Ictal PET in presurgical workup of refractory extratemporal epilepsy

Ictal Pet in presurgical workup of refractory epilepsy is seldom performed and limited due to technical difficulties. In carefully selected patient subset with frequent extratemporal seizures, ictal PET depicts ‘seizure onset zone’ with high spatial resolution even within a widespread pathology. We here depict a four year old with posterior quadrant dysplasia evaluated with ictal PET.Key Words: Epilepsy, Ictal PET, presurgical workup, refractory     

Autosomal recessive bilateral frontal polymicrogyria with ectopia lentis and chorioretinal dystrophy

Polymicrogyria is a type of cortical dysplasia with cortical organizational defect. Bilateral polymicrogyria are distinct with genetic basis in a subset. We hereby report a case of bilateral frontal polymicrogyria (BFP) in association with chorioretinal dystrophy and ectopia lentis (EL) in a 26-year-old lady born of a consanguineous parentage. Her male sibling also had chorioretinal dystrophy and EL. This combination of autosomal recessive inheritance has not been reported earlier in the literature and suggests a role of connective tissue genes in BFP.Key Words: Autosomal recessive, chorioretinal-dystrophy, ectopia lentis, frontal-polymicrogyria     

Noxious heat evokes stronger sharp and annoying sensations in women than men in hairy skin but not in glabrous skin

Brief noxious heat evokes more intense pain in women than in men; however, sex differences in the intensity of pain sensations evoked in hairy and glabrous skins are not clearly understood. Glabrous skin putatively lacks the type of A-delta nociceptors that underlie heat-evoked sharp sensation. Therefore, we assessed whether noxious heat-evoked pain qualities differed for hairy and glabrous skins and whether sex differences exist in these evoked pains. We applied a prolonged (30 s) ramped noxious heat stimulus to the dorsal and ventral aspects of the feet of 16 males and 16 females. Stimuli were calibrated in each subject to evoke a peak pain magnitude of 50/100. Subjects provided continuous online ratings of pain, annoyance, burning, sharp, stinging and cutting sensations in separate runs. The results indicate that both sex and skin type impact noxious heat-evoked sensations. Specifically, ratings of sharp sensations and annoyance evoked in hairy skin were significantly more intense in women than in men. Sharp, stinging and cutting sensations were evoked in glabrous skin, but the magnitude of these sensations was greater in hairy skin than glabrous skin; an effect only in females. Also, there was no sex difference in sharp sensation and annoyance in glabrous skin. These findings suggest that sharp sensations are evoked more prominently in hairy than in glabrous skin of women and that sharp sensations and annoyance play a prominent role in mediating aspects of pain-evoked from hairy skin in women.     

Teratogenicity of cobalt chloride in Xenopus laevis, assayed by the FETAX procedure.

The teratogenicity of cobalt chloride (CoCl2) was tested by the FETAX (Frog Embryo Teratogenesis Assay: Xenopus) procedure in the South African frog, Xenopus laevis. In five assays, beginning at 5 h post-fertilization, groups of Xenopus embryos were incubated for 96 h in media that contained CoCl2 at concentrations ranging from 1.8 x 10(-6) to 1.8 x 10(-2) mol/L; control groups were incubated in the same medium without added CoCl2. At 101 h post-fertilization, surviving embryos were counted, fixed in formalin, and examined by microscopy to score malformations and measure head-to-tail lengths. In control embryos, survival was greater than or equal to 95% and malformations were less than or equal to 5%. Malformations were found in greater than 99% of embryos exposed to Co2+ levels greater than or equal to 56 mumol/L. Co2+)-exposed embryos showed a concentration-related pattern of malformations, comprising gut malrotation, ocular anomalies, kinked tail, craniofacial dysplasia, cardiac deformities, and dermal blisters. Other concentration-dependent abnormalities, not categorized as malformations, included stunted growth, edema, ventral distention, and hypopigmentation. The median embryolethal concentration (LC50) of CoCl2 was 10.4 (SE +/- 0.4) mmol/L; the median teratogenic concentration (EC50) was 25 (SE +/- 2) mumol/L; the teratogenic index (TI = LC50/EC50) was 416 (SE +/- 13), indicating that CoCl2 is a potent teratogen for Xenopus laevis.     

Overall and gender-based negative predictive value of a normal gated myocardial perfusion SPECT study: a single center experience

Aims and objective

A normal gated myocardial perfusion imaging (GMPI) has been found to have high diagnostic and negative predictive value (NPV) in western population. The goal of the present study was to evaluate the overall and gender-based NPV of a normal GMPI in local population.

