Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature

Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.

Callus Induction, Proliferation, Enhanced Secondary Metabolites Production and Antioxidants Activity of Salvia moorcroftiana L. as Influenced by Combinations of Auxin, Cytokinin and Melatonin

Abstract: Tissue culture technique is one of the best methods to reproduce salvia plant Therefore, the aim of this research was to enhance the in-vitro callus proliferation and production of secondary metabolites of S. moorcroftiana using different combinations of auxin, cytokinin and melatonin. Initially, callus induction was optimized using indole acetic acid (IAA), 2, 4-dichlorophenoxy acetic acid (2,4-D), and naphthalene acetic acid (NAA) applied at different concentrations in combination with 1 mg L-1 of 6-benzylaminopurine (BAP). The results indicates that earliest days to callus induction (14.67 days) was occurred in the media fortified with 2, 4-D+BAP (2.0+1.0 mgL-1). Whereas the highest callus initiation (100%) was induced on MS medium incorporated with 2,4-D+BAP (1+1mgL-1). Furthermore, maximum fresh weight was obtained when 2,4- D + BAP at the rate of (1+ 1mg L-1) was incorporated and dry weight was attained when 2,4- D + BAP at the rate of (2+1 mg L-1) was added to MS media. The maximum fresh and dry weight was obtained when melatonin at rate of 1.5 mg L-1 was supplemented with MS media including 2,4-D + BAP (1+1mg L-1), moreover the maximum DPPH scavenging activity, total phenolic and flavonoid content was noted when supplemented with melatonin at rate of 1.5 mg L-1. In conclusion, among various concentrations of plant growth regulators, 2,4- D + BAP at the rate of (1+ 1mg L-1) along with 1.5 g L-1 melatonin was the best for callus growth and production of secondary metabolites of S. moorcroftiana.

Risk factors and outcomes of uterine rupture in Singapore: Emerging trends

INTRODUCTION@#Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred uterus and abnormal placentation are known contributory factors. The aim of our study was to review the contributing factors, clinical presentation, complications and management of uterine rupture in our population in light of the changing nature of modern obstetric practices.@*METHODS@#A retrospective observational study was conducted at KK Women's and Children's Hospital by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These cases were analysed according to their past history, clinical presentation, complications, management and outcome.@*RESULTS@#A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately 3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the antenatal period, while abnormal cardiotocography findings were the most common presentation in intrapartum rupture.@*CONCLUSION@#There is a notable shift in the trend of uterine rupture cases given the increasing use of laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their pregnancy care.

Clinical correlation of vitamin D in depression

Background: Literature has substantially advanced our understanding of the action of vitamin D in depression, much is still unknown concerning how vitamin D relates to dimensions of depression. Hence, authors aimed to examine the relationship of vitamin D in patients of depression, its correlation with the severity of depression and different symptom domains of depression.Methods: This Hospital based case control study included 75 patients with depression and 50 controls who were age and gender matched. Beck’s Depression Inventory II was used to assess the severity and symptom domains of depression. Vitamin D levels was assessed using Enhanced Chemiluminescence Technique.Results: Vitamin D deficiency was found significantly (<0.001*) among cases than controls. Significant (0.003*) inverse correlation was observed between severity of depression and vitamin D level.In cognitive symptoms, pessimism, punishment feeling, self-criticism, suicidal thoughts and worthlessness were found significantly higher among vitamin D deficient patients. However, in somatic-affective symptoms, crying, indecisiveness, loss of energy, irritability, concentration difficulty and being tired were the significant by prominent symptoms in vitamin D deficient patients.Conclusions: Vitamin D (<50 nmol/L) was found to be significantly associated with depressive symptoms with cognitive and somatic-affective symptoms being affected by vitamin D deficiency.

Depression and anxiety in patients with epilepsy

Background: Anxiety and depression are commonly found in epileptic patients. However, the etiology behind the mechanism remains multifactorial, mostly because of variability in study settings. In order to fill the knowledge gap, we investigated the prevalence of anxiety and depression among epileptic patients and their correlation with certain demographic variables.Methods: In a Cross Sectional Out Patient Based Study, a total of 147 patients with epilepsy were recruited and evaluated for inclusion and exclusion criterion. Participants who met the inclusion criterion were assessed using standardized scales HARS and HADS rating scale for anxiety and depressive symptoms respectively.Results: 100 participants were included with mean age of 33.63 years for men and 30.16 years for females. 27% showed mild to severe anxiety and 21% had mild to moderate depression. Prevalence of both anxiety and depression was found more among females, singles, participants from urban background and having partial epilepsy. Significantly (p-0.020*) higher anxiety was seen in patients with partial epilepsy than those with generalized epilepsy.Conclusions: Individuals with partial epilepsy are more prone to get affected from comorbid disorder like anxiety and depression, especially females, singles and those from urban domicile.

General public perceptions and knowledge on tooth bleaching in Riyadh, KSA

Objective: To assess the perceptions and knowledge on tooth bleaching among general public in 5 different areas in Riyadh, KSA

Method: We assessed a population sample of 300 individuals aged between 15 and 65 years old resident in Riyadh region [2016]. We used frequency distribution and Chi-square test to investigate the association between socio-demographic factors and knowledge/use of bleaching products

Results: The sample is consisted of 66.7% of males and 33.3% of females. 83.3% of the respondents reported knowing bleaching products and advertisements seemed to be the most popular source of information [65.2%]. However only 53.1% reported using bleaching products. Most respondents tried using bleaching products at home [86%], while only 9% undergone tooth bleaching treatment in dental clinics. The commonest reason reported for bleaching was to improve esthetics [66.7%]. Data analysis showed that knowledge of bleaching in Riyadh City is not related to gender, nationality, education and occupation [p >0.05]

Conclusion: Large majority of patients were not happy with the appearance of their teeth, the main complaint being the color. Most of the patients knew that bleaching is a treatment option to improve dental aesthetics, and those who knew only half tried the treatment. More efforts are needed by the dental professions

Health-seeking behaviour of people living with HIV/AIDS and their satisfaction with health services provided at a tertiary care hospital, Karachi, Pakistan

Appropriate health-seeking behaviour is important as it allows prompt treatment for a condition and this can reduce complications and improve quality of life. This study aimed to assess the health-seeking behaviour and satisfaction with health care services of people living with HIV/AIDS attending the HIV/AIDS clinic of the Civil Hospital in Karachi. A total of 182 patients were interviewed using a pretested semi-structured questionnaire. Mean age of the participants was 32.31 [SD 7.91] years, 76.9% were male, 81.3% had no education and 75.8% were employed. Only 23.6% showed positive health-seeking behaviour and 57.7% were satisfied with the health care services. In logistic regression analysis, the cost of treatment per visit < US$ 5 and duration of HIV infection < 2 years were significantly associated with health-seeking behaviour. Efforts are needed to improve the health-seeking behaviour of people living with HIV/AIDS at the clinic and the health services offered

Assessment of parents' attitude toward EPI [expanded program on immunization] in tertiary care hospitals of Karachi

Objective:To assess parents' attitude toward EPI [Expanded program on Immunization] in three Tertiary Care Hospitals of Karachi

Materials and Methods:This cross sectional hospital based study was conducted at three tertiary care hospitals of Karachi,PNS SHIFA Hospital, Jinnah Postgraduate Medical Center [JPMC] and Liaquat National Hospital [LNH] from a period of 20th July to 20th September, 2015. A structured questionnaire based interview was conducted on150 parents of children less than 5 year of age visiting for vaccination at these three tertiary care hospitals.Data was analyzed using SPSS version 23

Results:A total of 150 parents were interviewed, out of which 93 [62.0%] parents vaccinated their child immediately after birth, 148[98.7%] parents considered EPI as beneficial for their child's health, 113 [75.3%] parents were found to be aware of the complete vaccination schedule, 56[37.3%] parents had appropriate knowledge regarding vaccines and diseases enlisted on the EPI card, 139 [92.7%] parents kept the record of vaccination schedule, 143[95.3%] parents didn't ignored vaccination due to increased number of children and 21[14%]parents had fear regarding vaccination program

Conclusion:Parent's attitude toward EPI was positive. However, knowledge about vaccines and diseases and vaccines enlisted on EPI card was low

Synthesis, antibacterial and antifungal possession of amino acids containing sulfonamide moieties

