Necrotizing infundibulohypophysitis: A rare cause of central diabetes insipidus

Diagnosis of central diabetes insipidus (CDI) requires a high index of clinical suspicion, especially when it manifests as a coexisting condition like traumatic brain injury or following neurosurgery. We would like to report a rare case of necrotizing infundibulohypophysitis (NIH) as a cause of CDI in a 21-year-young male who presented with a severe progressive headache not responding to routine analgesics followed by vomiting, altered sensorium. His baseline blood investigations were normal including his cerebrospinal fluid examination, plain and contrast magnetic resonance imaging (MRI) scan. The patient partially responded to the treatment of headache and after 2 days, complained of polyuria with severely reduced serum sodium level. A repeat plain and MRI of the brain was done which showed classical findings of NIH with CDI which we discuss along with the differential diagnosis and its prognosis

FACEts of mechanical regulation in the morphogenesis of craniofacial structures / 国际口腔科学杂志·英文版

During embryonic development, organs undergo distinct and programmed morphological changes as they develop into their functional forms. While genetics and biochemical signals are well recognized regulators of morphogenesis, mechanical forces and the physical properties of tissues are now emerging as integral parts of this process as well. These physical factors drive coordinated cell movements and reorganizations, shape and size changes, proliferation and differentiation, as well as gene expression changes, and ultimately sculpt any developing structure by guiding correct cellular architectures and compositions. In this review we focus on several craniofacial structures, including the tooth, the mandible, the palate, and the cranium. We discuss the spatiotemporal regulation of different mechanical cues at both the cellular and tissue scales during craniofacial development and examine how tissue mechanics control various aspects of cell biology and signaling to shape a developing craniofacial organ.

Effects of Interferon Beta in COVID-19 adult patients: Systematic Review / 감염과화학요법

Background@#The high rate of transmission and infection of coronavirus disease 2019 (COVID-19) is a public health emergency of major epidemiological concern. No definitive treatments have been established, and vaccinations have only recently begun. We aim to review the efficacy and safety of Interferon Beta (IFN-β) in patients who have a confirmed COVID-19 diagnosis. @*Materials and Methods@#A search from PubMed, Science Direct, Cochrane, and Clinicaltrials.gov databases were conducted from December 2019 to December 2020 to review the efficacy and safety of IFN-β in adult patients with COVID-19 confirmed. We included randomized controlled trials, case reports, and experimental studies. Correspondences, letters, editorials, reviews, commentaries, case control, cross-sectional, and cohort studies that did not include any new clinical data were excluded. @*Results@#Of the 66 searched studies, 8 were included in our review. These studies demonstrated that although IFN-β did not reduce the time to clinical response, there was an increase in discharge rate at day 14 and a decrease in mortality at day 28. The time to negative reverse transcription polymerase chain reaction (RT-PCR) was shown to be significantly shortened in patients receiving IFN-β, along with a lower nasopharyngeal viral load.Further, patients receiving IFN-β had a less significant rise in IL-6. IFN-β was shown to decrease intensive care unit (ICU) admission rate, the requirement of invasive ventilation in severe cases, and improve the survival rate compared to control groups. There were no severe adverse events reported.Our review found that patients who received early treatment with IFN-β experienced significantly reduced length of hospitalization, mortality, ICU admission, and mechanical ventilation. A greater chance of clinical improvement and improved imaging studies was noted in patients who received IFN-β. There were no reported deaths associated with the addition of IFN-β. Further randomized trials involving more significant sample sizes are needed to better understand the effect of IFN-β on survival in COVID-19. @*Conclusion@#This review identified encouraging data and outcomes of incorporating IFN-βto treat COVID-19 patients. IFN-β has been shown to decrease hospital stay's overall length and decrease the severity of respiratory symptoms when added to the standard of care. Also, in some studies, it has been demonstrated to reduce the length of ICU stay, enhance survival rate, and decrease the need for invasive mechanical ventilation. There were minor side effects reported (neuropsychiatric symptoms and hypersensitivity reaction). However, randomized clinical trials with a large sample size are needed to assess IFN-β's benefit precisely.

Effects of Interferon Beta in COVID-19 adult patients: Systematic Review / 감염과화학요법

Background@#The high rate of transmission and infection of coronavirus disease 2019 (COVID-19) is a public health emergency of major epidemiological concern. No definitive treatments have been established, and vaccinations have only recently begun. We aim to review the efficacy and safety of Interferon Beta (IFN-β) in patients who have a confirmed COVID-19 diagnosis. @*Materials and Methods@#A search from PubMed, Science Direct, Cochrane, and Clinicaltrials.gov databases were conducted from December 2019 to December 2020 to review the efficacy and safety of IFN-β in adult patients with COVID-19 confirmed. We included randomized controlled trials, case reports, and experimental studies. Correspondences, letters, editorials, reviews, commentaries, case control, cross-sectional, and cohort studies that did not include any new clinical data were excluded. @*Results@#Of the 66 searched studies, 8 were included in our review. These studies demonstrated that although IFN-β did not reduce the time to clinical response, there was an increase in discharge rate at day 14 and a decrease in mortality at day 28. The time to negative reverse transcription polymerase chain reaction (RT-PCR) was shown to be significantly shortened in patients receiving IFN-β, along with a lower nasopharyngeal viral load.Further, patients receiving IFN-β had a less significant rise in IL-6. IFN-β was shown to decrease intensive care unit (ICU) admission rate, the requirement of invasive ventilation in severe cases, and improve the survival rate compared to control groups. There were no severe adverse events reported.Our review found that patients who received early treatment with IFN-β experienced significantly reduced length of hospitalization, mortality, ICU admission, and mechanical ventilation. A greater chance of clinical improvement and improved imaging studies was noted in patients who received IFN-β. There were no reported deaths associated with the addition of IFN-β. Further randomized trials involving more significant sample sizes are needed to better understand the effect of IFN-β on survival in COVID-19. @*Conclusion@#This review identified encouraging data and outcomes of incorporating IFN-βto treat COVID-19 patients. IFN-β has been shown to decrease hospital stay's overall length and decrease the severity of respiratory symptoms when added to the standard of care. Also, in some studies, it has been demonstrated to reduce the length of ICU stay, enhance survival rate, and decrease the need for invasive mechanical ventilation. There were minor side effects reported (neuropsychiatric symptoms and hypersensitivity reaction). However, randomized clinical trials with a large sample size are needed to assess IFN-β's benefit precisely.

Seafood Allergy: Causes, Prevention Modalities, and Treatment Guidelines in the Indian Scenario

Seafood allergy is a hypersensitivity disorder with growing prevalence. Allergy to shellfish is among the leading cause of food allergyin adults, and the most common cause of food allergic emergency department visits. Seafood allergy is immunologic response toproteins in these foods and include IgE antibody-mediated allergy. Allergies can occur at any age but are common in adults andadolescents than in children. While figures vary from country to country, approximately 1–2% of the adult population and <1% ofchildren are affected. In most patients tolerance develops to food antigens, however, when tolerance fails to develop, hypersensitivityreaction occurs. Food allergy affects up to 8% of the children below 5 years of age and approximately 3.5% in the general population.Adults with shellfish allergies should be aware of how to use this on themselves or their child if child is suspected shellfish allergy.It is also recommended for such individuals to wear medical alert bracelet necklace or carry USB drive so that health care workercan be aware of their condition in emergency. Effective and accurate diagnostic workup is essential for clinicians and patients. Thisarticle summarizes about seafood allergy cause, diagnostic approaches, and management in case of life-threatening emergencies.

Prevalence of premenstrual syndrome and dysmenorrhea among medical students and its impact on their college absenteeism

Background: Dysmenorrhea and premenstrual syndrome are two most common gynaecological problem leading to college absenteeism seen among female medical students. Aim of the study was to evaluate the factors associated and prevalence of dysmenorrhoea and PMS and its effects on the quality of life, particularly absenteeism from college in female medical students. The health care profession has an obligation to provide and to promote education on menstruation and related subjects.Methods: This is a prospective study, conducted on 100 MBBS students studying in a medical college at Mangalore. All participants were given a preformed questionnaire to complete. Dysmenorrhea was assessed based on WaLiDD scoring system. Diagnosis of PMS in the present study was made according to diagnosis criteria proposed by American College of obstetrician and gynecology. The severity of their condition was assessed based on their absenteeism from college/classes.Results: The average age of the participants was 21 year±1 year. The prevalence of dysmenorrhea was 45% and that of the pre-menstrual syndrome was 68%. Pre-menstrual syndrome (p = 0.05) is significantly associated with overweight, obesity and physical inactivity but not the same for dysmenorrhea. 73% and 60% of students consumed junk food suffered from PMS and dysmenorrhea respectively, 40% of students with dysmenorrhea reported limitation of daily activities and significantly associated with college absenteeism (p = 0.005). The most frequent somatic symptom of PMS in this study was breast tenderness (41%) and affective symptom was irritability (35%).Conclusions: Dysmenorrhea and PMS is highly prevalent among female medical students; it is related to college/class absenteeism. Unhealthy and sedentary lifestyle could be the attributing factors which has to be addressed by health education in order to improve the quality of life and academic performance by the medical students.

