Guillian-Barre syndrome after COVID-19 infection: a case report

Guillain-Barre syndrome (GBS) is an auto-immune disorder characterized by ascending motor weakness with hypo-reflexia or areflexia. In GBS molecular mimicry leads to the targeting of peripheral nerves. The treatment of GBS is mainly supportive, however, the definitive management of GBS includes IVIGs (intravenous immunoglobulins) and plasma exchange (plasmapheresis). We reported a case of 42 year old man who presented with weakness of both lower limbs associated with pain and numbness after recovering from COVID-19 infection. Clinical examination, radiological findings and lab results confirmed the diagnosis of GBS. He was admitted in the hospital and treated with intravenous immunoglobulins along with periodic cardiac, respiratory and neurological assessment. The patient showed a substantial response to intravenous immunoglobulins and resulted in a remarkable recovery with no residual motor or sensory deficit

ASSOCIATION OF ADVERSE PERINATAL OUTCOMES WITH INCREASING AGE IN TWIN PREGNANCIES AT A TERTIARY CARE HOSPITAL.

Background; Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources which translate into insufficient care during pregnancy and delivery.  Due to inherent biological factors, twin pregnancies have increased rates of obstetric and perinatal complications such as preeclampsia, post-partum haemorrhage and preterm birth, which are known risk factors for maternal and perinatal mortality. Objective; To determine the frequency of adverse fetomaternal outcome in twin pregnancy in women of advanced age. Material and methods: A total of 181 patients with dichorionic diamniotic twin pregnancy on ultrasound having gestational age more than 24 weeks were taken in this cross-sectional study. Demographic information of patients (name, age, weight) was taken. Informed consent was taken from each patient, ensuring confidentiality and fact that there is no risk involved to the patient while taking part in this study. An obstetrical ultrasonography was done to confirm twin pregnancy. Blood samples were taken from all patients for assessment of anemia. Patients were followed up until pregnancy outcome. Results; Mean age of these study cases was noted to be 34.35 ± 2.41 years. Mean gestational age of our study cases was 34.67 ± 2.25 weeks. Mean BMI of our study cases was noted to be 22.45 ± 1.67 kg/m2 (with minimum BMI was 19.4 kg/m2 and maximum BMI was 32 kg/m2) and obesity was present in 27 (14.9 %) of our study cases. Of these 181 study cases, 126 (69.6%) delivered vaginally while 55 (30.4%) had to undergo cesarean section delivery. Mean hemoglobin level was noted to 8.67 ± 1.40 g/dl while anemia was seen in 126 (69.6%) of these study cases. Preterm labor was observed in 144 (79.6%), abruptio placentae in 19 (10.5%) and low birth weight in 123 (68 %) of our study cases. Conclusion; Twin pregnancy is associated with high risk of perinatal and pregnancy outcomes. There was higher frequency of anemia, cesarean section deliveries, preterm births and low birth weight babies in our study. There is a need for specialised prenatal care to reduce complications and adverse outcome in multiple pregnancies, and the need for ongoing social and medical care beyond the prenatal and perinatal periods to improve perinatal outcomes in these patients. Keywords; Preterm labor, anemia, twin pregnancy. DOI: 10.7176/JMPB/58-04 Publication date: August 31st 201

ASSOCATION OF NON – MODIFIABLE RISK FACTORS (DIABETES, HYPERTENSION AND OBESITY) WITH DYSLIPIDEMIA IN STROKE PATIENTS AT A TERTIARY CARE HOSPITAL

Background; Stroke is a global health problem. Stroke is responsible for major disabilities in adult population, and is 2nd leading cause of deaths all over the world. Different studies have reported dyslipidemia as major cause of stroke in different populations. Objective; To determine the association of non – modifiable risk factors such as diabetes, hypertension and obesity with dyslipidemias in patients with ischemic stroke at Nishtar Hospital Multan. Material and methods; All the cases of stroke (n=240) Patients having finding on CT scan brain (plain) consistent with ischemic stroke of either sex aged less than 80 years were enrolled in this cross-sectional study from department of Medicine, Nishtar Hospital, Multan. Complete history about onset of illness, diabetes, hypertension and cardiac illness of the patients was taken. Baseline laboratory investigations including lipid profile and Hb A1c were done. Results; Of these 240 study cases, 155 (64.6 %) were male patients and 85 (35.4%) were female patients. Mean age of our study cases was 68.37 ± 14.55 years (with minimum age was 34 years while maximum age was 79 years). Out of these 240 study cases, 138 (57.5 %) were from poor families, 53(22.1 %) were diabetic and only 11 out of 53 (20.75%) had controlled glycemic levels. Hypertension was present in 182 (75.8%) of our study cases and 39 (16.3 %) were obese. Smoking was present in 101 (42.1%), previous history of stroke was present in 35 (14.6%) and 83 (34.6%) were Saraikis. Mean duration of illness was 2.24 ± 0.53 months and 135 (56.3%) had disease duration more than 1 month. Mean serum cholesterol level was 202.06 ± 45.36 mg/dl, mean serum LDL level was 91.13 ± 10.24 mg/dl, mean serum triglyceride level was 147.51 ± 20.21 mg/dl and mean serum HDL level was 42.92 ± 3.85 mg/dl and dyslipidemia was present in 85 (35.4 %).  Conclusion; Frequency of dyslipidemia was high among patients having ischemic stroke in our study. Dyslipidemia was significantly associated with diabetes, hypertension, obesity, smoking, previous history of stroke and ethnicity. Early diagnosis followed by timely management can help reduce disease morbidity and improve clinical outcomes in these patients. Keywords; ischemic stroke, dyslipidemia, frequency. DOI: 10.7176/JMPB/58-03 Publication date: August 31st 201

Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy

Jaundice: a basic review

Jaundice is a complex disease. Jaundice is actually the high bilirubin level in the body. Yellowing of skin, mucous membranes and skin are common presentations of jaundice. Jaundice has various variants including pre-hepatic jaundice (due to hemolysis of red blood cells), hepatic jaundice (due to defect in capture, conjugation and excretion of bilirubin by liver) and post hepatic jaundice (due to the obstruction of extra hepatobiliary system). The causes of various variants of Jaundice is either acquired or congenital. High plasma bilirubin level can cause various manifestations involving satiety, gastrointestinal bleeding, diarrhea, anemia, edema, weight-loss and can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. High bilirubin level can help in the diagnosis of Jaundice. Differential diagnosis of various variants of Jaundice can be carried out on the basis of bilirubin level (conjugated and unconjugated), ultrasonography and other radiological techniques. The proper management of Jaundice is high water intake and low fat diet. The primary effective treatment for pre-hepatic jaundice and neonatal physiological jaundice is phototherapy. Infusion of immunoglobulins is also used for treatment of pre-hepatic jaundice. Proper nutrition, steroids and immunosuppressant are used for treatment of hepatic jaundice. The treatment for post hepatic jaundice is decompression and surgery

Diabetes insipidus: the basic and clinical review

Diabetes insipidus (DI) is a complex disease. DI is inability of the body to conserve water. Polydipsia and polyuria are the major manifestations of DI. DI has various variants including central diabetes insipidus (due to defect in ADH secretion), nephrogenic diabetes insipidus (due to defect in ADH receptors or urea receptors), gestational diabetes insipidus (due to catabolism of ADH by placental vasopressinase) and primary polydipsia (due to massive fluid intake). The cause of various variants of DI is either acquired or congenital. High plasma osmolality due to hypotonic urine excretion can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. Polyuria and polydipsia help in the diagnosis of DI. Differential diagnosis of various variants of DI can be carried out on the basis of water deprivation test, MRI and other radiological techniques. The proper management of DI is the replenishment of water loss and correction of clinical presentations produced as a result of DI, major is hypernatremia. The best management for primary polydipsia is fluid restriction while fluid intake is used for adipsic diabetes insipidus. ADH replacement therapy is widely used to treat DI. DDAVP or desmopressin is mostly preferred ADH analogue because it has less side effects and resistant to placental vasoprssinase

Evaluation of Lumber Spine Stenosis on Magnetic Resonance Imaging Correlating with Its Clinical Manifestation

