Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis.

BACKGROUND: Long-term care facilities (LTC) plays a pivotal role in caring for geriatric population. However, the risk of suicide in long-term care institutions among older individuals is little understood (e.g., nursing homes, assisted living facilities). OBJECTIVE: The purpose of this systematic review is to pool and meta-analyze the data on prevalence of suicidal behaviors in geriatric population residing in long-term care facilities. METHODS: We have conducted the systematic review in accordance with the PRISMA guidelines. The utilized databases are Pubmed, Medline, Google scholar and Scopus. The Meta-analysis was done using OpenMeta [analyst] software. Subgroup analysis was also performed. RESULTS: After running an analysis on pooled data from twenty cross-sectional studies with 3,023,224 participants, the prevalence of suicidal behavior is 6.4% (95% CI = 5.7-7) in LTC. CONCLUSION: This meta-analysis shows pooled prevalence of suicidal behavior among geriatric residents of LTC was found to be moderately high all over the world.

Alteration in cerebrospinal fluid (CSF) markers associated with α-synucleinopathies.

Rapid eye movement sleep behavior disorder (RBD) is linked to other α-synucleinopathies such as Parkinson's disease and Lewy body dementia. It is essential to consider and exclude RBD while studying CSF markers in the latter two to avoid confounding bias and improve test results' specificity.

Prevalence of depression, anxiety and stress in china during COVID-19 pandemic: A systematic review with meta-analysis.

BACKGROUND: The novel coronavirus disease which is believed to have initially originated in Wuhan city of China at the end of 2019 was declared as pandemic by March 2020 by WHO. This pandemic significantly impacted the mental health of communities around the globe. This project draws data from available research to quantify COVID-19 mental health issues and its prevalence in China during the early period of the COVID-19 crisis. It is believed that this pooling of data will give fair estimate of the effects of the COVID-19 pandemic on mental health. METHODS: We conducted this study in accordance with PRISMA guidelines 2009. The protocol for this review is registered and published in PROSPERO (CRD42020182893). The databases used were Pubmed, Medline, Google scholar and Scopus. The studies were extracted according to pre-defined eligibility criteria and risk of bias assessment was conducted. The Meta-analysis was done using OpenMeta [analyst]. RESULTS: Total of 62382 participants in nineteen studies fulfilled the eligibility criteria. Stress was the most prevalent (48.1%) mental health consequence of Covid-19 pandemic, followed by depression (26.9%) and anxiety (21.8%). After performing subgroup analysis, prevalence of depression and anxiety in both females and frontline health care workers were high as compared to the prevalence in general Chinese population. CONCLUSION: The prevalence of depression and anxiety is moderately high whereas pooled prevalence of stress was found to be very high in Chinese people during this Covid-19 crisis.

Resolving mystery behind autonomous retrogression of low-grade gliomas: A systematic review.

OBJECTIVE: To review evidence-based data on spontaneous retrogression of low-grade gliomas with respect to interval till regression, type of glioma and patient outcome. METHODS: The systematic review comprised medical literature in English language published from January 1997 to January 2017 on Scopus, PubMed and Google Scholar databases to establish consensus about the possible mechanism of spontaneous regression, the role of therapeutic intervention and failure of management strategies in low-grade gliomas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed during the review. RESULTS: Of the 176 articles identified, 73(41.5%) were shortlisted for detailed assessment. Of them, 10(13.7%) were included; 5(50%) case reports and 5(50%) case series. There were 23 cases of spontaneous regression; 15(65.2%) males and 8(34.7%) females. The interval of regression varied from 3 months to 15.5 years, and the most commonly presenting low-grade glioma type was optic pathway glioma 11(47.4%). CONCLUSIONS: The phenomenon of regression was most evident in optic pathway glioma. Literature suggested that low-grade gliomas should undergo serial imaging before implying any therapeutic intervention. However, the evidencebased proof, large-scale experimental studies and ethical considerations are still required to standardise this strategy.

Morphometric features of Linea aspera on dry femur bones.

