ABSTRACT
Objective: we aimed to explore the difference of short-term prognosis in controlled, uncontrolled and non-diabetic patients suffering from ischemic stroke
Methods: this was a prospective observational study conducted at Neurology department of Services Hospital, Lahore over a period of 6 months from January 2014 to June 2014. A total of 113 patients with first-time ischemic stroke [confirmed on CT scan] were admitted in our department. In all patients fasting blood glucose [FBG] level was monitored on 1st admission day and history of Diabetes Mellitis [DM] was acquired. FBG >126mg/dl was taken as cut-off level. In all patients with positive history of DM, HbA 1 C level was evaluated. So it divided our patients into four groups: A] Uncontrolled Diabetics [HbA 1 C>/=6.5%, positive history of DM]; B] Controlled Diabetics [HbA 1 C 5.7-6.5%, positive history of DM]; C] Impaired glucose group [Deranged FBG, No history of DM]; D] Normoglycemics [FBG <126mg/dl, No history of DM]. The outcome in all patients was measures in terms of early neurological deterioration [increase in the NIH Stroke Scale [NIHSS] of >/=2 points during the first 14 days after admission] and poor short-term outcome [30-day modified Ranking Scale [mRS] score 2-6] was evaluated
Results: of 113 patients, 17 patients were in group A [uncontrolled diabetics], 7 patients were in group B [controlled diabetics], 4 patients were in group C [lmpaires glucose group] and 85 patients [75.2%] were in group D [Normoglycemics]. All the groups were comparable regarding demographic details. The risk of early neurological deterioration was higher in group A [9/17 patients] [0Rs=1.839; 95% Cl, 0.707-4.782],] than group B [3/7 patients] [0Rs=1 .48; 95% Cl, 0.35-6.31],], group C [1/4 patients] [ORs=0.868; 95% Cl, 0.091-8.238], and group D [19/85 patients]. Similarly the risk of poor short-term outcome was also significantly higher in the group A [13/17 patients][ 0Rs=2.75; 95% Cl, 0.83-8.238; p=0.047] than group B [5/7 patients] [0Rs=2.12; 95% Cl, 0.389-11.54; p=0.207], group C [2/4 patients] [ORs=0.847; 95% Cl, 0.114- 6.301; p=0.440], and group D [46/85 patients]
Conclusion: In our study population, patients having hyperglycemia with history of DM were associated with poor short-term prognosis than those with normal glycemic readings after ischemic stroke
ABSTRACT
Objective: our hypothesis was that an EEG recording of 20 minutes' duration would yield more information than a 10-minute EEG in capturing epileptiform abnormalities
Methods: the study was conducted in electrophysiology section of neurology department of services hospitals, Lahore during 2012. Total 171 consecutive EEG patients were evaluated
Results: we prospectively studied 171 consecutive EEGs [patients of 16-29 years old] of 20 minutes' duration performed at Services Hospital. Although the majority [89%] of interracial EEG abnormalities can be identified within the first 20 minutes of a routine EEG, extending the time of a routine EEG may increase the yield. The single electrical abnormality was found to appear between 11 to 14 minutes
Conclusion: it should be emphasized that every EEG should be done for at least 20 minutes duration as recommended, especially when the first 10 minutes are normal
ABSTRACT
Objective: to find Public awareness regarding stroke and the cause of delayed presentation of stroke patients in our setup at Services Hospital Lahore
Material and Methods: this prospective study was conducted on 113 patients in Department of Neurology, Services Hospital, and Lahore over a period of one year from January, 2012 to December, 2012. The time of presentation was divided into 4 segments; within 6 hours of stroke onset, within 6-12 hours of stroke onset, within 12-24 hours of stroke onset and more than 24 hours of stroke onset with diagnosis of cerebral infarction. Also knowledge of patients regarding tPA and cause of delay was assessed
Results: there were 68 males and 45 females with age range of 27 to 83 years. Only 9 patients presented within 6 hours, 22 within 6-12 hours, 4 7 within 12-24 hours and 35 more than 24 hours. A very little percentage of patients with cerebral infarction landed in Emergency department within 6 hours of stroke onset. Also 91.1 % of patients were unaware of thrombolytic therapy. When asked for a single factor for pre-hospital delay, 67% of patients labelled transportation issues as a cause
Conclusion: because early presentation is a prerequisite for thrombolysis for acute ischemic stroke we recommend to start educational programs that increase public awareness of the need to seek medical help promptly after stroke and word stroke should be replaced with brain attack and measures to improve the traffic sense should also be undertaken
ABSTRACT
Objective: the aim of our study is to determine the level of stress in young doctors categorizing it on yearly and specialty basis and also to determine personal factors like gender and marriage. So that we can counter this problem to improve patient care/ clinical management and finally health care delivery system
Material and Methods: across sectional survey of resident doctors in different specialties was conducted in Jinnah Hospital Lahore. The questionnaire we used i.e. AKUADS along with a proforma for the collection of data of the participants. AKUADS is a self-reporting scale in Urdu language which has been designed and validated for study in our population
Results: there were 200 postgraduate resident doctors of which 52 % male and 48 % female were recruited in the study. Mean age was 27 years; minimum age was 23 years, and maximum age was 36 years. Of the randomized data, 32 % 1st year resident, 24% 2nd year result, 33% and 3rd year, 11 % were 4th year. 56% were from medicine and allied and 44 % were from surgery and allied. In our participants who had scored less than 19 i.e. not suffering from depressive and anxiety symptoms on AKUADS were 58% [67.3% male and 47.9% female]. Participants scoring between 20 to 40 i.e. mild were 34% [25%male and 43.8% female]. Participants scoring between 41 to 60 i.e. moderate were 6% [7.7% male a d 4.2% female]. Participants scoring between 61 to 80 i.e. severe were 2% [0%male and 100% female]
Conclusions: frequency of high degree of anxiety and depressive symptoms can be considered as bad indicator of deteriorating health care system and need for urgent concern and action to change the current situation
ABSTRACT
Objective: the objective of the study is to determine the frequency of dementia in patients with Parkinson's disease
Material and Methods: a hundred patients of Parkinson's disease presenting to OPD between the ages of 40 and 100 years were enrolled in the study and dementia was assessed in these patients by performing mini-mental state examination
Results: mean age was 69.31+/-16.37years,. The age range was 40-100 years, but 68 [68 %] patients were more than 60 years of age. Out of the 100 patients, 66 [66%] were males and 34 [34 %] were females. Mean mini-mental state score at admission was 16.75+/-2, 7[24%] Patients were having mini-mental score of 5-10, 10 patients [34%] had mini-mental score 11-18, and 12 patients [41 %] had mini-mental score of 19-24 at presentation. Mean duration of disease was 11 +/-2.08 years. Out of total 100 patients, 29 [29%] patients had dementia, whereas 71 [71 %] did not have cognitive impairment
Conclusion: it is concluded from the study that dementia develops in considerable number of patients and is most commonly associated with late onset of disease and with longer duration of PD. Most of the patients had moderate dementia. Therefore, it is recommended that every patient with PD should be assessed for cognitive impairment so as to enable early detection of dementia and to halt the progression in such patients
ABSTRACT
Objective: to explore the ideas and attitudes of care givers towards patients suffering from schizophrenia with the help of survey form formulated after group discussion with a focus group of families, which was later used to gather information from a larger sample
Material and Methods: this study was conducted at Neuro Clinic, Johar Town, Lahore, over a, period of six months from March 2009 to August 2009. Rural as well as urban population is equally represented in sample. A focus group, comprising of ten patients and their care givers, who were attending for the last two years for follow-up participated in a group discussion and a survey form was formulated on the basis of this to explore the beliefs and attitudes of care givers of patients suffering from schizophrenia. In the next stage this form was used during the study period on all those care givers who consented to participate in the survey
Results: majority of care givers were females [82.6%] and had no formal education. Majority [almost 50%] of them believed in supernatural causes. Others believed in psychological factors [14%], physical as well as psychological [11 %], physical reasons alone [8.5%], physical and supernatural [7%], malingering [7%] and inheritance [2.8%]. Nearly 93% respondents believed -that treatment is possible in this illness; however there were variations in people's beliefs about treatment modality
Conclusion: nearly half of the study participants believed in non scientific and supernatural' muses of schizophrenia. There is a need to establish community based mental health services; that can impart psycho-eductional interventions at the level of community and families
ABSTRACT
This article has reviewed cultural variations in the presenting features of depression focusing on somatic symptoms as it has implications on diagnosis, treatment and remission. This article tries to bring out the importance and relevance of knowing sub cultural somatic idioms in modern day psychiatric practice
ABSTRACT
Background: To determine the frequency of depressive symptoms in patients of Parkinson's disease [PD]
Material and Methods: It was an observational study conducted in out-door and in-door departments of the Neurology ward, King Edward Medical University/Mayo Hospital, Lahore from April 2003 to November 2003. 100 patients of Parkinson's disease [diagnosed by consultant neurologists] were registered and after fulfilling all the inclusion and exclusion criteria, Hospital Anxiety and Depression Scale [HADS] was applied to see the depressive symptoms in patients of PD
Results: Out of 100 patients, 81 [81%] patients were depressed. All the patients with bradykinesia were depressed. Only 07 depressed patients were taking antidepressants
Conclusion: Depression can be viewed as a common clinical feature of PD and goes unrecognized in majority of the patients of PD. Depression and PD are not coexisting diseases but probably biochemical identical diseases. Bradykinesia can be a strong predictor for depression in patients of PD. Majority of PD patients with depression were not being treated for depression
ABSTRACT
Spontaneous spinal epidural hematomas are very rare. These generally occur in adult males and are most frequently located in the lower cervical region. Most common symptoms are sudden onset cervical or thoracic pain followed by features of cord compression. MRI is the diagnostic investigation of choice. Early diagnosis and prompt surgical evacuation are of paramount importance for a better neurological recovery. We present a report of two cases of spontaneous acute spinal epidural hematoma who presented with sudden onset of very severe pain in the neck and interscapular region followed by acute onset quadriparesis. They were diagnosed on MRI and were operated