Surgical Management Of Irreducible Atlanto-Axial Dislocation With OS Odontoideum And Klippel-Feil Syndrome.

Klippel-Feil syndrome (KFS) is the congenital fusion of two or more cervical vertebrae which is often associated with various other abnormalities in the cervical spine. Involvement the upper cervical segments leads to atlanto-axial instability which manifests as progressive neurological symptoms due to compression on the spinal cord. These cases pose a surgical challenge due the abnormal and unique anatomy of each patient. A 37-year-old patient presented with neck pain and cervical myelopathy due to a posterior subluxation of C2-3 fused segment over C4-6 fused segment. The patient had an os odontoideum, incomplete posterior arch of C1, anomalous course of vertebral artery and C3 hemi-vertebra. The patient was successfully managed with transoral odontoidectomy and occipeto-cervical fusion. Irreducible atlanto-axial dislocation in a patient with an abnormal upper cervical spine anatomy may require transoral decompression followed by posterior fusion.

Transoral Odontoidectomy - Our Experience in A Limited-Resource Setup.

BACKGROUND: Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression. METHODS: Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared. RESULTS: Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy. CONCLUSIONS: With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.

Case of pedicle lag screw fixation for oblique axis body and pars fractures with displacement.

Background: Multiple axis fractures with instability are rare and appropriate treatment modalities have not been established. Case Description: A 33-year-old male presented with severe neck pain, bilateral upper-extremity numbness, and brisk reflexes in both lower extremities of 14 days' duration after a car accident. The cervical CT revealed an oblique C2 body fracture and asymmetrical neural ring fractures, while the MRI showed a normal C2-3 disk. As traction failed to reduce the fracture, the patient underwent an anterior retropharyngeal approach to release the fracture fragments, followed by posteriorly passing bilateral C2 pedicle lag screws. Eight months later, the patient exhibited full range of motion across the C1-2 level with fusion of the previously noted fractures. Conclusion: A 33-year-old male with an unstable C2 body fracture and asymmetrical neural ring fractures successfully underwent an anterior retropharyngeal approach to release the fracture fragments, followed by posteriorly passing bilateral C2 pedicle lag screws to achieve stability/fusion.

Anterior transcervical release with posterior atlantoaxial fixation for neglected malunited type II odontoid fractures.

Background: Type 2 odontoid fractures are associated with a high rate of nonunion without surgical treatment. If neglected, they may become fixed in an abnormal position, causing progressive myelopathy. Conventionally, odontoidectomy or transoral release is performed to relieve symptoms in such cases. Here, were report our experience with a transcervical approach for odontoid release (i.e., of a chronically fractured dens) followed by a posterior C1-C2 fusion. Methods: The 11 patients (2017-2021) retrospectively included; in this study, all had a history of remote trauma and the radiological appearance of an old odontoid fracture that was displaced and could not be reduced with traction. There were eight males and three females who averaged 52.6 years of age. Results: All 11 patients underwent anterior retropharyngeal release with a C4-C5 level incision followed by a posterior C1-C2 fusion. The mean Japanese orthopedic association on presentation was 9.9 ± 2.7 which improved to 13.8 ± 2.7 on final follow-up (P < 0.01). Patients were followed an average of 9.6 months ± 4.4 (mean ± SD) postoperatively during which time they all clinically improved. Conclusion: Anterior release through a retropharyngeal approach coupled with posterior C1-C2 instrumentation proved to be an effective alternative to the traditional transoral approach to treat a chronic malunited odontoid fracture.

Postponement growth and antioxidative response of Brassica nigra on CuO and ZnO nanoparticles exposure under soil conditions.

Due to unique physiochemical properties, nanoparticles (NPs) have acquired substantial attention in the field of research. However, threats of ecotoxicity and phytotoxicity have limited their biological applications. In this study in vivo experiments were performed to determine the effect of CuO (12.5, 25 and 50 mg/kg) and ZnO (200, 400 and 600 mg/kg) NPs on growth, and antioxidant activities of Brassica nigra. The results showed that CuO NPs did not affect the seed germination while presence of ZnO NPs in the soil generated an inhibitory effect. Both CuO and ZnO NPs positively influenced the growth of stem and other physiological parameters i.e. stem height increased (23%) at 50 mg/kg CuO while root length decreased (up to 44%) with an increase in the concentration of NPs. Phytochemical screening of apical, middle and basal leaves showed elevated phenolic and flavonoid contents in the range of 15.3-59 µg Gallic Acid Equivalent (GAE)/mg Dry Weight (DW) and 10-35 µg Querceitin Equivalent (QE)/mg DW, respectively, in NPs-treated plants. Antioxidant activity was higher in CuO NPs-treated plants as compared to ZnO and control plants. Results conclude that CuO and ZnO NPs at low concentrations can be exploited as nanofertilisers in agriculture fields.

