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Merga Daba Mulisa,1 Shalom Kassahun Bekele,1 Sebhatleab Teju Mulate,1 Zerubabel Getahun Kiflu,1 Yared Getachew Tadesse,1 Walelign Worku Mamo2 1Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Neurology, School of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Merga Daba Mulisa, Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251912684411, Email mergadaba1995@gmail.comAbstract: Hypermagnesemia is a rare electrolyte abnormality observed in the clinical setting. Patients with this condition can present with a variety of symptoms, depending on the level of serum magnesium. Hypermagnesemia is rarely complicated by weakness of the extremities. We report the case of 32 years old female patient who presented with bilateral upper- and lower-extremity weakness due to hypermagnesemia. Following correction of the serum magnesium level, extremity weakness subsided, and the patient was discharged with improvement. Here, we discuss the delay in the diagnosis and management of this type of clinical presentation.Keywords: hypermagnesemia, extremity weakness, flaccid paralysis

Published information about fish botulism is scant. We review here the current literature on fish botulism. Freshwater fish are susceptible to botulism. Only anecdotal evidence exists about possible botulism cases in saltwater fish. With only a few exceptions, the etiology of all cases of fish botulism reported is Clostridium botulinum type E, although fish are sensitive to, and may carry, various C. botulinum types. Clinical signs of botulism in fish include loss of equilibrium and motion, abducted opercula, open mouths, dark pigmentation, and head up/tail down orientation in which attempts to swim result in breaching the surface of the water. Dark pigmentation is thought to be associated with acetylcholine imbalance in botulinum neurotoxin (BoNT)-affected fish. Rarely, but similar to the situation in other animal species, fish can recover from botulism. Fish botulism can cause secondary outbreaks of the disease in birds, as botulism-affected fish stand out from normal fish, and are selectively preyed upon by fish-eating birds, which thus become intoxicated by the BoNT present in sick fish. The source of BoNT in fish has not been definitively confirmed. Fish may ingest C. botulinum spores that then germinate in their digestive tract, but the possibility that fish ingest preformed BoNT from the environment (e.g., dead fish, shellfish, insects) cannot be ruled out. The presumptive diagnosis of botulism in fish is established based on clinical signs, and as in other species, confirmation should be based on detection of BoNT in intestinal content, liver, and/or serum of affected fish. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barre' syndrome (GBS) is the most common acute autoimmune disease of peripheral nervous system. GBS has received little attention in Saudi Arabia. GBS causes an acute flaccid paralysis that may lead to respiratory failure. So, it requires early diagnosis and management. GBS is a clinical diagnosis which has no international criteria and needs a high index of suspension for diagnosis. It is characterized by a heterogeneous group of clinical presentations that may delay the diagnosis. Objective: this study aimed to conduct an analytical, crosssectional study based on the data obtained from the online self-administrated questionnaire about the level of awareness of GBS presentation in Qassim region. Materials and methods: This study follows an analytical, cross-sectional design, focusing on data collected through an online self-administered questionnaire to assess awareness of GBS presentation in Qassim region. The study comprised a randomly selected sample of at least 926 participants. Results: The study revealed among 926 participants, 112 were familiar with GBS. Younger participants showed greater awareness. Notably, 62.5% without medical backgrounds knew about GBS. About 75% had personal contact with GBS patients, possibly influencing their awareness. Misconceptions persisted, with only 19.6% recognizing GBS's typical onset duration. Urgency was recognized by 61.6%, but only 29.5% identified the ER as the right care setting. Conclusion: The results unveiled a mix of awareness and misconceptions about GBS. Strengthening education is crucial for better understanding and management. [ABSTRACT FROM AUTHOR]

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Abstract Background West Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage–Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus. Clinical presentation In late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage–Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb. Conclusions West Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage–Turner syndrome diagnosis. We diagnosed Parsonage–Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.

Background: West Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage–Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus. Clinical presentation: In late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage–Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb. Conclusions: West Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage–Turner syndrome diagnosis. We diagnosed Parsonage–Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities. [ABSTRACT FROM AUTHOR]

The poliovirus was declared extinct in 1988. In Morocco, the most recent case of wild poliovirus (WPV) was reported in 1989. From 1994 to 2018, Kenitra's polio topographical and etiological epidemiology were described using WHO-recommended polio surveillance criteria. This retrospective descriptive study was conducted following WHO guidelines to examine the topographic and etiological factors that contribute to acute flaccid paralysis (AFP) in Kénitra, Morocco. Patients were recruited from several communities in the Kenitra province throughout a 25-year period, from January 1, 1994, to December 31, 2018. From 1994 to 2018, 76 cases of AFP were reported. The children ranged in age from 3 months to 14 years old; 52% were under the age of 5, and 58.67% were boys. At the time of paralysis onset, 57.33% of children had a fever, and 16% had asymmetric paralysis. The most common diagnosis was Guillain-Barré syndrome (59%), and 72% of sick children received more than three doses of the polio vaccine. Good coverage was obtained due to the national immunization program, as evidenced by the vaccination status. All cases were classified as non-polio AFP. There were no reports of poliovirus, and the vaccination status suggests that there was enough coverage due to the national immunization program. Morocco is vulnerable to the reintroduction of wild viruses due to its geographical location and constant intake of immigrants. This necessitates ongoing vaccination and surveillance efforts until the disease is declared eradicated. [ABSTRACT FROM AUTHOR]

Background: Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Literature review: Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which—according to our literature search—was reported in 27 cases, some of which were published as case reports and others as case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases Case presentation: We herein add the case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb. Conclusion: Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before. [ABSTRACT FROM AUTHOR]

Abstract Background Guillain-Barré syndrome is the most common cause of flaccid paralysis, with multiple known clinical variants. Autonomic dysfunction, although frequently reported in the clinical course, is often overlooked in the pediatric population and is usually not the initial presenting symptom in this age group Case presentation We present the case of a previously healthy 17-year-old who arrived at the Emergency Department complaining of gastrointestinal symptoms associated with lipothymia. An initial electrocardiogram (ECG) showed sustained sinus bradycardia subsequently associated with arterial hypertension. Structural and inflammatory cardiac pathology were ruled out, as well as auriculoventricular conduction block and posterior reversible encephalopathy syndrome. On the ninth day after initial symptoms, the patient presented sensory and motor nerve disturbances with the cerebrospinal fluid analysis showing a clear albumin-cytologic dissociation, consistent with an atypical presentation of GBS with autonomic dysfunction. Immunoglobulin therapy was administered, developing subsequent aseptic meningitis, that required discontinuation of previous therapy and treatment with plasmapheresis. Clinical improvement was achieved with full motor function recovery. Conclusion This case illustrates a Guillain-Barré syndrome variant in which autonomic dysfunction preceded neurologic deficit, a finding uncommon in children, emphasizing this as an important differential diagnosis for severe bradycardia in pediatric patients.

Mycotic aortic aneurysms are a rare entity. In this report, we consider a patient with mycotic thoracic aortic aneurysm and paraplegia without any evidence of overt infective spondylitis, vertebral osteomyelitis, or spinal abscess. Clinical presentation, treatment, and complications unique to our case are considered.

ABSTRACT: Botulism is generally a fatal disease caused by ingestion of neurotoxins produced by Clostridium botulinum. The present study describes the epidemiological, clinical, and laboratory aspects of a type C botulism outbreak in free-living aquatic birds residing in an urban park in Quirinópolis, Goiás, Brazil. Among a population of approximately 80 waterfowl, a total of 30 birds, including ducks (Cairina moschata), teals (Anas platyrhynchos), and geese (Anser cygnoides), died within 10 days. Of these, six birds showed signs of flaccid paralysis of the pelvic limbs, eyelids, neck, and wings. To confirm the suspicion of botulism, four lake water samples, two samples of the feed consumed by the birds, and samples of serum, intestinal content, stomach content, and liver tissue from two teals that died after presenting clinical signs were analyzed. Using bioassay and neutralization with homologous antitoxin in mice, it was possible to detect the presence of botulinum toxin type C in a water sample and in the intestinal content of one of the necropsied teals. Additionally, the presence of C. botulinum type C was identified in the lake water using polymerase chain reaction. Based on the clinical signs and laboratory results, a diagnosis of botulism caused by botulinum toxin type C was confirmed with probable transmission by lake water.

Background: Guillain-Barré syndrome is the most common cause of flaccid paralysis, with multiple known clinical variants. Autonomic dysfunction, although frequently reported in the clinical course, is often overlooked in the pediatric population and is usually not the initial presenting symptom in this age group CASE PRESENTATION: We present the case of a previously healthy 17-year-old who arrived at the Emergency Department complaining of gastrointestinal symptoms associated with lipothymia. An initial electrocardiogram (ECG) showed sustained sinus bradycardia subsequently associated with arterial hypertension. Structural and inflammatory cardiac pathology were ruled out, as well as auriculoventricular conduction block and posterior reversible encephalopathy syndrome. On the ninth day after initial symptoms, the patient presented sensory and motor nerve disturbances with the cerebrospinal fluid analysis showing a clear albumin-cytologic dissociation, consistent with an atypical presentation of GBS with autonomic dysfunction. Immunoglobulin therapy was administered, developing subsequent aseptic meningitis, that required discontinuation of previous therapy and treatment with plasmapheresis. Clinical improvement was achieved with full motor function recovery.Conclusion: This case illustrates a Guillain-Barré syndrome variant in which autonomic dysfunction preceded neurologic deficit, a finding uncommon in children, emphasizing this as an important differential diagnosis for severe bradycardia in pediatric patients. [ABSTRACT FROM AUTHOR]

Abstract Objective: To report the seasonal trends of Guillain-Barré Syndrome in a cohort of Pakistani population from southern Punjab, Pakistan. Study Design: A retrospective observational study. Place and Duration of Study: Department of Physical Medicine & Rehabilitation, Combined Military Hospital Bahawalpur, from Jan 2016 to Oct 2018. Methodology: One-hundred and fifty-two individuals fulfilling the electrophysiological criteria of Guillain-Barré Syndrome were included from the records of the department and subdivided into four main subtypes on the basis of electrodiagnostic studies including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor Axonal Neuropathy, Acute Motor and Sensory Axonal Neuropathy, and Miller Fisher Syndrome. The seasons were divided as: summer; May to August, autumn; September and October, winter; November to February, and spring; March and April. Demographic characteristics, type of Guillain-Barré Syndrome, and month and season of presentation were investigated. Data were analyzed with SPSS version 20. Results: The sample (mean age: 39 ± 21 years) consisted of 114 (75%) males and 38 (25%) females. The highest reporting (63, 41.4%) was in winter followed by (53, 34.9%) summer (p

Apart from the usual differentials of transverse myelitis and cord compression, paraparetic GBS should be considered when sudden, flaccid paralysis of the lower limbs occurs, as prompt diagnosis and management can minimize sequel and unnecessary procedures. We do report a case wherein we managed a similar situation without the use of an immunomodulatory therapy. [ABSTRACT FROM AUTHOR]

Abstract Apart from the usual differentials of transverse myelitis and cord compression, paraparetic GBS should be considered when sudden, flaccid paralysis of the lower limbs occurs, as prompt diagnosis and management can minimize sequel and unnecessary procedures. We do report a case wherein we managed a similar situation without the use of an immunomodulatory therapy.

Abstract Recurrent GBS is a rare neurological condition in which patients develop similar symptoms of motor weakness after different preceding infections and suffer shorter intervals in between subsequent episodes of GBS. However, the majority of RGBS patients undergo full recovery.

Guillain-Barre Syndrome is a rare acute inflammatory demyelinating polyradiculoneuropathy, affecting 1.2-1.9 per 100000 women in pregnancy. Whilst the condition is rare, delays in diagnosis and management are associated with poor maternal and perinatal outcomes. We present and discuss a case of 33-year old woman who presented at Harare Central Hospital Maternity Unit with acute flaccid paralysis in late pregnancy following a bout of diarrhoea. We discuss the diagnosis and management of pregnant women with the condition, as well as maternal outcomes.

Background: Acute poliomyelitis (APM/polio) is a viral infection caused by the polio virus that continues to have a fascinating social and economic impact on countries throughout the world. Humans acquire the virus by close personal contact with transmission occurring through the fecal–oral route. The majority of poliovirus infections results in no illness or produces only self-limited symptoms, however in approximately 5% of infected patients flaccid paralysis of the limbs can occur and 1% can die. Although APM is no longer a feared disease mainly due to the development of effective vaccines, its eradication remains elusive. Methods: The aim of this study is to review the historical impact of APM in Trinidad. A retrospective analysis of all cases occurring from 1939 to 1972 was undertaken. Data for the study were derived from two sources the Annual Statistical Reports of the Ministry of Health 1972–2000 and the epidemiological publications of the League of Nations Health Organization and the World Health Organization. Results: There were four outbreaks of APM in Trinidad 1941, 1942, 1954, and 1972. After the final outbreak in 1972, APM was eradicated not only from Trinidad but also all the countries of the Americas mainly through the effective use of the oral polio vaccine. Conclusion: Polio has brought together international agencies, governments, and the people to build an effective public health system around a common vision for health and wellbeing. The polio eradication and endgame strategic plan represents a major milestone in polio eradication developed by global polio eradication initiative. The initiative would still benefit from adopting some of the best practices in governance from other organizations in the global health sector.

Sudden onset limb weakness in a young individual requires a thorough evaluation and prompt diagnosis. Delay in treatment awaiting CT scan reports or laboratory investigations can lead to complications. Our case report stresses upon the clinicians to consider hypokalemic periodic paralysis in the differential diagnosis in evaluating such patients. Classical ECG changes and blood gas analysis can effectively diagnose hypokalemia and institute gradual correction of the electrolyte abnormality. In a very rare incident, our patient developed hypokalemia after strenuous exercise. [ABSTRACT FROM AUTHOR]

Objective: To report the seasonal trends of Guillain-Barré Syndrome in a cohort of Pakistani population from southern Punjab, Pakistan. Study Design: A retrospective observational study. Place and Duration of Study: Department of Physical Medicine & Rehabilitation, Combined Military Hospital Bahawalpur, from Jan 2016 to Oct 2018. Methodology: One-hundred and fifty-two individuals fulfilling the electrophysiological criteria of Guillain-Barré Syndrome were included from the records of the department and subdivided into four main subtypes on the basis of electrodiagnostic studies including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor Axonal Neuropathy, Acute Motor and Sensory Axonal Neuropathy, and Miller Fisher Syndrome. The seasons were divided as: summer; May to August, autumn; September and October, winter; November to February, and spring; March and April. Demographic characteristics, type of Guillain-Barré Syndrome, and month and season of presentation were investigated. Data were analyzed with SPSS version 20. Results: The sample (mean age: 39 ± 21 years) consisted of 114 (75%) males and 38 (25%) females. The highest reporting (63, 41.4%) was in winter followed by (53, 34.9%) summer (p<0.001). May was the peak reporting (n=24) month with January to follow (n=20) (p=0.002). Acute Inflammatory Demyelinating Polyneuropathy was the most frequent sub-type 88 (57.9%). Acute Inflammatory Demyelinating Polyneuropathy and Acute Motor Axonal Neuropathy were significantly more frequent in winter season (p<0.001 and p=0.008 respectively) while Acute Motor and Sensory Axonal Neuropathy was in summer season (p=0.01). Regarding the association with a particular month, Acute Inflammatory Demyelinating Polyneuropathy was significantly more common in May (p=0.025). Acute Motor Axonal Neuropathy and Acute Motor and Sensory Axonal Neuropathy could not find any association. Statistics for Miller-Fisher Syndrome were not computable. Conclusion: Clustering of Guillain-Barré Syndrome cases was found in winter. Acute Inflammatory Demyelinating Polyneuropathy and Acute Motor Axonal Neuropathy were significantly more frequent in winter while Acute Motor and Sensory Axonal Neuropathy was in summer. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barre syndrome is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis. Severe cases may require intensive care and mechanical ventilation.Purpose: was to study pediatric patients with severe GBS requiring intensive care unit (ICU) admission, to assess their course and response to initial treatment modality plasma exchange (PE) or intravenous immunoglobulins (IVIg) and their final outcome.Methods: children with severe GBS who had either actual or impending respiratory failure, bulbar involvement or rapid progression of acute flaccid paralysis with trunk, upper limb and neck involvement within 24 h of the onset of weakness were enrolled.Results: 40 children were included. Following the initial treatment (33 subjects had 5 PE sessions each and IVIg in 7), 16 patients improved (40%), two died and 22 (55%) showed initial treatment failure. Axonal neuropathy, rapid progression and severe motor weakness significantly predicted poor response to therapy. At discharge, favorable outcomes (patient can walk unaided) were present in 22 cases (58%).Conclusion: Despite relatively low mortality, critically ill children with severe GBS have increased prevalence of axonal neuropathy and guarded response to initial therapy with PE or IVIg.