Patients and methods

This is a prospective study conducted at Nuclear Cardiology Department of Karachi Institute of Heart Diseases (KIHD), Karachi from December 2008 till May 2009. All patients (with intermediate risk) with a normal GMPI with adequate dynamic or dipyridamole stress were included and followed up for 18 months (mean 15 ± 3 months) for fatal or non-fatal infarctions.

Results

The mean ejection fraction (EF) of studied population was 69 ± 8% while mean end diastolic (EDV) and end systolic volume (ESV) were 71 ± 19 and 22 ± 11 ml, respectively. In studied female cohort, the mean EF (%), EDV (ml) and ESV (ml) were 71 ± 08, 64 ± 15 and 19 ± 09, respectively. In studied male cohort, the mean EF (%), EDV (ml) and ESV (ml) were 66 ± 06, 82 ± 18 and 27 ± 11, respectively. At 18 months follow-up, one fatal (male patient) and one non-fatal MI (male patient) were reported. The overall NPV was 99.4% over 18 months follow-up with an event rate of 0.6% (95% CI 0.03–1.16%) and annualized event rate of 0.3%. The NPV and annualized event in subgroup analyses, was similar for female and male (P = 0.213).

Conclusion

We conclude that a normal GMPI with adequate stress in our population has high NPVs for major cardiac events as in western population. In addition, the prognostic utility of GMPI is similar for both men and women.     

Asthmatic patient’s preferences regarding frequency of physician consultation

Background & ObjectiveTo identify patient’s factors from their clinical picture and demographics, and recognize their association and influence on frequency of physician visit.MethodStudy was conducted in Karachi from January – December 2019. Primary data was collected from 255 asthmatic patients that visited different hospitals, homeopathic and herbal clinics. Questionnaire included patient’s demographic details, treatment choice for asthma and satisfaction level with different treatments. Collected data was analyzed by SPSS 20.ResultAmong 255 asthmatic patients, 101 visited 5 – 7 times to physician from the past year, 48 visited 8–10 times and 27 went to physician more than 10 times in past 12 months. While 30 patients did not visit the physician even once and only 20 patients visited 1–2 times in the last year. From clinical factors, association of severity (p = 0.0001), limitation (p = 0.0001) and side effects (p = 0.003) with physician visit were found to be statistically significant. In addition, among demographics, age (p = 0.004), education (p = 0.0001), income (p = 0.0001) and having pets (p = 0.007) were found to be significant factors associated with physician visit for asthma in the past year.ConclusionMost of the asthmatic patients covered in the study visited the physician more than five times during the last year and chose allopathic treatment for asthma. Age, education, severity and side effects of asthma treatment were some of the significant factors associated with physician visit. Patients with frequent follow up visits to the physician were satisfied with their treatment.     

Prospective phase II trial of alternating intravesical Bacillus Calmette-Guérin (BCG) and interferon alpha IIB in the treatment and prevention of superficial transitional cell carcinoma of the urinary bladder: preliminary results

BACKGROUND AND OBJECTIVE: Evaluate the efficacy and toxicity of alternating intravesical instillation of Bacillus Calmette-Guerin(BCG) and Interferon alpha2-b (IFN) in the treatment and prevention of recurrence of superficial transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Patients with Ta, T1 tumors and carcinoma in situ, either recurrent (TaG1, T1G1) or primary/recurrent TaG2 TaG3, T1G2, T1G3 and Tis (T: Tumor stage, G: grade) are eligible. All patients received intravesical BCG 81 mg on Weeks 1, 3, 5 and 7 and IFN 100 million units on Weeks 2, 4, 6 and 8. Cystoscopy performed 4 weeks after completion of therapy, and every 3 months thereafter. RESULTS: There was a total of 37 patients. Thirteen had TaG2, 13 T1G2, 1 T1G1, 4 TaG1, 1 TaG3, 3 T1G3 and 7 Tis (5 concurrent with other above tumors). Index lesion cleared in 7/10 patients. With a median follow-up of 26.2 month, 22 patients (59%) failed above therapy. Median time to treatment failure was 7 months. Seven, 6 and 9 patients recurred at a higher, lower and same stage or grade respectively. No grade 3 or 4 toxicity was encountered. CONCLUSIONS: Alternating intravesical BCG and IFN is effective and well tolerated therapy for superficial TCC of urinary bladder.