Myasthenic crisis: a retrospective study.

BACKGROUND AND OBJECTIVE: Myasthenic crisis (MC) is one of the important and common complications in the natural history of myasthenia gravis (MG). MC can be precipitated by multiple factors including deficiency or excess of the acetylcholinesterase inhibitors (AChEI). Any episode of MC is an emergency requiring aggressive therapy. We studied the demographic, clinical and treatment-related characteristics of patients who developed MC. MATERIALS AND METHODS: A retrospective study was conducted in patients with MC admitted during a 31-month period from February 1999 to August 2001, at a tertiary care center in India. RESULTS: Eleven patients (9.69% of the total 114 patients with MG) were admitted with 12 episodes of MC. Mean age at presentation was 39.83 + 13.18 years with male predominance. Seven patients had undergone thymectomy previously; of which 2 had postoperative MC. Six patients had thymoma. Steroid or cholinesterase inhibitor withdrawal and infections were the commonest precipitating factors for MC. Patients required ventilatory support for median 14 days. They responded to low volume of plasma exchange (PE) (mean 854 ml / day with mean 6.5 cycles per patient). CONCLUSIONS: This report highlights that the subset of Indian patients with MG who are at risk to develop MC belong to the 3rd and 4th decade, have bulbar symptoms at presentation and are associated with thymoma. Patients with MC should have judicious drug adjustments under supervision and should be treated aggressively during impending MC.

Pulmonary manifestations in brucellosis: a report on seven cases from Bikaner (north-west India).

OBJECTIVES: Pulmonary manifestations of Brucellosis are rare. We came across seven patients with predominant symptomatology of pulmonary involvement amongst 98 patients of active brucellosis seen in last four years. MATERIAL AND METHODS: The study is related to patients of brucellosis whose principal presenting features were related to respiratory symptom (cough, expectoration, pain in chest and breathlessness) along with fever and other constitutional symptoms. It included seven patients amongst 98 patients of active brucellosis seen during June 1996 to Feb. 2000 at PBM Hospital Bikaner. Diagnosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum. All patients were treated with rifampicin 900 mg daily and doxycyclin 100 mg twice daily for six week. The treatment was extended for another four weeks in two patients because of persistence of skiagram abnormalities. RESULT: Three patients had abnormality in skiagram chest in the form of pleural effusion, multiple paranchymal opacities and pneumonia. The skiagram chest was normal in remaining four patients. The response of treatment started with 10-15 days and all the patients became symptom-free at the end of six weeks except one patient. Skiagram chest at this time was normal in patients of pleural effusion but there was persistence of haziness and few opacities in other two patients. Follow up skiagram chest at the end of six months and twelve months was normal in all patients except calcified opacity in one patient. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed. CONCLUSION: Pulmonary manifestations of brucellosis are rare. Treatment with rifampicin and doxycylin showed marked clinical and radiological improvement. All patients were completely disease-free at the end of one year follow up.

Choice of oviposition site between surface of the medium and paper in four Indian species of Drosophila.

Choice of oviposition site between surface of the medium and paper positioned vertically on the medium by females was studied in four species of Drosophila: D. ananassae, D. bipectinata, D. malerkotliana, and D. biarmipes. Several geographic strains of these species were used. Females of all the four species laid greater proportions of eggs on the surface of medium as compared to surface of the paper. Thus all the four species tested show preference for oviposition on surface of medium. When the comparison is made for oviposition on paper among the four species, D. ananassae lays more eggs on the surface of paper as compared to other three species.

P300 in newly diagnosed non-dementing Parkinson's disease: effect of dopaminergic drugs.

Changes in cognitive function are an integral part of the clinical presentation of Parkinson's Disease (PD). P300 potential studies in early stages of Parkinson's disease are lacking and effect of L-dopa therapy on these potentials is controversial. In this study, changes in P300 potentials in early stages of PD and effects of dopaminergic therapy were investigated. P300 waves were elicited by standard auditory 'odd ball' paradigm and were recorded before the start of therapy and 15 days, 3 and 6 months after the start of L-dopa therapy in 25 newly diagnosed patients with idiopathic PD. All patients were classified according to Hoehn and Yahr scale. Minimental status examination (MMSE) was done in all. Control group had 20 normal subjects. The P300 latency was not significantly increased in early Parkinson's disease. This latency was reduced with dopaminergic therapy on 15th day, but increased later. Implications of the data are discussed.

Palatal myoclonus in postinfectious opsoclonus myoclonus syndrome : a case report.