Lumber spine stenosis (LSS) is one of the major reasons of spinal surgery all over the globe. Despite using standard Diagnostic tools for LSS, the clinical and imaging findings often do not correlate. Over past years, the central spinal canal stenosis is assumed to be the diagnoses of lower back pain, while other anatomical stenosis (i.e lateral recess stenosis) not gaining as much attention. This fact assumed to be the reason for failed back surgery. In this context numerous studies in past have done. The aim of this study is to verify the clinical manifestation of LSS correlation to its Diagnostic find. To evaluate the lumbar spine stenosis on magnetic resonance imaging & correlating with its clinical manifestations. The duration of study was three months. Study was done at Lahore General Hospital, Pakistan. A cross-sectional analytical study included 120 patients. According our study the patients comes with lumber spine stenosis at different levels. At L4L5 presents 39 (32.5%) patients, 47(39.2%) patients reveal at the level of L5S1, 14 (11.7%) patients at L2L3, and only 3 (2.5%) patients appear at the level of L1L2, 19 (15.8%) patients show stenosis at L3L4 Then we correlate the pain intensity with all lumber spine levels and the results are 35 (29.2%) patients are absent and 85 (70.8%) presents at the level of L4L5. On the level of L5S1 pain intensity is absent in 81 (67.5%) patients, & present in 39 (32.5) patients. On the level of L2L3 106 (83.5%) absent and 14 (11.7%) patients are present pain intensity.  On the level of L1L2 117 (97.5%) absent of pain intensity and only 3 (2.5%) patients are present with pain intensity. The study concluded that the clinical manifestation of lumber spine stenosis to devise the management plan for the patient for better diagnoses in magnetic resonance imaging in LSS. Keywords: Lumber spine stenosis, manifestation, MRI DOI: 10.7176/JHMN/90-10 Publication date:June 30th 202

The cross-sectional study of anxiety levels and ratio of severity of thirteen symptoms of anxiety among medical students

Background: Anxiety is defined as physical, behavioral, social and psychological response to treat self-concept characterized by subjective, consciously perceived feelings of tension. Nowadays anxiety is most commonly found among medical students. This study was conducted to find out the anxiety levels and ratio of severity of thirteen symptoms of anxiety.Methods: A questionnaire based study was conducted among 178 medical students which tests the level of anxiety and severity of symptoms of anxiety. The questionnaire used was hamilton anxiety rating scale (HAM-A).Results: Out of 178 students, 80 (44.94%) students scored mild anxiety levels, 63 (35.39%) students scored moderate anxiety levels and 35 (19.66%) students scored severe anxiety levels.Conclusions: Mild form of anxiety is much more common among medical students and majority of these medical students are females. Moreover, the symptoms of anxiety including tension, anxious mood, depressed mood, insomnia, fear and CVS symptoms appear with moderate severity in majority of medical students while on the other hand some symptoms including general somatic muscular and sensory symptoms, difficulties in concentration and memory, genitor-urinary symptoms, respiratory symptoms, GIT symptoms and other autonomic symptoms appear with least severity among majority of medical students

Issues and Optimization of UMTS Handover

UMTS is an emerging cell phone technology and it is basically another name for 3G mobile communication systems. It provides an enhanced range of multimedia services like video conferencing and high speed internet access. Sometimes UMTS is marketed as 3GSM emphasizing the both 3G nature and GSM standards which it was designed to succeed. UMTS is also European term for wireless systems based on the IMT-2000 standards. To utilize various merits in mobile telecommunication system which consist of various radio access networks, UMTS as Third Generation wireless technology utilizes a wideband CDMA or TD/CDMA transceiver and also cover large area. Handover is basically a function which continues the communication between users without any gaps when the hardware goes to a place where it finds no network coverage. When we talk in terms of cellular communications systems, handover is a process which is referred to the transfer of a connection from one cell to another. Handover time is generally between 200 and 1,200 milliseconds (ms), which accounts for the delay. In this thesis we are going to find the reasons for these factors which affect the Quality of service of handover. The main focus of this research is to study the some factors which really affect the handover phenomenon in UMTS that basically affect the overall quality of mobile network. For this we intend to find the solution for problems which born during the handover. Handover provides the mobility to users which are the main theme of wireless technology and it is also make the interoperability between different network technologies

Issues and Optimization of UMTS Handover

UMTS is an emerging cell phone technology and it is basically another name for 3G mobile communication systems. It provides an enhanced range of multimedia services like video conferencing and high speed internet access. Sometimes UMTS is marketed as 3GSM emphasizing the both 3G nature and GSM standards which it was designed to succeed. UMTS is also European term for wireless systems based on the IMT-2000 standards. To utilize various merits in mobile telecommunication system which consist of various radio access networks, UMTS as Third Generation wireless technology utilizes a wideband CDMA or TD/CDMA transceiver and also cover large area. Handover is basically a function which continues the communication between users without any gaps when the hardware goes to a place where it finds no network coverage. When we talk in terms of cellular communications systems, handover is a process which is referred to the transfer of a connection from one cell to another. Handover time is generally between 200 and 1,200 milliseconds (ms), which accounts for the delay. In this thesis we are going to find the reasons for these factors which affect the Quality of service of handover. The main focus of this research is to study the some factors which really affect the handover phenomenon in UMTS that basically affect the overall quality of mobile network. For this we intend to find the solution for problems which born during the handover. Handover provides the mobility to users which are the main theme of wireless technology and it is also make the interoperability between different network technologies