History Of Sleepiness Research Articles

Pseudo Bulbar Palsy a Rare NEURO-COVID Presentation

Background: The Global pandemic of COVID-19 with more than half million people passed away from their families tragically, wide variety of signs and symptoms resulted from this Novel SARS Cov2 virus. Although the respiratory and Gastro-intestinal symptoms are dominant, however, neurological symptoms whether specific or nonspecific have been reported. Till now the extents of knowledge regarding the neurological sequel of COVID-19 infection are finite. Pseudo Bulbar Palsy is a neurological disease characterised by dysarthria, dysphagia, facial and tongue weakness in addition to emotional liability resulted from an upper motor neuron lesion in the corticoid bulbar tracts. Peripheral neuropathy, Demyelisation and vascularise are underlying aetiologies. This will result in deglutition, and speech disturbance. Case presentation: 60 years old male from Najaf, went to the emergency department with three days history of drowsiness and anorexia after COVID-19 related fever and myalgias. He had significant risk factors. He had 2 weeks fever following a contact with COVID-19 patient. Examination revealed drowsiness, dehydration, the patient was not aware for time and place, eye refluxes was symmetrical. The face was normal with exaggerated jaw jerk CT of the chest showed evidence of COVID-19 infection confirmed by positive PCR. Brain CT showed only brain atrophy without signs of localised ischemia. Farther blood investigations confirm activity of infection. During this the patient developed tonic clonic convulsion required anticonvulsant therapy; he remained semiconscious, with difficulty to swallow and dysarthria, Irritability, drowsiness and disorientation. He received anticoagulant, Steroids, mannitol. The condition improved and the patient discharged in better condition with two weeks anticoagulation. Discussion: this is a story for a rare complication belong to COVID-19 infection, treated as a stroke, as mention in literatures, many recorded cases of Neurocovid that required treatment accordingly. Conclusion: neurological symptoms of COVID-19are extreme and might be nonspecific but some time life threatening, these might overlap severe infection. The improvement in the neurological sequel overlap the COVID-19 improvement both clinical aspect and investigation.

A Case Report an Apple a Day, Can Make it Your Last Day

Asphyxial death is one of the commonest modes of death which may be homicidal, suicidal or accidental in nature. Accidental death is defined as unexpected or unplanned event that may result in death. Asphyxia refers as lack of oxygen in blood & tissues due to impaired or absence of exchange of oxygen and carbon dioxide leading to death. Choking is a form of asphyxia caused by mechanical occlusion within various sites of air passages by foreign object. It is more common among those people who laugh and talk during their meal, when food is accidentally inhaled. Choking of both organic and non-organic foreign bodies continues to be a common cause of mortality, requiring prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences. The other most common cause of aspiration is general anaesthesia with full stomach or when patient is unconscious, under any intoxication or drowsiness. Such a case is brought to casualty of Sri Aurobindo Medical College and PG Institute, Indore with the history of drowsiness due to severe acute diarrhoea. At first site this case appeared a case of food poisoning but autopsy revealed that, it is a case of aspiration of mashed apple, which the deceased had consumed just before the death.

Acute Liver Failure and Aplastic Anemia in an 11-Year-Old Girl

An 11-year-old previously healthy female presented with a 1-week history of jaundice and fatigue. Her aspartate aminotransferase (AST) level was 1,420 U/L, alanine aminotransferase (ALT) 1,044 U/L, total bilirubin 16.5 mg/dL and international normalized ratio (INR) for prothrombin time 1.2. Complete blood count showed a white blood count of 7,700/mm, hematocrit 40.6 g/dL, and platelet count 509,000/mm. Ultrasound demonstrated mild hepatomegaly but was otherwise normal. Serology was negative for hepatitis A, B, and C and Epstein-Barr virus (EBV) and cytomegalovirus (CMV). After discharge, she was followed by her outpatient pediatric gastroenterologist, who noted that she continued to have jaundice and elevated aminotransferase levels. A liver biopsy was recommended, but her parents refused, and the patient was lost to followup for several months. Four months after her initial presentation, the patient represented with a 2-week history of sleepiness, headaches, increased jaundice, and anorexia. During the time she was lost to follow-up, her parents noted an initial improvement of her jaundice and energy. However, 2 weeks prior to her readmission, she had increasing fatigue, jaundice, and epistaxis. Complete blood count revealed a WBC of 2.3 g/mm, hematocrit 33.2 g/dL, and platelet count 13,000/mm. Total bilirubin was 21.8 mg/dL, direct bilirubin 14.6 mg/dL, AST 3,158 U/L, ALT 3,239 U/L, INR 2.0, erythrocyte sedimentation rate 16, C-reactive protein 23 mg/dL, and ammonia 38 lm/L. She was admitted for lethargy in the setting of liver failure and pancytopenia. On admission to the hospital, her vital signs were normal and physical examination revealed an alert, interactive female with marked jaundice. Lungs were clear to auscultation, and heart tones were regular with no murmurs. Her abdomen was soft, nontender and not distended; her liver was palpated 2 cm below the right costal margin, and the spleen tip was palpated 3 cm below the left costal margin. Ultrasound of the abdomen showed mild hepatomegaly and thickened gallbladder wall with no sludge or stones. She was listed for liver transplantation, and began transfusion therapy with fresh frozen plasma and platelets as needed for procedures. Further blood tests showed negative human immunodeficiency virus (HIV) antibody, CMV polymerase chain reaction (PCR), and EBV PCR. Her alpha-1-antitrypsin level was normal, anti liver-kidney microsome antibody negative, antismooth muscle antibody negative, antinuclear antibody negative, drug screen for urine and serum negative, varicella immunoglobulin (Ig)G negative with an equivocal IgM. Ophthalmology consultation was negative for ocular abnormalities and Kayser-Fleischer rings, and her serum ceruloplasmin was 29 mg/dL. A 24-h urine collection for copper was 260 mcg/specimen (normal, less than 60), but the reliability of this test was questioned given that the patient had 4 L of urine collected while receiving furosemide. A magnetic resonance cholangiopancreatography (MRCP) showed no biliary stones or biliary dilatation, a mildly enlarged liver and spleen, thickened gallbladder wall, pericholecystic fluid, trace bilateral pleural effusions, and A. M. Yeh D. Bass (&) Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University Medical Center, Lucile Packard Children’s Hospital at Stanford, 750 Welch Road, Suite 116, Palo Alto, CA 94304-0126, USA e-mail: dmbass@stanford.edu

Nonketotic hyperglycinemia in Suleimaniah Children’s Hospital, Riyadh, Saudi Arabia

Nonketotic hyperglycinemia in Suleimaniah Children’s Hospital, Riyadh, Saudi Arabia

A Pediatric Case of Ophthalmoplegic Migraine with Recurrent Oculomotor Nerve Palsy

Purpose: A young patient of ophthalmoplegic migraine with recurrent oculomotor nerve palsy is reported. Case: A 4-year-old girl came to our hospital complaining of recurrent left ptosis and double vision which completely resolved within a few days. She had a history of drowsiness after vomiting every two months. Left oculomotor nerve palsy with internal ophthalmoplegia was observed. Electroencephalography revealed mild changes, but computed tomography, single photon emission computed tomography, and cerebrovascular Doppler-ultrasound examination demonstrated no abnormalities. This oculomotor nerve palsy completely improved on the next day. Results: Thereafter, left episodic mydriasis and oculomotor nerve palsy occurred twice each. However, the frequency and symptoms of migraine were remarkably reduced by topical administration of 0.25% timolol maleate twice daily to both eyes. Conclusion: In isolated oculomotor nerve palsy in childhood, ophthalmoplegic migraine should be also considered. We emphasize that a detailed case history is very important to its diagnosis.