Efficacy of memantine in treating patients with fibromyalgia

To evaluate the efficacy of Memantine as a therapeutic intervention for fibromyalgia. Methods: This clinical trial was conducted between October 2014 and December 2014. A total of 30 subjects with diagnosed fibromyalgia presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Adult patients belonging to both genders were included in the study. Patients were treated with incremental doses of Memantine. Data was analyzed using SPSS version 20 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. Results: Out of 30 patients, 2 (6.7%) were males and 28 (93.3%) were females which shows a very high occurrence of fibromyalgia in females. The mean age of the subjects was found to be 38 years. Efficacy of the drug in patients with fibromyalgia was observed to be 93.3% which is significantly high. The baseline FIQ score when compared with the score at 3-month follow-up by applying Wilcoxon signed rank test showed mean ± S.D (67.18±13.23 vs. 34.17±15.18) where p=0.000. This shows a highly significant result (≤0.05). All of the patients with fibromyalgia reported improvement in their physical functioning and majority of the patients felt less anxious and less depressed on their final follow-up visit. By the end of the 3rd month, the level of stiffness and intensity of pain decreased significantly and patients reported less difficulty in performing work. Conclusion: Memantine has shown significant beneficial effects in reducing the intensity of pain and disability in patients with fibromyalgia

Analytic study of clinical presentation of intracranial space-occupying lesions in adult patients

Intracranial space-occupying lesions can be caused by a variety of disease processes, ranging from neoplasms to non-neoplastic lesions including hematomas, abscesses and vascular malformations. This article provides an overview of varied clinical presentations of patients with intracranial space-occupying lesions.Methods:A total of 200 cases of intracranial space-occupying lesions presenting at Neuro Clinic and Care were retrospectively analyzed. Adult patients from all age groups and both genders were included in this study. Results: 165 patients (82.5%) had neoplastic lesions while 35 (17.5%) had non-neoplastic lesions. Metastatic lesions from primary tumor elsewhere in the body comprised the most common group with81 cases (40.5%), followed by meningiomas with 27 cases (13.5%). Males were affected slightly more than females (1:0.8). The most common presenting symptom was headache 87 patients (43.5%,) followed by focal symptoms such as numbness, tingling or weakness being present in 80 (40%)and seizures observed in 65 (32.5%).Conclusion: The study reviews the wide range of symptoms the patients with intracranial space-occupying lesions present with, the most common being headache, followed by focal symptoms such as numbness, tingling or weakness, seizures and vomiting. Knowledge of these typical as well as atypical patterns of clinical presentation can aid physicians in timely detection and prompt application of diagnostic and therapeutic modalities

Efficacy of memantine on cognitive functions of patients with moderate vascular dementia

Introduction: Vascular dementia is a common condition for which there is no effective approved pharmacological treatment available. Absence of effective treatment creates a difficult situation for those suffering from the disease, their caregivers, and healthcare providers. The objective of this study is todetermine the Efficacy of Memantine on cognitive functions in patients with Moderate vascular dementia. Material and methods: This Case series study was carried out inthe Neurology Section of department of Medicine Ziauddin University and Hospitals North Nazimabad campus, Karachifrom 12th March 2010 to 11th March 2011.90 patients were included, who fulfilled the inclusion criteria after taking an informed consent. The SPSS version 11 was applied to the data. Results: There were 55 (59.1%) males and 38 (40.9%) females. Mean ± standard deviation age 69.7 ± 6.6 years, mean duration of symptoms was 1.76 ± 1.1 years. Baseline minimental examination score was 15.14 ± 3.1. Minimental score after 24 weeks of drug therapy was 17.14 ± 4.1. Efficiency was found in 62 (66.7%) patients. Conclusion: Memantine produced only a small benefit in cognition (of uncertain clinical significance) in patients with moderate vascular dementia. Data is insufficient to support widespread use of this drug in vascular dementia. Individual patient analysis is needed to identify subgroups of patients with vascular dementia who might benefit

Hyperhomocysteinemia - An unidentified risk factor for stroke in our population

Introduction: Various studies show that moderate elevation of plasma homocysteine level has been associated with increased risk for cardiovascular and cerebrovascular disease. Objective: To observe the frequency of increased homocysteine level in ischemic stroke patients; and its association with other risk factors. Methodology: Observational pilot study was conducted on a sample of 75 ischemic stroke patients, enrolled regardless of their age, gender and comorbidities, at Ziauddin university hospital, Karachi. Fasting serum homocysteine, folate and vitamin B12 levels were measured. Results were interpreted using spss 20.0. Results and Discussion: Mean homocysteine level in our population was 19.51 (SD: 11.47)micromol/l. It was higher in groups with vitamin B12 and folic acid deficiency, difference being statistically significant (p=0.013 and 0.017, respectively). Males had greater propensity to hyperhomocysteinemia; the mean homocysteine value being higher, and the difference, statistically significant (p=0.010). Other factors that affect homocysteine levels were also evaluated, that is hypertension, increased cholesterol levels and smoking. There was no significant statistical difference in the homocysteine value between the groups of patients who had these risk factors and the groups that did not (p=0.747, 0.252 and 0.565, respectively). Conclusion: It was speculated that hyperhomocysteinemia is an imperative risk factor for stroke

Efficacy of memantine in treating patients with migraine and tension-type headache

Objective: To assess the efficacy of Memantine as a preventive and therapeutic intervention for migraine and tension-type headache. Methods: This clinical trial was conducted over a period of 3 months. A total of 44 subjects, with diagnosed migraine and/or tension-type headache, presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Patients were treated with incremental doses of Memantine. Adult patients belonging to both genders were included in the study. Data was analyzed using SPSS version 16.0 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. Results: Out of 44 patients, 35 (79.5%) were females and 9 (20.5%) were males which shows a very high occurrence of migraine and tension-type headache in females. Average age was found to be 32.6 ≈ 33 years. Efficacy of the drug was observed to be 81.8% which is significantly high. The baseline MIDAS score when compared with the score at 3-month follow-up by applying Wilcoxon signed rank test showed mean ± S.D (39.52±21.27 vs. 6.72±6.41) where p=0.000 (\u3c0.05) which shows a highly significant result. All 44 patients were known cases of migraine while 25% (11) of them also suffered from tension-type headache. Patients were treated with incremental doses of Memantine and were observed for the efficacy of the drug. Patients maintained their diaries of intensity of pain, distressing influence of the pain and how it hindered their daily routine. Results showed that intensity of pain decreased significantly by the end of the 3rd month of treatment and majority of the patients felt less distressed on their final follow-up visit. By the end of the 3rd month, the level of hindrance in the daily routines of the patients caused by the headache also fell significantly. Conclusion: Memantine has significant beneficial effects in reducing intensity of pain and disability in patients with migraine and tension type headache

A case of hashimoto’s encephalopathy in a patient with lithium toxicity

Hashimoto’s encephalopathy is a rare neurological disorder of unknown etiology. We presented, a case of middle aged male with bipolar disorder on Lithium carbonate for 30 years, admitted with altered behavior for 2 weeks and high Lithium levels. He was admitted with the suspicion of Lithium toxicity. EEG showed generalized epileptiform discharges. MRI brain revealed frontal cortical atrophy. CSF detailed report was normal. Further workup showed a high TSH level and positive anti-TPO (anti thyroid peroxidase) antibodies. Based on clinical picture, raised antibodies and no discernible cause, diagnosis of probable Hashimoto’s encephalopathy was made. He received pulse of methylprednisolone for five days and his symptoms improved dramatically. Our case report highlights the importance of diagnosing a rare neurological syndrome in a complex clinical scenario

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030