A Rare Case of Sporadic Inclusion Body Myositis (s-IBM).

Sporadic inclusion body myositis (s-IBM) is an acquired inflammatory myopathy. Clinical presentation is variable. The usual presentation is progressive weakness and atrophy of the arms and leg muscles, especially of the quadriceps femoris which is invariably affected. It is classified under inflammatory myopathies, along with polymyositis and dermatomyositis. We present a case of s-IBM who presented with gradually progressive quadriparesis with characteristic quadriceps wasting and weakness in neck flexors. Electromyography revealed myopathic potential and muscle biopsy revealed features of inclusion body myositis.

Dynamics of electroencephalogram (EEG) in different stages of chronic kidney disease.

AIM: To study Electroencephalogram (EEG) in different stages of chronic kidney disease (CKD). MATERIALS AND METHODS: This observational study was carried out in the Department of Medicine, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha conducted over a period of 24 months, spanning from August 2011 to August 2013. Eighty three cases of CKD at different stages were studied. EEG was done in all the subjects and the various EEG dynamics like morphometric waveform patterns, symmetricity, amplitude were recorded and compared with the different stages of CKD. RESULTS: We found that characteristic changes were observed with increasing severity of CKD. Slow delta wave patterns were more prominent in stage 5 (p<0.0001), asymmetric discharges, dysthymia, sharp wave transients and low amplitude wave forms were more prominent beyond Stage 4 (p<0.0001). CONCLUSION: EEG can be used as an effective tool for detection of subclinical or latent uremic encephalopathy. EEG findings which are characteristics of uremic encephalopathy can be present in CKD patients without overt signs of encephalopathy. So, EEG can be used as a prognostic indicator of response to clinical therapy of CKD.

Ertapenem usage in cancer patients with and without neutropenia: a report on 97 cases from a comprehensive cancer center.

PURPOSE: Ertapenem is being increasingly utilized in cancer patients, but published data regarding its usage are limited. Our objective was to describe the various indications for ertapenem therapy and its safety and efficacy in cancer patients. METHODS: We conducted a retrospective cohort study of cancer patients who received monotherapy with ertapenem for at least 72 h, between January 2007 and February 2013. RESULTS: Among 97 unique patients who received ertapenem monotherapy, the most common indications were: (1) To facilitate discharge from the hospital of stable patients still requiring antimicrobial therapy (46 %). (2) Primary therapy of various documented infections (bacteremia, pneumonia, urinary tract infection, skin and skin structure infection) with ertapenem (28 %). (3) De-escalation from a different broad-spectrum agent or regimen to ertapenem within the hospital setting in patients not ready for discharge (25 %). The median age of the 97 patients studied was 59 years (range 9-87 years) with 52 % being men. Most patients had underlying hematologic malignancies (54 %), and 7 % were recipients of hematopoietic stem cell transplantation. Twenty-nine patients (30 %) were neutropenic, 26 % were diabetic, and 6 % had chronic lung disease. Primary ertapenem monotherapy was successful in all patients, de-escalation in 95.8 % of patients, and the strategy of discharge on outpatient therapy with ertapenem in 95.6 % of patients. Patients failing de-escalation or early discharge responded to alternative regimens. We documented no significant ertapenem associated toxicity or adverse events. CONCLUSIONS: Ertapenem appears to be safe and effective for several indications in cancer patients.

Multiple visceral abscesses due to tuberculosis.

Tuberculosis is a global epidemic, especially in India. In immuno-competent host, abdominal tuberculosis most commonly presents as ileo-caecal tuberculosis and ascitis. Presented is a rare case of immuno-competent host with abdominal tuberculosis in the form of multiple visceral abscess.

Prehypertension in young females, where do they stand?

BACKGROUND: To determine the prevalence of prehypertension in young females and its correlation to various parameters like body mass index (BMI), waist hip ratio (WHR), waist circumference (WC) and family history, and blood pressure (BP) response to exercise stress testing. METHODS: One hundred and fifty apparently healthy females of age group 18-25-years were randomly selected from the student population of Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, after satisfying all the inclusion criteria and written informed consent. Along with all the anthropometric parameters BMI, WHR, WC and family history of hypertension (HTN) and/or diabetes, resting BP, and BP response to exercise stress testing were measured in the study. RESULTS: Amongst 150 subjects, 63 (42%) subjects were normotensive and 87 (58%) were prehypertensive. Body mass index, WHR, WC and family history of HTN were significantly higher in prehypertensive group. Prehypertensive group also had an exaggerated BP response to exercise stress testing and higher BP during recovery. CONCLUSION: Prevalence of prehypertension was found to be high in females, also there was a strong correlation between prehypertension and BMI, WHR and WC suggesting a positive correlation between obesity and prehypertension. Prehypertensive group also showed an exaggerated BP response to exercise stress testing.

Congenital hypoparathyroidism presenting as recurrent seizures in an adult.

Hypocalcemia due to hypoparathyroidism may manifest as serious neurologic symptoms such as seizures, movement disorders, or raised intracranial pressure. Several patients were observed to have these dangerous neurologic complications even without subtle signs of hypocalcemia like tetany, chvostek's sign or carpopedal spasms. We present a case of recurrent hypocalcemic seizures due to congenital hypoparathyroidism.

Localizationism to neuroplasticity---the evolution of metaphysical neuroscience.

Neuroplasticity (also referred to as brain plasticity, cortical plasticity or cortical re-mapping) is the changing of neurons, organization of their networks, and their function via new experiences. The brain consists of nerve cells or neurons and glial cells which are interconnected, and learning may happen through changing of the strength of the connections between neurons, by adding or removing connections, or by adding new cells. "Plasticity" relates to learning by adding or removing connections, or adding cells. Contrary to the traditional belief of neurolocalizationism, which states that each region of brain is dedicated for a particular type of activity, neuroplasticity has struggled a long way and has created a safe niche in the neuroscientific hall of honor. Salute to the neuroplasticians for their efforts to revolutionize the doctrine of neurology for the better understanding of the remarkable powers of brain. This article is a brief attempt to fathom the mysterious and scientific ways of neuroplasticity.

Correlation of sputum smear status with CD4 count in cases of pulmonary tuberculosis and HIV co-infected patients--a hospital based study in a rural area of Central India.

BACKGROUND: In HIV-infected patients, PTB (Pulmonary Tuberculosis) is still the commonest form of TB. The most cost-effective method of detecting TB cases among PTB suspects in high-prevalence countries is by sputum smear microscopy. World Health Organisation (WHO) states that sputum positivity decreases accompanying with atypical chest x-ray findings as CD4 count decreases. This expectation that infection with HIV would reduce the sensitivity of acid-fast smears, due to a decreased frequency of cavitary pulmonary MTB, has not been substantiated in a few studies done in the past. This study was undertaken to see the correlation of sputum smear status with CD4 count in cases of Pulmonary Tuberculosis HIV coinfected patients in our institute, being a tertiary referral centre. METHODOLOGY: In our hospital based cross-sectional study, 98 patients having PTB-HIV co-infection were followed and acid fast smear positivity status was assessed in correlation with chest radiograph and CD4 count. RESULTS: Acid-fast smear positivity to negativity was almost 1:1 in CD4 count between 0-200 whereas it was 3:1 in cases of CD4 count above 200. There was significant difference (p value 0.013) in two groups with CD4 count cut-off value 200 which endorses the fact by WHO that sputum smear negativity increases with increase in degree of immunosupression. CONCLUSION: Sputum examination remains an important diagnostic tool for pulmonary tuberculosis in immunocompromised host with CD4 count above 200 but there is an urgent need for better diagnostic methods in CD4 count below 200.

Gonadotropin levels in hypothyroid women of reproductive age group.

OBJECTIVE: To study serum gonadotropin (FSH, LH) levels in cases of subclinical and overt hypothyroid women in reproductive age group. MATERIAL AND METHOD: Female patients of reproductive age group attending thyroid clinic of Acharya Vinoba Bhave Hospital were included in the study. Detail menstrual history was taken, and serum FSH and LH levels were estimated by radio immuno assay method. RESULT: Eighty patients were included in the study, out of whom 46 (57.5%) had subclinical hypothyroidism and 34 (42.5%) had overt hypothyroidism. In subclinical hypothyroidism group the menstrual dysfunction which dominated in our study was oligomenorrhea (28.2%) followed by menorrhagia (17.39%). 39.13% had normal menstruation. In overt hypothyroidism group again it was oligomenorrhoea (23.5%) which was the principal menstrual abnormality followed by menorrhagia (17.64%). The percentage of females with normal menstruation was 47.05%. The levels of serum FSH and LH were significantly low in cases of both subclinical and overt hypothyroid women. They were significantly low when done between day 2 and 5 of the cycle. CONCLUSION: Hypothyroidism decreases levels of serum FSH and serum LH. Subclinical hypothyroidism is one of the major etiological factors of infertility. Autoantibodies against thyroid should be searched for in cases of female patients with infertility.

