Supplementation of the diets with hydroponic maize fodder affects digestibility, puberty, sexual behavior, and semen characteristics in buck kids.

Hydroponics is one of the widely adopted technologies for fodder production in arid and semi-arid regions. In addition to the benefits such as shorter growth period and minimal water and land use, it also produces nutritious fodder that contains essential nutrients required for the growth and reproduction of livestock. This study was conducted to evaluate the effect of feeding hydroponic maize fodder on the reproductive performance of buck kids. Twenty-four Tellicherry buck kids aged around 3 months were randomly selected and allocated into three treatment groups, namely, control, treatment 1 (T1), and treatment 2 (T2). Experimental diets were formulated by replacing the concentrate with hydroponic maize fodder at 0% (control), 25% (T1), and 50% (T2) level. The buck kids supplemented with hydroponic maize fodder attained puberty earlier (T1, 246.50 ± 2.61 days; T2, 241.00 ± 2.06 days) (P < 0.05); had higher (P < 0.05) scrotal circumference, testicular volume, and fresh semen characteristics; and exhibited intense sexual behaviors than the non-supplemented kids. Furthermore, hydroponic maize fodder supplementation improved the digestibility of dry matter (DM) (P < 0.01), organic matter (OM) (P < 0.01), crude fiber (CF) (P < 0.05), ether extract (EE) (P < 0.01), and nitrogen-free extract (NFE) (P < 0.01) in the kids. In conclusion, hydroponic maize fodder feeding did not have any negative impact on the reproductive performance of kids. Furthermore, the hydroponic maize fodder supplementation enhanced the kids' nutrient digestibility and reproductive performance.

Relapsing Guillain-Barre syndrome in pregnancy and postpartum.

Guillain-Barre syndrome (GBS) rarely complicates pregnancy, but can be associated with high maternal and perinatal morbidity if not properly identified and treated. A high index of suspicion, supportive measures, access to intensive care unit and intravenous immunoglobulin (IVIG) therapy are cornerstones of management in GBS complicating pregnancy. Neurologists and Obstetricians should be aware of the risks of relapsing GBS in the immediate postpartum period. Surgery and anesthesia may be triggers for relapse in association with an overall increase in pro-inflammatory cytokines in the postpartum period. We report a unique case of GBS complicating pregnancy in the third trimester followed by a relapse in the postpartum period. She made a good recovery with supportive measures and a repeat course of IVIG during the relapse.

Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke.

A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.

Recombinant factor VIIa in a case of pontine hemorrhage.

A 59-year-old lady presented with hypertensive hemorrhage involving the pons. Since she presented within 3 hours of onset of the stroke, recombinant factor VIIa was administered. From a state of altered sensorium there was a rapid recovery of consciousness followed by gradual improvement in limb weakness. Serial CT scans of the brain revealed no further expansion of the hematoma. The hematoma progressively resolved. Recombinant factor VIIa could be an attractive therapeutic option in treating hemorrhages at critical sites like brainstem where expansion of hematoma could be fatal.

Wilson's disease: a clinico-neuropathological autopsy study.

Wilson's disease (WD), a familial neurological disorder involving the brain and liver secondary to altered copper metabolism, is common in South India. In view of the paucity of studies on this condition, the pathomorphological features of eight cases of WD were studied in detail at autopsy (brain alone, 1; brain and liver biopsy, 1; brain and visceral organs, 6), and are described with a discussion of the differential features of the neurological and hepatic forms. Of the six patients presenting with neurological manifestations, five had central pontine myelinolysis, five had subcortical white matter cavitations, four had putaminal softening, and six had variable ventricular dilatation, unlike the hepatic form. The presence of Opalski cells and pontine myelinolysis appear to be specific to the neurological form of WD. Liver abnormalities were observed in all cases (cirrhosis, 6; steatosis, 4; chronic active hepatitis, 2). Contrary to the rubric 'hepatolenticular degeneration', involvement of the lenticular nucleus was not universal, and nor was the pathology restricted to these anatomical areas.

Wilson disease: description of 282 patients evaluated over 3 decades.

The clinical manifestations of Wilson disease (WD) are varied and challenging. We conducted the current study to present the phenotypic characteristics and follow-up for a large cohort of patients with WD. We reviewed the medical records of 282 cases of WD (male:female ratio, 196:86) for clinical features, investigations, treatment, and outcome data. The clinical presentations were as follows: hepatic, 42 (14.9%); hepato-neurologic, 10 (3.5%); neurologic, 195 (69.1%); pure psychiatric, 7 (2.4%); osseomuscular, 6 (2.1%); and "presymptomatic," 15 (5.3%). Mean age was 15.9 years. Presymptomatic patients and those with the hepatic form of WD were younger and patients with osseomuscular and psychiatric forms were older than neurologic patients. The mean duration of illness at the time of diagnosis was 28 months. Predominant neurologic features were as follows: parkinsonism, 62.3%; dystonia, 35.4%; cerebellar, 28%; pyramidal signs, 16%; chorea, 9%; athetosis, 2.2%; myoclonus, 3.4%; and behavioral abnormalities, 16%. Kayser-Fleischer (KF) rings were seen as follows: neurologic patients, 100%; hepatic patients, 86%; and presymptomatic patients, 59%. Positive family history was noted in 47% and consanguinity in 54%. Patients born of consanguineous parents had an earlier age of onset and shorter duration of illness before presentation. Serum ceruloplasmin was decreased in 93% and 24-hour urinary copper excretion was increased in 70% of patients. Neuroimaging (computed tomography/magnetic resonance imaging) and electrophysiologic abnormalities were seen in many patients. Overall, 195 patients were on D-penicillamine therapy and 182 on zinc sulphate. Follow-up data, available for 225 patients, for a mean duration of 46 months, revealed improvement in 176, no change in 20, and deterioration in 6. Twenty-three patients died. To conclude, despite increased awareness and recognition and significant inroads into therapeutic frontiers, follow-up remains poor in developing countries and a return to previous level of functioning is not universal.

