Case report: Primary ependymoma of the trigeminal nerve presenting as trigeminal neuralgia.

Background: Ependymomas are usually found in the posterior fossa originating from the fourth ventricle. Primary ependymomas arising from cranial nerves are rare with only a handful of reported cases. Trigeminal neuralgia (TN) is rarely due to space occupying lesions. Case Description: A 20-year-old female presented with TN with a rare presentation of a pure extra-axial ependymoma involving the right trigeminal nerve in the cerebellopontine angle. Conclusion: It is essential to explore the possibility of a mass arising from the trigeminal nerve when investigating the cause of TN.

Contralateral metastatic cerebellopontine angle glioblastoma: A rare manifestation.

BACKGROUND: Glioblastoma is the most common glioma presenting within adults with an incidence of 10 per 100,000 people globally. These are mostly supratentorial tumors with rare cases of extra-axial spread. Even rarer is the presentation of glioblastoma within the cerebellopontine angle (CPA). Here, we present a case of a previously resected and irradiated glioblastoma metastasizing from the right temporal lobe region to the contralateral CPA. CASE DESCRIPTION: A 24-year-old female who previously underwent surgery and concurrent chemoradiotherapy for a right temporal glioblastoma in August 2020, presented to us 6 months later with headaches, vomiting, and dizziness for the past 6 days. She had left-sided dysmetria on examination. MRI of the brain showed an extra-axial, heterogeneously enhancing lesion within the left CPA. The patient subsequently underwent a left retrosigmoid craniotomy and maximum safe resection of the lesion. Histopathology reported the lesion as a glioblastoma. CONCLUSION: Glioblastoma within the CPA is rarely reported within the literature. To date, our case is the first instance of an extra-axial contralateral metastasis of glioblastoma.

Giant tumefactive perivascular spaces in a pediatric patient: A rare radiological entity.

BACKGROUND: Giant tumefactive perivascular spaces (TPVS) are radiological rarities and may mimic other neurological structural lesions. Fewer than 80 cases have been reported in the literature with even fewer in the pediatric population. CASE DESCRIPTION: The authors present an image report showcasing a 3-year-old boy presenting with uncontrolled seizures despite multiple anti-epileptic medications. His magnetic resonance imaging showed multiple, non-contrast enhancing cyst clusters within the left parieto-occipital region that was hyperintense on T2-weighted imaging, and isointense to cerebrospinal fluid. Due to a characteristic absence of perilesional edema seen on fluid-attenuated inversion recovery imaging or diffusion restriction on diffusion-weighted imaging (DWI) sequences, this was diagnosed as a giant TPVS. CONCLUSION: Accurate diagnosis of these rare radiological entities is based on pathognomonic findings that can help prevent unnecessary surgery and guide management for patients, particularly in the pediatric population as seen in our case.

Effect of Sociodemographic Variables and Other Factors on the Usage of Different Doses of Aspirin in Postmyocardial Infarction Patients: A Cross-sectional Study.

BACKGROUND: Aspirin (acetylsalicylic acid) is commonly prescribed to patients with a history of myocardial infarction (MI) or occlusive vascular events (e.g., stroke). Due to the complications associated with failure to follow aspirin usage guidelines, determining predictors of aspirin noncompliance in these patient populations is of clinical value and may help prevent poor outcomes. METHODS: This cross-sectional study of all patients with a previously diagnosed MI was conducted over a period of 3 months from May 2015 to July 2015 at a government-based hospital in Karachi, Pakistan. Patients were administered a questionnaire that comprised two parts. Part A was designed to measure sociodemographic data including age, gender, and marital status. Part B determined whether the patient was counseled on aspirin significance, and dosage recommendation, and was participating in cardiac rehabilitation therapy. RESULTS: A total of 456 patients included in the study. Of them, 298 (66.7%) were males. The average age was 59 (standard deviation 11) years. The outcome from univariate logistic regression revealed that with 1 year increase of age, the usage of low dose of aspirin was significantly decreased by 2%. Patients with higher education attributed a significantly different effect on the usage of aspirin. Marital status divulged no significant association with the use of different doses of aspirin. The role of rehabilitation had no effect when adjusted for age and level of education. CONCLUSION: Post-MI patients with higher education level and undergoing rehabilitative therapy are more likely to take low-dose aspirin as compared to those who failed to have these attributes. There is a need for carrying out further work to confirm these findings and expand our recommendations, particularly the sensitive issue regarding adequate doctor counseling among these high-risk patients.

Comparison of the Quality of Life after Skeletonized versus Pedicled Grafts in Coronary Artery Bypass Graft Surgery.

It remains a controversial issue whether internal thoracic artery (ITA) should be dissected in skeletonized or pedicled manner during coronary artery bypass graft (CABG) surgery. The main objective of this cohort study was to compare skeletonized versus pedicled grafts on the basis of patients' perceptions of their physical and mental well-being. Isolated nonemergent CABG patients were divided into two groups according to the type of graft used; skeletonized or pedicled. The quality of life (QOL) was measured preoperatively, 6 months postoperatively, and 12 months postoperatively for each patient using the 36-Item Short Form Health Survey tool. The main outcome variables were physical component summary (PCS) score and mental component summary (MCS) score. A total of 140 patients were included in the study with 70 patients in each group. The PCS (p-value = 0.235) and MCS (p-value = 0.239) scores of patients were similar in both the groups before CABG. The PCS and MCS scores were significantly (p-values < 0.0001) improved after CABG at 6 months in both the groups. However, the PCS and MCS scores in the skeletonized group were significantly higher (p-values < 0.0001) than the scores in the pedicled group at 6 and 12 months post-CABG. Both the harvesting techniques improve QOL significantly after CABG. However, skeletonization results in significantly better PCS and MCS scores compared with pedicled harvesting technique.

Assessing acceptability of hypertensive/diabetic patients towards mobile health based behavioral interventions in Pakistan: A pilot study.

INTRODUCTION: Diabetes and hypertension are prevalent chronic diseases among the general population of Pakistan with an exponential progress expected over the upcoming years. Mobile Health services can be an efficient method of helping curtail this rise and improve quality of life of such patients as proven in developed countries. We aim to assess the acceptability of using Mobile Health services among diabetic and hypertensive patients in Pakistan. METHODS: A total of 100 patients were approached in a large tertiary care Government Hospital of Karachi, Pakistan, using a nonprobability convenient sampling technique. Co-authors conducted an interview based sampling of a modified questionnaire to each participant after consent. All data was recorded and analyzed on SPSS 16. RESULTS: A total of 100 patients participated in our study with 66 (66%) males and 34 (34%) females having a mean prevalence age of 54.27. All the 100 participants had easy access to cell phones with 88% participants (88/100) stating that they would be willing to participate in Mobile Health based interventions. A statistically significant number (p=0.014) of them preferred receiving phone calls (85.2%) rather than SMS (14.8%) reminders for these interventions. 85% of the participants even agreed to participate in such intervention on cash incentives. CONCLUSION: The use of phone call reminders or SMS reminders seems like an acceptable and favorable option among hypertensive and diabetic patients. This can greatly improve their self-management and help curtail this rise in the future.

On pump coronary artery bypass graft surgery versus off pump coronary artery bypass graft surgery: a review.

There are two basic ways of performing coronary artery bypass graft surgery (CABG): on pump CABG and off pump CABG. Off pump CABG is relatively a newer procedure to on-pump CABG and does not require the use of the cardiopulmonary bypass machine. On pump CABG is the more traditional method of performing bypass surgery. However its resultant inflammatory effects cause renal dysfunction, gastrointestinal distress and cardiac abnormalities which have forced the surgeons to look for alternatives to the procedure. An extensive literature search revealed that on pump CABG causes better revascularization as compared to off pump CABG while off pump CABG has a much lower post operative morbidity and mortality especially in high risk patients. We suggest that the technique used should depend on the ease of the surgeon doing the operation as both the methods seem almost equally efficient according to the review.