In vivo studies could not confirm in vitro prophylactic synergism between Moringa essential oil and Lactobacillus reuteri (MT180537) / Estudos in vivo não puderam confirmar o sinergismo profilático in vitro entre o óleo essencial de Moringa e Lactobacillus reuteri (MT180537)

Aerobic vaginitis (AV) is a recently defined vaginal recurring infection, which is treated with antibiotics. However, excessive and prolonged use of antibiotics disrupts healthy vaginal microflora and leads to the emergence of antibiotic resistance among pathogens. This situation has directed researchers to explore alternative antimicrobials. The current study describes in vitro and in vivo antimicrobial efficacy and pharmaceutical interactions between plant essential oils (EOs) and five lactic acid bacteria (LABs), isolated from the healthy vagina, against E. faecalis, one of the major etiological agents of AV. In vitro experiments confirm good antimicrobial activity of both plant EOs and cell free supernatant (CFS) from LABs. Based on high antimicrobial efficacy, Moringa essential oil (MO) was selected to determine its nature of interaction with CFS of five LAB strains. Synergism was recorded between MO and CFS of L. reuteri (MT180537). To validate in vitro findings, prophylactic responses of individual and synergistic application of MO and L. reuteri (MT180537) were evaluated in an E. faecalis (MW051601) induced AV murine model. The prophylactic efficacy was evidenced by a reduction in intensity of clinical symptoms, E. faecalis (MW051601) count per vaginal tissue along with a reduction in AV associated changes in histological markers of infection in animals receiving Moringa essential oil and L. reuteri (MT180537) alone or in combination. However, significant synergism between Moringa essential oil and L. reuteri (MT180537) could not be observed. Our data confirms the importance of in vivo experiments in deducing pharmacological interactions.

Vaginite aeróbica (VA) é uma infecção vaginal recorrente definida recentemente, que é tratada com antibióticos. No entanto, o uso excessivo e prolongado de antibióticos perturba a microflora vaginal saudável e leva ao surgimento de resistência aos antibióticos entre os patógenos. Esta situação levou os pesquisadores a explorar antimicrobianos alternativos. O presente estudo descreve a eficácia antimicrobiana in vitro e in vivo e as interações farmacêuticas entre óleos essenciais vegetais (OE) e cinco bactérias lácticas (BAL), isoladas de vagina sã, contra E. faecalis, um dos principais agentes etiológicos da AV. Os experimentos in vitro confirmam a boa atividade antimicrobiana de ambos os EOs de plantas e sobrenadante livre de células (CFS) de LABs. Com base na alta eficácia antimicrobiana, o óleo essencial de Moringa (MO) foi selecionado para determinar sua natureza de interação com o sobrenadante livre de células (CFS) de cinco cepas de LAB. Sinergismo foi registrado entre MO e CFS de L. reuteri (MT180537). Para validar os resultados in vitro, as respostas profiláticas da aplicação individual e sinérgica de MO e L. reuteri (MT180537) foram avaliadas em um modelo murino AV induzido por E. faecalis (MW051601). A eficácia profilática foi evidenciada por uma redução na intensidade dos sintomas clínicos, contagem de E. faecalis (MW051601) por tecido vaginal, juntamente com uma redução nas alterações associadas a AV nos marcadores histológicos de infecção em animais que receberam óleo essencial de Moringa e L. reuteri (MT180537) sozinho ou em combinação. No entanto, não foi possível observar sinergismo significativo entre o óleo essencial de Moringa e L. reuteri (MT180537). Nossos dados confirmam a importância dos experimentos in vivo na dedução de interações farmacológicas.

