Seizure Episodes Research Articles

Prognostic factors for the recurrence of afebrile seizures after benign convulsions associated with mild gastroenteritis.

The overall prognosis of benign convulsions associated with mild gastroenteritis (CwG) is favorable, and the incidence of afebrile seizure recurrence with or without gastroenteritis (ASwGI and ASwoGI, respectively) is low. In this study we investigated the prognostic factors associated with afebrile seizure (AS) relapse after the first CwG episode. A hospital-based cohort with an initial CwG episode from January 2012 to October 2019 was followed for at least 19months. The relapse types were divided into ASwGI and ASwoGI. Logistic regression analysis was performed to identify the independent prognostic factors for the recurrence of AS after the initial CwG episode. Furthermore, the clinical characteristics between ASwGI and ASwoGI were compared. Among the 868 patients enrolled, 67 (7.7%) experienced a second AS and 71% (48/67) showed gastroenteritis-associated recurrence. Except for five patients with subsequent epilepsy (0.6%), only eight (0.9%) experienced three seizure episodes. The independent predictive factors for the subsequent recurrence of AS were age less than 18months at onset (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 1.53-5.63), repeated seizures over 24h (OR: 4.09, 95% CI: 2.19-7.65), and absence of fever (OR: 2.33, 95% CI: 1.26-4.33) during the first CwG episode. The probability of recurrence of AS for those with one, two, and three predictive factors was 3.23%, 13.35%, and 22.85%, respectively. In addition, the age at onset was significantly lower in the ASwoGI group than in the ASwGI group during the first episode (p < .05). The risk of AS relapse after the initial CwG episode is low, and the majority of patients presented with gastroenteritis. The risk can be predicted by age at onset, repeated seizures over 24h, and absence of fever during the first CwG episode.

P18 Steroid-induced malignant hypertension causing cytopenia in a case of lupus nephritis

Case report - IntroductionProteinuria, hypertension and renal impairment are among the features of lupus nephritis, whereas seizure and cytopenia are part of systemic manifestations of active lupus. In these situations, high-dose steroid is usually considered and can lead to severe/malignant hypertension (MHT). We are reporting a case of lupus nephritis admitted with seizures and later developed thrombotic microangiopathy (TMA). Further evaluation revealed a diagnosis of steroid-induced malignant hypertension which was later improved after controlling blood pressure and reducing the dose of steroid. Case report - Case descriptionA 25-year-old lady who was previously diagnosed at 17 years old with systemic lupus erythematosus (SLE) based on clinical features of polyarthralgia, lymphadenopathy, fatigability and positive auto immune profile. She was lost to follow up since the diagnosis and had not been on relevant treatment. She was recently admitted with myalgia, polyarthralgia, pleural effusion and leg oedema. Blood test showed stage 2, acute kidney injury and urine analysis showed significant proteinuria (PCR 826mg/mmol). Renal biopsy showed class IV lupus nephritis and she was commenced on prednisolone 50 mg orally and was discharged home with outpatient follow up appointment.A few days later, she presented with generalized tonic clonic seizure. Physical examination revealed high blood pressure at 160/120 mmHg. MRI brain scan did not show features of ischaemia or thrombosis. She was treated with antiepileptic, antihypertensive medications and parenteral methylprednisolone 500 mg in view of lupus with neurological manifestation. While being on methylprednisolone, her blood pressure further rose with systolic 220/ diastolic 170 mmHg. Her blood parameter started deteriorating showing features of microangiopathic haemolytic anaemia (MAHA) with low haemoglobin of 56 and low platelets of 46. Blood test for anti-cardiolipin antibody, lupus anticoagulant were negative and marker for thrombotic thrombocytopenic purpura (TTP) Serum ADAMTS13 (A Disintegrin and Metalloprotease with a Thrombospondin type1 motif, member 13) was normal. Haematology team’s opinion was sought and TTP ruled out as a cause of her anaemia and thrombocytopenia. Repeat blood test did not show any features of worsening lupus and urine analysis showed improved proteinuria. Management plan was focused on controlling her blood pressure with optimization of antihypertensive medications. Parenteral steroid therapy was stopped. Within a few days of achieving good control of blood pressure, cytopenia improved. Antiepileptic treatment was stopped and she did not have any further episodes of seizure. Case report - DiscussionIn assessing a case of lupus nephritis who appeared to have MAHA and thrombocytopenia with severe HTN, clinicians need to consider possibility of TMA along with other common differentials such as active lupus, TTP and haemolytic uraemic syndrome (HUS). In this case lupus nephritis and neurological manifestation (seizure) diverted attention towards active lupus. Patient was treated with parenteral steroids in order to control active lupus which caused worsening haematological parameters. Steroid-induced malignant hypertension can be difficult to consider as a differential diagnosis in these situations and can be easily missed.TMA is a rare but serious condition which describes a specific pathological abnormality in the vessel wall of arterioles and capillaries leading to microvascular thrombosis. It is commonly manifested as MAHA and thrombocytopenia in blood film which indicates underlying endothelial injury. This case’s blood film showed thrombocytopenia and red blood cell fragmentation suggestive of MAHA. Malignant hypertension is one of the underlying causes of TMA where blood pressure control would be the most critical and may be the only management required to reverse the haematological abnormality as was evident in this case. Case report - Key learning pointsCytopenia in a case of SLE can be due to autoimmune process or drug-induced. However, malignant hypertension can also cause thrombotic microangiopathy which can lead to cytopenia. Thus, clinicians should be vigilant and relate this complication to the high dose of steroid.

Seizure related injuries – Frequent injury patterns, hospitalization and therapeutic aspects

PurposeEpileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. MethodsThis retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0–G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal–Wallis one-way analysis of variance were used for statistical analysis. ResultsA total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%, n = 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (−1.04 ± 1.15) and Z-score (−0.84 ± 0.75) compared to healthy subjects were found. ConclusionFractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.

Epilepsy in “Sunflower syndrome”: electroclinical features, therapeutic response, and long-term follow-up

BackgroundSunflower syndrome (SFS) is a rare childhood-onset generalized epilepsy characterized by photosensitivity, heliotropism, and drug-resistant stereotyped seizures maybe self-induced by hand-waving maneuvers. Data on the long-term prognosis are scantly and evidence over best treatment strategies is lacking. MethodsWe retrospectively describe the electroclinical features, and therapeutic response in a group of 21 patients with SFS, without intellectual disability. Results16 patients were female (67%), with a median age at onset of 7 years. In all patients, ictal episodes began with sun-staring, and hand-waving in front of the sunlight, accompanied by brief typical absence seizures. 17 patients (81%) showed interictal EEG abnormalities, mainly characterized by spike and polyspike-and-wave discharges. Ictal epileptiform activity occurred approximately less than one second after the start of hand-waving. At the last follow-up (median length 8.2 years), 12 patients (57%) were drug-resistant. Nine of them (75%) achieved seizure control with the use of tainted lenses, either alone or compared with anti-seizure medications (ASM). Disappearance of seizures was associated with EEG improvement/normalization when tinted glasses were used during EEG recordings. ConclusionWhile the clinical and EEG characteristics of SFS are well defined, the best therapeutic approaches are still under debate. Our data confirms a high rate of drug-resistance and frequent need of polytherapy. Of note, in drug-resistant patients, lenses (but not ASM) were able to suppress PPR in our patients while wearing lenses. Regarding the role of lenses, we do not only rely on the PPR reduction but also clinically by the reduction of seizures.Although additional data are needed, lenses seem to have a powerful potential role for the management of SFS.

Oral and cephalometric study in Brazilian Rubinstein-Taybi syndrome patients.

The purpose of this study was to describe a detailed investigation of craniofacial and dental characteristics in a group of Brazilian Rubinstein-Taybi syndrome (RSTS) patients. Thirteen RSTS patients treated in a special care dental clinic after 10 years were studied. Panoramic radiographs were obtained from all patients, and cephalometric analysis was performed in eight patients. Five male and eight white female patients with a median age of 11.7 years were analyzed. All the RSTS patients were mouth breathers and presented malocclusion, transverse hypoplastic maxilla, nine subjects (9/13; 69.2%) had posterior crossbite, and eight (61.53%) exhibited talon cusps. Most patients presented class II skeletal pattern and were brachycephalic. Regarding systemic disorders, one patient (7.69%) reported seizure episodes during childhood, and four patients (30.76%) presented heart valve disorders. All patients presented reduced attention span, low intolerance to dental interventions, impulsiveness, and irritability. Since RSTS exhibits oral and skeletal changes, early dental treatment is essential for these patients. Dentists must be aware of medical problems related to heart disease and persist in conditioning techniques to obtain cooperation and avoid dental care under general anesthesia.

Case Report on: Dandy Walker Malformation Syndrome

Introduction: Dandy Walker Syndrome is a congenital brain malformation that affects the cerebellum and the fluid filled areas that accompany it. The cerebellum is a part of the brain that deals with movement coordination as well as cognition and behavior.&#x0D; Case Presentation: The male patient 8 year old who was apparently admitted in A.V.B.R.H on 18/8/2019 is diagnosed with a known case of dandy walker malformation and came with the complaints of headache since 4 days, fever since 3 days, vomiting since 5 days and 3 episodes of seizures. All the necessary blood investigations has been done. The CT scan as well as MRI reports has shown that large posterior fossa cyst with open communication with fourth ventricle with hypoplastic left cerebellar hemisphere and no visualized cerebellar vermis. Before taking this case, information was given to the patients and their relatives and Informed consent was obtained from patient as well as relatives.&#x0D; Therapeutic Intervention: The patient was treated with NSAIDS, antibiotics, anticonvulsant, antiemetic and antacid and physical therapy to help keep muscle strength and flexibility The patient underwent VP shunt head circumference assessed regularly, vital signs hourly, provided vitamins enriched diet as per dietician’s order assisted dressing for drainage and physical therapy. Conclusion: The patient was admitted in A.V.B.R.H in a critical condition with the diagnosis of dandy walker syndrome, after providing the required treatment by the health care team members of hospital the patient condition was improved and satisfactory.

SYN1 Mutation Causes X-Linked Toothbrushing Epilepsy in a Chinese Family

Toothbrushing epilepsy is a rare form of reflex epilepsy (RE) with sporadic incidence. To characterize the genetic profile of reflex epilepsy patients with tooth brushing-induced seizures in a Chinese family. Solo clinical whole-exome sequencing (WES) of the proband, a 37-year-old Chinese man, was performed to characterize the genetic etiology of toothbrushing epilepsy. Mutations in the maternal X-linked synapsin 1 (SYN1) identified in the proband and his family members were confirmed by Sanger sequencing. The pathogenicity of these mutations was determined using in silico analysis. The proband had four episodes of toothbrushing-induced seizures. The semiology included nausea, twitching of the right side of the mouth and face, followed by a generalized tonic-clonic seizure (GTCS). The proband's elder maternal uncle had three toothbrushing-induced epileptic seizures at the age of 26. The proband's younger maternal uncle had no history of epileptic seizures but had a learning disability and aggressive tendencies. We identified a deleterious nonsense mutation, c.1807C>T (p.Q603Ter), in exon 12 of the SYN1 gene (NM_006950), which can result in a truncated SYN1 phosphoprotein with altered flexibility and hydropathicity. This novel mutation has not been reported in the 1000G, EVS, ExAC, gnomAD, or HGMD databases. We identified a novel X-linked SYN1 exon 12 mutant gene in a Chinese family with toothbrushing epilepsy. Our findings provide novel insights into the mechanism of this complex form of reflex epilepsy that could potentially be applied in disease diagnosis.

Elizabethkingia meningoseptica –An emerging infection: A case report

Elizabethkingia meningoseptica are Gram-negative rod bacteria that are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards. Rapid diagnosis and early institution of appropriate therapy for prolonged period are essential for the management of such infections. Here, we report a case of bacteremia due to E. meningoseptica in a neonate who was presented with respiratory distress and seizure episodes. A diagnosis of bacterial meningitis was made based on clinical findings and examination of cerebrospinal fluid. The baby was treated with antibiotics and other supportive measures, that helped to improve the condition. During follow-up, the baby showed developmental delay with hydrocephalus. E. meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for the case management. Awareness among clinicians along with correct diagnosis in microbiology laboratory is required to minimize the fatal outcome associated with this infection.

