Do Anti-Epilepsy Drugs Increase Suicide Ideation Risk In Epilepsy Patients?

Objective: To determine the frequency of suicide risk within first six months after starting anti-epilepsy treatment. Methodology: This Descriptive cross-sectional study conducted at department of Medicine, Jinnah Hospital Allama Iqbal Medical College Lahore Pakistan from January 2019 to January 2020.The Scale of Suicidal Ideation (SCI)consists of 19 items which were used to evaluate patients’ suicidal intentions and to monitor patients’ response tointerventions over time. Patients with diagnosed psychiatric illness such as depression and schizophrenia, past historyof suicidal attempts and patients with poor drug compliance were excluded. After informed consent, 140 epilepticpatients, who had been recently started on anti-epilepsy medicines, aged 20 to 55 years of both gender were enrolled using non-probability consecutive sampling technique. Demographic information and detailed medical history were noted and patients were assessed for suicide risk using the Scale of Suicidal Ideation (SCI). All data was recorded and analyzed using SPSS version 23.0. Results: Mean age was 28.9±6.3 years with 104 (74.3%) males and 36 (25.7%) females. Sixty-eight (48.6%) patients belonged to low socio-economic status whereas 29 (20.7%) and 43 (30.7%) patients were from middle and high Socio-economic Status respectively. Sixty-eight (48.6%) patients were illiterate while 42 (30.0%) and 30 (21.4%) patients had educational status of up to matriculation and graduate or above respectively. In the present study, 46 (32.8%) patients had suicidal ideation with low socio-economic status  (p-value 0.013)  and illiterate educational status (p-value 0.002) having statistically significant association with suicidal ideation. Conclusion: Suicidal ideation was seen in almost one-third epilepsy patients on anti-epileptic drugs with low socioeconomic status and illiterate educational status being significant risk factor

Crowned Dens Syndrome: A Rare Cause of Sudden Onset Neck Pain

Objective: To report a case of Crowned Dens Syndrome (CDS), which is a rare disorder caused by crystal deposition by calcium pyrophosphate dihydrate in the peridontoid soft tissues surrounding the C1 and C2 vertebrae that presents in elderly with sudden onset neck pain, neck stiffness, fever, and elevated inflammatory markers, with periodontal calcification in a halo or crown configuration on radiography considered diagnostic.Methods: A 64-year-old diabetic and hypertensive female patient presented with a 6-day history of sudden onset posterior neck pain and stiffness. Movements of the cervical spine were equally limited in all directions, causing marked aggravation of pain. There was no focal neurologic loss. Her inflammatory markers were markedly raised.Results: Based on radiography, she was diagnosed with Crowned Dens syndrome and started on oral prednisolone, paracetamol, and tizanidine along with topical diclofenac. Oral NSAIDs were contraindicated due to her renal insufficiency.Conclusion: Crowned Dens Syndrome (CDS) is a rare cause of neck pain. Clinicians should consider this syndrome in their differential diagnosis. Timely diagnosis and treatment of CDS will lead to avoidance of unnecessary investigations and medications in such patients, along with a reduction in the length of stay

Frequency of Modifiable Risk Factors in Ischemic Stroke Patients at a Tertiary Care Hospital in Lahore Pakistan

Objective: The objective was to find out the frequency of modifiable risk factors among patients of ischemic stroke at a tertiary care hospital in Lahore Pakistan. Study type,settings& duration:This observational cross-sectional study was conducted at Medical Department Services Hospital, Services Institute of Medical Sciences, Lahore Pakistan from January 2019 to January 2020. Methodology:After an informed consent 105 patients with ischemic stroke aged between 18-65 years from both sex wasincluded in this study. Patients with trauma, tumor, arteriovenousmalformations, unstable cardiopulmonary condition, psychiatric disease and hemorrhagic stroke were excluded. Demographic information and detailed history with physical examination was noted. Blood pressure and sugar levels were measured for all patients. All bloods test including fasting lipid profile were determined. SPSS version 17.0 was used for data analysis. Results:A total of 105 patients of ischemic stroke were enrolled in the present study. Mean age of the patients was 51.2±8.4 years and 73 (69.5%) were male. Mean BMI was 29.3±2.9 kg/m2. Hyperlipidemia was the most frequent risk factor seen in 53 (50.5%) patients with ischemic stroke followed by obesity in 48 (45.8%) patients, smoking in 43 (40.9%), hypertension in 41 (39.1%) and diabetes mellitus in 41 (39.1%) patients. Conclusion:Hyperlipidemia was the leading risk factor in ischemic stroke patients in the present study followed by obesity, smoking, diabetes mellitus and hypertension respectively

Thrombocytopenia and its Comparison with Plasmodium Vivax and Plasmodium Falciparum in Malaria Patients

Background: Malaria in Pakistan is a serious public health problem and thrombocytopenia can serve as diagnostic predictive marker. Objective: The objective of present study was to find out the frequency of plasmodium vivax and falciparum in malaria patients and to compare the frequency of thrombocytopenia in patients effected by plasmodium falciparum versus vivax. Study type, settings & duration: This observational cross-sectional study was conducted at Department of Medicine, Jinnah Hospital, Lahore from February 2018 to July 2018. Methodology: Fever more than 100°F for >3 days and >2 hours daily along with evidence of presence of >1 parasite of plasmodium on microscopic examination of thick smear of blood was labeled as malaria. Subsequently, depending on the type of parasite on microscopic examination of thin smear of blood (>1per film) the patients were labeled plasmodium falciparum and plasmodium vivax. Thrombocytopenia was defined as a platelet count <150,000 per mm3. After taking informed written consent, 236 patients of malaria were enrolled using non-probability consecutive sampling technique. Approximately three ml of blood was taken from each patient for microscopic examination of plasmodium type and platelet count measurement. SPSS version 17.0 was used for data entry and analysis. Data was stratified and chi square test applied keeping p-value <0.05 significant. Results: Mean age was 42.14±13.5 years with 123(52.1%) females. Seventy two (30.5%) patients had previous history of malaria. Mean duration of fever was 4.61±0.6 days. There were 88 (37.3%) patients with plasmodium falciparum and 148 (62.7%) had plasmodium vivax. Thrombocytopenia was seen in 41 (17.3%) patients. Out of the 88 patients with plasmodium falciparum, 11 (12.5%) patients had thrombocytopenia while it was seen in 30 (20.27%) patients out of 148 with plasmodium vivax. Conclusion: Plasmodium vivax was more commonly seen in our population. Over all, thrombocytopenia was seen in 17.3% malaria patients while frequency of thrombocytopenia was higher in malaria patients affected by plasmodium vivax as compared to those affected from plasmodium falciparum