Ocimum sanctum attenuates oxidative damage and neurological deficits following focal cerebral ischemia/reperfusion injury in rats

Stroke is an enormous public health problem with an imperative need for more effective therapy. Free radicals have been reported to play a role in the expansion of ischemic brain lesions, and the effect of free radical scavengers is still under debate. The present study investigated the neuroprotective effect of Ocimum sanctum (OS) to reduce brain injury after middle cerebral artery occlusion (MCAO). Male Wistar rats were subjected to MCAO for 2?h and reperfused for 22?h. The administration of OS (200?mg/kg bwt., orally) once daily for 15?days before MCAO showed marked reduction in infarct size, reduced the neurological deficits, and suppressed neuronal loss in MCAO rats. A significantly depleted activity of antioxidant enzymes and content of glutathione in MCAO group were protected significantly in MCAO group pretreated with OS. Conversely, the elevated level of thiobarbituric acid-reactive substances (TBARS) in MCAO group was attenuated significantly in OS-pretreated group when compared with MCAO group. Consequently, OS pretreatment may reduce the deterioration caused by free radicals, and thus may used to prevent subsequent behavioral, biochemical and histopathological changes that transpire during cerebral ischemia. This finding reflects that supplementation of OS intuitively by reasonable and understandable treatment effectively ameliorates the cerebral ischemia-induced oxidative damage.     

Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure

Background

Few centers are undertaking major laparoscopic liver resections, because of the well-recognized technical difficulties and lack of training opportunities.

Methods

The authors describe their technique for laparoscopic right hepatectomy, highlighting relevant details for accomplishing a safe and efficient procedure. Patients were chronologically divided into 2 groups to evaluate the impact of increasing experience on the surgical outcomes.

Results

Group I included 17 patients and group II 18 patients. The conversion rate to open or hybrid techniques significantly decreased from 36% in group I to 6% in group II (P = .03). The hospital stay decreased from a median of 6 days in group I to a median of 4 days in group II (P = .05). Complications occurred in 4 patients (11%), of whom 3 were in group I. The mortality was zero.

Conclusions

Laparoscopic right hepatectomy is a safe and efficient procedure when performed at specialized centers with extensive experience in hepatic surgery. Long-term training is necessary to acquire adequate expertise.     

Clinical,Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention

BackgroundSmoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients.ObjectivesThis study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan.MethodsWe included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (Catheterization–Percutaneous Coronary Intervention) Registry from our site.ResultsA total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 ± 10.59 versus 55.98 ± 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p = 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p = 0.502.ConclusionsSmokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.     

Does scaphoid bone bruising lead to occult fracture? A prospective study of 50 patients

Introduction

Bone bruising of the scaphoid is a term reported when magnetic resonance imaging (MRI) is carried out for scaphoid injury. The aim of our study was twofold: to see if bone bruising alone without fracture of the scaphoid bone seen on initial MRI, in a clinically symptomatic (tender) patient at 10-14 days, progressed to fracture, and to define how this entity of bone bruising should be managed.

Methods

This was a prospective study looking at 170 patients with scaphoid injuries, of which 50 had bone bruising without fracture. These were followed up for at least 8 weeks to ascertain whether or not they had developed a fracture. They were assessed for continuity or resolution of their symptoms by way of clinical examination and/or a further MRI and X-ray (scaphoid views).

Results

Of the 170 scaphoid injuries identified, there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 were clinically symptomatic and had MRI scaphoid imaging, which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster, and re-examined at 8 weeks. There were four patients who remained symptomatic, for whom MRI scans were performed, which revealed all four with resolving scaphoid bone bruising, and one with a scaphoid fracture (p value = 0.0386). Incidentally, 2 further weeks of immobilisation resolved the symptoms of those four patients. The one patient with a fracture was offered further treatment for the risk of progressing to a nonunion.

Conclusion

Bone bruising detected on MRI without fracture is an important entity, and can lead to occult fracture (2%). It can take anywhere up to 8 weeks to declare. Treatment for bone bruising should be with a scaphoid cast and follow-up X-ray.     

A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma

BackgroundResectable pancreatic ductal adenocarcinoma continues to carry a poor prognosis. Of the controllable clinical variables known to affect outcome, margin status is paramount. Though the importance of a R0 resection is generally accepted, not all margins are easily managed. The superior mesenteric artery [SMA] in particular is the most challenging to clear. The aim of this study was to systematically review the literature with specific focus on the role of a SMA periadventitial dissection during PD and it''s effect on margin status in pancreatic adenocarcinoma.ResultsThe overall incidence of a R1 resection ranged from 16% to 79%. The margin that was most often positive following PD was the SMA margin, which was positive in 15–45% of resected specimens. Most studies suggested that a positive margin was associated with decreased survival. No consistent definition of R0 resection was observed.ConclusionsMargin positivity in resectable pancreatic adenocarcinoma is associated with poor survival. Inability to clear the SMA margin is the most common cause of incomplete resection. More complete and consistently reported data are needed to evaluate the potential effect of periadventitial SMA dissection on margin status, local recurrence, or survival.