Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Overseas Pakistanis seeking medical education in Pakistan

Background: Pakistanis migrated to western countries face difficulty in letting their children get higher education from abroad. It has been observed that many overseas Pakistanis feel secured to send their children to Pakistan to acquire higher education. The purpose of this study was to evaluate the reasons for overseas Pakistani students seeking medical education in Pakistan. Methods: A cross-sectional survey was conducted from October 2010 to May 2011 recruiting overseas Pakistani students studying in different medical colleges of Sindh, Pakistan. Cluster of 8 medical colleges were selected and a convenient sample [n=700] was recruited. Of the 700 administered questionnaires, 530 [76%] were returned and 25 were incomplete and therefore, rejected. A total of 505 [72%] were included in the analysis. Results: A statistical significance was found when origin of students was compared with the economic aspect of medical education in Pakistan [p=0.01]. Overall 71% students agreed that the cost of medical education in Pakistan is much less then their respective countries of origin. Another highly significant difference was observed [p<0.001] between student's origin and their reasons behind taking medicine as a career. Conclusion: The study establishes that Pakistan as a country offers quality medical education in minimum possible costs and more foreign students can pursue medical education in Pakistan

Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre

Rheumatic Heart Disease [RHD] continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. A total of 13, 414 patients [7, 219 Males [53.8%], 6, 195 Females[46.2%]] ranging from 11 to 90 years with a mean age of 42.33 +/- 18.976 were studied. On echocardiography, 7, 500 [56%] had mitral regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4%] had aortic regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4$] had aortic regurgitation [4.8% severe AR]. MS was detected in 2, 729 [20.3%] patients [15.3% severe MS], AS in 102 [0.8%] and TS in 31 [0.2%] patients. Mixed mitral valve disease was seen in 3, 185 [23.7%], mixed aortic valve disease in 222 [1.7%] and mixed tricuspid valve disease in 47 [0.4%] patients. All three valves were involved in 2, 826 [21.06%] patients, combination of mitral and aortic valves in 3, 103 [23.13%], mitral and tricuspid in 3, 784 [28.2%], and mitral only in 3, 701 [27.59%] patients. There was some mitral valve abnormality in all patients. Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in

Seroprevalence of HBsAg, HCV and HIV antibodies in healthy individuals in Makkah region, KSA

People from all over the world tend to travel to KSA for seeking better jobs in a variety of fields i.e. skilled and unskilled. As per requirement of Saudi Government, all the employees must get themselves screened for HIV; HCV and HBV from the Medical Centers registered with Saudi Consulates in their respective countries prior to endorsement of visa for entering the kingdom. Once these potential employees enter the Kingdom, it is imminent for the employer to get them working permit i.e. Iqama. In the Kingdom, to obtain Iqama, once again all these employees need to get medical fitness certificate from Medical Centers registered with the Ministry of Health. This may be pointed here that HIV co-infection with hepatitis C virus [HCV] or/and hepatitis B virus [HBV] has a growing public health concern. The objective of this study is to determine the positive influx of HBV, HCV and HIV in general population of KSA and to describe associations between risk behaviours and co-infection. This study ensures that none of these new employees should escape the required law of obtaining medical fitness certificate for concealing the infectious diseases if any, and latter on become the source of spreading these diseases in the society. It is suggested that the government may give a thought to enhancing the prevailing system of medical certification to the point where it becomes infallible

