RHEOLOGICAL BEHAVIOR OF DSPC-, DBPC-, AND DPPC-OXYGEN MICROBUBBLES AND THEIR EFFECTIVENESS IN IMPROVING SURVIVAL IN A RAT MODEL OF LIPOPOLYSACCHARIDE-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME

Acute respiratory distress syndrome (ARDS) causes 75,000 deaths in the U.S., annually. It is characterized by hypoxemia and damage to the lung alveoli. ARDS Management strategies involve extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, but none of these methods improve the mortality rates. Oxygen microbubbles (OMBs) consist of a lipid shell with an oxygen core and have potential to augment oxygenation to manage ARDS. Previous studies demonstrated significant improvements in systemic oxygenation and mortality upon administering OMBs. We replicated an ARDS rat model by intratracheal administration of lipopolysaccharide at a 24 mg/kg dose. After inducing the disease in rats, the distearoylphosphatidylcholine (DSPC), dibehenoylphosphatidylcholine (DBPC), or dipalmitoylphosphatidylcholine (DPPC) OMBs were administered intraperitoneally at a 100 mL/kg dose every 12 h, up to 36 h. Arterial blood gas analysis and pulse oximetry were then performed. Results showed 77.8%, 20%, and 10% survival in the DSPC, DBPC, and DPPC groups. Rats in the first group had significantly greater survival than others. Beyond 12 hours, the mean %SpO2 and PaO2 of rats was greater in the DSPC group. Additionally, the mean edema score, wet/dry ratio, and inflammation scores were lower in the DSPC group. The rheological behavior was characterized using a rotating rheometer. The oxygen microbubbles showed a shear-thinning behavior. The results also showed that the viscosity decreased with a decreasing volume fraction and increasing temperature. Lipids with longer chain lengths showed greater viscosities and greater storage and loss moduli. The viscoelastic behavior at lower angular frequencies was predominantly viscous. At greater frequencies, the behavior was predominantly elastic. These results explain the behavior of OMBs when acted upon by a stress. Non-Newtonian fluid models (Casson, Herschell-Bulkley, Power-law) were fit to the shear stress-shear strain data and the R2 and best-fit parameters were obtained to assess the fit. The viscoelastic behavior provides insight into the structure, molecular weight, and temperature-dependent properties of a material. Advisor: Benjamin S. Terr

Presentation and Surgical Outcome of Carpal Tunnel Syndrome

Objective:  The authors present their experience in evaluation of Clinical features and the surgical outcome of carpal tunnel syndrome. Material and Methods:  This descriptive study was conducted in Neurosurgery Department Hayatabad Medical Complex (HMC), Peshawar from 31march 2008 to 30 march 2010. Thirty one patients from both sexes were included. There was no gender discrimination in patient selection. However age limit was from twenty to sixty years. Cases with multiple nerve compression abnormalities, cervical radiculopathy, ulnar nerve compression, diabetic polyneuropathy or those who had Long-term exposure to vibrating tools were excluded. Diagnosis were made on positive clinical history, clinical examinations and Confirmed by nerve conduction studies. Open carpal tunnel release was done and then followed for 3 months for relief of symptoms and complications. Results:  Thirty one patients were included. The youngest patient was 22 years while the oldest one was 56 years with mean age 34 years ± 29.3. Female to male ratio was 6:1.Commonest presentation was pain and paresthesia in the affected hand. Open surgical release was performed for all patients. One patient (3%) developed super-ficial surgical site infection. The results of surgical treatment were excellent with 90% patients being completely relieved of symptoms after three months fallow up. Conclusion:  Carpal tunnel syndrome is common in female and manual workers. Pain is the predominant symptoms. Some patients may present with complications. Open carpal tunnel release is still preferable because of minimum complications and quick recovery. Key Words:  Presentation. Surgical outcome. Carpal tunnel syndrome. Abbreviations:  CTS: Carpal tunnel syndrome

Efficacy of Discectomy by Fenestration Technique in Lumbar Radicular Pain

Objectives:  To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc. Material and Methods:  This descriptive study was conducted in the department of Neurosurgery of Hayatabad Medical Complex, Peshawar, from October 2008 to September 2010. All those patients were included in whom straight leg raising (SLR) sign was less than 60 degree and prolapsed disc at L4 – 5 or L5 – S1 levels on MRI. Patients with multiple level discs, previous history of spine surgery, central disc, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in prone position under general anesthesia.  Results:  One hundred and nine patients were studied. 66 (55%) were male and 59 (45%) were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The commonest level of involvement was L 4 -L 5 in 67 (61%) followed by L5 – S1 in 42 (89%). Sixty five patients had left sided while forty four had right sided symptoms. Majority of patients presented in Dennis pain scale 4 i.e. 67% (n = 73).  Conclusion:  In selected patients with prolapsed intervertebral disc, surgical treatment provides quick pain relief. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater expertise, sophisticated instrumentation and techniques

Knowledge gain of the non-vascular surgeons after attending a course on traumatic vascular emergencies

Objective: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies.Methodology: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives.Results: Total of 21 participants attended the workshop with mean age of 29 ± 6.06 years. Majority of participants 15 (71%) were surgery residents from different subspecialties. Only 3 (14%) had prior exposure in Vascular Surgery. Mean pretest score was 11.9 ± 4.27 (59.52% ± 21.3) which improved to 16.14 ± 3.69 (81.6% ± 16.6). Gain in knowledge was measured using paired t-test and there was 21% of gain in knowledge of the participants compared between the pretest and posttest score. Overall participants found this workshop to be very useful in refining their skills and learning innovative techniques in managing vascular emergencies.Conclusions: Carefully designed workshop improves the knowledge of non-vascular surgeons in dealing with common vascular emergencies

