A Rare Presentation of Non-systemic Vasculitic Neuropathy Mimicking Guillain-Barré Syndrome: A Case Report.

Vasculitic neuropathy typically presents as a painful, asymmetrical sensory-motor polyneuropathy, more commonly demonstrating a mononeuritis multiplex. We present the case of a 63-year-old woman who experienced acute-onset flaccid weakness in all four limbs following an episode of diarrhea. Guillain-Barré syndrome (GBS) was considered, which supported acute motor axonal neuropathy (AMAN) in the nerve conduction study (NCS). On the second day of treatment with intravenous immunoglobulin (IVIG), a vasculitic-type rash appeared along with limb pain. Furthermore, the asymmetrical sensory and motor weakness did not respond well to the treatment. A positive skin biopsy, however, with a negative nerve biopsy combined with repeat NCSs demonstrating mononeuritis multiplex, confirmed the diagnosis of non-systemic vasculitic neuropathy (NSVN) based upon Brighton Case Collaboration type 3. This presentation underlines the significance of considering vasculitic neuropathy as a potential diagnosis and highlights the importance of an accurate diagnosis, as this condition can be effectively treated.

Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis.

Granulomatosis with polyangiitis (GPA) typically presents with upper or lower respiratory tract symptoms and/or with renal involvement. Although it can affect the peripheral nervous system frequently, with mononeuritis multiplex being the most common pattern, the occurrence of peripheral sensory-motor polyneuropathy as a presenting manifestation is distinctly rare. Prevalence of digital gangrene is also extremely rare in GPA. We describe a 46-year-old woman presenting with severe peripheral sensorimotor polyneuropathy affecting bilateral lower limbs preceded by a purpuric skin rash and multiple painful ulcers confined to the lower limbs. She had evidence of digital ischemia affecting multiple toes and dry gangrene of the left 4th toe. Diagnosis of GPA was made based on skin biopsy, positive ANCA serology, and clinical criteria. She made a good recovery following aggressive immunosuppressive treatment with methylprednisolone and cyclophosphamide and was maintained on prednisolone and azathioprine. This case highlights the importance of suspecting GPA in a patient presenting with sensorimotor polyneuropathy and/or digital ischemia even in the absence of more classic presenting features and underlies the necessity of accurate differential diagnosis in evaluating a case of peripheral neuropathy.

Zinc supplementation in prediabetes: A randomized double-blind placebo-controlled clinical trial.

BACKGROUND: This study evaluated the effects of zinc supplementation on glycemic control, other cardiometabolic and anthropometric parameters, and disease progression in prediabetes. METHODS: A randomized double-blind placebo-controlled Phase 2 clinical trial was conducted over a 12-month period in 200 subjects (43% male; mean [± SD] age 51.8 ± 7.3 years), randomly assigned (1: 1) to the treatment or control group. The treatment group received zinc (20 mg daily). Subjects were evaluated at baseline and at 1, 3, 6, and 12 months. The primary outcome was the change in glycemic control from baseline. Multiple regression analyses were performed, with change in outcome variables after intervention from baseline used as continuous dependent variables. RESULTS: In both groups, mean serum zinc concentrations prior to the trial were below normal (15.29-21.41 µmol/L). During the 12-month follow-up, a significantly higher percentage of participants developed type 2 diabetes in the control compared with zinc-treated group (25.0% vs 11.0% respectively; P = 0.016). Fasting plasma glucose (FPG), 2-h glucose levels in the oral glucose tolerance test (OGTT), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were significantly lower in the treated group, with significant improvement in ß-cell function. In all four regression models, the best predictor of the dependent variables (i.e. change in FPG, 2-h glucose in the OGTT, HOMA-IR, and homeostatic model assessment of ß-cell function) was zinc treatment. CONCLUSIONS: Zinc supplementation reduced blood glucose and insulin resistance while improving ß-cell function. Furthermore, supplementation reduced disease progression to diabetes and had beneficial effects on TC and LDL-C.

Evaluation of pharmacodynamic properties and safety of Cinnamomum zeylanicum (Ceylon cinnamon) in healthy adults: a phase I clinical trial.

BACKGROUND: Cinnamon is considered as a treatment for many ailments in native medicine. Evidence suggests that Cinnamomum zeylanicum (CZ) has anti-microbial, anti-parasitic, anti-oxidant, blood glucose lowering properties and beneficial cardiovascular effects. The present study aims to evaluate Pharmacodynamic properties and safety of CZ in healthy adults using a Phase I Clinical Trial. METHODS: This phase I clinical trial was conducted at the Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka. Thirty healthy adults were recruited for the study, conducted for a period of 3 months, with the dose of CZ (water extract) increased at monthly intervals (85 mg, 250 mg and 500 mg). Data collection was carried out at baseline and during each monthly follow up visit. Anthropometric, clinical and biochemical assessments were done at baseline and during follow up. Adverse effects and drug compliance was also evaluated. RESULTS: Twenty eight subjects completed the three months follow up. Mean age was 38.8 ± 10.4 years and 50% were males. There were no significant changes in the anthropometric parameters during the three months follow up. Both systolic and diastolic blood pressure reduced significant during the 1st month and this reduction was sustained throughout follow up. Full blood count, renal function tests, liver function tests, fasting blood glucose, HDL-c, VLDL-d and triglycerides remained within the normal range without any significant alteration during the 3 months. A significant reduction in the TC (p < 0.05) and LDL-c (p < 0.001) was noted at the end of the 3 months follow up period. There were no serious adverse effects (including hypersensitivity) noted. In two participants dyspepsia necessitated the discontinuation of study participation. Drug compliance was between 85 and 95% during the study period. CONCLUSIONS: This is the first phase I clinical trial in health adults evaluating efficacy and safety of CZ. Our results demonstrate no significant side effects and toxicity of CZ, including hepatotoxicity and anti-coagulation properties. CZ demonstrated beneficial anti-hyperlipidaemic and blood pressure lowering effects among healthy adults. Further studies with larger samples and longer durations may be able to elucidate other side effects and better describe the pharmacodynamic properties. TRIAL REGISTRATION: SLCTR/2013/001 (Sri Lanka Clinical Trials Registry: http://www.slctr.lk/trials/106 ) (Date of Registration: 01/01/2013).

The "e-Generation": The Technological Usage and Experiences of Medical Students from a Developing Country.

BACKGROUND: The medical community is increasingly using Portable Electronic Devices (PEDs). We evaluated usage of PEDs and medical apps among medical students from Sri Lanka. METHODS: This descriptive cross-sectional study was conducted at Faculty of Medicine, University of Colombo. Medical students from 2nd to 5th year were invited for the study. A self-administered questionnaire was used to collect details of PEDs availability, accessibility, and usage, perceived advantages/barriers of PEDs, and availability, accessibility, and usage of medical apps. RESULTS: Sample size was 505 (response rate, 61.8%). Mean age was 23.2 ± 1.3 years and majority were females (60.4%, n = 305). Majority (87.5%, n = 442) of students owned a PED. Nonaffordability was the most common reason for having not owning a PED (46%). Nonaffordability and lack of knowledge were key determinants of the usage of PEDs and medical "apps." Doubts about reliability and lack of knowledge regarding reliable electronic sources of information were other significant barriers. CONCLUSIONS: Our results show that a significant majority of students owned a PED, a higher percentage than what is reported elsewhere. Considering barriers identified, it is important for institutions to promote usage of PEDs and medical apps by providing financial support, training, and knowledge to build confidence in technology.