Psychiatric Underpinnings of Chronic Diabetic Neuropathic Pain

There is increasing evidence that psychosocial factors may be involved in the pathophysiology of chronic diabetic neuropathic pain. Individuals with diabetic polyneuropathy exhibit significantly higher rates of axis I psychiatric disorders, and worsening neuropathic symptoms correlate with worsened psychiatric illness. This association exists even when social-support and quality-of-life measures are controlled. Aberrant supraspinal structures and neuronal networks in diabetic neuropathy mimic those found in other psychiatric illnesses. Response to standard medications and therapeutic approaches remains unsatisfactory, and antidepressants continue to serve as first-line treatment for diabetic neuropathy. The exact interplay between neuropathic pain and psychiatric illness remains unclear and may have a common pathophysiological focus. This area of study needs to be revisited and psychological interventions must be explored as possible treatment options for diabetic neuropathy.

Nonketotic Hyperglycemic Chorea-Ballism (NKHCB): An Atypical Case and a Review of Literature

Nonketotic hyperglycemic chorea-ballism (NKHCB) is a rare movement disorder characterized by hemichoreahemiballism, contralateral striatal abnormality, and rapid resolution following glycemic control. We describe an atypical case of NKHCB in a 71-year-old female with uncontrolled type 2 diabetes exhibiting hemichorea and hemiballism limited to the right upper extremity. While NKHCB patients typically show abnormalities on computed tomography (CT) imaging of the head, a CT scan of our patient during the acute phase was unremarkable. The movements subsided following glycemic control and fluid administration. The current literature on NKHCB is sparse and largely limited to case reports and series. We discuss several typical and atypical presentations and findings on imaging.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

The role of prehealth student volunteers at a student-run free clinic in New York, United States

Purpose: The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. Methods: We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. Results: A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. Conclusion: After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care

Using Social Media to Reduce Language Barrier Among Foreign Students in Pakistan

Social networking is rapidly changing the communication environment of contemporary social media. Social media's growth has had a profound effect on students' academic lives. Institutions and researchers are actively playing with social networking technologies with the expectation of stimulating strategic thinking, collaboration, and knowledge rising. Today's higher education establishments have adopted social media to communicate for students with teachers, fellow students, and other higher authorities. This necessitated the investigation and analysis of the impact of social media on students' academic lives in this report. The study argued for a qualitative approach to assessing these effects. Thirty International students enrolled at Karachi's university were randomly chosen and questioned over four weeks. Following an examination of the phenomena that motivated the study and transcription of the participants' comments, the results suggest that students in higher education often use social networking and that participants believe that social media plays a major role in their academic success. Social networking applications can augment classroom content and have a beneficial effect on conversations, community service, and authoring. However, since these media are inherently accessible, it is critical to closely understand the advantages, consequences, and pitfalls of transparency, as well as the critical nature of ongoing contact with students in order to discuss their concerns and resolve any problems that arise as a result of social media use. The analysis concludes that as an International student studying in Pakistan, social media contributes to academic creativity

Co-delivery of amphotericin B and pentamidine loaded niosomal gel for the treatment of Cutaneous leishmaniasis

AbstractTopical drug delivery is preferable route over systemic delivery in case of Cutaneous leishmaniasis (CL). Among the available agents, amphotericin B (AmB) and pentamidine (PTM) showed promising result against CL. However, monotherapy is associated with incidences of reoccurrence and resistance. Combination therapy is therefore recommended. Thin film hydration method was employed for amphotericin B-pentamidine loaded niosomes (AmB-PTM-NIO) preparation followed by their incorporation into chitosan gel. The optimization of AmB-PTM-NIO was done via Box Behnken Design method and in vitro and ex vivo analysis was performed. The optimized formulation indicated 226 nm particle size (PS) with spherical morphology, 0.173 polydispersity index (PDI), −36 mV zeta potential (ZP) and with entrapment efficiency (EE) of 91% (AmB) and 79% (PTM), respectively. The amphotericin B-pentamidine loaded niosomal gel (AmB-PTM-NIO-Gel) showed desirable characteristics including physicochemical properties, pH (5.1 ± 0.15), viscosity (31870 ± 25 cP), and gel spreadability (280 ± 26.46%). In vitro release of the AmB and PTM from AmB-PTM-NIO and AmB-PTM-NIO-Gel showed more prolonged release behavior as compared to their respective drug solution. Higher skin penetration, greater percentage inhibition and lower IC50 against the promastigotes shows that AmB-PTM-NIO has better antileishmanial activity. The obtained findings suggested that the developed AmB-PTM-NIO-Gel has excellent capability of permeation via skin layers, sustained release profile and augmented anti-leishmanial outcome of the incorporated drugs