Hemichorea-hemiballismus in a patient with hyperglycaemic hyperosmolar state

Hemichorea-hemiballismus (HCHB) is a rare manifestation of hyperglycaemic hyperosmolar state caused by contralateral lesion in basal ganglia. A 74-year-old, known diabetic and hypertensive woman presented with one-week history of high-grade fever and loss of consciousness associated with involuntary movement of the right upper and lower limbs for 10 hours prior to presentation. Physical examination revealed pyrexia, tachycardia and altered sensorium. Blood glucose was 53.8 mmol/l, hemoglobin A1c (Hb A1c) 9.9% and brain computed tomography (CT) scan showed cerebral atrophy with bilateral basal ganglia hyperdensities. Escherichia coli was cultured from the urine. She did well on treatment with soluble insulin, rehydration and intravenous ceftriaxone. HCHB is a rare complication seen in patients with poorly controlled diabetes mellitus. This report highlights the reversibility of the disease with prompt diagnosis and appropriate insulin treatment. HCHB should be distinguished from other intracranial pathologies.

Maternal Vitamin D Status and Risk of Preeclampsia in Abuja, Nigeria

Aim: To determine the relationship between maternal serum 25(OH) D concentrations and development of preeclampsia.Study Design:A cross sectional comparative study.Place and Duration of Study:Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, between March 2016 and February 2017.Methodology: We included 55 women with preeclampsiaand 55 healthywomen. Data obtained includedsociodemographic characteristics, clothing style and duration of exposure to sun light. ELISA method was used for evaluation of serum vitamin D levels.Original Research Article Results:The prevalence of VD deficiency in the population was 15%, while 16.8% and 73% of the participants had insufficient and normal levels respectively. The prevalence of VD deficiency in women withpreeclampsia was 20.4% while that in healthy pregnant women was 9.4% (P=.19). The mean serum 25-OH-D level of women with pre-eclampsia was significantly lower than that of healthy women (34.5±14.9 vs. 43.5±15.1, P = .003). Preeclamptic women with vitamin D insufficiency delivered at a higher gestational age than those with vitamin D deficiency (37.67(2.77) weeks vs. 33.55(2.38) weeks respectively, P=.007). In the adjusted analysis of cases with vitamin D defficiency, the odds of developing preeclampsia was not statistically significant [odds ratio (OR) = 3.27, CI = 0.99-10.83,P=.05]. However, the odds of developing preeclampsia in women with Vitamin D insufficiency wasstatistically significant (OR = 3.20, CI = 1.02–10.06, = 0.046).Conclusion: In conclusion, an association between vitamin D deficiency and preeclampsia was not demonstrated in this study. The results however suggest that maternal vitamin D insufficiency in late pregnancy is an independent risk factor for preeclampsia.