Medical Specialties Commons^™

Pregabalin Induced Hypersensitivity Reaction And Joint Pains In Patient With Lumbosacral Radiculopathy, Ramla Nayaib Hashmi, Iqra Khan, Ummul Kiram, Soobia .S Siddiqui, Tamaniat .

Pakistan Journal of Neurological Sciences (PJNS)

Pregabalin is an antiepileptic medication commonly used for other purposes. It is also approved for neuropathic pain. Reported adverse effects are not severe, short lasting and are usually well tolerated1. The most common side effects comprise of lightheadedness , sedation , double vision ,increase in bodyweight and imbalance whereas decrease in neutrophil count and hypersensitivity are the uncommon adverse effects. In the literature till date, few case reports are available on the drug reactions to pregabalin. We report a case of young female who developed hypersensitivity reaction with pregabalin including body rashes, hives peripheral edema, and joint pains. Using the …

Neurological Associations Of Covid-19 Vaccines, Rija Zehra Ghazanfar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

It does not come as a surprise that the introduction of an unprecedented treatment for a recently notorious disease will cause concerns and raise some questions. As a race we have become cautious over the centuries about what treatment modalities we accept and reject. With the advent of social media and endless sources of information we find ourselves standing at an intersection of many pathways, thinking meticulously where to go from there? At one point the widely available stats and the complex way in which these vaccines work do not really interest the general population as much as how they …

Development Of Stress-Induced Cardiomyopathy After Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Saad Ahmed Naved, Sadiq Shoukat Parpia, Huma Shoukat Ali

Medical College Documents

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. …

Paediatric Pseudo Papillary Pancreatic Tumour: A Case Based Review, Mir Ibrahim Sajid, Ayesha Saleem, Muhammad Arshad

Medical College Documents

Solid pseudopapillary neoplasms are rare and represent approximately 4% of all cystic pancreatic tumours, and predominately affect females. They have an excellent prognosis, however 10-15% of the patients show metastasis at the time of surgery or recurrence of tumour during follow-up after pancreatectomy. Surgical resection is the recommended treatment. We present a rare case of a 15-year-old female, with a pseudopapillary tumour of the pancreas which was diagnosed pre-operatively.

Optimizing Stroke Care In Baluchistan, Anjum Farooq, Wazir Akbar, Ahmed Wali

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death after ischemic heart disease.(1) Pakistan, currently the fifth most populous country of the world, has limited data on prevalence of stroke and its risk factors. Only two small-scale population-based studies conducted in Karachi showed stroke prevalence of 4.8% and 19.1%. (1) One study conducted in KP province of Pakistan showed estimated stroke prevalence of 1.2%. (1) The burden of stroke risk factors in Pakistan is enormous. Diabetes and hypertension are the most common risk factors in Pakistan. (2) Other common risk factors in Pakistan are active smoking, obesity, and family history of …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Maternal Sociodemographic Factors And Antenatal Stress, Maheshwari Andhavarapu, James Orwa, Marleen Temmerman, Wangira Musana

Obstetrics and Gynaecology, East Africa

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, …

Developmental Status Of Young Children In Foster Care, Jill Mcleigh, Cecy Lazcano, Karlyn Tunnell

Health Status, Outcomes, and Literacy and Healthcare Utilization

Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains. This cross-sectional study used the Ages and Stages Questionnaire, Third Edition, demographic, and health-related data retrieved from electronic health records. The study included 796 children aged 1 to 66 months seen at an integrated primary care clinic exclusively serving CFC. Frequencies and percentages of …

Social Intervention By The Numbers: Evidence Behind The Specific Public Health Guidelines In The Covid-19 Pandemic., Michael P. Savage, David L. Fischman, Mamas A. Mamas

Department of Medicine Faculty Papers

Coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic ushering in a global health and economic crisis. In the absence of vaccines or definitive drug therapies, current strategies against COVID-19 rely on preventing the transmission of disease through nonpharmaceutical interventions such as social distancing and proper hand hygiene. For practical and perhaps ethical reasons, the clinical efficacy of these public health measures for managing pandemics has not been demonstrated in randomized controlled clinical trials. Accordingly, guideline recommendations for using nonpharmaceutical interventions are based primarily on observational and modeling studies and on expert opinion. A recent position paper from the …

The Association Of Symptoms Of Overactive Bladder With Pelvic Organ Prolapse And Its Improvement After Pelvic Reconstructive Surgery, Saida Abrar, Raheela Mohsin Rizvi, Nida Zahid