In vivo studies could not confirm in vitro prophylactic synergism between Moringa essential oil and Lactobacillus reuteri (MT180537)

Abstract Aerobic vaginitis (AV) is a recently defined vaginal recurring infection, which is treated with antibiotics. However, excessive and prolonged use of antibiotics disrupts healthy vaginal microflora and leads to the emergence of antibiotic resistance among pathogens. This situation has directed researchers to explore alternative antimicrobials. The current study describes in vitro and in vivo antimicrobial efficacy and pharmaceutical interactions between plant essential oils (EOs) and five lactic acid bacteria (LABs), isolated from the healthy vagina, against E. faecalis, one of the major etiological agents of AV. In vitro experiments confirm good antimicrobial activity of both plant EOs and cell free supernatant (CFS) from LABs. Based on high antimicrobial efficacy, Moringa essential oil (MO) was selected to determine its nature of interaction with CFS of five LAB strains. Synergism was recorded between MO and CFS of L. reuteri (MT180537). To validate in vitro findings, prophylactic responses of individual and synergistic application of MO and L. reuteri (MT180537) were evaluated in an E. faecalis (MW051601) induced AV murine model. The prophylactic efficacy was evidenced by a reduction in intensity of clinical symptoms, E. faecalis (MW051601) count per vaginal tissue along with a reduction in AV associated changes in histological markers of infection in animals receiving Moringa essential oil and L. reuteri (MT180537) alone or in combination. However, significant synergism between Moringa essential oil and L. reuteri (MT180537) could not be observed. Our data confirms the importance of in vivo experiments in deducing pharmacological interactions.

Resumo Vaginite aeróbica (VA) é uma infecção vaginal recorrente definida recentemente, que é tratada com antibióticos. No entanto, o uso excessivo e prolongado de antibióticos perturba a microflora vaginal saudável e leva ao surgimento de resistência aos antibióticos entre os patógenos. Esta situação levou os pesquisadores a explorar antimicrobianos alternativos. O presente estudo descreve a eficácia antimicrobiana in vitro e in vivo e as interações farmacêuticas entre óleos essenciais vegetais (OE) e cinco bactérias lácticas (BAL), isoladas de vagina sã, contra E. faecalis, um dos principais agentes etiológicos da AV. Os experimentos in vitro confirmam a boa atividade antimicrobiana de ambos os EOs de plantas e sobrenadante livre de células (CFS) de LABs. Com base na alta eficácia antimicrobiana, o óleo essencial de Moringa (MO) foi selecionado para determinar sua natureza de interação com o sobrenadante livre de células (CFS) de cinco cepas de LAB. Sinergismo foi registrado entre MO e CFS de L. reuteri (MT180537). Para validar os resultados in vitro, as respostas profiláticas da aplicação individual e sinérgica de MO e L. reuteri (MT180537) foram avaliadas em um modelo murino AV induzido por E. faecalis (MW051601). A eficácia profilática foi evidenciada por uma redução na intensidade dos sintomas clínicos, contagem de E. faecalis (MW051601) por tecido vaginal, juntamente com uma redução nas alterações associadas a AV nos marcadores histológicos de infecção em animais que receberam óleo essencial de Moringa e L. reuteri (MT180537) sozinho ou em combinação. No entanto, não foi possível observar sinergismo significativo entre o óleo essencial de Moringa e L. reuteri (MT180537). Nossos dados confirmam a importância dos experimentos in vivo na dedução de interações farmacológicas.

Physiological and biochemical changes induced by Qiangdi nano-863 biological assistant growth apparatus during rice seed priming under temperature stress / Alterações fisiológicas e bioquímicas induzidas pelo aparelho de crescimento assistente biológico Qiangdi nano-863 durante o priming de sementes de arroz sob estresse de temperatura

