Therapeutic Effect of Atorvastatin on kidney functions and urinary excretion of Glimepiride in healthy adult human male subjects

Glimepiride and Atorvastatin in combination are commonly employed for treating the hyperglycemia and dyslipidemia, respectively, in patients of type 2 diabetes. The present study was designed to find out the influence of Atorvastatin on urinary excretion and renal clearance of Glimepiride in healthy adult male volunteers. In each experimental subject, Glimepiride 2mg was given orally after an overnight fasting. Samples of blood and urine were taken at different specific time intervals. After a washout period of ten days, Glimepiride 2mg was co-administered with Atorvastatin 20mg orally. Post-medication, blood and urine samples were collected following the same sampling schedule as for Glimepiride alone. The samples were analyzed for Glimepiride and creatinine concentration by HPLCUV and Spectrophotometer, respectively. Mean [ +/- SE] values for blood pH 7.445 +/- 0.05 and 7.382 +/- 0.05, urine pH 4.972 +/- 0.08 and 5.08 +/- 0.10, diuresis 0.0207 +/- 0.00 and 0.0237 +/- 0.00ml/min/kg, endogenous creatinine in plasma 9.048 +/- 0.33 and 8.613 +/- 0.024 micro g/ml, endogenous creatinine in urine 512.34 +/- 18.20 and 556.72 +/- 4.60 micro g/ml, Glimepiride plasma concentration 0.16069 +/- 0.00 and 0.3227 +/- 0.01 micro g/ml, Glimepiride urine concentration 1.5994 +/- 0.03 and 0.8665 +/- 0.04 micro g/ml, renal clearance of creatinine 1.224 +/- 0.09 and 1.550 +/- 0.09ml/min/kg, renal clearance of Glimepiride 0.2064 +/- 0.01 and 0.0641 +/- 0.00ml/min/kg and clearance ratio 0.1791 +/- 0.01 and 0.0414 +/- 0.00 were observed for Glimepiride alone and its concurrent administration with Atorvastatin, respectively. Atorvastatin decreased the urinary excretion and renal clearance of Glimepiride due to which chances of hypoglycemia provokes and renal handling of Glimepiride involves back diffusion besides glomerular filtration and no influence of Atorvastatin was seen on these mechanisms

Endoscopic third ventriculostomy [ETV]; outcome

To know the surgical outcome of endoscopic third ventriculostomy [ETV] in non communicating hydrocephalous. This study was conducted in Abaseen Hospital, Peshawar, from 13th December 2010 to 12th October 2011. Patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients with communicated hydrocephalous, patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous was diagnosed on CT scan brain. The procedure was done under general anesthesia. Clinical Outcome of ETV was evaluated by the time of discharge and on subsequent follow up visits i.e. monthly for the first three months and then at six months. Any patient who subsequently needed VP shunting after the ETV procedure was described as having treatment failure. We operated 27 patients during our study period. Age ranged from 2 years to 57 years with mean age 20.8 years. There were 16[59.26%] males and 11[40.74%] females. Etiologically, 4th ventricular tumors was present in 9 patients [33.33%], tuberculous meningitis in 8[29.62%], aquiductal stenosis in 7[25.92%], brain stem glioma in 1[3.70%]. cerebellar haemengioblastoma in 1[3.70%] and pineal tumor [3.70%] with infra tentorial extension in 1 [3.70%] patient. The procedure was successful in 24[88.89%] patients and converted to ventriculoperitoneal shunts in 3[11.11%] cases. Post operatively CSF leakage was present in 2 [7.40%] patients, transient memory loss in 1[3.70%], pneumocephalus in 1[3.70%] and pseudomeningocele in 1[3.70%] patients. Endoscopic third ventriculostomy is a good alternative to the VP shunt in cases of non-communicating hydrocephalous. Although ETV does have some complications but these are transient and can be minimized with proper patient selection and meticulous surgical technique

Non operative treatment; functional outcome of radius ulna diaphyseal fractures in children

Pediatric forearm fractures result in substantial morbidity and costs. Despite the success of public health efforts in the prevention of other injuries, the incidence of pediatric forearm fractures is increasing. Most forearm fractures occurred during the spring season. Objective of the study is to determine the functional outcome of conservatively treated radius ulna fractures in Children. Descriptive study. Department of Orthopedics and Traumatology, Khyber Teaching Hospital Peshawar. March 2009 to April 2010. Total 236 children with radius ulna fractures were manipulated and above elbow plaster Cast applied for 6-8 weeks and reviewed every second week. After plaster cast removal Pronation and supination measured with goniometer and fortnightly thereafter for 6 weeks. All the fractures united. Normal range of pronation and supination at the end of follows up period was in 182 [80.53%] children. Loss of pronation and supination of average 10 degrees were in 9[3.98%] patients. Patients having displacement of the fracture and opted for surgery were 35 [15.46%]. Closed reduction of diaphyseal fractures in children results in normal pronation and Supination in majority of the patients

Clinical manifestation of cervical neurofibroma type 1 in patients of a tertiary care hospital

