Background: Diabetes mellitus is fast becoming the epidemic of the 21st century. It is a metabolic disease that affects multiple organ system in the body including bone metabolism and bone mass. There is high prevalence of decreased bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) patients leading to osteoporosis, osteopenia and fracture. The aim of the present study was to find the magnitude and correlates of altered BMD in T2DM patients of central rural India.Methods: This cross-sectional study was carried out at a tertiary care teaching hospital in central rural India from 2014 to 2016. It comprises of 200 T2DM patients with aged ≥35 years. Bone mineral density measurements were done by using peripheral dual energy X-ray absorptiometry (DEXA).Results: Mean age of study subjects was 56.13±11.12 years with 43.5% males and 56.5% females. Our study results showed the magnitude of decreased BMD was 82%. 53% of the study subjects were osteoporotic and 29% were osteopenic. Significant associations were detected between decreased BMD and old age, female gender, high body mass index, high fasting blood sugar, high HbA1c and low serum calcium on multivariate analysis.Conclusions: The prevalence of decreased BMD in patients with T2DM of central rural India is high, especially in females’ patients, obese patients, and uncontrolled diabetic patients. Awareness amongst the health care provider of this changes will directly affect the treatment decisions for patients, thereby preventing osteoporosis, osteopenia and mitigating potential fracture risk.

Introduction Human immunodeficiency virus (HIV) is a disease that affects millions of people globally and affects almost all the body systems including bone metabolism. Derangement of bone mineral density (BMD) in HIV patients is well established in international literature but least studied in India. Therefore, this study aims to determine the association between BMD change and HIV infection with or without antiretroviral therapy (ART) and compare the different regimens of ART. Materials and Methods The cross-sectional study was conducted at the Department of Medicine and ART Center of Regional Institute of Medical Sciences, Imphal, India. A total of 50 HIV patients were screened by a central dual-energy X-ray absorptiometry (DEXA) examination for measuring BMD. Correlation of BMD with a CD4 count, and different ART regimens were also studied. Results In our study, majority of the patients (29 [58%]) had low BMD. Of the 29 patients, 18 (36%) had osteopenia and 11 (22%) had osteoporosis. Of the ART naïve patients, 81.8% have reduced BMD. Among different ART regimens, tenofovir-based regimes were mostly associated with low BMD (52.4%). A statistically significant association between low CD4 count and low BMD was found. Conclusion Our study concluded that HIV infection is associated with bone loss and low BMD in people living with HIV (PLHIV) irrespective of its treatment with ART. PLHIV are at a greater risk of bone loss secondary to decreased BMD. Among the ART regimens, tenofovir-based regimens are mostly associated with low BMD. Therefore, all HIV patients should be screened by DEXA scan for BMD status, and timely intervention should be started.

One of the common causes of superior vena cava (SVC) syndrome is malignancy of the lung. The invasion of SVC leads to opening of the various venous channels for continuation of the blood flow from upper extremity and proximal trunk and finally draining into right atrium. Vein of Sappey is one of these channels and it causes focal striking enhancement in segment IV of the liver on arterial phase of contrast computed tomography (CT). This enhancement causes diagnostic difficulty and unnecessary biopsy due to misinterpretation of it as a secondary from lung cancer. Awareness and accurate diagnosis can avoid further examination in such patients. It can also provide an idea of a more proximal major thoracic vessel obstruction if first detected on CT of the abdomen (contrast).

Background: Stroke is defined as abrupt onset of symptoms and/or sign of focal and global loss of cerebral function lasting for at least 24 hrs with no apparent cause other than of vascular origin. Dyslipidemia in stroke is not widely studied especially from the population of Northeast India (Manipur). Moreover, most prior studies did not specifically compare hemorrhagic stroke risk among those with elevated lipid levels to those with optimal or near optimal lipid levels. Therefore, we studied the levels of different Lipids in stroke patients (hemorrhagic and ischemic) to understand its role in pathogenesis of stroke.  Methods: This cross-sectional study was conducted in RIMS, Manipur from 2017-2019 and included 185 patients above 18 years with stroke within 48 hrs of onset of symptoms. NCCT brain and serum lipids, other related blood investigations were performed.Results: We found that serum total cholesterol, LDL-C and triglycerides are significantly higher in infarction patients with average levels of 210.82 mg/dl, 143.64 mg/dl and 151.50 mg/dl respectively which is statistically significant (p<0.001). The average serum total cholesterol, LDL-C and triglycerides are significantly lower in ICH patients with average levels of 143.34 mg/dl, 84.67 mg/dl and 113.94 mg/dl respectively which is statistically significant. (p<0.001).Conclusions: We concluded that raised level of serum total cholesterol, serum LDL-C, serum triglyceride are associated with cerebral infraction (p=0.001) and lower level of serum total cholesterol, serum LDL-C, serum triglyceride are associated with cerebral hemorrhage (p=0.001). Thus, serum lipid levels should be carefully monitored to prevent life threatening stroke.

Introduction India has third largest human immunodeficiency virus (HIV) population in the world. Average HIV prevalence was 0.22% (range, 0.16–0.30%) in 2017, and Manipur is one of the five states with the highest prevalence of HIV. Cryptococcal meningitis being one of the acquired immunodeficiency syndrome (AIDS)-defining illnesses is the second most common cause of opportunistic neuro-infection and usually occurs in advanced HIV disease when the cluster of differentiation 4 glycoprotein (CD4+) count is usually less than 100 cells/µL. Treatment includes amphotericin-B induction therapy for 2 weeks followed by fluconazole consolidation therapy for 8 weeks as per National AIDS Control Organisation guidelines. There is not much data on how much infection is cleared off after induction and consolidation treatment. So, this study was conducted to know the clearance of Cryptococci in cerebrospinal fluid (CSF) after induction and consolidation treatment in people living with HIV (PLHIV)-associated cryptococcal meningitis. Objective This work aimed to study the persistence of cryptococcal meningitis after amphotericin-based 2 weeks of induction therapy and 8 weeks of consolidation therapy with fluconazole and to evaluate the association between CD4 count and clearance rate of cryptococcal infection. Materials and Methods The study was conducted in Department of Medicine, Regional Institute of Medical Sciences, Imphal, from 2016 to 2018. Fifty-one patients above 18 years of age diagnosed as cryptococcal meningitis with HIV were included and treated with amphotericin for 2 weeks and fluconazole for 10 weeks. CSF analysis was done at 2nd and 10th weeks to study the clearance of infection. Results At 2nd week of induction therapy, out of 51 patients, 28 (54.9%) got cleared of infection, 18 (35.3%) had persistent infection, and 5 (9.2%) patients had either died or discontinued treatment. At 10th week of consolidation therapy, 36 (70.5%) patients got cleared of cryptococcal infection, 2 (4%) patients were having persistent infection, and 5 (9.8%) patients died, while 8 (15.7%) patients were lost in follow-up. However, after excluding mortality and lost in follow-up cases, from analysis in final outcome, 94% (34 out of 36) patients showed response to this regimen. Conclusion The present study showed that cryptococcal meningitis in PLHIV responded to amphotericin-based induction therapy with 60% clearance of infection followed by fluconazole-based consolidation therapy with 94% of clearance of infection. However, there is still need for good antifungal regimen that could clear infection in induction phase with less side effects.