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Introduction: Multisystem inflammatory syndrome in adults (MIS-A) after SARS-CoV-2 infection or vaccination is a known complication. However, longitudinally extensive transverse myelitis (LETM) as a manifestation of MIS-A after SARS-CoV-2 infection or vaccination has not been reported before.Case presentation: 38-year old female, known case of hypothyroidism with history of mild SARS-Cov-2 infection in May 2021 and recent second dose of SARS-CoV-2 vaccination (on 1st November 2021, COVISHIELD TM Oxford/Astra Zeneca) presented with acute onset progressive flaccid quadriparesis with bowel and bladder involvement since 26th December 2021. Over next 3 days she developed fever, maculopapular rash , shock, myocarditis, breathlessness, Jaundice, acute kidney injury. Investigations revealed polymorphonuclear leukocytosis, thrombocytopenia, deranged Liver and renal function , severe left ventricular dysfunction. C reactive protein, D-dimer, procalcitonin, Interleukin-6 levels were raised. MRI whole spine revealed LETM from C6 to conus medullaris. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 infection was negative. SARS-CoV-2 antibody titre was raised. Diagnosed as a case of MIS-A with LETM. Managed with ventilatory and ionotropic support, Intravenous Iimmunoglobulin, antibiotics, hemodialysis and intravenous methyl prednisolone and oral steroid. Improved gradually and discharged. Presently patient has grade 5/5 power in both upper limbs and 2/5 power in both lower limbs with improving bowel and bladder control.Conclusions: This is the first reported case of LETM associated with MIS-A after SARS-CoV-2 infection or vaccination. With wider availability of SARS-CoV-2 vaccination, various side effects are emerging. However as these side effects are rare, SARS-CoV-2 vaccination represents the hope for mankind to overcome this global pandemic.

To measure the impact of 12 weeks of physical exercise as complementary management strategy on quality of life (QOL) in people with epilepsy (PWE).In a parallel-group, randomized controlled study with blinded outcome assessment, PWE of 18-65 years old, smartphone users were randomized into two groups. The exercise group was advised minimum 150 min per week of moderate-intense aerobic activity, as per current WHO recommendation [1], in addition to standard medical care; the control group received only standard medical care. QOL was assessed using Quality of Life in Epilepsy (QOLIE-31) inventory [2,3]; physical activity, with Global Physical Activity Questionnaire version 2 (GPAQ), and Pedometer Step Counter (a smartphone-based activity tracker application), at baseline and after 12 weeks. Body weight, body mass index, seizure frequency, and stigma scores (Epilepsy Stigma Scale Austin and colleagues) [4] were also noted.One hundred and seventeen PWE were recruited (58 exercise, 59 control). Although there was an improvement in the physical activity correlates after 12 weeks compared to mean values at baseline, the differences were not significant between the groups. The total QOL mean scores at baseline in the exercise and control groups were 64.9 and 63.7 (p = 0.597) and after 12 weeks, 68.4 and 66.9 (p = 0.660), respectively. However, intragroup comparison of energy/fatigue score in the exercise group showed significant change with a p value of 0.009 and intragroup comparison of Overall QOL score in the control group showed a significant change with a p value of 0.003. Similar improvement was seen in stigma scores (p = 0.500) and seizure frequency (p = 0.388) at 12 weeks in exercise and control groups. After 12 weeks, mean values of METS ((metabolic equivalents) were 794.81 and 714.27 (p = 0.159), steps per day were 4018.32 and 3730.0 (p = 0.314), calories spent per day were 173.85 and 159.68 (p = 0.320 and distance walked per day in meters were 2576.52 and 2198.42 (p = 0.072), in the exercise and control groups, respectively.Regular physical activity for at least 150 min per week, in the form of moderate-intense aerobic exercises resulted in positive yet non-significant improvement of QOL, seizure frequency, and stigma in PWE.

Naphthalene (C10H8) is a natural component of fossil fuels such as petroleum, diesel and coal. The common consumer products made from naphthalene are moth repellents, in the form of mothballs or crystals, and toilet deodorant blocks. It is also used for making dyes, resins, leather tanning agents, and the insecticide carbaryl1. Naphthalene itself is a strong oxidizing agent, leading to formation of free oxygen radicals, which in turn cause erythrocyte membrane damage. It also leads to depletion of glutathione, a major reducing agent which protects erythrocyte from damaging effects of various oxidants.Major toxic effects of naphthalene are due to precipitation of acute intravascular hemolysis. Naphthalene poisoning has been commonly reported in children who accidently suck or chew the moth balls. Very few cases of naphthalene poisoning and its effects have been reported from India,. We report a case of accidental naphthalene poisoning, who presented with intravascular hemolysis and methemoglobinemia.

Background: Polycystic ovarian syndrome (PCOS) and hypovitaminosis D are the two most common endocrine disorders in young women leading to many adverse metabolic consequences. We evaluated the correlation of 25-hydroxy Vitamin D (25OHD) with metabolic parameters and insulin resistance in PCOS. Materials and Methods: We included 100 PCOS patients (age 18–40 years, duration >6 months) serially, in this cross-sectional study. We excluded patients with past use of insulin sensitizers and hormone therapy. All patients underwent a physical examination, body fat estimation, and a single fasting blood sample was analyzed for the biochemical parameters. The patients were divided into 2 groups as per the 25OHD level: Group 1 (Deficient, 0.05). Conclusion: Hypovitaminosis D is very common in PCOS patients and exacerbates the metabolic abnormalities. It is essential to screen all the PCOS patients for 25OHD deficiency, and further large-scale studies are required to confirm our findings.

A 24-year-old male presented with classic features of the nephrotic syndrome. An initial renal biopsy revealed minimal change disease and thereafter, a second biopsy showed features of focal and segmental glomerulosclerosis. There was no response to conventional immunosuppression, and the patient had to be given rituximab; in spite of this, he went on to develop end-stage renal disease. He continued to have heavy proteinuria leading to severe hypoalbuminemia, thrombosis, infections, and malnutrition, placing the patient in a life-threatening situation. Bilateral renal ablation with embolization of both kidneys with coiling was done at one setting, which finally resolved the proteinuria in the patient. He then underwent a living-related renal transplant, developing recurrence immediately post-transplant. He was again given rituximab along with tacrolimus, mycophenolate mofetil, and prednisolone. There was no response to rituximab, and the patient underwent plasmapheresis, which leads to complete remission. An arteriovenous fistula was created post-transplant to facilitate regular plasmapheresis.

We present a young lady who consumed hair dye, which contained paraphenylene diamine (PPD), as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated, and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI). The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria, causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances, timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly, because PPD is a nondialyzable toxin, and its long-term effect necessitates its speedy removal, hemoperfusion might be helpful and is worth considering.