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Abstract Background Mucormycosis is a serious fungal infection associated with uncontrolled diabetes and immunocompromised patients. This angioinvasive infection emerged as a post‐covid complication worldwide especially in developing countries. Due to the common socio‐demographic status of South Asian countries, we expected a surge in mucormycosis cases in Pakistan. This study aims to observe the frequency and survival of Covid associated mucormycosis patients at tertiary care hospitals in Pakistan during the third wave of Covid‐19 in 2021. Materials and Methods In this retrospective study, we collected the data of clinically and histopathologically confirmed cases of rhino‐occipito‐cerebral mucormycosis from three tertiary care hospitals of Lahore. These cases were analysed for history of Covid‐19 and other associated comorbidities using SPSS28. History of steroid medication was also taken. Data were retrieved from May to July 2021 after the approval from the ethical review board. Results Out of the total 43 reported patients of mucormycosis in the set time frame only 22 cases had a history of Covid‐19. The mean age was 50 ± 13.27 years with slight male predilection (60%). Diabetes mellitus was the most common comorbidity (88.4%) and all the patients with covid associated mucormycosis (CAM) had taken corticosteroid regimen for covid management (p

Using anti-epileptic drugs in neurosurgery patients is a routine practice. This controlled trial aimed to assess whether prophylaxis with Valproate in brain surgery patients is justified or not. Group A (n=50; controls) patients received valproic acid postoperatively for three months, while group B (n=50; subjects) received a placebo. Serum valproic acid levels between 50-125g/ml were required. Kendall’s Tau was applied to see the correlation between the ‘frequency of seizures’ between different surgical procedures performed and the extent of manipulations-EOMs. A wireless EMOTIV EPOC device was used to visualize the Electroencephalogram patterns. In controls, 12 patients had one seizure and only two patients had 2 seizures. In the placebo group, 13 patients had one and 4 patients had 2 seizures. The seizure frequency was highest amongst brain tumor patients. An insignificant difference was found between the seizure frequencies of the placebo and control groups. A statistically insignificant correlation was found between seizure frequency and independent variables: surgical procedures and EOM (%). Using an AED or not, the frequency of seizures did not substantially reduce over the postoperative period. If not necessary, the anti-epileptic medication that is frequently provided as a prophylactic against seizures in the post-operative period should not be administered. [ABSTRACT FROM AUTHOR]

Background: The introduction of endovascular aortic repair has revolutionised the treatment of abdominal aortic aneurysms, replacing open surgical repair for the majority of elective cases due to its optimal morbidity and mortality. Several endovascular aortic repair stent grafts exist commercially, one of which is the Fenestrated Anaconda™ by Terumo Aortic which benefits from a very innovative design, unique custom-made approach and highly favourable results. Aims: The main scope of this narrative review is to provide a comprehensive overview of endovascular aortic repair clinical outcomes using the Fenestrated Anaconda™ stent-graft and comparing these with its market competitor, Zenith. This review will also examine the evidence in the literature on the Anaconda™'s custom-made approach. Methods: A comprehensive literature was conducted on several search engines including PubMed, Google Scholar, Ovid, Scopus and Embase to collate the evidence in the literature on clinical outcomes achieved with the Fenestrated Anaconda™ and Zenith including, but not limited to, survival, technical success, target vessel patency, endoleak, reintervention and aneurysm sac regression. Results: The Fenestrated Anaconda™ is associated with excellent results, including highly favourable survival, technical and clinical success and target vessel patency rates, very low need for reintervention or conversion, and minimal incidence of complications such as endoleak and endograft migration. The Fenestrated Anaconda™ also drives significant sac regression and aortic remodelling. In addition, its unique custom-made approach enables it to treat highly complex aortic anatomy as well as to 'rescue' failed competitor grafts. Conclusion: The Fenestrated Anaconda™ has proven that it is a very safe, highly applicable and extremely effective device used for complex aortic and/or iliac pathology based on its novel design and outstanding track record of clinical outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background In Xenopus retinogenesis, p27Xic1, a Xenopus cyclin dependent kinase inhibitor, functions as a cell fate determinant in both gliogenesis and neurogenesis in a context dependent manner. This activity is essential for co-ordination of determination and cell cycle regulation. However, very little is known about the mechanism regulating the context dependent choice between gliogenesis versus neurogenesis. Results We have identified NM23-X4, a NM23 family member, as a binding partner of p27Xic1. NM23-X4 is expressed at the periphery of the ciliary marginal zone of the Xenopus retina and the expression overlaps with p27Xic1 at the central side. Our in vivo functional analysis in Xenopus retina has shown that knockdown of NM23-X4 activates gliogenesis. Furthermore, co-overexpression of NM23-X4 with p27Xic1 results in the inhibition of p27Xic1-mediated gliogenesis, through direct interaction of NM23-X4 with the amino-terminal side of p27Xic1. This inhibitory effect on gliogenesis requires serine-150 and histidine-148, which correspond to the important residues for the kinase activities of NM23 family members. Conclusion This study demonstrates that NM23-X4 functions as an inhibitor of p27Xic1-mediated gliogenesis in Xenopus retina and suggests that this activity contributes to the proper spatio-temporal regulation of gliogenesis.

A total of 270 glioblastoma patients were treated for tumor resection during 2004 to 2014. The following variables were examined: patient age group (PAG) and percent of the extent of resection (EOR) in four types of resections: gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy/decompression (BD). The Karnofsky performance scale (KPS) was used and the average survival time noted. The least survival time (7 months) was noticed in the patient age group 18 to 35 years with biopsy only, whereas, the maximum survival time (14.5 months) was noted with the patient age group 54 to 71 years by gross tumor resection. The largest number of (n = 76) patients had PR (80%) and these patients had an average survival time of 10.5 months. Total 190 patients out of 270, with EOR (100-80%) had a KPS score "0" (80 and above) and total 80 patients out of 270 patients, with EOR (50%) had a KPS score "1" (below 80). The correlation was statistically significant at (p < 0.050) for EOR (%) and KPS score (0/1) only. Correlation analysis showed that the maximum resection has a strong impact on the glioblastoma patient's survival. A lesser EOR correlated with poor quality of life and also a decreased survival of patients. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is based on a comparison of freehand and stereotactic biopsy regarding diagnostic yield in terms of adequate tissue sample, morbidity in terms of postoperative complications like neurological deficit, bleeding, infection etc. and mortality. Material and Methods: A randomized clinical study was carried out and included 70 patients (35 patients underwent freehand biopsy and 35 patients underwent stereotactic biopsy). The data was collected for variables including age, sex, location and size of tumor. The outcome was assessed by diagnostic yield in terms of adequate tissue sample, morbidity in terms of postoperative complications like neurological deficit, bleeding, infection etc. and mortality between the two groups was compared. Results: Total 70 biopsies were excised and 35 (50%) of them underwent freehand biopsy while the rest of 35 (50%) underwent stereotactic biopsy. Freehand biopsy was associated with 5.71% morbidity, compared to 2.85% morbidity for stereotactic biopsy. Four freehand biopsies (11.42%) and two stereotactic biopsies (5.71%) were non-diagnostic. Statistical analysis showed no significant difference between morbidity in the two groups. The rate of diagnostic failure between two groups was not significantly different with a p-value of 0.673, but it was found significant clinically. Conclusion: Stereotactic biopsy has provided us with a powerful and a safer tool to provide tissue diagnosis with minimal disruption of the normal-functioning studies, though with minimal morbidity. Our study is comparable to other international studies there is very little difference in the morbidity but significant difference in diagnostic yield. [ABSTRACT FROM AUTHOR]

Objectives: To assess environmental factors that may influence formation of brain tumors and to evaluate alterations in blood parameters of high grade brain tumor (HGBT) and low grade brain tumor (LGBT) patients. Methods: After WHO classification of brain tumors, CBC parameters were evaluated for all groups, i.e., HGBT patients, LGBT patients and control group (CG). Mean values of CBC (complete blood count) parameters were compared statistically with T test between patients and CG. Results: Most reported tumor grade was glioblastoma. Most of the parameters were found below the normal range for both HGBT and LGBT patients. CBC parameters were altered in majority of HGBT patients as compared to LGBT patients. According to T test, statistically significant differences were observed (p<0.050) in the mean values of following parameters between CG and patients: hemoglobin, white blood cells, hematocrit, red blood cells, lymphocytes, neutrophils, absolute lymphocyte count and absolute neutrophils count. Most affected parameter was lymphocyte which was low both in HGBT and LGBT patients. Conclusion: Environmental factors such as contamination of nitrate by agriculture practices and chlorinated byproducts in drinking water were suspected to be associated with the brain tumor formation. Ionizing radiations were considered another factor of brain tumor incidence among the patients who came from areas where terrestrial radiation activity is found. Hematological abnormalities can occur in brain tumor patients and this study affirms that brain tumor cells may be modulating host immune response. Peripheral blood cells may have genetic markers correlating with brain tumor development. [ABSTRACT FROM AUTHOR]

Pakistani Himalaya stretches over a wide range of altitudinal gradients and supports high diversity of medicinal plants that are an important source for rural livelihood. Altitudinal effects on ground vegetation have already been indicated but ground vegetation is also under severe threat of grazing and over collection. The present study investigated the effect of altitude on medicinal plants abundance in both old-growth and derived woodland forests. Each of the five line transects was selected in old-growth and derived woodland forests. Each line transect consisted of four plots distributed at four altitudinal levels (2200, 2300, 2400, and 2500 m asl). Species richness under derived woodland had shown strong negative correlation (r = -0.95) with altitude while it was found to be nonsignificant under old-growth. Cover of most of the species such as Veronica laxa (r = -0.95, P ≤ 0.05) had shown significant negative correlation with altitude under derived woodland. Cover abundance of some species like Valeriana jatamansi and Viola canescens has also shown significant negative correlation under old-growth forest. Derived woodland can decrease the cover abundance of valuable medicinal plants towards extension at higher altitudes. Thus, protection of the derived woodland could serve as a tool for the improvement of rural livelihood and ecological restoration.

Objectives: To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center., Methods: This observational study was conducted at Children Hospital Quetta (CHQ) from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot® tests were performed for the diagnosis of Typhoid fever in the suspected populations., Results: Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis., Conclusion: The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever.