Why physicians and lay people smoke and how can it be reduced?

Objective: The objective of this study was to find out the level of knowledge the physicians and lay people have pertaining to the effect of cigarettes, why certain physicians smoke and what measures could be applied to reduce the rate of smoking. Methods: A questionnaire was administered to the one hundred physicians who smoke, one hundred non-smoking physicians and one hundred lay people who smoke to determine their attitude towards this addition. Subjects were chosen using convenience sampling. The physicians were picked from six hospitals of Karachi. Results: When the smoking physicians were asked what could motivate them to stop smoking, majority of them said that an occurrence of a smoking related illness would. Majority of the physicians who do not smoke felt that individual will was the greatest force keeping them from smoking. When asked how smoking can be reduced in Pakistan, majority of the physicians, both smoking and non-smoking, favoured mass health education. Lay smokers expressed marked ignorance about deleterious effects of cigarette smoke. Like smoking physicians, majority of them said that occurrence of an illness related to smoking would effectively motivate them to stop smoking. CONCLUSION: Based on this survey we conclude that mass health education and enforcement of the ban on smoking in public places will effectively reduce the number of smokers. There is a need to educate physicians and the general public about the cardiac and carcinogenic effects of smoking

Emergency Intraperitoneal Onlay Mesh Repair of Incarcerated Spigelian Hernia

This report suggests that Spigelian hernia in an emergency setting may be easily and quickly repaired with an intraperitoneal onlay method using composite mesh

Radiation-induced tongue myokymia with hypoglossal nerve damage, mimicker of motor neuron disease

This teaching case of tongue myokymia offers clear electromyographic findings of myokymic discharges on two different sweeps. Radiation-induced tongue myokymia should be considered in the differential diagnosis for motor neuron disease (MND)

Foix Alajouanine Syndrome Mimicking Longitudinally Extensive Transverse Myelitis

Objective: To describe an interesting case of Foix-Alajouanine Syndrome presenting as a longitudinally extensive transverse myelitis (LETM). Background: Foix-Alajouanine Syndrome is caused by a spinal dural arteriovenous malformation and presents as paraparesis and progressive walking impairment. It most commonly involves the thoracolumbar region and affects elderly men. Though treatable, it is a cause of progressive myelopathy often misdiagnosed or missed. Case Discussion: A 77-year-old man with a history of coronary artery disease presented with a one-year history of progressive lower extremity paresthesia, weakness, gait instability, and recurrent falls. He had no lumbar or lower extremity pain. He had no bladder incontinence. His symptoms were attributed to lumbar spinal stenosis and he underwent L3-L4 lumbar decompression at an outside hospital with no improvement. MRI of the lumbar spine without contrast done at the outside facility was reviewed and it showed an LETM from T8 through the tip of the conus medullaris. MRI of the entire spine was repeated with gadolinium. MRI lumbar spine with gadolinium showed flow voids at the dorsal aspect of T8-T9 consistent with a Type I spinal dural AV fistula. This was confirmed by the spinal angiogram. The patient had a negative MRI brain and cervical spine imaging. The spinal fluid analysis was unremarkable. Aquaporin-4 antibody and anti-MOG antibody tests were negative. He underwent a laminectomy with microsurgical obliteration of the AV fistula and regained 50% of his lower extremity strength within 48 hours of his surgery and continues to improve with physical therapy. Conclusion: Foix-Alajouanine Syndrome should be considered in the differential diagnosis of LETM. It is a reversible cause of progressive myelopathy and needs a careful review of imaging, laboratory data, and clinical findings.https://scholarlycommons.henryford.com/merf2020caserpt/1106/thumbnail.jp

Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody

The presentation of several autoimmune neurological disorders in a single patient is rare and often debilitating. However, early diagnosis and efficacious treatment can lead to a significant recovery. Here, we present an interesting case of a triple antibody-positive autoimmune neurological syndrome patient who manifested the clinical features of neuromyelitis optica (NMO) spectrum disorder (NMOSD), N-methyl-D-aspartate (NMDA) receptor (NMDAR) encephalitis, and myasthenia gravis (MG). Hence, the patient manifested both central and peripheral nervous system immune-mediated neurological syndromes. A middle-aged female with a history of seropositive aquaporin-4 (AQP4) NMOSD on mycophenolate 1 g twice daily presented with severe fatigue and right eye ptosis (three months since NMOSD diagnosis) and tested positive for acetylcholine receptor (AchR) binding antibody, consistent with MG. Six months after the patient\u27s NMOSD diagnosis, she began to experience subacute progressive cognitive decline, behavioral changes, imbalance, anxiety/panic attacks, and paranoid delusions. NMDAR encephalitis was suspected, and she tested positive for cerebrospinal fluid NMDAR antibodies. After treatment with steroids failed, she was given two doses of rituximab 1 g, two weeks apart, and reported improvement in her symptoms shortly after the second dose

The Application of Human-Centric Lighting in Response to Working from Home Post-COVID-19

COVID-19 has caused a considerable proportion of the public to work from home, either part- or full-time, in unregulated domestic conditions, which have not been designed for commercial activities. This study determined what existing lighting conditions were present in a selection of work-from-home (WFH) environments (Objective One) through quantitative lux level and equivalent melanopic lux (EML) readings by evaluating them against regulatory standards, where further study is required to validate the results with a larger dataset. This study also investigated the social demand for human-centric lighting (HCL) installations within WFH environments (Objective Two) through qualitative questionnaires by considering key parameters: sustainability, practicality, and cost. The results of Objective One showed that compliance with general safety lighting requirements was achieved by 80% of the installations. The mean lux level recorded was 452.4 lux and 0.729 uniformity, which fell below commercial requirements defined for commonly performed WFH activities; 34.3% of recorded EML dropped below the regulatory requirements under daylight conditions. When isolated to artificial lighting, only 7.5% of the required EML was achieved. The results of Objective Two showed that generally participants did not feel that their WFH installations were unsuitably lit, however, 46.2% of participants identified noticeable headaches or eye strain when working from home. A total of 80% of participants highlighted that HCL task lighting would be preferable. It was also found that participants were willing to invest in circadian lighting for health, where 63.2% of them would not accept a reduction in efficiency of over 10% compared to non HCL. Wellbeing was found to be participants’ key preference for their lighting systems, followed by efficiency, home impact, and cost