Early electrophysiological findings in guillain barre syndrome

Early electrophysiological testing is more important as early abnormalities can be obtained even in the first week. However the electrical abnormalities may not be that prominently evident for definitive diagnosis in the first 2 weeks. However at times the decision of treatment has to be taken early. Research is required to look at different electrophysiological parameter which could give clue for an earlier diagnosis. The aim of our study is to determine early electrophysiological parameters with in first week to identify GBS at earliest

SPECTRAL ANALYSIS OF HEART RATE VARIABILITY IN PATIENTS WITH CORONARY ARTERY DISEASE

Objective: To carryout frequency domain analysis ofheart rate variability in patients with coronary artery disease. Methods: Forty coronary artery disease patients with coronary artery stenosis greater than 70% of at least one vessel lumen were included. Patients with diabetes mellitus, atrial fibrillation, structural heart diseases and bundle branch block were excluded. DMS 300 4A Holter monitors were used to obtain long-term 12 lead digital ECG recordings. Cardio Scan premium luxury software was used for analysis of heart rate variability. Results: The mean values of heart rate variability in patients were TP (2171.70 ± 1028.7), VLF (1661.41 ± 807.88), LF (392.71 ± 227.92), HF (112.03 ± 77.90) and LF/HF ratio (4.03 ± 1.75). On comparison with normal reference values there was a significant decrease (p-value < 0.05) in all parameters except VLF (p-value = 0.351). TP was reduced in all the patients (100%), VLF in 26 (65%), LF in 36 (90%), HF in 36 (90%) and LF/HF ratio in 29 (72.5%) patients. The difference between the frequency of patients with decreased heart rate variability was statistically significant (p-value < 0.05) except VLF (p-value = 0.082). Conclusion: Heart rate variability decreases significantly in patients with coronary artery disease

Validating Learning Organization in the Medical Profession: A Preliminary Analysis

This study investigates the underlying pattern of learning organisation practices among medical doctors using Learning Organization Survey (LOS) designed by Garvin, Edmondson and Gino (2008). The instrument was modif ied to adapt to settings in clinical care. A preliminary data of 150 medical doctors were used for reliability and exploratory factor analysis (EFA). Cronbach’s alpha indicated an excellent reliability score. The outcome of EFA was a seven-factor solution. While some subscales converged to new factors, the three building blocks of a learning organisation successfully retained the original items. The outcomes reveal that LOS in the context of medical vocation is reliable and valid at an initial stage. The three building blocks of a learning organisation as specif ied by Garvin et al. (2008) can, therefore, be instrumental in fostering continuous learning in medical vocation. The conception of the learning organisation, albeit important for continuous development of human resources for health in the 21st century, was not well researched in medical vocation. The present study, in this context, is an initial analysis that suggests grounds for future research. The findings call for further enquiries with an expanded sampling framework as well as further validation on LOS using conf irmatory factor analysi

Validating Learning Organization in the Medical Profession: A Preliminary Analysis

This study investigates the underlying pattern of learning organisation practices among medical doctors using Learning Organization Survey (LOS) designed by Garvin, Edmondson and Gino (2008). The instrument was modified to adapt to settings in clinical care. A preliminary data of 150 medical doctors were used for reliability and exploratory factor analysis (EFA). Cronbach’s alpha indicated an excellent reliability score. The outcome of EFA was a seven-factor solution. While some subscales converged to new factors, the three building blocks of a learning organisation successfully retained the original items. The outcomes reveal that LOS in the context of medical vocation is reliable and valid at an initial stage. The three building blocks of a learning organisation as specified by Garvin et al. (2008) can, therefore, be instrumental in fostering continuous learning in medical vocation. The conception of the learning organisation, albeit important for continuous development of human resources for health in the 21st century, was not well researched in medical vocation. The present study, in this context, is an initial analysis that suggests grounds for future research. The findings call for further enquiries with an expanded sampling framework as well as further validation on LOS using confirmatory factor analysis

