Keyhole approach in anterior circulation aneurysm: Current indication, advantages, technical limitations, complications and their avoidance

Keyhole surgery recently evolved as a minimal invasive surgical approach for treatment of anterior circulation aneurysm. This review was done to evaluate the keyhole approach for anterior circulation aneurysms, their indications, advantages, technical limitations, complications and their avoidance. The literature review was performed with the phrase “keyhole approach for anterior circulation aneurysm” as a search term in PubMed central, Medline, Google scholar and Embase data base to identify all the articles published till December 2020. Out of 113 articles searched, 22 were included in this review after screening for eligibility. On analyzing these articles, there was total 2058 aneurysm in 1871 patients. Out of 2058 aneurysm, 988 were ruptured and 547 unruptured. In 5 studies, which include 344 aneurysms in 344 cases, aneurysm ruptured or unruptured status was not specified. The most frequent aneurysm site was anterior communicating artery (n=573). The size of the aneurysm mentioned in most of the study was <15 mm. The rate of complete occlusion was ranged from 93.6-100%. The range of intra operative rupture (IOR) was 0-28.6%. The mean operative time was ranged from 70 min-5.34 hours as reported in 13 studies. Good outcome [Glasgow outcome scale (GOS): 4-5] were seen in 75-100% cases. The frontalis muscle weakness has been reported in 3 studies and ranged from 0-1.99%. Keyhole surgery can be a safe and effective treatment modality for treatment of a selected anterior circulation aneurysm. In the experienced hand it has certain advantages over standard pterional craniotomy.

Serum Cytokine Profile in Patients with Chronic Rhinosinusitis with Nasal Polyposis Infected by Aspergillus flavus

BACKGROUND: Fungi, especially Aspergillus flavus, can cause chronic rhinosinusitis with nasal polyposis and modulate host innate immune components. The objective of this study was to examine the serum levels of T helper (Th) cell subset Th1, Th2, and Th17 cytokines and total IgE in patients having chronic rhinosinusitis with nasal polyposis and Aspergillus flavus infection. METHODS: A case-control study including 40 patients with chronic rhinosinusitis with nasal polyposis and 20 healthy controls was conducted. Aspergillus flavus infection was confirmed by standard potassium hydroxide (KOH) testing, culture, and PCR. Serum samples of all patients and controls were analyzed for various cytokines (interleukins [IL]-1β, IL-2, IL-4, IL-6, IL-17, IL-21, IL-27, TGF-β) and total IgE by ELISA. Data from patients with Aspergillus flavus infection and healthy volunteers were compared using the independent t-test and non-parametric Mann-Whitney U test. RESULTS: Aspergillus flavus infection was found in 31 (77.5%) patients with chronic rhinosinusitis with nasal polyposis. IL-1β, IL-17, IL-21, and TGF-β serum levels were significantly higher in these patients than in controls; however, IL-2, IL-4, IL-6, and IL-27 levels were lower. Compared with nine (22.5%) patients without Aspergillus flavus infection, IL-17 level was higher while IL-2 level was lower in patients with Aspergillus flavus infection. Total IgE was significantly higher in patients with Aspergillus flavus infection than in controls. CONCLUSIONS: High levels of IL-17 and its regulatory cytokines in patients with chronic rhinosinusitis with nasal polyposis infected by Aspergillus flavus raise a concern about effective disease management and therapeutic recovery. Surgical removal of the nasal polyp being the chief management option, the choice of post-operative drugs may differ in eosinophilic vs. non-eosinophilic nasal polyposis. The prognosis is likely poor, warranting extended care.

Outcome after surgical repair of partial anomalous pulmonary venous connection

Objective: To review the operative results of 55 cases of partial anomalous pulmonary venous connection [PAPVC]

Methods: This retrospective case series of 55 cases of PAPVC operated from January 2011 to June 2016 at CPE Institute of cardiology, Multan. Baseline characteristics of patients, their operative findings and results were retrieved from the hospital record

Results: Operation for PAPVC was performed in 55 patients. Patient's age varied from 3-28 years [mean 12.56 +/- 7.49], their weight was 9-62 kg mean [25.61 +/- 16.28]. There were 41[74.5%] males and 14[25.5%] females. 49[89.0%] patients had right sided PAPVC associated with ASD moreover 3[5.4%] cases had right pulmonary vein draining into right atrium. While there was only one case having left sided PAPVC [1.8%] and two cases [3.6%] of bilateral PAPVC [4%]. Reassuringly, there was not a single mortality. However, one patient developed junctional rhythum, which was successfully controlled on amiodarone. SVC obstruction having 6mmHg gradient was observed in one case however patient is doing well and is on follow up since 9 months

Conclusion: Surgical correction of PAPVC generally carries highly reproducible results with low morbidity

HIV/AIDS outbreak investigation in Jalalpur jattan [JPJ], Gujrat, Pakistan

In June-July 2008 a non-governmental organization [NGO] in Jalalpur Jattan [JPJ], Gujrat, Pakistan arranged two voluntary HIV screening camps after numerous HIV-infected persons reported to their treatment center in Lahore; 88 [35.8%] of 246 persons screened in those camps were positive by rapid test. Intense media coverage made the residents of JPJ hostile to further inquiries. The Pakistan Field Epidemiology Training and Laboratory Training Program [FELTP] was requested by the Provincial AIDS Control Program to carry out an epidemiological investigation. HIV-positive persons or family members of patients who died of AIDS and consented to be interviewed during the period 15 December 2008 to 2 January 2009 were investigated. Enhanced contact tracing was done to identify additional cases. A structured questionnaire was used to collect data regarding clinical history, risk factors, and HIV knowledge and practices. The national HIV/STI Referral Laboratory collected blood samples for HIV serology and molecular studies independently following pre- and post-counseling. A total of 53 HIV-infected persons were investigated. Out of these, 47 [88.7%] were alive at the time of investigation and 27 [50.9%] of the cases were female with 6 children aged 10 years or less. Median age was 35 years [mean 34.7, range 3-70]. Most frequent symptoms were unexplained fever 42 [79.2%], diarrhea 34 [64.15%] and skin infections 27 [50.9%]; 13 [24.5%] had co-infection with tuberculosis [TB] and 10 [18.9%] with hepatitis [B or C]. Use of injections 51 [96.2%], dental procedures 21 [40%] and barber shop visits among males 18 [72%] were common risk factors. Extramarital sex was reported by 4 [9.4%]. Only 19 [35.8%] were aware that HIV can be sexually transmitted and 18 [34%] were aware of HIV transmission by blood transfusion. Phylogenetic analysis revealed HIV infection in this group was HIV-1 Subtype A, transmitted over a decade, and the situation is endemic rather than an outbreak. The investigation indicates high rates of HIV infection in JPJ. Unlike other studies from Pakistan, a high proportion of cases in females and children less than 10 years of age were observed. Socio-cultural norms and stigmatization limited in-depth investigation of sexual and behavioral practices and history of drug abuse. A shift of HIV infection from high-risk groups to the general population was seen and requires vigilant surveillance besides targeted health education, clinical management, lab facilities for diagnosis and monitoring, and voluntary counseling and testing services to limit disease spread

DMFT of 12-15 years old rural area students of south Punjab - Pakistan

Dental caries is an age old problem of the human beings which needs elimination. Advances in the world have caused different effects to this problem. Surveys are conducted to evaluate the extant of this disease and the possible causative factors, periodically in different areas. Present study was conducted to evaluate the DMFT of 12-15 years old population in a rural area of south Punjab- Pakistan. About 950 students [male and female] 12-15 years old from Six rural area school of Muzaffargarh District were included in the study. Examination was made in day light with a mirror and probe. Entries were made in a printed proforma. An overall DMFT of 2.09 was observed for the 922 subjects. DMFT increased with age. It was more in females [2.22] and less in male [2.01] and the children from better socio economic status had less scores [1.94] as compared to poor [2.24]. More meals were associated with less caries while more intermeal snacks caused increase in caries, Brushing habits could not be correlated to DMFT. Rural population needs Oral Hygiene education. Better oral hygiene measures, less frequency of intermeal snacks and prophylactic measures may help reduce the caries

Unhealthy attitudes and health problem in Paksitani society

This paper attempts to analyze the attitudes and behavior of the community in Pakistan, distinguished into urban and rural setup. With the advancement in technology and betterment in socioeconomic status, the community has changed the approaches to the health which is said to be the [absolute state of wellbeing]. These changes have produced discontrol of emotions, over weight, isolations, intolerance, leading to depression. The message of this paper is for the health planners, thinkers and policy makers to reassess the pulse of the Pakistani community

Factors determining, the time lost between onset of psychiatric disorders and first psychiatric consultation

To find out delay between onset of psychiatric illness and first psychiatric consultation; and the factors leading to such delay. Retrospective Study. Isra University Hospital from January 2002 to February 2004. The record of patients who had attended for psychiatric consultation at Isra University Hospital from January 2002 to February 2004; was transferred to a proforma on which demographic characteristics, diagnosis, delay and reason of delay in psychiatric contact after first onset of psychiatric disorder was recorded. The data was subjected to analysis after being fed on SPSS. Descriptive Statistics, i.e. frequencies, percentages and means were calculated. An average delay was of about 36.34 months. Neurotic patients, Females [37.63 months, as compared to 33.93 months' delay of males], and patients belonging to urban catchments [delay of 37.37 months as compared to 39.59 months' delay], had greater delay. Lack of awareness [25.41%] was found to be the most common reason for delay, followed by Un-reachable psychiatric facility [23.01%], non-affordability [21.27%], Stigma feeling [19.03%] and misconception that medicines are addictive [11.25%]. The delayed psychiatric help was pervasive in majority of people with the psychiatric disorders, studied. Most common reason of delay was found to be the lack of awareness about psychiatric illness