Sectional Anatomy Quiz III

This series comprises of a quiz pertaining to the identification of salient and important anatomical structures and landmarks expected to be seen at a given level on the computed tomography (CT) image. The representative image is followed by a series of images showing examples of different commonly encountered pathological entities that can be seen at this level in a routine clinical practice. Readers are encouraged to identify highlighted anatomical structures and landmarks in all the images and appreciate how a given abnormality can alter the appearance of normal structures. It is expected that this series will help nuclear physicians in interpretation of the CT component of the single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies

Polymer Retention during Flow of Polymer Solutions through Porous Media

Polymer solution flow and retention through porous media is of interest to many applications in the oil industry such as drilling, water shut-off and enhanced oil recovery. Operators of mature oil and gas fields are faced with the problem of excessive water production (EWP), which can cause a premature abandonment of some oil and gas wells. It has been found that the injection of high molecular weight polymer solutions through the pay zones of the oil and gas wells would induce a sharp decrease of the water production without affecting the oil and gas production. This effect is called disproportionate permeability reduction (DPR) and the polymer solutions inducing such an effect are called relative permeability modifiers (RPM). Hence, the DPR effect has been utilized in the water shut-off or conformance control of oil and gas wells suffering from EWP. In spite of the extensive research of the DPR effect, there is still a lack of agreement on the mechanisms controlling such an effect and relatively high percentage failures are observed during conformance control field applications. Polymer retention in porous media has been attributed to mechanisms such as bridging-adsorption, adsorption-entanglement, and flow-induced adsorption. These mechanisms have been proposed to account for the increase in flow resistance during or after the flow of polymer solutions through porous media. The DPR effect has been attributed to effects induced by this retained polymer such as steric and lubrication effects, wettability change, segregated oil and water pathways, and swelling and shrinking of the adsorbed polymer layer. The aim of this study is to add knowledge on the effect of polymer solution flow on polymer retention in porous media. In this study, the rheology of high molecular weight polymer solutions was studied using a cone-and-plate setup. Moreover, the characteristics and the effective hydrodynamic thickness of adsorbed polymer layers on glass from these polymer solutions under static conditions were investigated using atomic force microscopy (AFM). Also, quartz crystal microbalance with the dissipation monitoring (QCM-D) was used to investigate the effect of increasing the flow rate of polymer solutions on the adsorbed amount on silica and gold surfaces. Additionally, the mobility reduction and the residual resistance as a result of polymer solution flow through single glass capillaries, 2D and 3D models of porous media were studied. The implementation of the above techniques was used to relate the microscopic effect of the flow of the polymer solutions to the polymer retention in the porous media. The anti-thixotropic behaviour of the polymer solutions, which can be attributed to the shearinduced formation of micron-size transient entanglement networks (TEN), is expected to play a major role in the polymer retention in porous media. These microscopic structures can adsorb on the solid surfaces if the adsorption energy of the polymer/solid system is sufficient. Also, in porous media in which mechanical entrapment is possible, these structures can be entrapped in the small pores and pore throats. Two new mechanisms for polymer retention are proposed in this study: transient-entanglement networks adsorption (TENA) and transient-entanglement networks entrapment (TENE). The TENA is the retention mechanism of the TEN structures in flow systems in which mechanical entrapment is not possible provided that the adsorption energy is sufficient. If mechanical entrapment is possible, then the retention by adsorption and mechanical entrapment are lumped in the TENE mechanism. The results from this study have given a new insight on the flow and retention of polymer solutions through porous media. Hence, it is believed that the improved understanding will improve the design of high molecula

Outcome of Judet\u27s quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss

Objective: To evaluate the effectiveness of Judet\u27s quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.Methods: A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet\u27s quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet\u27s outcome, blood loss, drop in hemoglobin and required blood transfusion were noted for all patients and compared between both groups.Results: Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture (p = 0.02). All functional outcome measures including Judet\u27s outcome were similar in both groups. In contrast, duration of surgery (p = 0.01), blood loss (p = 0.02), drop in hemoglobin (p = 0.01) and number of transfusions (p = 0.03) were significantly reduced in epinephrine group.Conclusion: Judet\u27s quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements

Does Borrower’s Personality Affects the Repayment of the Loan? A Study of Banking Sector of Pakistan

The continuing global increase in economic activities is increasing the importance of the banking sector as the hub of such activities. The banking sector issue loans to individuals, firms, and government. Various factors influence the repayment of these loans. In this study, we argue that the personality of the borrower affects the repayment of the loan. We have selected a sample of 500 borrowers of five major banks in Pakistan by using a cluster sampling technique. We selected 250 (50%) regular borrower and 250 (50%) defaulters. We measured borrower personality through a 44-items big five inventory (BFI) questionnaire similar to John & Srivastava (1999). We analyzed data using one-way ANOVA and regression. The results show considerable significant differences between the personality of regular borrowers and defaulters on all five traits of personality, which reveals that the borrower’s personality affects the repayment of the loan. The defaulters were high on extroversion and neuroticism dimensions, while regular borrowers were high on agreeableness, conscientiousness, and openness to experience. The results also depict the strong effect of demographic characteristics such as income, education, and family size on loan repayment. The study suggests banks consider the personality traits of the borrower at the time of issuing of loan

Incidence, outcome and risk factors for sepsis- a two year retrospective study at surgical intensive care unit of a teaching hospital in Pakistan

