in vitro comparative study of growth media, sera and FSH effects on the growth and maturation of Syrian mice preantral follicles and enclosed-oocytes

Developing a culture system for preantral follicles has important biotechnological implications due to the potential to produce a large number of oocytes for embryo production and transfer. To accomplish this goal, the present study was aimed to culture preantral follicles in the presence of different media, sera and FSH concentrations. Six-week-old preantral follicles [95 +/- 5 micro m] were cultured in North Carolina State University medium 23 [NCSU23], tissue culture medium 199 [TCM199] and leibovitz-15 medium [L-15] for 6 days. Tissue culture medium 199 showed a significant increase in the follicle diameter [115 micro m], survival [39%], oocyte maturation [32%] and germinal vesicle breakdown [GVBD] [29%] rates as compared to L-15 and NCSU23 [P<0.05]. A 6-day culture showed increased follicular growth as compared to 2, 4 and 8-days [P<0.05]. When the experiment was run with 1, 2, 5 and 10% fetal calf serum [FCS], prepubertal gilt serum [PGS], embryonic stem cell fetal calf serum [ESFCS] and hypogonadal mouse serum [hpgMS], the 5% FCS showed increased follicle diameter [134 micro m], survival [52%], oocyte maturation [49%] and GVBD [45%] as compared to control and other types of sera used [P<0.05]. While 100 mIU/ml FSH + 5% FCS in TCM199 showed a significant increase in follicle diameter [197 micro m], survival [96%], oocyte maturation [91%] and GVBD [67%: P<0.0001]. So, it is concluded that the TCM199 medium, with the addition of 100 mIU/ml FSH and 5% FCS, is appropriate for the optimal in vitro growth of Syrian mice preantral follicles and enclosed oocytes

Awareness and attitudes amongst basic surgical trainees regarding radiation in orthopaedic trauma surgery

This study investigated the awareness and attitudes of basic surgical trainees. Trainees were asked to answer questions from a pre-set questionnaire. Fifty basic surgical trainees from England and Wales were involved in the study. The areas covered were basic knowledge of radiation hazards, use of protective wear, pregnancy test in female trauma victims of reproductive age, and principles of safe radiation. All the questions were asked in the context of orthopaedic trauma surgery. All questions were evidence based. It was unfortunate to notice that basic surgical trainees are lacking in the essential knowledge of ionising radiation. Most of the trainees are not adhering to radiation safety principle, and are not practising safely. The authors strongly recommend that surgical trainees should have more robust training and information available in this context. And they suggest that it should be provided on local, regional and national basis.

[Antimicrobial activities of TiO[2] nanoparticle against escherichia coli and staphylococcus aureus]

Organic antibacterial materials have been used as insecticides and bactericides for many years. Unfortunately, high temperatures in manufacturing process reduce their antibacterial properties. However, inorganic material of antibacterial agents have excellent bacterial resistance and thermal stability. Over the past few decades, inorganic nanoparticles whose structures exhibit significantly novel and improved physical, chemical and biological properties and functionality due to their nano-scale size have elicited much interest. The aim of this study was to investigate the antibacterial properties of one kind of nano-specimens [TiO[2] nanoparticle] against Escherichia coli and Streptococcus aureus. Our study was research perusal. In the first study, the optical density of E.coli and S. aureus cultures were observed in the presence of 0.01%, 0.75% and 1.5% of TiO[2]. In the second study, 6.3 log CFU/ml of E.coli and S. areus were separately exposed to 1.5% TiO[2] at 37[degree sign] C in water. In third study, we studied the growth of E.coli in solid medium with and without nanoparticles. The presence of 0.01% TiO[2] nanoparticles didn't have a statistically significant effect, but in the presence of 0.75% and 1.5% nanoparticles, the bacterial colonies decreased significantly. In the control group, bacterial cells survival was nearly 13 days, while complete cell death of E.coli was seen when 1.5% TiO[2] was applied for 24 hours. The same experiment for S. aureus, showed that complete cell death occurred in the solid medium suppressed the growth of E.coli 5.6 times more [p<0.001]. Our findings showed antibacterial effects of TiO[2] nanoparticles against both bacteria, but S. areus bacteria were more sensitive to nanoparticles as compared to E.coli bacteria

