Can “HINTS” aid the Diagnosis of Posterior Circulation Stroke among patients with Acute Vestibular Syndrome?

Introduction: Identifying posterior circulation stroke in patients with AVS without obvious focal neurological deficits poses a difficult diagnostic challenge. It is estimated that about 10% to 20% of patients who present with acute dizziness to the Emergency department have AVS7. Most AVS patients have a benign peripheral vestibular cause (vestibular neuritis or nonbacterial labyrinthitis), but about 25% have brainstem or cerebellar strokes7, 9-10. Rapid, accurate diagnosis of posterior stroke is important for early management as well as prevention of devastating complications. HINTS is a clinical three-step bedside oculomotor exam, that has been suggested of high diagnostic accuracy in identifying posterior circulation stroke in patients with isolated continuous vertigo. Methods: A comprehensive systematic search of literature was done using the NHS Evidence healthcare databases Medline, EMBASE, CLINIL, Google scholar and Cochrane. Results: 10 relevant articles were identified, combining the results of all six prospective studies showed a total of 338 patients on which Clinical HINTS exam was performed. The overall Hints exam sensitivity was 96.86% 95%CI (92.8-99), specificity 96.09% 95%CI (92.1-98.4) and negative predictive value was 0.03 95%CI (0.01-0.08). ROC analysis was done in which area under curve was found to be 0.965. Conclusion: Delay in diagnosis of posterior stroke can result in 8-fold increase in mortality7. HINTS is a useful clinical bed side oculomotor exam, which if done appropriately by trained ED doctors, could aid in the early recognition of a subtly presenting posterior stroke with “acute isolated continuous vertigo”. Hence, will improve the overall diagnostic evaluation of acute vestibular syndrome

Frequency Of Raised Mean Platelet Volume In Patients With Acute Coronary Syndrome In HIT Hospital Taxila

To determine the frequency of raised Mean Platelet Volume (MPV) in patients with acute coronary syndrome (ACS) in HIT Hospital Taxila. Materials and Methods: A case-control study was at HIT Hospital Taxila. All the patients presented with chest pain who fulfilled the inclusion criteria were recruited into the study. Patients with acute coronary syndrome were included in the case group (ACS group). The patients included in the control group (non-ACS group) had chest pain without having ischemic heart disease or risk of ischemic heart disease. Data were analyzed using SPSS version 28. To find out the correlation between the type of chest pain and mean platelet volume chi-square test was applied. Results: Total 93 patients were included in this study. 51 patients were included in the ACS group while 42 were in non- ACS group. To find out the correlation between the type of chest pain and mean platelet volume chi-square test was applied. The results show a significant association between raised MPV and acute coronary syndrome. Conclusion: Patients with raised MPV are at higher risk of acute coronary disease and complications related to it. It could be used as a predictor of ischemic heart disease and its complications