An in silico investigation of phytochemicals as potential inhibitors against non-structural protein 1 from dengue virus 4

Dengue fever has emerged as a big threat to human health since the last decade owing to high morbidity with considerable mortalities. The proposed study aims at the in silico investigation of the inhibitory action against DENV4-NS1 of phytochemicals from two local medicinal plants of Pakistan. Non-Structural Protein 1 of Dengue Virus 4 (DENV4-NS1) is known to be involved in the replication and maturation of viron in the host cells. A total of 129 phytochemicals (50 from Tanacetum parthenium and 79 from Silybum marianum) were selected for this study. The tertiary structure of DENV4-NS1 was predicted based on homology modelling using Modeller 9.18 and the structural stability was evaluated using molecular dynamics simulations. Absorption, distribution, metabolism, excretion and toxicity (ADMET) along with the drug-likeness was also predicted for these phytochemicals using SwissADME and PreADMET servers. The results of ADMET and drug-likeness predictions exhibited that 54 phytochemicals i.e. 25 from Tanacetum parthenium and 29 from Silybum marianum showed effective druglikeness. These phytochemicals were docked against DENV4-NS1 using AutoDock Vina and 18 most suitable phytochemicals with binding affinities ≤ -6.0 kcal/mol were selected as potential inhibitors for DENV4-NS1. Proposed study also exploits the novel inhibitory action of Jaceidin, Centaureidin, Artecanin, Secotanaparthenolide, Artematin, Schizolaenone B, Isopomiferin, 6, 8-Diprenyleriodictyol, and Anthraxin against dengue virus. It is concluded that the screened 18 phytochemicals have strong inhibition potential against Dengue Virus 4.

Thiosemicarbazone and thiazolylhydrazones of 1-indanone: as a new class of nonacidic anti-inflammatory and antiplatelet aggregation agents

This research based on the anti-inflammatory and antiplatelet aggregation properties of some new thiazolyl hydrazone derivatives of 1-indanone. In this regard a thiosemicabazone and twelve thiazolyl derivatives of 1-indanone have been synthesized. Out of these synthetic compounds seven derivatives 1-3, 6, 11-13 exhibited varying degree of anti-inflammatory action with IC50 esteems going from 5.1+/-1.3 - 78.8+/-4.6µM/mL. Compound 1 [IC50 =5.1+/-1.9µM] displayed potent result than standard ibuprofen [IC50 = 11.2+/-1.9 µM]. In antiplatelet aggregation assay, five compounds 1, 5, 6, 8 and 11 were observed to be dynamic with IC50 esteems observed in the range of 38.34-255.7+/-4.1µM, whereas, aspirin [IC50 = 30.3+/-2.6 µM] was used as standard. However, compound 11 was found to be good active for both anti-inflammatory and antiplatelet aggregation activities [IC50 = 13.9+/-4.9µg/mL] [IC50 = 38.60+/-3.1µM], respectively

Student perception of learning modalities in physiology in integrated curriculum

Background: Currently most of the medical schools are incorporating innovative medical curricula in their bachelor programs. Most of the institutions are moving towards a more student centered approach to learning and assessment. Physiology being one of the mandatory basic science disciplines is also experiencing these changes. Student learning is always related to the teaching methodologies being used. Student's perception of the various teaching methodologies is useful in improving the quality of learning in medical education and to evaluate the student perception of different learning modalities in physiology in an integrated curriculum

Methods: Study was conducted on 100 medical students of 1st and 2nd Year. Participating students were explained the purpose of study. Based on the teaching methods practiced in the department of Physiology at Ziauddin Medical College, a survey questionnaire was prepared and given to the participants. The questionnaire consisted of questions enquiring about the preference of different learning/ teaching methods and the reason for the preference

