Anti-Biofilm Forming Activity of Natural Products Extract Punica Granatum L. and Magnifera Indica L

OBJECTIVES o evaluate the biofilm activity of Escherichia coli and the anti-biofilm forming activity of Pomegranate peels Punica granatum L. and Mango leafs Mangifera Indica L. extracts against Escherichia coli and their combined synergistic effect using 96 well microtiter plate. METHODOLOGY The study design was a cross-sectional study. The sample size was 150. The samples were collected from patients at PNS Shifa Hospital Karachi. The age group of the individuals included was from 15 to 50 years. The specimens received in the lab were inoculated on CLED agar, Blood agar, and MacConkey’s agar culture plates. Escherichia coli was identified by colony morphology, gram staining, TSI, and further biochemical test analysis. After identification, the samples were processed for biofilm activity on 96 well microtiter plate method and using serial dilution method to assess the anti-biofilm activity of natural product extracts. Patient's age, gender, and hospital number of patients were recorded on specially designed proforma with ERC approval no 83/2021.  RESULTSAmong 150 patients, 64% were males, and 36% were females. Overall mean age was (33.79±9.94) and (34.02±10.59) years. 90% of samples showed biofilm formation. We found a significant relationship between culture and examination (p-value 0.000), while no significant association was found between gender (p-value 0.69), age (p-value 0.44) and biofilm formation (p-value 0.57). Anti-biofilm forming activity of pomegranate peel extract against Escherichia coli was (24.46±19.09) with mean and standard deviation. Anti-biofilm forming activity of Mango leaf extract against Escherichia coli was (14.90±9.56). Significant synergistic relation was observed in both extracts, Punica granatum L. and Mango leaf extract Mangifera Indica L. used in combination. CONCLUSION It was concluded that a novel combination of natural product extracts had shown higher effectiveness against the rapid emergence of biofilm-forming pathogens

fMRI of Working Memory Impairment after Recovery from Subarachnoid Hemorrhage

Recovery from aneurysmal subarachnoid hemorrhage (SAH) is often incomplete and accompanied by subtle but persistent cognitive deficits. Previous neuropsychological reports indicate these deficits include most prominently memory impairment, with working memory particularly affected. The neural basis of these memory deficits remains unknown and unexplored by functional magnetic resonance imaging (fMRI). In the present study, patients who experienced (SAH) underwent fMRI during the performance of a verbal working memory paradigm. Behavioral results indicated a subtle but statistically significant impairment relative to healthy subjects in working memory performance accuracy, which was accompanied by relatively increased blood-oxygen level dependent signal in widespread left and right hemisphere cortical areas during periods of encoding, maintenance, and retrieval. Activity increases remained after factoring out inter-individual differences in age and task performance, and included most notably left hemisphere regions associated with phonological loop processing, bilateral sensorimotor regions, and right hemisphere dorsolateral prefrontal cortex. We conclude that deficits in verbal working memory following recovery from (SAH) are accompanied by widespread differences in hemodynamic correlates of neural activity. These differences are discussed with respect to the immediate and delayed focal and global brain damage that can occur following (SAH), and the possibility that this damage induces subcortical disconnection and subsequent decreased efficiency in neural processing

Follicular thyroid carcinoma presenting as solitary skull metastasis: Report of two cases

We report two otherwise healthy patients with no prior history of thyroid cancer, who presented to us with a solitary scalp lump. Neuroimaging of both patients showed osteolytic lesions involving the cranium which were subjected to complete excision biopsy and cranioplasty. Histopathological examination revealed metastases from well differentiated follicular thyroid carcinoma (FTC). Subsequent workup confirmed occult primary carcinoma of the thyroid gland in both patients

Microdiscectomy for lumbosacral disc herniation and frequency of failed disc surgery

Background: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The Patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including Patient demographics. Failed disc surgery refers to failure of improvement in Patient\u27s symptoms following microdiscectomy, and has been observed to occur in up to 12% of Patients. To date, no study form Pakistan has looked into Patient demographics and failed disc surgery rates within the local context.Objective:The aim of this study was to review the demographics of the Patient population presenting for surgical treatment of lumbosacral disc herniations and to review our results of lumbosacral microdiscectomy at a university hospital in Pakistan.Methods: This is a retrospective analysis of all adult Patients admitted from January 2003 to January 2008 for symptomatic lumbosacral disc herniation requiring microdiscectomy, at the Aga Khan University Hospital, Karachi. Data were collected through our medical records, on a standardized form. Basic information about the Patient population, disease process, modes of nonsurgical treatment, and details on surgery and postoperative course were recorded and analyzed using SPSS.Results: Five hundred one Patients were studied, based on inclusion criteria. The mean age was 41.2 years, 347 (69%) Patients were male and 154 (31%) female. Mean body mass index of the population was 26 and was higher in females. All Patients primarily presented with radiculopathy, and the mean duration of these symptoms was 438 days. Mean duration of nonoperative management was 53 weeks. Fifty-one Patients (10.2%) had previously undergone spine surgery. A total of 442 (88%) Patients were operated at single disc level, and the rest at two levels. Sixty-six (13%) Patients were operated for upper lumbar disc herniations. Mean operative time was 94 minutes, and the most common complication was dural tear. Mean length of hospital stay was 5 days (2-12 days). Mean follow-up was 48.3 weeks (4 weeks to 14 years). Complete resolution of symptoms was seen in 360 (71.9%) Patients and failed disc surgery was diagnosed in 42 (8.4%) Patients. Twenty-six Patients (5.2%) were reoperated upon, with gradual improvement. The authors report an overall failed back surgery rate of 8.38%.Conclusions: Overall our results were comparable to published international literature. However, the authors observed significant differences in demographics, especially in terms of age, gender distribution, and mean BMI of Patient population as well as frequency of involvement of upper lumbar discs

