The effect of noxious stimulation of the right masseter muscle on single motor unit activity at two sites in the masseter muscle during standardized jaw closing tasks

Background and aims: The Pain Adaptation Model and the Vicious Cycle Theory are older theories of the effects of pain on motor activity. While some data sets are consistent with these theories, other data sets are not, and a number of new models (the Integrated Pain Adaptation Model; Theory of Motor Adaptation to Pain) have been proposed. Two of these models propose a reorganization of motor activity in pain. The aim of the present study was to determine whether experimental masseter muscle pain resulted in a change in muscle activity at two different sites within the masseter muscle during the performance of isometric jaw-closing tasks in asymptomatic participants. Methods: Single motor unit (SMU) activity was recorded with bipolar fine wire electrodes at 2 sites within the right masseter muscle during the performance of standardized isometric biting on an intraoral force transducer in 17 healthy participants. Participants performed standardized biting trials during infusion of 5% hypertonic saline into the right masseter (pain), and during isotonic saline infusion (control). Recruitment patterns, force thresholds and firing rates were compared between pain and control trials. Results: A total of 50 SMUs were discriminated from the 2 sites. Changes in recruitment patterns of SMUs at one site within the masseter muscle during pain in comparison with control was observed during the tasks and some of these changes were different to the changes occurring at the other site. There were no changes in thresholds of SMU firing nor in SMU firing rates between pain and control trials. Inter-individual variability in the motor response to pain was observed at the two different sites of the masseter. Discussion and Conclusions: In general, the data are not consistent with the earlier models of pain-motor interactions, but provide support for more recent models proposing a re-organization of motor activity in the presence of pain

Clinical significance of maternal anti-Cw antibodies: a review of three cases and literature

Anti Cw antibody is a low frequency immunoglobulin (IgG) against red cell antigen- Cw. It is clinically significant and may cause haemolytic disease of the newborn. Due to its low frequency, it is not included in routine antenatal antibody screening panel. The incidence of Anti Cw antibodies has not been reported in our population. Here, we describe the clinical and laboratory spectra of three pregnant women having low titres anti Cw antibodies. Fortunately, haemolytic disease of the newborn was not encountered in any case

Management of Helicobacter pylori among medical doctors working in Khartoum, Sudan 2019: a cross-sectional study

Background: Various international guidelines have been developed regarding Helicobacter pylori (H. pylori) management, as it is infecting more than half of the world's population. Sudan's health system lacks guidelines regarding H. pylori management, leading to a discrepancy in practice. Investigating the current approach could be a step forward in the formulation of a national consensus in the management of H. pylori. Methods: A cross-sectional study was conducted among medical doctors currently working in Khartoum, Sudan. Participants were enrolled from platforms of medical associations through an online questionnaire. The questionnaire was scored out of 25 points, and scoring 13 or above considered a good approach. Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results: A total of 358 medical doctors participated in the study. The mean (±SD) score was 12.9(±4.5). Those who were using textbooks, campaigns, symposiums or general medical information to their primary Source of knowledge significantly scored higher. The most selected indication for both diagnosis (76.8%) and treatment (67.6%) was an active peptic ulcer. Stool antigen test (SAT) was the most preferred test (70.7%). The majority of respondents selected triple therapy (82.1%) as a first-line regimen. Only 37.7% confirmed the eradication after four weeks of stopping the treatment. They ensure eradication mainly through SAT (29%). Conclusion: A suboptimal approach was noted among medical doctors of Khartoum, Sudan, regarding H. pylori management. Efforts should be invested in forming national guidelines and the implementation of continuous medical education programs. Keywords: Helicobacter pylori, Medical doctor, Sudan

Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed

Introduction: Upper gastrointestinal bleeding is a common reason for hospitalisation across the world, with a UK frequency of 10% and a death rate of 8-14 percent. [1] Several risk assessment scores have been created to predict clinically relevant outcomes like death, the requirement for hospital-based care, rebleeding, and hospital stay length Objective: To determine frequency of mortality in patients with high AIMS65 score presenting with upper gastrointestinal bleeding. Setting: Gastroenterology Department –removed for blind review--- Material & Methods: It was a cross-sectional, prospective, observational research study. Patients having a high AIMS score were recruited in the study. The patient's medical history, physical examination, and biochemical data were all properly recorded. Patients were observed for the outcome variable, which was hospital mortality. Results: 119 patients fulfilling the inclusion criteria were included. There were 77 (64.7%) males and 42 (35.3%) females. The mean age was 43.10 ± 14.213 years On analysis of demographic data, it was observed that 61 (51.3%) patients were below 40 years of age. On analysis of organ dysfunction 79 (66.4%) had cardiovascular dysfunction, 55 (46.2%) had respiratory dysfunction, 39 (32.8%) had renal dysfunction. On outcome variable, It was observed that 81 (68.1%) of the people had died. Conclusion: Majority of the patients with high AIMS had mortality. Majority of the patients were males and had cardiovascular dysfunction. Key words: GERD, endoscopy, gastroduedonal disease, carcinoma, gastritis

Frequency of Hyperlipedemia in Patients Coming with Ischemic Stroke in Tertiary Care Hospital Karachi

Background and objective: Stroke is the second leading cause of death and the third leading cause of disability. This study was designed to determine the frequency of hyperlipidemia in patients with ischemic stroke visiting at a tertiary care hospital in Karachi. Methods:This was a descriptive cross-sectional study and was done in Department of Medicine, LCMD/ Dar-ul-Sehat Hospital Karachi, Pakistan. A total of 184 patients were studied during the study period of six months and all the consecutive patients were recruited who presented with acute stroke in the department of medicine from the duration April 1st 2022 to September 30th, 2022.Those fulfilling the inclusion criteria for this study were included for data analysis, while the patients who did not meet the said criteria were excluded. Their serum lipid levels were collected within 24 hours of admission. Hyperlipidemia was measured through fasting lipid profile and was labeled as present if any one or more of the following profile like total cholesterol \u3e200 mg/dl, LDL cholesterol \u3e 100 mg/dl, TGL \u3e 150 mg/dl, HDL cholesterol \u3c 40 mg/dl, as appropriate. Results:The mean age of the patients was 65.17±12.73. Average systolic and diastolic blood pressure was 152.34±21.31 & 83.35±13.71 mm Hg respectively. Mean duration of smoking and diabetes mellitus in first ever ischemic stroke patients was 9.33±4.03 & 13.65±5.8 years respectively, whereas average fasting blood sugar was found 151.98±69.73mg/dl; 118 (64%) were males and 66 (36%) were females. A total of 124 (67.4%) of patients had a history of hypertension, while 94 (51.1%) were diabetic. Fifty-three (28.8%) of patients had a history of coronary artery disease while 22 (11.95%) patients had history of smoking. Increased triglycerides level was seen in 47 (25. 5%). The frequency of hyperlipidemia was 145 (79%) patients respectively. Conclusion: Frequency of hyperlipidemia was 145 (79%) in patients with ischemic stroke which is moderately high in our setup. A high prevalence of hyperlipidemia is alarming in our setup and requires attention of the physicians on modifiable risk factors

On Some Integral Operators for Certain Classes of p

We study some generalized integral operators for the classes of p-valent functions with bounded radius and boundary rotation. Our work generalizes many previously known results. Many of our results are best possible

Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients

Background: This study investigated the clinical features and outcome of hospitalized coronavirus disease 2019 (COVID-19) patients admitted to our quaternary care hospital.Methods: In this retrospective cohort study, we included all adult patients with COVID-19 infection admitted to a quaternary care hospital in Pakistan from March 1 to April 15, 2020. The extracted variables included demographics, comorbidities, presenting symptoms, laboratory tests and radiological findings during admission. Outcome measures included in-hospital mortality and length of stay.Results: Sixty-six COVID-19 patients were hospitalized during the study period. Sixty-one percent were male and 39% female; mean age was 50.6±19.1 years. Fever and cough were the most common presenting symptoms. Serial chest X-rays showed bilateral pulmonary opacities in 33 (50%) patients. The overall mortality was 14% and mean length of stay was 8.4±8.9 days. Ten patients (15%) required intensive care unit (ICU) care during admission, of which six (9%) were intubated. Age ≥60 years, diabetes, ischemic heart disease, ICU admission, neutrophil to lymphocyte ratio ≥3.3, and INR ≥1.2 were associated with increased risk of mortality.Conclusion: We found a mortality rate of 14% in hospitalized COVID-19 patients. COVID-19 cases are still increasing exponentially around the world and may overwhelm healthcare systems in many countries soon. Our findings can be used for early identification of patients who may require intensive care and aggressive management in order to improve outcomes

Formulation and in vitro /in vivo Evaluation of Silymarin Solid Dispersion- Based Topical Gel for Wound Healing

Silybum marianum, from which silymarin (SM) is extracted, is a medicinal herb. In the Biopharmaceutics Classification System, it is of the class II type, meaning it is almost completely insoluble in water. It has a number of therapeutic properties, including anti-inflammatory as well as properties that promote wound healing. This research target is to promote the dissolution and solubility of SM by employing a technique called solid dispersion and then incorporating the formula of solid dispersion into a topical gel that can be used for wound healing.   Solid dispersion is a technique used to enhance solubility and dissolve pharmaceuticals that are not water-soluble. This method is widely used because of its low cost and high efficiency. Because of its capacity to repair skin, the hydrophilic carrier nicotinamide (NA) was selected in this investigation as the  carrier. Kneading, solvent evaporation and fusion  with a consistent drug-to-carrier ratio were the three separate processes utilized in the preparation of solid dispersion (1:1, 1:3, and 1:5). In addition, the products were examined to determine their physical characteristics and the degree of crystallinity. The selected formula was combined into a hyaluronic acid base gel using the cold method. This gel was then evaluated in vitro for physical qualities and put to an in vivo (animal) examination to determine how it healed wounds. The study found that the solvent evaporation made SM 25 times more soluble and caused all of it to be released in 20 minutes for a 1:3 ratio.  Additional research using DSC and XRD demonstrated the amorphous nature of the result. According to FTIR, there was no evidence of interaction between the two. The gel formula had good qualities, like a pH of 6.6, good spreadability, and drug release within three hours. It also contributed to the rapid healing of wounds

Systemic lupus erythematosus presenting as hemolytic uremic syndrome: a case report

Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general condition improved. Unfortunately she was lost to follow up as she decided to return back to Afghanistan

Clinical Presentation of Alzheimer Disease (ad): a hospital based observational study.

Introduction: Alzheimer's disease (AD) is a neurodegenerative illness that mani-fests itself clinically and pathologically.Objective: To identify the various patterns of Alzheimer’s disease (AD) in adults.Methodology: A hospital based observational study was conducted in the Depart-ment of Neurology Jinnah Postgraduate Medical Centre (JPMC) Karachi, Pakistan from May 2018 to November 2019.Cases with complaint of memory impairment and/or cognitive impairment, with or without behavioral changes were included in the study. Acute delirious state uremia / hepatic encephalopathy hypo / hypergly-cemia and hypo / hypernatremia were excluded diagnosis. The main outcome measures were clinical patterns of AD with age and sex distribution, affective disor-der with cognitive impairment (Pseudo dementia) and affective disorder without cognitive impairment.Results: A sample of 51 cases (36 males and 15 females) with memory impairment was included. Age’s between 25-85years (mean 57years). Out of 51 cases 44 had probable /possible Alzheimer’s disease (AD) 03 had affective disorder with cogni-tive impairment (pseudo dementia), 04 patients had affective disorder without cognitive impairment. Among probable / possible cases of AD 23 (52.27%) had multi infarct dementia (having history of past cerebrovascular disease), same sta-tistics among Parkinson’s patient’s i.e. diagnosis was Parkinson’s disease with memory impairment were 18 (40.90%) followed by alcoholic dementia in 03 (6.8%). There was no definite Alzheimer’s disease case in this study.Conclusion: Vascular dementia not the definite Alzheimer’s disease is the com-monest memory impairment type presentation in our study. Among Parkinson’s disease patient’s dementia was found quite high in our study.Keywords: Alzheimer’s disease (AD), Vascular dementia (MID), Parkinson’s disease (PD), Cognition, Memory