Herpes simplex encephalitis presenting with normal CSF analysis

A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis [HSE]. MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis.

Carpal tunnel syndrome

Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. The symptoms of CTS include pain, paraesthesia and hypoesthesia in the hand, in the area innervated by the median nerve, and often occurs or worsens during the night or early morning, waking the patient up. Physical examination and nerve conduction studies are used to diagnose this condition. Early diagnosis and treatment of CTS are important because any delay can cause irreversible median nerve damage. To highlight the role of physical examination and nerve conduction study in the diagnosis of CTS. Setting: Kuwait teaching Hospital Peshawar. June 2008 to June 2010. Methods: Fifty patients of carpal tunnel syndrome were studied. All patients who reported numbness and/or tingling in the median nerve distribution in the hands at least twice weekly during the preceding four weeks were enrolled to undergo clinical examination and nerve conduction tests. Following the clinical examination the symptomatic persons underwent bilateral nerve conduction tests. Out of these twelve patients were males and thirty eight were females with a ratio of 1:3.1. The age range was between 20 to 60 years. CTS was bilateral in 22 patients [44%], right-sided in 23[46%] patients and left-sided in 5[10%] patients. In addition to the clinical presentation, electrophysiology has been proposed as the standard of care for diagnosing CTS with a recommendation that it should be performed in all cases

Effectiveness and safety profile of cyclosporin A in rheumatoid arthritis

To describe the effectiveness and safety profile of Cyclosporine A in the treatment of Rheumatoid Arthritis. The study was conducted in the department of Medicine, Khyber Teaching Hospital from Sep 98 to Aug 99. 'There was three months recruitment period i.e. July to September prior to the actual treatment phase. Those patients that fulfilled the criteria of the American College of Rheumatology for Rheumatoid Arthritis were included in the study. A total of 25 patients with Rheumatoid Arthritis [RA] completed the study. Patients started on Cyclosporine A were followed for a period of one year. Outcome was assessed in respect of functional grade and joint score during the study and at the end of one year and was graded as very good, good and poor. Sixty percent patients showed very good to good response to Cyclosporine treatment, as they were in functional class I and showed more than 80% reduction in joint score. The other 40% had poor response as they were in functional class 2 or more and had less than 80% reduction in joint score. Mild hypertension was seen in 2 [8%] patients. Two [8%] patients developed hypertrichosis. One patient with severe gingival hyperplasia eventually dropped out of the study. None of the patients showed elevation of serum creatinine level above 30% of the baseline values at any time during treatment. The study shows that Cyclosporine A is an effective agent in active and potentially disabling RA. It has a good safety profile when used in recommended doses

Clinical audit of treatment of acute watery diarrhoea in paediatrics unit, Hayatabad medical complex, Peshawar

To look into the treatment given to children with acute watery diarrhea by Trainee Medical Officers at the time of admission and to compare it with the standard treatment protocol as recommended by World Health Organization for the treatment of acute watery diarrhoea. This was a retrospective study conducted in Department of Pediatric Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar from June 15 to August 15, 2008. Treatment charts of children admitted with acute watery diarrhoea were studied for demographical findings, degree of dehydration and other clinical findings and treatment given at the time of admission. The data was statistically analyzed by SPSS version 10. Eighty children were included in the study. The age range was from one month to five years with mean age of 25.5 months. The majority were in the range of 1 to 3 years with male to female ratio of 1.4:1. Majority [68.75%] had bowel movements more than 6 times/24 hours. Blood in the stool was present in only five cases [6.25%]. Thirty-five [44%] and 12 [28%] were presented with some and severe dehydration respectively at the time of admission. Analysis of drug treatment [antibiotics, anti-protozoal, anti-emetics, stool hardeners, probiotics] showed that 65 [81.25%] children received appropriate treatment as per recommendations of World Health Organization. All children were discharged uneventfully. Continuous training and supervision of the Trainee Medical Officers is required to implement standard treatment of acute watery diarrhoea according to laid down World Health Organization guidelines. Such activities will help to reduce inappropriate use of drugs and wrong treatment for diarrhea

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs