The existence of subclinical adrenal insufficiency in active tuberculosis is a matter of debate and little is known in this regard. This analytical cross-sectional study is contemplated to find out the association between active tuberculosis and subclinical adrenocortical insufficiency. Where 77 active tubercular patients have been included consecutively in the study along with 30 age and sex matched healthy controls for comparison. Nearly two-thirds (64.9%) of the cases ware diagnosed as pulmonary tuberculosis and rest 35.1% as extra pulmonary tuberculosis. In pulmonary tuberculosis 68.8% had subclinical adrenal insufficiency but 31.2% in extra pulmonary tuberculosis. It shows that 62.3% of the cases had sub-clinical adrenocortical insufficiency as opposed to none in the control group (p < 0.001). Adrenal insufficiency appeared to be significantly associated with smear positivity, X-ray evidence of severe disease and multi-drug resistance. Therefore, physician ought to look for subclinical adrenal insufficiency among patients with active tuberculosis specially if they are sputum positive, X-ray evidence of severe disease and multidrug resistant TB.
Faridpur Med. Coll. J. Jul 2019;14(2): 67-70
A 52 years old lady presented with sudden severe headache with the history of similar intense headache twenty years back which ended up with left sided blindness. Her physical examination was unremarkable except optic atrophy of the left eye. Investigation included biochemical work up, imaging studies and CSF study. The MRI of brain with contrast gave the key diagnostic clue with characteristic findings of hypertrophic pachymeningitis. Other investigations helped to rule out possible etiologies and the diagnosis idiopathic hypertrophic pachymeningitis was finally made. The patient has been treated with steroid and enjoyed improvement in her yearlong symptoms.
Amyotrophic lateral sclerosis (ALS) is the commonest MND phenotype. Although many of the atypical motor neuron disorders share some features with ALS, they often can be distinguished by their clinical and electrophysiologic characteristics. Here we present five different cases with varied clinical findings. All the patients were referred from outpatient department to neurophysiology laboratory where electrodiagnostic (EDX) correlations helped to come to a conclusion. The nerve conduction study protocol for a suspected atypi¬cal motor neuron disorder is the same as that for ALS. Akin to the nerve conduction studies, the EMG evaluation of patients with suspected atypical motor neuron disorders is similar to that of ALS. An extensive study is indicated, often of all four limbs, the paraspinal muscles, and the bulbar muscles to reach a possible diagnosis. History, clinical findings and electrophysiological correlation often help to differentiate these atypical motor neuron disorders. Correct diagnosis is needed for further evaluation and prognosis. In this case series five (5) cases have described who are referred from outpatient department to neurophysiology laboratory for electrodiagnostic (EDX) correlations. [Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 57-61]
Dermatomyositis is overly simplified as inflammatory myopathy with characteristic rashes. Understanding dermatomyositis is challenging because firstly presentation may be non-specific, vague and delayed. Secondly there is no specific diagnostic test or universally acceptable diagnostic criteria. Therefore, to missed or delayed diagnosis results in failure to treatment. A forty year old lady with facial rash and generalized weakness was diagnosed with dermatomyositis on the basis of generalized weakness, typical facial rash with very high CK and eletrophysiological study. Steroid treatment initially improved her symptoms.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 191-193
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