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.