Medical Specialties Commons^™

Finger Drop Sign In Guillain-Barre Syndrome, Iqra Athar, Neelma Naz Khattak, Haris Majid Rajput, Mazhar Badshah, Zukhruf Zayian, Tashfain Shifa

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a post-infectious, immune-mediated disease that causes a rapidly progressing poly-radiculoneuropathy resulting in weakness and areflexia. It has several variant forms like AIDP, AMAN and AMSAN,

Common Peroneal Neuropathy In Harvesting Farmers, Harwindar Kumar, Syed Muhammad Anwar Shah, Jamita Kor, Sadaf Qazi, Jasvindar Kumar

Pakistan Journal of Neurological Sciences (PJNS)

In Pakistan harvesting season occurs from April to May and again from October to December. Thirteen farmers with a history of foot drop were studied in neurophysiology laboratory of Lady Reading Hospital (LRH) during the period from March 2019 to December 2019. All the patients had nerve conduction study (NCS) while in some of the patients, electromyography (EMG) was also done to determine the duration of injury and to rule out other differential diagnoses.

A Case Of Acute Psychosis Following Dengue Fever, Waleed Shahzad, Omer Ismail Khalid, Neelam Sarwar, Muhammad Hassan, Tehmina Inayat, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever has been infecting millions of people all around the world specially the rural areas of South East Asia according to World Health Organization. It is caused by an Arbovirus and transmitted by the bite of an infected female Aedes aegyptii mosquito. Dengue commonly presents with fever and thrombocytopenia; rare presentations include acute pancreatitis, dengue hemorrhagic stroke and encephalopathy. Common psychiatric complications of dengue fever include anxiety, depression, manic episodes and catatonia. We present a rare case of a 51 year old man who presented with an acute episode of psychosis including over talkativeness, irritability, authoritative and disinhibited behavior, …

Intra-Carpal Tunnel Steroid Injections Are Superior To Nsaids In Management Of Carpal Tunnel Syndrome, Saba Zaidi, Shafaq Abbas

Pakistan Journal of Neurological Sciences (PJNS)

Carpal tunnel syndrome (CTS) is caused by the compression of median nerve in carpal tunnel. Carpal bones make the floor of the carpal tunnel and the transverse carpal ligament forms the roof. Components include median nerve and the flexor tendons. The pain may be localized to the wrist or may radiate to forearm, arm or rarely shoulder. Effectiveness of treatment by intracarpal corticosteroid injection in comparison with NSAID has never been investigated. The objective of this study was to determine if corticosteroid injections for carpal tunnel syndrome are effective compared to NSAID.

Post Herpes Nmdar Encephalitis In A 8 Month Old Girl, Farida Jan, Shahnaz H Ibrahim

Pakistan Journal of Neurological Sciences (PJNS)

Patients with Herpes Simplex virus Encephalitis are seen to have a relapse of symptoms namely seizures and choreoathetoid movements along with impairment of consciousness1. Though infective relapse is a possibility requiring extended antiviral therapy2, immune mediated mechanism is most probable.3 Although there is a similarity of symptoms between relapsing HSVE and N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis, the most likely culprit is the latter.

Guillain‐Barre Syndrome In Covid-19: A Literature Review, Imran Ahmad, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

The novel coronavirus (COVID-19) can result in several neurological complications including Guillain-Barré Syndrome (GBS). It is an acute parainfectious paralytic neuropathy. This review summarizes the demographic features, clinical presentation, diagnostics workup, and management strategies of COVID-19 associated GBS reported in the literature. We searched Medline, PubMed Central, SCOPUS, and Google Scholar using pre-defined keywords. We included all kinds of manuscripts in the English language only. Demographics, clinical features, diagnostic workup, management, and outcomes were documented in the datasheet. We identified 24 cases of COVID-19 associated GBS. Most were reported from Italy, followed by the USA. The majority were males (18/24) …

Demonstrating Competence In Endoscopic Retrograde Cholangiopancratico Graphy (Ercp): Recently Credentialed Operator's Performance For Deep Biliary Cannulation Over 1 Year Period From A Tertiary Care Hospital In Pakistan, Om Parkash, Umar Bhatti, Hasnain Zafar, Saeed Hamid

Section of Gastroenterology

Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital.
Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19. …

High-Dose-Rate Brachytherapy For The Treatment Of Basal And Squamous Cell Carcinomas On Sensitive Areas Of The Face: A Report Of Clinical Outcomes And Acute And Subacute Toxicities, James M. Taylor, Bahar Dasgeb, Spencer Liem, Ayesha Ali, Amy Harrison, Mitchell Finkelstein, Jisun Cha, Rani Anne, Steven Greenbaum, William Sherwin, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face.

Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos …

Levonorgestrel Intrauterine System Embedded Within Tubal Ectopic Pregnancy: A Case Report, Dorothy Makena, Ingrid Gichere, Khadija Warfa

Obstetrics and Gynaecology, East Africa

Background: The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature.

Case presentation: A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine …

Early Detection Of Cervical Cancer In Western Kenya: Determinants Of Healthcare Providers Performing A Gynaecological Examination For Abnormal Vaginal Discharge Or Bleeding, Emily Mwaliko, Guido Van Hal, Stefan Van Dongen, Peter Gichangi, Barasa Otsyula, Violet Naanyu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: In western Kenya, women often present with late-stage cervical cancer despite prior contact with the health care system. The aim of this study was to predict primary health care providers’ behaviour in examining women who present with abnormal discharge or bleeding.

Methods: This was a cross-sectional survey using the theory of planned behaviour (TPB). A sample of primary health care practitioners in western Kenya completed a 59-item questionnaire. Structural equation modelling was used to identify the determinants of providers’ intention to perform a gynaecological examination. Bivariate analysis was conducted to investigate the relationship between the external variables and intention. …

Subacute Thromboembolic Pulmonary Hypertension With Acute Clinical Worsening But Improving Ct Findings - A Case Reporrt, Doaa Aly, Alvin Singh, Pamela Finn, Kate Carp, Brian Birnbaum

Posters

ackground: • Subacute massive pulmonary embolism (PE) is associated with high mortality. • The subacute presentation makes it difficult to diagnose and older clots are less amenable to systemic thrombolysis. • This can result into increased likelihood of recurrence and thromboembolic pulmonary hypertension Case description: • 17-year-old, previously healthy male presented with a month of exertional dyspnea, initially misdiagnosed with asthma. • CT demonstrated diffuse PE on repeat presentation (Fig1). • Echocardiography demonstrated moderate to severe RV dilation and systolic dysfunction and suggested an RV systolic pressure of 73mmHg + RAP. • He was subsequently admitted to the ICU and …

Safety And Efficacy Of Catheter Directed Thrombolysis (Cdt) In Elderly With Pulmonary Embolism (Pe)., Eneida Harrison, Jin Sun Kim, Vladimir Lakhter, Ka U Lio, Rami Alashram, Huaqing Zhao, Rohit Gupta, Maulin Patel, James Harrison, Joseph Panaro, Kerry Mohrien, Riyaz Bashir, Gary Cohen, Gerard Criner, Parth Rali

Department of Psychiatry and Human Behavior Faculty Papers

INTRODUCTION: Acute pulmonary embolism (PE) remains a common cause for morbidity and mortality in patients over 65 years. Given the increased risk of bleeding in the elderly population with the use of systemic thrombolysis, catheter-directed therapy (CDT) is being increasingly used for the treatment of submassive PE. Nevertheless, the safety of CDT in the elderly population is not well studied. We, therefore, aimed to evaluate the safety of CDT in our elderly patients.

METHODS: We conducted a retrospective observational study of consecutive patients aged >65 years with a diagnosis of PE from our Pulmonary Embolism Response Team database. We compared …

Comparison Of Two Different Methods In The Removal Of Oil-Based Calcium Hydroxide From Root Canal System: A Triple-Blinded Randomised Clinical Trial, Momina Motiwala, Sheikh Bilal Badar, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the effectiveness of rotary master apical file (RMAF) with ultrasonic activation of endodontic file (UAF) in the removal of silicon oil-based calcium hydroxide (SOBCH) from the canal.
Methods: Ethical review committee approval and informed consent was obtained. 60 cases with necrotic teeth in which silicon oil-based intracanal medicament (Metapex) was to be placed were randomised in one of the two groups using sealed envelopes containing assignment codes for medicament removal: RMAF and UAF group. After standard protocol of coronal access, cleaning and shaping, silicon oil-based SOBCH was placed using a Lentulo spiral. A periapical radiograph was taken …

Angioembolisation For The Treatment Of Pseudo-Aneurysm Of Internal Maxillary Artery, Muhammad Azeemuddin, Anosha Khan, Atif Hafeez Siddiqui, Asad Shakil, Basit Salam, Raza Sayani

Department of Radiology

Pseudo-aneurysm of internal maxillary artery, following a road traffic accident, is a rare clinical scenario. The consequence of pseudo-aneurysm may be spontaneous rupture of the arterial wall, which may eventually lead to life-threatening hemorrhage. We report a case of a 20-year male who presented with recurrent epistaxis. CT scan was performed, which revealed a pseudo-aneurysm of the internal maxillary artery; this was successfully treated by angioembolisation. Similar cases of traumatic pseudo-aneurysms have been reported, however, none presented with recurrent epistaxis after management of pan-facial fractures. Key Words: Epistaxis, Pseudo-aneurysm, Angioembolisation, Pan-facial fracture.

Relative And Absolute Risk To Guide The Management Of Pulse Pressure, An Age-Related Cardiovascular Risk Factor, Jesus D. Melgarejo, Lutgarde Thijs, Dong-Mei Wei, Michael Bursztyn, Wen-Yi Yang, Yan Li, Kei Asayama, Tine W. Hansen, Masahiro Kikuya, Gladys E. Maestre, Benjamin Gavish

School of Medicine Publications

BACKGROUND Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan.

METHODS In 4663 young (18-49 years) and 7185 older adults (≥50 years), brachial PP was recorded over 24-hour. Total mortality and all major cardiovascular events combined (MACE) were co-primary endpoints. Cardiovascular death, coronary events and stroke were secondary endpoints.

RESULTS In young adults (median follow-up, 14.1 years; mean PP, 45.1 mmHg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1000 person-years. The adjusted hazard ratios expressed per 10-mmHg …

Knowledge About Continuous Positive Airway Pressure Machine Usage Among Nurses At A Tertiary Hospital In Tanzania, Wilson Paulo Lomnyack, Tumbwene Mwansisya, Stewart Mbelwa, Kahabi Isangula, Zephania Saitabau Abraham

School of Nursing & Midwifery, East Africa

Introduction: Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP.

Method: A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented …

Managing Work Flow In High Enrolling Trials: The Development And Implementation Of A Sampling Strategy In The Prepare Trial, David Pogorzelski, Uyen Nguyen, Paula Mckay, Lehana Thabane, Megan Camara, Lolita Ramsey, Rachel Seymour, J. Brett Goodman, Sheketha Mcgee, Joanne Fraifogl, Andrea Hudgins, Stephanie L. Tanner, Mohit Bhandari, Gerard P. Slobogean, Sheila Sprague, Jeffrey Wells, Prep-It Investigators Executive Committee

Orthopaedic Surgery Faculty Publications

Pragmatic trials in comparative effectiveness research assess the effects of different treatment, therapeutic, or healthcare options in clinical practice. They are characterized by broad eligibility criteria and large sample sizes, which can lead to an unmanageable number of participants, increasing the risk of bias and affecting the integrity of the trial. We describe the development of a sampling strategy tool and its use in the PREPARE trial to circumvent the challenge of unmanageable work flow. Given the broad eligibility criteria and high fracture volume at participating clinical sites in the PREPARE trial, a pragmatic sampling strategy was needed. Using data …

Preliminary Data On The Potential For Unintentional Antidoping Rule Violations By Permitted Cannabidiol (Cbd) Use., Ute Mareck, Gregor Fusshöller, Hans Geyer, Marilyn A. Huestis, Anja B Scheiff, Mario Thevis

Institute of Emerging Health Professions Faculty Papers

According to the World Anti-Doping Agency (WADA) regulations, cannabinoids use is prohibited in competition except for cannabidiol (CBD) use. For an adverse analytical finding (AAF) in doping control, cannabinoid misuse is based on identification of the pharmacologically inactive metabolite 11-nor-delta-9-carboxy-tetrahydrocannabinol-9-carboxylic acid (carboxy-THC) in urine at a concentration greater than 180 ng/ml. All other (minor) cannabinoids are reported as AAF when identified, except for CBD that has been explicitly excluded from the class of cannabinoids on WADA's Prohibited List since 2018. However, due to the fact that CBD isolated from cannabis plants may contain additional minor cannabinoids, the permissible use of …

