Immunosuppressants including corticosteroids (prednisolone >15 mg/day) are responsible for an increased risk of susceptibility to infections (especially pneumonia, tuberculosis [TB] including extra pulmonary TB), an important safety concern when providing immunosuppressive therapy. Anti-TB treatment (ATT) is medicines used to treat tuberculosis, an infectious disease which can affect lungs and other organs. Isoniazid, rifampicin, and pyrazinamide are known to cause ATT induced hepatitis. The prevalence of immunosuppressant induced TB and pyrazinamide induced hepatotoxicity during treatment for active TB ranges to about 0.6%-1% and <1%, respectively. Here, we illustrate a typical case report of a 61-year-old woman who is a known case of interstitial lung disease and developed TB arthritis following therapy with the long-term use of immunosuppressants (prednisolone, azathioprine, leflunomide, and sulfasalazine). ATT regimen was started for TB arthritis which was later modified along with addition of liver protectant due to the development of hepatotoxicity. The causality of both the adverse drug reactions was confirmed to be probable via NARANJO causality assessment scale. This case highlights the incidence of infectious complications like TB which may be expected to be encountered more frequently in the future due to the increasing use of immunosuppressants for the treatment of allergic and inflammatory disorders.

Management and prevention of vasospasm in subarachnoid haemorrhage are one of the complex dictums so far. Aneurysmal subarachnoid haemorrhage (aSAH) is the condition in which bleeding occurs in subarachnoid space. Vasospasm is a complex immunologically active phenomenon which requires a multimodality approach in the treatment of established vasospasm. Various treatment strategies for vasospasm and related disabilities include vasodilators such as nimodipine, sodium nitroprusside and papaverine. Intra-arterial nimodipine shows drastic improvement in several patients by resolving and preventing vasospasm. Intra-arterial administration of nimodipine can cause hypotension which can be easily managed. Papaverine is also an efficient drug-producing vasodilatory action on cerebral arteries. Papaverine is considered as the first intraarterial agent to reduce angiographic cerebral vasospasm which has the side effect of elevated intracranial pressure. Besides, the intrathecal administration of sodium nitroprusside has also demonstrated the effect in ischemic vasospasm after subarachnoid haemorrhage. Intraarterial administration of this drug can induce arterial hypotension which is not a recommended method. Vomiting is the main side effect of sodium nitroprusside, which can be managed with antiemetics such as ondansetron. Here we present a case of management of cerebral vasospasm in subarachnoid patients using the combination of these three effective drugs which showed a remarkable improvement in the resolution of aneurysmal vasospasm.

Congenital lobar emphysema (CLE) disorder is an uncommon respiratory issue in which air can enter the lungs yet cannot escape, bringing about over inflation (hyperinflation) of the projections of the lung with an incidence 1 per 20,000-30,000 per birth. It is frequently recognized in babies or youthful newborn children; however, a few cases do not get to be distinctly evident until adulthood. This issue might be sufficiently serious to bring about related heart issues. We report a case of a 1-month-old female infant who showed the signs and symptoms of this disease, but responded well to her treatment and was discharged in a stable state.

Background: As known to every Neuroscientist the spontaneous subarachnoid haemorrhage is a medical condition in which bleeding occurs in subarachnoid space due to cerebrovascular disease most commonly due ruptured aneurysms. Nimodipine is a calcium channel antagonist used to treat vasospasm. When compared to oral, intravenous nimodipine shows better neurological outcome with low dose, less frequency of administration and less fluctuations of blood pressure in between doses ( as in oral ) due to availability of continuous infusion . Titrated dose Intra venous nimodipine is useful in the initial Intensive Care management of Subarachnoid haemorrhage for Vasospasm with close monitoring of blood pressure.Objective: To evaluate the clinical outcomes of intravenous Nimodipine in the management of acute ischemic vasospasm in subarachnoid hemorrhagic patients. Material and methods: The study was a prospective and observational study conducted in all inpatients with SAH having acute ischemic vasospasm in the intensive care unit using IV Nimodipine admitted the department of Neurosurgery in AIMS during a period of 1yr.Results: Evaluation of SAH occurrence in study patients (n=38) showed predominance of females (68.4%) and majority with hypertension (57.9%) as the common comorbid condition. The chance of developing SAH was high in patients who did not practice any form of exercise (60.5%). None of the patients had occurrence of adverse drug reactions while administering IV nimodipine other than hypotension which was corrected with inotropic support with close blood pressure monitoring. Out of the subjects enrolled, 37 patients showed improvement clinically and resolution of ischemic changes in CT scan . Majority of patients experienced cerebral edema. Using pair t test, it was found that the difference between the Glasgow Coma Score pre and follow up post treatment score were mild. Using pair t test, it was found that the difference between the mRS pre and follow up post treatment score were significant.Conclusion: Introduction of IV Nimodipine to the treatment strategy of SAH showed significant improvement in the clinical and radiological outcome.IV Nimodipine showed benefit in treating the condition without any life-threatening adverse events other than correctable hypotension. A significant decrease in the mRS score in majority of patients after treatment indicates the improvement in the quality of life of SAH patients. Pre and Post neurological status strengthens the evidence of improvement in our study subjects.

Anti N-methyl-D-aspartate (NMDA) re-ceptor en-cephalitis is an immune medi-ated disorder and it is a dis-order of the limbic system that largely af-fects female children. Anti-NMDA recep-tor encephalitis was actually described as a paraneoplastic syndrome as it is associated with ovarian teratomas con-taining neural tissue with an-tibodies cross reacting to the NMDA recep-tors. Here we discuss a case of NMDA re-ceptor en-cephalitis.