Abstract A huge amount of rice cultivation and consumption occur in Asia particularly in Pakistan and China. However, multiple abiotic stresses especially high and low-temperature proved to be a substantial threat for rice production ultimately risks for food security. To overcome various types of abiotic stress; seed priming is among the effective approaches to improve the rice seed germination and growth vigor. Therefore, the present study was planned to evaluate physiological and biochemical modifications in Chinese and Pakistani rice varieties by Qiangdi 863 biological assistant growth apparatus nano treated water (NTW), Osmopriming Calcium chloride (CaCl2), redox priming hydrogen peroxide (H2O2) and hormonal priming by Salicylic acid (SA) under temperature stress conditions. The experiment was performed with completely randomize design conditions. Five rice varieties, nomenclature as Zhongzoa 39, (Chinese rice variety) KSK 133, KS 282, Super basmati and PK 1121 aromatic (Pakistani rice variety) were sown under low temperature (LT) (17ºC), optimal temperature (OT) 27ºC and high temperature (HT) 37ºC conditions. The present study indicated that nanopriming were the most effective treatments increased Germination Energy Percentage (GEP) (96.1, 100, 100%), Speed of Germination (SG) (27.2, 35.45, 37.1), Final Germination Percentage (FGP) (98.2, 99.1, 99.4%), Seedling Dry Weight Biomass (DWB) (0.1, 0.137, 0.14g), Total Chlorophyll Content (0.502, 13.74, 15.21), antioxidant enzymes Superoxide Dismutase (SOD)(3145, 2559, 3345 µg-1FWh-1), Catalase (CAT) (300, 366, 3243 µg-1FWh-1) and decreased Malondialdehyde (MDA) (6.5, 12.2, 6.5 µmol g-1 FW) for Zhongzao 39 and KSK 133 rice varieties under low (LT+NTW), optimal temperature (OP+NTW) and high temperature (HT+NTW) stress., Therefore, nano-priming is recommended to cope with the high and low-temperature stress conditions along with improved productivity of rice.

Resumo Cultivo e consumo de arroz ocorrem em grandes quantidades na Ásia, particularmente no Paquistão e na China. No entanto, vários estresses abióticos, especialmente de alta e baixa temperatura, provaram ser uma ameaça considerável para a produção de arroz, em última análise, riscos para a segurança alimentar. Para superar vários tipos de estresse abiótico, o priming de sementes está entre as abordagens eficazes que melhoram a germinação e o vigor de crescimento das sementes de arroz. Portanto, o presente estudo foi planejado para avaliar as modificações fisiológicas e bioquímicas em variedades de arroz chinês e paquistanês por Qiangdi 863, aparelho assistente biológico de crescimento com água nanotratada (NTW), Osmopriming cloreto de cálcio (CaCl2), peróxido de hidrogênio redox (H2O2) e priming hormonal por ácido salicílico (SA) em condições de estresse de temperatura. O experimento foi realizado em condições de delineamento inteiramente ao acaso. Cinco variedades de arroz, nomenclaturas como Zhongzoa 39 (variedade de arroz chinês), KSK 133, KS 282, Super basmati e PK 1121 aromático (variedade de arroz do Paquistão) foram semeadas sob baixa temperatura (LT) (17 ºC), temperatura ótima (OT) 27 ºC e condições de alta temperatura (HT) 37 ºC. O presente estudo indicou que nanocondicionamento foi o tratamento mais eficaz: aumento da porcentagem de energia de germinação (GEP) (96,1%, 100%, 100%), velocidade de germinação (SG) (27,2, 35,45, 37,1), porcentagem de germinação final (FGP) (98,2%, 99,1%, 99,4%), biomassa de peso seco de mudas (DWB) (0,1 g, 0,137 g, 0,14 g), conteúdo total de clorofila (0,502, 13,74, 15,21), enzimas antioxidantes superóxido dismutase (SOD) (3145, 2559, 3345 µg-1FWh- 1), catalase (CAT) (300, 366, 3243 µg-1FWh-1) e malondialdeído diminuído (MDA) (6,5, 12,2, 6,5 µmol g-1 FW) para as variedades de arroz Zhongzao 39 e KSK 133 sob baixo (LT + NTW), temperatura ótima (OP + NTW) e estresse de alta temperatura (HT + NTW). Portanto, o nanopriming é recomendado para lidar com as condições de estresse de alta e baixa temperatura, juntamente com a produtividade aprimorada do arroz.