Association Between Preterm-Birth Phenotypes And Differential Morbidity, Growth, And Neurodevelopment At Age 2 Years: Results From The Interbio-21st Newborn Study, Jose Villar, María C. Restrepo-Méndez, Rose Mcgready, Fernando C. Barros, Cesar G. Victora, Shama Munim, Aris T. Papageorghiou, Roseline Ochieng, Rachel Craik, Zulfiqar Ahmed Bhutta

Department of Obstetrics & Gynaecology

Importance: The etiologic complexities of preterm birth remain inadequately understood, which may impede the development of better preventative and treatment measures.
Objective: To examine the association between specific preterm-birth phenotypes and clinical, growth, and neurodevelopmental differences among preterm newborns compared with term newborns up to age 2 years.
Design, setting, and participants: The INTERBIO-21st study included a cohort of preterm and term newborn singletons enrolled between March 2012 and June 2018 from maternity hospitals in 6 countries worldwide who were followed up from birth to age 2 years. All pregnancies were dated by ultrasonography. Data were analyzed from November 2019 …

Point-Of-Care Lung Ultrasound For Covid-19: Findings And Prognostic Implications From 105 Consecutive Patients, Kosuke Yasukawa, Taro Minami, David R Boulware, Ayako Shimada, Ernest A Fischer

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.

Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length …

Effectiveness Of Cidofovir In Treating Natalizumab-Associated Progressive Multifocal Leukoencephalopathy (Pml), Salman Mansoor

Pakistan Journal of Neurological Sciences (PJNS)

Natalizumab (Nz) a monoclonal antibody has been in medicinal use for treatment of Relapsing Remitting Multiple Sclerosis (RRMS) since 2004. Progressive Multifocal Leukoencephalopathy (PML) is one of its serious risks which is a demyelinating disorder of brain associated with John Cunningham Virus (JCV). There have been 801 cases up till December 2018 which were reported with its use1. Lack of prospective trials and retrospective studies due to small number of these cases there is no consensus on Nz-associated PML treatment. To date there is no cure for this condition and there is a debate on effectiveness of different modalities2. Cidofovir …

Effect Of Listening To A Relaxing Water Sound For Fifteen Minutes On Traumatic Stress Subjects’ Immediate Stress Levels And Electroencephalograms, S. Farah Jafri, S. Farah Batool, Shamoon Noushad

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: Music and calmness are noteworthy stimulators that significantly affect mental health. Listening to relaxing sounds activates the feeling of wellbeing. The present study aimed to analyze the effect of closed eyes brief exposure to a relaxing water sound on Electroencephalogram (EEG) in pre and post-test states. METHODOLOGY: A total of 20 traumatic stress subjects were included to participate in this study. The subjects were requested to be seated with eyes closed while the sound of water flowing was played for 15 min in between (before and after) the EEG recordings. A subsection of the Sadaf Stress Scale (SSS) i.e. …

Covid-19 Vaccines And Cerebral Venous Thrombosis, Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Impact Of Recipient And Donor Characteristics On Kidney Transplant Graft Survival, Ashraf Donia, Azza A. I. Elmenyawia, Tarek T. Ahmed

Journal of Medicine in Scientific Research

Introduction Many factors determine the outcomes of renal transplant, including characteristics of both donors and recipients. Antihuman leukocyte antigen donor-specific antibodies are strongly linked to antibody-mediated rejection and late allograft loss. Aim The aim was to determine the effect of recipient and donor characteristics on kidney transplant graft survival, with special stress on panel-reactive antibodies. Participants and methods This study included 168 adult recipient and donor couples. The authors analyzed data of kidney transplants performed between the years of 2008 and 2018 at National Institute of Urology and Nephrology. Results The authors found a significant increase in renal failure in …

Phenotype Expression Variability In Children With Gabrb3 Heterozygous Mutations., Abdulhafeez M. Khair, Alana E. Salvucci

