Post Covid-19 Vaccine (Sinovac) Cerebral Venous Sinus Thrombosis

SINOVAC is an inactivated virus COVID 19 vaccine given emergency authorization for COVID-19 Pandemic. Different adverse reactions have been seen in after-marketing of COVID-19 vaccines. Here we present a case of patient who developed cerebral venous sinus thrombosis two weeks after the first dose of SINOVAC vaccine

Post Covid-19 Vaccine Guillain Barre Syndrome

The Guillain Barre Syndrome (GBS) is an acute immune-mediated progressive polyneuropathy having an acute monophasic illness leading to paralysis. The clinical features are progressive ascending symmetrical muscle weakness that may lead to respiratory failure. Diagnosis is based upon clinical presentation and is supported by a lumbar puncture with CSF analysis demonstrating albumin-cytological dissociation, and electrophysiological studies. Our patient presented to us with progressive ascending paralysis after receiving COVID 19 vaccine

Cerebellar Symptoms After Dengue Fever with Bright Middle Cerebellar Peduncle Sign

Dengue fever is a seasonal epidemic that effects population all across Pakistan every monsoon season and leads to thousands of cases every year. Dengue fever can be associated with neurological complications both during the acute stage and after recovery. These include encephalitis and hemorrhagic complications as well as late immune-related conditions such as Guillain-Barre syndrome and acute disseminated encephalomyelitis. Here we present case of a patient who developed new onset cerebellar symptoms two weeks after recovery from dengue fever, with a middle cerebellar peduncle sign on MRI Brain

A Rare Presentation of Wilson Disease: A Case Report

Wilson Disease results from autosomal recessive mutation in ATP7B gene which leads to reduced formation of ceruloplasmin protein in the body that acts as a copper transporter. Due to its deficiency, there is the build-up of copper in the liver and brain among other organ systems and it leads to the development of various clinical abnormalities but commonly presents either as hepatic dysfunction and/or cirrhosis in young patients with movement disorder. Here we present a case that presented with hypoglycemia and hypothermia in absence of any infection, drug abuse or metabolic abnormality. He was later diagnosed as Wilson disease. Wilson Disease is mostly thought of hepatic /neurological disease. Contrary to this Wilson’s disease is a multisystem disease affecting multiple organ system including, kidneys, endocrine system and musculoskeletal system and can present with manifestations of above-mentioned systems

Outcome of Endoscopic Third Ventriculostomy

Background: To study the outcome of endoscopic third ventriculostomy (ETV)Methods: In this observational study an endoscopic third ventriculostomy was applied in patients who suffered from hydrocephaly. The diagnosis of hydrocephalus was determined by  physical, neurological and neuro-radiological criteria. Patients with obstructed hydrocephalus whether congenital or acquired, with a dilated 3rd ventricle were included. Linear incision was given 2cm anterior to the coronal suture in mid pupillary line. Right frontal burr hole is made. For ETV, burr hole is placed on a line joining the foramen of monro and inter-peduncular line. Floor of the thirdventricle was punctured close to or over the dorsum sellae. Membrane was dilated with balloon. Balloon was inflated and subsequently was taken out from puncture site. It ensured easy visibility of basilar artery and its perforators.Result: Age of patients ranged from 06 months to 24 years, with a mean age of 4 years . Fourteen patients had posterior fossa tumour’s with dilated third ventricle, sixty four patients had aqua ductal stenosis, two patients with CSF ascites as complication of ventriculo-peritoneal shunt, eleven patients had blocked lower end of ventriculoperitoneal shunt. Seven patients had CSF leak. Time taken to complete endoscopic third ventriculostomy was from 20 to 40 min as compared to 1 hour to 1.30 hours, taken in a VP shunt. Patients who had ETV performed had a mean hospital stay of 3 days, where as patients in whom a VP shunt was performed stayed in the ward for an average of 5 to 10 days, depending on how eventful the post op period was. The cost incurred to the VP shunt patient who remained admitted for an average of 5 days was between Rupees 16,000 to 25,000, ascompared to Rs: 2000 for the patient who underwent endoscopic third ventriculostomy.Conclusion: Patients of ETV, with less per operative time, had decreased length of stay. ETV also was less expensive to the patient and he did not have to buy the shunt apparatus with less rehospitalization rates, compared to patients who had undergone shunt

Nano Medicine in Healing Chronic Wounds: Opportunities and Challenges

Chronic wounds pose a continual healthcare challenge, demanding innovative interventions to improve healing outcomes. This comprehensive review navigates the transformative landscape of nanotechnology in chronic wound healing, covering mechanisms, clinical applications, challenges, and future directions. The introduction establishes the need for advanced therapeutic strategies, providing an overview of chronic wounds and the evolving landscape of therapeutic approaches. The exploration of nanoparticle types and their mechanisms in wound healing encompasses lipid-based, polymeric, and inorganic variants, each contributing uniquely to drug solubility, controlled release, and tailored interactions within the wound microenvironment. Clinical applications and formulations exemplify real-world efficacy, demonstrating nanotechnology\u27s success in promoting wound healing. Opportunities in nano-medicine for chronic wounds focus on targeted drug delivery precision and overcoming cellular barriers through enhanced cellular uptake. Acknowledging challenges, including biocompatibility concerns and regulatory hurdles, the review emphasizes the need for rigorous evaluation and streamlined regulatory pathways. Future directions delve into emerging nanotechnologies and potential breakthroughs, highlighting advancements in design, fabrication, and integration with artificial intelligence and personalized medicine

The Uniqueness of Albumin as a Carrier in Nano Drug Delivery

The quest for precision medicine hinges on targeted drug delivery, minimizing off-target effects while maximizing therapeutic impact. Among nanocarriers, albumin – the most abundant protein in human blood – emerges as a uniquely biocompatible stealth bomber. Its inherent advantages, including exceptional biodegradability, prolonged circulation, and natural affinity for diseased tissues, perfectly align with the goals of personalized medicine. Albumin readily solubilizes poorly soluble drugs, enhancing bioavailability and broadening the therapeutic arsenal. Its versatile surface allows for targeted modifications, enabling dual diagnosis and treatment (theranostics) tailored to individual needs. While challenges remain in optimizing drug loading and targeting specificity, albumin-based nanocarriers hold immense promise for revolutionizing personalized healthcare, delivering potent therapeutics with pinpoint accuracy. The burgeoning field of nanodrug delivery seeks to redefine therapeutic landscapes by engineering nanoscale carriers that meticulously deliver potent drugs to their designated targets, minimizing systemic exposure and maximizing therapeutic efficacy. This pursuit aligns perfectly with the burgeoning field of precision medicine, where personalized treatments demand exquisite control over drug delivery. Within this intricate choreography, albumin, the abundant and versatile protein resident in human plasma, emerges as a maestro, orchestrating a symphony of advantages that make it a prime candidate for nanocarrier construction

Comparison of Decompressive Craniectomy and Multi-Dural Stabs with Decompressive Craniectomy and Open-Dural Flap Method, in the Treatment of Acute Subdural Hematomas

Background: To compare the functional outcome between decompressive craniectomy and multi-dural stabs, with decompressive craniectomy and open-dural flap, in the removal of acute subdural hematomas . Methods : In this randomized controlled trial,  64 patients, with acute sub-dural hematomas were included.  Patients were divided into two groups on the basis of lottery method. All patients gave informed written consent. In group A, all patients were operated upon by multi-dural stab technique and in group B, patients were operated upon by open-dural flap technique. The objective degree of recovery in the patients treated by both craniectomy techniques was assessed by Glasgow Outcome Score (GOS), having maximum of 5 and minimum of 1 score. Favourable outcome was at points 4-5 and Un-favourable at 1-3 points, at 2 weeks. GOS attached as annexure A. Favourable outcome was assessed at 2 weeks according to GOS. Results : The mean age in group-A and group-B was 59.09 ± 9.39 years and 59.56 ± 9.98 years. Males constituted the main in both groups. Mean GOS in group A and in group B, was 3.06 ± 1.24 and 2.69 ± 0.82 respectively. Statistically mean GOS was same in this study groups, p-value 0.159, > 0.05. There were 37.5% patients in group A and 9.4% patients in group B who had favourable results, while in group A and group B, 62.5% and 90.60% patients had unfavourable results. Favourable results were statistically more in group A as compared to group B, p-value =0.008. Conclusion: Treatment of acute subdural hematoma by decompressive craniectomy with multi dural stabs technique has more favourable results (using GOS) than decompressive craniectomy with open-dural flap technique

Caffeine Levels and Dietary Intake in Smokers with Schizophrenia and Bipolar Disorder

This study investigates the relationship between caffeine levels and dietary intake among individuals with schizophrenia and bipolar disorder who are smokers. The research aims to understand the patterns of caffeine consumption and dietary habits in this specific population. A sample of participants diagnosed with either schizophrenia or bipolar disorder and who smoke will be analyzed to assess their caffeine intake through self-reported measures and biological markers. Additionally, their dietary patterns, including the consumption of caffeine-containing products and nutritional choices, will be evaluated. The findings of this study aim to contribute to a better understanding of the dietary behaviors of individuals with mental health disorders, specifically focusing on caffeine intake among smokers with schizophrenia and bipolar disorder

Dundee Ready Educational Environment Measure Tool for Evaluating the Educational Environment: A Systematic Review and Meta-analysis

OBJECTIVE: The purpose of this systematic review was to study the literature evaluating the educational environment by using DREEM tool and compute overall mean DREEM score by using Meta-analysis. Further, variation in DREEM score was also studied by distributing studies into different time periods. MATERIALS AND METHODS: A systematic literature search was performed using PubMed and Web of Science databases, followed by review and analysis. All the studies which used DREEM as a tool, published from 1997 to December 2015 were included. Heterogeneity between the studies was assessed by I2-coefficient and Q-statistics. Where significant heterogeneity existed random effect, model was used. Egger’s symmetric test and Begg’s funnel plot was used to study possibility of publication bias. The PRISMA Guideline for systematics review was used. RESULTS: Out of 128 published DREEM studies, 43 passed the criteria and included in analysis. Overall mean DREEM score through Meta-analysis was 2.426 (95% confidence interval [CI]: 2.34-2.52). Studies were divided into two groups for analyzing the time effect. Mean score of the studies published during 1997 to 2009 (group 1) was 2.5 (95% confidence interval [CI]: 2.35-2.64) and for the studies from 2010 to 2015 (group 2) was 2.39 (95% confidence interval [CI]: 2.29-2.5). CONCLUSION: Overall DREEM score was more towards positive side than negative. Current review revealed that DREEM has not been used as predictor for achievement of any medical college instead it can be used to predict high and low achievers in a medical school. This review can signify DREEM to be suitable and consistent tool showing learning environment of institute and student’s prerequisites