Multiple myeloma presenting as isolated sixth cranial nerve palsy

Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We report a case of a 30-year-old man who developed sudden onset left-sided complete abducens nerve palsy without pain. Cranial and orbital magnetic resonance imaging and cerebrospinal fluid examination demonstrated no abnormalities. He was diagnosed as having IgG type multiple myeloma, based on the immunological and pathological investigation. After instituting chemotherapy, palsy resolved within 3 weeks. Etiology is not established beyond doubt but probably palsy was caused by nerve ischemia due to hyperviscosity of the serum.

Induced supersolidity in a Dy-Er mixture

Recent experimental realization of the heteronuclear dipolar mixture of Dy and Er atoms opens fascinating prospects for creating intriguing novel phases in dipolar quantum gases. The experimentally measured value of intra-species $s$-wave scattering length of $^{166}$Er condensate in a $^{164}$Dy-$^{166}$Er mixture is larger than its intra-species dipolar length, implies that the $^{166}$Er condensate itself will not be in a regime of dominated dipole-dipole interaction (DDI). However, we find that the presence of $^{164}$Dy atoms with high magnetic moment induces droplet nucleation and supersolidity in $^{166}$Er condensate via the long-range and anisotropic inter-species DDI. Remarkably, we find that the imbalance in the magnetic dipole moment combined with its strong anisotropic coupling led to the emergence of unique ground state phases. The emerging phases include doubly superfluid states, a mixture of insulating droplets and supersolid states, binary supersolids with uniform and alternating domains and a combination of supersolid-superfluid mixed states. We delineate the properties of all these ground state phases and construct a phase diagram. We also explore the dynamical evolution across these phase boundaries via a linear quench of inter-species scattering length. Although we have demonstrated the result for the $^{164}$Dy-$^{166}$Er mixture, our results are generally valid for other dipolar bosonic mixtures of different Dy-Er isotope combinations and may become an important benchmark for future experimental scenarios.Comment: 11 pages, 8 figure

Two-dimensional miscible-immiscible supersolid and droplet crystal state in a homonuclear dipolar bosonic mixture

The recent realization of binary dipolar BEC [Phys. Rev. Lett. 121, 213601 (2018)] opens new exciting aspects for studying quantum droplets and supersolids in a binary mixture. Motivated by this experiment, we study groundstate phases and dynamics of a Dy-Dy mixture. Dipolar bosonic mixture exhibits qualitatively novel and rich physics. Relying on the three-dimensional numerical simulations in the extended Gross-Pitaevskii framework, we unravel the groundstate phase diagrams and characterize different groundstate phases. The emergent phases include both miscible and immiscible single droplet (SD), multiple droplets (MD), supersolid (SS), and superfluid (SF) states. More intriguing mixed groundstates may occur for an imbalanced binary mixture, including a combination of SS-SF, SS-MD, and SS-SS phases. We observed the dynamical transition from a miscible MD state to an immiscible MD state with multiple domains formed along the axial direction by tuning the inter-species scattering length. Also by linear quenches of intra-species scattering lengths across the aforementioned phases, we monitor the dynamical formation of supersolid clusters and droplet lattices. Although we have demonstrated the results for a Dy-Dy mixture and for a specific parameter range of intra-species and inter-species scattering lengths, our results are generally valid for other dipolar mixtures and may become an important benchmark for future experimental scenarios.Comment: 15 pages, 14 figure

Rayleigh-Taylor instability in a phase-separated three-component Bose-Einstein condensate

We investigate the Rayleigh-Taylor instability at the two interfaces in a phase-separated three-component Bose-Einstein condensate in the mean-field framework. The subsequent dynamics in the immiscible three-component condensate has been studied in detail for different cases of instigating the instability in the system. The rotational symmetry of the system breaks when the atom-atom interaction is tuned in such a way that the interface between the components becomes unstable giving rise to non-linear patterns of mushroom shapes which grow exponentially with time. We also identify these non-linear patterns as the solutions of the angular Mathieu equation, representing the normal modes.Comment: 12 pages, 11 figure

A study on prognostic significance of serum uric acid in acute myocardial infarction in a tertiary care institute

Background: This study was done to find out any relationship between serum uric acid and AMI severity and its short-term outcome. To see the correlation between serums uric acid level with Killip Class and mortality outcome following AMI.Methods: 100 patients of AMI were included this study based on the inclusion and exclusion criteria. Detailed history, physical examination and relevant systemic examination including detailed examination of CVS system were done as per a structured proforma and necessary laboratory investigations were done.Results: 100 cases of myocardial infarction were studied, out of which 90 patients had STEMI and 10 patients had NSTEMI. There is significant difference of D0 uric acid level was observed for previous history of AMI. There is significant difference in mean uric acid level between dyslipidemic and non-dyslipidemic population. There is significant difference in mean uric acid level on D0 between diabetic and non-diabetic population. Serum uric acid level is low among patients with lower Killip class and high among higher Killip class. Lower the uric acid level, higher the percentage of survival and higher the uric acid level, higher the percentage of mortality.Conclusions: Patients of Killip class lll and lV had higher levels of uric acid as compared to patients of class l and ll. Combination of Killip class and serum uric acid level after acute myocardial infarction is a good predictor of severity of heart failure after AMI

Etiological study of generalized lymphadenopathy in a tertiary care hospital

Background: This study was done to know about the clinical biochemical as well as radiological profile of patients presented as generalized lymphadenopathy in a tertiary care centre and to know the different causes of generalized lymphadenopathy.Methods: 116 patients of generalized lymphadenopathy were included this study based on the inclusion and exclusion criteria. Detailed history, physical examination and relevant systemic examination including detailed examination of lympho-reticular system were done as per a structured proforma and necessary lab investigations were done for confirming diagnosis.Results: Among 116 patients of generalized lymphadenopathy 59.5% were non-malignant causes where 40.5% diagnosed as malignant causes. Among them tuberculosis consist of 39 (33.6%), NHL 18 (15.5%), reactive lymphadenopathy 16 (13.8%), CLL and HD 8 (6.9%) each, ALL 7 (6%), SLE 5(4.3%), Kikuchi’s disease 4 (3.4%), AML and RA 3 (2.6%) each and castleman’s disease, phenytoin lymphadenopathy, metastatic lung and breast carcinoma 1 (0.9%) each. Cervical groups of lymph nodes were most commonly involved 86 patients (74.1%) followed by axillary groups 73 patients (62.9%). Lymph nodes size 1.5cm were due to malignant and non-malignant granulomatous cases. FNAC give definite diagnosis 80.9% malignant cases where 76.8% in non-malignant cases. HPE shown definite diagnosis in 100% cases both malignant and non-malignant diseases.Conclusions: Tuberculosis is most common cause of generalized lymphadenopathy followed by lymphoma. And reactive lymphadenitis is also an important consideration.

Basal-bolus insulin therapy during switching over from continuous intra venous regular insulin to sub cutaneous insulin therapy as compared to conventional regimens in type-2 diabetes patients admitted

Background: According to the World Health Organization (WHO), over 347 million people worldwide have diabetes. Latest estimates reveal that 25.4 million Americans have diabetes mellitus (DM), with up to 95% of those having type 2 DM. This study was done to know the effects of Glargine insulin plus human regular insulin on blood sugar control while switching over from continuous IV insulin infusion to SC route as compared to conventional SC insulin regimens in CCU setup.Methods: 65 patients of T2DM were included this study. Detailed history, physical examination and relevant systemic examination were performed and necessary lab investigations were done.Results: The mean age was 49.52±10.16. Mean FPG on 1st Day: The p value of B-B against PRE is significant. Mean FPG on Day of discharge: The p value of B-B against PRE is significant and B-B against NPH is also significant. Mean FPG 2Weeks after discharge: The p value of B-B against PRE is significant and B-B against NPH is also significant. Mean PPPG on 1st Day: The p value of B-B against NPH is significant. Mean PPPG on day of discharge: The p value of B-B against PRE is significant. Mean PPPG 2weeks after discharge: The p value of B-B against PRE is significant. Hypoglycemia was occurring in 25, 15, and 25 in BB, NPH, and PRE group respectively. The p value is significant when NPH compared to PRE.Conclusions: B-B regimen was better than other regimen for controlling FPG and PPPG. The insulin dose was high in NPH regimen compared to both B-B and PRE regimens. 

