Cerebral venous sinus thrombosis associated with coronavirus infection (covid-19)

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome (SARS) caused by the SARS-CoV-2 coronavirus. Despite its primarily respiratory involvement, an increased propensity for systemic inflammation, neuroinvasion, and thromboembolic events has been reported. This systemic prothrombotic state may predispose to cerebral venous sinus thrombosis (CVST), which is an uncommon cerebrovascular disease with hypercoagulability as one of its important risk factors. We conducted a literature search using the PubMed electronic database and reviewed the published literature for a possible association of CVST with the COVID-19 disease

Effect of Examination on Instructional Practices of Elementary School Teachers: A Mixed Methods Study

Examination conducted by the Punjab Examination Commission (PEC) at grade VIII is high-stakes as intended and unintended consequences are associated with result of the examination and influence teaching learning process in school. A mixed methods sequential explanatory study was conducted to investigate effects of the examination conducted by the PEC on instructional practices of teachers at elementary level in seven districts of the Punjab. In quantitative phase survey data was collected from 521 elementary school teachers teaching in seven districts of the Punjab selected through multistage random sampling. The quantitative results were used to select participants for qualitative phase of the study through maximum variation strategy of purposive sampling. Quantitative phase identified female teachers perceived more effects of examination on their instructional practices. Moreover, teachers belonged to age group 42-48 experienced most of the effects of examination on their instructional practices as compared to teachers belonged to other age groups. Similarly teachers belonged to district 3 (Okara) experienced more effects of examination on their instructional practices as compared to teachers serving in other districts. The qualitative data indicated that instruction was driven by the examination. Teacher centred instructional strategies were dominant. Paper pattern defined the instruction and tests were extensively practiced in classes. Teachers used strategies for helping students to attempt MCQs. One of the objectives of this examination reform was to improve teaching and learning and in the light of this study it remains rhetoric. The findings of the study have posed several challenges for examination board, curriculum and educational authorities in the Punja

Guillain-Barre Syndrome Following a Snakebite: A Case Report and Review of Literature

Guillain-Barre syndrome (GBS) is preceded by a respiratory or gastrointestinal illness in more than 50% of the patients. A rare association of GBS with a preceding snakebite is reported in the literature in only four previous cases. We present a case report of a patient diagnosed with GBS following the bite of a yellow-bellied sea snake (Hydrophis platurus) and a brief review of the available literature

Comparison of Local Infiltration of Bupivacaine and Tramadol in Post- Operative Pain Management in Children after Inguinal Herniotomy

Introduction: Adequate pain control is essential in immediate postoperativeperiod. Different methods are being used to provide pain management but none of these is completely effective. Regional blocks are becoming more popular then systemic opioids in all age groups due to efficacy and safety of agents used. The objective of this study was to establish the effectiveness of tramadol and bupivacaine for pain control after inguinal herniotomy in children.Materials and Methods: This randomized controlled trial was conducted at pediatric surgery department, services hospital Lahore over 2 years. Two hundred and eighty four cases randomly divided into two groups B (Bupivacaine) & T (Tramadol). Bupivacaine (dose of 2 mg/kg) in group B or Tramadol (2mg/kg) in group T was infiltrated in the wound. Postoperatively pain score was measured using Wong-Baker Faces pain scale (WBFPS) at 0,1,2,4 and 8 hours. Both groups experienced side effects.Results: Age and gender distribution in both groups were comparable. Pain score in both Groups was equal at 0- hours. However at 1-hour, 2-hour and 4-hour, pain score was slightly more in Group-B, But at 8-hours mean pain score was markedly raised in Group-B as compared to Group-T (3.32 ± 1.42 vs 2.45 ± 1.35). Only complication noted in patients was vomiting which was higher in Group T.Conclusion: Locally infiltrated Tramadol is a better choice than bupivacaine as a local anesthetic for pain management in children after inguinal herniotomy. Further research is needed to elucidate any benefits it may have in other surgeries

Early Neurological Deterioration After Acute Stroke; Mechanism and Predictors

Neurological deterioration after acute ischemic stroke (AIS)is a common occurrence, leading to increased mortality, morbidity, and poor quality of life among stroke survivors. Recognition of the individuals at a greater risk for neurological deterioration may contribute to making early decisions and monitoring the therapy. Neurological deterioration arises in up to 40% of subjects after AIS during hospitalization and is followed by neurological and functional debility. Numerous predictors have been devised that predict this progression. This includes preliminary assessment of the severity of stroke, brainstem infarction, hyperglycemia, atrial fibrillation, diabetes mellitus and substantial fluctuations in blood pressure. Sequential observations, in depth analysis, and skilled professionals in specific stroke centers are crucial in early recognition, prevention and management of neurological deterioration in AIS patients. Recent advancements in the neurological and vascular imaging have contributed to providing a better understanding of the underlying mechanisms, though several questions remain unanswered. There is an immense need to evaluate the risk of neurological deterioration after AIS. This concise review summarizes the published data and highlights the causes, mechanisms and the risk factors that influence the incidence of neurological deterioration in patients with AIS

Assessment of Environment of Pediatric Surgery Residents of Pakistan using PHEEM

Introduction: Different countries have their own residency programs in order to train new residents in the field of medicine. Some of these programs are very efficient while some have room to improve, especially in developing countries. These residency programs can play an important role in producing great consultants in the future. So it is very important to evaluate the residency program of a country so as to make sure their residents receive quality training.Materials and Methods: A cross-sectional survey was conducted in Pakistan using PHEEM questionnaire; for assessment of educational environment of pediatric surgery post graduate residents (PGR’s) of Pakistan. A questionnaire was sent to all 95 pediatric surgery residents via E-mail in February 2017 and SPSS 20 was used to analyze data.Results: The response rate from pediatric surgery PGR’s was 48.4% (n= 45).The mean age of participants was 29.69 ± 2.71 years. Most of the participants were male (76%) and in 5th year of residency (39.13%). The high scored items (mean >2.5) were only 3: question 9, 17 and 26. The mean PHEEM total score was found to be 63.06 ± 16.77. When categorized into global scales, most of the residents (84.4%) labeled educational environment into level 2. Mean PHEEM score was found significantly higher among female and those residing in province ‘Sindh’.Conclusion: We conclude that although educational environment depends upon and varies with many factors; overall it is not reported to be satisfactory by pediatric surgery PGR’s across our country. Authorities urgently need to look into the matter and take serious actions in order to improve the quality of our future consultants

Cerebral venous sinus thrombosis with positive Dengue serology

Dengue fever is a viral febrile illness caused by dengue virus and spread by Aedes mosquito worldwide. It usually manifests as an acute fever associated with body ache, skin rash, and thrombocytopenia. Neurological manifestations are relatively uncommon but well-known. We report a case of a 25-year-old male patient who presented to our hospital with acute febrile illness, headache, and vomiting. Extensive laboratory investigations were done and he was diagnosed with cerebral venous sinus thrombosis. Dengue serology was positive. He was treated with anticoagulation and hydration with complete recovery. The treatment with anticoagulation is challenging due to accompanying thrombocytopenia. Only two previous case reports of cerebral venous sinus thrombosis with positive dengue serology have been reported in the literature

Longitudinally extensive transverse myelitis with seropositive chikungunya

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of LETM are reported worldwide in association with CHIKV fever and this is the first case from Pakistan. With frequent chikungunya outbreaks, neurological complications are increasingly seen in clinical practice. The knowledge of these associations will result in their early diagnosis and treatment