Multiple parameters in the diagnosis of ectopic pregnancy

Objective: To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy.Methods: A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml.Results: Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitivity.CONCLUSION: The use of multiple parameters in the diagnosis of ectopic pregnancy resulted in 100% sensitivity and specificity

Flexible Unidirectional PTD-Symmetric Waveguide

The transmission and reflection characteristics of a bent square transverse electromagnetic waveguide constituted by two opposite perfect electric conductor and perfect magnetic conductor walls are analyzed. This waveguide exhibits a parity, timereversal, duality (PTD) symmetry with respect to both the diagonal axes. It is found that this property is maintained even when the structure is bent in a plane orthogonal to one of the two PTD symmetry axes (PTDbend). As a consequence, the transverse electromagnetic mode propagation is protected against backscattering by this class of discontinuities. The preservation of the PTD symmetry in presence of a geometric flexibility of the bend is also analyzed, thus introducing a new class of bendable waveguides that are largely immune to backscattering by bend discontinuities

Brain Abscesses in Children: A Study of Microbiological Spectrum and Outcome of 80 Cases

Objective:  Brain abscess is a focus of pus in the brain due to infection somewhere else in the body. It is common in males than females and the average age in children ranges from 4 to 7 years. It develops by skull trauma or contiguous or hematogenous spread of infection. The study aimed to identify the pattern of microbiological involvement in the etiology of pediatric brain abscesses and the outcome so as to enable us to ensure definitive treatment with the appropriate and specific antimicrobial regimen. Materials and Methods:  A prospective study was conducted in 80 pediatric patients of brain abscess admitted to the Pediatric Neurosurgery Department, Children Hospital, Lahore, Pakistan. Results:  The median age was 5.2 years with a predominance of males (60%). The most common presentation was fever (72.5%) and then fits (35%). Congenital heart disease was the commonest factor in 32% of cases. Streptococcus was a commonly isolated pathogen in 17% cases out of 70% of culture positive cases. Recovery was seen in 70% of cases and the mortality was 7.5%. Conclusion:  Congenital heart disease is the most common causative factor in pediatric brain abscesses and most of the abscesses were found culture negative. There is a pressing need to carry out multicenter studies over a large sample size over extended study duration in developing countries to help establish guidelines in treating pediatric brain abscesses

A COMPARISON OF TEACHERS’ AND STUDENTS’ PREFERRED METHOD OF LECTURE DELIVERY AND EXAMINATION SYSTEM IN MEDICAL EDUCATION

Introduction: In an effort to improve the quality of knowledge delivery, medical mentors are combining old and new methods of teaching and technology. Furthermore, various examination methods are used to assess the impact of the knowledge produced on the students. It was designed to gain a deeper understanding of teachers and students' preferences regarding lecture delivery methods and examination systems used in medical education. Material & Methods: A cross-sectional survey was conducted at six educational institute located in Faisalabad from April 2019 to September 2019. A convenient sample of 3673 students between age 18 to 24 years and 88 faculty members. Data was collected through the use of structured questionnaire after taking informed consent. Data was analyzed using SPSS version 23. Results: 1426(38.8%) students and 52(59.1%) teachers preferred interactive lecture the most, followed by formal lecture method preferred by 820(22.3%) students and 15(17.0%) teachers, and student presentation appeared as least preferred method by both populations. SEQs examination method was mostly preferred by students 2157(58.7%) as well as by teacher 37(42.0%) while, OSCE/OSPE appeared least preferred method by students 21(.6%) and teachers 0(0%). There was significant difference in perception of students and teachers on different lecture delivery methods (p<.05). Students were less agreed (M=4.14, SD=090) that the lectures are well organized as compare to teachers ((M=4.49, SD=097). Students were less agreed (M=3.98, SD=0.79) that the lectures are clear and understandable as compare to teachers ((M=4.20, SD=0.82). Conclusion: Based on the current study, teachers and students have no different preferences regarding lecture delivery and assessment methods in medical education, suggesting that there is a paradigm shift from formal to interactive teaching

Effects of Fertilizers on Copper and Nickel Accumulation and Human Health Risk Assessment of Vegetables and Food Crops

Despite the fact that fertilizers have been used for millennia for sustainable crop production, this high and considerable dependence on fertilizers heightens environmental concerns with the indirect human exposure due to accumulation of toxins in food chain via soil contamination. The purpose of this study is to evaluate the application of fertilizers to the soil and their effect on the accumulation of copper and nickel in spinach (Spinacia oleracea), garlic (Allium sativum), wheat (Triticum aestivum), maize (Zea mays), and barley (Hordeum vulgare); as well as potential health concerns associated with consuming vegetables cultivated on this contaminated land. Samples of available soil, food crops, and human blood were collected from three different Tehsils: Bhalwal, Sahiwal, and Silanwali and were regarded as site 1, site 2 and site 3 respectively. Urea, farmyard manure, and potassium chloride were delivered to Site 1; urea phosphate, manure, and ammonium sulphate were delivered to Site 2; and superphosphate, ammonium phosphate, and nitrate phosphate were delivered to Site 3. Data was subjected to statistical analysis for computing out ANOVA and correlation. Analysis revealed that minimum copper concentration was found in the soil of T. aestivum grown at Site-1 while the inhabitants of Site 3 had the highest concentration of Cu in their blood. The highest level of HIR was found in the human beings that ate the S. oleracea grown at Site 3. It is strongly advised that fertilizers be used sparingly, as their excessive use can cause human health risks

Assessment of Human Health Risk of Zinc and Lead by Consuming Food Crops Supplied with Excessive Fertilizers

For the study of heavy metals impact on human beings, areas in Sargodha city that were supplied with various types of fertilizers were chosen. The three industrial areas; (Bhalwal, Sillanwali, and Sahiwal) of this city were explored for research reasons. The researchers wanted to know how much heavy metal was in the soil, food crops, and human. Excess fertilizer use contributes to global pollution. Farmyard manure, urea, and potassium chloride were used on Site 1; urea phosphate, manure, and ammonium sulphate were used on Site 2; and super phosphate, ammonium phosphate, and nitrate phosphate were used on Site 3. Samples of commonly used food crops, their respective soils and blood of residents who ingested the food crops of the studied area were collected. The zinc and lead levels in soil (8.30-16.80 and 1.80-12.71 mg/kg) and food crops (0.26-2.02 and 2.26-4.70 mg/kg) were far lower than WHO permitted limits. Blood mean concentration of both Zn (2.30-4.30 mg/L) and Ni (0.24-0.70 mg/L) were found maximum in residents of Site 3. The values of pollution load index, bioconcentration factor, enrichment factor for both zinc and lead were (0.18-0.37 and0.220-0.948), (0.027-0.138 and 0.316-1.705), (0.020-0.144 and 0.515-2.780), respectively. Daily intake of metal (0.004-0.008 and 0.001-0.002 mg/kg/day) and health risk index (0.0001-0.016 and 0.005-0.115) values were observed to be lower in individuals for Zn and Pb, respectively. In present work values of all pollution indices wereSo, there would be no human health hazard

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

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed