mohamed babi

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized idiopathic systemic disorder associated with elevated serum IgG4 level and tissue infiltration by IgG4-positive plasma cells. Multiple neurological manifestations, including peripheral neuropathy, have been described in IgG4-RD. Our objective is to discuss a case report and review of the literature, which would expand the spectrum of IgG4-RD. We describe the clinical features and biopsy findings in a patient with IgG4-RD who presented with features suggestive of neuromyopathy in the setting of recurrent pleural effusion and weight loss. Electrodiagnostic findings were suggestive of an irritable myopathy and polyradiculoneuropathy with primary demyelination and secondary axonal degeneration. Pleural biopsy and laboratory studies confirmed the diagnosis. Improvement was sustained with steroid therapy. We describe the first case, to our knowledge, of IgG4-related neuromyopathy associated with recurrent pleural effusion. Our case expands the clinical spectrum of IgG4-RD. Neurologists should be aware of this treatable disorder and in the appropriate clinical context consider it in the differential diagnosis of neuromyopathy.

The effect of home and industrial processing on the protein quality of baby foods and breakfast cereals, commonly consumed in Pakistan, was studied. The nutritive value of baby foods and breakfast cereals was determined chemically (including amino acid analyses) and biologically in N-balance experiments with growing rats. Lysine and threonine were found to be the limiting amino acids in home and industrially produced baby foods whereas lysine was the limiting amino acid in all the breakfast cereals. The lysine contents of home-prepared baby foods were damaged to a great extent at 150–160°C compared with 100–110°C. The levels of lysine (35–76%) and arginine (10–41%) were in all the breakfast cereals reduced by the industrial processing. The net protein utilisation (NPU) of home-prepared baby foods ranged from 51–81% as compared to 57–60% for industrially produced baby foods. The net dietary protein calorie per cent (NDp cal%) of home and industrially produced baby foods varied between 2.6 and 7.3% and between 7.0 and 7.1% respectively. The industrial processing reduced significantly the true digestibility (4–20%), biological value (13–34%) and net protein utilisation (17–41%) of all the breakfast cereals.

A 27-year-old woman was admitted at 39 weeks' gestation for induction of labour for gestational diabetes. During artificial rupture of her membranes, cord prolapse occurred necessitating an emergency caesarean section. At closure, the incision, instead of being in the lower uterine segment, was found to be in the vagina about 1.5 cm below the anterior lip of the cervix. This was closed routinely, both mother and the baby made an uneventful recovery and at a 6 week postnatal check-up the vaginal wall was completely healed and normal.

Blood samples from 813 newborns were spotted on to filter paper and the 17-hydroxyprogesterone concentration was measured using the Delfia (R) fluorometric immunoassay. The median, mean, and standard deviation (SD) for the total population were 20, 21 and (11) nmol/L respectively. Males had significantly higher levels than females with median, mean and (SD) of 22, 22 and (12) nmol/L. Similarly, low birth weight babies were found to have significantly higher levels than normal birth weight babies with median, mean and (SD) of 21, 24 (12) nmol/L. Preterm babies were also found to have significantly higher levels than full term babies, with median, mean and (SD) of 25, 29 (16) nmol/L. As experienced elsewhere, those factors should be taken into consideration when considering a cut-off point in any neonatal screening program for congenital adrenal hyperplasia.