An electrodiagnostic study on carpal tunnel syndrome

OBJECTIVE: To study the changes occurring in electrophysiological parameters such as nerve conduction velocity [NCV], conduction time [CT] and amplitude of median [sensory and motor] nerve action potential inpatients with carpal tunnel syndrome [CTS]

DESIGN: Experimental observational study

SETTING: This study was carried out in Department of Physical Medicine and Rehabilitation, Jinnah Postgraduate Medical Centre, Karachi

DURATION: August 2009 to September 2010

METHODOLOGY: Subjects were patients of carpal tunnel syndrome [n=30] and normal healthy persons [n=20] were examined during the course of present study. The electro-diagnostic recording of effected 33 wrists [17 unilateral and 8 bilateral] were obtained by electromyography, using "surface electrodes" for determination of median motor nerve conduction velocity [M-MNCV] and "ring-electrodes" for determination of median sensory nerve conduction velocity [M-SNCV]

The recordings of 5 patients were out of range of electromyography, therefore excluded from the study. Besides the NCV, other parameters such as, median motor conduction time [M-MCT], amplitude of motor action potential [MAP], amplitude of sensory action potential [SAP] and median sensory latency [M-SL] were also recorded in patients and healthy subjects for comparison of our results. Data was analyzed statistically on SPSS version 17.0

RESULTS: Among 30 patients with suspected CTS, 5 patients has unobtainable electro-diagnostic results

In 33 wrists of 25 patients M-MCT significantly increased [5.26 +/- 0.36 m sec] as compared with normal subjects [4.12 +/- 0.12 m sec P<0.01]. Highly significant slower M-MNCV found in patients of CTS [46.50 +/-1.26 m/sec] than normal subjects [58.30 +/- 0.73 m/sec P<0.01]

The amplitude of M-MAP was low [less than 4.29 mv in CTS], 2.25 +/-0.40 vs. 6.55 +/- 0.45, P<0.01

Finger III median sensory digital nerve of CTS showed significantly increased value of M.-SL [2.48 +/- 0.16] when compared with normal [1.89 +/- 0.03 msec P<0.01]

The significant decreased values of M-MSNCV recorded in CTS patients [42.14 +/- 2.22] as compared to the normal subjects [54.20 +/- 1.11 P<0.01]

The significant decrease amplitude of SAP also recorded in patients [7.25 +/- 2.42 mv] as compared to normal subjects [27.90 +/- 2.40, P<0.01]

CONCLUSION: This study confirmed that nerve conduction study is a sensitive and helpful test for early detection of abnormal functions of nerve which direct the physician towards the appropriate line of treatment

Assessment of homocysteine levels in preeclampsia

Assessment of Homocysteine levels in preeclampsia. A cross-sectional analytical study. Department of Physiology, BMSI, JPMC, Karachi in collaboration with Department of Gynecology and Obstetrics, JPMC, Karachi from March 2005 to November 2005. Study included 90 subjects distributed into three groups of 30 subjects each. 30 were apparently health subjects. 30 mild pre-eclamptic and 30 severely prerec lamptic. Clinical details were collected. Fasting blood samples were drawn by adopting aseptic methods and serum was analyzed for Homocysteine levels by !Mx Analyzer method. Among 90 screened subjects Homocysteine in 30 normal subjects was 6.61 mmol/L. 30 mild preeclamptic subjects showing 12.65 mmol/L was highly significant as compared to normal. However; 30 severe preeclamptic subjects shows mean Homocysteine level 14.44 mmol/L as compared to normal. The difference in both groups weir statistically highly significant as compared to normal subjects. Concluded that serum homocysteine levels were strongly associated with preeclampsia, which suggests that elevated circulating homocysteine may be involved in pathogenesis of uteroplacental vascular disease associated with preeclampsia, which may he a risk marker in pregnant women

Changes in haemoglobin, red cell count, red cell indices and reticulocyte count in response to daily versus intermittent oral iron supplementation during pregnancy in local population

To assess and compare the relative effectiveness of different oral iron supplementation regimens on hematological parameters in pregnant anemic women. This study was carried out in the Department of Physiology, Basic Medical Sciences Institute with collaboration of Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre Karachi. Subjects were pregnant women [n=90] showing clinical anemia [Hb<11g /dl] in their 20-24 weeks of gestation. All selected women were randomly assigned to one of the three treatment groups at the time of registration [30 in daily, 30 in TW, 30 in WS] 75 out of 90 enrolled women successfully completed 12 weeks trial. Group-I received 60 mg oral iron daily, Group-2 received 60 mg TW and Group-3 received 120mg once weekly. Haemoglobin, red cell count, red cell indices and reticulocyte count were evaluated by routine methods initially at baseline before iron therapy then at four weeks interval for 12 weeks following iron therapy. There was no significant difference existed in the mean haemoglobin level, RBC count, Red cell indices and Reticulocyte count between three treatment groups at the end of 12 weeks therapy. The increase in reticulocyte count showed effective erythropoiesis following iron therapy. The results within the group were compared from baseline to twelve weeks and all the groups were compared with each other. Intermittent iron supplementation is an equally effective mode of treatment of anemia as it has similar effect on hematological status to those of standard daily supplements

Iron status in pregnancy complicated with preeclampsia

The present study was undertaken to evaluate the iron-status in preeclampsia and a possible contributory role of iron in the etiology of preeclampsia. The study subjects were classified into two groups, normal healthy pregnant women as a control and preeclamptic group. The blood was used for estimation of hemoglobin and haematocrit while serum was used to assess the serum iron, total iron binding capacity [TIBC] and serum ferritin. Significantly increased levels of iron, serum ferritin and transferrin saturation were found in preeclamptic as compared to control group. The total iron binding capacity [TIBC] and unsaturated iron binding capacity [UIBC] were significantly decreased in preeclamptic group as compared to the control group. It was concluded from this study that increased level of serum iron may be implicated in oxidative stress in preeclampsia but no positive correlation was found between serum iron, serum ferritin, total iron binding capacity and elevated blood pressure in preeclamptic group