Recurrent venous thrombosis with factor V Leiden mutation.

A patient who presented with recurrent venous thrombosis is reported. Following an episode of spontaneous deep vein thrombosis of the lower limb he was started on oral anticoagulant therapy, which he discontinued. He presented with cerebral venous thrombosis and improved partially with anticoagulant therapy. Evaluation for hypercoagulable states revealed factor V Leiden mutation by polymerized chain reaction method. Long-term anticoagulation has been planned. Evaluation for factor V Leiden mutation is always warranted in patients presenting with spontaneous thrombosis, especially if there is recurrent thrombosis.

Cognitive dysfunction in cholesterol embolic disease.

A patient who developed neurological and renal complications following coronary angiogram and coronary artery bypass grafting is reported. Neurological involvement was in the form of fluctuating sensorium and a subcortical pattern of dementia. Renal failure was seen in the form of raised urea and creatinine levels. Renal biopsy revealed the cause of the renal failure to be due to cholesterol embolic disease. While the sensorium often improved following renal replacement therapy (dialysis), the dementia was poorly responsive to therapy. The patient succumbed due to progressive renal failure. Awareness of the protean manifestations and a high index of suspicion are essential for appropriate diagnosis in order to enable the clinician to accurately prognosticate in this often fatal disease.

Neuroacanthocytosis misdiagnosed as Huntington's disease: a case report.

A patient with the typical features of neuroacanthocytosis is reported. Chorea, tics, personality changes and caudate atrophy on cranial MRI resulted in an erroneous diagnosis of Huntington's disease elsewhere. Attention to other features viz., absence of ocular motility disturbances, amyotrophy, areflexia, EMG evidence of axonopathy, raised serum creatinine phosphokinase (CPK) levels and the typical erythrocytic acanthocytosis enabled us to establish the correct diagnosis. The typical features of the disease as seen in the patient are discussed. In view of the implications for genetic counseling, careful clinical and laboratory evaluation is always warranted to exclude neuroacanthocytosis in all suspected cases of Huntington's disease.

Cardiac involvement in Wilson's disease--an electrocardiographic observation.

BACKGROUND: Wilson's disease is known for its protean manifestations; however electrocardiographic abnormalities have not received much attention. AIM: To evaluate the various electrocardiographic (ECG) changes in patients with Wilson's disease. METHOD: The resting ECGs of 50 patients with Wilson's disease were systematically analyzed independently by three observers after excluding other causes that could induce ECG abnormalities. RESULT: Fifteen patients had at least one abnormality in the ECG. Sinus tachycardia was seen in eight and sinus bradycardia in six. Other abnormalities included: bifid P wave (1), ST elevation (2), ST depression (2), T inversion (4), ventricular premature contraction - VPC (1) and prominent U waves (1). QRS axis, PR interval, QRS complex, R/S amplitude ratio and QT interval were normal in all. Ventricular premature beats were not recorded in any. None had features of ventricular hypertrophy. There was no statistically significant difference in ECG abnormalities with reference to age, gender, duration of illness or treatment, serum copper or ceruloplasmin, and severity of neurological impairment. CONCLUSION: ECG abnormalities are not uncommon in Wilson's disease and are presumably related to an underlying cardiomyopathy due to deposition of copper in heart.

Marinacci communication: an electrophysiological study.

OBJECTIVE: Prevalence of Martin-Gruber anastomosis, an anomalous median-to-ulnar forearm communication, is well reported in literature while Marinacci communication, the reverse of Martin-Gruber with a forearm ulnar-to-median communication is under-recognized. We systematically evaluated the presence of Marinacci communication in a series of patients referred for electrophysiological studies. METHODS: One hundred consecutive patients referred to the electrophysiological laboratory for various diagnoses were studied using standard techniques for motor, sensory and f wave studies. RESULTS: Of the 100 patients (200 arms) studied, electrophysiological features of Marinacci communication were observed in 4 patients (7 arms). Median stimulation with recording over abductor pollicis brevis (APB) revealed a pseudo-conduction block over the forearm segment while on ulnar stimulation and recording over abductor digiti minimi (ADM), the amplitude of the compound muscle action potential (CMAP) obtained on proximal stimulation was higher than that obtained on distal stimulation. Ulnar stimulation at the elbow but not at the wrist revealed CMAP from APB without initial positivity. Its amplitude was 50% of the amplitude obtained on median stimulation at the wrist. CONCLUSIONS: Marinacci communication is not uncommon in the general population. A pseudo-conduction block on median stimulation and higher CMAP amplitude on proximal than distal stimulation provide valuable clues to its recognition.