Samarth Shukla

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.

Mirror neurons: Enigma of the metaphysical modular brain.

Mirror neurons are one of the most important discoveries in the last decade of neuroscience. These are a variety of visuospatial neurons which indicate fundamentally about human social interaction. Essentially, mirror neurons respond to actions that we observe in others. The interesting part is that mirror neurons fire in the same way when we actually recreate that action ourselves. Apart from imitation, they are responsible for myriad of other sophisticated human behavior and thought processes. Defects in the mirror neuron system are being linked to disorders like autism. This review is a brief introduction to the neurons that shaped our civilization.

Neurotheology-Matters of the Mind or Matters that Mind?

Understanding the true nature of an individual, be it a child or an adult, a male or a female, is almost an impossible task. The vast abyss like behaviour of a human mind is virtually unfathomable. Yet, with the advent of neurosciences, it can be said that we, as the medical fraternity, have been in a position to decipher a considerable part of the human mind. This review accepts the fact that religion and theology have extreme reverence and respect. Yet, when it comes to extraordinary beliefs, phenomena, unimaginable feats and emotional deviations of the human mind, especially those which involve deep faiths and beliefs, comprehensive neuroscientific explanations from the emerging data, with the aid of elaborate neuroimaging, have proved to be extremely rational and logical. This review did make an attempt to untangle some facets of spirituality and to make rational explanations of the same. It was an attempt to understand the function of the mind (as an abstract) and the brain, on the spiritual experiences and sudden enlightments, the experience of togetherness with the universe, and to understand the phenomena of trance and an altered state of consciousness, which is better referred as the emerging science of neurotheology.

Giant cavernous hemangiomas of the brain.

Cavernous angiomas or hemangiomas or cavernomas are benign, vascular malformations of the central nervous system and classified as occult vascular brain lesions, usually present in adulthood. With the advent of computed tomography and magnetic resonance imaging, these lesions are increasingly recognized in children. We report two cases of pediatric brain cavernomas where the children presented with recurrent seizures. Imaging findings were suggestive of giant cavernous hemangioma. The lesions were excised completely and the patients recovered well without deficits with good control of seizures.

Choroid Melanoma - A Rare Case Report.

Uveal tract encomprise melanomas of the iris, ciliary body and the choroid. The choroid melanomas are more frequent to occur in comparison to iris and ciliary body melanomas. Choroid melanoma though rare, is the most common occurring intraocular malignancy amongst the adults. Incidence of occurrence of choroid melanoma is around 20 per million cases per year globally. The uveal tract pigment producing melanocytes are the origin for the melanoma in the eye. Melanomas tend to commonly arise from sixth decade of age with increasing incidence with progressive age. We present a rare case choroidal melanoma, in a 65-year-old adult, who presented with three months history of headache and gradual dimunision of vision, his investigations revealed clinical diagnosis of choroid melanoma , an enucleation was carried.

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.

Ascitic Fluid High Sensitive C-Reactive Protein (hs-CRP). A Prognostic Marker in Cirrhosis with Spontaneous Bacterial Peritonitis

INTRODUCTION C-Reactive Protein (CRP) is an acute phase reactant. Its level increases in the presence of acute or chronic inflammation and infections. High sensitive CRP (hs-CRP) is more sensitive than CRP as an inflammatory marker. High sensitive CRP has been known to be elevated in chronic liver diseases and Spontaneous Bacterial Peritonitis (SBP). AIM The aim of the study was to establish the role of ascitic fluid high sensitive C-reactive protein (hs -CRP) as a prognostic indicator in patients with SBP. MATERIALS AND METHODS A total of 100 patients with decompensated cirrhosis admitted in medicine ward and ICU were included, of which 50 patients of acute bacterial peritonitis were used as study group and 50 patients of sterile ascites were used as control group. Hs-CRP level of cases and controls were estimated. SBP cases were treated with its standard recommended antibiotic therapy and hs-CRP level was again estimated after 5 days of antibiotic therapy or at the time of discharge. RESULTS The mean level of hs-CRP before antibiotic therapy of the patients with SBP was significantly higher than that of the patients without spontaneous bacterial peritonitis (t98=17.72; p=0.0001). The mean level of hs-CRP at 5(th) day or discharge after initiation of antibiotic therapy was significantly lower than that of level of hs-CRP before initiation of antibiotic therapy (p<0.05). The mean hs-CRP of the cases with poor outcome (death and prolonged hospital stay) was significantly higher than others. CONCLUSION Ascitic fluid hs-CRP level can be considered as a surrogate prognostic marker in cases of Cirrhosis with SBP.

An unusual case of triazophos poisoning presenting with new-onset refractory status epilepticus

Background: There is equipoise regarding the status of bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH), where patients need to be on long-term low-dose steroids. Objective: We aimed to evaluate BMD at the hip, spine and forearm in women with CAH and compare it to healthy young adult women of the same age range. Subjects and Methods: Fifteen adult women with CAH with age ranging from 18 to 40 years (mean ± standard deviation = 27.5 ± 6.2 years) underwent dual-energy X-ray absorptiometry along with laboratory evaluation. BMD at lumbar spine, hip, forearm along with T-scores were measured. Serum total calcium, phosphate, alkaline phosphatase, 25 hydroxy Vitamin D, intact parathyroid hormone, total testosterone, and dehydroepiandrosterone were assayed. History of any fractures in the past was taken. Fifteen healthy women in the same age range were taken as controls for comparison. Results: The BMD at hip (0.85 ± 0.02 g/cm2) in CAH was significantly lower as compared with controls (0.92 ± 0.03 g/cm2, P = 0.029). BMD at lumbar spine was also reduced (0.96 ± 0.02 vs. 1.03 ± 0.03, P = 0.057). The BMD at forearm was not significantly different between CAH and controls. The mean Vitamin D was 9.8 ng/ml (deficient range). There was no history of fractures in CAH. Conclusion: Young adult CAH women had lower BMD at spine and hip than healthy young adult women of the same age range. The forearm BMD was not different from controls. No change in fracture frequency was present. Patients with CAH being treated with steroids are at increased risk of osteopenia, and their bone health needs to be monitored.

Assessment of functional capacity of offspring of hypertensive versus normotensive parents by 6 minute walk test.

Introduction: Hypertension is one of the commonest worldwide disease afflicting humans. It is an important public health challenge. A new analysis shows that in 2000 nearly one billion of the world’s population was hypertensive and suggests that the global burden of hypertension may reach 1.56 billion people worldwide by 2025.The situation of hypertensive disorders in India is more alarming. AIM- To assess the functional capacity of offspring of hypertensive parents with control group (offspring of normotensive parents) by 6 minute walk test. Methods: A cross-sectional study is carried out in DMIMSU with 100 subjects (of hypertensive and normotensive parents) taken into consideration using 6 minute walk test. The comparison is done on the basis of physiological parameters mainly as 6MWD, VO₂ Max, Walk Work. Results: The 6MWD covered and the VO₂max consumed by the offspring of hypertensive parents is less than the normotensive parents. Conclusion: The functional capacity of study group comes out to be less than control group. Therefore, study group should adopt primordial preventive measures to avoid the risk of developing hypertension in future.

Dengue Encephalitis---A Rare Entity

Encephalitis is an uncommon manifestation of dengue fever. We present a case of a 30 year old female who presented with severe encephalitis due to dengue infection.