Neurological Improvement after Decompression for Dorsal Spine Tuberculosis (TB)

Objectives:  To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading. Materials and Method:  Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented. Results:  Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery. Conclusion:  Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization. Keywords:   Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization

Clinical outcome and complication of anterior cranial Fossa meningiomas in tertiary care Hospital Peshawar

Objectives:  We examined the surgical outcome and complications of anterior cranial Fossa meningiomas. Materials and Methods:  A prospective study was conducted at the Department of Neurosurgery Prime Teaching Hospital, Peshawar, KPK, Pakistan from June 2019 to June 2021. A total of 31 patients were selected through non-probability consecutive sampling. After clinical examination and radiological findings, the patients were diagnosed with anterior cranial Fossa meningiomas. Microsurgical Trans cranial approaches did. Clinical outcomes and complications were documented. Tumor anterior cranial fossa meningiomas. A low Karnofsky performance scale index was used to analyze the functional impairment of the patients. Results:  9 (29.03%) were male and 22 (70.96%) patients were female. The mean age of presentation was 42 ± 5 years. Headache 25 (80.6%) and Visual loss were the main presenting symptoms 24 (77.5%), and Tuberculum sellae meningioma patients 08 (25.08%). The most common approach was Bifrontal craniotomy for OGM in 9 patients and two small OGM were operated on utilizing frontolateral craniotomy. The rest of the cases were operated through Pterional craniotomy. Tuberculamsalle meningiomas surgery results in a visual improvement in 6 patients (75%), Complete tumor resection was achieved in 22 (70.9%) patients and subtotal resection is achieved in 6 (19.3%) patients. In a few patients 03 (9.67%) only safe debulking and biopsy were taken. Postoperative hemorrhage was in 4 (12.9%) patients. Conclusion:  Transcranial approach for microsurgical resection of anterior cranial fossa meningiomas is an effective and feasible approach in terms of visual outcome and extent of resection. Keywords:  Anterior cranial Fossa Meningioma, Bifrontal Craniotomy, Front-lateral craniotomy

Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

<p>Abstract</p> <p>Background</p> <p>Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka.</p> <p>Case presentation</p> <p>Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts.</p> <p>Conclusion</p> <p>Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.</p

Synthesis and Magnetic Properties of Cobalt Ferrite (CoFe2O4) Nanoparticles Prepared by Wet Chemical Route

Magnetic nanoparticles of cobalt ferrite have been synthesized by wet chemical method using stable ferric and cobalt salts with oleic acid as the surfactant. X-ray Diffraction (XRD) and Transmission Electron Microscope (TEM) confirmed the formation of single phase cobalt ferrite nanoparticles in the range 15-48nm depending on the annealing temperature and time. The size of the particles increases with annealing temperature and time while the coercivity goes through a maximum, peaking at around 28nm. A very large coercivity (10.5kOe) is observed on cooling down to 77K while typical blocking effects are observed below about 260K. The high field moment is observed to be small for smaller particles and approaches the bulk value for large particles.Comment: 18 pages, accepted in JMMM, (May, 2006

RETROMASTOID SUBOCCIPITAL MICROVASCULAR DECOMPRESSION TECHNIQUE FOR THE TREATMENT OF TRIGEMINAL NEURALGIA

Introduction: Trigeminal neuralgia is a condition of craniofacial pain which is characterized by sudden, excruciating, and brief pain in the sensory distribution of one or more branches of the fifth cranial nerve resulting in decreased quality of life of the affected patient. In patient’s refractory to pharmacological or conservative treatment, the surgical procedure of choice is microvascular decompression. The aim of our study was to determine the outcome of retro mastoid suboccipital microvascular decompression technique for the trigeminal neuralgia. Material & Methods: This case series study was conducted in Department of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar from January 2020 to January 2022. Consent from the ethical committee and patients were taken. All patients of trigeminal neuralgia were included. Those patients having mass lesion were excluded. All information were put in proforma. Results were analysed by SPSS version 20. Results: Total sample size of our study was 58 patients. Majority of the patients were female (n 34 59%). Mean age of the patients was 44+ 5 years (range 25-60 years). The common level of pain distribution was in maxillary and mandibular branches V2-V3, 39(67.8%). The most common aetiology of trigeminal neuralgia was superior cerebellar artery loop in 41(70.7%) patients. Surgical outcome in terms of pain relief was in 49 (84.5 %) patients, after 6-8 months follow-up, The most common complication of surgery was CSF leak in 3(5.2%) patients, followed by post operative Sub arachnoid haemorrhage in 1(1.8%) patient, mortality was reported in 2 (3.4%) patients. Conclusion: The results of our study concluded that microvascular decompression surgery is effective in reducing pain, improving patient satisfaction in trigeminal neuralgia patients who are refractory to conservative treatment options such as carbamazepine’s. The procedure also has some complications such as cerebrospinal fluid leakage and sub arachnoid haemorrhage

Hubungan Tingkat Pendidikan dengan Tingkat Ketertarikan Masyarakat terhadap Pelayanan Gizi berbasis Gen di Indonesia

Latar Belakang: Penyakit Tidak Menular (PTM) merupakan salah satu penyebab kematian di dunia yang terus meningkat setiap tahunnya. Perkembangan ilmu Nutrigenetik dan pelayanan gizi berbasis gen memiliki peran dalam mencegah terjadinya PTM, tetapi masih banyak masyarakat yang tidak mengetahuinya. Tujuan: Untuk mengidentifikasi hubungan antara tingkat pendidikan dengan tingkat ketertarikan masyarakat terhadap pelayanan gizi berbasis gen di Indonesia. Metode: Desain penelitian cross-sectional dilakukan secara online menggunakan Qualtrics Survey pada Mei-Juni 2023 di DKI Jakarta, Jawa Barat, Jawa Tengah, Jawa Timur, dan DI Yogyakarta menggunakan teknik cluster sampling. Kuesioner sosiodemografi dan ketertarikan dibuat dan telah diuji validitas dan reliabilitasnya. Data statistik penelitian ini menggunakan uji chi-square. Hasil: Masyarakat memiliki tingkat ketertarikan yang tinggi terhadap adanya pelayanan gizi berbasisi gen di Indonesia (92,3%). Mayoritas responden setuju bahwa mereka akan menyarankan keluarga mereka untuk melakukan tes nutrigenetik (89,7%). Mereka setuju bahwa pelayanan gizi berbasis gen akan memberikan banyak manfaat bagi mereka (97,5%), serta sebagian besar responden menyatakan bersedia mengeluarkan biaya lebih untuk mendapatkan pelayanan gizi berbasis gen (62,4%). Sebagian besar responden tertarik melakukan tes nutrigenetik untuk mengetahui apakah mereka memiliki risiko penyakit atau tidak (95,9%). Namun, tidak terdapat hubungan antara tingkat pendidikan dengan tingkat ketertarikan masyarakat terhadap pelayanan gizi berbasis gen di Indonesia (p=0,134, OR:0,551, CI=95% (0,27 – 1,11)). Kesimpulan: Tinggi atau rendahnya pendidikan masyarakat Indonesia tidak berhubungan dengan ketertarikan terhadap pelayanan gizi berbasis gen. Tetapi, masyarakat tertarik dan setuju pelayanan gizi berbasis gen dapat memberikan banyak manfaat terutama untuk pencegahan PTM

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Clinical Outcome and Complication of Endoscopic Endonasal Transsphenoidal Surgery (ETSS) for Pituitary Adenoma: A Retrospective Study at Prime Teaching Hospital Peshawar

Objectives:&nbsp;&nbsp;The study aimed to ascertain the clinical outcome and complications of endoscopic endonasal transsphenoidal surgery (ETSS) for pituitary adenomas. Material &amp; Methods:&nbsp;&nbsp;A retrospective study conducted at the Department of Neurosurgery Prime Teaching Hospital Peshawar, Pakistan. Pituitary adenoma was diagnosed in 89 patients on MRI Brain with contrast and post-surgical biopsy. Post-surgical outcomes and complications were documented. Results:&nbsp;&nbsp;Out of 89 patients, 54% were male, and 46% female patients. The mean age was 42 ± 5 years. Headache was reported in 92% as a most common presentation, followed by decreased visual acuity in 62 %, amenorrhea in 22%, and acromegaly in 29% of patients. Overall, the symptoms related to surgical improvement were observed in 72% of patients. A good surgical outcome was observed in 80% of patients with microadenomas, as compared to the patients with macroadenomas. The most common complication was the transient diabetes insipidus followed by Cerebrospinal fluid (CSF) leak and post-operative hematoma. Conclusion:&nbsp;&nbsp;Endoscopic endonasal transsphenoidal surgery (ETSS) is a safe, less invasive, cosmetically effective technological advancement for pituitary adenomas

Coefficient Inequalities of Analytic Functions Related to Robertson Functions

We introduce and study a subclass of analytic functions related to Robertson functions. Here we discuss the coefficient estimate for function in this class