THE GUT MICROBIOTA REVOLUTION: AN OVERVIEW OF FECAL MICROBIOTA TRANSPLANTATION FOR GASTROINTESTINAL DISORDERS

Abstract The gut microbiota revolution has emerged as a significant breakthrough in understanding the intricate relationship between the microbial community residing in the human gut and its impact on various aspects of human health. Among the notable advances in this field, fecal microbiota transplantation (FMT) has gained considerable attention as a promising therapeutic approach for gastrointestinal disorders. This review provides an overview of FMT, its historical background, methodology, and its potential applications in the treatment of gastrointestinal disorders. FMT involves the transfer of fecal material with the aim of restoring a balanced and diverse gut microbiota. FMT is most commonly utilized for the management of recurrent Clostridioides difficile infection. Clinical studies investigating the efficacy of FMT have shown promising results, particularly in the management of recurrent Clostridioides difficile infection. The restoration of a healthy gut microbiota through FMT appears to promote microbial diversity, improve microbial functions, and modulate the host immune response. However, challenges remain, including standardization of the procedure, long-term safety monitoring, and optimizing donor selection and preparation protocols. In conclusion, fecal microbiota transplantation represents a revolution in the field of gut microbiota research and offers a promising therapeutic avenue for gastrointestinal disorders. While the evidence base continues to evolve, FMT holds significant potential to transform the management of various conditions by targeting the root cause of dysbiosis. Continued research and clinical trials are warranted to establish guidelines, refine protocols, and expand the applications of FMT in gastrointestinal medicine

Effectiveness of Unilateral Approach for Bilateral Decompression in Lumber Spinal Stenosis

Background: Lumbar spinal stenosis is defined as “buttock or lower extremity pain, which may occur with or without low back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine. Patients complain of neurogenic claudication that is compatible with a narrowing of the lumbar spinal canal. Conventional laminectomy is frequently associated with surgical failures, generally related to postoperative iatrogenic spinal instability. Other operative options that are less invasive, such as the bilateral laminotomy and, in particular, the unilateral laminotomy for bilateral decompression (ULBD), have been introduced during the past years. Objectives: The objective of this study is to determine the effectiveness of unilateral approach for bilateral decompression in Lumbar spinal stenosis. Methods: It was a Descriptive case series study conducted in the admitted patients of Lumbar spinal stenosis in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, in six months duration. Total of 171 patients were enrolled in the study. Bilateral decompression through a unilateral approach was performed under general anesthesia by single expert neurosurgeon having a minimum of 5 years of experience. All the patients were followed up till 24 hours post operatively for the determination of effectiveness in terms of improvement in at least one grade of pain on visual analogue scale from baseline. Results: In this study, 171 patients with Lumbar spinal stenosis were observed. Male to female ratio was 1.41:1. The study included age ranged from 40 to 78 years. Average age was 59.29 years ± 11.41 SD. Efficacy of unilateral approach for bilateral decompression in Lumbar spinal stenosis was found in 136 (79.53%). Conclusion: Unilateral approach for bilateral decompression is the better option for the patients presenting with Lumbar spinal stenosis

Operative Findings during Microvascular Decompression in Patients with Idiopathic Trigeminal Neuralgia

Objective: To know about operative findings during microvascular decompression for idiopathic trigeminal neuralgia.  Material and Methods: This prospective observational study was carried out on 108 patients who had idiopathic trigeminal neuralgia at Neurosurgery Department of PGMI, Lady Reading Hospital Peshawar from Jan 2010 to dec 2012 with total 2 year duration. All patients who underwent micro vascular decompression for idiopathic trigeminal neuralgia with both gender and having age from 2nd – 8 th decades were included in the study. Patients’ operative findings were noted during MVD and were documented on predesigned Proforma. Data was analyzed by SPSS version 17 and represented in the form of graphs and charts.  Results: 108 patients were operated for trigeminal neuralgia. Males were 64 (59.25%) and females were 44 (40.74%). Age ranged from 18 – 70 years, mean age was 44 ± 5 years. Right side was involved in 75 (70%) cases. In 106 patients (98%), a neurovascular conflict was found, the superior cerebellar artery (SCA) being the most common cause of compression in 86 (80%) patients. Regarding branches mandibular division (V3) was most commonly involved having 64 (59.25%) patients followed by maxillary (V2) 32 (29.62%) and ophthalmic (V1) division 8 (7.40%). After surgery complete pain relief was noted in 97 (90%) patients. Post operatively, nausea, vomiting and dizziness was noted in 18 (16.66%) cases, diplopia in 5 (4.62%), slight deafness in 4 (3.70%) cerebellum infarct 2 (1.85%), CSF leakage in 6 (5.55%), facial palsy in 8 (7.40%), and wound infection in 5 (4.62%) one of which subsequently died.  Conclusion: Vascular compression of trigeminal nerve is most common cause of Idiopathic neuralgia. Superior cerebellar artery is the most common compressing vessel, found during Microvascular decompression

