Correlation of brain-derived neurotrophic factor with severity of depression and treatment response.

Background: Brain-derived neurotrophic factor (BDNF) is a modulator of neuroplasticity in the brain. It plays an important role in the pathophysiology of depression through the stress pathway. The information about correlation of BDNF levels with depression severity and treatment response in Indian population is scarce. Methods: Consecutive 60 never treated cases with depression reporting to a large tertiary care psychiatry unit and 60 healthy matched controls from 01 January 2016 to 31 December 2016 were enrolled for study. Sociodemographic data were collected. Diagnosis of depression was carried out as per International Classification of Diseases-10th revision (ICD-10) diagnostic criteria for research. The Hamilton Rating Scale for Depression (HRSD) was administered and accordingly scored. Venous blood for BDNF levels was collected from all cases and controls. Cases were reassessed after 04 weeks of treatment with HRSD and BDNF levels. Results: The mean level of serum BDNF among cases (18.56 ng/ml) was found to be reduced significantly as compared with healthy controls (32.41 ng/ml). The mean serum BDNF level (18.56 ng/ml) in never treated cases was significantly negatively correlated with the median clinical HRSD score (18.5). There was a significant increase in the mean level of serum BDNF after antidepressant treatment. Conclusion: The study has revealed statistically significant low levels of serum BDNF in cases not exposed to treatment with depression compared with healthy controls. There was significant negative correlation of levels of serum BDNF with depression severity. The levels of serum BDNF significantly increased after four weeks of treatment.

Efficacy of chitosan-coated textile waste biochar applied to Cd-polluted soil for reducing Cd mobility in soil and its distribution in moringa (Moringa oleifera L.).

Soil pollution with Cd has promoted serious concerns for medicinal plant quality. Amending Cd-polluted soils with textile waste biochar (TWB) coated with natural polymers can lower Cd bioavailability in them and reduce associated environmental and human health risks. In this study, we explored the impacts of solely applied TWB, chitosan (CH), their mix (TWB + CH) and TWB coated with CH (TBC) in Cd-polluted soil on Cd distribution in moringa (Moringa oleifera L.) shoots and roots as well as plant-available Cd in soil. Moreover, amendments effects on plant growth, dietary quality, and antioxidative defense responses were also assessed. Results revealed that the addition of TWB, CH, and TWB + CH in Cd-polluted soil reduced Cd distribution in shoots (56%, 66%, and 63%), roots (41%, 48%, and 45%), and plant-available Cd in soil (38%, 52%, and 49%), compared to control. Interestingly, the TBC showed significantly the topmost response for reducing Cd concentrations in shoots, roots, and soil by 73%, 54%, and 58%, respectively, relative to control. Moreover, amending Cd-polluted soil with TWB, CH, and TWB + CH depicted significantly better effects on plant growth, dietary quality, and activities of soil enzymes but the topmost response was observed with TBC treatment. Compared with control, TBC improved plant growth parameters: shoot length (81%), root length (90%), shoot fresh weight (60%), root fresh weight (76%), shoot dry weight (75%), root dry weight (68%) contents of chlorophyll-a (42%) and chlorophyll-b (74%), and soil enzyme activities: urease (130%), catalase (138%), protease (71%), cellobiohydrolase (45%), acid phosphatase (34%), peroxidase (60%), ß-glucosidase (152%), chitinase (62%), and phosphomonoesterase (139%). Furthermore, TBC treatment arrested Cd-induced oxidative stress via escalating the activities of antioxidant enzymes as well as improved moringa dietary parameters (protein, tannins, lipids, alkaloids, saponins, terpenoids, flavonoids, and tocopherols contents). Such findings suggest that the TBC has an immense perspective to remediate Cd-polluted soils and prevent human health risks associated with Cd exposure through the diet.

Effects of biochar and zeolite soil amendments with foliar proline spray on nickel immobilization, nutritional quality and nickel concentrations in wheat.

Since Ni-rich soils are a threat to the environment, growing edible crops on Ni-rich soils can pose a serious risk to human, animal, plant and ecosystem health and, hence, is considered as a challenging task for the researchers. Contrarily, limiting the bioavailability of Ni in such soils upon the addition of suitable amendments cum foliar spray of proteinogenic amino acids having an objective to alleviate stress to crop plants can considerably reduce the environmental risk. In this pot trail, we substantiate the effects of biochar (BR) and zeolite (ZL) addition in the soil along with proline (PN) spray on the resistance, and stress responses of wheat against Ni as well as on Ni translocation and accumulation in wheat plants grown on a Ni-rich soil contaminated by electroplating effluent. The treatments, applied with and without PN spray, involved: no amendment; BR; ZL; and a concoction of both amendments (BR50%+ZL50%). We found that BR50%+ZL50% treatment significantly immobilized Ni in the soil, reduced its accumulation in the shoot, root, and grain, blocked membrane lipid peroxidation and showed an improvement in photosynthetic parameters, the status of antioxidant activities, grain biochemistry and grain yield, compared to the control. Interestingly, exogenous PN spray caused a significant additive effect on the aforementioned parameters in the wheat plants grown on BR50%+ZL50% treated soil. Our results involved a reduced Ni bioavailability in wheat rhizosphere due to BR50%+ZL50% in soil and, furthermore, the additive effect of PN spray to scavenging ROS, obstructing peroxidation of lipid membrane and, thus providing resilience to wheat plant against Ni stress. The suggested technique can make Ni-rich soils suitable for cultivation and production of high-quality food by minimizing Ni bioavailability and toxicity to plants.

Interventions for infantile haemangiomas of the skin.

BACKGROUND: Infantile haemangiomas (previously known as strawberry birthmarks) are soft, raised swellings of the skin that occur in 3% to 10% of infants. These benign vascular tumours are usually uncomplicated and tend to regress spontaneously. However, when haemangiomas occur in high-risk areas, such as near the eyes, throat, or nose, impairing their function, or when complications develop, intervention may be necessary. This is an update of a Cochrane Review first published in 2011. OBJECTIVES: To assess the effects of interventions for the management of infantile haemangiomas in children. SEARCH METHODS: We updated our searches of the following databases to February 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, LILACS, and CINAHL. We also searched five trials registries and checked the reference lists of included studies for further references to relevant trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) of all types of interventions, versus placebo, active monitoring, or other interventions, in any child with single or multiple infantile haemangiomas (IHs) located on the skin. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcome measures were clearance, a subjective measure of improvement, and adverse events. Secondary outcomes were other measures of resolution; proportion of parents or children who consider there is still a problem; aesthetic appearance; and requirement for surgical correction. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included 28 RCTs, with a total of 1728 participants, assessing 12 different interventions, including lasers, beta blockers (e.g. propranolol, timolol maleate), radiation therapy, and steroids. Comparators included placebo, an active monitoring approach, sham radiation, and interventions given alone or in combination.Studies were conducted in a number of countries, including China, Egypt, France, and Australia. Participant age ranged from 12 weeks to 13.4 years. Most studies (23/28) included a majority of females and different types of IHs. Duration of follow-up ranged from 7 days to 72 months.We considered most of the trials as at low risk of random sequence generation, attrition bias, and selective reporting bias. Domains such as allocation concealment and blinding were not clearly reported in general. We downgraded evidence for issues related to risk of bias and imprecision.We report results for the three most important comparisons, which we chose on the basis of current use. Outcome measurement of these comparisons was at 24 weeks' follow-up.Oral propranolol versus placeboCompared with placebo, oral propranolol 3 mg/kg/day probably improves clinician-assessed clearance (risk ratio (RR) 16.61, 95% confidence interval (CI) 4.22 to 65.34; 1 study; 156 children; moderate-quality evidence) and probably leads to a clinician-assessed reduction in mean haemangioma volume of 45.9% (95% CI 11.60 to 80.20; 1 study; 40 children; moderate-quality evidence). We found no evidence of a difference in terms of short- or long-term serious adverse events (RR 1.05, 95% CI 0.33 to 3.39; 3 studies; 509 children; low-quality evidence), nor in terms of bronchospasm, hypoglycaemia, or serious cardiovascular adverse events. The results relating to clearance and resolution for this comparison were based on one industry-sponsored study.Topical timolol maleate versus placeboThe chance of reduction of redness, as a measure of clinician-assessed resolution, may be improved with topical timolol maleate 0.5% gel applied twice daily when compared with placebo (RR 8.11, 95% CI 1.09 to 60.09; 1 study; 41 children;low-quality evidence). Regarding short- or long-term serious cardiovascular events, we found no instances of bradycardia (slower than normal heart rate) or hypotension in either group (1 study; 41 children; low-quality evidence). No other safety data were assessed, and clearance was not measured.Oral propranolol versus topical timolol maleateWhen topical timolol maleate (0.5% eye drops applied twice daily) was compared with oral propranolol (via a tablet taken once per day, at a 1.0 mg/kg dose), there was no evidence of a difference in haemangioma size (as a measure of resolution) when measured by the proportion of patients with a clinician-assessed reduction of 50% or greater (RR 1.13, 95% CI 0.64 to 1.97; 1 study; 26 participants; low-quality evidence). Although there were more short- or long-term general adverse effects (such as severe diarrhoea, lethargy, and loss of appetite) in the oral propranolol group, there was no evidence of a difference between groups (RR 7.00, 95% CI 0.40 to 123.35; 1 study; 26 participants; very low-quality evidence). This comparison did not measure clearance.None of our key comparisons evaluated, at any follow-up, a subjective measure of improvement assessed by the parent or child; proportion of parents or children who consider there is still a problem; or physician-, child-, or parent-assessed aesthetic appearance. AUTHORS' CONCLUSIONS: We found there to be a limited evidence base for the treatment of infantile haemangiomas: a large number of interventions and outcomes have not been assessed in RCTs.Our key results indicate that in the management of IH in children, oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harms. We found no evidence of a difference between oral propranolol and topical timolol maleate with regard to reducing haemangioma size, but we are uncertain if there is a difference in safety. Oral propranolol is currently the standard treatment for this condition, and our review has not found evidence to challenge this. However, these results are based on moderate- to very low-quality evidence.The included studies were limited by small sample sizes and risk of bias in some domains. Future trials should blind personnel and participants; describe trials thoroughly in publications; and recruit a sufficient number of children to deduce meaningful results. Future trials should assess patient-reported outcomes, as well as objective outcomes of benefit, and should report adverse events comprehensively. Propranolol and timolol maleate require further assessment in RCTs of all types of IH, including those considered problematic, as do other lesser-used interventions and new interventions. All treatments should be compared against propranolol and timolol maleate, as beta blockers are approved as standard care.

Assessment of nickel bioavailability through chemical extractants and red clover (Trifolium pratense L.) in an amended soil: Related changes in various parameters of red clover.

Application of immobilizing agents may efficiently reduce the bioavailability of nickel (Ni) in the soil. Here we report the effect of biochar (BC), gravel sludge (GS) and zeolite (ZE) as a sole treatment and their combinations on the bioavailability of Ni after their application into a Ni-polluted soil. The bioavailability of Ni after the application of immobilizing agents was assessed through an indicator plant (red clover) and chemical indicators of bioavailability like soil water extract (SWE), DTPA and Ca(NO3)2 extracts. Additionally, the effects of Ni bioavailability and immobilizing agents on the growth, physiological and biochemical attributes of red clover were also observed. Application of ZE significantly reduced Ni concentrations in all chemical extracts compared to rest of the treatments. Similarly, the combined application of BC and ZE (BC+ ZE) significantly reduced Ni concentrations, reactive oxygen species (ROS) whereas, significant enhancement in the growth, physiological and biochemical attributes along with an improvement in antioxidant defence machinery of red clover plant, compared to rest of the treatments, were observed. Furthermore, BC+ ZE treatment significantly reduced bioconcentration factor (BCF) and bioaccumulation factor (BAF) of Ni in red clover, compared to rest of the treatments. The Ni concentrations in red clover leaves individually reflected a good correlation with Ni concentrations in the extracts (SWE at R2=0.79, DTPA extract at R2=0.84 and Ca(NO3)2 extracts at R2=0.86). Our results indicate that combined application of ZE and BC can significantly reduce the Ni bioavailability in the soil while in parallel improve the antioxidant defence mechanism in plants.

