Effectiveness of clobazam on perception, creativity, intelligence, selective and visual memory

Clobazam belongs to benzodiazepine class and is preferably used against anti-epileptic disorders. However, when used in reduced doses, its ability for improving cognitive functions becomes explicitly evident. This study objectively undertook the task of using the reduced doses of clobazam for proving potentials effects on cognitive functions. The drug, clobazam was administered in "active group? which contained 15 young healthy volunteers. The "placebo group? also entailed 15 subjects and each was administered with placebo drug. The controlled group? also included 15 subjects. All these 45 young healthy subjects were subjected to tests for perceptual learning, creativity, selective memory, visual memory and intelligence. Results clearly demonstrated significant impact of clobazam at the dose of 5mg/day on perceptual learning [P=0.0380], creativity [P=0.0787], memory function [P=0.4920], visual memory [P=0.4816] and intelligence of the subject [P=0.4920]. The outcomes highlighted in the studies reviled the positive effects of clobazam when used at reduced doses

Sofosbuvir adverse events profile in a subset of Pakistani population

Objective: To determine frequency and pattern of adverse events reporting in a subset of Pakistani population being treated for chronic hepatitis C with sofosbuvir combination therapy

Study Design: Descriptive study

Place and Duration of Study: Department of Medicine, Gastroenterology Division, Shalamar Hospital, Lahore, from September 2015 to May 2016

Methodology: Patients who were offered sofosbuvir therapy for treatment of chronic hepatitis C were randomly enrolled. The study subset included both treatment naïve as well as retreatment groups. Patients were screened for subjective as well as objective evidence of adverse events at regular intervals. Frequency was determined

Results: Among 196 patients with chronic hepatitis C, 192 patients received dual therapy consisting of ribavirin and sofosbuvir. The most frequent complaints in these subjects were fatigue, fever, myalgias and nausea accounting for 55%, 42%, 44.2% and 50%, respectively. Twenty-seven percent of patients reported with drop in hemoglobin of >2g/dl, while absolute neutropenia and moderate to severe thrombocytopenia was observed in 3% and 5% of patients, respectively. One patient died as a result of severe pancytopenia. Later derangements were all observed in patients with decompensated disease

Conclusion: Sofosbuvir showed less severe adverse effects in terms of symptomatology and less frequent neutropenia and thrombocytopenia as compared to previous regimens. Careful monitoring is required, especially in those with decompensated liver disease

Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients

Background and objective: Postoperative pain requires a well-planned analgesia regimen to ensure adequate patient comfort, satisfaction, early mobilization and also to decrease the hospital stay after anesthesia. We conducted this study to compare the transversus abdominis plane block with direct infiltration of bupivacaine into surgical incision in cesarean section to prolong the mean duration of postoperative analgesia

Methodology: This Randomized control trial was conducted in department of anesthesia, Nishtar Hospital, Multan from July 2016 to December 2016. A total of sixty patients were included in the study and randomly divided into two equal groups of 30 each; Group-T and Group-I. Group-T received TAP block with 0.3 ml/kg of 0.25% bupivacaine on each side under double pop technique, and Group-I received 0.6 ml/kg of 0.25% bupivacaine infiltration in surgical incision. Postoperatively all the patients were monitored in PACU. VAS was noted at 1/2, 1, 2, 4 and 6 h intervals. Inj tramadol 1.5 ml/kg was given as rescue analgesia when VAS score >/=4. Time to requirement of first rescue analgesia was noted. Sample size was calculated with 80% power of test, 95 % confidence interval taking mean and standard deviation of rescue analgesia in Group-T 148 +/- 46.7 and in Group-I 85.38 +/- 38.07. Data were analyzed with computer software SPSS version 23. Mean +/- SD was calculated for quantitative variables and frequency [percentage] was calculated for qualitative variables. Student t-test and chi square test were applied. P value 0.05 was considered as significant

Results: Mean VAS score at half hour in Group-T was 3.8 +/- 2.9 and in Group-I was 5.0 +/- 3.0; and mean VAS score at one hour was 4.4 +/- 3.01 in T Group and in Group-I was 5.3 +/- 3.09 respectively; at two hours 4.7 +/- 2.9 and 6.3 +/- 4.2, and at four hours was 5.2 +/- 2.9 and 5.7 +/- 2.8 in Group-T and Group-I respectively. Mean VAS score during six hours was 5.5 +/- 2.8 and 6.1 +/- 2.5 in Group-T and Group-I respectively. Mean time for 1st analgesia in Group-T was 296.3 +/- 37.1 min and in Group-I was 202.0 +/- 34.9 min, by applying t-test P= 0.000 a significant value

Conclusion: TAP block is a promising technique in alleviating postoperative pain in patients' cesarean section. The procedural simplicity of this block, along with reliable level of analgesia [T10-L1], and longer duration makes the TAP block a good option

Efficacy of probiotics versus placebo in the prevention of necrotizing enterocolitis in preterm very low birth weight infants: a double-blind randomized controlled trial

Objective: To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis [NEC] in preterm very low birth weight [VLBW] infants

Study Design: A randomized double blind controlled trial

Place and Duration of Study: The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet Bangladesh, from July 2012 to June 2015

Methodology: Preterm [28 - 33 weeks gestation] VLBW [birth weight 1000 - 1499 g] neonates were enrolled. The study group was fed with probiotics once daily with breast milk from first feeding, and the control group with only breast milk without the addition of probiotics. Both the groups received other standard care. The primary outcome was the development of NEC [stage II and III], categorized by modified Bell's classification

Results: In 108 neonates, development of NEC was significantly lower in the study group than that of control group [1 [1.9%] vs. 6 [11.5%]; p=0.044]. Age of achievement of full oral feeding was significantly earlier in the study group than that in the control group [14.88 +/-3.15 and 18.80 +/-4.32 days; p < 0.001]. Duration of hospital stay was significantly short in the study group compared to the control group [15.82 +/-2.94 days vs. 19.57 +/-4.26 days; p < 0.001]

Conclusion: Probiotic supplementation reduces the frequency of necrotising enterocolitis in preterm neonates with very low birth weight. It is also associated with faster achievement of full oral feeding and short duration of hospital stay

Spinal anaesthesia; comparison between prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia in patients undergoing lower abdominal surgeries

Perioperative shivering is a common problem during spinal anaesthesia. It causes tremendous deleterious effects on metabolism of body. Despite of re-warming and raising the ambient temperature, several drugs are under research to evaluate their preventive role in shivering during anaesthesia like tramadol, butorphanol, midazolam, ketamine and ondansetron. The present study was conducted to evaluate the effect of prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. To compare prophylactic low dose ketamine with ondansetron for prevention of shivering during spinal anaesthesia in patients undergoing lower abdominal surgeries. Randomized controlled trial. Department of Anaesthesia, Nishtar Hospital Multan. November 2012 to May 2013. A total of 256 patients were included in the study divided into two equal groups. In this study basic demographics like age, gender, mean weight and height and type of surgery patients underwent were similar, having no significant difference in both groups, while on comparison in both groups, the frequency of shivering revealed 4.69%[n=6] in K Group and 11.72%[n=15] in O Group while remaining 95.31%[n=122] in K and 88.28%[n=113] in O Group had no findings of the morbidity, p value was calculated as 0.03, which showed significant difference. The result of the study concluded that prophylactic intravenous administration of low dose ketamine [0.25mg/kg] is significantly more effective than ondansteron [4 mg] for prevention of shivering during spinal anesthesia in patients undergoing lower abdominal surgeries

Role of non coaxial bone marrow biopsy needle and bone biopsy needle in CT guided core needle biopsies

Objective: to compare bone marrow biopsy needle [BMBN] with bone biopsy needle [BBN] in CT guided core biopsies considering size of core, diagnostic yield and cost of needles

Methodology: retrospective study was done on 50 out of 68 patients referred to Interventional Radiology department for CT guided bone biopsy from 2008 till 2013. Grading of specimen length was done as small, medium and large. Diagnostic yield was determined on basis of clinical, imaging and histopathology data. Local cost of both needle types was determined. Comparison was made and statistical analysis was performed

Results: biopsy was performed by BBN in 16 patients and by BMBN in 34 patients. Overall diagnostic yield of bone biopsies was 82% [41 of 50 biopsies]. Diagnostic yield with BMBN was 85% and with BBN was 75%. Overall longer specimen length was obtained using BMBN. Statistically, there was no significant difference between them in diagnostic yield and specimen length; however, BMBN costs almost one half than BBN

Conclusion: diagnostic yield and sample length using bone marrow biopsy needle proved to be equivalent to bone biopsy needle. Bone marrow biopsy needle has an added benefit of being low in cost. Despite being a non-coaxial technique these needles can achieve diagnostic yield comparable to that of coaxial techniques as reported in past literature

Infratemporal, masticator space infection and orbital abcess following carious maxillary first molar extraction in a four month pregnant patient. A case report

Odontogenic infections lead to life-threatening complications once they reach potential fascial spaces due to decreased immunity in pregnancy. It may also occur due to patient negligence, delayed diagnosis and mismanagemnet. Infratemporal space infection is a rare but a serious sequel of odontogenic infection. We report the case of a 20 year old, four months pregnant patient with carious left maxillary first molar with fascial space infection. Following extraction of this tooth and despite appropriate antibiotics the patient developed infection in the infratemporal and masticator space, followed by a orbital abscess

Endovascular treatment of a post catheterization pseudoaneurysm: a stitch in time saves nine

External iliac artery [EIA] pseudoaneurysms are a well-known complication after arterial catheterization procedures. Most develop as a result of high femoral puncture. Small asymptomatic pseudoaneurysms are usually of no consequence but large symptomatic pseudoaneurysm carries a significant risk of rupture with serious life-threatening consequences and needs to be treated. We report here a case of EIA pseudoaneurysm in a 60 year old male patient after a cardiac catheterization procedure. CT angiography demonstrated a large pseudoaneurysm arising from the EIA and compressing the urinary bladder. Patient complained of abdominal pain and felt dizzy and required transfusions due to rapidly developing anaemia secondary to blood loss. Conventional angiography revealed free extravasation of contrast from the EIA. Percutaneous intervention through femoral access was performed by deploying a covered stent which effectively sealed off the perforation site with no evidence of contrast extravasation

Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

The objective of this study was to assess the prevalence of polypharmacy [PP] and the associated factors in medical outpatients. A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of >/= 5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients' age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated [SPSS Inc] Version 18. Out of 766 patients included in the study, 683 [89%] had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age [>/= 61 years], disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care

Erythrocyte sedimentation rate at diagnosis in culture positive cases of active tuberculosis

To evluate the Erythocyte Sedimentation Rate [ESR] at the time of diagnosis in culture positive cases of different types of active tuberculosis [TB]. In this retrospective descriptive study conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, ESR was done by a modified Westergren method using a rapid test. Cases of active TB [defined as a case of TB up to two weeks from the start of anti-tuberculous treatment], were evaluated for ESR at the time of diagnosis. Of 246 cases of culture positive TB, ESR results during active phase were available in 195 [79.3%] patients. Number [%] of patients with pulmonary, extra-pulmonary and disseminated TB were 69 [35%], 78 [40%] and 49 [25%] respectively. Two [1%] of these patients were HIV positive. ESR was elevated in 169 [87%] and was normal in 26 [13%] patients. Mean ESR in all patients was 67.6 mm/hr with no statistical difference between patients with different TB types. ESR between 1-30, 31-60, 61-90, 91-120 and 121-150 mm/hr represented 19%, 23%, 23%, 19% and 6% of the cases respectively, whereas 44 [22.6%] of the patients had ESR more than 100 mm/hr. In HIV negative patients with suggestive features of TB but without any other underlying disease affecting the ESR, the baseline ESR may be a valuable diagnostic test to suspect TB in resource poor countries

Comparison of high sensitivity C-reactive protein level between obese and non-obese pregnant women

To find out whether obesity is associated with low grade systemic inflammation as measured by serum c-reactive proteins [CRP] levels. Cooperative Observational Study. This was conducted in the department of Physiology BMSI, JPMC with the collaboration of gynecology and obstetric department of JPMC Karachi from October 2008 to May 2009. This study includes thirty obese pregnant women and thirty normal weight pregnant women as a control group of similar age, sex, height and gestational age. Subjects were randomly selected from gynae OPD of JPMC Karachi. The mean values of C - reactive protein concentration was higher in obese pregnant women as compared with control group [4.3 +/- 0.16 mg/L vs 9.0 +/- 12 mg/L]. It showed statistically significant positive correlation with body mass index [BMI]. Higher BMI was associated with higher C-Reactive proteins concentration. These findings suggest a state of low-grade systemic inflammation in obese pregnant women

Use of traditional herbal medicines in the treatment of eczema

Use of traditional herbal medicines is very common in Pakistani society. It is more prevalent in villages and Cholistan desert areas where medical facilities are less available, so generally people rely on herbal treatments for their diseases. Mostly herbal remedies are very effective and have fewer side effects. In this review some commonly used herbal remedies for treatment of eczema are discussed. Unfortunately, research on herbal drugs in terms of controlled clinical trials in humans is scanty. Hopefully, clinical research in the herbals opens new avenues in therapeutics

Myocardial infarction; streptokinase study on ST-segment resolution in patients age less than 40 years

Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. The study was conducted at national institute of cardiovascular diseases [NICVD] of Pakistan, Karachi. Subject and All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECG recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Streptokinase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124+3.32 and 112+3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant [P<0.001]. The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80+2.70 and 72+1.91 before and after the Streptokinase therapy's, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69% respectively. The P values were highly significant [P<0.001]. Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis

Streptokinase study on ST segment resolution in patients age less than 40 years with myocardial infarction

Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. The study was conducted at national institute of cardiovascular diseases [NICVD] of Pakistan, Karachi. All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECO recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Streptokiriase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124 +/- 3.32 and 112 +/- 3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant [P<0.001]. The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80 +/- 2.70 and 72 +/- 1.91 before and after the Streptokinase therapy's, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69% respectively. The P values were highly significant [P<0.001]. Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis

Clinical characteristics of patients with atrial fibrillation at a tertiary care hospital in the central region of Saudi Arabia

To report on the clinical presentation, etiology, and laboratory features of acute and chronic atrial fibrillation [AF] in a tertiary hospital in Riyadh, Saudi Arabia. We retrospectively studied records of 720 patients with AF seen in outpatients and inpatients departments at King Abdulaziz Medical City, Riyadh, during the period of 1 January 2002 to 31 August 2008. Documented acute and chronic AF was present in 157 [21.8%] and 563 [78.1%] patients, respectively. Palpitations, dizziness and syncope were the most frequent symptoms in acute AF, while dyspnea and palpitations were the most common symptoms in the chronic type. Acute respiratory problems and acute myocardial infarction were significantly more common in acute AF, while congestive heart failure and acute respiratory problems [chest infection, bronchial asthma, and pulmonary embolism] were significantly more common in chronic AF. The most common causes of both types of AF were diabetes mellitus [DM] in 68.8%, hypertension [HTN] in 59.3%, chronic lung diseases [bronchial asthma, chronic obstructive pulmonary disease and interstitial lung disease] in 31.8%, valvular heart disease in 23.6%, and ischemic heart disease [IHD] in 23.1%. In 9 [1.3%] patients, no cause was detected. The echocardiographic findings of left ventricular hypertrophy, valve lesions, and depressed left ventricular function were significantly more common in chronic AF [P<0.01]. Nowadays, DM, HTN, and IHD are becoming the most common predisposing factors for AF in the central region of Saudi Arabia and require prevention and control

Comparative study of verapamil and thioridazine in acute opioid abstinence syndrome

