Lateral medullary syndrome: an unwanted ischemia to identify early

Lateral medullary syndrome also referred to asWallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, orvertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom istransient ischemic attack (TIA) with dizziness or vertigo andatherosclerosis in the posterior cerebral circulationbeingthe most common cause. Lateral Medullary Syndrome patients sufferfrom strokes or infarction and alsopresentwith vomiting,nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibersinvolved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.

Exploring the iceberg of gluten

Gluten, a protein present in wheat, rice or barley shares the reputation of common etiological agent for childhood disease ‘Coeliac Disease’ (CD) and adult ‘Non-Coeliac Gluten Sensitivity’ (NCGS).

Multiple sclerosis in pregnancy: meeting the challenges

Multiple sclerosis being a chronic, autoimmune inflammatory disease of central nervous system with its common and uncommon semiology has a predilection for women of child bearing age. The stressful period of pregnancy is further complicated with presence of multiple sclerosis. Overall multiple sclerosis has stabilising effect on pregnancy especially in its second and third trimester but adversely affects the post-partum period with increasing relapse rate. This is related with intense immune response triggered by marked changes in levels of circulating hormones. A better understanding of anti-natal, natal and post-partum effect of multiple sclerosis helps us to decide for institution or continuation of disease modifying drugs which are generally associated with favourable outcome.

Common invisible symptoms of multiple sclerosis

Multiple sclerosis (MS) with its protean manifestations of central and peripheral nervous system pose a challenge to its management in different clinical scenario. The issue becomes much more complicated with occurrence of strange and unusual symptoms intermingling with common symptoms in people living with MS. The frequency and severity of these unusual symptoms changes overtime and raise a suspicion of other neurological disease. The occurrence of any of these symptoms at times may be a sign of active disease. A reasonable understanding of these strange symptoms both to the patient and healthcare team could be of help in taking appropriate steps to manage MS more efficiently

Multiple sclerosis: making the invisibles visible

Multiple sclerosis (MS), a chronic inflammatory autoimmune disease with its protean manifestations commonly present as motor weakness, diplopia, visual loss, sensory symptoms in limbs or face or even bladder and bowel dysfunction. Underneath the umbrella of these common symptoms many invisible, unpredictable and erratic symptoms persists which complicates both the clinical presentation and the treatment. As majority of these symptoms are subjective so their true assessment on objective ground is difficult. It is important to consider that patients with MS and their care-takers should have reasonable knowledge about these symptoms because if these symptoms go unidentified or untreated then they may lead to a difficult diagnostic dilemma hence complicates further management.  The frequency and severity of these unusual symptoms at times raise a suspicion of other neurological diseases. The occurrence of any of these symptoms at times may be a sign of active disease.

Assessment of overweight and obesity among urban adolescents

Background: Obesity is defined as the abnormal growth of adipose tissue due to enlargement of fat cell size or increase in their number or a combination of both. Adolescents are nutritionally vulnerable age group considering their increased nutritional needs, eating patterns, lifestyle and susceptibility to environmental influences. The present study was conducted with aims to access the prevalence of overweight and obesity among urban adolescents and to study various factors associated with overweight and obesity.Methods: A community based cross sectional study of 872 adolescents of both sexes in urban population of Pune, Maharashtra, India was conducted to assess prevalence and various factors influencing overweight and obesity, especially type of diet, frequency of junk foods, physical activity and sleeping habits. The Body Mass Index (BMI) and Waist-Hip Ratio (WHR) were used to define overweight and obesity as per WHO growth standards.Results: The prevalence of overweight and obesity in urban adolescents according to BMI were 17.4% and 6.9% respectively with overall prevalence being 24.3% but with Waist-Hip Ratio (WHR) it was 43.1%. Risk factors in urban areas were consumption of fast/junk food, carbonated drink, physical inactivity while afternoon sleep was not a significant factor.Conclusions: This study showed an increased prevalence of overweight and obesity in urban adolescents especially in those who have more consumption of fast food, carbonated drink, those who were either inactive or engaged in physical activity for less than 30 min/day were strongly associated with overweight and obesity.

Bacteriological study of post-operative wound infections with special reference to MRSA and ESBL in a tertiary care hospital

Background: Surgical site infections are known to be one of the most common causes of nosocomial infections worldwide and raises an important public health concern.Methods: A prospective observational study was conducted across 12 months (July 2018-June 2019) in a tertiary care hospital. The present study includes 50 pus samples from clinically suspected cases of post-operative wound infections from various surgical wards which were inoculated in Department of Microbiology. The phenotypic identification of different bacterial isolates especially MRSA and ESBL producers along with their antimicrobial susceptibility testing was interpreted according to CLSI guidelines.Results: Out of 50 samples, 44 showed positive culture. The infections were more common in emergency situations, age group of 20-30 years and in females. The most common bacterial isolates were Staphylococcus aureus (43.18%) followed by E. coli (22.72%), Klebsiella (15.9%), CONS (13.63%) and Pseudomonas (4.54%). Out of 19 Staphylococcus aureus 9 were MRSA and these gram-positive bacteria were highly sensitive to Linejolid and Clindamycin. In gram negative group 22.72% of E. coli and 15.9% of Klebsiella were ESBL producers who were susceptible mainly to Aztreonam, Linezolid or Cefoxitine.Conclusions: Post-operative wound or surgical site infections is the most important factor responsible for significant morbidity, mortality, prolonged hospitalization and additional cost to treatment in surgical patients. Marked resistance of isolates to commonly used antibiotics indicates the need of judicious use of these drugs to prevent the emergence of multi-drug resistant strains.