Infections in post stroke setting: a study from The neurology section of Aga Khan University Hospital, Karachi

Stroke is one of the commonest neurological disorders, contributing to the major burden of inpatient and outpatient neurology services. Infections after the stroke are the major factor, contributingto prolonged hospital stay and poor outcome in term of increasing morbidity and mortality. The aim of this study is to define the different types of infections in post stroke patients and their impact on the outcome of patients with stroke. METHOD: This is a descriptive, cross sectional study, that was carried out in the section of Neurology, Department of Medicine at Aga Khan University Hospital, Karachi over the span of one year. The strokes were classified as either ischemic or hemorrhagic. Different types of infections i.e. chest infections, urinary tract infections,, phlebitis, cellulitis and others were noted and the risk factors associated with their occurrence were identified. Data was entered and analyzed on SPSS 23. RESULTS: 104 patients with the diagnosis of acute stroke, who developed infections at least 48 hours after their presentation, were identified. There were sixty (58%) male and forty-four (42 %) females. Sixty-four (61.5%) of patients had a diagnosis of ischemic stroke, while thirty-six (34.6%) had hemorrhagic strokes, while data was missing in 4(3.8%)cases about the type of stroke. The commonest infection was Aspiration pneumonia, accounting for seventy-two (69%) of patients, followed by Urinary tract infections, that was found in fifty-six (54%) of the patients. Significant association of aspiration pneumonia with the level of consciousness was found. CONCLUSION: Stroke is one of the commonest neurological disorders. Ischemic strokes accounts for almost 2/3rd. of the stroke.The commonest infection was Aspiration pneumonia, accounting for seventy-two(69%) of patients, followed by Urinary tract infections, that was found in fifty-six (54%) of the patients. Significant association of aspiration pneumonia with the level of consciousness was found

Relationship Between Glycated Haemoglobin and Carotid Atherosclerotic Disease Among Patients with Acute Ischaemic Stroke

Objectives: This study aimed to determine the relationship between glycaemic control and carotid atherosclerotic disease among patients with acute ischaemic stroke (AIS). Methods: This retrospective cross-sectional study took place in the Neurology Department of King Fahad Hospital of University, Khobar, Saudi Arabia, from April to October 2017. Data were collected from the medical records of 244 patients with a diagnosis of AIS confirmed by computed tomography. Doppler ultrasounds of the carotid artery were performed to determine the presence of increased carotid intima media thickness (CIMT) and plaques. Results: Significantly higher mean glycated haemoglobin (HbA1c) levels were noted in cases with high CIMT values (P = 0.002), but not in cases with carotid plaques (P = 0.360). In addition, there was a significant association between diabetes mellitus (DM) and high CIMT (P = 0.045), but not with carotid plaques (P = 0.075). Finally, while dyslipidaemia and age were independently correlated with high CIMT values (P = 0.034 and 0.050 each). Conclusion: High HbA1c levels were associated with high CIMT values, but not with carotid plaques. Therefore, HbA1c levels may be useful as an indirect marker of the initial stages of carotid artery atherosclerosis. Keywords: Glycated Hemoglobin A1c; Diabetes Mellitus; Carotid Intima-Media Thickness; Atherosclerotic Plaque; Stroke

Area 5 Influences Excitability within the Primary Motor Cortex in Humans

In non-human primates, Brodmann's area 5 (BA 5) has direct connectivity with primary motor cortex (M1), is largely dedicated to the representation of the hand and may have evolved with the ability to perform skilled hand movement. Less is known about human BA 5 and its interaction with M1 neural circuits related to hand control. The present study examines the influence of BA 5 on excitatory and inhibitory neural circuitry within M1 bilaterally before and after continuous (cTBS), intermittent (iTBS), and sham theta-burst stimulation (sham TBS) over left hemisphere BA 5. Using single and paired-pulse TMS, measurements of motor evoked potentials (MEPs), short interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were quantified for the representation of the first dorsal interosseous muscle. Results indicate that cTBS over BA 5 influences M1 excitability such that MEP amplitudes are increased bilaterally for up to one hour. ITBS over BA 5 results in an increase in MEP amplitude contralateral to stimulation with a delayed onset that persists up to one hour. SICI and ICF were unaltered following TBS over BA 5. Similarly, F-wave amplitude and latency were unaltered following cTBS over BA 5. The data suggest that BA 5 alters M1 output directed to the hand by influencing corticospinal neurons and not interneurons that mediate SICI or ICF circuitry. Targeting BA 5 via cTBS and iTBS is a novel mechanism to powerfully modulate activity within M1 and may provide an avenue for investigating hand control in healthy populations and modifying impaired hand function in clinical populations

