Background:Sleep deprivation among junior physicians (house officers) is of growing concern. In developed countries, duty hours are now mandated, but in developing countries, junior physicians are highly susceptible to develop sleep impairment due to long working hours, on-call duties and shift work schedule.Aim:We undertook the study to assess sleep quality among Pakistani junior physicians.Subjects and Methods:A cross-sectional study was conducted at private and public hospitals in Karachi, Pakistan, from June 2012 to January 2013. The study population comprised of junior doctors (house physicians and house surgeons). A consecutive sample of 350 physicians was drawn from the above-mentioned study setting. The subject underwent two validated self-administered questionnaires, that is, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS).Results:A total of 334 physicians completely filled out the questionnaire with a response rate of 95.4% (334/350). Of 334 physicians, 36.8% (123/334) were classified as “poor sleepers” (global PSQI score > 5). Poor sleep quality was associated with female gender (P = 0.01), excessive daytime sleepiness (P < 0.01), lower total sleep time (P < 0.001), increased sleep onset latency (P < 0.001), and increased frequency of sleep disturbances (P < 0.001). Abnormal ESS scores (ESS > 10) were more prevalent among poor sleepers (P < 0.01) signifying increased level of daytime hypersomnolence.Conclusion:Sleep quality among Pakistani junior physicians is significantly poor. Efforts must be directed towards proper sleep hygiene education. Regulations regarding duty hour limitations need to be considered.

Objective. Restless leg syndrome (RLS) is a chronic distressing disease characterized by an urge to move the legs with an unpleasantsensation during periods of rest. The global prevalence estimates of RLS range from 2.5% to 15%. Method. This cross-sectional study was conducted at various hospitals in Karachi during August 13 to March 14. The visitors who had accompanied patients to Outpatient Department or had come to visit admitted patients were approached conveniently. Subjects were interviewed regarding the essential criteria of RLS and its attributes. Results. The sample size was 390 with 56% being females. The point prevalence of RLS was estimated to be 23.6%. The prevalence in females was twice as high as compared to males. Smoking and low level of education were associated with RLS (P < 0.001). Among RLS positive individuals, 50.1% reported frequency of their symptoms to be greater than 16 days per month and 64.1% graded their symptom severity as mild to moderate. About 37% of RLS positive individuals consulted a general physician for their symptoms. Conclusion. RLS is highly prevalent and underdiagnosed condition among Pakistani population. Efforts must be directed to raise the awareness of this condition among physicians and general population.

Syphilitic hepatitis is a rare manifestation of syphilis with an incidence of 0.2-38%. We describe a case of a healthy, immunocompetent male patient with elevated liver function tests (LFTs) who was found to have syphilitic hepatitis.A 28-year-old male with no past medical history presented with abdominal pain for two to three weeks. He also reported diminished appetite, intermittent chills, weight loss, and fatigue. His history was positive for high-risk sexual behavior including multiple partners and absence of using protection. His physical examination was remarkable for right-sided abdominal tenderness and a painless chancre on his penile shaft. His workup revealed elevated aspartate aminotransferase (AST: 169 U/L), alanine transaminase (ALT: 271 U/L), and alkaline phosphatase (ALP: 377 U/L). His abdominal CT scan was unremarkable except for the abdominal and pelvic lymphadenopathy. A thorough serology panel revealed negative hepatitis A, B, C, human immunodeficiency virus (HIV) (including HIV RNA), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). His immunological workup was negative as well. His rapid plasma reagin (RPR) was reactive with positive IgG/IgM treponemal antibodies. He was managed as secondary syphilis and received 2.4 million units of benzathine penicillin. Upon follow-up after one week, he reported a complete resolution of his symptoms, and his LFTs were normalized on a repeat checkup.Given the significant morbidity associated with a missed diagnosis, syphilitic hepatitis should be considered an essential part of the workup for evaluating elevated LFTs in an appropriate clinical setting. This case also highlights the importance of obtaining a comprehensive sexual history and performing a thorough genital examination.

Background Aims: In this study, the effects of perfusion pressure, insulin, L-carnitine, propionate and 2,4-dinitrophenol on the utilization and oxidation of acetoacetate were investigated in the isolated nonworking perfused heart from normal and diabetic rats. Materials and Method: Hearts from Male Wistar albino rats were used. In the diabetic subgroup, Diabetes was induced by an intravenous injection of alloxan. The hearts were perfused at a perfusion pressure of 40 or 80 mmHg for 1 h with Krebs-Henseleit Medium, with the concentrations of calcium and magnesium halved, and oxygenated by equilibration with 5% carbon dioxide and 95% oxygen. Determination of acetoacetate and D-3-hydroxybutyrate levels were made by the method of Mellanby and Williamson and Williamson and Mellanby respectively, and comparison between groups was done using the twotailed Student's t-test for independent samples.