OBJECTIVE: To observe and describe the features of line a aspera in dry femurs. METHODS: The prospective observational study was conducted from October to December 2017 at Darul Sehat Hospital, Karachi, and comprised dry femurs. Data was collected by trained medical students. Observations of landmarks of linea aspera were taken using classical measuring techniques. Data was analysed using SPSS 21. RESULTS: There were 48 dry femurs with mean maximum length of linea aspera 133.4±22.4 mm, and mean minimum length 188±79 mm. The mean diameter of antero posterior thickness was 2.7±1.1 mm. Linea aspera was widest at its lower one third 30(62.5%) and narrowest at its middle one-third 5 (10.4%). The most common pattern on linea aspera was three ridges 26 (54.2%). Majority of bones had at least one uninterrupted ridge 32(66.7%). The most prominent ridge on linea aspera was lateral in 20 (41.7%) bones. The largest nutrient foramen in 19 (42.2%) bones was located at the level of proximal one-third of linea aspera.. CONCLUSIONS: linea aspera was widest at its lower one-third. In majority of bones the lateral ridge was the most prominent, and the largest nutrient foramen of femur was most commonly located at the level of proximal one-third of linea aspera.

Robotics in neurosurgery: A literature review.

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of virtual procedures which turn out to be of great succour for young apprentice surgeons to practise their surgical skills in a safe environment. It also allows senior professionals to rehearse difficult cases before involving into considerable risky procedures.

Prodromal depression and subsequent risk of developing Parkinson's disease: a systematic review with meta-analysis.

Aim: Parkinson's disease (PD) is a progressive neurological disorder that predominately affects dopaminergic neurons. We believe that this pooling of data will help to better understand the prodromal nature of depression in PD. Materials & methods: We conducted this study in accordance with PRISMA guidelines 2020. Fifteen eligible articles were shortlisted for final analysis. Risk of bias assessment was also conducted Results: The random-effect model revealed that the risk of subsequent PD in patients with prodromal depression was twice as likely (odds ratio, 2.04; 95% CI, 1.02-4.08) as compared with a healthy population. Conclusion: Our meta-analysis concluded that the subsequent risk of PD is significantly higher in patients with depression as compared with healthy individuals.

Parkinson's disease (PD) is a nervous system disease that predominantly affects neurons of the brain that controls voluntary movement and behavioral processes such as mood, reward, addiction and stress. There is a wide spectrum of problems that can present in patients with PD, however, there are few that can precede the beginning of the illness. Previous studies have evaluated the relation of psychiatric symptoms with PD. However, many aspects need to be studied to understand this relationship. The main emphasis of this systemic review is to establish the association of prodromal depression before the development of PD. Our study showed that there is a strong association between depression and PD and suggests an increased risk of developing PD in formerly depressed patients. Though, it is still unclear if depression is either an early prodromal symptom of PD or a causative risk factor for PD and warrants further studies to determine the causality relationship between the two.

Covid-19-Related Suicides in Pakistan, India, and Bangladesh: Can we Rely on Reporting System? A Rapid Systematic Review.

Purpose of Review: With other life-altering changes, Covid-19 pandemic has brought a mental health crisis upon the global community. Untreated psychological disturbances can lead to tragic outcomes such as suicide. Currently, the most feasible way to know the true burden of Covid-related suicides is through media reports. However, the standards of media-reported suicide cases and their compliance to WHO checklist of suicide reporting in Pakistan, India, and Bangladesh are concerning. The question that arises here is if we can truly rely on the media reporting system of these countries to establish exposure-causality relationship. We've attempted to gather the evidence of reporting sources of Covid-related suicide cases in Pakistan, India, and Bangladesh. We've conducted a systematic review in accordance with the PRISMA guidelines to identify the media-reported cases of COVID-related suicides. Recent Findings: After compilation of the results, it was observed that most of the reported cases were from India (74.2%) whereas males died of suicide more often than females. When risk of bias was assessed using Pierson's method, it was observed that 70% of the studies had high risk of bias. Summary: We've attempted to gather the evidence of reporting sources of Covid-related suicide cases in Pakistan, India, and Bangladesh and found that nearly all media reports hadn't followed the WHO reporting guidelines for suicide cases. This could lead to a false sense of panic among the general population.

