The Safety and Efficacy of Anakinra, an Interleukin-1 Antagonist in Severe Cases of COVID-19: A Systematic Review and Meta-Analysis / 감염과화학요법

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

The Safety and Efficacy of Anakinra, an Interleukin-1 Antagonist in Severe Cases of COVID-19: A Systematic Review and Meta-Analysis / 감염과화학요법

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

Integrative Omics Reveals Metabolic and Transcriptomic Alteration of Nonalcoholic Fatty Liver Disease in Catalase Knockout Mice

The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased with the incidence of obesity; however, the underlying mechanisms are unknown. In this study, high-resolution metabolomics (HRM) along with transcriptomics were applied on animal models to draw a mechanistic insight of NAFLD. Wild type (WT) and catalase knockout (CKO) mice were fed with normal fat diet (NFD) or high fat diet (HFD) to identify the changes in metabolic and transcriptomic profiles caused by catalase gene deletion in correspondence with HFD. Integrated omics analysis revealed that cholic acid and 3β, 7α-dihydroxy-5-cholestenoate along with cyp7b1 gene involved in primary bile acid biosynthesis were strongly affected by HFD. The analysis also showed that CKO significantly changed all-trans-5,6-epoxy-retinoic acid or all-trans-4-hydroxy-retinoic acid and all-trans-4-oxo-retinoic acid along with cyp3a41b gene in retinol metabolism, and α/γ-linolenic acid, eicosapentaenoic acid and thromboxane A2 along with ptgs1 and tbxas1 genes in linolenic acid metabolism. Our results suggest that dysregulated primary bile acid biosynthesis may contribute to liver steatohepatitis, while up-regulated retinol metabolism and linolenic acid metabolism may have contributed to oxidative stress and inflammatory phenomena in our NAFLD model created using CKO mice fed with HFD.

Surgical repair of post-infarction ventricular septal rupture: determinants of operative mortality and survival outcome analysis

Background and Objective: Ventricular septal rupture [VSR] is one of the fatal complications of myocardial infarction [MI]. Surgery provides the maximum survival benefit. Our objective was to investigate the risk factors of surgical mortality and to do the survival analysis in the past six years at our hospital

Methods: All the patients operated at CPE Institute of Cardiology Multan Pakistan, between 2009 and 2015 for repair of post MI VSR were analysed retrospectively for demographics, comorbidities, operative and post operative outcomes. The primary outcome was 30 days mortality. The follow up was done till April 2017 and the follow up data was obtained from hospital records and by telephoning the patients. SPSS was used for statistical analysis. P value < 0.05 was considered significant

Results: A total of 31 patients were operated for VSR repair with a mean age of 57.19 +/- 7.73 years. Eighteen patients also had a concomitant coronary artery bypass grafting [CABG]. The operative mortality in this series was 25.8% Univariate analysis showed that pre-operative ejection fraction [E.F] [p value 0.010] and cardiogenic shock [p value 0.031] were a significant risk factors for operative mortality while on logistic regression analysis only the cardiogenic shock was found to be an independent risk factor for operative mortality with the odds ratio of 2.17. Low ejection fraction only acted as a confounding variable. The mean survival at six years was 34 months with a survival rate of 28.6%. The additional CABG did not confer any survival benefit

Conclusion: The patients in cardiogenic shock pre-operatively have a high operative mortality. Low ejection fraction [E.F] acts as a confounding factor. Concomitant CABG does not confer any survival benefit

Impact of age at diagnosis on clinicopathological outcomes of oral squamous cell carcinoma patients in Karachi

Objective: A recent trend in diagnosis of oral cancer in young age is observed, however its impact on various clinicopathological parameters needs to be explored. The aim of the current study was to compare and analyze impact of age at diagnosis with clinicopathological parameters of oral squamous cell carcinoma patients

