Study DesignA prospective study on spinal tuberculosis (TB) at a tertiary care hospital in an endemic region.PurposeThe aim of the study is to reiterate the importance of conservative management of spinal TB.Overview of LiteratureSpinal 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.MethodsForty-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.ResultsPresenting 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.ConclusionsThe 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.

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Background: Lamotrigine is a member of antiepileptic drugs, it belongs to the sodium channel blocking agent’s class and it is pregnancy category C drug. While its teratogenic effects are not hidden by the doctors but it is the preferred drug being prescribed in pregnancy. The current study aims to investigate the effects of fetus resorption and histologic changes in cranium of fetus of albino mice and to compare their weight changes due to lamotrigine therapy. Methodology: It was an experimental animal study conducted in collaboration of anatomy and surgery department at animal house of University of Lahore in 2019. The duration of study was 25 days, twenty-four albino mice (12 males and 12 females) were placed in conventional cages in pairs for mating purpose. Female mice Group A, controls in which normal saline was administered intraperitoneally on 10th day of gestation and Group B, in which lamotrigine was given intraperitoneally on the 10th day at the dose of 10 mg/kg. Maternal health was monitored daily during the intervention. Body weight, food and water consumption, and changes in general health, behavior, activity and any sign of toxicity were checked daily. After 18th day the pregnant mice were sacrificed under euthanasia and fetuses were removed and histologic assessment was carried out. Results: Weight of mice treated with lamotrigine decreased significantly (p-value=0.03) and fetus resorptions were also more (p-value=0.013) in Group B. Histologic assessment reveled that there were cleft of lip and palate in group B. Conclusion: Lamotrigine increased the fetal resorption and decrease the weight and seemed to be responsible for inducing cleft of lip and palate at 10mg/kg dose in albino mice.

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To the Editor, "Mitral valve repair with the edge-to-edge technique: A 20 years single-center experience" by Konstantinos Sideris et al. 1 provided remarkable information regarding the surgical intervention of mitral valve defects by illuminating its essential components. In-depth details support the article as a result of the authors'

Over the past few years great progress has been achieved in anticancer therapy, but development of resistance and unavoidable side effects have incapacitated these fulfilments. Keeping in view this demanding condition, numerous drugs with unique antitumor mechanisms are under investigations including antimicrobials which have been shown to possess anti-inflammatory, immunomodulatory and cytotoxic effects. In this regard, both conventional and novel antimicrobials are being studied to explore their anticancer potential along with underlying mechanisms which may render them as effective anticancer drugs in near future. Moreover, the new approach of drug repurposing is also being encouraged especially in cancers in order to reduce cost and limit adverse effects. In recent times a cumulative number of studies have laid stress upon the antitumor properties of antimicrobials. Consequently, this study has been conducted to see comparative inhibitory effect of Sorafenib and its combination with a macrolide antibiotic Azithromycin on growth rate HepG2 cell line.