Comparison of the Efficacy of Multi Dural Stab Craniectomy with Open Dural Flap Craniectomy in Patients Having Acute Subdural Hematoma

Background/Objective:  We compared the efficacy of multi-dural stab craniectomy with open dural flap craniectomy in patients having acute subdural hematoma. Materials and Methods:  A randomized controlled trial was conducted in the Department of Neurosurgery, Allied hospital, Faisalabad. 70 patients having acute subdural hematoma were included. All of the patients were randomized in two groups: group A received a multi-dural stab craniectomy, while group B received an open dural flap craniectomy. Efficacy was assessed after 3 months of treatment in terms of a good recovery. Results:  Out of 70 patients, the mean age was 34.51 ± 8.712 years. Because of similar age and presenting GCS, the data show a non-significant difference in clinical outcomes between patients undergoing multi dual stab and open dural flap operations. However, a significant difference between the clinical results occurred at 3 months after the surgery (p-value 0.004). The efficacy of the multi-dural stab procedure was significantly higher from the open dural flap surgery (p-Value 0.006). The efficacy of the multi-dural stab surgery was significantly higher in the under 35 years age group of patients compared to open dural flap surgery. The results highlight those better results were seen in both surgeries when the presenting GCS of patients was higher (GCS= 6 – 8) compared to poor outcomes in patients with GCS of less than 5/15. Conclusion:  Multi-dural stabs are a safer alternative to the open dural flap for removing acute SDH with satisfactory recovery

Frequency of SCF Leakage in Post-operative Patients of Tethered Spinal Cord in A Tertiary Care Hospital

Objective:  The study aimed to report the incidence of CSF leakage in patients with a tethered spinal cord, post-operatively. Materials and Methods:  A total of 75 individuals aged more than 2 years and of either gender who were hospitalized for surgery for tethered cord syndrome were included. All patients had a preoperative MRI of the spine, and those above the age of 6 had urodynamic tests. Clinical evaluations were performed until hospital release, then again at 3, 6, and 12 months. Urodynamic tests and spine MRIs were redone one year following surgery. Under general anesthesia, all patients had microscopic untethering procedures to release tethering materials and heal the thecal sac. Results:  52% of patients fall under TCS type ‘simple’, whereas, 48% of patients found with complex TCS. The frequency of CSF leakage in post-operative patients with a tethered spinal cord was found in 17.33%. No CSF leak was reported in the majority of patients (49%) patients in the age group 2-30 years. 52% of patients with simple TCS reported no CSF leak, whereas, only 13(18%) patients with complex TCS reported CSF leaks. 40% of patients reported no CSF leak who was diagnosed with complex TCS. There existed a significant relationship between the types of TCS (simple/complex) for CSF leak distribution. Conclusion:  This study concluded that the frequency of CSF leakage in post-operative patients with tethered spinal cord was found in 17.33% of patients. Keywords:  Tethered Spinal Cord (TCS), CSF Leakage, Lipomyelomeningocele

Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis

Objective:  To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis. Material and Methods:  The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score. Results:  Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value<0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value < 0.0001) observed only in male patients between two surgery groups for the back pain scores. Conclusion:  Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis

Spectral signature analysis to determine mangrove species delineation structured by anthropogenic effects

In this study, we used the spectral information divergence (SID) and spectral angle mapper (SAM) algorithm classification to identify ~ 40,000 individual trees from 19 mangrove species; these data were collected from 7 sampling points spread across 40,288 ha of the Matang Mangrove Forest Reserve (MMFR) in the state of Perak, Malaysia. This information was examined and analysed to answer two questions: (1) can medium resolution of satellite image identify the individual mangrove species (2) how are the distributions of individual species within the mangrove zonation associated with the anthropogenic matrix? Species identification with spectral library derived from the in-situ measurements using the SID algorithm was compared with that derived from the Landsat 8 using the SAM algorithm; it was found that the two methods offered different but complementary information with different rates of accuracy. The observed levels of classification accuracy are at 84.95% and 85.21%, respectively for SID and SAM algorithm classification. The mangrove species distribution has a correlation with the anthropogenic activities, but the distribution occurred randomly without specific zones. All the 19 selected mangrove species are closely related with different correlation by the anthropogenic activities. The use of the SID and SAM algorithms may provide the most promising way of classification for improving the mangrove species identification, with medium resolution of satellite image. Recognising the characteristics of mangrove zonation may give a better understanding of mangrove species appearances and conservation. However, mangrove zonation will remain a daunting mapping task and is a challenge for the ecologists in the future

Molecular Biology of Hepatitis C Virus: An Overview

Abstract: The Hepatitis C virus (HCV) is an enveloped, positive strand RNA virus and has been classified as a separate genus Hepacivirus of the family Flaviviridae. The HCV genome is a linear molecule with a length of approximately 9.6 kb that is flanked by 5` and 3' untranslated regions (UTRs) and encodes to a nearly 3,010 amino acids polyprotein precursor. It is cleaved by combination of viral and host proteases into structural (C, P7, El, and E2) and non-structural proteins (NS2, NS3, NS4A, NS4B, NS5A and NS5B), essential for viral replication and viron formation in post-translational process. The 5` and 3' UTRs are highly conserved regions in HCV genome, crucial for molecular processes such as replication and translation. In this review, we summarize the current knowledge about HCV molecular and structural HCV biology. This knowledge may help to improve treatment strategies and development of vaccine against HCV