Immunohistochemical Expression of Nkx3.1 in Prostatic Adenocarcinoma and Benign Prostatic Hyperplasia at a Tertiary Care Hospital in Karachi

OBJECTIVES To determine NKX3.1 expression in prostatic adenocarcinoma and benign prostate hyperplasia on Immunohistochemistry at a tertiary care hospital in Karachi. METHODOLOGY 74 prostatic specimens were recruited in this comparative cross-sectional study at the Department of Pathology, Pakistan Navy Station Shifa Hospital, Karachi, from January 2018 to February 2019. Of these, 37 specimens were of prostatic adenocarcinoma, and 37 were benign prostate hyperplasia. All specimens were subjected to immunohistochemical staining with NKX3.1. Statistical analysis was done by using SPSS version 23.0. The association of the extent of NKX3.1 staining between the adenocarcinoma and hyperplasia group was assessed using the Chi-square test x2. RESULTSOf the 37 cases of benign prostatic hyperplasia subjected to NKX3.1 staining, 32 showed positive staining with strong to moderate intensity. No staining was observed in 5 cases. 37 cases of adenocarcinoma prostate stained for NKX3.1 revealed positive staining in 30 cases with strong to moderate intensity. Negative staining was seen in 7 cases. The prostatic adenocarcinoma showed a statistically significant association of NKX3.1 positivity compared to benign prostatic hyperplasia cases. The p-value was found to be 0.03. CONCLUSION NKX3.1 staining was highly specific for prostate epithelium, as it was positive in most cases. This immune marker was useful for distinguishing prostatic origin in the context of metastatic lesions. Adding NKX3.1 protein staining to a panel of features may add value to the diagnosis if applied in the appropriate clinicopathologic context

Leukocytosis: Predictor of Radiological and Neurological Outcome of Patients of Traumatic Brain Injury Presented to Jinnah Hospital, Lahore

Background/Objective: Catecholamines and cortisol cause raised TLC (total leukocyte count) and brain inflammation after injury. We found out that weather leukocytosis is predictive for radiological and neurological outcome in patientswith TBI presenting to JHL.Materials and Methods: Blood samples of patients (n = 100) were collected on presentation in the emergency room, after 72 hours and on the 5th day for TLC count.CT Brain was obtained on presentation in emergency, after 72 hours and on the 5th day. The progression of imaging findings on CT scan were assessed and compared with TLC count. The outcome of these patients was assessed according to the Extended Glasgow Outcome Scale.Results: TLC after TBI is raised initially and then it declined afterwards in mild and moderate TBI, but remained on the upper limit in moderate TBI. In severe TBI, TLC was raised initially and then it progressed to higher limits afterwards.These results showed that there is a strong relation between TLC and TBI.Regarding the association between radiological assessment and severity of injury along with raised TLC, it was observed that the patients having EDH had raised TLC along with expansion of hematoma, while patients with contusions, T-SAH (traumatic sub-dural hematoma) SDH had TLC on upper limit, but there was no significant resolution of radiological severityConclusion: WBC count can be used as a predictor of radiological outcome, as it was found that patients with severe head injury had raised TLC. TLC count can be used to assess the severity of injury and prognosis

Postoperative Wound Pain and Hospital Stay in Patients of Open Lumbar Discectomy (OLD) Versus Endoscopic Lumbar Discectomy (ELD) in Lumbar Disc Herniation (LDH)

Background: Endoscopic lumbar discectomy is also beneficial regarding relieving wound pain, less hospital stay and smaller incisions. We compared visual analog scores (VAS) and hospital stay in patients treated with either endoscopic lumbar discectomy or open lumbar discectomy postoperatively.Material and Methods: Half patients underwent open lumbar discectomy – OLD (group A) and half operated with endoscopic lumbar discectomy – ELD (group B). The pain was quantified through visual analog score (VAS) observation in all patients. A preoperative medical management included prescribing a combination of an analgesic and a muscle relaxant along with physiotherapy with an avoidance of lifting heavy loads. Mann- Whitney (U) tests were applied for the comparison of postoperative VAS and hospital stay between groups.Results: 85% patients were having left sided prolapsed paracentral disc, and 15% were having right sided prolapsed paracentral disc. The mean postoperative VAS was 4 in patients treated with ELD and it was 1.32 in patients treated with OLD. The mean hospital stay was 1.5 days in ELD treatment, whereas, it was 2.5 days in OLD treatment. A significant difference (p=0.037) was found in the comparison of mean post-operative VAS between two vertebral levels (i.e., L4-L5 & L5-S1). The post-operative VAS and hospital stay (days) in ELD group were statistically significantly higher than the OLD group (p values 0.000).Conclusion: ELD procedure was effective as compared to open lumbar discectomy in terms of postoperative wound site pain and hospital stay. Endoscopic Lumbar discectomy is a minimally invasive procedure for discectomy

Bacterial Profile and Antimicrobial Susceptibility Pattern in Septicemia Suspected Children and Available Treatment Options

OBJECTIVES Septicaemia (blood poisoning) is one of the chief sources of global morbidity and mortality in pediatric patients and presents with multidrug and extensive drug resistance. This study aims to detect the major causative agents, antimicrobial susceptibility patterns and associated factors of bacteraemia among pediatric patients.METHODOLOGY This retrospective cross-sectional study was done at National Medical Center, Karachi microbiology laboratory. Clinical specimens consist of blood. Blood samples were processed in BACTEC's automated blood culture system, and positive samples were sub-cultured on blood, Mac-Conkey. Final identification was done by API 20E and API 20NE (Biomerieux) and confirmed by MicroScan (Beckman coulter)®. The antimicrobial susceptibility was performed by using Bauer– Kirby disk diffusion method.RESULTS A total of 395 pediatric patients were taken in the study. Out of these patients, 226 (57.2 %) were female. The children with age 1-4 years were highly affected. Almost 50% were handled in emergency and transferred for admission. 36.2% of patients were exposed to intravenous devices. 89 (22.5%) patients had a history of prolonged use of antibiotics. Most patients with pneumonia presented with septicemia as a complication, and were detected by Klebsiella pneumonia (35.4%), Acinetobacter bauminii (25.3%) and Pseudomonas aeruginosa (20.3%).  CONCLUSION The study revealed that gram-negative organisms are the predominant causative organisms of septicaemia. Antibiotic resistance to Carbapenem is gradually increased in the case of Acinetobacter bauminii and Escherichia coli. These issues can be overcome by early detection of microorganisms and establishing antibiotic stewardship

Catalytic degradation of carbamazepine by surface modified zerovalent copper via activation of peroxymonosulfate: Mechanism, degradation pathways and ecotoxicity.

ABSTRACTIn this research work, surface modified nano zerovalent copper (nZVC) was prepared using simple borohydride reduction method. The spectroscopic and crystallographic results revealed the successful synthesis of surface modified nano zerovalent copper (nZVC) using solvents i.e., ethanol (ETOH), ethylene glycol (EG) and tween80 (T80). The as-synthesized material was fully characterized for morphological surface and crystal structural properties. The results indicated that EG provides excellent synthesis environment to nZVC compared to ETOH and T80 in terms of good dispersion, high surface area and excellent catalytic properties. The catalytic efficiency of nZVC/EG was investigated alone as well as with the addition of peroxymonosulfate (PMS) in the absence of light. The degradation results demonstrated that the involvement of PMS synergistically boosted the catalytic efficiency of synthesized nZVC/EG material. Furthermore, the degradation products (DPs) of CBZ were determined by GC-MS and subsequently the degradation pathways were proposed. The ecotoxicity analysis of the DPs was also explored. The proposed (nZVC/EG/PMS) system is economical and efficient and thus could be applied for the degradation of CBZ from aquatic system after altering the degradation pathways in such a way that results in harmless products formation

Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.

Objective:  To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan. Material & Methods:  A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions. Results:  85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p<0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months. Conclusion:  Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability

Development of zerovalent iron and titania (Fe0/TiO2) composite for oxidative degradation of dichlorophene in aqueous solution: synergistic role of peroxymonosulfate (HSO5−)

Abstract Binary composite of zerovalent iron and titanium dioxide (Fe0/TiO2) was synthesized for the catalytic removal of dichlorophene (DCP) in the presence of peroxymonosulfate (PMS). The as-prepared composite (Fe0/TiO2) exhibits synergistic effect and enhanced properties like improved catalytic activity of catalyst and greater magnetic property for facile recycling of catalyst. The results showed that without addition of PMS at reaction time of 50 min, the percent degradation of DCP by TiO2, Fe0, and Fe0/TiO2 was just 5%, 11%, and 12%, respectively. However, with the addition of 0.8 mM PMS, at 10 min of reaction time, the catalytic degradation performance of Fe0, TiO2, and Fe0/TiO2 was significantly improved to 82%, 18%, and 88%, respectively. The as-prepared catalyst was fully characterized to evaluate its structure, chemical states, and morphology. Scanning electron microscopy results showed that in composite TiO2 causes dispersion of agglomerated iron particles which enhances porosity and surface area of the composites and X-ray diffraction (XRD), energy dispersive X-ray (EDX), and Fourier-transform infrared (FTIR) results revealed successful incorporation of Fe0, and oxides of Fe and TiO2 in the composite. The adsorption–desorption analysis verifies that the surface area of Fe0/TiO2 is significantly larger than bare Fe0 and TiO2. Moreover, the surface area, particle size, and crystal size of Fe0/TiO2 was surface area = 85 m2 g−1, particle size = 0.35 μm, and crystal size = 0.16 nm as compared to TiO2 alone (surface area = 22 m2 g−1, particle size = 4.25 μm, and crystal size = 25.4 nm) and Fe0 alone (surface area = 65 m2 g−1, particle size = 0.9 μm, and crystal size = 7.87 nm). The as-synthesized material showed excellent degradation performance in synthesized wastewater as well. The degradation products and their toxicities were evaluated and the resulted degradation mechanism was proposed accordingly. The toxicity values decreased in order of DP1 \u3e DP5 \u3e DP2 \u3e DP3 \u3e DP4 and the LC50 values toward fish for 96-h duration decreased from 0.531 to 67.2. This suggests that the proposed technology is an excellent option for the treatment of antibiotic containing wastewater.Graphical abstrac

