Postoperative outcome of early appendectomy in patients having appendicular mass by laparoscopic surgery

Objective: To determine the frequency of postoperative outcome of early appendectomy in patients having appendicular mass by laparoscopic surgery.Methodology: It was a descriptive & case series study. Study was conducted in the department of surgery Liaquat University Hospital Jamshoro/Hyderabad, during the time period of Jan 2015 to Dec 2017. Patients were both gender and patients aged between 10-40 years having tender and palpable right iliac fossa mass on clinical examination confirmed on ultrasound abdomen as appendicular mass. Patients with mass in right iliac fossa but with associated features like fixed and immobile mass for more than 1 month, bleeding per rectum, history of weight loss, cardio respiratory diseases like recent myocardial infarction, congestive cardiac failure, chronic obstructive pulmonary disease and renal diseases like glomerulonephritis, nephrotic syndrome and renal failure etc, gynecological and obstetrical diseases in female patients were excluded from the study. The postoperative hospital stay was counted and wound infection was noted.Results: During the study period of one year, total of 73 patients with appendicular mass were included in this study.  The age range 10 to 40 years with mean age ± SD (range) was 25.75±9.2 years. Out of them 46 (63.0%) were male whereas 27(37.0 %) were females During operation we found appendicular abscess in 12(16.43%) cases followed by perforated appendix in   10(13.69%) cases, while during operations we found in adhesions in 15(20.5%) cases and difficulty in localisation of appendix 06 (8.21%) cases. The mean hospital stay + SD (range) was 4.91 +1.65 (3-9 days).  Wound infection was seen in 15(20.5 %) cases.Conclusion: Early appendectomy can be safely performed in appendix mass without any increased risk of mortality and morbidity. The outcome of early surgical management of appendicular lump showed benefits for single hospitalization, shorter hospital stay and lower treatment costs

Comparison of Outcome of Bipolar Electrocautery versus Harmonic Scalpel in the Management of Third and Fourth Degree Hemorrhoids

Objective: To compare the outcome of bipolar electrocautery versus harmonic scalpel in the management of third degree hemorrhoids. Methodology: This is a comparative study performed at Different Private Clinics of Karachi from the duration of January 2020 to June 2020. Patients with symptomatic grade III hemorrhoids and grade IV hemorrhoids were randomly divided into two groups. . Either group had 64 patients. One group underwent hemorrhoidectomy using bipolar electrocautery (Group A), other group underwent hemorrhoidectomy using harmonic scalpel hemorrhoidectomy (Group B). Results: The total number of patients was 128 with 64 in either group. The mean operating time in group A was 22 ± 4.7 minutes, while that in group B was 35 ± 2.2 minutes. The mean duration of hospital stay among group A was 1.7 ± 0.5 days while among group B patients was 2.1 ± 1.2 days. Mean VAS score for pain at first post-operative day in group A patients was 7 ± 0.6 days while mean VAS score for pain among group B patients was 8.5 ± .2 days. Conclusion: Our study concludes that harmonic scalpel hemorrhoidectomy offers better post-operative patient satisfaction score as compared to bipolar diathermy. No significant difference in hospital stay was found. The number of patients with post-operative urinary retention were more in harmonic scalpel group while in diathermy group, more patients had post-operative hemorrhage

Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country

Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM. Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department of Neurology at Jinnah Medical College Hospital (JMCH), Karachi. In total 131 patients of TM were enrolled and treated as per standard protocol, and re-evaluated after eight weeks for assessment of clinical outcomes. Results: The average age of patients was 51.15 ± 6.56 years. Out of 131 cases, 36.6% of patients had full recovery and 63.4% had poor recovery while recurrence occurred in 66.7% cases. Urinary frequency was observed in 12.2% cases and incontinence in 6.9% cases. Conclusion: Acute TM has become transformed with recent developments, especially the advent of the MRI and the discovery of biomarkers

Importance of Social Psychology in the Society

ABSTRAC

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Examining consumers' intention, behavior, and beliefs in mobile banking adoption and continuous usage

Changing consumer behavior continues to have a profound impact on digital banking adoption and prolonged usage in developed and emerging markets. Several factors influence the consumer decision journey when choosing any specific digital channel or combination of channels. Among a variety of digital banking channels, this dissertation research seeks to contribute to the mobile banking (m-banking) literature by examining consumer behavior in m-banking services as well as technology (application) adoption and continuous usage, especially after considering the fact that financial service institutions have entered a time when offering mobile-based services is no longer a novelty but a necessity. This dissertation analyzes and synthesizes a plethora of literature on information systems/information technology and m-banking and their adoption and usage across various strata of populations in developed and emerging countries. The dissertation provides useful insights into the drivers of adoption and continuous usage of m-banking services and application. The most valuable findings indicate that the m-banking adoption and usage literature is fragmented and lacks a clear road map or agenda. The extant literature appears limited by its narrow focus on SMS banking in developing countries. More surprisingly, no studies address the use of m-banking applications via smartphones or tablets or consider the consequences of such usage. Self-congruence is significantly related to perceived value (PEVA) and addresses a critical gap in the extant literature, which does not seem to have analyzed the effect of self-congruence on m-banking continuous usage. Overall, PEVA is significantly associated with increased m-banking usage, and PEVA is a significant antecedent of the intention to use for consumers in a mature market. On a different note, the main motivation for the continuous usage of m- banking is convenience. The results also indicate positive changes in bank customers’ relationship commitment after using m-banking services

Mobile banking services adoption in Pakistan: are there gender differences?

Purpose The purpose of this paper is to provide a comprehensive insight into the deciding factors affecting an individual’s intention to adopt mobile banking (m-banking) services in Pakistan. Design/methodology/approach A survey approach was used with a sample of 189 responses from across Pakistan. Multi-group analysis was performed in order to detect gender differences among men and women in the process of adopting m-banking. Findings The paper found support for the positive effect of perceived behavioral control (PBC) and attitudes (ATT) toward m-banking adoption intentions. Significant differences between men and women were found to affect subjective norms (SN) on adoption intention, even though the combined sample of men and women was insignificant. The effect of SN on m-banking adoption is stronger for women than for men. Interestingly, the paper provides contradictory findings on the role of PBC on adoption intention. The effect of PBC on m-banking adoption intention was found to be significantly stronger for men than for women. Practical implications The results present implications of consumer behavior and marketing communication for bank marketing. Although men and women do not differ in their ATT toward m-banking service adoption in general, the succinct nuance between men and women in terms of the influence of SN and PBC with adoption intention calls for a strategic reorientation of how men and women as consumers of m-banking services should be appropriately segmented, targeted and communicated. The formulation of marketing strategies to target potential consumers and to reinforce the usefulness of m-banking to existing consumers should not be “one size fits all.” The marketing of m-banking services to segments of men and women should be approached strategically in order to increase adoption rates in developing/emerging economies. Originality/value This is the first study on m-banking services adoption in Pakistan to examine the role of gender in the innovation adoption process. The differences between the two genders and the insightful results that we found in our study help shed light on the uniqueness of the context. This study is also one of the first to test a combined technology acceptance model and theory of planned behavior model in the context of m-banking adoption in a developing country using a variance-based modeling technique

Analysis of Coverage and Area Spectral Efficiency under Various Design Parameters of Heterogeneous Cellular Network

As day by day the population is increasing, the use of mobile phones and different applications is increasing which requires high data rate for transmission. Homogeneous cellular network cannot fulfill the demand of mobile users, so creating a heterogeneous cellular network (HCN) is a better choice for higher coverage and capacity to fulfil the increasing demand of upcoming 5G and ultra-dense cellular networks. In this research, the impact of antenna heights and gains under varying pico to macro base stations density ratio from 2G to 5G and beyond on two-tier heterogeneous cellular network has been analyzed for obtaining optimum results of coverage and area spectral efficiency. Furthermore, how the association of UEs affects the coverage and ASE while changing the BSs antenna heights and gains has been explored for the two-tier HCN network model. The simulation results show that by considering the maximum macro BS antenna height, pico BS antenna height equal to user equipment (UE) antenna height and unity gains for both macro and pico tiers, the optimum coverage and area spectral efficiency (ASE) for a two-tier fully loaded heterogeneous cellular network can be obtained

Experience with Extra Hepatic Intra Abdominal Hydatid Cyst

Introduction: Hydatid disease is a signi cant health problem with their location at Extrahepatic Intra abdominal sites is a very rare disease. Disease in these sites usually found concurrently with liver hydatid disease. Diagnosis is based blood tests & imaging studies. Surgery is the mainstay of treatment. This study will help us in determining the frequency of Extra Hepatic Intra Abdominal Hydatid Disease. Also different methods to diagnose & treat the disease will be evaluated.  Methods: It includes patients of extra hepatic intra abdominal Hydatid cyst above 13 years and underwent surgery from 2009 to 2014. Variables include age, sex, clinical ndings, diagnostic investigations, operative ndings, operative procedure, post operative complications. Results: Eleven patients; 07 male & 04 female; mean age 37.54 years. Most common symptoms were mass in abdomen in 11 patients & dull pain abdomen in 09 (81.8%) patients. Examination revealed non tender mass in epigastric & umbilical region in 04 (36.3%) patients. Ultrasound Abdomen showed hydatid cyst spleen in 02 (18.1%) patients, epigastrium in 04 (36.3%) patients, beneath left crus of diaphragm in 02 (18.1%) patients & right iliac fossa & pelvis in 1 (9.09%) patient. In 02 (18.1%) patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6%) patients. C.T scan Abdomen was performed in 09 (81.8%) patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05 (45.4%) patients. Conclusion: Extra hepatic intra abdominal is an infrequent disease presents signicant diagnostic & therapeutic challenge for surgeons.  Keywords: extra hepatic; hydatid disease; intra abdominal