BACKGROUND Peripheral cytopenia is defined as reduction in either of the cellular elements of blood, i.e. red cells, white cells, or platelets. The aetiology varies widely ranging from transient marrow suppression by viral infections to marrow infiltration by lifethreatening malignancy. Megaloblastic anaemia is not uncommon in India. Diagnosing this disease assumes great clinical importance since it responds exceedingly well to treatment. OBJECTIVES To study the aetiology and clinical profile of patients with cytopenias with special reference being made for cytopenias in megaloblastic anaemia. MATERIALS AND METHODS An observational study was conducted on 149 patients who presented with cytopenias to the Dept. of General Medicine and Dept. of Haematology, GMCH, Guwahati, during the period of June 2014 to May 2015. Their clinical profile, complete haemogram, and bone marrow examination were studied. RESULTS A total of 149 patients with cytopenia were studied. The patients were predominantly males with mean age of 37 years. Bicytopenia (59.7%) was more commonly seen than pancytopenia (40.3%). The most common cause of cytopenia was Megaloblastic Anaemia (28.2%) followed by Acute Myeloid Leukaemia (22.1%). Majority of the patients presented with Generalised Weakness (94.6%) and Fatigue (74.5%). Most common physical finding was Pallor (94.6%) followed by Splenomegaly (40.3%) and Hepatomegaly (36.2%). Of the 42 patients with Megaloblastic Anaemia, majority of the patients had a macrocytic (71.5%) peripheral blood smear followed by dimorphic picture (21.3%) of which all but 7 patients had hypersegmented neutrophils. Bone marrow examination was done in 31 patients of megaloblastic anaemia, which showed mainly a hypercellular marrow (83.8%). CONCLUSION A detailed clinical history and meticulous physical examination along with a complete haemogram and bone marrow examination in patients presenting with cytopenias is useful in diagnosing the aetiology and initiating quick management.

BACKGROUND Diabetes mellitus is a metabolic disorder which is characterized by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. Globally, the prevalence of diabetes among adults is estimated to be 537 million in 2021 and is expected to be 783 million by 2045. Most patients with DKA recover when treated appropriately but if remained untreated, may lead to complications and rise in mortality and morbidity. Hence, early identication of ketoacidosis and aggressive management with insulin, intra-venous uids and electrolytes replacement may change the outcome of the disease. A hospital based METHODOLOGY observational study recruited 60 patients of age more than 12 years admitted under the Department of Medicine, GMCH with Diabetic Ketoacidosis from 1stJuly 2020 to 31st June 2021. DKA was seen in all the age RESULTS groups but predominantly in middle-aged patients in 41-50 years age group (28%) with male predominance (Male:Female ratio =1.7:1). The incidenceof DKA was more among Type 2 Diabetes (76.7%) than with Type 1 Diabetes (23.3%) . Mortality of patients in the study was found to be 18.3%, which was higher in comparison to standard literature. Most of the patients in the study presented with nausea, vomiting and pain abdomen (28.30%). Sepsis and inadequate therapy (31.6% and 20.0%) were the leading precipitating cause of DKA Among the patients, 33.33% presented with severe DKA at the time of presentation and it was also observed that there is signicant correlation between severity of the disease and mortality (P <0.05). Patients with Poor GCS, raised serum creatinine, blood urea, serum calcium, alanine transaminase, aspartate transaminase and total serum bilirubin has signicant correlation with mortality (P value <0.05). However, the body mass index, blood sugar, pH, serum bicarbonate, sodium, potassium, magnesium, albumin, triglyceride, glycosylated haemoglobin, total leucocyte count and haemoglobin levels at the time of presentation do not have a signicant correlation with mortality (P value >0.05). It was observed from CONCLUSION our study that contrary to standard literature, the incidence of DKA is more common in adults than children. DKA was signicant in patients with type 2 diabetes in our series of patients and hence further studies are necessary to re-evaluatethis observation. CONFLICT OF INTEREST None

BACKGROUND Guillain-Barre syndrome (GBS) is a rare, immune mediated disorder which is associated with demyelination of peripheral nervous system and progressive muscle weakness, with an annual global incidence of approximately 1–2 per 100,000 person-years. GBS has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Recent advances in the eld of critical care has successfully improved the outcome of GBS. Successful management mandates anticipation, prompt recognition of modiable risk factors and optimal treatment of neuromuscular respiratory failure in GBS. There is limited Indian data with regards to the early determinants and outcome of severely affected GBS patients. Knowledge of early predictors can substantially improve patient care and provides essential data for triage at an early stage in the course of the illness. OBJECTIVE 1. To study the clinical, electrophysiological prole, progression and outcome of GBS in a tertiary care hospital. 2. To determine the factors associated with the poor functional outcome, including the need for mechanical ventilation. MATERIALS AND METHODS This was a single centre, prospective study with 50 patients with GB syndrome, conducted from from 1st June 2021 to 30th May 2022 for a period of 1 year at Gauhati Medical College and Hospital. Their clinical, electrophysiological, CSF parameters were analysed. Hughes grading, EGRIS, mEGOS, MRC sum score were used. Any clinical deterioration and need for mechanical ventilation were noted carefully. Patients were followed up at 3 months and 6 months at assess their outcome. The mean age of the patients was 30.5 RESULTS years with a male female ratio of 1.3:1. AIDP was the most prevalent subtype found in 23(46%) patients followed by AMAN in 14(28%), AMSAN in 9(18%) and 4(8%) cases were unclassied. 32(64%) had severe disease with Hughes score ≥ 4 and 28(56%) had MRC score <40 at presentation. Respiratory distress was found in 17(34%) of patients, and out of which 10(20%) required mechanical ventilation. During the study 2(4%) patients died of complications. At 3 months, 30(60%) patients had complete recovery, 12(24%) had partial recovery and 6(12%) had poor recovery. At 6 months, 35(70%) had good recovery, 9(18%) had partial recovery and 4(8%) had poor recovery. Delayed CONCLUSION presentation, early peak of illness, prolonged Hospital stay, bulbar weakness, neck exor weakness, bilateral facial weakness, quadriparesis, respiratory distress, need for mechanical ventilation, autonomic dysfunction; high Hughes grading, low average single breath count along with high EGRIS, mEGOS, MRC sum score, high CSF protein, albumin-cytological dissociation, presence of F-wave abnormalities and Non stimulable nerves or Inexcitable nerves on NCS, AMAN subtype and systemic complications are associated with poor outcome. The overall outcome of GBS is favourable.

BACKGROUND Considering the heavy toll taken by COVID- 19 pandemic, the understanding of the epidemiological parameters as well as various risk factors is crucial for future preparedness and tackling the pandemic in a more effective manner. We wanted to study the socio-demographic correlates of COVID -19 cases in Assam, India. Also to find the relationship of clinical status of COVID -19 cases with co- morbidities and with substance use. METHODS An institution-based cross-sectional study was undertaken from 1st April 2020 to 31st August 2020. Out of the total 12 COVID Care Centres / hospitals that had been established in Kamrup and Kamrup Metro districts of Assam, 6 were randomly selected. A total of 3000 patients were interviewed over telephone by using an android-based application; on or after discharge from the centres, while patient was put on mandatory quarantine. The patients were interviewed on various sociodemographic variables, co-morbidities and substance use behaviour. Categorical variables are expressed as percentages and the continuous variables are expressed as mean ± standard deviation. t-test and chi-square test were used for continuous and categorical variables respectively. RESULTS Mean age of moderate and severe cases were 55.10 and 55.9 years respectively. Smoking and use of alcohol were significantly associated with severity of symptoms. Diabetes, hypertension and co-existing lung diseases were found to be associated with status of symptoms. CONCLUSIONS Epidemiological risk factors like age has to be relooked. Primary prevention on risk factors of non-communicable diseases proved to be crucial in prevention of severity of communicable pandemic like COVID-19. Further studies are required to enhance the knowledge on this aspect. KEY WORDS COVID-19, Substance Use, Diabetes, Hypertension, Lung Diseases, Status of Symptoms.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a global issue with smoking being the most important risk factor. Co-existence of both COPD and cardiovascular diseases is very common and has diagnostic, therapeutic and prognostic implications. The cardiac manifestations of chronic obstructive pulmonary disease are numerous. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle leading to the development of pulmonary hypertension, cor pulmonale, right ventricular dysfunction and left ventricular dysfunction. Because cardiac abnormalities clearly contribute to overall morbidity of COPD, an understanding of their role and potential for treatment is vital. The purpose of this study was to evaluate various cardiac manifestations in chronic obstructive pulmonary disease patients and to observe correlation with its severity. METHODS This hospital based observational study was done in Gauhati Medical College and Hospital attending in-patient department (IPD) and out-patient department (OPD) of Department of General Medicine from 1st July 2018 to 30th June 2019. A total of 140 patients were included in this study. RESULTS Majority of the patients were in the age group of 60 - 70 years. Cardiovascular manifestations were most commonly observed in very severe stage of COPD (GOLD IV). Overall, 91 patients had ECG changes. The most common ECG findings were P pulmonale and right ventricular hypertrophy (RVH). Pulmonary arterial hypertension (PAH) and tricuspid regurgitation (TR) were common echocardiography findings. CONCLUSIONS Cardiac manifestations were more prevalent in COPD GOLD III and IV stages and therefore with increasing severity of COPD, occurrence and severity of cardiac complications becomes more prevalent. ECG and echocardiography are essential investigational tools for diagnosing COPD patients with cardiac complications and assessing their severity. However, a prospective study including a larger sample size is required to arrive at a definite conclusion. KEYWORDS COPD, Cardiac manifestations, ECG, Echocardiography, PAH, RVH