scholarly journals A Rare Case of Acute Axonal Motor Neuropathy in a Puerperal Woman

2015 ◽  
Vol 7 (1) ◽  
pp. 48-49
Author(s):  
N Sundari ◽  
Asha Swarup ◽  
Ashwini Nayak ◽  
Jyothi Girish
Keyword(s):  
Rare Case ◽  
Axonal Neuropathy ◽  
Critical Illness Polyneuropathy ◽  
Lower Limbs ◽  
Motor Neuropathy ◽  
Mortality And Morbidity ◽  
Puerperal Woman ◽  
The Individual ◽  
High Index Of Suspicion

ABSTRACT We report the case of a puerperal woman who presented to us with sepsis, multiorgan dysfunction and motor weakness of both lower limbs. On detailed evaluation, patient was found to have axonal neuropathy establishing the diagnosis of critical illness polyneuropathy (CIP). A high index of suspicion is required to arrive at the diagnosis as this condition is not only associated with high mortality and morbidity rates but also can affect the quality of life of the individual in the long-term. This case has been reported to highlight the importance of recognition of this common, but rarely diagnosed condition as it can help us to portend the prognosis. How to cite this article Nayak A, Sundari N, Swarup A, Girish J. A Rare Case of Acute Axonal Motor Neuropathy in a Puerperal Woman. J South Asian Feder Obst Gynae 2015; 7(1):48-49.

scholarly journals A Rare Case of Acute Axonal Motor Neuropathy in a Puerperal Woman

2015 ◽  
Vol 7 (2) ◽  
pp. 93-94
Author(s):  
N Sundari ◽  
Ashwini Nayak ◽  
Jyothi Girish ◽  
Asha Swaroop
Keyword(s):  
Rare Case ◽  
Axonal Neuropathy ◽  
Critical Illness Polyneuropathy ◽  
Lower Limbs ◽  
Motor Neuropathy ◽  
Mortality And Morbidity ◽  
Puerperal Woman ◽  
The Individual ◽  
High Index Of Suspicion

ABSTRACT We report the case of a puerperal woman who presented to us with sepsis with multiorgan dysfunction and motor weakness of both lower limbs. On detailed evaluation, patient was found to have axonal neuropathy establishing the diagnosis of critical illness polyneuropathy. A high index of suspicion is required to arrive at the diagnosis as this condition is not only associated with high mortality and morbidity rates but also can affect the quality of life of the individual in the long term. This case has been reported to highlight the importance of recognition of this common, but rarely diagnosed condition as it can help us to portend the prognosis. How to cite this article Nayak A, Sundari N, Swaroop A, Girish J. A Rare Case of Acute Axonal Motor Neuropathy in a Puerperal Woman. J South Asian Feder Obst Gynae 2015;7(2):93-94.

scholarly journals A Rare Case of Pheohyphomycotic Lumbar Spondylodiscitis Mistreated as Koch’s Spine

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Shakti A. Goel ◽  
Hitesh N. Modi ◽  
Yatin J. Desai ◽  
Harshal P. Thaker
Keyword(s):  
Weight Loss ◽  
Case Report ◽  
Rare Case ◽  
Radicular Pain ◽  
Lower Limbs ◽  
Low Back ◽  
Voice Changes ◽  
Erythematous Skin ◽  
Invasive Techniques

Pheohyphomycosis is an uncommon infection and its association in spondylodiscitis has not yet been reported. The purpose of this case report is to describe a rare case of Pheohyphomycotic spondylodiscitis and methods to diagnose and manage the patient with less invasive techniques. A 29-year-old male patient presented to the outpatient department with complaints of gradually increasing low back pain with bilateral lower limbs radicular pain since one and a half years. He had associated fever, weight loss, voice changes, and dry, scaly, erythematous skin with elevated ESR. The patient had been taking anti-Koch’s therapy since 1 year with little relief in pain and no radiological improvement. Percutaneous pedicle biopsy of L4 vertebra was taken under local anaesthesia and confirmed Pheohyphomycosis which was treated with antifungal medications. The patient showed sequential improvement with long term antifungal treatment. He was eventually able to walk independently without support.

scholarly journals Guillain-Barré syndrome in a child with COVID-19 associated multi system inflammatory syndrome

