Cerebellar Stroke in a Young Adult Following an Amusement Park Ride.

The incidence of stroke in young individuals has been showing an increasing trend. In such cases, atypical mechanisms of stroke should be considered. Here, we report a case of a 37-year-old healthy female who presented with complaints of right-sided ataxia and clumsiness that started after an amusement park ride where she was swung rapidly. Imaging revealed an infarct in the right cerebellar hemisphere. This case report highlights certain mechanisms that can cause a stroke in this situation, with special emphasis on recognition, timely medical management, public awareness of such risk factors, and the prevention of complications.

Timely Diagnosis of Basilar Artery Occlusion Leading to Improved Outcomes: A Case Report.

This is a case report of an 83-year-old female who presented to the emergency department within eight hours of symptom onset. A CT angiogram revealed a distal basilar artery occlusion, as well as a perfusion deficit in the right superior cerebellar artery. Her symptoms fluctuated, and she was started on a heparin drip, but later in the evening her symptoms worsened. A mechanical thrombectomy was performed by interventional radiology. The following morning, most of the patient's deficits had resolved, and, when seen in the clinic several weeks later, she continued to be asymptomatic. This case report highlights the importance of timely diagnosis and intervention in the management of distal basilar artery occlusion.

Acute Adverse Effects of Vaccines Against SARS-COV-2.

Introduction The global struggle against the impact of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) on physical and mental health and on economic and social aspects of human life continues even after two and a half years have passed since the emergence of this virus. The development of vaccines was a milestone. By June 2022, billions of people have been vaccinated against the deadly virus. However, like any other vaccine, the various vaccines against coronavirus disease 2019 (COVID-19) also cause a variety of adverse effects. Therefore this study aimed to determine the different acute side effects experienced after receiving the vaccines and correlating them with some socio-demographic and biomedical factors.  Methodology This cross-sectional study has a sample size of 467. Study participants were recruited after fulfilling inclusion and exclusion criteria. After gaining approval from the Ethical Review Board (ERB) of CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan, an online questionnaire was distributed via social media. The survey questionnaire had a series of questions regarding the socio-demographic and biomedical characteristics of the participants, as well as the type of vaccine they got, followed by questions about the development of adverse effects after each dose (first and second). Data were statistically analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The analysis was carried out in a confidence range of 95%, and a p-value<0.05 was considered statistically significant.  Results Sinopharm (76.0%) was the most frequently received vaccine. Adverse events were reported more after the first dose (79.7%) than in the second (67.2%) (p value 0.001). The reported adverse events after either dose were of mild intensity (p<0.05). None of the individuals reported serious adverse events or hospitalization after getting the shots. Females, younger age groups, and individuals with BMI in the underweight category were more prone to developing symptoms and experiencing difficulty doing routine work after getting the doses. The associations were statistically significant (p<0.05). Blood group (A,B,0,AB), past COVID-19 history, and smoking status were not positively associated with the appearance of symptoms after either dose or with inconvenience doing daily work post-vaccination. Conclusion The vaccines developed against COVID-19 offer benefits that outweigh the few mild adverse effects experienced. None of these symptoms is severe enough to stop an individual from doing routine work or result in morbidity or mortality. Therefore, people should avoid any hesitancy towards getting vaccinated to get past this pandemic.

A Rare Presentation of Type-III Takayasu's Arteritis in a 20-Year-Old Female.

Takayasu's arteritis is a rare chronic granulomatous vasculitis that predominantly affects the aorta and its branches. It is estimated to affect 2.6/million/annum, predominantly women in the second or third decade of their lives. This case report describes the case of a 21-year-old female, who initially only had low-grade fever and acrodynia, which over a few months, progressed to arm and leg claudication, weight loss, nausea, headache, and dizziness. A year later, the patient experienced impalpable radial pulses bilaterally, and her CT angiogram revealed multi-level arterial stenosis. A diagnosis of Takayasu's arteritis was made and the patient was started on steroids and methotrexate. A consult was made with vascular surgery but no intervention was deemed necessary and the patient responded well to the medical treatment given. Though Takayasu's arteritis is a very rare disease, a detailed history, clinical examination, and investigations can help with early diagnosis.

Effect of Buffered Local Anesthesia on Perioperative Pain During Arteriovenous Fistula Surgery: A Randomized Control Trial.

