Background Mitral regurgitation is a frequent valvular disease, with an increasing prevalence. We analysed the long-term outcomes of mitral valve repair procedures conducted over the last 10 years in our clinic using almost exclusively two different annuloplasty ring types. Methods A single-centre, retrospective analysis of mitral valve surgeries conducted between January 2005 and December 2015 for patients undergoing first-line mitral valve repair with either open (Cosgrove) or closed (CE Physio / Physio II) annuloplasty (OA or CA, respectively) rings. Results In total, 1120 patient documentations were available of which 528 underwent OA and 592 patients CA. The median age of patients was 64.0 years and 41.1% were female. The majority of these patients underwent the procedure because of degenerative valve disease. Rates of successful repair were about 90%, 72 h procedural mortality was 0.6% and the rate of re-intervention was 0.6% within the first 30 days. Functional (mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and systolic diameter and New York Heart Association class) as well as hard outcomes were comparable. 77.7 and 74.4% of patients were alive at the 10-year follow-up in the OA and CA groups, respectively. Upon multivariable adjustment, the hazard ratio was 0.926 (95% CI: 0.642–1.3135; p = 0.681). Conclusions The functional outcome and survival rates up to 10 years after mitral valve repair were comparable using open and closed annuloplasty rings. Whether this means these rings are interchangeable or a carefully selection of the best-for-the-patient devices will be subject of future investigations.

Aim: To determine the frequency of hydrocephalus in cases of Tuberculous meningitis Methods: This was a cross sectional study conducted during 01-07-16 to 31-12-2017 at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. The cases of tuberculosis meningitis of age range of 15 to 50 years of either gender with tuberculous meningitis were included in this study. The diagnosis of TBM was made on the basis of combination of clinical symptoms and laboratory data. The symptoms were fever, weight loss and neck rigidity with or without fits. These cases then underwent CSF analysis under aseptic measures. The findings to label TBM on CSF were low glucose (< 40 mg/dl), increased protein content (> 100 mg/dl) and high WBC count with predominance of lymphocytes. The cases of TBM were divided according to standard BMRC scale into three stages. The cases with bacterial meningitis, having any SOL in brain and those with any previous history of neurosurgery were excluded from this study. Then these cases underwent CT brain in the same institute and diagnosis of Hydrocephalus was made when any of the ventricle is dilated more than 25% of the baseline. Results: In this study there were total 93 cases of TBM with mean age of 37.11±08.67years. There were 54(58.06%) males and 39(41.94%) females. Maximum cases were seen in stage II of TBM which affected 65 (69.89%) cases. Hydrocephalus was seen in 61(65.59%) of the cases as shown in figure 01. Hydrocephalus was significantly high in male gender as compared to females where it affected 39(72.22%) of cases with p value of 0.03. It was also more common in cases that had age group 15-29 years affecting 40(67.79%) of cases with p= 0.86. Hydrocephalus was also significantly high in cases with stage II and III of TB affecting 66.15% and 77.27% of cases respectively with p= 0.01. Conclusion: Hydrocephalus is very common in cases of TBM and it is significantly high in male gender and stage II and III of TBM. Key words: TBM, Hydrocephalus

Kojic acid (KA) is a BCS class II drug having low solubility and high permeability. This study was designed to enhance the aqueous solubility of KA, as well as its dissolution rate and, in turn, bioavailability, by formulating its smart nanocrystals. Nanocrystals of pure KA were formulated by the top-down method under high-pressure homogenization followed by freeze drying. The nanocrystals were evaluated for stability and other physical characteristics, including zeta sizer analysis, DSC, surface morphology, XRD, drug content, solubility, FTIR and in vitro drug release. The KA nanocrystals were found to be stable when kept at exaggerated conditions. The particle size of the nanocrystals was 137.5 ± 1.7, 150 ± 2.8, and 110 ± 3.0 nm for the F1, F2 and F3 formulations, respectively. There was negative zeta potential for all the formulations. The dispersity index was 0.45 ± 0.2, 0.36 ± 0.4 and 0.41 ± 1.5 for the F1, F2 and F3, respectively. The DSC studies showed that there was no interaction between the KA and the excipients of the nanocrystals. The morphological studies confirmed the presence of rough crystalline surfaces on the nanosized particles. XRD studies showed the successful preparation of nanocrystals. The drug content was in the official range of 90 ± 10%. The solubility of KA was significantly (p < 0.05) enhanced in the formulations of its nanocrystals as compared with pure KA powder. The ATR-FTIR studies revealed the presence of functional groups in both KA and KA-loaded nanocrystals, and no interaction was found between them. The nanocrystals released 83.93 ± 1.22% of KA in 24 h. The study concluded that the nanocrystals were successfully formulated using the top-down method followed by high-pressure homogenization. The solubility, as well as the dissolution, of the KA was enhanced, and this could improve the therapeutic effects of KA.

Regurgitation and vomiting of milk due to GER is a common problem in infants especially under 6 months of age. It is a self limiting condition and improves as the infant becomes older & starts sitting, but in some cases pharmacological treatment may be required. Objective: This study aims to evaluate the effectiveness of erythromycin as a prokinetic agent in otherwise healthy infants with gastro esophageal reflux. Design: Interventional study Place & Duration of Study: Outpatient Pediatric Clinic of Govt. Kot Khawaja Saeed Teaching Hospital (KEMU) Lahore. From 1st May 2014 till 31st October 2014. Patients & Methods: Infants (15 days to 1 year) attending Pediatric Outpatient Clinic who were otherwise healthy except for history of regurgitation and vomiting after feed were included in the study. Erythromycin drops were started in a dose 10-15 mg/kg/day for a period of 2 weeks. Results: A total of 30 infants, 15 days to 10 months age were included in the study. Male to female ratio was 1.1:1. Twelve infants presented with history of regurgitation, twelve with history of vomiting and six with regurgitation and vomiting both. Twenty infants showed improvement within a week. Four infants showed partial improvement and four did not respond at all, while two infants were lost to follow up. Conclusion: Erythromycin has been found a helpful drug for the management of regurgitation and vomiting in infants.

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