Importance of Simpson/Shinshu Grading in Meningioma’s Excision, Outcome and Recurrence

Objective:  The study was aimed to determine the recurrence rate and recurrence-free survival of meningioma surgery with reference to Simpson grading of excision. Material and Methods:  The study was conducted in the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. Total 325 patients both male and female of age (13 – 70 years) with supratentorial grade I meningioma operated. The craniotomy with maximum safe excision of the meningioma was done in all patients under general anesthesia. All patients followed-up to one year clinically and radiologically. MRI brain plain and IV contrast were done at 6 months and then annually. The extent of resection was determined with the help of operative notes and post-op MRI and recurrences were studied with help of follow-up MRI. Results:  There were 227 female and 98 male patients in ages 13 – 70 years. The mean age of patients was 53.5 years. 227 (70%) skull base meningioma, 71 (22.0%) convexity meningioma, and 26 (8%) falx or tentorium meningioma were operated. We achieved Simpson grade I excision in 55 (17.45%), grade II in 208 (64%), grade III in 23 (7%), and grade IV in 36 (11%) cases. The median recurrence free survival (RFS) with reference to Simpson grading of excision was 250, 120, 98, 80 months for grades I, II, III, and IV excision; it was statistically significant according to the grading of excision.  Conclusion:  Excision of meningioma up to grades I and II had an excellent outcome with minimum chances of complications

Endoscopic Discectomy versus Microscopic Discectomy

Objective:  A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease. Material and Methods:  A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI). Results:  There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group. Conclusion:  Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain

ESTABLISHING CORRELATION OF pH WITH VARIOUS PHYSIOCHEMICAL AND TRADITIONAL PARAMETERS OF ACID BASE BALANCE: A CROSS-SECTIONAL STUDY

OBJECTIVE: To evaluate the effectiveness of Physiochemical versus traditional approach in diagnosing acid-base disorders (ABD). METHODS: This cross-sectional observational study was conducted on 212 patients, admitted during January to June 2020, in intensive care unit of Rehman Medical Institute, Peshawar, Pakistan. Samples were obtained from these patients for pH, PCO2, HCO3, lactate, Na, K and Cl processed on Cobas ABG analyzer b 221. Ca, Mg, albumin and phosphate were analyzed on Cobas-601. Data was analyzed to assess the association among different parameters in traditional and Physiochemical approach. RESULTS: Males were predominant in total cohort group (n=125/212; 59%) as well as in metabolic subgroup (n=109/184; 59%). Mean age of males and females was 55.01±11.80 years and 54.99±14.76 years respectively. pH showed a strong negative correlation with PO4 (p-value=0.001) (rs 0.238) in the total cohort of subjects and no significant correlation (p=0.005) (rs -.206) in the metabolic subgroup in physiochemical approach. In traditional approach acid base parameters, Standard Base Excess (SBE) showed strong positive correlation (p=0.001) (rs 0.413 and rs 0.567) and pCO2 showed the strongest negative correlation (p value 0.001) (rs value -0.721 and rs -0.673) with pH in both total cohort and metabolic subgroup. HCO3 (p=0.003) (rs value 0.221) and AG (p=0.024) (rs value -0.167) both showed a significant strong positive and strong negative correlation with pH respectively. CONCLUSION: No significant association between physiochemical parameters and blood pH was found in adults. Traditional approach is the simplest, most rigorous, and useful for diagnosing ABD

A Computational Systems Analyses to Identify Biomarkers and Mechanistic Link in Psoriasis and Cutaneous Squamous Cell Carcinoma.

