Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy

AbstractPurposeThe present study was conducted with the aim of evaluating the effects of reducing the number of antiepileptic drugs (AEDs) administered to patients with drug-refractory epilepsy (DRE) during their admission and document any change in seizure frequency in subsequent follow up.MethodsA total of 962 patients with DRE who were admitted to the neurology wards waiting for connection to video EEG were recruited for this prospective study. After their admission to the neurology ward, modifications in the number and dosage of AEDs were done with a target of a maximum of three AEDs in every patient. Drug tapering was done using a standardized protocol. The primary outcome was the change in seizure frequency in the follow-up period of 6 months. Secondary outcome measures were the adverse event profile (AEP) and the quality of life (QOL).ResultsOf the 1134 patients screened, 962 patients gave consent to participate in the study. The mean number of AEDs received by each patient was 4.24. After the tapering following a standardized protocol each patient received a mean of 2.65 AEDs per patient. In 82.70% patients with DRE, there was either a reduction or no change in seizure frequency in the subsequent 6 months follow up. There was a significant reduction in the AEP score after the reduction in the number of AEDs (P=0. 001).ConclusionOur study proves that optimization of reduction of the number of AED's in patients with DRE leads to reduction or no change in seizure frequency with a significant decrease in adverse effects

Effect of early maternal newborn skin to skin contact in labour room on third stage of labour and success at breastfeeding

Background: Immediate postpartum period and birth pose many challenges for the mother and the new-born. Initiation of early skin to skin contact in the labour room can be beneficial to both of them.Methods: Randomized control trial conducted over a period of 7 months in a tertiary care centre enrolling 400 laboring women.200 in the control group were given routine care. In the 200women in the study group, the newborn was given immediate skin to skin contact by placing him/her on the mother’s chest.Results: Duration of third stage of labour was less than 10 minutes in 95%women of study group compared to 56% women in the control group(p<0.01). Placenta was expulsed as a whole in 98% cases in the study group compared to 81% in the control group. Successful breastfeeding was observed in 88% women in study group compared to 54%in the control group(p<0.01). Breastfeeding was initiated within 30 minutes of birth in 96%women in the study group compared to 41% in the control group.Conclusions: Uterus could contract faster with the complete expulsion of placenta and shortening of the third stage of labour with early skin to skin contact. The newborn showed early initiation, success at breastfeeding and longer first breastfeeding with early skin to skin contact

A systematic review for the development of Alzheimer’s disease in in vitro models: a focus on different inducing agents

Alzheimer’s disease (AD) is the most common progressive neurodegenerative disease and is associated with dementia. Presently, various chemical and environmental agents are used to induce in-vitro models of Alzheimer disease to investigate the efficacy of different therapeutic drugs. We screened literature from databases such as PubMed, ScienceDirect, and Google scholar, emphasizing the diverse targeting mechanisms of neuro degeneration explored in in-vitro models. The results revealed studies in which different types of chemicals and environmental agents were used for in-vitro development of Alzheimer-targeting mechanisms of neurodegeneration. Studies using chemically induced in-vitro AD models included in this systematic review will contribute to a deeper understanding of AD. However, none of these models can reproduce all the characteristics of disease progression seen in the majority of Alzheimer’s disease subtypes. Additional modifications would be required to replicate the complex conditions of human AD in an exact manner. In-vitro models of Alzheimer’s disease developed using chemicals and environmental agents are instrumental in providing insights into the disease’s pathophysiology; therefore, chemical-induced in-vitro AD models will continue to play vital role in future AD research. This systematic screening revealed the pivotal role of chemical-induced in-vitro AD models in advancing our understanding of AD pathophysiology and is therefore important to understand the potential of these chemicals in AD pathogenesis

Therapeutic mammoplasty: a “wise” oncoplastic choice—lessons from the largest single-center cohort from Asia

IntroductionThe majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM.MethodsAll patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures.ResultsThe median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1–pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains.ConclusionWe conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation

Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South-East Asia, and Middle East: preliminary findings from the Inflammatory Bowel Disease-Emerging Nations' Consortium.

Background and Aim: Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. Methods: We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. Results: Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5–30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year. Conclusions: The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI

Effect of clobazam as add-on antiepileptic drug in patients with epilepsy

Background & objectives: The use of clobazam in epilepsy has increased since its introduction in 1975. However, it has not been audited for its overall usefulness in Indian set up. The present study was aimed to evaluate usage pattern, retention rate, effectiveness and tolerability of clobazam during routine practice in an outpatient epilepsy clinic of a tertiary care hospital in New Delhi, India. Methods: This study was performed on the patients prescribed antiepileptic medication who had clobazam as last added drug in their treatment regimen during October 2010 - March 2012. These patients were followed up for two OPD visits. The primary points evaluated were retention rate, percentage of seizure-free patients and reasons for discontinuing clobazam. Results: o0 f the 417 consecutive patients, 132 (31.7%) were on clobazam treatment for more than four years (median 6 yr, range 4-15 yr). No seizure for previous 12 months was considered as seizure free and was observed in 151 (36.2%) patients. There was no improvement in seizure control in 32 (7.7%) patients. A decrease in seizure severity without any change in seizure frequency was observed in 76 (18.2%) patients. Clobazam was discontinued by 15 (3.6%) patients due to complaints like drowsiness (13), fatigue/tiredness (8), headache (6), poor memory (6), irritable behaviour (5), abdominal pain (3) and dizziness (3). Interpretation & conclusions: Our results provide valuable information about the clinical use of clobazam as add-on antiepileptic drug therapy in the management of patients with epilepsy

Helicobacter pylori : Is it Transmitted Through Faecal-oral or Oral-oral Route?

The association of Helicobacter pylori with gastroduodenal diseases is well established. The mode of transmission of the organism is still unclear, although the faecal-oral route has been proposed. H. pylori has been detected in gastric antrum, dental plaques, faeces and water. In the light of these studies we attempted to detect H. pylori in antral biopsies, dental plaques, and stool specimens of patients who were suffering from upper GI complaints. These patients resided in Mumbai city, India. Clinical specimens from different sources were subjected to RUT, Culture, Histopathology and Polymerase chain reaction (PCR). We found H. pylori in antral biopsies and faeces by culture and PCR but absent in dental plaques. Therefore, faecal-oral is the possible route of transmission of this bacterium. Dental plaque may not be a permanent reservoir of this bacterium because this organism needs strict microaerophilic conditions to survive

Presence of Helicobacter pylori in Mumbai Water

Helicobacter pylon is found commonly in the gut of the human beings and animals. This bacterium is found usually when patients suffer from upper GI infections. H. pylon has been found in the patients in antral biopsies in Mumbai, India. We have found H. pylon in antral biopsies and faeces in another Study we have done. The mode of transmission of H. pylon is yet not confirmed although two routes are proposed : faecal-oral and oral-oral. Many studies have found that H. pylon survives in water in viable or viable but non-culturable forms. We found H. pylon in Mumbai water samples collected from different places by culture and PCR. Thus, we propose water as the possible vehicle of transmission of H. pylon infection