Anosmia in Parkinson’s Disease in Pakistan: A Matched Case – Control Study

Objective:  To assess olfactory dysfunction in Parkinson's disease (PD) patients in Pakistan utilizing an autochthonous smell test. Setting:  Tertiary care center, single-center study. Materials and Methods:  Eighty-seven non-demented patients with PD, who fulfilled Queen Square Brain Bank Criteria were enrolled at the Movement Disorder Clinic, Lahore General Hospital (LGH), Lahore. Fifty-eight controls matched by gender, age, and place of residence were enrolled among patients and visitors attending other hospital clinics. Both groups underwent olfactory testing using the Pakistani Smell Identification test (PKSIT). The participants were required to identify the smell from a set of choices and were scored out of 10. Results:  Among patients in the study group, the mean duration of disease was 4.7 years (range 6 months to 19 years). The PD onset mean age was 52.15 ± 13.02 years among patients. The mean number of smell test items accurately recognized by the PD patients was 4.55 ± 2.4. A multiple linear regression demonstrated that age (P < 0.05) but not disease duration (P = 0.899) was a significant determinant of the smell test result in PD and control groups. The mean number of smell test items appropriately recognized by the controls was 7.33 ± 1.69. Logistic regression showed that the PKSIT had 73.2% sensitivity and 84.3% specificity to distinguish PD from control. Conclusion:  PKSIT being easily available, cheap, and more convenient to use in the Pakistani population, can be used in the evaluation of olfactory dysfunction in PD subjects

Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy

Background:  Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF. Objective:  This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery. Materials and Methods:  It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage. Results:  A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population.  The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002. Conclusion:  PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM. &nbsp

Comparison of divided versus loop sigmoid colostomy in the management of anorectal malformation

Introduction: Anorectal malformation (ARM) is a birth defect of the digestive tract in which the anus and rectum are not normally developed. Surgical procedure such as colostomy (loop or divided) is suggested as the initial treatment for high variety ARM. Our objective was to compare frequency of stoma related complications of loop sigmoid colostomy versus divided sigmoid colostomy for high variety anorectal malformations.Materials and Methods: A randomized controlled trial was carried out at children’s hospital and the institute of child health Lahore. A total of 180 patients were divided into two groups randomly using lottery method loop sigmoid colostomy (group-A) and divided sigmoid colostomy (group-B). After surgeries patients were followed weekly up till 4 weeks. Stoma related complications were noted.Results: The mean age in group A and group B were 3.22 ± 1.26 days and 3.36 ± 0.97 days respectively. In group A there were 77 male & 13 were female, in group B there were 67 male & 23 female patients. In group A 24.5% patients had complications: 3.4% patients had retraction, 11.1% had prolapse, 2.2% had Obstruction, parastomal hernia was seen in 5.6%, stoma necrosis were seen in 2.2%. In group B 20% patients had different complications: 2.2% patients had retraction, 2.2% had prolapse, 5.6% had obstruction, parastomal hernia were seen in 2.2% and stoma necrosis were seen in 7.8%. The complications in group A were higher when compared to group B but were not significant, p-value > 0.05.Conclusion: Divided sigmoid colostomy can be adopted to avoid stoma related complications in future

Validation Study of the Mini-Mental State Examination in Urdu Language for Pakistani Population

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population. Objective: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 ± 5.6 (range 0-30) as compared to the controls 26.8 ± 2.6 (range 7-30). This difference between groups was statistically significant (p\u3c0.001). Educational based MMSE score below 15 yielded perfect sensitivity and specificity for the diagnosis of dementia. Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population

Validation Study of the Mini-Mental State Examination in Urdu Language for Pakistani Population

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population. Objective: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu MMSE were lower in patients with dementia 18.5 ± 5.6 (range 0-30) as compared to the controls 26.8 ± 2.6 (range 7-30). This difference between groups was statistically significant (p\u3c0.001). Educational based MMSE score below 15 yielded perfect sensitivity and specificity for the diagnosis of dementia. Conclusions: These finding confirm the influence of level of education on MMSE score and education stratified cutoff scores should be used while screening for cognitive impairment in this population

The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser

Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage. Our aim was to compare the efficacy & the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size). This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic. The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P > 0.05). Male patients were three times at a higher risk of recurrence as compared to females. This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size)

Stability-Indicating Photochemical Method for the Assay of Riboflavin: Lumichrome Method

A stability-indicating photochemical method for the assay of riboflavin (RF) in photodegraded samples and aged vitamin preparations has been developed. It is based on photochemical conversion of RF to lumichrome (LC) in alkaline solution under controlled conditions of light intensity, temperature, pH, time of exposure, and distance. Under these conditions about two-thirds of RF is converted to LC and on the basis of the RF : LC ratio the concentration of RF can be determined in degraded solutions. The method involves the extraction of photolyzed solutions of RF (pH 2.0) with chloroform and determination of LC along with lumiflavin (LF) by a two-component spectrometric method at 356 and 445 nm. The method has been validated and the results of the assay of RF in photodegraded solutions compare well with those of the standard USP fluorimetric method. The recovery of the method is 99–101% and the precision is within 2%. The method is stability-indicating and can be applied to the assay of RF in photodegraded solutions and aged vitamin preparations. The method is specific compared to that of the USP fluorimetric method in which the degraded LC may interfere with the fluorescence emission of RF

Assessment of collimator angle variation in volumetric-modulated arc therapy planning for head and neck carcinoma patients

Background & Aims:  The collimator angle significantly impacts radiation leakage between the multi-leaf collimator (MLCs) leaves. This study aims to examine dose-volume evaluation in planning target volume (PTV) and organs at risk (OARs) for Head & Neck patients undergoing volumetric-modulated arc therapy (VMAT) with 2.5 arcs and varying collimator angles. Materials & Methods:  In this experimental study, five patients with nasopharyngeal cancer were selected for treatment with the VMAT method. CT images were prepared using a CT simulator and transferred to the treatment planning system. For optimizing VMAT plans, volume and dose constraints were applied to OARs and PTVs by the algorithm. Then, the doses were calculated using the AAA algorithm. Results:  Although no significant differences were observed in DVH curves across different collimator angles, other parameters exhibited variations. Notably, in Head & Neck cancer patients, optimal values for dose conformity, homogeneity, MUs, and gradient index were found at collimator angles of 20° and 30°. Additionally, OAR sparing was favorable at these angles. Based on target coverage, homogeneity, and MUs, the collimator angles were optimized for VMAT planning. Conclusion:  Our findings offer valuable guidance to clinical medical physicists in making informed decisions regarding collimator angles. The dosimetric analysis underscores the importance of selecting the optimal collimator angle for accurate PTV coverage