Endoscopic transsphenoidal surgery for cushing\u27s disease: A review

Ever since the 1960s, transsphenoidal surgery has been the modality of choice for treating Cushing\u27s disease. Subsequent visualization of the pituitary fossa and sphenoid sinus may be done either with the operating microscope or with the relatively new endoscope. The endoscope due to its panoramic view allows greater visualization as compared to the operating microscope. It confers greater access to the cavernous sinus, sella, suprasellar, and parasellar regions and accommodates higher magnifications. It is bi-dimensional, however as opposed to the operating microscope that provides a three-dimensional view and allows greater depth perception. This article provides a comprehensive review of the advantages and disadvantages of the endoscope and compares it to the operating microscope. We hope this article will prove useful to both clinicians and academicians alike in their approach and management of Cushing\u27s disease

Comparing Different Routes of Vitamin D Administration: A Randomized Interventional Trial

Background: Vitamin D maintains overall good health by boosting up of the immune system through proper function of lungs, heart, muscles, brain and bones. The goal of the study was to determine and compare different routes and formulation of vitamin D3 that was per oral, injectable formulation given orally and intramuscular injection in patients of different groups. Methods: This was a randomized clinical trial designed for vitamin D deficient patients. Patients were randomly assigned to three routes of administration i.e. orally, injection formulation given orally andintramuscular injection group. For mild deficiency, 2 doses of 200,000 IU, for moderate deficiency, 3 doses of 200,000 IU and for severe deficiency, 4 doses of 200,000 IU, 25[OH] D was prescribed. Chi-Square (χ2 ) test was used to evaluate the significant association . Results: A total of 150 patients were enrolled in the study. The mean age ±SD of patients was 48.29 ± 4.65 years. At 4 and 12 weeks after completion of vitamin D3 replacement, levels of 25-hydroxycholecalciferol were measured. In the majority of participants of all three groups, the levels of vitamin D were increased to normal range by week 4 after the final dose of vitamin D3. However, the majority of patients failed to maintain their Vitamin D3 levels within the normal range 12 weeks after the final dose. All three routes of administration of Vitamin D were found equally effective with no significant difference between the routes (p>0.05). Conclusion: All three routes of administration of vitamin D supplements had equal efficacy with no significant advantage over one another

Pediatric brainstem gliomas: An institutional experience

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute.Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis.Results: The mean age of our cohort was 8.6 years (range 3-15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency \u3e1 month was found to have a statistically significant longer progression-free interval.Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative

Differential Requirement for Utrophin in the Induced Pluripotent Stem Cell Correction of Muscle versus Fat in Muscular Dystrophy Mice

Duchenne muscular dystrophy (DMD) is an incurable degenerative muscle disorder. We injected WT mouse induced pluripotent stem cells (iPSCs) into mdx and mdx∶utrophin mutant blastocysts, which are predisposed to develop DMD with an increasing degree of severity (mdx <<< mdx∶utrophin). In mdx chimeras, iPSC-dystrophin was supplied to the muscle sarcolemma to effect corrections at morphological and functional levels. Dystrobrevin was observed in dystrophin-positive and, at a lesser extent, utrophin-positive areas. In the mdx∶utrophin mutant chimeras, although iPSC-dystrophin was also supplied to the muscle sarcolemma, mice still displayed poor skeletal muscle histopathology, and negligible levels of dystrobrevin in dystrophin- and utrophin-negative areas. Not only dystrophin-expressing tissues are affected by iPSCs. Mdx and mdx∶utrophin mice have reduced fat/body weight ratio, but iPSC injection normalized this parameter in both mdx and mdx∶utrophin chimeras, despite the fact that utrophin was compromised in the mdx∶utrophin chimeric fat. The results suggest that the presence of utrophin is required for the iPSC-corrections in skeletal muscle. Furthermore, the results highlight a potential (utrophin-independent) non-cell autonomous role for iPSC-dystrophin in the corrections of non-muscle tissue like fat, which is intimately related to the muscle

Practice of teacher leadership: A comprative case study of two primary schools in Dar es salaam, Tanzania.

