Potential candidacy for thrombolysis among ischemic stroke patients presenting to Khyber Teaching Hospital, Peshawar.

Objectives: To determine the number of ischemic stroke patients presenting to a tertiary care hospital that are potential candidates for thrombolysis. Methods: This need analysis study was conducted on one hundred consecutive ischemic stroke patients during the last quarter of 2022 at the Department of Medicine, Khyber Teaching Hospital, Peshawar. The Arrival National Institute of Health Stroke Scale (NIH Stroke Scale) was calculated for all suspected stroke patients after a detailed history and clinical examination. An urgent non-contrast-enhanced CT scan brain was carried out. Patients were included in the study group after intra-cranial bleed was excluded on imaging. Results: The majority (43%) of the patients (male and female) fell in the age group 51-60 years. Fifty-nine (59%) patients had hypertension as a co-morbid condition; 49% had diabetes mellitus while the remaining percentages were constituted by other risk factors. Fifty-seven (57%) patients presented with NIH Stroke Scale between 5-15; 25% had NIH Stroke Scale greater than or equal to 21. Forty-one (41%) patients having daytime (8 am to 8 pm) strokes presented within 4.5 hours of stroke onset to the hospital while 31% of patients having nighttime strokes (8 pm to 8 am) presented within 4.5 hours of stroke onset to the hospital. Conclusion: The majority (72%) of ischemic stroke patients reached the hospital facility within 4.5 hours of stroke onset. These patients can be benefited from thrombolysis leading to improved outcomes if available in that particular health facility.

Analytic Study In Patients Presenting To A Tertiary Care Hospital Regarding The Artemether-Lumefantrine Induced Qtc Interval Changes In ECG.

BACKGROUND: Malaria is one of the most common causes of morbidity and mortality in our part of the world. Artemether-Lumefantrine (AL) Combination therapy is widely used for the treatment of malaria both in outpatients and inpatients hospital settings. Some of the previous anti-malarial were associated with prolongation of QTc interval. Similar query was raised about AL therapy. This study was conducted to determine the risk of QTc interval prolongation in ECG of patients with Falciparum malaria using oral Artemether-Lumefantrine (AL) combination therapy. METHODS: The venue of this analytical, quasi-experimental study was Medical Unit A, Khyber Teaching Hospital Peshawar, spanning 1st August 2015 to 31st July 2016. The study sample included male and female patients, having Plasmodium falciparum rings in their peripheral smear. These patients were treated with oral Artemether- Lumefantrine (AL) combination for 3 consecutive days in recommended doses. Electrocardiography (ECG) profile before and after 72 hours' treatment with AL was noted for discernable QTc interval changes. The calculated prolongation of the QTc interval between these two study points was analyzed using Paired samples t-test. The statistically significant P value for this study was 0.05. SPSS version 23 was used for statistical analysis. RESULTS: Amongst 200 cases, the QTc interval was noted to be normal before the start of the treatment in all. There was no significant prolongation of QTc interval following the treatment (p-value=0.119) in the treated patients. It appears that cardiotoxicity is a remote adverse effect of AL combination therapy and that its use is safe in patients with Falciparum malaria. CONCLUSIONS: It can thus be concluded that AL is a safe drug combination for the treatment of falciparum malaria with negligible cardiotoxic adverse effects.

Global Insights on Prehospital Stroke Care: A Comprehensive Review of Challenges and Solutions in Low- and Middle-Income Countries.

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability.

Snakebite Induced Cerebral Venous Sinus Thrombosis: A Case Report.

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but highly fatal neurological condition mostly caused by prothrombotic conditions like antiphospholipid syndrome, factor V Leiden, and G20210A prothrombin polymorphism. Snake bites are a rare cause of cerebral venous sinus thrombosis that must be recognized and treated promptly to improve survival. Case presentation: We present a case of a 25-year-old male who developed headaches and seizures following a Viper snake bite. The diagnosis was made based on a magnetic resonance venogram (MRV) showing transverse sinus thrombosis with sigmoid sinus stenosis. Initially, the patient was treated with antivenom and supportive treatment for disseminated intravascular coagulation (DIC). After the diagnosis of CVST, the patient was treated with rivaroxaban and levetiracetam. The patient improved within 1 week of treatment and was advised to follow up in 3 months. Conclusion: A high index of suspicion for cerebral venous sinus thrombosis is required if the patient presents with headaches, seizures, or abnormal vision following a snake bite. Early diagnosis and management can prevent further neurological damage.

How to Teach Professionalism in a Clinical Context?

Null.

Antisynthetase syndrome presenting as interstitial lung disease: a case report.

BACKGROUND: Antisynthetase syndrome is a relatively uncommon entity, and can be easily missed if not specifically looked for in adults whose initial presentation is with interstitial lung disease. Its presentation with interstitial lung disease alters its prognosis. CASE PRESENTATION: This case report describes a 27-year-old Pakistani, Asian man, a medical student, with no previous comorbidities or significant family history who presented with a 3 months' history of low grade fever and lower respiratory tract infections, associated with exertional dyspnea, arthralgias, and gradual weight loss. During these 3 months, he had received multiple orally administered antibiotics for suspected community-acquired pneumonia. When he presented to us, he was pale and febrile. A chest examination was significant for bi-basal end-inspiratory crackles. Preliminary investigations revealed raised erythrocyte sedimentation rate. High resolution computed tomography of his chest showed fine ground-glass attenuation in posterior basal segments of both lower lobes suggestive of interstitial lung disease. He was started on dexamethasone, to which he responded and showed improvement. However, during the course of events, he developed progressive proximal muscle weakness. Further investigations revealed raised creatinine phosphokinase and lactate dehydrogenase. A thorough autoimmune profile was carried out which showed positive anti-Jo-1 antibodies in high titers. A muscle biopsy was consistent with inflammatory myopathy. Clinical, radiological, serological, and histopathological markers aided in making the definitive diagnosis of antisynthetase syndrome. Antisynthetase syndrome is a variant of polymyositis but with visceral involvement, that is, interstitial lung disease and positive anti-Jo-1 antibodies. Our patient responded very well to glucocorticoids and azathioprine. CONCLUSION: Antisynthetase syndrome is a rare clinical entity which apart from clinical presentation requires specific serological investigations for diagnosis. Concomitant association of interstitial lung disease gives it a guarded prognosis.

Management Of Diabetes In Ramadan.

Ramadan, the ninth month of Islamic calendar brings alongwith it a sense of responsibility to fast among the Muslim adult population. Though patients with chronic illnesses like Diabetes mellitus are exempted from fasting during the month if their health does not allow, they still wish to fast. This creates a challenge for the health care professionals to enable the patients with Diabetes mellitus to fast safely, without developing complications like hypoglycemia, hyperglycemia, ketoacidosis and thrombosis. This article has reviewed multiple articles published over last two decades to develop a consensus plan regarding management of Diabetes mellitus in Ramadan. Insulin sensitizers are a better option than drugs increasing secretion of insulin. Type 2 Diabetic patients can fast much safely as compare to Type 1 Diabetics.

Spindle Cell Sarcoma Presenting as Pancoast Syndrome.

This report describes a patient who presented with pancoast syndrome, secondary to spindle cell sarcoma of the lung. A 56-year man presented with dyspnea, engorged neck veins and bilateral upper limb pitting edema. The patient also had ptosis and miosis in the right eye. Right ulnar nerve palsy with atrophy of hand muscles was seen. His chest X-ray showed bilateral pleural effusion with an opacity involving the apex of the right lung along with mediastinal widening. Echocardiography revealed a pericardial effusion which was drained. The patient's CTscan of chest strongly suspected a malignant mass in right upper lobe with extensive mediastinal lymphadenopathy, pleural metastases and pericardial involvement. He was started on oxygen inhalation, dexamethasone, and clopidogrel. Bronchoscopic biopsy confirmed the diagnosis of spindle cell sarcoma. Meanwhile, he was advised radiotherapy. The tumour was not amenable to surgery. Spindle cell sarcoma is a rare connective tissue tumor that replicates rapidly. To the best of the authors' knowledge, it is hereby reported the first case of spindle cell sarcoma of the lung presenting as Pancoast syndrome.

Protective Role of G6PD Deficiency in Aluminium Phosphide Poisoning.

A 15-year-old boy was referred to the hospital from the periphery with a history of ingestion of 5 wheat pills (aluminium phosphide) 5 days back. He had been given a stomach wash in his village hospital prior to referral. On arrival, he was jaundiced and had developed haematuria too, but otherwise appeared well in himself. Four days after admission, his haemoglobin showed a marked drop and he was shifted to intensive care, keeping in mind the high mortality rate associated with aluminium phosphide intoxication. His G6PD levels were checked, and he turned out to be G6PD deficient. The patient was given intravenous magnesium sulphate and supportive care and he improved subsequently. Wheat pill poisoning carries a high mortality of 98% in some cases; despite the high mortality, this patient survived. This may mean that G6PD deficiency has a protective role in poisoning due to aluminium phosphide.