Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability / 대한뇌졸중학회지

Background@#and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. @*Methods@#In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). @*Results@#A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). @*Conclusion@#A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.

Electrolyte abnormalities in neonates with probable and culture-proven sepsis and its association with neonatal mortality

Objective: To ascertain the frequency of electrolyte abnormalities in patients of probable and culture-proven sepsis on admission and assess any association of electrolyte disorders with mortality

Study Design: Descriptive study

Place and Duration of Study: NICU, Fazle-Omar Hospital, Rabwah, from October 2015 to September 2016

Methodology: All neonates with the diagnosis of probable and culture-proven sepsis during the study period admitted in NICU, Fazle-Omar Hospital, were included in the study. Electrolyte levels were categorised as normal, high or low and recorded in the data form, with age and outcome. Fisher exact test was used to test association. SPSS 20 was used for data analysis

Results: One hundred and fifty-one neonates were included in the study. Ten [6.6%] died. Among these, 114 [75.49%] had one or more electrolyte abnormalities. Median [IQR [interquartile range]] levels of sodium and chloride were, 140 [7.1], and 100.2 [7.4] mmol/L, respectively. Mean levels of potassium and calcium were 5.07 +/- 0.76 mmol/L and 2.35 +/- 0.338 mmol/L, respectively. Hyperkalemia was the commonest electrolyte disorder present in 60 [39.7%] neonates, followed by hypercalcemia in 50 [33.1%] and hypocalcemia in 20 [13.2%]. None of the neonates without any electrolyte abnormality died [p=0.053]

Conclusion: Majority cases of neonatal sepsis have got electrolyte abnormalities. Hyperkalemia was the commonest electrolyte imbalance followed by hypercalcemia and hypocalcemia

Pattern of vitamin D among Pakistani pregnant women

Vitamin D deficiency is an emerging health concern around the world, highly prevalent in south Asian population, despite abundant sunlight. In Pakistan, all age groups are vulnerable to Vitamin D deficiency including pregnant women. This systematic review aimed to determine the pattern of Vitamin D deficiency among Pakistani pregnant women as well as exploring the causes and possible interventions that have had a substantial effect on improving the vitamin D level. Three databases [PubMed, Pub Get and Google Scholar], for the present review up to 2016, were used for the identification of published peer reviewed original relevant studies regarding Vitamin D deficiency among Pakistani pregnant women with the keywords Vitamin D or 25-hydroxyvitamin D or 25[OH]D in combination with pregnant women. Five studies were included for the final analysis. Vitamin D deficiency was common and highly prevalent among Pakistani pregnant women and their neonates. The main reasons for this were found to be avoiding sun exposure, quality of diet, and lower intake of calcium. Maternal vitamin D supplementation was found to be a key intervention to improve the maternal and neonatal vitamin D status. These review findings can be emerging in ensuring the adequate vitamin D level for Pakistani pregnant women during pregnancy, ultimately to achieve positive maternal and neonate's health outcomes

Seroprevalence of measles igG antibodies in children of school going age

Background: Measles is highly contagious infectious disease and considered to be leading cause of death among young children. Although vaccination process of measles is well ascertained but still its associated morbidity and mortality is high among children of developing countries. This study was designed to see the level of measles IgG in children in District Bagh of Azad Jammu and Kashmir

Methods: Measles IgG antibodies were screened in total of 250 school going children [4-8 years] in the District Bagh, Azad Jammu and Kashmir were enrolled. The subjects were grouped on age basis; Group A had children of 4-5 years, Group B comprised of children of 5-6 years, Group C contained children of 6-7 years and Group D had age 7-8 years. A The collected samples were transferred to the Molecular Virology Laboratories at National Institute of Health [NIH], Islamabad for detection of measles IgG antibodies. Measles antibodies were estimated by using kits for Enzyme Linked Immunosorbant Assay

Results: There were 10 [4%] children in Group A, 18 [7.2%] were in Group B, 42 [16.8%] were in Group C, and 180 [72%] children were in Group D. Out of 250 children 61 [24.4%] were detected as unprotected and 13 [5.2%] were at borderline and 176 [70.4%] had protective antibody level against the measles virus

Conclusion: Significant number of children is under potential risk to develop measles infection. No significant relation could be established between disease, age, and gender

Protein requirement and its intake in subjects with diabetic foot ulcers at a tertiary care hospital

Objective: To assess the protein intake and requirement among subject with type 2 diabetes having foot ulcers

Methods: This study was conducted at Baqai Institute of Diabetology and Endocrinology [BIDE], a tertiary care diabetes centre of Karachi, Pakistan among people with type 2 diabetic foot ulcer attending foot clinic from January 2012 to March 2015. The baseline characteristics, dietary intake and laboratory investigations of the study participants were obtained through electronic hospital database ''Health Management System'' [HMS] based on the 24 hours dietary recall interview. Total grams of protein were calculated from each food group consumed by the subject. Protein intake of the subjects was recorded in mean grams and the protein requirement was calculated according to their body weight. The comparison of intake and requirement of protein choices was done through comparing the mean of both variables. SPSS version 13 was used for analysing the results

Results: A total of 542 subjects were included in the study, 365 [67.2%] were males and 178 [32.8%] were females. Mena age of the subject was 54.61 +/- 10.51 [yrs] with the duration of diabetes and mean body mass index were 14.22 +/- 7.98 [yrs] and 26.65 +/- 5.38 [kg/m[2]], respectively. The dietary records showed the protein intake of subjects with diabetic foot ulcer is not appropriate when compared to daily requirement. Mean grams of protein intake is 76.87gms in males and 56.84gms in females. On the other-hand protein requirement is much higher than the intake, which is 219.5gms in males and 130.2gms in females

Conclusion: Dietary counselling should be a part of the treatment among subjects with diabetic foot ulcer to identify their nutritional needs and suggesting them better option to fulfil their protein requirement essential for wound healing process

To evaluate the efficacy and safety of CartiNovex plus tablet in osteoarthritis and rheumatoid arthritis

Interminable arthritis issue, for example, osteoarthritis [OA] and rheumatoid arthritis [RA] have in like manner an upsurge of aggravation, and oxidative anxiety, bringing about dynamic histological modifications and incapacitating indications. As of now utilized allopathic prescription [extending from painkiller executioners to natural operators] is intense, yet regularly connected with genuine, even dangerous symptoms. Utilized for centuries in customary herbalism, restorative plants are a promising option, with bring down rate of unfavorable occasions and productivity every now and again tantamount with that of traditional medications. In any case, their instrument of activity is as a rule smooth and additionally indeterminate. Despite the fact that a large number of them have been demonstrated powerful in ponders done in vitro or on creature models, there is a shortage of human clinical proof. This clinical trial was conducted at Liaquat National Hospital, Karachi, Pakistan. This was a single blind, placebo control phase II clinical trial. Total 200 patients were enrolled in the study, in which 110 received the CartiNovex plus tablet and 90 received the placebo. The age range of patients was 40 years to above 70 years. The sample paired t-test was applied to evaluate the significant level. Different parameters like pain on sitting or lying, morning stiffness, pain on walking, stiffness in sitting, lying or resting later in the day, getting on/off toilet, light domestic duties [such as tidying room, dusting, cooking], WOMAC score % were tested for both group i.e. CartiNovex plus group and placebo group in all parameters CartiNovex plus show significant improvement in all parameters. CartiNovex plus tablet was very effective in the management of OA and RA. The CartiNovex plus tablet was safe and well tolerated in all patients and side effects are non-significant

Completeness and legibility of handwritten prescriptions in sana'a, yemen

objective: The aim of this study was to investigate the completeness and legibility of prescriptions dispensed in community pharmacies located in Sana'a, Yemen

Materials and Methods: A cross-sectional study was conducted at 23 randomly selected community pharmacies throughout the capital city of Sana'a, Yemen, from May 2015 to January 2016. A total of 2,178 prescriptions were analyzed for the essential elements of a complete prescription using a validated checklist

Results: Of the 2,178 prescriptions, 19 [0.87%] were considered to be of good quality. The remaining 2,159 [99.12%] were considered as being of very poor quality. Writing errors relating to patients and prescribed medications were the most common errors

Conclusion: In this study, the quality of prescription writing was found to be very poor. Hence, continuous professional development programs are recommended to improve the quality of prescription writing among physicians. Future studies in other cities and investigation of the impact of continuous educational programs on the quality of prescription writing are strongly recommended

The case for building residential facilities [Sarais'] for patient visitors. If not now, when?

Objective: To gather the opinion of attendants accompanying admitted patients in CMH Lahore about their satisfaction with existing eating and sleeping arrangements

Study Design: Cross sectional survey

Place and Duration of Study: Combined Military Hospital Lahore Pakistan, from Jul to Aug 2016

Material and Methods: For this descriptive observational study attendants of patients admitted in the hospital for more than 24 hours were administered a questionnaire. Only one family member per patient was surveyed

Results: Three hundred attendants were interviewed for the study of which 162 were males. One hundred and twenty eight 128 [42.7 percent] came from within the city. One hundred and eighty seven [62.3 percent] intended to stay with the patients till the time they were discharged. A total of 185 [61.7 percent] patients had only one attendant whereas 59 [19 percent] of patients had no attendants available. Two hundred and thirty one [77 percent] attendants were blood relatives. The hospital canteen served food to 140 [46.7 percent] attendants. Only 25 [4.3 percent] attendants were satisfied with their existing eating arrangements. One hundred and seventy eight [59.3 percent] of attendants slept inside the hospital wards whereas 54 [18 percent] slept within hospital premises. One third of them were satisfied with their sleeping arrangements whereas the remaining desired more comfortable residential facilities or [Sarais] which were affiliated with the hospital. Sixty four [52 percent] attendants experienced difficulties in affording their boarding and lodging expenses

Conclusion: Patients and families bear the emotional and financial cost of illness. Findings suggest that attendants are not satisfied with their existing sleeping

Frequency of ECG abnormalities in patients of chronic obstructive pulmonary disease according to disease severity

Objective: The objective of this study was to find out the frequency of ECG abnormalities in patients of COPD in relation to disease severity

Study Design: Cross Sectional study

Place and Duration of Study: This study was carried out at the Department of Medicine, Military Hospital Rawalpindi, from Oct 2011 to Jun 2012

Material and Methods: All patients presenting to the Department of Medicine both inpatient and outpatient, with diagnosis of COPD were included in the study. Patients with cardiac comorbidities were excluded. Also, patients on diuretics and long term oxygen therapy were excluded. A total of three hundred and forty three patients [343] were included in the study. Spirometry of all these patients was done to determine the FEV1 and FVC in order to classify the grade of severity of COPD. Standard 12 lead ECG of all these patients was done to find out the various ECG abnormalities

Results: About 77 [22.5%] patients had mild COPD, while moderate COPD was seen in 121 [35.3%]. Severe COPD was seen in 100 [29.2%] patients and very severe COPD was seen in 45 [13.1%] patients. The most common ECG abnormalities noted was right atrial enlargement [RAE] in 6 [7.8%] patients of mild COPD, 27 [22.3%] patients of moderate, 48 [48%] patients of severe and 24 [53.3%] patients of very severe COPD. Right ventricular hypertrophy [RVH] in 1 [1.3%] patient of mild, 7 [5.8%] patients of moderate, 19 [19%] patients of severe and 12 [26.7%] patients of very severe COPD. Sinus tachycardia was present in 6 [7.8%] patients of mild, 17 [14%] patients of moderate, 19 [19%] patients of severe and 10 [22.2%] patients of very severe COPD. Right bundle branch block [RBBB] was seen in 5 [6.5%] patients of mild, 9 [7.4%] patients of moderate, 13 [13%] patients of severe and 9 [20%] patients of very severe COPD. SVT was present in 1 [1.3%] patient of mild, 6 [5%] patients of moderate, 10 [10%] patients of severe and 8 [17%] patients of very severe COPD. Low voltage ECG was seen in 3 [3.9%] patients of mild, 7 [5.8%] patients of moderate, 12 [12%] patients of severe and 6 [13.3%] patients of very severe COPD. Atrial premature contractions [APCs] were present in 3 [3.9%] patients of mild, 11 [9.1%] patients of moderate, 14 [14%] patients of severe and 6 [13.3%] patients of very severe COPD. Normal ECG was seen in 54 [70.1%] patients of mild, 52 [43%] patients of moderate, 14 [14%] patients of severe and 3 [6.7%] patients of very severe COPD

Conclusion: A number of ECG abnormalities were seen in patients with COPD. They were more frequent with increased grade of severity of COPD. Therefore, it is recommended that ECG should be done routinely in patients with COPD

Role of nanodiamonds in drug delivery and stem cell therapy

Context: The use of nanotechnology in medicine and more specifically drug delivery is set to spread rapidly. Currently many substances are under investigation for drug delivery and more specifically for cancer therapy

Evidence Acquisition: Nanodiamonds [NDs] have contributed significantly in the development of highly efficient and successful drug delivery systems, and in stem cell therapy. Drug delivery through NDs is an intricate and complex process that deserves special attention to unravel underlying molecular mechanisms in order to overcome certain bottlenecks associated with it. It has already been established that NDs based drug delivery systems have excellent biocompatibility, nontoxicity, photostability and facile surface functionalization properties

