diagnostic dilemma of progressive muscular atrophy

Progressive muscle atrophy is a rare subtype of motor neuron disease that affects only the lower motor neurons and presents as asymmetrical rapidly progressive muscle weakness, atrophy and normal sensations. The diagnostic electrophysiological findings are denervation potentials in three out of four body segments [bulbar, cervical, thoracic and lumbosacral]. The disease is fatal and the management is supportive. We present the report of a 45-year-old female patient who presented with unilateral foot drop and rapidly progressed to profound weakness in muscles of all limbs, neck and back along with dysarthria and dysphagia. She had been operated twice for suspected cervical and lumbosacral intervertebral disc herniations and ultimately guided in right direction after muscle biopsy, nerve conduction studies and electromyography

Multiple myeloma presenting with a maxillary lesion as the first sign

Multiple myeloma is a clonal neoplastic proliferation of terminally differentiated B-lymphocytes involving the skeletal system in a multifocal fashion. Its oral manifestations are less common in the maxilla than in the mandible due to the lower amount of hemopoietic bone marrow in the maxilla. We report the case of a 50-year-old man who presented with a mass in the left maxillary alveolar region with tooth mobility. The mass had become enlarged after the teeth were extracted 15 days previously. Radiographs demonstrated multiple punched-out radiolucent lesions in the skull and pelvic region. Computed tomography images showed a soft tissue density mass in the left maxilla, eroding the floor and walls of the maxillary sinus. Although several analytical techniques were used to characterize the lesion, it was finally confirmed as multiple myeloma through immunohistochemistry.

Spinal cord injury without radiographic abnormalities [SCIWORA] in a preschool child: a case report

A 3, 1/2 year old boy presented at the Soldiers' Family Rehabilitation Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi with 2, 1/2 years' history of weakness and numbness in legs and loss of control over bowel and bladder following run over by a vehicle. At presentation, the child was unable to stand without support with power of 2/5 in iliopsoas, 3/5 in extensor hallucis longus and 0/5 in ankle plantar flexors on both sides. The power in quadriceps was0/5 on right and 2/5 on left side. The knee and ankle jerks were absent bilaterally. Sensations to both light touch and pin prick were impaired below T9 level on both sides. Perianal sensations were intact but voluntary anal contraction was absent. He was categorized as a case of Spinal Cord Injury T9 as classified by American Spinal Injury Association [ASIA] with impairment Scale C. X-Rays and Magnetic Resonance Imaging Scans were normal. These investigations aided by relevant clinical features qualified him as a case of Spinal Cord Injury without Radiographic Abnormalities

Hepatoprotective effects of curcuma longa against carbon tetrachloride induced liver injury in rats

To investigate the protective effect of Curcuma longa [CL] against carbon tetrachloride [CC1[4]] induced liver injury in adult male Wistar rat model. Study Experimental/Analytical study Place and Duration of Study: Animal House, Isra University Hyderabad from March to December 2013. Forty five adult male Wistar rats were divided into three groups; Group 1. controls received 0.9% isotonic saline, Group 2. received CC1[4] orally [1.9mg/kg] mixed in olive oil, and Group 3. received the CC1[4]+CL [250mg/kg] Blood samples were collected for liver biochemical assays. The animals were sacrificed, liver tissue, after fixation in 4% formaldehyde, was embedded in paraffin. Tissue sections of 5 micro thickness were subjected to haematoxylin and eosin staining and were assessed by light microscopy. The data was analyzed on SPSS 21.0 using one-way ANOVA, Fischer's LSD and Chi-square tests. A p-value of

effects of monosodium glutamate on the histology of fallopian tube in female rats

