Myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) is a distinct primary demyelinating disorder with an evolving clinical and imaging spectrum. The term MOGAD has been recently coined to describe the neuroinflammatory condition associated with MOG-IgG antibodies. We report an unusual clinical phenotype of aseptic meningitis later followed by bilateral optic neuritis with a distinct gap of 13 months in an adult patient with MOGAD. CaseA 46-year-old man presented with a history of fever, headache, and vomiting of 2-week duration without alteration in sensorium or seizures. Examination revealed that he was conscious, oriented, and had signs of meningeal irritation with no lateralizing or localizing neurologic deficits. The initial fundus examination showed a normal optic disc.

BACKGROUND Acute pyelonephritis (APN) is one of the most severe forms of urinary tract infections (UTI) with a higher incidence among females compared to males. Escherichia coli is the commonest causative organism isolated in 80 % of the cases in Kerala. Risk factors like structural or functional abnormalities of urogenital system, immunosuppression, comorbidities and virulence & resistance of microorganism play vital roles in predicting the prognosis. Our aim was to study the prevalence of various risk factors of acute pyelonephritis in adult patients, the clinical profile, aetiological agents and their sensitivity to antibiotics, and related complications on their usage. METHODS In a cross-sectional observational study, 100 adult patients with acute pyelonephritis admitted in a tertiary teaching hospital in Kerala were studied between January 2016 and January 2017. Detailed history and clinical examination were carried out. Complete haemogram, random blood sugar, renal function test, urine culture and sensitivity, and ultrasonogram of abdomen and pelvis were done. RESULTS The most common age group was 40 - 49 years with a male to female ratio of 2:3. Dysuria was observed in 82 % of patients followed by increased frequency of micturition in 65 % and vomiting in 42 %. Diabetes mellitus was observed in 55 % of patients and recurrent UTI in 44 %. Escherichia coli was found in 66 % of patients followed by Klebsiella in 23 %. Culture showed that 85 % of the bacteria were sensitive to piperacillin-tazobactam. 44 % of the patients did not respond to the empirical antibiotic, and the failure rate was higher among those empirically treated with ciprofloxacin. 41 % of the patients developed acute kidney injury, which necessitated haemodialysis in 23 %. 14 % of the patients developed septic shock and the mortality was 10 %. CONCLUSIONS Certain risk factors such as diabetes, hypertension, chronic kidney disease and indwelling catheters were associated with increased incidence of complications. Hence, in presence of such risk factors appropriate treatment and preventive measures should be initiated promptly. Among the pathogens, 85 % of the organisms were sensitive to piperacillin–tazobactam. Hence, piperacillintazobactam can be recommended as the first line empirical antibiotic. KEYWORDS Acute Pyelonephritis, Urinary Tract Infection, Acute Kidney Injury (AKI), and E. coli

Females with pituitary dwarfism and a multiple deficiency of pituitary hormones show ovarian dysfunction due to hypogonadotropism. Primary amenorrhea can be diagnosed if a patient has normal secondary sexual characteristics but no menarche by 16 years of age. A 16 year-old female patient admitted in general medicine department with chief complaints of shortness of breath on exertion since 15 days, swelling of both legs since 10 days, loss of weight since 5 months, loss of appetite since 3 months, history of pain during swallowing. Pelvis scan examination reveals that uterus measures 3.2×0.5×0.5cm; uterus is hypo plastic, ovaries not visualized. Patient parents reveled that from patient birth to 11years of age her growth and other developments were normal, after that her growth is stopped and no changes were observed in development since 5 years. Patient has hypothyroidism so pituitary gland make an important role to maintain hormone levels, pituitary gland produces thyroid stimulating hormone (TSH) which stimulates thyroid gland to produce thyroid hormones. Primary Amenorrhea, short stature and poorly developed secondary sexual characters which could have been contributed and should be subjected for karyotyping. This type of Pituitary Dwarfism is very difficult to manage.