Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature

Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.

Evaluation of Efficacy of Levetiracetam in treating Neonatal Seizures in DHQ Hospital, Pakistan

OBJECTIVE: evaluate the frequency of efficacy of Levetiracetam in treating seizures in neonates METHODOLOGY: In this descriptive observational study, we enrolled 110 cases from DHQ Hospital Kasur. We included all neonates of either gender, term cases, with seizures, loading dose of 50 mg/kg of intravenous levetiracetam was given at admission and maintained on a dose of 25 mg/kg every 12 hours. Outcome was measured in-terms of loss of EEG event within 72 hours of treatment and cessation of tonic, clonic seizures in ? 12hours. RESULTS: Out of 110 cases, 42.73%(n=47) were between 1-15 days of life and 57.27%(n=63) were between 16-28 days, 48.18%(n=53) were male and 51.82%(n=57) were females. The efficacy of the Levetiracetam in neonatal seizures was recorded in 62.73%(n=69) neonates. Conclusion: LEV is an effective drug for resolving neonatal seizures in our population.

Hypertensive patients and its association with age and gender: Evaluation of resistant hypertension

Objective: To evaluate the resistant hypertension in hypertensive patients and its association with age and gender. Material and methods: This cross sectional study was conducted at Basic Health Unit, Hassan Mandi Bahauddin . Total 146 hypertensive patients having age 40-70 years either male or female were selected for this study. Resistant hypertension was assessed in hypertensive patients. Results: Total 146 hypertensive patients were selected for this study. Mean age of the patients was 58.26 ± 8.656 years. Out of 146 hypertensive patients, resistant hypertension was found in 37 (25%) patients and 109 (75%) patients were not found with resistant hypertension. Total 50 (34.25%) patients belonged to age group 40-55 years and resistant hypertension was present in 11 (22%) patients. Total 96 (65.75%) patients belonged to age group 56-70 years and resistant hypertension was present in 26 (27.08%) patients. Total 68 (46.58%) patients were male and resistant hypertension was noted in 11 (16.18%) patients. Total 78 (53.42%) patients were female and resistant hypertension was noted in 26 (33.33%) patients. Conclusion: Results of this study showed a high percentage of resistant hypertension in hypertensive patients. Development of resistant hypertension is not associated with age of the patients. But significant association between resistant hypertension and gender of the patients was observed.

Hypertensive patients and its association with age and gender: Evaluation of resistant hypertension

Objective: To evaluate the resistant hypertension in hypertensive patients and its association with age and gender. Material and methods: This cross sectional study was conducted at Basic Health Unit, Hassan Mandi Bahauddin . Total 146 hypertensive patients having age 40-70 years either male or female were selected for this study. Resistant hypertension was assessed in hypertensive patients. Results: Total 146 hypertensive patients were selected for this study. Mean age of the patients was 58.26 ± 8.656 years. Out of 146 hypertensive patients, resistant hypertension was found in 37 (25%) patients and 109 (75%) patients were not found with resistant hypertension. Total 50 (34.25%) patients belonged to age group 40-55 years and resistant hypertension was present in 11 (22%) patients. Total 96 (65.75%) patients belonged to age group 56-70 years and resistant hypertension was present in 26 (27.08%) patients. Total 68 (46.58%) patients were male and resistant hypertension was noted in 11 (16.18%) patients. Total 78 (53.42%) patients were female and resistant hypertension was noted in 26 (33.33%) patients. Conclusion: Results of this study showed a high percentage of resistant hypertension in hypertensive patients. Development of resistant hypertension is not associated with age of the patients. But significant association between resistant hypertension and gender of the patients was observed.

Evaluation of ecto and endo parasitic fauna of Schizothorax plagiostomus inhabitants of river Swat, Khyber PakhtunKhwa, Pakistan / Avaliação da fauna ecto e endoparasitária de Schizothorax plagiostomus habitantes do rio Swat, Khyber Pakhtunkhwa, Paquistão

Abstract Fish is consumed as a rich and cheaper source of white meat and proteins all over the world. Fish farming is the leading source of income generation throughout the world. The present research study was conducted with aims to investigate the ecto and endo parasitic fauna of S. plagiostomus (snow trout) in River Swat. A total of 96 fish samples were collected on monthly basis from July-2018 to February-2019, from upper, middle and lower reaches. Fish samples were collected with the help of cast net, hand net and fishing rods. Local fishermen and experts help were also sought out for fish collection. 61 out of 96 fishes were found infected by helminth parasites. The total prevalence and intensity of 63.54% and 2.90 was observed respectively during data analysis. Highest monthly prevalence of 83.33% was recorded during July and August, while lowest prevalence of 33.33% was noted during February. Five species of helminths parasites were detected from S. plagiostomus, of which two were trematodes (Rhabdochona shizothoracis and Rhabdochona species), one species of Monogenia (Diplozoon paraddoxum), one species of Cestodes (Nippotaenia species), and one species of Acanthocephalan (Neoechynorhynchus devdevi). Highest parasite wise prevalence, intensity and relative density of 21.87%, 4.09 and 0.895 was noted for R. schizothoracis while the lowest prevalence, intensity and relative density of 4.16%, 1.25 and 0.052 was noted for N. devdevi. Highest infection of 76.08% was observed in adults host while lowest, 40% infestation rate was observed in young fish samples. 73.68% prevalence was observed in female hosts while only 56.90% prevalence was observed in male individuals. Higher infection (83.33%) was noticed during summer season, while lowest infection (44.44%) was observed during winter season. Similarly 71.79% fishes were found infected that were collected from lower reaches of the River Swat than the fish samples collected from upper reaches (52%).

Resumo O peixe é consumido mundialmente por ser uma fonte rica e barata de carne branca e proteínas. A piscicultura é a principal fonte de geração de renda em todo o mundo. O presente estudo foi conduzido com o objetivo de investigar a fauna ecto e endoparasitária de S. plagiostomus (truta da neve) no rio Swat. Foram coletadas mensalmente 96 amostras de peixes, no período de julho de 2018 a fevereiro de 2019, nos trechos alto, médio e baixo com auxílio de redes de arrasto, redes de mão e varas de pesca. Pescadores locais e especialistas também ajudaram na coleta de peixes. Dos 96 peixes encontrados, 61 estavam infectados por parasitas helmintos. A prevalência de 63,54% e a intensidade total de 2,90 foram observadas durante a análise dos dados. A maior prevalência mensal de 83,33% foi registrada nos meses de julho e agosto, enquanto a menor, de 33,33%, em fevereiro. Cinco espécies de parasitas helmintos foram detectadas de S. plagiostomus, dos quais dois eram trematódeos (espécies Rhabdochona shizothoracis e Rhabdochona), uma espécie de monogenia (Diplozoon paradoxum), uma espécie de cestóideos (espécie Nippotaenia) e uma espécie de acantocéfalo (Neoechynorhynchus devdevi). As maiores prevalências de parasitas (21,87%), intensidade (4,09) e densidade relativa (0,895) foram observadas em R. schizothoracis, enquanto as menores prevalências de parasitas (4,16%), intensidade (1,25) e densidade relativa (0,052), em N. devdevi. A infecção mais alta (76,08%) foi constatada em adultos hospedeiros, ao passo que a taxa de infestação mais baixa (40%) foi encontrada em amostras de peixes jovens. A prevalência de 73,68% foi verificada em hospedeiros do sexo feminino, enquanto a de 56,90%, em indivíduos do sexo masculino. Maior infecção (83,33%) foi observada durante a temporada de verão, e a menor infecção (44,44%), durante o inverno. Da mesma forma, 71,79% dos peixes encontrados infectados foram coletados no trecho baixo do rio Swat, enquanto 52%, no trecho alto.

Role of Speech Aid Prosthesis as Diagnostic and Therapeutic Aid for Velopharyngeal Insufficiency Defect: A Case Report

ABSTRACT@#Soft palate tumors pose the challenge during reconstructive and rehabilitating procedures. Surgical resection of these tumors leads to velopharyngeal insufficiency (VPI). The primary effects of VPI are hypernasality and air-flow escape, while the secondary effects are abnormalities in speech articulation. Surgical revision along with speech therapy is a common approach to the treatment of VPI. Prosthetic management by means of speech aid prosthesis helps to reduce resonance, nasal emission and consonants errors. This clinical report describes the different stages of rehabilitation of velopharyngeal insufficiency defect following resection of malignant melanoma of left posterior alveolar ridge and soft palate. The speech aid prosthesis helped to rehabilitate the velopharyngeal insufficiency defect and aided in the diagnosis of extent of speech function improvement by perceptual and objective methods.

Association between Lifestyle and Academic Performance among Medical Students, Majmaah, Saudi Arabia.

A healthy lifestyle includes practices such as proper nutrition, regular exercise, adequate hours of sleep, and avoiding substance abuse. Many research projects have shown that there is a correlation between lifestyle and academic performance, while others found that lifestyle is not consistent with academic achievement. We wanted to examine the association between lifestyle and academic performance among medical students of Majmaah University, Saudi Arabia.METHODSThis is a cross-sectional study, and a survey was carried out amongst the students attending college of medicine, Majmaah University, through a well-designed pre-tested questionnaire. Data were analysed using SPSS software.RESULTSA total of 171 medical students participated in the study. Most of the participants n= 119 (69.6%) were males, and the rest n= 52 (30.4%) were females. The mean age of participants was (21.64+1.88) based on the results; most of the participants n=101 (59%) were between the 2nd and 3rd academic years. The academic performance of the students did not correlate with the lifestyle habits of the students. Lifestyle parameters tested were physical activity, dietary habits, sleeping patterns, substance abuse, and the use of social media. Academic performance was measured using the cumulative grade point average (GPA) of the student. No statistically significant difference regarding academic performance was noted among the high GPA and low GPA students in relation to their lifestyle. None of the healthy behaviours like physical activity, dietary habits, sleep patterns, and substance abuse are related to the academic performance of medical students (p>0.05).CONCLUSIONSOur study showed that there was no association between lifestyle and academic performance.

Breast papillary lesions: a retrospective analysis from oncology set up of Pakistan

Background: Papillary lesions of the breast are a heterogeneous group of breast lesions that are difficult to diagnose as benign or malignant. These lesions have varied morphologic features that carry differing prognostic implications for affected patients. Accurate diagnosis is required to ensure that effective treatment is achieved. Papillary lesions can have increased risk of carcinoma and recurrence, in these patients even for lesions yielding a benign concordant diagnosis of papilloma at percutaneous biopsy, surgical excision may be warranted. Malignant lesions are usually surgically treated. Depending on stage-adjuvant chemotherapy and/or radiation therapy is given.Methods: A retrospective study was conducted at Shaukat Khanum Memorial hospital and Research Centre Lahore Pakistan. We reviewed the electronic records of diagnostic and registered patients from January 2007 till December 2017 in women imaging section, in age range of 25 to 75 years. Total 150 diagnosed patients with benign or malignant breast papillary lesions were selected and their conventional breast imaging (mammography and ultrasound) and histopathology was retrospectively analyzed on SPSS.Results: Patients were predominantly asymptomatic or on follow-up to an abnormal mammogram. Of the 150 cases most of the patients had intra-ductal papilloma followed by invasive papillary carcinoma and intra cystic papillary carcinoma. Few patients had intra-ductal papillomatosis and invasive micro papillary carcinoma.Conclusions: Conventional breast imaging remains the first main stay and quite sensitive in detecting breast papillary lesions leading to early detection and management.

Gene variant profiles and tumor metabolic activity as measured by FOXM1 expression and glucose uptake in lung adenocarcinoma

Background@#Cancer cells displaying aberrant metabolism switch energy production from oxidative phosphorylation to glycolysis. Measure of glucose standardized uptake value (SUV) by positron emission tomography (PET), used for staging of adenocarcinoma in high-risk patients, can reflect cellular use of the glycolysis pathway. The transcription factor, FOXM1 plays a role in regulation of glycolytic genes. Cancer cell transformation is driven by mutations in tumor suppressor genes such as TP53 and STK11 and oncogenes such as KRAS and EGFR. In this study, SUV and FOXM1 gene expression were compared in the background of selected cancer gene mutations. @*Methods@#Archival tumor tissue from cases of lung adenocarcinoma were analyzed. SUV was collected from patient records. FOXM1 gene expression was assessed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Gene mutations were detected by allele-specific PCR and gene sequencing. @*Results@#SUV and FOXM1 gene expression patterns differed in the presence of single and coexisting gene mutations. Gene mutations affected SUV and FOXM1 differently. EGFR mutations were found in tumors with lower FOXM1 expression but did not affect SUV. Tumors with TP53 mutations had increased SUV (p = .029). FOXM1 expression was significantly higher in tumors with STK11 mutations alone (p < .001) and in combination with KRAS or TP53 mutations (p < .001 and p = .002, respectively). @*Conclusions@#Cancer gene mutations may affect tumor metabolic activity. These observations support consideration of tumor cell metabolic state in the presence of gene mutations for optimal prognosis and treatment strategy.

Psychological Predictors of Anxious Responses to the COVID-19 Pandemic: Evidence from Pakistan

Objective@#COVID-19 epidemic can be associated with a variety of anxious responses and safety behaviors. The present research explored the psychological implications associated with COVID-19 during the outbreak in 2020 to date. Pakistani media has given particular attention to this outbreak in the region. @*Methods@#Three hundred and forty-seven undergraduate university students from Pakistan completed a battery of questionnaires focusing fear of COVID-19, associated safety behaviors, factual knowledge of COVID-19, and other psychological pointers hypothesized to be as predictors of anxious responses to COVID-19 threat and associated safety behaviors. @*Results@#The sample appeared to be fearful of COVID-19 and this fear was related to disgust sensitivity, anxiety sensitivity-related physical concerns, body vigilance, contamination cognitions, and general distress. Results suggested that the tendency of overestimating the severity of contamination and anxiety sensitivity towards physical concerns are significant predictors of COVID-19 related fear and consequent safety behaviors. @*Conclusion@#It is suggested that people with a greater concern of contamination are likely to respond fearfully to COVID-19 and that people with higher fear of COVID-19 are likely to feel contamination concerns.

Multi-purpose Use of Nasal Stents for Prosthetic Rehabilitation of Facial Defect: A Case Report

@#Basal cell carcinoma is the most common cause of nasal defects. For large lesions with deep tissue extensions a total rhinectomy may be indicated followed by adjunctive therapies, such as radiotherapy or chemotherapy. Subsequent surgical reconstruction of these defects poses a challenge due to the compromised tissue bed and may require rehabilitation with facial prosthesis. In current case report, patient had basal cell carcinoma, which had involved the nasal cartilages, right inferior turbinate, nasolabial fold, upper lip and adjacent vascular and perineural tissues. Basal cell carcinoma was surgically excised, followed by postoperative radiotherapy. The resulted nasal defect was closed by forehead pedicle flap. Nasal stents were inserted postoperatively to prevent stenosis of nostrils. Prosthetic rehabilitation of a complete nasal defect was done by utilising nasal stents to prevent nasal stenosis, improved stability and precision, in placement of prosthesis over flat nasal defect. Skin adhesive was applied on margins to enhance the retention of prosthesis and to blend the margins of prosthesis with adjacent skin.

A Comparison of Sensitivity and Specificity of AST to Platelet Index (APRI) and FIB-4 with Transient Elastography i.e. Fibro Scan in Chronic HCV Infected Patients

Background: Hepatitis C is a leading cause of liver fibrosis, cirrhosis, and cirrhosis associated complications. In this study, we compared readily available non-invasive fibrosis indexes with fibro scans for fibrosis staging and predicting its progression in Pakistani population. Methods: The retro prospective cross-sectional study was conducted in medicine unit 1 and 2 and hepatitis clinic of Lahore General Hospital, Lahore starting from February 12, 2018 to January 8, 2019. We studied 1464 HCV infected patients which were got CBC, LFTs, ELISA, PCR and fibro scan was done to perfectly diagnose ongoing hepatitis C infection. In order to differentiate HCV fibrosis progression, we compared the effectiveness of readily available AST to Platelet Index (APRI), and FIB-4 with fibro scan. Results: Readily available serum indexes AST to Platelet Index (APRI) and FIB-4 were able to stage liver fibrosis in advanced stages of fibrosis (F4 especially) with correlation coefficient indexes 0.462, and 0.131 with considerable specificities and sensitivities. For APRI >1.5, it did predict F4 stage with sensitivity of 87.6% and specificity of 74.8%. For Fib-4> 3.25, it did predict F4 stage with sensitivity of 72.3% and specificity of 53.2%. Conclusion: Readily available and cheap serum indexes, AST to Platelet Index (APRI) and FIB-4 accurately predicted distinguished between cirrhotic and non- cirrhotic stages in HCV infected patients in comparison to the costly and rarely available Fibro scan score.

Effectiveness of Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) for EGD, Colonoscopy and MRCP: A Prospective Study in 929 Patients

Background/objectives: The aim of our study was to review the safety and effectiveness of Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures, occurrence of major and minor adverse events followed by propofol sedation, level of patient satisfaction and possible choice of propofol as sedative agent in their future endoscopic procedures in Pakistani population. Materials and methods: Prospective data were collected from patients receiving diagnostic AGD, colonoscopy or ERCP. Subjects who stopped the emergency procedure or both EGD and colonoscopy were excluded on the same date. Other exclusions include over 20 years of age, pregnancy, the American society of associate psychologists (ASA) Class III or IV, overweight (body weight>100kg), or drugs or its components or components (Soybean or egg) allergies included. Result: In our study a total of 929 patients comprising 520 males (56%) and 409 females (44%) with mean age of 46.19 ± 15.3years, mean MBI 24.27 ± 2.7. Age-specific propofol dosage was similar across gender except for age group 60 years and above where higher mean propofol dosage was required for females as compared to males for EGD and Colonoscopy (82.8 ± 32.2 vs. 63.5 ± 29.8; p-value 0.005; 81.1 ± 26.1 vs. 75.3 ± 25.0; p-value 0.03). The required examination was completed in all cases. There was no major adverse event. Majority of the patients rated the procedure satisfactory and agreed to undergo same sedative for next time. Conclusion: Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures is safe and effective in selected patients.

Duration of in-hospital cardiopulmonary resuscitation and its effect on survival

Objective This study aims to determine the correlation between the duration of cardiopulmonary resuscitation (CPR) and the return of spontaneous circulation (ROSC) in an in-hospital cardiac arrest cohort. Methods All patients (age ≥ 17 years) who underwent CPR at our institution from 2015 to 2017 were included. The primary endpoint was ROSC or death. A total of 88 patients were included in the study. The Pearson correlation of CPR duration with the establishment of ROSC was calculated using the IBM SPSS, version 25. Results In all, 88 patients who received CPR, 55% (n = 48) experienced ROSC and survived. The remaining 45% (n = 40) of the total and 56% (n = 27) of those with ROSC died during the same hospitalization (Fig. 1). Among the 48 patients with ROSC, the documented duration of their CPR was about 10 min on average in comparison with 27.5 min CPR for patients who did not achieve ROSC (Fig. 2). Among all the patients, there was a negative correlation between the duration of the CPR and the establishment of ROSC. This is shown in Fig. 3. Conclusion Our study shows that CPR duration is inversely associated with the establishment rates of ROSC. Most of the benefits of CPR can be achieved in the first 15 min, and a further increase in the duration of CPR provides a minimal gain. Still, survival was achievable till 38 min in some cases, and the ideal duration of resuscitation should remain a bedside decision taking into consideration the whole clinical picture.

Psychodermatology: An Association of Primary Psychiatric Disorders With Skin / Psicodermatología: asociación de trastornos psiquiátricos primarios con la piel

ABSTRACT The association of nervous system with skin is well documented. Many common psychiatric disorders can involve skin either directly or indirectly. We found an association of 13 primary psychiatric disorders leading to dermatological diseases, with association of 2 of 13 considered to be idiopathic. Association of the mind and body has long been studied. Several skin problems lead to psychological and psychiatric symptoms, however not all skin problems lead to psychiatric symptoms. On the contrary, many primary psychiatric illnesses appear to have associated skin disorders.

RESUMEN La asociación del sistema nervioso con la piel está bien documentada. Muchos trastornos psiquiátricos comunes pueden implicar a la piel directa o indirectamente. Se encontró asociación de 13 trastornos psiquiátricos primarios que llevan a enfermedades dermatológicas, y de las 13, asociación de 2 consideradas idiopáticas. La asociación entre la mente y el cuerpo se ha estudiado durante mucho tiempo. Varios problemas de la piel conducen a los síntomas psicológicos y psiquiátricos, pero no todos los problemas llevan a síntomas psiquiátricos de la piel. Por el contrario, parece que muchas enfermedades psiquiátricas primarias se asocian con trastornos de la piel.

Dietary supplementation with turmeric polyherbal formulation decreases facial redness: a randomized double-blind controlled pilot study / 中西医结合学报

BACKGROUND@#Facial redness is multifactorial in nature and may be a sign of many different conditions, including rosacea, photo damage and flushing. Herbal medicines have been used for thousands of years to treat a variety of dermatological conditions. Turmeric (Curcuma longa) and its constituents have been shown to mediate dilation and constriction of peripheral arterioles and have demonstrated anti-oxidant, anti-inflammatory and wound-healing properties.@*OBJECTIVE@#To investigate the effects of turmeric and turmeric-containing polyherbal combination tablets versus placebo on facial redness.@*DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS@#This was a prospective, double-blind, randomized pilot study. Thirty-three healthy participants were recruited from the dermatology clinic at the University of California, Davis and nearby community from 2016 to 2017. Thirty participants were enrolled, and 28 participants completed the study. The enrolled participants were randomized to receive one of three interventions (placebo, turmeric or polyherbal combination tablets) and were told to take the intervention tablets by mouth twice daily for 4 weeks. Facial redness was assessed at baseline and 4 weeks after intervention by clinical grading and by image-based analysis.@*MAIN OUTCOME MEASURES@#The primary outcome measure was image-based facial quantification of redness using a research camera and software analysis system. The investigators performed an intention-to-treat analysis by including all subjects who were enrolled in the trial and received any study intervention. Differences were considered statistically significant after accounting for multiple comparisons. Effect sizes for clinical grading were calculated with a Hedges' g where indicated.@*RESULTS@#Twenty-eight participants completed the study and there were no reported adverse events. Based on clinical grading, facial redness intensity and distribution down trended in the polyherbal combination group after 4 weeks (P = 0.1). Under photographic image analysis, the polyherbal combination group had a significant decrease in redness of 40% compared to baseline (P = 0.03). The placebo and turmeric groups had no statistically significant changes in image analysis-based facial redness.@*CONCLUSION@#Polyherbal combination tablet supplementation improved facial redness compared to the turmeric or placebo. Overall, our findings suggested further investigations into the effects of turmeric and polyherbal formulations in skin conditions associated with facial redness would be warranted.@*TRIAL REGISTRATION@#ClinicalTrials.gov identifier: NCT03065504.

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.

Component Alignment in Simultaneous Bilateral versus Unilateral Total Knee Arthroplasty

PURPOSE: The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). MATERIALS AND METHODS: 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. RESULTS: There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). CONCLUSIONS: The angular alignment of components was similar between SBTKA and UTKA.

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.

Barriers to the provision of asthma services and perceived practice towards asthma management among urban community pharmacists in Selangor, Malaysia

This study aims to assess the perceived practice and barriers towards the provision of asthma management services among urban community pharmacists in Selangor, Malaysia. The study also highlights both pharmacist and patient-related barriers in asthma counseling. One hundred fifty urban community pharmacists in Selangor, Malaysia, were randomly selected and recruited for the present cross sectional baseline study. Previous studies have explored pharmacists' perception on their roles in asthma management in different parts of the world. The data was collected through self-explanatory questionnaires (containing 47 items). The extracted data from the completed questionnaires were analyzed descriptively and inferentially using Statistical Package for Social Science (SPSS) version 19. Results showed that pharmacists perceived their roles in asthma management along three major dimensions: 'patient self-management', 'medication use' and 'asthma control', mean (±SD) score of the perception towards asthma management was 99.29 ± 4.58 over a maximum possible score of 110 with 90.26%. There were significant differences between the pharmacy education level and perceived practice of asthma management while there were insignificant differences between age, gender, ethnicity, number of practicing year and perceived practice of asthma management among respondents. Most common barriers towards asthma counselling including lack of time, lack of asthma knowledge, lack of counselling space and cost of asthma drugs. Conclusively, urban community pharmacists in Selangor, Malaysia, demonstrate good perceived practice of better management of asthma with multidimensional dimensional role against in disease care.