A silver lining in the dark clouds: Medical Marijuana, in the Neurological disorders and its future in Pakistan.

Marijuana has been included in the list of illicit drugs for a long time despite its use as a remedy for several medical problems. However this use has been on the basis of the individual experiences with no concrete scientific evidence. Its positive effects have been mostly overshadowed by its recreational use worldwide. It has recently become the topic of hot debate due to several studies showing its role in various medical and especially neurological disorders. These new findings have created a controversy and world is still divided on its legalization for medicinal purpose. Several countries and states have legalized it recently, but many experts have raised concerns about its misuse and long term legal, ethical, financial and health implication, that need to be answered yet. Pakistan is considered as one of the largest cannabis producing country and with increasing evidence for potential medicinal benefits; we need to develop a consensus on this topic, considering health, legal and ethical perspectives linked to its medical uses in our society

Medicolegal issues in neurology Practice in Pakistan

Neurology despite its challenges have made tremendous improvement in past few decades. At the same time, the rapid advancement of media and internet has changed the traditional doctor-patient relationship into one of a service provider-consumer relationship1. The health service is now considered a commodity, and has become prone to lack of trust and litigation. Medical professionalism is challenged by increasing commercialism and influence of legal syste

Encephalopathy with behavioral and psychiatric features–firstantibody proven case of Anti-NMDA receptor encephalitis from Pakistan

Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is associated with psychiatric symptoms, memory disturbances, seizures, dyskinesia, and catatonia along with other constellation of symptoms. It is more common in females and usually associated with underlying ovarian teratoma. Treatment involves immunosuppression. This is the first antibody proven case from Pakistan. Case Report: A 16 year old girl with a short history of sore throat and no other prior illness, presented with 12 day history of behavioral changes (can you please describe some behavioral changes?) and seizures, followed by decreased responsiveness, involuntary limb movements and facial grimacing. She also had intermittent high grade fever for 3 days. On examination she had spontaneous eye opening with continuous involuntary oro buccal and lingual movements. CT/MRI brain was normal. Spinal tap showed increased WBCs with lymphocytic predominance. EEG showed severe diffuse encephalopathy with no clear epileptiform discharges. HSV PCR came out to be negative. She was treated with Ceftriaxone, Acyclovir, Ampicillin, Vancomycin, Phenytoin and Levetiracetam. Acyclovir was later stopped after negative HSV PCR results. On suspicion of non infectious (autoimmune) encephalitis, treatment with IVIg was started and serum anti NMDA receptor antibodies were sent, which came out to be positive. Ultrasound pelvis showed no teratoma. Parents on follow up reported gradual resolution of symptoms and resumption of usual activities. Conclusion: Anti NMDA receptor encephalitis is associated with anti NMDA receptor antibodies is responsive to autoimmune treatment

A rare case of medullary carcinoma thyroid metastasizing to bilateral breast parenchyma

Medullary carcinoma of the thyroid (MTC) commonly spreads through the lymphatics to distant sites such as lung, liver and bone. Spread to the breast is rare. We report a case of metastatic MTC which progressed to develop nodal metastases to cer­vical and mediastinal regions, visceral metastases to the liver, lung and ultimately to bilateral breasts. Clinically it is important to distinguish metastatic breast lesions from primary breast cancer as each is managed differently. Both cytological and radio­logical investigations were done followed by excision biopsy. Histopathological examination of post excision breast specimen revealed metastatic medullary carcinoma, with positive immunohistochemical staining for calcitonin. A brief review of literature and differential diagnosis is also presented

Dementia in Pakistan; an unprecedented Challenge and local cultural beliefs, problems And actions required.

Changing cultural and social dynamics has brought a major shift in lifestyles and associated risk factors for various disorders that were previously uncommon in Pakistan. Dementia is among the one of these emerging problems that is going to affect the elderly population worldwide but more so in the developing world. To adequately deal with the problems faced by patients with dementia and their caregivers, several important measures are needed that can help to reduce the morbidity and burden on the families and overall society. Increasing the awareness regarding the risk factors may help to reduce the dementia burden similarly knowledge about its symptoms will help early recognition and proper referral. Several modifications in the health system like focus on the palliative care, specialized dementia trained personnel and separate care units for dementia are the need of the time. Moreover, research regarding the various complementary therapies and enrolment into international research trials should be encouraged