Physiological and biochemical changes induced by Qiangdi nano-863 biological assistant growth apparatus during rice seed priming under temperature stress / Alterações fisiológicas e bioquímicas induzidas pelo aparelho de crescimento assistente biológico Qiangdi nano-863 durante o priming de sementes de arroz sob estresse de temperatura

A huge amount of rice cultivation and consumption occur in Asia particularly in Pakistan and China. However, multiple abiotic stresses especially high and low-temperature proved to be a substantial threat for rice production ultimately risks for food security. To overcome various types of abiotic stress; seed priming is among the effective approaches to improve the rice seed germination and growth vigor. Therefore, the present study was planned to evaluate physiological and biochemical modifications in Chinese and Pakistani rice varieties by Qiangdi 863 biological assistant growth apparatus nano treated water (NTW), Osmo priming Calcium chloride (CaCl2), redoxpriming hydrogen peroxide (H2O2) and hormonal priming by Salicylic acid (SA) under temperature stress conditions. The experiment was performed with completely randomize design conditions. Five rice varieties, nomenclature as Zhongzoa 39, (Chinese rice variety) KSK 133, KS 282, Super basmati and PK 1121 aromatic (Pakistani rice variety) were sown under low temperature (LT) (17ºC), optimal temperature (OT) 27ºC and high temperature (HT) 37ºC conditions. The present study indicated that nanopriming were the most effective treatments increased Germination Energy Percentage (GEP) (96.1, 100, 100%), Speed of Germination (SG) (27.2, 35.45, 37.1), Final Germination Percentage (FGP) (98.2, 99.1, 99.4%), Seedling Dry Weight Biomass (DWB) (0.1, 0.137, 0.14g), Total Chlorophyll Content (0.502, 13.74, 15.21), antioxidant enzymes Superoxide Dismutase (SOD)(3145, 2559, 3345 µg-1FWh-1), Catalase (CAT) (300, 366, 3243 µg-1FWh-1) and decreased Malondialdehyde (MDA) (6.5, 12.2, 6.5 µmol g-1 FW) for Zhongzao 39 and KSK 133 rice varieties under low (LT+NTW), optimal temperature (OP+NTW) and high temperature (HT+NTW) stress., Therefore, nano-priming is recommended to cope with the high and low-temperature stress conditions along with improved productivity of rice.

Cultivo e consumo de arroz ocorrem em grandes quantidades na Ásia, particularmente no Paquistão e na China. No entanto, vários estresses abióticos, especialmente de alta e baixa temperatura, provaram ser uma ameaça considerável para a produção de arroz, em última análise, riscos para a segurança alimentar. Para superar vários tipos de estresse abiótico, o priming de sementes está entre as abordagens eficazes que melhoram a germinação e o vigor de crescimento das sementes de arroz. Portanto, o presente estudo foi planejado para avaliar as modificações fisiológicas e bioquímicas em variedades de arroz chinês e paquistanês por Qiangdi 863, aparelho assistente biológico de crescimento com água nanotratada (NTW), Osmopriming cloreto de cálcio (CaCl2), peróxido de hidrogênio redox (H2O2) e priming hormonal por ácido salicílico (SA) em condições de estresse de temperatura. O experimento foi realizado em condições de delineamento inteiramente ao acaso. Cinco variedades de arroz, nomenclaturas como Zhongzoa 39 (variedade de arroz chinês), KSK 133, KS 282, Super basmati e PK 1121 aromático (variedade de arroz do Paquistão) foram semeadas sob baixa temperatura (LT) (17 ºC), temperatura ótima (OT) 27 ºC e condições de alta temperatura (HT) 37 ºC. O presente estudo indicou que nanocondicionamento foi o tratamento mais eficaz: aumento da porcentagem de energia de germinação (GEP) (96,1%, 100%, 100%), velocidade de germinação (SG) (27,2, 35,45, 37,1), porcentagem de germinação final (FGP) (98,2%, 99,1%, 99,4%), biomassa de peso seco de mudas (DWB) (0,1 g, 0,137 g, 0,14 g), conteúdo total de clorofila (0,502, 13,74, 15,21), enzimas antioxidantes superóxido dismutase (SOD) (3145, 2559, 3345 µg-1FWh- 1), catalase (CAT) (300, 366, 3243 µg-1FWh-1) e malondialdeído diminuído (MDA) (6,5, 12,2, 6,5 µmol g-1 FW) para as variedades de arroz Zhongzao 39 e KSK 133 sob baixo (LT + NTW), temperatura ótima (OP + NTW) e estresse de alta temperatura [...].

