Scrub Typhus: An Acute Precipitant for Acute on Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) is a clinical syndrome with high mortality. Many acute precipitating factors have been implicated in triggering the acute event of ACLF, with bacterial infections being a common precipitant. However, many other precipitants can cause ACLF; therefore, identification of these factors early in the golden window and their treatment can result in improved prognosis. Scrub typhus usually presents as uncomplicated acute febrile illness but rarely as complicated. Few case reports of scrub-typhus-induced acute liver failure have been reported but none with scrub-typhus-precipitating ACLF so far. Therefore, we are reporting a case of scrub-typhus-precipitating ACLF, where timely intervention with antibiotics results in improved outcome.

A three-dimensional virtual mouse generates synthetic training data for behavioral analysis.

We developed a three-dimensional (3D) synthetic animated mouse based on computed tomography scans that is actuated using animation and semirandom, joint-constrained movements to generate synthetic behavioral data with ground-truth label locations. Image-domain translation produced realistic synthetic videos used to train two-dimensional (2D) and 3D pose estimation models with accuracy similar to typical manual training datasets. The outputs from the 3D model-based pose estimation yielded better definition of behavioral clusters than 2D videos and may facilitate automated ethological classification.

Cortex-wide Computations in Complex Decision Making in Mice.

Seemingly, a paradox exists between reports of wide-scale task-dependent cortical activity and the causal requirement for only a restricted number of motor and sensory cortical areas in some behavioral studies. In this issue of Neuron, Pinto et al. (2019) indicate that scenarios where mice must accumulate evidence and hold it during a delay period are causally linked to wide regions of cortex.

Limitations of a Cardiac Risk (QRISK2) Calculator in Patients with High Density Lipoprotein (HDL).

INTRODUCTION: There is existing debate as to the relationship between blood concentration of HDL (high density lipoprotein) and cardiovascular outcomes. Patients with hyperalphalipoproteinaemia (HALP) have high HDL levels and this can be attributed to a variety of factors. AIM AND METHODS: This study aims for the first time to examine the HALP cohort and understand demographics, relationship with cardiovascular disease (CVD) risk and scoring with a cardiac risk calculator (QRISK 2 calculator). RESULTS: The study found 42 patients had a statistically significant difference (p = 0.001) between CVD risk estimated using actual measured HDL (Score 1) versus CVD risk calculated using standard population mean HDL values (Score 2). Furthermore, in the CVD event group (n = 6) a significant difference was also seen between Score 1 and Score 2 (p = 0.027). CONCLUSION: The study highlights issues with underestimation of CVD risk in this population and strongly advocates use of standard population mean values in assessment of CVD risk.

Intramedullary craniovertebral junction tuberculoma: An uncommon location of a common disease.

Central nervous system involvement is observed in no more than 10% of patients with systemic tuberculosis. Although CNS tuberculosis is not rare in endemic countries, such as India, intramedullary tuberculosis is not commonly reported. In this study, we report a case of a 40-year-old female who presented with a six-year history of insidious onset, gradually progressive, asymmetric quadriparesis. She was diagnosed with intramedullary tuberculoma at the craniovertebral junction and showed significant clinico-radiological improvement with medical management alone. To the best of our knowledge, this report describes the first case of intramedullary tuberculoma at the craniovertebral junction to be reported. With the increased availability of MRI in developing countries, it is now possible for clinicians to diagnose this condition without performing a biopsy. It is important for the clinicians in developed countries to be highly suspicious of intramedullary tuberculoma, as there has been a resurgence of CNS tuberculosis due to the emergence of the HIV pandemic.

Vertebrobasilar territory ischemic stroke after electrical injury: delayed sequelae.

Electrical injuries are of very common occurrence in India and can be rarely fatal. Usually most of the patients recover without any serious complications. Rarely, neurologic aftereffects have been observed in some survivors. These neurologic insults can occur as immediate or delayed manifestations and can affect the nervous system at various levels resulting in hemiplegia, aphasia, parkinsonism, choreoathetosis, and can also involve brainstem, spinal cord, peripheral nerves, and autonomic nervous system. The involvement of vertebrobasilar territory is a rare complication of electrical injury. We herein report a case of 55-year-old male laborer who presented with vertebrobasilar territory ischemic stroke, which occurred 2 weeks after an electrical injury. To the best of our knowledge, this is the first ante mortem case report of a posterior circulation ischemic stroke occurring as a delayed complication of electrical injury.

Design and development of a stable polyherbal formulation based on the results of compatibility studies.

INTRODUCTION: Ayurvedic and herbal medicinal products contain a combination of botanicals; each of these contains a number of chemical compounds that may give the anticipated activity in combination. Therefore, it is very important to analyze and evaluate the compatibility of various active constituents and markers from different medicinal plants for their possible chemical interactions with various excipients at different storage conditions during the development of a stable polyherbal formulation. OBJECTIVE: To study chemical stability of kalmegh (Andrographis paniculata) and kutki (Picrorhiza kurroa) extract for their active markers andrographolide, kutkoside and picroside-I and to develop stable polyherbal formulation based on the incompatibility studies. MATERIALS AND METHODS: The compatibility study was carried out on individual ethanolic extracts of these two plants along with the commonly used excipients in the ratio of 1:1 at 40 ± 2°C and 75 ± 5% relative humidity and at a refrigeration temperature of 5 ± 1°C for initial, 7-, 15- and 30-day intervals. The analysis was carried out using the validated reverse phase-high-performance liquid chromatography methods. A stable tablet dosage form was developed based on the results of these studies. RESULT: The study suggested that the active markers of kutki (kutkoside and picroside-I) were found to be degraded in the presence of the kalmegh extract. However, the active marker of the kalmegh extract (andrographolide) was found to be stable. Both the extracts showed excellent compatibility with all the excipients used in making this formulation. No significant decrease in the kutkoside and picroside-I content from the formulation was observed. CONCLUSION: By separate granulation process the exposure of both the extracts can be minimized thus avoiding the degradation of active markers.

Gabapentin as a rescue drug in D-penicillamine-induced status dystonicus in patients with Wilson disease.

D-penicillamine induced status dystonicus is a unique but serious drug related complication in a subset of patients with Wilson disease. Patho-physiological basis of its occurrence is not known. It often responds poorly to anti dystonia medications. We present three patients with Wilson disease who developed severe paroxysmal dystonic spells after receiving D-penicillamine treatment. All three patients responded well to gabapentin after failing to respond to other anti dystonia drugs.