Neurocutanoussarcoidosis: a rare entity

Neurosarcoidosis is a granulomatous disorder considered to be a great imitator. We report a case of young lady who presented with gradual onset flexed posturing of fingers of left hand for four years, followed by similar pattern of weakness involving the right hand for three years along with slipping of slippers for one year. Neurologic examination showed distal wasting & weakness in upper limbs with normal jerks and sensory impairment in gloves and stocking distribution. On skin examination there were hypopigmented macules over face, neck and back. Electro diagnostic studies showed sensory motor axonal polyneuropathy, while skin biopsy reported as naked noncaseating granulomas suggestive of sarcoidosis. No such case reported yet in Pakistan with sarcoidperipheral polyneuropathy and rare hypopigmented form of Sarcoidosis without pulmonary involvement

Frequency of peripheral neuropathy in newly diagnosed patients of diabetes mellitus iion clinical and electrophysiological basis

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to female was . 1.14The age group distribution of study population ranged from 30-60 years and mean age was 45.19 with standard deviation of 7.38. It was observed that 35 (32.7%) patients had symptoms of peripheral neuropathy as compared to this 72 (67.3.2%) patients did not have symptoms of peripheral neuropathy while mean ± standard deviation of duration of symptoms was 2.42±1.95 months and 18 (16.8%) patients had peripheral neuropathy as compared to these 89 (83.2%) patients did not have peripheral neuropathy, clinical or electrophysiological. Conclusion: Diabetic Peripheral Neuropathy is a fairly common entity in our patients with type 2 Diabetes Mellitus and was seen as early as within four weeks of diagnosis in 16.8% of patients

Assessment of the Predictors and Mortality in Patients of Acute on Chronic Liver Failure; A Prospective Study

Objective: To evaluate the predictors of short-term mortality in patients with acute-on-chronic liver failure (ACLF). Methodology: This prospective study was conducted at the gastroenterology department of the Asian Institute of Medical Sciences Sindh, Pakistan from January 2018 to December 2018. All the patients with acute-on-chronic liver failure (ACLF) aged more than 25 years and of either gender were included. A complete history was obtained including demographic profile and specifics on clinical characteristics (jaundice, ascites, gastro-intestinal bleed, grade of encephalopathy, records of vital parameters etc.). Serum electrolytes, viral serology, autoimmune profile, liver function tests, serum creatinine, prothrombin time, and INR were among the laboratory tests performed on each patient. Results: A total of 99 patients were studied; their average age was 40.90+13.93 years; and there was a male predominance (73.5%). HCV and HBV+HDV were the most common etiological factors. According to the frequency of organ failure, hepatic failure was in 59.8% of the cases, renal failure was in 43.6% of the cases, CNS failure was in 38.5% of the cases, 41.0% of the cases had circulatory failure, coagulation failure was in 55.6% of the cases, and respiratory failure was seen in 17.1% of the cases. Overall, the 30-day mortality rate was 61.5%. Hepatic failure, renal failure, CNS failure, coagulation failure, SBP, and grading of ACLF were significantly associated with short-term survival rate (p= <0.05). While gender, etiology, circulatory failure and respiratory failure were statistically insignificant (p= >0.05). MELD score >28, CTP score >13, organ failure >3 and ACLF grade II and III were also highly significantly linked to short term survival rate (p-0.0001). Conclusion: According to the study's findings, hepatic failure, renal failure, CNS failure, coagulation failure, and ACLF grading, CTP score > 13, MELD score > 28, and the presence of hepato-renal syndrome were found to be significant predictors of short-term mortality in patients with Acute On-Chronic Liver Failure (ACLF)

Patterns of Conversion Disorder cases reported at neurological outpatient clinic.

Objectives: This study was carried out to see the commonest presenting symptoms of conversion disorder attending Neurology Department Liaquat University of Medical &amp; Health Sciences Jamshoro/Hyderabad. Study Design: Cross-sectional study. Setting: Department of Neurology Outpatient at Liaquat University Hospital, Hyderabad, Pakistan. Period: September 2017 to August 2019. Material &amp; Methods: Sample size of 111 was estimated using Open epi online sample size calculator by taking statistics of conversion disorder as 63%, margin of error as 9% and 95% confidence level. All patients of age more than 9 years of either gender diagnosed as conversion disorder were included in the study using non-probability consecutive sampling technique. Results: A total of 111 patients were registered. 33 (29.7%) were male and 78 (70.3%) were females with male to female ratio of 0.4. The age ranged from 10 years to 30 years and the mean age was 23.30 ± 9.94. Out of 111 patients 47 (42.3%) were married and 64 (57.7%) were unmarried. On the other hand majority of patients having conversion disorders 51 (45.9%) had no formal education or educated up to primary 28 (25.2%). Most common symptom was episodic loss of consciousness 24 (21.6%) followed by seizure like activity 23 (20.7%), aphonia 9 (8.1%) &amp; headache 7 (6.3%). Conclusion: The results from our study showed conversion disorders with unexplained symptoms are relatively common in outpatient neurology clinics.</jats:p

Effect of atypical antipsychotics on blood glucose levels and HbA1c in patients of schizophrenia and bipolar disorder.