Department of Pediatrics Faculty Papers

GABRB3 gene is a recently identified gene located in 15q12 chromosome and encodes for gamma-aminobutyric acid (GABA) receptor subunit beta-3 protein, which is linked to the GABAA receptor. The gene is believed to share a role in inhibitory GABAergic synapses, GABA iron-gated channel function, and possible cellular response to histamine. The β3 subunit is expressed in cerebral grey matter, thalami, hippocampi, and cerebellum, among other structures. Faulty GABRB3 function is linked to several neurological disorders and clinical syndromes. However, the spectrum of such disorders is not yet well known. We present three case reports highlighting the potentially expanding clinical phenotype …

Importance Of Pgc-1Α Gene Expression In Egyptian Hemodialysis Patients, Ashraf Donia, Azza A. I. Elmenyawi

Journal of Medicine in Scientific Research

Introduction The peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) is an upstream transcriptional regulator of mitochondrial biogenesis and function. Its function is immediate elimination of reactive oxygen species to get rid of their cellular destruction sequelae. Decreased PGC-1α count and less mitochondrial function take part in renal failure. COX6C gene encodes mitochondrial oxidative phosphorylation proteins. Reaction of excessive reactive oxygen species with linolenic acid results in malondialdehyde (MDA) as a breakdown product. It is an important marker for evaluating oxidative damage. Patients and methods A total of 58 hemodialysis (HD) patients in the National Institute of Urology and Nephrology and 20 …

Comparing The Effect Of Volume Preload Versus Ephedrine Infusion For The Prevention Of Hypotension Due To Spinal Anesthesia For Lower Abdominal And Lower Limb Vascular Surgery, Ashraf A. H. Mahmoud Soliman

Journal of Medicine in Scientific Research

Objective To evaluate the efficacy of ephedrine infusion without preblock crystalloid administration in reducing the incidence of hypotension during spinal anesthesia. Patients and methods Fifty patients presented for lower abdominal and lower limb surgery under spinal anesthesia who were divided into equal groups (group F and group E), each group had 25 patients each. Results As regards demographic data there was no statistical significance between both groups. As regards blood pressure there is statistical significance between both groups except at 4 and 22 min postspinal; regarding heart rate there was no statistical significance between both groups; and regarding the incidence …

The Use Of Ultrasound Indices To Evaluate Volume Status And Fluid Responsiveness In Patients With Septic Shock, Ashraf A. H. Mahmoud, Wael A. E. El Hakeem

Journal of Medicine in Scientific Research

Objective The purpose of this study is to assess the use of ultrasound indices to evaluate volume status and fluid responsiveness in patients with septic shock. Patients and methods A total of 40 successive patients aged above 40 years, with septic shock on admission to the ICU, were enrolled in the study, comprising 26 fluid responders and 14 fluid nonresponders. Results Regarding demographic data and other patient characteristics, no statistically significant difference between both the study groups was seen. Regard baseline hemodynamics data, there was no statistically significant difference between both groups. but after fluid bolus, there was a statistically …

Initial Experience Of Thoracoscopic Video-Assisted Minimally Invasive Mitral Valve Surgery At National Heart Institute, Ahmed M. E. Abdelgawad, Ahmed Zayed, Tamer Elbanna

Journal of Medicine in Scientific Research

Background Advancements in instruments and thoracoscopes and the evolution of cannulation techniques and cannulae types for cardiopulmonary bypass as well as cardiopulmonary bypass machines during the past decade have encouraged many surgeons to adopt minimally invasive mitral valve surgery (MIMVS). Today, MIMVS has become the standard approach for many surgeons and institutions. Patients and methods This is a nonrandomized prospective study in which 150 patients of mitral valve pathology scheduled for mitral valve surgery over a period of 3 years from March 2014 to May 2017 at National Heart Institute were allocated to two groups after fulfilling the inclusion criteria. …

Invasive Versus Noninvasive Assessment Of Functional Significance Of Intermediate Coronary Artery Lesions, Ahmed Zayed

Journal of Medicine in Scientific Research

Background Myocardial perfusion imaging (MPI) is noninvasive test used for evaluation of functional significance of borderline coronary artery lesions. Moreover, instantaneous wave-free ratio (IFR) is a well-validated invasive method used for the same purpose. Objectives To compare the results of MPI and IFR in detection of ischemia in patients with single intermediate coronary artery lesion. Patients and methods A total of 60 patients with single intermediate coronary artery stenosis, visually judged as angiographic stenosis more than or equal to 50% and less than 70% during coronary angiography, were included. After coronary angiography, all patients were subjected to MPI and IFR …