Percentage Difference in Angiographic Findings Vs Per-operative Findings and Their Implications in Surgical Management of Sub Arachnoid Haemorrhage

Objective:  To determine the frequency of different treatment modalities used for the exclusion of aneurysms from circulation, to determine the percentage difference between the angiographic findings and per-operative findings related to aneurysm and its surroundings and to determine the outcome of our surgical management. Results:  Out of 25 cases, maximum cases were recorded in 4th and 5th decade. Male to Female ratio remained (1:1.08). Hypertension is involved significant number of cases. The most common aneurysm was of anterior communicating artery aneurysm (55%). Percentage difference in angiogram and per-operative findings about the appearance of perforators was maximum i.e. in 6 (24%) cases. In 18 (72%) cases clipping was done while remaining 4 (16%) cases were treated with clipping and reinforcement and 1 (4%) each with wrapping, trapping and carotid ligation. At admission Twelve (48%) patients in Grade-I; according to WFNS scale and 10 (83.33%) made good recovery while 2 (16.66%) died. In Grade-II; we had 7 (28%) patients out of which 3 (42.85%) had good recovery, 3 (42.85%) in the state of moderate disability and 1 (14.28%) expired. In Grade-III; we received 6 (24%) patients out of which 4 (66.66%) made good recovery while 2 (33.33%) expired.&nbsp

Prevalence of mixed genotype hepatitis C virus infections in the UK as determined by genotype‐specific PCR and deep sequencing

The incidence of mixed genotype hepatitis C virus infections in the UK is largely unknown. As the efficacy of direct acting antivirals is variable across different genotypes, treatment regimens are tailored to the infecting genotype, which may pose issues for the treatment of underlying genotypes within undiagnosed mixed genotype HCV infections. There is therefore a need to accurately diagnose mixed genotype infections prior to treatment. PCR-based diagnostic tools were developed to screen for the occurrence of mixed genotype infections caused by the most common UK genotypes, 1a and 3, in a cohort of 506 individuals diagnosed with either of these genotypes. The overall prevalence rate of mixed infection was 3.8% however this rate was unevenly distributed, with 6.7% of individuals diagnosed with genotype 3 harbouring genotype 1a strains and only 0.8% of samples from genotype 1a patients harbouring genotype 3 (p<0.05). Mixed infection samples consisted of a major and a minor genotype, with the latter constituting less than 21% of the total viral load and, in 67% of cases, less than 1% of the viral load. Analysis of a subset of the cohort by Illumina PCR-next generation sequencing resulted in a much greater incidence rate than obtained by PCR. This may have occurred due to the non-quantitative nature of the technique and despite the designation of false positive thresholds based on negative controls

Five years Review of Failed Back Surgery Syndrome (FBSS) at Dept of Neurosurgery Unit-I, Lahore General Hospital Lahore

Objective:  To report our data of cases of failed back surgery syndrome (FBSS) and surgical and non surgical etiologies. Materials and Methods:  A review of cases of Failed back surgery Syndrome (FBSS), from 2003 to 2008 man-aged at The Neurosurgery Department Lahore General Hospital Lahore/PGMI, was conducted. The inclusion criterion was Re-admission within one year of their previous lumbar disk surgery at our department or other teaching institutes. 39 patients were found and included in the review. Two groups of patients were created on the basis of whether patient managed conservatively or re-explored. Important Data was recorded, analyzed and is presented. Results:  Out of the total 39 patients 15 (38.46%), were managed conservatively and included in group A. Twenty four 61.5% patients who were managed surgically with re-exploration and were grouped as B. 26 patients were male and 13 were female. Group A:  In this group 15 (38.46%), were included. These patients did not have a radicular element in their history of recurrent backache, and symptoms were vague.  Group B:  In group B, 24 (61.5%) patients were included. All these patients presented at re-admission with backache and radiculopathy. The time since previous surgery was not more than One year in all these patients.  Conclusion:  The failure of back surgery remains a challenge for the surgeons. There is a constant search for the causes and the pathogenesis of this syndrome and the best method of treatment. Recurrent disc is the commonest cause of failed back syndrome which responded well with reexporotive

Role of Endoscopic Third Ventriculostomy in Congenital Obstructive Hydrocephalus

Object:  To improve the care of Obstructive Hydrocephalic infants, from six months to twelve months and to evaluate the efficacy and complications of Endoscopic Third Ventriculostomy (ETV). Materials and Methods:  The study was conducted in the Department of Neurosurgery PGMI, Lahore General Hospital, Lahore from July 2007 to June 2008. Total numbers of patients were 30, which were divided into two equal groups. Group A (15 patients) underwent Endoscopic Third Ventriculostomy (ETV) and Ventriculo-peritoneal VP Shunt were done in Group B (15 patients). Cases were selected randomly. Results:  The mean age for Group A was 9 months and for Group B was 8 months Endoscopic Third Ventriculo-stomy (ETV) procedure found successful in older than 8 months of age while ventriculoperitoneal VP Shunt procedure found successful in all age groups. Before procedure mean head circumference for Group A was 50.86 cm and for Group B was 50.84 cm. After one year follow up mean head circumference in Endoscopic Third Ventriculostomy (ETV) Group was 50.18 cm and in VP Shunt Group was 47.38 cm. Primary success in Endoscopic Third Ventriculostomy (ETV) Group was 53.3% (8 out of 15), whereas in VP Shunt Group it was 66.7% (10 out of 15).  Conclusion:  Although results are same in both groups but Endoscopic Third Ventriculostomy (ETV) Group remain shunt free. Endoscopic Third Ventriculostomy seems to be an effective alternative than VP Shunt in the management of Hydrocephalus in infants provided careful patient selection is done and surgeon is competent enough with Endoscopic Third Ventriculostomy technique

R2S100K: Road-Region Segmentation Dataset For Semi-Supervised Autonomous Driving in the Wild

Semantic understanding of roadways is a key enabling factor for safe autonomous driving. However, existing autonomous driving datasets provide well-structured urban roads while ignoring unstructured roadways containing distress, potholes, water puddles, and various kinds of road patches i.e., earthen, gravel etc. To this end, we introduce Road Region Segmentation dataset (R2S100K) -- a large-scale dataset and benchmark for training and evaluation of road segmentation in aforementioned challenging unstructured roadways. R2S100K comprises 100K images extracted from a large and diverse set of video sequences covering more than 1000 KM of roadways. Out of these 100K privacy respecting images, 14,000 images have fine pixel-labeling of road regions, with 86,000 unlabeled images that can be leveraged through semi-supervised learning methods. Alongside, we present an Efficient Data Sampling (EDS) based self-training framework to improve learning by leveraging unlabeled data. Our experimental results demonstrate that the proposed method significantly improves learning methods in generalizability and reduces the labeling cost for semantic segmentation tasks. Our benchmark will be publicly available to facilitate future research at https://r2s100k.github.io/

Tea and coffee consumption in relation to vitamin D and calcium levels in Saudi adolescents

Background Coffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents. Methods A total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays. Results Improved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9–12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9–12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure. Conclusion This study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively

Whistleblowing and interpretation, addressing organizational challenges: a conceptual reflection from Nigeria

Purpose – This study aims to explore the effect of whistleblowing and interpretation among practitioners in the Nigerian economy. The research puts a premium on understanding the relevance and critical issues in its practices and developing an improved model for the effective practice of whistleblowing and interpretation in Nigeria. Design/methodology/approach – This study adopted a conceptual approach, relying on extant literature to understand the management of whistleblowing incidents and identify the managers’ and other stakeholders’ responsibility in the whistleblowing process. It applied systems dynamics conceptual modelling and presented an improvement approach to addressing the complexities associated with whistleblowing and interpretation among Nigerian organizations. Findings – This study contributed to the extant literature by developing a model for proper management of whistleblowing in the Nigerian context and enhancing the robust practice of whistleblowing and interpretation in Nigeria. The findings highlighted critical factors such as managers’ skills development, legal system support, institutional stakeholders’ function and ethical balance as key factors to effective whistleblowing management and interpretation. This implies that the act of identifying and developing responses to an emerging case of whistleblowing requires a process of developing underpinning assumptions, engagement and consideration of stakeholders’ interests while driving the sustenance of organizational focus. Originality/value – This study emphasized the departure from absolute best practice to developing idea approaches that reflect stakeholders’ interests and the context of whistleblowing and interpretation. While the study acknowledges limitations in the sole focus on the Nigerian private sector and the Nigerian economic background, it recommends further exploration of whistleblowing and its interpretation on a comparative approach, to improving the current understanding of the topic

Firm level determinants and dividend policy in Pakistan

Dividend policy is a challenge in the field of corporate finance. This paper finds out the important factors of dividend policy of Pakistani listed firms. The current paper aims to examine the impact of firm specific factors of dividend policy in Pakistan. The factors examine in this study are profitability, free cash flow, firm size, liquidity, financial leverage, investment opportunities and corporate tax. The data are collected from annual reports and Pakistan Stock Exchange. To accomplish the objective, financial data from 2000 to 2017 are collected and analyzed to examine the impact of firm level determinants on dividend payout. This paper used pooled ordinary least squares model and fixed effect model. The findings reveal that firm specific factors have significant influence on dividend policy in Pakistan. The profitability of firm and corporate tax has positive influence, whereas firm size and investment opportunities have negative impact on dividend payout. The implication of current research is useful for board of directors and managers to decide the appropriate dividend policy for firm. This study is also helpful for investors about investment decision. This research is a contribution to the existing body of knowledge about the determinants that influence dividend policy of Pakistani listed firms. Future researcher should use the same phenomenon in different emerging economies using the different approach to reduce the dividend puzzle in the field of corporate finance

Acute-on-chronic liver failure: Consensus recommendations of the Asian pacific association for the study of the liver (APASL): An update

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the APASL ACLF Research Consortium (AARC) was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the \u27Golden Therapeutic Window\u27, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here