Acute bacterial meningitis in adults: an analysis of 95 cases from Saudi Arabia

To study the clinical features, laboratory profiles, treatment especially door-to-antibiotic time and outcome in adult patients admitted with acute bacterial meningitis in a tertiary care hospital. Neurology and medical department, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Retrospective analysis of 95 consecutive cases of acute bacterial meningitis in adults admitted during study period from January 2000 till June 2005. Clinical and laboratory features, treatment and outcome were analyzed. Total of 95 patients were identified. There were 78[82%] males and 17[18%] females. The mean age was 30 years with range from 14 to 74. Out of the 95 patients, 52[54.7%] cases had meningitis caused by Neisseria meningitides and 16 [16.8%] by Streptococcus pneumoniae. There was one case of meningitis caused by Klebsiella and E. coli each. Latex agglutination [bacterial antigen detection] test was positive in 72 [75%] cases, Gram stain in 40 [42%], and CSF culture in 27 [28.4%]. Triad of fever, headache and neck stiffness or altered conscious level was seen in only 52% of cases. Sixty-five [68%] cases belonged to an African ethnic background and a low socio-economic class. Unfavorable outcome was seen in 19 [20%]. Overall mortality was 6.3% [6 out 95 cases]. Mortality was more with pneumococcal meningitis 12.5% [2out of the 16 cases] compared with meningococcal meningitis 4% [2 out of 52 cases]. Patients, who died, were admitted in deep coma [Glasgow coma scale below 8]. Acute bacterial meningitis remained common and life threatening infection in the community. Neisseria meningitides and Streptococcus pneumoniae are the two most common pathogens for bacterial meningitis in immuno-competent adults. An African ethnic background, poor socioeconomic class and overcrowding were the main predisposing factors. Triad of fever, headache and neck stiffness or altered mental status was seen in about half of the cases

Identification and preservation of the external laryngeal nerve during thyroid surgery: surgical and anatomic considerations

Iatrogenic injuries of external branch of superior laryngeal nerve [EBSLN] during thyroid surgery are not uncommon due to the possibility of anatomic variations in the relationship of this nerve with superior thyroid vessels and the result may be devastating to those patients who rely on their voices professionally. The study included 2 groups. Group A was a prospective nonrandomized analytical series of all consecutive patients undergoing thyroidectomies for various conditions in Surgical Unit II, Shaikh Zayed Postgraduate Medical Complex, Lahore, Pakistan during a three years period [November 2004 - November 2007]. This group consisted of 133 patients. Male to female ratio was 1:3. Mean age was 35.22 years [range: 17-71 years]. Ninety one [68.42%] patients had bilateral dissection [total, sub-total or neartotal thyroidectomies] and 42 [31.57%] had unilateral dissection [hemithyroidectomy I lobectomy and isthumusectomy]. Thus, a total of 224 superior polar dissections were carried out. Three [3 .296 %] patients out of the 91 patients in the bilateral dissection group had asymmetrical nerves. Eighty one [60.9%] patients had benign disease, 32 [24.06%] had malignancy and 20 [15.03%] had toxic goiter. Nerve could not be identified in 42 [18.75%] polar dissections [positive identification in 182 [81.25%] polar dissections]. Three [2.25 %] patients in this study had clearly documented EBSLN injury as determined by voice changes, patient interview and IDL. In Group B, the anterior neck triangles of 19 embalmed human cadavers [i.e. 38 neck half preparations] of both sexes and variable ages with neither enlarged thyroid glands nor any other signs of abnormality in this region were dissected in the dissection halls of two medical colleges in Lahore. The course and topographical relations [especially in relation to the superior thyroid vessels, superior pole of the thyroid and the cricothyroid muscle] of the EBSLN as well as bilateral asymmetry were noted as for Group A. Nerves were classified according to classification of Cernea et al. Good knowledge of the anatomy and relations of the EBSLN with meticulous dissection and ske letonisation and individual ligation of the superior polar vessels is the key to success

Cerebral venous thrombosis: clinical and radiological features and outcome in 20 cases

To study the clinical and radiological features of cerebral venous thrombosis [CVT], the response to treatment with anticoagulation, and the outcome. A five year prospective study was performed from Febraary 2000 to January 2005. Diagnosis of cerebral venous thrombosis was confirmed by magnetic resonance venography [MRV] or CT venography [CTV]. All patients were treated with unfractionated heparin [UFH] for 7-10 days followed by treatment with warfarin for 6 months. The outcome in each case was assessed by modified Rankin Scale [mRS] score at the end of six months from the time of presentation. A total of 20 cases were identified, 14 were female [70%] and 6 male [30%] with F: M ratio of 2.3: 1. Mean age was 34.5 years [range 10-65 years]. The most common symptoms were headache [90%], vomiting [65%], seizures [40%], and impairment in conscious level [35%]. Most common signs were bilateral papilloedema [45%], hemiparesis or hemiplegia [30%], quadriparesis [25%], and cranial nerve palsies [20%]. Neuroimaging features on pre and post contrast CT scan and/or MRI were variable among all patients and revealed features like ischemic infarctions and/or intracerebral hemorrhages in various locations, sulcal sub-arachnoid hemorrhages, and intraluminal signal abnormalities due to presence of thrombus inside the dural sinuses. The most frequently involved dural sinus [85%] was one of the lateral sinuses [transverse and sigmoid dural sinus], followed by superior sagittal sinus [75%], and straight sinus [20%]. At the end of six months, 16 [80%] cases recovered completely while 2 [10%] were moderately impaired [mRS = 3], and one [5%] had mild impairment [mRS = 2]. Only one [5%] patient died. Cerebral venous thrombosis is a rare condition with variable clinical and radiological features at presentation making the diagnosis difficult. Early diagnosis and prompt treatment with anticoagulation resulted in better outcome even in the presence of hemorrhagic lesions

Tracheal injury due to blunt chest trauma: a rare surgical emergency

Tracheal injury is a rare complication of blunt chest trauma. The patients usually present with signs of respiratory distress. Primary repair is the treatment of choice in case of large defects, while small tears can be managed conservatively. Immediate operation is recommended to improve deteriorating pulmonary function. The decrease in mortality and long-term morbidity depends on early diagnosis. We report a case of tracheal injury due to non-penetrating thoracic trauma which was successfully managed with surgery

Delorme procedure for complete Rectal Prolapse in young adults - an analysis of 7 cases

The problem of full-thickness rectal prolapse is formidable, with no clear predominant treatment of choice. Several operations have been proposed to correct rectal prolapse which can be divided into transabdominal and perineal procedures. Delorme operation is a suitable procedure for elderly and/or medically unfit patients with rectal prolapse. However, good results have also been demonstrated for younger patients, suggesting that the operation may have wider application. From January 2001 to September 2003, 07 young adult patients underwent the Delorme repair of rectal prolapse in our unit with good results. The main outcomes measured were method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. In the 07 patients, the mean age of the patients was 24 years. The mean operating time was 55 minutes. Four patients were administered general anesthesia and 03 were administered spinal anesthesia. The mean postoperative stay was 05 days. No patients died as a result of th e procedure. Patients were followed up for 3 - 33 months. Preoperative incontinence was present in 02 patients, both of whom improved after the procedure. Postoperative incontinence was seen in only one of these patients but that too seemed to improve with time. No recurrent postoperative prolapse has yet been seen. None of the patients had complications that required operative intervention in the postoperative period. Although, the best operation for rectal prolapse remains a controversial subject, we believe that the Delorme Operation offers a promising option for the treatment of rectal prolapse even in young adults

Etiology of posterior reversible encephalopathy syndrome [PRES]

To study the causes and risk factors for the development of Posterior Reversible Encephalopathy Syndrome [PRES]. Prospective hospital based study over a period of five years from July 1999 to June2004.Patients and methods: Patients with clinical and neuroimaging features consistent with PRES were included in the study. All patients had detail clinical evaluation on presentation, and recovery from PRES. All had CT and/or MRI brain scan and other hematological and serological investigations to determine the most likely cause of the syndrome. Most patients also underwent follow up neuroimaging to demonstrate resolution of brain lesions. Thirteen patients fulfilled the clinical and radiological features consistent with PRES. Seizures and altered conscious level were most common clinical manifestations. Main radiological feature on CT and/or MRI brain was extensive subcortical edema mainly confined to the posterior parieto-occipital lobes. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia were main causes of PRES in our study. We also found that this syndrome was more common in females than males. Clinically all patients recovered with control of blood pressure and discontinuation or reduction in dose of the offending drug within 2-7 days. There was almost complete resolution of radiological abnormalities within 2-4 weeks in patients who underwent follow up imaging. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia are most common causes of posterior reversible encephalopathy syndrome with a greater predilection for females than males. Multiple factors may be contributory in some patients who develop PRES

Quality of life in chronic schizophrenic patients

To assess the quality of life in a group of schizophrenic patients who have completed rehabilitation programme in a residential Facility. Design: This prospective study was completed at Fountain House, Lahore. Subjects: Thirty patients and thirty controls were included in this study. Main outcome measures: Brief Psychiatric Rating Scale [BPRS], Morningside Rehabilitation Status Scale [MRSS] and Quality of life Index [QLI]. The results showed that patient groups, despite their successful rehabilitation, had significant lower scoring in terms of quality of life as compared to the controls. Female patients did comparatively well on the measure of quality of life. Conclusions: The results confirm the importance of measurement and evaluation of quality of life in psychiatric patients in routine clinical assessments, as well as, in follow up and after care plans

Risk factors in stroke

Risk factors in stroke were studied in fifty consecutive patients admitted to the Neurology ward and North medical ward of Mayo hospital, Lahore. The diagnosis was confirmed on CT scan of brain in all patients. There were 24 males and 26 females with mean age 52 years and range from 19-80 years. Hypertension was present in 31 [62%], Diabetes mellitus 16 [32%], Obesity 16 [32%], Ischcmic heart disease 10 [20%], Valvular heart disease 8 [16%] and 21 [42%] patients had history of heavy smoking

Emery- dreifuss muscular dystrophy: a study of four cases in a family

Emery-Dreifuss muscular dystrophy is characterised by a slowly progressive muscle weakness in a humero-peroneal distribution, early contractures, and cardiomyopathy. This study describes the characteristics and genetics of this syndrome in family of four male siblings all of whom were affected by the disorder. An 11 year old boy presented with muscle weakness and wasting in a humero-peroneal distribution, absent tendon reflexes, elbow contractures and elevation of creative kinase [CK] without cardiac involvement. Three asymptomatic male siblings were also found to have evidence of the syndrome. The father and two other paternal relatives of these siblings had persistently raised creative kinase levels without evidence of muscle weakness or cardiomyopathy. There was no evidence of the disorder on the maternal side. Clinically the pedigree was consistent with either X-linked recessive inheritance or could also represent autosomal dominant inheritance. Molecular genetic studies were carried out to confirm the pattern of inheritance. The marker st14 is closely linked to Emery-Dreifuss muscular dystrophy. All four boys and their mother had the same pattern, therefore confirming that all siblings had inherited the same maternal allele, strongly supporting sex linked recessive inheritance. This was virtually confirmed by further analysis which showed that all 4 boys had the same maternal allele for an informative microsatellite marker in intron 13 of the factor 8 coagulant gene

Paroxysmal ataxia and dysarthria

Three cases with transient episodes of ataxia and dysarthria are described. The episodes lasted for 10-20 seconds with frequency from 20-200/day. The primary diagnosis was multiple sclerosis in two cases and acute disseminated encephalomyelitis in one case. An electroencephalogram [EEG] recorded during the episodes in these patients was normal. All patients responded to low doses of carbamazepine with complete amelioration of episodes. Recovery from relapse was associated with spontaneous cessation of these paroxysmal symptoms

Non-Hodgkin's lymphoma presenting with spiral cord compression

To describe clinical features staging, histology, treatment, functional outcome and survival of 70 patients with histologically confirmed diagnosis of Non Hodgkin's Lymphoma of Epidural Space presenting with spinal cord compression at the outset. Design: A retrospective study of 70 patients of Non Hodgkin's Lymphoma presenting with spinal cord compression seen between March, 1983 and March 1994. Setting: Dept. of Neuro-surgery, Radiotherapy Oncology and Internal medicine of Nishtar Medical College/Hospital Multan. Subjects: Seventy patients out of 825 with biopsy proven diagnosis of Non-Hodgkin's Lymphoma and presenting with spinal cord compression and having stage 1e at initial presentation and treated with chemotherapy [CT] and radiotherapy [RT] after initial decompressive surgery. There were 70 patients with a median age of 35 years. Chronic backache in all the patients and leg weakness [Paraplegia or Severe Paraparesis] in 62 patients were the commonest complaints at the time of initial presentation. 42 patients were non ambulatory. Intermediate grade type was the commonest histology [90% of cases]. Postoperative treatment included Radiotherapy alone in 11 patients, C.T. alone in 22 patients and combination of both Chemotherapy + Radiotherapy [CT + RT] in 37 patients. Out of 70 patients only 23 patients were evaluable for long term follow up and functional results. 13 patients [56%] out of 23 who had combined modality treatment C.T. + R.T. had relapse free median survival of 5 years [0.5-8years] 10 patients out of 23 who either had C.T. alone and RT alone relapsed after a median survival of 2 years [range 0.5-3years]. Functional outcome was better in 13 patients who received combined Chemotherapy + Radiotherapy [CT +RT]. Conclusions: oSpinal Epidural Non-Hodgkin's Lymphoma [S.E.L.] had younger median age i.e. 35 years. This is a significant divergence from reports in the literature. oThere is poor follow-up of patients. oCombined modality treatment i.e. with CT and RT after initial decompressive surgery appears to have improved local control and survival. oLymphoma with involvement of spinal cord should be suspected in cases of spinal cord compression and appropriate neuroimaging be performed to exclude secondary involvement

Serotonin syndrome

The Serotonin syndrome results from an over stimulation of serotonergic neurotransmission. It can be induced by drugs like specific serotonin re-uptake inhibitors. Co-administration of these drugs with a number of psychotropic compounds have also been linked to this syndrome. A case is being reported showing clinical symptoms and signs of this condition following use of Fluoxetine