Clinical and EEG characteristics of juvenile myoclonic epilepsy

To determine the clinical and electroencephalographic characteristics of patients with Juvenile Myoclonic Epilepsy [JME]. In this descriptive case series study, 60 patients of Juvenile myoclonic epilepsy [JME] were included. After detailed history clinical examination, Electroencephalography [EEG] with standard protocol was performed in all patients and was analyzed by a neurologist. Out of 60 patients, 26 [43.3%] were males and 34 [56.6%] were females. Mean age at the onset of myoclonic jerks [MJ] and generalized tonic clonic seizures [GTCS] was 13.7 +/- 2.12 years and 14.15 +/- 1.79 years respectively. Average delay in the diagnosis was 5.2 years. Myoclonic jerks [MJ] were present in all patients, GTCS in 52 [86.6%], and absence seizures in 8 [13.33%] patients. 6 [10%] had only Myoclonic Jerks. First seizure type was MJ in 52 [86.6%] and absence in 8 [13.3%]. Most common precipitating factors were sleep deprivation in 80% and fatigue in 66.6%. Family history for epilepsy was positive in 20%. Diagnosis by referring physicians was JME in only 6 [10%] patients. EEG was abnormal in 42 patients [70%] showing generalized, 4- to 6-Hz polyspike and wave in 27 [45%], generalized single spike/ sharp waves in 7 patients [11.6%], 8 [13.3%] patients had 3-Hz spike-and-wave [SW] activity in addition to the polyspike-and-wave [PSW] pattern. Independent focal EEG abnormalities were noted in 12 patients [20%]. Many of our patients were misdiagnosed by the referring physicians and were prescribed inappropriate antiepileptic drugs. Factors causing misdiagnosis were failure to elicit history of myoclonic jerks, misinterpreting myoclonic jerks as partial seizures and misinterpretation of EEG abnormalities

Malarial hepatopathy in falciparum malaria

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-1 [Ward 5], Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease [e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice] was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years [mean 26.04 +/- 8.33]. All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two [51.6%] had serum bilirubin 3-6 mg%, 20 [32.2%] had 6-10 mg% and 10 [16.1%] had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients [45%] had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 [35.4%], splenomegaly in 48 [77.4%] and both hepatomegaly and splenomegaly in 16 [25.8%]. Gallbladder wall thickness was increased in 5 [8.06%] patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given

Association of non alcoholic fatty liver with type 2 diabetes mellitus

Background: Non alcoholic fatty liver disease [NAFLD] is a common chronic condition of which Diabetic fatty liver accounts for a large proportion, with 50 to 75% of the subjects demonstrating fat in the liver on Ultrasound. As a result of epidemic increase in obesity, hyperlipidemia and our diabetes mellitus patients, the prevalence of NAFLD in the general population is increasing. The aim of this study is to determine the frequency of NAFLD in type 2 diabetic patients in our setup at Jinnah postgraduate Medical Center, Karachi Pakistan

Methods: A total of 120 type 2 diabetic patients were included in the study. Patients with known chronic liver disease and history of alcohol intake were excluded. These patients were evaluated by abdominal ultrasonography to determine the presence of fatty liver. They were divided into fatty liver group and non fatty liver group; and were further evaluated by measurement of body mass index, HbA1c, liver function tests and lipid profile. The data obtained was analyzed using SPSS version 10.0

Results: Out of 120 type 2 diabetic patients, 73 [60.8 %] had fatty liver on ultrasonography. An increase in the BMI and levels of HBA1c, ALT, AST, alkaline phosphatase and GGT, total cholesterol, triglycerides, LDL and a decrease in HDL was observed in the fatty liver group as compared to non fatty liver group

Conclusion: The prevalence of NAFL is higher in type-2 diabetic patients. Obesity, dysglycemia, dyslipidemia and elevated liver enzymes are seen more frequently in fatty liver than nonfatty liver type-2 diabetic patients

Frequency of sensory motor neuropathy in type 2 diabetics

To determine the frequency of sensory motor neuropathy in type 2 diabetics at the time of presentation to the hospital. Non interventional, descriptive. The study was conducted at Medical Unit-1, Jinnah Postgraduate Medical Center, Karachi, from November 2005 to April 2006. Patients of different ages and either gender with history of confirmed diabetes for ten years and above, on regular follow up were included. Those with non-diabetic causes of hyperglycemia or neuropathy were excluded. Relevant features like age, gender, treatment, symptoms, signs, nerve conduction study [NCS] results, duration of Diabetes mellitus [DM], fasting blood sugar [FBS] and serum values of glycosylated hemoglobin [HB1Ac] were recorded. Out of a total of 300 patients, there were 111 female and 189 male patients. Mean age was 58 +/- 11.23 years. Mean duration of diabetes was 13.6 +/- 5.48 years. One hundred and twenty three patients had symptoms of neuropathy. Clinical examination revealed mixed sensory and motor signs in 135 [45%] patients. Nerve conduction studies revealed abnormalities in 159 [53%] patients. Among patients having an abnormal NCS, the fasting blood glucose [FBS] was <120 mg/dl in 12 [7.5%] patients, while it was > 120mg/dl in 147 [91%] patients. The glycosylated hemoglobin ranged from 4-15% with mean of 8.1% and standard deviation of 2.5%. This showed significant association [p <0.001] of peripheral neuropathy with abnormal FBS, HB1Ac and duration of diabetes. NCS diagnosed the neuropathy in more than half of the total number of patients, including both symptomatic and asymptomatic patients. Majority of the patients revealed symmetrical and a mixed type [motor and sensory] polyneuropathy. This shows that nerve conduction may not be concordant with the clinical signs and symptoms. NCS detects neuropathy much earlier, before it becomes evident clinically. The neuropathy is associated with abonromal fasting blood sugar, HB1AC and duration of diabetes