CRISPR-Cas System: A New Dawn to Combat Antibiotic Resistance.

Antimicrobial resistance (AMR) can potentially harm global public health. Horizontal gene transfer (HGT), which speeds up the emergence of AMR and increases the burden of drug resistance in mobile genetic elements (MGEs), is the primary method by which AMR genes are transferred across bacterial pathogens. New approaches are urgently needed to halt the spread of bacterial diseases and antibiotic resistance. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR), an RNA-guided adaptive immune system, protects prokaryotes from foreign DNA like plasmids and phages. This approach may be essential in limiting horizontal gene transfer and halting the spread of antibiotic resistance. The CRISPR-Cas system has been crucial in identifying and understanding resistance mechanisms and developing novel therapeutic approaches. This review article investigates the CRISPR-Cas system's potential as a tool to combat bacterial AMR. Antibiotic-resistant bacteria can be targeted and eliminated by the CRISPR-Cas system. It has been proven to be an efficient method for removing carbapenem-resistant plasmids and regaining antibiotic susceptibility. The CRISPR-Cas system has enormous potential as a weapon against bacterial AMR. It precisely targets and eliminates antibiotic-resistant bacteria, facilitates resistance mechanism identification, and offers new possibilities in diagnostics and therapeutics.

THEILERIA EQUI INFECTION IN WORKING HORSES OF PAKISTAN: EPIDEMIOLOGY, MOLECULAR CHARACTERIZATION, AND HEMATOBIOCHEMICAL ANALYSIS.

Theileria equi is 1 of the emerging and prevailing tick-borne hemoprotozoans adversely affecting the equids worldwide, including Pakistan. The current study aimed to investigate the prevalence and molecular characterization of T. equi in working horses (n = 194), the comparative efficacy of different diagnostic tests, associated risk factors, and hematobiochemical analysis. The blood samples of horses were subjected to microscopic examination, cELISA, and polymerase chain reaction (PCR) and the results revealed a prevalence of 9.79, 21.13, and 13.40%, respectively, for T. equi in working horses. The comparison of microscopy and cELISA results with PCR showed that cELISA had higher sensitivity (84.62%), but lower specificity (88.69%) and accuracy (88.14%) in comparison to microscopy (57.69, 97.62, and 92.27%). Molecular characterization of T. equi by phylogenetic analysis revealed a 61% resemblance of study isolates with each other OL662926, OL662925, and 82% similarity with isolate OL662924 while also showing homology with T. equi isolates of South Africa, South Korea, India, Pakistan, and Brazil. The risk factor analysis revealed a significant association (P < 0.05) of tick control status, previous tick history, tick infestation, house hygiene, deworming/vaccination, and the presence of other livestock species with T. equi infection in horses. The hematobiochemical profile revealed a significant (P < 0.05) decrease in red blood cells (RBCs), hemoglobin (Hb), packed cell volume (PCV), white blood cells (WBCs), platelet (PLT), phosphorus, and an increase in lymphocytes, granulocytes, aspartate aminotransferase (AST), glucose, bilirubin, blood urea nitrogen (BUN), and creatinine in T. equi-infected horses. The current study is the first comprehensive report for comparative evaluation of microscopy, cELISA, and PCR, assessment of epidemiological risk factors as well as hematobiochemical variations due to T. equi infection in Pakistan.

Back-table fenestrated endograft limb inversion for type Ia endoleak repair.

We present a case of a type Ia endoleak from an aortic endograft in close proximity to the renal arteries that was successfully treated with a back-table physician-modified endograft with inversion of the contralateral limb. This modification allowed for deployment of a fenestrated cuff and bifurcated distal main body over the flow divider of the previous endograft, thus avoiding the need for either an open aneurysm repair, physician-made fenestrations, or aorto-uni-iliac repair with femoral-femoral bypass. This case demonstrates that back-table physician-modified endograft contralateral limb inversion is an easy, reproducible, and effective technique.

Molecular evidence of ß-lactam resistant Staphylococcus aureus in equids with respiratory tract infections: Frequency and resistance modulation strategy.