Objective: Analysis of demographic, clinical, laboratory, electrophysiological and neuroimaging data and pathogenetic therapy of pediatric patients with chronic inflammatory demyelinating polyneuropathy (CIDP)., Material and Methods: Patients ( n =30) were observed in a separate structural unit of the Russian Children's Clinical Hospital of the Russian National Research Medical University named after. N.I. Pirogova Ministry of Health of the Russian Federation in the period from 2006 to 2023. The examination was carried out in accordance with the recommendations of the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society on the Management of CIDP (2021). All patients received immunotherapy, including intravenous immunoglobulin (IVIG) ( n =1), IVIG and glucocorticosteroids (GCS) ( n =17, 56.7%), IVIG+GCS+plasmapheresis ( n =12, 40.0%). Alternative therapy included cyclophosphamide ( n =1), cyclophosphamide followed by mycophenolate mofetil ( n =1), rituximab ( n =2, 6.6%), azathioprine ( n =3), mycophenolate mofetil ( n =2, 6.6%)., Results: In all patients, there was a significant difference between scores on the MRCss and INCAT functional scales before and after treatment. At the moment, 11/30 (36.6%) patients are in clinical remission and are not receiving pathogenetic therapy. The median duration of remission is 48 months (30-84). The longest remission (84 months) was observed in a patient with the onset of CIDP at the age of 1 year 7 months., Conclusion: Early diagnosis of CIDP is important, since the disease is potentially curable; early administration of pathogenetic therapy provides a long-term favorable prognosis.

Recurrent GBS is a rare neurological condition in which patients develop similar symptoms of motor weakness after different preceding infections and suffer shorter intervals in between subsequent episodes of GBS. However, the majority of RGBS patients undergo full recovery. [ABSTRACT FROM AUTHOR]

Hypokalemia is an electrolytic disorder, in some occasions difficult to control. When severe, it may be life-threatening. We report the case of a patient with relapse of acute lymphoid leukemia, who presented to the hospital with flaccid paralysis associated with severe hypokalemia. The cause was a tubulopathy associated with leukemic infiltration of the kidneys.

Acute flaccid paralysis is an emergency and includes a variety of diagnostic possibilities. Identification of life threatening problems and emergency stabilization should precede further diagnostic evaluation. The common differential diagnoses in the post polio eradication era include Guillain Bane syndrome, acute transverse myelitis and traumatic neuritis. It is essential to rule out reversible causes such as hypokalemia and snake envenomation in the appropriate clinical setting. Stabilization of spine is imperative when trauma is suspected, and early neuroimaging is essential in any child who presents with features of myelopathy to mie out compressive lesions. Careful monitoring of respiratory muscle strength is essential especially in children who progress rapidly and early institution of mechanical ventilation is essential. Management of these children is largely supportive, and includes appropriate ventilator support, provision of early enteral nutrition, physical therapy, strict asepsis, good musing care, bowel and bladder care and psychosocial support. Immunotherapy is useful in certain patients with Guillain Bane syndrome, transverse myelitis and myasthenic crisis. Prolonged ventilation is anticipated in children with severe disease and necessitates tracheostomy to increase patient comfort and facilitate weaning from ventilation. Children who are admitted in intensive care for various disease processes may develop weakness due to critical illness related neuromuscular weakness, no effective treatment exists and management is aimed at identification of risk factors and prevention strategies.

Pyruvate carboxylase (PC) is a biotin-containing enzyme that is responsible for the adenosine triphosphate-dependent carboxylation of pyruvate to oxaloacetate, a key intermediate in the tricarboxylic acid cycle. PC deficiency (OMIM 266150) is a rare autosomal recessive metabolic disease, causing elevation of pyruvate, lactate, and alanine. Three types of PC deficiency have been described in the literature; A, B, and C. Type A PC deficiency, also called infantile or North American type, is characterized by infantile onset acidosis, failure to thrive, and developmental delay. The second subtype or type B, the neonatal or French form, presents usually in the neonatal period, mostly in the first 72 hours of life with severe lactic acidosis, truncal hypotonia, and seizures. The third type is called type C, is extremely rare with few cases published in the literature. In this case report, we present an 11-month-old girl who presented with acute flaccid paralysis, lethargy, and constipation with elevated ketones and lactate. She was confirmed genetically and biochemically to have PC deficiency type C. The patient's unusual presentation expands the clinical phenotype of this extremely rare disease. [ABSTRACT FROM AUTHOR]

