Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Effect of early clinical skills teaching on 3rd year medical students' learning: the student perspective

The main purpose of the early introduction of Clinical Skills Learning [CSL] to pre-clinical years is to allow medical students to gain experience in clinical examination skills, basic medical procedures, history-taking and clinical communication. The objective of this study was to determine the effectiveness of the early teaching of clinical skills in preparing medical students for their clinical years. A validated questionnaire assessing the value of CSL on students in their first clinical year was distributed to 3rd year medical students. The questionnaire consisted of 8 items with a five-point Likert scale and one open-ended question. The response rate to the questionnaire was approximately 62%. Nearly 97 [70.8%] students suggested that CSL was a favourable teaching strategy. A high percentage of students [90.5%] agreed that CSL was a useful pre-clinical module to prepare them for their clinical years. The students gave positive feedback on the teaching of history-taking and physical examination, exposure to the hospital environment and acquisition of communication skills with supervisors and patients. No student perceived the CSL module as poor. Early CSL was well-perceived by students in preparing them for their clinical years. CSL is a vital part of the pre-clinical curriculum and should be further enriched with frequent hospital visits to enhance students' confidence level and performance when interacting with patients during their clinical years

incidence of leukemia in Saudi Arabia descriptive epidemiological analysis of data from the Saudi cancer registry [2001-2008]

To describe the epidemiological data of leukemia cases diagnosed from 2001 to 2008 among male and female Saudis, including the frequency and percentage of cases, the crude incidence rate [CIR], and the age-standardized incidence rate [ASIR] stratified by leukemia subtype, region, and year of diagnosis. This is a retrospective descriptive epidemiological analysis of all Saudi leukemia cases recorded in the Saudi Cancer Registry SCR between January 2001 and December 2008. The study was carried out in 2013 to investigate the pattern of leukemia in the Saudi population. Descriptive statistics and Poisson regression model were used. A total of 3852 leukemia cases were registered in the SCR between January 2001 and December 2008. The region of Riyadh, Saudi Arabia had the highest overall ASIR among Saudi males at 5.2 per 100,000 males, followed by both the Eastern region and Northern region at 4.9 per 100,000 males. Furthermore, the region of Najran recorded the highest overall ASIR among Saudi females at 4.5 per 100,000 females. However, Jazan had the lowest average ASIRs of leukemia in Saudi Arabia. There was a slight increase in the CIRs and ASIRs of leukemia in Saudi Arabia between 2001 and 2008. Riyadh, the Eastern region, and the Northern region had the highest overall ASIRs of leukemia among Saudi males, and Najran had the highest overall ASIRs of leukemia among Saudi females; while Jazan had the lowest rates among the Saudi population

incidence rate of prostate cancer in Saudi Arabia: an observational descriptive epidemiological analysis of data from the Saudi Cancer Registry 2001-2008

This study presents descriptive epidemiological data related to prostate cancer cases diagnosed from 2001 to 2008 among Saudi men, including the frequency and percentage of cases, the crude incidence rate [CIR] and the age-standardised incidence rate [ASIR] adjusted by region and year of diagnosis. This is a retrospective descriptive epidemiological analysis of all Saudi prostate cancer cases recorded in the Saudi Cancer Registry [SCR] between January 2001 and December 2008. Statistical analyses were conducted using descriptive statistics, the Poisson regression model, a simple linear regression model and analysis of variance with the Statistical Package for the Social Sciences version 20.0 [SPSS]. A total of 1739 cases were registered in the SCR between January 2001 and December 2008. The eastern region of Saudi Arabia had the highest overall ASIR at 10.1 per 100,000 men, followed by Riyadh at 7.1 and Makkah at 5.2, while Jizan and Najran had the lowest average ASIRs at 1.4 and at 2.0, respectively. The Poisson regression model for the region of Jizan shows that the incidence rate ratio [IRR] was significantly higher [p < 0.001]; for the regions of Riyadh at 3.43 times [95% CI, 3.13-3.73], followed by Makkah at 2.56 [95% CI, 2.38-2.74] and the eastern province at 1.93 [95% CI, 1.64-2.23]. The annual prediction of the CIR of prostate cancer in Saudi Arabia could be defined by the equation 1.53 + [0.094 Years], and the prediction of the ASIR could be defined by the equation 2.98 + [0.182 Years]. There was a steady increase in the CIRs and ASIRs for prostate cancer between 2001 and 2008. The eastern region, Riyadh and Makkah had the highest overall ASIR in Saudi Arabia. Further effective screening programmes and active treatment measures are needed to control prostate cancer disease among Saudi men

Management of appendiceal abscess. a 10-year experience in central Saudi Arabia

To study the outcome of patients with appendiceal abscess [AA] following immediate operative and non-operative management in terms of complications and hospital stay. Medical records of all adult patients treated for AA between July 2002 and June 2011 in the Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia were reviewed. We identified 2 main groups of patients with the diagnosis of AA. The first group of patients were managed by CT-guided percutaneous drainage and parenteral antibiotics [non-operative management [NOM group]]. The second group were patients who underwent surgical intervention [operative management [OM]]. The outcome was determined in terms of complications, recurrence rate, and hospital stay. Eighty AA patients were managed during the study period. Forty-two patients [52.5%] received NOM, while 38 patients [47.5%] underwent immediate OM. The complication rate was significantly higher in the OM group compared with the NOM group [44.7% versus 11.9%; p=0.0012]. Successful NOM was achieved in 92.8% of patients. The overall mean hospital stay of the NOM group was 8.54 +/- 2.25, and the OM group was 10.86 +/- 4.32 days [p=0.003]. Non-operative management is associated with significantly lower complication rate and shorter hospital stay than OM

Testicular abscess caused by salmonella para-typhi

This case is the first report of a bacteriologically proven testicular abscess in a child caused by Salmonella paratyphi 'A' in Pakistan that clinically simulates a testicular tumour. The case also emphasises that a course of 2 weeks antibiotic is sufficient for testicular abscess if complete surgical debridement is done. Keywords: Salmonella paratyphi 'A', Testicular Abscess, Tumour

Extraskeletal osteosarcoma, telangiectatic variant arising from the small bowel mesentery

Extraskeletal osteosarcoma [EOS] is a highly aggressive and rare malignant soft tissue tumor, characterized by the production of neoplastic osseous tissue without attachment to the bone or periosteum. It rarely involves the visceral organs. Only 3 cases of mesenteric EOS have been reported in English literature. Here, we describe a male patient of 40 years, who was diagnosed to have EOS arising from small bowel mesentery This patient presented with lower gastrointestinal [GI] bleeding. Upper GI endoscopy and colonoscopy were normal. Computed tomography scan demonstrated a well defined multi-loculated mixed density mass lesion measuring about 13x7x7 cm in lower abdomen adjacent to small bowel loops with liver metastasis. Palliative en bloc resection of tumor with adjacent small bowel was performed. The histopathology revealed a telangiectatic type osteosarcoma of mesentery. Diagnosis of EOS, its management and the outcome in context of the current literature are discussed

Operative management of liver trauma: a 10-year experience ib Riyadh, Saudi Arabia

To analyze our experience and the outcome of operative management of liver trauma, and to suggest ways to improve the management of such patients. This retrospective study was conducted on patients admitted with liver trauma to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 1997 and December 2006. Only patients who underwent operative management were included in this study. Sixty-four out of 138 patients with liver injury were treated surgically. Most of the patients were young [mean 29.4 years], and male [84%]. Fifty-six patients sustained blunt trauma. Eight patients had grade I, 17 had grade II, 21 had grade III, 12 had grade IV, and 6 patients had grade V liver injuries. Hepatorrhaphy [n=28] was the most common surgical technique used followed by peri-hepatic packing [n=12], simple hemostatic measures [n=9], and non-anatomical hepatic resections [n=8]. Laparotomy was non-therapeutic in 7 patients [11%]. Liver injury related morbidity was 19%, and mortality was 11%. Hepatorrhaphy was the most common surgical modality employed to control bleeding. Peri-hepatic packing was used in unstable patients. In 25% of patients, bleeding had either stopped from the injured liver or needed only simple hemostatic measures

Extremity vascular trauma. A 7-year experience in Lahore, Pakistan

To determine the outcome of various techniques of vascular repair in terms of repair related complications and limb salavagibility. From January 1999 to December 2005, this retrospective study was conducted in the Department of General Surgery, Lahore General Hospital, Lahore, Pakistan. The patients, who underwent various surgical interventions for extremity vascular trauma, were included in this study. Those, who underwent primary amputation due to non-salvageable injuries or who presented with late complications of vascular injuries were excluded. Ninety-three patients underwent different surgical procedures for extremity vascular trauma. Majority of the patients were young, mean, 29.4 years male 91.3%. Penetrating trauma was the most common mode of injury 77.4%. The median time interval between injury and repair was 4.5 hours. Superficial femoral artery was the most frequently injured artery 26.8%. Graft repair was carried out in 41 patients 46.6%, while 34.1% of the patients had end-to-end anastomosis. Wound infection was the most common complication 18.2%. Seven patients 7.5% had secondary amputations and 3 3.2% died from other injuries. Vascular reconstruction was successful in 89.3% of the patients. Early revascularization by employing simple repair or interposition autogenous vein graft repair results in successful limb salvage with acceptable complication rate

Peripartum cardiomyopathy presenting to cardiology department of Mayo Hospital, Lahore

