Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Comparison of medical therapy with renal denervation in patients with resistant hypertension

Introduction: Catheter-based renal denervation selectively reduces renal sympathetic efferent activity and is accompanied by an increase in renal blood flow and reduction in plasma renin activity. Thus, ablation of afferent and efferent renal nerves in patients with treatment-resistant hypertension probably leads to reductions in blood pressure. Material and methods: The present study conducted a non-randomized case-control study and enrolled 15 patients who underwent renal denervation therapy for resistant hypertension as cases and 16 patients who were on medical management for resistant hypertension served as controls. Results: It was found that catheter based renal denervation is safe, significantly reduces blood pressure at 1 month, 3 months and 6 months of follow-up without any major adverse events. It was observed that a significant BP reduction when compared to patients only on medical therapy. The mean number of drugs decreased significantly in the denervation group in follow-up. Conclusions: Though the present study showed a significant BP reduction in patients with renal denervation, a significant effect on BP was not observed in a large randomized trial simplicity HTN-3 and major criticism was on the trials design and neuroscience failings. Even today the clinical dilemma is still continuing and further evaluation in rigorously designed clinical trials are necessary to validate alternative methods of renal denervation or to confirm previously reported benefits of renal denervation. The current study anticipate that future trials will also address the effectiveness of renal denervation in disease states other than hypertension.

Currently available tools and teaching strategies for the interprofessional education of students in health professions

Interprofessional education [IPE] is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula

Intragenic deletion mutation in the gene desmoglein 4 underlies autosomal recessive hypotrichosis in six consanguineous families

Objectives: Localized autosomal recessive hypotrichosis is a non-syndromic human hair loss disorder, affecting scalp, eyebrows and eyelashes, and other parts of the body. Six consanguineous families with this form of hair loss disorder were investigated at both the clinical and molecular levels

Methods: Linkage in six families with twenty-one affected members was tested by genotyping microsatellite markers linked to autosomal recessive hypotrichosis loci including localized autosomal recessive hypotrichosis [LAH] 1, 2 and 3. Sequence analysis of the entire coding and splice sites of the gene DSG4 was performed to search for the disease-causing mutation

Results: Genotyping established linkage in families to the DSG4 gene at LAH1 locus on chromosome 18q21.1. Sequence analysis detected an intragenic deletion mutation [Ex5_8 del] in affected members of all six families

Conclusion: Identification of recurrent mutation in six additional Pakistani families strengthens the body of evidence that this is an ancestral mutation that is widespread among different Pakistani ethnic groups

Factors associated with dengue fever IgG sero-prevalence in south Kordofan state, Sudan, in 2012: Reporting prevalence ratios

Dengue fever [DF] is a vector-borne virus transmitted to humans by infected Aedes mosquitoes. In this study, we identified the most important factors associated with the prevalence of IgG antibodies in a border state between Sudan and the new republic of South Sudan. To quantify the association of specific factors with the prevalence of DF IgG antibodies in Lagawa among subjects aged 16-60 years in 2012. Analytical cross-sectional community-based study conducted in Lagawa in 2012. Indoor mosquito breeding was the most significant predictor affecting DF IgG serology. Household water storage was also strongly associated with the presence of IgG antibodies. Residence in urban areas, younger age and a history of travel to the Red Sea State were significant predictors of DF IgG seroprevalence in South Kordofan state. Indoor [household] behaviors associated with DF infection should be modified to mitigate the infection risk in the study area. Awareness should be raised regarding DF in Lagawa to ensure community participation in all control measures, and the surveillance system at the border between Sudan and the republic of South Sudan should be strengthened

Faculty and students' perceptions of student experiences in a medical school undergoing curricular transition in the United Arab Emirates

