Motor Neuropathy in Hypothyroidism: Clinical and Electrophysiological Findings

Background: Hypothyroidism is a clinical condition associated with low levels of thyroid hormones with raised TSH. Peripheral neuropathy may be associated with hypothyroidism which usually develops insidiously over a long period of time due to irregular taking of drugs or lack of thyroid hormone replacement. Objectives: The present study was done to evaluate the clinical and electro-physiological findings in hypothyroid patients in order to evaluate the neuromuscular dysfunction as well as motor neuropathy. Method: In this study, 70 subjects with the age range from 20 to 50 years of both sexes were included of whom 40 hypothyroids were taken in study group (B) with the duration of 6 months to 5 years and 30 healthy euthyroid subjects were taken as control (Group A). On the basis of their TSH level, group B was further divided into group B1 with TSH level <60 MIU /L (less severe) and group B2 with TSH >60 MIU /L (severe group). The d latency and NCV for motor nerve function were measured by NCV machine in median and ulnar nerve for upper limb and in common peroneal nerve for lower limb. TT3, TT4 were measured by RIA and TSH by IRMA method. All these parameters were measured on the day 1 (one) of their first visit. Data were analysed statistically by ANOVA and Z test. Result: Both TT3, TT4 levels were significantly (P<0.01) lower in hypothyroids in comparison to those of control. Diminished or absence of most of the deep tendon reflexes were found in all the hypothyroids. Most of the patients (67.5%) showed significantly higher (P <0.01) motor distal latencies (MDL) with lower (P> 0.001) conduction velocities (MNCV) and all these changes were more marked in group B2. Conclusion: So, the study revealed that motor neuropathy may be a consequence of hypothyroidism.DOI: 10.3329/bsmmuj.v1i1.3692 Key Words: Hypothyroidism; neuropathy; electrophysiology BSMMU J 2008; 1(1): 15-1

Effect of Losartan and Atenolol on heart rate variability in newly diagnosed essential hypertensive patient

Background: Essential hypertension is associated with altered autonomic function. Essential hypertension is treated with drugs which modify the sympatho-parasympathetic balance. Losartan (angioteosin II receptor blocker) and atenolol (beta blocker) is commonly used antihypertensive drugs.Objective: To evaluate the effect of antihypertensive drugs on heart rate variability (HRV) in patients with essential hypertension.Methods: This prospective observational study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from July 2012 to June 2013 on 120 newly diagnosed hypertensive patients without any medication (group B, age 30-55 years). They were selected from the Out Patients Department (OPD) of cardiology, BSMMU, Dhaka. Age, sex and BMI matched 60 apparently healthy norrnotensive subjects were also studied as control (group A). Based on treatment, these study subjects were divided into two groups (BI and B2). Group B1a included 60 patients received Josartan 50 mg daily and B2a included 60 patients received atenolol 50mg daily. They were observed once before the treatment (B1a & B2a), after 3 months medication (B1b & B2b) and after 6 months medication (B1c & B2c). For assessing HRV, Mean heart rate, Mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were recorded by a polyrite. Data were compared among before treatment, after 3 months treatment and after 6 months treatment. For statistical analysis ANOVA, independent sample't' test and paired sample 't' test were performed. Results: Mean resting pulse rate, mean heart rate, systolic blood pressure, diastolic blood pressure were significantly higher and mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normoten­sive subjects and after treatment. Jn both groups SDNN, RMS SD, mean R-R interval were found significantly higher after 6 months of treatment compared to their values after 3 months treatment. Again these values were found close to the values in normotensive subjects. In addition, mean heart rate was found significantly lower in atenolol treated patients than those of controls. Again in atenolol group these values were found significanLly higher than the corresponding values in losartan treated patients after 6 months treatment. Conclusion: Reduced cardiac vagal tone occurs in newly diagnosed hypertensive patients which is improved by both losartan and atenolol and in particular atenolol was found more effective

Effects of Oral Supplementation of Vitamin E on Fragility of RBC in Hemolytic Anemic Patients with G6PD Deficiency

Background: Vitamin E has role in maintaining the integrity of red cell membrane by preventing oxidation of polyunsaturated fatty acids and thereby protects cells from oxidative stress- induced lysis in G6PD deficiency, which can be reflected by changes in osmotic fragility of RBC and some absolute values like MCV, MCH & MCHC. Objective: To observe the effects of vitamin E supplementation on fragility of RBC in order to evaluate role of this antioxidant vitamin in reducing chronic hemolysis in G6PD deficient patients. Methods: For this, a total number of 102 subjects with age ranged from 5 to 40 years of both sexes were included in the study. Among them 68 were G6PD enzyme deficient patients, of whom 34 were in supplemented group (study group) and 34 were in non-supplemented group (control group). The supplemented group received vitamin E supplementation for 60 consecutive days at a dose of 800 IU/day for adult and 400 IU/day for children < 12 years (in a divided dose i,e. 4 times daily). Age and sex matched 34 apparently healthy subjects with normal blood G6PD level were taken to observe the base line data (healthy control) and also for comparison. All the G6PD deficient patients were selected from Out Patient Department (OPD) of Hematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2005 to June 2006 and all the healthy subjects were selected from personal contact. Blood G6PD level, osmotic fragility of RBC were measured by standard techniques and MCV, MCH, and MCHC were obtained by calculation. All the parameters were measured on day 1 (one) of their first visit and also were on day 60 in deficient group. Data were compared among the deficient groups, also in supplemented group just before and after supplementation. Analysis of data was done by appropriate statistical method. Results: Mean starting and completing points of osmotic fragility of RBC were significantly higher but MCV, MCH, MCHC were significantly lower in patients suffering from hemolytic anemia due to G6PD deficiency in comparison to those of the healthy control. After supplementation with vitamin E starting and completing points of osmotic fragility of RBC were significantly decreased whereas, MCV, MCH, MCHC were significantly increased towards those of healthy control in supplemented group of patients in comparison to those of their pre-supplemented (day-1) and non-supplemented groups both on day 1 and day 60. Conclusion: From this study it may be concluded that, disturbances of some of the hematological parameter like higher osmotic fragility of RBC and lower MCV, MCH, MCHC occur in G6PD deficient hemolytic anemic patients, which returned towards normal after supplementation of vitamin E, which clearly indicates the role of this anti-oxidant vitamin in maintaining red cell membrane integrity and thereby decreases the rate of hemolysis in this group of patients. So, vitamin E can be supplemented along with other drugs for better management of the patients. Key words: Osmotic fragility, G6PD, hemolytic anemia, vitamin E.DOI: 10.3329/bsmmuj.v1i1.3688 BSMMU J 2008; 1(1): 6-1

Study of Glucose-6-phosphate Dehydrogenase (G6PD) Status in Preeclampsia

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the common enzymopathy and may be one of the risk factor for complicated pregnancy. Objectives: To measure erythrocyte G6PD level in pregnant women with preeclampsia in order to observe this enzyme status and also to measure Hb, TC of RBC, serum bilirubin, reticulocyte count to observe hemolytic status. In addition, to correlate this enzyme level with all these hematological parameters in order to find out any relationships among them. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2008. For this, 30 pregnant women with preeclampsia, age ranged from 20 to 34 years during their third trimester (>24th weeks) were studied (group B). They were selected from the Obstetric and Gynae Out Patient Department (OPD) of BSMMU and Bangladesh Medical College Hospital (BMCH) of Dhaka City. For comparison age matched 30 apparently normal pregnant women of the same gestational age (control group - group A) were also studied. They were selected by personal contact. Erythrocyte G6PD level was measured by Spectrophotometric method using kit of Randox. Serum bilirubin, hemoglobin concentration, total count of RBC and reticulocyte count were measured by standard laboratory techniques. For statistical analysis ANOVA, independent sample t test, Chi-square test and Pearson's correlation coefficient test were performed by using SPSS for windows version-12 as applicable. Results: In this study, erythrocyte G6PD level was significantly lower in preeclampsia in comparison to that of control but their percentages of involvement was not statistically significant. In addition, hemoglobin concentration and RBC count were significantly lower and serum bilirubin and reticulicyte count were significantly higher in the study group than those of control group. On the other hand, erythrocyte G6PD level was positively correlated with hemoglobin concentration and total count of RBC while negatively correlated with serum bilirubin and reticulocyte count and all these relationships were statistically significant in the study group. Conclusion: Therefore, this study revealed that presence of G6PD deficiency associated with hemolysis in preeclampsia may act as a contributory factor for the development of this complicated pregnancy. Key words: G6PD; preeclampsia DOI: 10.3329/bsmmuj.v2i2.4758 BSMMU J 2009; 2(2): 56-6

