Neuromyelitis optica spectrum disorders (NMOSDs) are rare immunological inflammatory disorders of the central nervous system (CNS) primarily involving the optic nerve, spinal cord, and brain. [1][2][3] It is more common, has younger age of onset, has higher brain/brainstem involvement in Africans and Asians than Caucasians, and is usually diagnosed in middle-aged females. 2,4 The majority of NMOSD patients have positive AQP4-Ab. 1 Diagnosis of NMOSD is based on International consensus diagnostic criteria, requiring certain clinical, laboratory, and imaging criteria to be met with the exclusion of differentials. 5,6 Acute attacks are primarily managed with intravenous corticosteroids. 1 In worsening cases, plasma exchange may be indicated. 1 Also, monoclonal antibodies, such as rituximab, eculizumab, tocilizumab, satralizumab, etc., can be used to modify the course of the disease. 7,8 Early diagnosis and intervention are crucial to prevent worsening and ensure optimum quality of life in these patients. 9,10 Herein, we present the case of a middle-aged Asian male with NMOSD with AQP4-IgG. | CASE REPORTA 52-year-old Asian male presented with multiple episodes of hiccups, vomiting, decreased bladder sensation,

Objective: To evaluate the clinical features and laboratory profile of elderly patients with Coronavirus Disease-19 (COVID-19) at a tertiary care centre in South India. Material and Methods: A hospital-based retrospective study was conducted in 1,744 elderly patients by collecting the clinical and laboratory data from COVID-19 confirmed patients from May 2020 to June 2021 in a tertiary care hospital in Bangalore, India. The clinical features, comorbidities, serum biochemical parameters and inflammatory markers were recorded and collated with disease outcomes. The clinical presentation, inflammatory markers were studied and compared between survivors and non-survivors. P-value less than 0.05 set as statistical significance. Results: The mean age of the patients was 69.7±7.4 years and the male: female ratio was 1.65:1. The most common comorbidity reported in elderly patients with COVID-19 was type 2 diabetes mellitus (46.8%), followed by hypertension (35.7%), chronic kidney disease (10.7%), and ischemic heart disease (6.47%). 41.9% of the patients did not have any co-morbidities. Out of the 1,744 elderly patients, 164 (9.4%) died and mortality was highest in the COVID-19 patients with severe disease (103 patients, 62.8%). Inflammatory markers of neutrophil/lymphocyte ratio (N/L ratio), lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-Dimers and interleukin-6 were significantly elevated among the patients who did not survive. Conclusion: Mortality was highest in elderly COVID-19 patients with severe disease and most of the patients who died had one or more comorbidities. Neutrophilia, lymphopenia, eosinopenia along with elevated N/L ratio, LDH, ferritin, D-dimer, IL-6 and CRP were significantly associated with adverse disease outcomes.

BACKGROUND The clinical history taking and physical examination are the hallmarks of medical teachings and in clinical practice. However in present days these traditional methods are losing their importance due to availability of advanced technologies. The clinicians are more dependent on the investigations. History and clinical examination, till recent times were thought to be less objective and individualized. But there are statistical parameters based on evidence based medicine and clinical care that can be used to make the clinical examination more objective and precise. Utilizing these parameters the clinical examination will be more beneficial to the clinicians. In resource limited settings, clinical examination combined with the following statistical parameters will help to narrow down the diagnosis and provide timely diagnosis. The article tries to give a template for predicting the probability, establishing treatment and testing thresholds for common respiratory symptoms based on the evidence based medicine methods.