Department of Obstetrics & Gynaecology

Objectives: This study asseses the association of overactive bladder symptoms and pelvic organ prolapse severity and evaluates the effect of pelvic reconstructive surgery on overactive bladder (OAB) symptoms in women with pelvic organ prolapse (POP). It also looks into any pre and post-operative factors responsible for persistent postoperative OAB symptoms.
Methods: This was a retrospective cross-sectional study conducted at the Aga Khan University Hospital, Karachi between 1st January 2014 and 31st December 2018. In this study women presenting with POP and concommitent OAB who underwent surgery for site specific defects, measured using Pelvic Organ Prolapse Quantification (POP-Q) staging system. OAB …

Intraoperative Uses Of Near-Infrared Fluorescence Spectroscopy In Pediatric Surgery: A Systematic Review, Heba Alghoul, Farah Al Farajat, Osaid Alser, Andrea Rogers-Snyr, Carroll Harmon, Nathan Novotny

Conference Presentation Abstracts

No abstract provided.

Esophageal Magnamosis For The Treatment Of Type-B Esophageal Atresia In A Child With Prohibitive Operative Risk: A Novel Device And Indication., Irving J. Zamora, Muhammad Oa Ghani, Lauren L. Evans, Nathan M. Novotny, Lyndy J. Wilcox, Harold N. Lovvorn, Kristina A. Betters, Mohammad Sahlabadi, Matthew R. Lucas, Jeffrey S. Upperman, Oliver J. Muensterer, Michael R. Harrison

Conference Presentation Abstracts

No abstract provided.

Inequalities In Early Marriage, Childbearing And Sexual Debut Among Adolescents In Sub-Saharan Africa, Dessalegn Y. Melesse, Réka M. Cane, Aveneni Mangombe, Macellina Y. Ijadunola, Adom Manu, Eniola Bamgboye, Abdu Mohiddin, Rornald M. Kananura, Elsie Akwara, Elsabé Du Plessis

Obstetrics and Gynaecology, East Africa

Background: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators.

Methods: We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to exam- ine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for …

Intimate Partner Violence Against Adolescents And Young Women In Sub-Saharan Africa: Who Is Most Vulnerable?, Yohannes Dibaba Wado, Martin K. Mutua, Abdu Mohiddin, Macellina Y. Ijadunola, Cheikh Faye, Carolina V. N. Coll, Aluisio J. D. Barros, Caroline W. Kabiru

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) is a global public health and human rights issue that affects millions of women and girls. While disaggregated national statistics are crucial to assess inequalities, little evidence exists on inequalities in exposure to violence against adolescents and young women (AYW). The aim of this study was to deter- mine inequalities in physical or sexual IPV against AYW and beliefs about gender based violence (GBV) in sub-Saharan Africa (SSA).

Methods: We used data from the most recent Demographic and Health Surveys (DHS) conducted in 27 countries in SSA. Only data from surveys conducted after …

Patients’ Perceptions And Understanding Of Pre-Operative Informed Consent In Tertiary Care Setting- Dar-Es-Salaam, Steven Michael Esanju

Master of Medicine in General Surgery

Background: Informed consent under the ethical principle of autonomy demonstrates patient’s agreement to have procedure/intervention done to them. Considering its importance in safeguarding human rights and autonomy, it is now mandatory to take informed consent before any surgery/procedure. Many studies have questioned whether informed consent is being taken in tr ue spirit that ensures proper understanding of the disclosed information or it is just adhered to as a medico legal formality. Globally, studies have demonstrated that majority of patients do not fully understand even small matters regarding their health i ncluding diagnosis, treatment modalities and possible associated risks, because of …

Isolated Volar Dislocation Of The Distal Radioulnar Joint Treated With Successful Closed Reduction., Matthew T Glazier, Hayden B Schuette, Benjamin A Schnee, Brian Skura, Craig Goubeaux

Surgery Articles

We report the case of A 34-year-old right-hand-dominant male who presented with an isolated left volar dislocation of the distal radioulnar joint (DRUJ) without any associated fractures. The patient had sustained the injury in an altercation in the evening prior to the presentation and had woken up the next morning with left wrist pain and restricted wrist motion. Closed reduction was successful under conscious sedation and the patient was treated conservatively with splint immobilization without needing operative intervention. This report highlights a rare injury pattern - an isolated volar DRUJ dislocation - that was successfully closed reduced, despite reports that …

Secondary Hyperparathyroidism And Its Clinical And Biochemical Associated Factors In Patients On Maintenance Hemodialysis In Dar Es Salaam, Doris Samwel

Master of Medicine in Internal Medicine

Background: Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis. Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise. Objectives: This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association …

Compliance To Imaging Follow Up Recommendations Among Patients With Bi-Rads 3 Breast Lesions, Florence Thuita

