A RARE CASE OF SPACE OCCUPYING LESION OF BRAINSTEM IN AN ELDERLY MALE PATIENT

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy. Keywords: Neurological examination; Cerebellar ataxia; MRI brain; FFE

A RARE CASE OF SPACE OCCUPYING LESION OF BRAINSTEM IN AN ELDERLY MALE PATIENT

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy. Keywords: Neurological examination; Cerebellar ataxia; MRI brain; FFE

BARTTER\u27S SYNDROME

OBJECTIVE: Bartter\u27s syndrome is a rare genetic disorder characterized by renal salt wasting, hypokalemia and metabolic alkalosis. CASE REPORT: A 32 years old male patient presented to casualty with complaints of generalised weakness and chest pain of 15 days duration. Patient had pallor, with loss of buccal pad of fat, skin turgor was lost, and extremities were cold. PR-90bpm, feeble, BP-50/40mmHg. History of similar complaints 1 month back for which he was hospitalised for 15 days and was not completely relieved of symptoms. The differential diagnosis of metabolic alkalosis with hypokalemia without hypertension are; 1. Bartter\u27s syndrome, 2. Gitelman\u27s syndrome, 3. Surreptitious vomiting and 4. Diuretic abuse. CONCLUSION: Acquired Bartter\u27s and Gitelman\u27s like syndromes have been described with autoimmune disorders, sarcoidosis and various drugs. This patient could have a yet undetected or unknown mutation of a protein which has a structural or a functional role in renal tubular cells (of Loop of Henle). KEY WORDS: Bartter\u27s syndrome; Renal salt wasting; Hypokalemia; Metabolic alkalosis; Sarcoidosis

Empirical Evidence of Local Government Finance on Regional Building in Southwestern Nigeria

The relationship between state and local governments in Nigeria as established by the 1999 Constitution of the Federal Republic of Nigeria (as amended) makes both governments as tool for urban and rural development in Nigeria. However, it appears to be one of the challenging aspects of fiscal arrangement in providing social services to the citizenry within their jurisdiction. This study therefore analysed current trend of principles in local governments fiscal relations in the delivery of social service in Southwestern Nigeria. Data were obtained from both primary and secondary sources. This study concluded that financial relationship between the state and local governments enhances the smooth running of local governments in Nigeria has identified as a cardinal component of current trends in local government finance and Joint Allocation Account Committee (JAAC) also assists in equitable distribution of revenue to local governments without prejudice in Southwestern Nigeria. Keywords: Finance; Fiscal Relationship; Good Governance; Local Government; State Government; Intergovernmental Relations DOI: 10.7176/PPAR/10-8-06 Publication date:August 31st 202

BARTTER'S SYNDROME

OBJECTIVE: Bartter's syndrome is a rare genetic disorder characterized by renal salt wasting, hypokalemia and metabolic alkalosis. CASE REPORT: A 32 years old male patient presented to casualty with complaints of generalised weakness and chest pain of 15 days duration. Patient had pallor, with loss of buccal pad of fat, skin turgor was lost, and extremities were cold. PR-90bpm, feeble, BP-50/40mmHg. History of similar complaints 1 month back for which he was hospitalised for 15 days and was not completely relieved of symptoms. The differential diagnosis of metabolic alkalosis with hypokalemia without hypertension are; 1. Bartter's syndrome, 2. Gitelman's syndrome, 3. Surreptitious vomiting and 4. Diuretic abuse. CONCLUSION: Acquired Bartter's and Gitelman's like syndromes have been described with autoimmune disorders, sarcoidosis and various drugs. This patient could have a yet undetected or unknown mutation of a protein which has a structural or a functional role in renal tubular cells (of Loop of Henle). KEY WORDS: Bartter's syndrome; Renal salt wasting; Hypokalemia; Metabolic alkalosis; Sarcoidosis

Development and Evaluation of an Interactive Instructional Package for Teaching Engineering Graphics Skills

Exposure to modern pedagogical approaches and methods with appropriate instructional media can enhance the development of high-level critical thinking and technical skills. This study examined the development of an interactive instructional software package for teaching engineering graphics and evaluated its relative effectiveness on second-year undergraduate engineering students' academic achievement, skill transfer, and retention. In this study, the quasi-experimental, pre-test, post-test, control group design was employed. 45 research participants were sampled, employing two-stage stratified sampling technique, which comprises the simple random sampling to assign students into three groups from the study population and systematic sampling with k = 3 to select 15 students from each group to a control group and experimental groups A and B. The control group was exposed to conventional classroom instruction (CI), group A to computer-aided instruction (CAI); and group B to conventional and computer-aided instructions (CCAIs). A computer-aided learning package on engineering graphics was developed using the Camtasia software package, which served as the treatment instrument. The pre-test and post-test data used for analysis stemmed from a validated Engineering Graphics Achievement Test instrument. Analysis of covariance and Sidak post hoc test statistical analysis of the groups' performance provided the results on the comparative effects of the treatment conditions. Findings indicated significant differences between the academic achievement, skill transfer, and retention of students, exposed to CCAIs, and CI or CAI strategies. When used together, a significant improvement in students' academic achievement, transfer, and retention of engineering graphics skills occurred than either the CI or CAI strategy used alone

Study of Prescribing Pattern, Identification of Drug Related Problems and Therapeutic Intervention in Cardio Vascular Diseases (CVD) Patients

Cardiovascular disease (CVD) is a disorder of heart and blood vessels. CVD is one of the major causes of deaths in India, which contributed around 30 to 40%. The aim of the study was to study the prescribing pattern of drugs, identification of drug related problems and therapeutic intervention in CVD patients. A hospital based prospective and observational study was carried out for a period of nine months in a south Indian tertiary care hospital. Among 120 selected patients, 79 were male  (65.83%) and 41 were female  (34.16%), more number of patients (35) were between the age group of 55-64 (29.16%) of which 27 were males & 8 were females, and very less number of patients (6) were between the age group 85-94 (5%) of which all the 6 were male. Hypertension is the most commonest and dominant disorder, which affected 47(39.16%) patients, in which 30 were male (25%) and 17 were female (14.16%). Most common risk factor is HTN followed with smoking and diabetes of 45 patients (37.5%). The most often prescribed pattern adopted in CVD is Dual therapy, it is most frequently used therapy 50 (41.66%) and quadruple therapy is less frequently 6(6.5%) used. The diuretics and calcium channel blocker combination were maximally prescribed class of drugs as a dual therapy. A total of 47 drug-drug interactions were found, among 12 were major, 15 were moderate and 20 were minor interactions. Clinical pharmacist has intervened with the help of other health care professionals in order to reduce the risk factor and minimise the drug-drug interactions. The study provides the benefits of presence of clinical pharmacist in a hospital setting, in order to prevent the medication related errors and provide the expertise pharmacotherapy opinion in CVD patients, which improves the patient compliance.  Hence study justifies a need of active collaboration between clinical pharmacist, physician and other health care professionals for the better management of CVD patients. Keywords: Prescribing Pattern; Cardio Vascular Diseases; Drug Related Problems; Therapeutic Intervention