An adult male presenting with acute onset opsoclonus, myoclonus and cerebellar ataxia is being reported. Patient had myoclonus involving limbs and palate. There are only a few reported cases associated with palatal myoclonus. Patient showed gradual spontaneous recovery. Possibility of underlying malignancy was excluded by detailed investigations.

Inversion polymorphism in Drosophila ananassae: persistence of inversions, heterosis and intra- and inter-chromosomal associations in experimental populations of mixed geographic origin.

Two experimental populations of D. ananassae were synthesised by making reciprocal crosses among five geographic strains and mixing the hybrids. Each of the two populations of mixed geographic origin was maintained as mass cultures in food bottles. After five generations chromosomal analysis of these two populations was made by squashing a large number of larvae. The results showed that both experimental populations remained polymorphic due to the persistence of AL, (2L), ZE (2R) and DE (3L) inversions in population A and AL, ZE, DE and ET (3R) inversions in population B. Persistence of inversions in considerable frequency and significant deviation from Hardy-Weinberg equilibrium showed that heterosis is associated with these four inversions in D. ananassae. Further, there is non-random association (linkage disequilibrium) between linked inversions in second (AL-ZE) chromosome. However, the inversions of the different chromosomes are associated randomly indicating no interchromosomal interactions in D. ananassae. The results of these studies on population dynamics of inversion polymorphism in experimental populations are attributable to selection, genetic drift and Founder effect.

Cord blood cortisol levels and respiratory distress syndrome.

Cord blood cortisol levels were analyzed in 121 neonates, using a "Coat a Count" RIA kit. Forty two appropriate for gestation age (AGA) preterms < 34 weeks who had not received antenatal dexamethasone constituted Group A, 32 AGA preterms < 34 weeks gestation who had received dexamethasone antenatally comprised Group B, while Group C consisted of 47 term normal neonates. Cortisol levels were compared in these 3 groups and correlated to the development of respiratory distress syndrome (RDS). It was observed tht preterms (Groups A and B) had significantly (p < 0.005) lower levels (8.45 +/- 6.31 micrograms/dl) compared to term neonates (11.67 +/- 4.68 micrograms/dl). Antenatal dexamethasone therapy did not significantly alter cortisol levels within the group of preterms. There was a significant difference (p < 0.02) in cortisol levels between those preterms who developed RDS (5.41 +/- 4.91 micrograms/dl) and those who did not (9.58 +/- 6.45 micrograms/dl). Preterms (Grous A and B) who did not develop RDS had cortisol levels comparable to term neonates. There was a significant reduction in the incidence of RDS (p < 0.05) in preterms who had received antenatal dexamethasone. Cord blood cortisol levels < or = 7 micrograms/dl had a positive predictive accuracy of 36.59% and negative predictive accuracy of 93.75% in predicting onset of RDS.

Oviposition site preference in four species of Drosophila.

Oviposition site preference which is an important aspect of nonsexual behaviour of adult females was studied in four species of Drosophila, viz. D. ananassae, D. bipectinata, D. malerkotliana and D. biarmipes. The number of eggs laid by females in food vials was counted for 20 days. In each species, eggs were counted in both central and peripheral areas of culture medium. Eggs were also separated into two groups: deposited on the surface of food medium and inserted into the surface of culture medium. Greater proportion of eggs was oviposited in peripheral area of food medium and were inserted into the surface of the medium by females of all the four species. However, there are interspecies variations with respect to oviposition site preference. Further, these species show variation with respect to total fecundity. D. ananassae lays maximum number of eggs whereas D. biarmipes shows lowest rate of fecundity.

Osteoarticular tuberculosis in children.

One hundred and four cases of osteoarticular tuberculosis were studied. There were 74 boys (71.2%) and 30 girls (28.8%). The mean age at the onset of symptoms was 7.3 years, ranging from 9 months to 18 years. Seventy four cases (71%) reported 3 months after onset of symptoms. The spine was the commonest site involved (43%) followed by hip (14.9%) and knee joints (10.3%). Evidence of active or inactive pulmonary tuberculosis was found in 16.2%. All cases were treated by three drug regimen of rifampicin, isoniazid and ethambutol; rifampicin was discontinued after 6 months, ethambutol after 12-14 months. In 12 cases (11.5%) isoniazid was continued for 18 months. Along with chemotherapy suitable braces, splints, tractions, exercises and other form of physical therapy produced satisfactory results. Seventy eight patients (75%) showed clinical and radiological improvement with one year of treatment. The follow up period ranged between 4 months to 24 months with an average of 17 months. Children because of capacity to grow, showed progressive deformity in knee in 3 cases (2.8%), hip in 98 cases (8.6%), shortening of limbs in 14 cases (13.4%) and kyphosis in 13 cases (12.5%).