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Tenofovir disoproxil fumarate was the first nucleotide analogue reverse transcriptase inhibitor to be approved for treatment of human immunodeficiency virus infection. It is a relatively safe drug but can present with nephrotoxicity. We report a case of 36-year-old male who presented with acute onset flaccid paraparesis. He was a diagnosed case of acquired immunodeficiency syndrome for 9 years ago and was on tenofovir-based antiretroviral therapy for last 6 months. As the patient had normal anion gap metabolic acidosis, hypokalaemia and urine pH > 5.5, distal renal tubular acidosis (RTA) was suspected. He improved dramatically within 24 h of hospitalisation after potassium correction to regain normal power. Tenofovir-induced distal RTA presenting as hypokalaemic paralysis is a very rare complication of tenofovir; hence, we are reporting this case. In addition, we suggest regular follow-up of patients taking tenofovir with urine analysis and serum potassium to detect this complication earlier as it is reversible.

Rheumatoid arthritis (RA) is a chronic, symmetric, systemic inflammatory polyarthritis of unknown etiology. It primarily affects small diarthrodial joints of hand and has higher prevalence in women just like any other autoimmune disease. Metabolic Syndrome (MS) is a constellation of cardiovascular risk factors with insulin resistance as a core manifestation. Dyslipidemia, central obesity and hypertension form the other manifestations. Both the disorders share the common pathophysiology which centres around chronic systemic inflammation. High plasma levels or TNF and interleukins are found in both. The present work is a modest attempt to study the prevalence of metabolic syndrome among patients with rheumatoid arthritis and its correlation with disease activity.The study was carried out in a total of 100 rheumatoid arthritis patients enrolled as cases and compared with 100 age and sex matched non rheumatoid arthritis controls at R.N.T. Medical college and attached group of hospitals, Udaipur. It was an observational case control study done over a period of 1 year.In the present study, the prevalence of MS was 32% in RA patients and 14% in general population, with the difference being statistically significant. Females were more commonly affected by RA than males, however the prevalence of MS among both was similar. Statistical significance difference was noted in BMI (p=0.039) and FPG (p=0.008) among cases and controls. Significant association with MS among RA patients was also found with those who had pain, longer duration of illness, RF positivity, raised CRP and elevated ESR. The study didn't find correlation with RA disease activity and prevalence of MS.There exists a complex interplay between rheumatoid arthritis and metabolic syndrome with chronic systemic inflammation playing a major role. The prevalence of MS and associated atherosclerotic cardiovascular risk is increased among RA patients. Further research in this arena is required to mitigate the morbidity and mortality among RA patients.

At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread throughout the world. Identifying patients at highest risk for severe disease is important to facilitate early, aggressive intervention and to mitigate the crises occurring throughout the world. Biomarkers were needed for patient stratification into those likely to develop severe disease and with high risk of mortality. Present study aims to find out those indicators.Total patients admitted over a period of 1 year from 1st April 2020 to 31th March 2021 in Dedicated COVID Hospital of RNT Medical College and MB hospital Udaipur was 4304 out of which 620 died and 3498 got discharged, 186 couldn't be followed up as they took leave against medical advise. From death group (620 patients) and Survival group (3498 patients), 400 patients were selected randomly from each group and were analysed and comparison was made between both the groups including parameters like ALC(Absolute lymphocyte count), NLR(Neutrophil Lymphocyte)ratio and RDW(Red cell distribution width).Median age in death and survival group was 62.03 and 47.18 respectively. Mean Absolute lymphocyte count was 0.88 and 0.93 in death and survival group respectively. Mean Neutrophil -Lymphocyte ratio in death and survival group was 8.37 and 4.34 respectively. Mean RDW- CV was 1.86 and 1.67 in death and survival group respectively.From the present study we conclude that Decreased ALC and Elevated NLR are a reliable indicator of death as an outcome in COVID 19 disease whereas RDW was high in COVID19 patients but had no significant relationship with outcome of the disease.

