Hypokalemic paralysis associated with dengue fever:Study from a tertiary centre in North India

Objective: Dengue associated hypokalemic paralysis (DHP) is an unusual neurological complication of dengue fever. This was a retrospective study of patients with DHP compared with idiopathic hypokalemic paralysis (IHP) seen in a tertiary centre in North India. Methods: Dengue was diagnosed by positive nonstructural protein (NS) 1 antigen and dengue-IgM antibody. Various clinical and laboratory parameters were compared between patients with DHP and IHP. Results: DHP was seen in 18 out of 489 (3.7%) dengue patients seen in the 4-years study period. Complications of bulbar weakness or respiratory failure developed in 6/18 (33.3%) of DHP patients. DHP patients with complications had higher hematocrit (p<0.001), lower platelet count (p=0.002), lower serum potassium (p=0.007) and higher creatinekinase (CK) (p<0.001) as compared to those without complications. When compared to IHP, DHP patients had fever at admission (p<0.001); myalgia (p<0.001); no past episodes (p=0.032); greater disability (p=0.02); lower serum potassium (p=0.0338); higher CK (p=0.001); and nerve conduction abnormalities (p=0.035). Conclusions: DHP should be suspected in patients who present with acute onset muscle weakness associated with fever. Predictors of complications in DHP include high hematocrit, low platelet count, low serum potassium and raised CK.

Anti-mycobacterial screening of five Indian medicinal plants and partial purification of active extracts of Cassia sophera and Urtica dioica

OBJECTIVE@#To find out the anti-mycobacterial potential of Cassia sophera (C. sophera), Urtica dioica (U. dioica), Momordica dioica, Tribulus terrestris and Coccinia indica plants against multi-drug resistant (MDR) strain of Mycobacterium tuberculosis (M. tuberculosis).@*METHODS@#Plant materials were extracted successively with solvents of increasing polarity. Solvent extracts were screened for anti-mycobacterial activity against fast growing, non-pathogenic mycobacterium strain, Mycobacterium semegmatis, by disk diffusion method. The active extracts were tested against MDR and clinical isolates of M. tuberculosis by absolute concentration and proportion methods. The active extracts were subjected to bio-autoassay on TLC followed by silica column chromatography for isolation of potential drug leads.@*RESULTS@#Hexane extract of U. dioica (HEUD) and methanol extract of C. sophera (MECS) produced inhibition zone of 20 mm in disc diffusion assay and MIC of 250 and 125 μ g/mL respectively in broth dilution assay against Mycobacterium semegmatis. Semipurified fraction F2 from MECS produced 86% inhibition against clinical isolate and 60% inhibition against MDR strain of M. tuberculosis. F18 from HEUD produced 81% inhibition against clinical isolate and 60% inhibition against MDR strain of M. tuberculosis. Phytochemical analysis indicated that anti-mycobacterial activity of MECS may be due to presence of alkaloids or flavonoids and that of HEUD due to terpenoids.@*CONCLUSIONS@#C. sophera and U. dioica plant extracts exhibited promising anti-mycobacterial activity against MDR strain of M. tuberculosis. This is the first report of anti-mycobacterial activity form C. sophera. This study showed possibility of purifying novel anti-mycobacterial compound(s) from C. sophera and U. dioica.

Moyamoya syndrome associated with vitamin B12 defi ciency and hyperhomocysteinemia in a child

Moyamoya disease is a rare clinical disorder, characterized by chronic, progressive occlusion of supraclinoid internal carotid artery and proximal portions of the anterior and middle cerebral arteries, and consequent development of collateral vessels seen on imaging as puff of smoke appearance. Although the pathophysiology is unclear, various hematologic disorders have been associated with development of the moyamoya syndrome. We report a case of moyamoya syndrome in a 3 yr old girl who presented with recurrent ischemic strokes. The angiography was suggestive of moyamoya syndrome. The serum vitamin B12 level was remarkably low with bone marrow picture of megaloblastic anemia. There was also hyperhomocysteinemia. Moyamoya syndrome has not been previously reported to be associated with vitamin B12 defi ciency. We propose that vitamin B12 defi ciency with hyperhomocysteinemia could result in greater risk for arterial thrombosis and thus caused the moyamoya syndrome in our patient

Contralateral stroke with rapid recovery in a patient of herpes zoster ophthalmicus

Herpes zoster ophthalmicus commonly presents with vesicular eruptions of skin along a dermatome and post herpetic neuralgia. Viral invasion into the intracranial vessel and resultant arteritis is rare complication, reported mainly in elderly, children and immunocompromised individuals. We report a young immunocompetent male who reported to us with acute right sided hemiparesis following an episode of left sided herpes zoster ophthalmicus three months prior to stroke. Patient had a near complete recovery of his weakness without any treatment with persistent mild dysarthria. Magnetic resonance imaging of brain showed subacute infarct in left middle cerebral artery territory. Magnetic resonance angiogram demonstrated marked narrowing of the proximal segment of left middle cerebral artery. This case highlights herpes zoster ophthalmicus as one of the causes of stroke in young with good prognosis.