Survival rates of biological therapies for psoriasis treatment in real-world clinical practice: A Canadian multicentre retrospective study.

BACKGROUND/OBJECTIVES: Data on biologic drug survival in real-world psoriasis treatment are limited. There is a need to evaluate long-term trends of biologic use outside the realm of clinical trials. METHODS: A multicentre chart review was conducted with patients' data from September 2005 to September 2014. Kaplan-Meier plot analysis was used to determine 5-year drug survival rates. A log-rank test was used to compare the rates of drug survival between the studied biologics. RESULTS: For the 398 patients and 545 treatment series analysed, 1, 2, 3, 4 and 5-year survival rates were 0.826, 0.687, 0.563, 0.475 and 0.420 with etanercept; 0.804, 0.648, 0.553, 0.508 and 0.508 with adalimumab; 0.838, 0.664, 0.554, 0.485 and 0.382 with infliximab; and 0.914, 0.856, 0.800, 0.755 and 0.755 with ustekinumab, respectively. A statistically significant difference was seen between ustekinumab and the other three biologics. CONCLUSION: A progressive decrease in treatment adherence was seen with all four biologics, as expected, but the survival rate of ustekinumab was highest.

Promoting the productivity and quality of brinjal aligned with heavy metals immobilization in a wastewater irrigated heavy metal polluted soil with biochar and chitosan.

Depleting aquifers, lack of planning and low socioeconomic status of Pakistani farmers have led them to use wastewater (WW) for irrigating their crops causing food contamination with heavy metals and ultimately negative effects on human health. This study evaluates the effects of chitosan (CH) and biochar (BC) on growth and nutritional quality of brinjal plant together with in situ immobilization of heavy metals in a soil polluted with heavy metals due to irrigation with wastewater (SPHIW) and further irrigated with the same WW. Both CH and BC were applied at three different rates i.e. low rate [(LR), BC0.5%, CH0.5% and BC0.25%+CH0.25%], medium rate [(MR), BC1%, CH1% and BC0.5%+CH0.5%] and high rate [(HR), BC1.5%, CH1.5% and BC0.75%+CH0.75%]. Result revealed that brinjal growth, antioxidant enzymes, and fruit nutritional quality significantly improved from LR to HR for each amendment, relative to control. However, these results were more prominent with BC alone and BC+CH, compared with CH alone at each rate. Similarly, with few exceptions, significant reduction in Ni, Cd, Co, Cr and Pb concentrations in the root, shoot and fruit were found in sole CH treatment both at LR and MR but in both CH and BC+CH treatments at HR, relative to control. Interestingly, the concentrations of Fe in the roots, shoots and fruit were more pronounced at BC treatments relative to CH and BC+CH treatments at each rate, compared to control. Overall, the BC+CH treatment at HR was the most effective treatment for in situ immobilization of heavy metals in SPHIW and further irrigated with the same WW, compared to rest of the treatments. This study indicates that BC0.75%+CH0.75% treatment can be used to reduce mobility and bioavailability of heavy metals in SPHIW and facilitates plant growth by improving the antioxidant system. However, the feasibility of BC0.75%+CH0.75% treatment should also be tested at the field scale.

Improvement in productivity, nutritional quality, and antioxidative defense mechanisms of sunflower (Helianthus annuus L.) and maize (Zea mays L.) in nickel contaminated soil amended with different biochar and zeolite ratios.

