Dyke-davidoff-masson syndrome: an unusual cause of status epilepticus and refractory seizures

Dyke-Davidoff-Masson Syndrome [DDMS] is a rare neurological condition characterised by drug-resistance seizures, hemiparesis, mental retardation, facial asymmetry, and intellectual disabilities. On brain imaging, the disease is characterised by cerebral hemiatrophy with ipsilateral calvarial thickening and hyperpneumotisation of paranasal sinuses or mastoid air cells. Although more common in men and on the left side of the brain, the disease can affect both genders and cerebral hemispheres. It mainly presents in childhood. The adult presentation is unusual but has been reported in medical literature. Most of the patients need more than one antiepileptic agent for optimal control of seizures. Hemispherectomy is reserved for patients who have drug-resistant and disabling seizures. The good prognostic factors are disease onset before age of two and better seizure control. We report two cases of DDMS occurring in teenage boys who presented with status epilepticus. The clinical histories, radiological findings, and treatment of both patients are discussed below

Giant primary sinonasal mucosal melanoma: a rare malignancy

It is extremely rare to find a case of primary sinonasal mucosal melanoma, which is more aggressive and have poorer outcome than its cutaneous counterpart. This tumour is refractory to the treatment which includes wide surgical excision with or without adjuvant postoperative radiotherapy. We are reporting a case of 60 year old female who presented with right sided nasal mass and facial deformity, in whom the diagnosis of mucosal melanoma was made on histopathological examination and confirmed by immunohistochemistry

Comparative bioavailability and pharmacokinetic study of Cefadroxil capsules in male healthy volunteers of Pakistan

The current study was aimed to judge bioequivalence between two formulations of cefadroxil capsules as guided by FDA guidelines. Another objective was to conduct pharmacokinetic evaluation in Pakistani population. A single-dose, randomized, cross-over pharmacokinetic study was conducted during the month of May'2013 to August'2013. Washout period was one week. Fourteen healthy male adult volunteers were enrolled in the study, however twelve completed the study. Cefadroxil plasma concentration was analyzed by using validated HPLC method. Protein precipitation was achieved by the addition of 6% tri chloro acetic acid in 1:1 ratio and detection was done at 260 nm. Retention time was 7.792 min and correlation coefficient [R[2]] was 0.9953 showing linearity of the method. Blood sampling was carried out at different time intervals after administration of either test [TEST 500 mg] or reference [REF[registered] 500mg] formulation. Pharmacokinetic parameters [AUC[0-infinity], AUC[0-t], C[max], T[max], t[1/2] and k[el]] were calculated using Kinetica[register] PK/PD software. The geometric mean ratios and 90% confidence interval [CI] of these pharmacokinetic parameters for cefadroxil [test and reference] formulations were 0.986 [90.83-106.98%] for AUC[1-t]; 0.967 [89.13-104.92%] for AUC[0-infinity] and 0.999 [91.06-109.69%] for C[max]. The differences between T[max] of both formulations were not found to be statistically significant [p-value was more than 0.05]. The 90% CI of the test/reference AUC and C[max] ratio of cefadroxil were within the FDA recommended range for bioequivalence. Maximum plasma concentration C[max] was 12.5 micro g/ml for test and 12.47 micro g/ml for reference formulations. Average time to reach C[max] for test and reference formulation was 1.54 and 1.5 hrs. The two formulations of cefadroxil studied during the above study were verified bioequivalent. Maximum plasma concentration of cefadroxil was lower than those mentioned in some previous studies, while T[max] and half-life were near to values reported in literature

Predictive accuracy of model for end stage liver disease [MELD] as a prognostic marker for cirrhosis in comparison with Child - Pugh score

To compare Model for End Stage Liver Disease [MELD] and Child-Turcott-Pugh [CTG] scoring as predictors of survival in cirrhotic patients. Observational prospective study. Military Hospital, Rawalpindi from 1[st] Dec 2008 to 30[th] April 2009. The study was carried out at Military Hospital, Rawalpindi a tertiary care hospital of Pakistan. Study included 55 patients suffering from cirrhosis of both genders being above 12 years of age, admitted in medical wards during the period from 1[st] December, 2008 to 30[th] April 2009. Each patient was assigned a MELD and CTP score. On discharge, these patients were followed up at 03-months, O6months and 1-year duration through telephone. Thirty seven [67.3%] patients were male while 18 [32.7%] were female patients, with age ranging from 27 years to 75 years [mean 53]. Fourteen [25.4%] patients were dead at 3-months, 22 patients [40%] were dead at 6- months and 29 [52.7%] patients were dead at 1-year follow up. MELD score proved to be a better indicator of survival than CTP score over a period of 01 year follow-up. MELD score is a better prognostic marker for cirrhotic patients as compared to CTP score

Free medical camps in rural areas of Azad Jammu and Kashmir

To describe the demographics, diagnoses and treatment offered to the people attending five free medical camps in various rural areas of Azad Jammu and Kashmir [AJK] during 2012. Cross sectional descriptive study. Bhimber district of AJK from January 2012 to December 2012. Five free medical camps each of two days duration were established during this period in Nihala, Gola, Poona, Nalee and Barroh which are located in the Bhimber district. Camps were staffed by Army doctors and nursing assistants. The particulars of the attending patients were recorded at the reception and diagnoses along with the medicines dispensed noted at the dispensary. A total of 7320 patients attended the five medical camps. The age of the patients ranged from 05 days to 101 years, mean age being 35 years. Females constituted 59% [4319] of the patients. Majority of the patients were agricultural workers. The most frequent complamts were gastrointestinal [30.4%] musculoskeletel [25.5%] and visual acuity problems [15.1%]. Other common complaints were related with dermatology, ear, nose and throaf [ENT] and gynecology. A total of 5010 prescriptions were recorded and the commonest medicines prescribed were multivitamins [30.5%], analgesics [28.3%], antibiotics [22.3%] and antihelminthics [21.7%].Gastrointestinal and musculoskeletal ailments dominate in the rural population of AJK. Recruiting a pediatrician, gynecologist and ophthalmologist in rural medical camps would greatly improve the efficiency of such camps and increase patient satisfaction. Such camps are recommended until the indigenous healthcare system is developed enough

Various risk factors for irritable bowel syndrome

To assess the frequency of various known risk factors in patients with irritable bowel syndrome [IBS]. Descriptive study. Combined Military Hospital Okara on 60 patients [convenience sampling over a period of 01 year] who had been diagnosed with irritable bowel syndrome [IBS] and paid regular follow-up visits to the medical OPD. Each patient in the study was investigated for the presence of various risk factors of IBS i.e. their age, sex, weight, socioeconomics, state of education, any coexistent ailment [DM, HTN etc] and any history of enteritis and food intolerance. The frequency of each risk factor in this sample of patients was then analyzed. Two third of the patients were within the age bracket of 20-30 years showing a male predominance. Body mass index and educational status had no effect on the frequency of the disease. Neither could any co-existing ailment or food intolerance be linked with the disease. Relatively high socioeconomic status and a history of enteritis prior to developing IBS did show a positive co-relation with IBS. IBS is more common in young adult males. The disease shows a positive co-relation with a history of prior acute enteritis. It has a slight predilection for high socioeconomic status but its frequency is not related to food intolerance, any co-existing disease or BMI

Combat trauma experience at forward treatment centre during Swat operation

To have an overview of combat trauma experience at Forward Treatment Centre during Swat Operation. Descriptive study. Forward Treatment Centre of a medical battalion in Swat from Jan 2009 to August 2009. All battle casualties of different age groups operated under general anaesthesia were included in the study. Surgeries performed under local anaesthesia were excluded. Relevant information was recorded in specially prepared proforma. Two hundred and sixty eight surgeries were performed under general anaesthesia over the course of eight months. Twenty two [8.2%] were officers, 12 [4.5%] JCOs and 234 [87.3%] were soldiers. Majority of the casualities were between 20 -30 years of age [86%]. 73.9% of the casualities reached Forward Treatment Centre within 4 hours while 3.3% reached after 24 hrs. Most of the patients sustained injuries due to bullets [50.7%] and splinters [39.9%]. Most of the patients were putting on bullet proof jackets at the time of injury and sustained injuries to the limbs [237/268, 88.4%]. Blood transfusion was carried out in 32 [11.9%] cases. Fifteen [5.6%] cases required less than two and 17 [6.3%] cases required more than two units of blood transfusion. Most of the casualities were sustained by younger age group and were caused by bullets and splinters. Majority of the injuries were sustained on the limbs and less on the chest and abdomen. Blood transfusion and timely evacuation to a Forward Treatment Centre providing effective trauma surgical care to combat casualities saved a number of lives

Specific evoked motor response for supraclavicular brachial block

To assess and evaluate the accuracy of individual types of evoked motor responses [EMRs] for prediction of successful surgical anesthesia following peripheral nerve stimulator [PNS] assisted supraclavicular block. A prospective study was carried out over a period of one and half years from August 2004 to January 2006, at J. N. Medical College, Aligarh Muslim University, Aligarh, India, in 60 patients who underwent various elective operative procedures on the upper limb. Any of the EMR, such as forearm flexion or extension, carpal flexion, or extension, prono-supination, or finger flexion, at a definite current of 0.25 mA for 2 ms was taken as an end point for prediction of successful block, and a local anesthetic solution [0.375% Bupivacaine, 30 ml] was administered at that level. Complete surgical anesthesia was observed in those cases where EMR included: flexion of only second and third fingers [n=15/15] or flexion of all 4 fingers with thumb opposition [n=14/14] or uncommon flexion of all 4 fingers without movement of any other joint of the upper limb [n=2/2], suggesting a sensitivity of 100%. However, thumb opposition to the tip of the flexed little finger revealed a success rate of only 83% [n=5/6], and other EMRs were followed by high rates of inadequate surgical anesthesia or total failure. Specific EMR of flexion of second and third fingers, or all the 4 fingers are reliable predictors of complete surgical anesthesia following PNS assisted single injection supraclavicular nerve block with no incidence of pneumothorax and nerve damage