Comparison of Decompressive Craniectomy and Multi-Dural Stabs with Decompressive Craniectomy and Open-Dural Flap Method, in the Treatment of Acute Subdural Hematomas

Background: To compare the functional outcome between decompressive craniectomy and multi-dural stabs, with decompressive craniectomy and open-dural flap, in the removal of acute subdural hematomas . Methods : In this randomized controlled trial,  64 patients, with acute sub-dural hematomas were included.  Patients were divided into two groups on the basis of lottery method. All patients gave informed written consent. In group A, all patients were operated upon by multi-dural stab technique and in group B, patients were operated upon by open-dural flap technique. The objective degree of recovery in the patients treated by both craniectomy techniques was assessed by Glasgow Outcome Score (GOS), having maximum of 5 and minimum of 1 score. Favourable outcome was at points 4-5 and Un-favourable at 1-3 points, at 2 weeks. GOS attached as annexure A. Favourable outcome was assessed at 2 weeks according to GOS. Results : The mean age in group-A and group-B was 59.09 ± 9.39 years and 59.56 ± 9.98 years. Males constituted the main in both groups. Mean GOS in group A and in group B, was 3.06 ± 1.24 and 2.69 ± 0.82 respectively. Statistically mean GOS was same in this study groups, p-value 0.159, > 0.05. There were 37.5% patients in group A and 9.4% patients in group B who had favourable results, while in group A and group B, 62.5% and 90.60% patients had unfavourable results. Favourable results were statistically more in group A as compared to group B, p-value =0.008. Conclusion: Treatment of acute subdural hematoma by decompressive craniectomy with multi dural stabs technique has more favourable results (using GOS) than decompressive craniectomy with open-dural flap technique

Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Karachi, Pakistan: On a Road to Minimize ESRD Burden

End Stage Renal Disease (ESRD) is clinically defined as the progressive and irrevocable impairment of kidneys to perform life-sustaining functions and represents the final stage of Chronic Kidney Disease (CKD). With bulging morbidity and mortality and rampant rise in economic burden globally, ESRD is now recognized as a major public health issue. Certainly, it goes without saying that coming decades will observe a high prevalence of ESRD, and chronic non-communicable diseases such as hypertension and diabetes mellitus, with accumulating aging population as the driving force. This prognosticated upsurge in ESRD pool has been gauged to occur mainly in the developing countries

Correlation between Random Urinary Protein-to-creatinine Ratio and 24-h Urinary Protein Excretion in Preeclampsia

This study aimed to determine the correlation between random urinary protein-to-creatinine ratio in single-voided urine samples and 24-h urinary protein excretion in pregnant women with preeclampsia. A cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Abbasi Shaheed Hospital, Karachi, Pakistan, from July 2019 to June 2020. Fifty women with singleton pregnancy after 20 weeks of gestation with hypertension and 2+ proteinuria or more, according to a dipstick test, were included. Those with chronic hypertension; preexisting renal disease; gestational diabetes; eclampsia; hemolysis, elevated liver enzymes, a low platelet count syndrome; and coexisting urinary tract infections were excluded. Two random urine samples taken at 9:00 a.m. and 2:00 p.m. and 24-h urine samples were collected to evaluate the random urinary protein-to-creatinine and the 24-h protein excretion, respectively. The correlation coefficient (r) between them was calculated using Pearson's correlation test. The patients' mean age was 28.58 ± 5.09 years and their mean gestational age was 32.74 ± 4.44 weeks. Twenty-eight (56%) women were primigravidas, and 22 (44%) were multiparous. The average serum creatinine was 0.80 ± 0.16 mg/dL. The mean random urinary protein-to-creatinine ratio was 0.93 ± 0.7 mg/mg, and the mean 24-h urine was 481.08 ± 20.10 mL. A strong positive correlation was found between the protein-to-creatinine ratio and 24-h urinary protein excretion (r = 0.655; P = 0.01). We concluded that the protein-to-creatinine ratio in spot urine samples could be used as an alternative to in 24-h collection of urine to determine protein excretion in preeclamptic pregnant women

Successful treatment of hepatitis C in renal transplant recipient. A case report from Pakistan

The treatment of hepatitis C is a therapeutic challenge in renal transplant recipients. Interferon based regimens are relatively contraindicated due to their side effects and high risk of graft failure. With the availability of direct antivirals the situation has changed now and sustained virological response (SVR)\u3e90% had been achieved in patients with normal kidney function. There is limited data available on the safety of these agents in renal transplant recipients. Here we report a case of a kidney transplant recipient with Hepatitis C genotype 3 infections successfully treated with Sofosbuvir and Daclatasvir based regimen. This is the first reported case from Pakistan

Relation of copeptin with diabetic and renal function markers among patients with diabetes mellitus progressing towards diabetic nephropathy

Background: Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy.Aims of the study: The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM.Methods: Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson\u27s correlation tests on SPSS.Results: The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r = 0.171 (p = 0.101), BUN r = 0.244 (p = 0.007), creatinine r = 0.215 (p = 0.018), UACR r = 0.375 (p = \u3c0.001) and GFR r = 0.215 (p = \u3c0.019).Conclusion: The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its\u27 role as an early and reliable biomarker of DM and its associated nephropathy

CRISPR/Cas-9 and its therapeutic applications in Onco-viral diseases: A promising tool in cancer management

The CRISPR/Cas9 technique is one of the gene-editing tools. The CRISPR/Cas9 method is favoured by many due to its high degree of adaptability and precision when cutting and pasting DNA. It makes it possible to carry out genetic engineering on an unprecedented scale at a very low cost, which is one of the reasons why it is so popular. It differs from previous methods of genetic engineering in that it permits the addition or deletion of multiple genes simultaneously. Additionally, it is unique in that it is not species-specific, allowing it to be applied to organisms that were previously resistant to genetic engineering. CRISPR/Cas9 has emerged as a potent strategy for altering the genome, and it has been extensively utilized in a variety of cell lines. CRISPR/Cas9 creation of cell and animal models laid the groundwork for the clinical trials that might have treated the tumor. The technology of genome editing through CRISPR-Cas9 holds great promise for preventing tumor migration, invasion, and even treatment. However, its clinical application is constrained by the possibility of an off-target effect, necessitating an effective ethical review. The research and limitations of cancer clinical trials are discussed, as are the molecular mechanisms of CRISPR/Cas9