Surgical Outcome & Cost Analysis of Single Stage Anterior Decompression and Cage Fixation in Patients with Thoracic and Lumbar Tuberculous Spondylitis: A Single Centre Experience Over Six – Years with Comprehensive Literature Review

Objective:  For Tuberculous spondylitis (TS) the optimal mode of management for extensive tuberculous spondylitis is still a subject of debate. We determined the outcome for single stage anterior decompression and cage fixation for dorso-lumbar TS. Material and Methods:  This prospective study was conducted between 2012 and 2018. Worsening or new onset neurological deficit, increasing deformity, large paraspinal abscess and those not responding to anti-tuberculous drug therapy were included. Patients with severe comorbidities (> ASA class III) and recurrent cases were excluded. Demographics, clinical features, radiological characteristics, intraoperative details, postoperative complications and follow-up condition were recorded. Results:  One patient with mean age of 45.6 ± 14.9 years with 17 (54.8%) males and 14 (45.2%) females. Mean symptoms duration was 71.9 ± 29.4 days. 41.9% had spasticity & 25.8% had sphincter dysfunction on presentation. Half (48%) of patients had a Frankel grade 3 or less bilaterally. Mean length of the procedure was 137.4 ± 19.9 minutes. 19.4% (n = 6) had postoperative pulmonary complications, 16.1% (n = 5) wound infection, 9.7% (n = 3) had worsening of neurologic deficit and one (3.2%) remained static. Graft extrusion and cage subsidence were noted in one (3.2%) patient each. Favorable outcome was observed in 83.9% (n = 26) while 16.1% (n = 5) had unfavorable outcome. Mean out-of-pocket cost was 164677.4 ± 11469.9 rupees (USD: 1187 approx). Conclusion:  Timely spinal decompression with stabilization at the onset of the Pott’s disease in patients who fulfil the criteria as surgical candidates carries a promising outcome

Trends of expenditure on Immunization in Pakistan since 2000.

World health organization started Expanded Program on Immunization in 1974. At that time only 5% of the children were covered globally in the first year on pro-gram. In Pakistan 16.34% of the total population is under five years’ children. In 2000 Global Alliance for Vaccines and Immunizations (GAVI) was introduced in Paki-stan. Since 2000 by the finance and HR support from GAVI, additional 370 million children have been vaccinated from deadly disease. It has been noticed that the expenditure on immunization remained inconsistent over the time period. Since 2000 the massive change is seen in the pattern of expenditure on immunization both routine and campaigns to meet the goals. In Pakistan, expenditure on immun-ization has reached to $240 million annually but still the fully immunized children are between 43-62% of all the under-five population of the country. Immunization services needed to be on time and efficiently provided to the communities. The growth in fiscal gap and need for expenditure competition in financing, has subju-gated policymaking. There is a need for reviewing the current policies for budgeting immunization program and needful risk assessment will support future financial crisis.Key Words: Immunization, Global Alliance for Vaccines and Immunization,Extended Program of Immunization

A relationship between weak attentional control and cognitive distortions, explained by negative affect

People high in negative affect (anxiety or depression) show cognitive distortions, specific thinking errors which contribute to the maintenance of their condition. It is thought that weak attentional control is a risk factor for negative affect and emotional disorders, because weak attentional control exaggerates the expression of attentional bias, another cognitive feature of emotional disorders. We wondered whether weak attentional control might similarly exaggerate the expression of cognitive distortions. In two samples of students from Turkey and the UK, we found that weak attentional control was indeed related to cognitive distortions, but this relationship was explained by both variables’ relationships with negative affect. This suggests that weak attentional control, while related to negative affect, does not necessarily exaggerate all of its cognitive features. There seems to be a limit on the affective consequences of poor attentional control, which may limit its clinical usefulness as a risk factor for emotional disorders

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparison of upper and lower lip position, length and thickness in sagittal and vertical malocclusion

This study aimed to compare the upper and lower lips position, length, and thickness in different malocclusions, in randomly selected 180 patients’ pre-treatment lateral cephalograms. The subjects were grouped sagittally by using Steiner’s analysis and Wits appraisal and vertically based on Frankfort horizontal and mandibular plane (FHMP) angle and lower facial height. One-way ANOVA was applied to compare the upper and lower lip positions, thickness, and length in sagittal and vertical malocclusion and independent sample T test was applied for comparison between genders among soft tissue variables. Post-hoc Dunnett T3 was performed for comparison of lip variables in adjacent malocclusion groups. The level of significance was not less than or equal to 0.05 The anteroposterior position of the upper and lower lips with respect to E and S planes and upper and lower lip thicknessaried significantly (p < 0.05) in all classes of sagittal malocclusion, ---Continu

Quality Evaluation of Lemon Cordial Stored at Different Times with Microwave Heating (Pasteurization)

Consumer interest in food quality and safety has shifted over time, as consumers increasingly prefer minimally processed items. As a result, numerous non-thermal approaches have been implemented due to their potential to preserve the nutritional profile of products along with lengthening their storability. Microwaving, a green processing technique, volumetrically heats the product because of the interactions developed between charged ions, polar water molecules of foodstuff and the incoming electromagnetic waves. The study was mapped out to investigate the effect of microwave exposure time (60, 90 and 120 s) at fixed power (1000 W) and frequency (2450 MHz) on physicochemical properties, phytochemical constituents, antioxidant potential and microbial counts of lemon cordial stored at refrigerated temperature (4 ± 2 °C). The mentioned parameters were analyzed after an interval of 30–90 days. Statistical findings illustrated a highly significant (p ≤ 0.01) impact of microwave treatment and storage on titratable acidity, pH, total soluble solids, total phenolic contents, total flavonoids contents, antioxidant potential and total plate count. Sample microwaved for 120 s showed the highest pH values (2.45 ± 0.050), total soluble solids (56.68 ± 2.612 °B) and antioxidant activity (1212.03 ± 716.5 µg—equivalent of ascorbic acid per 100 mL of cordial); meanwhile, it exhibited the lowest total plate counts (1.75 ± 0.144 Log 10 CFU/mL). Therefore, microwaving can be suggested as a suitable alternate to traditional pasteurization techniques as well as to chemical preservatives

Design, synthesis, and in vitro and in silico studies of morpholine derived thiazoles as bovine carbonic anhydrase-II inhibitors

Carbonic anhydrase CA-II enzyme is essential for maintaining homeostasis in several processes, including respiration, lipogenesis, gluconeogenesis, calcification, bone resorption, and electrolyte balance due to its vital function within cellular processes. Herein, we screened 25 newly synthesized thiazole derivatives and assessed their inhibitory potential against the zinc-containing carbonic anhydrase CA-II enzyme. Intriguingly, derivatives of thiazole exhibited varying degrees of inhibitory action against CA-II. The distinctive attribute of these compounds is that they can attach to the CA-II binding site and block its action. Morpholine based thiazoles can be strategically modified to improve bovine CA-II inhibitor binding affinity, selectivity, and pharmacokinetics. Thiazole and morpholine moieties can boost inhibitory efficacy and selectivity over other calcium-binding proteins by interacting with target bovine CA-II binding sites. The derivatives 23-26 exhibited greater affinity when compared to the standard acetazolamide. Furthermore, kinetic study of the most potent compound 24 was performed, which exhibited concentration dependent inhibition with a Ki value of 9.64 +/- 0.007 mu M. Molecular docking, MD simulation and QSAR analysis was also carried out to elucidate the interactions, orientation, and conformational changes of these compounds within the active site of the enzyme. Moreover, pharmacokinetic assessments showed that most of the compounds possess attributes conducive to potential drug development

Quality evaluation of ozone-processed Kinnow (Citrus reticulata Blanco) juice at ambient temperature

ABSTRACTNon-thermal processing has been developed to increase the quality and storage life of fruit juices in response to consumer desire. Ozonation is a recently developed method that generates volatile oxygen atoms that can eliminate a broad spectrum of microbes and extend the shelf stability of food products. The present research was intended to investigate the ozone processing on the physicochemical characteristics, microbiological quality, sensory attributes, and antioxidant potential of Kinnow juice. In this study, Kinnow juice was processed to 150 mg/h of ozone gas at a constant concentration for 5, 10, and 15 min. The sample was then taken in a plastic container and stored at 35°C ± 2 for three months. The results revealed that ozone processing had a significant (p˂0.05) effect on the total phenolics (TP) contents, total flavonoids (TF) contents, total soluble solids (TSS), acidity, total antioxidant activity (TAA) and DDPH radical scavenging activity of Kinnow juice. In addition, the ozonation application also significantly (p˂0.05) decreased the population of the microbes when the ozone time was increased from 5–15 min. Among the treatments, it was observed that T3 had the highest TSS, acidity, TF contents, TAA, and DDPH radical scavenging activity values and the lowest mold and plate counts. Regarding sensory qualities, T0+ showed the highest sensory score during storage. Thus, it may be concluded from the findings of our study that ozone application improved the quality of Kinnow juice by increasing TSS, phytochemicals and decreasing the microbial population, thereby prolonging their shelf life

Independent Introduction of Two Lactase-Persistence Alleles into Human Populations Reflects Different History of Adaptation to Milk Culture

The T−13910 variant located in the enhancer element of the lactase (LCT) gene correlates perfectly with lactase persistence (LP) in Eurasian populations whereas the variant is almost nonexistent among Sub-Saharan African populations, showing high prevalence of LP. Here, we report identification of two new mutations among Saudis, also known for the high prevalence of LP. We confirmed the absence of the European T−13910 and established two new mutations found as a compound allele: T/G−13915 within the −13910 enhancer region and a synonymous SNP in the exon 17 of the MCM6 gene T/C−3712, −3712 bp from the LCT gene. The compound allele is driven to a high prevalence among Middle East population(s). Our functional analyses in vitro showed that both SNPs of the compound allele, located 10 kb apart, are required for the enhancer effect, most probably mediated through the binding of the hepatic nuclear factor 1 α (HNF1α). High selection coefficient (s) ∼0.04 for LP phenotype was found for both T−13910 and the compound allele. The European T−13910 and the earlier identified East African G−13907 LP allele share the same ancestral background and most likely the same history, probably related to the same cattle domestication event. In contrast, the compound Arab allele shows a different, highly divergent ancestral haplotype, suggesting that these two major global LP alleles have arisen independently, the latter perhaps in response to camel milk consumption. These results support the convergent evolution of the LP in diverse populations, most probably reflecting different histories of adaptation to milk culture