To investigate the effects of orally administered monosodium glutamate [MSG] on the fallopian tube histology in adult female Wistar rat model. Experimental/Analytical study. Animal House, Isra University Hyderabad from May to November 2013. Forty adult male Wistar rats were divided into three groups; Group A. controls received 0.9% isotonic saline, Group B. received MSG orally [1.5 mg/kg], and Group C. received MSG orally [3 mg/kg]. The animals were sacrificed after six weeks. Fallopian tubes were fixed in 4% formaldehyde, and were embedded in paraffin. Tissue sections of 5micro thicknesses were subjected to haematoxylin and eosin staining and were assessed by light microscopy. The fallopian tubes [FT] of the control group A showed normal histological features. The fallopian tubes of the treated groups showed some cellular hypertrophy of the columnar epithelium, distortion of the basement membrane separating the endosalpinx from the myosalpinx. There were degenerative and atrophic changes observed in some parts; these were more pronounced in those that received 3 mg/kg body weight of MSG. There were marked vacuolations and lysed red blood cells, [3 mg/kg body weight treated rats] appearing in the stroma cells. The monosodium glutamate may have deleterious effects on the fallopian tube histology in adult female Wistar rats particularly in high dose. Therefore caution must be taken for its frequent use in female because of possibility of female infertility

Penile amputation due to improvised explosive device [IED] blast injury in a pakistani soldier

Penile amputation is a catastrophe and the goal should be to restore adequate mass, sensation and functionality of penis considering penile prosthesis where necessary. A case of a 25 year soldier who had penile amputation due to improvised explosive device blast injury is reported

Quality of referrals for nerve conduction studies and electromyography to a tertiary care rehabilitation center

To perform an audit of quality of referrals for Electrodiagnosis [EDX]/Nerve conduction studies and Electromyography [NCS/EMG] to a tertiary care rehabilitation center. A detailed referral proforma covering all the prerequisites for EDX studies had already been distributed among the dependent Defense Forces hospitals. The data was taken from that proformas and the patients were asked if the referring physician had explained them about the test and if they had gone through the instructions. Frequencies and percentages were calculated for provision of clinical information, query, reading of instructions by the patients and punctuality of the patients. The reporting time of the patient, if they were late than the appointment time was calculated in minutes. Physician's explanation about the procedure to the patient and provision of information about precautions and contraindications was also included Of the total 130 registered patients, 85 were males and 45 females. 86 [66.2%] referrals were made by consultants, 42 [32.3%] by residents and 2 [1.5%] by General Practitioners. 41 out of total were from consultants and residents in Physical Medicine and rehabilitation followed by 22 from Orthopedics. Regarding institutions, largest number of referrals were from Combined Military Hospital Rawalpindi [43] and Armed Forces Institute of Rehabilitation medicine [40]. By large, the clinicians neither provided clinical notes [62%] nor mentioned the query and provisional diagnosis [53%]. Majority [92%] did not provide information about the test to the patient and did not cue the patient about any precaution to be taken [92%].The patients on the other hand generally read the instructions provided in the request pro forma [54%] and reported well in time for the appointment of procedure [86%]. An inappropriate practice in referring patients uncritically to the EDX studies. Adopting good referral practices seemed crucial for meaningful usefulness of NCS/EMG. Instructions for proper referrals were sent to the concerned hospitals and a repeat audit was planned after one year

Congenital insensitivity to pain with anhidrosis: a case report from Pakistan and literature review

Congenital insensitivity to pain with anhidrosis is a rare disease with an autosomal recessive inheritance. The patients present in early childhood with frequent episodes of fever and absence of sweating. Painless fractures, bruises and cuts are quite common. Defective lacrimation and mental retardation are strongly diagnostic. Repeated injuries often lead to a reduced life expectancy. The diagnosis depends on relevant clinical features, abnormal sensory response on nerve conduction studies and nerve biopsy showing loss of the unmyelinated and small myelinated fibers. We report here a 5 year old female child who presented for electrodiagnostic evaluation and was found to have this disease