Benefits of multi-day supplementation with probiotic kefir in Rasmussen encephalitis: the first case report

ABSTRACT Introduction Rasmussen encephalitis (RE) is a rare inflammatory disease, characterized by unilateral hemispheric atrophy, focal intractable seizures, progressive hemiparesis, and neurological deficits. Case report The patient is a young man under pharmacotherapy for epilepsy, exhibiting classical abnormal movements, which are consider typical hallmarks of RE. During clinical care sessions, he presented many episodes of tonic-clonic seizures involving sudden loss of consciousness followed by a post-ictal phase with weakness and interaction difficulty. During the kefir supplementation, the patient presented only short-term absence seizures, quickly returning to activities. Additionally, he presented cognitive and language improvement, being more responsive to commands. The daily diary control of patient’s mother and caregiver at school reported an impressive reduction in number and severity of seizures, becoming less aggressive and more involved in school activities. The serum biochemical markers showed that kefir administration caused a significant decrease of pro-inflammatory and a simultaneous increase of anti-inflammatory cytokine levels. In parallel, after treatment, this probiotic reduced reactive oxygen species levels, increased NO bioavailability, revealing antiapoptotic and antigenotoxic effects. Regarding the microbiological analysis, kefir increased Lactobacillus and Bifidobacterium species. Conclusion To our knowledge, this is the first case reporting remarkable beneficial effects of the probiotic kefir in RE. This case report strongly suggests kefir supplementation as a potential and safe-effective adjuvant therapeutic strategy in the control and treatment of RE.

The antioxidant and neuroprotective effects of the Psychotria camptopus Verd. Hook. (Rubiaceae) stem bark methanol extract contributes to its antiepileptogenic activity against pentylenetetrazol kindling in male Wistar rats.

A substantial number of epileptic patients are resistant to the current medication thus necessitating the search for alternative therapies for intractable forms of the disease. Previous studies demonstrated the acute anticonvulsant properties of the methanol extract of the stem bark of Psychotria camptopus (MEPC) in rats. This study investigated the effects of MEPC on pentylenetetrazole-kindled Wistar rats. Kindling was induced by intraperitoneal injection of pentylenetetrazole (37.5mg/kg) on every alternate day, 1h after each daily oral pretreatment of rats (8 ≤ n ≤ 10) with MEPC (40, 80 and 120mg/kg), vehicle or diazepam (3mg/kg) for 43days. The kindling development was monitored based on seizure episodes and severity. Rats' brains were collected on day 43 for the determination of oxidative stress parameters. The histomorphological features and neuronal cell viability of the prefrontal cortex (PFC) and hippocampus were also assessed using H&E and Cresyl violet stains. Chronic administration of pentylenetetrazole time-dependently decreased the latency to myoclonic and generalized seizures, and increased seizure scores and the number of kindled rats. MEPC and diazepam significantly increased the latencies to myoclonic jerks and generalized tonic-clonic seizures. These substances also reduced seizure score and the number of rats with PTZ-kindling. MEPC improved glutathione status and decreased lipid peroxidation in the brains of kindled rats. MEPC also exhibited neuroprotection against pentylenetetrazole-induced hippocampal and PFC neuronal damages. These results suggest that P. camptopus has antiepileptogenic activity, which might be related to the augmentation of antioxidant and neuroprotective defense mechanisms, and further confirm its usefulness in the management of epilepsy.

BPAN manifesting with febrile seizures and language delay:a case report from Brazil

Neurodegeneration with brain iron accumulation (NBIA) is a complex group of hereditary progressive neurodegenerative diseases characterized by deposition of iron in the basal ganglia. Twelve genetic forms of this disorder have been identified in previous studies. Though they have different inheritance mechanisms all are usually associated with abnormal brain MRI findings. One of NBIA types is an X-linked disorder known as Beta-propeller Protein Associated Neurodegeneration (BPAN). Herein we describe the case of a 4-year-old girl with 2 episodes of febrile seizures, a brain MRI showing nonspecific hyperintense signal in the dentate nucleus area, and delays in language and communication development. Her diagnosis was made based on a genetic evaluation where exome sequencing revealed a mutation in the position chrX:48.933.022 region of the WDR45 gene. The literature describes different clinical presentations for BPAN, each with a different prognosis, suggesting a wide range of possible symptoms of BPAN, including mild cognitive delay and even epileptic encephalopathy (EE).

