Wolbachia pipientis: A potential candidate for combating and eradicating dengue epidemics in Pakistan

AbstractDengue virus syndrome is an emerging global health challenge which is endemic in tropical countries like Pakistan. In recent years dengue incidences have increased considerably in different areas of Pakistan with more sever impacts on urban and peri-urban populations. This review is an effort to highlight the changing epidemiology of dengue fever, role of Government of Pakistan in disease management and control using preventive and community based approaches in the region. Moreover, there is an emphasis on application of Wolbachia as novel, inexpensive and environmentally benign candidate for control and eradication of dengue transmitting vectors

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)

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

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

Comparison of Cerebrospinal Fluid Leakage in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma with and without Sellar Floor Reconstruction

Objectives:  This study aimed to compare CSF leak in endoscopic endonasal TSS of pituitary adenoma with and without reconstruction of the sellar floor with no intraoperative CSF leakage. Materials and Methods:  It was a randomized controlled trial of 116 patients of both genders diagnosed case of pituitary adenoma who underwent endoscopic endonasal TSS over 1 year. The cases were randomized into 2 groups. In Group A endoscopic endonasal TSS and the sellar floor, reconstruction was done while in Group B only endoscopic endonasal transsphenoidal surgery was done without reconstruction. Results:  The patient’s mean age in group A was 40.7 ± 9.56 years, and in group, B was 41.9 ± 10.5 years. The gender distribution, for group A, males and females were 29 each (50%) and in group B, the males were 36 (62%) and females were 22 (38%). There were 52 (89.7%) cases of macroadenoma and 6 (10.3%) cases of microadenoma in each group. On the 1st postoperative day, CSF leakage was noted in 2 (3.4%) patients of group A, and CSF leakage was observed in 2 (3.4%) patients of group B. Results revealed no difference in CSF leakage between both groups. There were minor nasal complications in both groups. Conclusion:  There is an equal chance of success with endoscopic endonasal transsphenoidal surgery (TSS) of pituitary adenoma with and without reconstruction of the sellar floor, concerning post-operative CSF leak, in patients who have no intraoperative CSF leak which enlarges the pool of options for treatment

Recurrence of CSHD after Single Burr-Hole Evacuation and Closed Drainage System Versus Double Burr Hole Evacuation and Closed Drainage System

Objective: The recurrence rate was compared after single burr hole evacuation and closed drainage system versus double burr hole evacuation and closed drainage system of CSHD.Material and Methods: Sixty cases were included and randomized into two equal groups. Patient fulfilling the inclusion criteria were enrolled through the emergency and outdoor. CT scan brain was done and site, size and thickness of CSDH were evaluated. Patient were treated in exactly the same way as per standard ward routine practice except that the treatment option (whether to use the single or double burr hole) was decided through randomization by using random tables, Group A with single burr hole and Group B with double burr hole with closed drain used in both cases. Patients were kept admitted in the hospital till they were fit go home. Each patient was followed for recurrence at the 15th day, 1 month, 2 months and finally at 03 months.Results: Total 60 patients of chronic subdural hematoma were included. Total cases were divided into two equal groups with 30 cases in group A (single burr hole) and 30 cases in group B (two burr holes). The mean age of all patients was 59 yrs with SD ± 12 with minimum age 40 yrs and maximum age 80 yrs. Conclusion: Most of the patients (82%) had recovered after burr-hole craniostomy. However, some patients (18%) suffer recurrence of hematoma. No significant difference in recurrence of CSDH with one burr hole or two burr holes and was found and also noticed that the rate of recurrence is to some extent lower with double burr hole than with one burr hole evacuation of chronic subdural hematoma

Comparative Study Regarding Efficacy of Radiofrequency Rhizotomy and the Microvascular Decompression in the Treatment of Trigeminal Neuralgia

Objective: Trigeminal neuralgia is the lancinating electric shock like pain because of neurovascular compression in trigeminal nerve distribution. We compared the efficacy of radiofrequency rhizotomy with microvascular decompression in terms of complete pain relief.Material and Methods: The randomized controlled trial study was conducted in the neurosurgery department, LGH Lahore for a period of one year June 2017 to June 2018. A total of 110 patients were included and distributed into two groups, i.e. group-I who underwent radiofrequency rhizotomy (RFR) and group-II who underwent microvascular decompression (MVD). Follow-up of all the patients was assured up to six months. All the data were analyzed using S.P.S.S Ver. 23.0.Results: There were 38 (34.6%) male and 72(65.4%) female. Mean age was 51.25 ± 8.80 years. At the end of six months, in Group-I (RFR), Nineteen (34.5%) patients were completely pain free, 25 (45.5%) patients had significant pain relief, 7 (12.7%) had mild improvement in the pain and 4 (7.3%) patients had no improvement in the pain. In group-II (MVD), 30 (54.5%) patients were completely pain free, 14 (25.5%) had significant pain relief, 9 (16.4%) had mild improvement and 2 (3.6%) had no improvement in their pain (Chi-square = 6.49, p = 0.090).Conclusion: Microvascular decompression had better results than a radiofrequency rhizotomy in patients presenting with trigeminal neuralgia regarding excellent pain relief and fewer complications

Stability indicating RP-HPLC method for simultaneous determination of gatifloxacin and dexamethasone in binary combination

In this study, conditions were optimized for development of a simple RP-HPLC method for simultaneous analysis of gatifloxacin and dexamethasone in different matrices like pharmaceuticals, human serum and urine. Good separation of gatifloxacin and dexamethasone from the induced degradation products was accomplished using C8 as stationary phase; 0.02 M phosphate buffer (pH 3.0) and methanol (42:58 v/v) as mobile phase. The concentration was measured with DAD at 270 nm. Linearity was observed in the range of 0.000040-0.000280 mol/L for gatifloxacin (r2≥0.999) and 0.000013-0.000091 mol/L for dexamethasone (r2≥0.999). Both the analyte peaks were completely separated from the peaks of induced degradation products as indicated by the peak purity index (≥0.9999 for both analytes). The optimized method is recommended to be used for concurrent analysis of gatifloxacin and dexamethasone in different matrices

Role of Early Tracheostomy in the Management of Severe Head Injury

Objective: The objective of this study was to compare the role of early and late tracheostomy in patients presenting with severe head injuries.Material and Methods: This randomized controlled trial study was conducted in the department of neurosurgery, Lahore General Hospital Lahore from March 2018 to August 2018, after taking approval from the ethical committee. A total of one hundred and thirty patients was divided randomly into early (within three days) and late(after three days) tracheostomy groups. After tracheostomy, data regarding acute physiology, age and chronic health evaluation II (APACHE II), the total number of days since ventilation, tracheostomy, weaning, discharge from ICU and hospital, complications and mortality were noted. All the data was entered and analyzed with SPSS23.0. Quantitative variables were presented as mean and standard deviation, qualitative variables were presented as numbers and percentage. The Chi-square test was applied. A p-value of ≤0.05 was considered significant.Results: The mean age of the patients was 33.13 ± 2.53 years. There were 84 males (64.61%) and 46 females (35.38%) in the study. The duration of mechanical ventilation, ICU stay and stay in hospital for early and late tracheostomy groups were 25.68 ± 2.94 vs. 33.37 ± 3.32 days, 29.42 ± 2.97 vs. 38.54 ± 3.80 days and 37.20 ± 2.98 vs. 47.15 ± 3.84 days respectively. Four patients (3.08%) and seven patients (5.38%) suffered from mortality.Conclusion: Early tracheostomy among the patients presenting with severe head injuries was associated with a better outcome than late tracheostomy