Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States / 대한뇌졸중학회지

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention.

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.

Treatment of mycosis fungoides with total skin electron beam therapy using modified stanford technique

A retrospective review of three patients with mycosis fungoides treated with total skin electron beam therapy, from the year 2007 to 2009, at the Oncology department, Ziauddin University Hospital

Comparison of effectiveness of topical tacrolimus and betamethasone with soft paraffin in the treatment of patchy alopecia areata

To compare the effectiveness of Topical Tacrolimus and Betamethasone with soft paraffin in the treatment of patchy alopecia areata. Sixty patients with mild to moderate patchy alopecia areata were evaluated in a non-randomized, open label, intention to treat clinical trial. Patients were assigned to Tacrolimus [n=20] or to Betamethasone [n=20] or to soft paraffin [n=20]. All the three groups were advised to apply the treatment on the affected areas twice a day for 12 consecutive weeks. The primary study outcome was to compare the hair regrowth rate. Efficacy was evaluated at weeks 4, 8 and 12, using hair regrowth score [RGS] with a scale ranging from 0 [regrowth<10%] to 4 [regrowth>75%]. Fifty six subjects [93%] completed the study. At week 12, the RGS was 3.5 +/- 0.11in Betamethasone group [p<0.001], 2.2 +/- 0.15 in Tacrolimus group [p<0.005] and 0.85 +/- 0.08 [ns] in control group respectively. RGS>3 was observed in 70% of patients in Betamethasone group as compared to 45% in Tacrolimus group and none of the patients in control group. Betamethasone is more effective than Tacrolimus in promoting hair regrowth as compared with soft paraffin in patients with mild to moderate patchy alopecia areata

Metronidazole for bacterial vaginosis - a comparison between vaginal gel and oral therapy

To compare the efficacy of 0.75% metronidazole vaginal gel with oral metronidazole for the treatment of bacterial vaginosis. Comparative study, conducted in the Department of Obstetrics and Gynaecology at Ghurki Trust Teaching Hospital attached with Lahore Medical and Dental College, Lahore. The total number of patients included were 290. They were divided into two groups, by random selection. Group A [150 patients] and Group B [140 patients]. 150 patients received metronidazole vaginal gel for 5 days. 98 [85%] patients were free of signs of infection. 11 [9.5%] patients showed partial response and the dose was repeated, while 6 [5.2%] patients showed no response to treatment. 140 patients received metronidazole 400 mg x BD orally for 5 days. In which 80 [77%] patients were free of discharge while 14 [13%] patients and 10 [9.6%] patients showed partial or no response respectively and it was mainly because of gastro-intestinal complaints. Vaginal metronidazole is effective for the treatment of bacterial vaginosis and is associated with better compliance and less side effects as compared to oral metronidazole

Efficacy of fine needle aspiration [FNA] cytology in differentiating malignant and benign ovarian cysts

This study was carried out to determine the diagnostic efficacy of fine needle aspiration cytology between neoplastic and non neoplastic ovarian cysts and to verify the cytological diagnosis of aspirated fluid with histology of excised cyst. This was carried out at the Department of Obstetrics and Gynaecology, Ghurki Trust Teaching Hospital, Lahore from February 2003 to February 2005. It was an analytic study. A total number of 55 patients were included in the study. They were selected on the basis of ultrasonographic examination and having unilocular and non septate ovarian cysts. Ultrasound guided aspiration of cysts was done followed by excision. The cytology of fluid was correlated with histology of excised cyst. Follicular cysts were seen in the highest percentage followed by haemorrhagic luteal cysts, serous cyst adenomas and serous cyst adenocarcinomas. Ultrasound guided fine needle aspiration of ovarian cysts is a feasible alternative to surgery for benign cysts of the ovary

Vulval mass

Miss T, daughter of G. N., 25 years of age presented with history of swelling of the right side of the vulva for last 3 years. On examination a large growth arising from the labia majora and hanging down to just below the knee was seen. Excision of the vulval growth was done. Histopathology revealed fibroepithelial polyp

Vesico vaginal fistula after interval debulking in epithelial ovarian cancer

Mrs. S.E, 45 years of age was diagnosed as a case of ovarian carcinoma and had interval debulking, following which she developed vesico-vaginal fistula. Continuous bladder drainage was done for 6 weeks and she was given post operative chemotherapy with cisplatin and gemcitabine. On her 6 weeks postoperative examination, the fistula had healed completely. She is receiving her chemotherapy cycles and is in satisfactory condition

Intrauterine growth restriction: antenatal diagnosis and foetal outcome

The following study was conducted in the Department of Obstetrics and Gynecology Jinnah hospital Lahore to identify women with risk factors for IUGR [Intrauterine growth restriction: Antenatal diagnosis and foetal outcome.]on clinical assessment and ultrasound and to co -relate antenatal diagnosis with fetal outcome. Fifty [50] patients were picked on basis of risk factor. Fourteen [28%] had SFH less than expected for gestation. Eleven [22%] had hypertension, Nine [18%] had previous history of SGA babies. Other risk factors were diabetes mellitus, pre-pregnancy weight less than 50 kg and smoking. On ultrasound 18 [39.63%] of patients were diagnosed as IUGR while 28 [60.48%] were diagnosed as non IUGR. Among IUGR babies 66.24% had asymmetrical while 33.76% had symmetrical IUGR. 39.53% babies were suspected of IUGR on SFH, and 28% of IUGR babies were suspected on ultrasound, as outcome measure 25% of babies had birth weight less than 10th percentile after delivery. It was concluded that for antenatal diagn osis of IUGR sonographic assessment is more precise than clinical assessment

Comparison between single dose versus seven days metronidazole therapy in treatment of trichomonas vaginalis vaginitis

Comparison between single dose use of metronidazole versus seven days therapy in the treatment of trichomonas vaginalis infection. Design and Setting: A one year study from September 2002 to August 2003 conducted at Ghurki Trust Teaching Hospital attached with Lahore Medical and Dental College, Lahore. The total number of patients included are 109. Main Outcome Measure: Comparative treatment results of single dose versus 7 days therapy of metronidazole in treatment of trichomonas vaginalis. 54 patients received metronidazole for 7 days. 51[94.44%] were free of infection. 3 did not respond to treatment and were retreated in the same way. 55 patients received 3 gm single dose treatment. 53% [96.36%] were free of infection while 3 patients required repeat treatment. Conclusions: Single dose treatment is an acceptable option with few side effects and better compliance