Pathophysiology of cerebral venous thrombosis--an overview.

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations

Family systems: perceptions of elderly patients and their attendents presenting at a university hospital in Karachi, Pakistan

Objective: To know the present status of family systems in Pakistan, changes they are undergoing and implications of such trends on health of the elderly population. Methods: A cross-sectional study was carried out at the out-patient clinics, AgaKhan University Hospital, using convenience sampling method. Verbal informed consent was taken from the participants. The questions included demographic profile, satisfaction with current family system, opinions about changing trends of family systems, and their implications on health. Analysis was done using SPSS 13.0. Results: Four hundred subjects aged 65 and above were interviewed, out of which 226 (56.5%) were living in the joint family system (JFS), whereas 174 (43.5%) were living in a nuclear family system (NFS). A total of 77.5% respondents were in the age class of 65-70 years (mean=69).Majority were men (78%), married (78%), retired (55.8%) and with education below intermediate (61.8%). A total of 366 (91.5%) respondents were satisfied with their family system. 326 (81.5%) respondents said that the trend in family systems in Pakistan was changing and 318 (97.5%) of these subjects thought that it was a JFS to NFS trend. A decline in the proportion of JFS was seen with subsequent generations. 340 (85%) subjects said that a family system has a significant impact on health care. Conclusion: We have identified changing trends in family systems in Pakistan. Satisfaction with family system and the opinion about the role of a family system on healthcare is documente

Depression in the elderly: Does family system play a role? A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly. We conducted this study in Karachi, a large urban city of Pakistan, to determine the relationship between the type of family system and depression. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables.</p> <p>Methods</p> <p>A cross-sectional study was carried out in the premises of a tertiary care hospital in Karachi, Pakistan. Questionnaire based interviews were conducted among the elderly people visiting the hospital. Depression was assessed using the 15-item Geriatric Depression Scale.</p> <p>Results</p> <p>Four hundred subjects aged 65 and above were interviewed. The age of majority of the subjects ranged from 65 to 74 years. Seventy eight percent of the subjects were male. The prevalence of depression was found to be 19.8%. Multiple logistic regression analysis revealed that the following were significant (<it>p < 0.05</it>) independent predictors of depression: nuclear family system, female sex, being single or divorced/widowed, unemployment and having a low level of education. The elderly living in a nuclear family system were 4.3 times more likely to suffer from depression than those living in a joint family system (AOR = 4.3 [95% CI = 2.4–7.6]).</p> <p>Conclusion</p> <p>The present study found that residing in a nuclear family system is a strong independent predictor of depression in the elderly. The prevalence of depression in the elderly population in our study was moderately high and a cause of concern. The transition in family systems towards nucleation may have a major deleterious effect on the physical and mental health of the elderly.</p

Isolated deep venous thrombosis--case series, literature review and long term follow up.

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are reported. Even when one patient required intubation and mechanical ventilation for stupor, both had excellent neurologic recovery. Over 6 years of follow up there has been no recurrence. In spite of stupor at presentation, complete recovery is possible without long term recurrence

Moyamoya disease: A clinical spectrum, literature review and case series from a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Moyamoya is a rare cerebrovascular disease of unknown etiology. The data on moyamoya disease from Pakistan is sparse. We report a case series of 13 patients who presented with moyamoya disease to a tertiary care hospital in Pakistan with a national referral base.</p> <p>Methods</p> <p>We conducted a retrospective review of thirteen patients who presented to The Aga Khan University and diagnosed with "Moyamoya Disease" during the period 1988 – 2006. These patients were identified from existing hospital database via ICD-9 codes. A predesigned questionnaire containing information about clinical presentation, management and neuroimaging was administered to all identified patients.</p> <p>Results</p> <p>There were seven males and six females. Mean age at presentation was 16.5 years and a female predominance was found in the pediatric age group (n = 10, 71.4%). Stroke (n = 11, 84.2%) was the most common presentation with motor deficit being the universal cortical symptom. Fever was a common symptom in the lower age groups (n = 4, 51.7%). Cerebral Angiography and Magnetic Resonance Angiography showed bilateral involvement of the vessels in eleven patients while unilateral in two. Subarachnoid and interventricular haemorrhage appeared in 2(15.4%) adults. Twelve (92.3%) patients were discharged as independent with minor deficits regardless of therapeutic modality. Only three (23.0%) patients underwent surgery whereas the remaining were managed conservatively.</p> <p>Conclusion</p> <p>Physicians when dealing with childhood strokes and characteristic deficits in adult population should consider Moyamoya disease.</p

[4,4′-(Ethane-1,2-diyldinitrilo)­bis­(pent-2-en-2-olato)]copper(II) 0.25-hydrate

In the title compound, [Cu(C12H18N2O2)]·0.25H2O, the coordination of the O,N,N′,O′-tetra­dentate ligand results in a cis-CuN2O2 square-planar geometry for the metal ion and the presence of two six-membered and one five-membered chelate rings. The complete complex mol­ecule is close to planar (r.m.s. deviation = 0.047 Å). The uncoordinated water mol­ecule (O-atom site symmetry 2) was modelled as half occupied. In the crystal, C—H⋯Ow and Ow—H⋯O (w = water) hydrogen bonds link the components into layers parallel to ab plane

Awareness of cancer risk factors among patients and attendants presenting to a tertiary care hospital in Karachi, Pakistan

OBJECTIVE: To determine awareness of cancer risk factors in the patients and attendants of Out-patient Clinics at a University Hospital in Karachi, Pakistan. METHODS: A cross-sectional survey was conducted on 315 respondents reporting to a tertiary care hospital in Karachi, Pakistan, to assess their level of awareness regarding risk factors of cancer. RESULTS: The respondents belonged to an urban population with the mean time spent in Karachi of 29.1 years (SD +/- 13.94). There were 213 (67%) males and 102 (33%) females. All respondents had heard of the word \u27cancer\u27, while only 57.5% were aware of cancer risk factors. However, only 42.8% could identify age, 33% diet, 35% drugs and 31% obesity as risk factors for cancer. Even those who were aware of the risk factors were not able to appreciate personal risk of cancer. CONCLUSION: Despite awareness regarding some of the risk factors, the surveyed population was not aware of intrinsic risk factors for cancers like increasing age and obesity. It is important to create awareness through educational programs on cancer prevention, dissemination of knowledge pertaining to the preventable and avoidable cancer risk factors, the benefits of early diagnosis, and availability of screening tests

Knowledge, awareness and practices regarding dengue fever among the adult population of dengue hit cosmopolitan.

Background: The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country\u27s adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan. Methods: A cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through a face-to-face unprompted interview with 447 visitors. Knowledge was recorded on a scale of 1-3. Results: About 89.9% of individuals interviewed had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people (p\u3c0.001). Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti-mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease.Conclusion: Adult population of Karachi has adequate knowledge related to the disease \u27dengue\u27 on isolated aspects, but the overall prevalence of \u27sufficient knowledge\u27 based on our criteria is poor. We demonstrated adequate prevalence of preventive practices against the disease. Further studies correlating the association between knowledge and its effectiveness against dengue will be helpful in demonstrating the implications of awareness campaigns

The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.

BACKGROUND: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan. METHODS: Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke. RESULTS: Five hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease. CONCLUSION: This is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are