A Rare Case of Tuberous Sclerosis with Giant Cell Astrocytoma

Tuberous sclerosis complex (TSC) is a neurocutaneous disease inherited in an autosomal dominant pattern with variable penetration. This case report is of a 12-year-old boy who presented with complaints of headache, vomiting, and fits. His neurocutaneous stigmata combined with radiological imaging led us to the diagnosis of TSC with sub ependymal giant cell astrocytoma (SEGA). His family screening revealed interesting details of how the disease is running in his family. He is now scheduled for surgery at our neurosurgery department for the removal of SEGA.This case is significant because it is a typical depiction of the classic pattern of autosomal dominant inheritance of TSC with evident variable penetration within members of the same family

Frequency of Surgical Site Infection in Response to Single Dose Antibiotic Prophylaxis in Lumbar Intervertebral Disc Excision

Objective: To measure the frequency of infection with single dose antibiotic prophylaxis in surgery for intervertebral disc prolapse.Patients and Methods: This cross-sectional study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad for ten months. In total 400 patients both male and female, undergoing surgery for lumbar disc herniation (single level lumbar intervertebral disc), meeting inclusion criteria, were selected for the study. Postoperative frequency of surgical site infection was measured using redness, pain, raised local temperature and wound discharge as diagnostic criteria. Postoperative surgical site infection was measured using the above criteria scale on 3rd postoperative day and 15th postoperative day. The frequency of infection in the studied patients on day 3 and day 15 was calculated. P-value of <0.05 5 was considered as statistically significant.Results: Out of total 400 patients, 290 were males and 110 were females, the age distribution was from 24 to 70 years. Mean age was 48.2± 10.8 SD. ESR for the patients ranged from 2 to 36 with a mean of 11±4.6. White cell count of the patients ranged from 2900 to 20100 with a mean of 7342±2100. Only 7 patients (1.7%) developed infection on third day of surgery and it persisted in only 4 patients (1%) till day 15 of surgery.Conclusion: Single dose preoperative antibiotic is effective in postoperative wound infection prophylaxis. This protocol if followed can prevent drug resistance and multiple doses related side effects and can cut hospital cost

The Effect of Cognitive Rehabilitation on the Improvement of Language Skills in 9-12 Years Old Children with Attention Deficit/ Hyperactivity Disorder

Background: According to the research literature, there was a relationship between cognitive functions of attention and working memory and linguistic skills. The aim of this research was to investigate the effect of cognitive rehabilitation on the improvement of the linguistic skills in 9-12 years old children with attention-deficit/hyperactivity disorder. Methods: 40 students in grade 4, 5 and 6 of a primary school in Miyane city were assigned equally and randomly to two intervention and control groups. The research design was experimental with pre-test, post-test, follow-up, and control group. The language tests included; Thurston Verbal Fluency task, Token test of receptive language, Boston naming speed test, Assessment of Persian Reading Ability (APRA), verbal working memory subtest of Wechsler Intelligence Scale for Children, and Attention Register task. Parental version of the Swanson, Nolan, and Pelham (SNAP-IV) questionnaire was used to screen ADHD. The intervention method was based on Attentive Rehabilitation of Attention and Memory (ARAM) with emphasis on attention and working memory. Mixed ANOVA statistical test was used to analyze the data. Results: The results showed that the linguistic skills assessed in the research which include naming (F=29.42, P=0.01), verbal fluency (phonological fluency: F=15.68, P=0.01; semantic fluency: F=13.73, P=0.01), reading abilities (alphabet reading 1: F=17.84, P=0.01; alphabet reading 2: F=27.07, P=0.01; word reading: F=19.82, P=0.01; reading ability: F=19.97, P=0.01; voice change: F=13.47, P=0.01; reading comprehension: F=36.85, P=0.01), comprehension (F=6.75, P=0.01), verbal working memory (direct digits: F=7.7, P=0.01; inverse digits: F=14.26, P=0.01) and attention (attention registration 1: F=10.23, P=0.01; attention registration 2: F=4.33, P=0.04) were improved, following the intervention. Conclusion: Computerized Training of working memory and attention can enhance the language skills in children with ADHD. This result confirmed the role of attention and working memory on language skills

Role of Intermittent Self Catheterization after Cauda Equina Syndrome Surgery.

Background: To determine the effectiveness andsafety of intermittent self catheterization in caudaequina patients who have lost the bladder control.Methods : In this prospective study patients withsymptoms and signs of cauda equina syndrome, dueto lumbar disc herniation confirmed by relevantMRI ,were included. Emergency surgery wasperformed and post operatively these patients weretaught the technique of intermittent selfcatheterization. After full aseptic measures patientswere asked to sit on the chair and identify themeatus. Catheter was slowly inserted into thebladder,uptil the urine output was obtained.Pressure on the lower abdomen was applied to helpin emptying the bladder. Nelton catheter wasremoved and was kept in a bottle of clean water.After couple of attempts patients learnt to pass thecatheter. Patient was asked and helped to do thisactivity 3 to 4 times a day. The patient wasdischarged from the hospital only when he/she wasconfident enough to catheterize himself/herself.Initially patients were kept on biweekly follow upand later on monthly basis.Results : Majority (86%) continued to undergointermittent self catheterization, but 14% , elderlypatients, experienced insertion difficulty anddiscontinued intermittent self catheterization. Tenpatients (24%) had bacteriuria during the procedure.Epididymitis was seen in 2%. There were no urethralcomplications suggesting that the self-lubricatingNelton catheters are safe and less traumatic.Conclusion: Intermittent self catheterization is asafe, effective treatment and is associated withimproved quality of life in cauda equina syndromepatients

Screening for Y-chromosome microdeletions in a population of infertile males in the Gaza Strip

Infertility is an extraordinary public health problem in the Arab world, as it affects about 15% of couples seeking children. The male partner is responsible for infertility in approximately half of these cases. Classic microdeletions of the Y-chromosome involving the azoospermia factor (AZF) regions are known to be associated with spermatogenic impairment, and non-obstructive azoospermia must be differentiated on the basis of endocrine evaluation and testicular biopsy. Partial AZFc deletions remain controversial because there is no clear agreement regarding their role in spermatogenic failure. In the current study, 50 fertile males (controls) and 125 patients with primary idiopathic male infertility were studied in order to describe the frequency of Y-chromosome mirodeletions among male infertility patients in the Gaza Strip-Palestine area. No Y chromosome classical microdeletions could be detected in any of the 125 infertile men, suggesting that ethnic factors, genetic background, and Y chromosome haplogroups are key factors in such deletions. On the other hand, six gr/gr and one b1/b3 AZFc partial deletions were detected in the infertile population. The gr/gr deletion was also noted in relatives of four of the six patients with this deletion, and in one of the fertile controls. In conclusion, our study shows that the incidence of Y-chromosome microdeletions in our population is rare; these data suggest that other genetic, epigenetic, nutritional and/or local factors are responsible for impairments in semen parameters observed in this Gazan population. We further hypothesise that the gr/gr deletion is not associated with male infertility, at least in this sub-group

Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline

Background: N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis. Material and Methods: A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied. Results: The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant. Conclusion: Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly

Tris(1,10-phenanthroline-κ2 N,N′)nickel(II) dinitrate tetra­hydrate

In the title complex, [Ni(C12H8N2)3](NO3)2·4H2O, the NiII ion is octa­hedrally coordinated by three bidentate 1,10-phenanthroline ligands, each forming a five-membered chelate ring. In the crystal, O—H⋯O and C—H⋯O hydrogen bonds are present between the complex cations, nitrate anions and water mol­ecules. O—H⋯O hydrogen bonds between the uncoord­inated water mol­ecules lead to the formation of a four-membered ring water cluster, with a planar configuration. There were an additional five grossly disordered water mol­ecules in the asymmetric unit, which were removed by the subroutine SQUEEZE; these were were excluded in the calculation of the molecular weight, etc. π–π stacking inter­actions between the aromatic rings are also observed [centroid–centroid distances = 3.697 (2), 3.728 (2) and 3.761 (2) Å]

Expanding services to detect, manage, and prevent pre-eclampsia and eclampsia in Tando Allahyar District of Sindh Province, Pakistan

This endline report documents a USAID-supported implementation research project carried out by the Population Council in one district in Sindh province, as part of the global—Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan—Ending Eclampsia initiative. This project assessed community midwives’ (CMWs) abilities to screen and detect pre-eclampsia/severe pre-eclampsia/eclampsia (PE/SPE/E) in pregnant and postnatal women and provide a loading dose of magnesium sulfate (MgSO4) to clients suffering from SPE/E and referrals to facilities for further management. This study also explored opportunities to enhance collaboration between CMWs and lady health workers (LHWs), encouraging LHWs to refer pregnant women for group antenatal care (ANC) and postnatal care (PNC) sessions led by local CMWs, for improved ANC and PNC, as well as enhancing CMWs’ counseling skills and enabling their effective management of postnatal hypertension