Link between excessive social media use and psychiatric disorders.

Mental health disorders are an emerging challenge with the progressively increasing usage of social media platforms. Social media use is the second leading cause of disability among psychiatric disorders. A great deal of literature has tried to establish links between social media exposure and mental health diseases. However, there is a need to discuss the current literature that presents crucial perspectives on social media-induced psychiatric disorders to establish a holistic, evidence-based approach for their prevention and treatment. The use of social networks is strongly correlated with the development of anxiety and other psychological problems such as depression, insomnia, stress, decreased subjective happiness, and a sense of mental deprivation. The majority of the cited literature predicts that the likelihood of social media-induced mental health problems is directly proportional to the amount of time spent on these sites, the frequency of usage, and the number of platforms being used. Various possible explanations have been implicated, including a negative impact on self-esteem through unhealthy comparisons, social media burnout, stress, lack of emotional regulation due to social media preoccupation, and development of social anxiety due to decreased real-life social interactions. It has been postulated that increased social media use is driven by preexisting anxiety and is a coping strategy. This era of progressively increasing digitalization, the recent trend of a dramatic shift toward online social life, and the desire to get social attention is expected to take a gruesome toll on the population's mental health, which therefore warrants more attention to mental health care.

Significance of Educational Literature and Diabetes Log Sheet on Hemoglobin A1c.

Diabetes mellitus (DM) is a major cause of morbidity worldwide. The prevalence of DM has doubled over the last 35 years and is escalating. Various complications and manifestations of diabetes have caused numerous deaths worldwide, with numbers increasing every year. There have been many advances and breakthroughs over the past decade in the management of DM. The major focus of many research studies has been to evaluate effective medication combinations, preventative measures, and the way to control such morbid conditions. Our focus in this review is to discuss specific secondary prevention techniques with the diabetes log sheet and educational literature on its effectiveness in controlling diabetes. Hemoglobin A1c (HbA1c) has been accepted as a diabetes control measure in many resources worldwide. Here, we have assessed articles on the effectiveness of the diabetes log sheet and educational literature on HbA1c levels. We will begin with a few key points to acknowledge diabetes initially, followed by discussing the effectiveness of the diabetes log sheet and literature on HbA1c.

Stem Cell Therapy and Its Significance in Pain Management.

Pain management has always been a challenging issue, which is why it has been a major focus of many rigorous studies. Chronic pain which typically lasts for more than three months is prevalent at an astounding rate of 11% to 19% of the adult population. Pain management techniques have gone through major advances in the last decade with no major improvement in the quality of life in affected populations. Recently there has been growing interest in the utilization of stem cells for pain management. Advancement of stem cell therapy has been noted for the past few years and is now being used in human clinical trials. Stem cell therapy has shown promising results in the management of neuropathic, discogenic back, osteoarthritis, and musculoskeletal pain. In this article, we will discuss the role of stem cells in the pain management of the aforementioned conditions, along with the mechanism, adverse effects, and risks of stem cell therapy.

13q14 Deletion and Its Effect on Prognosis of Chronic Lymphocytic Leukemia.

Chronic lymphocytic leukemia (CLL) is the most common leukemia affecting adults. CLL results due to uncontrolled accumulation of B lymphocytes in the body with the clinical spectrum ranging from comparatively benign disease to an aggressive form. The disease pathogenesis lies in molecular genetics, the most common alteration being the deletion in the long arm of chromosome 13, at position 14 (13q14) region. This deletion leads to the loss of important microRNAs which are involved in maintaining the critical balance of the apoptosis mechanism of cell death of B lymphocytes. As such, the imbalance contributes towards B cells' immortality and, thus, CLL arises. This significant 13q14 deletion contributes to CLL's pathogenesis and paves the way for CLL treatment, hence affecting the prognosis of the affected patients. Furthermore, the size of deletion of the long arm of chromosome 13 (13q) has a remarkable effect on its prognosis and therapeutic intervention. The minimal deleted region (MDR)/small deletion or long 13q loss/mutation, and biallelic 13q deletion or monoallelic 13q deletion are commonly seen. 13q14 deletion is an initiating defect targeting tumor suppressor gene locus deleted in lymphocytic leukemia 2 (DLEU2))/microRNA15A (MIR15A)/microRNA 16-1 (MIR 16-1). Regarding CLL treatment, conventional therapy with alkylating agents has been used for a long time, which reported low- to non-existent complete remission rates and adverse events after prolonged use. Moreover, research into the 13q14 deletion has also provided new insights into the molecular genetics and pathways that interact in such a way, making it possible to transform healthy cells into malignant cells in an entirely new fashion with a complete disregard to its original form, resulting in CLL.

