Psychiatric implications of anti-seizure medications in epileptic population.

BACKGROUND AND OBJECTIVE: Epilepsy is a prevalent neurological disorder that affects a significant number of individuals globally. This condition is associated with a high occurrence of psychiatric comorbidities, which can significantly affect the quality of life of individuals affected. The aim of this study was to investigate the association between antiseizure therapies and the likelihood of psychiatric comorbidities in individuals with epilepsy. METHODOLOGY: Data for this study was gathered from the Neurology referral center in Islamabad, Pakistan. A standardized questionnaire was utilized to gather data from 120 individuals diagnosed with epilepsy. The survey consisted of inquiries regarding the management of seizures, the utilization of anti-seizure medications, and the presence of psychiatric comorbidities. The data was analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The findings indicated that individuals who were using multiple antiseizure medications had a notably higher likelihood of having psychiatric comorbidities in comparison to those who were on mono therapy (p = 0.010). suggests that patients with unsuccessful seizure control are more probable to have psychiatric comorbidities as compared to those with good seizure control (p = 0.029). CONCLUSION: To conclude poor seizure control and poly therapy are associated with increased risk of psychiatric comorbidities.

Collagen Type XI Inhibits Lung Cancer-Associated Fibroblast Functions and Restrains the Integrin Binding Site Availability on Collagen Type I Matrix.

The tumor microenvironment, including cancer-associated fibroblast (CAF), plays an active role in non-small cell lung cancer (NSCLC) development and progression. We previously reported that collagen type XI and integrin α11, a collagen receptor, were upregulated in NSCLC; the latter promotes tumor growth and metastasis. We here explored the role of collagen type XI in NSCLC stroma. We showed that the presence of collagen type XI in collagen type I matrices inhibits CAF-mediated collagen remodeling and cell migration. This resulted in the inhibition of CAF-dependent lung-tumor cell invasion. Among the collagen receptors expressed on CAF, we determined that DDR2 and integrin α2ß1, but not integrin α11ß1, mediated the high-affinity binding to collagen type XI. We further demonstrated that collagen type XI restrained the integrin binding site availability on collagen type I matrices, thus limiting cell interaction with collagen type I. As a consequence, CAFs failed to activate FAK, p38 and Akt one hour after they interacted with collagen type I/XI. We concluded that collagen type XI may have a competitive negative feedback role on the binding of collagen type I to its receptors.

Feasibility of low-cost accelerometers in measuring functional recovery after major oncologic surgery.

BACKGROUND AND OBJECTIVES: Low-cost consumer-based activity monitors (CAMs), such as the Fitbit, are popular for fitness and wellness tracking. Functional status is an excellent predictor of postoperative outcomes, yet objective measurements are resource-intensive. The aim of this study is to demonstrate the feasibility of using activity monitors during the perioperative period in patients undergoing major oncologic surgery. METHODS: An institution review board proved that a prospective study was conducted. CAMs were worn throughout the perioperative period and accelerometer data were collected. Baseline and 21-days follow-up functional measures included short physical performance battery, Community Health Activities Model Program questionnaire, mobility assessment tool-short form, and 400 m walk. RESULTS: A total of 19 of 22 (86%) patients who wore a CAM during the perioperative period had analyzable data. Compliance with wearing the device varied significantly: 100% preadmission, 19% in-hospital, and 82% postdischarge. Median daily steps decreased from preadmission to postdischarge (77% median reduction). Established resource-intensive measures of functional status did not perform well as measures of decreased functional status and activity when comparing baseline to 21-day postdischarge assessments. CONCLUSIONS: Activity monitors are a feasible, low-cost measure of perioperative activity for patients undergoing major surgery, and may be useful in identifying patients vulnerable to postsurgical complications.

Knowledge of head and neck cancer among medical students in the UK.

Head and neck cancer (HNC) refers to malignancies found in mucosal surfaces anywhere from the paranasal sinuses to the larynx, including the various glands and cavities. Between the years 2016 and 2018, there were about 3900 new cases every year in women and 8600 in men, making it the thirteenth most common cancer in women and fourth most common in men. The aim of our study was to evaluate the amount and type of teaching United Kingdom (UK) medical students receive on HNC, and to assess their current knowledge of these cancers. An online survey distributed via university representatives was responded to by 311 final year medical students from 25 medical schools across the UK. Regarding HNC teaching, 72 students (23.2%) reported receiving no teaching at their medical school. Of the 239 who reported receiving teaching, 169 (54.3%) received it in the format of a non-interactive, large group lecture. A total of 271 respondents (87.1%) believed that medical students at their university would benefit from more teaching on HNC. Based on our sample, there appears to be an overall dissatisfaction and lack of confidence surrounding HNC in the undergraduate curriculum. With its increasing prevalence in the UK, it is vital that red-flag symptoms and referral criteria are understood by the future medical workforce.

Upstage Rate of Complex Sclerosing Lesions/Radial Scars.

BACKGROUND: Radial scars (RS) and complex sclerosing lesions (CSL) are breast radiologic findings described as small, stellate lesions causing architectural distortion. This can mimic malignancy. Core needle biopsy (CNB) is often performed. Advances in breast imaging have led to increased detection of RS/CSL. The upstage rate of RS/CSL to in situ or invasive disease is 0-40%. We sought to determine the upstaging rate of RS/CSL to in situ, invasive disease, or high-risk lesion at our institution to create excision guidelines. METHODS: The pathology database of a single center was searched for RS/CSL, from January 2013 to September 2020. We included CNB without malignancy or high-risk lesion (eg, atypical ductal hyperplasia). Patient demographics, indications for biopsy, imaging findings, biopsy procedure, and final pathology were collected. RESULTS: Forty-four patients were included. 52.3% had CNB for architectural distortion on mammography, 18.2% for mass, 11.4% for calcifications, 2.3% for abnormal MRI, and 15.9% for multiple reasons (eg, calcifications and mass). Most had an ultrasound: 43.2% had no abnormality and 34.1% had a mass. All CNB were vacuum assisted, 65.9% with 9-gauge needle, and averaged 10.0 cores. 77.3% were stereotactic biopsies, 13.6% ultrasound, and 6.8% MRI. 59.1% had excision after CNB. 82.1% of patients did not upstage. One patient upstaged to invasive ductal carcinoma (3.6%) and two patients to high-risk lesion (7.1%). DISCUSSION: There was low upstage rate of RS/CSL on excisional biopsy. Centers could consider close surveillance for RS/CSL on CNB. Longer follow-up in cases of deferred excision is needed to ensure oncologic safety.

Assessment of spring water microbiology and role of Typha angustata as biosorbent.

More than 2.1 billion people worldwide are deprived of safe drinking water at homes. The situation is strikingly worse in a developing country like Pakistan where over 69% of the population does not have access to safe drinking water. The present study evaluated a perenial herb, Typha angustata (TA), to purify the spring water. For this purpose, 25 water samples were collected. Majority of samples (20/25) were highly contaminated with microbes ranging colony forming units (CFU) per millileter per Petri dish ranged from 85 to 279 with an average of 136.4. Microbial inhibition of water samples treated with the nonmodified plant extract was observed to be better with the average of 55.5% compared to the treatment with NaOH chemically modified plant where average 46.4% inhibition of microbial load was observed. Four species of microbes such as Bacillus cereus, Pseudomonas aeruginosa, Pseudomonas otitidis, and Streptococcus agalactiae were identified after sequencing. We concluded that T. angustata extract may be used as an antibacterial agent/biosorbent for the purification of drinking water to provide safe drinking water to billions of humans. PRACTITIONER POINTS: Spring water samples were collected from 25 different springs. Spring water samples were analyzed for physiochemical parameters. Spring water samples were found to be contaminated with pathogenic bacteria, that is, Bacillus cereus, Pseudomonas aeruginosa, Pseudomonas otitidis, and Streptococcus agalactiae. Pathogenic bacteria in spring water samples were treated with extract of Typha angustata. Extract of Typha angustata was found as a potential antibacterial agent against pathogenic bacteria.

A pragmatic randomized controlled trial comparing pathway-based versus usual care in community-acquired acute kidney injury.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular or interstitial disease, and pregnant women were excluded. Thirty-eight patients were enrolled from March 2012 to December 2013. The primary outcome was LOS. Secondary outcomes included: 30-day readmission, in-hospital mortality, determinants of LOS, and patient-centered outcomes. Eighteen patients were randomized to PC, and 20 to UC. Baseline characteristics were comparable in both groups. Using an intention-to-treat analysis, the median LOS was 4.96 [interquartile range (IQR) 6.57] and 4.80 days (IQR 6.84) for PC and UC, respectively (P = 0.770). Of the five readmissions, none were for AKI. No in-hospital mortality was reported. The CHAMP-Path AKI pragmatic trial demonstrated that PC was not different than UC in reducing LOS. There was no difference in 30-day re- admission, in-hospital mortality, and patient-centered outcomes.