A study of stroke patients with respect to their clinical and demographic profile and outcome

Background: The incidence of cerebrovascular diseases increases with age and the number of strokes is projected to increase as the elderly population grows, with an effect of doubling in stroke deaths in the United States by 2030. This study was done to know the clinical demographic profiles and outcome of the patients presented with stroke in a tertiary care centre.Methods: 501 patients of stroke were included this study. Detailed history, physical examination and relevant systemic examination including detailed examination of neurological system were performed and necessary lab investigations were done.Results: Among 501 stroke patients 90 (18%) patients were of young and 236 (47.1%) of elderly (>60years). Among them 435 (86.8%) were hypertensive and 130 (25.9%) had H/O diabetes and 160(75.83%) had dyslipidemia. In CT scan or MRI of brain, 125 (25%) had lacunar infarction, 76 (15.1%) had non-lacunar infarction, 180 (35.9%) had parenchymal hemorrhage with no ventricular extension and 120 (24%) had parenchymal hemorrhage with ventricular extension. All patients who expired (n=95) presented with poor GCS (≤8) on admission regardless of the stroke subtypes. Among all lacunar infarctions, 92% occurred in hypertensive individuals and among all hemorrhagic strokes, 93.33% occurred in hypertensive patients. Non-lacunar infarction is the most common type of stroke among non-hypertensives (54.55%). And infarction is the most common type of stroke events in diabetics.Conclusions: Stroke can occur at any age, but the elderly persons are more commonly affected with a slight predilection to male. The hemorrhagic stroke outnumbers the ischemic stroke mainly because of uncontrolled hypertension. The GCS at presentation can predict the stroke outcome. Risk factors of stroke include Hypertension, smoking, high cholesterol and Diabetes, obesity, lack of exercise, and genetic factors

Study of relation of serum magnesium level with glycemic control in diabetes mellitus

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of DM are caused by a complex interaction of genetics and environmental factors. This study was done to evaluate the relation between serum magnesium and glycemic control in diabetics.Methods: 50 patients of T2DM were included this study. Detailed history, physical examination and relevant systemic examination were performed and necessary laboratory tests FBS, PPBS, HbA1c, magnesium level were doneResults: The mean age (mean± SD) of the patients was 49.82±7.38 years with range 29-58 years and the median age was 51 years and Male 32 (64%), Female 18 (36%), M:F= 1.78:1. In this study, statistically significant correlation was found between level of magnesium and age (p=0.04). In present study no statistically significant association was found between level of magnesium and sex (p=0.738). In high magnesium level (≥1.7), mean BMI 25.08±2.82 whereas mean BMI 24.25±2.87 in low magnesium level (<1.7) and this difference was not statistically significant (p=0.308). Mean difference of FBS with magnesium level was statistically significant (p<0.001) and mean difference of PPBS with magnesium level was also statistically significant (p<0.001). It was also found that mean difference of HbA1c level with magnesium level was statistically significant (p<0.001).Conclusions: This study clearly depicts that in diabetes mellitus serum magnesium levels had a positive correlation with glycemic control. Serum levels of magnesium have been found to correlate inversely with fasting blood glucose concentration, post prandial blood glucose concentration and the percentage of HbA1c. The study also establishes a positive correlation of magnesium with age