Results: There is mounting evidence that suggests that such conjugated delivery systems well retain the properties of nanoparticles like small size, large surface area to volume ratio that provide greater biocatalytic activity to the attached drug in terms of selectivity, loading and stability

Conclusions: NDs based drug delivery systems may form the basis for the development of effective novel drug delivery vehicles with salient features that may facilitate their utility in fluorescence imaging, target specificity and sustained release

Efficacy of steroid injection in the treatment of trigger finger

Objective:To assess the efficacy of local steroid injection in trigger finger

Materials and Methods:This prospective study was conducted at department of Orthopaedics,Civil Hospital, Dow University of Health Sciences, Karachi, from March 2012 to 2013. Males and females with complain of trigger finger were included in this study during the specified period. All patients were injected depomedrol with plain xylocaine at the nodule site and functional outcome was assessed with respect to pain relief and finger movement

Results: Study included 43 patients with trigger finger.29 were males and 14 were females. Right hand fingers were involved in 24 patients, remaining had left hand fingers involvement. 10 involved the index finger,7 middle finger, 4 ring finger,10 little finger and 12 thumb. 9 patients had associated rheumatoid arthritis and 15 were known cases of diabetes. Remaining patients were primary with no known co-morbid. All patients had pain relief initially and regained movement of finger. 10 patients required repeated injection after 3 months. Maximum pain relief and regaining of movement after steroid injection was 4 months

Conclusion:Local steroid injection provides excellent symptomatic pain relief and regained movements without any complication in patients with trigger finger

Radial head fracture mason type III and IV treated with K-wire Fixation

Objective: To assess the functional outcome of radial head fracture Mason type III and IV treated with K-wire fixation

Materials and Methods:This prospective study was conducted at Department of Orthopaedics,Civil Hospital,Dow University of Health Sciences Karachi from 2013 to 2015. Patients with Radial head fracture type III and IV were included in the study

Results:A total of 42 patients were included in this study. Out of these 36 were males and 6 were females. Right side was injured in 18 patients and left side in 24 patients. 32 patients were with Mason type III radial head fracture and 10 were Mason type IV fractures. All fractures were fixed with open reduction and internal fixation with K-wire. Lateral approach was used in all fractures. In Type IV elbow was reduced with close technique. Outcome was measured on the basis of Morrey elbow scoring system. 22 patients with type III radial head fracture had excellent results while10 with type III had good result. All patients with radial head fractureType IV had good results

Conclusion:Assessment of functional outcome of radial head fracture Mason type III treated with K-wire fixation showed excellent outcome in majority of patients while Type IV had good outcome.Mason type III radial head fractures should be reduced and fixed with K-wire. It maintains the stability of elbow joint and elbow function

Frequency of urinary tract infections and causative agents in different age groups in both genders in a tertiary care hospital

Objective: To determine the frequency of urinary tract infections and their causative agents in different age groups in both genders

Materials and Methods: All urine samples received from February 2013 to October 2013 for culture and sensitivity in Baqai Laboratory [a subsidiary of Baqai University Hospital, Nazimabad, Karachi] were processed. Urine samples showing pyuria were inoculated on Cysteine Lactose Electrolyte Deficient [CLED] medium and blood agar and incubated at 37 degree C for 24 hours.Samples showing 10[5] organisms were considered to have significant bacteriuria. Organisms were identified by standard biochemical procedures

Results: Out of 633 samples inoculated, 40% [253] showed significant bacteriuria. Incidence of isolated uropathogens was E.coli [70%], Enterobacter species [9%], Enterococcus species [7.5%], Psudomonas species [5%], Klebsiella species [4%],Acinetobacter species [3.2%], Salmonella species [0.8%], Staph. aureus [less than 1%] and Candida [less than 1%]. Genderwise distribution of patients: Male 36%, Female 64%. Predominent number of female patients was in reproductive age group while greater frequency in males was seen in patients above 55 years of age

Conclusion: There is higher frequency of urinary infections in females in reproductive age groups and more men with urinary infections were aged above 55. E.coli is the prominent causative organism

Effect of Pakistani medicinal plants on IgE/antigen- and ionophore-induced mucosal mast cells degranulation

Cumulative evidence has now demonstrated the stimulation of mucosal mast cells by both allergic and non-allergic triggers and their inhibition as a potential therapeutic target in many diseases like food allergy and ulcerative colitis. Hence, we screened medicinal plants from Pakistan against antigen- and ionophore-induced degranulation of mucosal mast cells. Aqueous ethanol extracts were screened. IgE/antigen- and A23187-induced degranulation of mucosal-type murine bone marrow derived mast cells [mBMMCs] were screening assays and /2-hexosaminidase released from degranulated mBMMCs was measured. Real time-polymerase chain reaction was employed to examine the expression of TNF-a and IL-4 mRNA. Acetoxychavicol acetate, was examined by degranulation assays and real time-PCR. Among the ten plants screened against IgE/antigen stimulated degranulation, five plants Alpinia galangal, Mentha arvensis, Myrtus communis, Polygonum bistorta and Syzygium aromaticum demonstrated significant [p<0.01] suppression of the degranulation at 100 microg/ml. Of them, Alpinia galangal showed significant [p<0.0l] inhibition at 32 microg/ml. In A23187-induced degranulation, all plants showed significant [p<0.01] inhibition at 100 microg/ml except Tamarix dioica. Again Alpinia galangal exhibited significant [p<0.0l] suppression at 32 microg/ml. In a concentration dependent assay, Alpinia galangal revealed significant suppression at 10 microg/ml against A23187-stimulated degranulation

Acetoxychavicol acetate demonstrated significant [p<0.0l] inhibition at 3.2 microM in IgE/antigen-treated cells and at 10 microM in A23187-treated cells. Furthermore, both Alpinia galangal and acetoxychavicol acetate suppressed the IgE/antigen- and A23187-enhanced mRNA expression of inflammatory cytokines, TNF-alpha and IL-4, in mBMMCs. Our findings revealed the suppressive effect of Alpinia galangal and acetoxychavicol acetate on degranulation of mBMMCs by allergic and non-allergic stimuli, which can be utilized for future drug development against food allergy or ulcerative colitis

Morgagni hernia - presenting as vague abdominal pain since 8 years

Morgagni hernia is the rarest type of Congenital Diaphragmatic Hernia[CHD]. It accounts for 2% of all CHD cases and is detected incidentally through a chest xray The hernia occurs mostly on right side of diaphragm with incidence of 90%, 8% occur bilaterally and 2% limited to left side. It is predominant in females presenting symptom of abdominal pain. The presence of colonic sounds on chest examination is a significant finding in diagnosis. CT scans usually reveal a retrosternal or parasternal mass or fat density which represents omentum and air containing viscus. A case of a middle aged lady presenting with vague abdominal pain for the last eight years is reported. Suspicion was raised over a chest xray which highlighted the right dome of diaphragm being pushed up and the presence of gaseous shadow under the right dome. Subsequent computed tomography showed morgagani hernia. The patient underwent open transabdominal of the stomach and omentum, where the hernia sac not resected and a primary closure of the defect was performed. The post operative course was uneventful. Morgagni though rare, often remains undiagnosed and can lead to life threatening complications. Surgical intervention regardless of patient's asymptomatic state should be offered to avoid complications

High efficacy and low toxicity of short-course oral valganciclovir as pre-emptive therapy for hematopoietic stem cell transplant cytomegalovirus infection

Cytomegalovirus [CMV] infection is a major infectious complication post-allogeneic hemato-poietic stem cell transplantation [HSCT]. CMV seropositivity in Eastern Mediterranean and certain Asian countries is reported to be close to 100%; hence, the need for effective pre-emptive treatment strategy that has low toxicity. Valganiciclovir [VGC] is a prodrug of ganciclovir with high biovailability. HSCT patients with documented CMV infection [as defined by positive CMV anti-genemia] were treated as outpatients with VGC at a starting dose of 900 mg once daily for antoher week and treatment was subsequently discontinued. Those who were positive after one week of therapy continued on the twice daily treatment schedule for another week and changed to a daily schedule once they converted to antigenemia negativity. From January 2004 to December 2007, 47 HSCT patients received preemptive treatment with VGC for 61 episodes of CMV infection. The antigenemia range was 1 to 700 infected cells/slide. Complete responses were observed in 92% and 97% after the 1st and 2nd week of treatment, respectively. Three percent of the episodes were considred refractory, requiring alternative therapy. No CMV disease was observed in this cohort. Neutropenia was the main observed toxicity, requiring granulocyte-colony stimulating factor in 8 episodes. Outpatietn treatment of CMV infection with "short-course oral VGC" given as a one week twice dialy treatment and one week once daily maintenance is a highly effective therapy with minimal toxicity. These results require validation in a larger, randomized study