A Rare Case of Acute Cord Compression From Spinal Myeloid Sarcoma: A Complication of Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) is the most common malignancy in the acute leukemia category. AML is a very aggressive cancer with high mortality. The most common presentations include pancytopenia, bleeding, and recurrent infections. Unlike lymphoma, it rarely presents as a mass. Myeloid sarcoma is a peripheral collection of myeloid cells. Myeloid sarcoma most commonly involves the skin and gingival tissue and rarely it affects the central nervous system. Myeloid sarcoma involving the central nervous system is associated with high mortality. We present a patient with AML which evolved from myelofibrosis presented with acute spinal cord compression and found to have myeloid sarcoma involving the thoracic spinal cord. Despite acute radiation therapy, the patient could not recover her neurological function and passed away shortly after the diagnosis. We discuss the importance of early recognition of the complication due to myeloid sarcoma and treatment with neurosurgical intervention just like other mass causing acute cord compression.

Ophthalmic Timolol and Hospitalization for Symptomatic Bradycardia and Syncope: A Case Series.

Topical beta-blockers are commonly used for the management of primary open angle glaucoma (POAG). One of the rare but serious side effects of the topical beta-blockers is bradycardia, defined as a heart rate below 60 beats per minute. In few cases, the heart rate drops to much lower level resulting in syncope or symptomatic bradycardia. Topical beta-blockers are still widely used for POAG even though there are much better medications available. We present a series of four cases of symptomatic bradycardia resulting from the use of timolol eye drops and after discontinuation of the eye drops, heart rate improved to normal range (60-100 beats per minute).

Pain Intervention for Cancer and Non-cancer Pain: A Retrospective Analysis of Tertiary Care Hospital Experience.

Background With the recent advancement in medicine there has been a great emphasis on the management of chronic pain which remains as one of the major contributing factors for functional limitation in patients as well as a financial burden on healthcare. Newer treatment modalities are aimed at terminating the vicious pain cycles and in this regard peripheral nerve blocks have proven to be very effective. Objectives The aim of this study is to evaluate the effectiveness of interventions for both cancer and non-cancer patients by objective assessment of the patients before and after the procedure. Materials and methods The study included 252 patients who underwent nerve block procedures in Shaukat Khanum Memorial Cancer Hospital from December 2016 to December 2018. The patients were evaluated using numerical rating scale (NRS) for pain, reduction in analgesic doses and patient satisfaction after one and four weeks post procedure. The data was analyzed using mean values and calculating percentages. Results In cancer group, 168 patients were included; mean age 50.49 ± 15.39 with 46.43% females and 53.57% males, the average pain score was 2.62 ± 1.87 post procedure compared with 6.30 ± 1.87 post procedure. 48.21% of the patients reported a reduction in analgesia while 51.79% of the patients kept on using the same analgesics doses. 74.40% of the patients were satisfied and 25.60% patients remained unsatisfied after one week whereas 66.07% were satisfied, 23.81% were not satisfied and 10.12% loss to follow up after four weeks. In non-cancer group 84 patients were included; mean age 56.49 ± 15.79 with 41.67% females and 58.33% males, the average pain score before intervention was 5.99 ± 1.21 and after intervention it was 2.43 ± 1.62. In 73.81% non-cancer patients the analgesics doses were reduced and 70.24% patients were satisfied while 29.76% were unsatisfied after one week. After four weeks 55.95% were satisfied, 22.62% were not satisfied and 21.43% loss to follow up. Conclusion The study showed decrease in pain scores in both group of patients and the importance of nerve blocks as an effective method for chronic pain management. The reduction in the use of other analgesics was also commendable in both the groups.