Faculty Bibliography

Aim/UNASSIGNED:To assess the relative efficacies of clozapine plus Electroconvulsive Therapy (ECT) compared against non-clozapine typical and atypical antipsychotics plus ECT for the treatment of "Treatment Resistant Schizophrenia" (TRS). Primarily to assess if clozapine delivers a significant improvement over other antipsychotics when combined with ECT. Design/UNASSIGNED:Major electronic databases were searched between 1990 and March 2017 for trials measuring the effects of either clozapine augmented ECT, other antipsychotic-augmented ECT, or both. After the systematic review of the data, a random-effects meta-analysis was conducted measuring the relative effect sizes of the different treatment regimens. Subjects/UNASSIGNED:1179 patients in 23 studies reporting the usage of ECT augmentation with antipsychotics. A total of 95 patients were tested with clozapine, and ECT (9 studies) and 1084 patients were tested with non-clozapine antipsychotics (14 studies) such as flupenthixol, chlorpromazine, risperidone, sulpiride, olanzapine, and loxapine with concurrent ECT treatment considered for systematic review. Of these, 13 studies reported pre and post-treatment scores were included in the meta-analysis. Main outcome measures/UNASSIGNED:The main outcome measure was the presence and degree of both positive and negative psychotic symptoms, as measured by either of two standardized clinician administered tests, the Brief Psychiatric Rating Scale (BPRS), and the Positive and Negative Symptom Scale (PANSS). Results/UNASSIGNED:The comparison of the different antipsychotics established the supremacy of ECT-augmented clozapine treatment against other typical and atypical antipsychotics. The Forest Plot revealed that the overall standard mean difference was 0.891 for non-clozapine studies and 1.504 for clozapine studies, at a 95% interval. Furthermore, the heterogeneity plots showed that while clozapine studies showed no significant heterogeneity, non-clozapine studies showed an I2 statistic value at 42.19%, suggesting moderate heterogeneity. Lastly, publication bias showed asymmetrical plots and significant values of Kendal's tau and Egger's rank test. Conclusion/UNASSIGNED:ECT augmentation technique was found to be effective in the reduction of psychometric scale scores, and the resulting improvement was significant. Clozapine maintained its stance as the most effective treatment for Treatment-Resistant Schizophrenia, followed by flupenthixol.

Valproate is the best choice drug for a variety of medical conditions. As with any other drug, it has adverse effects, and it is important to emphasize the possibility of those adverse effects to prevent complications. We present the case history of a 44-year-old male with valproate-induced hyperammonemic encephalopathy, despite having normal liver function tests. This case includes a detailed literature review of this rare adverse event. In the light of this case report, we illustrate the importance of checking ammonia levels in all psychiatric patients receiving valproate as a treatment who present with new onset neurological symptoms or altered mental status.

Despite the high prevalence of hyperprolactinemia in patients receiving antipsychotic medications, its side effects are often neglected. In patients receiving risperidone, the incidence of menstrual abnormalities is relatively small. Our patient was a 44-year-old, Haitian female whose total course of hospitalization was nine months, during most of which she remained floridly psychotic with low cognitive function with waxing and waning symptoms. She developed hyperprolactinemia and amenorrhea on risperidone. She was treated and discharged to the state mental hospital. Menstrual abnormalities cause psychological distress in women. In women, hyperprolactinemia can cause sexual and reproductive dysfunction. Chronic hyperprolactinemia can predispose to osteoporosis and cardiovascular disease. Clinicians should be vigilant about the consequences when prescribing medications for women, particularly those suffering from a psychotic disorder.

BACKGROUND:In this age, diabetes is one of the most prevalent, incurable diseases present. The aim of this study was to assess knowledge, attitude and self-care practicesrelated to diabetes in an urban population in Pakistan. METHODS:A cross sectional survey to assess the knowledge and practices of people with diabetes was conducted in general urbanpopulace. People with diabetes were interviewed using a structured questionnaire from which data was collected. A total of 139 diabetics were included into the study. Basic knowledge about diabetes and its complications were assessed as well as the frequency of practices such as keeping a blood glucometer at home and checking blood sugar with it. RESULTS:A total of n=139 participants fulfilling the inclusion criteria were recruited in the survey. Only 18.7% had knowledge regarding the complications of diabetes mellitus. Only 8.6% of participants checked their blood glucose levels at homeregularly, and only 4.3% visited their physiciansregularlyfor check-ups. With regard to practices, a minority attested to have changed their lifestyle and commit to basic practices in order to reduce diabetes related complications with women being more prone to changes than men. CONCLUSION/CONCLUSIONS:The results show that most participants had a negative attitude and very little knowledge regarding diabetes.There is a need for increased diabetes related education and for developing positive attitudes towards reduction of diabetes related complications. The Pakistani population is seen to be almost completely unprepared to fight against an increase in type 2 diabetes prevalence.

INTRODUCTION/BACKGROUND:The main aim of this study was to determine the frequency of Enterobius vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. MATERIALS/METHODS:This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. RESULTS:Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8%) patients had Enterobius vermicularis infections. Malignancy (n=2, 0.1%) and infection with Ascaris (n=1, 0.1%) was found very rarely among the patients.Eggs in lumen (n=22, 0.7%), mucinous cystadenoma (n=28, 1.0%), mucocele (n=11, 0.4%), lymphoma (n=9, 0.3%), obstruction in lumen (n=17, 0.6%) and purulent exudate (n=37, 1.3%) were also seldom seen in the histopathological reports. CONCLUSION/CONCLUSIONS:Enterobius vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries.

The major aim of surgeons has always been a minimalist approach towards surgery, thereby reducing the complications associated with the surgery. The gold standard treatment for cholelithiasis with cholecystitis is currently the four port laparoscopic cholecystectomy (4 PLC). Recently, a newer technique has been introduced which uses a single port, rather than the four ports, for the removal of the gall bladder laparoscopically; it is known as Single Incision Laparoscopic Cholecystectomy (SILC). This is a comparatively minimal approach towards surgery. Therefore the purpose of this review is to compare the advantages and the disadvantages of SILC versus 4PLC, and hence, to give an idea of whether SILC is ready to replace the traditional approach as the new treatment of choice.