Programa Mais Médicos e as comunidades indígenas do Norte da Bahia: relato de experiência / The Mais Médicos Program and the indigenous communities of Northern Bahia: experience report / Programa Más Médicos y las comunidades indígenas del Norte de Bahía: reporte de experiencia

As ações para construção de um modelo de prestação de serviços de saúde para a população indígena só foram intensificadas em 2002, quando foi criada a Política Nacional de Saúde dos Povos Indígenas. Dessa forma, ocorreu a utilização de profissionais oriundos do Projeto Mais Médicos nos Distritos Sanitários Especiais Indígenas. Assim, este trabalho descreve a experiência de profissionais do Projeto Mais Médicos para o Brasil em comunidades indígenas do norte da Bahia, no polo de Paulo Afonso. Essas comunidades se caracterizam por baixas condições socioeconômicas de maneira geral e os povos indígenas do sertão do nordeste brasileiro são amplamente afetados pelo processo de urbanização. Durante o programa, foi possível perceber que as comunidades indígenas já trazem consigo os efeitos psicológicos das lutas territoriais, dos históricos de repressão violenta e da persistente cultura preconceituosa por parte do não indígena. Além disso, são evidentes o empenho e a dedicação do médico bolsista do Projeto Mais Médicos, bem como seu interesse em gerar cuidados para as comunidades tradicionais indígenas de seu polo de atuação, no entanto, vale ressaltar que mesmo após tantos anos da implementação do Projeto Mais Médicos, existe uma grande dificuldade no preenchimento de vagas destinadas ao atendimento nas comunidades indígenas e os últimos editais não conseguiram um médico para preenchimento da vaga em aberto para o polo de Paulo Afonso.

Actions for building a health service delivery model geared towards the indigenous population became more prominent only in 2002, upon creation of the National Health Policy for Indigenous Peoples. As a result, professionals from the Mais Médicos Project were included in the Special Indigenous Health Districts. Hence, this study describes the experience of professionals from the More Doctor for Brazil project within indigenous communities in northern Bahia, at the Paulo Afonso center. Overall, these communities face low socioeconomic conditions and the indigenous peoples of the Sertão are largely affected by urbanization processes. During the program, the professionals noted that indigenous communities bear the psychological effects of land struggles, the history of violent repression and the persistent prejudiced culture espoused by non-indigenous. Moreover, the commitment and dedication of Mais Médicos physicians, as well as their interest in providing care for the traditional indigenous communities in their area of activity, is evident. Importantly, however, even many years after the implementation of the Mais Médicos Project, vacancies geared towards indigenous health are difficult to fill out and the last public notices were unable to find a doctor to fill the open vacancy for the Paulo Afonso center.

Las acciones para construir un modelo de prestación de servicios de salud a la población indígena recién se intensificaron en el año 2002 cuando se creó la Política Nacional de Salud para los Pueblos Indígenas. De esta forma, se incluyó a profesionales en el Proyecto Más Médicos en los Distritos Sanitarios Especiales de Salud Indígena. Así, este trabajo describe la experiencia de profesionales del Proyecto Más Médicos para Brasil en comunidades indígenas del Norte de Bahía, en el polo Paulo Afonso. Estas comunidades se caracterizan por tener condiciones socioeconómicas bajas en general, y los pueblos indígenas del sertão del Nordeste Brasileño son en gran medida afectados por el proceso de urbanización. Durante el programa se pudo percibir que las comunidades indígenas traen consigo los efectos psicológicos de las luchas territoriales, la historia de represión violenta y la cultura prejuiciosa persistente por parte de los no indígenas. Además, es notorio el compromiso y dedicación del médico becario del Proyecto Más Médicos, así como su interés por brindar atención a las comunidades indígenas tradicionales de su zona de actuación; sin embargo, vale mencionar que aún después de tantos años de implementación del Proyecto Más Médicos, existe una gran dificultad para cubrir las vacantes destinadas a la atención de las comunidades indígenas y los últimos avisos públicos no encontraron a médicos para llenar la vacante abierta para el polo Paulo Afonso.