OBJECTIVE: This prospective, pilot randomized double-blind study aimed to compare the effects of buffered and non-buffered xylocaine solutions on injection pain and anesthesia effectiveness in patients undergoing arteriovenous fistula surgery. MATERIAL AND METHODS: A total of 100 adult patients meeting inclusion criteria undergoing arteriovenous fistula surgery were included in the study. They were split into two groups at random. The control group received 1% xylocaine dissolved in 5 ml distilled water, while the intervention group received sodium bicarbonate mixed with 1% xylocaine solution as a local anesthetic. The patients were asked to rate the pain of first and subsequent injections on a visual analog scale (VAS). Besides, the need for extra analgesia was investigated. The mean and standard deviation of the data was determined. RESULTS: During both the first and subsequent injections, the alkalinized local anesthetic group showed substantially lower VAS scores. In the alkalinized local anesthetic group, anesthesia satisfaction was also more than three times higher. Furthermore, the non-alkalinized group's mean analgesic requirement was higher than the intervention group. CONCLUSION: Our findings support the effectiveness of the alkalinized local anesthetic solution in minimizing injection pain and increasing anesthesia duration and overall patient's surgical experience in terms of anesthesia satisfaction score.

Follow-up of COVID-19 recovered patients with mild disease.

COVID-19 may manifest as mild, moderate or severe disease with each grade of severity having its own features and post-viral implications. With the rising burden of the pandemic, it is vital to identify not only active disease but any post-recovery complications as well. This study was conducted with the aim of identifying the presence of post-viral symptomatology in patients recovered from mild COVID-19 disease. Presence or absence of 11 post-viral symptoms was recorded and we found that 8 of the 11 studied symptoms were notably more prevalent amongst the female sample population. Our results validate the presence of prolonged symptoms months after recovery from mild COVID-19 disease, particularly in association with the female gender. Hence, proving the post-COVID syndrome is a recognizable diagnosis in the bigger context of the post-viral fatigue syndrome.

Physician Gender Preference Amongst Females Attending Obstetrics/Gynecology Clinics.

INTRODUCTION: The objective of our study was to explore the views and perceptions of female patients attending the obstetrics and gynecology (OB/GYN) outpatient department towards the gender of their healthcare provider, to look for any preference that might exist in this regard, and to highlight any discrimination towards male obstetricians/gynecologists. MATERIAL AND METHODS: A cross-sectional study was conducted from November 2020 to March 2021 at Combined Military Hospital, Lahore. A total of 280 female patients were included in the study and interviewed consecutively. A self-designed questionnaire was administered. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY). Chi-square test was used to determine for any statistical significance and p≤0.05 was considered significant. Numerical data were represented as percentages. RESULTS: Over 280 female patients participated in our study, out of which 132 were married and 148 were single. Thirteen of these patients were uneducated, 40 had completed high school and 227 patients had obtained a bachelor's level of education; 120 patients were aged 15-25 years, 95 patients were aged 26-35 years, 30 patients were aged 36-45 years, and 35 patients were aged >46. Women with less education preferred to be seen by a female obstetrician/gynecologist, whereas those with higher education were less biased (p=0.0001). Married patients preferred to be seen by female obstetrician/gynecologists as compared to single patients (p=0.0004). A significant proportion of females were impartial in terms of physician competence but those who did have a preference preferred female obstetrician/gynecologist based on three significant variables: competence, rapport building and empathy, and personal comfort. CONCLUSION: A female gender preference exists in obstetrics and gynecology clinic attendees. This is significant in those who are married and those with no formal education. Overall, a significant proportion of women feel a higher comfort level with female doctors and find it easier to discuss their medical issues and develop rapport.

Takayasu's Arteritis in a 33-Year-Old Male.

