Irfan Ahmad Shah

Multiple cerebral infarctions with severe multi-organ dysfunction following multiple wasp stings.

Wasp and bee sting are commonly encountered worldwide. Local reactions are more common, generally are self-limiting and settle within a few hours. Multiple stings can lead to various clinical manifestations like vomiting, diarrhea, dyspnea, generalized edema, hypotension, syncope, acute renal failure, and even death. Rarely, they can cause vasculitis, serum sickness, neuritis, and encephalitis. We are reporting a case of 40-year-old male who presented with stroke, right hemiparesis with severe multi-organ dysfunction due to multiple wasp stings.

Effect of Fluoxetine on Motor Recovery after Acute Haemorrhagic Stroke: ARandomized Trial

Background: A few clinical trials have suggested that selective serotonin reuptake inhibitors (SSRI’s) enhance motor recovery after stroke but no study has been done in haemorhagic stroke patients. We therefore aimed to investigate whether fluoxetine, an SSRI would enhance motor recovery in patients of haemorrrhagic stroke. Methods: Patients who had haemorrhagic stroke with hemiplegia or hemiparesis and were aged between 18 years and 80 years were included in this double-blind, placebo-controlled trial. Patients were randomly assigned, in a 1:1 ratio to fluoxetine (20 mg/d, orally) or placebo for 3 months starting 5-10 days after the onset of stroke. All patients also had routine physiotherapy. The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug. Results: A total of 89 patients were assigned to fluoxetine (n=45) or placebo (n=44), group, and 84 were finally included in the analysis (42 vs 42) after 5 patients lost to follow up. Mean FMMS score improved significantly greater at day 90 in the fluoxetine group (mean 35.64 points) than in the placebo group (23.60 points; p =0.001). Conclusion: Use of fluoxetine in patients of haemorrhagic stroke in early post stroke period added to physiotherapy increased recovery in motor deficits at 3 months.

Nonalcoholic Wernicke's encephalopathy: A retrospective study from a tertiary care center in Northern India

Objective: The objective of this study was to describe the demographic features, clinical presentation, and management and outcome of fifty cases of nonalcoholic Wernickes encephalopathy from a tertiary care hospital of a region with reported incidence of thiamine deficiency disorders. Materials and Methods: In a retrospective study, fifty adult cases of Wernickes encephalopathy were analyzed. The diagnosis of Wernickes encephalopathy was made according to the European federation of neurological societies guidelines 2010. Response to thiamine replacement and associated brain magnetic resonance imaging (MRI) findings were also considered as supportive evidence. Results: The mean age of patients was 50.38 years with 20 males and 30 females. The most common clinical manifestations were alteration in sensorium in 30 (60%), ataxia in 18 (36%), memory impairment in 15 (30%), nystagmus in 35 (70%), ophthalmoparesis in 11 (22%), and seizures in 4 (8%). A total of 42 patients had a history of recurrent vomiting. All patients had polished rice as their staple diet. Thirty-five patients had associated polyneuropathy and 15 had a gastrointestinal disorder. Twenty patients underwent MRI which showed both typical and atypical lesions. Majority of patients showed partial or complete response to intravenous thiamine. On discharge, the most common residual symptoms were lower limb weakness, ataxia, and memory impairment. Conclusion: The study shows high incidence of nonalcoholic Wernickes encephalopathy in the region with predominant causative factor being a thiamine deficient diet. Recurrent vomiting can be a prominent early symptom of thiamine deficiency and its recognition can help in the early diagnosis of Wernickes encephalopathy and related thiamine deficiency disorders. Thiamine fortification of food should be done in areas with reported incidence of thiamine deficiency disorders.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

Background/Aims Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. Methods This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. Results Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). Conclusions The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Genetic Approaches-Investigating Psychiatry

Rational and logical answers have been the basis of all the sciences. Many questions in the understanding of psychiatric psychopathology and symptoms are rationally understood and a lot more are revealing due to the development of modern investigative techniques. Genetic factors are under active and extensive research for better understanding of psychiatric illnesses. And these approaches have undergone a paradigm shift in the recent times. From basic molecular genetics to the pharmacogenetics, a lot many tools are in the kitty of the investigators. The study of theses genetic factors, development of genetic techniques, vis-a-vis the interaction with other factors is an active area of interest.

Complete ophthalmoplegia: A rare presentation of idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder defined by clinical criteria that include signs and symptoms isolated to those produced by increased intracranial pressure (ICP; e. g., headache, papilledema, and vision loss), elevated ICP with normal cerebrospinal fluid (CSF) composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. The most common signs in IIH are papilledema, visual field loss, and unilateral or bilateral sixth cranial nerve palsy. Here we report a case of IIH presenting as headache with vision loss, papilledema, complete ophthalmoplegia with proptosis in one eye, and sixth cranial nerve palsy in the other eye. Patient was managed with acetazolamide, topiramate, and diuretics. Symptoms remained static and she was planned for urgent CSF diversion procedure.

Posterior reversible encephalopathy syndrome due to seronegative systemic lupus erythematosus

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique computed tomography or magnetic resonance imaging (MRI) appearance. Recognized in the setting of a number of complex conditions (preeclampsia/eclampsia, allogeneic bone marrow transplantation, organ transplantation, autoimmune disease and high-dose chemotherapy) in the imaging, clinical and laboratory features of this toxic state are becoming better elucidated. We are presenting a case of PRES due to seronegative systemic lupus erythematosus, with MRI findings of diffuse vasogenic edema.