A Case of Multiple Sclerosis Presenting as Eight and Half Syndrome.

Multiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination, gliosis (scarring), and neuronal loss; the course can be relapsing-remitting or progressive. Manifestations of MS vary from a benign illness to a rapidly evolving and incapacitating disease requiring profound lifestyle adjustments. We report a 24 year old female who presented with right internuclear ophthalmoplegia with right lower motor neuron facial nerve palsy which is called eight and half syndrome. The etiology in our patient was multiple sclerosis which was confirmed by radio-imaging studies. Patient improved on pulse therapy of methyl prednisolone and tapering dose of steroids

ANALGESIC AND ANTI-INFLAMMATORY ACTIVITIES OF ETHANOLIC EXTRACT OF LEAVES OF PUNICA GRANATUM L. ON EXPERIMENTAL ANIMAL MODELS

Objective: The aim of the study is to evaluate the analgesic and anti-inflammatory activities of the ethanolic extract of Punica granatum L. (EEPG) on experimental animal models. Methods: Tail-flick method was used to test the central analgesic activity, using Pethidine as standard drug. The tail flick latencies or the basal reaction time of the animals were assessed using an analgesiometer. Glacial acetic acid induced writhing response was used to test the peripheral analgesic activity, using Aspirin as standard drug. Number of writhing responses was counted for 20 min in each group and the percentage protection was calculated. And Carrageenan induced rat paw edema method was used to test anti-inflammatory activity of EEPG against acute inflammation, using Aspirin as standard drug. The inhibition of rat paw edema was calculated in percentage. Results: In central analgesic activity, the extract and pethidine showed significant increase in the reaction time. In peripheral analgesic activity, the extract and aspirin significantly reduced the number of writhes induced by acetic acid. And in anti-inflammatory activity, the extract produced significant reduction of the carrageenan induced paw edema. Conclusion: The EEPG has demonstrated significant analgesic and anti-inflammatory activity

Cardiovascular abnormalities in severe scrub typhus

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%).   Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%).  Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome

Pseudohypoparathyroidism Presenting as Congestive Cardiac Failure

Hypocalcaemia can have a variety of manifestations including cardiovascular changes. Hypocalcemic cardiomyopathy has been reported in hypoparathyroidism and vitamin D deficiency but association of hypocalcemic cardiomyopathy in pseudohypo-parathyroidism has been reported scarcely in literature. We describe here a case of PHP presenting as congestive cardiac failure

Hirayama Disease - A Variant of Motor Neuron Disease and Role of Flexion MRI in Diagnosis

Hirayama disease is a monomyelic variant of motor neuron disease (MND) and has distinctive features of male predominance, asymmetric involvement of upper extremities with a self limiting course. Flexion MRI (magnetic resonance imaging) forms the main stay for diagnosis of this condition. Here we report such an unusual case of Hirayama disease in a male patient of 20 years who presented with weakness and atrophy in right upper limb. Careful clinical examination will help to use the flexion MRI studies for the diagnosis of this condition as done in our case

Himalayan P waves in COPD - A Rare Feature

Himalayan or giant P-waves (amplitude =5 mm) are often known to be classically associated with congenital heart diseases with right to left shunt like tricuspid atresia, Ebstein anomaly, combined tricuspid and pulmonic stenosis, etc, where they indicate a dilated right atrium and tend to be persistent. These type P waves are rarely seen in chronic obstructive pulmonary disease (COPD) and in this condition it may be due to structural right atrial changes or hypoxemia or combination of both. Here we report a case of COPD with Himalayan P waves which is a rare entity

Isolated Amoebic Abscess of Spleen

Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Extrahepatic amoebic abscesses have occasionally been described in the lung, brain, and skin and presumably result from hematogenous spread. Isolated amoebic abscess of spleen has been reported scarcely in literature. We report here a case of isolated amoebic abscess of spleen

Technical and clinical assessment of latest technology SiPM integrated digital PETCT scanner

ObjectiveThe aim of this study was to conduct a technical and clinical evaluation of a Silicon Photomultiplier (SiPM) integrated digital Positron Emission Tomography – Computed Tomography (PETCT) Scanner using National Electrical Manufacturers Association (NEMA) NU 2- 2018 standards.MethodsSystem sensitivity was measured by using a NEMA sensitivity phantom. Scatter fraction, count-rate performance, accuracy of count loss, and timing resolution were all computed. Clinical images were acquired and image quality was assessed and compared with published studies.ResultsAt 1 cm, tangential, radial, and axial spatial resolutions were 3.02 mm, 3.02 mm, and 2.73 mm at full width half maximum (FWHM), respectively. Sensitivity at centre and 10 cm was 10.359 cps/kBq and 9.741 cps/kBq, respectively. The timing resolution was measured at 372 ps.ConclusionThe digital PETCT exhibits a high-spatial resolution and a superior timing resolution, which advances the diagnostic ability to detect small lesions and boosts the diagnostic confidence.Implications for practiceIncreases clinical relevance by improving the ability to detect and differentiate tiny or low-contrast lesions without compromising radiopharmaceutical dose or overall scan time

Fetomaternal outcome in pregnancies complicated by fibroid

Background: Fibromyoma (leiomyoma) is the most common benign tumour of the uterus. Approximately 10% to 30% of women with uterine fibroids developed complications during pregnancy. The aim of the study was planned to ascertain the fetomaternal outcome in pregnancies complicated by fibroid.Methods: A hospital based cross-sectional study was conducted among pregnant women with documented uterine fibroid who was admitted for any complication or delivered in the department of obstetrics and gynaecology, RIMS, Imphal from September 2017 to August, 2019 in the department of obstetrics and gynaecology in collaboration with department of paediatrics, Regional institute of Medical Sciences, Imphal. Detailed clinical history and socio-demographic profile were recorded in pre-designed proforma. General physical examination and systemic examination and obstetrical examination was carried out for the participants.Results: Major proportions was in the age group of 30-39 years (73.9%). Fibroids were more frequent in primigravida (76.1%) followed by P1 (15.2%) and ≥P2 (8.7%). Out of 46 patients 43 (93.5%) delivered by CS (69.76%), NVD (25.58%) and instrumental delivery (4.65%) while 3 patients (6.5%) undergo spontaneous abortions. Most common myoma found in this study was intramural (47.8%) followed by submucous (34.8%) and subserosal (17.4%). Out of 43 deliveries most common complications found was atonic PPH (6.97%) and placenta previa (6.97%) followed by degenerations (2.32%), abruptio placentae (2.32%), malpresentations (2.32%). Out of 43 deliveries 6.9% baby born with low birth weight, IUGR (6.9%), IUFD (4.6%), NICU admission (4.65%) and early neonatal death (2.32%).Conclusions: Pregnancies with fibroids are considered as high-risk pregnancy associated with complications during the antepartum, intrapartum, postpartum period. Pregnant women with myoma can be advised for regular ANC along with TAS for early diagnosis and management of complication

Correlation between ultrasonographic and histopathological findings of hysterectomy specimen in patients with abnormal uterine bleeding

Background: AUB is a common and debilitating condition and it is one of the main gynaecological reasons for hysterectomy. Ultrasonography can be as good as histopathology (HPE) in the diagnosis of abnormal uterine bleeding. Hence, our study was conducted to validate the ultrasonographic findings with HPE findings in diagnosis of AUB.Methods: A hospital based cross-sectional analytical study was conducted among 86 patients with abnormal uterine bleeding in the department of Obstetrics and Gynaecology in collaboration with department of Pathology, RIMS, Imphal from September 2017 to March 2019. The clinical history and socio demographic profile were collected using a pre-designed proforma. General physical examination, pelvic examination and ultrasonagraphy was carried out and the hysterectomy specimens were subjected to histopathological examination.Results: Fibromyoma was diagnosed by ultrasound in 62.8% of the patients and it was the common diagnosis in this study. The sensitivity, specificity, positive predictive value, negative predictive value and kappa statistics of USG for diagnosing leiomyoma was 92.9%, 93.3%, 96.3%, 87.5% and 84.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and kappa statistics of USG for diagnosing adenomyosis was 53.8%, 98.6%, 87.5%, 92.3% and 62.3% respectively.Conclusions: The study provides an evidence that ultrasonography has good diagnostic accuracy as histopathology in the diagnosis of fibroid in patients with abnormal uterine bleeding. However, as with all the diagnostic procedures, the utility of ultrasound in the diagnosis of adenomyosis is questionable, since it has a low sensitivity amidst good specificity