In the field of medical, each and every analysis is decisive as the study links to life of the subject under observation. One of the most vital area in the field of medical is the healthcare of expecting women in low income countries. High mortality rate due to increased number of caesarean section is evident because of poor medical infrastructure in the region, misunderstood religious teachings, low education and lack of proper decision making at the right time. The root cause analysis of situations demanding caesarean section is a tough job, however in the presence of historical data, one may extract useful information that will help supporting a medical decision by predicting the outcome. It is obvious that regional disparities have a huge impact on the residents of that region. A study performed on any region cannot be all applicable to the residents of some other distant region. This motive has established grounds to conduct a local study upon the data collected from expecting women in city Muzaffarabad, Kashmir. It is believed that the findings of this study will be significant for women that share more or less similar physical, social and maternal traits. Keeping this in mind, study presents an analysis of two clustering techniques for the investigation of appropriate algorithm that groups data into relevant clusters robustly. Firstly, we analyzed K-means and K-medoids algorithms' capability to cluster the data using different distance metrics. Secondly, data transformation techniques including scale, range and Yeo-Johnson are applied. Finally, transformed data are used in K-means and K-medoids algorithms' to generate cluster accuracy. It is observed that the results produced from transformed data are better than using raw data. Yeo-Johnson transformation method is found best for k-means (Hartigan & Wang), K-medoids (SEV distance function) and Rank k-medoids (SEV distance function) with mean accuracy 67.58%, 69.58% and 72.64% respectively.

Objective: To determine the frequency of breakthrough seizures among paediatric patients suffering from epilepsy, and factors related to theprecipitation of these seizures. Method: The cross-sectional study was conducted from July 1, 2018, to July 1, 2020, at the Combined Military Hospital Lahore and the Military Hospital, Rawalpindi, Pakistan, and comprised children of either gender aged 2-12 years diagnosed with any type of epilepsy presenting at the children outpatient department. Diagnosis of epilepsy was established by either a consultant adult neurophysician or a consultant paediatrician. The presence of breakthrough seizures was assessed by obtaining detailed history from the patient and the primary caregiver. Socio-demographic profile, duration of epilepsy and poly-pharmacy were noted. Data was analysed using SPSS 23. Results: Of the 450 subjects, 259(57.6%) were boys and 191(42.4%) were girls. The overall mean age was 6.353±4.732 years. The presence of breakthrough seizures was noted in 227(50.4%) subjects. Children with young age, with low family income, and those in need of poly-pharmacy showed significantly higher odds for breakthrough seizures (p<0.05). Conclusion: The incidence of breakthrough seizures in epileptic children was high despite the anticonvulsant agents that were previously effective in controlling seizures. Key Words: Breakthrough seizures, Childhood epilepsy, Anticonvulsants, Risk factors. Continuous...

Behcet’s disease (BD) classically presents with recurrent oral ulcers, genital ulceration, uveitis and skin manifestations. Middle-aged people are usually affected with the male gender being associated with severe variant of the disease. It can involve any organ system of the body. Although central nervous system and vascular involvement tend to occur less frequently, they are the commonest cause of mortality. We present a case of a 30-year-old man referred with suspicion of cerebral venous sinus thrombosis to our hospital and subsequently diagnosed with BD. The patient developed, despite being on immunosuppression and anticoagulation, extensive arteriovenous thrombi of lower limbs requiring catheter-directed thrombolysis with continuous 24-hour infusion of tissue plasminogen activator for refractory right lower limb venous thrombosis and placement of inferior vena cava filter to prevent pulmonary embolism. Later disease remission was achieved with rituximab.

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults. Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al. Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ± 11.47 years. Seven cases occurred in the months of winter and spring (December–March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution. We found 5 (45.45%) patients had a CSF opening pressure >180 mmH 2 O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients. When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.