CuO and ZnO Nanoparticle Application in Synthetic Soil Modulates Morphology, Nutritional Contents, and Metal Analysis of Brassica nigra.

Black mustard (Brassica nigra) was grown in pots amended with 41 nm ZnO (200-600 mg/kg soil) and 47 nm CuO (12.5-50 mg/kg soil) nanoparticles (NPs) to analyze growth response and yield characteristics. B. nigra seed germination was not affected by CuO NPs, but significant toxicity was observed by ZnO NP treatment. Both NPs significantly increased the growth profile of B. nigra, i.e., the stem height, number of leaves, average leaf area, number of branches, and number of nodes per plant. Application of ZnO and CuO NPs brought a significant dose-dependent decrease in primary root length; however, the number of secondary roots increased in the presence of CuO NPs. The average number of flowers and pods per plant significantly increased in the presence of CuO NPs. The seed yield, average seed weight per plant, and seed diameter parameters were observed to be better in the presence of CuO NPs as compared with ZnO NPs. Total protein contents and glucosinolates increased in the seeds grown in the NP-amended soil, while total oil contents decreased. Oil analysis depicted that oleic acid and linolenic acid percentage decreased while erucic acid percentage increased in seeds in the presence of both NPs in the soil. An atomic absorption spectrophotometer showed accumulation of Cu and Zn in B. nigra in the following order: root > stem > leaves > seeds. The study concludes that CuO and ZnO NPs have detrimental effect on the B. nigra plant and yield. The release of NPs and type of metal in NPs might also have a positive effect on the plant; however, their concentration in the soil also matters.

Medicinal plants combating against cancer--a green anticancer approach.

Cancer is the most deadly disease that causes the serious health problems, physical disabilities, mortalities, and morbidities around the world. It is the second leading cause of death all over the world. Although great advancement have been made in the treatment of cancer progression, still significant deficiencies and room for improvement remain. Chemotherapy produced a number of undesired and toxic side effects. Natural therapies, such as the use of plant-derived products in the treatment of cancer, may reduce adverse and toxic side effects. However, many plants exist that have shown very promising anticancer activities in vitro and in vivo but their active anticancer principle have yet to be evaluated. Combined efforts of botanist, pharmacologist and chemists are required to find new lead anticancer constituent to fight disease. This review will help researchers in the finding of new bioactive molecules as it will focus on various plants evaluated for anticancer properties in vitro and in vivo.

Prevalence, risk factors and disease knowledge of breast cancer in Pakistan.

Breast cancer is the most common cancer in females all over the world with approximately one million new cases each year as well as one of second leading causes of death among females. In Pakistan, the most frequently diagnosed cancer among females is also breast cancer, accounting for nearly one in nine female patients. Its incidence in Pakistan is 2.5 times higher than that in neighboring countries like Iran and India. The risk factors associated with breast cancer are age, family history, early menarche, intake of combined estrogen and progestin menopausal hormones, alcohol consumption, physical inactivity, low socioeconomic status and lack of awareness regarding the disease. This mini-review article aims to provide awareness about breast cancer as well as an updated knowledge about the prevalence, risk factors and disease knowledge of breast cancer in Pakistan.

Ascorbic acid and salicylic acid mitigate nacl stress in Caralluma tuberculata Calli.

Plants exposed to salt stress undergo biochemical and morphological changes even at cellular level. Such changes also include activation of antioxidant enzymes to scavenge reactive oxygen species, while morphological changes are determined as deformation of membranes and organelles. Present investigation substantiates this phenomenon for Caralluma tuberculata calli when exposed to NaCl stress at different concentrations. Elevated levels of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), ascorbate peroxidase (APX), and glutathione reductase (GR) in NaCl-stressed calli dwindled upon application of non-enzymatic antioxidants; ascorbic acid (AA) and salicylic acid (SA). Many fold increased enzymes concentrations trimmed down even below as present in the control calli. Electron microscopic images accentuated several cellular changes upon NaCl stress such as plasmolysed plasma membrane, disruption of nuclear membrane, increased numbers of nucleoli, alteration in shape and lamellar membrane system in plastid, and increased number of plastoglobuli. The cells retrieved their normal structure upon exposure to non-enzymatic antioxidants. The results of the present experiments conclude that NaCl aggravate oxidative molecules that eventually alleviate antioxidant enzymatic system. Furthermore, the salt stress knocked down by applying ascorbic acid and salicylic acid manifested by normal enzyme level and restoration of cellular structure.