Cardiac failure occurring in last trimester of pregnancy or within one to six months after delivery in a woman without a history of heart disease and with no cause for heart failure other than pregnancy is termed as peripartum cardiomyopathy. To determine fetomaternal morbidity and mortality in women presenting with peripartum cardiomyopathy, we did an open non-randomized observational descriptive study at Department of Cardiology Mayo Hospital, Lahore from January 2004 to Oct 2005. The women referred from Lady Willingdon and Lady Aitchison Hospitals to Cardiology Department of Mayo Hospital during last trimester and after delivery for work up of heart failure were included. Twenty five women presented with heart failure due to peripartum cardiomyopathy were included in this study, 40% in last trimester, 40% within one month and 20% within 4 month after delivery. The mean age was 35 + 5 years. Out of these 2 [8%] were primiparous, 13 [52%] were multiparous and 10 [40%] were grandmultipara. Ten [40%] were booked and 15 [60%] were nonbooked for antenatal care. Twenty [40%] patients were diagnosed for the first time and 5 [20%] had recurrence. Based on NYHA classification 20% were in class I, 40% class II, 20% class III and 20% in class IV. The patients were on standard medical treatment. All patients reviewed at follow up after 1, 6, and 12 months. No maternal mortality occurred. Antenatal ward admission was required for 32% women due to obstetric reasons and 8% due to cardiac cause. Five had spontaneous labor and 5 inductions were done for obstetric reasons: poor biophysical profile, previous caesarean section, uncontrolled diabetes, breech presentation and fetal distress. Three babies have intrauterine growth retardation. On echocardiography mean ejection fraction was 20-25% with global hypokinesia, 5 patients had clot in LV apex, 10 had whiff of mitral regurgitation and tricuspid regurgitation. We conclude that peripartum cardiomyopathy has high morbidity and mortality. Women are very much receptive about c ontraception in the immediate post partum period, therefore counseling of the patient and their family should be done to reduce maternal mortality

Titrated cyclocryopexy - a report on long term results

To determine the efficacy and safety of a titrated cyclocryopexy in advanced glaucomatous eyes in term of intraocular pressure control and complications. Retrospective Cohort analysis of a titrated cyclocryopexy in 30 eyes of 25 patients with uncontrolled glaucoma during July 1996 to July 2003 at Hayatabad Medical Complex, Peshawar. Inclusion criteria applied was; patients having uncontrolled IOP with maximum medical therapy, previous trabeculectomy and a minimum follow-up of 2 years. All patients were assessed for glaucoma. Numbers of cryoapplications were determined according to the IOP. Four to 12 applications in one sitting were used. Repeat cryoapplication were applied at least after six-weeks of previous therapy if IOP was not controlled. A total of 30 eyes of 25 patients were studied. IOP control of less than 21 mm Hg was achieved in 83% of the eyes. Mean IOP was reduced from 29 ' 4.96 pre-op to 17 ' 7.36 at two years follow-up. Forty percent of the eyes ne eded single session, 40% received 2 sessions and other 20% needed sessions. All the patients lost at least one line of Snellen chart at 2 years follow-up, 70% retained useful vision, 20% retained light perception and 10% lost perception of light. Serious complications included phthisis, persistent vitreous hemorrhage with retinal detachment, and total retinal detachment and persistent vitreous hemorrhage in 1 eye each. Cyclocryopexy appears to be an effective procedure in cases of advanced glaucoma with an acceptable risk / benefit ratio. If done in a titrated manner the number of complications are reduced in severity

Immunohistolocalization of c-erbB-2 protein: a proliferative marker in benign prostatic hyperplasia

To examine possible role of c-erbB-2 in the development of benign prostatic hyperplasia. Design: A retrospective study of 25 patients suffering from benign prostatic hyperplasia. Setting: BMSI, Jinnah Postgraduate Medical Centre, Karachi. Subjects: Twenty five patients between the ages of 51-80 years were selected for the period of 2001 suffering from benign prostatic hyperplasia. Results of study show that overall frequency of c-erbB-2 expression was not found. Maximum numbers of BPH among total cases were in age group 61-70 years i.e 13 tumours [52% of total cases]. Results of current study and work of previous researchers indicate a lot of controversy over c-erbB-2 immunostaining in benign prostatic hyperplasia. Further study is required to elucidate the precise role played by this protein marker in the benign growth of prostatic tissue

Erectile dysfunction: the need for a scientific approach to this taboo topic

Erectile dysfunction is a problem that needs to be explored. This is an illness that has always been under discussed. Our study was carried in Mayo Hospital on 1252 patients. Out of these 434 [34.6%], were found to have some degree of erectile dysfunction. 114/434 [26.22%] did not seek medical advice. 192/434 [44.2%] went to quacks and 128/434 [29.4%] consulted doctors. 37.3% of patients with erectile dysfunction had diabetes mellitus as concomitant disease. 12.4% patients had hypertension while 6.9% and 3.9% patients had ischemic heart disease and tuberculosis respectively. These results emphasize the need that this disorder should be dealt scientifically. People and doctors should be made more aware of the recent advances in medical management of erectile dysfunction so that more people can seek a qualified medical advice and may benefit from the treatment. This article addresses the diagnosis of erectile dysfunction and identifies diagnostic tests that can be used by primary care physicians to determine the patients most at risk and the treatments most suited to meet the patients and their partners goal for therapy

Comparative evaluation of the tamarind kernel oil

The physical characterisation and chemical composition of the oil extracted from the indigenous tamarind kernel have been investigated and the results compared with the Indian, Egyptian and Malagasy varieties of the tamarind as well as with the other edible oils obtained from cotton, sesame and sunflower seeds

Basement membrane pattern in hyperplastic and neoplastic lesions of the endometrium the value of immunoperoxidase stain in the identification of borderline lesions

Atypical adenomatous hyperplasia and well-differentiated endometrial adenocarcinoma are sometimes difficult to diagnose on histology alone. It was therefore decided to study the basement membrane pattern of the hyperplastic and neoplastic endometrium, with the help of immunoper-oxidase stain, using specific antibody against the laminin component of the basement membrane. For this purpose 25 blocks each of normal endometrium in various phases of menstrual cycle, cystic hyperplasia, adenomatous hyperplasia and adenocarcinoma were selected for study. The staining was done with Histoset immunoperoxidase staining kit from E.Y. Laboratories. The procedure recommended by the suppliers was adopted. It was based on the methodology described by Sternberger. The stain demonstrated small breaks in a few glands in 4 cases of atypical adenomatous hyperplasia, well-defined breaks in 10 cases of non-invasive or micro-invasive carcinomas, gland breaks and fragmentation in 15 cases of frankly invasive adenocarcinoma. An intact basement membrane was seen in the normal endometrium during the various phases of the menstrual cycle and benign hyperplastic endometrium. Thus this technique helped in the differentiation of benign hyperplastic lesions, atypical adenomatous hyperplasia, and well-differentiated non-invasive or micro-invasive adenocarcinoma

Extracorporeal shock wave lithotripsy for gallstones: an AKUH experience

At the Aga Khan University Hospital were have used the Cornier MPL, 9000 for extra corporeal shock wave lithotripsy [ESWL] of age stones as well as renal stones. Between November 1988 and July 1990, 23 patients with gall stones underwent ESWL. The criteria for selection of gall stone lithotripsy were: history of biliary pain, absence of cakifications, a total stone bulk of less than 3 cms. diameter and a functioning gall bladder. All patients received adjuvant treatment with oral bile salts. Disintegration of stones to sludge was achieved routinely. Ten patients [43.5%] had complete resolution of their stones is a mean interval of 20 months [SD 0.15] after commencement of treatment. When the stone burken was less than 2 cms diameter: nine of the ten patients had single stone. Twelve patients [52.2%] who were followed up for a mean period of 7.2 months [SD 0.66] continue to have debris in the gall bladder. Two of these patients underwent cholecystectomy for continuing pain; the other ten were lost to follow up. One patients [4.3%] fail to report after first session of ESWL. There were no complications

Tumor markers in breast carcinoma: prognostic significance

In an attempt to identify biologic markers that might predict prognosis in patients with breast cancer, the serum levels of three tumor- associated antigens: CA 15.3, CEA, and 5-N were determined in 51 patients with infiltrating breast carcinoma, 70 patients with benign breast disease, and 50 normal females as controls. The mean values of these markers in breast cancer were significantly higher than those of bengin breast tumor and control groups There was significant correlation between each of CA 153, CEA, and 5-N with rumor size. Also a significant correlation existed between each of CA 153, and CEA with number of lymph nodes involved, while no significant correlation existed between -5-N, and lymph node involvement [r 0.19]. It is suggested that simultaneous determination of CA 15.3, CEA, and -5-N seem to be of value as sensitive indicators for earlier detection of metastases or recurrences and potentially useful for evaluation and monitoring of patients with breast cancer

Fine needle aspiration biopsy of thyroid lesion: a comparative study between cytological and histopathological findings

Fine needle aspiration biopsy [FNAB] was performed on 189 patients with thyroid lesions. 75 cases were studied cytologically and histopathologically, 2 cases were diagnosed as suspicious cytologically, proved to be malignant by histopathology, 66 cases were diagnosed benign cytologically, by histopathological examination 65 were benign and one case was malignant [false negative]. Thyroid FNAB is recommended as a preoperative procedure in the diagnosis of thyroid lesions