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.

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.

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.

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.

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.

Malaria in South Asia: prevalence and control

The "Malaria Evolution in South Asia" (MESA) program project is an International Center of Excellence for Malaria Research (ICEMR) sponsored by the US National Institutes of Health. This US-India collaborative program will study the origin of genetic diversity of malaria parasites and their selection on the Indian subcontinent. This knowledge should contribute to a better understanding of unexpected disease outbreaks and unpredictable disease presentations from Plasmodium falciparum and Plasmodium vivax infections. In this first of two reviews, we highlight malaria prevalence in India. In particular, we draw attention to variations in distribution of different human-parasites and different vectors, variation in drug resistance traits, and multiple forms of clinical presentations. Uneven malaria severity in India is often attributed to large discrepancies in health care accessibility as well as human migrations within the country and across neighboring borders. Poor access to health care goes hand in hand with poor reporting from some of the same areas, combining to possibly distort disease prevalence and death from malaria in some parts of India. Corrections are underway in the form of increased resources for disease control, greater engagement of village-level health workers for early diagnosis and treatment, and possibly new public-private partnerships activities accompanying traditional national malaria control programs in the most severely affected areas. A second accompanying review raises the possibility that, beyond uneven health care, evolutionary pressures may alter malaria parasites in ways that contribute to severe disease in India, particularly in the NE corridor of India bordering Myanmar Narayanasamy et al., 2012.

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.

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.

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.

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.

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.

Colorimetric determination of diazepam in pharmaceutical preparations

A colorimetric method is presented for the estimation of diazepam as the pure drug and in formulations. Diazepam is hydrolyzed with 6N HCl to 2-methylamino-5-chlorobenzophenone, which is extracted with chloroform to give a yellow solution whose absorbance is measured at 410 nm against a solvent blank. The color obeys Beer's law in the concentration range of 0-30 mug/ml. In 5 determinations, recovery was 99.0 +/- 1.9%. The method is applicable to pure diazepam and its formulations for oral and parenteral use. No interferences were observed from pyridoxine hydrochloride and commonly used preservatives, vehicles, and colors.