Perceptions and practices of mothers regarding child feeding

Perceptions and practices of mothers regarding child feeding vary depending upon their education, socioeconomic and cultural background. The objective of current study was to see the perceptions and practices of nutrition in mothers of malnourished children. It was also aimed to ascertain malnutrition due to poverty versus ignorance. It was a retrospective study. A total 200 malnourished children from children OPD, aged 6 months to 3 years were included in this study. History was taken regarding breast feeding, weaning, ORS preparation and care of children. Physical examination was carried out to assess the nutritional status and grade of malnutrition. Weaning age at enrollment of 18 [9%] children was 4 months, 9 [4.5%] children was 5 months, 105 [52.5%] children was 6 months, 34 [17%] children was 7 months while weaning age of 34 [17%] children was 8 months. Children being inadequately fed on food were 178 [89%]. Hundred percent children had history of an illness in the past. One hundred and sixty three [81.5%] of the mothers had heard about ORS but did not know how to prepare it. Only37 [18.5%] of the mothers had full knowledge about preparation of ORS. It was concluded that poverty alone is not the only factor in causing malnutrition. Ignorance is an important factor in child malnutrition. Nutritional education should be given to the mothers to eradicate malnutrition in the children

Comparison of 24 hour urine albumin and spot urine albumin to creatinine rattio as a predictor of diabetic nephropathy

Twenty four hours urine albumin is frequently used for prediction of the extent of nephropathy. Spot urine albumin to creatinine ratio has been recently introduced as an alternative to 24 hours urine albumin. Aims and objectives of the current study were to compare and contrast 24 hours urine albumin and spot urine albumin to creatinine ratio as a predictor of nephropathy. Two hundred cases of diabetes were selected for 24 hours urine albumin and spot urine albumin to creatinine ratio. Urine samples containing RBC 's or pus cells were excluded from the study. Twenty four hours urine albumin was estimated by pyrogallol method. First morning urine specimen was used for albumin to creatinine ratio. Creatinine was estimated by Jaffe reaction on semi-automated analyzer. Results revealed that mean 24 hours urine albumin was 693 mg/24 hours [reference range < 30 mg/24 hours], while mean albumin to creatinine ratio was 22.7 mg/mmol [reference range < 3 mg/mmol]. Fifty seven cases were having microalbuminuria, 103 cases had macroalbuminuria whereas 40 cases had normal urine albumin. Forty eight cases showed albumin to creatinine ratio in the normal range, 88 cases in microalbuminuria range while 64 cases had albumin to creatinine ratio in macroalbuminuric range. Correlation of 24 hours urine albumin versus urine albumin to creatinine ratio was 0.97, p value < 0.01. It was concluded that there was no significant difference between 24 hours urine albumin and spot urine albumin to creatinine ratio as a predictor of nephropathy, besides yielding immediate results and spot convenient sampling. It is recommended that spot urine albumin to creatinine ratio is a simple, clear, attractive and right predictor of nephropathy and can safely replace 24 hours urine sample for convenience of the patient, pathologist as well as the physician

Changes in endotracheal tube cuff pressure during cardiac surgery

This prospective study was conducted, to measure the changes in endotracheal tube cuff pressure [ETCP] and to find out its correlation with body temp during cardiac surgery, in 50 patients selected for open heart surgery. All the patients were kept on cardiopulmonary bypass machine [CPB] and their body temperature was brought down to a mean temp of 28 degree centigrade during surgery, these patients were intubated with BAXTER high volume, low pressure cuffed endotracheal tubes [ETT]. Standard anaesthesia technique was used to anesthetize the patients. Endotracheal tube cuff pressures [ETCP] were measured with Portex Cuff Inflator / Pressure Gauge. Significant changes in ETCP were noted during hypothermia and rewarming

Usefuless of Caudal Block in children

We are becoming aware of the need for adequate analgesia in children. Aim: is to find the effectiveness of caudal analgesia in children undergoing circumcision. Forty boys undergoing circumcision were studied in Services Hospital, Lahore. Caudal Block [CB] was given after general anaesthesia but before the start of surgery. Half the boys [LAG], received CB with 0.5 ml/kg of 0.2% bupivacaine solution, the other half received equivalent volume of normal saline [NSG].Behaviour of the boys, pain relief and side effects were assessed postoperatively. Complete pain relief was obtained in 100% of LAG while in [NSG] only 10% boys had adequate pain relief. Boys in LAG were pain free for 12 to 18 hours postoperatively. NSG required pethidine to achieve pain relief. Complications were only few and minor, but the pain relief was very good with CB. CB for circumcision in children is quite simple, safe and provides effective analgesia for 12 to 18 hours postoperatively

role of monoamines in the regulation of pituitary gonadotropins in normal and castrated rats