Nickel (Ni) contaminated soils pose a potential ecological risk to the environment, soil health, and quality of food produced on them. We hypothesized that application of miscanthus biochar (BC) and cationic zeolite (ZE) at various proportions into a Ni contaminated soil can efficiently immobilize Ni and reduce its bioavailability to sunflower (Helianthus annuus L.) and maize (Zea mays L.). An electroplating effluent contaminated soil was amended with BC and ZE, as sole treatments (2% w/w) and their combinations of various ratios (BC, ZE, BC25%ZE75%, BC50%ZE50% and BC75%ZE25%) for immobilization of Ni in the soil. Furthermore, the associated effects of these treatments on residual and DTPA-extractable Ni from the soil; concentrations of Ni in shoots, roots, and grain; growth, physiology, biochemistry and the antioxidant defence mechanisms of sunflower and maize were investigated. Results revealed that BC50%ZE50% treatment efficiently reduced DTPA-extractable Ni in the soil, Ni concentrations in shoots, roots, and grain, while improved selective parameters of both plants. Interestingly, the BC75%ZE25% treatment significantly improved the biomass, grain yield, physiology, biochemistry and antioxidant defense machinery, while decreased Ni oxidative stress in both sunflower and maize, compared to rest of the treatments. The results demonstrate that the BC50%ZE50% treatment can efficiently reduce Ni concentrations in the roots, shoots and grain of both sunflower and maize whereas, an improvement in biomass, grain yield, physiological, biochemical, and antioxidant defense machinery of both crops can only be achieved with the application of BC75%ZE25% treatment in a Ni contaminated soil.

It's Crowded Here - A Case of Cor Triatriatum Sinister.

The image presented is a still frame taken from a transesophageal echocardiogram of a 76-year-old male who was referred for evaluation of mitral valve disease. He was found to have a non-flow limiting membrane, dividing the left atrium into two sections, consistent with the diagnosis of cor triatriatum sinister.

Dural Tears In Patients With Depressed Skull Fractures.

BACKGROUND: The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. METHODS: This cross-sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma. RESULTS: A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients. CONCLUSIONS: In depressed skull fractures, there are high chances of associated traumatic dural tears which should be vigilantly managed.

Decompressive Craniectomy For Acute Subdural Haematoma With Expansile Duraplasty Versus Dural-Slits.

BACKGROUND: Traumatic subdural hematoma is one of the lethal injuries to brain. Various surgical techniques are used to evacuate the acute subdural hematoma. The hematoma evacuation can either be done by opening of dura by multiple slits or by opening of dura in single large c shape and then doing the expansile duraplasty. Present study aimed to compare both these techniques. METHODS: This randomized control study was conducted in department of neurosurgery, Ayub Medical College, Abbottabad from July 2011 to July 2013. A total of 59 patients were included in this study, which were randomly allocated in two groups (i.e., group A and group B) for decompressive craniectomy. Thirty-one patients were operated by craniectomy with full dural flap opening (Group A), and 28 patients were operated by craniectomy with multidural-slits (Group B). Glasgow Outcome score (GOS) at 6 weeks after the surgery was used to determine the outcome. RESULTS: Mean age of the patients was 33.4±12.8 years. Majority were males. In group A 51.6 % (16) of the patients survived out of which a favourable outcome (GOC 3-5) was observed in 41.9% of the patients, and 9.1% of patients ended up in vegetative state. While in group B 46.4% (13) of the patients survived among which favourable outcome was seen in 39.3% of patients and 7.1% of patients ended up in vegetative state. The difference in outcome measure is insignificant. CONCLUSIONS: There was no statistically significant difference among the two groups as regards the mortality, GOS, frequency of complications and hospital. While the duration of surgery was significantly shorter in patients operated with dural slits.

Comparison Of Efficacy Of Phenytoin And Levetiracetam For Prevention Of Early Post Traumatic Seizures.

BACKGROUND: The incidence of early post-traumatic seizures after civilian traumatic brain injury ranges 4-25%. The control of early post-traumatic seizure is mandatory because these acute insults may add secondary damage to the already damaged brain with poor outcome. Prophylactic use of anti-epileptic drugs have been found to be have variable efficacy against early post-traumatic seizures. The objective of this study was to compare the efficacy of Phenytion and Levetiracetam in prevention of early post-traumatic seizures in moderate to severe traumatic brain injury. METHODS: This randomized controlled trial was conducted in department of Neurosurgery, Ayub Medical College, Abbottabad from March, 2012 to March 2013. The patients with moderate to severe head injury were randomly allocated in two groups. Patients in group A were given phenytoin and patients in group B were given Levetiracetam. Patients were followed for one week to detect efficacy of drug in terms of early post traumatic seizures. RESULTS: The 154 patients included in the study were equally divided into two groups. Out of 154 patients 115 (74.7%) were male while 29 (25.3%) were females. Age of patients ranges from 7-48 (24.15±9.56) years. Ninety one (59.1%) patients had moderate head injury while 63 (40.9%) patients had severe head injury. Phenytoin was effective in preventing early post traumatic seizures in 73 (94.8%) patients whereas Levetiracetam effectively controlled seizures in 70 (90.95%) cases (p-value of .348). CONCLUSIONS: There is no statistically significant difference in the efficacy of Phenytoin and Levetiracetam in prophylaxis of early posttraumatic seizures in cases of moderate to severe traumatic brain injury.

Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study.

BACKGROUND: Safety profiles of biologics for treatment of psoriasis are limited to data from randomized controlled trials. There is a need for comparative safety reports of biologics based on data from clinical practice. OBJECTIVE: We sought to estimate and compare the incidence of adverse events (AEs) leading to withdrawal of biologics (etanercept, infliximab, adalimumab, and ustekinumab) in the treatment of psoriasis. METHODS: We conducted a multicenter retrospective chart review from September 2005 to September 2014. Incidence proportion and rate of AEs leading to withdrawal by biologic agent and AE were calculated. RESULTS: For 545 treatments administered in 398 patients, 22 (4.04%) AEs were associated with withdrawal, for a rate of 1.97/100 patient-years (95% confidence interval [CI] 1.32-2.94). Common AEs were injection-/infusion-site reactions (0.55%, 0.92%, 0%, and 0% for etanercept, infliximab, adalimumab, and ustekinumab, respectively); infections (0%, 0.18%, 0.55%, 0.18%); and malignancies (0.18%, 0.18%, 0%, 0.37%). LIMITATIONS: Possible incompleteness of chart details and small study population limit the conclusiveness of findings. CONCLUSION: Biologic agents for treatment of psoriasis are safe; AEs associated with withdrawal occurred in 4% of all administered biologic therapies. It does not appear that real-world patients encounter more AEs with biologics than patients in clinical trials.

RADIOLOGICAL OUTCOME OF TRANSPEDICULAR SCREWS FIXATION IN THE MANAGEMENT OF THORACOLUMBAR SPINE INJURY.

BACKGROUND: Traumatic fracture of the spine 'is a serious neurosurgical condition that has serious impact on the patient's quality of life. Thoracolumbar junction is the most common site of spinal injuries. The aims of management of thoracolumbar spinal fractures are to restore vertebral column stability, and to obtain spinal canal decompression. This ultimately leads to early mobilization of the patients. This study was conducted to compare preoperative and post-operative vertebral height, kyphotic angle and sagittal index in patients treated with pedicle screws and rods in thoracolumbar spine fractures. METHODS: This cross-sectional study was conducted in the department of Neurosurgery, Hayatabad Medical Complex, Peshawar from 1st. February 2010 to 31st. July 2011. A total 161 patients with unstable thoracolumber spine fracture were included in this study. In these patients fixation was done through transpedicle screws with rods. Anteroposterior and lateral views X-rays of thoracolumbar spine were done pre and post operatively. RESULTS: Out of 161 patients, 109 (67.7%) were males and 52 (32.3%) females. The age of patients ranged from 20 to 70 years (mean 42.2 years) with 71 (44.1%) in the age range of 31-40 years. Preoperative average vertebral height was 9.4194. mm while postoperative average was 19.642 mm. The mean kyphosis was 23.06 degrees preoperatively. Immediately after surgery the average correction of kyphosis was 9.45 degrees. The pre-operative average sagittal index was 19.38 degrees, which was reduced to an average 5.41 degrees post operatively. CONCLUSIONS: Transpedicular fixation for unstable thoraco-lumbar spinal fractures achieves a stable fracture segment with improvement of vertebral height, kyphotic angle and sagittal index. Hence, preventing the secondary spinal deformities.

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA.

BACKGROUND: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. METHODS: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. RESULTS: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4%) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2%) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3%) cases, both CSA and AICA in 3 (5.6%) cases, venous compressions in only 1 (1.8%) patient and thick arachnoid adhesions were seen in 10 (18.9%) patients. Postoperatively, 33 (68%) patients were pain free, in 14 (26.45%) patients pain was significantly improved whereas in 3 (5.6%) patients there was mild improvement in symptoms. Three (5.6%) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2%) patients post-operatively, 4 (7.5%) patients developed wound infection and 1 (1.8%) patient developed aseptic meningitis. Three (5.6%) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. CONCLUSION: MVD is a safe and effective surgical option for treating patients with idiopathic TGN with better surgical outcome and fewer complications.

FREQUENCY OF EXTRADURAL HAEMATOMA IN PATIENTS WITH LINEAR SKULL FRACTURE.

BACKGROUND: Apparently normal looking patients after traumatic brain injury can have serious neurological deterioration, and one of the common causes of such deterioration is extradural haematomas. This study was conducted to determine the frequency of extradural hematoma and common types of trauma leading to it among patients presenting with skull fracture due to head injury. METHODS: This cross-sectional study was conducted in the department of Neurosurgery Ayub Medical College, Abbottabad from June 2011 to June 2012. All patients who were suspected to have Skull fracture on X-ray skull, during the study period, were included in study after informed consent and later on CT-Scan brain was done to see for extradural hematoma. Findings were recorded on a predesigned pro fonna including demographic data, radiological findings and the type of head trauma. RESULTS: Out of 114 patients 85 (74.5%) were males and 29 (225.4%) were females. Age ranged from 2 to 70 years (18.23 +/- 16.5 years). Among these patients the most important cause of head injury was fall from height in 65 (57%), followed by road traffic accidents in 39 (34.2%), and assault in 10 (8.8%) patients. The most common site of fracture was parietal in 49 (43%) of patients, followed by frontal bone in 28 (24.6%) of patients, occipital bone in 24 (21.1%) of patients, and temporal bone in 23 (20.2%) of patients. Frequency of extradural hematoma among linear skull fracture was in 34 (29.8%) patients. Extradural hematoma was most common with parietotemporal linear skull fractures (73.5%). CONCLUSION: Extradural haematoma occurs commonly with linear skull fractures, so patients with linear skull fracture should be properly evaluated with CT brain.

Coagulation-flocculation for lignin removal from wastewater - a review.

Industrial discharge has tremendously increased inorganic pollutants in water bodies all over the world. Paper and pulp effluent is included in one of the most pollution generating discharges containing complex chemical compounds such as lignin. For clean and healthy water resources, the recovery of lignin from wastewater from the paper and pulp industry is of high importance. Available chemical and biological technologies for removal of lignin have certain drawbacks. Coagulation and flocculation is not only the economic but also the effective method for removal of lignin. The present review highlights available coagulants employed for removal of lignin from paper and pulp wastewater. Each coagulant is pH dependent and shows varied results with change in effluent characteristics. The hydrolysis products of aluminium-based coagulants, iron-based coagulants and copper sulphate have positive charges. These positive charges promote formation of flocs through charged neutralisation or sweep flocculation. In the case of titanium-based coagulants, hydrolysis product is negatively charged and mode is heterocoagulation. Ninety percent recovery of lignin is achieved by using a mixture of oxotitanium sulphate and aluminium sulphate and 80% with aluminium sulphate. Virtually complete recovery of lignin is observed with oxotitanium sulphate.

Effect of size on the surgical management of pulmonary hydatid cyst.

BACKGROUND: Hydatid cyst disease is a parasitic disease caused Echinococcus granulosus. Hydatid cysts of 10 cm or greater in diameter are called "giant" cysts and traditionally have been considered to be more difficult to treat surgically often requiring pulmonary resection. In this study we reviewed our experience with pulmonary hydatid cysts. METHODS: This study was carried out in Thoracic surgery unit Lady Reading Hospital Peshawar, from 1st June 2007 to 31st May 2012. Patients admitted with intra-thoracic hydatid cysts were evaluated. Patients were divided into 2 groups, i.e., patients who had cysts < 10 cm (group A) and those who had large cysts which were 10 cm (group-B). Data regarding age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes were collected and analysed. RESULTS: Total of 224 patients underwent hydatid cystectomy. Group A comprised 190 patients (85%), Group-B comprised 34 patients (15%). Large cysts were more common in younger patients. The most frequent complaints were cough, chest pain, and dyspnea. Patients with large cysts were more often symptomatic at presentation. In both groups, lower-lobe locations predominated. Parenchyma-saving operations were almost uniformly performed for each group; however, a higher percentage of patients in group B required anatomic resection (5.8% vs. 1%). Cystic rupture occurred more frequently in group-B than in group-A (26% vs. 12%). There were no deaths in either group, and the morbidity was 23 (12%) in (group-A) and 6 (17.6%) in (group- B). CONCLUSION: Large hydatid cysts of the lung occurred more often in younger patients and were more often symptomatic at presentation. Regardless of size, the cysts could usually be surgically treated without lung resection, and size did not appear to influence short-term post-perative outcomes.

Frequency of albuminuria in diabetic patients presenting with macrovascular complications.

BACKGROUND: Diabetes mellitus is major cause of morbidity and premature mortality from its long-term complications such as cardiovascular disease, blindness, renal failure, amputation and stroke. The study was conducted to determine the frequency of albuminuria in diabetic patients presenting with macro-vascular complications like myocardial infarction (MI) and stroke. METHODS: This descriptive study was conducted at Ayub Medical College, Abbottabad from December 2010 to May 2011. Total 88 diabetic patients admitted with macro-vascular disease were included in this study. The patients were subjected to two urine specimen's examination, one for routine examination for infection and dipstick analysis for albuminuria. Second was tested for albumin was tested in the urine. RESULTS: Out of 88 patients with a mean 47.12 ± 7.58 years, 39 (44.32%) were female while 49 (55.68%) were male. Overall albuminuria was detected in the urine of 81 out of total 88 patients (92%) when tested by heating method whereas it was detected in 41 (46.6%) cases by the dipstick method. CONCLUSION: Frequency of albuminuria is much.higher in diabetic population with macro-vascular complications; hence albumin in the urine of diabetic patient can be regarded as an indicator for impending macro-vascular complications of diabetes.

Frequency of cerebellopontine angle tumours in patients with trigeminal neuralgia. .

BACKGROUND: Though the classical type of trigeminal neuralgia is the most common type with the neurovascular conflict causing the symptoms, yet quite some patients have the secondary type of trigeminal neuralgia in which space occupying lesions are responsible for the symptoms. This study was conducted to determine the frequency of cerebellopontine angle tumours in patients presenting with complaints of trigeminal neuralgia. METHODS: This case series descriptive study was conducted in the department of Neurosurgery, Ayub Medical College, Abbottabad, from January 2009 to January 2012. It included patients who presented with symptoms of trigeminal neuralgia. Patients were subjected to further radiological investigation like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to look for secondary causes of trigeminal neuralgia. RESULTS: Among the 134 patients with age ranges 13-64 (51?4.3) years of age, 78(58.2%) were females and 56 (41.7%) were males. Frequency of cerebellopontine angle tumours in patients was 14 (10.4%), among them epidermoid was most common lesion being present in 10 (7.4%) of patients and accounted for 75% of Cerebellopontine Angle tumours in these patients. Meningioma and vestibular schwanoma accounted for 2(1.4%) cases each. In secondary trigeminal neuralgia mean age of onset of symptoms was 39.5±5.2 years as compared to classic trigeminal neuralgia which is 53±2.1 years. CONCLUSION: Trigeminal Neuralgia can be a typical symptom in cerebellopontine angle tumours like epidermoid, especially in young patients, so all the patients with trigeminal neuralgia should be investigated for lesion in cerebellopontine region.