Efficacy of gabapentin in trigeminal neuralgia: a non-randomized trial

Objective: To compare the efficacy of Gabapentin with carbamazepine in Trigeminal Neuralgia

Material/Method: The study was conducted in Agha Khan University Hospital and Abbasi Shaheed Hospital for four months. 19 patients of TN were collected through purposive convenience sampling. DN4 questionnaire was used to differentiate between Somatic and Neuropathic pain. Numeric Pain Rating Scale was used to assess the severity of pain

Results: Nine patients of Trigeminal Neuralgia refractory to carbamazepine were put on Gabapentin with male to female ratio of 4:5. All showed favorable response on 800-1600 mg Gabapentin on Numeric Pain Rating Scale. All patients were pain free in three weeks with no side effects. There was significant difference between pain response to carbamazepine and Gabapentin at P< .05. Four patients [44%] had pain relief on 900 mg Gabapentin, three [33%] on 1200 mg, one responded on 800 mg and one on 1600 mg

Conclusion: Gabapentin is effective as first line treatment in Trigeminal Neuralgia

Correlation of Qanadli score with right ventricular dysfunction in patients with acute pulmonary

Background: CT-pulmonary angiography [CTPA] is routinely performed in patients with suspected pulmonary embolism [PE] and a positive relationship between Qanadli score [Q-score] and RVdysfunction enables the clinicians in early diagnosis and management of RV-dysfunction on the basis of this single imaging modality. Objective of the study was to determine the correlation between an established angiographic clot burden score [Qanadli score-QS] and parameters of right ventricular dysfunction [RVD] on CT pulmonary angiography in patients with acute pulmonary embolism

Methods: A Cross-sectional study was carried out for the period of six months from 16 Jun to 15 Dec 2016. Total of forty-six [46] patients of either gender aged 15-70 years with confirmed evidence of PE were recruited. The Q-score and parameters of RV-dysfunction [LV/RV, ratio, SVC diameter, AVdiameter and PA/Ao ratio] were calculated in each patient. Correlation between Q-Score and RV parameters were determined and binary logistic regression analysis was applied to assess Q-score as an independent predictor of RV-dysfunction

Results: Avery strong positive correlation was found between Q-score and LV/RV ratio [r>0.7, p<0.05] collectively and after gender and age based stratification. No significant correlation was found between Q-score and other RV parameters among both genders and age groups [p>0.05 in all cases]. No independent factors were found to be significantly related to RV dysfunction after adjustment for other factors [p>0.05]

Conclusion: Qanadli score on CT pulmonary angiogram correlates positively with indicators of right ventricular dysfunction of CT angiogram in patients with acute pulmonary embolism and confer a poor prognosis with higher scores

Early laparoscopic sleeve gastrectomy outcomes in terms of weight loss

Objective: To investigate the outcomes of laparoscopic sleeve gastrectomy [LSG] in terms of weight loss. Study Design: Descriptive cohort study. Place and Duration of Study: Department of Surgery, Shifa International Hospital, Islamabad, from January 2009 to January 2015

Methodology: A total of 100 consecutive patients were included in the study through retrospective chart review. A 5-port technique was utilized with the gastric sleeve being created using endostapler. Postoperatively, patients gradually progressed from clear liquid diet and oral rehydration salts to nutritional supplements over three days. By two weeks postoperatively, patients had progressed to a solid diet. SPSS was used for data entry and analysis. Body mass index [BMI] and weight in kg were determined

Results: From 100 patients, 17 were lost to follow-up less than a week into the postoperative period. Of the remaining, average age of the patients was 34.7 +/- 11.3 years at the time of surgery. The majority of patients were females [72%]. Mean preoperative and postoperative BMI was 45.3 +/- 10.4 kg/m[2] and 35.0 +/- 10 kg/m[2], respectively. Of the 83 patients, 62 were followed-up for longer than 1 month [average 419 days]. For patients in this category, mean reduction in BMI was 10.3 +/- 6.5 kg/m[2] with average weight loss of 34.3 +/- 18.2 kg. There were no mortalities associated with LSG

Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective intervention in young Pakistani females with encouraging outcomes at a mean follow-up of over one year

Mother's awareness and practices regarding home management of childhood diarrhea in a squatter settlement of Karachi

Background: Diarrhea is cited as one of the main causes of death for infants and children, especially in squatter settlements, owing to poor sanitary conditions. Treatment and prevention of diarrhea can be managed at home by primary caregivers. It is therefore important for mothers and primary care givers to be aware of strategies for management and treatment of diarrhea

Objective: To assess the awareness of mothers regarding home management of childhood diarrhea in a squatter settlement of Karachi

Methods: A cross sectional study was conducted from 2012 to 2013 among mothers from Gulshan-eSikanderabad of Karachi who had at least one child under age of 5 years. In total 110 mothers were interviewed. Non probability convenience sampling technique was used. Data was collected by structured questionnaire filled via personal interview. Informed consent was obtained before collection of data. Data Analysis was done by using SPSS version 20

Results: Out of total 110, 93 [84.5%] mothers said that their children had an episode of childhood diarrhea during last 3 months. For the management of diarrhea 91 [82.7%] mothers took their children to PHC centre and 99 [89.9%] mothers were aware about ORS. Almost two third of them aware about the ingredients of homemade ORS but their knowledge about correct amount was poor. Dirty water and food was identified as the important causes of diarrhea by 106 [96%] and 76 [69%] mothers respectively. According to 101 [91.8%] mothers hand washing would be an effective measure to prevent diarrhea

Conclusion: Despite the high rate of diarrhea in this community, knowledge of mothers regarding home management of diarrhea was found satisfactory. Adopting the preventive measures and intensifying the mothers education is the dire need to reduce the high rate of diarrhea in this community

Outcome of laparoscopic cholecystectomy for gall stones disease in patients with liver cirrhosis

Laparoscopic cholecystectomy [LC], a gold standard procedure for cholelithiasis, is associated with higher incidence of bile duct injuries and perioperative bleeding. These complications are of further concern when LC is carried out on patients with liver cirrhosis. Although LC is now increasingly being performed for cholelithiasis in cirrhotic patients, the safety of the procedure is debatable in this group of patients. We retrospectively analysed 82 LCs, performed between January 2002 and December 2011, in cirrhotic patients with gall stone disease for perioperative complications. Patients were sub-classified into Class A, B and C based on child-Pugh classification of severity of liver cirrhosis. Intergroup comparisons were carried out using ANOVA, and p?0.05 was considered significant. LC was successfully completed in all but 3 patients [3.7%]. None of the cirrhotic patients had bile duct injury. Class C patients [n=27] had higher frequency of perioperative bleeding than Class B and A [p=0.03]. Class C patients had comparatively longer stay [5.42 days; range 4-8 days] than Class B [3 days; range 2-6] and Class A [2.74 days; range 2-4], [p=0.01]. There was no mortality in our series. The outcome in Child A and B cirrhosis is comparable to noncirrhotic patients undergoing LC for gall stone disease. Conversion rate and perioperative bleeding in these groups of patients is acceptable in relevance to LC in non-cirrhotic patients. Child C patients however need careful assessment and determination of operative risk versus advantages

Trans-sternal thymectomy in myasthenia gravis patients with laryngeal mask airway

TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion. A descriptive case series. Department of Anaesthesia, Jinnah Postgraduate Medical Centre Karachi, from June 2006 to December 2010. All patients who underwent trans-sternal thymectomy for myasthenia gravis under laryngeal mask airway [Prosea] were included. They were maintained with inhalation agent and analgesics. Muscle relaxants were avoided in all the patients. The haemodynamics and blood gases were monitored perioperatively. A total of sixteen patients underwent the procedure using laryngeal mask airway [Proseal]. There were ten females and 6 males. Mean age at presentation was 26.5 +/- 10.4 year. The haemodynamics and blood gases were well maintained perioperatively. Fourteen patients [87.5%] could be extubated successfully. Two patients needed intubation and ventilation; one for 9 hours and other for 24 hours. These patients were identified as those who were on higher doses of pyridostigmine [>240 mg] and had severe pre-operative muscle weakness. The use of laryngeal mask airway [Prosea] for patients undergoing trans-sternal thymectomy is a satisfactory alternative to tracheal intubation for those patients of myasthenia gravis who do not require airway protection. Avoidance of muscle relaxants and use of laryngeal mask airway [prosea] in facilitate rapid emergence and allowed early extubation

Role of combining long buccal nerve block with inferior alveolar nerve block to improve success of local anesthesia for extraction of mandibular teeth

The aim of this study is to ascertain the role of combining long buccal nerve block with inferior alveolar nerve block in achieving local anesthesia for extraction of mandibular teeth. The study took place at two teaching hospitals simultaneously [Fatima Jinnah Dental College Hospital, Jinnah Medical and Dental College Hospital Karachi], from January 2011 to June 2011. A total of 300 patients were randomly assigned to 3 groups of 100 patients each. Lidocaine 2% with 1:100,000 epinephrine was used for all injections. Group 1: patients received an IAN block using 1 cartridge of L/A + 1 cartridge as Buccal infiltration. Group 2: patients received an IAN block using 2 cartridges of L/A + 1 cartridge as Buccal Infiltration. Group 3: patients received 1 cartridge as an IAN block and 1 cartridge as a long buccal nerve block. A visual analogue scale [VAS] was used to rate pain immediately post-operative while subjective discomfort experienced during the surgical procedure [rated as yes/no]. Data was also collected for patients who would require extra cartridge of IAN block to achieve complete anesthesia. Data was analyzed using SPSS 14.0. The success rates for groups 1 to 3 were 25.20%, 27.27% and 75.54% respectively. Group 3 had significantly better anesthesia compared with group 1 and group 2 [P <0.05]. Combining an IAN block and a long buccal nerve block provided more effective anesthesia in mandibular extraction

Role of dexamethasone for prevention of post-extubation airway obstruction in critically ill adult patients

To evaluate whether dexamethasone started 24 hours prior to planned tracheal extubation in adults, can prevent post-extubation laryngeal oedema. Randomized placebo-controlled double-blind trial. Department of Anaesthsiology, Surgical ICU and Pain Management, Jinnah Postgraduate Medical Centre Karachi, from August 2006 to July 2008. Ninety-two patients who met weaning criteria after being intubated for more than 48 hours, with a cuff leak volume [CLV] of less than 110 ml were randomly allocated to two groups; receive either intravenous dexamethasone [5 mg] or identical volume of intravenous placebo [normal saline], and continued every six hours thereafter, for a total of four doses [total dose 20 mg] on the day preceding extubation. Cuff leak volume was measured at the time of the first injection, and one hour after each injection and 24 hours after the last injection. Patients were extubated twenty-four hours after the last injection of dexamethasone or identical volume of intravenous placebo. Occurrence of stridor was noted within 48 hours of extubation. Dexamethasone injection 24 hours prior to extubation increased the CLV significantly [P=0.001]. Post-extubation stridor was 54.6% significantly lower in the dexamethasone group than in placebo group [6/46 versus 15/46, P=0.025]. Dexamethasone given every six hours intravenously, commencing 24 hours before a planned tracheal extubation, substantially reduced the incidence of post-extubation stridor and re-intubation, in adult patients at high risk for post-extubation laryngeal oedema, as identified by the cuff leak test

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice

To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopsies. A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital [AKU], Karachi, in 2004. Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. Out of 20,000 biopsies, there were 4616 [23.08%] malignant neoplasms. Carcinoma of oral cavity is very common in our population in both sexes

Injection Sclerotherapy versus Electrocoagulation in the management outcome of early haemorrhoids

To study the symptomatology of early hemorrhoids and to compare injection Sclerotherapy [IS] with electrocoagulation [EC] in the management outcome of early haemorrhoids with respect to pain during the procedure, reduction in bleeding per rectum, and overall patient satisfaction score. A total of 102 patients were included in this experimental study at the POP Hospital, Wah Cantt from October 2004 to June 2005. A detailed history was taken and proctoscopic examination was performed. Patients were then randomly divided into two groups [Lottery method]. One group was subjected to EC and the other to IS. In the EC, using the EC machine [Wieda, China], direct current of 10-20 mA was applied in the submucosal plane of each pile core for 5-7 minutes. In the IS 1-2 ml of 5% phenol in almond oil was injected in the same plane in each pile core. Pain during the procedure, reduction in bleeding per rectum and overall patient satisfaction, were studied as outcome measures. The mean age of the patients was 44 years, 86 were males and 16 were females. Two thirds of the patients were having symptoms for more than 6 months. A third of patients had associated local pain while another third had associated mucous discharge. Chronic constipation was present in 81% patients. Only 24.5% of the patients had a positive family history of haemorrhoids. Patients in the electrocoagulation [EC] group experienced more pain during the procedure than the injection Sclerotherapy [IS] group [P<0.000], but EC was significantly more effective than IS in terms of reducing the bleeding per rectum [P= 0.039], and also significantly higher number of patients were fully satisfied with EC than with IS [P<0.04]. EC, although more painful, is a safe, more effective and a highly satisfying procedure for treating early hemorrhoids

Dural sinus thrombosis: frequency and imaging diagnosis

To determine the frequency of dural sinus thrombosis [DST] and highlight diagnostic importance of its subtle imaging findings in patients presenting for workup of their varied neurologic complaints and symptoms. Observational case series. Study Period: June 2002- May 2005. All new patients undergoing cranial computed tomography [CT] and magnetic resonance [MR] imaging were included in this study which consisted of 1676 consecutive subjects with 1780 examinations. These were reviewed in real time on monitors [as they were being performed] for evidence of DST before printing of hard copies prior to disposition of patients. CT studies were performed on Toshiba Auklet scanner with 5 mm thick axial slices and 1cm inter slice gap. MR imaging was performed on 1.5 Tesla Toshiba Visart scanner with T1 and T2 weighted [T1 and T2W], spin echo, FLAIR and post contrast T1 weighted [T1W] imaging in multiple planes. Subjects with inconclusive but suspicious conventional imaging [CT, MR] were evaluated by magnetic resonance venography [MRV]. Patients presenting for follow-up of established diagnoses including neoplasia, arterial infarcts, hypertensive parenchymal haemorrhages and postsurgical status were excluded. Delta and empty delta were the most commonly observed CT and MR signs diagnostic of DST on pre and postcontrast images and were present in 43 patients. Thrombus was also directly visible within lumen of superior sagittal, transverse and sigmoid sinuses on T1W MR images in 21 individuals. In 12 patients, these signs were either absent or too subtle to be conclusive. However, presence of venous haemorrhagic or non-haemorrhagic brain parenchymal edematous lesions prompted further evaluation by MRV, which confirmed presence of DST in these subjects as well. As a result, a total of 55 patients with a frequency of 3.3% were diagnosed and treated for DST. Frequency of DST in patients with neurological complaints and symptoms is 3.3%, which is significantly higher than has been clinically suspected or recognized. On routine CT and MR studies, diagnostic imaging signs, while highly specific for DST, can be absent or may be masked due to technical factors or associated complications. Presence of brain parenchymal venous haemorrhagic or non-haemorrhagic edematous lesions should prompt judicious and close scrutiny of images on monitors by changing viewing parameters to detect subtle signs of DST. If still in doubt, MRV must be pursued for definitive diagnosis