %). Basal ganglia (28 %) are the most common sites involved in haemorrhagic stroke; infratentorial location is associated with poor prognosis. Patients presenting with low GCS score (< 4) or having high ICH score (≥ 3) at the time of presentation are associated with increased mortality in haemorrhagic stroke. KEY WORDS Stroke, Hypertension, Basal Ganglia, GCS Score, ICH Score

Tetanus is a rare, severe, and potentially life-threatening disease caused by Clostridium tetani, which accounted 58,900 deaths worldwide in 2013.1 Usually tetanus is generalized, rarely it can be localized also. 20-30% of cases will not have any puncture wound. In this case report, we present a case of tetanus with rare manifestation (localized tetanus presented with trismus without any puncture wound). Multiple rare associations like tetanus presenting with trismus, tetanus occurring in the absence of puncture wound strengthens the need for reporting this case which if left unnoticed would have been detrimental to the patient.

Diabetes Mellitus is considered to be a cardiovascular disease equivalent. The risk of CVD in DM is manifold, and the implications of the disease becomes even more grave when young diabetics die of cardiovascular diseases. The escalating number of young diabetics emphasises the need for early diagnosis and intervention when necessary to halt the progression of CVD. The present study is a novel attempt to assess the prevalence of CVD in young diabetics in upper Assam with poor glycemia and dyslipidemia with the aims and objectives to study the glycemic status and lipid profile in young diabetics and to study the CVD risk and involvement. It is a hospital based observational study carried over a period of 1 year which showed A total of 42.7% of cardiovascular outcomes, of which Left Ventricular diastolic Dysfunction + Concentric LVH was found in 53.2% cases, Left Ventricular Diastolic Dysfunction alone was found in 21.8%, Concentric LVH alone was found in 25%. HbA1c level was found to be statistically extremely significant with the Cardiovascular Disease outcomes, with Left Ventricular Diastolic Dysfunction (p value 0.0007) and with Concentric LVH (p value 0.003). This was a hospital based observational study conducted in upper Assam among the patients with diabetes diagnosed at an early age of 25 years and below, to identify the presence of cardiovascular risks in young diabetes and the relation with glycemic status.

Background: Diabetes mellitus is assuming an epidemic form in India. Non-alcoholic fatty liver disease worldwide is increasing too and is a major cause of liver transplant in the west. Diabetes is a strong risk factor for non-alcoholic fatty liver disease, and some of them go on to develop steatohepatitis which is associated with a more rapid disease progression leading to chronic liver disease including hepatocellular carcinoma. This association of diabetes with fatty liver disease is least investigated. Liver biopsy is not routinely done in clinical practice and various non-invasive markers for fatty liver or steatohepatitis are used frequently to identify patients at risk of fatty liver disease. Methods: 116 Type 2 Diabetics Mellitus on therapy with oral anti-diabetic drugs and atorvastatin for at least 3 months’ duration were included and sonologically evaluated for fatty liver after proper exclusion of other causes of fatty liver. Serum hsCRP, an acute phase reactant, was measured in them. Liver function tests, BMI and other necessary investigations were done. 144 healthy controls were also taken. Results: The absolute risk of developing fatty liver was significantly high in T2 diabetics compared to controls. hsCRP was significantly associated with fatty liver and uncontrolled glycemic status. In addition AST/ALT > 1 also showed significant differences amongst the same groups. Conclusions: High hsCRP is a cheap, easily available laboratory marker to suspect fatty liver and possibly steatohepatitis in T2 Diabetics in our region. It can identify a subgroup of diabetic patients in whom liver biopsy may be advisable to confirm steatohepatitis which is important for prognosis and therefore need aggressive intervention.