Practical Measures for Disabled’s Empowerment-Time for Economic Growth!

The objective of this article is to advocate for persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness

Magnetic resonance imaging of intracranial extramedullary haematopoiesis in β-thalassemia: a case report

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the liver, spleen, and lymph nodes.Intracranial extra medullary hematopoiesis is a relatively rare manifestation of Thalassemia. There is paucity of literature for MR findings regarding intracranial EMH. It is essential to distinguish it from other central nervous system tumors, because treatment and prognosis are entirely different

Concurrent intracranial chloromas and leukemia cutis in chronic myeloid leukemia

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the Head revealed multiple hyper dense extra-axial nodular masses (with mean value of 48 HU) which showed vivid enhancement on post contrast images, along with multiple subcutaneous enhancing nodules seen in the scalp and maxillofacial region. The CSF cytological examination confirmed presence of immature leukemic cells in the subarachnoid space. The subcutaneous chest nodule histopathology showed granulocytic sarcoma. To the best of authors’ knowledge, the concurrent occurrence of granulocytic sarcomas at different locations in a single patient with Chronic Myeloid Leukemia has not been reported earlier in the literature

A giant right subclavian- axillary artery aneurysm presenting as brachial plexopathy

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous aneurysm rupture. Aneurysms of the subclavian- axillary artery are rare in the clinical setting, accounting for less than 1% of all peripheral arterial aneurysms

Histiocyt ic sarcoma of the flax cerebri with Distant metastasis

Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors\u27 knowledge, the extra-axial CNS histiocytic Sarcoma involving FalxCerebriin the humans has not been described earlier in the literature.We report an unusual case of22 year old male who presented to the Civil Hospital with symptoms of chronic headache and bilateral lower limb weakness. His MRI Brain showed an aggressive heterogeneously enhancing extraaxialfalxtumor with trans-calvarial invasion seen on interim CT scan and demonstration of distant metastases after resection and craniectomy. The immune-histochemical analysis was strongly positive CD68 and S-100 signifying Histiocytic Sarcoma

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Constellation of Centronuclear Myopathy and Craniofacial Dysmorphism

ABSTRACT: A 20 years old third-year MBBS female student from Dow Medical College in 2008 presented to the Neurology Dept. in Karachi with a short history of rapidly worsening bilateral lower limb weakness for 6 months. There was facial dysmorphism. Motor neuron disease was the suspicion; EMG/NCS study revealed non inflammatory myopathic process involving all limb muscles; Centro nuclear myopathy (CNM) was diagnosed via muscle biopsy. CNM is a group of congenital myopathies, where cell nuclei are abnormally located in skeletal muscle cells. Craniofacial dysmorphism is characterized by abnormal development of facial and skull structures. To the best of the author\u27s knowledge, this is the first case report from Pakistan, though few cases have been published in the international literatur

The rare association of diastematomyelia with lipomyelocele and dorsal dermal sinus - Case report and literatue review

We report the MRI dorsolumbar spine of 10-year child who was referred to the Civil Hospital in June 2016 with symptoms of backache for last one month and birth history of congenital discharging sinus. Magnetic Resonance Imaging of his spine revealed type A diastematomyelia, multilevel vertebral segmentation anomalies, anterior and posterior spina bifida and tethered cord, along with dorsal dermal sinus and lipomyelocele. Magnetic Resonance Imaging (MRI) is the investigation of choice for diagnosing occult spinal dysraphisms1. We present the rare case of triple occult spinal dysraphic anomaly of different embryological origin in a single patient

Outcome of laparoscopic cholecystectomy with and without drains at Ayub teaching hospital

Introduction: In terms of surgery, cholecystectomy performed using laparoscopy is the current standard of care for Cholelithiasis. This operation is by far the most common type of surgery done today. However, the literature is still divided on whether or not drainage should be performed following an elective laparoscopic cholecystectomy. Objectives: The aim of this study was to examine whether or not patients undergoing laparoscopic cholecystectomy at Ayub Teaching Hospital, Abbottabad were more likely to develop an infection in the wound if a drain was used. Results evaluation: Checks for wound infections were performed for up to a month after surgery to determine the outcome. Study Design: The study used a randomized controlled trial design. Settings: The study lasted for six months, from January 01, 2022, to June 30, 2022, and took place in the Department of General Surgery, Ayub Teaching Hospital, Abbottabad. Subjects: Patients having laparoscopic cholecystectomy for gall bladder disease were used as subjects.&nbsp

Assessment of in vivo antiepileptic potential and phytochemical analysis of Cassia absus seed extracts

Cassia absus, a member of Fabaceae family, has been a part of traditional medicine for various ailments such as Hypertension, Diabetes, and Cancer. This family of plants has been utilized for Anticonvulsant and Anxiolytic effects. The ongoing investigation is aimed to seek the antiepileptic potential of C. absus seed extracts in pentylenetetrazole-induced kindling mice. The seeds of C. absus were subjected to a sequential extraction process for the preparation of n-hexane, chloroform, methanol, and aqueous extracts. The PTZ-induced kindling model was employed to assess the antiepileptic activity of each extract. Seizure activity and antioxidant biomarkers in the brain tissue such as levels of CAT, SOD, tGSH, and MDA were assessed. Mechanism of action was elucidated by Flumazenil. Through GC-MS analysis, the phytochemical components in the chloroform extract of C. absus were evaluated.The outcomes showed that C. absus extracts markedly reduced the seizure activity in kindling mice. The extracts exhibited significant Antioxidant properties by enhancing the levels of antioxidant biomarkers in the brain tissue such as CAT, SOD, and tGSH, and decreasing the MDA level. The results demonstrated that C. absus extracts showed antiepileptic effects may be via GABA pathway.According to the results of this investigation, C. absus has significant antiepileptic potential in PTZ-induced kindling mice via GABA pathway modulation and combating reactive oxygen species