Organophosphates (OPs) account for a large portion of suicides globally. OP manifests as cholinergic crises, which underlie respiratory failure. There are many pathways by which respiration is inhibited secondary to organophosphate poisoning. These include central as well as peripheral mechanisms, with central mechanisms predominating. We conducted a literature review in June 2017. PubMed, Embase, and Google Scholar were searched for studies that reported acute organophosphate poisoning in humans. In our review, data were collected from studies published during the years 2001 to 2016. The data consisted of 1,996 patients with organophosphate poisoning, of which 491 (24.6%) required ventilatory support secondary to respiratory failure. Treatment offered to OP poisoning patients should focus on its pathophysiology to benefit from the future outcomes. Recent advances direct the need for a central nervous system (CNS) protective strategy for future prevention and treatment of events associated with cholinergic crises.
Epilepsy is considered to be one of the most common non-communicable neurological diseases especially in low to middle-income countries. Approximately one-third of patients with epilepsy have seizures that are resistant to antiepileptic medications. Clinical trials for the treatment of medically refractory epilepsy have mostly focused on new drug treatments, and result in a significant portion of subjects whose seizures remain refractory to medication. The off-label use of cannabis sativa plant in treating seizures is known since ancient times. The active ingredients of this plant are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the latter considered safer and more effective in treating seizures, and with less adverse psychotropic effects.Clinical trials prior to two years ago have shown little to no significant effects of cannabis in reducing seizures. These trials seem to be underpowered, with a sample size less than 15. In contrast, more recent studies that have included over 100 participants showed that CBD use resulted in a significant reduction in seizure frequency. Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.In most of the trials, CBD is used in adjunct with epilepsy medication, therefore it remains to be determined whether CBD is itself antiepileptic or a potentiator of traditional antiepileptic medications. Future trials may evaluate the efficacy of CBD in treating seizures due to specific etiologies (e.g., post-traumatic, post-stroke, idiopathic).
BackgroundA serene death may be achieved through skilled and compassionate care, as well as by the dying person's own sense of having lived a righteous life. The purpose of this study is to acquire information about students’ knowledge and understanding of euthanasia.Materials and MethodsFour hundred and fifty-six students from four classes of two institutions with similar demographic characteristics were included in this cross-sectional study. A questionnaire adapted from a study of ‘Gruber, et al.’ was distributed among the respondents after obtaining a verbal informed consent. The questionnaire had two parts, first dealing with demographics of respondents, and in the second part students were given different situations and asked about their decision in that particular setting to understand their opinion about euthanasia.ResultsThere were 31.7% medical students and 12.9% non-medical students in favor to provide complete medical information (p < 0.001) while 59.2% non-medical students thought that complete information should be given to a patient if any iatrogenic incident occurred. Same favored by 33.7% of medical students (p < 0.001). The majority of medical students (84.5%) felt that cardiopulmonary resuscitation (CPR) must always be provided (p < 0.001) and this was acceptable more among females (p = 0.001). Furthermore, medical students (57.6%) were more in favor of continuing maximum medical treatment including CPR than non-medical students (42.9%, p = 0.003). A total of 83% non-medical students and 46% medical students found euthanasia an acceptable practice.ConclusionResults show a significant difference in perception of medical and non-medical students regarding euthanasia. Non-medical students are more in favor of euthanasia than medical students. Also, it is observed that males seem to be more inclined towards euthanasia while females are more in favor to provide maximum medical treatment.
Von Gierke’s disease, also known as glycogen storage disease (GSD) type 1A, is an autosomal recessive disease in which there is an inability to cleave glycogen to glucose because of a glucose 6 phosphate deficiency resulting in hypoglycemia and lactic acidosis. The patient may present with hepatomegaly and signs and symptoms of hypoglycemia. We diagnosed a case of Von Gierke’s disease in a seven-month-old female infant who was admitted for abdominal distension, vomiting, and lethargy for a duration of four months with characteristic rounded doll's face, fatty cheeks, protuberant abdomen, and massive hepatomegaly. Lab investigations showed low hemoglobin, low blood sugar level, lactic acidosis, hyperlipidemia, hyperuricemia, mild elevation of liver enzymes, and high anion gap metabolic acidosis. The diagnosis was confirmed with a liver biopsy and dietary treatment was started. This case report highlights the value of dietary therapy in improving the quality of life and survival and minimizing complications.
The pineal gland is a small pinecone-shaped and functionally endocrine structure located in the epithalamus region. Developmentally, the pineal gland is considered as a part of the epithalamus. It plays a role in the entrainment of the circadian rhythms of an organism by producing melatonin, a functionally important hormone. Lesions of the pineal region are rare compared to other parts of the brain. A lesion may be tumorous or non-tumorous in nature. The most common lesions are tumors that are pineal parenchymal tumors (PPT) in origin. Gliomas are the second most common tumors in the pineal region. We report a case of a high-grade oligodendroglioma, not commonly seen in the pineal region, in a 45-year-old male. The patient was suspected to have a mass in the pineal region on a computed tomography (CT) scan and histology confirmed the diagnosis of oligodendroglioma. This is a unique case because only five such cases have been reported so far.
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