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

The Relationship between Physical Activity Levels, Sleep Habits and Academic Performance in Physical Therapy Students of Riphah International University, Islamabad

The objective of this study was to determine the relationship of physical activity level, sleep habits and academic performance of Physical Therapy students. Descriptive Cross Sectional Survey. The study was conducted from 1st January 2013 to 1st March 2013 in physical therapy institute of Rawalpindi/ Islamabad. A sample of 190 from first year and final year were taken by using systemic probability sampling. A self-administrated questionnaire, Epworth Sleepiness Scale [ESS] and Rapid Assessment of Physical Activity [RAPA] was used to collect data. The Epworth Sleepiness Scale score 25% and 42% students were categorized in the level 6-8 and 9-11 respectively. The average score of students 33% and 21% were 71-75% and 66-70% marks respectively. 41% students having marks 71-75% lie in 9-11 Sleep score. The total 33 out of 83 [39%] students do light physical activities and get 71-75% marks in exam. Only 2 out of 9 [22%] students who do not do any activity were in 71-75% marks category. It is concluded that students having good grades have less chances of dozing in day. The complete sleep has good effects on concentration of students towards study. It is also concluded that the students who indulge themselves in light activities get good grade in examination

Choroidal melanoma in a young patient - a case report and mini review of literature

Background: Choroidal melanoma is the most common primary intraocular malignant neoplasm in adults[1]. However, there are various benign and malignant lesions that mimic ophthalmoscopic features of choroidal melanoma[2]. Moreover, atypical presentation and unusual age distribution of choroidal melanoma in some cases make the diagnostic elucidation even more difficult and in such cases, supplementary tests especially ultrasonographic methods gain prime importance

Case Description: The authors report a case of primary choroidal melanoma in a 27 years old young male patient who presented to department of Orbit and Oculoplastic at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan in 2013 being the first case to be reported at this age at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan in more than fifteen years. Keeping in view the uncommon age distribution, supplementary tests and the clinical follow-up was essential for the correct diagnosis of the lesion

Conclusion: The present case report draws attention to the fact that age can be a misleading factor and choroidal melanomas should not be over looked in young individuals