Synergy in penicillin, cephalosporin, amphenicols, and aminoglycoside against MDR S. aureus isolated from Camel milk

Abstract This study investigated the synergy testing of penicillin, cephalosporin, amphenicols, and aminoglycoside in the camel milk (n=768 samples), subsequently used for isolation of MDR S. aureus targeting mecA gene. Antibiotic susceptibility of S. aureus showed >90% isolates were sensitive to ciprofloxacin and trimethoprim and resistant against oxacillin, ampicillin, and cefoxitin. Further, 50-85% of the S. aureus were sensitive to gentamicin, oxytetracycline, and chloramphenicol and resistant against cefotaxime, vancomycin, and cefixime. Minimum inhibitory concentration (MIC) of cefotaxime, (C) and ampicillin (A) in combination with gentamicin (G) was reduced by 99.34% and 70.46%, respectively, while with chloramphenicol (Ch), reduction was 57.49% and 60%, respectively. In addition, the Fractional Inhibitory Concentration Index (FICI) of G+A, Ch+C and Ch+G combinations showed synergy against 80%, 60%, and 30% of MDR S. aureus, respectively. Similarly, C+A and Ch+G displayed indifferent interaction against 70 % and 30% of isolates, respectively, while the later showed additive interaction against 10% of MDR S. aureus. Altogether, our results described effective combination of gentamicin and chloramphenicol with ampicillin and cefotaxime to combat MDR S. aureus

Effect of nigella sativa on biochemical changes in doxorubicin- induced nephrotoxicity in albino rats

Objective: To evaluate the protective effects of Nigella Sativa on biochemical changes in the kidney of Albino rat treated with Doxorubicin

Methodology: This experimental study was undertaken in April 2015 for a duration of 05 weeks at BMSI, JPMC. Forty Albino rats were divided into four groups, ten animals in each group. Group-A was taken as control. Group-B was treated with Doxorubicin [DOX]. Group-C was given doxorubicin and Nigella Sativa [NS], and Group-D was treated with Nigella Sativa only. At the end of the study, the serum urea and creatinine levels were measured

Results: The mean values [mg/dl] of serum urea and creatinine levels in group-A and B were 23.40±3.07, 0.61±0.059, 85.50+/-7.93, and 1.06+/-0.071 respectively. There was highly significant increase in the mean values of serum urea and creatinine levels in group-B when compared with group-A. Further, the mean values [mg/dl] of serum urea and creatinine levels in group-C were 56.10+/-6.87 and 0.96±0.087 respectively, which showed highly significant increase when compared with group-A, and significant decrease when these values were compared with group-B. The mean values [mg/dl] of serum urea and creatinine levels in group-D were 25.01+/-3.39 and 0.67+/-0.057 respectively. There was insignificant increase when these values were compared with group-A, and highly significant decrease when compared with the groups-B and C

Conclusion: This study concludes that Doxorubicin induced biochemical changes can be minimized by the administration of aqueous powder of Nigella Sativa. The free radical scavenging effects of Nigella Sativa might be attributed to the presence of flavonoid, alkaloids and steroids which are powerful antioxidant and anti-inflammatory agent

Mean platelet volume as an indicator of glycemic control in type 2 diabetes mellitus

Objective: To study platelet counts [PC], mean platelet volume [MPV] and glycated HbA1 in type 2 Diabetes mellitus [T2DM]

Study Design: Case control study

Place and Duration of Study: This study was conducted at the Department of Medicine, Indus Medical College Hospital, Tando Muhammad Khan, Sindh from March to November 2015

Materials and Methods: A sample of 150 subjects; comprising of Group A- controls [n=50], Group B- controlled diabetics [n=50] and Group C- [n=50] uncontrolled diabetics. DM was diagnosed according to American Diabetes Association. Permission was taken from ethics review committee of institute. Only willing subjects were included after they signed consent proforma voluntarily. Blood pressure, BMI, Blood glucose, Platelet counts, MPV and HbA1c were determined Data was typed on Microsoft excel, and then pasted SPSS 22.0 sheet for statistical analysis. Chi square test, one way ANOV, post-Hoc Tukey Cramer and Pearson's association was used for analysis of data variables. All data was analyzed at Confidence interval of 95% [

Results: MPV was raised in Diabetics in particular with uncontrolled glycemic index as shown in table II. MPV showed negative correlation with platelets was found with MPV [r = -0.27, p=0.03]. MPV was positively correlated with glycated HbA1 [r = 0.78, p= 0.0001]. HbA1c as high as 14.3% was noted in uncontrolled diabetics

Conclusion: The present study reports raised Mean platelet volume in Diabetics in particular uncontrolled diabetics. MPV showed positive correlation with HbA1c and negative correlation with platelet count

Effects of thirty minutes regular brisk walk on blood pressure in hypertensive subjects

Objective: The present prospective study was conducted to observe the physiological effects of brisk walk on the systemic blood pressure in hypertensive subjects

Study Design: Observational study

Place and Duration of Study: This study was conducted at Outpatient Department, NICVD-Jinnah Postgraduate Medical Center [JPMC] / Physiology department, BMSI, Karachi from December 2001 to May 2002

Materials and Methods: A sample of 30 diagnosed cases of mild uncomplicated systemic hypertension and 30 healthy controls were selected as per study criteria. Aerobic exercise was explained as of doing regular briskwalking of 30 minutes on alternate days for 60 days. Systolic blood pressure [SBP], diastolic BP [DBP], heart rate [HR] and respiratory rate [RR] were checked at baseline and after 60 days of aerobic exercise. Consent of subjects and approval of ethics committee of institute was observed. Data was analyzed on the SPSS 10.0. Continuous and categoricaldata wasanalyzedbystudent`st-testand Chisquaretestrespectivelyas95%confidenceinterval

Results: Baseline systolic BP, diastolic BP, HR and RR were raised in hypertensive subjects compared to controls [p=0.001]. After 60 days aerobic exercise, the systolic BP, diastolic BP, HR and RR were reduced in hypertensive subjects compared to controls [p >0.05]

Conclusion: The present study concludes that the aerobic exercise improves Systolic blood pressure [SBP], diastolic BP [DBP], heart rate [HR] and respiratory rate [RR] in hypertensive subjects

Effects of aerobic exercise on lipid profile in patients with type 2 diabetes[NIDDM]

Objectives: This study was undertaken to observe the effects of aerobic exercise on lipid profile in newly diagnosed type 2 diabetic patients

Study Design: Observational study

Place and Duration of Study: This study was conducted at Physiology Department, JPMC Karachi from December 2001 to May 2002

Materials and Methods: 30 adult male subjects with uncomplicated type 2 diabetes were selected from diabetic clinic of JPMC, Karachi. 30 apparently healthy adult male subjects were selected from friends, students and staff members of BMSI, as control. The subjects belonging to diabetic groups were then briefed about exercise protocol, which consisted of a regular brisk walk of 30 minutes on alternate days per week for 60 days

Results: Base line Values of mean HDL-cholesterol serum cholesterol, serum total triglycerides, LDL-cholesterol, and mean fasting blood glucose were significantly different in diabetic group as compared to control group [P<0.001] After aerobic exercise, all the parameters except HDL-C were significantly decreased while HDL-C was significantly increased as compared to the pre-exercise values

Conclusion: Regular aerobic exercises improve blood glucose, TAG, LDLc and cholesterol and increases the HDLc in type 2 diabetic subjects has been concluded by the present study

Vivax malaria; frequency, severity of thrombocytopenia and variation in red cell distribution width [RDW]

To determine the frequency and severity of thrombocytopenia and to evaluate the variation of red cell distribution width [RDW] in patients with acute vivax malaria. Cross sectional descriptive case series study. Six months. Liaquat University Hospital. All the patients with acute vivax malaria were evaluated for thrombocytopenia its severity and RDW. The data was analyzed in SPSS 10 and the frequency and percentage was calculated. Total 126 patients with acute vivax malaria were recruited, of which 88 were males and 38 were females. The mean age +/- SD for male and female subjects was 44.76 +/- 6.83 and 40.83 +/- 7.42. The common features observed were fever 31%, rigor 15% and combined features 14% [p=0.05]. The thrombocytopenia was identified in 86 patients of which 65 were males and 21 were females [p=0.04]. The increased RDW was observed in 75 patients of which 57 were males and 18 were females [p=0.05]. The bleeding was detected in 56 and dyspnea and heart failure was found in 30 thrombocytopenic subjects [p=0.02]. Regarding outcome 82 subjects were recovered while the 04 patients were expired [p=0.05]. Regarding severity of thrombocytopenia majority 48.8% were in moderate category with male predominance [p=0.02]. The thrombocytopenia and increased RDW was observed in patients with acute vivax malaria

