The effect of shock duration on trauma-induced coagulopathy in a murine model

Background Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. TIC can present with different coagulation defects. In this study, the aim was to determine the effect of shock duration on TIC characteristics. We hypothesized that longer duration of shock leads to a more hypocoagulable rotational thromboelastometry (ROTEM) profile compared to a shorter duration of shock. Methods Male B57BL/6J(c) mice (n = 5–10 per group) were sedated and mechanically ventilated. Trauma was induced by bilateral lower limb fractures and crush injuries to the liver and small intestine. Shock was induced by blood withdrawals until a mean arterial pressure of 25–30 mmHg was achieved. Groups reflected trauma and shock for 30 min (TS30) and trauma and shock for 90 min (TS90). Control groups included ventilation only (V90) and trauma only (T90). Results Mice in the TS90 group had significantly increased base deficit compared to the V90 group. Mortality was 10% in the TS30 group and 30% in the TS90 group. ROTEM profile was more hypocoagulable, as shown by significantly lower maximum clot firmness (MCF) in the TS30 group (43.5 [37.5–46.8] mm) compared to the TS90 group (52.0 [47.0–53.0] mm, p = 0.04). ROTEM clotting time and parameters of clot build-up did not significantly differ between groups. Conclusions TIC characteristics change with shock duration. Contrary to the hypothesis, a shorter duration of shock was associated with decreased maximum clotting amplitudes compared to a longer duration of shock. The effect of shock duration on TIC should be further assessed in trauma patients.

Bilateral thalamic infarction due to artery of Percheron occlusion: a case report

The artery of Percheron is a rare variant of the posterior cerebral circulation. It is characterised by a single arterial trunk that supplies blood to bilateral paramedian thalami and rostral midbrain. Its occlusion can have a very wide range of presentation, and initial imaging including CT of the head maybe normal. Diagnosis and eventual treatment is usually delayed. We describe the case of an elderly man who presented with loss of consciousness, aphasia, and bilateral lower limb weakness. He was diagnosed with bilateral thalamic infarction due to the occlusion of the artery of Percheron only after an MRI of the brain was performed. Despite treatment his symptoms did not resolve completely. Keywords: Thalamus/blood supply, Cerebral arteries, Magnetic Resonance Imaging.

Familial Hemophagocytic Lymphohistiocytosis Secondary to PRF1 Mutation

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that causes systemic inflammation which can progress to multiorgan failure and death. Symptoms and signs commonly seen in HLH include high fever, hepatosplenomegaly, pancytopenia, and hypertriglyceridemia. This report describes the 8-month clinical course of a 17-year-old male with G6PD deficiency who presented with intermittent high fever of unknown origin for 8 months accompanied by pancytopenia and bilateral lower limb weakness. A pathogenic homozygous missense mutation (c.1081A > T p.(Arg361Trp)) in the PRF1 gene was detected by whole exome sequencing (WES). The brain and the whole spine MRI showed leptomeningeal enhancement at different levels involving both the brain and the spine. Therefore, a diagnosis of familial HLH type 2 with CNS involvement was confirmed. Accordingly, treatment with dexamethasone, cyclosporin, and etoposide in addition to intrathecal methotrexate and hydrocortisone was given. The patient showed a dramatic response with significant neurological improvement of the bilateral lower limb weakness. Genetic analysis has helped the patient’s family with appropriate genetic counselling. This case highlights the importance of immediate treatment with immunosuppressants and the high clinical suspicion of physicians regarding HLH in areas where consanguinity is common.

Bilateral basal ganglia ischemia associated with COVID-19: a case report and review of the literature

Background Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported. Case presentation We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn. Conclusion This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.

AN AYURVEDIC MANAGEMENT OF ALCOHOLIC LIVER DISEASE W.S.R TO SHAKHASHRITA KAMALA - A CASE STUDY

Alcoholic liver disease is a pathological condition of the liver parenchymal tissue due to excessive consumption of alcohol over a long period of 6-10 years or even earlier. Here in we present a case of a married male of 35 yr. old reported in the Panchakarma OPD of SJIIM Government Ayurveda Medical College Bengaluru on 30th -Jan- 2021, with chief complaints of swelling in the bilateral lower limbs, deep yellowish and burning micturition, yel- lowish discoloration of sclera, reduced appetite, nausea and generalized weakness in the body since 3 months, with the increased level of LFT and USG-abdomen report suggesting hepatomegaly with fatty changes, was ex- amined and diagnosed as alcoholic liver disease and treated with Amapachana with Trikatu Churna, Nitya Virechana with Chitraka Haritaki Leha fallowed by Mustadi Yapana Basti had shown a very good improvement in normalizing appetite, bilateral lower limb swelling and deep yellow micturition. Total bilirubin, SGOT and ALP values were reduced. Keywords: Alcoholic Liver disease, Shakhashrita Kamala, Nitya Virechana

Myelopathy associated with intrathecal methotrexate

A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of systemic chemotherapy. MR scan of the spinal cord showed bilateral symmetric and extensive T2/fluid attenuated inversion recovery (FLAIR) increased signal involving the dorsal columns in the thoracic cord. His serum folate concentration was at the lower end of the normal range. We stopped the intrathecal chemotherapy and gave folate; after a few days, he progressively improved. Myelopathy is an important adverse effect of intrathecal methotrexate, which may cause clinical and imaging features resembling subacute combined degeneration of the spinal cord. CNS infiltration must be excluded, intrathecal chemotherapy stopped and deficiency of folate or vitamin B12 treated as appropriate.

Spontaneous spinal epidural hematoma: a case report

Background Spinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma. Case presentation A 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery. Conclusion In patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.

Case Report on Pott’s Spine

Introduction: Extra spinal infection causes Pott's illness, which is a spine infection. This condition is extremely rare. It is also called as tuberculosis spondylitis. Due to haematogenous spread over sites, it often involves the lungs and multiple vertebrae. It causes a kind of tuberculous arthritis of the invertebral disc space. The vertebral body's front part, near to the plate underneath the chondral i.e. subchondral plate, is the most prevalent location of involvement in the lower thoracic vertebrae. If anyone vertebra gets affected the disc is normal and if both it cannot receives nutrients, and collapses and spinal damage that results in kypotic spine deformity. 45 years old male patient admitted to AVBRH with the chief complaints of weakness of bilateral lower limb since 1 month, back pain, loss of weight, and loss of appetite. Clinical Findings: Weakness of bilateral lower limb since 1 month, back pain, loss of weight, loss of appetite. Diagnostic Evaluation: Generally, we examine medical history, symptoms, and physical examination of a patient. The patient has been undergone with the investigation like x-ray, MRI, CT scan, CBC, ESR and mantox test. Patient has elevated haemoglobin level i.e. 8.9%. RBCs – normocytic mildly hypochromic platelets. Patient also has elevated sodium and potassium level. Conclusion: Patient has undergone surgical management i.e. spinal fixation. Patient showed minor signs of progress and thus he was asked to undergo the medical management and was kept under observation.