HIV and Messenger RNA (mRNA) Vaccine.

Human immunodeficiency virus (HIV) is a part of the lentivirus genus of the retroviridae family that incorporates its genome into the host DNA via a series of complex steps. HIV can be classified into two types, HIV-type 1 (HIV-1) and HIV-type 2 (HIV-2), with HIV-1 being the most common type worldwide. Seventy-six million people have been infected since the start of the pandemic, with a mortality rate of 33 million. Even after 40 years, no cure has been developed for this pandemic. The development of the mRNA vaccine has led to further research for the utilization of mRNA vaccine in HIV, in attempts to create a prophylactic and therapeutic treatment. Although messenger RNA (mRNA) vaccine has been around for many years, it has recently drawn attention due to its role and response in the unforeseen coronavirus pandemic. mRNA vaccine has faced its fair-share of challenges, but it also offers many advantages compared to conventional vaccines such as safety, efficacy, rapid preparation, and versatility. mRNA vaccine has shown promising results and has great potential. In this review, we discuss the types of mRNA vaccine, along with development, delivery, advantages, challenges, and how we are working to overcome these challenges.

Depression and Its Effect on the Menstrual Cycle.

A strong association is noted between depression and early perimenopause as well as menopause. The association was found to be the greatest in women with natural menopause at the age less than 40 years. Excessive corticotropin-releasing hormone (CRH) levels in depression lead to inhibition of the hypothalamic-pituitary-gonadal (HPG) axis and increased cortisol levels which further inhibits the action of gonadotropin-releasing hormone (GnRH) neurons, gonadotrophs, and gonads. The resulting changes in luteinizing hormone (LH) amplitude, follicle-stimulating hormone (FSH) levels, and LH pulse frequency were noted in patients with depression. Besides depression, earlier surgical menopause is associated with cognitive decline. In addition, it is seen that menopausal changes predisposed females to an increased risk of depression. The association between dysmenorrhea and depression was found to be bidirectional and congruent in most studies. Patients with dysmenorrhea and coexisting depression had enhanced pain perception along with a poor response to pain relief measures. Even the treatment of underlying depression has been shown to cause menorrhagia. On the other hand, amenorrhea has also been reported as a side effect of sertraline and electroconvulsive therapy. Menstrual disorders contribute to a significant number of outpatient gynecological visits per year in the United States. Co-existing or history of depression can either be the cause of or interfere in the treatment of these disorders. Furthermore, the treatment of depression can be the etiology of various menstrual abnormalities, while menstrual disorders themselves could be the cause of depression. The increasing prevalence of depression, women's health, multiple female-specific subtypes, and the preexisting burden of menstrual disorders necessitates more detailed studies on the effects of depression on the menstrual cycle.

Chimeric Antigen Receptor T Cell Therapy and Its Significance in Multiple Myeloma.

Multiple myeloma (MM) has a five-year prevalence worldwide of 230,000 people and is known as the second most common hematological malignancy within the United States. Extensive research has been conducted to gain a wide range of treatment strategies, providing hope to these patients. Combination therapy using chemotherapy, monoclonal antibodies, and immunomodulatory drugs are the current management of choice. After the introduction of chimeric antigen receptor (CAR) T cell therapy, promising results have been evidenced. In this therapy, T cells are derived from the patient and modified in-vitro to induce receptors that later target specific antigens when they are injected into patients. CAR T cells use three mechanisms to kill tumor cells: cytolytic pathways, cytokine release, and Fas/FasL axis. In this review, we highlight the different tumor markers targeted for therapy against multiple myeloma (MM). Target antigens for CAR T cell therapy include B-cell maturation antigen (BCMA), signaling lymphocyte activation molecule F7 (SLAMF7), CD38, CD138, CD19, immunoglobulin kappa light chain, orphan G protein-coupled receptor class C group 5 member D (GPRC5D). With the benefit of improving survival and prognosis, this therapy does carry a risk of some adverse events such as cytokine release syndrome, encephalopathy, infections, hypogammaglobulinemia, and tumor lysis syndrome.

Surgical resident training in Pakistan and benefits of simulation based training.

Apprentice-mentor is the traditional method for training surgical residents, but with the advent of time, advanced techniques have been developed to train residents. Simulation training is a time-effective method for training residents and is being used globally, but the majority of training hospitals in Pakistan have been practising apprenticeship model since it came into being. This review was planned to demonstrate the results of studies comparing the efficacy of trainees trained via the traditional apprenticeship model versus simulator-based training. Pubmed and Google Scholar were searched. Keywords used were 'simulation-based training', 'laparoscopic simulators' and 'surgical teaching methods'. Articles published between 1995 and 2017 were selected for review. The search was limited to articles published in English language. The review advocates implementation of simulation for training as well as assessment. This can be a magnificent step towards upgrading our healthcare system.

Depression Among Patients with Chronic Cluster Headaches.

INTRODUCTION: Chronic headaches account for a significant proportion of people leading a poor quality of life. Chronic cluster headaches can be defined as episodes of headache usually around the eye in the pattern of a cluster lasting 15-180 minutes each followed by multiple similar episodes occurring at a frequency of 1-8 times per day. METHOD: This cross-sectional study was conducted in Jinnah Postgraduate Medical Center, Karachi. One hundred patients who were diagnosed cases of chronic cluster headaches were asked to fill the Beck Hopelessness Scale (BHS), Headache Impact Test (HIT), and Hospital Anxiety and Depression Scale (HADS). RESULTS: Of our study subjects, 57 were males and 43 were females. The mean HIT-6 score among these patients was found to be 60.5±7.67 (p-value = 0.04). The mean BHS score among these patients was found to be 13±6.87. The mean HADS reporting anxiety (HADS-A) was found to be 12.54 ± 5.65; whereas, the mean HADS reporting depression (HADS-D) was found to be 7.65 ± 4.65. CONCLUSION: Patients with chronic cluster headaches have higher scores than the general population. There is an association between headache syndromes and depression which require further investigation.

Role of Intra-articular Platelet Rich Plasma in the Management of Osteoarthritis: A Review.

Intra-articular injections are a minimally invasive option developed for the management of patients with joint degenerative conditions. These injections can involve the use of steroid preparations, hyaluronic acid, and blood products. Platelet-rich plasma (PRP) is a cost-effective management modality developed for patients with joint degenerative conditions and has provided promising outcomes. It provides nourishment to the chondrocytes through a rich supply of growth factors and cytokines. This article demonstrates the beneficial effects of PRP therapy in patients with osteoarthritis.

Gustatory Rhinorrhea: A Rare Presentation of Parkinson's Disease.

Non-motor symptoms appear earlier than the motor symptoms of Parkinson's disease. Gustatory rhinorrhea is a rare presentation of Parkinson's disease. We report a case of 70-year-old male who presented to the outpatient department (OPD) with watery secretions on thought or site of food. Symptomatic treatment was advised along with many investigations for the cause. Twenty-two months later the patient developed fine tremors of hands which were evident of Parkinson's disease.

Bilateral Posterior Vitreous Detachment in a Young Patient with Systemic Lupus Erythematosus.

Vitreous detachment is a rarely reported manifestation of systemic lupus erythematosus (SLE). We present here the case of a 20-year-old woman with a history of SLE who presented with a decrease in vision in both eyes, massive hepatosplenomegaly, and multiple joint pain. B-scan ultrasonography revealed bilateral vitreous detachment. Ocular involvement in SLE is associated with high disease activity and morbidity. Therefore, ophthalmological screening for ocular involvement is important for SLE patients at any age.

Complete blood picture with skeletal and visceral changes in patients with thalassemia major.

OBJECTIVE: The objective of this to find the prevalence of skeletal and visceral changes in thalassemics and its relationship with variation in blood components. METHODOLOGY: This is a cross-sectional study conducted in tertiary care hospital in Karachi among patients diagnosed with thalassemia major who require regular blood transfusions. RESULT: Among 200 individuals, 95 were females, whereas 105 were males. 96.5% of the study sample showed normocytic normochromic blood picture. Mean pre-transfusion hemoglobin (Hb) for 200 patients was 8.91 g/dl, while the mean post-transfusion Hb was 12.07 g/dl. Among all the variables, some strong predictors of change were age and HbA which were found associated with the development of cardiac change in transfusion-dependent thalassemia patients. Hepatomegaly was observed in 66.5% of the patients while normal liver span was observed in 33.5%. 6% of patients showed evidence of skeletal changes on X-ray. Splenomegaly was observed in 26.5%, while in 4.5% of the patients, spleen was not visualized due to splenectomy. Cardiac involvement was observed in 8% of the patients on T2*magnetic resonance imaging. CONCLUSION: Visceral changes particularly hepatomegaly is very common among transfusion-dependent thalassemia patients. Blood studies for Hb and ferritin levels help to detect these changes when conventional investigations are not possible.

Transcatheter Mitral Valve Replacement: An Alternate Treatment Methodology for Patients at High Surgical Risk.

Mitral valve regurgitation (MVR) is the reverse passage of blood through the mitral valve when the valve fails to close during ventricle contraction. Transcatheter mitral valve repair and replacement (TMVR) is a recent technology that can benefit MVR patients as an alternative, minimally invasive, and safer solution than conventional open-heart surgical approaches. TMVR uses a catheter guided by ultrasonography to replace or repair the defective valve and has provided better clinical outcomes, decreased hospital stay, and reduced mortality rates. Therefore, TVMR should be made possible worldwide, especially in South-Asian regions where heart conditions such as atrial fibrillation and stroke are major contributing factors in a high postoperative mortality rate.

A case report of gustatory rhinorrhea after maxillectomy performed for squamous cell carcinoma.

A case of 75-year-old male presented with gustatory rhinorrhea for 3 months. Patient has positive history of maxillectomy performed 4 years back for squamous cell carcinoma of maxilla.

Sleep Abnormalities Among Patients With and Without Diabetes Using Pittsburg Sleep Quality Index and Epworth Sleepiness Scale.

Introduction Diabetes has a great influence on sleep patterns. Several hormonal mechanisms are disrupted in patients with diabetes and, hence, affect their sleep patterns. Sleep disturbances further worsen the state of the disease itself. Method In this cross-sectional study, we collected data from 50 healthy adults and 50 patients diagnosed with type 2 diabetes mellitus without comorbidities. Study participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) surveys. Results The mean PSQI score was 8.64 ± 3.96 for patients with type 2 diabetes and 4.24 ± 2.72 for patients without diabetes. The mean Epworth Sleepiness score was 6.3 ± 5.29 among patients with diabetes and 1.94 ± 2.34 for patients without diabetes. Conclusion The early diagnosis and management of sleep problems can help maintain target blood glucose levels and may help impede the future development of complications.

Respiratory Failure Following Organophosphate Poisoning: A Literature Review.

Organophosphates (OPs) account for a large portion of suicides globally. OP manifests as cholinergic crises, which underlie respiratory failure. There are many pathways by which respiration is inhibited secondary to organophosphate poisoning. These include central as well as peripheral mechanisms, with central mechanisms predominating. We conducted a literature review in June 2017. PubMed, Embase, and Google Scholar were searched for studies that reported acute organophosphate poisoning in humans. In our review, data were collected from studies published during the years 2001 to 2016. The data consisted of 1,996 patients with organophosphate poisoning, of which 491 (24.6%) required ventilatory support secondary to respiratory failure. Treatment offered to OP poisoning patients should focus on its pathophysiology to benefit from the future outcomes. Recent advances direct the need for a central nervous system (CNS) protective strategy for future prevention and treatment of events associated with cholinergic crises.