The emergence of antimicrobial-resistant strains in Staphylococcus aureus (ß-lactam and methicillin-resistant) is an overwhelming issue worldwide. Using the purposive sampling technique, 217 equids samples were collected from district Layyah which were subjected to culturing followed by genotypic identification of mecA and blaZ genes by PCR. This study revealed that by phenotypic methods, a prevalence of 44.24%, 56.25%, and 47.92% was found for S. aureus, MRSA, and ß-lactam resistant S. aureus in equids. While genotypically, MRSA was found in 29.63% and ß-lactam resistant S. aureus in 28.26% of equids. In-vitro antibiotic susceptibility testing against S. aureus isolates harboring both mecA and blaZ genes showed a high resistance against Gentamicin (75%), followed by Amoxicillin (66.67%) and Trimethoprim+sulfamethoxazole (58.34%). In an attempt to re-sensitize the resistant bacteria to antibiotics, a combination of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) was used which revealed synergistic effect of Gentamicin and Trimethoprim+sulfamethoxazole with Phenylbutazone; and Amoxicillin with Flunixin meglumine. Analysis of risk factors revealed significant association with the S. aureus-associated respiratory infection in equids. Phylogenetic analysis of mecA and blaZ genes showed a high resemblance of study isolate's sequences with each other and variable resemblance with already reported isolates obtained from different samples of neighboring countries. This study reports the first molecular characterization and phylogenetic analysis of ß-lactam and methicillin resistant S. aureus in equids in Pakistan. Moreover, this study will help in the resistance modulation of resistant antibiotics (Gentamicin, Amoxicillin, Trimethoprim+sulfamethoxazole) and provide a good insight into planning an effective therapeutic regime.

Pharmacological Effects of Houttuynia cordata Thunb (H. cordata): A Comprehensive Review.

Houttuynia cordata Thunb (H. cordata) is a rhizomatous, herbaceous, and perennial plant widely distributed in Asia. It has multiple chemical constituents, such as alkaloids, essential oils, phenolic acids, and flavonoids used against various health problems. The essential oils and flavonoids are the main components of H. cordata that play an essential role in disease treatment and traditional health care. Moreover, the leaves and stems of H. cordata have a long medicinal history in China. In addition, H. cordata is used against several health issues, such as cold, cough, fever, pneumonia, mumps, and tumors, due to its anti-inflammatory, anti-bacterial, anti-viral, anti-oxidant, and anti-tumor effects. It protects organs due to its anti-inflammatory activity. H. cordata regulates immunity by enhancing immune barriers of the oral cavity, vagina, and gastrointestinal tract, and shows broad-spectrum activity against liver, lung, breast, and colon tumors. However, there are some gaps to be filled to understand its pathways and mechanisms. Mechanisms such as its interaction with cells, cell membranes, and various drugs are important. Studies in relation to the blood-brain barrier, lipophilicity, cAMP signaling, and skin permeability, including pharmaceutical effects, will be very useful. This review includes the biological and pharmacological activities of H. cordata based on up-to-date research.

Social assistance programme impacts on women's and children's diets and nutritional status.

Investments in social assistance programmes (SAPs) have accelerated alongside interest in using SAPs to improve health and nutrition outcomes. However, evidence of how design features within and across programme types influence the effectiveness of SAPs for improving diet and nutrition outcomes among women and children is limited. To address this, we reviewed evaluations of cash, in-kind and voucher programmes conducted between 2010 and 2020 among women and children, and examined associations between design features (targeting, including household and individual transfers, fortified foods and behaviour change communication) and positive impacts on diet (diet diversity, micronutrient intake) and nutrition (anthropometric indicators, haemoglobin, anaemia) outcomes. Our review has several key findings. First, SAPs improve dietary diversity and intake of micronutrient-rich foods among women and children, as well as improve several nutrition outcomes. Second, SAPs were more likely to impact diet and nutrition outcomes among women compared with children (23/45 [51%] vs. 52/144 [36%] of outcomes measured). Third, in-kind (all but one of which included fortified foods) compared with cash transfer programmes were more likely to significantly increase women's body mass index and children's weight-for-height/length Z-score, and both women's and children's haemoglobin and anaemia. However, there is limited evidence on the effectiveness of SAPs for improving micronutrient status and preventing increased prevalence of overweight and obesity for all populations and for improving diet and nutrition outcomes among men, adolescents and the elderly. Further research in these areas is urgently needed to optimize impact of SAPs on diet and nutrition outcomes as countries increase investments in SAPs.

Bacterial Symbionts Confer Thermal Tolerance to Cereal Aphids Rhopalosiphum padi and Sitobion avenae.