To determine the clinical presentation of cervical neurofibroma type 1 [NF 1] tertiary care hospital. This descriptive study was conducted at Neurosurgery department, Lady Reading Hospital Peshawar from February 2001 to July 2011. A total 31 patients with symptomatic cervical spineneurofibromas who underwent surgical decompression and tumor resection were included in this study. Both gender [male and female] and patients in the age range of 20-70 years were included in this study. The patients' demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11. Out of 31 patients, there were 17 [54.8%] males and 14 [45.2%] females. The age of patients ranged from 20 to 70 years. In this study the overall mean age was 32.38 years. Majority of patients fifteen [48.38%] were in the age range of 31-40 years. Most common clinical presentation of patient was quadrapresis in seventeen [54.8%] patients. Cervical neurofibroma type 1 commonly occurred in the third decade of life. Quadriparesis was the common clinical presentation of cervical cord neurofibroma type 1

Management of brain abscesses

To find the etiology and outcome of treatment of brain abscesses. Descriptive case series. Department of Neurosurgery, Hayatabad Medical complex Peshawar, from October 2008 to January 2010. This study was carried out on patients of brain abscesses of all ages and both genders. Patients having fungal brain abscess, amoebic brain abscess and tuberculous brain abscess were excluded. Brain abscess was diagnosed on contrast CT scan. Cases of early cerebritis were treated using parenteral antibiotics for six to eight weeks. Surgical treatment consisted of either burr hole aspiration with the help of brain cannula, re-aspiration or craniotomy and excision of abscess capsule. Therapeutic outcome was assessed with CT scan on follow up. Procedure related complications and mortality were also recorded. A total of 73 patients were managed. The commonest age group was from 11-20 year. The mean age was 26.36 +/- 14.1 year [range - 0.16 - 67 year]. There were 46 [63.01%] male and 27 [36.99%] female patients. The majority of brain abscesses were supratentorial [n=65 - 89.04%]. In 8 [11.96%] cases abscess was in infratentorial region. Contiguous focus of infection was responsible for brain abscess in 29 [39.72%] patients, Majority of patients presented with headache [n=30 - 41.09%] and vomiting [n=25 - 34.24%]. Surgical drainage was performed in 70 [95.89%] patients where as 3 [4.11%] patients were treated conservatively. Initially only burr hole aspiration was done in all surgically treated patients. In 60 [85.71%] patients there was complete resolution. Craniotomy was done in 4 [5.71%] cases. There was no mortality in this study. Sixty one [87.14%] patients recovered without complications. Majority of the cases needed surgical intervention. Burr hole aspiration was effective initial surgical treatment. Cases of early cerebritis successfully managed with broad spectrum antibiotics

Microvascular decompression in patients with intractable idiopathic trigeminal neuralgia

To evaluate etiology and implications of microvascular decompression [MVD] in patients with intractable idiopathic trigeminal neuralgia. Descriptive case series. Neurosurgery department of Hayatabad Medical Complex, Peshawar from January 2007 to December 2009. Patients with idiopathic trigeminal neuralgia [ITN] irrespective of age and sex, were included in the study. Patients responding to medical treatment were excluded. MRI brain was done for all patients to exclude secondary causes. Microvascular decompression was performed in all patients under general anesthesia. Patients were examined on seventh postoperative day and the clinical findings were documented. Outcome of surgery was declared as successful when there was a commensurate relief of neuralgia paroxysms and deep background pain along with total withdrawal of medications. Fifty two patients were operated for trigeminal neuralgia. There were 23 [44%] males and 29 [56%] females [M:F 1:1.26]. Age ranged between 20-70 years [Mean 56 years]. Right sided neuralgia was present in 34 [65%] cases. In 50 cases [96%] a neurovascular conflict was found. The superior cerebellar artery [SCA] was the cause of compression in 45 [86.53%] patients, anterior inferior cerebellar artery [AICA] in two patients, and one patient each, the vessel involved was posterior inferior cerebellar artery [PICA], basilar artery, and petrosal vein. In 2 patients trigeminal nerve was found encased by tight arachnid adhesions. Trigeminal nerve entry zone was the point of conflict in 38 cases [73.07%]. The mandibular division [V3] was involved in 30 cases [57.7%] followed by maxillary division [V2] in 18 cases [34.61%] and ophthalmic division [V1] in 4 cases [94.23%]. Cerebrospinal fluid [CSF] leakage occurred in 3 cases [5.76%]. One patient developed wound infection. One patient [1.92%] expired in the postoperative period due to mid brain stroke. The main etiological factor of trigeminal neuralgia was vascular compression, especially by SCA, of the 5[th] nerve roots at brain stem. Microvascular decompression is safe and effective therapy for all ages

Efficacy in pain relief; fenestration technique for disc excision

To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc. Descriptive study. Department of neurosurgery of Hayatabad Medical Complex, Peshawar. October 2008 to September 2010. All those patients were included in whom straight leg raising [SLR] sign was less than 60 degree and prolapsed L4-5 or L5-S1 disc on MRI. Patients with multiple level discs, previous history of spine surgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chest position under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day of discharge. Statistical analysis was performed with SPSS [version 10]. One hundred and nine patients were studied. Sixty were male and fifty nine were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The most common level of involvement was L 4 -L 5 [n=67] followed by L 5 -S 1 [n=42]. Sixty five patients had left sided symptoms while forty four had right sided. Majority of patients presented in Dennis pain scale 4 i.e. 66.97% [n=73]. Twenty patients [18.36%] were in P3 and 16 patients [14.67%] were in Dennis pain scale 5. Complete pain relief [P1], three weeks after disc excision, was achieved in 90 [82.57%] patients .Fourteen patients[12.85%] were in P2 and five [4.58%] patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Surgical treatment provides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques