Coil embolization of wide neck cerebral aneurysms using balloon remodeling technique-initial experience in pakistan

The balloon remodeling technique [BRT] was developed for neuroendovascular treatment of wide-necked cerebral aneurysms. Herein, we describe our initial experience of aneurysm embolization using BRT in Pakistan with the new double-lumen balloon catheters (Sceptor C and Ascent) and Hyperform balloon micro catheter and discuss its benefits

Endovascular treatment of spontaneous indirect high flow carotid cavernous fistula with a covered stent.

The treatment of symptomatic carotid-cavernous fistulas [CCF] has been historically treated in the developed world through the endovascular route. We report our first case of using a covered stent in a patient with spontaneous CCF. Method: Single patient with spontaneous indirect high flow CCF treated with a covered stent. We present retrospective analysis of technical success, initial and 6-month follow-up angiography and clinical outcome. Result: The stent was successfully navigated and deployed covering the CCF orifice. Immediate post stent deployment angiography showed marked reduction in flow and complete occlusion at 6-months. Clinically, patient showed near-complete recovery at 6 months. Conclusion: With proper neuroendovascular training and experience, use of a covered stent is cost effective and feasible for the treatment of CCFs in under developed countries

In-hospital outcome in patients with spontaneous intracerebral hemorrhage (ich)

Spontaneous intracerebral hemorrhage (ICH) is associated with a high in-hospital mortality and morbidity. One radiological parameter which was found significant in predicting mortality was the presence of hydrocephalus on CT brain (plain). The aim of this study was to determine the frequency of hydrocephalus in patients with spontaneous ICH and to determine the in-hospital outcome in patients of spontaneous ICH with hydrocephalus.MATERIALS AND METHODS: This was a descriptive case series carried out in Department of Neurology, Pakistan institute of Medical Sciences, Islamabad from December 30, 2013 to June 29, 2014. All patients who meet the inclusion criteria were selected for the study. Plain CT brain was done at the time of admission. Radiological parameters recorded included the presence of hydrocephalus on CT brain. Every patient was then being observed for outcome within 7 days. RESULTS: A total of 96 patients were included in the study. The mean age of patients was 45.1 years with standard deviation of 15.641 years. Out of 96 patients, 52 (54.17%) patients were male and 44 (45.83%) patients were female. 51 (53.12%) patients of intra-cerebral hemorrhage had hydrocephalus. Out of 51 patients of intra-cerebral hemorrhage with hydrocephalus, 33 (64.7%) patients had survived while 18 (35.3%) patients had died.CONCLUSION: In our study, significant number of patients of intracerebral hemorrhage had hydrocephalus and it is associated with high mortality and morbidit

The burden of dysphagia and chest infection in acute ischemic stroke in a tertiary care hospital of islamabad capital territory

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the set protocol and monitored for the development of chest infection up to 1 week. Demographics and clinical features were recorded. Results: The mean age of patients was 59.09 ± 13.38 years with no sex predilection.Dysphagia was seen in 57 (37.7%) patients of AIS. Chest infection was seen in 38 (25.2%) of the patients. 32 (84.21%) patients with chest infection had dysphagia while 6 (15.78%) patients with chest infection did not have dysphagia. Conclusion: Chest infection is more common in patients of AIS with dysphagia

Survey on Classification Algorithms for Data Mining:(Comparison and Evaluation)

Data mining concept is growing fast in popularity, it is a technology that involving methods at the intersection of (Artificial intelligent, Machine learning, Statistics and database system), the main goal of data mining process is to extract information from a large data into form which could be understandable for further use. Some algorithms of data mining are used to give solutions to classification problems in database. In this paper a comparison among three classification’s algorithms will be studied, these are (K- Nearest Neighbor classifier, Decision tree and Bayesian network) algorithms. The paper will demonstrate the strength and accuracy of each algorithm for classification in term of performance efficiency and time complexity required. For model validation purpose, twenty-four-month data analysis is conducted on a mock-up basis. Keywords: Decision tree, Bayesian network, k- nearest neighbour classifier

Role of neuroradiology in predicting outome in spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) accounts for 8-13% of all strokes and is associated with a high mortality and morbidity. Western studies have identified various clinical and radiological factors which help in predicting outcome in patients with spontaneous ICH. Materials and methods: A consecutive series of 100 patients diagnosed with spontaneous ICH admitted to the neurology department were enrolled from 1stJanuary to 30th June, 2014.Radiological parameters on CT brain (plain) were recorded. In-hospital outcome was measured at the end of 7 days of hospital stay in terms of survival or mortality. Different radiological parameters and their effect on outcome were compared by using Chi square test. Multivariate logistic regression analysis was performed to find independent predictors of mortality with a “p” value of \u3c 0.05 indicating statistical significance. Results: The mean age was 47.95 years with SD ± 1.560, with a male preponderance (56%). Of the total cohort, 34% patients expired and 66% survived at the end of 1 week. On univariate analysis age, gender and ICH location had p value \u3e0.05 whereas hematoma volume, presence of IV extension, midline shift and hydrocephalus had p value \u3c0.05. On multivariate logistic regression analysis only higher baseline hematoma volume was an independent predictor of mortality (p=0.00). Among 66 survivors, 44% had moderately severe to severe disability with mRS 4 and 5 at the time of discharge. Conclusion-Intracerebral hemorrhage is associated with high in-hospital mortality and long-term severe disability. Larger baseline hematoma volume was an independent predictor of mortality in this study

Association of serum albumin levels and guillain barre syndrome (gbs) outcome.

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker for clinical outcome in plasmapheresis treated-GBS patients

Paraglide: Interactive Parameter Space Partitioning for Computer Simulations

In this paper we introduce paraglide, a visualization system designed for interactive exploration of parameter spaces of multi-variate simulation models. To get the right parameter configuration, model developers frequently have to go back and forth between setting parameters and qualitatively judging the outcomes of their model. During this process, they build up a grounded understanding of the parameter effects in order to pick the right setting. Current state-of-the-art tools and practices, however, fail to provide a systematic way of exploring these parameter spaces, making informed decisions about parameter settings a tedious and workload-intensive task. Paraglide endeavors to overcome this shortcoming by assisting the sampling of the parameter space and the discovery of qualitatively different model outcomes. This results in a decomposition of the model parameter space into regions of distinct behaviour. We developed paraglide in close collaboration with experts from three different domains, who all were involved in developing new models for their domain. We first analyzed current practices of six domain experts and derived a set of design requirements, then engaged in a longitudinal user-centered design process, and finally conducted three in-depth case studies underlining the usefulness of our approach

Diagnostic accuracy of serum albumin for diagnosis of esophageal varices in patients of chronic liver disease

Objective: To determine the diagnostic accuracy of serum albumin for detection of esophageal varices (EVs) in patients of chronic liver disease (CLD) taking Esophagogastroduodenoscopy (EGD)as a gold standard.Methodology: The cross sectional study was accomplished at the department of gastroenterology, Isra University Hospital Hyderabad in collaboration with department of Gastroenterology, AIMS Hospital, Hyderabad, during six months from February 2017 to July 2017. All the Patients of age 20-60 years of either gender presenting with CLD were included. Blood samples from each patient submitted to laboratory to assess serum albumin level. Serum albumin level <3.4 g/dl was assessed as positive. Then patients were referred to department of gastroenterology for EGD. The data recording process was carried out by a proforma. Results: mean age of the patients was 53.63±14.61 years with male to female ratio was 2.3:1. Esophageal varices on serum albumin were found positive in 39 (41.1%) cases and EGD was found positive in 38.95% cases. The sensitivity of esophageal varices on serum albumin was 81.08% with specificity of 84.48%. The PPV value was 76.92%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.16% taking esophageal varices on EGD as gold standard.Conclusion: Serum albumin is a useful forecaster of esophageal varices among patients of chronic hepatic disorder with 81.08% sensitivity and of 84.48% specificity

Neuroradiology in tuberculous meningitisdiagnostic significance and prognostic value.

Tuberculous meningitis (TBM) is the most common and belligerent form of CNS TB.Prompt definitive diagnosis of TBM is arduous due to tedious microbiological procedures. This study was conducted to evaluate the neuroradiological findings in patients with TBM as a modality forearly diagnoses and predicting prognosis. Materials and methods: A successive series of 100 patients diagnosed with TBM admitted to the PIMS neurology ward were studied between March 2013 and April 2014. Cranial imaging results were obtained by non-contrast enhanced CT brain (NECT) and MRI (magnetic resonance imaging) brain with contrast. MRC staging on admission and in-hospital mortality were recorded.Results: The mean age was 34.86 ± 1.76 years with a female preponderance (55%, 55 out of 100). On admission, 72% were in MRC stages II or III. The in-hospital mortality was 16%. NECT was obtained in all the patients and was abnormal in 67% of the patients with hydrocephalus (58%), edema cerebral (24%) and infarcts (5%) being the commonestfindings.CT infarct had the highest mortality rate of 60%. MRI was obtained in 61% of the patients and was abnormal in 88.5% of these cases. Hydrocephalus (61%), tuberculomas (54%), leptomeningeal involvement (46%) and infarcts (13%) were the most frequent radiological signs on MRI. Mortality was significantly associated with infarcts but not with tuberculomas.Conclusion: Neuroimaging techniques are a handy tool in the early diagnosis of TBM. MRI is particularly helpful in defining findings such as infarcts and tuberculomas and in predicting mortality and morbidity