Bilateral Anterior Shoulder Dislocation after an Episode of Grand-Mal Seizure: A Case Report and Literature Review

Background: Among all joint dislocations, dislocations of the shoulder are the most common. Although posterior shoulder dislocation is infrequent, it is more common following seizures. Trauma, electrocution, and seizures can cause bilateral shoulder dislocation. Anterior shoulder dislocations can be accompaniment by greater tuberosity (GT) fractures, Bankart fractures, and other complications such as rotator cuff tears and neuro-vascular injuries. Case Report: This article describes a 19-year-old boy who suffered from bilateral anterior shoulder dislocation due to an episode of generalized seizure, which happened after taking tramadol. Conclusion: Any sign of shoulder pain in a patient who has experienced a generalized tonic-clonic seizure should warrant full radiographic evaluation to prevent the complications.

Outcomes of the Latarjet Procedure in Recurrent Anterior Shoulder Instability due to Tramadol-Induced Seizure

Background: This study was aimed to evaluate the final results of surgical treatment (Latarjet procedure) in the recurrent anterior shoulder instability following episodes of tramadol-induced seizure. Methods: From January 2005 to March 2013, 47 patients with recurrent anterior shoulder dislocation after suffering a seizure episode following tramadol use underwent surgical procedure. There were 53 shoulders in 47 male patients (six had bilateral recurrent dislocations). The mean age of the patients at the time of operation was 24.7 years (ranging from 20 to 44 years). The average number of episodes of anterior shoulder dislocation before surgery was 16. Results: External rotation with the elbow at the side improved from 45.8 ± 9.3° (30°-60°) pre-operatively to 61.5 ± 7.8° (45°-90°) postoperatively (P &lt; 0.001). Forward elevation also increased significantly post-operatively (P = 0.002). Mean pre-operative Rowe score was 28.41 ± 4.30 (30-85) which increased to 73.57 ± 8.40 post-operatively. The Western Ontario Shoulder Instability Index (WOSI) score decreased from 1352 ± 74 to 618 ± 46 (P &lt; 0.0001). Conclusion: Correcting glenoid bone loss by Latarjet procedure combined, if necessary, with humeral head defect reconstruction could be a proper treatment method in patients experiencing recurrent anterior shoulder dislocation after idiosyncratic seizure reaction of tramadol.

Low serum zinc and magnesium–a possible risk factor for first episode Simple febrile seizures in children between 6 months to 5 years of age

Background: Febrile seizure is the most common type of seizure in children. The incidence of febrile seizure is 5-10% in India. There are multiple aetiologies like high grade fever; genetic predisposition, viral infections and trace elements deficiency like iron, zinc, magnesium and calcium are postulated to be risk factors for developing febrile seizures. Recent studies had shown there is a significant association between low serum zinc, low serum magnesium levels and febrile seizures in children.Methods: This was a case control study with 40 children in each group. Children aged 6 months to 5 years with first episode of simple febrile seizures who attends the out-patient department/emergency room (OPD/ER) were included in case group consecutively and 40 children with acute febrile illness without febrile seizures were included in control group. Serum zinc and magnesium levels were estimated for all the children along with other investigations after proper consent from parents. Using statistical package for the social sciences (SPSS) software, independent sample t test was used to analysis the observations between the two groups. Normal lab reference value of serum zinc was 60-120 μg/dl and serum magnesium was 1.7-2.5 mg/dl.Results: The incidence of febrile seizure was high (37.5%) in children between 1-2 years and male (55%) children had increased incidence when compared to female children in case group. The children with febrile seizure had significantly low levels of serum zinc with mean value of 35.08 μg/dl (±8.56) when compared to control group with mean value of 70.23 μg/dl (±13.41) and serum magnesium level in case group was 1.35 mg/dl (±0.29) versus 1.68 mg/dl (±0.42) in control group, which was also statistically significant.Conclusions: The incidence of febrile seizure was high in children between 1-2 years of age with male preponderance. The serum levels of both zinc and magnesium is significantly low in children with febrile seizure pointing a need of further studies in role of supplemental zinc and magnesium in this age group to reduce the incidence of febrile seizures.

