Recent advances in epilepsy

Listening to Dr Sarosh Irani in a recent Epilepsy conference about Fascio Brachial dystonic seizures associated with voltage gated potassium channel (VGKC complex/LG1 antibodies)(1) and then reading reports published in Neurology about continued recent use of trephination ‘expelling the demons’ in India(2), I was wondering how far we are in Southeast Asia in the understanding and treatment of this fascinating illness

assessing interprofessional continuing education and planning ahead

The purpose of this survey is to check the concept of Interprofessional education (IPE) to continuing education among working physicians.It assessed 150 randomly selected working physicians of the Aga Khan University Hospital. One -best type questionnaire was designed and piloted to check its completion within 90 seconds.Four quick questions were dedicated at C1 & C2 level focused to check the knowledge and understanding of the physicians to IPE. The results showed 100% response rate. Majority (i.e. \u3e 80%) of the respondents were familiar with the term IPE.The next three items tested physicians understanding regarding the IPE ability to improve communication, teamwork, healthcare coordination and quality (n=69 i.e. 46%); impact of IPE on patient-centered care and physician care (n=89 i.e. 59%); and its contextual understanding (n=40 i.e. 27%). The studyis subject to desirability bias and more overa single university setting restricts the generalizability of the results.The conclusion will alert the CME providers within Pakistan to address physicians’cognitive gaps in this innovative interdisciplinary model.There is no other study of its kind in the Pakistani contextand hence is of high interest

Oral contraceptives and cerebral venous thrombosis: case report and a brief review of literature

Cerebral venous thrombosis remains an important and sometimes an elusive cause of strokes. Oral contraceptives seem to have a strong causative association with this entity. We describe a case that highlights the importance of asking specific questions about oral contraceptive use in patients with strokes due to cerebral venous sinus thrombosis, especially, where the cause remains cryptic

Continuing medical education and pharmaceutical industry

Continuing medical education providers\u27 (academia) and industrial relationship is drawing attention all over the world. To date, there are no national commercial support guidelines available in Pakistan to properly regulate cooperation between the two distinct entities. However, the fact is that the future of all continuing medical education depends on pharmaceutical support and the providers are heavily dependent on the pharmaceutical industry to remain in action. It should always be remembered that medical education and profession is regarded as a moral of enterprise based on a blind faith between the physician and the patient. The funding support by the industry should not bind or influence physician\u27s prescription for any reason. To be trusted, medicine must be free of all such dependency; it should be accountable only to the society it serves and to its own professional standards

Post-dural puncture posterior reversible encephalopathy syndrome

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there was complete resolution of neurological symptoms. We highlight the importance of high index of suspicion of this reversible encephalopathy in obstetric cases with intentional or inadvertent dural puncture, with headache similar to post-dural punctural headache, and the essential role of neuroradiology in confirmation of the diagnosis, as placement of an epidural blood patch would be highly detrimental in these cases

Task-based learning versus problem-oriented lecture in neurology continuing medical education.

Objective: To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education (CME) set-up. Study Design: Quasi-experimental study. Place and Duration of Study: The Aga Khan University, Karachi campus, from April to June 2012. Methodology: Fifty-nine physicians were given a choice to opt for either Task-based Learning (TBL) or Problem Oriented Lecture (PBL) in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach\u27s alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. Results: Cronbach\u27s alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty (p) and discriminatory indexes (d) was obtained for both groups. The results for the lecture group showed pre-test (p) = 42% vs. post-test (p) = 43%; pre- test (d) = 0.60 vs. post-test (d) = 0.40. The TBL group showed pre -test (p) = 48% vs. post-test (p) = 70%; pre-test (d) = 0.69 vs. post-test (d) = 0.73. Lecture group pre-/post-test mean scores were (8.52 ± 2.95 vs. 12.41 ± 2.65; p \u3c 0.001), where TBL group showed (9.70 ± 3.65 vs. 14 ± 3.99; p \u3c 0.001). Independent t-test exhibited an insignificant difference at baseline (lecture 8.52 ± 2.95 vs. TBL 9.70 ± 3.65; p = 0.177). The post-scores were not statistically different lecture 12.41 ± 2.65 vs. TBL 14 ± 3.99; p = 0.07). Conclusion: Both delivery methods were found to be equally effective, showing statistically insignificant differences. However, TBL groups\u27 post-test higher mean scores and radical increase in the post-test difficulty index demonstrated improved learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME