The knowledge of the relationship of the vertebral artery with the atlas is very important, in order to avoid any injury to the vertebral artery, during surgeries in the craniovertebral region. Different researchers have measured the distance of the vertebral artery from the midline along the posterior arch of atlas (oblique distance), but some authors have measured the perpendicular distance of vertebral artery from the midline. Usually, it is the perpendicular distance along which the surgeons are exploring in this region. Hence, the present study was planned to study and compare both oblique and perpendicular distances of the vertebral artery from the midline and find out statistical differences between these two parameters. It was carried out on 30 atlas vertebrae of Indian origin. The oblique and perpendicular distances of vertebral artery groove from midline and the thickness of vertebral artery groove were measured. The results suggest that dissection on the posterior aspect of the arch of atlas should remain 17.00 mm lateral to the midline and dissection on the superior aspect of the arch of atlas should remain 8.00 mm from the midline to prevent injury to the vertebral artery. It was also observed that “oblique distances of vertebral artery groove from the midline to the medial margin of inner and outer cortex are larger than the corresponding perpendicular distances from the midline”. Although, the differences of oblique and perpendicular distances are not statistically significant but it may be clinically significant for the surgeons operating in the craniovertebral region. Hence, it is concluded that the surgeon should be aware of both the distances while operating in the craniovertebral region to avoid any iatrogenic injury to the vertebral artery.

The commonly used examination procedures of the upper cervical spine depend upon the symmetry for comparison and interpretation of joint functions. If symmetry is not normal, then these assessments may mislead the examiners, allowing them implementation of incorrect treatment plans. Objectives of this study are to explore the possibility that asymmetry is more common than symmetry and, if it is true, to find out the effects of asymmetry on the biomechanics of these joints. The study was carried out on 30 atlas vertebrae of cadavers of Indian origin. The different intra-atlas distances were measured on both sides by digital vernier calliper. All the parameters studied showed statistically significant differences between the right and left side i.e. a p value of < 0.05. The anteroposterior diameter of the foramen transversarium, the transverse diameter of the foramen transversarium, the distance from the midline to medial edge of the vertebral artery groove (inner as well as outer cortex) and the length of the superior articular facets were more on the right side as compared to the left side. The breadth as well as the length of the inferior articular facet, the breadth of the superior articular facet and the difference of posterior arch thickness at the site of vertebral artery groove were more on the left side as compared to the right side. These differences may be explained by the handedness of an individual, which influences the intra-osteal asymmetry in a characteristically distinct manner, which needs to be confirmed or refuted in a further study.
Cervical Atlas

Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.

Chemical investigation of the methanol extract of Koordersiodendron pinnatum Merr. leaves resulted a new naphthalene derivative, (Z)-4-(tetradec-3-enyl)naphthalene-1,2,7-triol (1), together with three known compounds, β-sitosterol (2), 20-epibryonolic acid (3), and scopoletin (4). The structure of the new compound was elucidated based on spectroscopic evidence. The isolated compounds (1-4) were tested their cytotoxic activities against the P-388 murine leukemia cell line and compound 1 has highest activity with IC50 1.94 ㎛

Chemical investigation of the methanol extract of Koordersiodendron pinnatum Merr. leaves resulted a new naphthalene derivative, (Z)-4-(tetradec-3-enyl)naphthalene-1,2,7-triol (1), together with three known compounds, β-sitosterol (2), 20-epibryonolic acid (3), and scopoletin (4). The structure of the new compound was elucidated based on spectroscopic evidence. The isolated compounds (1-4) were tested their cytotoxic activities against the P-388 murine leukemia cell line and compound 1 has highest activity with IC50 1.94 ㎛

Objective: To determine hepatitis C virus (HCV) genotypes and explore the associated risk factors in chronic HCV patients. Methods:A total of 116 patients with chronic hepatitis C were subjected to polymerase chain reaction (PCR) based detection out of which 112 chronic HCV patients [53 male (47.32%), 59 female (52.68%);mean age (43.76±16.40) years;mean BMI (23.8±3.9) kg] were enrolled in this study. The frequency of 6 HCV genotypes and associated risk factors were evaluated from five districts of North West Frontier Province (NWFP). Results:Genotype 3 was the most prevalent in 73 samples (65.17%) followed by genotype 1 in 24 (21.42%) and genotype 2 in 13 (11.60%) samples. Genotype 3 had significantly high prevalence (P=0.000 2). The results showed that 48 (42.85%) samples were infected with HCV 3a;25 (22.32%) with 3b;14 (12.50%) with 1a;10 (8.92%) with 1b; 11 (9.82%) with 2a; 2 (1.78%) with 2b;and 2 were untypable. The distribution of HCV genotypes in Mardan, Charsadda, Peshawar, Sawabi and Nowshehra districts was different. Use of unsterile equipment for medication, barbers and previous history of hospitalization were the main risk factors for HCV transmission. Conclusions:Genotype 3a and 3b, 1a, 1b and 2a are the common genotypes in NWFP. Genotype 4, 5, and 6 can not be found in a single sample. The level of awareness about various modes of transmission of HCV among the population is found to be very low.

Influenza A virus(H1N1),a genetic reassortment of endemic strains of human,avian and swine flu,has crossed species barrier to human and apparently acquired the capability of human to human transmission.Some strains of H5N1 subtype are highly virulent because NS1 protein inhibits antiviral interferon α/β production.Another protein NS2 mediates export of viral ribonucleoprotein from nucleus to the cytoplasm through export signal.In this paper,we have studied structure-function relationships of these proteins of H1N1 subtype and have determined the cause of their pathogenicity.Our results showed that non-conservative mutations slightly stabilized or destabilized structural domains of NS1 or NS1-dsRNA complex,hence slightly increased or decreased the function of NS1 protein and consequently enhanced or reduced the pathogenicity of the H1N1 virus.NS2 protein of different strains carried non-conservative mutations in different domains,resulting in slight loss of function.These mutations slightly decreased the pathogenicity of the virus.Thus,the results confirm the structure-function relation-ships of these viral proteins.

STUDY DESIGN: A prospective study on spinal tuberculosis (TB) at a tertiary care hospital in an endemic region. PURPOSE: The aim of the study is to reiterate the importance of conservative management of spinal TB. OVERVIEW OF LITERATURE: Spinal tuberculosis can present with wide spectrum of symptoms, with back pain being the most common symptom. It is the leading cause of non-traumatic paraplegia in developing countries. There is an emerging trend to operate on patients early with spinal TB. METHODS: Forty-seven (M=14, F=33) patients were enrolled in the study during the four year study period. Initially, all the patients were subjected to computed tomography guided percutaneous needle aspiration (PCNA) followed by antituberculous therapy (ATT) for 12 months. Indications for surgery included patients with moderate to severe symptoms in which PCNA either failed, was impossible to carry out, or produced minimal improvement within 48 hours. RESULTS: Presenting complaints included pain (95.7%), weakness (85.1%) and sphincter involvement (12.8%). On the magnetic resonance imaging, a paravertebral abscess was seen in 37 (78.7%), disc and body destruction in 29 (61.7%), and an epidural abscess in 12 (25.9%) patients. Of the 47 patients, 9 (19.1%) required surgery, 4 of whom had failed PCNA attempts and 5 demonstrated indications despite successful PCNA. CONCLUSIONS: The results of conservative treatment consisting of PCNA and ATT for at least 12 months in compliant patients are excellent. A combined approach using clinical staging, PCNA, and ATT can minimize surgical intervention in most patients. However, ATT remains to be the cornerstone of management of spinal TB.
Abscess ; Back Pain ; Biopsy, Fine-Needle ; Decompression, Surgical ; Developing Countries ; Epidural Abscess ; Humans ; Magnetic Resonance Imaging ; Needles ; Pakistan ; Paraplegia ; Proliferating Cell Nuclear Antigen ; Prospective Studies ; Tertiary Healthcare ; Tuberculosis, Spinal

Purpose: Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy. Methods: Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented. Results: The median age of the study patients was 10 years (range, 1.7–15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful. Conclusion We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.

Ergonomics and design have made the greatest relation in producing an artifact or creating a workplace. A computer table is widely used in classrooms in universities. However, the problems of the current computer table have been detected through the results of RULA analysis. In this project, a survey of the questionnaire was done and the anthropometric data have also been collected. The dimensions of the current computer table are then collected and the deficiencies of the current computer table have been focused on RULA analysis. A new structural design of the computer table has been designed, in order to meet the requirements of ergonomics. A product of the new design of ergonomics computer table is made and has been focused on RULA analysis to define the improvement between both tables. The paper showed a comparison between the current computer table and the new ergonomics computer table were analyzed. The improvement of the new ergonomics computer table was identified and reduced the injuries and disorders. A further investigation on better working posture when using a computer table is required, while further improvement for the product design of a new ergonomics computer table is needed, as well as the application of the ergonomics design aspect in our life.