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Research paper thumbnail of Erythema ab igne: a cutaneous marker of prolonged thermal exposure

Research paper thumbnail of Cerebral Venous Thrombosis as The Sole Presenting Manifestation of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection

Medical Research Archives

Background: Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) ... more Background: Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection. Methods: Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India. Results: A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful r...

Research paper thumbnail of A Novel Variation of the Short-Chain Enoyl-CoA Hydratase-1 Gene Presenting with a Novel Mild Phenotype: The Second Case Report from India

Journal of Pediatric Neurology

A 9-year-old girl presented with asymmetric abnormal twisting movements affecting her left side m... more A 9-year-old girl presented with asymmetric abnormal twisting movements affecting her left side more than the right side, initially action induced, but later persistent. Examination revealed generalized persistent dystonia with choreoathetosis and right partial tonic ocular tilt reaction. Brain magnetic resonance imaging showed T1 and T2 fluid-attenuated inversion recovery (FLAIR) hypointense and T2 hyperintense signal changes in bilateral globus pallidi. Clinical exome sequencing revealed compound heterozygous variatnts in enoyl-CoA hydratase-1 (ECHS1) gene: a novel pathogenic variant in exon 6, chr10:g.133366045G > A (p.Gln224Ter) and a likely pathogenic variant in exon 5, chr10:g.133366990G > A (p.Ala173Val). Metabolic testing and arterial lactate levels were normal. She was treated with valine restricted diet, trihexiphenidyl, clonazepam, N-acetyl cysteine and mitochondrial cocktail, without significant improvement over the 6 months follow-up period.

Research paper thumbnail of Spontaneous resolution of a lenticulostriate artery aneurysm

Annals of Indian Academy of Neurology

Research paper thumbnail of Screening of arbuscular mycorrhizal fungi associated with Persea bombycina kost and their effect on improvement of plant health

Persea bombycina Kost, locally known as Som plant is an economically important plant in the North... more Persea bombycina Kost, locally known as Som plant is an economically important plant in the North-Eastern region of India which is the primary food plant of the muga silk worm Antheraea assama Westwood. The association of AMF with the Som plants was studied and their diversity was assessed in eight morphotypes. Among these, Glomus sp, Scutellospora sp, Acaulospora sp and Gigaspora sp were found associated with the different morphotypes of Som plants, wherein Glomus sp was predominant. Mass multiplied spores were further inoculated in all eight morphotypes separately. Histopathology of AMF colonized roots of Som plants revealed the presence of intra and inter radical hyphae, vesicles and arbuscules showing the colonization of AMF within the roots of the plant. Growth promotion in Som plants following successful root colonization with AMF was noted in terms of increase in height, no of leaves and no of branches. Plants inoculated with AMF also showed high phosphate solubilizing activi...

Research paper thumbnail of Water stress amelioration and plant growth promotion in wheat plants by osmotic stress tolerant bacteria

World Journal of Microbiology and Biotechnology, 2012

The present study was initiated with testing of fifteen previously isolated indigenous plant grow... more The present study was initiated with testing of fifteen previously isolated indigenous plant growth promoting rhizobacteria for drought tolerance. Among all, two best isolates Pseudomonas aeruginosa (JHA6) and Bacillus amyloliquefaciens (ROH14) were selected for in-vivo studies. A total of ten treatments comprising Plant growth promoting rhizobacteria (PGPR) (JHA6 and ROH14) inoculated plants held at 80%, 60% and 40% field capacity (FC) soil moisture level was laid down in Completely Randomized Design with three replications. Un-inoculated plants held at various stress levels and non-stressed conditions (100% FC) served as control. In general, both the bacteria could promote Capsicum growth in terms of increase in root and shoot biomass, height of plants, chlorophyll content as well as increase in nutrient content and uptake. Besides, the bacterial inoculated Capsicum plants could withstand water stress more efficiently as indicated by increases Original Research Article

Research paper thumbnail of The Coexistence of Two Genetic Astrocytopathies—Megalencephalic Leukoencephalopathy and Vanishing White Matter Disease—in an Indian Child

