Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

THE CONCEPT OF NIQRIS (GOUT) AND ITS MANAGEMENT WITH THE HELP OF REGIMENAL THERAPY: A REVIEW

Gout is one of the oldest known diseases and described in Unani system of medicine under the term Niqras.Niqris (gout) is a type of Waja' al-Mafasil(arthritis) which is characterized by recurrent attack of acute pain and swelling primarily affecting one joint usually the metatarsal joint of big toe and small joints of hand and feet. It is a commonest joint pain creating problems in day to day life of various people of the world. In Modern drugs used for subsiding acute attacks or lowering serum uric acid are associated with potent adverse effects. Moreover, these commonly used therapeutic agents often, and for various reasons, do not achieve the desired lowering of serum urate levels to below 6.0 mg/dl. The objective of present study was to ascertain the Unani concept described in Unani classical literatures regarding various causes, symptoms and management of this common arthritic disorder by Renowned Unani Physicians with an aim to spread the knowledge for preventive measures, home remedies, regimenal therapy to get relief from the disease and the management of gout by Unani compound formulations, which are not only easily available but also have no side effect on human body. In this regard, we may conclude that spread of knowledge of enormous effective Unani components and general principles of treatment, which are being used by Unani physicians since ancient times, shall be extremely effective in the management of this musculo skeletal disorder.

A Traditional Clinic Chinese Medicine Prescription Qu-Zhuo-Tong-Bi (QZTB) Alleviates Gouty Arthritis in Model Rats

Qu-Zhuo-Tong-Bi (QZTB) is an empirical traditional Chinese medicine prescription for treating acute gouty arthritis clinically without serious adverse effects in mainland China. However, the biochemical mechanism underlying the therapeutic action produced by QZTB treatment against acute gouty arthritis and the effect on recurrent attack remain unknown. In this study, we investigated the anti-inflammatory and analgesic effects of QZTB on acute gouty arthritis and the recurrent attack in rats, as well as the underlying mechanisms. The gouty arthritis model was established by intra-articular injection of monosodium urate (MSU) crystal suspension (2 mg/50 μL) into the right ankle joint of Sprague Dawley (SD) male rats. QZTB (500 mg/kg) and the positive control drug meloxicam were administrated by gavages twice a day for 7 days before, or 3 days after, first MSU injection in different experiments, respectively. The analgesic effects were evaluated by pain-like behaviors and hind paw mechanical withdrawal threshold testing. The anti-inflammatory activities were evaluated by ankle swelling measurement, histologic examination, NLRP3 inflammasome, and inflammatory cytokine expression. Western blot and quantitative real-time PCR were used to detect the protein and mRNA expressions of NLRP3. IL-1β and TNF-α level in the blood serum were detected by enzyme-linked immunosorbent assay (ELISA). QZTB can suppress ankle swelling and synovial inflammation in the MSU-induced gouty arthritis rat model. QZTB alleviated the acute attack and prevented the recurrent attack of gouty arthritis. In addition, QZTB treatment significantly decreased both mRNA and protein levels of NLRP3, as well as the production of IL-1 and TNF-α in the ankle joint of model rats. Taken together, these results suggest that QZTB may be a promising herbal formula for the prevention and treatment of gouty arthritis in humans.

CROHN'S DISEASE AND MULTIPLE MYELOMA: A CLINICAL CASE AND LITERATURE REVIEW

Crohn's disease and multiple myeloma are pathological entities, the development of which, at least in part, is associated with an immune disregulation. Crohn's disease is often combined with extra-intestinal manifestations from different organs and systems (joints, skin, eyes, etc.). Hematological extra-intestinal manifestations, such as myelodysplastic syndrome, aplastic autoimmune anemia, autoimmune thrombocytopenia, B12-deficiency anemia are less common. The list of extra-intestinal manifestations of Crohn's disease is constantly expanding, including more and more descriptions of the combination of Crohn's disease with diseases of the blood system. The paper presents a rare clinical case of a combination of Crohn's disease and multiple myeloma. The female patient is 53 years old. In 1993 ulcerative colitis was diagnosed and she received Sulfasalazine 4gr per day. In 2015, with the recurrent attack, the diagnosis was transformed towards Crohn's disease basing on colonoscopy. She received steroid therapy. In 2018 the control examination revealed an increase in the level of total protein to 117gr/l. Patient underwent a sternal biopsy. Multiple myeloma was diagnosed on the basis of a myelogram.

Prevalence, pattern and management of tonsilitis in students-an online survey

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat-one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. The objective of the study is to study the prevalence of tonsillitis in adults, to evaluate which triggering factors contributes to tonsillitis and to evaluate the treatment strategy for tonsillitis. A Prospective survey will be carried out in 49 peoples using the information's gathered from students in Pharmacy colleges in Trivandrum. This study provides the prevalence of tonsillitis. Past history, medication usage, diagnosis, treatment and triggering factors was collected and analyzed properly. Also response is recorded. In the current research, a survey on prevalence of tonsillitis in adults was formulated .Approximately, 77% female are affected with tonsillitis than 22.9% of male. Among the responders, 75% have tonsillitis and remaining 25% not. About 13% of patients taken self medication, 47.8% consulting physician and 41% are taken home remedies. From this study, most of the responders were satisfied with OTC medicines and home remedies and recurrent attack of tonsillitis are increasing day by day to abolish Tonsillitis, to reduce the frequency and severity of recurrent throat infections to improve general well-being, behavior, and educational achievement with minimal adverse effects.

A Rare Case of Cardiogenic Shock following Severe Multivessel Coronary Vasospasm

Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected.

A Holistic Approach to Phimosis in Children

Phimosis is described as condition in which prepuce or foreskin of glans penis is not retracted backwards resulting in poor narrowed stream of urine during micturition causing ballooning of prepuce along with recurrent attacks of balanoposthitis and Urinary Tract Infections (UTIs). Majority of new born boys do have non-retractile foreskin called as Physiological Phimosis. In Ayurveda phimosis is described as Nirudhaprakasha. Physiological phimosis usually does not require any kind of treatment as it resolve spontaneously within first couple of years mostly taking 3 to 6 years after which measures are considered to correct it surgically. Pathological phimosis is condition in which prepuce get adhered to glans secondary to adhesions or scarring made because of infection, inflammation or trauma. Pathological phimosis and physiological phimosis with recurrent attack of balanoposthitis and UTIs do require treatment. There are several treatment modalities are available according to severity of adhesions such as local application of steroid cream or oil, manual retraction, dilatation and Circumcision. In this review article we assess the various treatment modalities available in Ayurveda and contemporary medical science for better management of Phimosis.