2021 ◽  
Vol 8 (11) ◽  
pp. 1890
Author(s):  
Alekhya Erubothu ◽  
Sudha Rudrappa ◽  
Pratibha Manjunath Patagar
Keyword(s):  
Axonal Neuropathy ◽  
Lower Limbs ◽  
Guillain Barre Syndrome ◽  
High Grade Fever ◽  
Immune Mediated ◽  
Guillain Barré Syndrome ◽  
Paediatric Age ◽  
Guillain Barré ◽  
High Index Of Suspicion ◽  
Inflammatory Syndrome

Multi-system inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 is a new entity affecting a small percentage of children during the COVID-19 pandemic. This usually presents with multi-organ dysfunction, predominantly affecting cardiovascular, muco-cutaneous, and gastrointestinal systems. Till now, neurological manifestations as a part of this spectrum, such as, encephalopathy, inflammatory CNS syndromes, cerebrovascular disease, and Guillain-Barré syndrome (GBS), have been well reported in adults, but there is a paucity of data from the paediatric age group. Here, we present a case of a 6-year-old girl who presented to us with progressive, bilaterally symmetrical ascending weakness of lower limbs followed by upper limbs along with drooling of saliva and dyspnea. Nerve conduction studies showed motor axonal neuropathy suggestive of GBS and child was treated accordingly with intravenous immunoglobulin. On 4th day of admission, the child developed high grade fever spikes, hypotension and diarrhoea. Hence, worked up for MIS-C which revealed elevated inflammatory markers with positive SARS-CoV-19 IgM, IgG antibodies. The diagnosis was hence revised to GBS with MIS-C, the child was then started on methylprednisolone following which the child showed both clinical and biochemical improvement and was then discharged. A high index of suspicion for the possibility of MIS-C should be kept in mind in the present pandemic times, as the immune-mediated damages in MIS-C are potentially treatable with a timely institution of intensive care measures along with the use of steroids, IV-Ig, and plasmapheresis.

scholarly journals Guillain-barré syndrome (GBS): acute motor axonal neuropathy (AMAN) - case report

2021 ◽  
Author(s):  
Leonardo Martins Parca ◽  
Ahmad Abdallah Hilal Nasser ◽  
Gabriel Rodrigues Gomes da Fonseca ◽  
Gabriel Nogueira Noleto Vasconcelos ◽  
Grazielle de Oliveira Marques ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Axonal Neuropathy ◽  
Lower Limbs ◽  
Motor Symptoms ◽  
Motor Neuropathy ◽  
Related Factors ◽  
Acute Motor Axonal Neuropathy ◽  
Clinical Criteria ◽  
Phenotypic Variant

Background: GBS is an acute inflammatory polyneuropathy resulting from an immune response after infection. Characterized as an ascetic, progressive, selflimiting flaccid tetraparesis. It has several phenotypic presentations, which one is AMAN. The treatment’s based on use of intravenous immunoglobulin (IGIV) and plasmapheresis (PLEX). Methods: A literature review of the PubMed and UpToDate databases using descriptors “GBS” and “AMAN” between 2014-2020. Objectives: Report a case of GBS, addressing AMAN variant; a literature review with therapeutic and diagnostic possibilities. Case report: DTS, 32y, male, admitted with a picture of flaccid, limp asymmetrical tetraparesis, with an asymmetrical pattern, predominant in lower limbs, without sensory symptoms. Progressive evolution, onset of motor symptoms on the 8th day after self-limited diarrhea. CSF on 3rd day of onset of motor symptoms without dissociation cytological protein - CN: 62 / Ptn: 80.1mg / dl. Repeated CSF on the 10th day with CN: 27 / Ptn: 215 mg / dl. electroneuromyography 16/04: electrophysiological examination shows motor neuropathy of axonal pattern with signs of denervation in activity, findings compatible with axonal neuropathy. IGIV was performed for 5 days, without complications. Results: The diagnosis of GBS is based on CSF clinical criteria and findings on electroneuromyography. AMAN is a phenotypic variant characterized by purely motor and axonal impairment. The therapeutic options proven effectiveness are PLEX, and IGIV. Conclusion: Studies demonstrates that there’s no difference in effectiveness between PLEX and IGIV, the choice of treatment being dependent on socioeconomic and patient-related factors.

Drug-Induced Agranulocytosis: A Mini Review

2016 ◽  
Vol 2 (1) ◽  
pp. 57-59
Author(s):  
Pavithra D ◽  
Praveen D ◽  
Vijey Aanandhi M
Keyword(s):  
Bone Marrow ◽  
Complete Blood Count ◽  
Genetic Manipulation ◽  
White Blood Cells ◽  
Deep Infection ◽  
Morbidity Rate ◽  
Drug Induced ◽  
Serious Adverse Event ◽  
Mortality And Morbidity ◽  
The Individual

Agranulocytosis is also known to be granulopenia, causing neutropenia in circulating blood streams .The destruction of white blood cells takes place which leads to increase in the infection rate in an individual where immune system of the individual is suppressed. The symptoms includes fever, sore throat, mouth ulcers. These are commonly seen as adverse effects of a particular drug and are prescribed for the common diagnostic test for regular monitoring of complete blood count in an admitted patient. Drug-induced agranulocytosis remains a serious adverse event due to occurrence of severe sepsis with deep infection leading to pneumonia, septicaemia, and septic shock in two/third of the patient. Antibiotics seem to be the major causative weapon for this disorder. Certain drugs mainly anti-thyroid drugs, ticlopidine hydrochloride, spironolactone, clozapine, antileptic drugs (clozapine), non-steroidal anti-inflammatory agents, dipyrone are the potential causes. Bone marrow insufficiency followed by destruction or limited proliferative bone marrow destruction takes place. Chemotherapy is rarely seen as a causative agent for this disorder. Genetic manipulation may also include as one of the reason. Agranulocytosis can be recovered within two weeks but the mortality and morbidity rate during the acute phase seems to be high, appropriate adjuvant treatment with broad-spectrum antibiotics are prerequisites for the management of complicated neutropenia. Drugs that are treated for this are expected to change as a resistant drug to the patient. The pathogenesis of agranulocytosis is not yet known. A comprehensive literature search has been carried out in PubMed, Google Scholar and articles pertaining to drug-induced agranulocytosis were selected for review.

The Acceptance of Party Unity in Parliamentary Democracies

2017 ◽  
Author(s):  
David M. Willumsen
Keyword(s):  
Political Parties ◽  
Costs And Benefits ◽  
Parliamentary Democracies ◽  
Survey Questions ◽  
Ideal Policy ◽  
Central Argument ◽  
The Individual ◽  
Policy Incentives

The central argument of this book is that voting unity in European legislatures is not primarily the result of the ‘disciplining’ power of the leadership of parliamentary parties, but rather the result of a combination of ideological homogeneity through self-selection into political parties and the calculations of individual legislators about their own long-term benefits. Despite the central role of policy preferences in the subsequent behaviour of legislators, preferences at the level of the individual legislator have been almost entirely neglected in the study of parliaments and legislative behaviour. The book measures these using an until now under-utilized resource: parliamentary surveys. Building on these, the book develops measures of policy incentives of legislators to dissent from their parliamentary parties, and show that preference similarity amongst legislators explains a very substantial proportion of party unity, yet alone cannot explain all of it. Analysing the attitudes of legislators to the demands of party unity, and what drives these attitudes, the book argues that what explains the observed unity (beyond what preference similarity would explain) is the conscious acceptance by MPs that the long-term benefits of belonging to a united party (such as increased influence on legislation, lower transaction costs, and better chances of gaining office) outweigh the short-terms benefits of always voting for their ideal policy outcome. The book buttresses this argument through the analysis of both open-ended survey questions as well as survey questions on the costs and benefits of belonging to a political party in a legislature.

scholarly journals Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service

2021 ◽  
pp. e001681
Author(s):  
Oliver O'Sullivan ◽  
R Barker-Davies ◽  
R Chamley ◽  
E Sellon ◽  
D Jenkins ◽  
...  
Keyword(s):  
Occupational Medicine ◽  
Armed Forces ◽  
Acute Illness ◽  
Medical Rehabilitation ◽  
Rehabilitation Centre ◽  
Operational Effectiveness ◽  
Mortality And Morbidity ◽  
Recovery Service ◽  
Significant Mortality

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.

scholarly journals COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Borges ◽  
M Lemos Pires ◽  
R Pinto ◽  
G De Sa ◽  
I Ricardo ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cardiac Rehabilitation ◽  
Lean Mass ◽  
Lower Limb ◽  
Lower Limbs ◽  
Phase Iii ◽  
Face To Face ◽  
Home Based ◽  
Lower Limb Strength

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

Tetralogy of Fallot: stent palliation or neonatal repair?

2021 ◽  
pp. 1-9
Author(s):  
Adeolu Banjoko ◽  
Golnoush Seyedzenouzi ◽  
James Ashton ◽  
Fatemeh Hedayat ◽  
Natalia N. Smith ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Hospital Length Of Stay ◽  
Mortality And Morbidity

Abstract Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

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