Neuropediatrics

A 9-month-old male child, born of second-degree consanguinity, presented with a progressively enl... more A 9-month-old male child, born of second-degree consanguinity, presented with a progressively enlarging head since early infancy. The child had normal early development, but further acquisition of milestones after 6 months was delayed. He had afebrile seizures at 9 months, followed by the appearance of appendicular spasticity. First magnetic resonance imaging (MRI) showed nonenhancing, diffuse, bilaterally symmetrical T1/fluid-attenuated inversion recovery (FLAIR) hypointensity and T2 hyperintensity of the cerebral white matter and anterior temporal cysts. Subsequently, the periventricular and deep white matter developed microcystic changes with a pattern of radial stripes. Next-generation sequencing revealed homozygous autosomal recessive variations in the MLC1 gene [c.188T > G, (p.Leu63Arg)] on exon 3 and also in the EIF2B3 gene [c.674G > A, (p.Arg225Gln)] on exon 7, the parents being heterozygous carriers for both variations. This article highlights the rare occurrence of t...

Research paper thumbnail of Hypokalaemia with Guillain-Barré syndrome: a diagnostic and therapeutic challenge

BMJ Case Reports

Acute-onset quadriparesis is not only debilitating and a grave concern for the patient but also p... more Acute-onset quadriparesis is not only debilitating and a grave concern for the patient but also perturbs the clinician as it demands early diagnosis and prompt management to prevent catastrophic outcome due to respiratory failure. Guillain-Barré syndrome (GBS) and hypokalaemia are notorious causes of acute-onset lower motor neuron (LMN) quadriparesis and warrant a rapid evaluation to necessitate early management. However, coexistence of these two entities is extremely rare and may pose a diagnostic and therapeutic challenge and mandates exclusion of either condition to avoid a poor outcome. We hereby report a case of a young woman who presented with an acute-onset LMN quadriparesis, initially found to have significant hypokalaemia with poor response to supplementation and was further evaluated to have an axonal variant of GBS.

Research paper thumbnail of Toxoplasma Lymphadenopathy in an Immunocompetent Host

Dubai Medical Journal

Toxoplasma infection can be congenital or acquired. Infection with Toxoplasma gondii can result i... more Toxoplasma infection can be congenital or acquired. Infection with Toxoplasma gondii can result in multi-organ involvement in immunocompromised patients; whereas in immunocompetent patients, it usually remains asymptomatic. Toxoplasma is a rare cause of isolated lymphadenopathy especially in immunocompetent individuals, though it is a common manifestation of this protozoal infection. We present a 27-year-old male who presented to us with isolated cervical lymphadenopathy. Histopathology and serological studies confirmed the diagnosis of toxoplasma lymphadenopathy. It usually affects the posterior cervical group of lymph nodes, but in our case, it had also affected anterior group and presented without any constitutional symptom. The patient was treated with cotrimoxazole double strength tablet once daily for 1 month and responded well.

Research paper thumbnail of Space occupying lesion presenting as Millard-Gubler syndrome

BMJ Case Reports

Millard-Gubler syndrome (MGS) is a ventral pontine syndrome due to an ipsilateral involvement of ... more Millard-Gubler syndrome (MGS) is a ventral pontine syndrome due to an ipsilateral involvement of abducens and facial nerve with a contralateral hemiparesis or hemiplegia. Although classically described as a vascular brainstem syndrome, various other aetiologies such as infection or demyelination may lead to MGS. In this case, a young female presented with MGS, which was attributed to a strategically located infective granuloma of the brainstem. In countries, where tuberculosis is still considered an endemic, central nervous system involvement due to tuberculosis may have protean manifestations.

Research paper thumbnail of Essential palatal tremor

BMJ Case Reports, 2022

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published b... more © BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 30yearold man, without any preexisting comorbidities, presented to us with a longstanding complaint of being able to perceive a ‘click’ in his ears. He found it increasingly difficult to concentrate on tasks. He did not have any other accompanying symptoms such as ataxia or vertigo. He had several ear, nose and throat (ENT) consultations where he was prescribed agents for vertigo and tinnitus but in vain. Brain imaging as well as brainstem auditory evoked response (BAER) tests were unfruitful. Examination of the palate revealed a rhythmic, symmetrical, vertical and oscillating movement of the soft palate at a frequency of 30–50 clicks/min, which produced a clicking sound each time (video 1). It was said to worsen with stress. The movement was not voluntarily suppressible and there were no accompanying signs of brainstem or cranial nerve dysfunction. As per his spouse...

Research paper thumbnail of Clinical Images

Research paper thumbnail of Radiological illusion of longitudinally extensive myelitis in multiple sclerosis

Research paper thumbnail of COVID-19 associated symmetrical peripheral gangrene: A case series

Diabetes & Metabolic Syndrome, 2021

Background and aims The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the ... more Background and aims The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the world topsy-turvy since its onset in 2019. The thromboinflammatory complications of this disease are common in critically ill patients and associated with poor prognosis. Symmetrical peripheral gangrene (SPG) is characterized by symmetrical distal gangrene in absence of any large vessel occlusion or vasculitis and it is usually associated with critical illness. Our aim was to report the clinical profile and outcome of patients diagnosed with SPG associated with COVID-19. To the best of our knowledge, no such similar cases have been reported till date. Methods In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of two patients of SPG associated with COVID-19 and also compared those findings. Due to paucity of data, we also reviewed the literature on this under-diagnosed and rarely reported condition and association. Results Two c...

Research paper thumbnail of Oral histoplasmosis presenting as a solitary ulcer on tongue in an immunocompetent adult

The American Journal of Medicine

Research paper thumbnail of Parry-Romberg Syndrome with Intracranial calcification

The American Journal of Medicine

Research paper thumbnail of OUP accepted manuscript

Qjm: An International Journal Of Medicine

Research paper thumbnail of Starry sky appearance in Tuberculoma

QJM: An International Journal of Medicine

Research paper thumbnail of Chik sign: post-chikungunya hyperpigmentation

QJM: An International Journal of Medicine

Research paper thumbnail of Post COVID-19 HSV encephalitis: a review

QJM: An International Journal of Medicine

Background Herpes simplex virus encephalitis (HSVE) is one of the most common infectious cause of... more Background Herpes simplex virus encephalitis (HSVE) is one of the most common infectious cause of sporadic encephalitis. COVID-19 has been associated with immune dysregulation of the host which might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analysing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within six weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post COVID-19 HSVE. Methods This observational study included patients who had laboratory confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous six weeks. Patients were followed up for 3 months. Results Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and majority of the patients have received i...

Research paper thumbnail of Erythema ab igne: a cutaneous marker of prolonged thermal exposure

Research paper thumbnail of Cerebral Venous Thrombosis as The Sole Presenting Manifestation of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection

Medical Research Archives

Background: Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) ... more Background: Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection. Methods: Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India. Results: A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful r...

Research paper thumbnail of A Novel Variation of the Short-Chain Enoyl-CoA Hydratase-1 Gene Presenting with a Novel Mild Phenotype: The Second Case Report from India

Journal of Pediatric Neurology

A 9-year-old girl presented with asymmetric abnormal twisting movements affecting her left side m... more A 9-year-old girl presented with asymmetric abnormal twisting movements affecting her left side more than the right side, initially action induced, but later persistent. Examination revealed generalized persistent dystonia with choreoathetosis and right partial tonic ocular tilt reaction. Brain magnetic resonance imaging showed T1 and T2 fluid-attenuated inversion recovery (FLAIR) hypointense and T2 hyperintense signal changes in bilateral globus pallidi. Clinical exome sequencing revealed compound heterozygous variatnts in enoyl-CoA hydratase-1 (ECHS1) gene: a novel pathogenic variant in exon 6, chr10:g.133366045G > A (p.Gln224Ter) and a likely pathogenic variant in exon 5, chr10:g.133366990G > A (p.Ala173Val). Metabolic testing and arterial lactate levels were normal. She was treated with valine restricted diet, trihexiphenidyl, clonazepam, N-acetyl cysteine and mitochondrial cocktail, without significant improvement over the 6 months follow-up period.

Research paper thumbnail of Spontaneous resolution of a lenticulostriate artery aneurysm

Annals of Indian Academy of Neurology

Research paper thumbnail of Screening of arbuscular mycorrhizal fungi associated with Persea bombycina kost and their effect on improvement of plant health

Persea bombycina Kost, locally known as Som plant is an economically important plant in the North... more Persea bombycina Kost, locally known as Som plant is an economically important plant in the North-Eastern region of India which is the primary food plant of the muga silk worm Antheraea assama Westwood. The association of AMF with the Som plants was studied and their diversity was assessed in eight morphotypes. Among these, Glomus sp, Scutellospora sp, Acaulospora sp and Gigaspora sp were found associated with the different morphotypes of Som plants, wherein Glomus sp was predominant. Mass multiplied spores were further inoculated in all eight morphotypes separately. Histopathology of AMF colonized roots of Som plants revealed the presence of intra and inter radical hyphae, vesicles and arbuscules showing the colonization of AMF within the roots of the plant. Growth promotion in Som plants following successful root colonization with AMF was noted in terms of increase in height, no of leaves and no of branches. Plants inoculated with AMF also showed high phosphate solubilizing activi...

Research paper thumbnail of Water stress amelioration and plant growth promotion in wheat plants by osmotic stress tolerant bacteria

World Journal of Microbiology and Biotechnology, 2012

The present study was initiated with testing of fifteen previously isolated indigenous plant grow... more The present study was initiated with testing of fifteen previously isolated indigenous plant growth promoting rhizobacteria for drought tolerance. Among all, two best isolates Pseudomonas aeruginosa (JHA6) and Bacillus amyloliquefaciens (ROH14) were selected for in-vivo studies. A total of ten treatments comprising Plant growth promoting rhizobacteria (PGPR) (JHA6 and ROH14) inoculated plants held at 80%, 60% and 40% field capacity (FC) soil moisture level was laid down in Completely Randomized Design with three replications. Un-inoculated plants held at various stress levels and non-stressed conditions (100% FC) served as control. In general, both the bacteria could promote Capsicum growth in terms of increase in root and shoot biomass, height of plants, chlorophyll content as well as increase in nutrient content and uptake. Besides, the bacterial inoculated Capsicum plants could withstand water stress more efficiently as indicated by increases Original Research Article

Research paper thumbnail of The Coexistence of Two Genetic Astrocytopathies—Megalencephalic Leukoencephalopathy and Vanishing White Matter Disease—in an Indian Child

Neuropediatrics

A 9-month-old male child, born of second-degree consanguinity, presented with a progressively enl... more A 9-month-old male child, born of second-degree consanguinity, presented with a progressively enlarging head since early infancy. The child had normal early development, but further acquisition of milestones after 6 months was delayed. He had afebrile seizures at 9 months, followed by the appearance of appendicular spasticity. First magnetic resonance imaging (MRI) showed nonenhancing, diffuse, bilaterally symmetrical T1/fluid-attenuated inversion recovery (FLAIR) hypointensity and T2 hyperintensity of the cerebral white matter and anterior temporal cysts. Subsequently, the periventricular and deep white matter developed microcystic changes with a pattern of radial stripes. Next-generation sequencing revealed homozygous autosomal recessive variations in the MLC1 gene [c.188T > G, (p.Leu63Arg)] on exon 3 and also in the EIF2B3 gene [c.674G > A, (p.Arg225Gln)] on exon 7, the parents being heterozygous carriers for both variations. This article highlights the rare occurrence of t...

Research paper thumbnail of Hypokalaemia with Guillain-Barré syndrome: a diagnostic and therapeutic challenge

BMJ Case Reports

Acute-onset quadriparesis is not only debilitating and a grave concern for the patient but also p... more Acute-onset quadriparesis is not only debilitating and a grave concern for the patient but also perturbs the clinician as it demands early diagnosis and prompt management to prevent catastrophic outcome due to respiratory failure. Guillain-Barré syndrome (GBS) and hypokalaemia are notorious causes of acute-onset lower motor neuron (LMN) quadriparesis and warrant a rapid evaluation to necessitate early management. However, coexistence of these two entities is extremely rare and may pose a diagnostic and therapeutic challenge and mandates exclusion of either condition to avoid a poor outcome. We hereby report a case of a young woman who presented with an acute-onset LMN quadriparesis, initially found to have significant hypokalaemia with poor response to supplementation and was further evaluated to have an axonal variant of GBS.

