This observational cross-sectional nutritional survey was done on 100 patients from the Hills and Dooars of North Bengal. The survey was done to study the contribution of protein, fat, and carbohydrate to the calorie intake of the population of hills and Dooars. The average daily consumption of protein and the number of various food groups comprising the intake of protein of the population of North Bengal were also studied. The mean protein intake in the study population was 72.95 gm/day while the mean fat intake and mean carbohydrate intake were 52.75 gm/day and 283.83 gm/day respectively. The mean calorie intake was 1842.28 Kcal. Protein contributed 16.8% of the total energy intake of the study population that is, the protein energy (PE) ratio was 16.8% while fat contributed 24%. Among males PE ratio was 18.7% while among females it was 15.44%. The energy intake of females was significantly different from that of males. The protein intake was more in males compared to females, as also the fat intake. However, the same was not true for carbohydrates. The calorie intake in our population was substantially lower than the recommendations while the protein intake was quite high. This perhaps may be one of the reasons why in North Bengal a large section of the population suffers from hyperuricemia, gouty arthritis, urinary tract calculi, and chronic kidney diseases.

Background: Treatment choice and therapeutic targets in diabetes care are much individualized and are based on not only clinical data but also patient parameters. A multidisciplinary collaboration in care delivery can help achieving the glycemic targets and improving patients’ quality of life simultaneously. This study aimed to evaluate the effect of clinical pharmacological (CP) consultation in optimizing diabetes care. Methods: A cross-sectional observational study included patients from both groups—those receiving CP consultation as an add-on and those not. Each patient was interviewed for awareness on hypoglycemic alert, insulin injection technique, importance of self-monitoring of blood glucose (SMBG) and foot care, dietary advices, exercise prescription, and sensitization regarding adverse drug reactions (ADRs). Treatment adherence and potential drug–drug interactions (DDI) were also noted for each group and results were statistically analyzed. Results: Significantly higher awareness regarding hypoglycemic alert, insulin injection technique, importance of SMBG, and ADR sensitization was noted in those receiving CP consultation (p < 0.05). Adherence was also significantly higher in such patients and (DDI) significantly lower (p < 0.001). Conclusion: Better patient knowledge can have significant influence on self-care behavioral practices. As diabetes care goes a long way and treatment approaches should be primarily patient-centric, a co-professional support can further aid in optimizing better and safer patient outcomes.

Myxoma, though rare but most common among primary cardiac tumors, with the age of onset usually between 30 and 60 years, is more common in females.¹ On one hand atrial myxoma frequently comprises a diagnostic triad of obstructive symptoms, constitutional symptoms, and embolic phenomena. On the other hand, it can be asymptomatic or can present with nonspecific systemic symptoms that may be overlooked. Thereby, cardiac investigations may not be considered, and diagnosis of this rare condition is often missed so that it may present later with more significant embolic disease, such as stroke with neurological deficits, as in the case reported here. A healthy 50-year-old lady developed left hemiparesis with dysarthria. Imaging showed right middle cerebral artery (MCA) territory infarct. Cardiac evaluation revealed left atrial myxoma. The possible mechanism of stroke in this patient is discussed.

Secondary adrenal insufficiency (SAI) had been diagnosed in a nondiabetic lady with recurrent hypoglycemia having low morning cortisol and low-normal adrenocorticotropic hormone. Her symptoms persisted despite being on supplemental hydrocortisone. Appropriate workup subsequently documented endogenous hyperinsulinemia. Solitary pancreatic endocrine tumor, primary hyperparathyroidism due to multiglandular pathology, and the presence of multiple collagenomas established the diagnosis of multiple endocrine neoplasia type 1 (MEN1) syndrome. Basal morning cortisol (1.9 µg/dL) was grossly suppressed in this lady, and so was the cortisol value (2.2 µg/dL) measured during hypoglycemia (plasma glucose: 24 mg/dL). Recurrent hypoglycemia due to any cause, results in a functional abnormality of the hypothalamus–pituitary–adrenal (HPA) axis in individuals without primary disease of the HPA pathway. The defect may be severe enough to lower the basal and stimulated cortisol values much below the established cut-offs for adrenal insufficiency, and patients may be misdiagnosed to have adrenal failure. Complete normalization of cortisol values are observed following strict avoidance of hypoglycemia.

Aim and background: This study presents a rare interesting case of primary pleural sarcoma in a young patient. Case description: A 22-year-old Ethiopian male, with no significant past medical history, presented with fever, dry cough, and right-sided chest pain of 4-day duration. The chest X-ray showed moderate right-side effusion. Pleural tap revealed yellowish slightly turbid fluid that was lymphocyte predominantly exudate with high lactate dehydrogenase (LDH), normal glucose and negative malignant cell cytology. Computerized tomography (CT) chest showed mild-to-moderate right-sided pleural effusion with subsequent underlying right basal lung collapse associated with multiple scattered calcified right pleural plaques. Laboratory investigations interestingly showed high alkaline phosphatase. He presented again after 10 days with a massive right pleural effusion. Diagnostic thoracoscopy was done and a pleural biopsy revealed malignant spindle cells in a haphazard pattern, forming neoplastic bone and osteoid with foci of necrosis. Immunohistochemistry was consistent with malignant spindle cell sarcoma of pleura. Follow-up revealed the patient succumbed to illness within a few weeks before further evaluation and chemotherapy could be done. Conclusion and clinical significance: Primary pleural sarcoma is a rare tumor with a poor prognosis and has little past literature review. Diagnosis might be missed and early thoracoscopic biopsy and immunohistochemistry are usually necessary for diagnosis. Presentation in a young patient, presence of pleural calcification in CT scan, elevated alkaline phosphatase, and evidence of new bone formation in histopathology were interesting and unique features seen in this case.

Geographic tongue is usually self-resolving and relatively a benign condition. Sometimes, these lesions in the tongue can move from one location to another in the tongue hence this condition is also called benign migratory glossitis. Although the etiology is idiopathic, it can often be associated with increased environmental allergies. At times it may resemble oral cancer. Thorough clinical examination and investigations are needed if there is any sudden increase in the size of erythematous plaques or if there is pain with supra-added systemic features suggestive of any malignancy. We herein present a case of geographic tongue in a 57-year-old gentleman which was diagnosed as benign. It was conservatively managed and self-resolving in nature.