Budding Medical Professionals And Covid-19: The Impact Of Covid-19 On Mental Health And Medical Students.

BACKGROUND: Due to the Novel Coronavirus Disease, medical education has transformed from a physical to an online-medium. The importance of physical education in low-and-middle-income countries (LMICs), where online education can be challenging there is a need to explore the factors that affect online education. This study assesses the perspective and mental health of students whose medical education has been impacted by the pandemic. Methods: An online-questionnaire was distributed through social media platforms from October-to-December 2020 through Google-Forms among medical students across Pakistan. Two grading-scales were used to score anxiety and depression. Descriptive statistics and a logistic regression analysis were used to identify factors associated with anxiety and depression among medical students. p<0.05 was considered as significant. Data was analyzed using STATA v.15. RESULTS: Total of 433 medical students participated in the study where 68.1% had some form of depression and 10.9% had anxiety. Around 65%-participants disagreed with the preference for online-classes. Seventy percent agreed on "Has the thought of the pandemic made you worry about your academic future" being associated with COVID-19 related-depression (OR: 2.03, 95%CI: 1.32-3.11). Multivariate analysis showed agreeing to "COVID affected my educational performance" was associated with anxiety (OR:1.45, 95%CI: 1.03-2.06) and depression (OR: 1.27, 95%CI: 1.03-1.56). CONCLUSIONS: Being part of the Low- and-Middle-Income Countries (LMIC), online-education itself becomes a challenge. Given the continued shutdown of universities across the country and the growing anxiety and depression amongst the students, adequate measures should be taken to help in coping up with the current challenge.

Hutchinson-Gilford Progeria Syndrome: A Literature Review.

Hutchinson-Gilford progeria syndrome (HGPS) is a premature aging condition that involves genetic mutations, resulting in debilitating phenotypic features. The present state of knowledge on the molecular pathways that contribute to the pathophysiology of HGPS and the techniques being tested in vitro and in vivo to combat progerin toxicity have been discussed here. Nuclear morphological abnormalities, dysregulated gene expression, DNA repair deficiencies, telomere shortening, and genomic instability are all caused by progerin accumulation, all of which impair cellular proliferative capability. In addition, HGPS cells and preclinical animal models have revealed new information about the disease's molecular and cellular pathways and putative mechanisms involved in normal aging. This article has discussed the understanding of the molecular pathways by which progerin expression leads to HGPS and how the advanced therapy options for HGPS patients can help us understand and treat the condition.

Therapeutic Role of Vitamin D in Multiple Sclerosis: An Essentially Contested Concept.

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the nervous system with incredibly intricate etiopathogenesis involving numerous genetic, epigenetic, and environmental risk factors. Major environmental risk factors include ultraviolet (UV) radiation, vitamin D, Epstein-Barr virus (EBV) infection, smoking, and high body mass index (BMI). Vitamin D, in particular, can be viewed as one piece of this puzzle, with various tabs and pockets, occupying a sequential site. In this article, we have briefly discussed the neuroimmunology of MS and the role of vitamin D in regulating immune responses. Various observational studies and clinical trials were reviewed and discussed according to stages of disease activity and course of the disease. The data reviewed in this article implied that serum vitamin D levels greatly influence the risk of developing MS and disease activity. Long-term follow-up studies indicated that low serum vitamin D levels correlate with worse disability outcomes. Since clinical trials did not provide significant evidence, the role of vitamin D in controlling disease activity remains unresolved. Larger clinical trials are needed to support the findings of observational studies and provide significant evidence in favour of vitamin D.

Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod.

Celiac disease (CD) is a small intestinal inflammatory disease commonly seen in the Western population. It has been observed that patients with monoglandular and polyglandular autoimmunity have a higher prevalence of celiac disease. Hashimoto's thyroiditis (HT) and Graves' disease (GD), which mainly constitute the autoimmune thyroid diseases (AITD), characterized by lymphocytic infiltration of the thyroid parenchyma, are noted to be frequently associated with celiac disease. The fundamental mechanism of this frequent coexistence is thought to be a shared genetic background. Due to the subclinical nature of the celiac disease, the diagnosis is often missed or made coincidentally during screening. The rising prevalence of the celiac disease among AITD patients has urged researchers to investigate the link between the two. We reviewed the most recent and relevant literature on the intriguing relationship between celiac disease and thyroid autoimmunity. The objectives of this article were to study the shared genetic background, the incidence of CD in AITD, the effect of a gluten-free diet on AITD, and the need for routine screening of CD in AITD patients.

Anemia and Heart Failure: A Narrative Review.

Anemia in heart failure patients is a relatively common finding and has been linked with an increased risk of hospital admissions, morbidities, and significant mortality making its correction a significant factor in improving the quality of life and clinical outcomes in those suffering from it. This review article has discussed the multifactorial pathophysiology, including iron deficiency, longstanding inflammation, abnormal levels of human erythropoietin (Epo), and the abnormal activation of the renin-angiotensin-aldosterone system (RAAS) being the most significant. The diagnostic guidelines as well as research-based management modalities specifically with iron supplements and erythropoietin stimulating agents have also been discussed, although research done in this area has been limited and shown conflicting results.

Magnesium and Hypertension: Decoding Novel Anti-hypertensives.

Hypertension (HTN) is a complex multifactorial disease that is one of the most prevalent disorders in our modern world. It can lead to fatal complications like coronary artery disease (CAD) and congestive heart failure (CHF) in high-risk individuals. The silent nature of HTN also contributes to its immense caseload and, today, with a number of combinations and various antihypertensive agents, patient compliance is becoming increasingly difficult. This article has reviewed the role and mechanisms of magnesium (Mg) in reducing HTN in the human body so as to provide more information that may help include it as a mainstream antihypertensive regimen. This review has also shed light on the cardioprotective nature of Mg against pathologies like CHF with special mention to patient groups who are at high risk for low Mg levels. Many studies included in this article solidify the former link, but some also provide contradicting data.

Virtual Screening Approach to Identify High-Affinity Inhibitors of Serum and Glucocorticoid-Regulated Kinase 1 among Bioactive Natural Products: Combined Molecular Docking and Simulation Studies.

Serum and glucocorticoid-regulated kinase 1 (SGK1) is a serine/threonine kinase that works under acute transcriptional control by several stimuli, including serum and glucocorticoids. It plays a significant role in the cancer progression and metastasis, as it regulates inflammation, apoptosis, hormone release, neuro-excitability, and cell proliferation. SGK1 has recently been considered as a potential drug target for cancer, diabetes, and neurodegenerative diseases. In the present study, we have performed structure-based virtual high-throughput screening of natural compounds from the ZINC database to find potential inhibitors of SGK1. Initially, hits were selected based on their physicochemical, absorption, distribution, metabolism, excretion, and toxicity (ADMET), and other drug-like properties. Afterwards, PAINS filter, binding affinities estimation, and interaction analysis were performed to find safe and effective hits. We found four compounds bearing appreciable binding affinity and specificity towards the binding pocket of SGK1. The docking results were complemented by all-atom molecular dynamics simulation for 100 ns, followed by MM/PBSA, and principal component analysis to investigate the conformational changes, stability, and interaction mechanism of SGK1 in-complex with the selected compound ZINC00319000. Molecular dynamics simulation results suggested that the binding of ZINC00319000 stabilizes the SGK1 structure, and it leads to fewer conformational changes. In conclusion, the identified compound ZINC00319000 might be further exploited as a scaffold to develop promising inhibitors of SGK1 for the therapeutic management of associated diseases, including cancer.

Frequency and clinicopathologic correlation of different types of non Hodgkin's lymphoma according to WHO classification.

OBJECTIVES: To analyze the frequency and clinicopathologic correlation of different types of Non Hodgkin's Lymphomas (NHL) according to WHO classification of lymphoid neoplasms. METHODS: Total sixty two consecutive biopsy proven cases of NHL, from October 2008 to June 2010, were selected. The inclusion criteria was, all newly diagnosed patients of NHL with appropriate clinical information regarding age, gender, anatomic location and occurrence of B symptoms. All the cases were evaluated on Haematoxylin and Eosin (H & E) and special stains. Cases were subjected to Immunohistochemistry (IHC) using extensive panel of antibodies and classified according to WHO classification of lymphoid neoplasms. RESULTS: Clinical data showed that 42 (67%) were males and 20 (33%) females. The male to female ratio was 2.6:1. The age range was 6 to 80 years. Mean age for males was 39.6 +/- 17.3 years and for females 45.1 +/- 17.8 years. The B cell lymphoma comprised of 85.5% as compared to T cell lymphoma consisting of 14.5%. The extra nodal involvement was seen in 25 (40.3 %) cases, while 37 (59.3%) cases showed nodal involvement. The B symptoms were found in overall 29 (46.7 %) cases. CONCLUSION: B cell NHL is more common as compared to T cell lymphoma. Diffuse large B cell lymphoma (DLBCL) was the most frequent B cell lymphoma. The major bulk of T cell lymphomas comprised of anaplastic large cell lymphoma (ALCL). Significant association was seen in the occurrence of B symptoms with extra nodal origin and male gender.

Frequency of Helicobacter pylori in biopsy proven gastritis and its association with lymphoid follicle formation.

OBJECTIVE: To determine the frequency of H. pylori infection in biopsy proven gastritis and its association with lymphoid follicle formation. METHODS: This was a cross sectional study conducted at the Department of Histopathology, Dow Diagnostic Reference and Research Laboratory between January 2008 and December 2009. Analysis of 185 gastric antral biopsy specimens was done. Tissue sections were stained with haematoxylin and eosin for histological examination for severity of gastritis and lymphoid follicle formation. Giemsa stain was used for H. pylori assessment. RESULTS: Out of 185 cases, H pylori was found in 114 (61.6%) patients. Frequency of H. pylori infection was seen in fourth and fifth decades as 17.8% and 15.1% respectively. A total of 51 (27.6%) cases in which lymphoid follicle formation was found, 44 (38.6%) were associated with H. pylori infection. This association was statistically significant (p value < 0.0005) by using Chi square test. CONCLUSION: The frequency of H. pylori infection is common in our population, moreover, significant association is seen between lymphoid follicle formation and H. pylori infection.