Diagnostic Accuracy of Ultrasound in Detection of Synovial Hypertrophy in Patients with Osteoarthritis

Objective: To determine the diagnostic accuracy of  ultrasound in the detection of  synovial hypertrophy in patients with osteoarthritis by using MRI as the gold standard. Methods: In this descriptive study, 150 patients  with complaint of joint pain and stiffness, were included. Ultrasound was carried out. Subsequently, MRI scan of affected joint was performed. Results: By taking the synovial thickness of more than 2.3mm as discriminatory level for synovial proliferation, the overall sensitivity of ultrasound was 94.23%,  and specificity was 87.23%. The positive predictive values of the ultrasound in patients with synovial hypertrophy  was 95.14%  and negative predictive value was calculated to be 92.67%. The diagnostic accuracy of the test was 89.12%. Conclusion: Duplex Doppler ultrasound can detect synovial hypertrophy  with sensitivity of approximately 94.23

Successful management of invasive aspergillosis with voriconazole and amphoteracin B therapy in a patient with acute mycloid leukemia (AML-M2)

An eleven-year-old boy presented with one month\u27s history of fever and weight loss. He was diagnosed with Acute Mycloid Leukemia (AML-M2). During treatment he developed recurrent infections with neutropenia requiring prolonged antibiotics and subsequently developed invasive aspergillosis. He was treated with amphotericin B and Voriconazole. This case shows the efficacy and safety of combined antifungal therapy, including voriconazole, for invasive aspergillosis complicating AML

Diagnostic Accuracy of Endovaginal Scan in Detection of Retained Products of Conception after Incomplete Abortion

Background : To determine diagnostic accuracy of Endo-vaginal Scan (EVS) in detection of retained products of conception (RPOC) in patients with incomplete abortion. Methods: In this prospective study 200 pregnant females, with gestational age <20 weeks and with persistent vaginal bleeding, diagnosed clinically with retained products of conception, were included. Endo-vaginal ultrasound scan pelvis was done in real time in axial and saggital planes. Imaging of the examination was directed towards evaluation of the uterus and any intrauterine contents. Endometrial thickness of >12mm on EVS was considered positive for diagnosis of RPOC which was later on confirmed with histopathology(HP) . Comparisons was then made between EVS and HP findings. Results: Mean age of selected patients was 30.8 years age ± 3.9 and mean gestational age 17.2 weeks ± 1.8 SD . Patients positive on EVS were 63.0% and patients positive on HP were 72.5%. Sensitivity, specificity, PPV, NPV and accuracy were found to be 71.7%, 60.0%, 82.5%, 44.6% and 68.5% respectively. Conclusion: Endovaginal ultrasonography allows detection of RPOC with reasonable accuracy

Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons

Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

Delay in Diagnosis of Brain Tumors: A Dilemma For Neurosurgical Community Due To Spirituality and Quackery In A Developing Country

Objectives:  Primary and metastatic brain tumors are a significant cause of mortality and morbidity. The complex pathway to a cancer diagnosis is not human error and the achievements of better outcomes solely depend on the early diagnosis and management of symptomatic tumors. The estimated time between the first presentation to any health care professional and diagnosis is approximately 3 times longer in the UK as compared to other developed countries. Material and Methods:  It was a descriptive study and included 52 patients who were admitted to the Neurosurgery department at Jinnah hospital Lahore. The required data were collected either directly from the patients or from the hospital record of discharged patients. Our study compares the time interval difference of presentation of a patient to a local care provider (Quacks, Hakeem, and spiritual healers) and Neurosurgeon as well as delay in surgical intervention even after diagnosis and radiological investigations. Results:  54% of patients presented with supratentorial lesions and out of these, parietal lobe lesions were more common (39%) while 29% of lesions were infratentorial. Around 50% of patients presented to a Local Care Provider within 20 days. However, only 42% of patients presented to a neurosurgeon after 6-9 months of the onset of symptoms. Conclusion:  Public awareness is the key to timely diagnosis, proper management, and better outcomes. The availability of specialists in peripheral hospitals can bring a change in this regard

Common Methods to Understand and Develop Indigenous Probiotics Yeast for Ruminant

Probiotic yeast enhanced the ruminal gut microbial balance by producing intercellular effectors and important metabolites. The impact of yeast addition on animal health is influenced by different interlinked factors including animal genomics, its gut microbiota, and environment. Therefore, all factors should be considered regarding achieving the maximum outputs from animal probiotic yeast. In the situation of a high feeding cost, microbial feed supplements provide a suitable nutritional approach, which allows increased nutrient digestion rate and accordingly improves animal performance. Many yeast products are commercially available, but their efficiency as probiotic dietary addition in a particular breed is mostly questionable. Therefore, identification of ideal probiotic yeast strain is of great interest in this context. Innovative methods in relation to develop new probiotic are mainly focused on the exploring novel microbial strains from indigenous sources. It has been noted that for the identification of best probiotic strain for the host, a linkage between culture-independent and culture-dependent methods is a functional step. In this chapter, we will discuss the mode of action of probiotic yeast on animal lower gut microbiota and identification of ideal probiotic yeast by using advanced molecular methods