Sulfonamides were developed by the simple reaction of amino acid with p-toluenesulfonyl chloride and structures of the new products [2a, 2b and 2c] were confirmed by elemental and spectral analysis [FT-IR, [1]HNMR and[13]CNMR]. In vitro, developed compounds were screened for their antibacterial and antifungal activities against two sensitive bacteria belonging to both gram positive and gram-negative types and two fungi. The synthesized sulfonamides [2a, 2b, 2c] exhibited excellent antifungal activities against the tested fungi. Among the tested compounds 2a and 2b have marked activity against E. coli with zone of inhibition [mm] 22.3+/-0.11and 20.2+/-0.26 [MIC: 12.5[micro]g/mL, 12.5[micro]g/mL] and S. aureus with zone of inhibition [mm] 20.2+/-0.26 and 23.2+/-0.55 [MIC: 12.5[micro]g/mL, 6.25[micro]g/mL]. Compound 2c is moderately efficient towards E. coli [zone of inhibition [mm] 14.2+/-0.64, MIC: 100[micro]g/mL] and no activity against S. aureus

comparative study of QT dispersion for coronary artery disease in cardiac stress test by transesophageal atrial pacing

Objective: To compare the QT dispersion for coronary artery disease in cardiac stress test by transesophageal atrial pacing in patients with coronary heart disease

Study Design: Comparative study

Place and Duration of Study: This study was conducted at the Cardiology Department, Mayo Hospital, Lahore, Punjab Institute of Cardiology and Umar Cardiac Center, Lahore from January 2015 to August 2015

Materials and Methods: Fifty consecutive inpatients underwent cardiac stress testing [CST] by TEAP firstly, and then accepted selective coronary arteriography [SCA]. These patients were suspected to have coronary heart disease [CHD], 28 were positive [CAD] and 22 were negative, normal coronary group [NCA], as control group. Measurements of QTd in two groups before and after CST were analyzed in and between groups

Results: QTd was high in CAD than NCA group at baseline or every stages after CST [P

Conclusion: Patients with CAD have greater QTd than normal subjects; and QTd increased further in CAD during CST by TEAP, whereas, NCA group with no significant change

Prevalence of multi-drug resistant bacterial gastroenteritis in Karachi, Pakistan

Multidrug resistant Escherichia coli [E. coli] associated diarrheal diseases are the most prevalent health problems in Karachi, Pakistan. The main objective of the present study was to evaluate the clinical experiences of individuals suffered from gastroenteritis and also to determine the prevailing sensitivity / resistance pattern of E. coli among the population of Karachi. A cross-sectional retrospective survey was conducted by distributing questionnaires to a total of 150 individuals in December, 2014. The data collected from the questionnaire was statistically analyzed. Majority of the surveyed population was found to be infected by gastroenteritis lately or sometime in their life. On asking the questions about the possible reasons for being infected, it was revealed that the use of untreated water was the major source for the occurrence of the infection. Diagnostic tests were not carried out in most of the cases. Evaluation of questionnaire also indicated that physicians prescribed 2nd line of drug therapy due to the failure of treatment by cephalosporins, quinolones and fosfomycin. The susceptibility pattern of E. coli against selective antimicrobials agents was determined by using disc diffusion method. A total of 50 non-duplicate isolates of bacteria were collected from clinical laboratory of tertiary care hospital. The results were evaluated according to the guidelines of Clinical and Laboratory Standards Institute [CLSI]. The findings of sensitivity determination supported the retrospective data indicating that cefexime and ceftriaxone failed to inhibit the growth of 80% of the bacterial sample while ciprofloxacin was also found to be less effective since 65% of the isolates showed resistance to it. A 50% resistance pattern was observed against cefoperazone and sulbactam. The most effective antibiotic against E. coli was found to be colistin [100% sensitive] followed by amikacin [90%], merepenem [90%] and gentamicin [70%]. Hence, the in-time monitoring of infection through diagnostic procedures is suggested to avoid treatment failure

Synthesis, antimicrobial and antifungal possessions of tramadol esters: In vitro studies

Tramadol esters were prepared by refluxing equimolar concentration of tramadol with leucine and asparagine separately with methanol, sulphuric acid and phthalic anhydride for 10 hours and temperature was maintained at 75[degree]C. After refluxing, the colour of sample solutions were changed from colorless to yellow, blank solution was prepared in the same way as the sample solution except the Tramadol. Both the products and blank were neutralized with sodium carbonate and excess of sodium bicarbonate was precipitated as sodium sulphate, which was washed with acetone. The structures of both the products were confirmed with spectral data [FT-IR, [1]HNMR and [13]CNMR]. Antimicrobial and anti-fungal property of derivative of analgesic tramadol drug was tested with one fungus and three sensitive bacteria belonging to both gram positive and gram-negative types. Esterified product of tramadol with leucine and asparagine showed moderate activity against Escherichia coif and Tricophyton rubrum. Both the products showed marked activity against Staphylococcus aureus and found no activity against Salmonella spp

