A rare presentation of pulmonary sarcomatoid carcinoma with left atrial involvement and spinal metastasis presenting with an ischemic infarct.

Pulmonary Sarcomatoid Carcinoma is a rare, aggressive tumor comprising of both epithelial and mesenchymal cells. It is important to distinguish it from other lung tumors due to its poor prognosis and extensive metastasis. We present a case of a 36 year old female patient who initially presented with right sided weakness and slurred speech due to an ischemic infarct of the left basal ganglia. Further workup revealed a lung mass extending to the left atrium with spinal metastasis. Sarcomatoid Carcinoma remains a diagnostic challenge due to its early recurrence and atypical presentation

Longitudinally extensive transverse myelitis with seropositive chikungunya

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of LETM are reported worldwide in association with CHIKV fever and this is the first case from Pakistan. With frequent chikungunya outbreaks, neurological complications are increasingly seen in clinical practice. The knowledge of these associations will result in their early diagnosis and treatment

Utility of Pudendal Nerve Electrodiagnostics in Cases of Bladder-Bowel Dysfunction- A Retrospective Study from A Tertiary Care Center in Pakistan

Background and Objective: Electrodiagnostic studies play a crucial role in identifying neurogenic and non-neurogenic causes of bladder and bowel dysfunction. Such data is scarce in Pakistan. The objective of this study was to evaluate utility of pudendal nerve assessment in bladder-bowel dysfunction. Methods: A retrospective observational study was carried out at the neurophysiology lab in Aga Khan University Hospital. Patients referred for electromyography/nerve conduction studies (EMG/NCS) for pudendal nerve assessment from June 2013 to June 2023 were included. Clinical data, EMG/NCS results, and demographic information were analyzed using SPSS. Results: Twenty patients (11 male and nine female) were included. Five patients experienced backache radiating to one or both lower extremities, along with urinary or fecal incontinence. Three patients had urinary incontinence, and additional three presented with both urinary and fecal incontinence. Three patients reported perianal numbness. Four patients had fecal incontinence, while one patient each reported painful defecation and backache along with perianal numbness. Three patients were diagnosed with pudendal neuropathy, out of which one had a coexisting lumbosacral radiculopathy as well. Five patients had isolated lumbosacral radiculopathy. Twelve patients exhibited normal EMG/NCS results. Conclusion: This study highlights the diagnostic utility of EMG/NCS in diagnosing pudendal nerve injuries. Despite its widespread use worldwide, the utilization of these tests in Pakistan is hindered by factors such as limited awareness, inadequate training, and resource constraints

A Comprehensive Electroencephalogram Audit in A Tertiary Care Center in Pakistan: Demographic Distribution, Referral Indications and Findings

Background and Objective: Electroencephalography (EEG) is a widely employed non-invasive technique for recording brain electrical activity, pivotal for diagnosing various neurological conditions. The study aims to provide insight into demographic distribution, referral indications, and EEG findings in a tertiary care hospital in Pakistan. Methods: A retrospective cross-sectional analysis was conducted involving 2,924 patients who underwent routine EEG evaluations over a three-year period. Data was collected from the EEG records after approval from the ethical review committee. Demographic variables, referral reasons, and EEG findings were recorded and analyzed using descriptive statistics. Results: The study revealed a gender distribution of 41.35 % females and 58.65 % males, aligning with broader epidemiological trends. Participants were categorized into different age groups and most of the patients in our study belonged to the five to 18 years of age group. Most common indication was a suspected seizure disorder (78.32 %), followed by subclinical seizures (7.38 %) and medication adjustment (6.81 %). Notably, encephalopathy was the most common abnormal EEG finding (31 %), with temporal epilepsies being predominant within the focal seizure category. Conclusion: The descriptive nature of the study contributes novel insights. The study’s contribution provides valuable guidance for healthcare professionals, enhancing their comprehension of neurological conditions and refining diagnostic and treatment strategies

Frequency of Hyperlipedemia in Patients Coming with Ischemic Stroke in Tertiary Care Hospital Karachi

