Medwin Hospital

Our study aimed to confirm the therapeutic effects of using a trunk stabilization training robot (3DBT-33) in patients with chronic stroke. A total of 38 patients with chronic stroke were randomly assigned to either an experimental or a control group. The robot group (n = 19) received 30 min of trunk stability robot training in addition to conventional physical therapy, while the control group (n = 19) received a similar conventional physical therapy as the robot group. All participants were assessed using the following: the Functional Ambulation Categories (FAC), timed up and go (TUG) test, Berg Balance Scale (BBS), Korean Modified Barthel Index (K-MBI), and Fugl-Meyer Assessment of Lower Extremity (FMA-LE). There were statistically significant improvements in all parameters at follow-up assessment after 4 weeks of intervention (P < 0.05). There were statistically significant differences in the FMA-LE, K-MBI, and BBS between the robot and control groups (P < 0.05). There was no significant difference in FAC (P = 0.935) and TUG (P = 0.442). Minimal detectable change was more significantly observed in the FMA-LE and BBS than in FAC, TUG, and K-MBI. The findings in the present study showed that trunk stabilization rehabilitation training using a rehabilitation robot in patients with chronic stroke was effective in improving the balance and functions in the lower extremities.

Background and Aims:Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre.Methods:Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management.Results:The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P < 0.000) compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day). The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse's response, doctor's response to pain and the overall pain management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively.Conclusion:There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a newly recognized entity caused by monoclonal deposition of IgG. PGNMID resembles immune complex glomerulonephritis (GN) on light and electron microscopy. The monotypic immunoglobulin deposits seen on immunofluorescence (IF) clinches the diagnosis. We report a case of proliferative GN associated MGRS and review the relevant literature. The patient had significant proteinuria and elevated serum creatinine. The renal biopsy showed proliferative GN with focal crescents and monoclonal immune deposits confirming a diagnosis of PGNMID. Serum work up showed no monoclonal proteins. Proliferative GN as a manifestation of a monoclonal gammopathy needs to be borne in mind especially in renal biopsies of older patients.

Aim: Hypothyroidism and metabolic syndrome are well-associated risk factors for atherogenic cardiovascular disease. Insulin resistance, being a common pathogenic mechanism in both, can cause a considerable overlap between hypothyroid and metabolic syndrome population. This cross-sectional study was intended to assess the thyroid function in patients with metabolic syndrome and to investigate the association between hypothyroidism and metabolic syndrome. Materials and Methods: One hundred patients with metabolic syndrome as per National Cholesterol Education Program-Adult Treatment Panel (NCEP ATP) III criteria and 50 controls (0 out of 5 criteria) attending the internal medicine outpatient clinic were included in the study. Patients were subjected to anthropometry, evaluation of vital parameters, and lipid and thyroid profile, along with other routine laboratory parameters. Students' t test, Chi-square test, linear regression, and multiple logistic regression models were used for statistical analysis. P value <0.05 was considered significant. Results: Body mass index, waist circumference, mean systolic pressure, diastolic pressure, fasting blood sugar, total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and thyroid stimulating hormone (TSH) were significantly higher, and free triiodothyronine (FT3), free thyroxine (FT4), and high density lipoprotein (HDL) cholesterol were significantly lower in the study group compared to the control group. In the metabolic syndrome group, 22 had subclinical hypothyroidism (22%), 4 were overtly hypothyroid (4%), and 74 were euthyroid (74%). Subclinical hypothyroidism was significantly associated with metabolic syndrome group (P = 0.032). There was significant linear association between TSH levels and total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol across the metabolic syndrome group in the linear regression model. Multiple logistic regression analysis recognized the association between body mass index with subclinical hypothyroidism (P = 0.006) in the metabolic syndrome group. Conclusion: It is concluded from this study that there is significant association between subclinical hypothyroidism and metabolic syndrome, and it highlights the importance of thyroid function tests in patients with metabolic syndrome.

Aim: Obesity affects pituitary thyroid axis resulting in elevated thyroid stimulating hormone (TSH) levels. The objective of our study was to investigate whether there is an association between body mass index (BMI) and TSH in euthyroid and subclinical hypothyroid obese persons and to compare serum TSH levels among obese and overweight subjects presenting to our obesity clinic. Materials and Methods: A total of 150 consecutive subjects aged between 18 and 60 years presenting to our obesity clinic were enrolled. Patients were divided in three groups, group 1: overweight (BMI: 23- 24.9 kg/m 2, n = 65), group 2: class I obese (BMI: 25-29.9 kg/m 2, n = 58), and group 3: class II obese (BMI: 30-34.9 kg/m 2, n = 27). All subjects underwent thyroid profile along with other routine tests. Fisher's exact test, Mann-Whitney U test and Pearson's correlation were used for statistical analysis. P value <0.05 was considered significant. Results: Elevated TSH level (5-10 μIU/ml) with normal T3 and T4 was seen in 12/65 overweight, 19/58 class I obese (P = 0.614) and 12/27 of class II obese subjects (P = 0.529). Mean TSH levels were higher in subjects with higher BMI (group 1: 3.2 ± 3.1, group 2: 3.6 ± 2.2, group 3: 3.8 ± 2.8). Over all TSH showed no correlation with BMI (r = 0.0018, P = 0.872). Conclusion: Though higher BMI leads to higher TSH levels in our series, we could not find any significant relation between severity of obesity and TSH levels. Further large scale data from population is required to confirm or negate our finding.

A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable; however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.

Down's syndrome (DS) is known to be associated with autoimmune disease including type 1 diabetes. To the best of our knowledge, there are no reports of DS with type 2 diabetes mellitus in the literature. We hereby report two cases of DS with type 2 diabetes.

Acute pancreatitis is a medical emergency. Alcohol and gallstones are the most common etiologies accounting for 60%-75% cases. Other important causes include postendoscopic retrograde cholangiopancreatography procedure, abdominal trauma, drug toxicity, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown (idiopathic pancreatitis). Metabolic conditions giving rise to pancreatitis are less common, accounting for 5%-10% cases. The causes include hypertriglyceridemia, hypercalcemia, diabetes mellitus, porphyria, and Wilson's disease. The episodes of pancreatitis tend to be more severe. In cases of metabolic pancreatitis, over and above the standard routine management of pancreatitis, careful management of the underlying metabolic abnormalities is of paramount importance. If not treated properly, it leads to recurrent life-threatening bouts of acute pancreatitis. We hereby review the pathogenesis and management of various causes of metabolic pancreatitis.

Tuberous Sclerosis is a multi system genetic disorder affecting skin, central nervous system,kidney,heart and lungs. We present a case report of a 26 year old female with tuberous sclerosis who presented with galactorrhea and menstrual irregularities due to hyperprolactinemia.