Rare Manifestation Of Anti-Nmdar Encephalitis.

N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis is an autoimmune syndrome with the development of antibody production against the NMDAR, affecting synaptic plasticity and cognition. It has a common association with ovarian teratomas with women being affected disproportionately. We present a case of an eight-year-old female child presented with complaints of fever, altered level of consciousness and choreiform movements. Owing to its common occurrence in the developing world, initially, rheumatic fever was kept in the differential diagnosis and was treated accordingly, but through a series of investigations, was diagnosed as a case of N methyl-d-aspartate receptor (NMDAR) antibody encephalitis. This case report urges the healthcare providers to keep Anti NMDAR encephalitis as a differential in their minds, while dealing with patients, having chorea as their main clinical manifestation. Owing to its rarity, we have primarily reported it here.

A misdiagnosis of choledochal cyst type IB and recommendation to use gold-standard imaging techniques: A case report.

A choledochal cyst (CC) is a rare congenital dilation of the biliary ductal system that can cause troublesome complications when left untreated. CC in children classically manifests as a rare triad of the right upper quadrant mass, jaundice, and abdominal pain. Here, we report the case of an eight-year-old boy seen in Paediatric Unit I of Dr Ruth K. M. Pfau Civil Hospital Karachi, Pakistan, on October 9, 2019, who was initially misdiagnosed for liver abscess due to the non-specific symptoms and managed appropriately with antibiotics, which failed to improve the symptoms. Moreover, a hydatid cyst was considered based on ultrasonography (USG) which was later ruled out by the negative serology. A definitive diagnosis of CC was established on magnetic resonance cholangiopancreatography (MRCP). In resource-limited countries, USG is always the first line screening tool for biliary duct abnormalities which in some cases is comprehensibly enough for the diagnosis of a rare entity like CC, thus requiring a highly specific imaging test like MRCP to be performed to devise an effective treatment and surgical plan.

Antagonistic behaviour of organic compounds from Bacillus species and Brevundimonas specie.

Bacterial strains, Bacillus cereus Lb (KF011486), Brevundimonas sp. A2 (JX996070), Bacillus cereus AZS and Bacillus sp. 11A, isolated from soil sample, were checked for their antimicrobial property against Bacillus as test organism. The bactericidal effect of the antagonistic strains against test organism was found to be at 1280, 1280, 40 and 160 arbitrary units (AU/ml), respectively. The Crude Antimicrobial Compound (CAC) had a bactericidal effect on target cell by degeneration of its cell wall. The chemical analysis of TLC purified extract of intracellular and extracellular antimicrobial compound produced by Bacillus cereus Lb by GC-MS analysis revealed the presence of organic compounds such as acetic acid and certain volatile organic substances such as, toluene, 2-butanone, etc., with antimicrobial property. N-acetylmuramoyl-L-alanine amidase is a cell wall hydrolysing enzyme and involved in cell wall degeneration of the target cells. These volatile organic compounds help this enzyme by decreasing the pH of the environment hence maximizing the amidase activity which possesses maximum activity at pH range of 5.5-6.5.

Primary CNS Lymphoma vs. Tumefactive Multiple Sclerosis: A Diagnostic Challenge.

Primary CNS (central nervous system) lymphoma is a rare condition with the incidence of less than 1% of all non-Hodgkin lymphomas (NHLs) and approximately 2% of all primary brain tumours. Diagnosis can be challenging and necessitates brain biopsy for definitive diagnosis. A 41-year male presented with history of impaired cognition, facial asymmetry, visual impairment and left sided body weakness. MRI brain demonstrated multiple enhancing lesions with one larger lesion in right basal ganglia with surrounding oedema and mass effect. These findings suggested the differential diagnoses of tumefactive multiple sclerosis (MS), primary CNS lymphoma (PCNSL) and tuberculosis. The patient had normal CT chest, abdomen and pelvis, normal CSF examination and cytology, negative CSF oligoclonal bands (OCBs) and negative HIV screening. It was impossible to differentiate between tumefactive MS and PCNSL without undertaking brain biopsy. Diffuse large B cell lymphoma (DLBCL) was the final diagnosis. Diagnosing PCNSL can be challenging and brain biopsy should not be delayed for definitive diagnosis and targeted treatment.