Pattern of analgesic overuse in probable medication overuse headache

This study aims to highlight the overuse of analgesics in patients with chronic daily headache who meet criteria for probable medication overuse headache. This was a cross-sectional comparative study conducted at the department of Neurology, JPMC, Karachi during a period of 1 year i.e. from 01-01-2011 to 31-12-2011. All patients with chronic daily headache were screened for probable Medication Overuse Headache. Total of 110 patients who met ICHD-II [international classification of headache disorder] criteria for probable Medication Overuse Headache [MOH] were included in this study. Detailed history and neurological examination were performed in all cases with appropriate blood workup, CSF studies and MRI+MRV in those cases where required. Drug history was taken in detail in all cases and pattern of overuse of different acute symptomatic medications was assessed with reference to underlying primary headache disorder. Total of 110 patients who met ICHD-II [revised] Criteria for probable MOH were included in this study. Females outnumbered males i.e. 2.3:1. This gender preference was noted in all primary headache subtype. Migraine was found more frequently[44.2%] in younger age groups with probable MOH while TTH [tension type headache] [55%] and other primary [83%] headache disorder [including Cluster Headache, New daily persistent headache] were more frequent disorders in old age patients with probable MOH. Among different analgesic medications, simple analgesics were found to be the most frequently overused acute symptomatic medication [66%] followed by combination analgesics [40.9%] and triptans /ergots [14.6%]. Use of combinations of various acute symptomatic medications was also assessed in patients with chronic primary headaches who met the criteria for probable MOH. Excessive use of acute symptomatic drugs without consultation with the treating physician should be discouraged. Patient education is very important about the genesis of the problem. Prophylactic treatment and follow up visits should be encouraged

Gerd symptoms and body mass index: a study in outpatients of Abbasi Shaheed hospital

This study aimed to determine the association between GERD [Gastro-Esophageal Reflux Disease] symptoms and Body Mass Index [BMI] in the outpatients of Abbasi Shaheed Hospital, Karachi. A comparative cross-sectional study was conducted in Abbasi Shaheed Hospital, Karachi from December 2008 to March 2009. By convenient sampling method, 200 outpatients who met the inclusion criteria were enrolled in the study, visiting the hospital with symptoms of epigastric pain, nausea, vomiting, acid regurgitation, heart burn, burping, belching, and feeling of wind. A questionnaire was filled, which contained patient's demographic profile, information on the frequency of all GERD symptoms and severity of main GERD symptoms. History of smoking, alcohol, drugs or any illness were also inquired and noted. Statistical analysis was done by SPSS version 16. Among 200 outpatients, 65% were females and 35% were male. Mean age was 38.4 years. Nausea was complained in 87%, epigastric pain in 66%, acid regurgitation in 66% and heart burning in 64% of patients. The frequency of heartburn and acid regurgitation was seen once a week in 39% and 45% of patients respectively while severity of heartburn and acid regurgitation was found 25% and 33% of patients respectively and there relation with body mass index were found insignificant. Co-relation of body mass index was not associated with symptoms of gastro-esophageal reflux disease i.e.: nausea [p=0.06], epigastric pain [p=0.658], acid regurgitation [p=0.935], heart burn [0.525]. Our study concludes that in our setting, the symptoms of GERD occur independently of body mass index. It seems that high BMI plays a more important role to cause symptoms of GERD among western population but not in Asian populations. However, further studies in Asian communities are also required in this regard

Clinical presentation and course of Lassa fever in Pakistani troops serving in United Nations' Mission in Liberia

To document clinical presentation and course of Lassa fever in Pakistani troops serving in United Nations' Mission in Liberia [UNMIL]. Case series. Pak Level-II Hospital Tubmanburg, Liberia; over a period of four months from January 2006 to April 2006. Pakistani soldiers who presented with fever and later were confirmed to be suffering from Lassa fever by Polymerase Chain Reaction [PCR] test were included in the study. A total of 6 patients were confirmed to be suffering from Lassa fever. Three cases also had concomitant Falciparum malaria. Three cases presented with symptoms of upper respiratory infection, three presented with gastrointestinal symptoms and two cases with cervical lymphadonopathy. Two cases died while four recovered without any sequelae. Lassa fever presents with nonspecific signs and symptoms. In endemic areas, Lassa fever should be suspected in any patient who presents with fever and does not respond to antimalarials and broadspectrum antibiotics within a few days

Grown up Congenital Heart Disease patient presenting for non cardiac surgery: anaesthetic implications

Congenital heart disease patients surviving to adulthood have increased over the years due to various reasons. These patients are admitted in the hospital for non cardiac surgeries and other procedures more often than normal adult population. Management of grown up congenital heart disease patient presents a challenge during perioperative period for cardiologists, surgeons, intensivists and particularly for the anaesthetist. Management issues include psychological and physiological impact on the patient, complexity of defects, presence of previous palliative procedure, impact of anaesthetic agents on shunting and myocardium, endocarditis prophylaxis and associated extra cardiac anamolies