In 2008, the Gulf Medical College in the United Arab Emirates underwent a curricular change from a discipline-based to an organ-system-based integrated curriculum. In this context, this study aimed to compare the faculty and students' perceptions of the student experiences with the new curriculum. Data were collected from faculty and second-year students in the integrated curriculum using the Dundee Ready Education Environment Measure [DREEM]. Data collected were transferred to Predictive Analytics Software, Version 18. Global and domain scores were assessed with the Wilcoxon Rank-Sum Test. Percentage agreement, disagreement and uncertainty were assessed by the z-test for proportion. There were no significant differences between the total DREEM scores of faculty [139/200] and students [135/200]. The faculty perceived that the students were experiencing significantly more positive learning as indicated by the domain score of "Students' Perceptions of Learning". Proportions of agreement between faculty and students showed that more faculty members than students perceived the need for increased feedback to students and a greater emphasis on long term learning. The study showed that the faculty and students had similar perceptions about the student experiences in the integrated curriculum. Areas necessitating remedial measures were the need for faculty to learn constructive feedback techniques and an emphasis on long term learning in the new curriculum

effect of neem [Azadirachta indica] leaf extract and neem compound nimolicine on gastric acidity

This study has been conducted to look at the and acid effect of Neem and to compare the effect of leaf extract with the pure compound nimolicine on the gastric acidity. Nimolicine has been studied for its anti acid effect for the first time. Experimental study. This study was conducted in the department of Physiology, Baqai Medical College and the Department of Pharmacology in Baqai Institute of Pharmaceutical Sciences, Karachi. Ethanol induced gastric ulcers in albino rats were treated with methanolic neem leaf extract [800mg/day for 5 days] and nimolicine [1%/day for 3 days] and the gastric acid secretion was estimated. The control of the treated group was given peanut oil 1 ml/day for 5 days. The effect on gastric secretion was compared with the effect of anti-ulcer drugs cimetidine [50 mg/kg for 7-10 days] and omeperazole [2.5 mg/kg/day for 7-14 days]. Neem leaf extract is a better suppressor of H-ion secretion compared to nimolicine but both neem leaf extract and nimolicine did not show a significant suppression of acid compared to ranitidine and omeperazole. The comparison between control and ranitidine in suppression of acid was significant. Methanolic NLE and neem compound nimolicine do not decrease gastric acidity and their role as anti-ulcer agents may be because of other mechanisms which need to be studied

Patient-reported adverse drug reactions and drug-drug interactions: a cross-sectional study on malaysian HIV/AIDS patients

This study aimed to explore the adverse drug reactions [ADRs] reported by patients and to identify drug-drug interactions [DDIs] among human immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS] patients. This cross-sectional study was conducted at the Medication Therapy Adherence Clinic, Hospital Sungai Buloh, an HIV/AIDS referral centre. The patients were randomly selected and were encouraged to describe ADRs caused specifically by any of the prescribed antiretroviral drugs [ARDs]. Sociodemographic characteristics were recorded from the patients' medical records. In addition data on antiretroviral treatment [ART], DDIs and other conventional medication were also documented. A total of 325 randomly selected HIV/AIDS patients with a mean age of 22.94 years participated in the study. The most frequently prescribed ARDs were lamivudine [64.6%], zidovudine [40.6%] and efavirenz [42.5%]. Commonly reported ADRs were fatigue [54.8%], allergic reactions [41.5%], weight loss [41.5%], dry mouth [35.1%] and memory loss [35.1%]. Female [87.8%], non-complementary and alternative medicine [CAM] users [87.3%] and participants below 50 years old [81.1%] were identified as having a higher prevalence of ADRs compared to males [79.6%], CAM users [78.7%] and participants aged 50 years or more [77.5%]. Patient age was found to be significantly associated [p = 0.048] with the ADRs. In addition, a total of 44 cases of DDIs belonging to category D were also found in this study. This study enabled us to identify the most common ADRs and DDIs associated with the use of ART. Safe and effective treatment depends on the healthcare providers' knowledge of the same

Quantitative and qualitative analysis of pubmed-indexed biomedical publications in Oman from years 2005-2009

Research activities are promoted at the government and the institutional levels in Oman. However, the quantity and quality of research conducted in various institutes of Oman has not been measured. Therefore, this study was conducted to analyze the quantity and quality of biomedical publications emanating from Oman over the last five years [2005-2009]. Data regarding the biomedical publications of Omani origin published from January 2005 to December 2009 were retrieved from Pubmed. All abstracts were manually checked to exclude false retrievals. The journal impact factor [IF] for 2008 was applied for every publication. Full-length original articles, review articles and publications mentioning new research methods/new technique were assigned full IF of the journal. However, half of the journal IF were assigned to correspondences/commentaries, case reports/series and short communications. Of biomedical publications, 752 were retrieved from Pubmed and 519 publications were included for final analysis after excluding false positives. The number of biomedical publications steadily increased over the last five years, but it was not statistically significant. Original research articles constituted more than half [54.3%] of all the publications, followed by case reports/series [30.1%]. Sultan Qaboos University [SQU] contributed more than half of the biomedical publications [51.5%], followed by the Ministry of Health [MoH], which contributed 38% of the publications. Interestingly, the mean IF of the publications was not significantly different throughout the years. The number of publications emanating from Oman increased over the last five years; however, the quality of research has not improved. Furthermore, the research in Oman is mainly conducted by the government-run institutions and there is hardly any contribution from the private institutions

Emergency Contraception: Knowledge and Attitudes of Family Physicians of a Teaching Hospital, Karachi, Pakistan.

This study was conducted to assess the knowledge of family medicine providers and their attitudes towards emergency contraception in a teaching hospital in Karachi, Pakistan. A 21-item questionnaire containing the demographic profile of respondents and questions concerning knowledge of and attitudes towards emergency contraception was distributed among participants. In total, 45 interviews were conducted, with a response rate of 100%, with faculty physicians (33%), residents (27%), medical officers (40%), 36% male and 64% female physicians; of them, the majority (64%) were married. Although the large majority (71%) of the respondents reported considerable familiarity with emergency contraception, objective assessment revealed deficiencies in their knowledge. About 38% of the participants incorrectly chose menstrual irregularity as the most common side-effect of progestin-only emergency contraception pills, and only 33% answered that emergency contraception was not an abortifacient while 42% were unsure. Forty percent of the physicians prescribed emergency contraception in the past. The large majority (71%) of the physicians were familiar with emergency contraception, yet deficiencies in knowledge inaccuracies were identified. Barriers to its use were identified as ‘it will promote promiscuity’ (31%), religious/ethical reasons (27%), liability (40%), teratogenicity (44%), and inexperience (40%). Overall attitudes regarding emergency contraception were positive; however, most (82%) physicians were unsatisfied with their current knowledge of emergency contraception, and there was a discrepancy between perceptions of physicians and actual knowledge. Interventions providing education to family physicians regarding emergency contraception is strongly recommended.

Changes in serum lipid profile and malondialdehyde following consumption of fresh or heated red palm oil

The effect of chronic consumption of fresh and heated red palm oil [RO] on lipid profile and lipid peroxidation was investigated. Thirty male rats were divided into 3 groups, each treated with the following prescribed food: [i] basal diet fortified with 15% weight/weight [w/w] fresh red palm oil [FRO], or [ii] heated once red palm oil [1H-RO] or [iii] heated 5 times red palm oil [5H-RO] for 20 weeks. There was a significant increase [p<0.05] in MDA concentration in all 3 groups compared to their respective baseline concentrations and a significant decrease [p<0.05] in total cholesterol [TC] concentration. However, the transient changes observed in serum triglyceride and HDL-cholesterol concentration did not attain significant values. The LDL-cholesterol concentration in 5H-RO group increased significantly [p<0.05] compared to pretreatment value, FRO and 1H-RO groups. Ratio of TC/HDL in 5H-RO group initially increased, but dropped to baseline level at the end of the study. There was no significant difference in the ratio of TC/HDL between the groups. In conclusion, both fresh and heated RO appeared comparable in their effect on serum cholesterol and lipid peroxidation. It appears that long term feeding with fresh and heated RO did not have an adverse effect on serum TG, HDL and TC/HDL ratio. However, it appears that prolonged heating increases LDL-cholesterol level. Further studies are required to ascertain whether the increase in LDLcholesterol and MDA with heated oil would render it more atherogenic

