BACKGROUND Fibromyalgia syndrome (FMS) had raised controversy including its existence. From early twentieth century, it was established as a disease, causing disability, where there are symptoms without signs, biomarkers or investigational abnormalities. It is common in all ethnic groups across countries. A considerable fraction of outpatients are FMS patients. So, this study was planned to assess the awareness of this clinical entity among medical professionals at different levels. MATERIALS AND METHODS Qualitative study using in depth interview was conducted among undergraduate (UG) medical students doing clinical posting, house surgeons and internal medical residents. Informal data collection was done from internists, orthopaedicians, psychiatrists & neurologists. All were interviewed at their work places. Enquiries were made regarding FMS, aetiopathogenesis, diagnosis, differential diagnosis, approach to FMS and management. Patients were interviewed in neurology OPD. Data was collected in detail regarding symptomatology, number of specialty consultations, investigations, interference with work and relationships, economic burden incurred, drug treatment and loss of hope. Enquiry was done to know whether they were told about their disease. They were followed up. RESULTS Undergraduate students, house surgeons and residents were unable to diagnose FMS. Residents were able to diagnose, but occasional errors were observed. Attitude of some of senior consultants were sceptical. Most patients were unaware of the diagnosis. CONCLUSION Knowledge and attitude in relation with FMS is poor among medical students and clinicians. Patients like to get educated about their illness.
Background Worldwide leprosy is a common cause of peripheral neuropathy. Electrophysiology is underutilized in its diagnosis. Objective This study aims to evaluate the usefulness of electrophysiological study in the diagnosis of leprous neuropathy. Materials and Methods Clinical and electrophysiological abnormalities of 36 histopathology proven leprosy patients from January 2015 to January 2017 were studied. Statistical Analysis Proportions were compared by Chi-square test. Results Total patients were 36. Thirty-four patients had abnormal electrophysiology and 34 had neurological deficits like weakness, sensory changes, and thickening. By clinical examination, multiple nerve involvement (motor weakness, sensory changes, and nerve thickening) occurred in 29, single nerve in 5, and no nerve involvement in 2. With electrophysiology, multiple nerve involvement (mononeuritis multiplex) was present in 32, single nerve in 2, and normal conduction parameters in 2. From the 36 patients, a total of 1,008 nerves were subjected to clinical examination and 132 were picked up clinically as affected, (13.1%). Electrophysiological study was done in 504 nerves, and 215 were found to be involved, (43%). Nerve abnormality detected by electrophysiology is significantly higher than clinical detection. (Chi-square =164.4054; p = 0.0000). Clinically, the most commonly affected nerve was unar (27) and the least affected was median (2) nerve. Electrophysiology detected 69% of nerves with demyelination and 35% of nerves with axonal features (mosaic pattern). Discussion There was subclinical neuropathy with electroclinical dissociation, as evidenced by more abnormality in electrophysiology than clinical examination. The nerve involvement was mononeuritis or mononeuritis multiplex pattern, both clinically and electrophysiologically. Electrophysiology showed both axonal and demyelinating nerve involvement (mosaic pattern). All the three features are present in leprous neuropathy. In corollary, if a patient has these electrophysiological features, he should be thoroughly investigated for leprosy. Conclusion Triple findings, such as subclinical neuropathy with electroclinical dissociation, mononeuritis multiplex, and mosaic pattern of demyelination and axonopathy, suggest leprous neuropathy
Background Fibromyalgia (FM) is a common disorder in general population and it causes an increased patient load in hospitals and specialty clinics. FM attendance will be high in clinics dealing with neuropathic pain and other pain syndromes. Though prevalence of FM has been studied in community and pain clinics in other countries, it has not so far been studied in India. So, a study is relevant and hence it was planned in neurology clinic of a teaching government hospital. At present, they are treated mainly by nonsteroidal anti-inflammatory drugs (NSAIDs) which are public health hazard. Methods Using 2016 revision of 2010/2011 American College of Rheumatology criteria of FM, patients were screened in neurology OPD. Proportion and clinical profile were noted. Study was continued for 6 months till the sample size was met. Results A total of 2,300 patients were screened. Two hundred and ninety-eight FM patients were identified among them. Proportion was 12.96%. Delayed diagnosis of more than a year occurred in 55%. Only 29.2% were treated, but none was offered cognitive behavioral therapy (CBT) before. NSAIDs for pain were given for 51.01%. Conclusion Proportion of FM detected is considerable. Affection of homemakers and manual laborers, delayed diagnosis, coexisting comorbid illness, and treatment of pain with NSAIDs are causes of concern. Clinicians should be sensitized to clinical profile and criteria of FM. Patients should be diagnosed and treated by CBT at the earliest and NSAIDs should be avoided as far as possible.
BACKGROUND The aim of the study is to evaluate the clinical profile of early-childhood Limb Girdle Muscular Dystrophy (LGMD) and to determine the phenotype and age of manifestation. MATERIALS AND METHODS It is a retrospective, descriptive, observational study; data collected by hospital-chart review, in University Hospital of South India. Children with muscle-biopsy proven children with dystrophy, with symptom-onset of less than or equal to five years were included. RESULTS Eight had onset at or below two years, fourteen between two to five. Of early-onset cases, seven did not have definite referral diagnosis presented with delayed milestones. Phenotypically all were Duchenne Muscular Dystrophy (DMD). Other types of LGMD were not recognized. CONCLUSION Early diagnostic suspicion of muscular dystrophy, (especially DMD, which is having genetic implications and treatable to limited extent), should be emphasized in those with delayed milestones. Neonatal screening of DMD is not recommended universally. It is important to have clinical suspicion very early in life, as DMD presents as delayed milestones. Serum CK estimation helping in diagnosis, can be followed by genetic testing or muscle biopsy with immunostaining. Calf hypertrophy adds weightage to diagnostic suspicion. Early diagnosis will contribute to genetic counselling and treatment will slow disease progression, improve quality and life expectancy.
BACKGROUNDA fifty-two-year-old man presented with acute onset right lower facial and ear numbness and facial weakness, after two weeks of the onset of symptoms. Examination revealed right central facial palsy, depressed corneal reflex and hemifacial sensory loss (mild over forehead, severe over lower cheek, jaw & pinna) Localization was proposed in brainstem Vs Cerebellopontine angle. MRI Brain revealed infarct in peri Rolandic area; four more patients had similar presentation over next few years.1 Core findings were ipsilateral graded facial sensory impairment with central facial palsy, ear involvement & impaired corneal reflex. Four had spastic hand.Hypothesis-Cortical lesions can have LMN-like presentation; impairment of facial and external ear (pinna) sensations, and attenuated corneal reflex.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.