High-temperature events are evidenced to exert significant influence on the population performance and thermal biology of insects, such as aphids. However, it is not yet clear whether the bacterial symbionts of insects mediate the thermal tolerance traits of their hosts. This study is intended to assess the putative association among the chronic and acute thermal tolerance of two cereal aphid species, Rhopalosiphum padi (L.) and Sitobion avenae (F.), and the abundance of their bacterial symbionts. The clones of aphids were collected randomly from different fields of wheat crops and were maintained under laboratory conditions. Basal and acclimated CTmax and chronic thermal tolerance indices were measured for 5-day-old apterous aphid individuals and the abundance (gene copy numbers) of aphid-specific and total (16S rRNA) bacterial symbionts were determined using real-time RT-qPCR. The results reveal that R. padi individuals were more temperature tolerant under chronic exposure to 31 °C and also exhibited about 1.0 °C higher acclimated and basal CTmax values than those of S. avenae. Moreover, a significantly higher bacterial symbionts' gene abundance was recorded in temperature-tolerant aphid individuals than the susceptible ones for both aphid species. Although total bacterial (16S rRNA) abundance per aphid was higher in S. avenae than R. padi, the gene abundance of aphid-specific bacterial symbionts was nearly alike for both of the aphid species. Nevertheless, basal and acclimated CTmax values were positively and significantly associated with the gene abundance of total symbiont density, Buchnera aphidicola, Serratia symbiotica, Hamilton defensa, Regiella insecticola and Spiroplasma spp. for R. padi, and with the total symbiont density, total bacteria (16S rRNA) and with all aphid-specific bacterial symbionts (except Spiroplasma spp.) for S. avenae. The overall study results corroborate the potential role of the bacterial symbionts of aphids in conferring thermal tolerance to their hosts.

Clinical outcomes of hepato-pancreato-biliary surgical patients during COVID-19 pandemic.

OBJECTIVE: To determine the outcome of hepato-pancreato-biliary patients who were operated upon during the pandemic under a safety protocol devised to minimise the risk of coronavirus disease-2019 infection in patients and staff during the perioperative period. METHODS: The retrospective study was conducted at the Hepato-Pancreatico-Biliary (HPB) Unit of Bahria International Hospital Orchard, Lahore, Pakistan, in February 2021, and comprised data of all patients who were discussed in the multidisciplinary meeting of the Unit between May 1 and December 31, 2020. The coronavirus disease-2019 screening protocol was a negative polymerase chain reaction test just before admission and a second negative test 24-48 hours pre-surgery. All patients had computed tomography scan of chest to rule out atypical pneumonia due to coronavirus disease-2019 infection. Surgery was deferred for positive patients for at least 2 weeks until their test was negative. Surgeries were carried out with full personal protective equipment. Further testing was carried out if clinically indicated. Data was collected of 30-day coronavirus disease-2019-related morbidity and mortality. Data was analysed using SPSS 20. RESULTS: Of the 44 patients, 29(65.9%) were males and 15(34.1%) were females. Overall, 32(72.7%) patients were aged >40 years, 8(18.2%) were aged 20-40 years and 4(9%) were aged <20 years. Of the total, 7(15.09%) patients were found to be positive for coronavirus disease-2019 during preoperative screening. Among them, 5(71.4%) had successful surgery post-recovery, 1(14.3%) died without surgery due to pulmonary complications related to coronavirus disease-2019 and 1(14.3%) patient was lost to follow-up. Among the 42(95.5%) patients who underwent any procedure, 2(4.7%) patients turned positive for coronavirus disease-2019 in the postoperative period. There was 1(2.4%) mortality in the 30-day post-operative period which was not related to coronavirus disease-2019. Complications were seen in 5(11.90%) patients. Three (9.3%) out of 32 staff members were found to be asymptomatic carriers. CONCLUSIONS: Hepato-pancreatico-biliary surgery could be safely carried out during coronavirus disease-2019 pandemic if strict safety protocols were followed.

Management of a giant carbuncle on the posterior trunk with excision and grafting.

Carbuncle is a painful subcutaneous mass of interconnected infected hair follicles with multiple discharging sinuses. It has predisposition in conditions like diabetes, immune-compromised states, chronic skin diseases etc. The authors present a case of a 67 year old diabetic male admitted in July 2020 at Akbar Niazi Teaching Hospital (ANTH) Islamabad, with a giant carbuncle on his back. Due to its large size, systemic co-morbidity, and increased risk of complications in surgical treatment, a multi-disciplinary team approach was employed. Both general and plastic surgeons were involved, who performed excision and soft tissue coverage respectively. The aim of the surgical intervention methods, like wide excision and debridement, application of vacuum assisted wound closure (VAC), and skin grafting was to minimise the healing time and risk of development of post-operative infection. The patient was surgically managed and sent home in a good condition.

