Abdominal pain with rigidity secondary to the anti-emetic drug metoclopramide

We report a case of abdominal pain with rigidity, mimicking an acute abdomen, caused by metoclopramide, a common anti-emetic drug. Extrapyramidal symptoms are commonly reported side-effects of this medication. They generally include involuntary movements of limbs, torticollis, oculogyric crisis, rhythmic protrusion of tongue, trismus, or dystonic reactions resembling tetanus, etc. Abdominal rigidity due to this medication, resembling an acute abdomen, has not been reported previously. This case report illustrates the importance of considering medication side-effects when evaluating a patient with abdominal pain and rigidity

New Onset Refractory Status Epilepticus as an Unusual Presentation of a Suspected Organophosphate Poisoning

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures

(1E)-1-[4-(Dimethyl­amino)phen­yl]pent-1-en-3-one

The title mol­ecule, C13H17NO, is close to planar: the dihedral angle betweent the dimethyl amino group and the benzene ring is 7.94 (19)°. No significant inter­molecular inter­actions are observed in the crystal structure

Importance of clinical toxicology teaching and its impact in improving

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.Result: There were 22 participants in the course. The pre-test mean score was 31.6±15.1% (95% CI; 24-40; n=19) compared to the post-test the mean score of 56.0±10.8% (95% CI; 47- 61; n=17). The positive difference was also statistically significant (pConclusion: Short training in clinical toxicology improved knowledge of the participants

Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.RESULT: There were 22 participants in the course. The pre-test mean score was 31.6 +/- 15.1% (95% CI; 24-40; n = 19) compared to the post-test the mean score of 56.0 +/- 10.8% (95% CI; 47- 61; n = 17). The positive difference was also statistically significant (p \u3c 0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants.CONCLUSION: Short training in clinical toxicology improved knowledge of the participants

1-(5-Hydr­oxy-3-methyl-1-phenyl-1H-pyrazol-4-yl)ethanone: a new monoclinic polymorph

The title compound, C12H12N2O2, crystallized in the monolinic space group P21/n, with two independent mol­ecules (A and B) in the asymmetric unit. This is in contrast to the first monoclinic polymorph reported [Cingolani et al. (2002 ▶). Inorg. Chem. 41, 1151–116], which crystallized in the space group C2/c with one independent mol­ecule per asymmetric unit. The dihedral angles between the two rings differ slightly; in mol­ecule A it is 4.90 (11)° and in mol­ecule B it is 16.05 (13)°. In both mol­ecules, there is an intra­molecular O—H⋯O hydrogen bond involving the hydroxyl substituent and the carbonyl O atom of the adjacent acetyl group. In the crystal structure, mol­ecules A and B are linked via a C—H⋯N inter­action. There are also some weak C—H⋯π inter­actions involving the phenyl ring of mol­ecule A and H atoms of the acetyl groups of both mol­ecules

Comparison of predictive protocols in chest pain patients in a tertiary care hospital in Karachi, Pakistan

Background: The most challenging aspect in evaluation of a patient presenting with chest pain in the Emergency Department (ED) is diagnosis of acute cardiac ischemia (ACI). Various decisions aids have been developed to aid the ED physician in the diagnosis of chest pain. Three different predictive protocols – the Goldman protocol, ACI-TIPI, and the Troponin protocol are used in predicting the occurrence of ACI. None of these decision aids have been tested in the Pakistani population, where risk factors and prevalence of CAD are much different than what is seen in other regions of the world.Aims: The aim of this study was to compare how three different predictive protocols for ACI fared in the Pakistani population.Methods:This retrospective case series included a consecutive sample of 212 patients who presented to the ED with symptoms of chest pain or its equivalent. Patient data was collected and retrospectively analyzed with each predictive protocol to analyze sensitivity, specificity, PPV, and NPV of each protocol.Results: 63% of patients were diagnosed with ACI. The sensitivities of the Goldman, ACI-TIPI, and Troponin protocols were 94%, 98%, and 38% respectively. The specificities of the Goldman, ACI-TIPI, and Troponin protocols were 14%, 29%, and 95% respectively. Conclusion: Sensitivities from a small sample size show promise in the use of predictive protocols for chest pain in the Pakistani population. However, prospective studies on a larger level need to be conducted to validate these findings

2-Ethyl-2,3-dihydro-1,2-benzothia­zole-1,1,3-trione

In the title mol­ecule, C9H9NO3S, the bond lengths and angles fall within normal ranges. All nine ring atoms almost lie in a common plane (r.m.s. deviation 0.021 Å). In the crystal, symmetry-related mol­ecules are linked via C—H⋯O hydrogen bonds, forming a three-dimensional network

Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results.Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians