A 29-year-old white man presents for evaluation of refractory daily generalized convulsions and drop attacks previously diagnosed as cataplexy. The patient's typical convulsive events started at 8 years of age, occur daily, and consist of jerking in all extremities with preserved consciousness. He has been on multiple anti-epileptic drugs (AEDs) including phenobarbital, valproic acid, and levetiracetam without decrease in event frequency. At age 17 he started having daily drop attacks consisting of full body weakness followed by collapse. The drop attacks, referred to as "cataplexy" by the patient, always occurred in public, have no clear trigger and have never resulted in injury to the patient. A typical drop attack is shown in Video 1.Magnetic resonance imaging of the brain, and 3 routine electroencephalograms (EEGs) without video monitoring were normal. A polysomnogram (PSG) followed by multiple sleep latency testing (MSLT) performed at an outside institution while on AEDs was interpreted as showing 5 out 5 sleep onset REM sleep periods (SOREMPs), with an average sleep latency of 1.2 minutes (data from PSG was not available). With complaints of daytime sleepiness, the patient was diagnosed with narcolepsy with cataplexy and started on sodium γ-hydroxybutyrate (GHB) with no improvement in drop attack frequency. Clomipramine and venlafaxine were added with no improvement noted.

Background: A serious worldwide medical and public health concern occurs with the dengue virus, which is also an emerging health threat. A victim can be vulnerable and acquire dengue because of his age, genetics, nutritional status, viral strain and secondary infections. Our objective was to identify the ABO blood group system's distribution and relationship in dengue fever (DF) patients. Methodology: The current study was conducted at Dr. Ishrat ul Ebad Institute of Blood Diseases Department between September 2019 and September 2020. The research work was viewed and accepted by the ethics and research committees. Case records of patients with blood systems and their relation among dengue nonstructural protein 1 (NS1) antigen /dengue immunoglobulin M (IgM) and immunoglobulin G (lgG) were included in this study. Results: Among 204 cases, 82 were blood group O positive, 59 were B positive, 38 were A positive, 16 were AB positive, 4 were O negative, and 2 were blood group A negative. The association of the ABO blood group with dengue was statistically significant (p=0.046). Blood group O+ has the highest number of cases, 66 (42.9%), than controls, 16 (32%). Conclusion:This study overall consummates that blood group O is linked with a greater possibility of acquiring DF in comparison with different other blood group types. There is a significant relationship between blood group and DF observed.

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