Teacher Leadership is recognized as a powerful and highly influential genre or Educational leadership due to its potential for school improvement. Although much has been discussed about Teacher Leadership in the western academic world, little is Explored in the context of developing countries, in Eastern Africa. Therefore, my study aims at understanding the practice of Teacher Leadership in t two schools in Dar es Salaam. Tanzania. i have used a qualitative case study approach to understand the practices of two primary schools; a public and a private. Purposive sampling was undertaken for this study to obtain a rich data. The results have shown that teachers practice leadership in all the four levels of Grant\u27s (2006) model of Teacher Leadership; in the classroom, in working with other teachers, in whole school development and into the community. It also emerged from the study that the practice of Teacher Leadership is contextual in the school culture, structure and social interactions of various stakeholders. The study has reported several challenges, which the teachers face in the practice of Teacher Leadership. Some of these challenges are large class sizes and increased workload of the teachers. These challenges are the typical representations of\u27 contextual realities of Tanzania; being a developing country. While these challenges tend to affect the quality of Teacher Leadership, the study has also revealed that teachers do not stop to Practice leadership. Even in such disadvantageous circumstances. This report also highlights several factors, which either promote or hinder Teacher Leadership in the two schools under study. Within these factors, the role of the head teacher has proved to be of great importance. Hence, this study has documented insights on the practice of Teacher Leadership in Tanzania: a genre of educational leadership, which was being practiced unknowingly for long

The Impact of Data Normalization on KNN Rendering

Data normalization is a vital preprocessing technique in which the data is either scaled or converted so features will make an equal contribution. The success of classifiers, like K-Nearest Algorithm, is highly dependent on data quality to generalize classification models. In its turn, KNN is the simplest and most widely-used model for different machine learning-based tasks, including text classification, pattern recognition, plagiarism and intrusion detection, ranking models, sentiment analysis, etc. While the core of KNN is basically based on similarity measures, its performance is also highly contingent on the nature and representation of data. It is commonly known in literature that to secure competitive performance with KNN, data must be normalized. This raises a key question about which normalization method would lead to the best performance. To answer this question, the normalization of data with KNN, which has not yet been given good attention, is investigated in this work. We provide a comparative study on the significant impact of data normalization on KNN performance using six normalization methods, namely, Decimal, L2-Norm, Max/Min, Std Norm, TFIDF and BoW. On eight publicly-available datasets, experimental results show that no method dominates the others. However, the L2-Norm, Decimal, and TFIDF methods were shown to obtain the best performance (measured by accuracy, precision, and recall) in most evaluation metrics. Moreover, run time analysis shows that KNN is working efficiently with BoW, followed by TFIDF

Frequency of language and swallowing problems in children with cerebral palsy Tertiary care Hospital Rawalpindi, Pakistan

Objective: To investigate the occurrence of language and swallowing problem in individuals with cerebral palsy. Methods: The cross-sectional survey was conducted at the Riphah International University, Rawalpindi, Pakistan, from September 2018 to January 2019 while data was collected from the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, a tertiary care hospital. The sample comprised individuals with cerebral palsy of either gender aged 5-18 years. Language Sample Checklist was used for language problems and the Northwestern Dysphagia Patient Checklist was used for swallowing problems.Data was analysed using SPSS- Version 21. Results: Of the55 subjects,62% were males, 38% were females, 76% were from urban areas and 24% were from rural areas.In terms of concepts, processing, and comprehension, 18(33%) persons were able to attempt the tasks, 45(81%) were unable to attempt morphological tasks, 41(74%) were unable to attempt sentence structure tasks, 40(72%) were unable to attempt literacy and narrative skills tasks, 41(74%)could not fulfil pragmatic tasks and 49(89%) had unintelligible speech. The patient checklist showed that 47(85%) children had normal medical history, 41(75%) had normal behavioural variable, 29(52%) had normal gross motor ability,40(73%) completed oral motor test, and 39(71%) had normal swallow trials. Conclusion: Language problems were more prevalent in children with cerebral palsy compared to swallowing difficulties. Key Words: Cerebral palsy, Dysarthria, Language, Swallowing, Dysphagia

