Comparison of Absorbable with non Absorbable sutures in closure of Laparotomy incisions

Objective: To compare the absorbable with non absorbable sutures in wound dehiscence after closure of Laparotomy incisions. Methodology: This randomized control trial was conducted in the department of general surgery, Bahawal Victoria Hospital, Bahawalpur in seven months duration from June 2016 to January 2017. Data was entered in statistical software SPSS version 23 and analyzed for desired variable analysis. Mean and SD was calculated for numerical data like age and Body Mass Index,  and frequency percentages were calculated categorical data like gender, Anemia etc. Chi square test was applied for effect modification or association of outcome variables with effect modifiers. P value < 0.05 was considered as significant. Results: In this study, a total number of 100% (n=130) patients were included, divided into two equal groups, 65 in each i.e. group Prolene and group Vicryl. In our study, wound dehiscence occurred in 6.2% (n=4) cases in whom Prolene was used whereas 21.5% (n=14) had wound dehiscence with the use of Vicryl suture. Vicryl was followed by significantly higher incidence of wound dehiscence than closure by Prolene (χ2= 6.448 DF = 1, P value=0.011). Conclusion: Observation of our study concluded that non absorbable Prolene has better outcome and less wound dehiscence and other complication as compared to absorbable Vicryl suture. Keywords: Absorbable suture, non absorbable suture, wound dehiscence, laparotomy

Comparison of Functional Outcomes in Terms Of Post-Operative Mobility for Unipolar Versus Bipolar Un-Cemented Hemiarthroplasty in Elderly Patients with Displaced Intracapsular Femoral Neck Fractures

Objective: To compare of functional outcomes in terms of post-operative mobility for unipolar versus bipolar un-cemented hemiarthroplasty in elderly patients with displaced intracapsular femoral neck fractures. Methodology: Our study design is Randomized Control Trialconducted inDepartment of Orthopedics Bahawal Victoria Hospital, Bahawalpur. April 2015 to October 2016.Sample size is (calculated by taking n6 =138, confidence interval 95, power of study 80, P1= 33%, P2=13%) 69 in each group. Sampling technique used was non probability consecutive sampling. All patients who meet the inclusion criteria presenting to orthopedic unit of Nishtar Hospital Multan with fracture neck of femur were selected for study. Patients were divided into two groups randomly by lottery method and enrolled for unipolar or bipolar hemiarthroplasty. Chi-square test was used to compare outcome variable in both groups. A p-value < 0.05 was considered statistically significant. Effect modifiers like age and sex was controlled by stratification. Chi square test was applied to see significant difference. Results: Overall, there were 100% (n=138) patients in this study, both genders. The mean age of the patients was 66.35±4.29 years. (Range: 60 to 80years) Mean age and SD of group A (no walking aid) was 54.52 ± 3.10 and in group B (walking aid) 54.99 ± 3.19. Time up go score was noted as successful 33.3% (n=46) and 66.7% (n=92) as unsuccessful. Walking aid was noted in 65.2% (n=90) patients. Functional outcome was noted as good in 26.8% (n=37) patients and noted as bad in 73.2% (n=101) patients. Out of 100% (n=38) patients, good outcome was 26.3% (n=10) unipolar and 73.7% (n=28) bipolar. Out of 100% (n=100) Bad outcome was 59% unipolar and bipolar 41%. Conclusion: Functional outcome in term of mobility is better in case of bipolar prosthesis as compared to unipolar. Thus in our conclusion bipolar prosthesis is preferred procedure as compared to unipolar hemiarthroplasty in treating patients with displaced intracapsular femoral neck fracture. Keywords:Bipolar Hemiarthroplasty, Unipolar Hemiarthroplasty, Displaced intracapsular femoral neck fractures

QuSecNets: Quantization-based Defense Mechanism for Securing Deep Neural Network against Adversarial Attacks

Adversarial examples have emerged as a significant threat to machine learning algorithms, especially to the convolutional neural networks (CNNs). In this paper, we propose two quantization-based defense mechanisms, Constant Quantization (CQ) and Trainable Quantization (TQ), to increase the robustness of CNNs against adversarial examples. CQ quantizes input pixel intensities based on a "fixed" number of quantization levels, while in TQ, the quantization levels are "iteratively learned during the training phase", thereby providing a stronger defense mechanism. We apply the proposed techniques on undefended CNNs against different state-of-the-art adversarial attacks from the open-source \textit{Cleverhans} library. The experimental results demonstrate 50%-96% and 10%-50% increase in the classification accuracy of the perturbed images generated from the MNIST and the CIFAR-10 datasets, respectively, on commonly used CNN (Conv2D(64, 8x8) - Conv2D(128, 6x6) - Conv2D(128, 5x5) - Dense(10) - Softmax()) available in \textit{Cleverhans} library

Frequency and predictors of recurrence of bladder tumour on first check cystoscopy - a tertiary care hospital experience

Abstract OBJECTIVE: To determine the frequency and predictors of non-muscle invasive bladder tumour recurrence on first-check cystoscopy after transurethral resection of bladder tumour. METHODS: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to November 2014, and comprised patients with a suspected newly-diagnosed urothelial cancer. Patients with non-muscle invasive disease with complete resection of all visible lesions along with deep biopsy from the tumour base were included. Patients received standard adjuvant intravesical therapy according to their risk stratification and underwent a white-light check cystoscopy at 3 months to look for tumour recurrence. Association between clinico-pathological variables and recurrence at first cystoscopy was determined. SPSS 20 was used for data analysis. RESULTS: The mean age of 84 patients at presentation was 63.3±12.5 years (range: 36-89 years). There were 75(89%) men and 9(11%) women. On initial transurethral resection, the size of tumour was less than 3cm in 32(38%) participants and equal to or above 3cm in 52(62%). Single tumour was found in 51(61%) subjects and multiple tumours in 33(39%). None of the resected tumours was primary carcinoma in situ and 35(42%) tumours were of high grade. The overall recurrence rate at first cystoscopy was 28(33.3%). Larger tumour, higher grade and tumour multifocality were factors associated with recurrence at check cystoscopy (p\u3c0.05 each). Patients\\u27 age, gender, smoking status and tumour stage did not correlate with early recurrence (p\u3e0.05 each). CONCLUSIONS: The number, size and grade of the tumour strongly correlated with recurrence at check cystoscopy

Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

Incidental renal cell carcinoma in pelvic malignancies

Simultaneous diagnosis of renal cell carcinoma with pelvic malignancies is rare but a well-documented phenomenon. It is not uncommon to have incidental renal masses on imaging done for investigating other tumors. There are no established guidelines for the treatment of patients with dual malignancies. The management of such patients is challenging and requires a multidisciplinary approach. We present a series of three cases with a diagnosed pelvic malignancy but further workup revealed a kidney tumor. Both the malignancies were evaluated individually and diagnosed as two different primary neoplastic lesions. This case series examines each distinct patient\u27s presentation, discusses the diagnosis, and compares and contrasts the findings while discussing the literature on this topic

In Silico and In Vivo : Evaluating the Therapeutic Potential of Kaempferol, Quercetin, and Catechin to Treat Chronic Epilepsy in a Rat Model

Recently, alternative therapies are gaining popularity in the treatment of epilepsy. The present study aimed to find out the antiepileptic potential of quercetin, catechin, and kaempferol. In vivo and in silico experiments were conducted to investigate their therapeutic potential. 25 mg/kg/day of pentylenetetrazole was administered for 4 weeks after epilepsy was induced in the rats; this was followed by the behavioral studies and histological analysis of rat brain slices. Binding affinities of kaempferol, quercetin, and catechin were assessed by performing in silico studies. Kaempferol, quercetin, and catechin were found to have the highest binding affinity with the synaptic vesicle 2A (SV2A) protein, comparable to standard levetiracetam (LEV). The mRNA levels of SV2A, as well as the expression of TNF, IL 6, IL 1 beta, NFkB, IL 1Ra, IL 4, and IL 10, were investigated using qPCR. Our results indicate for the first time that SV2A is also a transporter of understudied phytoflavonoids, due to which a significant improvement was observed in epileptic parameters. The mRNA levels of SV2A were found to be significantly elevated in the PF-treated rats when compared with those of the control rats with epilepsy. Additionally, downregulation of the pro-inflammatory cytokines and upregulation of the anti-inflammatory cytokines were also noted in the PF-treated groups. It is concluded that kaempferol, quercetin, and catechin can effectively decrease the epileptic seizures in our chronic epilepsy rat model to a level that is comparable to the antiepileptic effects induced by levetiracetam drug.Peer reviewe