C3a Receptor Inhibition Protects Brain Endothelial Cells Against Oxygen-glucose Deprivation/Reperfusion

The complement cascade is a central component of innate immunity which plays a critical role in brain inflammation. Complement C3a receptor (C3aR) is a key mediator of post-ischemic cerebral injury, and pharmacological antagonism of the C3a receptor is neuroprotective in stroke. Cerebral ischemia injures brain endothelial cells, causing blood brain barrier (BBB) disruption which further exacerbates ischemic neuronal injury. In this study, we used an in vitro model of ischemia (oxygen glucose deprivation; OGD) to investigate the protective effect of a C3aR antagonist (C3aRA, SB290157) on brain endothelial cells (bEnd.3). Following 24 hours of reperfusion, OGD-induced cell death was assessed by TUNEL and Caspase-3 staining. Western blot and immunocytochemistry were utilized to demonstrate that OGD upregulates inflammatory, oxidative stress and antioxidant markers (ICAM-1, Cox-2, Nox-2 and MnSOD) in endothelial cells and that C3aRA treatment significantly attenuate these markers. We also found that C3aRA administration restored the expression level of the tight junction protein occludin in endothelial cells following OGD. Interestingly, OGD/reperfusion injury increased the phosphorylation of ERK1/2 and C3aR inhibition significantly reduced the activation of ERK suggesting that endothelial C3aR may act via ERK signaling. Furthermore, exogenous C3a administration stimulates these same inflammatory mechanisms both with and without OGD, and C3aRA suppresses these C3a-mediated responses, supporting an antagonist role for C3aRA. Based on these results, we conclude that C3aRA administration attenuates inflammation, oxidative stress, ERK activation, and protects brain endothelial cells following experimental brain ischemia.

How to decrease the complication rate in the initial phase of introduction of laparoscopic cholecystectomy in a new setup

Laparoscopic Cholecystectomy [LC] is yet to be fully established in developing countries due to lack of economic resources and training facilities. These limitations dictate that an approach be used whereby laparoscopic technique can be established without the need of attending costly training sessions. This study was aimed to describe the strategy that we used to introduce LC in our hospital and to present the outcome of the initial 250 cases. Prospective Study, Place and Duration of Study: Sindh Government Qatar Hospital [SGQH], Karachi, Pakistan from January 2009 to July 2011. The strategy used involved initial detailed literature review regarding LC, practice with instruments using a costless endotrainer, initial careful case selection and hands-on supervision of the first 25 cases by an experienced laparoscopic surgeon. Initially selected patients included those with duration of symptoms less than 6 months, thin patients and patients with gallbladder wall thickness of up to 4 cm on ultrasound. Outcome in terms of conversion rate, postoperative recovery, complications including CBD injury and mortality is described. The mean operative time for the first 25 cases was 89 minutes and overall was 46 minutes. Four [1.6%] patients were converted to open procedure. 153 [61.2%] were discharged by the 3rd postoperative day. 35 postoperative complications were detected in 22 [8.8%] patients with rate of CBD injury being 1.2%. Major complications occurred in 8 [3.2%] patients. The mortality rate was 1 .2%. Our results indicate that the strategy we used to introduce LC in our setup was successful in establishing the procedure with an initial slightly higher but comparable complication rate

Repair of fistula in ANO: is primary closure worth?

To determine the efficacy of primary closure of wound after fistulectomy in anal fis-tulae patients as a method of successful treatment to reduce the time of healing and hospital stay with special reference to recurrence and continence. Descriptive, retrospective study from 1995 to 2005. Sindh Government Qatar Hospital Orangi Town Karachi and author's private clinic, Medlyn Hospital Block H North Nazimabad Karachi. 300 patients who presented with low anal fistula [Park's classification I and II] during the above-mentioned period. The data of all 300 patients were analyzed as regards to presentation, treatment, and the outcome. A total of 300 patients with low fistula in ano were treated by primary closure. The postoperative complications were minimal and managed conservatively. The mean length of follow-up was 3 years. Recurrence took place in 3% patients. The average recovery time was 12 days. Similarly return to work is also early 14 days. Three patients were incontinent to flatus while 1 was incontinent to faeces and flatus for the first six months. It is observed that following fistulectomy and primary closure of low fistula in ano, sound healing can be achieved in over 97% of cases with amazingly early return to work

Abdominoplasty with prosthetic mesh in incisional hernias

Abdominoplasty known more commonly as a "tummy tuck" is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. Mesh repair of incisional hernias along with fat reduction of abdominal wall is still a procedure not very frequently done in our country. A study was conducted in Sindh Govt. Qatar Hospital during the period of three years [2000 to 2003] to evaluate the outcome of this procedure and complications. Total of 56 patients were operated, most of them were females [47] and many [23] have recurrent incisional hernias of abdominal wall. The overall results were satisfactory with uneventful recovery in 95% and low rate of complications which is .5%. And mesh rejection seen only in 1 patient

Para-testicular rhabdomyosarcoma

We are presenting the case report of a young male, aged 19 years, who presented with a scrotal swelling and loss of weight and was ultimately diagnosed to have a rare tumour viz. Para-testicular rhabdomyosarcoma