OBJECTIVE: Ropivacaine, a local anesthetic with duration of action of 2-3 hours, has shown greater selectivity for sensory blockade along with lower systemic toxicity as compared to bupivacaine when used for spinal anesthesia. This study was aimed to compare the intrathecal efficacy and safety of 0.75% isobaric ropivacaine for cesarean delivery with 0.5% heavy bupivacaine in parturients. 

MATERIALS AND METHODS: We enrolled 46 parturients of ASA (American Society of Anesthesiologists) grade I-II scheduled for elective cesarean delivery under spinal anesthesia for this prospective randomized control trial. The patients were randomized to receive either 12.5 mg of 0.5% hyperbaric bupivacaine or 24 mg of 0.75% isobaric ropivacaine intrathecally. Intraoperative hemodynamic parameters, characteristics of sensory and motor nerve block, neonatal outcome and maternal adverse effect (such as hypotension, bradycardia, nausea, vomiting, shivering or pruritis) were evaluated.

RESULTS: Baseline demographic variables were similar in the 2 groups (p-value>0.05).  Neonatal outcomes were also similar in both the groups. The time to achieve sensory block to T10 (3.2 ± 1.5 vs 2.5 ± 1.3 minutes) or to the maximal level (9.8 ± 3.1 vs 7.9 ± 2.3 minutes) was longer in the ropivacaine group (p-value 0.048) but the median maximal level of sensory block was similar between the two groups (p-value>0.05). Duration of sensory block was shorter in the ropivacaine group (160.5± 22.2 vs 182.3± 30.5 minutes) (p-value 0.03). Duration of motor block was also significantly shorter than bupivacaine group (112.5 ± 45 vs 165.3 ± 26) (p-value 0.004). 

CONCLUSION: Spinal anesthesia for elective cesarean delivery with intrathecal 24 mg of 0.75% isobaric ropivacaine provided clinically effective surgical anesthesia of shorter duration without compromising neonatal outcome and can be used as an effective and safe alternative to bupivacaine.

About 10 million Pakistani population is infected with Hepatitis C virus (HCV). The prevalence is even more pronounced among high risk population. The commonest mode of transmission is the use of injections, unsterilized needles and contaminated instruments. Combination of standard interferon and ribavirin is still the first line therapy with sustained viral response (SVR) up to 40-50%. Pool of relapsers and non-responders is increasing in Pakistan and needs treatment with pegylated interferon plus ribavirin (peg IFN/RIB). Pegylated interferon has limited use due to being costly. Efficacy of pegylated interferon in genotype 3 is still debatable. HCV related end stage liver disease and hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in health care settings of Pakistan causing exponential burden on financial health care resources.

Ectopic pituitary adenoma occurs outside the sella without any continuity with the normal pituitary gland. We present a case of sphenoidal ectopic pituitary adenoma presenting as Cushing’s syndrome. Imaging studies revealed a normal, compressed pituitary gland, a partial empty sella, and a sphenoidal mass initially suspected to be a mucocele. At surgery, sellar floor was intact and adenomatous lesion was completely resected from the sphenoid sinus. Biochemical remission was achieved post-operatively. Histopathology revealed pituitary adenoma cells in the center of a mucocele sac. A detailed review of the literature is included.

BACKGROUND: The present investigation was undertaken to explore the effect of curcumin on rosuvastatin-induced short-term memory loss.

MATERIALS AND METHODS: For our study, we built an experimental model that consisted of a box with a starting point at one end and an ending point at the other end. These two points were separated by three partitions which had interconnecting doors. Control and rosuvastatin-treated rats received different treatments orally; control (vehicle), negative control, 5mg/kg and 10 mg/kg of curcumin and 150mg/kg of piracetam (standard) for 14 days. Rosuvastatin 10mg/kg p.o. was administered to all the four groups except control. At the end of the treatment, rats were placed individually in the apparatus and allowed to explore the pattern of doors. After initial exposure the rats were placed individually and the latency to cross each door was recorded, the reduction in the time taken to cross the 3^rd door when compared to the time taken to cross the 1^st door is taken as an index of short term memory protection.

RESULTS: Rosuvastatin-treated group (negative control) did not show any decrease in the time taken to cross the 3^rd door when compared to the time taken to cross the 1^st door. Treatment with curcumin at both 5 and 10mg/kg showed a significant decrease (p<0.001) in the time taken to cross the 3^rd door when compared to the time taken to cross the 1^st door and were comparable with that of piracetam-treated group.

CONCLUSION: Our study shows evidence for the protective effect of curcumin against rovustatin induced short-term memory loss. We suggest further studies be done in order to explore the relationship in humans.

Pleuropulmonary blastoma (PPB) is a rare childhood neoplasm accounting for less than one percent of all primary malignant lung tumors of children less than six years of age. Metastasis to central nervous system (CNS), orbit, iris, bone, contralateral lung, liver, kidney, and pancreas and rarely to adrenal glands has been described. This report presents a case of pleuropulmonary blastoma with hemorrhagic pleural effusion and metastasis to the CNS at the time of presentation.