Background: Brain tumours are the most prevalent solid cancers in children and are a significant cause of cancer morbidity. However, there is limited information on surgical outcomes in Pakistan, particularly in newly established paediatric neurosurgery units. This study aimed to determine the incidence, clinical features, imaging findings, surgical treatment and prognosis of supratentorial and infratentorial brain tumours in children.Methodology: This was a descriptive retrospective study conducted at the Punjab Institute of Neurosciences from June 2023 to June 2024, including 92 pediatric patients who underwent surgical resection of brain tumours. The clinical presentation, imaging characteristics, surgical interventions, histopathology and outcomes were recorded and evaluated.Results: Among 92 patients, 63% (n = 58) had supratentorial tumors and 37% (n = 34) had infratentorial tumors. Mean ages were 11.34 ± 4.77 years and 10.94 ± 3.78 years, respectively. Out of 92, 46 (50%) were male, and 46 (50%) were female. Headache was the most common presenting symptom in both groups (n = 46 supratentorial (76.3%) and n = 31 infratentorial (91.3%). Supratentorial tumors were most frequently located in the middle cranial fossa (53.4%, n = 31), with gliomas being the predominant histology. Gross-total resection was achieved in 69% (n = 40) of supratentorial cases and 88.3% (n = 30) of infratentorial cases. Ventriculoperitoneal (VP) shunt placement was more commonly required in infratentorial tumors (42.1%, n = 14) compared to supratentorial tumors (6.9%, n = 4). Pilocytic astrocytoma was the most common histology in the infratentorial group. Postoperative Glasgow Coma Scale (GCS) and Lansky Play-Performance Scale (LPPS) scores were comparable between the two groups.Conclusion: Supratentorial tumors were more common, while infratentorial tumors had higher resection rates and had high VP shunt requirements.
Background: Lateral internal anal sphincterotomy (LIAS) is the treatment of choice for chronic anal fissure (CAF) when conservative management fails to heal the fissure. While both closed and open techniques are widely used, comparative data on wound healing outcomes and predictors of healing remain limited. This randomized controlled trial compared closed versus open LIAS under different anesthesia protocols and identified independent predictors of wound healing.Methodology: In this trial 160 patients suffering from chronic anal fissure were randomly allocated to undergo either closed LIS under local anesthesia with sedation or open LIS under spinal anesthesia. The primary outcome was complete wound healing at 6 weeks. Secondary outcomes included pain at 24 hours, return to work, anal incontinence at 6 weeks and 1 year, and recurrence at 1 year. Multivariate logistic regression was computed to identify in-dependent predictors of non-healing.Results: Baseline characteristics were comparable between groups. Closed LIAS was associated with significantly lower pain scores at 24 hours (1.1 ± 0.3 vs 3.3 ± 0.6, p < 0.001) and faster return to work (3.3 ± 1.1 vs 6.6 ± 1.4 days, p < 0.001). Healing rates at 6 weeks were excellent and comparable between the two groups (96.3% vs 97.5%, p = 0.62). Transient flatus incontinence occurred in 2.5% of closed LIAS and 5.0% of open LIAS patients (p = 0.41), with no cases of fecal incontinence. Recurrence at one year was 4.0% in the closed group and 3.0% in the open group (p = 0.58). On multivariate analysis, independent predictors of non-healing were age ≥ 40 years and fissure duration > 12 months. Conclusion: Both closed and open lateral internal anal sphincterotomy are highly effective treatments for chronic anal fissure, achieving excellent healing rates with no permanent incontinence. Closed LIAS under local anesthesia with sedation offers superior early outcomes with less pain, faster return to work, and the advantage of same-day discharge.
Background: Cigarette smoking is a reversible cause of cardiopulmonary diseases that may, in other cases, cause short-term and long-term complications, including declined aerobic capacity in adolescents. This study aimed to identify the most common smoking trends, associated short-term complications and the effect on aerobic endurance among young adults.Methodology: An analytical cross-sectional study was conducted in Rawalpindi & Islamabad, recruiting 140 participants (88 males, 52 females). Smokers and non-smokers aged 16 to 26 years were selected through non-probability convenience sampling over 5 months (February-June 2019). The Basic Smoking Assessment Questionnaire (BSAQ), the Modified Borg Scale, and the Progressive Aerobic Cardiovascular Endurance Run (PACER) test were used for data collection purposes. The Kolmogorov-Smirnov test was used to assess the normality of the data.Results: Cigarette smoking is the most common mode of smoking (25%), while halitosis (bad breath) was the most frequently occurring short-term complication (8.6%). The VO₂ max evaluated via Progressive Aerobic Cardiovascular Endurance Run (PACER) showed a significant difference (p<0.001) in endurance between smokers and non-smokers. Non-smokers had greater cardiovascular endurance than smokers. Conclusion: Smoking is highly prevalent among young adults and is associated with early short-term adverse effects and reduced cardiorespiratory fitness. Also smoking among young adults was predominantly cigarette-based, with a considerable proportion engaging in multiple forms of tobacco use. The findings highlight the need for targeted tobacco control strategies and early interventions to reduce smoking-related short-term health complications in this population.
Background: Inflammation is a key pathological process underlying arthritis and contributes to progressive damage to the joints, cartilage, and surrounding tissues. Persistent inflammatory responses are associated with infiltration of inflamma-tory cells, pannus formation, cartilage degradation, and bone erosion, ultimately leading to impaired joint function. Chrysin (5,7-dihydroxyflavone) is a naturally occurring flavonoid found in various plants, honey, and propolis. It possesses several pharmacological properties, particularly anti-inflammatory and antioxidant activities, which may help attenuate inflamma-tory tissue damage. Therefore, the present study was designed to evaluate the anti-inflammatory effects of chrysin in an experimentally induced arthritic rat model using histopathological assessment of joint tissues.Methodology: This study determined the healing effect of Chrysin in a FCA-induced arthritic rat model. Chrysin was inject-ed intraperitoneally on the 8th post-administration day of FCA, and treatment continued for the next three consecutive weeks. GraphPad Prism was used to analyse the results, considering p-values ≤ 0.05 statistically significant. Results: Anti-inflammatory effect of Chrysin upon bones and cartilage was determined by Ankle joint histopathology. Upon histopathology, Chrysin reduced the severity of arthritis in the joint, infiltration of inflammatory cells, subcutaneous in-flammation, cartilage erosion, bone erosion and pannus formation. Piroxicam was used as a reference drug to compare the anti-arthritic effect of Chrysin.Conclusion: Results showed that Chrysin possesses anti-arthritic effects and may be a potential drug for the treatment of arthritis.
Ecthyma gangrenosum (EG) is a rare but fatal condition in preterm babies with characteristic skin manifestations primarily associated with critically ill and immunocompromised states, often caused by Pseudomonas aeruginosa (Pa) infection but also resulting from various other bacterial and fungal pathogens. This case report describes ecthyma gangrenosum in a preterm (31 weeks), low-birth-weight (1.8 kg) neonate with early-onset neonatal sepsis (EONS) born to a primigravida mother with prolonged premature rupture of membranes (PROM). On the second day of life, multiple erythematous cutaneous lesions appeared and rapidly evolved into characteristic necrotic ulcers, accompanied by systemic manifestations of sepsis. Diagnostic challenges included the overlap of EG symptoms with other neonatal skin conditions and the absence of positive culture results. Despite these challenges, prompt recognition and initiation of broad-spectrum antibacterial therapy, supportive measures, and multidisciplinary care resulted in clinical improvement with eventual discharge on oral linezolid on the 17th day in healthy condition. This case highlights the importance of early recognition of EG in neonates, necessitating early initiation of appropriate therapy and close monitoring for improved outcomes in this vulnerable population. Further research is needed to enhance understanding and optimize management strategies for EG in neonatal sepsis.