We discuss a case of a 20-year-old female who presented with history of fever, vomiting, and decreased oral intake for 10 days followed by one episode of generalized tonic--clonic seizure and altered sensorium for 5--6 h. On arrival in the emergency room, she had Glasgow Coma Scale 3 (E1V1M1), both pupils fixed and dilated, low blood pressure, low oxygen saturation, and few gasping breaths. She appeared to be brain dead and was assumed to have a very poor prognosis. Investigations revealed severe hypokalemia. She had also suffered acute hypoxic-ischemic injury to the brain. However, she recovered and was discharged about 2 weeks later. [ABSTRACT FROM AUTHOR]

Background: Acute poliomyelitis (APM/polio) is a viral infection caused by the polio virus that continues to have a fascinating social and economic impact on countries throughout the world. Humans acquire the virus by close personal contact with transmission occurring through the fecal–oral route. The majority of poliovirus infections results in no illness or produces only self-limited symptoms, however in approximately 5% of infected patients flaccid paralysis of the limbs can occur and 1% can die. Although APM is no longer a feared disease mainly due to the development of effective vaccines, its eradication remains elusive. Methods: The aim of this study is to review the historical impact of APM in Trinidad. A retrospective analysis of all cases occurring from 1939 to 1972 was undertaken. Data for the study were derived from two sources the Annual Statistical Reports of the Ministry of Health 1972–2000 and the epidemiological publications of the League of Nations Health Organization and the World Health Organization. Results: There were four outbreaks of APM in Trinidad 1941, 1942, 1954, and 1972. After the final outbreak in 1972, APM was eradicated not only from Trinidad but also all the countries of the Americas mainly through the effective use of the oral polio vaccine. Conclusion: Polio has brought together international agencies, governments, and the people to build an effective public health system around a common vision for health and wellbeing. The polio eradication and endgame strategic plan represents a major milestone in polio eradication developed by global polio eradication initiative. The initiative would still benefit from adopting some of the best practices in governance from other organizations in the global health sector. [ABSTRACT FROM AUTHOR]

Aim: To describe the causes, clinical presentation and neurological outcome of acute flaccid paralysis in children.Methods: A retrospective study in a tertiary paediatric hospital in South Africa. Data on clinical presentation, respiratory complications and long-term neurological outcomes of children presenting with acute flaccid paralysis were collected. Logistic regression analysis was applied to determine predictors for the need of mechanical ventilation.Results: The study included 119 patients, 99 of whom had Guillain-Barré syndrome (GBS); 47 patients (39.5%) required mechanical ventilation. Backward logistic regression analysis revealed that bulbar dysfunction (P < 0.001), autonomic dysfunction (P = 0.003) and upper limb paralysis (P = 0.038) significantly predicted the need for mechanical ventilation. EuroQol-5D scores of self-care problems and usual activities after discharge significantly declined over time.Conclusions: In this large series from Africa, GBS was the main cause of acute flaccid paralysis in children and was associated with significant morbidity. Other causes of acute flaccid paralysis mimicking GBS were not uncommon and should be excluded in this setting. [ABSTRACT FROM AUTHOR]

Background: Tick paralysis is a frequently overlooked severe disease characterized by bilateral ascending flaccid paralysis caused by a neurotoxin produced by feeding ticks. We aimed to characterize suspected tick paralysis cases documented at the BC Centre for Disease Control (BCCDC) in British Columbia (BC) from 1993 to 2016 and reviewed prevention, diagnosis, and treatment considerations. Methods: Demographic, geographic, and clinical data from test requisition forms for ticks submitted to the BCCDC Public Health Laboratory (PHL) from patients across BC between 1993 and 2016 for suspected human and animal tick paralysis were reviewed. Descriptive statistics were generated to characterize tick paralysis cases in BC, including tick species implicated, seasonality of disease, and regional differences. Results: From 1993 to 2016, there were 56 cases of suspected tick paralysis with at least one tick specimen submitted for testing at the BCCDC PHL. Humans and animals were involved in 43% and 57% of cases, respectively. The majority of cases involved a Dermacentor andersoni tick (48 cases or 86%) and occurred between the months of April and June (49 cases or 88%). Among known locations of tick acquisition, the Interior region of BC was disproportionately affected, with 25 cases (69%) of tick bites occurring in that area. Conclusions: Tick paralysis is a rare condition in BC. The region of highest risk is the Interior, particularly during the spring and summer months. Increasing awareness of tick paralysis among healthcare workers and the general public is paramount to preventing morbidity and mortality from this rare disease. [ABSTRACT FROM AUTHOR]