An unusual presentation of gbs: case report and literature review

Guillain-Barre syndrome (GBS), also known as Landry paralysis is an acute idiopathic polyneuritis, believed to be immunologically mediated. It usually presents as a demyelinating neuropathy with ascending weakness, however, many clinical variants have been well documented in the medical literature, and variants involving the cranial nerves or pure motor involvement with axonal injury have also been described. We report a case of a 50 year old patient who initially presented to the ER with hemiparesis and cranial nerve palsies simulating a cerebrovascular event. Based on neurological examination, CSF analysis and needle EMG finding a diagnosis of GBS was made

Neuroradiological manifestations of tuberculous meningitis

Tuberculous meningitis (TBM) represents the most severe form of extra pulmonarytuberculosis (1).The early and exact diagnosis of TBM is important but difficult due to time consuming definitive microbiological procedures (2).Neuroimaging is an important initial investigation in tuberculous meningitis(3).This study was conducted to evaluate the neuroradiological findings in patients with tuberculous meningitis, as a useful modality for itsearly diagnoses and prompt treatment

Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR)

Clinical predictors of mechanical ventilation in guillain-barré syndrome (gbs)

Guillain-Barre’ Syndrome is the most common cause of acute flaccid paralysis worldwide. One of the most serious complications is respiratory failure warranting mechanical ventilation which is required in about 30% of the patients. Various studies have been carried out to identify clinical factors which could help identify patients with impending respiratory failure and facilitate elective mechanical ventilation in these patients to reduce the associated mortality. Material and methods: 92 patients diagnosed with GBS were enrolled from February 6, 2013 to August 5, 2013 in department of Neurology, PIMS, Islamabad. Each patient was then be managed accordingly and monitored for therequirement of ventilatory support. Based on the need of Mechanical ventilation patients were divided in to 2 groups: ventilated (Group 1) and non-ventilated (Group 2) and presence of various clinical factors were assessed in both groups. Results: The mean age of patients was 33.83 ± 16.91 years with a male preponderance (68.48%). 31 (33.7%) patients of GBS needed mechanical ventilation.Patients requiring mechanical ventilation tended to have more severe disease evidenced by the presence of bulbar dysfunction (P=.000), autonomic dysfunction (P = .000), and upper limb paralysis (P = .010). The presence of a preceding gastrointestinal illness did not prove to be an independent predictor of mechanical ventilation on multivariate analysis. Conclusion: The course of patients with severe GBS leading to mechanical ventilation can, to some extent, be predicted on the basis of clinical factors. This study identifies bulbar dysfunction and dysautonomia as significant independent predictors of mechanical ventilation

Bridging the Gap Between Guidelines and Clinical Practice: An Audit of Asthma Management

Background: To assess clinical practice in the light ofGINA guidelines and to identify and rectify areas ofweaknesses in current clinical practice so as to provideGINA guidelines described standard of care to ourpatients.Methods: In this descriptive study 50 consecutiveasthma patients were audited prospectively.Patientdemographics were recorded. Every patient underwentdetailed clinical evaluation as well as objective assessmentby spirometry.Results: The mean age was 43 years with femalepredominance (66%). Fifty eight percent had a familyhistory of asthma and 90% belonged to lower middle andlower classes. Diagnosis of asthma was made on clinicalgrounds in 90% and only 10% of patients had objectiveconfirmation of asthma by spirometry. Fifty two percent ofthe patients were on suboptimal treatment according todisease severity and only 30% had correct inhalertechnique. Only 40% were compliant with the prescribedtreatment and only 36% had good control of asthma.Conclusion: Discrepancy in the theoretical instructions(GINA guidelines) and the clinical practice was observedin our setting. Majority of patients were on sub-optimaltreatment with incorrect inhaler technique leading to poorasthma control

The Impact of Authentic Leadership on Organizational Citizenship Behaviours and the Mediating Role of Corporate Social Responsibility in the Banking Sector of Pakistan

This study was designed to examine the effect of authentic leadership on organizational citizenship behaviour (OCB), as well as to examine the mediating mechanism of corporate social responsibility (CSR) on the aforementioned relationship. Using the cross-sectional design method, the data were collected from 395 employees working in the banking sector of Pakistan. Drawing on social exchange theory, it was hypothesized that authentic leadership would positively predict organizational citizenship behaviour. Furthermore, it was hypothesized that CSR would positively mediate the relationship between authentic leadership and OCB. The results of the study indicate that authentic leadership positively predicts OCB. Importantly, CSR was found to positively mediate the effect of authentic leadership on OCB. Theoretical implications of the study and future research directions are also discussed

Clinical profile of acute pancreatitis and the application of different severity indices in patients treated at Rehman Medical Institute, Peshawar

Background: Acute Pancreatitis (AP) is the inflammation of the pancreas. Based on the severity of the disease, one can easily manage it, for this purpose certain scoring systems, such as Ranson’s Score, Glasgow Score and modified CT Severity Index Score are being used to predict the severity and prognosis of AP. Objectives: The objective of our study is to assess the efficacy of various severity indices (Ranson’s score, Glasgow score, Modified CT severity index score) in predicting the prognosis of patients. Methodology: This retrospective study was conducted in the Dept of Medicine at Rehman Medical Institute, Peshawar, between May 2021 to September 2021 after approval from the Department of Research, Rehman Medical College. Data was retrieved from the patients’ records on a structured proforma. Those with a definitive diagnosis and were treated for acute pancreatitis in the past 5 years, were included in the study. Results: CT Severity Index Score found that out of 35 males, 10 (28%) had mild, 16 (45%) had moderate and only 9 (25%) had severe pancreatitis. Whereas out of the 34, only 5 (14%), 17 (50%) and 12 (35%) females had mild, moderate and severe disease respectively.&nbsp