Abstract
Rawal Medical Journal
An official publication of Pakistan Medical Association Rawalpindi Islamabad branch
Established 1975
Volume 37 Number 2 April – June 2012

ABSTRACTS

6th Annual Neurology Research Day for Medical Students and Residents
May 19, 2012

Division of Neurology
Shifa International Hospital, Islamabad, Pakistan


Medical Residents Platform

Title: Correlation between ammonia levels and the severity of hepatic encephalopathy.
Authors: Dr. Muhammad Omar Qureshi
Affiliation: Gastroenterology Department, Shifa International Hospital, Islamabad

Background: Hepatic encephalopathy (HE) is a broad spectrum of neuropsychiatric manifestations usually affecting individuals with end-stage liver disease. There is agreement that ammonia is a key toxin involved in this disease process.
Objectives: As the correlation between ammonia levels and the severity of hepatic encephalopathy remains controversial, we prospectively evaluated the correlation between ammonia levels with the severity of hepatic encephalopathy in 135 patients coming to tertiary care hospital with liver cirrhosis and hepatic encephalopathy.
Methods: It was prospective non interventional study. A total of 135 patients with liver cirrhosis and hepatic encephalopathy had serum ammonia levels measured. The diagnosis of hepatic encephalopathy was based on clinical criteria, and the severity of hepatic encephalopathy was based on the West Haven Criteria for grading of mental status. Relationship of Ammonia levels were correlated with the severity of hepatic encephalopathy.
Results: Out of 20 patients with normal ammonia levels 13 (65%) patients were in hepatic encephalopathy I-II, 6 (30%) were in Grade III, while 1 (5%) patients was found to be in Grade IV .Out of 45 patients with Mild hyperammonemia 27(60%) patients were in grade I-II, 12 (26%) were in Grade III and 6(13%) were in Grade IV. For moderate hyperammonemia 9/34 were in Grade I-II (26%), 18/34 were in Grade III (53%) , and 7/34 ( 20%) were in Grade IV. While out of 36 patients with severe hyperammonemia 31 ( 86 %) patients were in Grade IV( P<0.001).
Conclusion: Ammonia levels correlate with the severity of hepatic encephalopathy. Greater the ammonia levels ,severe is the grade of hepatic encephalopathy.


Title: To identify causes of poor recovery in upper limb as compared to lower limb in stroke patients after three months of rehabilitation.
Authors: Dr Syed Hussain Shah, Dr. Khalil Ahmed, Dr. Akhter Waheed, Dr. Noreen Akhtar
Affiliation: Armed Forces Institute of Rehabilitation Medicine, Abid Majeed Road, Rawalpindi

Objective: To identify causes of poor recovery in upper limb as compared to lower limb in stroke patients after three months of rehabilitation.
Methods: It’s a cross sectional study which included 28 patients of strok