Gamma Knife Radiosurgery – A Revolutionary Modality in the Treatment of Brain Tumors

Shahid Kamal

For delivering highly accurate radiation therapy with pin-point accuracy to brain tumors, radiosurgery employing Gamma Knife Radiosurgery technique is a revolutionary new armamentarium that enables delivering focused intense beam of gamma rays to brain lesions. Neither employing an actual knife nor surgery, it is called “surgery” because the results are as good, even better, than actual surgeries.
Gamma Knife radiosurgery can be as effective in treating nerve conditions and blood vessel malformations as brain tumors [1] (Table 1). The tumor gradually shrinks after treatment that damages and destroys the tumor cell DNA that cannot grow or reproduce anymore.


Endoscopic Evaluation and Helicobacter Pylori Prevalence in Dyspeptic Patients with Chronic Kidney Disease

Ozgur Ecemiş, Muge Ustaoglu, Hasan Eruzun, Tulay Bakir and Ahmet Bektaş

Abstract: Objective: Dyspepsia is a common symptom in chronic kidney disease (CKD) as well as in the normal population and may develop due to functional or organic causes. In the literature, there are different results about dyspepsia symptoms, upper gastrointestinal tract lesions and Hp prevalence in CKD. In this study, endoscopic findings and the prevalence of Helicobacter Pylori (Hp) in dyspeptic chronic kidney patients were investigated and compared with the normal population.
Materials and Methods: 67 patients with dyspeptic CKD (52 hemodialysis, 6 continuous ambulatory peritoneal dialysis, 9 predialysis) and 63 age and gender-matched control groups were included in our study. Gastrointestinal symptom scoring, upper endoscopic examination, histopathological examination of gastric antrum and corpus biopsies taken during this period, and rapid urease test (RUT) for Hp were performed on all cases included in the study.
Results: Gastrointestinal symptom scores were not different between the CKD and control groups (6.2±2.5 vs 7.7±3.6) (p>0.05). Although the prevalence of Hp in the CKD group (44.8%) was lower than the control group (54%) according to gastric biopsy findings, there was no difference between them (p>0.05). In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis in the CKD group, and the difference between them was significant (p<0.05). When compared with histopathological evaluation, the sensitivity (78% vs. 79%) and specificity (95% vs. 93%) of the urease test were similar in the CKD and control groups in both groups.
Conclusion: Gastrointestinal symptom score and Hp prevalence in chronic kidney disease were similar to the control group. No correlation was found between Hp and gastrointestinal symptom score. In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis was more common in the CKD group.

Received: February 02, 2023
Revised: April 03, 2023
Accepted: April 03, 2023


Osteoporosis Knowledge, Attitude and Practice among Doctor Of Physical Therapy Students

Shamsa Abdul Rehman, Kanwal Lalwani and Rabbiah Mughal

Abstract: Background: Osteoporosis is a metabolic disease which is common globally. It is defined as decrease in bone mass and bone tissue destruction that causes decrease in bone strength and increase the chances of fractures. Over 200 million people are suffering from osteoporosis worldly and the number of individuals will increase greatly in coming decades due to aging and sedentary lifestyle. Knowledge combined with strategic planning related to preventive measures decrease its occurrence.
Objective: The objective of this study was to evaluate the knowledge, attitude and practice of osteoporosis in students of physical therapy.
Materials and Methods: A Questionnaire-Based survey was conducted at Department of Physiotherapy, Isra University Hyderabad in April 2021 to December. 2021. The study approval was given by Ethical Committee of Isra Institute of Rehabilitation Sciences, Isra University Hyderabad. 200 students from 3rd to final year were asked to complete the questionnaire. The knowledge, attitude and practice (KAP) of osteoporosis questionnaire consisted of 20 close ended questions.
Results: A total of 200 were selected out of which 182 participants completely filled and returned the questionnaire. The mean age of participants was 22.31±1.86 years. Male participants were 34 (18.7%) and female participants were 148 (81.35%) in this study. High knowledge regarding osteoporosis was found among students with percentage of 99.45%. The participants showed positive attitude related to osteoporosis with percentage of 60.9%. These students also had positive impression towards management practices for osteoporosis with the percentage of 70.33%.
Conclusion: This study concluded that the participants have better knowledge regarding osteoporosis. Further proper health education programs must be held in university to encourage them to adopt healthy practices about osteoporosis in daily life.

Received: September 02, 2022
Revised: December 03, 2022
Accepted: December 07, 2022


Magnitude of Hydrocephalus in Neonates: Its Surgical Management and Complications

Muhammad Kashif Bashir, Aisha Ishtiaq and Shazia Bashir

Abstract: Background: To determine magnitude of congenital or acquired hydrocephalus and its possible management and complications.
Materials and Methods: This Hospital based Retrospective observational study was conducted in department of pediatric surgery King Edward medical university / Mayo hospital Lahore from January 2021 to March 2022. All patients presented from neonatal life till 3 months of age with hydrocephalus due to congenital or acquired reasons were included in this study. There were 55 male and 28 female patients with male predominance. A detailed Proforma was made giving patients information, associated congenital or acquired anomaly and surgical management of hydrocephalus. All patients were operated on elective operation theatre list. Post-operative complications were noticed on admission files and addressed.
Results: During the study period, 83(n=1) patients with hydrocephalus were admitted in department of pediatric surgery Mayo hospital Lahore. Among these patients, 56(67.5%) patients have hydrocephalus associated with myelomeningocele while 10(12%) patients with encephalocele. 11(13.3%) patients showed hydrocephalus due to post tuberculosis meningitis while 3(3.6%) patients with Arnold chiari 2 malformation. 1(1.2%) patients presented with hydrocephalus due to Congenital obstruction of cerebral aqueduct while 2(2.4%) with Intracranial hemorrhage ventriculoperitoneal shunting was performed in 55(66.3%) patients to treat hydrocephalus. Conservative management of hydrocephalus was done in 24(28.9%) patients while in 4(4.8%) patients ventricular taping was done. Wound infection was major post-operative complication and was noted in in 13 (15.7%) patients.
Conclusion: Ventriculo peritoneal shunting is main treatment modality for obstructed hydrocephalus. Major complication of ventriculo pertoneal shunting is infection which can be prevented by proper prophylactic antibiotics as well as sterile environment of operation theatre.

Received: September 10, 2022
Revised: December 05, 2022
Accepted: December 08, 2022


Assessing Resilience in Healthcare Setups of Karachi using Connor Davidson Resilience Scale

Moinuddin, Hassan Raza, Nadia Shah, Nazia Nazir and Noman Ali

Abstract: Background: Healthcare sector of Pakistan is complex and changing rapidly. This complex and transforming phase create more hurdles for employees especially for healthcare managers. During this transition phase, healthcare managers are burdened with more ncertainties and adversities. Managing under these circumstances is not an easy task as this requires frequent adaptations. One of the most important traits that can aid in these adaptations is resilience, which is ignored in healthcare management.
Objectives: The first and main objective of the study is to assess the extent to which the healthcare managers are resilient. Secondly, to compare the resilience of public and private sector healthcare managers. At last, to assess the impact of gender, income and other demographic variables like age, socioeconomic status, marital status, education, designation, and work experience etc.
Materials and Methods: It was a cross sectional study conducted at 13 different leading healthcare institutes of Karachi. These hospitals and healthcare services were divided broadly according to public and private sector categories. Employees were asked to complete structured questionnaire, a 25 item Connor Davidson Resilience Scale (CD-RISC) and demographic characteristics. Data were collected from 438 healthcare managers working at tertiary care hospitals in Karachi.
Results: Health managers at both sectors were found resilient, with mean score of public sector and private sector were 52.55 (SD± 15.05), and 50.74 (SD± 14.15) respectively although the relationship was found insignificant relationship. Income, experience, designation, and worksite variables were significantly associated with resilience while age, gender, working hours, marital & socioeconomic status were insignificant.
Conclusion: In conclusion, the healthcare managers working in both public and private sector were found resilient. There was no significant difference found in resilience of male and female healthcare managers. In addition demographic variables like age, marital status, socioeconomic status, and working hours showed no significant relationship with resilience while designation, income, working experience, and worksite variables showed significant relationship with resilience.

Received: September 16, 2022
Revised: December 13, 2022
Accepted: December 15, 2022


Correlation of βhCG Levels with Size of Gestational Sac in Patients of Ectopic Pregnancy Presenting to a Tertiary Care Health Facility

Sara Malik, Sobia Nawaz, Masooda Rasheed, Iqra Nadeem, Sajid Ali Shah and Falak Nigar

Abstract:The objective of this study was to determine correlation of β- HCG levels with size of gestational sac in patients of ectopic pregnancy presenting to a tertiary care health facility.
Materials and Methods: This descriptive cross-sectional study was carried out in the Department of Obstetrics and Gynecology, district headquarter Hospital, Rawalpindi from Jan 2019 to Jan 2020. This study involved 100 pregnant women aged between 20-40 years diagnosed of ectopic pregnancy on transvaginal ultrasound. Serum βhCG level was acquired in all these women while the size of gestational sac was measured on transvaginal ultrasound. Outcome variable was correlation between serum βhCG level and size of gestational sac on transvaginal ultrasound which was noted and compared across various subgroups of patients based on age, gestational age, site of ectopic pregnancy and presence/absence of fetal cardiac activity.
Results: The mean age of the patients was 29.3±6.1 years while the mean gestational age was 5.1±1.1 weeks. Serum βhCG level ranged from 1647 mIU/mL to 18378 mIU/mL with a mean of 7968.4±4523.7 mIU/mL while the size of gestational sac on TVS ranged from 17 mm3 to 45 mm3 with a mean of 36.40±7.86 mm3. There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p- value<0.001).
Conclusion: There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p-value<0.001).

Received: September 07, 2022
Revised: December 12, 2022
Accepted: December 14, 2022


Tumor Board can save Sphincter, A Review of Contemporary Multidisciplinary Management of Rectal Cancer

Tooba Ali1, Sehrish Abrar, Maria Tariq, Yumna Jamil and Muhammad Muaz Abbasi

Abstract: Colorectal cancer ranks third amongst various malignancies worldwide out of which a major proportion is of rectal carcinoma. With increasing incidence of rectal cancer amongst younger population in past two decades various advancements towards organ preservation approach have been devised. Total Neo-adjuvant approach (TNT) is current standard of care in various clinical scenarios involving rectal malignancy. In this review article role of Radiation in neo adjuvant setting and various landmark trials leading to it are discussed in detail.

Received: September 09, 2022
Revised: December 15, 2022
Accepted: December 19, 2022


Psoriasis and its Variants

Sana Khan, Arghadip Das, Khalid Mahmood Uddin, Shamail Zia, Areij Khan, Marrium S. Memon, Danial Hassan, Sharmeen Naz and Sarah Khalid

Abstract: Background: Psoriasis is a chronic, immune-mediated, inflammatory illness of the skin which is quite common. The typical lesions are well demarcated, flaky and erythematous plaques that are frequently observed on the extensor regions. Psoriasis causes vasodilatation and hyper proliferation of keratinocytes expressed as thickened and erythematous skin, generally covered with silver gray scales. Although the etiology of this disease is not very clear, yet there may be genetic and environmental implications. There are a number of variants of psoriasis which include palm plantar, pustular, erythrodermic, and guttate types. Psoriasis is related to several systemic impediments and coexisting illnesses rendering a great effect on patients. Psoriasis displays coexistence of both autoimmune and auto inflammatory reactions and the stability between the two is important for clinical and histopathological demonstration. Chronic plaque psoriasis shows adaptive immune responses whereas pustular psoriasis displays innate a auto inflammatory responses. Histopathological analysis is the main diagnostic tool for atypical and controversial situations which aids in discerning psoriasis from other dermatoses; biopsy is seldom required for typical psoriasis.

Received: August 17, 2022
Revised: October 19, 2022
Accepted: October 28, 2023


Acute Myeloid Leukemia Transformed from Aplastic Anemia following Anti-thymocyte Globulin Therapy: A Case Report with Clinicopathologic and Molecular Findings

Qurat ul Abedin, Saima Siddiqui and Jawad Hassan

Abstract: Aplastic Anemia (AA) incidence is threefold higher in Asia compared to the western world. It is associated with pancytopenia that is induced by impaired bone marrow function. Cytopenias of at least two lineages are required for the diagnosis. Symptoms include pallor, weakness, fever, frequent infections, bruises, petechiae, and mucosal bleeding. Bone Marrow Transplant (BMT) and immunosuppressive therapy are the treatment options. Patients with Severe Aplastic Anemia (SAA) are susceptible to developing malignancies like acute myeloid leukemia (AML) or Myelodysplastic Syndrome (MDS). In this report, we present a case of SAA who transformed to AML/MDS. 5 years of post- Anti-Thymocyte Globulin (ATG), she acquired monosomy 7, RUNX1 & SETBP1 gene mutations. RUNX1 and SETBP1 mutations are correlated with poor overall survival and are predicted to have a lack of response from hypo-methylating agents. As the aspect of somatic mutation is complex and still not fully understood, it should be cautiously analyzed along with morphologic and cytogenetic results.
Received: September 19, 2022
Revised: December 14, 2022
Accepted: December 17, 2022


Total Laryngectomy in Advanced Papillary Thyroid Cancer Infiltrating into Larynx: A Case Report & review of Literature

Ahad Yousaf Molvi, Qandila Ali, Ayesha Pervaiz, Muhammad Paras Naseem, Mubasher Ikram and Rahim Dhanani

Abstract: Among differentiated thyroid cancer (DTC), papillary thyroid cancer (PTC) is the most commonly encountered histological type. Patients with papillary thyroid carcinoma (PTC) show an excellent prognosis. Infiltration of PTC into the larynx is very rare and can worsen the disease prognosis. We are reporting one such rare case in which PTC showed invasion in the larynx causing narrowing of the airway. We performed total thyroidectomy with total laryngectomy and neck dissection.

Received: September 18, 2022
Revised: December 07, 2022
Accepted: December 08, 2022



NJHS Front Page v7.n4
2022 VOL 7 , Issue 4