Oxidative stress in patients with rheumatoid arthritis: A cross-sectional study

Abstract not availabl

28 Motor Neuropathy in Hypothyroidism: Clinical and Electrophysiological Findings

Background: Hypothyroidism is a clinical condition associated with low levels of thyroid hormones with raised TSH. Peripheral neuropathy may be associated with hypothyroidism which usually develops insidiously over a long period of time due to irregular taking of drugs or lack of thyroid hormone replacement 1. Objectives: The present study was done to evaluate the clinical and electro-physiological findings in hypothyroid patients in order to evaluate the neuromuscular dysfunction as well as motor neuropathy. Method: In this study, 70 subjects with the age range from 20 to 50 years of both sexes were included of whom 40 hypothyroids were taken in study group (B) with the duration of 6 months to 5 years and 30 healthy euthyroid subjects were taken as control (Group A). On the basis of their TSH level, group B was further divided into group B 1 with TSH level <60 MIU /L (less severe) and group

Relationship of serum ionized calcium and magnesium concentration with parasympathetic nerve Function in type 2 diabetes mellitus

Background: Changes in serum Ca2+ and Mg2+ level may have some relationship to the occurrence of autonomic neuropathy in diabetes. Objective: To observe relationship between parasympathetic nerve function and serum ionized calcium & magnesium in type 2 diabetes mellitus (T2DM). Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka on 47 T2DM patients aged 40-68 years of both sexes. Twenty five patients were recently diagnosed diabetics (RDM) and 22 were long term diabetics (LDM) with 10-20 years duration of diabetes. Parasympathetic nerve functions of all patients were assessed by three simple non-invasive cardiovascular reflex tests. Ionized serum calcium and magnesium were measured by ion sensitive electrode method using NOVA electrode. Data were analyzed by unpaired‘t’test and Pearson’s correlation co-efficient test. Results: Serum ionized calcium and magnesium levels were significantly higher in RDM (P<0.001) and LDM (P<0.001) compared to healthy control. On correlation analysis, significant negative correlation of parasympathetic nerve function with Mg2+was found in both RDM and LDM patients. Conclusion: The result of this study concluded that higher calcium and magnesium ion may be associated with type 2 diabetes and parasympathetic nerve function of diabetic patients may have inverse relationship to serum Mg2+

EFFECTS OF VITAMIN E SUPPLEMENTATION ON SOME ASPECTS OF HEMATOLOGICAL VARIABLES IN PATIENTS OF HEMOLYTIC ANEMIA WITH GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY

Vitamin E works within the cell membrane as a biological antioxidant and may prevent premature destruction of RBC in Glucose 6-phosphate dehydrogenase (G6PD) deficient hemolytic anemia. Changes in some of the hematological variables like hemoglobin (Hb) concentration, total count (TC) of RBC, packed cell volume (PCV) and reticulocyte counts may occur due to hemolysis of RBC in G6PD deficiency In the present study the role of vitamin E supplementation on these changes were observed in reducing chronic hemolysis in anemic patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency For this, a total number of 102 subjects with age ranged from 5 to 40 years of both sexes were included in the study Among them 68 were G6PD enzyme deficient patients, of whom 34 were in supplemented group (experimental group) and 34 were nonsupplemented group (control group). The supplemented group received vitamin E supplementation for 60 consecutive days at a dose of 800 IU/day for adult and 400 IU/day for children 5. 12 years (in a divided dose i,e. 4 times daily). Age and sex matched 34 apparently healthy subjects with normal blood G6PD level were taken to observe the baseline data (healthy control) and also for comparison. All the G6PD deficient patients were selected from Out Patient Department (OPD) of hematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period o