Master of Medicine in Imaging and Diagnostic Radiology

Background: The Breast Imaging Reporting and Data System 3 (BI-RADS 3) category is assigned to lesions which are deemed to be probably benign on breast imaging with a low likelihood of malignancy (≤2%). With regular imaging follow-up, this category is intended to reduce the rate of invasive biopsies while enabling early detection of breast cancer. However, imaging follow-up has been reported to be challenging to both radiologists and referring clinicians in terms of its appropriate use on the various imaging modalities and understanding management of the patients in this category. Furthermore, it has been reported to induce patient anxiety and …

The Utility Of An Initial Point-Of-Care Lactate In Predicting In-Hospital Mortality Among Adult Patients With Sepsis And Septic Shock At The Emergency Department Of A Tertiary Hospital In Nairobi, Gicheru B. Nyachira

Master of Medicine in Clinical Pathology

Background: Sepsis is a leading cause of death and now a global health priority. Rapid identification, diagnosis and intervention can result in reduced in-hospital mortality. Elevated lactate has been shown to be a strong predictor of in-hospital mortality. However, the optimal cut-off has not been well defined. Identification of the optimal Point-of-Care (POC) lactate cut off that best predicts in-hospital mortality can therefore be used to rapidly risk stratify patients with suspected sepsis and septic shock presenting to the emergency department allowing for immediate intervention. Objective: To determine the lactate cutoff from an initial Point-of-Care lactate result from a GEM …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi, Kenya, Isabella Chelagat Mengich

Master of Medicine in Clinical Pathology

Background; Multiple myeloma (MM) is a heterogeneous disease with variable patient outcomes ranging from indolent to aggressive disease. GLOBOCAN data places Kenya amongst the top five African countries for MM incidence and MM-related mortality. Aberrant expression of CD56, CD117, Cyclin D1 and Ki-67 on neoplastic plasma cells has been demonstrated to be useful in disease prognostication. However, majority of the data on MM comes from western countries. The significance of expression of this markers is uncertain in our population. The aim of this study was to determine the immunophenotypic expression profile of CD56, CD117, Cyclin D1 and Ki-67 in a …

Clinicians’ Perceptions Of Pediatric Assent For Invasive Bedside Procedures At Three Tertiary Referral Hospitals In Nairobi County, Kenya., Grace Petrine Oyito Omondi

Master of Medicine in Paediatrics and Child Health

Background: The medical profession is built on the foundation of morals and ethics guided by principles of beneficence, non- maleficence, autonomy and justice. In order for an individual to be sufficiently autonomous, the value of information is indispensable. The information allows the patient to make an informed decision concerning their healthcare. The patient then gives an informed consent or assent as is applicable to the pediatric population. Majority of the studies surrounding pediatric assent revolves around obtaining it for research. There is a paucity of literature in regards to pediatric assent for clinical treatment more so as regards clinicians’ perceptions …

Knowledge, Attitudes And Practice Of Venous Thromboembolism Risk Assessment Among Surgical Doctors In Tanzania, Biswalo Mugeta Yango

Master of Medicine in General Surgery

Introduction Surgical patients are at increased risk of venous thromboembolism due to the nature of their conditions and treatments. The incidence ranges from 61.3% to 64.9% in developed countries, compared to 43% in Africa. Although venous thromboembolism is fatal, it is potentially preventable. Physician-implemented risk assessment models reduce events by 70%. No country in sub-Sahara Africa has implemented a national venous thromboembolism risk assessment guideline. The subsequent burden is probably a reflection of low awareness and knowledge, negative attitudes, and substandard practice among physicians towards risk assessment. Justification In the current study, we assessed Tanzanian surgical doctors' knowledge, attitudes, and …

The Saudi Critical Care Society Extracorporeal Life Support Chapter Guidance On Utilization Of Veno-Venous Extracorporeal Membrane Oxygenation In Adults With Acute Respiratory Distress Syndrome And Special Considerations In The Era Of Coronavirus Disease 2019, Hani N. Mufti, Ahmed A. Rabie, Alyaa M. Elhazmi, Husam A. Bahaudden, Mostafa A. Rajab, Ayed Y. Assiri, Khalid A. Maghrabi, Abdullah M. Abudayah, Adel A. Tash, Awad A. Al-Omari, Mohamed H. Azzam

Saudi Medical Journal

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). This …

Anti-Nmda Receptor Encephalitis, Zaid Waqar, Haris Majid Rajput, Muhammad Hassan, Iqra Athar, Neelma Naz Khattak, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Anti N-methyl-D-aspartate receptor (NMDA)receptor encephalitis is one of the most common type of auto immune encephalitis. Its diagnosis is often delayed due to initial clinical presentation with psychiatric clinical features. Initial clinical features resemble those of acute psychosis or depression which later evolve into frank neurological dysfunction. This was first described in association with ovarian teratoma, but it was later also found to exist without neoplastic association and in men as well. It occurs more frequently in younger age group, mostly below 50 years of age. Diagnosis is established with the help of cerebrospinal fluid (CSF) analysis for oligo clonal …