Bibliometric Analysis of Publication Activity in the Field of GIANT Cell Arteritis: A SCOPUS-based Study.

Objective Giant cell arthritis (GCA) is a type of vasculitis which is more common in female gender and is closely associated with Polymyalgia rheumatic. One of its important complication include visual impairment. The burden of disease is expected to be very high by 2050 and there is a need to compile the data on most influential studies on GCA to define future strategy to deal with this dangerous disease. Bibliometrics is a statistical analysis of published literature that reflects the value and impact of a particular publication within the specific field. Aim of our study is identify the most significant contributors and their quality of contribution in the field. Method We conducted this analysis utilizing SCOPUS database using different related MeSH terms. After a detailed screening, the list of top-50 articles were presented in the results in descending order of their ranks on the basis of their total number of citation. Most of our data comprises of publications from 1971-2012. Result The top-50 most cited articles on GCA were published between 1971 and 2012 with the median number of citations 274 ranging from 598-187. Annals of Internal Medicine was the top ranked journal with 13 publications from the list. The highly ranked author based on the number of publications was Hunder GG (20 publications) with h-index of 40, retaining affiliation with Mayo Clinic, Rochester, United States. Mayo Clinic was the most frequently mentioned institute among the affiliations. The United States was found to be the most productive country rendering most of the articles (64%). Conclusion Our bibliometric analysis on Giant cell arteritis identifies the information which may direct future research contributions, identify field experts, guide researchers to fill knowledge gaps, and assist in research fund allocation.

A bibliometric analysis of top 50-most cited articles on repetitive trans-cranial magnetic stimulation (rTMS) for treatment of depression.

BACKGROUND: Citation count can be used as a key tool to assess the quality of the published literature and because of its immense advantages it is now widely used in ranking the articles on specific topics. OBJECTIVE/HYPOTHESIS: To extract and assess the top cited work on repetitive transcranial magnetic stimulation (rTMS) for depression treatment. METHODS: Scopus Library Database was searched and two independent authors produced a list of 50 most cited articles on repetitive transcranial magnetic stimulation (rTMS) for treatment of depression. All the relevant articles having key-terms within their titles, abstract and keywords were included in our search. Our list was categorized into two categories, "mixed" and "focused". RESULTS: The articles in the produced list of top 50 most cited articles on rTMS for treatment of depression belong to the time period 1993-2012 with total citation count 12078. George MS was prominent in the list. 'Biological Psychiatry' published most number of articles (n = 13) among the list. Articles were categorized on the basis of primary population and intervention into 'Focused' and 'Mixed' categories. LIMITATIONS: Articles that were published before 1993 and after 2012 on rTMS for depression couldn't made it to the final list of top-50 most cited article. CONCLUSION: We attempted to conduct a topic-specific citation analysis considering the paucity of specified bibliometrics in medical literature. Our research provides an insight on emerging trends in rTMS for depression and highlights the characteristics, quality and dynamics of frequently cited articles in the field.

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review.

The combination of bradycardia, renal failure, atrioventricular (AV)-nodal blocker medications, shock, and hyperkalemia (BRASH) is a new syndrome that is a consequence of a positive loop of bradycardia due to AV-nodal blockers and hyperkalemia secondary to renal insufficiency. We present a case of BRASH syndrome in which the patient on chronic AV-nodal blockers presented with bradycardia, hypotension, underlying kidney dysfunction, and hyperkalemia. The patient was medically managed and discharged upon clinical improvement. The purpose of this report is to highlight the rare cases of BRASH syndrome and improve its management.

Redundancy Is of No Good; Iatrogenic Hypervitaminosis D: A Rare Case of Persistent Vomiting Due to Hypercalcemia.