Response of Falciparum malaria to a combination of quinine and sulfadoxine-pyrimethamine in Boomy county of Liberia

To document the response of Falciparum malaria to a combination of Quinine and sulfadoxine-Pyrimethamine in Boomy County of Liberia. Quasi-experimental study. Pak Level-II Hospital Tubmanburg, Boomy Country Liberia over a period of one year [Jan 2006- Dec 2006]. Employees of United Nations' Mission in Liberia [UNMIL] mostly Pakistani soldiers but also other nationals belonging to different countries; who presented with Falciparum malaria and treated with quinine were included in the study. Falciparum malaria was confirmed microscopically in each case and was treated with a seven day course of Quinine followed by a single dose of Fansidar [sulfadoxine- Pyrimethamine]. A total of 69 patients were treated with Quinine; age range 20 to 50 years; 43 Pakistanis and 26 other nationals. All responded well to a combination of Quinine and sulfadoxine-Pyrimethamine. Fever settled within 72 hours in 91% of cases and parasite disappeared from the blood in 96% cases within 72 hours. A combination of Quinine and sulfadoxine- Pyrimethamine is very effective in the treatment of Falciparum malaria. Majority of patients became asymptomatic within 72 hours

Anatomical studies on cones of cupressus sempervirens Linn

The cones of Cupressus sempervirens Linn, belong to the family Cupressaceae were collected from Government Botanical Garden, Ootacamund and dried under shade. The dried cones were powdered and used for physico-chemical constants determination. The macroscopical and microscopical characters were also evaluated [by using fresh cones] and reported. The anatomical parameters of the cones were studied first time on this plant

study of hearing levels in children of rural and urban setups

To assess the hearing levels of children belonging to two different environmental set ups. A Comparative analysis. ENT department Fatima Hospital, Baqai Medical University June 2006 to Nov. 2006. Study includes 100 students of Saleemullah Fahmi Primary School and equal number of Cadets of Baqai Cadet College Gadap. Hearing levels of these two groups of children were assessed and recorded with the help of pure tone audiometer [PTA]. It was found that the hearing levels of the students of Baqai cadet college were noticeably better i.e. 59/100 having normal hearing, hearing grade-I, and 41/100 having mild loss, hearing grade-Il, than the students of Saleemullah Fahmi primary school where 41/100 having mild loss i.e. hearing grade-I and 58/1 00 moderate loss hearing grade-Il and only 01/100 having severe bilateral loss i.e. hearing grade-III. The hearing assessments of 200 sample students from rural and urban background [divided into two equal groups] were found to have different levels of hearing without any detectable pathology in their hearing apparatus

Formulation and HPTLC standardization of safoof-e-kasir-e-reeh, a unani formulation

Safoof-e-Kasir-e-Reeh is a Unani preparation containing Cumin [Zira safed], Ajowan [Ajwain], Black salt [Namak-e-Siyah], and Black Pepper [Filfll Siyah] used as carminative and antiflatulent. The Safoof [powder] was prepared by blending all the powdered ingredients after passing through 100 mesh sieve. The Safoof was extracted with methanol and filtered. The filtrate was used for estimation of piperine by High Performance Thin Layer Chromatographic technique using silica gel 60 F HPTLC plates [Merck]. Benzene: Ethyl acetate: Diethyl amine [60:30:10] was used as mobile phase for piperine. The detection was performed at the wavelength of 254 nm. The piperine content was found to be 2.284%. This estimation technique is very much useful for the standardization of Unani formulations containing black pepper

case of pulmonary sarcoidosis, not tuberculosis

The case of sarcoidosis of the lungs is described in a 50 years old female who presented with symptoms similar to pulmonary tuberculosis. As she showed no improvement on anti-tubercular therapy, sarcoidosis was suspected and confirmed by endobronchial biopsy and she responded well to treatment

Short term results after tetracycline pleurodesis in recurrent pneumothorax and malignant pleural effusion

Therapeutic Tetracycline pleurodesis was performed in twenty-nine patients, including Twelve men and seventeen women, the aim of this pro spective study was to determine the Cure or success rate of pleurodesis for recurrent pneumothorax and malignant pleural effusion with tetracycline. From 1995 to 1999, twenty-nine patients were enrolled; eighteen were with malignant pleural effusion and eleven with pneumothorax. Pleurodesis was induced by instillation of tetracycline through Pleural drain. Followup period was from six months to forty months, with mean of fifteen months. Follow up rates were ninety-four percents. Three patients required repeated pleurodesis

Tuberculosis contact tracing in an outpatient pulmonology practice

The aim of this study was to analyze the results of tuberculosis contact tracing Carried out in an out patient pulmonary center and assess its per formance in Detection of new cases. One thousand four hundred and three contacts of one hundred and ninety four tuberculosis patients were evaluated at Abbasi Shaheed hospital between 1996 and 1999. Out of them 852 were tuberculin positive and 178 persons [11. 8%] found to have active disease. The portion of infected and disease contacts were significantly higher for those who had contact with smear Positive patients and especially in children