Evaluation of Midline Shift and GCS as an Outcome in Severe Traumatic Brain Injury

Objectives: We determined the frequency of mortality in patients with traumatic brain injury and to compare frequency of midline shift and poor motor response in traumatic brain injury patients with and without mortality.Materials & Methods: Total 108 patients with severe TBI aged between 18 to 60 years were included. Admission GCS and motor response of post-nonsurgical resuscitation were recorded, along with midline shift on initial CT-scan. All patients were followed for the mortality up to 2 weeks. Chi square test applied for the frequency comparisons of ‘midline shift’ and ‘poor motor response’.Results: Mean age was 38.88 ± 8.94 years. Out of the 108 patients, 68 (62.96%) were males and 40 (37.04%) were females. Mean admission GCS was 3.39 ± 1.87. Mean motor response was 3.12 ± 1.68. Mean midline shift was 7.37 ± 2.09 mm. Mortality was found in 66 (61.11%) patients, whereas, there was no mortality in 42 (38.89%) patients. High mortality percentage (60%) was found in age group: 20-30 years. In male patients, high mortality percentage was found (63.24%) as compared to female patients. Comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’ in patients with mortality.Conclusion: The frequency of mortality in patients with severe TBI was found high. The ‘motor scores’ and ‘midline shifts’ can predict the outcome of severe TBI, because, comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’

Management and Outcome of Chronic Subdural Hematoma: A Prospective Study of Shaikh Zayed Hospital, Lahore

Background/Objective: Chronic subdural hematoma (CSH) is a type of intracranial hemorrhage is commonly seen in old age. It has a poor prognosis when misdiagnosed or a delayed treatment can lead to significant morbidity. We evaluated the effectiveness of available surgical treatments for the management and outcome of CSH.Method: The prospective cases (n = 48) of CSH were included from Department of Neurosurgery, Sheikh Zayed Hospital, Lahore during January 2014- December 2017. Detailed history of patients was taken along with comprehensive examinations with CT scans and MRIs. The CSH patients were treated surgically either with burr-hole evacuation (unilateral/bilateral) with irrigation or burr-hole drainage with drain 48 to 72 hours.Results: The mean age of male patients was 68 years and 56 years in female patients. Most of our patients recovered (81.25%; GOS 5) uneventfully. Patients were mostly treated with burr-hole evacuation with irrigation. The 15% patients had required ICU management with GOS 2-3. Older (> 65 years) male patients were at higher risk of CSH. Trauma was not the only major cause of the CSH as history of trauma was not present in the majority (< 25%) of the patients. We found following significant risk factors, i.e., hypertension (73%), DM (62.5%) and ischemic heart disease (60%) and intake of anticoagulant/antiplatelet drugs (60%). A 4% recurrence was reported in our CSH patients. Stroke as a postoperative complication was reported in two patients (4%) and only one patient (2%) died of aspiration pneumonia.Conclusion: Chronic subdural hematoma can be effectively treated by simple surgical intervention if diagnosed early and mortality can be reduced. We found burr-hole evacuation (unilateral/bilateral) with irrigation an effective treatment against CSH, as most of our patients (> 80%) were recovered with it. The trauma was not the only cause of CSH as history of trauma was not present in the majority of the patients, therefore, some other factors are also involved in the CSH formation in old age

The Woes of Economic Burden of Traumatic Brain Injury (TBI) Cases Borne by Public Sector Hospital of Pakistan

Objectives: To highlight the role of public sector hospitals in sharing the major burden of severely head injured patients in a resource constrained economically striving countryMaterials and Methods: The study was conducted in the Neurosurgery department of Jinnah Hospital, Lahore, Pakistan. 70 patients with moderate to severe TBI cases above one year of age were included. The data was analyzed for the cost estimation for the period of six months, for the following heads: 1) hospital cost per day, 2) ICU setup cost per day, and 3) salaries of hospital staff per day.Results: There were 53 cases of moderate injury and 17 cases of severe injury. Mean hospital stay was 14 days, minimum number of stay was 2 days and the maximum number of stay was 124 days in six months. Overall, in six months, per day cost of hospital bills head was Rs. 42,333/$263/€ 238. For the ICU setup head, the total cost was Rs. 17,9923/$1130/€ 1016 per day. The salary head’s total cost was Rs. 2573/16.06/€ 14.44. The grand total of all heads, (bills, ICU setup & salaries) was Rs. 22,482,29/1409/€ 1270.Conclusion: We evaluated the cost effectiveness of the Neurocritical care unit of a public sector hospital who provides the best possible health care facilities at a cheaper rate as compared to developed countries. We are highlighting the economic burden borne by the developing country’s government