Methods: In this cross sectional study conducted at Department of Oncology Ziauddin Hospital Karachi, we included histologically confirmed cases of oral squamous cell carcinoma. The patients were categorized as young age group [40yrs and younger] and old age group [41 yrs and above]. A total of 115 patients diagnosed between 2013 and 2016 were enrolled in the study. The variables considered were age at diagnosis, sex, site of lesion, positive family history, tumor grade, stage, uric acid level and survival

Results: A statistically significant difference was observed between two age groups in overall survival, uric acid level and positive family history of cancer. No significant difference was observed in tumor location, grade and stage

Conclusion: Majority of oral cancer patients present at an advanced stage irrespective of age at diagnosis but young age has an overall improved survival. Moreover, a positive family history of cancer in young age group mandates further exploration of possible role of genetic polymorphisms which might be responsible for early onset of the disease

Association of homocysteine with body mass index, blood pressure, hba1c and duration of diabetes in type 2 diabetics

Objective: To determine the Homocysteine levels in type 2 diabetics and correlate homocysteine with HbA1c levels, BMI, blood pressure and duration of diabetes

Methods: This cross-sectional study was conducted in Endocrinology Unit of Hayatabad Medical Complex [HMC] Peshawar and Rehman Medical Institute [RMI] Peshawar over a period of six months from July 2015 to December 2015. Data was recorded and analyzed in SPSS v 20. P value of less than 0.05 was taken as significant. Bivariate Pearson's correlation test was used to see the relationship between homocysteine and BMI, systolic BP and duration of diabetes

Results: One hundred twenty five patients were included in our study in which female were 68% and 32% were male with mean age of 51.45 +/- 8.37 years. Mean BMI expressed in kg/m2 was 28.71 +/- 4.76, mean systolic blood pressure was 130 +/- 20.98 mmHg, mean diastolic blood pressure was 83.36 +/- 11.28 mmHg and mean duration of diabetes was 7.018 +/- 6.18 years. Significant correlation was found between systolic blood pressure [r: 0.239, p: 0.007] and duration of diabetes with homocysteine [r: 0.302, p: 0.001]. The correlation of homocysteine with HbA1c and BMI was not significant

Conclusion: Systolic blood pressure and duration of diabetes showed a significant positive correlation with homocysteine. The correlation of homocysteine with HbA1c was not certain from researcher's point of view and further studies of larger sample size and longer duration must be conducted to ascertain the association between the two variables

Incidence of malaria in the population of Korangi creek area, Karachi, Pakistan

Parasites lives on host organism with some or complete metabolic dependence on it, while the haemoparasites inhabit and nourished from blood cells of the host. The current investigation evaluated to raise awareness of blood parasite [Plasmodium spp.] infection in Korangi creek, Karachi, population and to know as to which Plasmodium species was most prevalent. One year data was collected from different hospitals and laboratories of the Korangi creek area, blood slides were prepared under the microscope. Four hundred and eighty one infected slides with Plasmodium were observed amongst them 396 [82.32 percent] had P. vivax and 85 [17.67 percent] had P. falciparum infection. The rate of infection did not vary with gender but had a signification association with age. Highest incidence was recorded in age group 16-40 years for both P. vivax and P. falciparum followed by age group 1-15 years in P. vivax and age group 41-60 years for P. falciparum. It was suggested that protective measures are required to overcome disease that include covering arms and legs, using repellents mosquito nets along with proper dispensing and appropriate treatment

Diagnosing Diabetic Neuropathy: Something Old, Something New

There are potentially many ways of assessing diabetic peripheral neuropathy (DPN). However, they do not fulfill U.S. Food and Drug Administration (FDA) requirements in relation to their capacity to assess therapeutic benefit in clinical trials of DPN. Over the past several decades symptoms and signs, quantitative sensory and electrodiagnostic testing have been strongly endorsed, but have consistently failed as surrogate end points in clinical trials. Therefore, there is an unmet need for reliable biomarkers to capture the onset and progression and to facilitate drug discovery in DPN. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging modality for in vivo evaluation of sensory C-fibers. An increasing body of evidence from multiple centers worldwide suggests that CCM fulfills the FDA criteria as a surrogate endpoint of DPN.

Clinicopathological features associated to MiRNA-195 expression in patients with breast cancer: Evidence of a potential biomarker

Background and Objective: MiRNAs are a systematic class of small non-coding RNAs with impending role; tumor biomarkers. Our objective was to identify the level of expression of Mir-195 in patients with brea cancer along with its correlation with clinicopathologic features

Methods: A total of 209 females in which 139 historically diagnosed breast cancer [BC] cases and] healthy controls matched for age, their relative clinical and histopathological findings were recorded fro their laboratory reports and hospital record of the patients. Plasma was used for extraction of total l" and cDNA was prepared by using both miR-195 stem loop RT primers and gene specific antisense prime while U6 IT was used as control. Quantitative real-time PCR [qRT-PCR] for miR-195 expression status w< performed and amplification [down regulation] was recorded

Results: Of 139 samples the expression of miR-195 was down regulated in 72.6% cases and the remains 27.3% cases behaved same as 70 healthy or normal controls. Significant correlation of low miR-15 expression with higher differentiation grade, lymph node metastasis and clinical stage was found

Conclusion: Significant correlation between miR-195 expression and some Clinicopathological feature were recognized. MiR-195 could be used as potential non-invasive, molecular biomarker for early detectio of breast cancer

Primary gastric burkitt's lymphoma

The primary gastrointestinal non-Hodgkin's lymphoma is a rare entity. Burkitt's lymphoma [BL] is an aggressive form of B-cell lymphoma which is endemic in Africa, while in rest of the world non-endemic cases has been reported. Primary gastric BL is extremely rare and only around 53 cases have been reported till now. Here we present the case of a middle-aged male, immunocompetent who presented with anorexia weight loss and diarrhea. His upper gastrointestinal endoscopy and biopsy revealed a large primary gastric Burkitt lymphoma. After chemotherapy, he remains in remission

Serum uric acid level in the severity of congestive heart failure [CHF]

Background and Objective: It has been observed that in a clinical condition like hypoxemia there is an increase in the serum Uric acid level. The objective of our study was to find out the relationship between serum uric acid levels in the severity of Heart failure

Methods: We analyze 285 patients with a diagnosis of Congestive heart failure admitted in Lady Reading Hospital Peshawar from March 1[st] to August 2016. Age group of patients was 17- 67 years. New York Health Association [NYHA] scoring were used to access the severity of Congestive Heart Failure. Serum UA level >7.0 mg/dl was considered high

Results: Total 285 patients with CHF were analyzed with a mean age of 54+/-2.8 years in which males were 65.96% and 34.03% were female. 40% were in class II of New York Health Association [NYHA], 32.63% in class III and 25.61% in class IV and 1.75% were in class I. Out of 285, 59.29% met the definition of hyperuricemia. In which 83.43% were male and 16.57% were female. Most of the Hyperuricemic patients 62.13% were in age group of 51- 60 years, with a mean age of 57+/-4.5 years. We found a significant correlation between uric acid level and BNP [p= <0.001], and use of diuretics [p=<0.001]. 34.93% of the Hyperuricemic CHF patients were in NYHA III and NYHA IV whose SUA was above 8 mg/dl as compared to 31.57% Hyperuricemic CHF patients whose SUA was below 8 mg/dl

Conclusion: High serum Uric acid was observed in 59.29% of patients with CHF. The observed significant correlation between UA level and some established prognostic markers in these patients may indicate that serum UA could provide additional prognostic information in this population. SUA as a marker can be measured anywhere at a low cost to help identify high-risk patients with CHF. Lowing uric acid is expected to be a new approach for prevention and therapy of HF

