Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration / 대한뇌졸중학회지

Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.

Early detection of chronic obstructive pulmonary disease in apparently healthy attendants of tertiary care hospital and assessment of its severity

Objective: Early detection of Chronic Obstructive Pulmonary Disease in apparently healthy attendants of tertiary care hospital and assessment of its severity

Study Design: Cross-sectional, observational study

Place and Duration of Study: Study was conducted from January 2015 to July 2015 at Dow University Hospital, Ojha campus

Methodology: A screening method was designed for apparently healthy individuals including attendants of patients, hospital staff, faculty and students, belonging to age group 18-60 years after excluding severe obesity and already diagnosed respiratory and cardiovascular diseases by means of history. Each participant performed pulmonary function tests via spirometer after filling a questionnaire based on various risk factors and symptoms of chronic obstructive pulmonary disease [COPD]. Data was entered and analysed by SPSS-20

Results: Out of the 517 participants, 122 [23.6%] were found to have COPD diagnosed by means of spirometry. Out of these, 23 [4.4%] had COPD stage I, 42 [8.1%] had COPD II, 34 [6.6%] had COPD III, and 23 [4.4%] had COPD IV. Exposure to smoking, wooden stoves, pesticides, biomass fuel, aerosol sprays, gas grill and vehicle exhaust were found to be statistically significant factors in relation to development of COPD

Conclusion: Apparently healthy individuals may have underlying COPD and active screening by means of spirometry plays vital role in early detection of COPD. Smoking and exposure to certain hazardous environmental pollutants are responsible for the development and progression of COPD

Surgical site infection in diabetic and non-diabetic patients undergoing laparoscopic cholecystectomy

Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients

Study Design: Cohort study

Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012

Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05

Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs [p = 0.07]

Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy

Comparison of open mesh hernioplasty verses laparoscopic intraperitoneal onlay mesh for ventral hernias

Objective: compare the outcome of laparoscopic intraperitoneal on lay mesh [IPOM] with open mesh repair in ventral hernias

Material and Methods: seventy patients were divided into two groups of 35 each. Group A= I POM repair and Group B = Mesh hernioplasty

Results: the mean+/-SD age was in group A 44.54+/-7.06 years and 46.40+/-7.14 in group B. Twelve [34%] patients were male in group A, 14 [40%] patients were in group Band 23 [66%] patients were female in group A and 21 [60%] were female in group B with male to female ratio 1: 1.91. There were only 3 [8%] patients had postoperative pain in group A and 10 [28%] patients were in group B [p<0.05] which is statistically significant. In comparison postoperative early surgical site infection in both groups, there was no patient on 3rd postoperative day in both groups. On 10th postoperative day 1 [3%] patient had surgical site infection in group A and 6 [17%] patients had postoperative early surgical site infection in group B [p<0.05] which is statistically significant

Conclusion: laparoscopic approach appears to be as effective, safe, feasible, and cosmetically good procedure. It has fewer rates of early surgical site infection and postoperative pain. Laparoscopic repair is good alternative to the open repair in the treatment of ventral hernias

Comparison of laparoscopic total extraperitoneal repair with Lichtenstein repair in inguinal hernia

Objective: To compare the laparoscopic inguinal hernia repair with Lichtenstein repair in terms of hospital stay and postoperative pain

Study design: Randomized clinical trial

Place and Duration of study: Department of Surgery Services Hospital Lahore, from September 2013 to May 2014

Methodology: Inguinal hernia patients were admitted electively. They were randomly assigned into groups A and B. The group A patients were treated with laparoscopic total extraperitoneal repair [TEP] and group B patients underwent Lichtenstein's repair. Patients were evaluated for 24 hours discharge rate and postoperative pain

Results: A total of 100 patients were included with 50 patients in each group. Group A patients had short hospital stay [discharged within 24 hours - 68.08%] as compared to group B [31.91% -p <0.001]. From 2[nd] to 6[th] postoperative week group A patients had significantly less postoperative pain as compared to group B [p <0.05]

Conclusion: Laparoscopic TEP repair was safe with early hospital discharge and less postoperative pain

Harmonic Scalpel versus electrocautery in axillary dissection in Carcinoma Breast

Objective: To compare the results between harmonics scalpel and electrocautery use in axillary dissection for carcinoma breast

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Surgery, Services Hospital, Lahore, from December 2013 to June 2014