Lower Backache after Pelvic Surgeries can be an Indicator of Tuberculosis of Lumbar Spine

Objective: To find out that lower backache after pelvic surgeries can be an indicator of tuberculosis of lumbar spine. Materials and Methods: It was retrospective study performed in Lady Reading Hospital Peshawar at Neurosurgical Department from Jan. 2012 to Dec. 2015 of 4 years duration. Patients who presented with backache after pelvic surgeries and diagnosed as tuberculosis lumbar spine were included in this study and other cases of tuberculosis lumbar spine without pelvic surgeries were excluded from this study. Results: There were 11 patients, 4 (36.3%) were female and 7 (63.7%) were male. Mean age was 58 years and age range was from 35 to 73 years. Three patients (27.3%) had gone through haemorrhoidectomy, 2 (18%) had done TURP (Transurethral prostatectomy), 2 (18.1%) had done transvaginal hysterectomy and other 2 (18.1%) had gone uterine dilatation curettage (D&C). Only 1 (9.1%) patient had done manipulation for lower backache elsewhere. Conclusion: Lower backache after pelvic surgeries is an alarming sign for tuberculosis lumbar spine and patients should be evaluated by hematological and radiological images like, CT and MRI of lumbosacral spine

Politics of Constitutional Rightism and Musharraf’s Enlightened Moderation: An Estimate of JUP’s Endeavors on MMA’s Platform

The Jamm’iyyat Ulama-i-Pakistan (abbreviated hereafter as JUP), in 1990s onwards was headed by dynamic reliogio-political echelon Moulana Shah Ahmad Nurani who believed in ‘constitutional rightism’ and didn’t believe in extra-constitutional maneuvers in order to with the game of power politics. He ran his political affairs under some set principles and abided by with them throughout his political career. His religio-political dynamism during Musharraf regime was the last but ever-glorious episode of his political strife for the enforcement of Islamic socio-economic system to which he termed as Nizam-e-Mustafa. Under his dynamic leadership the religio-political alliance, Mutahidda Majlis-i-Amal, popularly called as the ‘MMA’ showed one of the unprecedented performances the religio-political right ever showed. Up till his death in 2003, The MMA showed no compromise on the set principles, but later things went different. Among other measures of General Musharraf, his policy of so-called moderation of the society on allegedly US command was taken by the religious right of the country as ‘Command Enlightened Moderation’, hence reaction was inevitable. It flocked under the banner of MMA and tried its level best to cope with it. The research in hand highlights this interesting epoch of the history of Pakistan.

Role of Emergency Decompressive Craniectomy in Patients of Traumatic Brain Injury