Background: Sepsis is amongst the leading causes of admission to the intensive care units and is associated with a high mortality. However, data from developing countries is scarse. Aim of conducting this study was to determine the incidence, outcome and risk factors for sepsis on admission to surgical intensive care unit (SICU) of a teaching hospital in Pakistan. Methods: Two year retrospective observational study included all consecutive adult admissions to the surgical intensive care unit (SICU) of a University Hospital, from January 2012 to December 2013. Results: Two hundred and twenty-nine patients met the inclusion criteria. Average age of the patients was 46.35±18.23 years (16–85), mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 15.92±8.13 and males were 67.6%. Median length of ICU stay was 4 [IQR 5]. 43% patients fulfilled the criteria of sepsis at the time of admission to the SICU and incidence of severe sepsis/septic shock was 35%. Abdominal sepsis was the most frequent source of infection (57.5%). The overall intensive care unit mortality was 32.31% but the mortality of sepsis-group was 51.15% as compared to 17.7% of the non-sepsis group. Stepwise logistic regression model showed that increasing age, female gender, non-operative admission, admission under general surgery and co-morbidities like ischaemic heart disease and chronic kidney disease were significant predictors of sepsis. Conclusion: The incidence of sepsis and severe sepsis/septic shock, on admission to SICU is high and mortality of the sepsis group is nearly three times the mortality of the non-sepsis group

APACHE II analysis of a surgical intensive care unit population in a tertiary care hospital in Karachi (Pakistan)

Purpose: Performance of prognostic models deteriorates over time by changes in case-mix and clinical practice. This study was conducted to describe the case-mix of a surgical intensive care unit (SICU) and assess the performance of APACHE II scoring system in this cohort. Methodology: We analyzed 213adult patients admitted to the surgical intensive care unit (SICU) of Aga Khan University Hospital, from January 2011 to December 2012 and the performance of APACHE II scoring system was assessed in this population. Results: The mean age of patients was 46.31 years (SD ±18.43), 67.1% patients were male and mean length of ICU stay was 6.54 days (SD ± 7.18).Admissions to SICU were from seven service departments with the highest admissions from general surgery followed by trauma and neurosurgery. The mean APACHE II score of this SICU population was 15.89 (SD ±8.06), 12.88 (SD ±6.29) in survivors and 22.24 (SD ±7.66) in non-survivors (p Conclusion: APACHE II scoring system allows meaningful analysis of SICU population, therefore, it is recommend, that this simple and cost effective scoring system should be used to identify patients with high risk of death to justify the decisions of withholding expensive therapies in resource limited settings

Toe-tourniquet syndrome: A rare potentially devastating entity

Toe-tourniquet syndrome is a rare and commonly misdiagnosed condition caused by a hair or a fiber wrapped around digits (fingers and toes). A four months baby girl who was crying and presented with redness and swelling at her 2nd and 3rd toes of right foot. Child had red and swollen 2nd and 3rd toes of right foot with hair end protruding through wounds. Constricting hairs were cut and removed. Toetourniquet syndrome is a rare entity which is caused by hair wrapped around a toe or a digit. Diagnosis is mostly clinical. In order to prevent this condition to happen, education of parents and clinicians is a cornerstone

Frequency and type of toenail tumors in the dromedary camel

A total of 275 dromedary camels (16 males and 259 females) of local “Arabiyat” breed suffering from different types and degrees of severity of toenail tumors were surgically treated. Histopathological examination of the tissue samples removed from 50 tumor-like growths (2 males and 48 females) revealed three types of tumors; squamous cell carcinoma (70%), spiny keratoderma (22%) and fibroma (8%). An increased incidence of tumors was recorded in the medial when compared to the lateral toenails in both sexes. In females, the incidence in the medial toenails was 90/259 (34.75%) and 71/259 (27.41%) in the right and left forelimbs respectively when compared to the lateral toenails which was 25/259 (9.65%) and 5/259 (1.93%) for the respective right and left forelimbs. In the hind limbs, this ratio was 29/259 (11.20%) and 20/259 (7.72%) for right and left medial toenails respectively, whereas it was 17/259 (6.56%) and 2/259 (0.77%) for the right and left lateral toenails respectively. Similar to the observations in female camels, male camels also showed a higher incidence of these tumors in the medial when compared to the lateral toenails in both fore and hind limbs. Based on these findings, we conclude that in the dromedary camels, the medial toenails of the fore limbs are most commonly affected with tumors; with the most common tumor being the squamous cell carcinoma

Functional and radiological outcomes of atypical femur fractures among elderly in Karachi, Pakistan

Objective: To assess the functional and radiological outcomes in a unique class of fractures i.e. atypical femur fractures and to assess the effects of osteoblastic agents in healing.Methods: It is a retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All patients with atypical femur fractures who were surgically managed with intramedullary nailing from January, 2013 to June, 2017 and with a follow-up till December 2019, were included in the study. Radiological outcomes were expressed as mean healing time and functional outcomes were recorded as mean Short Musculoskeletal Functional Assessment (SMFA) score.Results: A total of twenty-four patients were included in this study. Mean age of patients was 65.8 ± 8 years. Mean healing time was 10 ±3.2 months post operatively. Two patients underwent redo procedures. No other complications like paresthesia or weakness was observed in any patients. All the patients reported a good score on SMFA ranging from 19% to 31%.Conclusion: Intra-medullary nailing shows a promising result in treatment of atypical femur fractures. Use of post-operative osteoblastic supplements showed statistically significant results with early healing time (p=0.008 [95% CI])

Delayed spinal cord infarction following anterior cervical surgical decompression

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient\u27s postsurgical course is consistent with a delayed ischaemic/reperfusion injury to the cord following surgical decompression and restoration of blood flow through the anterior spinal artery and we make suggestions for management of such clinical events