To determine the effectiveness of verapamil and thioridazine in the treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioids. The study was conducted at Psychological Medicine Ward, Civil Hospital Karachi and Arshi Hospital, Naseerabad, F.B. area Karachi. A total of forty [40] patients were admitted for ten [10] days in hospital. No treatment was given during the first two days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Patients were divided into 2 groups. Each group comprising of 20 opiate addicts. One group was given verapamil orally in a 40mg dose thrice daily and the other group was given thioridazine orally in a 10mg dose thrice daily from day 3 to day 9 of admission. The intensity of sign and symptoms were recorded by using subjective and objective opiate withdrawal questionnaire. Urine analysis for opioids was done on day 1, 5 and 10 of admission. Verapamil in comparison to thioridazine significantly decreased admission. Urine analyses for opioids were positive on day 01 while zero on day 10. Verapamil in comparison to Thioridazine was found to be safe and effective for the treatment of signs and symptoms of acute opioid withdrawal in in-door patients without any significant side effect

Extremely elevated erythrocyte sedimentation rate: etiology at a tertiary care center in Saudi Arabia

To evaluate the etiology of extremely elevated erythrocyte sedimentation rate [ESR] in adolescents and adults at a tertiary care center. This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Wetergren method of determining ESR in adolescents and adults aged >/= 12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/= 100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient. During the study period, out of the 44,366 ESR tests carried out at this center, 1864 [4.2%] had an ESR >/= 100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections [38.6%], autoimmune diseases [15.9%], malignancy [15.4%], miscellaneous causes [10.2%], ischemic tissue injury or trauma [8.7%], and renal diseases [8.4%]. Ten common individual causes included: rheumatoid arthritis [7.3%], osteomyelitis [6.9%], tuberculosis [5.5%], trauma [5.3%], lymphoma and sepsis of unknown origin [5.1%] each, urinary tract infection [4.7%], septic arthritis [3.1%], abscesses [2.8%], and pregnancy [2.2%]. Fourteen [2.4%] patients had no known cause. Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis

Toxicity of aminoglycoside [streptomycin] in the management of tuberculosis in placebo controlled study

The study was planned with an aim to identify the toxicity of streptomycin in the treatment of Tuberculosis. It's early an easy detection, establishment of existing damage without the use of sophisticated, costly and time consuming methods and also to assess the existing popular modalities of treatment. This prospective study was carried out in the Chest Ward and OPD JPMC Karachi and duration of twelve weeks. Patients were selected from chest ward and OPD of JPMC. Prospective randomized study of adverse effects of Streptomycin in the treatment of tuberculosis was done. It showed that like other antituberculous drug the streptomycin must be careful to use in combination therapy in the treatment of tuberculosis. The major side effects were those giving rise to serious health hazards, and required discontinuation of the drug. Minor side effects caused relatively little discomfort and often responded to symptomatic or simple treatment but occasionally persisted for the entire duration of drug treatment. In fact tuberculosis drugs are relatively toxic and side effects are not uncommon but most of them do not warrant drug withdrawal

Role of verapamil in acute opioid abstinence syndrome

To determine the effectiveness of calcium channel blocker, verapamil in the treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioid. A clinical study. The study was conducted at Psychological Medicine ward, Civil Hospital Karachi from January 1998 to April 1998. A total of twenty [20] patients were admitted for ten [10] days in hospital. No treatment was given during the first two days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Then the verapamil was given orally to each patient in a 40mg dose thrice daily from day 3 to day 10 of admission. The intensity of signs and symptoms was recorded by using subjective and objective opiate withdrawal questionnaire. Urine analysis for opioids was done on day 1, 5 and 10 of admission. Verapamil significantly decreased the intensity of signs and symptoms of acute opioid withdrawal from day 4 to day 10 of admission. Urine analyses for opioids were positive on day 1 while zero on day 10. Verapamil was found to be safe and effective for the treatment of signs and symptoms of acute opioid withdrawal in in-door patients without any significant side effect