Post-Coronavirus Disease Autoimmunity-associated Morvan's Syndrome.

A lot of autoimmune conditions have been found to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are multiple cases of autoimmune and autoinflammatory diseases reported after the coronavirus disease 2019 (COVID-19) pandemic. Autoimmune neurological presentations have also been reported but are very rare. Morvan's syndrome is a life-threatening autoimmune disease and is very rare. Morvan's syndrome is classically characterized by neuromyotonia, dysautonomia, insomnia, and neuropsychiatric symptoms. Leucine-rich glioma-inactivated protein 1 (LGI1) and contactin-associated protein 2 (CASPR2) autoimmunity has also been associated with Morvan's syndrome. We hereby report an interesting case of a male patient in his 40s, who had a history of COVID-19 infection, following which he had bilateral lower-limb weakness and pain, with profuse sweating, and was later diagnosed as a case of SARS-CoV-2-associated Morvan's syndrome.

Glucose Monitoring in Critically Ill: Is Absence of "Stress Hyperglycemia" a Cause for Concern?

AIM: To study variations in glucose levels over 48 hours in critically ill patients by capillary blood glucose done on glucometer and compare the same in different categories of patients based on various diseases, as well as their correlation with sepsis and diabetes mellitus. To compare the same results in a subset of patients with the readings of continuous glucose monitoring. MATERIAL AND METHODS: We studied 50 critically-ill patients (Age≥18 years), admitted in medical ICU (on mechanical ventilation/ionotropic supports/in sepsis) in a teaching hospital in semi-urban Maharashtra. Critical illness was defined as any physiological instability leading to disability or death within minutes or hours, based on neurological assessment, respiratory system involvement and cardiovascular involvement. Capillary blood sugar levels were done 4 hourly using 'NIPRO' glucometer. Site was rotated. 5 patients had simultaneous continuous glucose monitoring, using I-Pro bio-sensor. RESULTS: Total 50 patients were included in the study. The data was collected and tabulated. Analysis showed that all critically ill patients showed some higher than normal recordings of blood sugar, which till now has been attributed to 'stress-hyperglycaemia'. This may be absent or blunted in sepsis. In the criticallyill patients with primary involvement of gastrointestinal tract, meal-unrelated fluctuations were seen. In critically-ill patients with CNS and CVS involvement, lowest BSL recordings were seen (meal unrelated) at 2 am. CONCLUSIONS: We concluded that that patients who develop hypoglycaemia may have an equally bad prognosis or even worse than those who develop hyperglycaemia during the period of critical illness. CGM devices record tissue glucose levels continuously, and may be useful as a 'tissue hypoglycaemia' alert.

Fault in Our Genes: A Case of Pulmonary Thromboembolism in Young.

Methylenetetrahydrofolate reductase (MTHFR) enzyme is one of the key enzymes involved in the metabolism of folate. Mutations in this enzyme can lead to a procoagulant state. We present a case of a 20-year-old male with no known comorbidities, who presented with fever and hemoptysis and was diagnosed as a case of pulmonary embolism. He was found to have a homozygous mutation in the MTHFR gene that was responsible for his disease state. He was started on unfractionated heparin infusion and underwent catheter-directed thrombolysis. He showed marked improvement in his condition and was discharged on oral anticoagulants with an advice to follow-up.

RésuméL'enzyme méthylènetétrahydrofolate réductase (MTHFR) est l'une des enzymes clés impliquées dans le métabolisme du folate. Les mutations de cette enzyme peuvent conduire à un état procoagulant. Nous présentons le cas d'un homme de 20 ans sans comorbidités connues, qui s'est présenté avec de la fièvre et une hémoptysie et a été diagnostiqué comme un cas d'embolie pulmonaire. Il s'est avéré qu'il présentait une mutation homozygote du gène MTHFR responsable de son état pathologique. Il a commencé une perfusion d'héparine non fractionnée et a subi une thrombolyse dirigée par cathéter. Il a montré une nette amélioration de son état et a été libéré sous anticoagulants oraux avec un conseil de suivi.

