Ultra-short-course and intermittent TB47-containing oral regimens produce stable cure against Buruli ulcer in a murine model and prevent the emergence of resistance for

Buruli ulcer (BU), caused by

Frequency of demyelinating pattern on electrophysiological study in patients with diabetic peripheral polyneuropathy

To determine the frequency of demyelinating pattern on electrophysiological study in patients with diabetic peripheral polyneuropathy. Cross sectional study. This study was performed at Department of Neurology, Mayo Hospital, Lahore and Medical Unit II, Allied Hospital, Faisalabad from 01-Jan-2012 to 30-Sep-2012. In this study non-probability purposive sampling technique was used. The calculated sample size was 100 cases. All patients with diabetic peripheral neuropathy and of both gender and age between 15-65 y were included in the study. Whereas Diabetic patients in whom history, clinical examination or medical record showing renal failure, hereditary neuropathies, thyroid disease, alcohol intake and toxic drug intake like anti tuberculous treatment, anti-cancer medicine etc were excluded from the study. Nerve conduction studies and electromyography were performed. Patients were labeled as having demyelinating, axonal or mixed pattern. The collected information was entered into SPSS version 15. Among the enrolled 100 patients, 56 [56%] patients were male and 44 [44%] patients were female. On electrophysiological examination, demyelinating pattern was found in 18[18%] patients, axonal pattern in 54[54%] patients and mixed pattern in 28[28%] patients. Mean duration of diabetes mellitus was 82 months + 56 S.D. The duration of diabetes ranged from 8-264 months. Our study indicates that there is high frequency of demyelinating neuropathy in patients of diabetic peripheral polyneuropathy in our local population

study of chronic inflammatory demyelinating polyneuropathy [CIDP] in diabetics: clinical features, laboratory findings and response to treatment

The association of chronic inflammatory demyelinating neuropathy [CIDP] in diabetics is a recently recognized form of neuropathy. It is important to recognize CIDP occurring in diabetics because, unlike diabetic polyneuropathy, it is treatable. These patients can respond to immune therapies similar to patients with CIDP without diabetes. To study the clinical, electrophysiological, and laboratory features and response to immune modulating treatments in diabetic patients with CIDP. This was a retrospective cross sectional study from January 2009 till December 2012 carried out at Mayo Hospital and National Hospital, Lahore. The inclusion criteria included proven cases of diabetes mellitus with subacute motor weakness fulfilling the research criteria for diagnosis of CIDP. All patients underwent electrophysiological [EP] studies and cerebrospinal fluid analysis [CSF] especially for proteins. Diagnosed CIDP patients were treated with oral prednisolone 1mg/kg body weight along with azathioprine 50-150mg/day. The steroids were gradually tapered after achieving normal muscle strength or a static phase of one month without further improvement in muscle strength. The maintenance dose of prednisolone was continued to complete two years therapy. A course of IVIg [400mg/kg body weight daily for five days] or plasmapharesis [five sessions on alternate days] were used in patients with severe motor weakness to expedite the initial recovery phase. Follow was done at monthly interval for one year and bimonthly for subsequent years. The Hughes functional grading scale was used to assess the outcome. Treatment was considered effective when the patient's condition improved by 1 or more grade on the Hughes scale. There were 10 patients with 6[60%] males and 4[40%] females and M: F ratio of 1.5:1. The mean age of patients was 63.7 + 7.83 years. Mean duration of diabetes mellitus was 11.3 +3.77 years. All patients had Type 2 diabetes mellitus with six patients on Insulin and 4 on oral hypoglycemic agents. Mean duration of motor weakness before treatment was 5.30 + 1.16 months. Mean power as assessed by medical research council [MRC] grading in upper limbs was 3/5 [range 1-5] and lower limbs 1/5[range 0-2]. Seven [70%] patients had mixed demyelinating and axonal picture on EMG, and 3[30%] patients showed predominantly demyelinating type of neuropathy. CSF protein was high in all patients with mean CSF protein of 208.4 + 93.07 mg/dl. Mean duration of follow up after treatment was 25.10 + 15.82 months. Attempt was done to stop immunotherapy after 2 years but relapse occurred in 3 [30%] patients which again responded to steroids. Outcome was assessed by Hughes functional grading scale. Mean Hugh's functional severity grade before treatment was 4.10 + 0.316 and after treatment was 1.30 + 1.16. We conclude that CIDP in diabetics is potentially reversible type of neuropathy and needs careful evaluation for its recognition. The classical demyelinating pattern on EMG may be lacking because of coexistent axonal neuropathy but clinical history of subacute onset predominantly proximal motor weakness [LMN type] and high CSF protein are most sensitive markers to predict response to corticosteroids in these patients. This is more common in males and elderly long standing diabetics. The response to corticosteroids and other immunosuppressive therapies is excellent. The recognition of this entity is important as appropriate management can reverse the disability in these patients

Chronic relapsing inflammatory optic neuropathy [Crion]

This newly recognized entity named chronic relapsing inflammatory optic neuropathy [CRION] is a form of inflammatory optic neuropathy which is frequently bilateral and often painful, and is characterized by relapses and remissions. There is no evidence of acquired demyelinating disorders and systemic collagen vascular or granulomatous diseases. To study the clinical features and response to treatment in patients with recurrent optic neuritis consistent with diagnosis of chronic relapsing inflammatory optic neuropathy [CRION]. Materials and. This is retrospective cross sectional study carried out at department of Neurology, King Edward Medical University, Lahore. Patients with history of recurrent episodes of acute or subacute loss of vision accompanied by pain consistent with optic neuritis, unilateral or bilateral, but, without evidence of an acquired demyelinating disorders, systemic collagen vascular orgranulomatous diseases were included in the study. The response to various treatments was also analyzed.A total of 4 patients were identified. All were females with mean age at presentation 35.50+8.10 years and mean age at onset of first episode was 28+10.92 years. Mean duration of illness was 7. 25 + 4.57 years. The number of episodes varied from 3-6 [mean 4+1.41episodes]. Mean episodes of right optic neuritis were 2.25+0.95 and left side 1.50+ 0.57. Only one patient had an episode of simultaneous bilateral optic neuritis. All patients experienced severe pain with loss of vision to finger counting at less than one meter. MRI brains, detailed vasculitis profile, serum angiotensin converting enzyme [ACE] inhibitor level, and X-ray chests were normal in all patients. The CSF for oligoclonal band was also negative. All patients received pulse therapy with methylprednisolone 1 gm daily for three days followed by two weeks oral taper. Most patients improved after first episode but there was partial recovery after the second and subsequent episodes. Only one patient had complete loss of vision in one eye. Two patients received long term oral steroids and azathioprine with prevention of further relapses. One patient received beta interferonwith complete remission so far. One patient received cyclosporine and oral steroids with remission for 6 years but subsequently relapsed after immunotherapy was discontinued. Chronic relapsing inflammatory optic neuropathy [CRION] should be considered in patients with history of recurrent optic neuritis after exclusion of acquired demyelinating disorders, and systemic collagen vascular or granulomatous diseases