INTRODUCTION: Iatrogenic or physician-induced hypervitaminosis D is a rare cause of persistent vomiting. To the best of our knowledge, this is the first case report on iatrogenic hypervitaminosis D presenting with persistent vomiting in Pakistan. CASE REPORT: We report a rare case of continual vomiting for 15 days in a 48-year-old woman of Pakistani descent. She was a known case of diabetes mellitus for 8 years, which was well controlled at the time of presentation. CONCLUSIONS: The correct diagnosis of our patient was based on clinical suspicion, appropriate lab tests, and deliberation of the differential diagnosis. It is important to consider hypervitaminosis D as a cause of persistent vomiting if no other obvious is apparent.

Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management.

Severe aortic stenosis (AS) affects 3.4% of the elderly over 60 years of age. It presents with exertional dyspnea, syncope, angina, and progression to irreversible congestive heart failure. Early intervention produces a better outcome in preventing the clinical deterioration of AS. The choice of intervention is transcatheter aortic valve implantation or surgical aortic valve replacement (SAVR). The decision should be made after evaluating an individual case based on its clinical features and the user's experience with transcatheter aortic valve replacement (TAVR). We reviewed available data to illustrate the types of ASs, the background of interventions, current guidelines for TAVR, and its comparison with SAVR in terms of adverse effects.

Risk of Multiple Sclerosis in Epstein-Barr Virus Infection.

Multiple sclerosis (MS) is a chronic neuro-inflammatory, immune-mediated disorder of the central nervous system; however, less is known about its cause. It causes neurological disability in young adults, more commonly in women. Several risk factors including environmental, genetics, and infections have been identified, which contribute to the abnormal immune response. Viruses belonging to the Herpes family have been indicated as a potential risk for MS; their biological mechanisms are not known but several possibilities have been discussed. Epstein-Barr virus (EBV) is the leading and most common virus associated with MS. It is a potential oncogenic virus that hosts the B lymphocytes and has been associated with numerous cancers such as Burkitt's lymphoma, Hodgkin's lymphoma, and nasopharyngeal carcinoma. The risk of MS is low in patients who are EBV negative but increases by several folds in individuals who have a history of infectious mononucleosis (IM). Several ecological studies, co-occurring pathologies, and experimental laboratory-based research provide evidence to support the relationship between EBV and MS.

Prevalence of Anger in Medical Students: A Tertiary Care Experience from a Developing Country.

BACKGROUND:  Anger is defined as an emotional state that involves displeasure and consists of subjective feelings that vary in intensity, from mild irritation or annoyance to intense fury and rage. Anger is dangerous because it affects the health of the individual. It also affects relationships between fellow physicians and nurses and can ultimately compromise patient care. Medical school is perceived as stressful and a number of studies have proved the high prevalence of anxiety, stress, and depression in medical students. However, no significant studies have been performed to assess the frequency of anger in medical students. The purpose of our study is to find out whether anger is prevalent among medical students and its effect on different aspects of student's lives. METHODS:  A cross-sectional survey was conducted on the students from all five years of Liaquat National Medical College. Sampling technique used was nonprobability purposive sampling. A self-administered questionnaire was filled by medical students. Data were recorded and analyzed using the IBM statistics SPSS software. RESULTS:  A total of 205 students participated in the survey. Using the questionnaire, it was found that the highest frequency of anger was found in first-year students (97.5%), followed by the fourth year (97.4%), final year (97.2%), third year (95.7%), and second year (91.9%). All five years identified stress as a major predictor of anger. Anger had the greatest effect on decision making, especially in final year medical students. CONCLUSION:  Authors concluded a high frequency of anger in medical students. Increased stress has negative impacts on the mental health and coping strategies of students which greatly affect their decision-making power.

Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country.

BACKGROUND: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM. METHODS: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department of Neurology at Jinnah Medical College Hospital (JMCH), Karachi. In total 131 patients of TM were enrolled and treated as per standard protocol, and re-evaluated after eight weeks for assessment of clinical outcomes. RESULTS: The average age of patients was 51.15 ± 6.56 years. Out of 131 cases, 36.6% of patients had full recovery and 63.4% had poor recovery while recurrence occurred in 66.7% cases. Urinary frequency was observed in 12.2% cases and incontinence in 6.9% cases. CONCLUSION:  Acute TM has become transformed with recent developments, especially the advent of the MRI and the discovery of biomarkers.

Endovascular Coiling Versus Neurosurgical Clipping for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis.

Background Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping. Methods Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software. Results Mortality was found to be significantly higher in the endovascular coiling group (odds ratio (OR): 1.17; confidence interval (CI): 95%, 1.04, 1.32). Re-bleeding was significantly higher in endovascular coiling (OR: 2.87; CI: 95%, 1.67, 4.93). Post-procedure complications were significantly higher in neurosurgical clipping compared to endovascular coiling (OR: 0.36; CI: 95%, 0.24, 0.56). Neurosurgical clipping was a 3.82 times better surgical technique in terms of re-bleeding (Z = 3.82, p = 0.0001). Neurosurgical clipping is a better technique requiring fewer re-treatments compared to endovascular coiling (OR: 4.64; CI: 95%, 2.31, 9.29). Endovascular coiling was found to be a better technique as it requires less rehabilitation compared to neurosurgical clipping (OR: 0.75; CI: 95%, 0.64,0.87). Conclusion Neurosurgical clipping provides better results in terms of mortality, re-bleeding, and re-treatments. Endovascular coiling is a better surgical technique in terms of post-operative complications, favorable outcomes, and rehabilitation.

Comment to Empirical Therapy for Chronic Suppurative Otitis Media.

Chronic suppurative otitis media is an inflammatory condition characterized by disruption of tympanic membrane and aural discharge. It is one of the most incidental conditions in head and neck. There has been a substantial debate about the therapeutic approach for some decades now. From review of past medical literature, it was evident that culture and sensitivity is essential in eradicating the causative organism. However, the cost-effectiveness is a major concern for low-income population. Due to such concern, empirical therapy has proved to be a suitable therapeutic approach since commonly found organisms are highly sensitive to routine antibiotics.

Re-expression of the p53 Gene by Inhibiting the Mdm-2 Receptor in Wild-type p53 Tumors for the Treatment of Glioblastoma: A Mini Review.

Glioblastoma multiforme (GBM) has been the topic of immense research in recent years. The suitable therapeutic approach towards this wild-type p53 tumor has been the topic of ongoing discussion for some decades now. There has been a substantial debate about the role of mouse double minute-2 (MDM-2) antagonists in the treatment of GBM recently. We have reviewed the current data in our study to establish the consensus about recent interventions. Our review of the literature suggests that MDM-2 antagonists are currently a more suitable approach with improved efficacy, and it might be utilized in the future for significant results. Newer analogs of MDM-2 antagonists with better pharmacokinetics profiles and the least drug-drug interactions were also discussed in our research. It was concluded that MDM-2 antagonists are improved therapy against GBM but evidential proof with more experimental studies is needed to standardize this therapy in near future.

Advancement in Stem Cell Therapy for Ischemic Myocardial Cell: A Systematic Review.

Background: Cardiac muscle possesses a limited capacity to regenerate its tissue on its own. It is less likely to reverse the altered cardiac functioning to its normal physiological state after a major myocardial infarction. Stem cell transplantation provided a unique therapeutic approach in managing such injuries. There has been a substantial debate about the complexity, scope and medical application of stem cell transplantation in past few years. Materials and Methods: An extensive review of medical literature was conducted to establish the consensus about the possible mechanism of cell renewal, associated complications and risks of failure of this technique. Twenty cases of mammalian animals and twenty-four cases of stem cell transplantation in human subjects were reviewed. Results: Most common associated complication was re-stenosis of coronary artery. Few clinical trials reported the failure in improving cardiac functioning. The success rate of stem cell transplantation was remarkable in the literature related to experimental animal subjects. Conclusion: It was concluded that renewal of the cardiac cell is a result of induction of angiogenesis and prolonged cell survival. This topic still requires an immense amount of research to fill the gap in adequate knowledge.