Methodology: Eighty patients fulfilling the inclusion criteria were selected and equally divided in two groups. Axillary dissection for carcinoma breast was performed by using the harmonic scalpel in one group and by using electrocautery in the other group. Total mean axillary drain output and frequency of axillary numbness were noted in both groups and compared

Results: All the patients were females with mean age of 53.52 +/- 9.8. Mean axillary drain output in harmonic scalpel group was 167.75 +/- 43.90 as compared to 310.00 +/- 60.09 in electrocautery group while only 12.5% of patients were positive for axillary numbness in harmonic scalpel group as compared to 100% of patients who were positive for electrocautery group

Conclusion: Use of harmonic scalpel in axillary dissection resulted in decreased total mean axillary drain output and lowered frequency of axillary numbness when compared to utilizing electrocautery

Mesh fixation vs. non-fixation in total extra peritoneal mesh hernioplasty

To compare mesh fixation with non-fixation and its effect on outcome. The interventional prospective study was conducted at the National Hospital and Medical Centre, Lahore from January 2007 to December 2008. After the two-year intervention period, the patients were followed up for 5 years. The selected patients were divided into two groups. In group 1, mesh fixation was performed with metal non-absorbable tackers and in group II no fixation of mesh was performed. Patients were followed up at 6, 12, 24 and 60 months. Of the 63 patients in the study, 32[50.7%] were in group I and 31[49.2% in group II. The Mean pain score in group I was 4.7 +/- 0.683 and 4.1 +/- 0.860 in group II [p< 0.001]. Urinary retention was more common in group 1 [p>0.05], while recurrence was more common in group II [p>0.05]. Pain was significantly less in the non-fixation group, while urinary retention and recurrence were not significantly increased. Non-fixation is a viable option for total extraperitoneal mesh hernioplasty and should be preferred over mesh fixation

Laparoscopic splenectomy

Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia [n=2], pleural effusion [n=4] and prolonged pain > 48 hours [n=1]. No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 10[9]/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted

Are medical undergraduates more likely to indulge in substance abuse than non-medical undergraduates? a survey from Karachi

To determine frequency of substance abuse and the commonest substance of abuse among medical and non-medical undergraduates. Survey report. Dow International Medical College, Karachi, from June 2012 to August 2012. Semester VIII students from Dow International Medical College, Dow University of Health Sciences who visited the selected medical and non-medical universities, data collected through self responding questionnaire which was handed out to the participants. Data was collected from 4 medical and 4 non-medical universities. All responding undergraduate students in selected universities were included. Data was maintained and analyzed on SPSS version 16 for descriptive statistics. Total number of responders was 572 with male: female ratio of 1.23: 1.0 and mean age of 21.76 +/- 2.168 years. Frequency of regular substance abuse was 20.1%. Males were abusing substance more than females, ratio being 4.7: 1.0 among abusers. The most common substance of abuse was tobacco. Frequency of regular substance abuse in nonmedical undergraduates was 29.4% which was higher than medical graduates [13.4%]. Substance abuse among undergraduates in selected universities in Karachi was overall 20.1%. Male nonmedical undergraduates were more frequently using such substances; tobacco being the most common

Laparoscopic repair of peptic ulcer perforation: our initial experience

Objective: to evaluate our experience of laparoscopic peptic ulcer repair at National Hospital, Lahore over a one-year period

Material and Methods: a prospective case series study. The National Hospital and Medical Centre, Lahore. Four patients operated from January 2013 to December 2013. Post-operative pain, average hospital stay. Intra-operative and postoperative complications and outcome

Results: average operating time was 95 minutes, Average hospital stay 3.75 days. No intraoperative or operative postoperative complications documented so far

Conclusion: laparoscopic perforated duodenal ulcer repair is an excellent surgical option in selected patients without any added risk of complications

Role of modified alvarado score in diagnosing acute appendicitis in emergency setup

