Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion

Objective:  To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine. Material & Methods:  This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used. Results:  Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients. Conclusion:  The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion

Outcome of Adolescent Bike Riders after Road Crash with and without Safety Measures in a Developing Country

Background: Road traffic crash is of growing public health importance worldwide contributing significantly to the global disease burden. There is paucity of published data on road traffic crashes in our local circumstances. This study was carried out to describe the outcome in patients of traumatic brain injury after road traffic crash in our local setting and provide baseline data for establishment of preventive strategies for the well being of adolescent bike riders.Methods: This was a prospective hospital based study of road traffic crash victims carried out at Department of Neurosurgery, Jinnah hospital Lahore from January 2015 to December 2015. After informed consent from patients or their attendants, all patients were consecutively enrolled into the study. A total of 1490 patients were enrolled in the study who presented in emergency after road crash and only the bike riders were observed for the outcome. Data was collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.Results: A total of 1490 road traffic crash victims were studied. All patients were male. The patients ages ranged from 12 to 57 years with the mean and median of 22.5 and 26 years respectively. The patients were divided into five groups as GROUP-A 10-20yrs age, GROUP -B 21-30yrs, GROUP -C 31-40 yrs, GROUP-D 41-50yrs and GROUP-E 51-60yrs. Regarding the vehicle only bike was included. Number of patients in group A was 340 (22.8%), group B 650 (43.6), group C 80 (5.3), group D 320 (21.4%) and group E 100 (6.7%). Regarding the mechanism 618 (41.4%) patients came after bike skidding, 636 (42.6%) patients came after bike with bike crash and 236 (15.8%) patients came after bike with other vehicle crash. Among total number of patients 216 (14.4%) were those having severe traumatic brain injury (STBI). Mortality rate among STBI was 106 (49.07%). The highest mortality was noticed in group C was 37.7% and in group A(adolescent patients) was 24.5% and this was significant (P < 0.001) whereas regarding the outcome according to Glasgow outcome scale, Grade 5 was observed in 63.6% and Grade 4 & 3 in 13.02% & 14.4% respectively and Grade 2 in 1.7% of the patients. The stratification of patients was also done regarding the severity of injury and their outcome according to GOS. It showed that in group A 22.03% patients with mild TBI had GOS 5 & 6.78% with moderate TBI had GOS 5. Regarding severe TBI of group A 15.38% patients had GOS 2 & 24.53% had GOS 1 which was highest in all groups, same stratification was done for other groups as well which showed that the outcome in group A is devastating and its results are comparable with the elder age groups.Conclusion: Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality especially for youth. Urgent preventive measures in the form of helmet wearing for bike riders and enforcement of traffic rules targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. There should be uniform implementation of traffic rules and regulation of motorcycle industry all over the country

The Outcome of Minimally Invasive Percutaneous Transpedicular Screw Fixation (TPSF) in Thoracolumbar Spine Fractures

Background & Objective:  This study aimed to determine the outcome of percutaneous transpedicular screw fixation (TPSF) in patients with thoracolumbar fractures. Material & Methods:  A total of 157 patients with thoracolumbar fractures were included from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays, CT, and MRI scans. Neurological status was documented preoperatively and postoperatively. All patients were treated with Minimally Invasive Percutaneous Transpedicular screw fixation. Data for operative time and per-operative blood loss was obtained through the operative notes. The severity of postoperative pain and length of hospital stay were also documented. Results:  Out of 157 patients, 69.4% were male and 30.6% were female. The 141 (89.8%) were traumatic from road traffic accidents/falls, and 16 (10.2%) were pathologic. The 128 (81%) patients were discharged on the first day, 23(15%) were discharged on the second day, and 6(3.8%) on the third day. 79% of patients had a single level of spine fracture whereas, 20% had 2 spinal fracture levels. The average operative time for MIS percutaneous TPSF was 55 minutes. Postoperative pain was markedly reduced as compared to traditional open surgery and no patient had any new neurological deficit. The mean blood loss was 25 ml and none of the patients needed a postoperative blood transfusion. Conclusion:  Percutaneous transpedicular instrumentation is an ideal surgical approach for thoracolumbar spinal stabilization. Keywords:  Thoracolumbar Fractures, Percutaneous Transpedicular Screw Fixation, Minimally Invasive Spine Surgery, Road Traffic Accidents (RTA)

Data on the role of accessible surface area on osmolytes-induced protein stabilization

