Myths and fallacies about epilepsy among residents of a Karachi slum area

Misconceptions about epilepsy may explain the considerable stigma accompanying it. We aimed to identify such fallacies through questionnaire-based interviews of 487 adult residents of a slum area in Karachi, Pakistan. Of those interviewed, 25% believed that epilepsy was caused by evil spirits, black magic and envy by others those without a school education were more likely to hold these views (P \u3c 0.05). Perceived complications included impotence and cancer. Shoe-sniffing was considered a treatment modality by 13%. It appears that misconceptions abound regarding epilepsy\u27s causes, complications and methods of treatment. However, those who had received a school education were less likely to link epilepsy with supernatural phenomena

Factors associated with non-adherence among psychiatric patients at a tertiary care hospital, Karachi, Pakistan: a questionnaire based cross-sectional study

OBJECTIVE: To elucidate predictors of non-adherence among psychiatric patients presenting at a tertiary care hospital of Pakistan, for follow-up with consultant psychiatrist. METHODS: A convenient sampleof psychiatric patients from Aga Khan University Hospital was enrolled between April and May, 2005. An interviewer assisted, standardized questionnaire was used for data collection. Patients with cognitive deficit or psychosis and those presenting for the first time were not included in the study. RESULTS: Out of 128 patients, those with co-morbidity (32.81%) were less adherent than those without comorbidity (p-value:0.002). Adherence among depressed was 61.53%; psychotic was 58.82%; bipolar disorder was 73.91%. Reasons for non-adherence included sedation (30%), medication cost (22%), forgot to take medication (36%); and inability of the physicians to explain timing and dose (92%) or benefit of medication (76%). CONCLUSIONS: Non-adherence is a common and important issue. Treatment cost and co-morbidity should be reviewed in order to keep the medication regime affordable and comprehensible

Cytotoxicity against A549 Human Lung Cancer Cell Line via the Mitochondrial Membrane Potential and Nuclear Condensation Effects of Nepeta paulsenii Briq., a Perennial Herb

The genus Nepeta belongs to the largest Lamiaceae family, with 300 species, which are distributed throughout the various regions of Africa, Asia, India, and America. Along with other plant families distinguished by their medicinal and therapeutic values, the Nepeta genus of Lameaceae remains relatively valuable. Hence, the phytochemicals of N. paulsenii Briq. were extracted using different plant parts, i.e., leaves, stem, roots, flowers, and the whole plant by using various solvents (ethanol, water, and ethyl acetate), obtaining 15 fractions. Each extract of dried plant material was analyzed by FT-IR and GC-MS to identify the chemical constituents. The cytotoxicity of each fraction was analyzed by MTT assay and mitochondrial membrane potential and nuclear condensation assays against lung cancer cells. Among the ethyl acetate and ethanolic extracts, the flowers showed the best results, with IC50 values of 51.57 μg/mL and 50.58 μg/mL, respectively. In contrast, among the water extracts of the various plant segments, the stem showed the best results, with an IC50 value of 123.80 μg/mL. 5-flourouracil was used as the standard drug, providing an IC50 value of 83.62 μg/mL. The Hoechst 33342 stain results indicated apoptotic features, i.e., chromatin dissolution and broken down, fragmented, and crescent-shaped nuclei. The ethanolic extracts of the flowers showed more pronounced apoptotic effects on the cells. The mitochondrial membrane potential indicated that rhodamine 123 fluorescence signals suppressed mitochondrial potential due to the treatment with the extracts. Again, the apoptotic index of the ethanolic extract of the flowers remained the highest. Hence it can be concluded that the flower part of N. paulsenii Briq. was found to be the most active against the A459 human lung cancer cell line

Nepeta paulsenii Briq. inhibits hepatic toxicity in albino rats: Phytochemical analysis and chemical profiling

Nepeta paulsenii is a less explored plant found in the South-Eastern hilly region of Pakistan. Local people consider it a medicinal plant. The protective effect of methanol extract of N. paulsenii leaves on carbon-tetrachloride (CCl4) tempted liver damage in male rats was assessed. Forty-eight rats were equally divided into 8 groups and various concentrations of extract + CCl4 were induced for 30 days. Crude methanolic extract of N. paulsenii plant was examined through phytochemical analyses and gas chromatograph coupled with mass spectrometre (GC–MS) before biological testing on albino rats. Phytochemical analysis of extract showed coumarins, flavonoids, terpenoids, saponins and betacyanins, while GC–MS results revealed the existence of several compounds belonging to diverse classes, responsible for the hepatoprotective attribute of N.paulsenii. CCl4 exposure substantially decreased the antioxidant enzymes activity while increased the thiobarbituric acid reactive substances and reactive oxygen species levels. A remarkable increase in the aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels was observed in CCl4 treated rats. Comet-parameters were observed after CCl4 administration. N. paulsenii extract administration substantially improved the antioxidant enzyme activity, hepatic markers as well as comet parameters and reversed the CCl4 induced histopathological damages. The results revealed that N. paulsenii has therapeutic effects against CCl4-induced liver damages

Ectopic ACTH Syndrome Due to MEN-I Associated Metastatic Neuroendocrine Pancreatic Gastrinoma in a 22 Year Old Female without Hyperparathyroidism: Diagnostic and Therapeutic Challenges

Introduction: Ectopic ACTH production due to malignant tumors is a rare cause of Cushing\u27s syndrome (CS). Diagnosis and treatment of such patients can be challenging. Case: 22 year old female with recent onset fatigue, weight gain, polyuria, polydipsia, presented with melena and hypotension. She had cushingoid facies, acne, central obesity, muscle weakness and purple striae. Labs showed: Cortisol 56 µg/dl (5-15), 24 hour UFC \u3e1000 µg/24hr (5-50), Cortisol after 1mg Dexamethasone suppression 54 µg/dl (Learning points: When evaluating patients with suspected ectopic ACTH production, independent review of radiologic imaging should be done to avoid being misled by prior reports. EUS is a superior method for identifying PNET (1). Biochemical confirmation with IPSS helps exclude Cushing\u27s Disease in the setting of a pituitary adenoma. Medical therapy to control hypercortisolism and anticoagulation are necessary to lower morbidity and mortality associated with severe CS (2). Finally, screening for MEN-1 in these patients is recommended, even in the absence of hyperparathyroidism (3)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit