Efficacy of memantine in treating patients with migraine and tension-type headache

Objective: To assess the efficacy of Memantine as a preventive and therapeutic intervention for migraine and tension-type headache. Methods: This clinical trial was conducted over a period of 3 months. A total of 44 subjects, with diagnosed migraine and/or tension-type headache, presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Patients were treated with incremental doses of Memantine. Adult patients belonging to both genders were included in the study. Data was analyzed using SPSS version 16.0 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. Results: Out of 44 patients, 35 (79.5%) were females and 9 (20.5%) were males which shows a very high occurrence of migraine and tension-type headache in females. Average age was found to be 32.6 ≈ 33 years. Efficacy of the drug was observed to be 81.8% which is significantly high. The baseline MIDAS score when compared with the score at 3-month follow-up by applying Wilcoxon signed rank test showed mean ± S.D (39.52±21.27 vs. 6.72±6.41) where p=0.000 (\u3c0.05) which shows a highly significant result. All 44 patients were known cases of migraine while 25% (11) of them also suffered from tension-type headache. Patients were treated with incremental doses of Memantine and were observed for the efficacy of the drug. Patients maintained their diaries of intensity of pain, distressing influence of the pain and how it hindered their daily routine. Results showed that intensity of pain decreased significantly by the end of the 3rd month of treatment and majority of the patients felt less distressed on their final follow-up visit. By the end of the 3rd month, the level of hindrance in the daily routines of the patients caused by the headache also fell significantly. Conclusion: Memantine has significant beneficial effects in reducing intensity of pain and disability in patients with migraine and tension type headache

Pseudomembranous aspergillar tracheobronchitis in a non-neutropenic critically ill patient in the intensive care unit

Invasive aspergillosis is an important cause of morbidity and mortality among immunocompromised patients. Prolonged neutropenia is the most common risk factor. It has rarely been reported to occur in non-neutropenic critically ill patients in the intensive care unit setting. Mortality rate in this group has been reported to be as high as 92%. We report a case of tracheobronchial aspergillosis in a non-neutropenic critically ill patient to highlight the fact that critically ill patients admitted in the intensive care unit can develop opportunistic infections such as invasive aspergillosis even in the absence of classic risk factors and prior history of immunosuppression. Early diagnosis and prompt initiation of antifungal therapy may improve the outcome and decrease mortality rate

Triple Pancreatic Walled-off Fluid Collections Treated Simultaneously with Endoscopic Transmural Drainage

Pancreatic pseudocysts and walled-off pancreatic necrosis arise as a complication of pancreatitis. Multiple fluid collections are seen in 5-20% of the patients who have walled-off peripancreatic fluid collections. There is a paucity of data regarding the role of endoscopic transmural drainage in the management of multiple pancreatic fluid collections. In this case report, we present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis. The patient underwent simultaneous endoscopic ultrasound-assisted cyst gastrostomy and cyst duodenostomy and aggressive irrigation without index endoscopic necrosectomy of the three peripancreatic fluid collections. Significant improvement in the size of the fluid collections was seen on the computed tomography scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention

Triple Pancreatic Walled-off Fluid Collections Treated Simultaneously with Endoscopic Transmural Drainage.

Pancreatic pseudocysts and walled-off pancreatic necrosis arise as a complication of pancreatitis. Multiple fluid collections are seen in 5-20% of the patients who have walled-off peripancreatic fluid collections. There is a paucity of data regarding the role of endoscopic transmural drainage in the management of multiple pancreatic fluid collections. In this case report, we present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis. The patient underwent simultaneous endoscopic ultrasound-assisted cyst gastrostomy and cyst duodenostomy and aggressive irrigation without index endoscopic necrosectomy of the three peripancreatic fluid collections. Significant improvement in the size of the fluid collections was seen on the computed tomography scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention