Forebrain epileptiform activity is not required for seizure-induced apnea in a mouse model of Scn8a epilepsy.

Sudden unexpected death in epilepsy (SUDEP) accounts for the deaths of 8-17% of patients with epilepsy. Although the mechanisms of SUDEP are essentially unknown, one proposed mechanism is respiratory arrest initiated by a convulsive seizure. In mice, we have previously observed that extended apnea occurs during the tonic phase of seizures. Although often survived, tonic seizures became fatal when breathing did not immediately recover postictally. We also found that respiratory muscles were tonically contracted during the apnea, suggesting that muscle contraction could be the cause of apnea. In the present study, we tested the hypothesis that pyramidal neurons of the motor cortex drive motor units during the tonic phase, which produces apnea. Mice harboring the patient-derived N1768D point mutation of an Scn8a allele were crossed with transgenic mice such that inhibitory Designer Receptors Exclusively Activated by Designer Drugs (DREADD) receptors were selectively expressed in excitatory forebrain neurons. We then triggered audiogenic and hippocampal (HC) stimulated seizures under control conditions and when excitatory forebrain neurons were inhibited with the synthetic ligand Clozapine-N-Oxide (CNO). We found that inhibition with CNO was sufficient to increase seizure threshold of HC stimulated, but not audiogenic, seizures. In addition, regardless of seizure type, CNO nearly eliminated epileptiform activity that occurred proximal to the tonic phase; however, the seizure behaviors, notably the tonic phase and concomitant apnea, were unchanged. We interpret these results to indicate that while cortical neurons are likely critical for epileptogenesis and seizure initiation, the behavioral manifestations of tonic seizures are generated by neural circuitry in the mid- and/or hindbrain.

Physiological effect of cholecystectomy on lipid profile of patients with cholelithiasis

Background:The association of cholecystectomy with alterations in lipid profile is well documented. Objectives of this study were to determine the effect of cholecystectomy on lipid profile of cholelithiasis patients.Methods:This cross-sectional observational study was done on 170 patients admitted in general surgery department of Naz Memorial Hospital, Karachi from July 2018 to June 2019. Symptomatic cholelithaisis patients between 18 to 60 years, elective cholecystectomy was included while patients previously on lipid lowering agents, diagnosed renal failure, nephrotic syndrome, cardiac failure, pregnant mothers, hypothyroidism, pancreatitis and obstructive jaundice were excluded. For data analysis, SPSS was used. Wilcoxon signed ranked test was used to compare mean values of pre-and post-operative lipid profiles after cholecystectomy keeping p value of <0.05 as significant.Results:60% of patients were females with majority, 31% patients between 31-40 years while least, i.e. 11% were between 61-70 years. The mean pre-operative and post-operative difference of 52±7.32 mg/dl was seen in total cholesterol levels (p<0.001). The mean difference in high density lipoprotein (HDL)between preand post-operative was of 13±0.36 mg/dl (p<0.001). The mean difference in low density lipoprotein (LDL) between preand post-operative was 61±10.45 mg/dl (p<0.001). The mean difference in triglycerides levels between preand post-operative was 46±25.49 mg/dl (p<0.001).Conclusions:Cholecystectomy in gall stone disease patients elicited favorable response in significantly lowering levels of total serum cholesterol, LDL and triglycerides while substantially increasing levels of HDL cholesterol.

Management of obstetric hemorrhage; an observational study highlighting the efficacy of uterine artery ligation

Background: Obstetrical hemorrhage is leading cause of maternal mortality. UAE is termed safe and effective method for resolving hemorrhage. objective of this study was to determine efficacy of uterine artery ligation in management of obstetrical hemorrhage.Methods: This cross sectional observational using non-probability convenient sampling technique was carried out for six months. After ethical approval, females between 18 to 35 years diagnosed with obstetrical hemorrhage, uterine atony refractory to medical treatment, having active bleeding from placental side or having normal coagulation profile were while females with post-partum hemorrhage because of retained products of conception, due to genital tract trauma or with disseminated intravascular coagulation were excluded. Analysis of data was done using SPSS version 23.0. Quantitative variables were reported as mean and standard deviation and for qualitative variables, frequency and percentages. Chi-square test was applied keeping p-value of <0.05 as statistically significant.Results: From 109 females with mean age 47±5.25 years. In comparison of parity distribution, 62 (56.88%) were multiparous and 47 (43.12%) were primiparous. Type of bleeding observed was antepartum 36(33.03%), peripartum 39 (35.78%) and postpartum in 34 (31.19%). Efficacy of uterine artery ligation in management of obstetric hemorrhage was observed to be 35 (32.11%). The efficacy of uterine artery ligation in management of obstetric hemorrhage in three categories of age groups reported significant association (p=0.0005) and type of bleeding (p=0.025).Conclusions: Efficacy of UAE in different types of obstetrical hemorrhage reported in our study was lower than expected in about one-third of females.

Helicobacter pylori infection among type 2 diabetics: a case control study

Background: Helicobacter pylori infection has been associated with hyperglycemia among type 2 diabetics. The objective of this study was to compare the H. pylori infection frequency in diabetic and non-diabetic patients.Methods: This case-control study was done at Al-Tibri Medical College and Hospital from May 2019 to August 2019. After written and informed consent, patients between 18-75 years with epigastric burning, dyspepsia, regurgitation were included and with history of eradication therapy, antibiotic or NSAID use in the last 6 months or surgery of upper GI tract months were excluded. Type 2 diabetics were placed in one group and non-diabetic individuals in another. Both groups were compared for presence of H. pylori infection. Data was analysed using SPSS. Demographic variables included age, gender and status of H. pylori infection. Quantitative data was expressed as frequency and percentages. Chi-square test was applied to test for significance keeping p-value of <0.05 statistically significant.Results: From 480 patients, 355 patients showed positive H. pylori, among them 282 were diabetic and 73 non-diabetic (p-value <0.001). Amongst the 355 diabetics, 55% were male Among 73 non-diabetics, 64% were male. All the patients in the study had dyspeptic symptoms and complained of dyspepsia, epigastric burning and regurgitation.Conclusions: A substantial relationship between H. pylori infection among type 2 diabetes mellitus patients was observed compared to non-diabetics. As a result, diabetic patients having active dyspeptic symptoms should undergo further confirmatory tests for diagnosing H. pylori infection.

Disparities among pediatric hospital admissions according to gender

Background:The objective of the study was to determine the pattern of disparities among paediatric hospital admissions according to gender.Methods:This retrospective observational study was done at pediatric ward of Al-Tibri Medical College and Hospital Karachi from June 2018 to May 2019. Pediatric patients below 12 years of age admitted to the pediatric ward of the hospital were included while patients who were admitted for less than 24 hours, refused for consent by parent/guardian, surgical or ICU pediatric patients were excluded. SPSS was used for data analysis. Quantitative data included age, gender, diagnosis and seasonal variation, expressed as frequency in percentages and chi-square test was applied to test for significance.Results:Among 734 pediatric hospital admissions, 423 (58%) were males and 311 (42%) females. Highest percentages of pediatric admission in both genders were infants afterwhich second most patients were from the 1-4 years group in both genders (p=0.01). 215 patients of acute gastroenteritis were male while 142 females. Among patients admitted with respiratory disease, 56 were males while 48 were females. 52 male patients were admitted with viral fever while 34 patients admitted were females (p=0.01).Conclusions:Our study reported a significant difference among gender variances in pediatric hospital admissions. Overall, not only males were predominant in admission to pediatric wards, they were also found to be predominant in disease categorization. Further studies set to determine the reasons behind such gender differences would help in determining plans accordingly to improve outcome of diseases

Perception of medical students regarding breast feeding at Al Tibri Medical College and Hospital: a comparative study

Background: Breast milk is an ideal feed for infants, and it is effective in ensuring child health and survival. The study was done to assess the perception regarding breastfeeding among medical students of basic and clinical sciences and to compare knowledge regarding feeding among basic sciences with clinical sciences students.Methods: This cross-sectional survey was done at Al-Tibri Medical College and Hospital over a period of 6 months from February 2019 till July 2109. A self-generated Questionnaire was used to assess the perception of 367 medical students regarding breast feeding from basic and clinical sciences of medical students. Result was statistically analyzed using SPSS version 22. Chi-square test was used to compare qualitative data, p-value <0.05 was considered significant.Results: A total of 367 students participated in the study with 159(43.3%) from basic medical sciences and 208(56.7%) from clinical sciences. Out of respondents, 54.5% were females. Internet was the main source of knowledge (47.3%) as shown in the graph, 74.1% were native. Generally, the majority of students from clinical group had a better perception regarding breastfeeding initiation and continuation along with infant and maternal benefit. Clinical science group had an edge on the basic science group with reference to their perception of breastfeeding in special circumstances.Conclusions: Medical universities are the main platform for future physicians, so knowledge regarding breast feeding promotion and practices should be given from this stage.

Patient satisfaction after cataract surgery using visual functioning questionnaire

Background: NEI VFQ-25 questionnaire is widely used to determine different health benefits to patient’s daily activities, social and mental health. The objective of this study was to determine satisfaction of patients undergoing cataract surgery.Methods: After ethical approval, a cross-sectional study using non-probability convenient sampling technique was done. Post-operative cataract patients between 18-75 years of both gender were included and patients reluctant to participate, <18 years of age or above 75 were excluded. SPSS version 20 was used for data analysis. Scoring of NEI VFQ-25 questionnaire was done. Chi-square test was applied between groups of patients with or without glasses using distant and near visual acuities keeping p-value of ≤0.05 as significant.Results: Mean age of 100 patients was 58.56±9.63 years, 78 patients were female housewives. Significant improvements in visual acuities was reported with distant or near vision with or without glasses after cataract surgery (p-value <0.01). Patient’s difficulties in worrying with eye sight, reading newspapers, reading stuff well up close, reading street signs, having issue in visiting others, going out to movies/plays, feeling of accomplishing less, having limited endurance and need for help from others in order to perform visual tasks were associated independently with reduced visual acuity and visual impairment.Conclusions: Cataract surgery significantly improved patients’ visual acuities, daily activities, mental and social health issues. Most patients were satisfied with cataract surgery and had fulfilling improvements to post-operative quality of life.