Gaba-B Encephalitis In Pakistan: A Rare But Treatable Entity, Asfandyar Khan Niazi, Shafain Shaikh, Arsalan Ahmad, Ayesha Zafar, Tahir Aziz Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune and paraneoplastic encephalitides are a group of neurologic disorders that present with cognitive decline, neuropsychiatric symptoms, movement disorders, or seizures. These diseases can present before, with, or after the diagnosis of malignancy. We report two cases of GABA-B encephalitis from Pakistan. The first patient was a 67-year-old gentleman presented with cognitive decline and neuropsychiatric symptoms. His CSF analysis showed increased protein levels and GABA-B receptor antibodies. He was treated with pulse steroids, which improved his symptoms. The second patient was a 34-year-old lady with cognitive decline and psychomotor symptoms. Her serum autoimmune antibody panel showed antibodies against GABA-B receptors. …

Association Of Hypomagnesaemia & Hypocalcemia With Intracerebral Hemorrhage And Outcome, Muhammad Hassan, Naveed Ullah Khan, Mansoor Iqbal, Haris Majid Rajput, Ehsan-Ur- Rehman, Waleed Shahzad, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Determine if hypomagnesemia & hypocalcemia on admission was associated with ICH and outcome.

Magnesium is a vascular smooth muscle relaxant and appears to provide protection against cellular injury in experimental stroke models. The implication of low serum magnesium in primary ICH is not well defined.

All patients with a primary ICH presented to PIMS, Islamabad prospectively analyzed in a pilot study. Demographics, initial lab values, ICH location, Mg+2 level, NIHSS & MRS at presentation were recorded. All patients with INR <= 1.5 were included in this study. We took normal serum magnesium in our study was 1.8 - 2.5 mEq/dL. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP).

We identified 66 patients who met the inclusion criteria. The mean age was 52.76 years with minimum and maximum age …

Criminal Thinking Styles And Criminal Social Identity Among Juvenile Delinquents: Moderating Role Of Parenting Styles, Fatima Sana, Muhammad Rafiq, Muhammad Nasar Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Parenting is considered imperative in the development of juvenile's cognitions, and beliefs. The parent-child relationship might significantly influence juvenile’s thought patterns and social communications. Different parenting styles perhaps indicate criminal involvement of juveniles, resultantly turns them into delinquent. The present study was done to discover whether parental authority styles moderate the path that links criminal thinking styles to criminal social identity amongst juvenile delinquents. Participants of the study were 211 juvenile delinquents who responded on Juvenile Criminal Thinking Styles’ Inventory (Sana & Rafiq, 2019), Measure of Criminal Social Identity (Boduszek, et al., 2012), Parental Authority Questionnaire (Babree, 1997) and approached …

Valproate Used In Women Of Childbearing Age With Epilepsy, Salman Mansoor, Kevin Murphy, Siobhan Kelly, Shoab Saadat

Pakistan Journal of Neurological Sciences (PJNS)

Valproate is one of the oldest known anti-epileptic drugs (AED) in practice which was discovered in 1881 and later in 1962 was approved for treating epilepsy. It is indicated in most of the seizure types including generalized onset (motor, non-motor and myoclonic), focal onset, unknown onset and unclassified. Valproate has other indications in migraine prophylaxis, and bipolar disorder.

Early Neurological Deterioration After Acute Stroke; Mechanism And Predictors, Bushra Ammad Taimuri, Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurological deterioration after acute ischemic stroke (AIS)is a common occurrence, leading to increased mortality, morbidity, and poor quality of life among stroke survivors. Recognition of the individuals at a greater risk for neurological deterioration may contribute to making early decisions and monitoring the therapy. Neurological deterioration arises in up to 40% of subjects after AIS during hospitalization and is followed by neurological and functional debility. Numerous predictors have been devised that predict this progression. This includes preliminary assessment of the severity of stroke, brainstem infarction, hyperglycemia, atrial fibrillation, diabetes mellitus and substantial fluctuations in blood pressure. Sequential observations, in depth …

Migraine And Fasting, Lubna Ashraf Jafri, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Migraine is considered as the second leading cause of disability worldwide, most commonly seen in young women. Skipping meals, dehydration and fasting are among many triggering factors which have been described in literature as a cause of increased frequency and severity of migraine attacks. The underlying pathophysiology, prevention and management of fasting induced migraine has been documented, however, there is a lack of randomized controlled trials for the same. This review article discusses these important aspects in the light of published literature and gives directions on future areas of research.