Extremely Preterm (23 Weeks) Vaginal Cephalic Delivery En Caul and Subsequent Postpartum Intraventricular Hemorrhage and Respiratory Distress: A Teaching Case.

En caul deliveries are defined as a fetus that is delivered completely contained within an amniotic sac and are considered to be less common than 1 in 80,000 live births. Vaginal en caul births compared to abdominal or cesarean are the rarest subtype. Most en caul births are associated with prematurity and low gravida. The combination of prematurity, high gravida, vaginal en caul birth, and severe postpartum complications has not previously been described. We report a woman with gravida of 12 delivering vaginally a neonate female en caul at the extremely preterm gestational age of 23 weeks. The neonate subsequently decompensated, underwent respiratory distress, and was diagnosed with a bilateral intraventricular hemorrhage. Owing to deteriorating status, supportive care was removed and the infant was pronounced dead 5 days after delivery

Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest

AbstractObjectives: Although retrograde cerebral perfusion has become a popular adjunctive technique and may improve cerebral ischemic tolerance during hypothermic circulatory arrest, direct cerebral metabolic benefit has yet to be demonstrated in human subjects. We investigated the post-arrest metabolic phenomena with and without retrograde cerebral perfusion in patients. Methods: In a prospective randomized trial, 42 patients undergoing aortic surgery requiring hypothermic circulatory arrest were allocated to receive hypothermic circulatory arrest alone (n = 21) or hypothermic circulatory arrest with additional retrograde cerebral perfusion (n = 21). Circulatory arrest was commenced at 15°C, and retrograde perfusion was instituted through the superior vena cava at a maximum jugular bulb pressure of 25 mm Hg. Transcranial, paired, repeated samples of the arterial and jugular bulb blood were analyzed for oxygen and glucose. Velocity in the right middle cerebral artery was also measured simultaneously. Results: There were 3 (7.1%) deaths and 3 (7.1%) episodes of neurologic deficit. Mean bypass and circulatory arrest duration (in minutes) were similar between groups (P = .4 and .14). The mean retrograde perfusion duration was 23 minutes. Post-arrest nasopharyngeal temperature was similar (15.3°C vs 15.3°C). Retrograde perfusion did not affect post-arrest oxygen extraction, glucose extraction, or jugular bulb Po2. There was no immediate lactate release immediately after hypothermic circulatory arrest. Conclusions: Retrograde cerebral perfusion did not influence immediate post-arrest nasopharyngeal temperature or cerebral metabolic recovery. The low jugular bulb Po2 suggests equivalent ischemia. These findings cast doubt on the effectiveness of retrograde cerebral perfusion as a metabolic adjunct to hypothermic circulatory arrest.J Thorac Cardiovasc Surg. 2002;123:943-50

COVID-19 pandemic moral injury in healthcare professionals: a systematic review

Moral injury (MI) refers to psychological distress resulting from witnessing or participating in events which violate an individual's moral code. Originating from military experiences, the phenomenon also has relevance for healthcare professionals dealing with wars, natural disasters and infectious diseases. The deontological basis of medicine prioritises duty to the individual patient over duty to wider society. These values may place healthcare professionals at increased risk of moral injury, particularly in crisis contexts where they may be party to decisions to withdraw or divert care based on resource availability. We conducted a systematic review of medical literature to understand the extent and clinical and socio-demographic correlates of moral injury during the COVID-19 pandemic

Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura (ITP)

Background: To determine the operating time, blood loss, postoperative rise in platelet count, need of conversion to open surgery, postoperative hospital stay and postoperative complications in ITP patients undergoing laparoscopic splenectomy.Methods: In this cross-sectional study patients diagnosed with ITP undergoing laparoscopic splenectomy were included. Patient characteristics regarding operating time, blood loss, postoperative hospital stay, conversion to open surgery, postoperative complications and postoperative rise in platelet count were analyzed..Results: Out of 23 patients, 9 were males and 14 were females. The mean age of the patients was 31±7 years. There was 1 conversion to open surgery. The mean operating time was 90±22 mins and mean blood loss 131±55 ml. 21 out of 23 (91.3%) patients showed a positive response of rise in platelet count after surgery. There was no postoperative complication in any patient. The mean postoperative hospital stay was 3±1 days.Conclusion: Laparoscopic splenectomy is associated with less operating time, postoperative hospital stay, blood loss, and postoperative complications. It produces an adequate postoperative rise in platelet count

Rule of Law in a Pakistani Society

In every society and country almost every person needs a smooth, fair,peaceful, and organized system not only for survival but also for well-being.With all these everyone needs a fair justice system. To find it, man has beenfighting hard since ancient times. Almost majority of the people including writershas attempted to propose a draft. No free persons shall be subjected toarbitrary arrest, detention or exile, and we will not continue or deport, withoutlegal action by his peers or by law of the land. The obedience to the lawelevates empires and discards them equally as digging the graves of empires.The sustainability of earlier and current civilization is directly linked with the law.Those communities which are respecting the law and following rules in theirdaily life are considered as developed nations of the world. In the current timedifferent developed countries represent great great civilization because theyhave embraced the rule of law with its spirit of truth. At one time the Islamicworld was civilized until they believed in law, they followed law, they believed inequality and justice but they fell down on their knees when they began todisobey the principles of the rule of law. Considering Pakistan it is still rising inestablishing a well developed rule of law. In each department and at theindividual level, the law is not respected. No one cares about respecting andfollowing the rule of law, which is why they have not been able to find outwhere we are going in Pakistan

Evaluation of Accessibility Through Mobile Phones

This research thesis presents a study of mobile-enhanced accessibility evaluation. In the first phase we have identified the evaluation methods that enable evaluation of mobile-enhanced accessibility. In the second phase we have performed evaluation of a specific mobile-enhanced accessibility prototype named “Augment” based on some selected evaluation methods that enables evaluation of mobile-enhanced accessibility. Finding methodologies for accessibility evaluation is just as important as early assessment. Therefore, in the last step on the basis of the evaluation results and literature review findings, we have presented an efficient and usable evaluation method that would enable valid and reliable evaluation of mobile-enhanced accessibility. The name of the presented evaluation method is “AccessEva” that is a diary method supported by a software application, which will run on a smart phone with the mobile-based accessibility software. This enables the testers to survey user attitudes, and experiences about the mobile-enhanced accessibility. At the end of this diary method period we suggest that a group discussion will be introduced and conducted together with the participants under the supervision of evaluators.Cell No: +467004488

Evaluation of Accessibility Through Mobile Phones

This research thesis presents a study of mobile-enhanced accessibility evaluation. In the first phase we have identified the evaluation methods that enable evaluation of mobile-enhanced accessibility. In the second phase we have performed evaluation of a specific mobile-enhanced accessibility prototype named “Augment” based on some selected evaluation methods that enables evaluation of mobile-enhanced accessibility. Finding methodologies for accessibility evaluation is just as important as early assessment. Therefore, in the last step on the basis of the evaluation results and literature review findings, we have presented an efficient and usable evaluation method that would enable valid and reliable evaluation of mobile-enhanced accessibility. The name of the presented evaluation method is “AccessEva” that is a diary method supported by a software application, which will run on a smart phone with the mobile-based accessibility software. This enables the testers to survey user attitudes, and experiences about the mobile-enhanced accessibility. At the end of this diary method period we suggest that a group discussion will be introduced and conducted together with the participants under the supervision of evaluators.Cell No: +467004488