Cost-effectiveness of clipping vs coiling of intracranial aneurysms after subarachnoid hemorrhage in a developing country-A prospective study

Background: Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular. treatment vs surgical clipping in a developing country.Methods: The study population consisted of 55 Patients with aneurysmal subarachnoid hemorrhage (SAH) identified prospectively from January 2004 to June 2007. Of the 55 Patients with ruptured intracranial aneurysms, 31 underwent surgical clipping, whereas 24 were treated via interventional coils. Clinical outcome at 6 months, using the modified Rankin Scale, and cost of treatment related to all aspects of the inPatient stay were evaluated in both groups.Results: The average age of the Patients in the endovascular group was 38 years, whereas in the surgical group, it was 45 years. Most Patients (43) were found to be in grades (1 and 2). Of these Patients, 18 received coils and 25 were clipped. The remaining 12 Patients were of poor grades (3 and 4), of which 6 had coiling and 6 underwent clipping. Most the Patients (46/55) had anterior circulation aneurysms, and the rest of the Patients (9/55) had posterior circulation aneurysms. The clinical outcome was similar in comparison (good in 81% for clipping and 83% for coiling). The average total cost for Patients undergoing endovascular treatment of the aneurysms was $5080, whereas the average total cost of surgical clipping was$3127.Conclusion: Patients with aneurysmal SAH whom we judged to require coiling had higher charges than Patients who could be treated by clipping. The benefits of apparent decrease in length of stay in the endovascular group were offset by higher procedure price and cost of consumables. There was no significant difference in clinical outcome at 6 months. We have proposed a risk scoring system to give guidelines regarding the choice of treatment considering size of aneurysm and resource allocation

Developing the Compiler to Upgrade Features of Object Oriented Programming (OO) C++

© ASEE 2011The latest deployment of emerging technologies with advances in internet and web enabled services change the style of conducting business and managing the daily life. The latest and faster technology has made the world as global village for exchanging the information and service delivery. However, developing the new software and interactive applications for these environments perpetuate to be more challenging and complex issue. To handle these complex tasks, many programming languages are developed to meet the requirements for all of the applications but flaws in programming languages are still continuing. With design and development of Object-Oriented Programming (OOP) languages, handling the complexity issues associated with the design, development, maintaining the software and applications, have been controlled with some extend but not fully guaranteed goals are achieved. OOP provides the solution and satisfaction in form of encapsulation, inheritance, polymorphism, Class/Object and data abstraction. Despite of provision of such rich features, OOP has some minor flaws, which causes the weak performance. This paper introduces and handles the flaws of parsing related with C++ language. The major focus of the contribution is to improve an efficiency of parsing associated with current C++ parsers; such as delayed loop statements, nested multi-line Comments, friend functions boolean expression. To handle these issues, we introduce Java Compiler Compiler (Java-CC), which maintains the Lexical and the Parser. Java CC also provides the facility to write flexible coding and definitions in OOP C++. Second, we implement new concept of Java-CC and get the desired results. Finally, we conclude the paper and give the future directions to make C++ more richer language

Traumatic carotid-cavernous fistula: Clinical presentation and outcome

Objective:To evaluate the presentation, clinical course and outcome of traumatic carotid-cavernous fistula (CCF) withendovascular treatment at our institution during the last five years. Design: Retrospective descriptive study. Setting: The study included patients seen at Aga Khan University Hospital from January 2000 to December 2005. Methods: Retrospective analysis based on data retrieval from medical records using ICD coding system. Only those cases who had traumatic CCF and underwent endovascular treatment were included in the study. Results: A total of 8 patients were diagnosed with post-traumatic CCF and 11 procedures were done. Mean age at presentation was 35.6 years; mean duration of symptoms was 23 weeks after trauma; 6 patients were male and 2 female. Patients presented from 1 week to 2 years after the trauma; 7 had high-flow fistulas and 1 had low-flow fistula. Proptosis was the most common symptom (6 patients); decreased vision was present in 3 patients; 4 patients had an accompanying skull base fracture; and 1 patient had bilateral CCF. All patients were treated by endovascular procedures; 2 patients had recurrences, seen within 1 month of initial treatment and subsequently successfully treated. In 1 patient, the procedure failed due to the small size of the fistula. Conclusion: High success rate with minimal complications as seen in our series supports endovascular treatment as the leading option for CCF managemen