Gallstone Ileus with COVID-19 Infection: An Unintended Sequela of Non-Operative Management of Acute Cholecystitis During the COVID-19 Pandemic.

Appropriate risk stratification and careful follow-up are mandated in elderly patients with comorbidities. Herein, we report a case presenting 5 months after the nonoperative management of acute cholecystitis during the height of the COVID-19 pandemic.

The Processed food revolution in African food systems and the Double Burden of Malnutrition.

African consumers have purchased increasing amounts of processed food over the past 50 years. The opportunity cost of time of women and men has increased as more of them work outside the home, driving them to buy processed food and food prepared away from home to save arduous home-processing and preparation labor. In the past several decades, this trend has accelerated with a surge on the supply side of the processing sector and small and medium enterprises (SMEs) and large private companies making massive aggregate investments. Packaged, industrialized, ultra-processed foods and sugar-sweetened beverages (SSBs) are a growing proportion of the processed food consumed. Also, in the past several decades, overweight and obesity have joined the long-standing high levels of stunting and wasting among children and extreme thinness among women of childbearing age. Together these phenomena have formed a double burden of malnutrition (DBM). The DBM has emerged as an important health problem in sub-Saharan Africa. The rise of the DBM and the increase in ultra-processed food consumption are linked. Policy makers face a dilemma. On the one hand, purchases of processed food are driven by long-term factors, such as urbanization, increased income, and employment changes, and thus policy cannot change the pursuit of convenience and labor-saving food. Moreover, much processed food, like packaged milk, is a boon to nutrition, and the processed food system is a major source of jobs for women. On the other hand, the portion (some 10-30%) of processed food that is ultra-processed is a public health challenge, and policy must address its detrimental effects on disease burden. The global experience suggests that double duty actions are most important as are selected policies focused on healthy weaning foods for addressing stunting and taxes on SSBs, nutrition labeling, and other measures can steer consumers away from unhealthy ultra-processed foods to addressing obesity and possibly child nutrition and stunting. We recommend that African governments consider these policy options, but note that the current extreme fragmentation of the processing sector, consisting of vast numbers of informal SMEs in sub-Saharan Africa, and the limited administrative/implementation capacity of many African governments require pursuing this path only gradually.

Video assisted thoracoscopic management of primary spontaneous pneumothorax.

OBJECTIVE: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). METHODS: This case series was carried out from Jan 2010 to Jan 2017 in Department of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anaesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. RESULTS: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax 37 (37.7%), persistent air leak 19 (19.38%) and contra lateral pneumothorax n=4 (4.08%). Mean age was 22.8 ± 6.5 years. Majority of the cases , 69(70.4%) were in stage 3 of Vanderschueren's classification. Stage 4 were (18.5%) and stage 2 were 7 (7.14%). Mean operative time was 51 ± 14. 4 minutes. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 ±5.5 months, range 5-24 months for all patients. One had generalized recurrence and 2 patients had subpulmonic trapping of air. CONCLUSION: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence.

Ribavirin targets sugar transporter 6 to suppress acquisition and transmission of rice stripe tenuivirus by its vector Laodelphax striatellus.

BACKGROUND: Rice stripe tenuivirus (RSV) is one of the most destructive pathogens of rice and other cereal crops. The virus is transmitted by the small brown planthopper (SBPH, Laodelphax striatellus) in a circulative-propagative manner. Thus, blocking transmission by the insect vector would provide an effective strategy to prevent epidemic outbreaks of the disease. RESULTS: In this study, we explored the effect of ribavirin on acquisition and transmission of the virus by specifically inhibiting the expression of sugar transporter 6 (LsSt-6), which was recently reported as a key vector component for RSV transmission. Ribavirin at the highest concentration tested (250 µmol L-1 ) significantly reduced RSV acquisition and transmission efficiency by SBPHs through inhibiting LsSt-6 messenger RNA (mRNA) level. Survival of the model insect Spodoptera frugiperda cell line (Sf9) was 95.0 ± 2.2 and 85.6 ± 2.1% after exposure to 250 µmol L-1 ribavirin or 8-azaguanine, respectively. Further study confirmed that 250 µmol L-1 ribavirin also significantly reduced LsSt-6 mRNA and protein levels in Sf9 cells. However, 8-azaguanine did not significantly inhibit viral infectivity and LsSt-6 mRNA levels in SBPH or the Sf9 cell line. CONCLUSION: This result provides evidence that ribavirin has the potential to disrupt LsSt-6 expression but not others like viral RNAs to prevent acquiring RSV, which leads to less viral accumulation in SBPH tissues and thereby lower transmission efficiency. © 2020 Society of Chemical Industry.

Outcome Analysis Of Total Laryngopharyngeal Oesophagectomy In Carcinoma Hypo-Pharynx And Cervical Esophagus, With Stomach Reconstruction.

BACKGROUND: Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result. METHODS: It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. Thirty-five patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases. RESULTS: Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak. Postop 28 days mortality was 8.57% (n=3). CONCLUSIONS: TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.

The complete genomic sequence of a new iflavirus from the leafhopper Psammotettix alienus.

A novel iflavirus, tentatively named "Langfang leafhopper iflavirus" (LfLHV) was detected in leafhopper (Psammotettix alienus) by total RNA sequencing, and its genome sequence was confirmed by Sanger sequencing. The complete genome consisted of 10,700 nucleotides (nt) excluding the poly A tail and included one open reading frame (9,453 nt in length), encoding a polyprotein of 3,150 amino acids (aa). The nucleotide sequence of the complete genome was shared 44.1-53.3% identical, and the deduced amino acid sequence RNA-dependent RNA polymerase (RdRp) 22-74% identical to those of other iflaviruses. These values were all below the species demarcation threshold of 90%. Conserved motifs for structural proteins, helicase, protease, and RdRp were also similar to those in other iflaviruses. These results, as well as those of phylogenetic analysis based on the deduced amino acid sequences of the polyprotein and RdRp of LfLHV and other iflaviruses, indicate that the sequence represents a novel virus of the family Iflaviridae.

Decortication as an Option for Empyema Thoracis.

OBJECTIVE: To analyse the outcome and morbidity associated with decortication in empyema thoracis. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Departments of Surgery, Combined Military Hospitals (CMH) of Rawalpindi, Quetta and Lahore, from January 2006 to March 2018. METHODOLOGY: This is a retrospective study of 812 cases of open and VATS (video-assisted thoracic surgery) decortication for empyema thoracis, operated by the same consultants. Only patients with established empyema were included. Those who were unfit for one-lung ventilation, undergoing local anesthesia procedures like rib resection, clagget window or tube windows, with clotted hemothorax and malignant pathology were excluded. Posterolateral serratus sparing thoracotomy was used in open decortications. Multiportal or uniport VATS was employed for video-assisted thoracoscopic decortications (VATD). Histopathology and microbiological sampling was also done in all cases. RESULTS: There were 537 (66.1%) males and 275 (33.9%) females. Age ranged from 1 to 80 years with a mean of 37 years. Open decortication was done in 650 (80%), standard decortication with posterolateral thoracotomy in 458 (56.4%), minithoracotomy was done in 69 (8.4%) patients with loculated empyema, thoracotomy and open decortication with conventional thoracoplasty was done in 21 patients. Twenty-two patients required open decortications with tailored thoracoplasty and muscle flap. Open decortication with intercostal muscle (ICM) flap or primary closure of bronchopleural fistula was performed in 55 patients. VATD was done in 162 cases, out of which 120 were early empyema, and 42 were of chronic empyema; of which 22 required a further utility thoracotomy. Decortication with lung resection and muscle flap reinforcement to bronchial stump was done in 25 patients. Blood transfusion was required in 331 (40.7%). Twenty-six (3.4%) patients developed residual space and collection requiring intervention; and 384 (47.3%) patients had a histopathology diagnostic for tuberculosis. There were 11 (1.3%) deaths. CONCLUSION: Open decortication is still one of the preferred procedures in developing countries. VATD is also increasingly utilised for empyema.

Pediculated Intercostal Muscle Flaps in Bronchiactasis Resectional Surgery for Bronchial Stump Reinforcement.