Takayasu's arteritis (TA), commonly referred to as "pulseless" disease, is a large-vessel inflammatory vasculitis most commonly affecting the aorta and its major branches. Due to its irregular nature, it has the propensity to involve any organ system thus leading to a wide spectrum of clinical features. Most patients affected by TA are females in their second or third decades of lives. Our case is of a 33-year-old male who presented with sudden onset of hypertension for which he was prescribed antihypertensives. Over the next few weeks, he had multiple visits to the emergency department for a variety of different symptoms including fever, myalgias, left arm numbness, and persistence of hypertension. His CT aortogram showed multi-vessel narrowing including that of the celiac axis, superior mesenteric, renal, and internal iliac arteries with right atrophic kidney. At this time, a diagnosis of TA was made and he was started on oral corticosteroid and immunosuppressant therapy and continued to be treated as an outpatient. Nearly five years after his initial symptoms, he presented to the Emergency for acute abdomen, severe vomiting, and constipation, at which time an emergency laparotomy was done and peritonitis was found. A CT angiogram of the abdomen done after this procedure showed tight stenosis of the inferior mesenteric artery (IMA) and proximal stenosis of the left renal artery. He is currently planned for left renal artery and IMA stenting. Our case highlights the important characteristics of TA in male patients and how they differ from females. It also focuses on the importance of early initial workup and diagnosis and the need for a multi-disciplinary team when handling any patient with TA.

Assessment of risk factor profile in young patients undergoing elective coronary artery bypass grafting surgery in Armed Forces Institute of Cardiology/National Institute of Heart Disease, a tertiary care cardiac facility.

OBJECTIVE: To identify modifiable and non-modifiable risk factors among young patients undergoing elective coronary artery bypass graft surgery. METHODS: The descriptive cross-sectional study was conducted at the Department of Adult Cardiac Surgery of the Armed Forces Institute of Cardiology and National Institute of Heart Disease, Rawalpindi, Pakistan, from January 1, 2015, to April 24, 2018, and comprised patients who underwent elective coronary artery bypass grafting. Data was collected using a predesigned questionnaire, and the risk factors studied were hypertension, diabetes, smoking, serum cholesterol, family history and body mass index. Data was analysed using SPSS 23. RESULTS: Of the 1270 patients, 838(66.1%) were males and 432(33.9%) were females. The overall mean age was 39.29±8.64 years (range: 18-49 years). Of the total, 319(25.2%) patients were hypertensive; 170(13.3%) were diabetics; 303(23.9%) had history of smoking; 566(44.6%) were obese. CONCLUSIONS: There was a high prevalence of obesity, hypertension and smoking in the patients undergoing coronary artery bypass graft surgery at age <50 years.

Do Patients With Osteoarthritis get Weight Loss Counseling?

INTRODUCTION: Osteoarthritis (OA) is a degenerative disease of joints which if untreated can lead to a permanent disability of joints. Obesity plays an important role in the morbidity of OA. Since there is no curative treatment for OA, several researches focusing on nonpharmacological intervention for OA have come forth. Triad of education, exercise, and weight loss has been gaining popularity as a first-line nonpharmacological treatment for OA. This article measures the number of OA patients, irrespective of age and gender, who have received weight-loss counseling from their physicians and it also studies patients' willingness to lose weight after being counseled. METHODOLOGY: A cross-sectional study was conducted from 10th June 2020 to 10th July 2020. Diagnosed cases of OA were included and their consent was taken. A self-administered questionnaire was used which included questions asking if they have ever received weight-loss counseling and if they will try to lose weight on being advised by their physician. Data were collected from the participants using google forms and analyzed using SPSS-22. RESULTS: Out of 199 OA patients included in our study, only 28 (14%) participants received weight loss and exercise counseling from their physicians. A positive response was observed in 175 (87.9%) participants out of 199 who reported that they would exercise and practice a healthy lifestyle to lose weight if they were advised properly. CONCLUSION: Results of our study showed that the total number of OA patients receiving advice from their treating physician regarding weight loss is less. However, the majority of the patients were willing to exercise and control their weight if advised properly by their physician.

Idiopathic Dilatation of Inferior Vena Cava: A Case Report.

Inferior vena cava (IVC) is a large collapsible vein whose diameter and extent of inspiratory collapse are known to correlate with right atrial (RA) pressures; hence, IVC dilatation represents a cardiac pathology. IVC dilatation in the absence of any cardiac involvement is termed as idiopathic. We report a case of a 39-year-old male who presented with abdominal pain and had an incidental finding of isolated IVC dilatation with diminished inspiratory collapsibility and normal RA pressures. This case report emphasizes that IVC dilatation may not always have an underlying cardiac pathology.

Awareness Among Healthcare Professionals Regarding Contaminated Stethoscopes as a Source of Nosocomial Infections.

Objectives The objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard. Methodology A descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection. Results Participants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals. Conclusion A majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.