B-cell lymphoma of the brainstem with central neurogenic hyperventilation

Non-Hodgkin\u27s lymphoma of the brainstem is a rare entity. Central Neurogenic Hyperventilation (CNH), an associated manifestation of this disease, is an even rarer event. We report a case of an immunocompetent individual who presented to us with tachypnea and facial nerve palsy. Neuroimaging showed a Cerebellopontine angle tumour which on histopathology showed feature consistent with a Non-Hodgkin\u27s B-Cell Lymphoma. The patient went on to develop severe respiratory alkalosis with findings consistent with CNH. Chemotherapy with Methotrexate was started and high dose Dexamethasone was added to the regimen a month later. Radiologically, the tumour size decreased by 50% but the patient\u27s clinical condition deteriorated. He eventually expired due to cardiopulmonary arrest. Some common clinical presentations of this disease and various diagnostic modalities and treatment options available to such patients are discussed

Prevalence of perceived heavy postpartum hemorrhage and its associated factors among married mothers in squatter settlements of Karachi

Objectives; To estimate the prevalence of postpartum hemorrhage (PPH) and identify its associated factors among the married women of 15-49 years, residingin the Karachi, Pakistan. Methodology: This cross-sectional survey was carried out in five squatter settlements of Karachi during 2000-2001. Information was collected regarding age, gravida, education, antenatal, natal and postnatal care, with perceived puerperal morbidities from 525 mothers, who were in their 42nd to 56th post delivery day. Univariate and multivariate analyses were computed using multiple logistic regression method. Results: The estimated prevalence for perceived PPH was 7.24%. Three hundred and ninety six (75.4 %) women received ante-natal care with 273 (52%) consulting skilled health professionals and 268 (51%) gave birth to their babies at a health facility. Eighty nine (16.9%) women who delivered at a health facility were advised for the post partum routine care and only 127 (24.2%) women followed the instructions. Two hundred and seventy eight (53%) mothers reported at least one perceived puerperal morbidity and among them 38 (7.24%) women perceived PPH. On multivariate analysis, the factors associated with PPH were older age (aOR=1.10, 95% CI:1.04-1.1), longer duration of labor (aOR=1.08,95% CI :1.02-1.2) and restricted fluid intake (aOR=2.1, 95% CI :1.05-4.0).Conclusion: Older age group, longer duration of labor and restricted fluid in take were found to be the common factors associated with PPH. Women need to be educated regarding family planning program, safe and timely delivery by skilled medical personnel and intake of extra fluid during post partum period

Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap

Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis have been reported with acetaminophen usage in the past. We present the case of a 40 years old lady who developed an overlap of the two condition after taking several doses of acetaminophen for fever. She presented with widespread maculopapular rash, stinging in the eyes, oral mucosal ulcerations and high grade fever. She was successfully treated with corticosteroid therapy along with the supportive treatment. This case addresses the fact, that severe hypersensitivity reactions can occur with acetaminophen which can be potentially life threatening

Associations of controlling behavior, physical and sexual violence with health symptoms

Controlling behavior is often manifested as monitoring, coercing or threatening the partner. Globally, it has been experienced by the women (in range of 5.2% to 56.6%) and often results in their physical and mental ill health. To the best of our knowledge there is no published research on controlling behaviors. Therefore, a cross sectional study was conducted to measure the magnitude of the controlling behaviors and its association to some physical stress symptoms of women. The study was conducted in urban settings of Karachi, Pakistan, using simple random sampling technique. The data was collected by trained midwifes from the 759 married women of aged 25 to 60 years. The data was entered in Epi Info version 6 and analyzed on SPSS version 11. The study showed that the prevalence of pastyear physical and sexual violence is 68% while controlling behavior was experienced by 51.6% of the women. Among the different types of controlling behavior, refusal of the husband to give money for the household chores was the most common. The results of the bi-variate analysis showed that there was a significant association between women who had past-year physical or sexual violence experience with shoulder and neck pain, feeling worthlessness and suicidal thoughts. This study identified that most women in middle and lower socioeconomic groups are exposed to physical, sexual and psychological violence. Furthermore, we found that in addition to exposure to violence, women face controlling behaviors from their partner which restrict their decisions making toward their health

Clinically significant contrast induced acute kidney injury after non-emergent cardiac catheterization--risk factors and impact on length of hospital stay.