AbstractThis paper describes data related to the research article “Testing the dependence of stabilizing effect of osmolytes on the fractional increase in the accessible surface area on thermal and chemical denaturations of proteins” [1]. Heat- and guanidinium chloride (GdmCl)-induced denaturation of three disulfide free proteins (bovine cytochrome c (b-cyt-c), myoglobin (Mb) and barstar) in the presence of different concentrations of methylamines (sarcosine, glycine-betaine (GB) and trimethylamine-N-oxide (TMAO)) was monitored by [ϴ]222, the mean residue ellipticity at 222nm at pH 7.0. Methylamines belong to a class of osmolytes known to protect proteins from deleterious effect of urea. This paper includes comprehensive thermodynamic data obtained from the heat- and GdmCl-induced denaturations of barstar, b-cyt-c and Mb

Comparison of Short Segment Percutaneous Transpedicular Fixation With and Without Inclusion of Fractured Vertebrae in Thoracolumbar Fractures

Objective:  To compare the outcome of SSPF (Short Segment Posterior Fixation) with and without the inclusion of fractured vertebrae in thoracolumbar fractures in terms of visual analog score and vertebral column stability. Materials and Methods:  The study enrolled 96 patients who were divided into two groups. Group A treated by SSPF (four screws: one level above and below the fracture), and Group B was treated by PSFFV (six screws: including fractured vertebrae). Assessment of parameters related to clinical and radiological aspects was recorded at 3 – 6 months. Results:  Mean ages of patients were 36.96 and 37.41 years with an M:F ratio of 1.8:1 and 1.4:1 in groups A (SSPF) and B (PSFFV), respectively. Mean VAS preoperatively, and postoperatively, at 3 and 6 months were 8.78 vs. 9.01, 4.98 vs. 5.01, 2.08 vs. 2.11, and 0.47 vs. 0.67 in groups A and B, respectively. Mean Kyphotic angle preoperatively, postoperatively, at 3 and 6 months were 21.76 vs. 22.91, 11.13 vs. 10.16, 13.59vs. 11.16 and 14.88 vs. 12.87 in groups A and B respectively. Mean AVH preoperatively, and postoperatively, at 3 and 6 months were 19.11 vs. 18.72, 20.01 vs. 22.71, 20.61 vs. 22.87, and 20.02 vs. 22.67 in groups A and B, respectively. Conclusion:  The results of this study favor PSFFV (Group B) over SSPF (Group A) in terms of vertebral column stability which was better achieved in PSFFV. PSFFV was also found superior with no implant failure which declares it safer and more effective than SSPF. None of the techniques was found superior in terms of pain. Radiologically, PSFFV, showed significant improvement in achieving anterior vertebral height, while there was no important distinction in kyphotic angle between the two

Comparison of Open Versus Percutaneous Transpedicular Screw Fixation in Thoracolumbar Fractures

meantime to return to work following percutaneous transpedicular fixation versus open pedicle screw fixation. We evaluated the average time required to return to work following percutaneous transpedicular fixation versus open pedicle screw fixation in traumatic lumbar spine injury. Material and Methods:  A randomized controlled trial included 60 patients. At study entry baseline demographics (age, gender, & duration of injury) were recorded. 30 patients were in the percutaneous transpedicular fixation group (A), while 30 patients were in the open pedicle screw fixation group (B). All the patients were followed every month time taken to return to work (TTRW) was noted on a proforma. Results:  Mean time taken by patients to return to work after surgery in Group A was 2.9 days, while in group B it was 5.1 days in group B. The difference between the two groups was significant (p-value 0.001). Within Group A, male and female genders showed a significant difference (p-value 0.032) in the TTRW after surgery. However, Group B did not show a similar difference between male and female patients. Duration of procedure had a significant effect on the TTRW (p-value 0.001). Conclusion:  We found ‘ time is taken to return to work’ was 2.93 ± 0.82 in group A and 5.10 ± 0.71 in group B (P-value 0.001). There was a significant difference in both groups. Percutaneous transpedicular fixation is a fast, safe and effective method as compared to other methods

Outcome of Partial Application of Non-operative Tools in Management of Severe Traumatic Brain Injury in a Developing Country

Objective: To see the outcome of partial application of non-operative tools like endotracheal intubation and early enteral nutrition on mortality in severe traumatic brain injury. Introduction: Severe Traumatic Brain Injury (TBI) is the leading cause of death in children and young adults1. Mainstay in management of severe head injury is based on the concept that little can be done about primary brain injury but a lot can be done to minimize secondary brain injury because its severity and duration influences the outcome. Several non operative tools can prevent this secondary brain injury and can improve outcome but from these tools only some can be applied in developing countries. These are Endotracheal Intubation, Ventilatory Support, Sedation & Paralysis, Analgesia, Normothermia, Normovolemia, Electrolyte Balance, Enteral Nutrition, Head Elevation and Mannitol

Outcome & Complications of Decompressive Craniectomy with Expansion Duroplasty in Severe Head Injury

Objective:  A descriptive case series was conducted to find the frequency of complications and complications of decompressive craniectomy with expansion duraplasty in severe head injury. Material and Methods:  189 patients fulfilling the selection criteria were included. All patients had TBI which was confirmed by CT scan. Surgery was performed on the day of admission under general anesthesia and a large trauma flap. Patients were monitored daily by evaluators from the date of surgery until hospital discharge or death. Patients were followed up for 3 months and the outcome was assessed using the Glasgow outcome scale (GOS). Results:  Mean age of the patients was 36.57 years. There were 61.4% (116) males and 38.6% (73) females. 3.7% had CSF leakage. 1.6% had meningitis. Wound infection was seen in 7.4% of patients. Forty percent had a favorable outcome and 60% had a poor outcome. Fifty patients out of 111 patients between 18 – 40 years showed good outcomes. Twenty-six out of 78 from the 41 – 60 years age group showed good outcomes. Out of 189 total, 76 patients had a good outcome. The outcome was good in 63 patients out of 148 patients with GCS 5 – 8, whereas 13 (out of 41) patients had a good outcome with GCS below 5. Conclusion:  We discovered that the result was good in 40% of patients, with 11 percent of complications recorded. Therefore, we concluded that decompressive craniectomy with expansion duraplasty is an effective procedure for the treatment of the severe head injury

Results of Resection of Giant Pituitary Adenomas through Endoscopic Endonasal Approach

Background/Objective:  A minimally invasive surgical method is in use to create endoscopic transsphenoidal surgery. Because of the intricate dissection of the sellar region, surgical treatment of large pituitary adenomas is challenging. The study focused to determine the frequency of complications after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas. Materials and Methods:  A descriptive case series study was conducted at the Neurosurgical Department of Lahore General Hospital, Lahore. A total of 70 patients fulfilling the selection criteria were enrolled. Major vascular injury was noted when there is an injury to the internal carotid artery or cavernous sinus. After discharge, patients were followed-up in OPD for 3 months. After 3 months, patients were evaluated for CSF leak and vision. The presence of complications was recorded. During surgery, operative time was noted. Results:  Mean age of patients was 55.7 ± 6.5 years. 45.71% of patients were male while the remaining 54.29% of patients were female Total of 41.43% of patients had disease < 2 years, whereas the duration of surgery was ? 3 hours in 64.3% of patients. A total 15.71% had complications which included diabetes insipidus (8.57%), infections (5.71%), pituitary dysfunction (4.29%), CSF leak (2.8%) and vascular injury (1.43%). The mortality rate was 1.43%. Conclusion:  The complication rate after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas was high. Keywords:  Endonasal Endoscopic, Transsphenoidal Resection, Pituitary Macroadenomas, Complication

Antibacterial and antibiofilm activity of Abroma augusta stabilized silver (Ag) nanoparticles against drug-resistant clinical pathogens

Infectious diseases remain among the most pressing concerns for human health. This issue has grown even more complex with the emergence of multidrug-resistant (MDR) bacteria. To address bacterial infections, nanoparticles have emerged as a promising avenue, offering the potential to target bacteria at multiple levels and effectively eliminate them. In this study, silver nanoparticles (AA-AgNPs) were synthesized using the leaf extract of a medicinal plant, Abroma augusta. The synthesis method is straightforward, safe, cost-effective, and environment friendly, utilizing the leaf extract of this Ayurvedic herb. The UV-vis absorbance peak at 424 nm indicated the formation of AA-AgNPs, with the involvement of numerous functional groups in the synthesis and stabilization of the particles. AA-AgNPs exhibited robust antibacterial and antibiofilm activities against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). The MIC values of AA-AgNPs ranged from 8 to 32 μg/mL. Electron microscopic examination of the interaction of AA-AgNPs with the test bacterial pathogens showed a deleterious impact on bacterial morphology, resulting from membrane rupture and leakage of intracellular components. AA-AgNPs also demonstrated a dose-dependent effect in curtailing biofilm formation below inhibitory doses. Overall, this study highlights the potential of AA-AgNPs in the successful inhibition of both the growth and biofilms of MRSA and VRE bacteria. Following studies on toxicity and dose optimization, such AgNPs could be developed into effective medical remedies against infections