The objective of the study was to evaluate the diagnostic accuracy of modified Alvarado score on patients presenting in surgical emergency with suspicion of acute appendicitis. We studied the Alvarado score of 200 patients in 11 months period who presented to the emergency department with right iliac fossa pain. We decided to design this study with the aim of investigating whether the Alvarado Score can be used by emergency doctors as a criteria for diagnosing acute appendicitis. We compared the Alvarado Score with the operative findings and grade of appendicitis. A total of two hundred patients were studied. We found that patients who had a score of less than 5 had a normal appendix, but at the same time 17% had acute appendicitis. While if, Alvarado Score >5, 59% had acute appendicitis and 1% have normal appendix. Thus the Alvarado Score is both specific and sensitive in diagnosis of acute appendicitis. It is concluded that Alvarado score is a free and easy to use tool and is very helpful in diagnosing acute appendicitis and decreasing the incidence of negative appendectomies

Retrosternal goitre, presentation and treatment outcome

To assess the clinical presentation, surgical out come and complications of retrosternal goitre [RSG]. A descriptive retrospective study. Departments of Ear Nose Throat and Head and Neck Surgery, Fatima Hospital Baqai Medical University and Civil Hospital Dow University of Health Sciences Karachi, between January 2002 to March 2008. Twenty seven patients of both gender and different ages of retrosternal goitre who under went for thyroidectomy between January 2002 to March 2008 were studied regarding their clinical presentation, and surgical outcome. Only two [7.4%] of our patients were presented with acute air way obstruction. Six [22.2%] patients were complained of dsypnoea only in supine posture, dysphagia and hoarseness were noticed in 3[11.1%] and 1 [3.7%] patients respectively while fifteen [51.5%] were asymptomatic apart from the obvious neck swelling. Total thyroidectomy was performed in twenty two [81.4%] cases and lobectomy with isthemectomy was done in five [18.1%] patients. CT scan was done in seven [25.9%] cases. Majority of our cases i.e. twenty five [92.6%] were benign while malignancy was noted in only two [7.4%] cases. Complications noted was haematoma formation in one [3.7%], recurrent laryngeal nerve injury in four [14.8%], hypoparathyroidism [transient] was recorded in three [11.1%] patients, and wound infection was observed in two [7.4%] patients. There was no mortality pre and post-operatively and no case of permanent hypoparathyroidism was noted where as only one patient had permanent unilateral recurrent laryngeal nerve injury. Retrosternal goitre is often asymptomatic and thyroidectomy is the treatment of choice with very low mortality and morbidity

Otogenic intracranial complication

Two patients one male of 25 years the other a girl of 10 years old presented to us with purulent ear discharge, severe hcadache and nausea/vomiting and amastoid abscess in one of them of few days duration. Otoscopy revealed purulent foul smell discharge filling the ipsilateral ears with X-ray mastoid showing a cavity due to bone erosion. Incision and drainage of mastoid abscess followed by radical mastoidectomy in one and radical mastoidectomy straight away in the other were performed with complete eradication of disease and chlesteatoma was achieved clinically. But within 16 hour in the young girl and after 12 days in the 25 years old male again both cases presented in emergency with sever headache, nausea/vomiting and disorientation. CT scan of both the cases revealed right temporal lobe abscess. The girl was already in ICU and the male was re- admitted for the drainage of abscesses under care of neurosurgeon and follow up was done in both the departments for four months

Obstructive jaundice; diagnostic role of ERCP

Objective: To determine the efficacy of Endoscopic Retrograde Cholangiopancreatography [ERCP] in patients presenting with obstructive jaundice. DESIGN: Prospective study. Place and Duration of Study: This study was conducted at Military hospital Rawalpindi from 2000 to 2001, which is a tertiary referral centre for armed forces

Patients and Methods: 50 patients were selected of both sexes for ERCP. Subjects of this study were patients who were diagnosed to have obstructive jaundice on the basis of laboratory investigations and sonography. Patients with less than 15 years of age and with conditions other than obstructive jaundice were not included. ERCP was carried out in left lateral position with the left arm held behind the back of the patient. The results were then prepared and analyzed by Fisher Exact test to find out significance between the ultrasound and ERCP

Results: Successful ductal pacification was achieved in 45 cases. The gross pathological findings included 18 cases with stones, 11 cases with stricture and 12 cases with carcinoma. Only one case had choledochal cyst

Conclusion: ERCP is a useful diagnostic tool, providing direct and non-surgical imaging of pancreatic and biliary ducts. It has improved the diagnostic yield and has proved to be more safe and economical mean of pre-operative assessment of obstructive jaundice without the need for more expensive CT scan / MRI or more invasive Per cutaneous Transhepatic Cholangiography [PTC]