Intramedullary cavernoma with extralesional haemorrhage

Intramedullary cavernomas are rare lesions constituting 5 to 12% of all intramedullary tumours. They are more recognized after introduction of magnetic resonance imaging and detection rates have improved by advance techniques. They may be solitary or multiple or may have associated cranial lesions. They may present with gradual neurological decline or with acute loss of spinal function. In addition neurological deficit depends on the location of the lesion within the spinal cord. We are reporting the case of a 45 year old male who presented with neck pain and progressive right arm weakness with numbness. MRI cervical spine with contrast showed intramedullary lesion with peripheral T2 hypointense rim and extralesional haemorrhage consistent with cavernoma. Patient underwent successful surgery and his symptoms markedly improved with mild residual grip weakness in right hand

Prevalence of NAFLD in Healthy and Young Male Individuals

Introduction. Nonalcoholic fatty liver disease (NAFLD) is an important cause of liver disease in adults and the most common cause of liver disease in children (Lavine and Schwimmer 2004). The abnormalities include increased liver fat without inflammation (steatosis) and nonalcoholic steatohepatitis (NASH). NASH may lead to fibrosis, cirrhosis, and ultimately liver failure if it is not treated (Matteoni et al. 1999). The objective of the study is to estimate the magnitude of the problem which will help us to formulate strategies in managing the potentially difficult problem. Materials and Methods. We included 1000 individuals between the ages of 30 and 50 years who came for annual checkup. The patients with other comorbidities like diabetes, ischemic heart disease, chronic liver disease, or renal diseases were excluded from the study. History of alcohol ingestion was also taken; any individual with history of alcohol intake was also excluded. All of them underwent investigations including CBC, LFTs, height and weight. The individuals who were found to have increased ALT (50 to 150 u/L) further underwent investigations including ultrasound of abdomen hepatitis b and c serology RA and ANA antibodies. All the individuals who were found to have viral or autoimmune illness were excluded from the study. The individuals having raised ALT levels and ultrasound evidence of fatty liver were taken. Results. 13.5% of the individuals were found to have NAFLD among those selected for the study. Conclusion. Mass campaign regarding physical and dietary measures needs to be undertaken in general masses regarding the gravity and potential prevention of the disease

Association of NS1 Antigen, IgM, IgG Antibodies and RT-PCR in the Diagnosis of Dengue Virus Infection

Background: To determine the association of ELISA based serological markersNS1 antigen, IgM, IgG antibodies and RT-PCR in the diagnosis of dengue virus infection Methods: In this descriptive cross sectional study 420 serum samples from patients with suspicion of dengue fever were tested for detection of dengue by NS1 antigen ELISA, IgG, IgM ELISA. RT-PCR for dengue was carried out in all NS1 antigen ELISA positive cases for confirmation of dengue. Results: Out of 420 cases , 249 cases were positive for either one of the three markers NS1, IgM,IgG. Males constituted 71.66%.Two hundred and two (48.09%) were positive for NS1 only,13 (3.09%) were positive for NS1 and IgG, 07 (1.66%) were NS1, IgM and IgG positive,16 (3.80%) were positive for IgG only ,11 (2.61%) were positive for NS1 and IgM whereas 171 (40.17%) samples were reported negative for NS1, IgM and IgG.RT-PCR was conducted on 233 NS1 positive cases out of which 80.06% cases turned out positive. Maximum number of cases belonged to DEN-2 genotype. Conclusion: Early diagnosis helps in improved patient care, suitable treatment, prevents severe complications and helps limit the spread of the disease. RT PCR is  a reliable test for the  diagnosis of acute dengue fever

Nutritional Quality of Wheat

The criteria of wheat quality are varied, which is suitable for one product may not have properties for another product. Wheat endosperm contains the proteins, carbohydrates, iron, and B-vitamins such as riboflavin and niacin. It also contains soluble fiber as well as trace minerals. Soluble fiber is considered to have health benefits that are not shared by insoluble part. It is the leading source of vegetal protein in human food, having a protein content of about 13%, relatively high as compared with other major cereals. Natural wheat has a number of medical properties, such as every component of the whole wheat grain contains elements that the person’s body requires. Wheat comprises carbohydrates and gluten protein, which offer massive amounts of energy; inner bran coats, phosphates, and other mineral salts; and dietary fiber, which helps with bowel movements. Wheat protein and vitamins B and E aid to develop and rebuild muscle tissues. The wheat germs that are eliminated during the purification process are also high in important vitamin E, which could also lead to heart disease if not consumed. Constipation and other gastrointestinal disorders and nutritional diseases are common as a consequence of the lack of vitamins and minerals in refined wheat flour

Pathological Mechanism of Atherosclerosis

Atherosclerosis is a multifactorial, smoldering, focal (intima of bifurcated blood arteries), chronic, progressive asymptotically, immune-inflammatory, disorder driven by lipid imbalance, in the large to medium sized (upto3mm external diameter) arteries with many cardiovascular clinical manifestations. Atherosclerosis developmentinvolves many cells, organs and even disturbed blood flow. The progression of atherosclerotic disease depends on the presence, degree, and persistence of risk factors like high-fat diet, smoking, hypertension, history of heart diseases, or diabetes. Endothelial dysfunction, ROS, accumulation of LDL, recruitment of Monocytes and T cells, differentiation of monocytes into macrophages and foam cells, formation of plaque and rupturing of plaque are key steps behind the clinical manifestation of atherosclerosis in cardiovascular diseases. This article describes the pathogenesis of atherosclerosis, possibility of therapeutically targeting mechanism and interventions which can be helpful to reverse or slower the atherosclerosis.

Outcome of inadvertent high dose BCG administration in newborns at a tertiary care hospital, Karachi- Case series

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months and 11/26 (42.3%) were followed for atleast one year. 13/26 (50%) were male. All 26 patients were prescribed isoniazid and rifampicin for 3 months. 3/26 (11.5%) were lost to follow-up before completion of anti-tuberculous drugs (ATT). Lesions at the BCG site were observed in 16/26 (61.5%) infants, of which 15 (93.8%) had a papule, 3 (18.8%) developed a pustule, 3 (18.8%) had skin induration and 2 (12.5%) had skin erythema. Axillary lymphadenopathy was observed in 1/26 (3.8%) patient. Coagulation was deranged in 3/26 (11.5%) of babies. Intracranial bleeding was observed in 1/26 (3.8%) case. Localized skin lesions were the most common adverse events. None of them developed clinical tuberculosis. Chemoprophylaxis for inadvertent high dose BCG administration should be given for atleast 3 months. Furthermore, vigilant follow-up, transparency and disclosure are the vital steps in the management of any medical error

The relation of ABO blood group to the severity of coronavirus disease: A cross-sectional study from a tertiary care hospital in Karachi

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available. Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the blood group with the severity of coronavirus disease.Result: Among the study participants, blood group B has the highest distribution (39.8%), followed by O (30.0), A (21.9%), and AB (8.1%). About three-fourths (69.9%) had mild to moderate disease while 30.0% had severe disease. Age, gender, hypertension, diabetes mellitus, and hemoglobin level were all associated with disease severity among COVID-19 patients in univariate analysis on P-value for selection (Conclusion: Blood groups don’t have any role in forecasting the severity of coronavirus disease. However, the male gender and diabetics are prone to have severe disease

Comment : Utopianism and Communitarianism

千葉大学公共研究センター21世紀プログラム「持続可能な福祉社会に向けた公共研究拠点

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly