Histopathological Outcome of Testicular Lesions at PIMS

Objective: This study was undertaken to determine the incidence, Age wise distribution and Histopathological outcome of the testicular lesion at Pakistan Institute of Medical Sciences Islamabad.Methodology: A retrospective study of 69 patients in which orchiectomies was done for testicular lesion from January 2013 to March 2016 at Department of Urology Pakistan Institute of Medical Sciences, Islamabad. The epidemiological data were retrieved from case files and histopathological reports. Data was analyzed in respect of side involvement, age and histological type of tumors.Results: A total of 69 patients included in the study, of which 49(71.01%) were Non-neoplastic and 20(28.98%) were neoplastic lesions. Among Non- neoplastic lesions 24(48.98%) were undescended testis, 24(48.98%) were torsion and 1(2.04%) were an abscess. A maximum number of cases were diagnosed in the second decade of life (30.62%), left side involvement (59.18%) was common then right side involvement (40.82%).Among neoplastic lesions 40% were Yolk sac tumors,30% were Mixed germ cell tumors,20% were seminoma, 5% were teratoma and 5 % were B-cell lymphoma. Most of the cases were diagnosed in the third decade of life (45%), Right side involvement (70%) was more common than left side involvement (30%).Conclusion: Testicular tumors is still common in our population, but in our study, there is no evidence of malignancy in the undescended testis

Neurological Improvement after Decompression for Dorsal Spine Tuberculosis (TB)

Objectives:  To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading. Materials and Method:  Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented. Results:  Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery. Conclusion:  Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization. Keywords:   Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization

Clinical outcome and complication of anterior cranial Fossa meningiomas in tertiary care Hospital Peshawar

Objectives:  We examined the surgical outcome and complications of anterior cranial Fossa meningiomas. Materials and Methods:  A prospective study was conducted at the Department of Neurosurgery Prime Teaching Hospital, Peshawar, KPK, Pakistan from June 2019 to June 2021. A total of 31 patients were selected through non-probability consecutive sampling. After clinical examination and radiological findings, the patients were diagnosed with anterior cranial Fossa meningiomas. Microsurgical Trans cranial approaches did. Clinical outcomes and complications were documented. Tumor anterior cranial fossa meningiomas. A low Karnofsky performance scale index was used to analyze the functional impairment of the patients. Results:  9 (29.03%) were male and 22 (70.96%) patients were female. The mean age of presentation was 42 ± 5 years. Headache 25 (80.6%) and Visual loss were the main presenting symptoms 24 (77.5%), and Tuberculum sellae meningioma patients 08 (25.08%). The most common approach was Bifrontal craniotomy for OGM in 9 patients and two small OGM were operated on utilizing frontolateral craniotomy. The rest of the cases were operated through Pterional craniotomy. Tuberculamsalle meningiomas surgery results in a visual improvement in 6 patients (75%), Complete tumor resection was achieved in 22 (70.9%) patients and subtotal resection is achieved in 6 (19.3%) patients. In a few patients 03 (9.67%) only safe debulking and biopsy were taken. Postoperative hemorrhage was in 4 (12.9%) patients. Conclusion:  Transcranial approach for microsurgical resection of anterior cranial fossa meningiomas is an effective and feasible approach in terms of visual outcome and extent of resection. Keywords:  Anterior cranial Fossa Meningioma, Bifrontal Craniotomy, Front-lateral craniotomy

Outcome of Endoscopic Third Ventriculostomy: An Experience of 80 Treated Patients

Objective: To examine the outcome of Endoscopic Third Ventriculostomy in 80 consecutive patients operated in Irfan General Hospital and Prime Teaching Hospital Peshawar.Materials and Methods: Prospective observational study was conducted in the neurosurgery department of Prime Teaching Hospital and Irfan General Hospital Peshawar. 80 patients (48 male and 32 female) were followed for 3 months. The inclusion criteria all patients with Third ventricular hydrocephalus were included in this study and the exclusion criteria unwilling patients and those who opted for VP shunting rather than ETV. Data was analyzed using SPSS version 22.Results: ETV was performed in 80 patients. With highest success rate inAqueductal stenosis and posterior fossa tumors 88% and 87% respectively. ETV had a lowest success score of 50% in patients with Hydrocephalus TBM. Common post-operative complications were seizures and CSF leakage.Conclusion: ETV is less invasive and effective treatment for non-communicating hydrocephalus.ETV is most effective in treating aqueductal stenosis and posterior fossa tumors. The overall success rate of ETV is 74%. Based on these findings, it is recommended that ETV should be attempted as first line treatment for patients with triventricular hydrocephalus due to various pathologies

Outcome of Anterior Cervical Discectomy with PEEK Cage Fixation for Single Level Cervical Disc Disease

Objective:  To assess the outcome of anterior cervical discectomy and fusion (ACDF) with PEEK cage. Material and Methods:  This prospective study was conducted in the Departments of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar. Patients undergoing one level ACDF with PEEK cage fixation were enrolled in the study. Patients who needed multiple level ACDF or corpectomy with plating and redo cases were excluded from the study. A proforma, which included age, gender, address, level of prolapsed disc, sign and symptoms, pain score, MRI findings were filled. All patients were assessed on day of discharge and on follow-up visit after one month. Data was analyzed with SPSS version 22. Results:  Total 95 patients were included out of which 58 (61%) were male and 37 (39%) were female. Range of patients` Age was from 27 years to 64 years with 50.4 years mean age. Most patients (65%) had C6 radiculopathy. 58 patients (61%) had right sided radicular pain. 5 patients (5.26%) had radiculomyelopathy. C5 – C6 was the most common level operated (68 patients). Excellent results were achieved in 75 patients (79%) while satisfactory results in the rest of patients using Odom’s criteria. Bony fusion occurred in 92% of patients at 6 months. Conclusion:  ACDF with PEEK cage fixation is a safe and beneficial procedure in one level cervical prolapse disc diseas

Giant Tuberculoma Resembling Brain Tumor in a Child

13 years old child from tribal area of Khyber Pakhtunkhwa presented to us with chief complaints of headache and vomiting for last 3 months with recent onset of aggressive behavior. Patient had normal neu-rological examination except that he had frontal lobe release signs and bilateral papilledema. MRI scan of brain showed a large ring enhancing lesion measuring 5x6x5 cm in the frontal lobe with surrounding edema (Figures 1 – 3). Because of Short history and relevant MRI picture diagnosis of high grade glioma was made. Though there was history of tuberculosis in the family but because of large size of the lesion with short his-tory with no fever or cough the differential of tubercu-loma was not considered before surgery. Routine in-vestigations were unremarkable. Patient was prepared and put on elective list for craniotomy and excision of the lesion. During surgery patient brain was edematous so patient was hyperventilated and mannitol was given before opening the dura. Per operatively the lesion was fibrous, firm and not easily removable as is the case with high grade glioma and gross total resection was not possible because of brain edema and respiratory distress. Biopsy was taken and subtotal resection was performed. Patient was put on ATT and metastastic work up also advised started. Histopathology report showed a caseating granulomatous lesion (Figure 4)

Securing Cognitive Radio Networks using blockchains

Due to the increase in industrial applications of Internet of Things (IoT), number of internet connected devices have been increased accordingly. This has resulted in big challenges in terms of accessibility, scalability, connectivity and adaptability. IoT is capable of creating connections between devices on wireless medium but the utilization of scarce spectrum in efficient manner for the establishment of these connections is the biggest concern. To accommodate spectrum allocation problem different radio technologies are being utilized. One of the most efficient technique being used is cognitive radio, which dynamically allocate the unlicensed spectrum for IoT applications. Spectrum sensing being the fundamental component of Cognitive Radio Network (CRN) is threatened by security attacks. Process of spectrum sensing is disturbed by the malicious user (MU) which attacks the primary signal detection and affects the accuracy of sensing outcome. The presence of such MU in system, sending false sensing data can degrade the performance of cognitive radios. Therefore, in this article a blockchain based method is proposed for the MU detection in network. By using this method an MU can easily be discriminated from a reliable user through cryptographic keys. The efficiency of the proposed mechanism is analyzed through proper simulations using MATLAB. Consequently, this mechanism can be deployed for the validation of participating users in the process of spectrum sensing in CRN for IoTs.publishe

Extrusion of the Peritoneal Catheter of Ventriculoperitoneal Shunt Through the Rectum

A ventriculoperitoneal shunt is a common procedure for hydrocephalus. It is a life-saving procedure but is not risk-free. Some of the most common complications are shunt blockage and infection but they can also present with uncommon presentations. We report A child who presented with extrusion of a shunt catheter through the rectum. It was treated as an infected shunt. Externalization of the shunt was done through the abdominal site and the exposed shunt was removed through the rectum by gentle traction. Once CSF was clear a new shunt was placed on the opposite side. Keywords:  VP shunt, shunt infection, anal extrusion. Key Message:  Exposure to a shunt catheter through the rectum is an uncommon presentation. It should be treated as an infected shunt. Most of these cases do not cause peritonitis or meningitis. The exposed shunt catheter should be removed through the rectum by gentle traction. Abbreviations:  VP-Ventriculoperitoneal, CSF: Cerebrospinal fluid. ETV -Endoscopic Third Ventriculostomy

Internet of Things-Based Fire Alarm Navigation System: A Fire-Rescue Department Perspective

In the past few years, fire alarm systems have become increasingly sophisticated and more capable and reliable. The two main objectives are the protection of life and property. As a result of state and local codes, fire protection has become more concerned with life safety over the past two decades. Several safety measures have been implemented to address the problems caused by the fires and reduce the number of fatalities and property damage. Our project is to develop and review a fire alarm navigation system and application that uses the internet of things. Fire alarm systems are designed to warn people about fires in advance so that they can evacuate the fire-affected area and take immediate action to control the fire. There will be a GPS module, a flame sensor, a smoke sensor, buzzers, LEDs, and a GSM module to ensure early notification to authorities and fire stations. The aim is to reduce the loss of lives and property. A questionnaire was designed to conduct a brief survey in a multinational sports production company in Sialkot, Pakistan, regarding the IoT fire alarm navigation system. Besides installing the system in the factory, we compare the results with fire incident response time with and without this system at rescue 1122 fire head station.publishedVersio

Oral Co-Supplementation of Curcumin, Quercetin, and Vitamin D3 as an Adjuvant Therapy for Mild to Moderate Symptoms of COVID-19-Results From a Pilot Open-Label, Randomized Controlled Trial

Background: Curcumin, quercetin, and vitamin D3 (cholecalciferol) are common natural ingredients of human nutrition and reportedly exhibit promising anti-inflammatory, immunomodulatory, broad-spectrum antiviral, and antioxidant activities. Objective: The present study aimed to investigate the possible therapeutic benefits of a single oral formulation containing supplements curcumin, quercetin, and cholecalciferol (combinedly referred to here as CQC) as an adjuvant therapy for early-stage of symptomatic coronavirus disease 2019 (COVID-19) in a pilot open-label, randomized controlled trial conducted at Mayo Hospital, King Edward Medical University, Lahore, Pakistan. Methods: Reverse transcriptase polymerase chain reaction (RT-PCR) confirmed, mild to moderate symptomatic COVID-19 outpatients were randomized to receive either the standard of care (SOC) (n = 25) (control arm) or a daily oral co-supplementation of 168 mg curcumin, 260 mg quercetin, and 9 µg (360 IU) of cholecalciferol, as two oral soft capsules b.i.d. as an add-on to the SOC (n = 25) (CQC arm) for 14 days. The SOC includes paracetamol with or without antibiotic (azithromycin). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test, acute symptoms, and biochemistry including C-reactive protein (CRP), D-dimer, lactate dehydrogenase, ferritin, and complete blood count were evaluated at baseline and follow-up day seven. Results: Patients who received the CQC adjuvant therapy showed expedited negativization of the SARS-CoV-2 RT-PCR test, i.e., 15 (60.0%) vs. five (20.0%) of the control arm, p = 0.009. COVID-19- associated acute symptoms were rapidly resolved in the CQC arm, i.e., 15 (60.0%) vs. 10 (40.0%) of the control arm, p = 0.154. Patients in the CQC arm experienced a greater fall in serum CRP levels, i.e., from (median (IQR) 34.0 (21.0, 45.0) to 11.0 (5.0, 16.0) mg/dl as compared to the control arm, i.e., from 36.0 (28.0, 47.0) to 22.0 (15.0, 25.0) mg/dl, p = 0.006. The adjuvant therapy of co-supplementation of CQC was safe and well-tolerated by all 25 patients and no treatment-emergent effects, complications, side effects, or serious adverse events were reported. Conclusion: The co-supplementation of CQC may possibly have a therapeutic role in the early stage of COVID-19 infection including speedy negativization of the SARS-CoV-2 RT-PCR test, resolution of acute symptoms, and modulation of the hyperinflammatory response. In combination with routine care, the adjuvant co-supplementation of CQC may possibly help in the speedy recovery from early-stage mild to moderate symptoms of COVID-19. Further research is warranted. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT0513067