OBJECTIVE: To determine the outcome of muscle flap to cover the bronchial stump in the resectional surgery for bronchiectasis for prevention of bronchopleural fistula. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Combined Military Hospitals of Quetta, Lahore, and Rawalpindi from January 2006 to August 2017. METHODOLOGY: Patients with localised bronchiectatic changes were included. Patients with carcinoma and without flap resection were excluded. Resectional surgery was performed through posterolateral thoracotomy approach, under general anesthesia with one lung ventilation. Pediculated or bipediculated intercostal muscle flap (ICM) was used to reinforce the bronchial stump. Pediculated ICM flaps were utilised for reinforcement of bronchial stump and bipediculated flaps were used over lesser. RESULTS: Three hundred and ninety-eight cases of bronchiectasis with average age of patients 38.5 ±19.8 years and male to female ratio of 2:1 were included. Bronchiectasis was unilateral in 377 cases. Tuberculous was found in 278 of the cases. Thirty-five had poor lung function tests (FEV1 <1.5%). Eighty-two patients underwent pneumonectomy, 228 patients had lobectomy and 88 patients underwent segmentectomy. Posterior-based pediculated ICM flap was used in 365 patients, and bipediculated ICM flaps in 30 cases. The most common complication was post-thoracotomy neuralgia 53. Bronchopleural fistula, despite transposition of intercostal muscle flap on bronchial stump, was present in 4 patients. CONCLUSION: Application of muscle flap over bronchial stump after resection surgery for bronchiectasis, is simple, safe and effective surgical option to avoid complication of bronchopleural fistula.

Complex Tibial Plateau Fractures: Primary Fixation Using the Ilizarov External Fixator. A Two-year Study at Civil Hospital Karachi, Pakistan.

Background The proximal tibia with the meta-diaphysis junction is a critical weight-bearing area. An injury around this region may be restricted to the tibia or associated with a significant soft-tissue injury. The objective of the present study is to assess the results of closed reduction and Ilizarov external fixation in the management of complex tibial plateau fractures. Patients and methods The study included 26 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 60 years, with an average of 35 years. The trauma was a road traffic accident in 19 cases and a fall from a height in eight cases. The fractures were closed in 18 cases and open in five. The open fractures were Gustilo-Anderson type I in three cases and type II in five cases. Soft-tissue injuries associated with closed fractures were classified according to the Tscherne system. The follow-up period averaged 24 months. The average time of surgery was 85 mins (range: 60-120 min). The mean time to union was 12 weeks. At the final follow-up, the average total range of knee flexion was 120° (range: 0-170°). Results Results were satisfactory in 22 cases and unsatisfactory in four cases according to Rasmussen's knee functional score. Complications included pin-tract infection in 10 cases, an extension lag in three cases and varus deformity of about 17° in one case. Conclusion Hybrid external fixation is a good method for the treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.

Diagnostic accuracy of Focused Assessment with Sonography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia.

OBJECTIVES: To determine the diagnostic accuracy of  Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma caused by motor vehicle accidents at our Hospital in Dhahran city. METHODS: This descriptive, observational study was conducted in the Radiology Department at King Fahad Military Medical Complex   Dhahran, Saudi Arabia between September 2016 and September 2017.  All adult patients (n=105) involved in motor vehicle accidents with blunt abdominal injury on presentation were retrospectively reviewed for FAST and CT scans for detection of free fluid. Focused assessment with sonography for trauma studies were conducted or supervised by senior registrar of general surgery (trauma team leader). Computed tomography findings were reviewed by 2 experienced radiologists. High and low-grade solid abdominal visceral (liver, spleen, kidney) injuries were identified on CT scans. Focused assessment with sonography for trauma and CT scan findings were identified as 'positive' and 'negative' for presence and absence of free fluid respectively. Outcomes of FAST were presented on a 2x2 contingency table. RESULTS: Sensitivity of FAST in detecting intraperitoneal free fluid was calculated as 76.1% (95% confidence interval [CI], 64.14-85.69%), specificity 84.2% (95% CI, 68.75-93.98%) and accuracy 79% (95% CI, 70.01-86.38%). Focused assessment with sonography for trauma detected free fluid in most cases of high-grade solid visceral injuries. Nearly half of true-negative cases were having low grade visceral or other injuries. CONCLUSION: Focused assessment with sonography for trauma is an important tool in initial assessment of suspected blunt abdominal injury patients with high sensitivity and specificity. A negative FAST does not exclude low grade solid visceral or other injuries.