A prospective observational study to identify the effectiveness of intravenous magnesium replacement in an intensive care setting.

Background and Aims: To estimate the incidence of hypomagnesemia and identify the effectiveness of a calculated dose of intravenous magnesium sulfate (MgSO4) in correction of hypomagnesemia and its relationship with renal function in critically ill patients. Material and Methods: All patients admitted in the adult intensive care unit were enrolled in the study and magnesium levels were monitored. Patients with serum magnesium levels <1.7 mg/dL received calculated doses of Intravenous MgSO4. The average rise in serum magnesium levels per gram of MgSO4 administered was calculated and relationship with estimated glomerular filtration rate (eGFR) was identified. Results: In total, 27.27% of patients admitted in our intensive care unit had an incidence of hypomagnesemia. The average rise of serum magnesium levels in patients with hypomagnesemia was 0.13 (±0.05) mg/dl. The average rise of serum magnesium levels was 0.10 (±0.04) mg/dL in patients with eGFR ≥ 90 mL/min/1.73 m2 and 0.15 (± 0.05) mg/dL in patients with eGFR < 90 mL/min/1.73 m2. This difference between the two groups (P-value = 0.002) and the trend of increasing average rise in serum magnesium levels with declining eGFR values (P-value = 0.013) were both statistically significant. Conclusion: Incidence of hypomagnesemia in the critically ill population is around 27.27%. Intravenous administration of 1 g of MgSO4 results in a rise of serum magnesium levels by 0.1 mg/dL in patients with normal eGFR and around 0.15 mg/dL in patients with eGFR values between 30 and 89 mL/min/1.73 m2.

Epilepsy Surgery in Hospital Universiti Sains Malaysia: Our Experiences since 2004.

Epilepsy surgery has been performed by a few centres in Malaysia, including Hospital Universiti Sains Malaysia (HUSM). To date, a total of 15 patients have undergone epilepsy surgery in HUSM. The epilepsy surgery included anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH) and Vagal nerve stimulation (VNS). The surgical outcomes of the patients were assessed using the International League Against Epilepsy (ILAE) outcome scale. The ILAE scores for patients who underwent ATL with AH were comparatively better than those who underwent VNS. One of the patient who underwent ATL with AH and frontal lesionectomy was found to have psychosis during follow up. Epilepsy surgery has proven to be an important treatment for medically resistant epilepsy. Thus it is important to raise public awareness regarding epilepsy and its treatment.

Teletherapy sources with imported and indigenous Co activity.

Board of Radiation and Isotope Technology, a unit of the Department of Atomic Energy, fabricates and supplies radioactive sources for medical, industrial, agriculture and research applications. High specific activity cobalt-60, required for teletherapy is normally imported. There was a proposal for manufacturing high specific activity sources indigenously. A study was carried out to observe the feasibility of mixing imported and indigenous cobalt-60 pellets to fabricate teletherapy source capsules. The specific activity of imported pellets is more than 300 Ci/g, whereas that of indigenous pellets obtained from Indian power reactors is 140 Ci/g. The radiation output from a capsule for different combinations of specific activity was evaluated. Losses due to self-absorption were accounted in the evaluations. In another study, the optimized lengths of the capsule for an output of 200 RMM and the additional activity to be added to compensate losses due to self-absorption were also estimated for different specific activity pellets. Sources fabricated on the basis of this study showed a good agreement with the estimations. Source capsules with a combination of different specific activities are yet to be fabricated.

Neuropsychological assessment in epilepsy surgery - preliminary experience in a rural tertiary care hospital in north East malaysia.

We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient's cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients' quality of life (QOLIE 31) were administered to refractory epilepsy patients under evaluation for surgical treatment. These tests were repeated one year after surgery and we studied any changes in trends. A total of seven patients were recruited in this study between July 2004 and July 2006. The aetiologies of refractory epilepsy were pure mesial temporal sclerosis (MTS) in five patients, dysembryogenic neuroepithelial tumour (DNET) in one and dual lesion of cavernous angioma with ipsilateral MTS in one. The preoperative neuropsychological tests were all in concordance to MRI finding, and showed good contralateral function; five lateralises to the right and two to the left. The post-operative Engel seizure count (median 8.00, IQR 7.00-8.75), general IQ (88 vs. 79), performance IQ (94 vs. 79), verbal memory (89 vs. 71), non-verbal memory (88 vs. 75) and QOLIE (53.14 vs. 44.71) were better compared to preoperative values. The verbal IQ (84 vs. 84) was unchanged. Neuropsychological tests are useful as ancillary investigations to determine the laterality of seizure focus and integrity of function in the contralateral temporal lobe. Following successful surgical treatment, there is a trend towards improvement in memory, IQ and quality of life scores in this small group of patients.

Extradural spinal schwannoma in 12 year old child : a case report.

We report a case of a 12 year old girl who presented with cord compression. Imaging studies demonstrated an extradural spinal tumour in the lower thoracic and upper lumbar levels. Histology confirmed the diagnosis of schwannoma while associated findings suggested the possibility of Neurofibromatosis Type I.