Vestibular schwannoma: anatomical, medical and surgical perspective

The term "acoustic" is a misnomer, as the tumor rarely arises from the acoustic (or cochlear) division of the vestibulocochlear nerve. The correct medical term is vestibular schwannoma, because it involves the vestibular portion of the 8th cranial nerve. They are benign, rather raretumors. They expand in size and grow larger; they can push against the brain. While the tumor does not actually invade the brain, the pressure of the tumor can displace brain tissue

Hydatid disease of liver and disseminated hydatidosis: anatomical, microbiological and radiological perspective

The article underlies the geographic locations of the disease as the disease is not uniformly distributed and is common in certain parts of the world and rare in other parts. The article tries to summarize the microbiological aspects along with the anatomical and surgical perspectives for in depth knowledge and reasons for spread of disease. The photographs indicate the radiological spectrum of the disease in line with the text

The influence of seasonal variations on yield components of sunflower

The wider adaptability of the crop and wide range of climatic conditions of Pakistan make it possible to have two crops of sunflower in a year. Field experiments, one in spring and one in autumn were conducted at the University of Arid Agriculture, Rawalpindi, Pakistan to evaluate the influence of seasonal variation on yield and yield components of sunflower. Four sunflower hybrids were planted in randomized complete block design with three replications. Two central rows were harvested for the measurement of yield and yield components. It was observed that head size of spring crop was larger than autumn crop which was considered to be the result of overall better plant structure, length of crop life cycle, slow and gradual rise in cumulative degree days. Contrary to head size, thousand seed weight of autumn crop was found to be more than that of spring crop. Lesser seed weight of spring crop may be the result of competition for assimilates which left many seeds malnourished as larger head might have encouraged the initial setting of seeds. However, final yield of spring crop was greater than that of autumn crop. It led to the conclusion that having spring crop is the best option, however, autumn crop could be supplementary one to increase the production of oil seeds

Surgical significance of variations in anatomy in the biliary region

Variations in the anatomy of the gallbladder, the bile ducts, and the arteries that supply them and the liver are important to the surgeon, because failure to recognize them can cause iatrogenic injury to the biliary tract. A surgeon should be always be careful while operating in this area. In addition these anomalies are associated with a range of other congenital anomalies, including biliary atresia and cardiovascular or other gastrointestinal malformations, biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction etc, so a look out for other anomalies should be carried out simultaneously

Synthesis of novel cyanoacetamides derivatives and their urease inhibition studies

The present study reports a convenient approach for the synthesis of cyanoacetamide based derivatives (7-27) via two-step process involving Knoevenagel reaction, followed by three component reaction to avail desired compounds. All the synthesized compounds were obtained in good to excellent yield and extensively characterized employing 1H NMR, 13C NMR, mass spectrometry and physical parameters. Further, these compounds were screened for urease inhibition. All of the synthesized compounds exhibited good to excellent urease activity notably compound 15 and 19 showed excellent urease inhibition activity with IC50 value ~17.34 μg/mL and 36.75 μg/mL in comparison to thiourea (used as standard) having IC50 value ~27.5 μg/mL

N-Acetyl-4-(benzene­sulfonamido)benzene­sulfonamide

In the mol­ecule of the title compound, C14H14N2O5S2, the dihedral angle between the aromatic rings is 77.75 (9)°. The acetamide group is planar [maximum deviation = 0.002 (3) Å] and oriented at dihedral angles of 13.49 (21) and 73.94 (10)° with respect to the aromatic rings. An intra­molecular C—H⋯O inter­action results in the formation of a six-membered ring. In the crystal structure, inter­molecular N—H⋯O and C—H⋯O inter­actions link the mol­ecules into a three-dimensional network, forming R 2 2(20) ring motifs

Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic new-borns

Background:Congenital Cardio-Vascular Malformations (CCVMs) are relatively common with a prevalence of 5-10 in every 1000 live births. CCVM represents a new-born condition that would be ideally suited to a screening program if simple and reliable methods were available. Pulse oximetry has been proposed as a screening method for the detection of congenital heart defects.Methods:Hospital based prospective non-randomized study conducted over a period of one year at the department of pediatrics in G.B. Panth hospital (Neonatology) and L.D. hospital (Neonatology). A total of 1200 asymptomatic new-borns attending G.B. Panth, neonatology/L.D. neonatology were screened with pulse oximetry. Oximetric screening for CCVM was performed by obtaining a single determination of postductal saturation at >24 hours. All new-borns underwent additional evaluation by echocardiography.Results:Out of 1200 newborns screened three had postductal saturation ≤95%. Echocardiography revealed TGA (transposition of great vessels) in one; TA (truncus arteriosus) in other and third one had structurally normal heart on echocardiography. There was one false negative screen (found in the inpatient records of G.B. Panth hospital). The sensitivity, specificity, positive predictive value and negative predictive value of pulse oximetry in screening for CCVM in asymptomatic new-borns was found to be 66.67%, 99.9%, 66.67% and 99.9% respectively.Conclusion:This screening test is simple, non-invasive and inexpensive. The sensitivity, specificity, and predictive value in this population were satisfactory, indicating that screening should be applied to larger populations, particularly in developing countries where lower rates of detection result in increased CCVM prevalence in asymptomatic new-borns.

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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication