Plasma Exchange as a First Line Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorders.

BACKGROUND AND AIMS: Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disorder of central nervous system with deleterious effects. At present Intravenous corticosteroids are used for the relapse as the first line of treatment, but with only a class evidence III-IV. Having an underlying humoral immune mechanism in the pathogenesis of NMOSD and as it is rightly said that "Time is Cord and Eyes", delaying the time to start plasma exchange (PLEX) awaiting favorable outcome in response to corticosteroids is detrimental for the patient. Hence, PLEX may be a promising first line therapeutic approach in the management of severe attacks of NMOSD. The aim of this study is to evaluate the efficacy of PLEX as the first line of treatment for the acute attacks in patients with NMOSD that is being largely used as an add-on therapy for more than 10 years, and also to define the time opportunity window for the starting of PLEX. METHODS: The study analysed the therapeutic efficacy and safety profile of PLEX as a first line therapy in 30 patients diagnosed with NMOSD over a period of 30 months. PLEX was performed using a Hemonetics Mobile Collection System plus machine with due written consent including the risks and benefits of the treatment that is being proposed to the patient/relative in their own language. RESULTS: A total of 30 patients were analysed, out of which 16 were females and rest males. 85% of the patients were in the age group of 25-35 years. All the patients had severe Expanded Disability Status Scale (EDSS) scores at the baseline, and 73.33% showed significant improvement following PLEX. The only predictor of good outcome was the time to PLEX i.e shorter delay betters the outcome. CONCLUSION: The study ascertained the importance of early PLEX as a therapeutic intervention in severe attacks of NMOSD irrespective of their Anti-Aquaporin 4 (AQP4) antibody status.

Reversible electrophysiological abnormalities in hypokalemic paralysis: Case report of two cases.

Compound muscle action potential (CMAP) amplitude declines during a paralytic attack in patients with hypokalemic periodic paralysis (HPP). However, serial motor nerve conduction studies in hypokalemic paralysis have not been commonly reported. We report two cases with hypokalemic paralysis, who had severely reduced CMAPs in all motor nerves at presentation during the episode of quadriparesis. However, the amplitude of CMAPs increased and reached normal levels, as the serum potassium concentration and motor power returned to normal state.

Annual variation in flowering phenology, pollination, mating system, and pollen yield in two natural populations of Schima wallichii (DC.) Korth.

BACKGROUND: Schima wallichii is a highly valuable tree of tropical forest in north-east Himalaya region that grows naturally in a wide range of altitudes between 750 and 2400 m asl with varying environments. Flowering phenology of tropical tree species at population level is generally ignored and therefore a detailed knowledge of flowering and fruiting patterns of important multipurpose tree species is critical to the successful management of forest genetic resources. MATERIALS AND METHODS: The study was conducted at two different altitudes (i.e., 750 m and 900 m asl) in the tropical semideciduous forest of north-east Himalaya. The floral phenology including flowering synchrony in the populations, anthesis, anther dehiscence, stigma receptivity, pollinators visitation frequency, and mating system including index of self-incompatibility were worked out in Schima wallichii according to the ear-marked standard methods given by various scientists for each parameter. RESULTS: The flowering period in Schima wallichii varied from 33 to 42 days with mean synchrony of 0.54 to 0.68 between the populations. The stigma was receptive up to 2.5 days only and showed slightly protandrous type of dichogamy. Average pollen production ranged between 6.90 × 10(7) pollen per tree in 2007 and 15.49 × 10(8) pollen per tree in 2011. A three-year masting cycle was noticed in this species. The frequency of visitation of honey bees was fairly high (5.2 ± 1.12 visits/flower/hour) as compared to other pollinators. The hand pollination revealed maximum fruit (74.2 ± 5.72%) and seed (70.8 ± 7.46%) settings. CONCLUSIONS: The variation in flowering phenology and pollen yield individually and annually along with temporal separation in anther dehiscence and pollinator's visitation cause pollen limited reproduction, which ultimately influences the reproductive success in Schima wallichii.

Variation in carbon stocks on different slope aspects in seven major forest types of temperate region of Garhwal Himalaya, India.

The present study was undertaken in seven major forest types of temperate zone (1500 m a.s.l. to 3100 m a.s.l.) of Garhwal Himalaya to understand the effect of slope aspects on carbon (C) density and make recommendations for forest management based on priorities for C conservation/sequestration. We assessed soil organic carbon (SOC) density, tree density, biomass and soil organic carbon (SOC) on four aspects, viz. north/east (NE), north/west (NW), south-east (SE) and south-west (SW), in forest stands dominated by Abies pindrow, Cedrus deodara, Pinus roxburghii, Cupressus torulosa, Quercus floribunda, Quercus semecarpifolia and Quercus leucotrichophora. TCD ranged between 77.3 CMg ha⁻¹ on SE aspect (Quercus leucotrichophora forest) and 291.6 CMg ha⁻¹ on NE aspect (moist Cedrus deodara forest). SOC varied between 40.3 CMg ha⁻¹ on SW aspect (Himalayan Pinus roxburghii forest) and 177.5 CMg ha⁻¹ on NE aspect (moist Cedrus deodara forest). Total C density (SOC+TCD) ranged between 118.1 CMg ha⁻¹ on SW aspect (Himalayan Pinus roxburghii forest) and 469.1 CMg ha⁻¹ on NE aspect (moist Cedrus deodara forest). SOC and TCD were significantly higher on northern aspects as compared with southern aspects. It is recommended that for C sequestration, the plantation silviculture be exercised on northern aspects, and for C conservation purposes, mature forest stands growing on northern aspects be given priority.

Wilson's disease presenting as isolated obsessive-compulsive disorder.

Wilson's disease (WD) is a genetic neurodegenerative disorder; it exhibits wide heterogeneity in symptoms and usually presents with liver disease and/ or neuropsychiatric manifestations. The common neurological manifestations observed are dysarthria, gait disturbance, dystonia, rigidity, tremor, dysphagia and chorea. The frequent psychiatric manifestations reported are personality and mood changes, depression, phobias, cognitive impairment, psychosis, anxiety, compulsive and impulsive behavior. Isolated obsessive-compulsive disorder (OCD) is a rare presentation of WD. Reported herein is a case of a 17-year-old boy with isolated OCD. He presented to the psychiatrist with symptoms of contamination obsessions and washing compulsions, along with compulsion of repeated feet tapping and was treated with adequate doses of fluoxetine for 6 months but did not improve. Later on, he was diagnosed as a case of WD and showed improvement with chelating and behavior therapy. This implies the importance of the occurrence of isolated psychological symptoms in WD.

Acute inflammatory demyelinating polyneuropathy with P. falciparum malaria.

Various types of neuropsychiatric manifestations are described in P. falciparum malaria of which peripheral neuropathy has been described mainly from India. We are reporting such a case who presented with seven days history of fever and weakness of two days duration. On investigations it turned out to be acute inflammatory demyelinating polyneuropathy (AIDP) with peripheral blood showing heavy parasitaemia of P. falciparum. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with quinine and other supportive therapy.

Pollen production, microsporangium dehiscence and pollen flow in Himalayan cedar (Cedrus deodara Roxb. ex d. Don).

Microsporangium dehiscence, pollen production and dispersal were studied in Himalayan cedar (Cedrus deodara) during 1998 and 1999. Microsporangium dehiscence showed diurnal periodicity and was found to be related to air temperature and relative air humidity, with a strobilus taking 2 d to dehisce completely in warmer conditions and 3 d in cooler ones. The frequency of flowering in C. deodara was highly variable during the two successive years; however, cyclical production of pollen grains was observed in 50% of the trees. The maximum concentration of pollen grains in the air was found between 1200 and 1600 h, and this period was also noted to be the best time for pollination. Studying migration of pollen grains from isolated single trees in three directions showed that migration was not uniform in all directions. Long-distance transport of pollen grains was observed in the downhill direction. However, in the uphill and horizontal directions grains could travel only up to 97.5 and l95.1 m, respectively, and the frequency of pollen grains to the source frequency at these distances was only 1.9 and 2-5%, respectively. The results suggest that an isolation barrier of 190 m may be considered as a minimum for the management of deodar seed orchards.

Metabolic neuropathy.

In this article a review and summary of peripheral neuropathies secondary to metabolic disorders, affecting the lower extremity, have been presented. The clinical presentation of individual symptomatology is variable depending on the nature and chronicity of illness. The clinical features that the podiatric physician must recognize is weakness, sensory, and gait disturbances resulting from these syndromes. Some disorders are reversible if recognized and treated early in their course. Thus, a thorough general history and physical examination is required of all patients presenting with apparent podiatric symptomatology.