Research paper thumbnail of Toxoplasma Lymphadenopathy in an Immunocompetent Host

Dubai Medical Journal

Toxoplasma infection can be congenital or acquired. Infection with Toxoplasma gondii can result i... more Toxoplasma infection can be congenital or acquired. Infection with Toxoplasma gondii can result in multi-organ involvement in immunocompromised patients; whereas in immunocompetent patients, it usually remains asymptomatic. Toxoplasma is a rare cause of isolated lymphadenopathy especially in immunocompetent individuals, though it is a common manifestation of this protozoal infection. We present a 27-year-old male who presented to us with isolated cervical lymphadenopathy. Histopathology and serological studies confirmed the diagnosis of toxoplasma lymphadenopathy. It usually affects the posterior cervical group of lymph nodes, but in our case, it had also affected anterior group and presented without any constitutional symptom. The patient was treated with cotrimoxazole double strength tablet once daily for 1 month and responded well.

Research paper thumbnail of Space occupying lesion presenting as Millard-Gubler syndrome

BMJ Case Reports

Millard-Gubler syndrome (MGS) is a ventral pontine syndrome due to an ipsilateral involvement of ... more Millard-Gubler syndrome (MGS) is a ventral pontine syndrome due to an ipsilateral involvement of abducens and facial nerve with a contralateral hemiparesis or hemiplegia. Although classically described as a vascular brainstem syndrome, various other aetiologies such as infection or demyelination may lead to MGS. In this case, a young female presented with MGS, which was attributed to a strategically located infective granuloma of the brainstem. In countries, where tuberculosis is still considered an endemic, central nervous system involvement due to tuberculosis may have protean manifestations.

Research paper thumbnail of Essential palatal tremor

BMJ Case Reports, 2022

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published b... more © BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 30yearold man, without any preexisting comorbidities, presented to us with a longstanding complaint of being able to perceive a ‘click’ in his ears. He found it increasingly difficult to concentrate on tasks. He did not have any other accompanying symptoms such as ataxia or vertigo. He had several ear, nose and throat (ENT) consultations where he was prescribed agents for vertigo and tinnitus but in vain. Brain imaging as well as brainstem auditory evoked response (BAER) tests were unfruitful. Examination of the palate revealed a rhythmic, symmetrical, vertical and oscillating movement of the soft palate at a frequency of 30–50 clicks/min, which produced a clicking sound each time (video 1). It was said to worsen with stress. The movement was not voluntarily suppressible and there were no accompanying signs of brainstem or cranial nerve dysfunction. As per his spouse...

Research paper thumbnail of Clinical Images

Research paper thumbnail of Radiological illusion of longitudinally extensive myelitis in multiple sclerosis

Research paper thumbnail of COVID-19 associated symmetrical peripheral gangrene: A case series

Diabetes & Metabolic Syndrome, 2021

Background and aims The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the ... more Background and aims The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the world topsy-turvy since its onset in 2019. The thromboinflammatory complications of this disease are common in critically ill patients and associated with poor prognosis. Symmetrical peripheral gangrene (SPG) is characterized by symmetrical distal gangrene in absence of any large vessel occlusion or vasculitis and it is usually associated with critical illness. Our aim was to report the clinical profile and outcome of patients diagnosed with SPG associated with COVID-19. To the best of our knowledge, no such similar cases have been reported till date. Methods In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of two patients of SPG associated with COVID-19 and also compared those findings. Due to paucity of data, we also reviewed the literature on this under-diagnosed and rarely reported condition and association. Results Two c...

Research paper thumbnail of Oral histoplasmosis presenting as a solitary ulcer on tongue in an immunocompetent adult

The American Journal of Medicine

Research paper thumbnail of Parry-Romberg Syndrome with Intracranial calcification

The American Journal of Medicine

Research paper thumbnail of OUP accepted manuscript

Qjm: An International Journal Of Medicine

Research paper thumbnail of Starry sky appearance in Tuberculoma

QJM: An International Journal of Medicine

Research paper thumbnail of Chik sign: post-chikungunya hyperpigmentation

QJM: An International Journal of Medicine

Research paper thumbnail of Post COVID-19 HSV encephalitis: a review

QJM: An International Journal of Medicine

Background Herpes simplex virus encephalitis (HSVE) is one of the most common infectious cause of... more Background Herpes simplex virus encephalitis (HSVE) is one of the most common infectious cause of sporadic encephalitis. COVID-19 has been associated with immune dysregulation of the host which might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analysing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within six weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post COVID-19 HSVE. Methods This observational study included patients who had laboratory confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous six weeks. Patients were followed up for 3 months. Results Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and majority of the patients have received i...