Impact of Epidemiological Factors on Development of Puccinia Triticina Sp. Tritici on Wheat in Pakistan

The weather changes after the host-pathogen interaction play a vital role in the wheat leaf rust development. This study presents the impact of weather changes at wheat growing areas of Faisalabad, Bahawalpur and Sakrand  on development of wheat leaf rust  by taking into account the disease and weather data (from 4th February -5th March) of the respective years from 2003-2009. For the purpose multiple regression analysis of the temperature, relative humidity and wind velocity with the disease severity on six wheat cultivars namely Morroco, Inqilab-91, Sarsabz, Kirin-95, Soughat-90 and Tandojam-83 was conducted. It was found that temperature and relative humidity both played a significantly positive effect in disease development while wind velocity had negative impact on disease development. The most favorable conditions for leaf rust development on wheat in Pakistan were recorded at Bahawalpur, where the temperature (16.85-20.44°C), relative humidity (57.08-76.95%) and wind velocity (1.98-4.07 km/hr) acts collectively in onset of leaf rust. When these weather parameters were individually regressed no clear trends were noticed keeping in view their coefficient of determination (R2), regression coefficients/lines. This study depicts that all these factors interact with each other in a multi-colinear interaction, and had a collective effect on onset of leaf rust in the natural environment. Key words: Climate change, wheat, leaf rust, weather parameter

Surgical Management and Outcome of Depressed Skull Fracture

Objective: To know the surgical management and outcome of depressed skull fracture.Materials and Methods: This descriptive study was conducted in Head injury unit Hayatabad Medical Complex, Peshawar from October 2006 to October 2009. Detail history regarding the cause of depressed skull fracture, duration since injury, clinical condition, and CT Scan picture were documented in a Performa. Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. These patients were followed up for six months. History of fits, clinical examination of the wound, CSF leak and neurological assessment of patients were done on every visit. The data was analyzed in SPSS 16.Results: This study includes 48 consecutive, surgically treated, depressed skull fractures patients. Male-to-female ratio was 2.2 : 1. The age range of the patients was 1-63 years with a mean age of 14.1 years. The pediatric population constituted the largest group 26 (54.1%) with the 16-30 year-old age group the next largest 12 (25.0%). 10 (20.8%) patients were older than 30 years. Etiological factors include fall from height in 26 (54.16%) cases, road traffic accident in 15 (31.25%), recreational activities injury in 1 (2.08%), physical violence in 3 (6.25%) and miscellaneous in 3 (6.25%) cases. 35 (72.91%) patients presented with mild head injury, 7 (14.58%) had moderate head injury and 6 (12.5%) with severe head injury. Closed depressed skull fracture was noted in 11 (22.91%) cases, while compound depressed skull fracture was in 37 (71.09%) cases. The incidence of depressed skull fracture was 8 (16.67%) in frontal bone, 8 (16.67%) in fronto-parietal, 10 (20.8%) in temporal, 13 (27.08%) in parietal, 5 (10.41%) in occipital, 2 (4.17%) on superior saggital sinus, 1 (2.08%) on confluence of sinuses and 1 (2.08%) on transverse sinus. Associated intracranial lesions were Extradural hematoma 16 (33.3%) Contusions 15 (31.25%), Dural tear 23 (47.92%) and in driven bone fragment 7 (14.58%). Postoperatively, 35 (72.9%) patients showed excellent recovery, 6 (12.5%) were hamiparetic, 4 (8.33%) were having seizures and 2 (4.17%) remained in vegetative state, and 3 (6.25%) developed meningitis. 2 (4.17%) patients had surgical site wound infections. 1 patient developed pseudomeningocele. One patient had CSF leak.Conclusion: Depressed skull fractures are common in children. Anticonvulsants and antibiotics are effective in prevention of epilepsy and infection during perioperative period. Early surgical treatment is extremely desirable when fracture is more than 5 mm depressed and open depressed skull fractures. The outcome of depressed skull fracture depends on severity of injury and presence of other associated intracranial lesion

Acute Lymphocytic Leukemia in a child presenting as a solitary intracranial epidural mass

Acute Lymphocytic leukemia (ALL) is the most common childhood malignancy, CNS involvement occurs in 3-5% of the patients. We present a case of a 14-year-old boy who presented to us with nighttime fever, headache, and right-sided focal fits. Reports showed decreased platelets, increased WBC with predominant eosinophils and imaging showed a subgaleal, epidural and subdural collection. Bone marrow biopsy and CSF analysis were negative for any hematological malignancy. A biopsy and histopathology of the CNS lesion confirmed the diagnosis of Precursor B-cell Lymphocytic Leukemia. Although CSF analysis is useful for evaluating CNS involvement, ALL cannot be ruled out by negative CSF report

Acute Lymphocytic Leukemia in a child presenting as a solitary intracranial epidural mass

Acute Lymphocytic leukemia (ALL) is the most common childhood malignancy, CNS involvement occurs in 3-5% of the patients. We present a case of a 14-year-old boy who presented to us with nighttime fever, headache, and right-sided focal fits. Reports showed decreased platelets, increased WBC with predominant eosinophils and imaging showed a subgaleal, epidural and subdural collection. Bone marrow biopsy and CSF analysis were negative for any hematological malignancy. A biopsy and histopathology of the CNS lesion confirmed the diagnosis of Precursor B-cell Lymphocytic Leukemia. Although CSF analysis is useful for evaluating CNS involvement, ALL cannot be ruled out by negative CSF report