Neuroleptic Malignant Syndrome (NMS) after Treatment with Metoclopramide - A Rare Case Report

Neuroleptic Malignant Syndrome (NMS) is a medical emergency. It presents with mental status change, rigidity, fever, and autonomic dysfunction. It is caused by antipsychotics especially neuroleptic agents and certain antiemetic drugs like metoclopramide that block central dopamine pathways. We present a case of a 32-year-old male chronic alcoholic who presented to us with alcohol withdrawal symptoms and was given injection metoclopramide and developed neuroleptic malignant syndrome (NMS).Incidence rates for NMS range from 0.02 to 3 percent in patients treated with antipsychotic agents.1,2 Though it is commonly encountered in young adults, any age group can be affected.3,4 Males are two-fold more affected than females.4Metoclopramide, a commonly used anti-emetic agent has anti-dopaminergic properties and can give rise to development of NMS. The signs and symptoms of NMS include hyperthermia, altered mental status, muscular rigidity resembling extrapyramidal rigidity, autonomic instability, diaphoresis, hyper salivation, dysphagia, tachycardia, hypertension. NMS if left untreated, is usually fatal. So, early recognition and treatment is of great importance.

Atypical Presentation of Gitelman Syndrome (GS) Masquerading as Hypokalaemic Periodic Paralysis

Gitelman syndrome once considered to be a subset of Barter’s syndrome, is a disorder of the distal tubule.1,2 It is an inherited disorder of the thiazide sensitive sodium-chloride transport channel. It is characterised by its main clinical features of metabolic alkalosis, hypomagnesemia, hypokalaemia and hypocalciuria. It’s an infrequently diagnosed condition where there diagnosis is made based on the clinical and the biochemical parameters of the disease. We present a case of Gitelman syndrome in a young male who presented with recurrent episodes of weakness to different private hospitals with documented hypokalaemia and labelled as hypokalaemic periodic palsy (HPP), presented to us with quadriparesis and on investigation diagnosed as GS.

Clinical Application of Fasting and Post-Prandial Lipid Profile in Patients of Chronic Kidney Disease.

Dyslipidemia is a traditional risk factor for cerebrovascular disease and cardiovascular disease (CVD). CKD is associated with dyslipidemia. Patients with CKD will be more prone to the CVD and cerebrovascular disease as compared to normal healthy individuals. Thus, it is important to cover the postprandial lipid profile for better assessment and treatment of dyslipidemia. We wanted to study the postprandial lipid profile in patients of CKD. MethodsThis is a case control study conducted in Acharya Vinoba Bhave Rural Hospital (AVBRH) Sawangi (Meghe), Wardha, Maharashtra, between September 2016 and September 2018. In this study, we enrolled 150 cases and 75 controls. ResultsFasting lipid profile in CKD patients was higher as compared to controls and was found to have similar post-prandial lipid profile. When we compared the fasting and post-prandial lipid profile in patients with CKD, we found that a substantial difference existed. We found a considerable difference in the fasting and post-prandial lipid profiles even in the controls. ConclusionsPatients with CKD and diabetes mellitus had a significant increase in the total cholesterol, triglycerides, low density lipoprotein and very low-density lipoprotein in the fasting and post-prandial state. In clinical practice, the implementation of standardized methodologies and biomarker profiles would allow for the early and reliable detection of those at risk.

Splenic Abscess Complicating Scrub Typhus Induced Splenic Infarct - A Rare Case Report

Any condition leading to the interruption of blood flow to the spleen, such as blockage in the splenic artery due to a plaque or a clot in one of its branches leads to Splenic Infarction. It could also be due to infection, trauma, disseminated intravascular coagulation and vasculitis. The complications of splenic Infarct include pseudocyst, haemorrhage, rupture, aneurysm and rarely abscess formation due to infection of the infarcted region. Splenic abscess is a rare and potentially lethal clinical condition. We present a case of a 24-year-old male who was diagnosed with splenic infarct because of scrub typhus and later developed splenic abscess.Spleen is a lymphatic organ present in the left hypochondrium of the abdomen. It filters and stores the red cells, produces white blood cells and scavenges microorganisms like bacteria. Any condition leading to the interruption of blood flow to the spleen could cause an infarct. The infarction could be classified as partial or complete based on the extent of involvement. The area of the spleen which had loss of blood supply leading to the death of the area is called splenic Infarct. It could also be due to infection, trauma or certain diseases. Rarely splenic infarcts may lead to formation of abscess. The most commonly occurring symptoms of a splenic abscess pain in the abdomen, fever and nausea are not specific to splenic abscess.[1] Hematogenous spread is the most common cause of splenic abscess.[2]

Acute Exacerbation of COPD Triggered by Pneumonia, and Secondary Spontaneous Pneumothorax (SSP).

Secondary Spontaneous Pneumothorax (SSP) can rarely complicate Chronic Obstructive Pulmonary Disease (COPD). Infections are common triggers for exacerbations of COPD. COPD with acute exacerbation presents with increasing dyspnoea. We present a rare case of a 75 year old female, who was a known case of COPD and developed right middle lobe pneumonia with partial collapse of the middle lobe along with a secondary spontaneous pneumothorax.