When muscle quivers and undulates

We describe a patient who presented with fatigue and pulling sensation in his lower limbs. He had continuous muscle contractions over his trunk (myokymia) which pointed towards the diagnosis of Isaacs syndrome which was confirmed by strongly positive CASPR2 antibodies in blood.     

Effect of fasting on hepatic lipase activity in the liver of developing rats

The effect of fasting on hepatic lipase was studied during postnatal development in the rat. It was found that fasting produced a significant decrease in hepatic lipase only in neonatal (1-day-old) and adult (60-day-old) rats. We studied the effect of fasting on the distribution of hepatic lipase between extracellular (heparin-releasable) and intracellular (liver-retained or residual) compartments in perfused livers, and on the secretion of hepatic lipase by isolated hepatocytes. Fasting had similar effects in neonates and adults: it decreased both the heparin-releasing and the residual activities in perfused livers, and also decreased the rate of hepatic lipase secretion by isolated hepatocytes. Finally, the effect of fasting on hepatic lipase mRNA relative abundance in developing rat livers was determined. No difference was observed among the groups studied. It is concluded that the mechanisms involved in the effect of fasting on hepatic lipase appear to be similar in neonates and adult animals and may involve the post-translational processing of the enzyme.     

Phase I/II study of gefitinib and capecitabine in patients with colorectal cancer

Objective The objectives of this phase I/II study were to determine the maximum tolerated dose (MTD), characterise the principal toxicities in the phase I part and assess the efficacy in the phase II part of gefitinib, an oral selective inhibitor of the epidermal growth factor receptor, in combination with capecitabine in patients with advanced colorectal cancer (CRC). Methods and patients Patients with advanced CRC were treated with gefitinib administered daily for 21 days and capecitabine administered twice daily for 14 days of a 21-day cycle. The dose levels of gefitinib (mg) and capecitabine (mg/m² bid) assessed were 250/1000 and 250/ 1250. An expanded cohort was enrolled at the MTD to better characterise toxicity and efficacy. A total of 32 previously treated patients were accrued. In the phase I part 10 subjects were treated, with one dose-limiting toxicity. Overall 26 patients were treated at the MTD of the combination, which was gefitinib 250 mg/day and capecitabine 1250 mg/m² twice daily. Results The most frequent treatment-related adverse events included asthenia, diarrhoea, nausea, rash and anorexia. The incidence profile was very similar in phases I and II. No objective responses were documented but 53% of the patients achieved stable disease as best response to therapy. Conclusions Capecitabine 1250 mg/m² twice daily 14 of 21 days and gefitinib at 250 mg/day can be safely administered in combination. The combination is relatively well tolerated. There were no objective responses, although an interesting stabilisation rate was documented, in previously treated advanced CRC patients.     

Surviving 27 weeks fetus expelled out of the ruptured rudimentary horn and detected a month later as a secondary abdominal pregnancy

A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.     

Clinical course,diagnosis, and management of bilateral COVID-19 associated conjunctivitis: A case study

We present a rare case of COVID-19 associated conjunctivitis where patient presented with redness, foreign body sensation, watering, and pain. Symptoms started while patient was COVID-19 positive. On examination, severe conjunctival congestion was present along with follicles. Visual acuity was 6/6 in both eyes. The patient was started on topical antibiotics and showed improvement but again presented with aggravated symptoms. Conjunctival swab was sent for culture and sensitivity, which was negative for any organisms. The patient was then started on oral and topical steroid, which showed improvement. Even though COVID-19 associated conjunctivitis is self-limiting, here it showed a progressive course and resolved only after steroid.