We report a case of a four-year-old boy with stage 1 Wilms tumour, who developed Vincristine-induced acute life-threatening hyponatremia, which presented as generalized tonic clonic seizures and coma. He was intubated and mechanically ventilated. There were no localizing neurological signs. CSF study showed no cells and CSF proteins were 20 mg%. Electrocardiography, chest X-ray, echocardiography, CT scan and liver function tests were normal. Evaluation of electrolytes and arterial blood gas showed serum sodium of 113 mEq/L with mild metabolic acidosis. Serum osmolality was 260 mOsm/L (normal value 285-295 mOsm/L) and urine osmolality was 625 mOsm/L (normal range 300-900 mOsm/L), urine sodium 280 mEq/d (normal range 100-260 mEq/d), serum potassium, blood urea, blood sugars were normal. Serial blood cultures showed no bacterial growth. Patient was treated with fluid restriction, hypertonic saline (3%) and other supportive care. Patient improved clinically over three days and was extubated on the third day and shifted to the ward on the fifth day.
Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed.
Background: Stroke is the second most common cause of death and third most common cause of disability in the world. Knowledge of prognostic factors is necessary for the clinician to make a reasonable prediction of outcome for individual patients, to provide rational approach to management and to help patients and their families understand course of the disease. Hence, this study to determine the prognostic factors in acute ischemic stroke with special emphasis on atrial fibrillation, hyperglycemia and fever was undertaken.Methods: This is a prospective and hospital based observational study of 70 patients with acute ischemic stroke. The diagnosis of acute ischemic stroke was based on history, physical examination and CT imaging. The severity was assessed based on Scandinavian Stroke Scale (SSS). The prognostic factors with special emphasis on atrial fibrillation, hyperglycemia and fever were studied based on the standard diagnostic criteria.Results: Prevalence of Atrial Fibrillation was 20% in present study. Mortality and dependency rates were significantly higher in AF group. Fever during the first few days of acute ischemic stroke was a statistically significant predictor of poor outcome. Neuronal damage in brain is directly proportional to its temperature. The results of the study confirm that hyperglycemia at stroke onset is an adverse prognostic factor with 33.33% mortality in hyperglycemic stroke.Conclusions: Atrial fibrillation, hyperglycemia and fever were found to be poor prognostic factors in acute ischemic stroke. Prompt recognition and correction of these poor prognostic factors improve the outcome for such patients.
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