Japanese Encephalitis with Global Aphasia- A Case Report

Introduction: Japanese Encephalitis (JE) is a brain infection caused by the Japanese Virus of Encephalitis (JEV).JE is also known as Mosquito-Borne Encephalitis, Summer Encephalitis and Brain Fever etc. Global aphasia is caused by a number of factors, one of which is JE.&#x0D; Presentation of Case: A 15 years old male child was brought to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India on date 22/08/2019 with complaints of fever since 7 days with 2 episodes of seizures with loss of consciousness for approximately 20 hours and the patient was unable to speak after becoming conscious. On examination, the patient had a fever, was lethargic and appeared depressed, unable to speak, and experienced pain when moving his hands. The patient had a complete blood count, which revealed that his haemoglobin percent, total red blood count, were all low, while his RDW and granulocytes were high. RBCs are predominantly normocytic Normochromic RBCs with mild anisopoikilocytosis, with a few microcytic RBCs, pencil cells, and tear drop cells visible on a peripheral smear as well as platelets were adequate, and no Hemiparasite was found. CSF analysis, CT scan of the brain, an MRI of the brain, and a blood test for P. Falciparum were all performed for diagnostic purposes. The patient was diagnosed as Japanese Encephalitis with Global Aphasia after comprehensive examinations. He was treated Tab. Cefexime, Tab. Levetiracetam, Tab. Phenytoin, Tab. Paracetamol, and Tab. Emset, as well as nursing care was provided based on his needs.&#x0D; Conclusion: Patient showed spontaneous recovery.

Understanding status epilepticus and its treatment in the community

Status epilepticus (SE) is a complication of epilepsy characterised by prolonged or repeated seizures. It is a life-threatening condition that requires the immediate administration of a rescue medicine. If given promptly, rescue medicines can reduce the duration of seizures and support SE cessation. Buccal midazolam is the recommended first-line treatment for SE in the community in people who have had a previous episode of prolonged or serial convulsive seizures. Therefore, it is crucial that all those who care for people with learning disabilities who have epilepsy in the community – including family members, friends and professional carers – receive support, training and guidance in the administration of buccal midazolam. This article provides an overview of the treatment of SE in the community, including the administration of buccal midazolam.

Evaluation of Serum 25-hydroxyvitamin D Levels in Children with The First Episode of Seizures

BackgroundSeizures have been prevalent among children leading to critical complications and death in some cases, investigation of the reasons for seizures is of great importance. The aim of this investigation was to assess the influence of 25-hydroxyvitamin D deficiency on seizures.Materials and MethodsThis study was a case control study and carried out on 1 to 16-year-old children of Besat Hospital of Sanandaj, Kurdistan province, Iran, with the first episode of seizures (case) and children who were caming for routine laboratory checkup (control) in the year 2020.Serum 25-hydroxyvitamin D level was measured by chemiluminescence immunoassays methods of blood sample for both case &control groups. The required data were collected and entered in SPSS software version 21.0 to be analyzed. A p-value less than 0.05 was considered as the significance level.ResultsTotal individuals of 120 children (72 (60%)boys) with an average age of 46.77+40.5 months were selected for the investigation.Sixty-two patients(51.7%)of the children received an appropriate vitamin D supplement, and prevalence of vitamin D supplementation use was higher in case group(P=0.011).The average serum level of 25-hydroxyvitamin D in individuals was 31.36+19.01,and the average serum level of vitamin D in the patient group was greater than that of the control group(P=0.003).The frequency of 25-hydroxyvitamin D deficiency was higher in the control group(p=0.001).ConclusionBased on the obtained results, an important conclusion can be reached that seizures in children were not effectively prevent by normal vitamin D supplements.