Despite suggestion of multiplicity of neurotransmitters and neuromodulators contributing in the regulation of pituitary gonadotropins secretion the picture regarding catecholamines in intact and castrated rats is not clear. This study deals with the differential response of pituitary FSH and LH to immediate effect of different adrenergic and non - adrenergic agonist/antagonist [adrenaline, noradrenaline, proparnolol, isoprenaline, clonidine, phenoxybanzamine HCI] in the short -term castrated rat model. The evidence is presented for a direct excitatory or facilitatory effect of adrenaline and noradrenaline for pituitary LH regulation viz - a viz testosteron feed back mechanism in castrated rats

Use of all-trans-retinoic acid [ATRA] as remission induction agent in acute promyelocytic leukemia [APL]

We present here the details of treatment and hospital course of three patients with APL who were given ATRA therapy. Two complete remmissions and one partial remission were obtained. In addition, the coagulopathy present in one case was controlled easily. The mode of action and other features of ATRA therapy are discussed

Study of antimutagenic and mutagenic effect of different chemicals on clinically isolated strains of pseudomonas aeruginosa

This project was undertaken to study the effect of twelve different compounds to test their antimutagenic and ii mutagenic activity against clinically isolated strains of Pseudomonas aeruginosa. The effect of these compound was estimated by counting the number of rifampicin resistant colonies growing in a particular time in a it compound. The results were interpreted by plotting graphs between lOg N/No [Rif R Colonies/ml] and time to estimate the forward mutation rate. The results revealed that Acridine, Basic fuchsin, Caffeine, Cyclohexamide, Zehidium bromide and Histidine probably have an antimutagenic effect, while [steine, Folic acid, Ethyl-methane. ulphonate, Manganous Chloride and N-nitrosodietylamine acted as mutagen. E.coli was used as control through out the study

Effect of ramadan fasting on blood chemistry in healthy volunteers

Previous reports on the effect of Ramadan fasting are limited to the analysis of blood and urine constituents in different groups of subjects and they are not sufficient to relate the alterations in blood chemistry with the physiological responses of the whole body. This study presents a detailed analysis of the effect of Ramadan fasting on a wide range of blood constituents including metabolites, enzymes and isoenzymes which are frequently used by clinicians as diagnostic tools. The analyses were performed on blood taken from healthy adult male Muslims [20-45 years of age] of the United Arab Emirates before and after Ramadan. The key metabolites glucose, triglycerides, cholesterol and lipoproteins, were measured. Serum proteins, albumin-globulin ratio, bilirubin, SGOT, SGPT and GGT, were measured to assess liver function. BUN, creatinine, electrolytes, calcium, and phosphorus were measured to assess kidney functions. In addition LDH and CPK isoenzymes were measured. A significant increase in the concentration of cholesterol, triglycerides and HDL cholesterol were observed in individuals after Ramadan fasting. However, no clinically significant changes in blood chemistry related to liver, kidney or cardiac functions were observed. It is concluded that normal healthy individuals adapt well to the change in eating-fasting schedule during Ramadan and there appears to be no adverse effect on the physiology of the body

Lactate dehydrogenase isoenzyme patterns of rat testis and reproductive tract: changes during postnatal development

Electrophoretic patterns of LDH isoenzymes in whole testis as well as in testicular isolated cells of immature and mature rat are demonstrated. Further, these molecular forms are studied in testis, vas deferens, epididymis, seminal vesicle, prostate and during development from one week to 4 weeks and above at selected time intervals. LDH - X is demonstrated only in testis and cells found in seminiferous tubular compartment and is suggested to appear during the prophase of frist meiotic divison of spermatogenesis. The isoenzymes appear to be intense during 2 - 3 week of age and do not show any significant shift as the development progresses