To detect the dyslipidemia in patients with rheumatic arthritis

Objective: To determine the abnormalities of lipid profile in patients with rheumatic arthritis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted in the Department of Medicine, Peoples University of Medical and Health Science, Nawabshah and MMC Mirpur khas from 2011 to 2013

Materials and Methods: Total 48 patients with RA were selected. All the equitable investigation was done. The patients were chosen for the study after a brief medical history. Patients with smoking and alcohol habits, those suffering with systemic disease like diabetes mellitus, hypertension and those on corticosteroids, statins, immunosuppression and vitamins supplementation, liver, kidney, thyroid abnormalities, ischemic heart disease, pregnant and post menopausal women were excluded. Lipid profile HDL, LDL, TC and TG were checked in all the cases after an overnight fasting of 12 hours. All the data was entered in the written proforma

Results: Total 48 cases were selected in the study after diagnosis of RA, mean age of the cases was found 36.5 +/- 7.2 years, female found in the majority 30/62.5%, mostly patients were married 35/72.9.A significant difference was found in the lipid profile, HDL was found low in majority of cases 17/35.4%, while TG was high in the majority of the patients 15/31.2%

Conclusion: In the conclusion of this study dyslipidemia is highly associated with RA disease. In patients with RA disease lipid profile should be checked necessarily, to reduce the morbidity and mortality due to cardiovascular disease

Comparison of sodium hypochlorite and mixture of tetracyline citric acid and detergent as irrigating material in endodontics

The main objectives of root canal therapy are cleaning, shaping and obturating the canal system in three dimensions and preventing reinfection. So the irrigation is important part of a root canal treatment as it allows for cleaning beyond the reach of root canal instruments. Inadequate irrigation or instrumentation without irrigation increases the accumulation of debris on the cutting surfaces of instruments as well as debris and smear layer on root canal walls. In this review article, comparison of MTAD [mixture of tetracycline citric acid and detergent] and sodium hypochlorite [NaOCl] as irrigating material in endodontics is made

Flare-ups following single versus multiple visits in endodontic treatment

The purpose of this study was to analyze the incidence of post-obturation flare-ups in teeth following single visit versus multiple visits in Root Canal Treatment. Two hundred patients were assigned for single-visit versus multiple visits root canal treatment. For each tooth treated, the clinical factors and conditions existing before and after the completion of treatment were recorded. This data included patient's age, gender, type of tooth, pre-operative status of pulp and periapical tissues and recording pain and swelling [flare-ups] postoperatively after 1 day,1 week and 1 month. Statistics analyzed by chi-square test, SPSS 19. Fifteen out of two hundreds cases showed flare-ups after treated single visit versus multiple visits appointments. All patients in this study suffered irrereversible pulpitis 200 patients divided into two equal groups. Group1 Patients were obturated in single visit while group 2 patients were obturated in multiple visits appointments. It was observed that out of total 15[7.5%] cases of flare-up, 6[40%] were visited multiple time and 9[60%] were visited single time. It was concluded that the incidence of flare-up or post obturation pain is related to the number of visits and clinical experience of the dentist

Electronic apex locator versus conventional radiograph; determination of working length: a prospective in-vivo study

For successful endodontic outcome, accurate working length has to be determined. Even with improved systems of working length [WL] measurement, different readings may be recorded in different electrolytes present in the canal

Methodology: total 90 patients were selected for this prospective in vivo study resented at Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, during 6 months i.e. from 1[st] Sep 2014 to 28[th] Feb 2015, with single rooted permanent mandibular first premolars with matured apices. After extirpated pulp tissue a file was inserted in the canal and WL was obtained by radiograph as well as by electronic apex locator [EAL]. The measurements determined by both methods were compared by applying paired sample t-test. SPSS 18 was used for data analysis

Results: among 90 subjects 37 were males. Mean +/- SD WL obtained radiographically was 19.8 +/- 1.03-m whereas mean +/- SD WL obtained electronically was 18.9 +/- 1.05 mm. Mean difference between measurements of both methods was 0.87-mm, which was statistically significant [P <0.05]

Conclusion: the electronic apex locator was better than the radiograph in determining working length of root canal at statistically significant level

Prisoners in Karachi – a health and nutritional perspective

The aim of this study was to assess the health and nutritional status of prisoners in Karachi, Pakistan. This cross sectional study was conducted from September 2012 to February 2013. Convenient sampling technique was used. A sample of 433 prisoners was taken from Karachi prison. Selected inmates were interviewed using a structured questionnaire. Prisoners were assessed with measurements of height, weight, body mass index [BMI] status, Blood pressure, Random Blood Sugar levels, dietary pattern, occupational status, source of food, duration of exercise, history of diseases and addictions were recorded. Age of the prisoners varied between 18-65 years. Among 433 prisoners, 39.7% were under weight and 8.3% were malnourished. Exercise was not reported in 80% of prisoners. It was noted that 11.8% prisoners were having respiratory tract infections at time the study was conducted. Among 433 inmates, 386 were addicted to at least one addiction such as smoking, naswar, pan, gutka and manpuri, heroin, ganja [cannabis], charas [hashish form of cannabis], and opium. This study showed that the diet of the prisoners was insufficient and nutritionally imbalanced and has led to malnourished and underweight prisoners. Substance abuse is common among inmates

Bird's eye on LMC dental graduates academic contributory role to enhance undergraduate dental education and vision for pakistan: a commentary

Dental education, like Medical education in our country, should now be shifted towards student centered, be Evidence cum Competence based and incorporate room for Faculty Development to meet International trends. This special GJC dentistry commentary is dedicated to the academic contributions of our entire respected LMC dentistry faculty from a lecturer to the level of professor, who taught and trained us to play vital academic role, from the year 1963 till 2013. This commentary is contribution to share our academic role for the promotion of our dynamic skill oriented Oral Health Profession in Pakistan

Type 2 diabetes mellitus; dental caries in patients

To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Cross sectional descriptive study. Patients with history of type 2 diabetes mellitus for >/=02 years duration with >/=35 years of age and of either gender with dental pain visit at medical and dental outpatient department [OPD] of Liaquat University Hospital Hyderabad. The detail history was taken and the blood samples were taken for haemoglobin A1c [HbA1c] to assess the glycemic status. The existence of dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience >/=05 years. The data was collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. A total of 137 type 2 diabetic patients were selected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 [71.5%] patients. Out of these ninety eight, 53 [54.08%] were males and 45 [45.92%] were female. Upper molar teeth involvement was present in 46 patients and lower molar teeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in 16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in 32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients, lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 [43.9%] patients in patients whose duration of diabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, while regarding duration of <5 years only 24 [24.5%] patients had dental carries. The diabetic patients are more prone to acquire dental caries

Comparison of analgesic effects of oral carbamezapine with pregablin in idiopathic trigeminal neuralgia

Idiopathic trigeminal neuralgia, a form of neuropathic pain, caused by not well defined etiology, is a formidable therapeutic challenge to clinicians because it does not respond well to traditional drug therapies. Anticonvulsant drugs are regarded as useful treatment for neuropathic pain. Carbamazepine, the first anticonvulsant studied in clinical trials, probably alleviates pain by decreasing conductance in Na[+] channels and inhibiting ectopic discharges. Pregabalin has the most clearly demonstrated analgesic effect for the treatment of neuropathic pain. The role of anticonvulsant drugs in the treatment of Idiopathic trigeminal neuralgia is evolving and has been clearly demonstrated with Pregabalin and carbamazepine. The aim of this study was to investigate comparison of analgesic effects of oral carbamezapine with pregablin in idiopathic trigeminal neuralgia. Interventional study. Oral and Maxillofacial surgery department, LUMHS. Jan 2012 to DEC 2012 . 30 patients with well defined history and diagnostic clinical symptoms of idiopathic trigeminal neuralgia were selected, divided into two groups of 15 individuals with similar gender and age difference. Clinical trial were conducted with group 1 with carbamazepine and group 2 with Pregabalin for 4 weeks. Subjective pain level of both groups was recorded before intervention [pre treatment recording] and after intervention [1[st], 2[nd], 3[rd] and 4[th]] on weekly basis by using 0-10 visual analogue scale [zero represent no pain 10 represent pain that could not be worse]. Following intervention, both groups were evaluated for pain score in 1[st] and 2[nd] week, there was no significant difference observed between the two groups. [P value 0.44 and 0.456], but after 3[rd] and 4[th] weeks it was observed that, there is significant difference, [p value 0.000 and 0.009] on visual analogue scale. It was observed that there was a significant difference between pretreatment and fourth week mean pain score in group 2, [8.9 and 1.07]. Similarly marginally significant difference with [r = .640] was seen in 1[st] week of group 2 receiving Pregablin, the mean value was [2.53, 1.60] respectively. Based on these results that are in line with the recommendations made by other studies, the 1[st] line medical therapy is Carbamazepine but this should be changed to other drug therapy if there is no pain relief or adverse effect