Oral hygiene knowledge and source of information among 12 to 16 years' old Karachi school children

The aim of this study was to assess the knowledge of school children about dental diseases, oral hygiene practices, dietary habits and pattern of visit to dental clinic and also to identify the source of information regarding dental health. This cross-sectional study was conducted from January 2012 to June 2012, among students aged between 12 to 16 years studying in schools. Results of the study showed that 100% students believed that caries had negative effect on their dental health and sweets were the most common cause of dental caries. About the question of caries affecting dental health, 76 [25%] acquired knowledge from their dentists while 114 [37.75%] learned from school teacher and rest 113 [37.25%] gained their knowledge from parents? guardians. Moreover, regarding the source of information of soft drink as a hazard to oral health 76 [25%] got the knowledge from their dentists while 110 [36%] of students thought that soft drinks did not affect their dental health and 117 [39%] students said that they had not known the negative effect of soft drinks on their dental health. In the study, 56% responded that caries prompt them to visit dentist whereas only 10.7% visited dentist when they had bleeding gums. School teachers, parents and dentists were the main source of oral health information. The results of the present study showed that majority of the children obtained oral health information from their school teachers. Schools may provide effective settings for oral health screening and oral health educational programs

Imminent pathology in microvascular decompression for idiopathic trigeminal neuralgia

Objective: to know about the impending pathology in microvascular decompression for idiopathic trigeminal neuralgia

Methodology: this was a prospective observational study conducted in the Department of Neurosurgery, Lady Reading Hospital Peshawar, from 20[th] August 2012 to 25[th] august 2013. The clinical and the operative records of the patients were noted and demographics such as the age, sex, side of the lesion as well as the per-operative impending pathology i.e. compression by an artery, vein or distortion by adhesions or a combination of them compressing upon the trigeminal nerve root was recorded on a predesigned proforma. All patients undergoing surgery for idiopathic trigeminal Neuralgia were included in the study. Patients who had trigeminal neuralgia secondary to a mass lesion were excluded from the study. The data was expressed in percentages and was analyzed through SPSS version 16

Results: total of 55 patients in the study period fulfilled the criteria. There were 28 males and 27 females with a male to female ratio approaching 1:1. The age range was from 28 to 73 years with a mean age of 54.6 years. In 56.4% the pathology was right sided and in 34.5% it was left sided while in 9.1% it was bilateral [operated unilateral at the time]. The impending pathology was compression by an artery in 76.6%, by a vein in 21.6% or purely by adhesions in 1.6% of cases

Conclusion: compression by an artery is the most common pathology en-countered in the microvascular decompression for trigeminal neuralgia

Spectrum of intramedullary spinal cord tumours: case series of 30 patients

Objective: to assess the frequency of intramedullary spinal cord tumours based on clinical and histological features

Materials and methods: this descriptive study was performed at the Department of Neurosurgery Lady Reading Hospital Peshawar, from 20[th] Jan 2003 to 19[th] Jan 2009. Treatment charts of patients with spinal tumours were reviewed and patients operated for spinal tumours were identified. A total of 30 patients out of 480 cases of spinal tumours with different intramedullary spinal tumours were considered in this study. Their frequency, clinical features, and histological reports were analyzed in different aspects

Results: there were total of 30 patients with mean age of 36 years and a wide range beginning as young as 6years. Seventeen patients [56%] were male and 13[43%] were female. Common presenting complaints were loss of sensation in 24 patients [80%], paresis in 20 patients [66%], altered sensation in 12 patients [40%], back pain 11 patients [36%] and sphincteric disturbances 9 patients [30%]. MRI spine was the main diagnostic tool and was done in 30 [100%] cases. Cervical spine was involved in 12 patients [40%], cervicothoracic 6 patients [20%], thoracic 10 patients [32%], conus 2 patients [08%]. Ependymoma was the most common intramedullary spinal cord tumour 20 patients [60%], while 07 [21%] patients had astrocytoma and 03[09%] had haemangioblastoma. We had follow up of 1 year with follow up visit after every 3 months. Superficial wound infection in 2 [6.66%] patients, CSF leak in 3[10%] cases.Worsening of neurodeficit in 3[10%] patients

Conclusion: ependymoma and astrocytoma constituted majority of cases. Intramedullary spinal cord tumours peak during 3[rd] to 4[th] decade of life

Snake bite; frequency of various clinical presentations of admitted patients and average time to reach hospital

To determine the frequency of various clinical presentations of snake bitten admitted patients. Study design: Descriptive case series study. This study was carried out in General Medicine ward, at Medical department of Peoples Medical University and Hospital Nawabshah, from September 2011 to March 2012. This study consisted of 55 patients admitted through the outpatient department, as well as from casualty department of Peoples Medical University and Hospital Nawabshah. Detailed History was taken from all the patients with special regard to type of snake, age, sex, site, time of bite, time lapsed between bite and reaching to hospital. Detailed clinical examination of local features were fang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting, echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure of envenomation. Systemic review was also done to see any co-morbidity. All patients underwent for base line and specific investigations especially clotting time [CT]. Inclusion criteria were that all diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history of snake bite with irrespective of toxicity were included. Patients with history of thorn prick, insect bite were excluded criteria. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 55 patients included in this study, 39 were men [70.9%] and 16 patients were female [29%]; with male to female ratio of 2.4:1. There was wide variation of age ranging from a minimum of >12 year to 60 year. The mean age was 39 +/- 5.8 years. In our study mostly patients 35[63.63%] reached hospital within 60 minutes followed by 12[21.88%] patients within 30 minutes. 5[9%] patients reached within 90 minutes and one patients reported more than 120 minutes. Symptoms of patients were pain at the bite side in 55[100%], ecchymosis in 18[32.72%], discharge from wound in 9[16.36%], bleeding from gum in 8[4.4%] Nausea and vomiting in 7[12.72%], hematuria in 11[20%], ptosis in 8[14.54%], drowsiness in 5[9%] and respiratory failure in 5[9%]. We conclude that males are commonly affected than females and the farmers and labourers are the most vulnerable section of the population for snake bites. In this study age, presence signs and treatment by faith healers is independent predictors of death in case of snake bite. This may provide important evidence to formulate preventive strategies especially health education

Neurological improvement after cervical traction in patients with cervical spine injury

To estimate frequency of neurological improvement after cervical traction in patients with cervical spine injury. This observational study was conducted at Department of Neurosurgery, Lady Reading Hospital, Peshawar - Pakistan from December 2010 to November 2011. The medical record of all cases, in which cervical traction was applied for cervical spine injury, was checked from record room. Documentation was done according to proforma designed, indicating age, sex, neurological status before and after cervical traction and investigations with findings on X-rays, CT and MRI. The data was analyzed from different angles in SPSS software. A total of 30 patients were included in this study. There were 20 males and 10 females. The age of the patients ranged from 13 to 80 years [mean= 31.07 +/- 15.45]. Majority of the patients [83.3%] were young, in the age range of 13- 40 years. Neurological improvement was noted in 14 [46.7%] patients. It was more in age group of 13-20 years [66.7%] and in those who presented with weakness of Frankle grade "B" and "C" [66.7% each]. The improvement was more in patients in whom anatomical alignment of spine was achieved. Skeletal cervical traction is safe and effective means of early decompression of spinal cord with neurological improvement. It is more effective in young individuals and those presenting with Frankle grade B and C weakness

Endoscopic third venfri'cufosfomy for obstructive hydrocephalus

To determine the success rate of endoscopic third ventriculostomy [ETV] for treating obstructive hydrocephalus. Cross-sectional observational study. The Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from May 2010 to November 2011. Patients with Obstructive hydrocephalus due to aqueductal stenosis, tectal and non-tectal tumour and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. Patients with congenital hydrocephalus and secondary to meningitis were excluded. Endoscopic third ventriculostomy was performed. Success, complications and mortality was noted. Data was analyzed by descriptive statistics using SPSS software version 17. There were 155 patients including 72 males and 83 females with ratio of 1: 1.33. Success rate was 71%. Indication of surgery was obstructive hydrocephalus due to aqueductal stenosis, posterior fossa tumour, brain stem and CP angle tumour. Complications were seen in 18 patients including mortality in 3 patients. ETV is effective, safe and successful procedure in patients with obstructive hydrocephalus. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients

Respiratory distress syndrome in preterm neonates of Lahore

Compromised health facilities in developing countries often result in inadequate care for both mothers and their newborns. Consequently, a large number of neonates who are born prematurely with serious prepartum difficulties develop additional postpartum complications. Respiratory distress syndrome [RDS] in infants is a complex pulmonary state in which the lungs are not properly developed and therefore produce very little surfactant resulting in morbidity of many preterm newborns. The present study investigated the frequency of RDS in neonates born at various gestational ages and of various birthweights. Out of 180 subjects, 50 [27.8%] developed RDS, the diagnosis of which was based on radiological findings and symptoms such as tachypnoea, nasal flaring and central cyanosis. The frequency of RDS is inversely, and significantly, associated with both gestational age and birthweight, which were found to be good predictors of the likelihood of a newborn developing RDS. Preterm newborns of low birthweight have a higher risk of developing RDS than full-term newborns of heavier birthweight. In light of these observations, proper management strategies should be devised for the assessment and treatment of preterm neonates with, or without, RDS

Experience with endoscopic third ventriculostomy in the management of hydrocephalus secondary to posterior fossa tumor

To analyze the outcome of endoscopic 3[rd] ventriculotomy in the management of hydrocephalussecondary to posterior fossa tumor. Sixty five cases of hydrocephalus secondary to posterior fossa tumor underwent endoscopic3[rd] ventriculostomy in the Department of Neurosurgery, Lady Reading Hospital, Peshawar Pakistan from January, 2011 to June, 2012 [18 months]. This was an observational study and the sampling was by simple random method. The study included 65 patients, 37 males, 28 females; M/F ratio, 1.32; with the age range 1-45 years. Fifty one percent [33 cases] of posterior fossa tumors occurred in children less than five years, 23% [15cases] in the 6-10 year age group, 16% [11 cases] occurred in 11-14 years and 10% [06 cases] in age group >14 yrs. Endoscopic third ventriculostomy was performed in 54 [83.07%] patients with successful outcome. Ventriculoperitoneal shunt was required in 5 [7.69%] patients for the suspicion of inadequate ventriculostomy. Ventricular drainage device [EVD] was inserted in 2 [3.07%] cases for hemorrhagic CSF. In 4 [6.15%] patients no drainage procedure was done [4th ventricle floor not involved / Aqueduct opening visible]. Preoperative endoscopic third ventriculostomy [ETV] control the intracranial pressure [ICP], avoid the necessity of an emergency procedure, allow appropriate scheduling of the operation for tumor removal, and eliminate the risks related to the presence of an external drainage. The most common age group involved was under 5 years. The success rate of ETV was 83% and Medulloblastoma was the most common Histopathological findings

Traumatic brain injury: a common neurosurgical entity

Traumatic brain injury [TBI] is leading cause of death and disability worldwide. Every year about 1.5 million affected people die and several millions receive emergency treatment. TBI with curret best practice, results in only about one third of patients being able to live independently in the long term. Although people from all age groups may be affected; the TBI is more common in young age because of the exposure of this age to more chances of accidents on roads, work place and during leisure activities. Decompressive craniectomy is a surgical operation to decrease intracranial pressure, has been used with increasing frequency. Neurological surgeons however do not know whether the operation achieves its goal of improving patient outcomes. The question is considered of great importance internationally. In Pakistan and especially in the province of Khyber Pukhtunkhwa, firearm injuries are more common and children are more prone to fall. The incidence of TBI is on the rise in developing countries. Anything that can improve the outcome from TBI has the potential of improving the lives of many head injured patients

Unilateral approach for bilateral decompression of lumbar spinal stenosis: a minimal invasive surgery

To assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression. Cross-sectional observational study. Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from January to December 2010. A total of 60 patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy [30 patients, Group A], or a unilateral approach [30 patients, Group B]. Clinical outcomes was measured using the scale of Finneson and Cooper. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months. Data was analyzed by descriptive statistics using SPSS software version 17. Adequate decompression was achieved in all patients. Compared with patients in the conventional laminectomy group, patients who received the novel procedure [unilateral approach] had a reduced mean duration of hospital stay, a faster recovery rate and majority of the patients [88.33%] had an excellent to fair operative result according to the Finneson and Cooper scale. Five major complications occurred in all patient groups, 2 patients had unintended dural rent and 2 wound dehiscence each and fifth patient had worsening of symptoms. There was no mortality in the series. The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements. An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability, as it requires only minimal muscle trauma, preservation of supraspinous/intraspinous ligament complex and spinous process, therefore, allows early mobilization. This also shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory outcome.

Immediate symptomatic relief after microvascular decompression for hemifacial spasm: a case series

Hemifacial spasmis a movement disorder characterized by intermittent, involuntary clonic or tonic clonic contractions of muscles innervated by the ipsilateral facial nerve. It is commonly caused by vascular compression of the facial nerve at its Root Exit Zone [REZ] from the brainstem. Anterior inferior cerebellor artery, posterior inferior cerebellor artery, vertebral artery commonly compress the facial nerve. Usual symptoms are progressive involuntary facial twitching. MRI brain and MRA are advised to know about neurovascular compression. Four case of hemifacial spasm are reported diagnosed on clinical grounds, and MRI brain and MRA are advised. Our objective is to assess the surgical outcome of microvascular decompression [MVD] for Hemifacial spasm [HFS]

Role of anterior decompression with internal fixation in dorsal spine tuberculosis

To assess efficacy of anterior decompression and internal fixation using mesh cage and rod with screws in patients with dorsal spine tuberculosis This observational study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from July 2010 to June 2012 [2 years]. There were 38 patients with dorsal spine tuberculosis who underwent anterior decompression and fusion using anterior spinal instrumentation and allograft replacement. We included those patients in our study, who undergone anterior decompression with internal fixation for dorsal spine tuberculosis, of both genders irrespective of their age. We excluded those patients who were unfit for surgery, treated conservatively, involved spine other than dorsal spine or undergone procedure other than anterior approach for Carrie's spine. Clinical outcome of the patients was assessed using the frankle grade. The patients were observed for post-operative complications, neurological improvement and bony fusion. We had total of 38 patients who undergone the procedure in whom23 [60.5%] were males and 15 [39.5%] females with male / female ratio of 1.5: 1. Their age ranged from 4-70 years [mean 37years]. The most common level involved were between D5-D12 for which thoracotomy was needed. Preoperative neurodeficit was observed in 76.3% patients of whom 89.7% showed improvement after surgery. Our patients had 7.9% complications after surgery. We had wound infection in 5.3% and dyspnea in 2.6% cases. There were no graft related complications and bony fusion was observed in all the patients. It is concluded from our study that anterior decompression with internal fixation using cage and rod with screws is an effective procedure in dorsal spine tuberculosis. It has few complications and yields good results

Methylglyoxal level in type-2 diabetes mellitus patients: a prospective, randomized and case control study at tertiary care hospitals, Hyderabad, Pakistan

To study the methyglyoxal [MG] levels in type 2 diabetes mellitus [T2DM] subjects compared with normal controls and to evaluate relationship of MG with blood sugar, systolic and diastolic blood pressure. Comparative case control study. This study was conducted at the Diabetic clinics of Isra University Hospital for a period of six months from. Thirty normal controls [Group. I] and thirty T2DM [Group. II] were studied according to inclusion and exclusion criteria. 5.0 ml of blood was transferred into citrated bottles. Serum was obtained by centrifugation at 4000 rpm for ten minutes and were frozen at -20 Degree C. The blood glucose level was detected by glucose oxidase method. MG was measured by the ELISA assay. Student`s t-test, Chi square test and Pearson`s correlations were used for the continous and categorical variables and linear association respectively. The Data was analyzed using SPSS version 17.0. A p-value of