Most common body parts infected with scabies in children and its control

Scabies a skin disease caused by mite Sarcoptes scabiei is common in Pakistan and spreads mostly where there is frequent skin to skin contact. In the present study children belonging to four age groups 0-3 years, 4-6 years, 7-9 years and 10-12 years attending Baqai Institute and Hospital Gadap from June-September 2013 were examined. The association between scabies of different human parts and age for boys was significant [p<0.01], while for girls it was highly significant [p<0.001]. The most frequent body parts infected with scabies lesions were hands, head and feet. Oral ivermectin was effective antiscabietic for children as it was easy to administer and had good patient acceptability

Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa [MENA] region: Much work needs to be done

The prevalence of diabetic peripheral neuropathy and painful diabetic peripheral neuropathy in the Middle East shows huge variability. This reflects the differing diagnostic techniques employed to diagnose neuropathy, but also the heterogeneity of the populations studied and the selection of populations from primary and secondary care. The treatment of diabetic neuropathy per se is inadequate as reflected by the poor control of risk factors such as glucose control, blood pressure and lipids in this region, which translates into the high rates of foot ulceration and amputation. In relation to symptomatic treatment, recommendations based on trials conducted in the West are without question, endorsed for the treatment of populations in the Middle East. Surely the demographics and patient responses both in terms of efficacy and side effects differ and therefore warrant local clinical trials. There is an over reliance on the prescription of B vitamins with the claim that they induce nerve repair. Whilst there is evidence for the relief of neuropathic symptoms with both vitamin B and D, again clinical trials are required in this region to establish their role in the treatment of diabetic neuropathy and painful diabetic neuropathy

Post thrombolytic resolution of ST elevation in STEMI patients

Objective: To study the effect of timing of thrombolytic therapy, cardiac risk factors and site of infarction on S.T. resolution post thrombolysis in STEMI patients

Methods: This was a descriptive hospital based study conducted at the Hayatabad Medical Complex Peshawar. The duration of our study was 5 months from February 2015 to June 2015. Diagnosis of STEMI in symptomatic patients was based on the ECG recognized. Definition of Myocardial Infarction. Time from onset of chest pain to presentation of patients in emergency was noted through history of patients along with time of streptokinase. ECG recordings of patients were taken upon presentation in Emergency. Serial ECG monitoring was done after administration of Streptokinase [SK]. ST resolution was observed in the lead with the maximum ST elevation. Data were presented as frequencies and percentages, chi square test was applied

Results: Among 83 patients with STEMI 50.6% were males and 49.4% were females with the age group range of 30-83 years. Fifty nine patients [71.08%] with STEMI underwent thrombolysis within 12 hours of onset of chest pain while 24 patients [28.92%], underwent thrombolysis after 12 hours of onset of chest pain. Out of the 59 patients who received thrombolytic therapy before 12 hours, 43 [72.88%] completely resolved, while those who received thrombolytic therapy after 12 hours none of them completely resolved as per ECG findings. By applying chi-square test it gives us value of 36.470, and p-value <0.001. In our study 28 patients were diabetic and out of these six [21.43%] completely resolved as per ECG post thrombolysis, 9 [32.14%] partially resolved and 13 [46.43%] failed to resolve. On the other hand, in non-diabetics out of 55, 37 [67.27%] completely resolved, 12 [21.82%] partially resolved and 6 [10.91%] failed to resolve. Among 61 hypertensive, 26 [42.62%] had complete resolution and in 22 who were non-hypertensive, 17 [77.27%] had complete resolution on ECG. Hyperlipidemia and site of infarction didn't have statistically significant effect on the resolution of ECG post thrombolysis in STEMI patients

Conclusion: Patients with diabetes, hypertension and those who receive thrombolysis after 12 hours of onset of chest pain respond poorly to thrombolytic therapy as per ECG findings whereas hyperlipidemia and site of infarction don't affect the response of STEMI patients to thrombolysis

