Role of Inflammation and Serum Creatine Phospho Kinase in Seizures

Background and Objectives: Epilepsy which is a disorder with an extensive variability of symptomatology and multifactorial origins is categorized by emergent and recurrent seizures. Numerous studies showed that seizures are triggered by hyperactivity of the neurons of the brain which may be atypical and synchronous. Our study was aimed to find out the association of inflammation in terms of total leukocyte count (TLC) and serum creatine phosphokinase (CPK) concentration in epilepsy and their comparison with pseudo-seizures and healthy controls. Methodology: We conducted this study in Mayo Hospital, Lahore with the collaboration of the Physiology Department of King Edward Medical University, Lahore after approval from Advanced Studies and Research Board of KEMU, Lahore. The sample size was ninety and they were divided equally into three groups, 30 patients of GTCS, 30 patients with a history of pseudoseizures and 30 healthy subjects of comparable age. p< 0.001 was taken as significant. Statistical analyses were done using SPSS 21. Results: Mean total leukocyte count (TLC) in Pseudo-seizures groups was 8216.3 ± 2195.8 cu.mm, in the epileptic group was 13219.9 ± 2686.8 cu.mm and in the control group, the mean TLC was 6832.1 ± 1154.9 cu.mm. Mean serum CPK in pseudo-seizure groups was 130.1 ± 74.3 IU/100 ml, in the epileptic group was 257.7 ± 24.6 IU/100 ml and in the control group, the mean CPK was 79.9 ± 27.7 IU/100 ml. Conclusion: Total leukocyte count (TLC) and CPK were higher in the epileptic group as compare to the pseudo-seizure groups as well as the control group. Elevated WBC levels may be a result of continuing inflammatory progressions in the pathogenesis of epilepsy. Therefore it was concluded that serum CPK and TLC may serve as a differentiating marker between epileptic generalized tonic-clonic seizures (GTCS) and pseudo seizers.

Patient Safety Awareness among Future Health Professionals in a Pakistani Medical College of Military Set-up

Objective: To assess the awareness among undergraduate medical students towards patient safety in a medical school of the military set up in Pakistan. Methods: “Attitudes toward Patient Safety Questionnaire III” was used to assess awareness of MBBS students regarding patient safety. The questionnaire on 7 points Likert scale was administered to MBBS students of the fourth and final year during their clinical rotation at “The CMH Lahore Medical College and Institute of Dentistry” in 2019. Social Sciences (SPSS) Version 20 was used for the analysis of data. Results: The questionnaire was filled by 166 participants, yielding a response rate of 80%. The two out of nine domains regarding “teamwork” and “long working hours” scored the highest 6.0 mean score. “Disclosure responsibility” scored lowest 4.4 mean score followed by domain regarding “Professional incompetence” 4.5 and “Error inevitability” 4.7. Domain about the integration of this emerging issue in the curriculum scored 5.5. The mean scores of items showed no significant difference with respect to their academic levels and gender. Conclusion: Students showed an interest in patient safety. Most of them supported the integration of this important issue in an undergraduate medical curriculum. However, there was a knowledge gap among students regarding the causes and disclosure of medical errors. Due to insufficient awareness among future doctors, the inclusion of the formal patient safety curriculum and its early integration from the beginning of medical education is imperative.

Comparison of Latex Agglutination Test with Polymerase Chain Reaction for Detection of mecA Gene in Methicillin Resistant Staphylococcus aureus

Background: Antimicrobial resistance is a devastating question that threatens health globally. The extensive, indiscriminate and unnecessary consumption of antibiotics for humans, as well as wildlife and in agriculture; lead to the development of notoriously resistant Staphylococcus aureus; through possession of mecA gene, encoded by modified Penicillin binding protein (PBP2a); being labeled “Methicillin resistant Staphylococcus aureus”. Conventional phenotypic techniques for MRSA detection rely on standardization of cultural characteristics. The latex agglutination method can be adopted as an accurate strategy for rapid detection of MRSA. Methodology: A total of 713 consecutive, non-duplicate isolates of Staphylococcus aureus were processed. Methicillin resistance was determined using cefoxitin (30 µg) by Kirby-Bauer method following Clinical and Laboratory Standards Institute (CLSI) guideline, latex agglutination method; and PCR for mecA gene. Results: The results showed that out of 713 Staphylococcus aureus isolates, 12.90% isolates were detected as MRSA due to resistance to cefoxitin. By latex agglutination method, 87 (94.50%) were positive for PBP2a; while on PCR mecA gene was detected only in 82 (89.10%) MRSA isolates. When assessed with PCR (gold standard) the sensitivity and diagnostic accuracy of latex agglutination was 100% and 94.57%, respectively. Conclusion: Latex agglutination test can be used as a prompt and reliable diagnostic technique for mecA gene detection in MRSA isolates, where molecular methods are limited. This can effectively minimize the misdiagnosis of resistant strains, and over/misuse of antibiotics.

Salivary Cortisol Levels in Severely Depressed Patients and Healthy Individuals

Introduction: This study compared the levels of salivary cortisol in patients suffering from severe depression and in healthy individuals. Methods: Sample size included 30 diagnosed cases of major depression based on outdoor clinical assessment (from April 2015 to December 2105) and was established by ICD-10 and DSM-IV criteria and 30 physically and mentally healthy subjects. In this study diagnosed cases of hyperaldosteronism, Cushing’s syndrome/ disease were omitted. A predesigned proforma was created on the basis of Becks Inventory. Saliva samples were collected and processed, and the measurement of cortisol levels was done by ELISA. Results: In a normal subject, the mean cortisol level was 1.46 ± 0.9 μg/dl (Mean ± SD) whereas in depressive patients it was raised (2.2 ± 1.6 μg/dl, p=0.031). Results also showed that high level of cortisol in saliva was found in individuals with a positive family history of depression (2.3 ± 1.8 μg/dl) as compared to healthy subjects (1.5 ± 1.0 μg/dl). Mean BMI was also found to be different between the 2 groups (p=0.012). Conclusion: We concluded that salivary cortisol may act as an early diagnostic tool and non-invasive biomarker for prompt diagnosis of potential cases of depression for effective management. Hence, early initiation of treatment can be helpful in improving the late clinical consequences in severely depressed patients and decreasing the morbidity.