Physiological and biochemical changes induced by Qiangdi nano-863 biological assistant growth apparatus during rice seed priming under temperature stress

Abstract A huge amount of rice cultivation and consumption occur in Asia particularly in Pakistan and China. However, multiple abiotic stresses especially high and low-temperature proved to be a substantial threat for rice production ultimately risks for food security. To overcome various types of abiotic stress; seed priming is among the effective approaches to improve the rice seed germination and growth vigor. Therefore, the present study was planned to evaluate physiological and biochemical modifications in Chinese and Pakistani rice varieties by Qiangdi 863 biological assistant growth apparatus nano treated water (NTW), Osmopriming Calcium chloride (CaCl2), redox priming hydrogen peroxide (H2O2) and hormonal priming by Salicylic acid (SA) under temperature stress conditions. The experiment was performed with completely randomize design conditions. Five rice varieties, nomenclature as Zhongzoa 39, (Chinese rice variety) KSK 133, KS 282, Super basmati and PK 1121 aromatic (Pakistani rice variety) were sown under low temperature (LT) (17ºC), optimal temperature (OT) 27ºC and high temperature (HT) 37ºC conditions. The present study indicated that nanopriming were the most effective treatments increased Germination Energy Percentage (GEP) (96.1, 100, 100%), Speed of Germination (SG) (27.2, 35.45, 37.1), Final Germination Percentage (FGP) (98.2, 99.1, 99.4%), Seedling Dry Weight Biomass (DWB) (0.1, 0.137, 0.14g), Total Chlorophyll Content (0.502, 13.74, 15.21), antioxidant enzymes Superoxide Dismutase (SOD)(3145, 2559, 3345 µg-1FWh-1), Catalase (CAT) (300, 366, 3243 µg-1FWh-1) and decreased Malondialdehyde (MDA) (6.5, 12.2, 6.5 µmol g-1 FW) for Zhongzao 39 and KSK 133 rice varieties under low (LT+NTW), optimal temperature (OP+NTW) and high temperature (HT+NTW) stress., Therefore, nano-priming is recommended to cope with the high and low-temperature stress conditions along with improved productivity of rice.

