Neurocritical Care of a Reperfused Brain

Cerebral hyperperfusion and reperfusion injuries are not infrequently encountered following in reperfusion of ischemic or hypoperfused brain. Mechanism of injury could be related to tissue plasminogen activator toxicity, oxidative stress, and hyperperfusion due to impaired cerebral autoregulation in already maximally dilated cerebral vasculature and compromised cerebral hemodynamic reserve. Reperfusion injury can present as headaches and seizures in mild forms and as subarachnoid hemorrhage, intracranial hemorrhage, cerebral edema, and encephalopathy in its most severe manifestation. Prevention and identifying those at risk of hyperperfusion syndromes are the best strategy. Active treatment includes basic neurocritical care with reduction of blood pressure to a reperfused brain and timely neuroprotection and cerebral edema control measures are the mainstay of its management approach.     

A comparative study of prevalence and predictors of metabolic syndrome in various psychiatric disorders in state of Haryana: More than 30 years Vs. less than 30 years

BackgroundExponential growth of metabolic syndrome in psychiatric disorders is becoming alarming situation to handle with. It is associated with reduced life span of 10–30 years in psychiatric patients attributed to metabolic syndrome, thus needs to be screened and addressed in all psychiatric patients.Objectivethe objective of this study was to know the prevalence and its risk factors in various psychiatric disorder and comparing them in older vs younger patients.MethodologyA cross sectional indoor based study was conducted after taking ethical committee approval in 140 patients (substance use disorder, schizophrenia, bipolar and depressive disorders). All the metabolic parameters as per International diabetes federation criteria for metabolic syndrome were assessed involving waist circumference, weight, height, Systolic/diastolic blood pressure, fasting blood sugar, high density lipoprotein and triglycerides.StatisticsChi square and t-test were used.ResultsIt was seen that prevalence of metabolic syndrome (MS); 21.4% in psychiatric illness, up to 40% in major depressive disorders, followed by 33% in substance use disorder and 26.7% in psychotic disorders. Prevalence of MS was higher in older patients >30 years group (26% Vs. 16.4% in <30 years group). It was observed that substance use and depressive disorder and high BP in older male patients are all the significant risk factors for metabolic syndrome.ConclusionMore than 1/5th psychiatric patients are affected by metabolic syndrome. Thus, all male psychiatric patients with high BP must be evaluated for metabolic syndrome.     

Predictors of response to antiviral therapy in patients with chronic hepatitis C from Pakistani population

Background  Hepatitis C virus (HCV) constitutes a major public health issue around the world, especially in developing countries like Pakistan. In this study, we assessed outcome of interferon (INF) treatment in chronic hepatitis C patients categorized by gender, age, and viral load.

Methods  In this study, 750 HCV positive patients with genotype 3 were selected, out of which 616 completed the entire treatment. Their personal history, pre-treatment HCV RNA and serum alanine transaminase (ALT) was quantified. Patients were treated with combination therapy of INF-α 2b three million units (thrice a week) plus ribavirin (1000–1200 mg per day) for 24 weeks. After 24 weeks their HCV RNA and serum ALT level was quantified.

Results  Out of the 616 patients, 391 (63.5%) responded to therapeutic regimen (INF-α 2b plus ribavirin). Among the responders, 27.1% were men and 36.4% were women. Best treatment response was observed in patients having low viral load <8×10⁵ IU/ml and age ≤40 years than patients having low viral load and age >40 years (73.2% vs. 60.3%, P=0.05).

Conclusions  Better response to IFN-α 2b plus ribavirin was observed in patients with lower viral RNA and younger age. It suggests that all patients considered for treatment should have quantification of serum HCV RNA level. The result can be used to counsel patients on the likelihood of response and may influence the patient’s decision on treatment.

     

Contact lens use and its compliance for care among healthcare workers in Pakistan

Background:

Poor care and hygiene of contact lens (CL) results in eye problems and infections. Healthcare workers have an important role in advocating correct lens care.

Objectives:

To determine the practices of CL care and the adverse consequences of poor CL care among healthcare workers.

Setting and Design:

A cross-sectional study in one public and three private sector hospitals in Karachi, Pakistan, in 2009–2010.

Materials and Methods:

We questioned 500 healthcare workers of all ages and both sexes, who wore CL, about compliance with advice on care and any complications due to improper hygiene practices. Ethical approval was obtained. Chi-square tests were used to determine significance and p-value less than 0.05 was considered statistically significant.

Results:

Of the total CL users, 385 (77%) were females. Most (75%) respondents wore CL to correct myopia, whereas 54% wore CL only occasionally. Surprisingly, only 24% knew the CL cleaning protocol. Lens solution was changed daily by 33% of users and after more than 2 weeks by 42%. Although 412 (82%) participants practised reasonable hand hygiene before inserting CL, 88 (18%) did not. Infection and eye dryness were statistically significantly (P < 0.01) associated with sex, hand-washing, and frequency of CL use.

Conclusion:

Noncompliance with the CL protocol was common among healthcare workers in our society. This behavior calls for targeted health education and awareness programs for healthcare workers.     

Single screw fixation in stable and unstable slipped upper femoral epiphysis

The aim of this single centre retrospective study was to assess the outcome of patients after the fixation of slipped upper femoral epiphysis (SUFE) using a single cannulated screw. Thirty-eight slips, 28 stable and 10 unstable were treated with single in-situ screw fixation. The minimum follow-up was 1 year. The overall adverse outcome in terms of avascular necrosis (AVN), chondrolysis and revision surgery for slip progression was 18%, which was considered satisfactory. Slip progression of more than 10° was higher in the unstable when compared with the stable group but not statistically significant. Two out of the nine satisfactorily fixed unstable slips required revision surgery as opposed to none in the stable group. The incidence of AVN in the unstable group was 20%. There were no cases of AVN in the stable group. The adverse outcome in terms of AVN, chondrolysis and revision surgery for slip progression was significantly higher in the unstable group. In our study, results of single screw fixation for SUFE were found to be satisfactory as shown by earlier studies with the unstable SUFEs as expected having a poorer outcome when compared with the stable SUFEs.