Rare Case of Bilateral Coexistence of Caroticoclinoid Foramen, Inter-Clinoid Bar and Posterior Clinoid Foramen in a Dry Human Skull..

The superior surface of the body of the sphenoid is centrally occupied by sella turcica. The sella turcica has median depression called as hypophysial fossa; its anterior border is formed by tuburculum sella and posterior by dorsum sellae. It is surrounded by two anterior and posterior clinoid processes at its corners. Some parts of the sphenoid bone are connected by the ligaments that occasionally ossify.1 These ligaments have important relations with the surround vascular and neuronal structures. Hence such altered anatomy leads to difficulties or serious complications during surgical approach of this region in various conditions like aneurysm of internal carotid artery (ICA), caroticoclinoid fistula, pituitary adenoma and tuberculum sellae meningiomas etc.Knowledge of such variations would help radiologists and neurosurgeons in accurate diagnosis and treatment of the patients.Caroticoclinoid foramen (CCF) is an inconstant or abnormal anatomical feature formed due to ossification of a ligament between anterior and middle clinoid processes. It was first described by Henle (1855) as quoted by Mallik S and Sawant VG.2It was postulated that although ossification of the ligaments is normally age dependent physiological condition but CCF is an exception as its existence is seen even in the fetal and infant skull because of developmental anomaly.3The development of the sphenoid bone is complex has 18 or 19 ossification centers which may lead to early ossification of carotico-clinoid ligament.4CCF allows the passage of clinoid segment of the internal carotid artery.5 It may lead to compression, tightening or stretching and cause changes in the artery which reflects in compression of the cavernous sinus6. CCF may also cause endocrinal problems affecting hypothalamus or hypophysis cerebri and neurological problems by affecting oculomotor nerve, optic nerve or pituitary gland, which manifest in different ways as headache, behavioural changes, hormonal disturbances, visual problems, epileptic seizers, craniofacial disorders and tooth anomalies.7 Interclinoid osseous bar (ICB) results from ossification of the interclinoid ligament present between anterior and posterior clinoid processes.8 The osseous bridges represent a developmental anomaly of the embryonic chondrocranium.4 The ICB can be partial or complete; unilateral or bilateral.2 ICB may influence structures like trochlear nerve, oculomotor nerve, pituitary gland or remains as a normal variant. ICB is demonstrated radiologically in idiots, criminals, epileptics and cases of mental disorders.2,8Posterior clinoid foramen (PCF) is very rare and scarcely mentioned in the literature. Jolly Agarwal and Virendra Kumar recorded it in one specimen unilaterally (2.5%). PCF, when present exists on the sphenoid bone posterior to CCF. It is created between middle and posterior clinoid processes when the interclinoid bar is complete (i.e. between anterior and posterior clinoid processes).9

review of hepatitis viral infections in Pakistan

A review of published literature on viral hepatitis infections in Pakistan is presented. A total of 220 abstracts available in the Pakmedinet and Medline have been searched. All relevant articles were reviewed to determine the prevalence of hepatitis viral infections in Pakistan. Two hundred and three [203] relevant articles/abstracts including twenty nine supporting references are included in this review. Of the articles on prevalence of hepatitis infection, seven were related to Hepatitis A, fifteen to Hepatitis E while the remaining articles were on frequency of hepatitis B and C in different disease and healthy population groups. These included eight studies on healthy children, three on vertical transmission, nineteen on pregnant women, fifteen on healthy individuals, six on army recruits, thirty one on blood donors, thirteen on health care workers, five on unsafe injections, seventeen on high risk groups, five on patients with provisional diagnosis of hepatitis, thirty three on patients with chronic liver disease, four on genotypes of HBV and five on genotypes of HCV. This review highlights the lack of community-based epidemiological work as the number of subjects studied were predominantly patients, high risk groups and healthy blood donors. High level of Hepatitis A seroconversion was found in children and this viral infection accounts for almost 50%-60% of all cases of acute viral hepatitis in children in Pakistan. Hepatitis E is endemic in the country affecting mostly the adult population and epidemic situations have been reported from many parts of the country. The mean results of HBsAg and Anti-HCV prevalence on the basis of data aggregated from several studies was calculated which shows 2.3% and 2.5% prevalence of HBsAg and Anti-HCV in children, 2.5% and 5.2% among pregnant women, 2.6% and 5.3% in general population, 3.5% and 3.1% in army recruits, 2.4% and 3.6% in blood donors, 6.0% and 5.4% in health care workers, 13.0% and 10.3% in high risk groups, 12.3% and 12.0% in patients with provisional diagnosis of hepatitis and 25.7% and 54% in patients with chronic liver disease respectively. This review has illustrated the high endemicity of hepatitis viral infections in Pakistan where hepatitis B and C potentially account for a serious burden of the disease. This review has triggered the launching of a network intervention for the control of hepatitis viral infectious. This review was used as the basis for the launch of hepatitis programme, but putting it into a formal review took time and the hepatitis program was initiated

Etiology of a suspected measles outbreak: preceding measles reduction activities in Pakistan

To characterize patients with suspected measles, determine the magnitude of the outbreak in selected areas, and perform laboratory testing on patients with suspected measles to confirm the etiology of the outbreak. Cross-sectional survey. Islamabad and Rawalpindi in June 2006. Survey and specimen collection from households was carried out in areas affected by rash and fever during the outbreak. Teams asked if household members had rash and fever and administered a detailed questionnaire of clinical signs and symptoms for measles for each person who reported a rash and fever episode. A sample of cases with fever, rash, and either cough, conjunctivitis, or coryza was laboratory tested for measles and rubella. Of 2,225 households visited, 284 individuals met the rash and fever case definition. Laboratory testing of eleven blood specimens revealed that the rash and fever outbreak was caused by rubella in 6 and measles in 2 with three equivocal results. Laboratory confirmation of suspected measles cases is essential during measles elimination activities in Pakistan and other countries with endemic rubella