Resumo Cultivo e consumo de arroz ocorrem em grandes quantidades na Ásia, particularmente no Paquistão e na China. No entanto, vários estresses abióticos, especialmente de alta e baixa temperatura, provaram ser uma ameaça considerável para a produção de arroz, em última análise, riscos para a segurança alimentar. Para superar vários tipos de estresse abiótico, o priming de sementes está entre as abordagens eficazes que melhoram a germinação e o vigor de crescimento das sementes de arroz. Portanto, o presente estudo foi planejado para avaliar as modificações fisiológicas e bioquímicas em variedades de arroz chinês e paquistanês por Qiangdi 863, aparelho assistente biológico de crescimento com água nanotratada (NTW), Osmopriming cloreto de cálcio (CaCl2), peróxido de hidrogênio redox (H2O2) e priming hormonal por ácido salicílico (SA) em condições de estresse de temperatura. O experimento foi realizado em condições de delineamento inteiramente ao acaso. Cinco variedades de arroz, nomenclaturas como Zhongzoa 39 (variedade de arroz chinês), KSK 133, KS 282, Super basmati e PK 1121 aromático (variedade de arroz do Paquistão) foram semeadas sob baixa temperatura (LT) (17 ºC), temperatura ótima (OT) 27 ºC e condições de alta temperatura (HT) 37 ºC. O presente estudo indicou que nanocondicionamento foi o tratamento mais eficaz: aumento da porcentagem de energia de germinação (GEP) (96,1%, 100%, 100%), velocidade de germinação (SG) (27,2, 35,45, 37,1), porcentagem de germinação final (FGP) (98,2%, 99,1%, 99,4%), biomassa de peso seco de mudas (DWB) (0,1 g, 0,137 g, 0,14 g), conteúdo total de clorofila (0,502, 13,74, 15,21), enzimas antioxidantes superóxido dismutase (SOD) (3145, 2559, 3345 µg-1FWh- 1), catalase (CAT) (300, 366, 3243 µg-1FWh-1) e malondialdeído diminuído (MDA) (6,5, 12,2, 6,5 µmol g-1 FW) para as variedades de arroz Zhongzao 39 e KSK 133 sob baixo (LT + NTW), temperatura ótima (OP + NTW) e estresse de alta temperatura (HT + NTW). Portanto, o nanopriming é recomendado para lidar com as condições de estresse de alta e baixa temperatura, juntamente com a produtividade aprimorada do arroz.

Item analysis as tool to validate multiple choice question bank in pharmacology

Background: Multiple choice questions (MCQs) are a common method for formative and summative assessment of medical students. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), distracter efficiency (DE). The objective of this study was to assess the quality of MCQs currently in use in pharmacology by item analysis and develop a MCQ bank with quality items.Methods: This cross-sectional study was conducted in 148 second year MBBS students at NKP Salve institute of medical sciences from January 2018 to August 2018. Forty MCQs twenty each from the two term examination of pharmacology were taken for item analysis A correct response to an item was awarded one mark and each incorrect response was awarded zero. Each item was analyzed using Microsoft excel sheet for three parameters such as DIF I, DI, and DE.Results: In present study mean and standard deviation (SD) for Difficulty index (%) Discrimination index (%) and Distractor efficiency (%) were 64.54±19.63, 0.26±0.16 and 66.54±34.59 respectively. Out of 40 items large number of MCQs has acceptable level of DIF (70%) and good in discriminating higher and lower ability students DI (77.5%). Distractor efficiency related to presence of zero or 1 non-functional distrator (NFD) is 80%.Conclusions: The study showed that item analysis is a valid tool to identify quality items which regularly incorporated can help to develop a very useful, valid and a reliable question bank.

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Tuberous sclerosis with bilateral angiomyolipomas

A case of a 30-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease is described in the present case report. Clinical symptoms were unexplained fever, pain in lumber areas and gross hematuria. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts in the lungs characteristic for pulmonary lymphangioleiomyomatosis. CT scan of the brain revealed subependymal calcifications. These three diagnostic features are rarely exhibited in a single patient. Bilateral renal angiomyolipomas and pulmonary lymphangioleiomyomatosis are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality

Management of thoracolumbar spine injuries at a tertiary care hospital

The purpose of descriptive case series study was to see the conservative and surgical outcome in respect of neurological improvement, sphincter functions and early ambulation in cases of traumatic thoracolumbar injuries in a tertiary care hospital. This was a hospital based prospective study comprised of 50 thoracolumbar injury cases registered during the period of 1 year from September 2005 to September 2006. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using Frankle grades. Operative and postoperative record with x-rays and MRI were maintained. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. A total of 50 cases were registered, 43 [86%] were males and 7 [14%] were females. Fall was the most common cause of injury [92%]. The most common level involved was L[1] [46%]. The 2[nd] common site of injury was T[12] [12%]. The treatment given was conservative in 42.55%, and surgery was performed on 57.44%. Three [6.38%] patients were left against medical advice. Thoracolumbar injuries occur in young population and creates socio-economic burden to the society. Patients with partial neurological deficit benefit from surgery

Effect metformin on urinary VMA levels in type II diabetic subjects

The purpose of this study was to observe the effect of metformin on 24-hours urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects. The study consisted of four weeks for each participant with weekly follow up visits. Samples were collected at 0800-0900 hours after over night fast. Study was conducted in the Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi. Total duration of study was six months. Fifteen newly diagnosed untreated type 2 diabetics, with fasting plasma glucose levels >/= 126 mg/dl on two occasions and/or postprandial glucose levels >/= 200 mg/dl were enrolled in the study. Patients with concurrent illness or diabetic complications were excluded. Metformin was started from 500 mg/day and titrated at weekly intervals according to glycaemic control and the subjects tolerance to the drug. A 24-hour urinary VMA was assessed at day - 0 [before metformin therapy] and day - 28 [4 weeks after metformin therapy] by using VMA reagent kit of Biosystems Spain on Spectronic -21 spectrophotometer USA. Metformin caused highly significant [P < 0.001] reduction in mean fasting plasma glucose from 233.33 +/- 15.62 mg /dl on day-0 to 151.53 +/- 6.02 mg/dl on day - 28, and a significant [P < 0.01] decrease in 24 - hour urinary VMA levels from 5.18 + 0.50 mg / 24 hours on day-0 to 3.32 + 0.28 mg / 24 hours on day-28. Our results indicate that metformin causes highly significant reduction in fasting plasma glucose and a significant decrease in 24 - hour urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects

Pattern of encephaloceles: a case series

Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele [occipital, Scincipital, parietal] admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 [76%] were male and 6 [24%] female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 [80%]. All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it

Anterior decompression, fusion and plating in cervical spine injury: our early experience

To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. The Descriptive case series study was conducted at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh Pakistan during year 2005 to 2007. Patients with cervical spine injuries were admitted during study period were included in this study. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using ASIA impairment scale. Cervical traction was applied to all patients. Operative and post operative record with x-rays and MRI were maintained. Patients with Injury to C3-6 underwent decompression, fusion and local titanium plate implant fixation by anterior approach. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. 37 cases of sub axial cervical spine injuries included in this study during year 2005 to 2007. Out of these, 28 [75.67%] were males and 9 [24.32%] females. Age range was 8-60 years mean [32-40%]. Common mode of injury was fall. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. No immediate complication found except temporary dysphagia. Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological and radiological outcome

Lymphocele incidence following renal transplantation our experience in sims/services hospital Lahore

To determine the incidence of lymphocele in patients who under went renal transplantation, as well as potential factors responsible or associated to its development. All records of 25 patients who were operated for renal transplant in SIMS/SHL between March 2006 to December 2007 were reviewed for lymphocele. The surgical technique was the standard one. All lymphatic vessels were either ligated or diathermized. Baseline post operative ultrasound after one week done or whenever indicated for lymphocele. 10% povidone iodine instilated in case of lymphocele. Patients were followed for an average of six months with history, physical examination and ultrasound on each visit. 25 patients [20 male and 5 female] have received renal allograft from live donors. There was 1[4%] instance of lymphocele; encountered at two weeks after renal transplantation. Careful ligation of lymphatic vessels both during graft preparation and during implantation can significantly contribute to reducing incidence of lymphocele following renal transplantation. Instillation of 10% povidone iodine in the lymphpcele can cure and prevent its recurrence

Clinical outcome of modified thiersch duplay urethroplasty for proximal hypospadias

To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias. Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias [penoscrotal] with chordee. Two stage repair was performed in all cases. 1[st] stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter [5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults] without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Age range was 3-25 years with mean +/- SD of 12.7 +/- 5.09. Total hospital stay was 10-12 days with mean +/- SD of 11.9 +/- SD 0.85. Twenty five patients [80.2%] could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean +/- SD of 6 +/- 1.43. Main complications seen were urethrocutaneous fistulae in three [9.9%], meatal stenosis in three [9.9%], hematoma in one [3.3%], complete disruption in one [3.3%] infection in two [6.6%] and painful bladder spasm in two [6.6%]. These seen in five [16.5%] patients. Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay

Significance of uroflowmetry in small voided volume

Uroflowmetry is a useful diagnostic tool for the evaluation of bladder outlet obstruction. Significance of uroflowmetry was studied in small voided volumes as many of the patients with bladder outlet obstruction, are unable to void required volumes i.e. > 150 ml were included. The patients above the age of 50, having IPSS >20, post void residual urine less than 100 ml and voided volumes less than 150 ml. Study parameters were; patients' age, residual urine, traces of uroflowmetry, maximum flow rate [Qmax], average flow rate [Qave], flow time, voiding time and voided volume. Out of 77 patients 23 voided less than 150 ml. 12 patients proved to be obstructed [5 developed retention and 7 were operated due to bothersome score]. Out of 23 patients 12 [52%] proved to be obstructed and 10 [43.45%] were diagnosed by uroflowmetry. Pearson correlation coefficient between voiding time and voided volume was 0.432 [p<.05]. There was no correlation between voided volume and Qmax among these patients who voided less than 150ml. It has been concluded that in some of the cases even with small voided volumes, uroflowmetry can be helpful in diagnosing bladder outlet obstruction

Efficacy, safety and tolerability of mometasone furoate 0.1% ointment in chronic eczema

Eczema covers a wide range of skin problems, which trouble people at different stages of their lives. Mometasone furoate has been reported to be an effective vasoconstrictive agent on human skin. To evaluate the therapeutic efficacy, safety and tolerability of mometasone furoate ointment 0.1% in chronic eczema following a four-week course of therapy and to record the main events in the cascade of eczema. This quasi-experimental, multi-center study was conducted in four cities. of Pakistan [Karachi, Lahore, Islamabad, and Peshawar] from December, 2005 to February, 2006. A total 180 patients aged > 24 months of either sex with chronic eczema without secondary infection were recruited while pregnancy, known hypersensitivity to corticosteroids, presence of skin atrophy, those on systemic steroids within 28 days were excluded. Patients were instructed to apply a thin layer of ointment once daily. Tubes of mometasone furoate ointment were dispensed to the patients on days 1, 8 and 15 of the study. Patients were asked to return the used tubes at the next weekly follow-up visit. SPSS-13.0 was used for statistical analysis. Friedman test was applied to compare the significance of clinical outcome, relief in signs/symptoms and patient`s comfort at p < 0.05. On first follow up 8 days after treatment, significant majority [77%] showed improvement and in 7 [4%] patients fully resolved. After 15 days, 75% showed improvement and resolved in 19% patients. After 21 days of treatment, improvement was seen in 32% and 55% had resolved. Efficacy in terms of relief in signs and symptoms on last follow up > 21 days after treatment revealed significant resolution of signs and symptoms [p < 0.001]. The cumulative level of comfort on various follow up visits was found significant [p < 0.001]. Mometasone furoate ointment is significantly effective in relief in sign and symptoms and provides a high level of comfort after the treatment of chronic eczema

Seroprevalence of antibodies to toxoplasma gondii, with particular reference to obstetric history of patients in Rawalpindi-Islamabad, Pakistan

Six hundred and forty blood samples were obtained from Rawalpindi-Islamabad to determine the frequency of Toxoplasma gondii antibodies using indirect immunofluorescent antibody [IFA] test. Two hundred and forty samples were from suspected cases of Toxoplasmosis. Forty [17%] cases were positive for IgG antibody. Seven [3%] of these cases showed antibody titre greater than 1:320. Of 65 children tested, 8 [12.30%] were positive. Four [6%] children had a rising titre from 1:160 to 1:1025. Prevalence of Toxoplasma antibodies was correlated to mode of living, maternal obstetric history, their animal contact and age of the children