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

Consistent Valid Physically-Realizable Adversarial Attack against Crowd-flow Prediction Models

Recent works have shown that deep learning (DL) models can effectively learn city-wide crowd-flow patterns, which can be used for more effective urban planning and smart city management. However, DL models have been known to perform poorly on inconspicuous adversarial perturbations. Although many works have studied these adversarial perturbations in general, the adversarial vulnerabilities of deep crowd-flow prediction models in particular have remained largely unexplored. In this paper, we perform a rigorous analysis of the adversarial vulnerabilities of DL-based crowd-flow prediction models under multiple threat settings, making three-fold contributions. (1) We propose CaV-detect by formally identifying two novel properties - Consistency and Validity - of the crowd-flow prediction inputs that enable the detection of standard adversarial inputs with 0% false acceptance rate (FAR). (2) We leverage universal adversarial perturbations and an adaptive adversarial loss to present adaptive adversarial attacks to evade CaV-detect defense. (3) We propose CVPR, a Consistent, Valid and Physically-Realizable adversarial attack, that explicitly inducts the consistency and validity priors in the perturbation generation mechanism. We find out that although the crowd-flow models are vulnerable to adversarial perturbations, it is extremely challenging to simulate these perturbations in physical settings, notably when CaV-detect is in place. We also show that CVPR attack considerably outperforms the adaptively modified standard attacks in FAR and adversarial loss metrics. We conclude with useful insights emerging from our work and highlight promising future research directions

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/

The randomized clinical trial trustworthiness crisis

Background The rising number of retracted randomised clinical trials (RCTs) is a concern over their trustworthiness. In today’s digital landscape electronic observational data is easily accessible for research purposes. This emerging perspective, in tandem with the growing scrutiny of RCT credibility, may steer some researchers towards favouring non-randomized studies. It is crucial to emphasize the ongoing need for robust RCTs, shedding light on the areas within trial design that require enhancements and addressing existing gaps in trial execution. Main body Evidence-based medicine pivots on the nexus between empirical medical research and the theoretical and applied facets of clinical care. Healthcare systems regularly amass patient data, creating a vast reservoir of information. This facilitates large-scale observational studies, which may appear as potential substitutes for RCTs. These large-scale studies inherently possess biases that place them a notch below randomized evidence. Honest errors, data manipulation, lapses in professionalism, and methodological shortcomings tarnish the integrity of RCTs, compromising trust in trials. Research institutions, funding agencies, journal editors and other stakeholders have the responsibility to establish robust frameworks to prevent both deliberate and inadvertent mishandling of RCT design, conduct and analysis. Systematic reviews that collate robust RCTs are invaluable. They amalgamate superior evidence instrumental in improving patient outcomes via informed health policy decisions. For systematic reviews to continue to retain trust, validated integrity assessment tools must be developed and routinely applied. This way it will be possible to prevent false or untrustworthy research from becoming part of the recommendations based on the evidence. Conclusion High-quality RCTs and their systematic reviews play a crucial role in acquiring valid and reliable evidence that is instrumental in improving patient outcomes. They provide vital information on healthcare effectiveness, and their trustworthiness is key to evidence-based medicine.Beatriz Galindo (senior modality) programme of the Spanish Ministry of Educatio

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

Salivary Expression of HIF-1 α in Oral Submucous Fibrosis

Background: Oral submucous fibrosis (OSMF), a chronic debilitating condition distinguished by juxtaepithelial fibrosis or extensive fibrosis of submucosa and reduced vascularity, results in compromised blood supply causing tissue hypoxia. This brings about the transcription of a set of genes associated with angiogenesis, breakdown of iron/glucose, cell division and cell stability. Hypoxia Inducible Factor-1α (HIF-1α) is the main biomarker intervening in this reaction. The aim of research was to measure the salivary levels of HIF-1α in OSMF patients and healthy controls. Methods: This study included 60 participants (30 Oral submucous fibrosis cases and 30 healthy controls). The consecutive sampling technique was used for the recruitment of the study participants. The enzyme-linked immunosorbent assay (ELISA) was used to evaluate HIF-1α levels in saliva. In order to determine data normality, the Kolmogorov-Smirnov test was used. Independent t test was applied to compare salivary levels of HIF-1α between cases and controls and p-value of less than 0.05 was considered statistically significant. Results: The mean salivary HIF-1α value for the oral submucous fibrosis group was 20.18±7.78, compared to healthy controls 13.62±8.86. A statistically significant difference was seen between levels of HIF-1α in the OSMF and control group (p=0.003). The mean mouth opening for cases was 22.94±9.51 mm and for controls 42.00±5.19 mm. There was no correlation among salivary levels of HIF-1α in both the case and control groups (-0.059, -0.030) respectively. Conclusion: Higher levels of HIF-1α were seen in the OSMF group in comparison to healthy individuals suggesting that HIF-1α may play a role in malignant transformation of OSMF. Keywords: Oral Submucous Fibrosis; Saliva; Hypoxia Inducible Factor-1α