Low dose albumin for the prevention of renal impairment following large volume paracentesis in cirrhosis.

OBJECTIVES: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis. METHODS: Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine \u3e1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was \u3c5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded. RESULTS: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the inclusion criteria and were analyzed. Patients were divided into two groups based on the amount of albumin given. The amount of albumin given was 25 grams and 50 grams while the volume of ascitic fluid removed were 6.2±1 litres and 10.4±1.5 litres in groups A and B respectively. One hundred and eight patients were in group A while thirty one patients were in group B respectively. Both groups received albumin at a dose of 4 grams per litre of ascitic fluid removed. Mean age in both groups were 53 years. Hepatitis C was the commonest etiology in both the groups, followed by Hepatitis B. More than 70% patients in both the groups were in child class C. Serum creatinine at baseline and one week post LVP was 1.04±0.24 mg/dl and 1.07±0.35 mg/dl in GROUP A while 1.11±0.23 mg/dl and 1.41±0.94 mg/dl in GROUP B. (P value 0.35). Similarly, serum sodium at baseline and one week post LVP was 130 ±5.6 meq/lit and 129.6±5.9 meq/lit in GROUP A while 127.6±5.8 meq/lit and 128±6.2 meq/lit in GROUP B respectively. (P value 0.14). CONCLUSION: This study suggests that 4 grams of albumin per litre of ascitic fluid drained is effective in preventing the PICD related renal impairment following large volume paracentesis in cirrhosis

Yield of esophagogastroduodenoscopy and colonoscopy in cancer of unknown primary

Objectives: Carcinoma of unknown primary origin (CUP) is heterogeneous group of cancers. Role of gastrointestinal (GI) endoscopy in this entity is under investigated. Aim of this study was to evaluate yield of Colonoscopy and Esophagogastroduodenoscopy (EGD) in localizing primary tumor in patients with CUP. METHODOLOGY: Patients with histopathologically proven CUP who underwent colonoscopy / EGD to find the primary tumor from December 2009 to December 2011 were included in the study. Abdominal symptoms and cytokeratin (CK) 7 and 20 markers were correlated with presence of primary in GI tract. Results: After giving informed consent 86 patients were included in final analysis. All patients underwent colonoscopy while 60(70%) got EGD along with colonoscopy. Mean age was 55.10 +/-11.94 years with 52(60%) male. Abdominal symptoms were present in 50%. CK7+/CK20- in 34(40%); CK7-/CK20+ in 2(2%) while CK7+/20+ in 7(8%) of metastatic tumor samples. Liver was metastatic site in 47(55%), Lymph node 12(14%) and Ascites in 8(9%). Endoscopy detected primary in 6 (7%) patients with 3 each in stomach and colon. No association of abdominal symptoms and cytokeratin markers was found with presence of GI primary site. CONCLUSION: Yield of localizing primary lesion in the GI tract by pan-endoscopy was limited. Abdominal symptoms and cytokeratin markers do not predict presence of gastrointestinal malignancies

Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and non-medical students

Background: Breast cancer is a common health problem among females in Saudi Arabia. The disease account for 27% of all female malignancies representing 25.1% of all newly diagnosed female cancers. The objectives of the current study were to assess the level of carcinoma breast awareness of female university students, Majmaah University in Saudi Arabia and to compare the level of awareness, breast self-examination and breast cancer screening between medical and non-medical students.Methods: The current study was a cross-sectional, conducted among female students in Majmaah University in Saudi Arabia. The stratified and the systematic sampling were employed to select the colleges and the students respectively. The sample size was calculated as 325. Data was collected by a pre tested questionnaire and analyzed by SPSS.Results: The university students who acquired good knowledge were 111 (34.2%). Students who acquired average and poor knowledge were 42.2% and 23.6% respectively. Medical students who had good knowledge were 37.6% compared to 26.9% of non-medical students.  The results showed that 94 (28.9%) of the participants practice breast self-examination and 25 (7.6%) performed a screening test.Conclusions: The study concluded that Majmaah University students’ awareness of carcinoma breast is low. There is no significant difference in the level of awareness between students of medical colleges and those of non-medical colleges. The level of practicing breast self-examination and performing screening test for carcinoma breast among female university students is low. There is a significant difference in performing carcinoma breast screening test between medical and non-medical students.

Current management of glioma in Pakistan

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and instrumental technologies is a constant struggle for neurosurgeons in Pakistan, considering the cost-effectiveness. Hence, this results in significant limitations for surgeons to provide the best outcome for their patients. As most Pakistanis (74%) pay out of pocket, measuring cost‑effectiveness is extremely crucial. It was found that significant differences in intra‑operative and postoperative care existed among various centers. Public sector institutions fared much worse. The role of diagnostics in glioma surgery is severely limited across centers in Pakistan and as such, research and training need to be addressed promptly. In order to achieve success in glioma management, the data in our article demonstrate various facets of health care that need to be addressed simultaneously and swiftly. Surgical access needs to be improved; only then, optimal management of glioma can be accomplished in Pakistan

