Hirayama Disease: A Rare Case Report and Review

Hirayama disease, or brachial monomelic amyotrophy, is not a common neurological disease characterized by unilateral or asymmetric bilateral lower motor weakness of distal upper limbs. The basic pathophysiology is compression of the dural sac and spinal cord during flexion of the neck. A case of a 21-year-old male presented with chief complaints of tremors in both hands (right more than left) with gradually progressive weakness of the right hand and forearm. Electromyography (EMG), nerve conduction velocity (NCV), and magnetic resonance imaging (MRI) neck in flexion showed focal atrophy of lower cervical myotomes and confirmed the diagnosis of monomelic amyotrophy.

Carbon Monoxide Poisoning Secondary To Gas Geyser

Carbon monoxide (CO) is a non-irritating, colorless and odorless gas produced by the incomplete burning of carbon-containing fossil fuels. CO poisoning remains a leading cause of unintentional poisoning worldwide. During winters, accidental CO poisoning has been reported mostly due to incomplete burning of coal. Here, we report the case of a young female patient who presented with hypoxic brain injury due to CO poisoning while using gas geyser in bathroom. The diagnosis of CO poisoning was made on the basis of history, vital signs, blood gas, and MRI scan. The patient recovered well after high-flow normobaric oxygen therapy and showed significant resolution on follow up MRI. A high index of suspicion, early recognition of symptoms by emergency physicians followed by careful history taking can help in making a clinical diagnosis of CO toxicity.

Deodorant Cap Lodged In The Rectum: A Case Report

Anorectal foreign bodies are rare but have shown a rising trend in recent times. Various kinds of a foreign object may be observed in the rectum, including sharp instruments which may pierce rectum, colon, or create visceral organ injuries. Most common presenting symptoms include abdominal, rectal pains and bleeding per rectum. Without proper history and examination, these foreign objects can easily be missed in the emergency department as these are still a matter of taboo especially in countries like India. We report a case of an elderly gentleman who presented to the emergency with bleeding per rectum and did not initially give a history of foreign body insertion

Unusual Case Of Seizures Due To Prolonged Qt Syndrome - A Case Report

Long QT syndrome (LQTS) is a cardiac electrical disorder. One of the rare symptoms of long QT caused by ventricular arrhythmia is seizure. Patients with LQTS may develop seizures due to an acute hypoxic-ischemic event associated with a ventricular arrhythmia. We present a case of a 47-year-old male who came to the Emergency Department (ED) with seizures and was diagnosed as LQTS. The cardiac cause of seizures was suspected because the patient was pulseless during the episode of seizures. The patient developed refractory ventricular tachycardia in the ED and was cardioverted (synchronized) multiple times. He was also put on amiodarone infusions. The patient was then urgently shifted to the Coronary Cath Lab for temporary pacemaker insertion with overdrive pacing. He was advised for an automated implantable cardioverter-defibrillator. This case illustrates that prolonged QT syndrome can masquerade as seizure. Therefore, a careful examination should be done in the patient presenting with the same and a cardiac cause should be excluded. Delays in recognition and treatment may expose the patient to a high risk of sudden cardiac death

Bottle gourd (Lagenaria siceraria) juice poisoning / 世界急诊医学杂志（英文）

@#BACKGROUND: Bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional medicine healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other diseases. However, in last few years there have been reports of suspected toxicity due to consumption of its juice leading to severe vomiting and upper gastrointestinal bleeding. As emergency physicians we need to be aware of this very rare poisoning specially in India. METHODS: We present a case of a 52-year-old woman who presented with multiple episodes of hematemesis and shock to the emergency department (ED) after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and shifted to the intensive care unit (ICU) under the care of a gastroenterology team for urgent endoscopy and further management. RESULTS: The patient received intravenous fluids, antibiotics, antiemetics, and antacids and underwent upper gastroenterologic endoscopy during the hospitalization. She was discharged in a stable condition 4 days later. CONCLUSIONS: As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only. It is important to educate the public about the harmful effects of this potentially life-threatening toxicity.

International normalized ratio as a predictor of mortality in trauma patients in India / 世界急诊医学杂志（英文）

BACKGROUND: Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality. METHODS: A total of 99 trauma patients aged 18–70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5. RESULTS: The total mortality rate of the patients was 16.16％ (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14％). Of these patients, 11 died (78.57％) and 3 survived. INR was deranged in 11 (68.75％) of the 16 patients who died, but 5 deaths (31.25％) had normal INR values. The sensitivity of INR was 69％ (95％CI 41％–88％) and the specificity 96％ (95％CI 90％–99％). The diagnostic accuracy of INR was 92％ (95％CI 85％–96％). Positive predictive value and negative predictive value were 79％ (95％CI 49％–95％) and 94％ (95％CI 87％–98％), respectively. CONCLUSION: Our results showed that INR is a good predictor of mortality in trauma patients.