Is Metoclopramide Effective in Treating Symptoms in Diabetic Gastroparesis?

Objective: The objective of this selective EBM review is to determine whether or not is metoclopramide effective in treating symptoms in diabetic gastroparesis? Study Design: Systematic review of 1 controlled randomized double blinded study, 1 controlled randomized open label study, and 1 controlled open label case analysis published in peer reviewed journals between 2012-2014, all in English language. Data Sources: 1 randomized double blinded study, 1 randomized open label study, and 1 case analysis comparing symptom reduction of gastroparesis after the intervention of nasal and oral metoclopramide compared to placebo controls. These sources were found using PubMed and OVID. Outcomes Measured: Patients graded their symptoms on a scale and graded the severity of each symptom after the use of nasal and oral metoclopramide. The studies gave patients different scales to measure the severity of each symptom which included a Symptom Assessment Questionnaire (SAQ), Gastroparesis Cardinal Symptom Index Daily Diary, and a Clinical Patient Grading Assessment Scale (CPGAS). Results: Conclusively, the studies did not show a reduction in symptoms after the intervention for gastroparesis in diabetic patients. Only one study demonstrated symptom reduction to be statistically significant while the other two studies did not. Conclusions: The use of metoclopramide did not show an improvement in gastroparesis symptoms as assessed by patients after the use of the medication from these studies. More RCT need to be done to prove this scientifically rather than through patient report due to bias or misunderstanding of scoring and through a trial using same comparison groups for a longer duration

Existence of Dependency-Based Attacks in NodeJS Environment

Node.js is an open source server-side run-time platform for JavaScript applications. Node.js applications are dependent on several, even hundreds, packages, which in turn have many dependencies. There is always a risk of malicious code hidden in one of these dependencies. This work analyzes vulnerabilities found in Node.js based applications, discusses basic types of attacks and reports about the assessment of five frequently-used Node.js packages

A rare case of serologically diagnosed overlap syndrome presents as an idiopathic inflammatory myositis without any overlapping features

Overlap syndrome is a rare inflammatory rheumatic condition that shares features suggestive of at least two distinct autoimmune diseases with a reported prevalence of less than 34/100,000 persons and an incidence of less than 20/million/year. One example of an overlap syndrome is the presence of dermatomyositis or polymyositis with other autoimmune afflictions such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or Sjogren’s syndrome. We present a case report of a 22-year-old male presented with progressive weakness in both upper and lower limbs without any other significant complaints. On investigation, serology revealed antibodies suggestive of overlap syndrome, which on further investigations, categorized as idiopathic inflammatory myositis (IIM). This shows that overlap syndrome, as an IIM, is one of the differential diagnoses in patients presenting with progressive extremity weakness involving both extremities even if there is no involvement of any sensory function

Management of post-partum haemorhage at tertiary care center

Background: In developing countries like India post-partum haemorrhage (PPH) contributes to 35% of all maternal deaths and 239 per 1,00,000 deaths. So, PPH is a high-risk condition which increases maternal morbidities and mortalities. Hence it mandates a multidisciplinary approach. Audit of misses and near misses helps to determine causes of maternal morbidity and mortality and identify gaps in care. Aim of the study was to study conservative and definitive management of PPH. Methods: A retrospective analysis of all patients who has undergone PPH and also cases who referred from outside with PPH in department of obstetrics and gynaecology at civil hospital Ahmedabad from January 2021 to January 2022. Results: Out of 6029 deliveries there were 171 cases of PPH (2.8%). Which of 150 cases (87.7%) managed by conservative management (uterine conserving) and 21 (12.3%) cases were required definitive management (hysterectomy) due to failure of conservative management. Out of all cases 78.8% cases of PPH were due to atonicity of uterus and 19.1% cases were due to traumatic cause. Early recourse to hysterectomy was recommended especially where bleeding is associated with morbidly adherent placenta. Conclusions: PPH is an important cause of morbidity and mortality. We now have more options for conservative management which can greatly reduce its sequelae and more importantly in patients with wider issues of reproductive health. But in case of intractable bleeding and non-responsive by conservative management definitive management (Hysterectomy) is life saving and last resource

Neural mechanisms of attention and speech perception in complex, spatial acoustic environment

We can hold conversations with people in environments where typically there are additional simultaneous talkers in background acoustic space or noise like vehicles on the street or music playing at a café on the sidewalk. This seemingly trivial everyday task is difficult for people with hearing deficits and is extremely hard to model in machines. This dissertation focuses on exploring the neural mechanisms of how the human brain encodes such complex acoustic environments and how cognitive processes like attention shapes processing of the attended speech. My initial experiments explore the representation of acoustic features that help us localize single sound sources in the environment- features like direction and spectrotemporal content of the sounds, and the interaction of these representations with each other. I play natural American English sentences coming from five azimuthal directions in space. Using intracranial electrocorticography (ECoG) recordings from the human auditory cortex of the listener, I show that the direction of sound and the spectrotemporal content are encoded in two distinct aspects of neural response, the direction modulates the mean of the response and the spectrotemporal features contributes to the modulation of neural response around its mean. Furthermore, I show that these features are orthogonal to each other and do not interact. This representation enables successful decoding of both spatial and phonetic information. These findings contribute to defining the functional organization of responses in the human auditory cortex, with implications for more accurate neurophysiological models of spatial speech processing. I take a step further to investigate the role of attention in encoding the direction and phonetic features of speech. I play a mixture of male and female spatialized talkers eg. male at left side to the listener and female at right side (talker’s locations switch randomly after each sentence). I ask the listener to follow a given talker e.g. follow male talker as they switch their location after each uttered sentence. While the listener performs this experiment, I collect intracranial EEG data from their auditory cortex. I investigate the bottom-up stimulus dependent and attention independent encoding of such a cocktail party speech and the top-down attention driven role in the encoding of location and speech features. I find a bottom-up stimulus driven contralateral preference in encoding of the mixed speech i.e. Left brain hemisphere automatically and predominantly encodes speech coming from right direction and vice-versa. On top of this bottom-up representation, I find that attended talker’s direction modulates the baseline of the neural response and attended talker’s voice modulates the spectrotemporal tuning of the neural response. Moreover, the modulation to attended talker’s location is present throughout the auditory cortex but the modulation to attended talker’s voice is present only at higher order auditory cortex areas. My findings provide crucially needed evidence to determine how bottom-up and top-down signals interact in the auditory cortex in crowded and complex acoustic scenes to enable robust speech perception. Furthermore, they shed light on the hierarchical encoding of attended speech that have implications on bettering the auditory attention decoding models. Finally, I talk about a clinical case study where we show that electrical stimulation to specific sites in planum temporale (PT) of an epilepsy patient implanted with intracranial electrode leads to enhancement in speech in noise perception. When noisy speech is played with such an electrical stimulation, the patient perceives that the noise disappears, and that the speech is similar to clean speech that they hear without any noise. We performed series of analysis to determine functional organization of the three main sub regions of the human auditory cortex- planum temporale (PT), Heschl’s gyrus (HG) and superior temporal gyrus (STG). Using Cortico-Cortical Evoked Potentials (CCEPs), we modeled the PT sites to be located between the sites in HG and STG. Furthermore, we find that the discriminability of speech from nonspeech sounds increased in population neural responses from HG to the PT to the STG sites. These findings causally implicate the PT in background noise suppression and may point to a novel potential neuroprosthetic solution to assist in the challenging task of speech perception in noise. Together, this dissertation shows new evidence for the neural encoding of spatial speech; interaction of stimulus driven, and attention driven neural processes in spatial multi-talker speech perception and enhancement of speech in noise perception by electrical brain stimulation

Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98 F) with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2–7 cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70 k/mm3. Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity

Mustard Magic: A Palate-Pleasing Review

This comprehensive review article explores the medicinal properties and key bioactive components of Brassica juncea, Brassica nigra, and Sinapis alba. These three members of the Brassicaceae family have long been recognized for their therapeutic potential. We provide an in-depth analysis of the bioactive compounds present in each plant, shedding light on their pharmacological properties and potential health benefits. From anti-inflammatory, analgesic and antioxidant effects to potential anticancer properties, we examine the diverse medicinal applications of these Brassica species. This review aims to consolidate current knowledge on the subject, offering a valuable resource for researchers, healthcare professionals, and individuals interested in the medicinal aspects of Brassica juncea, Brassica nigra and Sinapis alb

Tolosa Hunt syndrome: a rare syndrome

Tolosa Hunt Syndrome (THS) is rare syndrome with an estimated annual incidence of 1 case per million per year. THS is painful ophthalmoplegia caused by nonspecific inflammation of cavernous sinus or superior orbital fissure. It is often unilateral with severe headache and ophthalmoplegia involving third, fourth, fifth and sixth cranial nerves. We present a case admitted in our hospital that came with complaint of severe unilateral headache with loss of vision of left eye. He did not have any other significant history except that he was complaining of partial sensory loss over left upper part of face. Ophthalmologist reference was taken to rule out any other cause involving optic disc and funduscopy which was normal. Further investigations were done which ruled out all possible causes. Patient was started on steroids and on MRI scan and clinical presentation, patient was diagnosed as Tolosa- Hunt Syndrome. Thus we report a rare case of THS which showed gradual recovery with corticosteroids