Polytrauma Patients and the Significant Role of the Radiologist Diagnosis Through the Imaging Management

This study aimed at recognizing that images have become important not only for diagnosis but also for treatment, and also lies in the analyzing processes of the imaging diagnosis of multiple trauma patients and the significant role of the radiologist diagnosis through the imaging management. The researchers adopted the survey methodology for gathering data upon the recent worldwide studies concerning the polytrauma patients and the significant role of the radiologist diagnosis through the imaging management. The study concluded that the decision to manage the patient surgically or by percutaneous intervention depends upon the clinical severity and secondarily on the findings of whole body MDCT; which identifies blunt polytrauma related injuries which require intervention. Keywords: Polytrauma, Radiologist, Imaging Management and Diagnosis

Survival Rate of Patients with Cardiothoracic Injuries in Road Traffic Accidents, and their Relationship with ISS, GCS and blood transfusions.

Severe thoracic trauma is one of the major causes of injury-related mortality. In the United States, thoracic trauma results in one-fourth of all trauma deaths. Globally, cardiothoracic trauma is also a major contributor to mortality. The most common cardiothoracic injuries include rib fractures, thoracic vertebral fractures, haemothorax, pneumothorax, flail chest, and lung contusions. The purpose of the present study was to determine the survival rate of patients with cardiovascular injuries in road traffic accidents and its relationship with ISS, GCS and blood transfusions at King Khalid Hospital. This study is a useful addition to the literature, as research in this topic is lacking. A total of 189 patients were transported to the hospital with cardiothoracic injuries during the study period. Data was gathered regarding age, gender, nationality, vehicle user type, anatomical region injured, Intensive Care Unit (ICU) admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), blood transfusion, treatment and mortality rate. The neurological status was assessed using the GCS score. Injury Severity Scores were calculated to categorize the injury severity. The mean patient age was 31.81 years, with a peak age of between 21–30 years. Males predominated (93.7%) with a male to female ratio of 15:1. Most of the patients were Saudi nationals (61.3%). Overall mortality was 7.9%. Factors that were significantly associated with mortality were head and neck involvement, ICU admission, age (above 60), treatment delivered, and blood transfusions. Cardiothoracic trauma is associated with a high mortality rate, which may depend on the clinical presentation such as GCS, ISS, degree of shock, pattern of injuries, and associated injuries. Immediate management is vital for patients with life-threatening cardiothoracic trauma, as mortality is high if the diagnosis is missed, wrong or left untreated

Turn on the Lights: Macroeconomic Factors Affecting Renewable in Pakistan

The objective of the study is to examine the relationship between macroeconomic factors (i.e., population growth; urbanization, industrialization, exchange rate, price level, food production index and live stock production index) and renewable energy in Pakistan over a period of 1975-2012. In addition, this study uses oil rent as an intervening variable to overcome the biasness of the single equation model. The results indicate that macroeconomic factors positively contributed to renewable energy consumption in Pakistan. The causality test indicate that there is a unidirectional causality running towards macroeconomic factors to renewable energy in Pakistan, however, renewable energy Granger cause oil rent but not via other route. In addition, there is bidirectional causality between exchange rate and live stock production in Pakistan. Variance decomposition analysis shows that economic growth has a major contribution to increase renewable energy in Pakistan

Turn on the Lights: Macroeconomic Factors Affecting Renewable in Pakistan

The objective of the study is to examine the relationship between macroeconomic factors (i.e., population growth; urbanization, industrialization, exchange rate, price level, food production index and live stock production index) and renewable energy in Pakistan over a period of 1975-2012. In addition, this study uses oil rent as an intervening variable to overcome the biasness of the single equation model. The results indicate that macroeconomic factors positively contributed to renewable energy consumption in Pakistan. The causality test indicate that there is a unidirectional causality running towards macroeconomic factors to renewable energy in Pakistan, however, renewable energy Granger cause oil rent but not via other route. In addition, there is bidirectional causality between exchange rate and live stock production in Pakistan. Variance decomposition analysis shows that economic growth has a major contribution to increase renewable energy in Pakistan

Certified high-efficiency "large-area" perovskite solar cells module for Fresnel lens-based concentrated photovoltaic

The future of energy generation is well in tune with the critical needs of the global economy, leading to more green innovations and emissions-abatement technologies. Introducing concentrated photovoltaic (CPV) is one of the most promising technologies owing to its high photo-conversion efficiency (PCE). While most researchers use silicon and cadmium telluride for CPV, we investigate the potential in nascent technologies, such as perovskite solar cell (PSC). This work constitutes a preliminary investigation into a ‘large-area’ PSC module under a Fresnel lens (FL) with a ‘refractive optical concentrator-silicon-on-glass’ base to minimise the PV performance and scalability trade-off concerning the PSCs. The FL-PSC system measured the solar current-voltage characteristics in variable lens-to-cell distances and illuminations. A systematic study of the PSC module temperature was monitored using the COMSOL transient heat transfer mechanism. The FL-based technique for ‘large-area’ PSC architecture is an unfolded technology that further facilitates the potential for commercialisation