Naveed Mohsin

Isolated skeletal muscle metastasis and hypercalcemia in non-small cell lung carcinoma

Lung cancer is the most common malignancy throughout the world. Non-small cell lung carcinoma is the most common type and squamous cell type is the most common in India. Patients mostly present with chest related symptoms and signs. Isolated skeletal muscle metastasis (ISMM) is rarely seen. We describe a patient who presented with ISMM and hypercalcemia without any pulmonary symptoms.

Clinical profile of acute flaccid paralysis: A study from North India, Kashmir

Background and Aims: As a part of Global Polio Eradication Programme by the World Health Organization, 1988 surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing the eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. This study was designed to know the clinical characteristics, and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on the basis of history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled. Out of 106 patients, 58 (54.7%) were suffering from Guillain-Barrι syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include; acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Most cases, 42/106 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most of the AFP cases occurred during the spring season. No case of poliomyelitis was found.

Clinical profile of acute flaccid paralysis

Background and Aims: As a part of the Global Polio Eradication program by the World Health Organization (WHO, 1988), surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. Our study was designed to know the clinical characteristics and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid (CSF) analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled in the study. The mean age of males was 40.2 years (standard deviation [SD] 17.1) and the mean age of females was 33.4 years (SD 14.1). Of 106 patients, 61 (57.5%) were male and 45 (42.5%) were female. Out of 106 patients, 58 (54.7%) were suffering from Guillain-Barre′ syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Of 106 patients, 42 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most AFP cases occurred during the spring season. No case of poliomyelitis was found.

Hashimoto's encephalopathy misdiagnosed as pyogenic meningoencephalitis

Hashimotos encephalopathy is a controversial and under-recognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalographic and neuroimaging findings yielded the diagnosis.

Patterns of infections in chronic obstructive pulmonary disease exacerbations and its outcome in high dependency area, intensive care setting in a tertiary care hospital

Background and Objectives: Chronic obstructive pulmonary disease is a common problem in both developed and developing nations. It is directly linked with smoking. It is associated with frequent exacerbations and then hospitalizations. A large percent of Gross domestic product is spent on its management. We conducted a hospital-based study in such patients who got admitted with exacerbation, whether infective or noninfective, and who required invasive ventilation during management. Such kind of study has not been reported from our country so far. The aim of this study is to determine the prevalence, etiology, and sensitivity of infective exacerbations and its impact on the outcome with the use of invasive ventilation. Materials and Methods: We enrolled 150 admitted patients for the study and recorded their clinical and laboratory parameters. The respiratory specimen was obtained by different ways and sent for culture and drug sensitivity. The outcome was noted with the use of invasive ventilation, and prognostic values of different variables were ascertained. Results: The infective exacerbation was seen in 65% and organisms involved were Gram-negative bacteria, with a predominance of Acinetobacter in 35%, Klebsiella in 32%, Pseudomonas in 17.5%, and Escherichia coli in 5%. The number of hospitalization days of the 150 patients ranged from 5 to 40 days with a mean of 16.39 ± 11.45 days. The number of Intensive Care Unit days range was 0-25 days with a mean of 7.35 ± 7.9 days. The number of days of invasive ventilation range was 2-18 days with a mean of 3.28 ± 5.2. The number of days on Bi-level positive airway pressure ventilation (BiPAP) was between 2 and 22 with a mean of 6.15 ± 5.7 days. The outcome was significant between the survivors/nonsurvivors in terms of a number of days of invasive ventilation required ( P Conclusion: There was higher mortality among patients admitted with multiorgan dysfunction and multiple infiltrates on chest X ray, and there was significant advantage in outcome on invasive ventilation.

Clinical profile of acute flaccid paralysis: A study from a tertiary care centre in Kashmir, India

Background and Aims: As a part of Global Polio Eradication Programme by World Health Organisation, surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing the eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. This study was designed to know the clinical characteristics, and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on the basis of history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled. Out of 106 patients, 58 (54.7%) were suffering from acute inflammatory demyelinating polyneuropathy, a subtype of Guillain-Barré syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include; acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Most cases, 42/106 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most of the AFP cases occurred during spring season. No case of poliomyelitis was found.

Idiopathic Distal Renal Tubular Acidosis Presenting as Polymorphic Ventricular Tachycardia

Renal tubular acidosis is a known clinical entity, in which type I distal renal tubular acidosis (dRTA type I), also known as classical dRTA, is second most common type after dRTA type IV. We report 21-year-old female presenting as polymorphic ventricular tachycardia (VT), which on evaluation was found to have the type I dRTA with idiopathic etiology. Polymorphic VT as presentation of type I dRTA has not been reported in the literature in human beings so far but has been reported in animal models.

Antiphospholipid antibody syndrome presenting as transverse myelitis

The antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis and pregnancy morbidity in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disorder or secondary to a connective tissue disease, most frequently systemic lupus erythematosus. Central nervous system involvement is one of the most prominent clinical manifestations of APS, and includes arterial and venous thrombotic events, psychiatric features, and a variety of other nonthrombotic neurological syndromes. Although the mechanism of neurological involvement in patients with APS is thought to be thrombotic in origin and endothelial dysfunction associated with antiphospholipid antibodies. APS presenting as acute transverse myelitis is very rarely seen with a prevalence rate of 1%. We are describing a foreigner female presenting as acute transverse myelitis which on evaluation proved to be APS induced. So far, very few cases have been reported in literature with APS as etiology.

Hepatosplenic tuberculosis, a rare presentation

Tuberculosis (TB) is one of the known endemic diseases in this part of world; the most common organ involvement is lung. Among extrapulmonary involvements, tubercular lymphadenitis is the most common. Gastrointestinal TB is very uncommon, making up to 3.5% of extrapulmonary TB. Hepatosplenic TB with abdominal tubercular lymphadenitis is very rare form of TB, accounting <1%. We are describing a patient who had lymphoma-like presentation and at the end proved to be a rare form of TB.