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy(CIN) in patients undergoing non-emergent coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of ≥ 1.5 mg/dl atthe time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure.Results: One hundred and sixteen patients met the inclusion criteria. Mean age was 64.0 ± 11.5 years, 72% were males.Overall prevalence of CIN was 17% (rise of serum creatinine by ≥ 0.5 mg/dl) while that of clinically significant CIN (CSCIN) was 9.5% (11 patients). Patients with CSCIN had significantly lower left ventricular ejection fraction (p = 0.03, OR: 0.24;95% CI = 0.06 – 0.91) and higher prevalence of cerebrovascular disease (p \u3c 0.001, OR: 14.66; 95% CI = 3.30 – 65.08).Mean baseline serum creatinine was significantly higher, 3.0 ± 1.5 vs. 2.0 ± 1.1 mg/dl (p = 0.03, OR: 1.47; 95% CI =1.03 – 2.11) whereas mean GFR estimated by Cockcroft-Gault formula was significantly lower at 25 ± 7.4 vs. 41.0 ± 14.6ml/minute (p = 0.001, OR = 0.89, 95% CI = 0.84 – 0.95) at the time of procedure in patients with CSCIN. Mean length ofhospital stay was significantly higher in this group compared to those without CIN, 9.0 ± 5.1 vs. 3.0 ± 3.2 days (p = 0.001,OR = 1.31, 95% CI = 1.12 – 1.54). Multivariate analysis revealed low GFR (p = 0.001, OR = 0.88; 95% CI = 0.82 – 0.95)and low ejection fraction (p = 0.03, OR = 0.20; 95% CI = 0.04 – 0.91) to be independent factors associated withCSCIN. No significant differences were noted between the two groups in patients with hypertension, diabetes andheart failure. Conclusion: CSCIN is a significant concern in high risk groups despite prophylaxis. Patients with lower EF, cerebrovascular disease and low GFR at the time of procedure are more likely to have CIN

Craniocerebral aspergillosis: A review of advances in diagnosis and management

Craniocerebral aspergillosis is a rare but dangerous central nervous system infection. The infection has a spectrum of presenting features, mostly affecting immunocompromised individuals. The incidence appears to be on the rise that has been especially observed in the immunocompetent population. A high index of suspicion, a comprehensive understanding of the infectious process and advanced laboratory and radiological diagnostic techniques, allow early diagnosis. Surgery, followed by systemic antifungal medications, remains the cornerstone of management. Early administration of empirical anti-fungal agents along with immunomodulators may further improve prognosis. Immunocompetent patients tend to have better outcomes as compared to those who are immunocompromised. Patients with intradural disease carry the worst prognosis

Helping students to get better grades in mathematics at the elementary level

The current study is conducted to explore the learning potential of students at the elementary level by using the scaffolding technique. The study aimed to measure the efficiency of the scaffolding teaching method provided to the students at the elementary level. As it was an experimental study, so, no population was defined. The sample was selected from Gov. Girls Higher Secondary SchoolModel Town A, Bahawalpur, Punjab, Pakistan. All 6th classes of this school were included to analyze the effect of scaffolding as an intervention. Retention of learning after 3 months, the provision of scaffolding in comparison to the traditional method was assessed. After the posttest, there was a retention test as the final test from all four groups. Solomon's four-group design was used for this experiment in which there were 40 students in each group and 160 total participants. In the current study, Pretest, posttest, and after 3months retention test was conducted as research tools. To analyze the data, SPSS version 20 one-sample t-test were used to analyze the data. The Data revealed that scaffolding was proved to be a better strategy compared to the control group. Even the results of retention of learning skills were higher than the control group. Students showed good understanding, remembering, and better-solving processes in experimental groups. Study recommended that scaffolding teaching needs a highly structured supervised environment and may be conducted in controlled conditions. It is recommended that in teacher education, the prospective teachers may be prepared in the principles, procedures, and rules of scaffolding. A due consideration may be given to teaching strategies in all teacher education programs in the country as it is an innovative and progressive way of teaching

Immediate Procedural Success of Primary Percutaneous Intervention in Patients with Acute ST Segment Elevation Myocardial Infarction

Objective: To determine the frequency of immediate procedural success of Primary PCI in patients with Acute ST segment elevation Myocardial infarction. Methodology: This observational study was conducted at Cardiology unit of P.I.M.S, Islamabad from April 2018 to October 2018. Study included 43 patients with STEMI. All of them had primary PCI. The main outcome variable was frequency of procedural success which was described as frequency distribution table. Results: Procedural success was achieved among all (100%) patients.  There were 16.3% patients who developed contrast induced nephropathy (recovered), they all were diabetics. There were 4.6% patients who developed hematoma. No other complications seen Conclusions: Immediate procedural success of primary PCI is high (almost successful in every case) and should be offered to the patients with STEMI whenever the facility is available. Keywords: ST-segment elevation myocardial infarction; primary percutaneous coronary intervention