Isotretinoin-Induced Thrombocytosis in a Patient With Acne Vulgaris: A Case Report

Isotretinoin is one of the first-line medications for the treatment of acne. One of the reported side effects of isotretinoin is thrombocytopenia, in addition to other abnormalities such as incomplete blood count. However, reports on thrombocytosis associated with isotretinoin are controversial. The present report discusses the case of a patient with acne vulgaris who was treated with isotretinoin and consequently suffered from isotretinoin-induced thrombocytosis.A 20-year-old female patient was diagnosed with acne vulgaris and started treatment with systemic isotretinoin (20 mg once daily) for one month. A baseline complete blood count was performed, as well as another blood count after one month of medication administration. Platelet count was recorded at each visit. The baseline platelet count was within the normal range; however, it was found to be elevated after one month of treatment. Accordingly, the medication was discontinued, and the platelet count returned to normal levels after one month, as measured during the monthly visit. The patient also experienced seizure episodes during treatment, which did not cease with the treatment discontinuation. Although isotretinoin-induced thrombocytosis is considered a rare side-effect for isotretinoin, it should be routinely monitored in high-risk patients and those undergoing surgeries. Further prospective studies on isotretinoin-induced thrombocytosis need to be conducted to gain a deeper insight into the various aspects related to the condition.

A neonate with late-onset hypocalcemia due to unrecognized maternal hyperparathyroidism and a systematic overview of similar cases.

Objective: Neonatal seizures are alarming manifestations of an underlying significant disorder demanding immediate attention and intervention. Hypocalcemia, although rare, must be considered in the differential diagnosis of neonatal seizures.Method: We present an unusual case of a 10-day-old infant with unexplained symptomatic hypocalcemia, experiencing multiple episodes of focal tonic-clonic seizures, born by an entirely asymptomatic mother. Moreover, we conducted a systematic search in PubMed and Scopus databases to present a clinical overview of all similar cases.Result: Maternal laboratory investigation revealed markedly increased calcium levels with concomitant high parathyroid hormone levels due to a parathyroid adenoma, undiagnosed during antenatal checkup.Conclusion: This is one of the few cases in the literature where neonatal symptomatology led to the diagnosis of undiagnosed maternal hyperparathyroidism. Early detection and appropriate management of neonatal hypocalcemia could eliminate serious maternal and fetal morbidity.

Evaluation of Platelet Counts in the Normal Pregnancy and other Gestational Conditions at Tertiary Care Hospital of Sindh

Background: During gestational period, the most common disorder is hypertension that directly affects the gestation. The frequency of gestational hypertension is increasing day by day and ultimately the pressure is developed on the endothelial wall. Gestational hypertension mostly reduces the platelet counts.&#x0D; Aim of Study: The major theme of this research is evaluating the count of platelet during pregnancy and other gestational conditions.&#x0D; Methodology: A Retrospective research was carried out for the period of 06 months at Gynae and Obstetrics ward at tertiary care hospital of Sindh, Pakistan. Total 104 females were selected with different gestational age and trimester. A questionnaire was filled by all participants that were comprised of demographic data and gestational conditions such as preeclampsia, eclampsia, parity and seizure episodes. Females with highest risk factors diseases such as Diabetes, Hepatic disorder, Anemia, renal disorder and cardio vascular disease were not included in our research. Blood samples were collected from all selected participants for proper platelet count and data was compared with normal ranges of platelet count among the pregnant females. Data was analyzed by using statistical software 24.00 versions.&#x0D; Results: It was observed that 49 patients were having normal pregnancy, 32 had preeclampsia and 23 had eclampsia. 38 participants were first timer &amp; 52 were having second time parity. 58 participants had 2nd trimester of pregnancy. According to condition of anemia, 27 had severe anemic condition whereas 43 had moderate anemic condition. 49 participants had reduced level of platelet count and 17 had very low platelet count. Severity of gestation can be managed through proper management and physician instructions. Hypertension was measured through severity scale, 29 patients had moderate level of hypertension and 22 had severe level of hypertension. 19 participants had very abnormal level of blood count.&#x0D; Conclusion: It was concluded that proper diagnostic test should be conducted on time for proper management of reduced platelet count and there should be proper mass counseling should be conducted in order to overcome the deficiency of platelet count. There should be proper diet and exercise during pregnancy that can manage the condition of hypertension. Severity of gestation can be managed through proper management and physician instructions.