Epidemiology of rheumatoid arthritis in a tertiary care unit, Karachi, Pakistan

Objective: To determine the frequency, demographic characteristics, associated co- morbidities and extraarticular manifestations in patients with rheumatoid arthritis (RA) visiting the rheumatology clinic at a tertiary care hospital, Karachi.Method: A retrospective medical chart review of 4900 patients, who visited the rheumatology clinic at Liaquat National Hospital, from January 2005 to June 2007, was conducted. All patients with RA, of both gender and ages 16 years and above, who fulfilled the 1987 ACR criteria were included. Demographic characteristics, base line co-morbidity and extra-articular manifestations were recorded according to pre-defined criteria.Result: Among 4900 patients, 633 (12.9%) visited the rheumatology clinic with RA, female to male ratio being 4:1. The mean age of onset was 38.5 +/- 12.4 years in females and 44.8 +/- 13.12 years in males. Among the age group 16-29 years females were more affected, whereas greater number of males presented between 50-75 years of age. Co-morbidities were found in 35.38% of RA patients. Cardiovascular disease including hypertension (13.79%) and ischaemic heart disease (6.6%) were the most common co-morbidities. RA factor was positive in 85.05% of the patients with hypertension and 88.09% of the patients with ischaemic heart disease. Extra-articular manifestations were reported in 3.47% of patients. Interstitial lung disease (1.57%) was the most common extra-articular manifestation.Conclusion: Significant proportion of patients with female predominance visited the rheumatology clinic at a tertiary care hospital due to RA. Rheumatoid factor may predict the risk of developing cardiovascular disease in patients with RA. The frequency of extra-articular manifestation was lower than that reported in western population

Co-Morbidities associated with hypomagnesemia and affecting in-hospital mortality in tertiary care hospital of Sindh Pakistan-2021

Background: Hypomagnesemia may cause severe and fatal complications if not timely diagnosed and properly treated, and associated with increased In-Hospital Mortality. Methods: A case-control study was conducted. The case definition was any patient of any age and sex having hypomagnesemia and admitted to ICU. The controls were taken in 1;2. We defined Hypomagnesemia with less than 1.46mg/dl level of magnesium and In-Hospitals mortality as the primary endpoint. Demographic, risk factor data were taken and analyzed using EPI INFO TM 7. The association was calculated using Odds Ratios and reported at 95% CI and P value less than 0.05. Results: Of 139 patients, 42 were cases. The average age was 53 years (14 to 85 Years ±16 years). Males were 72 (49%) and 78 (66%) participants were from rural setup. Diabetes mellitus was found in 33 (78%) of cases and 44 (46%) in controls, hypertension in 36 (85%) of cases and 41 (42%) of controls, dyslipidemia in 20 (48%) of cases and 37 (38%) of controls, obesity in 26 (62%) of cases and 37 (38%) of control, and anaemia in 28 (67%) of cases and 41 (42%) of control

Toxic Effects of Chloroform and Aqueous Extracts of Peganum harmala on Hematological and Growth Parameters in Rabbits

Abstract.-The primary objective of the study was to evaluate the toxic effects of Peganum harmala extracts on hematological and growth parameters using rabbit model. Thirty five rabbits (1200-1700 g) of either sex were randomly divided into 3 groups D, E and F. The rabbits in group D were given P. harmala chloroform extract, while the members in group E were administered P. harmala water extract. The animals in group F were given normal saline. The groups D and E were further divided into three sub-groups of 5 each receiving 1, 5 and 10 mg/ml of extract. Blood samples from each rabbit were collected at day 0 (pre-medication), day 9 and day 30 (post-medication). Feed efficiency and daily weight gain in group D3 and E3 on day 30, was significantly lower (P&lt;0.05) compared to control group F. Erythrocytes count in group D3 was significantly lower (P&lt;0.05) than control group F on day 30. A non-significant difference (P&gt;0.05) was observed in hemoglobin concentration and leukocyte count in rabbits of all treatments groups. It was concluded that parenteral administration of chloroform extract of P. harmala at 10mg/kg had more deleterious pronounced effect on growth rate and erythrocyte count in rabbits compared to aqueous extract of the plant