Objective: To study the role of emergency decompressive craniectomy in patients of traumatic brain injury. Methodology: This observational study was performed in the department of Neurosurgery, MTI, LRH, Peshawar, from 1st February, 2016 to 31st January, 2017. A total of 28 patients of traumatic brain injury, who underwent emergency decompressive craniectomy within 24 hours of their admission were included in the study after applying the inclusion and exclusion criteria. A questionnaire was used to document the data. Data analysis was performed with the help of SPSS version 20. Results: The total no. of patients were 28, out of which 21 (75%) were male and 7 (25%) were female. The mean age of all the patients was 31 ± 19.84, with a range of 10 – 80 years. The preoperative diagnosis was acute subdural hematoma (ASDH) in 15 (53.6%), large contusion in 6 (21.4%), post-traumatic intracerebral bleed in 3 (10.7%), and ASDH plus small multiple contusions in 4 (14.3%) patients. Dura was left open in all the cases. The preoperative mean GCS was 8.39 ± 3.01. A total of 8 (28.6%) patients expired during the first postoperative week. The mean GCS of the remaining 20 patients at discharge was 10.55 ± 4.05. At 3 months follow-up, 7 (25%) patients were in vegetative state (GOS2), 3 (10.7%) were having major disability (GOS3) and 10 (35.7%) had good (GOS 4 and 5) clinical outcome. Conclusion: The decompressive craniectomy can be very helpful in patients of traumatic brain injury because it can lower the ICP and improve the survival rate in TBI patients. Abbreviations: GCS (Glasgow Coma Scale), GOS (Glasgow Outcome Scale), ICP (Intracranial Pressure)

Incidence of Infection and Causative Organisms in Patients with Ventriculoperitoneal Shunting for Hydrocephalus

Objective: To determine about the incidence of infection and causative organisms in patients with Ventriculoperitoneal shunting for hydrocephalus. Materials and Methods: This retrospective observational study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from Jan 2012 to Dec 2013 (one year). The medical record of all cases operated in last one year was checked from record room. Documentation was done according to Performa designed indicating age, sex, clinical features and type of microorganism. All patients of either sex and age with Previous Ventriculoperitoneal shunt surgery and Signs and symptoms suggestive of shunt infection were included in the study. While patients of previous Ventriculoperitoneal shunt with no signs and symptoms were excluded from the study. All the data were analyzed by SPSS 20 and results were represented in the form of graphs / tables. Results: Total 82 patients were included in the study in which males were 50 (60.97%) and females were 32 (39.02%). All the patients were in the age range of 6 months to 75 years having mean age of 37.75 years ± 5 SD. 58 (70.73%) were in pediatric age group and 24 (29.26%) were adults. Regarding etiology congenital acquiductal stenosis was the leading cause in children’s having 22/58 (37.93%) and CNS tumors were the most common cause in adults having 10/24 (41.66%). Fever and vomiting were the most common mode of presentation with 66 (80%) cases. overall incidence of shunt infection was 12 (14.63%) in which the most common microorganism was coagulase negative staphylococci having 6/12 (50%) cases. Conclusion: Shunt infection most commonly occur in children’s and coagulase negative staphylococci is the most common causative organism. Abbreviations: CSF: Cerebrospinal Fluid

Maternal Concepts and Practices of Antenatal Care in Patients with Spinal Dysraphism

Objective: To know about the antenatal care practice and concepts of the mothers who are having child with Spinal Dysraphism. Materials and Methods: This was a cross sectional study conducted in the Department of Neurosurgery, Lady Reading hospital Peshawar between July 2013 and January 2014 (seven months). All patients who were having a spinal dysraphism were approached and history was taken from the mother or chaperon. The patients included all who presented to the out patients clinic, those admitted for surgery, and who had a surgical complications like the tethered cord syndrome. The patient's name, gender, address, age of the mother, maternal views about antenatal care, time of first antenatal visit if any, history and time of folate intake, number of total children and the serial number of the child affected. Other variables like socio-economic status, educational status of the mother was also noted. The data was entered and analyzed using SPSS version 17 and was expressed in tables and charts. Results: During the study period 67 patients' particulars were noted. The age range was from 3 days to 12 years, there were 36 males and 31 females with a male to female ratio approaching nearly 1:1. The mother's age range was from 18 to 43 years and the socioeconomic status was low income in 43 patients. 23.73% of mothers have no idea of antenatal care, 34.32% mothers were not having any history of antenatal care, and only 22.38% were having a prenatal visit in the first trimester of pregnancy. 25 mothers were not having history of folate intake and only 8 (11.94%) were having positive history of taking in the first trimester. 18/67 (26.86%) of the affected children were the first child and the rest were the second or third. Conclusion: none of the mother had enough knowledge and practices to prevent MMC. The first antenatal visit and folate intake was not at proper time to prevent MMC. If the woman with children been advised about folate intake, at least a third of the patients been prevented, since in majority it was the second child affected.   Abbreviations: MMC: Myelomeningocele. HC: Hydrocephalus

SuprasellarArachnoid Cyst as a Cause of Triventricular Hydrocephalus, Found Incidentally During Endoscopic Third Ventriculostomy

Background: Arachniod cyst is a rare congenital disorder of the brain accounting 1% of all intracranial masses. They may also be acquired following head trauma, meningitis, tumors or surgery. They may be the cause of triventricular hydrocephalus (TVH). It occupies the third ventricle so flow of CSF is obstructed at aqueduct of Sylvius. Per operatively, it differs from colloid cyst in consistency, its capsule is transparent and blood vessels are visible. Objectives: To determine the frequency of suprasellar arachnoid cyst as cause of triventricular hydrocephalus and outcome of ventriculocystocisternotomy performed for these cysts at Lady Reading Hospital, Peshawar. Materials and Methods: A retrospective study of 18 cases who undergone ETV for congenital TVH from January, 2013 to December 2015 at Neurosurgery department LRH was performed. On pre operative CT scan brain they were having triventricular hydrocephalus. Ventriculocysto-cisternotomy was performed in all these cases. Biopsy was taken in all cases. Results: Out of these 18 cases, 11 (61%) were males. The presenting symptoms in our study were that infants presented with increased head circumference (n = 3) 16.6%. In pediatric and middle age group the symptoms were those of elevated ICP (n = 13) 72.22%. No endoscopic complication occurred during the procedure except for clinically non-significant bleeds. We followed all cases for a period of 6 months. Clinical and radiological improvement occurred in all cases. Conclusion: Arachnoid cyst should also be considered as a differential for congenital TVH. Endoscopic Ventriculocystocisternotomy is the treatment option of choice forsuprasellararachnoid cyst.  Abbreviations: TVH: Triventricular Hydrocephalus. CSF: Cerebral Scleral Fluid. ICP: Intracranial Pressure. AC: Arachnoid Cyst. SSCs: Suprasellar arachnoid cysts. VC: Ventriculocystostomy. VCC: Ventriculocystocisternotomy. CT: Computer Tomography

Risks of Surgery for Myelomeningocele in Children

Objective: To know about complications in Myelomeningocele (MMC) surgery.Material and Methods: Fifty five children underwent surgical repair of MMCs and represent our experience about complication in surgery for MMC. Retrospective observational study carried out in Neurosurgery ward, Lady reading hospital Peshawar, from 2013 to 2015. Patients suffering from MMC were admitted. The clinical, radiological and laboratory finding of patients were documented on a designed proforma. Moreover ventri-culoperitonial shunting (V/P) was performed for children who had or developed hydrocephalus. Eliptical incision in vertical plane was given in 45 cases and horizontal incision in 6 cases. Plastic surgery unit consulted for very large MMC in rest of 4 cases and transposition of gluteus maximus musculocutaneous unit performed. All patients with MMC of both gender and age range from 1 month to 10 years who were willing and fit for surgery were included in this study and all those who were not willing and fit for surgery were excluded. The study was approved by Institute of Research in Ethics and Biomedicine (IREB).This study will help to make recommen-dations.Results: Patients in this study were in the age range of 1 month to 10 years. Mean age was 1.8 years. Thirty seven patients (67%) were Paraparetic (MRC grade from 1 to 4) and 18 patients (32.72%) were completely paraplegic. Seventeen patients (30.9%) had ruptured MMC at presentation and underwent surgery in emergency. Fifteen patients (27.27%) had V/P shunting before surgery for MMC and 11 patients (20%) developed hydro-cephalus after excision and repair of MMC and V/P shunting carried out. Seven patients (12.72%) developed wound dehiscence and CSF leak and subjected to redo surgery. Three patients (5.45%) had wound infection followed by meningitis and two patients (3.63%) died after surgery.Conclusion: From this study we concluded that wound dehiscence and CSF leak are the most common complication after surgery for MMC and can be prevented by tensionless closure of the wound. In MMC patients with overt hydrocephalus prior to repair and excision of MMC V/P shunting should be performed. If patient develop hydrocephalus after surgery then immediate diversion of CSF should be carried out