Diabetes mellitus; incidence of chronic hepatitis C patients

Hepatitis C virus [HCV] is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma [HCC]. HCV infection and type 2 diabetes are two common disorders with a high impact on health worldwide. There is growing evidence to support the concept that HCV infection is a risk factor for developing type 2 Diabetes Mellitus. Both insulin resistance and diabetes can adversely affect the course of chronic hepatitis C, and lead to poor response to antiviral therapy and increased incidence of Hepatocellular carcinoma. The objective of the study was to assess the frequency of type 2 Diabetes mellitus in newly diagnosed chronic hepatitis C patients presenting in Allied hospital Medical unit II during six month period. Cross sectional study. Medical unit-II, Allied Hospital, Faisalabad. 01-08-2009 to 28-02-2010. All newly diagnosed patients of chronic hepatitis C on the basis of PCR for HCV-RNA were included in the study. Fasting and two hours postprandial blood sample were tested. Diabetes Mellitus was labeled as per slandered. Out of 180 patients with CHC 19 [10.6%] were found to have Diabetes mellitus while 161[89.4%] were non-diabetics. There is close association in the development of type 2 diabetes mellitus in patients with chronic hepatitis C

In vitro susceptibility of chloramphenicol against methicillin-resistant staphylococcus aureus

To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin [30 microg] disc for detection. Minimum inhibitory concentration [MIC] of chloramphenicol against MRSA was determined by using E-strip [AB BIO DISK]. The susceptibility was determined by swabbing the Mueller-Hinton agar [MHA] plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol [in microg/ml]. Clinical and Laboratory Standards Institute [CLSI] recommendations of /= 32 microg/ml as resistant were followed in interpreting the results. Out of the 174 MRSA isolates, 132 [75.86%] isolates were susceptible to chloramphenicol with MICs of A[2] 8 microg/ml, 38 [21.84%] were resistant >/= 32 microg/ml while 4 [2.30%] were in intermediate range with MIC of 16 microg/ml. Chloramphenicol has shown good in vitro activity against MRSA and is likely to have a key role in the treatment of MRSA infections providing us a good alternative to newer expensive antimicrobials in resource limited countries

Frequency of hepatitis C virus infection and estimation of serum alanine aminotransferase in HCV positive patients

Hepatitis C virus [HCV] has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Hepatitis C is rapidly emerging as a major health problem in developing countries including Pakistan. Serum Alanine Aminotransferase [ALT] is the most frequently utilized screening test in routine evaluation of liver damage. This study was conducted to determine the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase. Determination of the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase in patients at social security hospital, Islamabad. A cross sectional study was conducted at clinical laboratory of social security hospital Islamabad, from May 2009 to October 2009. All samples referred to social security hospital for hepatitis profile were included in the study. All patients were screened serologically for hepatitis C virus antibodies and serum alanine aminotransferase was determined in selected HCV positive patients only. Out of 1006 blood samples 146 were positive for anti-HCV antibodies with an overall positivity of 14.5%. Out of these 55% cases were males and 45% were females. Seroprevalence of HCV was found to be 8% in the age group of <20 years, and almost equal i.e. 46% and 49% in 20-40 years and >40 years age groups respectively. Serum ALT was determined in total 83 patients only: they showed levels less than 30U/L in 25% patients, 30-45U/L in 15% patients, 46-60U/L in 19% patients, 61-100U/L in 29% patients and more than 100U/L in 12% patients. The present study revealed that prevalence of HCV was 14.5% and ALT levels were found to be more than 45U/L in 75% of the anti HCV positive cases, showing the significance of this biochemical marker as diagnostic tool in such patients

Polymyositis presenting with respiratory failure.

Polymyositis is a systemic autoimmune disorder characterised by inflammatory myopathy of the skeletal muscles predominantly affecting the proximal muscles and associated with extra-muscular manifestations like dysphagia and skin involvement. In this case report, we describe the occurrence of diaphragmatic weakness and respiratory failure due to polymyositis with relatively well preserved power in limb muscles.

Stiff person syndrome and myasthenia gravis.

Association of stiff person syndrome, an immune related disorder of anterior horn cells and myasthenia gravis an endplate disorder with similar pathogenesis, is rare. This communication documents this association in the Indian literature for the first time.

Phytochemical studies on the species of genus abutilon

The medicinal properties attributed to various Abutilon species created wide interest in their phytochemistry. This article deals with a summarized account of various chemical constituents isolated so far from Abutilon species