Rheumatoid interstitial lung disease presenting as cor pulmonale.

Rheumatiod arthritis (RA) is a multisystem connective tissue disorder. The predominant presentation is polyarticular, symmetric peripheral arthritis with relative sparing of axial skeleton. Inflammatory synovitis is the pathologic hallmark. Extra-articular manifestations of RA can involve several other organ systems and amongst them pulmonary manifestations occur commonly. We report a case of rheumatoid interstitial lung disease presenting as cor pulmonale.

Acute dengue myositis with rhabdomyolysis and acute renal failure.

Dengue is an acute mosquito-borne infection caused by dengue viruses from the genus flavivirus. Neurologic complications have been attributed chiefly to metabolic alterations and to focal and sometimes massive intracranial haemorrhages, but anecdotal cases and limited case series have indicated the possibility of viral CNS and skeletal muscle invasion causing encephalitis and myositis. We present a case of a 40-year-old male who presented with severe dengue myositis resulting in quadriparesis, respiratory failure and acute renal failure with red urine. His elevated serum creatine kinase (CK), serum and urine myoglobin levels justified rhabdomyolysis as the cause of acute renal failure. A muscle biopsy revealed inflammatory myositis. He required ventilator support for respiratory failure and was treated conservatively. This case highlights the severe and persistent muscle involvement in dengue which is a rarity.

Molecular mimicry in human diseases--phenomena or epiphenomena?

Molecular mimicry is one mechanism by which infectious agents (or other exogenous substances) trigger an immune response against the host antigens. When a susceptible host acquires an infection with an organism that has antigens immunologically similar to the host antigens but differ sufficiently, to induce, an immune response when presented to T cells, results in loss of tolerance to host antigens. Further more there is development of a pathogen-specific immune response that cross-reacts with host structures to cause tissue damage and disease. Till date the advances in the research in molecular biology has documented evidence to suggest that molecular mimicry plays in important role in pathogenesis of a number of diseases. This review is a brief overview of some of these disorders.

Blood pressure response to treadmill testing among medical graduates: the right time to intervene.

BACKGROUND: Longitudinal studies have revealed significant correlation between exaggerated blood pressure response to exercise and higher incidence of developing resting hypertension in future. Normotensive persons at high risk of developing systemic hypertension have greater cardiovascular reactivity to exercise. METHODS AND RESULTS: Our study compared the blood pressure response to treadmill exercise in normotensive offspring of the hypertensive parents (age 22 +/- 1.7 years, n = 50; study group) with those of the normotensive parents (age 22 +/- 1.4 years, n = 50; control group). The morphometric characteristics, resting, exercise (treadmill exercise with Bruce protocol) and recovery blood pressure values of all the subjects were recorded. The analysis showed that the difference in mean peak systolic blood pressure during exercise was the only statistically significant parameter in the study and control groups (188.52 +/- 25.16 mmHg and 178.56 +/- 14.96 mmHg, respectively, p < 0.05). The number of hyperreactors (defined as peak systolic blood pressure > 200 mmHg during exercise) was significantly more in study group compared to control group (10 and 3 respectively). The mean resting systolic blood pressure of hyperreactors (126.46 + 8.49 mmHg) falls in the pre-hypertension category as designated by JNC VII. Also, their resting diastolic blood pressure, recovery blood pressure and body mass index were significantly higher as compared to normoreactors. CONCLUSIONS: Our study showed that this response pattern could represent impairment in cardiovascular adjustment to exercise indicating a greater risk for development of resting hypertension in the future. Therefore there is a need for early lifestyle modifications to postpone/prevent development of hypertension.

New colorimetric method for folic acid assay in dosage forms.

A new colorimetric method has been developed for estimating folic acid. The British Pharmacopoeial method has been modified to reduce folic acid to 2,4,5-triamino-6-hydroxy-pyrimidine (TAHP), which is treated with ninhydrin to yield a stable purple complex. Participation of 5-amino and 6-hydroxy groups of TAHP in the color reaction with ninhydrin is suggested on the basis of experimental evidence. The color obtained has an absorbance maximum at 555 nm and obeys Beer's law in the concentration range of 4.5 to 45 microng folic acid/ml. The method has been successfully used for assaying folic acid, its tablets, and injections.