Background: With declining age, elderly admissions are encountered with sleep disturbances during the hospital stay. Poor sleep health can adversely affect many organ functions causing a weakened immune system, increased adverse cardiovascular events, impaired cognitive function, and increased fall risk and frailty in the elderly. The present study tried to address the issue of sleep quality in admitted elderly patients in a hospital setup. Materials and methods: A prospective observational study was conducted among the elderly inpatients of a few tertiary care setups in Eastern India. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality in the subjects. Patient-reported factors contributing to poor sleep health were noted. Data were statistically analyzed. Results: Sleep efficiency is significantly affected by hospital stay. The global PSQI score conferred poor sleep quality in 51.05% elderly in baseline, 58.64% after the first night of hospitalization, and 62.86% after the third night of hospitalization. Sleep quality was assessed using PSQI questionnaire. Prolonged sleep latency and decreased total sleep duration were noted among study participants at the third time point in comparison with the first. Factors like doctor–nurse interruption, pain, light, and noise as some of the most frequently reported factors contributed to poorer sleep. Higher age, infrequent physical activity, previous history of hospitalization, anxiety, and depressive state were significantly associated with higher odds of poor sleep quality. Conclusion: The study demonstrated that overall sleep quality was significantly affected during hospital stay in older adults. Patient-reported factors contributing toward poorer sleep health must be intervened in order to achieve better treatment outcomes in the elderly.

Although “spongy myocardium” was first observed by Grant in 1926, left ventricular noncompaction (LVNC) cardiomyopathy was originally described by Engberding and Bender in 1984.¹ Left ventricular noncompaction cardiomyopathy is characterized by abnormal ventricular myocardial protrusions with a thin layer of properly compacted myocardium.^2,3 It is a rare entity, with a prevalence less than 0.02%.⁴ We report a case of LVNC cardiomyopathy with dyssynchrony, which was successfully managed with cardiac resynchronization therapy (CRT).

Aim: To emphasize the importance of a timely, systemic approach to hypercalcemia to reach an etiological diagnosis. Background: Hypercalcemia is commonly encountered in many individuals, in both inpatient and outpatient settings. Its evaluation entails careful history taking, a battery of investigations to arrive at an etiological diagnosis. Hypercalcemia is more common in adults but not uncommon in children and adolescents. Case description: Here, we present a case of an apparently healthy young male presenting with a nontraumatic vertebral fracture who was incidentally detected to have hypercalcemia. Further evaluation revealed parathyroid hormone (PTH)-independent hypercalcemia. He also had mild anemia and mildly impaired renal function at presentation. During his in-hospital stay, he developed bicytopenia. Bone marrow studies and flow cytometry showed a hypercellular marrow suggestive of acute lymphoblastic leukemia (ALL). Discussion: This case illustrates an uncommon presentation of aleukemic ALL, i.e., low-trauma fracture with PTH-independent hypercalcemia. Conclusion: Hypercalcemia, especially PTH-independent, should entail a high index of suspicion across all age groups for malignancies, including solid tumors and hematological malignancies. Clinical significance: Malignancies, even in younger individuals, can present with low-trauma fracture and hypercalcemia.

Lucio phenomenon (LP) is a rare reactional state seen in cases of diffuse lepromatous leprosy. Lucio leprosy is a pure, primitive, and diffuse form of lepromatous leprosy. It is observed almost exclusively in Mexico and Central America and is considered a globally restricted phenomenon. However, isolated cases are being reported worldwide. Patients with Lucio leprosy often present with manifestations of LP, which includes purpuric macules with multiple and extensive areas of ulceration with bizarre-patterned, angulated borders mainly affecting the extremities. Lucio phenomenon is difficult to recognize, especially in nonendemic countries, which can lead to a delay in its diagnosis and management. We report a case of LP due to its occurrence in the classical form of lepromatous leprosy and rarity in Eastern India.

Addison's disease (AD) or primary adrenocortical insufficiency results from hypofunction/dysfunction of an adrenal cortex with a decreased production of mineralocorticoids, glucocorticoids, and androgens, and with increased levels of adrenocorticotropic hormone and plasma renin activity. The AD prevalence is 110–144 cases for every million population among the developed countries.¹ Autoimmune AD is the most common etiological type in adult patients, which includes about 80% of cases, followed by the second one which is post-tuberculosis AD, seen in 10–15% of the cases, the rest 5% of the cases are caused by neoplastic, vascular, or any rare genetic conditions. The most common form of AD in children is congenital adrenal hyperplasia, and it includes 72% of cases, on the other hand, autoimmune AD is responsible for 10–15% of cases.

Management of type 2 diabetes mellitus (T2DM) needs to address hyperglucagonemic states, too, along with the insulin centric approach. Incretin physiology needs utmost attention as in type 2 diabetes incretins level declines like beta-cell function. Professor Robert Unger and his team had re-emphasized the importance of glucagon as the central pathogenic hormone in diabetes, which is responsible for accelerated catabolic destructions in the absence of insulin. Glucagon-like peptide 1 (GLP-1) analogs and dipeptidyl peptidase 4 (DPP4) inhibitors have the greatest potential to reduce the ill-effects of glucagon and metformin, and α-glucosidase inhibitors produce some effect to increase endogenous GLP-1 level and can address hyperglucagonemia. Using GLP-1 analog could be helpful to address misbalanced incretins axis in diabetics. Different professional societies of diabetes are now recommending GLP-1 receptor agonist (GLP-1 RA) like liraglutide, semaglutide, and dulaglutide in a variety of subgroups like people with atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, patient needing weight loss, or having high risk of hypoglycemia. Though exenatide had not shown beneficial role in cardiovascular outcome trial, it was proved to be safe in high risk cardiovascular patients. As Indian patients are more prone to develop incretin deficiency compare to the Caucasians, if we have more generic exenatide (in the 2017 patent expired), it may address this issue holistically. Past history of pancreatitis and family history of medullary thyroid carcinoma are two important serious concerns while using any GLP-1 RA. Informed prescribing on gastrointestinal side effects, such as nausea, anorexia, vomiting, and loose motion, needs to be addressed, and patients should be educated regarding mitigation strategies for these adverse effects.