Frequency and Risk Factors of Depression among Medical Students: A Cross-Sectional Study in Karachi

OBJECTIVES The study aimed to determine the frequency of depression among medical students and to identify the different risk factors associated with depression. METHODOLOGY A cross-sectional study was conducted among medical students at a private medical college in Karachi. The study was initiated after approval was taken from the ethical committee. Consent was taken before the data collection after explaining the details of the study. Students were selected for this study as per inclusion criteria. They were provided with the PHQ-9 questionnaire in which they were inquired about the factors for depression. The total students with depression positive were presented by their frequencies with a 95% confidence interval. RESULTSThree hundred seventy medical students participated, and 207 (56%) tested positive for depression. Notably, depression was more prevalent among final-year students, with 80% affected. Additionally, the severity of depression gradually increased with advancing medical years, reaching the highest level in the final year, where 61 students (80%) reported significant depression. The most frequent causes of depression were living away from home and facing the challenges of a demanding curriculum. CONCLUSION The study findings revealed a higher likelihood of depression among medical students, particularly in their final year. This vulnerability was exacerbated by the stress associated with extensive coursework and peer pressure to achieve excellent exam grades

Artifact quantification and tractography from 3T MRI after placement of aneurysm clips in subarachnoid hemorrhage patients

Abstract Background The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid hemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To characterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH patients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry, blood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to explore the ability to reconstruct white matter pathways in these patients. Methods T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with titanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on aligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/brain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed from DW-MRI at varying distances from the artifacts using deterministic methods. Results Artifact volume varied by MR sequence for length (p = 0.007) and volume (p Conclusions Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at different spatial ranges depending on sequence type. White matter pathways near clip artifacts can be reconstructed and visualized. These findings provide a reference for designing functional and structural neuroimaging studies of recovery in aSAH patients after clip placement.</p

Artifact quantification and tractography from 3T MRI after placement of aneurysm clips in subarachnoid hemorrhage patients

Background: The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid hemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To characterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH patients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry, blood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to explore the ability to reconstruct white matter pathways in these patients. Methods: T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with titanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on aligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/brain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed from DW-MRI at varying distances from the artifacts using deterministic methods. Results: Artifact volume varied by MR sequence for length (p = 0.007) and volume (p &lt; 0.001) ratios: it was smallest for structural images, larger for DW-MRI acquisitions, and largest on fMRI images. Inter-rater reliability was high (r = 0.9626, p &lt; 0.0001), and reconstruction of white matter connectivity characteristics increased with distance from the artifact border. In both patients, reconstructed white matter pathways of the uncinate fasciculus and inferior fronto-occipital fasciculus were clearly visible within 2 mm of the artifact border. Conclusions: Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at different spatial ranges depending on sequence type. White matter pathways near clip artifacts can be reconstructed and visualized. These findings provide a reference for designing functional and structural neuroimaging studies of recovery in aSAH patients after clip placement

Pituitary adenomas: Presentations and outcomes in a south Asian country

Objective: The purpose of this retrospective review of all operated cases of pituitary adenomas in the last decade, is to define the demographic patterns and characteristics of such tumors and to assess surgical outcomes with regards to safety and efficacy of trans-sphenoidal tumor removal in our institution.Methods: Surgically treated pituitary adenomas presenting from 1995 till 2005 were reviewed for different variables. Results were expressed as mean, standard deviation and median for continuous and number with percentage for categorical data. Chi square test was applied to measure differences and significance was taken at p value \u3c 0.05.Results: One hundred and twenty-five patients were operated for pituitary adenoma. Sixty-three percent were male and mean age was 37 years. Sixty percent of the patients presented with headache and/or visual symptoms. Twelve percent presented with pituitary apoplexy and 28% presented with symptoms due to pituitary hyperfunction. Fifty-five percent of patients had functioning and 44% had nonfunctioning adenomas. Mean pre operative tumor diameter from 86 pre op MRI scans was 26.76 mm (3-78 mm). Eighty-four percent of patients underwent trans-sphenoidal tumor resection and three percent had craniotomy. Mean size of post op residual tumor as calculated from 76 available post operative scans was 5.3 mm (range 0-31 mm). 17.6% of the patients required hormone replacement beyond three months and 10% were re-operated. Overall mortality was 1.6%.Conclusion: In Pakistan, patients are more likely to present either with apoplexy or with a giant pituitary adenoma than patients reported from developed countries. Overall, our results have been satisfactory and comparable with the literature