Stroke in sickle cell disease: case report

Sickle cell disease is an inherited blood disorder that affects red blood cells. It is characterized by polymerization of haemoglobin, erythrocyte stiffening, and subsequent vaso-occlusions. These can lead to microcirculation obstructions, tissue ischemia, infarction and acute stroke. Transient ischemic attack, Ischaemic stroke, haemorrhagic stroke, silent cerebral infarction, headache, Moyamoya disease, neuropathic pain, and neurocognitive impairment are neurological complications of sickle cell disease. Here we report a case of ischemic stroke in a patient of sickle cell disease. For early diagnosis and proper management of sickle cell disease neurological complications require specialised haematological and neurological expertise. The newly used medications under ongoing research will be the hope to overcome this devastating disease and its complications.

Comparative lipid profile study between ischemic and haemorrhagic stroke

Background: Stroke is one of the major global health problems. Stroke is the most common clinical manifestation of cerebrovascular disease of which more than 99% are due to arterial involvement and less than 1% due to venous involvement in the form of Cerebral Venous Thrombosis (CVT). Among arterial causes 85% are due to infarction and 15% due to haemorrhage.1,2 There is  difference in serum lipid levels in subtypes of strokes to guide lipid-lowering therapy which can reduce incidence of stroke and stroke related mortality by adapting primary and secondary preventive measures.3,4  Authors have endeavoured to correlate severity of lipid derangement and stroke.Methods: In this study 64 consecutive eligible ischaemic stroke cases and 64 eligible hemorrhagic stroke cases would be included. Cases of strokes will be divided into ischaemic and hemorrhagic as per clinical features and with help of brain imaging by CT scan and MRI at the time of admission and 8 hour fasting lipid profile was collected from all cases. All this information will be filled in preformed format.Results: Serum lipid profile of two categories of stroke showed raised serum total cholesterol in 39.1% patients of ischaemic stroke in contrast to 18.8% patients with haemorrhagic stroke (p=0.019).Stroke patients showed raised in LDL cholesterol in 29.7% patients of ischaemic stroke in contrast to 9.4% patients with haemorrhagic stroke, (p=0.007).Conclusions: Based on the finding of our study we conclude that ischemic stroke patient had higher lipid derangement as compare to haemorrhagic stroke in terms of raise total cholesterol, LDL cholesterol and decrease HDL cholesterol.

A rare case of polydactyly with multiple defects

Bardet-Biedl Syndrome (BBS) is a very rare genetically heterogenous disorder. Here is a case of 27 yr. old obese male presented with acute gastroenteritis with shock in our department. He had polydactyly in both upper limb and left lower limb, blindness since childhood, with difficult in learning and delayed onset of milestones. Patient抯 sibling (younger brother 20-year-old) also had same problems since childhood and one female baby died within few days of birth. He was having single testis. Patient was managed conservatively. The available literature on this syndrome was reviewed.

Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning

Neonicotinoids are a new class of insecticides widely applied for crop protection. Information on human exposures to neonicotinoids is limited. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death the high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. Present study report three cases presented to us with acute neonicotinoid poisoning with different manifestations including acute myocardial infarction, central nervous system (CNS) depression, and acute kidney injury, who recovered subsequently with supportive care. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients.

Relation of bone mineral density with severity of liver cirrhosis

Background: Osteoporosis is commonly associated with chronic liver disease. Pathologic fracture in osteoporotic patients affects quality of life as well as decrease life expectancy. Around 40% of patients with chronic liver disease may experience osteoporotic fracture. The present study was undertaken to observe the relation of bone mineral density (BMD) with severity of liver cirrhosis along with effects of smoking and alcohol.Methods: A total of 187 liver cirrhosis patients who were admitted in SMS Hospital were taken for study and were classified into class A, B, C as per Child Turcot Pugh’s classification, after applying inclusion and exclusion criteria. All patients underwent standard laboratory testing and bone densitometric studies of the lumbar spine using dual X-ray absorptiometry (DEXA) scan. Statistical analysis done.Results: The bone mineral density was significantly low in Class C. Class C have 41 patients of osteoporosis out of 62 whereas only 16 patients have osteoporosis in Class B and only 1 case of osteoporosis in class A. Hypocalcemia and hypophosphatemia were more in class C as in comparison to class A and B. Also, chronic smoking and alcohol intake were strongly associated with the severity of cirrhosis.Conclusions: The prevalence of osteopenia and osteoporosis is higher in cirrhotic patients and significantly increases with severity. Hypocalcemia and hypophosphatemia are also associated with the cirrhosis. Thus, patients should undergo routine bone densitometry assessment and, if necessary, to be treated for osteoporosis