Hepatoblastoma is one of most common types of liver cancer. However it is comparatively a rare variety of solid tumor in paediatric age. The disease usually affects children below the age of 3 years. Hepatoblastoma (HB) accounts for 79 % of all the liver tumors in children. Though it is usually seen in childhood, few cases of hepatoblastoma has also been reported in adults worldwide. Studies suggest the disease is more common in males as compared to females. The etiology of HB has not been yet fully understood. Alpha Feto Protein (AFP) is a sensitive and specific marker of the tumor for early diagnosis and monitoring. The complete surgical resection is the most important modality of treatment. Chemotherapy has been proven beneficial in both adjuvant and neo-adjuvant treatment. However inspite of all these available therapies, the prognosis of hepatoblastoma in adults is yet to be fully understood.

Schwartz Jampel syndrome is a very rare genetically heterogenous disorder characterized by myotonia, typical facies, growth retardation and osteoarticular changes. Prevelance of this syndrome is1 in 100000. 150 cases have been reported in medical literature so far. We hereby report this rare syndrome in neurology.

Benign glandular enlargement of male breast is called gynaecomastia.Various drugs have been implicated as the cause. Most widely used HAART regimen TLE is enlisted in least common cause of gynaecomastia. A 42 yr old male diagnosed HIV seropositive since last 10 yrs was put on TLE regimen and he presented with gynaecomastia since 11 months. We hereby report this finding on HAART.

Marchiafava-Bignami Disease (MBD) is a progressive neurological disease, characterized by corpus callosal demyelination and necrosis and subsequent atrophy. It is usually seen in the context of alcoholism and malnutrition. Clinical diagnosis of this disease is quite challenging due to various presentations but a high degree of suspicion often leads to the correct diagnosis with help of neuroimaging. We report a case of MBD with a classical clinical course and typical radiological features. This case is highlighted in order to generate awareness regarding this uncommon but historic complication of chronic alcoholism.

A 27 years old female was admitted to our hospital with complaints of swelling of feet and abdomen, pain abdomen and exertional dyspnea from last 1 week. On examination she was found to have congestive heart failure. Chest x-ray revealed mild cardiomegaly with left pleural effusion and electrocardiography showed right axis deviation with right ventricular hypertrophy. By echocardiography she was diagnosed to have double chambered right ventricle without any other congenital heart anomaly. She was started on medical treatment following which she recovered well and she was advised for surgery. This case is unique as usually double chambered right ventricle is associated with other cardiac malformations, common ventricular septal defect, pulmonary stenosis and aortic stenosis but no such association was present in this case.

Background: Diabetes mellitus is an endocrine disorder which involves multiple organ systems and leads to significant morbidity and mortality. Diabetes mellitus has been defined as “A metabolic syndrome characterized by chronic hyperglycemia and disturbance of carbohydrate, fat and protein metabolism associated with absolute or relative deficiency in insulin secretion and or insulin action”. Thyroid diseases are also a common endocrinopathy seen in the adult population. Thyroid hormones are intimately involved in cellular metabolism. The present work is a modest attempt to study the prevalence of thyroid disorders in patients with type 2 diabetes mellitus.Methods: The study was carried out in total 108 diabetic patients without known thyroid disorder admitted in various Medical wards of R.N.T. Medical college and attached group of hospitals, Udaipur. It was a cross Sectional study done over a period of 10 months. Results: In the present study, 13% of patients with type 2 diabetes mellitus had abnormal thyroid profile. Out of which the most common presentation was sub clinical hypothyroidism found in 9.25% followed by1.9% had overt hypothyroidism and 1.9% had sub clinical hyperthyroidism. In persons with abnormal thyroid profile 85.7% were females and 14.3% were males which was statistically significant.Conclusions: Prevalence of thyroid dysfunction is common among T2DM patients and is higher in females than in males. There is no significant correlation between thyroid dysfunction and age, diabetes control, family history, type of treatment and HbA1c level in diabetic patients.