EARLY RESPONSE OF LOCAL STEROID INJECTION VERSUS MINI INCISION TECHNIQUE IN TREATMENT OF CARPAL TUNNEL SYNDROME.

BACKGROUND: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the postoperative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. METHODS: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups.58 Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. RESULTS: In this study mean age of the patients was 32.8 +/- 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. CONCLUSION: The difference in pain after 1 month of the intervention was not statistically significant.

Relationship between anti-acetylcholine receptor antibody titres and severity of myasthenia gravis.

OBJECTIVE: To study the relationship of anti acetylycholine receptor antibody (AchR-Ab) titres with the demographic profile and severity of myasthenia gravis (MG). METHODS: This prospective study was carried out on inpatients and outpatients at the Department of Neurology at Pakistan Institute of Medical Sciences, Islamabad. Seropositive cases of myasthenia gravis were collected and were classified as having low AchR-Ab titres (< 50 nmol/L) and high AchR-Ab titres (> 50 nmol/L). The comparison of these patients was done using the following parameters: sex, age, clinical presentations, severity of the disease, repeated nerve stimulation test, prostigmine test, the association with thymus status, other autoimmune diseases, and therapeutic outcome. RESULTS: Out of a total 71 seropositive MG patients enrolled in the study, forty one (57.7%) patients had low titres and thirty (42.2%) had high titres. Their mean age was 33.18 +/- 12.99 years (range 13-70) and thirty eight of them were females. The AchR-Ab titers were higher in the younger age group and in women than in men, however, the results were statistically insignificant. The most common presenting symptoms were ocular (91%), followed by generalized weakness with easy fatiguability (57%) and bulbar weakness (46.4%). Majority of the patients at the time of presentation were in Osserman's stage III (43%); while 26% and 19.7% were in stage IIA and IIB respectively. There was no association between the AchR-Ab titers and clinical grades of Osserman's classification. CONCLUSION: Serum concentration of anti acetylcholine receptor antibodies do not relate with the clinical severity of myasthenia gravis.

Chest radiographic findings in neurotuberculosis without pulmonary signs and symptoms.

OBJECTIVE: To determine the chest radiographic findings in patients of adult neurotuberculosis, with no pulmonary signs and symptoms. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January 2004 to January 2006. PATIENTS AND METHODS: A total of 100 patients fulfilling pre-defined criteria of neurotuberculosis were included. Chest radiographic (CXR) evidence of pulmonary TB was looked for in those patients and its frequency, pattern and association with the clinical grades at presentation was determined by using Chi-square test. RESULTS: Out of the 100 patients of neurotuberculosis, with no clinical evidence of pulmonary TB, radiographic evidence of pulmonary TB was seen in only 30% patients. The predominant patterns on CXR were apical infiltration (26.6%), miliary mottling (20%) and hilar enlargement (16.6%). Positive CXR was found in 16.7% patients in clinical grade I and 40% and 43.3% in patients in grade II and III respectively. There was a strong association of grade II and grade III with positive chest radiographic findings (p= 0.03). CONCLUSION: Patients of neurotuberculosis may have chest radiographic evidence of pulmonary TB even in the absence of pulmonary signs and symptoms at presentation. There is a strong association of clinical grade II and grade III with positive chest radiographic findings.