Aim and objective: This study is aimed to evaluate the prevalence of chronic diseases and frailty which can inform the next generation of models to understand frailty as an emergent property in a complex adaptive system. Materials and methods: A cross-sectional observational study was planned to evaluate chronic diseases and frailty upon 200 patients of more than 60 years of age. Patients were evaluated for having frailty syndrome by frailty-defining criteria as defined by Fried and colleagues, along with the presence of some chronic diseases. Results: The mean age of patients was 71.61 ± 6.65 years and 76.5% of the study population were male. Weight loss, exhaustion, low physical activity, slowness, and reduced grip strength were seen among 40, 28, 11.5, 17.5, and 49.5% of the patients, respectively. It was observed that 78 (39.0%), 74 (37%), and 48 (24%) patients were in nonfrail, prefrail, and frailty group, respectively. Also, 73.5% of the total study population had at least one chronic disease and 33 (16.5%) patients had more than two chronic diseases. Chronic diseases were mostly present among the frail group. Conclusion: Frailty syndrome was very common among the elderly population in our study. Hypertension, diabetes, and osteoarthritis were the commonest comorbidities in the geriatric population of our study.

Background: In contrast to general population, athletes demonstrate enhanced cardiovascular functions and thus higher spirometric values, which necessitates the need of spirometric measures typically specific to athletes, which could avert misdiagnosis of certain respiratory dysfunction in them. Addressing this issue, the present study conducted in athletes vis-à-vis nonathletes assessed their anthropometric measures and pulmonary function parameters and explored for association, if any. Materials and methods: A cross-sectional study was undertaken in athletes vis-à-vis nonathletes. Respondents were screened for risk factors and were then assessed for their anthropometric measures including height, weight, body circumferences, fat level, skeletal muscle, and skinfold thickness. Pulmonary function test was then conducted in all respondents. Results: Mean anthropometric measures including body mass index, body fat percentage, waist circumference, waist–hip ratio, and skinfold thickness were on a slightly higher mark for nonathletes. Spirometric indices were on a bit higher grades for athletes’ group. However, consistent negative association was noted between increased anthropometric measures and pulmonary functions. Conclusion: Standardizing higher level of normalcy in spirometric indices for athletes may be considered to avoid misdiagnosis or misclassification of certain respiratory dysfunctions in them.

Coronavirus disease-2019 (COVID-19) has had its share of evils that have been and continue to be so for all of us globally. Our lives as we used to know them prior to March 2020 have changed forever. The way we went about gathering in academic meetings to educate ourselves, present our work to others and meet people in our professional communities seems like from another era. We have now transitioned to the virtual format of medical conferences in league with all other professions taking on the advantages of the internet and the platforms that had been hitherto used for social communications in the last decade in a progressively finessed manner with seamless synchronous voice and video transmission using the webinar format. This has resulted in a change of the delivery of medical conferences that have come to stay not only for its advantages but also for the benefits of making use of technology available, costs, and convenience for all participants and reducing the carbon footprint and reducing the ozone layer depletion. A change of mindsets for attendees and newer ways of working for investors who relied on the older format will be the expected challenges, hopefully, overcome with the passage of time and adaptation of what is the perceived good for the global interests.

A 16-year-old girl presented with acute-onset quadriparesis with urinary incontinence. Examination revealed an upper motor neuron (UMN) pattern of weakness in all four limbs, accompanied by a UMN type of bladder involvement in a shock stage. Two significant cervical lymph nodes were noted in the right submandibular region. MRI of the cervical spine revealed an extradural mass, compressing the cord at the C2 to C4 region. Excisional biopsy of the cervical lymph nodes revealed an extramedullary myeloid sarcoma, and immunohistochemistry showed CD117 and myeloperoxidase positivity.

Takayasu's arteritis (TA) is a rare form of granulomatous vasculitis of unknown etiology. It is also known as “pulseless disease” or “aortic arch syndrome” and commonly occurs in young- or middle-aged females. We describe a 28-year-old female who presented with chest pain and dyspnea in the Department of Medicine of Calcutta National Medical College and Hospital, Kolkata, West Bengal, India. On initial examination, the patient had absent pulses in all four limbs, and the patient's blood pressure (BP) was not recordable. Clinical examination also revealed features of biventricular failure. Relevant routine investigations like electrocardiogram (ECG), two-dimensional Doppler electrocardiography (2D-Echo), cardiac markers, and blood parameters were done. 2D-Echo was suggestive of ischemic cardiomyopathy. Considering the patient's physical findings along with raised erythrocyte sedimentation rate (ESR), further investigations like CT angiography (CTA) were done, which led to the diagnosis of TA. The patient was treated with oral steroid, diuretic, beta-blocker, and antiplatelet and then discharged in a stable condition.

Madras motor neuron disease (MMND) is a rare childhood/juvenile motor neuron disease reported from various parts of southern India, the first report being from Chennai. This case report is about a young girl who presented with insidious onset, a gradually progressive neurological illness characterized by bilateral sensorineural hearing loss, wasting, and weakness of all four limbs along with bulbar paralysis. On examination, she had involvement of lower cranial nerves, tongue fasciculation, generalized amyotrophy, and bipyramidal features. Electrophysiological studies showed features of chronic denervation. A provisional diagnosis of MMND was made. MMND resembles Brown–Vialetto–Van Laere (BVVL) syndrome and some of the other complex childhood motor neuron disease syndromes, like Boltshauser syndrome, Nathalie syndrome, and Fazio–Londe syndrome. Early diagnosis of BVVL, which is a riboflavin transporter deficiency, is essential, as it is fully responsive to high-dose riboflavin supplementation. In BVVL syndrome, a female predominance has been documented (1:5), while in MMND, an equal distribution is noted. In BVVL, at least half of the reported cases are familial whereas in MMND most of the cases are sporadic. In BVVL, lower motor neuron signs in the limbs are infrequently present and pyramidal signs are rare, whereas in MMND lower and upper motor neuron signs are seen in the majority of the patients. Third, fifth, or sixth cranial nerves are never noted to be affected in MMND, but they may rarely be involved in BVVL. The etiopathophysiology of MMND is still unclear and supportive or symptomatic therapy forms the mainstay of treatment of this orphan disease.

Primary sclerosing cholangitis (PSC), a disease of unknown etiology, is diagnosed on the clinical and biochemical findings of cholestasis combined with the characteristic findings seen on cholangiography. Small duct cholangitis is a variant of the PSC spectrum with distinct clinical course and outcome. We present two cases of small duct PSC, which are presented with the clinical and biochemical features of cholestasis but without typical positive findings on cholangiography. A liver biopsy was attempted, which confirmed sclerosing cholangitis. Upon diagnosis, both the patients were prescribed ursodeoxycholic acid at a dose of 15 mg/kg body weight/day and liver biochemistry was followed up after 3 months, which revealed biochemical improvement. Being an uncommon variant of this “not so common” disease spectrum, small duct PSC often poses a diagnostic dilemma with its presentation due to the clinical and cholangiographic mismatch. The cases remind that a negative cholangiography does not rule out the PSC spectrum.