Results: Majority of the students of 1st and 2nd year MBBS selected Problem based learning [PBL] 48% lecture 40% and small group session 7 % and other teaching method 5%

Conclusion: Problem based learning was found to be the preferred learning modality to study physiology and lecture was the most helpful method in preparing for exams

Impact of academic interventions on students performance in electives

Background: Elective clinical rotations have become a significant part of most of the medical educational curricula. Evaluation of electives is imperative to assess their usefulness in achieving the objective of improving the competencies of graduating students. Results of these evaluations can be used to guide future academic developments

Objective: The purpose of this study was to assess the change in the performance of medical students after academic intervention based on the results of evaluation of previous year electives

Methods: Students' performances in elective rotations were evaluated in the year 2012 and again in 2013 after bringing modifications in teaching / learning program. The data collected was from 60 students. Students consisted of two sets, those who completed their electives in the country while the other completed their electives abroad. Scores were calculated in three distinct domains of education i.e knowledge, attitude and ethical behavior. Independent Sample T test was applied to compare the scores

Results: Findings suggest that as a result of the academic interventions carried out in 2013 in the educational program by the combined efforts of the faculty and students, the scores for all the three educational domains in both the local and abroad groups improved considerably

Conclusion: Study findings conclude that active curricular interventions play important role in improving the outcomes of teaching programs

prospective study of extracorporeal shock wave lithotripsy [ESWL] induced hypertension in Lahore division, Pakistan

Our aim was to evaluate the hypothesis in a randomized clinical trial, whether extra- corporeal lithotripsy [ESWL] causes any blood pressure change, in subjects with different genders having normal blood pressure and kidney lithiasis. A descriptive cross sectional study. This study was carried out at the Department of lithotripsy, Khan Kidney Hospital and King Edward Medical University, Lahore from February 2012 to January 2013. Adult patients [

Knowledge, attitude and practice [KAP] about malaria among inhabitants of a slum area of Karachi

To assess the KAP regarding malaria among inhabitants of slum area of Karachi. A community based comparative cross sectional study was conducted in a slum area of Karachi i.e. Arafat town, for a period of seven months from Oct 2011 to April 2012. Total 151 inhabitants of Arafat Town were included and interviewed by trained Lady Health Worker using structured questionnaire, comprising of three components i.e. KAP about malaria. Individuals who scored more than 70% were labeled as having satisfactory KAP. Proportions of score regarding KAP were compared with one another and also with demographic variables by using chi-square test. Most of the participants were married female, having mean age of 33.87 +/- 7.5 years. Large proportion [97%] of sample had satisfactory attitude as compared to knowledge [50%] and practice [59%]. Difference in knowledge and practice was found to be significant [p=0.040]. Inhabitants of Arafat Town, had positive attitude towards prevention of malaria, but their levels of knowledge and practice were found to be low, may be due to low literacy rate or poor socioeconomic condition or both. Prompt interventions are required to enhance their knowledge and practice and thus ultimately would reduce the burden of malaria

Poland syndrome: a case report

Poland Syndrome is a rare birth anomaly commonly found in males characterized by partial or complete absence of pectoralis major muscle on one side of the body [mostly right side], along with some other associated anomalies like asymmetry of upper limb, hypo-plastic nipple and syndactyly of the effected side. A 4-month old male baby presented with complaint of fever and respiratory distress, was admitted and treated as case of bronchopneumonia. The patient was ultimately diagnosed as a case of Poland syndrome

[ efficacy of an integrated treatment in comparison with treatment as usual in a group of children and adolescents with first-episode psychosis during a two -year follow-up]

This study aimed to compare the efficacy of an integrated treatment [IT] versus treatment as usual [TAU] in a group of inpatient children and adolescents with first episode psychosis [FEP] during a two year follow up. In a randomized controlled trial, 40 children and adolescents with FEP based on DSM-IV criteria were recruited from referrals to Robe Hospital [Tehran, Iran]. They were divided into a TAU group [N=20], and an IT group [N=20] who received a low dose of atypical antipsychotic medications and family psycho-education program, and were followed up by telephone contacts. All participants were evaluated at admission and discharge as well as in 6, 12, 18 and 24 month intervals using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Persian Version [K-SADS-PLPV], Positive and Negative Syndrome Scale [PANSS], Young Mania Rating Scale [YMRS], Children's Depression Inventory [CDI], Hamilton Depression Rating Scale [HAM-D], Global Assessment of Functioning Scale [GAF], and Children Global Assessment Scale [CGAS]. Statistical methods consisted of analysis of independent t and x[2] for qualitative variables, and random effect regression model for quantitative variables. The two groups showed significant improvement in all outcome measures at different time-points. The rate and duration of recurrences were lower in the IT group compared to the TAU group. All of the other outcome measures were comparable in the two groups and there was no difference between them in different follow-up periods. Integrated treatment may decrease the rate and duration of recurrences in children and adolescents with FEP

Risk factors in various subtypes of ischemic stroke according to TOAST criteria

To identify the frequency of risk factors in various subtypes of acute ischemic stroke according to TOAST criteria. Cross-sectional, observational study. Ziauddin Hospital, Karachi, from January to December 2007. Ziauddin Hospital, Karachi, from January to December 2007. Patients with acute ischemic stroke were enrolled. Studied variables included demographic profile, history of risk factors, physical and neurological examination, and investigations relevant with the objectives of the study. Findings were described as frequency percentages. Proportions of risk factors against subtypes was compared using chi-square test with significance at p< 0.05. Out of the 100 patients with acute ischemic stroke, mean age at presentation was 63.5 years. Risk factor distribution was hypertension in 85%, Diabetes mellitus in 49%, ischemic heart disease in 30%, dyslipedemia in 22%, smoking in 9%, atrial fibrillation in 5%, and previous history of stroke in 29%. The various subtypes of acute ischemic stroke were lacunar infarct in 43%, large artery atherosclerosis in 31%, acridoembolic type 8%, stroke of other determined etiology in 1% and stroke of undetermined etiology in 18%. Hypertension and Diabetes were the most association was found with ischemic heart disease [p=0.01]. Importance and relevance of risk factors evaluated for subtypes rather than ischemic stroke as a whole should be reflected in preventive efforts against the burden of ischemic stroke

Training health professionals to conduct family education for families of patients with first-episode psychosis: adherence to protocol

The implementation of family psychoeducation at the service delivery level is not without difficulty. Few mental health professionals receive special training to work with families especially in Iran. The aim of the present study was to evaluate the effectiveness of training health professionals in terms of their adherence to protocol. Eight professionals [general practitioners, nurses and social workers] participated in a training program for health professionals as part of the Roozbeh First-Episode Psychosis Program [RooF] to conduct family psychoeducation. Training included a 3-day- workshop and 12 supervision sessions during the course of the implementation of the psychoeducation program. The family psychoeducation sessions [multiple-family group or single-family home-based] were tape-recorded. Transcripts of the audiotaped sessions were analyzed based on the content of the manual and were scored accordingly. Twenty-four recorded sessions were analyzed in terms of the adherence to protocol, the number of questions and the time for each session. The overall rating showed a 72% adherence to the protocol. Multiple-family group sessions had a higher rate compared to the singlefamily home-based family psychoeducation sessions [79% to 69%] as well as the time spent and questions asked. The rate of adherence to the protocol of conducting the family psychoeducation sessions had not changed over time. Considering the amount of time taken for training and supervision, the level of adherence to the protocol was satisfactory. Tape recording sessions and regular supervision would be beneficial following specialized training. Further research is needed to tailor the amount of training and supervision required for professionals to conduct family psychoeducation programs in different settings

Hyperamylasemia and acute pancreatitis following organophosphate poisoning

To determine the frequency of hyperamylasemia and acute pancreatitis following organophosphate poisoning. This is a descriptive study conducted at the Medicine Department, Abbasi Shaheed Hospital Karachi during the period of six months from 16th June 2006 to December 2006. All patients of both sexes and ages above 15 years admitted with a positive history of organophosphate poisoning [OP] were included in the study. A special Proforma was designed to enter all the collected data containing the basic information about the patient, history of recent event and the past history, physical examination and the relevant investigations like complete blood count, serum amylase and lipase, alanine aminotransferase [ALT], lactate dehydrogenase [LDH] and ultrasound abdomen. Among 90 patients, hyperamylasemia was found in 28 [31%] patients. Hyperlipasemia was seen in nine [10%] patients and pancreatitis was seen in two [2.2%] patients. Hyperamylasemia is more frequently seen in organophosphate poisoning while two patients proved to have acute pancreatitis as a complication