Classic Raymond syndrome

Classic Raymond syndrome presents with abducens nerve palsy on the ipsilateral side with contralateral hemiparesis and facial nerve paralysis. A 60-year gentleman presented with deviation of left angle of mouth and right sided weakness. Examination showed that he had left sided abducens nerve palsy, with contralateral central facial paralysis and paresis. MRI of brain confirmed left pontine infarct. These findings were consistent with classic Raymond syndrome. Till now, only a few cases have been reported worldwide, this being the first case reported in South Asia. This case confirms that classic Raymond syndrome is different from the common type of Raymond syndrome in terms of sparing of coritcofacial fibers in the latter type

Diode Laser – A Boon in the Treatment of Mucocele – A Case Report.

A mucous cyst (mucous extravasation cyst, mucocele, ranula, mucous retention cyst) is a thin sac on the inner surface of the lips. They are painless swellings but can be bothersome. The cysts are thought to be caused because of trauma by sucking of the lip membranes between the teeth, if left untreated; they can organize and form a permanent bump on the inner surface of the lip. They are known as ranula when on the floor of the mouth, and epulis when present on the gums. This article highlights the advantages and evaluates the efficacy of treatment of mucocele with the help of diode lasers.

Correlation between glycosylated hemoglobin and platelet activity among patients with type 2 diabetes mellitus

To determine the correlation between glycosylated hemoglobin level and platelet activity among patients with type 2 diabestes mellitus [T2DM]. This study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar from January to June 2012. Through a Comparative Cross Sectional Study Design, a total of 80 patients with T2DM were selected from Medical Wards and OPDs and were grouped into those with glycated hemoglobin [HbA1c] levels < 7% [Group A, n=33] and those with HbA1c >/= 7% [Group B, n=47 patients]. Both the groups were compared with regards to MPV and HbA1c. The mean age of patients was 47.41 +/- 6.74 years. In group A there were 45.5% [15] males and 54.5% [18] females. In group B there were 48.9% [23] males and 51.1% [24] female patients. MPV was significantly higher in group B as compared to group A [9.21 +/- 0.76 fl vs. 8.29 +/- 0.46 fl; P < 0.001]. Among the group B patients, a positive statistical Pearson's correlation was seen between MPV and HbA1c levels [r = 0.589; p < 0.001]. However, no statistical correlation was seen between MPV and the duration of DM and BMI. There is a significant association between poor glycemic control and increased platelet activity in patients with uncontrolled T2DM

Gastrointestinal and hepatotoxic side effects of coamoxiclav in adults

Background: Co-amoxiclav which is a combination of Amoxicillin and Calvulanic acid is one of the most commonly prescribed antibiotics so there was need to study the side effects of this drug

Objectives: This study was done to enlist the adverse reactions especially the gastroinstestinal and hepatotoxic adverse reactions in patients who were prescribed co-amoxiclav

Patients and Methods: This cross-sectional study was conducted on 200 patients, both indoors and out-doors in the Department of Medicine of Khyber Teaching Hospital [KTH], Lady Reading Hospital [LRH] and Hayatabad Medical Complex Peshawar, in months of August-October of 2013. The individuals included in the study were those treated as inpatient or outpatient with the diagnoses of uncomplicated UTIs, RTIs including Sinusitis and Pneumonia and the Skin infection. Those who were below the age of 18 years, requiring more than one antibiotic, having previously known chronic disease especially the liver disease or on any long-term medications, alcoholics and pregnant ladies were excluded from the study. A detailed questionnaire mentioning the age, sex and ethnicity of the patients, indications for the use of co-amoxiclav, duration of the treatment, base line LFTs including Bilirubin, SGPT and Alkaline Phosphatase and use of any concomitant drugs was devised. The patients were asked for follow up at weekly intervals for eight weeks after the course of treatment and assessed clinically and biochemically and LFTs recorded. This study which was approved by the Ethics Committee of our hospital was self-funded by the authors and informed consent was taken from every patient. The data was processed using SPSS version 16

Results: Amoxicillin- Calvulanate combination was seen to be well tolerated by most of the patients in our study subjects and adverse reaction were noted only in 36 [18%] of the patients. The commonest side effect was diarrhea seen in 24 [12%] of the patients which was more severe in patients getting higher doses and for more than a week. Side effects were commonly seen in old patients 16 [8%] and in chronic smokers. Hepatotoxic side effects were seen in 6 [3%] of the participants mainly cholestatic type of derangement on LFTs was seen and the toxicity was Mild i.e. Grade 1 in five of them as per National Institute of Cancer's, "Common Toxicity Criteria for Adverse Events, version 4.0 [CTCAEv4]" while one developed Grade 2 Hepatocellular type of Liver injury secondary to Co-Amoxiclav. Only 2% of the patients were discontinued with the drug when they developed signs and symptoms of allergy on the 1[st] day of treatment while Oral candidiasis was seen in only 1% of the study subjects

Conclusion: Gastrointestinal and hepatic side effects are uncommon with Co-Amoxiclav and the commonest adverse reaction is diarrhea. Clinically obvious jaundice along with biochemically deranged LFTs is pretty remote possibility and can be reverted on stopping the drug and commencing the supportive treatment

effect of quinine on qt interval in patients in a tertiary care hospital

To determine the frequency of patients developing QT prolongation with the use of intravenous[IV] quinine therapy in medical unit D of Khyber Teaching Hospital, Peshawar. This cross-sectional study was conducted in Medical unit D of Khyber Teaching Hospital, Peshawar, from 1[st] June, 2011 to 30[th] November, 2011. The study population comprised of male and female patients who tested positive for malarial parasite on peripheral blood smear. Treatment was started with intravenous quinine for a minimum duration of 3 days to a maximum duration of 5 days. Electrocardiography [ECG] was done before starting the patients on IV quinine therapy and QT interval was calculated. Repeat ECG was done 72 hours after starting the therapy. Patients were evaluated for prolongation of the QT interval after initiation of treatment with quinine. All the statistical analyses were done using statistical program SPSS version 17.0. The mean with standard deviation, frequency and percentages were reported. Significance was tested at p<0.05. Out of a total of 200 patients, only 2 female patients [1%] had a prolongation of the QT interval from their normal baseline interval before treatment. It appears that the cardio toxic effects of quinine have been overstated and that the risk of QT prolongation and fatal arrhythmias is minimal with quinine therapy. It can thus be concluded that quinine is a safe drug for the treatment of malaria with negligible cardio toxic adverse effect profile

Spectrum of helicobacter pylori in hundred patients presenting with perforated duodenal ulcer

To find out the frequency of Helicobacter pylori in patients presenting with perforated duodenal ulcer. This observational study was conducted at Lady Reading Hospital Peshawar from July 2004 to January 2005 on 100 patients with confirmed diagnosis of perforated duodenal ulcer fulfilling the inclusion criteria. A semi-structured Questionnaire was designed for the study. Out of a total of 200 patients operated for perforated duodenal ulcer 100 patients were fulfilling study criteria. Among these100 patients 80 were males and 20 were females. The participants were ranging from 18 to 72 years in age with mean age of 47.02 +/- 13.42 years. Helicobacter pylori were found in 80[80%] patients on histopathology and 65 [65%] patients on rapid urease test Infection rates were maximum in the elderly and those belonging to poor socioeconomic class. All infected patients were treated with triple regimen eradication therapy comprising of clarithromycin, Proton Pump Inhibitor [PPI], and amoxicillin for 14 days. The patients were not followed to confirm eradication status. The spectrum of H. Pylori infection is very high in patients with duodenal ulcer perforation. An early and appropriate H. Pylori eradication therapy may prevent duodenal ulcer perforation

Spectrum of precipitating factors of hepatic encephalopathy in liver cirrhosis

To ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with liver cirrhosis. descriptive study. The study was conducted in the department of medicine, medical B unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over six months. All patients with cirrhosis of liver[CL] of more than 12 years of age, manifesting signs of hepatic encephalopathy [HE] were included and those who had acute fulminant hepatitis or had noncirrhotic portal hypertension were excluded from the study. Detailed history, clinical examination and thorough investigations were done to look for any precipitating factor and the findings were recorded on a proforma. Fifty patients [32 males and 18 females] were enrolled. 47 patients had hepatitis B, C or both positive. 64% were in the age group of 45-60 years and 76% were having either grade III or IV coma. Thirty three [66%] patients had asterixis which was found to be a sensitive index for the diagnosis of HE in patients who were not in coma. Jaundice and Ascites were other common presenting features. Electrolytes imbalance in 28[56%] patients, diarrhea in 20[40%], constipation in 16[32%], infections in 12[24%] and gastrointestinal bleed in 11[22%] patients were amongst the commonest precipitating factors. None gave the history of alcoholism or recent surgery Occurrence of precipitating factors for HE in patients with CL is a common phenomenon and all such patients must be hospitalized to ascertain and manage such factors

Risk factors stratification in 100 patients of acute stroke

To find out the relative frequencies of various risk factors associated with first ever stroke. This prospective observational study was conducted in medical B unit of the Department of Medicine, Post Graduate Medical Institute, Government Lady Reading Hospital, Peshawar, Pakistan from March 2001 to January 2002. A total number of 100 patients, 64 males and 36 females, with first ever stroke were included in the study. A questionnaire was designed comprising detailed history, general physical and neurological examinations. The association of different risk factors with stroke was studied. The ages of patients ranged from 17 to 100 years with mean age of 59 years +11.63 years standard deviation [SD]. Cerebral infarction constituted 68%, intracerebral hemorrhage 31% and subarachnoid hemorrhage 01%. Hypertension [HTN] was the most common risk factor [60%] followed by diabetes mellitus [DM] [28%], hyperlipidemia [28%], smoking [22%], ischemic heart disease [IHD] [18%], atrial fibrillation [12%] and history of oral contraceptive use [10%]. Main risk factors for stroke are Hypertension, Diabetes mellitus, Hyperlipidemia and Smoking. Stroke can be prevented by modification of these risk factors. There is a genuine need for health education programmes on stroke and their mortality

Renal tubular acidosis: a case report

This case report describes a 19 years old boy presenting with bilateral lumbar pain, abdominal cramps and generalized bodyaches. Systemic examination was unremarkable. Patient was diagnosed as Type I Renal Tubular Acidosis on the basis of alkaline urine, nephrocalcinosis, hypokalemic hyperchloremic metabolic acidosis with normal serum anion gap and positive amrnonium chloride challenge test