Objectives: To evaluate the effect of atypical antipsychotics on serum glucose levels and HbA1C in patients of schizophrenia and bipolar disorder. Study Design: Quasi-experimental study. Setting: Department of Neurology and Sir C. J Institute of Psychiatry LUMHS Jamshoro/Hyderabad. Period: Dec 2018-Dec 2019. Material &amp; Methods: Total 360 participants of age more than 15 years of either gender presenting with psychiatric illness i.e. schizophrenia and bipolar disorder and prescribed same brand of antipsychotic drugs were included in the study. Fasting blood glucose (FBS), random blood glucose (RBS) and glycosylated hemoglobin (HbA1c) were measured at baseline and 6th months after treatment with atypical antipsychotic agents. SPSS version 23 was used to analyze data. Results: A total of 360 patients were enrolled in the study duration, among them 338 patients were followed up till 6 months, while 22 patients were lost to follow up. The mean age of the study sample was reported as 39.33±8.83 years. At baseline mean FBS, RBS and HbA1c were reported as 92.52±9 mg/dl, 143.21±14.91, 5.83±0.37 which significantly increase after treatment with antipsychotics at 6 months (p&lt;0.05). About 23.6% developed diabetes mellitus and 21.3% developed hyperglycemia at the end of 6 months. Conclusion: Non-diabetic treatment naïve schizophrenia and bipolar disorders patients have higher chances developing side-effects on the glucose regulations after initiation of antipsychotic therapy. Overall, the early identification and diagnosis of antipsychotic-induced diabetes mellitus and hyperglycemia requires proper evaluation, reporting, and physician and patient awareness.</jats:p

Etiological Factors of Non-Traumatic Compressive Myelopathy

Objective: To determine the frequency of etiological factors of non-traumatic compressive myelopathies. Methods: This is tertiary care Hospital based descriptive cross sectional study conducted at Neurology department of Liaquat University of medical and health Sciences, Jamshoro / Hyderabad after approval of departmental ethical committee from 22th October 2020 to 21st April 2021. Study data was collected after informed consent from all cases. All cases fulfilled inclusion criteria were selected and included in study and data was recorded on preformed proforma. Data was analyzed on SPSS 21 and results were formulated accordingly. Results: In this study 163 patients were included to assess the etiological factors of non-traumatic compressive myelopathy and the results were analyzed. Out of theses 163 subjects who had nontraumatic compressive myelopathies, the etiological and demographic features revealed that, 106 (65%) were male & 57 (35%) were female patients, having a 1.85:1 male to female ratio. The study population’s age ranged from 20 to 60 years, and the mean age SD was 47.6 ± 11.2 years. One hundred and eleven 111 (68.1%) patients had paraparesis while fifty two 52 (31.9%) had Quadriparesis. Most common cause of non-traumatic compressive myelopathy was Tuberculosis spine 35(21.5%) followed by demyelinating Myelitis 30 (18.4%) spinal secondaries 24 (14.8%), disc prolapse was noted in 22(13.5%), multiple myeloma 12 (7.3%) cervical spondylosis 10(6.1%), spinal epidural abscess 8(4.9%), transverse myelitis 4(2.5%) while ossification of the posterior longitudinal ligament as 3(1.8%) patients. Conclusion: Tuberculosis of spine followed by demyelinating Myelitis were most common causes of non-traumatic compressive myelopathies. It is of prime importance to identify those risk factors and contributing states that prone the population for the development of such disabling ailments to address the burden of diseases and to optimize the management’s strategies for this already compromised patients

EPILEPSY;

Introduction: Epilepsy is among most frequent disorders visiting for neurology consultations while depression is documented as comorbidity with epilepsy that further disturbs the social life of such patients. Objectives: To find out the frequency of depression and difference in severity, age and gender among known epileptic patients visiting for neurology consultations at tertiary care hospital. Material and Methods: This cross sectional study was conducted in neurology outpatient clinic and neurology ward LUMHS from August 2017 to January 2018. Epileptic patients (129) fitting into the inclusion criteria were selected for study under informed consent on proforma using SSDS (Siddiqui Shah Depression Scale). Results: Mean age of study population was 26.2 ±11.1 (range15 to 60) years and Male, Female ratio was 1.6: 1. Depression was found in 77 (59.7%) patients with 34 (44.1%) mild21 (27.3%) moderate and 22 (28.6%) had severe depression. Conclusion: High prevalence of depression is seen in epileptic patients. There was male preponderance distribution in the study. There is no significant difference among the genders and age groups regarding severity depression.</jats:p

Short-Term Mortality and Survival among Patients with Acute-On- Chronic Liver Failure: A Prospective Cohort Study

Objective: To evaluate the frequency of short-term mortality (30 days) and survival among patients with acute-on-chronic liver failure (ACLF). Methods: A descriptive cross-sectional was carried out at gastroenterology department of the Asian Institute of Medical Sciences Sindh, Pakistan Patients with acute-on-chronic liver failure (ACLF) aged more than 30 years of either gender were included. The patients were monitored for one month to assess the mortality or survival.Results: Overall average age of 40.9 years. 73.5% were male and 26.5% were female.Organ failure stratification indicated that 51.3% had fewer than three organ failures, while 48.7% had three or more. In terms of 30-day mortality, 61.5% of participants expired, while 38.5% survived. Analyzing mortality by age, gender and etiology was not statistically significant (p = &amp;gt;0.05). Although organ category analysis indicated that mortality was significantly higher in category 2 (p = 0.043).Conclusion: Among patients with ACLF, the short-term mortality was observed to highly frequent and significantly associated to patients with multiple organ failures. The findings underscore the importance of organ failure stratification as a key predictor of outcomes in ACLF, suggesting that early identification and management of organ dysfunction may be critical in improving survival rates.Key words: ACLF, mortality, etiology, predictors