Assessment of topiramate's efficacy and safety in epilepsy.

OBJECTIVE: To study the significance of topiramate (TPM) addition on seizure control in treatment of epilepsy. DESIGN: A prospective open label add-on trial of TPM addition in patients with epilepsy was done. The events of baseline phase of 12 weeks followed by titration and maintenance phases were recorded. Assessment of the number of seizure and emergent adverse effects was done by a monthly visit for each case. MAIN OUTCOME MEASURES: Reduction of more than 50% mean seizure frequency or response ratio of 0.33 was taken as the criteria for responders. STATISTICAL ANALYSIS: Normal Z-test for significance of differences between two proportions and Chi-square test for presence of association was applied and mean age, median duration, sex ratio, percentage prevalence were depicted. RESULTS: Significant responses to TPM in both partial as well as generalized seizures were observed (Z = 6.66, P < 0.001 and Z = 4.185, P < 0.01). The effect was more pronounced in patients with partial seizures. However, the overall response was highly significant (Z = 7.839, P < 0.001). The best response was noted at the dose of 200-300 mg/day (Z = 6.708, P < 0.001). More than 35% cases of partial and generalized seizures reported more than 75% reduction levels. The drug was well tolerated in more than 65% cases for side effects on psychosis, giddiness, and anorexia. Mild side effects were seen only in about less than 35% cases. CONCLUSIONS: TPM was found as a significantly effective add-on anticonvulsant with some limitation or mild side effects.

Hypoglycemic effect of Rhizophora mucronata in streptozotocin induced diabetic rats.

Rhizophora mucronata, plant of Mangroove family, found on the coastal region of India and used in treatment of various diseases. Different parts of plants are used in treatment of diabetes as folkloric medicine. The present study was designed to evaluate the hypoglycemic effect of hydro-alcoholic extract of R. mucronata. Streptozotocin (STZ)-induced diabetic rats were treated with RME (100 mg/kg and 200 mg/kg) and glibenclamide (0.5 mg/kg). Blood glucose levels were evaluated for the acute and sub-acute studies and body weight of rats were also monitored. All the treatments showed the highly significant (p<0.01) hypoglycemic effect in both the acute and the sub-acute studies. RME and glibenclamide treated rats were maintained the body weight during the study period while as the body weight of diabetic rats had gone down. The result of this study scientifically proved the hypoglycemic folkloric use of leaves of R. mucronata in treatment of diabetes.

Apical pulmonary lesions due to Marfan syndrome misdiagnosed as pulmonary tuberculosis.

A 55-year-male with chest symptoms and apical pulmonary lesions was diagnosed as a case of sputum smear-negative pulmonary tuberculosis at a peripheral health centre in India on the basis of Revised National Tuberculosis Control Programme Guidelines--he was put on antitubercular chemotherapy. He had no radiological or clinical improvement with antitubercular treatment, so the patient was referred to our institute. On evaluation, we found that the patient had multisystem involvement with typical features of Marfan syndrome and a suggestive history in other blood-relatives. Upper lobe fibrosis, bronchiectasis, emphysematous changes, multiple blebs, small pneumothorax, pleural fibrosis and pleural thickening were seen which were due to Marfan syndrome rather than tuberculosis. The present case seems to signify the search for alternative aetiologies in similar clinico-radiological presentations if, after 3 months, cultures for Mycobacterium are still negative (despite sputum induction and/or bronchoscopy with biopsies) and the patient is having no radiological improvement.

Correlation between high-resolution computed tomography features and patients' characteristics in chronic obstructive pulmonary disease.

BACKGROUND: During the last few decades, high-resolution computed tomography (HRCT) has come up as a new diagnostic modality to diagnose emphysematous and chronic bronchitis components of chronic obstructive pulmonary disease (COPD). The present study was undertaken to evaluate for various quantitative and qualitative HRCT features in patients with COPD, and to detect patients' characteristics that correlate with these HRCT features. MATERIALS AND METHODS: Forty male patients with COPD attending the COPD clinic at a tertiary referral hospital and postgraduate medical institute were included in the study. Various HRCT features, including tracheal index, thoracic cage ratio, sterno-aortic distance, thoracic cross-sectional area, vascular attenuation, vascular distortion, mosaic attenuation pattern, and directly visible small airways, were evaluated and correlated with patients' characteristics, including age, duration of illness, quantum of smoking, dyspnea score, quality-of-life index, and various spirometric indices. RESULTS: We found significant correlations of various quantitative and qualitative HRCT features with age, duration of illness, quantum of smoking, quality-of-life index, and the spirometric indices showing the extent of airways obstruction. CONCLUSIONS: Various quantitative and qualitative HRCT features were found to correlate with patients' characteristics, spirometric indices, and health-related quality-of-life score, suggesting that HRCT is useful not only in detecting emphysema and its various subtypes but also in predicting the extent and severity of COPD.

Primary tuberculous glossitis in an immunocompetent patient.

Tuberculous glossitis is a rare entity that has been described sporadically. Primary tuberculous glossitis, as described in this case report, is still exceptional. A 25-year-old male with no known immunosuppressive disorder presented with a tuberculoma at the base of his tongue. This was confirmed by tongue biopsy and a positive polymerase chain reaction response to the mycobacterium. The patient had a favourable response to anti-tubercular treatment. This highlights the importance of considering tuberculosis in the differential diagnosis of chronic tongue lesions, even in the absence of pulmonary tuberculosis.