Problems in managing the outcome of posterior urethral valves at LRH Hospital

Aim: The goal of this study is to characterise the appearance of posterior urethral valves and evaluate the effectiveness of their treatment in settings with limited medical resources. Methods: The Department of Urology at lrh Peshawar performed a retrospective, descriptive research between Jan 2019 and Jan 2021. The presentation, duration of symptoms, complications, and treatment outcome were all considered. Results: There were 460 patients in total. Approximately three years old was the midpoint [02 days–10 years]. The average time from the onset of symptoms to diagnosis was [2.4 years]. 400 (90%) individuals reported urosepsis; 160 (34%) patients showed unilateral or bilateral reflux; 70 (16%) patients presented with big decompensated bladder, and 80 (18%) patients presented with substantial renal insufficiency. The radiological results verified the presumptive diagnosis of the posterior urethral valve. All patients underwent a cystoscopy and valve fulguration; some underwent further vesicostomy or ureterostomy procedures. Conclusion: According to the study, late presentation is common in our setting. High rates of illness and death are linked to this. The medical community must work toward greater awareness and earlier diagnosis to slow the epidemic

Pre-And post-Androgen deprivation lipid profiles of men with prostate cancer A multi-center study

Introduction: Dyslipidemia is the primary cause of hospitalization and death in men with advanced prostate cancer. Our goal was to examine how androgen deprivation therapy (ADT) affects lipid profiles in Indian men with locally progressed or metastatic prostate cancer. Methods: this multi center study was conducted in LRH urology department From jan 2020 to jan 2021 Patients with prostate cancer who received ADT and for whom lipid account data from the first two years of ADT treatment was available were split into two groups for retrospective analysis. Members of Group A had bilateral orchidectomy, whereas those in Group B were given a luteinizing hormone-releasing hormone agonist (LHRHa). The information considered are quality standards, prostate-specific antigen (PSA), and lipid profiles. Results: 69 eligible patients  were divided evenly between teams A (29) and B (40). After starting ADT, the median blood PSA level dropped significantly in both groups and remained low until 24 months. At six months, there was a statistically insignificant decline in all lipid profile parameters in team A patients  except for high-density lipoprotein cholesterol

Case series of naegleria fowleri primary ameobic meningoencephalitis from Karachi, Pakistan

Naegleria fowleri causes primary amoebic meningoencephalitis (PAM) which is almost always fatal. Naegleria fowleri is waterborne, and its infections are usually associated with aquatic activities but it can also be transmitted via the domestic water supply. An increasing number of N. fowleri cases have been reported from Pakistan. Improved methods for diagnosis are required. We report the utility of polymerase chain reaction (PCR) for the diagnosis of N. fowleri in patients suspected of PAM. One hundred and sixteen cases suspected of having PAM were examined. Cerebrospinal fluid (CSF) specimens were tested at the Aga Khan University Hospital, Karachi. Nineteen CSF specimens were positive for N. fowleri by using the PCR. Naegleria fowleri positive patients had a median age of 28 years and were 84% male and 16% female. Overall, the CSF wet preparation microscopy was performed in 85 (73%) cases and identified that seven specimens were positive for motile trophozoites. The CSF wet preparation microscopy and PCR were both performed in these cases. The CSF wet preparation results were available for 15 of the 19 N. fowleri PCR positive CSF samples; seven (40%) wet preparations were positive. Our data highlight the threat of N. fowleri infection as a cause of PAM. It also emphasizes the utility of the PCR-based diagnosis of the amoeba for early diagnosis and management of the disease