Screening for autoimmune thyroid disease in type 1 diabetics

A prospective study to screen high risk [type 1 diabetes mellitus] subjects for autoimmune thyroid disease was carried out on 55 patients at JPMC, Karachi from January to December 1998. Thyroid dysfunction was noted in 11 out of 55 patients screened. Microsomal antibody was present in high titre [mean 1:7866.667] in 9 patients and thyroglobulin antibody was found in low titre [mean 1:121.429] in 9 patients. Thyroid dysfunction has significant association with Type-I diabetes. Microsomal antibodies alone are good predictors of autoimmune thyroid disease in these patients

Weight of calcanei in adult Pakistani population

This observational study was conducted on right and left normal calcanei obtained from anatomy department Quaid-e-Azam Medical College Bahawalpur. Mean weight of right male calcaneus was 52.54gms and that of the left male calcaneus was 47.88 gms [Range: 31.1-64.51 gms and 31-68.13 gms respectively] with a standard deviation of 9.12 and 8.26, and calculated range of 25.18-79.9 and 23.1-72.66 respectively. There was statistically significant difference between the mean weights of bones of two sides. The mean weight of right and left female calcaneus was 35.28 gms and 35.03 gms, standard deviation of 1.63 and 1.48, actual range of 32.7-37.6 gms and 32.1-37.05 gms and calculated range of 30.39-40.17 gms and 30.59-39.47 gms respectively. No statistically significant difference was noted between the mean of weights of right and left bones. When compared there was statistically significant difference between the mean weight of right male and right female calcanei and left male and left female calcanei

Emergence of multi-drug resistance among beta-lactamase producing salmonella

Multi-drug resistant strains of Salmonella isolated from blood and bone marrow cultures of pyrexial patients received from physicians, hospitals and different clinics were studied from May to November, 1993. Of 2143 samples collected, 424 [20%] cases yielded the growth of different organisms. Out of these 266 [63%] were positive for Salmonella strains. The strains isolated were Salmonella typhi 239 [90%] and Salmonella paratyphi A 27 [10%]. Two hundred twenty [82%] strains of Salmonella showed increased beta-lactamase activity and an alarming increase in resistance against commonly used antibiotics for enteric fever

Female upsurge in incidence of gastric ulcer and relation with parity

476 patients underwent Upper Gastrointestinal Endoscopy at Holy Family Hospital Rawalpindi over a eight year period [1985-1992]. All presented with clinical features suggestive of peptic ulcer. Most of the patients suffering from duodenal ulcer were males [79%]. A female predominance was seen in gastric ulcer [63%] which further increased [77%] when only ulcers in the body of the stomach were taken into consideration. An increasing intake of non-steroidal anti-inflammatory drugs [NSAIDs] is thought to be the likely cause of the female upsurge in gastric ulcer incidence. However, the relation with parity is also a strong contributory factor to the higher female incidence of gastric ulcer

Anterior segment ocular trauma[ASOT] a hospital based study

A study of 134 cases of anterior segment ocular trauma [ASOT], shows that ASOT forms a considerable part of eye injuries in Rawalpindi division and Azad Kashmir. Males are more commonly affected. Children under the age of 15 years are more prone to injury. Most of the injuries occurred during sports. Modern surgical procedures have significantly improved the functional outcome. Intra ocular lens implantation and keratoplasty have greatly reduced the effects of post traumatic complications. Preventive measures, public education and necessary legislation will decrease the incidence of ASOT