A Study of Neurological Involvement in Dengue and Chikungunya Infection.

INTRODUCTION: Chikungunya virus (CHIKV) and dengue fever have been reported for recent epidemics worldwide, with varied clinical involvement. Chikungunya was first reported to affect the nervous system in the 1960s. The clinical profile of dengue with multi-organ involvement is varied with reported involvement of the central nervous system in some. AIM: The aim of this study was to study the frequency and pattern of neurological involvement in patients admitted with dengue and chikungunya in a tertiary care hospital. MATERIALS AND METHODS: Patients admitted with confirmed chikungunya and dengue were evaluated clinically and investigations were enrolled in the study. Patients with preexisting neurological issues, obvious metabolic, vascular, or septic causes for neurological involvement were excluded from the study. RESULTS: A total of 309 patients with chikungunya were included in the study. Out of these, 11 (3.56%) patients were found to have neurological involvement. The most common presentations were altered sensorium (100%) followed by headache (81.81%). The relative risk of mortality in patients with neurological involvement due to chikungunya was 7.96. A total of 443 patients with dengue fever were enrolled in the study. Out of these, 5 (1.10%) patients were found to have neurological involvement. The most common presentations were altered sensorium and headache (100%), followed by vomiting (80%). The relative risk of mortality in patients with neurological involvement due to dengue was 5.15. CONCLUSION: The recent epidemic of chikungunya and dengue virus infections was associated with various neurological complications. Neurological involvement of chikungunya and dengue was identified to be a bad prognostic factor with significantly higher mortality. LIMITATIONS: This is a single center study, involving only the patients admitted to the hospital. Furthermore, being an observational study, follow-up could not be done to look for neurological sequelae.

Résumé Introduction:le virus du chikungunya (CHIKV) et la dengue ont été signalés pour des épidémies récentes dans le monde, avec une implication clinique variée. Chikungunya a d'abord affecté le système nerveux dans les années 1960. Le profil clinique de la dengue avec une implication multi-organes est varié avec l'implication rapportée du système nerveux central dans certains.Objectif:Le but de cette étude était d'étudier la fréquence et le schéma d'implication neurologique chez les patients admis avec de la dengue et le chikungunya dans un hôpital de soins tertiaires.Matériaux et méthodes:patients Admis avec le chikungunya et la dengue confirmés ont été évalués cliniquement et les enquêtes ont été inscrites à l'étude. Les patients présentant des problèmes neurologiques préexistants, des causes métaboliques, vasculaires ou septiques évidentes de participation neurologique ont été exclues de l'étude.Résultats:Un total de 309 patients atteints de chikungunya ont été inclus dans l'étude. Parmi ceux-ci, 11 (3,56%) patients se sont révélés avoir une atteinte neurologique. Les présentations les plus courantes ont été modifiées du sensorium (100%) suivie de maux de tête (81,81%). Le risque relatif de mortalité chez les patients présentant une atteinte neurologique due au chikungunya était de 7,96. Au total, 443 patients atteints de dengue ont été inscrits à l'étude. Parmi ceux-ci, 5 (1,10%) patients se sont révélés avoir une atteinte neurologique. Les présentations les plus courantes ont été modifiées du sensorium et des maux de tête (100%), suivis par des vomissements (80%). Le risque relatif de mortalité chez les patients présentant une atteinte neurologique due à la dengue était de 5,15.Conclusion:L'épidémie récente des infections du chikungunya et du virus de la dengue a été associée à diverses complications neurologiques. L'atteinte neurologique du chikungunya et de la dengue a été identifiée comme étant un mauvais facteur pronostique avec une mortalité significativement plus élevée.Limites:Il s'agit d'une étude centrale unique, impliquant uniquement les patients admis à l'hôpital. De plus, étant une étude observationnelle, le suivi n'a pas pu être fait pour rechercher des séquelles neurologiques.

Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors.

Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.