Common Histopathological spectrum of Posterior Fossa Tumors in Pediatric Age Group

Objective:  To know about the common posterior fossa tumors in the pediatric age group on basis of Histopathology in Neurosurgery Department, Hayatabad Medical Complex Peshawar. Material and Methods:  This descriptive cross-sectional study was conducted in the department of MTI Hayatabad medical complex Peshawar from January 2017 to January 2020. We included a total of 52 patients who operated for posterior fossa tumors and biopsy reports were observed to know the histological pattern of the tumor. We included all those patients who have posterior fossa tumors except those tumors which involved or arise from brain stem and infections. The data was collected and analyzed using SPSS version 21. Results:  Our study shows that the mean age was 6 years with a standard deviation ± 2.81. Fifty-eight percent of children were male and 42% of children were female. Histopathologic patterns were analyzed as 48% of children had Medulloblastoma, 25% of children had Astrocytoma, 19% of children had Ependymoma, 8% of patients had other histopathologic patterns. Conclusion:  Our study concludes that common histopathologic patterns of posterior fossa tumors in children were medulloblastoma (48%), Astrocytoma (25%), ependymoma (19%) respectively

Impact of HR Practices on Perceived Performance of Hospital Employees in Pakistan

The objective of our study is to establish the relationship between Employee’s Performance and HR practices in the developing countries like Pakistan. Few studies have been conducted to examine the relationship between employee’s performance and HR practices in the developing countries. The core aim of our study is to investigate relationship between employee’s performance and three Human Resource practices (Performance Evaluation, Promotion and Compensation) among hospital employees in Pakistan. The outcomes of this paper shows the positive association between promotion practices and compensation practices with employee performance but employee performance are not significantly associated with performance evaluation. Pakistani hospitals need to change some compensation practices for the improvement of hospital employee’s performance. Keywords: Employee performance, HR practices, Hospital employees, Pakistan

Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan

Objective:  To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population. Material and Methods:  Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis. Results:  Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases. Conclusion:  Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism

Numerical study of time-fractional fourth-order differential equations with variable coefficients

AbstractIn this article, we study numerical solutions of time-fractional fourth-order partial differential equations with variable coefficients by introducing the fractional derivative in the sense of Caputo. We implement reliable series solution techniques namely Adomian decomposition method (ADM) and He’s variational iteration method (HVIM). Some applications are presented to highlight the significant features of these techniques. The comparison shows that the solutions obtained are in good agreement with each other and with their respective exact solutions. Some of these types of differential equations arise practically in the theory of transverse vibrations

COMPARISON OF OUTCOMES OF ENDOSCOPIC MICRODISCECTOMY VERSUS CONVENTIONAL DISCECTOMY FOR LUMBER DISC DISEASES

Introduction: Chronic lumbosacral pain is a communal and difficult clinical condition at the center of pain management. The most common surgical indication is back pain or intractable and severe functional impairment that does not respond to conservative measures. In this study we have compared the results of endoscopic d microdiscectomy and conventional discectomy procedure. Material and Methods: We included 54 patients with severe lower back pain who did not improve after long-term conservative treatment and who had level 3 disc prolapse, radiating to one or both lower limbs. Oswestry Disability Index (For Low Back Pain) was documented with questionnaire comeback and applied as a clinical tool for valuation. Results: The average age of the 54 patients was 46 years and 75% of patients have paracentral disc protrusion. The mean endoscopic microdiscectomy surgery time was 110 minutes; was longer than conventional discectomy (82 minutes). However, blood loss was very small compared to conventional discectomy. According to the ODI result, both conventional and endoscopic discectomy gave same outcomes in all classes. Conclusion: Endoscopic microdiscectomy is a new, effective and safe procedure that reduces the invasiveness of the surgical approach. The results obtained by this approach are comparable with those obtained with open discectomy to alleviate symptoms during prolonged observation, and because the tissue has minimal trauma, it is much better in early mobilization and morbidity

Progress on the national action plan of Pakistan on antimicrobial resistance (AMR) : a narrative review and the implications

Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan’s national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan. Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR. Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Frequency of Post-Operative Cerebrospinal Fluid (CSF) Leak in Retromastoid Surgery for Vestibular Schwannoma: A Three-Year Experience of a Tertiary Care Hospital

Objective:  Descriptive study was aimed is to find out the frequency of CSF leak in retro mastoid surgery for Vestibular Schwannoma. Material and Methods:  From 2017 to 2020, 63 patients underwent microsurgical excision of Vestibular Schwannoma with retro sigmoidal approach in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. All patients of either sex underwent retro mastoid approach for Vestibular Schwannoma surgery, having complete dural closure per operatively were included in this study. Data was collected which included symptoms, clinical assessment, radiological findings, per-operative and postoperative findings. Patients were monitored for 30 days after surgery and checked for any CSF leaks. Results:  There were 36 male and 27 female patients. In our study, the postoperative CSF leak was present in 9(14%) of cases. There was no significant difference (p-value 0.097) whether the dura was closed with graft and without graft. Insignificant differences existed in CSF leak vs. different age groups (p-value 0.964) and gender (p-value: 0.917). Conclusion:  Our study found that after retro sigmoid approach for vestibular Schwannoma surgery, the frequency of CSF leak was 14%, which gives us insight into our complication rate and allows us to change our surgical procedure technique, such as using fibrin glue or less frequently artificial dura, to reduce this rate

Extra-Super-Fast Charger for Electric Vehicles (EVs) and Plug-In Hybrid Electric Vehicles (PHEVs)

The main aim of this study is the development of a fast and secure charging system for electric vehicles. Recently, many different charging methods have been introduced. The main charging methods are the induction charging method and the conduction charging method. In this paper, the conduction charging method is employed. With regard to the conduction method, there are three levels of charging. At level 1, there is single-phase charging, while both single-phase and three-phase charging occur at level 2. Lastly, at level 3, a three-phase AC charging method, DC conduction charging method, and AC/DC conduction charging method is focused. The level 3 charging method is the main focus of this paper. Toward this end, a 12-diode rectifier or 12-pulse rectifier with a firing angle of zero degrees having two bridges is used for AC to DC conversion, while a SEPIC converter is used for DC-to-DC conversion. The design presented in this paper was simulated and verified using MATLAB/Simulink, and the results show that the Total Harmonic Distortion (THD) of the input current was reduced, and that overall efficiency was improved

Co-Movement of Pakistan Stock Market with the Stock Markets of Major Developed Countries which have Portfolio Investment in Pakistan

ABSTRACT: The focal objective of this study is to analyze and explore the Co-movement of Pakistan stock market (KSE-100) with the stock market of developed countries (US, UK, Canada, Australia, Germany, Japan, France and Neither land) which have portfolio investment in Pakistan by applying co-integration approach using Johansen and Juselius multivariate and bi-variate co-integration. Secondary data of stock indices of these equity markets covering the period from 1 July 2007 to June 2014 has been used. Analysis of study reveals that Pakistan stock market (KSE-100) is not co moved with any stock market of selected major developed countries. Non-existence of co-movement of KSE offers the investors and fund managers to get the diversification benefits by portfolio investment in KSE. This study will help the investors in searching such markets, which have greater diversification benefits because diversification minimizes the risk element. Investors and policy makers can make efficient portfolio investment decisions by studying these analyses. This Study provides awareness and guideline to decision makers including local and foreign investors, agencies, financial analysts and banks about diversification opportunities in equity market of Pakistan