Longevity, Frailty and Ageism.

Human lifespan has seen a rise globally. Extended lifespan is a trend projected to persist and continue. The gap is wide: from 52.67 years in the Central African Republic to 80.3 years in the OECD (Canada, Germany, Mexico, France, Japan, UK). In India the expectancy was 68.8 years in 2018. Concordant with the enhanced life span have been studies that explain determinants and mechanisms of human longevity, much of which has been attributed to better public health measures and improved care. The natural twin consequences of longevity: a) Frailty its characteristics and management and b) the behavioural cum attitudinal phenomenon of Ageism have come to the fore and require appropriate corrections. Physicians need to be aware of the demographic changes and implications thereof in management and healthcare. The medical aspects of either are elaborated.

Frailty Syndrome: A Review.

Frailty is a condition associated with ageing, co-morbidity and disability. Frailty was an elusive concept earlier despite efforts at consensus. There is now a better understanding of the multisystem dysfunction and the instability involved and an apparent clarity on measures that could correct deficits and ameliorate symptoms. The syndrome of frailty describes older people at a higher risk for adverse health outcomes such as illnesses, hospitalisations, disability and mortality. Clinically, it is diagnosed on combination of specific symptoms such as weight loss, muscle weakness/fatigue, low physical activity and slow walking speed. It can be identified by a multi-domain assessment of function. Interventions aimed at causative factors may help prevent conversion of frailty into disability. Current management measures are related to promoting physical activity including resistance training, clinical nutrition modifications in protein/amino-acids intakes, and usage of pharmacologic agents-ACE inhibitors, hormones-GH /testosterone in carefully investigated and selected patients. Large healthcare interventions and pharmacological trials are in progress.

Oxcarbazepine-induced Stevens Johnson syndrome: A rare case report.

Although carbamazepine is the most common cause of Stevens Johnson syndrome (SJS) a new antiepileptic drug, oxcarbazepine which is structurally related to carbamazepine, has also been rarely shown to induce SJS. Here we report a case with SJS, which was induced by oxcarbazepine.

Carpal tunnel syndrome caused by cysticercosis.

We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.

Acute subarachnoid hemorrhage as initial presentation of dural sinus thrombosis.

Subarachnoid hemorrhage (SAH) in the older is most often due to aneurismal rupture. Other vascular lesions are known to rarely cause SAH. Cerebral venous thrombosis (CVT) can be difficult to diagnose because of its wide spectrum of clinical manifestations. Its diagnosis can be further complicated when patients initially present with acute SAH. We report a case of dural venous sinus thrombosis with SAH, most probably, due to raised venous pressure draining venous tributaries. A 59-year-old man presented with severe headache. Computerized tomography (CT) scan head was normal. Magnetic resonance imaging (MRI) suggested right parasagittal fronto-parietal hemorrhage. No aneurysm was detected on magnetic resonance angiography (MRA) or digital subtraction angiography (DSA). MRV revealed superior sagittal sinus (SSS) and lateral sinus thrombosis. DSA showed occlusion of intracranial SSS and lateral venous sinus. The patient improved with anticoagulant therapy. This case highlights the fact that SAH may reveal a CVT, and emphasizes on the inclusion of MRV in the diagnostic workup of SAH, particularly in cases in which aneurysm is not detected.

Neuromuscular respiratory failure in Guillain-Barre Syndrome: evaluation of clinical and electrodiagnostic predictors.

UNLABELLED: Guillain-Barre Syndrome (GBS) has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Successful management mandates anticipation, prompt recognition and optimal treatment of neuromuscular respiratory failure in GBS. AIMS: To identify clinical and electrodiagnostic predictors of neuromuscular respiratory paralysis in GBS. MATERIALS AND METHODS: Forty six patients of GBS were studied over a 6 year period, the study being 2 year retrospective and 4 year prospective. Clinical and electrodiagnostic data were compared between ventilated (28) and non-ventilated (18) patients. The clinical parameters assessed were median age, gender, antecedent infection, prior lung disease, time to peak disability, bifacial weakness, upper limb weakness, bulbar paralysis, neck weakness and autonomic dysfunction. Electrodiagnostic studies included motor nerve conduction studies in 11 ventilated and 13 non-ventilated patients, done prior to maximum disability in each group. Multiple logistic regression analysis was used to compare the two groups. RESULTS: Comparing the clinical data in the ventilated and non-ventilated groups, 'early peak disability', autonomic dysfunction and bulbar weakness predicted the onset of respiratory paralysis. Age, gender, neck or bifacial weakness, upper limb paralysis, or preceding infection did not influence the development of neuromuscular respiratory weakness. Electrodiagnostic testing revealed abnormal H reflex and F waves to be the commonest abnormality in either group. Although data was not sufficient for statistical analysis, the presence of markedly attenuated Compound Muscle Action Potentials inexcitable motor nerves and denervation changes on the electromyography, was commoner in the ventilated group. Thirty six patients received treatment with either plasmapheresis (12) or intravenous immunoglobulin (24). Overall mortality was 5, all 5 patients being on assisted ventilation. CONCLUSION: Early progression to peak disability, bulbar dysfunction and autonomic instability predicted the development of neuromuscular respiratory paralysis in GBS. Early electrodiagnostic studies in this series suggest axonopathic GBS as a predictor of respiratory paralysis, a finding that needs to be evaluated with sufficient data to permit statistical analysis.

Geophagia leading to hypokalemic quadriparesis in a postpartum patient.

Pica is an eating disorder associated with ingestion of variety of non-food substances. A postpartum patient who presented with acute flaccid quadriparesis was detected to have severe hypokalemia. After extensive investigations for cause of hypokalemia, history of geophagia (clay-eating) was obtained. Approach to hypokalemia and health hazards of pica are discussed.