Hyperglycemia Followed by an Abrupt Decrease of Blood Glucose Is a Rare Cause of Posterior Reversible Encephalopathy Syndrome (PRES).

Introduction: Posterior Reversible Encephalopathic Syndrome (PRES) is a clinical syndrome of headache, confusion or decreased level of consciousness, visual changes, seizures and focal neurologic signs associated with characteristic neuroimaging findings of posterior cerebral white matter edema. In most cases, PRES is precipitated by sudden increase in blood pressure; however, in the case presented here, the etiology was different as it was secondary to extreme changes in glucose levels. Case Presentation: A 49-year-old female with a past medical history of hypertension and diabetes mellitus, type 2 was brought to the emergency room with a chief complaint of visual changes for 1 hour in duration. She described that the visual changes, like blurred vision in both eyes, happened after an abrupt decrease of blood glucose (BG) from 700 to 75 mg/dl. This abrupt drop in BG led to PRES in this patient, which is an uncommon presentation. Magnetic resonance imaging (MRI) of the brain was obtained, which was consistent with demyelinating lesions present in bilateral occipital lobes, suggestive of PRES. Fortunately, the patient's symptoms improved after avoidance of further abrupt fluctuations in BG. PRES commonly resolves within days if diagnosed and treated early. Prompt management can reduce morbidity and mortality. Conclusion: A diagnosis of PRES can be difficult, especially if it was caused by rare etiology. In this case we highlight the cause and explain the hypothesis behind it.

A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan.

BACKGROUND: The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia. This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia. METHODS: We included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases. RESULTS: Out of 96 included studies, 83 provided data for random effects meta-analyses. The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer. The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36). Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders. CONCLUSIONS: Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan.

Equity in the use of public services for mother and newborn child health care in Pakistan: a utilization incidence analysis.

BACKGROUND: Poor maternal and infant health indicators are mostly concentrated among low income households in Pakistan and health care expenditures - especially on medical emergencies - are the most common income shocks experienced by the poor. Public investments in health are therefore considered as pro-poor interventions by the government of Pakistan. This study employs nationally representative household data for Pakistan for 2007-08 and 2010-11 to investigate whether benefits from publicly financed services on Mother and Newborn Child Health (MNCH) are effectively captured by the poor in terms of service utilization. METHODS: The study conducts a Utilization Incidence Analysis of the use of public health services for MNCH in Pakistan. For this purpose, the utilization shares of households, ranked by economic status, are computed. The concentration curves are plotted and their dominance is tested against an equal distribution and Lorenz curves to determine whether the distribution is pro-poor and progressive. RESULTS: Although the shares of bottom income groups in the utilization of most services for MNCH have increased between 2007 and 2011, the utilization of some services such as post-natal consultation; institutional maternal delivery; and Tetanus Toxoid injections for pregnant women remains pro-rich in 2011. The utilization of pre-natal consultation, especially through lady health workers and visitors; the use of Family Panning Units; and immunization services is somewhat evenly distributed. The use of Basic Health Units (BHUs) is found to be pro-poor. The provincial analysis reveals that the province of Baluchistan depicts an unusually high level of inequity in the distribution of utilization benefits from almost all public health services. Finally, in terms of progressivity, public spending on all health services analyzed in the study is found to be progressive at the national level implying that investment in MNCH has the potential to redistribute income from rich to the poor. CONCLUSION: To target the poor effectively, the study recommends expanding the network of BHUs as well as basic reproductive and child health care services. The outreach of health facilities in Baluchistan need to be expanded while targeting the poor effectively by mitigating various access costs that prevent them from using public health services.