Prognostic indicators in patients with intracranial tuberculoma: a review of 102 cases

To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma. Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years. A total of 102 cases were seen with an age range of 1 to 75 years [mean, 30 years]. Predisposing factors included Diabetes mellitus [8 patients] and pregnancy or puerperium [7 patients]. Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever [59%], headache [57%], meningeal irritation [36%] were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis [one-third with neutrophilia]. Forty-nine [50%] patients had clinical or laboratory evidence of concomitant tuberculous meningitis, Chest radiographs showed active or old tuberculous infection [25%], with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas [mean, 4.5 lesions per patient] on contrast CT or MRI scan. Hydrocephalus was present in 37 [37%] patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis. The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis

Characteristics of diabetic patients and pattern of diabetic complications

The objective of our study was to elucidate and establish the basic characteristics of diabetic patients in Pakistani population and to determine the prevalence of micro and macrovascular complications in them. This was an observational study conducted in the diabetic clinic of Mayo Hospital, affiliated with King Edward Medical College Lahore. Six hundred and seventy patients attending diabetic clinic in the year 1996-97 were studied. We determined the basic characteristics of patients and diabetic complication on history, physical examination and investigations. A total of 670 patients [174 males and 496 females] were studied. Most of the patient's ages at the onset of diabetes ranged from 36-55 years, with the mean value of 41.1 t 13.5 years. Female to male ratio was 2.5:1. Fifty-four% of patients were overweight [BMI >25 kg/m2] and history of diabetes in first degree relatives was obtained in 46.7% of patients. Ninety one% had NIDDM and 9% IDDM. Out of the total, 22.3% had retinopathy, 14.6% had nephropathy while sensory and motor neuropathy was present in 40.6% and 29.1% respectively. History of angina pectoris was present in 16.4%, myocardial infarction in 5.5%, cerebrovascular accident in 5.8%, and 3.7% had peripheral vascular disease. Approximately 53% of the patients were hypertensive [systolic > 140 or diastolic >90]. Out of 112 patients with an early onset of disease [< 40 years] 8 had experienced ketoacidosis compared to 9 out of 503 [1.8"/0] who had late onset diabetes. Two hundred eighty nine [42.9%] patients required hospitalization, either for the control of diabetes or for the management of its complications. Seventy five% of the patients had at least one complication attributable to diabetes mellitus. We conclude that NIDDM is highly prevalent in our society with seventy five% of patients presenting with one or more complications. Needless to say that more attention given to good metabolic control can reduce the prevalence of diabetic Complications