The burden of dysphagia and chest infection in acute ischemic stroke in a tertiary care hospital of islamabad capital territory

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the set protocol and monitored for the development of chest infection up to 1 week. Demographics and clinical features were recorded. Results: The mean age of patients was 59.09 ± 13.38 years with no sex predilection.Dysphagia was seen in 57 (37.7%) patients of AIS. Chest infection was seen in 38 (25.2%) of the patients. 32 (84.21%) patients with chest infection had dysphagia while 6 (15.78%) patients with chest infection did not have dysphagia. Conclusion: Chest infection is more common in patients of AIS with dysphagia

Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: A cross-sectional survey in Karachi, Pakistan

Background: Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.Method: A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence\u27s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant.Results: Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes.Conclusion: Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers

Evaluation of post therapy functional status and residual weakness of patients with Guillain-Barre Syndrome

ABSTRACT: Introduction: The annual global incidence of Guillain-Barre Syndrome is approximately 1–2 per 100,000 person-years. Data on Guillain-Barre Syndrome is very rare from Pakistan, we conducted a retrospective study to assess the clinical presentation, and treatment response of these patients

Internal mammary artery flow in different racial groups of Pakistan

Objective: To find out any differences in free flow of internal mammary artery among different ethnic groups.Methods: This observational, cross-sectional study was conducted at the Civil Hospital, Karachi, from January 2013 to December 2015, and comprised patients who underwent coronary artery bypass grafting. The participants were divided into 5 groups, i.e. Sindhi, Muslim migrants from India, Punjabi, Pathan and Balochi patients. Free flow of internal mammary artery was measured immediately after harvesting within a syringe, and its flow was measured in 30 seconds. SPSS 18 was used for data analysis.Results: Of the 158 patients, 44(27.8%) were Sindhi, 33(20.9%) Punjabi, 8(5%) Baloch, 21(13.3%) Pathan and 52(32.9%) were migrants. The overall mean age was 52±8 years and the mean flow was 11.6±9.6ml per 30 seconds. The flow was 9.3±6 ml, 10±8ml, 13±11ml, 17±14ml and 15±13 ml in 30 seconds among migrants, Sindhi, Punjabi, Pathan and Baloch patients, respectively, with significant higher flow in Pathan patients compared to Sindhi and migrant patients (pConclusions: Internal mammary artery flow was higher in Pathan and Baloch patients and low in migrants and Sindhis

Management of fracture of neck talus and clinical evaluation of results

Background: Fracture of neck of talus is rare and serious injury with significant complication rate. The talus is involved in about 2% of all lower extremity injuries and about 5-7% of foot injuries. Talus neck fixation is associated with serious complications such as stiffness at ankle and subtler joint, AVN of body of talus, ankle arthritis and later on subtalar arthritis. The objective was to study and evaluate the operative treatment for talus neck fracture.Methods: All adult patients with talus neck fracture admitted in government medical college and hospital, Latur, Maharashtra, India from January 2006 to December 2015 were involved. There were 15 patients with 10 males and 05 females. Fractures were classified as per Hawkins classification and were treated with closed/open reduction and internal fixation with CC screws.Results: All patients were followed prospectively post operatively and clinical and radiological evaluation was done. Results were analyzed. We noted skin complications in 02 patients and rate of consolidation was 60-70%. The final follow-up examination included determination of the AHS score (ankle–hind foot scale) from the American orthopaedic foot and ankle society (AOFAS), range of motion evaluation and radiological analysis.Conclusions: Displaced talar neck fractures are a therapeutic challenge which has significant early and late complications. Despite of all excellent management, non-union rate in type III, and type IV Hawkins fracture is 85%; and AVN of body of talus is 90-95% due to inherent complications of cut off of blood supply which comes from talar neck. Types II, III, IV were associated with talar body dislocation which caused excessive pressure on soft tissues having significant soft tissue complications. Early anatomical reduction and stable fixation is of vital importance to achieve successful outcome

An Efficient Adaptive Noise Cancellation Scheme Using ALE and NLMS Filters

The basic theme of our paper is to implement a new idea of noise reduction in the real time applications using the concepts of adaptive filters.  Our model which is presented as one of the solutions is based on two stages of operation with the first stage based on the ALE (Adaptive Line Enhancer) filters and the second stage on NLMS (Normalized Least Mean Square) filter. The first stage reduces the sinusoidal noise from the input signal and the second stage reduces the wideband noise. Two input sources of voice are used; one for the normal speech and the other for the noise input, using separate microphones for both signals. The first signal is of the corrupted speech signal and the second signal is of only the noise containing both wideband and narrowband noise. In the first stage the narrowband noise is reduced by using the ALE technique. The second stage gets a signal with ideally only the wideband noise which is reduced using the NLMS technique.  In both the stages the concerned algorithms are used to update the filter coefficients in such a way that the noise is cancelled out from the signal and a clean speech signal is heard at the output.DOI:http://dx.doi.org/10.11591/ijece.v2i3.24