Man-in-the-barrel syndrome (MBS) is an uncommon presentation due to bilateral, predominantly proximal muscle weakness that has not been described to be associated with myasthenia gravis. We describe a case of myasthenia gravis presenting as MBS. Additionally, he had significant wasting of the deltoids bilaterally with fibrillations on electromyography (EMG) at rest and brief duration (3-6 ms) bi/triphasic motor unit potentials (MUPs) on submaximal effort apart from a decremental response on repetitive nerve stimulation (RNS) at 2 Hz. While electrophysiology is an important tool in the diagnosis of myasthenia gravis, pathological EMG patterns do not exclude the diagnosis of myasthenia gravis.
Adolescence is the most vulnerable stage in human life for malnutrition. When the need for nutrients increases during the growth phase. The prevalence rate of malnutrition among adolescent girls (11-18 years) in 11 states and 16 districts, of which 7.1 per cent, was found to be severe anemia, in India, by the recent state-level nutrition plan. Malnutrition is affecting about 50 per cent of the population in India. This problem is affecting women more than men. An estimated 20-40 per cent of maternal deaths in India are due to malnutrition and one out of every two Indian women (56 %) suffers from some form of malnutrition. According to several studies, the prevalence of malnutrition is very high (80-90 %) among pre-school children, pregnant and lactating women and adolescent girls in India. According to a report, more than half (56 %) of adolescent girls in India suffer from malnutrition. Comparing the nutritional status of adolescent girls in India, it was found that 47 per cent of adolescent girls in the age group of 15-19 years in India are victims of undernutrition.
Malnutrition is caused by the absence of any essential nutritional factor in the diet, including defects in the formation of hemoglobin or low absorption of essential nutrients. Some malnutrition due to lack of iron in the diet or high quality protein, vitamin B6 deficiency which affects the heme protein in the synthesis of hemoglobin, vitamin E deficiency which affects the stability of the membranes of red blood cells it happens. Copper is not part of the hemoglobin molecule but it affects the absorption of iron in the liver. Iron deficiency is the most common nutritional disorder in the world. Worldwide, anemia is estimated to affect 2 billion people, or 30 per cent of the world’s population and is more severe in developing countries due to frequent malaria and insect infestation. It particularly affects women in the reproductive age group and young children in tropical and sub-tropical regions. The World Bank estimates that malnutrition is a direct contributor to global diseases. Malnutrition occurs at all stages of life, but is most common in pregnant women, young children and teenage girls. Iron deficiency and malnutrition are a major public health problem among teenagers. Studies indicate that anemia in teenagers increases with age and the rate of growth is highest during teenage.
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