Effect of Reperfusion on Time Domain Parameters of Heart Rate Variability

Objective: To compare effect of reperfusion by measuring time domain parameters of heart rate variability before and after percutaneous transluminal coronary angioplasty. Study design: Quasi experimental study design Place and Duration: Department of Clinical Cardiac Electrophysiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi from January 2014 till January 2015. Patients and Methods: 40 patients with coronary artery disease having mean age of 55.20 ± 8.03 years were recruited by non-probability convenience sampling. DMS 300-4A Holter monitors were used to obtain 24 hours ambulatory ECG recording before and within 24 hours after percutaneous transluminal coronary angioplasty. Digital ECG data were transferred to the computer and edited with the help of DMS Cardioscan software. Heart rate variability was analysed in time domains measures. For time domain analysis normal heart rate, SDNN, SDNNi, SDANN, RMSSD and pNN50 were recorded from 12 lead digital ECG data. Results: The results of our study demonstrated significantly decreased heart rate variability in coronary artery disease patients on comparison of pre and post-angioplasty values only SDNNi was significantly reduced (p-value = 0.035) whereas the reduction in SDNN and pNN50 was statistically insignificant (p-value &gt; 0.05). On the contrary, SDANN and RMSSD displayed slight rise after angioplasty but it was not significant (p-value &gt; 0.05). Conclusion: Reperfusion after percutaneous transluminal coronary angioplasty decreases heart rate variability within 24 hours after the procedure. Whereas, heart rate during the same period after angioplasty increases. This reflects autonomic balance shifts towards sympathetic predominance as indicated by reduced heart rate variability and rise in heart rate. This makes the susceptible patients vulnerable for development of ventricular arrhythmias especially during 24 hours after angioplasty. Therefore, patients with decreased heart rate variability are at risk of ventricular arrhythmogenesis so they may be kept under medical surveillance for at least 24 hours after percutaneous transluminal coronary angioplasty

Polyethylene glycol functionalized carbon nanotubes/gelatin-chitosan nanocomposite: An approach for significant drug release

This research work blooms the new idea of developing a safe and controlled drug releasing matrix using multi-walled carbon nanotubes (MWCNTs). In aqueous solution, uniform and highly stable dispersion of MWCNTs was obtained after secondary functionalization with polyethylene glycol (PEG) which was studied by Fourier transmission infrared spectroscopy (FTIR) and thermogravimetric analysis (TGA). Solution casting method was used to prepare MWCNTs/gelatin-chitosan nanocomposite films and the effect of MWCNTs on physico-mechanical, thermal and water uptake properties of the nanocomposites were evaluated. Incorporation of MWCNTs into the porous gelatin-chitosan matrix showed interesting stiffness and dampness along with developed microfibrillar structures within the pore walls intended at being used in tissue engineering of bone or cartilage. A common antibiotic drug, ciprofloxacin was incorporated into nanocomposite matrix. The evaluation of the effect of MWCNTs on drug release rate by dissolution test and antimicrobial susceptibility test was performed. Sharp release of the drug was found at early stages (∼1 h), but the rate was reduced afterwards, showing a sustained release. It was observed that for all microorganisms, the antibacterial activities of drug loaded MWCNTs/gelatin-chitosan nanocomposites were higher than that of drug loaded gelatin-chitosan composite films containing no MWCNTs. Comparative statistical studies by ANOVA techniques also showed remarkable difference between the antibacterial activities, exhibited by MWCNTs-incorporated and non-incorporated composite films. Keywords: Carbon nanotubes, Functionalization, Nanocomposite, Thermo-mechanical properties, Drug dissolution, Antibacterial activitie

Brain Injury and Dementia in Pakistan:Current Perspectives

Alzheimer\u27s disease (AD) is the most common form of dementia, accounting for 50-75% of all cases, with a greater proportion of individuals affected at older age range. A single moderate or severe traumatic brain injury (TBI) is associated with accelerated aging and increased risk for dementia. The fastest growth in the elderly population is taking place in China, Pakistan, and their south Asian neighbors. Current clinical assessments are based on data collected from Caucasian populations from wealthy backgrounds giving rise to a diversity crisis in brain research. Pakistan is a lower-middle income country (LMIC) with an estimated one million people living with dementia. Pakistan also has an amalgamation of risk factors that lead to brain injuries such as lack of road legislations, terrorism, political instability, and domestic and sexual violence. Here, we provide an initial and current assessment of the incidence and management of dementia and TBI in Pakistan. Our review demonstrates the lack of resources in terms of speciality trained clinician staff, medical equipment, research capabilities, educational endeavors, and general awareness in the fields of dementia and TBI. Pakistan also lacks state-of-the-art assessment of dementia and its risk factors, such as neuroimaging of brain injury and aging. We provide recommendations for improvement in this arena that include the recent creation of Pakistan Brain Injury Consortium (PBIC). This consortium will enhance international collaborative efforts leading to capacity building for innovative research, clinician and research training and developing databases to bring Pakistan into the international platform for dementia and TBI research

Building the ecosystem for pediatric neuro-oncology care in Pakistan: Results of a 7-year long twinning program between Canada and Pakistan

Background: Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. Methods: Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. Results: A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. Conclusions: Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar program

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality