Sunil Kumar

Parsonage–Turner syndrome (neuralgic amyotrophy) typically begins with severe shoulder pain, followed by patchy upper limb weakness. In an estimated 4–10% of cases pain is absent, making the diagnosis easy to miss. We describe a man in his late twenties who woke to find he could not lift his left arm beyond 15 degrees of abduction. Examination showed weakness across the left brachial plexus territory, maximal in the deltoid at MRC 2/5, with serratus anterior, supraspinatus, infraspinatus, biceps, brachioradialis and triceps at 3/5, scapular winging on resisted forward push, and preserved grip. He had tingling over the left shoulder but no pain and no sensory loss; a viral illness had resolved one week earlier. Deep tendon reflexes were absent in the left upper limb. MRI of the brain, cervical spine, and brachial plexus (day 1) and nerve conduction studies (day 2) were reported as normal. Repeat brachial plexus MRI on day 3 showed STIR hyperintensity in the left-sided trunks and divisions, supporting a diagnosis of probable neuralgic amyotrophy. Needle electromyography was not performed during the acute illness, so the diagnosis was not established electrophysiologically. Intravenous methylprednisolone and physiotherapy were given, and power was MRC 5/5 throughout the limb at four weeks. At 20 months he remained asymptomatic, but the left axillary compound muscle action potential amplitude was approximately half that of the contralateral side, having been the larger of the two on day two. Painless neuralgic amyotrophy is under-recognised, and normal early investigations do not exclude it. Repeat imaging provided supportive evidence in this patient, though the two examinations were not acquired with identical parameters and a single case cannot establish how often this occurs.

Chronic obstructive pulmonary disease (COPD) continues to pose a major global health burden, leading to high rates of illness and death across the world. The Dyspnoea, eosinopenia, consolidation, acidemia, atrial fibrillation (DECAF) score is an established prognostic tool in patients hospitalized for COPD. But a modified DECAF (mDECAF) score, in which atrial fibrillation is replaced by frequency of hospitalizations, has recently emerged as potentially more practical, especially in low-resource environments. This study aimed to evaluate the DECAF score as a prognostic indicator and compare its performance with the mDECAF score in predicting mortality, ventilatory support requirements, and hospital length of stay in patients with acute exacerbation of COPD. A prospective hospital-based observational cross-sectional study was conducted over two years in the Department of Medicine at a tertiary care hospital in Wardha, Maharashtra, India. A total of 100 diagnosed COPD patients meeting inclusion criteria were enrolled. Detailed clinical evaluation, investigations, and application of DECAF and mDECAF scores were performed. Outcomes were recorded and analyzed. Of the 100 patients, 72% were aged >60 years, and 61% were male. The mean±SD DECAF and mDECAF scores were 2.59 ± 1.66 and 2.71 ± 1.81, respectively. Overall mortality was 26%, 51% required ventilatory support, and the mean hospital stay was 4.47 ± 4.02 days. Patients who improved had significantly lower scores than those who died (DECAF: 1.97 ± 1.28 vs. 4.35 ± 1.35; mDECAF: 2.04 ± 1.44 vs. 4.62 ± 1.33; p < 0.001). Similarly, ventilated patients had higher scores than non-ventilated patients (DECAF: 3.59 ± 1.54 vs. 1.55 ± 1.04; mDECAF: 3.84 ± 1.67 vs. 1.53 ± 1.02; p < 0.001). Both DECAF and mDECAF showed strong correlations with hospital stay (r = 0.6 and 0.7, respectively; p < 0.001) and were strongly intercorrelated (rho = 0.96; p < 0.001). The area under the receiver operating characteristic curve (AUROC) for predicting mortality was 0.882 (95% CI: 0.800–0.964) for DECAF and 0.888 (95% CI: 0.819–0.957) for mDECAF (both p < 0.001). At a cutoff ≥4, DECAF predicted mortality with 81% sensitivity and 89% specificity, while mDECAF showed 77% sensitivity and 86% specificity. Higher DECAF and mDECAF scores were significantly associated with increased mortality, need for ventilatory support, and longer hospital stay in patients with acute exacerbations of COPD, with both scores demonstrating excellent and comparable prognostic performance.

Background: In critical care, comorbidities significantly influence outcomes, but they are often underutilized in real-time decision-making. The Charlson Comorbidity Index (CCI), a widely validated tool for quantifying comorbid burden, offers a practical way to assess prognosis in intensive care unit (ICU) patients. This study was planned to explore the predictive utility of CCI alone in determining patient outcomes in a rural Indian ICU setting. Methodology: This prospective, cross-sectional study was conducted from April 2023 to March 2025 at a tertiary care center in central India. A total of 700 adult patients admitted to the medical ICU were included, excluding those with 3 were significantly older (mean age: 58.9 years) compared to those with CCI p < 0.001). The receiver operating characteristic (ROC) analysis revealed a fair predictive capacity of CCI for in-hospital mortality, with an area under the curve (AUC) of 0.635. At an optimal cutoff of 3.5, the CCI demonstrated good sensitivity (80.9%) but limited specificity (29.6%). Conclusion: The CCI is a valuable, easy-to-use tool for assessing the prognostic outlook of ICU patients, especially in low-resource settings. Although its standalone predictive power for mortality is moderate, its high sensitivity makes it a useful screening tool to identify high-risk patients early during ICU admission. The findings underscore the need to incorporate structured comorbidity assessment into critical care workflows, particularly where advanced physiological scoring systems may not be readily available.

A BSTRACT: Background: A glucose homeostasis condition known as insulin resistance (IR) is characterized by a decreased sensitivity of adipose tissue, muscle fiber, liver, and other bodily tissues to insulin, even in the presence of normal or elevated blood concentrations of the hormone. Nevertheless, it is uncommon to evaluate the comorbidity of insulin resistance and thyroid discrepancies, particularly the order in which these indicators appear. This study emphasizes the association between hypothyroidism and insulin resistance. Material and Method: Eighty individuals with suspected thyroid illness or related problems were recruited for this cross-sectional study at the AVBR Hospital in Wardha between December 2020 and September 2022. The participants were categorized as having subclinical hypothyroidism, overt hypothyroidism, or controls based on the thyroid indicators detected in their serum. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was used to perform the calculations. A Chi-square test was used in addition to control to examine the relationship between insulin resistance and thyroid function. Results are considered statistically significant only if the P value is less than 0.05. Results: Levels of HOMA-IR were lowest in the Controls (1.65), followed by the Subclinical Group (2.03), and highest in the Overt Group (5.00). HOMA-IR had a significant positive relationship with thyroid stimulating hormone, fasting insulin, and fasting blood sugar (FBS). The prevalence of insulin resistance was 64.3% in overt hypothyroid patients and 36% in subclinical hypothyroid patients. In contrast, it was 21% in the control group of hypothyroid patients on thyroxine therapy for over two months. Conclusion: Thyroid levels and the IR were significantly correlated. The prevalence of insulin resistance was 64.3% in overt hypothyroid and 36% in subclinical hypothyroid in this part of rural area. Therefore having awareness at the primary care physician level may prevent its morbid complications even assessed.

Introduction This study examined acute febrile illness (AFI) patients for several epidemiological and etiological factors. Acute febrile fever can result from various illnesses, including dengue, malaria, leptospirosis, and scrub typhus. The ranges of clinical outcomes of these cases were investigated as well. Methods This retrospective observational study was conducted from January 2023 to January 2024 for one year in the Medicine Department of Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research (Deemed to be University), a tertiary care teaching medical college in Wardha District of Maharashtra in Central India. Six hundred patients with acute febrile illness who tested positive for leptospirosis, dengue, scrub typhus, and malaria were included in the study. A pre-made proforma was used to record the data. Results Out of 600 patients, 150 (25%) were dengue, malaria (62 (10.3%)), scrub typhus (45 (7.5%)) cases, and leptospirosis (41 (6.8%)) cases. In 150 cases of dengue, 63 (42%) had hepatitis as a complication at the time of presentation. Twenty-seven (43.55%) had presented with shock in 62 patients of malaria, 13 (31.71%) had acute respiratory distress syndrome (ARDS) and pneumonia in 41 cases of leptospira, and 13 (28.8%) had hepatitis in 45 cases of scrub typhus patients. Among 38 deaths, three (2%) died due to dengue, two (3.23%) due to malaria, one (2.44%) due to leptospirosis, one (2.44%) due to scrub typhus, and 31 (10.36%) due to acute febrile illness. Conclusion Dengue, malaria, scrub typhus, and leptospirosis were the four primary illnesses that led to AFI in hospitalized patients, with dengue being the most prevalent. Using a mix of clinical, epidemiological, and laboratory information, a pertinent action plan should be created to treat and prevent such fevers in any hospital setting.

Export Introduction: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular diseases, leading to higher morbidity and mortality rates compared to the general population. The Clinical Disease Activity Index (CDAI) is a validated composite index used to assess disease activity in patients with RA, which may guide therapeutic decisions and help monitor disease progression or response to treatment. This study highlights about cardiovascular evaluations at all stages of rheumatoid disease activity as per CDAI. Materials and Methods: In this prospective cross-sectional study, 55 patients aged >18 years diagnosed with RA admitted to the Medicine Department of Jawaharlal Nehru Medical College at Wardha from July 2022 to June 2024 were included in the study. The presence of left ventricular (LV) systolic, diastolic function, ejection fraction (EF), pericardial effusion, and pulmonary hypertension was confirmed by a two-dimensional echo at the time of hospital admission. Results: Out of 55 patients with RA enrolled in the study, the mean age was 53.10 ± 12.68 years having a CDAI score of more than 22. There was a significant difference between the four groups in terms of EF (P ≤ 0.001), being highest in the total CDAI score category of ≤2.8 group. There was a significant difference between the various groups in terms of LV diastolic dysfunction (LVDD, P = 0.002). Participants in the group total CDAI score category of >22 had the largest proportion of LVDD. Conclusion: We have found that most of the patients with RA had echocardiographic abnormality. The most common echocardiographic abnormality was LVDD, followed by pericardial effusion. In this study, we have highlighted about cardiovascular complications in RA as per CDAI score and published data regarding that were limited.