Background and objective: Stroke is the second leading cause of death and the third leading cause of disability. This study was designed to determine the frequency of hyperlipidemia in patients with ischemic stroke visiting at a tertiary care hospital in Karachi. Methods:This was a descriptive cross-sectional study and was done in Department of Medicine, LCMD/ Dar-ul-Sehat Hospital Karachi, Pakistan. A total of 184 patients were studied during the study period of six months and all the consecutive patients were recruited who presented with acute stroke in the department of medicine from the duration April 1st 2022 to September 30th, 2022.Those fulfilling the inclusion criteria for this study were included for data analysis, while the patients who did not meet the said criteria were excluded. Their serum lipid levels were collected within 24 hours of admission. Hyperlipidemia was measured through fasting lipid profile and was labeled as present if any one or more of the following profile like total cholesterol \u3e200 mg/dl, LDL cholesterol \u3e 100 mg/dl, TGL \u3e 150 mg/dl, HDL cholesterol \u3c 40 mg/dl, as appropriate. Results:The mean age of the patients was 65.17±12.73. Average systolic and diastolic blood pressure was 152.34±21.31 & 83.35±13.71 mm Hg respectively. Mean duration of smoking and diabetes mellitus in first ever ischemic stroke patients was 9.33±4.03 & 13.65±5.8 years respectively, whereas average fasting blood sugar was found 151.98±69.73mg/dl; 118 (64%) were males and 66 (36%) were females. A total of 124 (67.4%) of patients had a history of hypertension, while 94 (51.1%) were diabetic. Fifty-three (28.8%) of patients had a history of coronary artery disease while 22 (11.95%) patients had history of smoking. Increased triglycerides level was seen in 47 (25. 5%). The frequency of hyperlipidemia was 145 (79%) patients respectively. Conclusion: Frequency of hyperlipidemia was 145 (79%) in patients with ischemic stroke which is moderately high in our setup. A high prevalence of hyperlipidemia is alarming in our setup and requires attention of the physicians on modifiable risk factors

Tacrolimus-associated posterior reversible Encephalopathy syndrome in allogenic Hematopoietic stem cell transplant

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus

Prevalence And Morphometric Analysis Of Fossa Navicularis Magna In Dry Human Skulls

Introduction: Basiocciput is the part of occipital bone present on the inferior aspect of skull. Fossa Navicularis Magna-an osseous defect is a variation in normal anatomy of basiocciput. Lately few case reports presented this fossa as a cause of spread of infection from nasopharynx to brain resulting in meningitis and osteomyelitis. Objectives: This study aims to find the incidence and morphometry of this fossa in Pakistani populace to avoid any misdiagnosis or misinterpretations. Materials & Methods: This study was conducted on dry human skulls at King Edward Medical University Lahore. Fossa was measured in its transverse and vertical diameters and to locate the fossa its distance from various anatomical land marks such as foramen ovale, foramen Lacerum, carotid canal, occipital condyles, pharyngeal tubercle and posterior border of vomer was noted. Results:  The incidence of this fossa was found to be 5.3% in Pakistani population. Predominantly oval shaped, fossa measured 5.5 and 3.06 mm in vertical and transverse diameters respectively. It was 12.2 mm posterior to vomer and 5.9 mm anterior to pharyngeal tubercle. Conclusion: This study is useful for radiologists and clinicians in avoiding any misinterpretations on radiographs and unnecessary investigation

An Efficient Method for Pivoting Free Variables in Linear Programming: A Computational Approach

Commonly used simplex method to solve linear programming problem do not allow variables to be negative during solution process and suggest to break each free variable (variable allowed to be negative) into difference of two non-negative variables. This transformation significantly increases the number of variables as well as after this the problem leaves its original variable space. , thus making the geometry of problem (during solution process) difficult to handle and understand. In this paper, we developed a natural generalization of simplex pivots for free variables. Described approach is capable of handling any general linear programming in its original variable space. In our computational study, the primary results showed that the new method outperforms simplex method on general LPs

Risk Factors for Stroke In, Bolan Medical Complex Hospital Quetta

Stroke is one of the leading causes of physical impairment and mortality worldwide. Optimizing preventive strategies will help decrease the burden of stroke. The objectives of this study were to determine common stroke risk factors, by analyzing a comprehensive panel of variables in our local population. 200 patients were consecutively enrolled in this prospective observational study at stroke unit (SU) of Bolan Medical Complex Hospital over 6 months from March 2019 to August 2019. Structured questionnaires were prepared History and clinical examination were performed to gather relevant information. CT scan of brain was done to confirm the diagnosis of stroke. Other necessary tests were run. A total of 200 patients were included in the study, of which 98 (49%) were males and 102 (51%) were females. Vascular risk factors were present in 182 patients (91%), of which the most common was hypertension in 121 patients (60.5%) followed by smoking in 89 patients (44.5%), diabetes in 62 patients (31%) and obesity in 58 patients (29%). Dyslipidaemia was present in 17 patients (8.5%), cardiac disease 14 patients (7.0%), ischemic heart diseases in 7 (3-5%), arterial fibrillation in 5 (2.5) and 5 (2.5) had a family history of stroke. Hypertension was the most common stroke identified in this study, likely because of the great pervasiveness of this disease in our region. This study also highlights the prevalence of other vascular risk factors including smoking, diabetes mellitis, obesity, dyslipidaemia, and ischemic heart diseases in our community, which are associated with poor physical activity, low income, and poor health awareness. We suggest numerous community-based awareness programs in Baluchistan to improve local area perception about stroke and its risk factors