Exercise tolerance test as screening tool for suspected myocardial ischemia

To identify the common indications for Exercise tolerance Test [ETT] and to determine the frequency of IHD among subjects who presented with chest pain. It was a cross-sectional study; the data was taken from the Exercise Tolerance Test [ETT] Unit at Department of Cardiology Rehman Medical Institute, Peshawar using Bruce protocol. Out of 200 patients, there were 116 [58%] males and 84 [42%] females who presented in the cardiology department for ETT. Common indications for ETT were chest pain 124 [62%] and shortness of breath 24[12%], while 24[12%] and 28[14%] of subject were referred for general checkup and nonspecific symptoms respectively. Exercise ECG showed no ST changes in 100[50%] patients. The most common risk factors were smoking, hypertension, obesity and diabetes. Majority of subjects 148[74%] were test negative for ischemic heart disease and angina, 36[18%] have test positive for ischemia and angina and only 16[8%] ETT were negative for ischemic heart disease and positive for arrhythmias. We recommend using ETT as a screening tool in patients who present with features simulating angina, this prevent unnecessary hospital admissions

Thrombolysis in the treatment of acute stroke: is there a role for streptokinase when tissue plasminogen activator is not available?

Every year 350,000 people suffer an acute stroke in Pakistan. Treatment of acute stroke has not improved significantly despite the availability of intravenous thrombolysis with tissue plasminogen activator [tPA].The drug is expensive and is offered to a selected few. Streptokinase [SK], a low cost alternative thrombolytic agent, is widely available in Pakistan and is utilized to treat patients with acute coronary syndromes. Streptokinase was tested in acute stroke in the 1980's and found to be ineffective in ischemic stroke. This is likely due to trial design flaws, rather than the drug itself. Factors that may have contributed to poor outcomes include a prolonged treatment window, inclusion of patients with established infarction on CT scan, failure to treat excessive arterial pressures, a fixed dose of streptokinase and concomitant use of antithrombotic medications. Given the lack of therapeutic alternatives we believe that a properly designed trial in appropriate patient population utilizing stricter inclusion criteria, including early treatment with a lower dose of SK is warranted

Comparability and validity of siriraj stroke score and allen stroke score in differentiation of acute ischemic and haemorrhagic stroke

To compare and validate Alien stroke score [ASS] and Siriraj stroke scores [SSS] in differentiating acute cerebral hemorrhage [CH] and cerebral infarction [CI]. This comparative, analytical study was conducted at Khyber Teaching Hospital Peshawar, Pakistan from July 2000 to February 2002. Study included 100 patients of acute ishemic or hemorrhagic stroke confirmed on CT scan brain after clinically evaluation. ASS and SSS were calculated for each patient and compared with the results of CT scan for comparability [Kappa Statistics] and validity by using SPSS 10. Out of 100 patients, 69 had CI and 31 had CH. The overall comparability of ASS and SSS was fair [Kappa=0.51]. ASS and SSS were uncertain in 27 and 18 cases respectively; with Kappa showing worst comparability in term of certain results [K= 0.23]. In 64 cases with both scores in the diagnostic range, the Kappa showing excellent comparability [K=0.91].The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of ASS was 38.70%, 91.30%, 66.67%, 76.82% respectively for CH and 71.1%, 80.64%, 89.09% and 55.56% respectively for CI, with overall predictive accuracy of 61%. The sensitivity, specificity, PPV and NPV of SSS was 67.74%, 94.2%, 84% and 86.67% respectively for CH and 78.26%, 90.32%, 94.73% and 65.11% respectively for CI, with overall predictive accuracy of 75%. Although, SSS being simple with more accuracy is better than ASS, both these scores lack sufficient validity to be used for exclusion of cerebral haemorrhage before offering antithrombotic or thrombolytic therapy

Effects of 5.5 millimeters clear corneal temporal versus steeest meridian phacoemulsification incision on preexisting corneal astigmatism

To compare the effects on astigmatism of 5.5 mm clear corneal phaco-incision at steepest meridian [group A] with uniformly selected temporal site [group B]. Randomized control trial [RCT] Armed forces institute of ophthalmology Rawalpindi [AFIO]. January 2007 to December 2007. One hundred cases were enrolled and randomly divided into two groups, 50 in each group. Subjects were divided by simple random method [lottery method] into two groups, group A and B. Cataract surgery was performed by phaco and PCIOL was implanted. In group A, incision was made on steepest meridian. While in group B, incision was made on uniformly selected temporal site [irrespective of steepest meridian]. On 12th post-operative week corneal astigmatism of group A [1.46 +/- 0.377] was significantly [p<0.05] less than pre-operative astigmatism [2.151 +/- 0.404]. For group B, difference between 12th week post-operative [1.73 +/- 0.344] and pre-operative astigmatism [2.03 +/- 0.342] was also statistically significant but the effects of phaco-incision in reducing pre-corneal astigmatism was much superior in group A than in group B. The difference was statistically significant at p<0.05. Steepest meridian phaco-incision results in significant decrease in pre-operative astigmatism than routine phaco-incision on temporal side

Frequency of seizures and epilepsy after ischaemic stroke

To evaluate the frequency and risk factors of seizures and epilepsy after ischemic stroke. This prospective observational study was conducted on patients with Ischemic Stroke in the Department of Neurology; Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. These stroke patients were followed up for a total period of 2 years. Initially 210 patients were enlisted in the study. Out of these, 10 patients died or lost to follow up so they were excluded from the final analysis leaving a figure of 200. The main outcome measures were the occurrence of single or recurrent seizures as well as the occurrence of both early [within 2 weeks] and late [after 2 weeks] seizures were recorded. Patients who already had history of seizures, those with intra-cerebral bleed and sub-arachnoid hemorrhage were excluded from the study. Out of 200 patients [130 males and 70 female], 6 [3%] patients had early seizures while 10 [5%] patients presented for the first time with late onset seizures. So a total of 16 [8%] patients had post stroke seizures. Early seizures were mostly generalized tonic clonic seizures, while late seizures were mostly partial with or without secondary generalization. Epilepsy characterized by recurrent seizures occured in 3 patient's [1.5%]. Stroke patients have overall 8% risk of seizures and 1.5% risk of epilepsy in the first 2 years after an ischemic stroke. Majority of these seizures occurred after 2 weeks of onset of stroke

Thymectomy for myasthenia gravis: Peshawar experience of 27 cases in five years

To determine the safety and efficacy of Thymectomy for myasthenia gravis. This observational descriptive study was conducted at Departments of Cardiothoracic Surgery and Neurology Lady Reading Hospital Peshawar from January 2002 to December 2006. Computerized clinical data of 27 diagnosed cases of myasthenia gravis that underwent thymectomy were retrospectively analyzed. Patients who were unfit for surgery were excluded from the study. CT scan was done in all patients apart from routine investigations. Preoperative medication included anticholinesterase drug. They all underwent Thymectomy via median sternotomy. A total of 27 patients [09 males and 18 females] with a mean age of 30.5 years [range 15-50 years] were analyzed. The preoperative duration of the disease ranged from 0.5 to 120 months [mean=25.72 +/- 30.68 months]. According to the Myasthenia Gravis Foundation of America [MGFA] clinical classification, 20 [74.07%] patients were in stage two while 7 [25.925%] patients were in stage three. The histology of thymus glands consisted of hyperplasia in 12 [44.4%] patients, normal in 10 [37.1%], atrophic thymus in 3 [11.1%] and thymoma in 2 [7.4%] patients. Hospital mortality was 7.4% [n=2/27] while morbidity was 3.7% [n=1/27]. The mean follow up period was 31.5 months [3-63 months]. Complete remission was achieved in 55.55% [n=15/27] patients, and marked improvement in 25.92% [n=7/27], for a total benefit rate of 80%. Five [18.51%] patients remained unchanged and had no clinical improvement. Thymectomy is a safe and effective treatment for patients with myasthenia gravis