Psoriasis is the most common and chronic skin disease that affects individuals from every age group. The rate of psoriasis is increasing over the time in both developed and developing countries. Studies have revealed the possibility of association of psoriasis with skin cancers, particularly non-melanoma skin cancers (NMSC), which, include basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). There is a need to analyze the disease at molecular level to propose potential biomarkers and therapeutic targets in comparison to cSCC. Therefore, the second analyzed disease of this study is cSCC. It is the second most common prevalent skin cancer all over the world with the potential to metastasize and recur. There is an urge to validate the proposed biomarkers and discover new potential biomarkers as well. In order to achieve the goals and objectives of the study, microarray and RNA-sequencing data analyses were performed followed by network analysis. Afterwards, quantitative systems biology was implemented to analyze the results at a holistic level. The aim was to predict the molecular patterns that can lead psoriasis to cancer. The current study proposed potential biomarkers and therapeutic targets for psoriasis and cSCC. IL-17 signaling pathway is also identified as significant pathway in both diseases. Moreover, the current study proposed that autoimmune pathology, neutrophil recruitment, and immunity to extracellular pathogens are sensitive towards MAPKs (MAPK13 and MAPK14) and genes for AP-1 (FOSL1 and FOS). Therefore, these genes should be further studied in gene knock down based studies as they may play significant role in leading psoriasis towards cancer

COMPARISON OF TWO DIFFERENT MODALITIES OF BICARBONATE FOR DETERMINATION OF ANION GAP IN CRITICALLY ILL PATIENTS

OBJECTIVE: To compare anion gap estimated through measured and calculated bicarbonate modalities to be used interchangeably in critically ill metabolic acidosis patients. METHODS: This cross-sectional study was conducted at Rehman Medical Institute, Peshawar, Pakistan from September 2019 to March 2020.  Out of 390 critically ill patients, 200 cases of metabolic acidosis were selected by non-probability consecutive sampling technique. Measured and calculated bicarbonate values were obtained through Cobas-c 501© (Roche) using enzymatic method and Cobas-b 221© (Roche) blood gas analyzer respectively. Statistical analysis was done by using SPSS-23. RESULTS: Normal anion gap metabolic acidosis (NAG-MA) and high anion gap metabolic acidosis (HAG-MA) based on calculated bicarbonate levels was observed in 57 (28.5%) and 143 (71.5%) cases as compared to 55 (27.5%) and 145 (72.5%) cases based on measured bicarbonate levels respectively (p>0.45). A significant correlation (r=0.888 and 0.656, r2=0.788 and 0.431) (p<.001) was found between mean values of NAG-MA and HAG-MA respectively, when each was calculated through both modalities of bicarbonate. On applying Bland Altman plot, bias was 1.45±2.89 and -2.14±3.87mmol/L, Upper limit of agreement (LOA) was 7.13 and 5.46 for NAG-MA and HAG-MA, while lower LOA was -4.23 and -9.74 for NAG-MA and HAG-MA respectively. According to the model Bland Altman plot and Story & Postuie criteria, bias and the levels of agreement were not appropriate to conclude that both entities of anion gap could be used interchangeably.  CONCLUSION: Normal and high anion gap metabolic acidosis estimated by measured and calculated bicarbonate cannot be used interchangeably in critically ill patients

A Computational Systems Analyses to Identify Biomarkers and Mechanistic Link in Psoriasis and Cutaneous Squamous Cell Carcinoma

Psoriasis is the most common and chronic skin disease that affects individuals from every age group. The rate of psoriasis is increasing over the time in both developed and developing countries. Studies have revealed the possibility of association of psoriasis with skin cancers, particularly non-melanoma skin cancers (NMSC), which, include basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). There is a need to analyze the disease at molecular level to propose potential biomarkers and therapeutic targets in comparison to cSCC. Therefore, the second analyzed disease of this study is cSCC. It is the second most common prevalent skin cancer all over the world with the potential to metastasize and recur. There is an urge to validate the proposed biomarkers and discover new potential biomarkers as well. In order to achieve the goals and objectives of the study, microarray and RNA-sequencing data analyses were performed followed by network analysis. Afterwards, quantitative systems biology was implemented to analyze the results at a holistic level. The aim was to predict the molecular patterns that can lead psoriasis to cancer. The current study proposed potential biomarkers and therapeutic targets for psoriasis and cSCC. IL-17 signaling pathway is also identified as significant pathway in both diseases. Moreover, the current study proposed that autoimmune pathology, neutrophil recruitment, and immunity to extracellular pathogens are sensitive towards MAPKs (MAPK13 and MAPK14) and genes for AP-1 (FOSL1 and FOS). Therefore, these genes should be further studied in gene knock down based studies as they may play significant role in leading psoriasis towards cancer

Morphological Identification and Resistance Profile of Antibiotic and Heavy Metals-Resistant Bacteria in Hospital Sewage of Peshawar

Background: Increased resistance of microorganisms to commonly prescribed antibiotics has emerged as a significant hurdle in contemporary medical practice. The World Health Organization (WHO) has declared antibiotic resistance as a " major threat to public health.". In the present study, bacterial isolates were selected based on high antibiotic and heavy metal tolerance from a water sample taken from hospital sewage.Methods: Antibiotic-resistant bacteria were isolated through the disk diffusion method. Gram staining was done for morphological identification. For molecular identification, the 16s rDNA PCR amplification was done with universal primers. Results: The strain BC1 was found resistant to ampicillin (10μg/ml), and cefixime (5μg/ml). While, susceptible to kanamycin (30μg/ml), azithromycin (15μg/ml) and intermediate in response to amoxicillin (30μg/ml). The strain BC2 was resistant to ampicillin (10μg/ml), cefixime (5μg/ml) and kanamycin (30μg/ml). While, Susceptible to amoxicillin (30μg/ml), and intermediate in response to azithromycin (15μg/ml). The strains were also found resistant to heavy metals.Conclusion: The recent investigation on bacterial strains from hospital effluent found interesting candidates for understanding the AMR bacteria and developing novel active biomolecules to combat the antibiotics problem. The isolated strains could be a source of novel resistant genes however; a comprehensive molecular analysis is needed for advanced studies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The Gross Total Resection and Molecular Markers in Grade II Glioma

Objective:&nbsp;&nbsp;The study determined the importance of gross total resection in grade II Glioma and evaluated the importance of tumor markers as prognostic factors. Material and Methods:&nbsp;&nbsp;We included the 240 patients aged 13 – 65 years with supratentorialsuspected low-grade Glioma. Craniotomy was done in all my patients under general anesthesia and excised the tumor safely with the help of a microscope and CUSA without causing any focal deficit or hemodynamic instability. The 3D conformal radiotherapy and or Temozolomide chemotherapy was started as advised by the oncologist, postoperatively. The 5 and 10 years’ overall survival and progression-free survival were evaluated in my study. Results:&nbsp;&nbsp;Median age of the patients was 45 years. The 46.66% patients were IDH mutant Astrocytoma, 39.1 6% patients were IDH mutant Oligodendroglioma with loss of heterozygosity at I p/l9q levels, and 14.16% patients had IDH wild type Astrocytoma. The gross total resection was done in 113 patients, subtotal in 53 patients, partial resection in 45 patients, and biopsy in 29 patients. Postoperative radiotherapy was done in 170 patients and Temozolomide chemotherapy in 67 patients. The 5 and 10 years’ progression-free survival was 80% and 49% and overall survival was 86.3% and 67%. The 10 – year overall survival for Oligodendroglioma, the IDH mutant Astrocytoma, and IDH wild Astrocytoma were 93%, 61.6%, and 34.7% (respectively), and progression-free survival were 89.2%, 48%, and 34% (respectively).&nbsp; Conclusion:&nbsp;&nbsp;The gross total resection of IDH mutant Astrocytoma had a good outcome

ناول ”چلتا مسافر“ اور ”روشنی قید ہے“ کے مردانہ کرداروں کا تقابلی جائزہ

The story of fall of Dhaka has been told in the novels "Chalta Mosafir" and "Roshni Qaid Hai" written by Altaf Fatima and Umme Ammara. In these novels the heart wrenching stories of fall of Dhaka. These novesl are based on true stories and events of that time. Altaf Fatima is famous for writing without involving her personal emotions and feelings. She writes as a third person and brings out the true colour of that time. She has written on migrants feelings, emotions and sufferings. She has brought into lime light the pains and hardships of migrants through her writings. On the other hand Umme Ammara create a special set of feelings and thoughts in her novel. She focuses on character more and teaches the reader how to reacts in difficult circumstances.