Transversus abdominis plane block as a sole anesthetic technique for open appendectomy in patient with treacher collins syndrome: A case report

Patients with Treacher Collins syndrome (TCS) present serious challenges to anesthetist in securing of airway; upper airway obstruction and difficult tracheal intubation are considered complex entity in these patients. This case report describes the significance of transversus abdominis plane (TAP) block as a sole anesthetic choice in appendectomy where airway management can be avoided. A 17-year-old boy, known case of TCS, presented with acute appendicitis underwent emergency laparotomy. Surgery was successfully performed by TAP block with dexmedetomidine infusion. Open appendectomy can be performed successfully in certain circumstances under TAP block with adjunctive use of dexmedetomidine infusion where airway handling is avoided. Further studies are warranted to distinct its use as sole anesthetic choice in lower abdominal surgeries

Fiscal Decentralization and Human Development in Selected Developing Countries in Asia: Role of Institutionali

The paper aims to investigate the impact of fiscal decentralization on human development and moderating role of political institutions in selected Asian countries for the time period 1990-2019, applying panel data Fixed and Random Effects models. The empirical findings show that fiscal decentralization at both the provincial and local levels significantly affects human development. The optimal level of fiscal decentralization is computed at 1.143 and 0.229, respectively, suggesting that fiscal decentralization above this level may revert the results for human development. The non-linear specification of the model also portrays a rising human development in the wake of fiscal decentralization but at a decreasing rate. Moreover, the role of institutionalization is proved effective in the case of the countries where provincial-level decentralization is controlled in the model. The results imply that a lack of proper coordination and mismanagement due to many governance tiers can subside human development. However, fiscal decentralization is an essential factor for Asian countries to increase the efficiency of the public sector if supported with a controlled decentralization at the sub-national level. JEL Classification: H50, H70, O1

Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future.

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after the results became available on the sixth day of admission. Considerable resources had to be expended on contact tracing and administration of ribavirin prophylaxis to all the health-care workers who had come in contact with the patient. It is crucial that Crimean-Congo hemorrhagic fever be recognized and treated at an early stage because of longer term financial and health implications for contacts such as health-care workers in the setting of a developing country. Increased surveillance of dengue and Crimean-Congohemorrhagic fever cases is warranted for the derivation of reasonably reliable, cost-effective and prompt predictors of disease diagnosis. These predictors can help guide future decisions in the management of similar cases. Ultimately, such a strategy may translate into better cost containment in resource-poor settings. Institution of ribavirin prophylaxis in selected patients also merits consideration

Placement and Replacement of Restorations in General Dental Practice in Iraq

Research needed to study how restorative practice is performed in all countries of the world.\Purpose: To causes of the placed and replaced restorations by northern Iraqi dentists. Method: A Practice-based study performed by seventy general practitioner dentists and one hundred of fourth and fifth grades of dental students from a dental faculty participated to perform this study. The study included filing forms about restorative dentistry practice during the normal working time of the dentists and during restorative dentistry course of the dental students. Results: Of the 10029 restorations included in this study, the placed restorations are more than the replaced ones with a statistically significant difference. The results show that the age group of 15-19 had the highest initial restoration placed (90%), in contrast, the highest restoration replacement was in >60 age group (23%). Conclusions: The study revealed different aspects of the restorative practice in Northern Iraq, for the first time in the region. The information is of significance that will make a relation between the experienced clinicians and academics in Ira

Anti-Caspr 2 Antibody Encephalitis: A Case Report

Encephalitis is a term denoted to Inflammation in the brain which can be due to infection, autoimmunity, or can be a part of a paraneoplastic phenomenon with malignancy. Anti-CASPR 2 antibody encephalitis is a rare form of encephalitis that can be associated with malignancy, paraneoplastic phenomenon or can be an autoimmune disease. We present a case of a young boy who presented with new onset seizures and altered sensorium and was diagnosed with anti-CASPR 2 antibody encephalitis. Anti-CASPR 2 Antibody Encephalitis is a rare form of encephalitis which due to its great diverse presentation should be kept in the differential diagnosis of conditions like limbic encephalitis

Cyclic Alternating Pattern of Encephalopathy (Cape) In CNS Infection: A Case Report

Cyclic Alternating Pattern of Encephalopathy (CAPE) is rare EEG phenomenon first described in 1944 in a comatose patient. It is similar to sleep EEG pattern of cyclic alternating pattern (CAP) which is a periodic electroencephalogram activity of non-REM sleep. The cyclic alternating pattern (CAP) is defined by sequences of transient electrocortical events that are different from the tonic background and repeat at intervals of up to one minute. CAPE, however, is abnormal EEG pattern. In this pattern of EEG abnormality slow wave activity of 1-2Hz alternates with fast activity of 6-10 hertz. Here we present a case of patient with CNS infection on mechanical ventilation whose EEG showed the above-mentioned pattern

Media Consumption and National Identity Formation of Adolescents in Pakistan

The study explores relationship between media consumptionpatterns of adolescents,with other intervening variables, andformation of national identity. The research proposes a model ofpolitical socialization to understand the relationship amongadolescents' demographics (gender, age, school), mass mediaconsumption (electronic, and print media), and place of discussionwith interpersonal agents (parents, peers, relatives and teachers) forthe formation of national identity. Adolescents from private, publicand madrassa (religious) schools of Lahore city are the populationof the research. The sub-constructs of national identity; nationalattachment, symbolic patriotism, constructive patriotism, uncriticalpatriotism, national pride, and nationalism are tested by CronbachAlpha. Findings show that in outer loading factors school, printmedia consumption, and the place of media discussion with parentsare the most significant factors in formation of national identity

Cerebellar Manifestation Secondary To Rectal Neoplasia

The condition known as paraneoplastic cerebellar degeneration (PCD) is among the most disabling examples of a cancer\u27s remote effects. Serology for paraneoplastic antibodies, clinical suspicion, and a targeted search for malignancy all play a role in the diagnosis. Tests for neuronal autoantibodies aid in diagnosis and point the way for the search for malignancy. Unfortunately, even with an early diagnosis, existing therapeutic approaches only have little success. Here we present the case of a young male who developed cerebellar syndrome secondary to rectal neoplasia

Design and evaluation of sodium alginate-based hydrogel dressings containing Betula utilis extract for cutaneous wound healing

Traditional wound dressings have a limited capacity to absorb exudates, are permeable to microbes, and may adhere to wounds, which leads to secondary injuries. Hydrogels are promising alternative dressings to overcome the above challenges. In this study, we developed sodium alginate-based hydrogel films loaded with Betula utilis bark extract. These films were prepared via solvent-casting crosslinking method and evaluated for wound healing activity. Prepared films were 0.05–0.083 mm thick, flexible with folding endurance ranging from 197–203 folds, which indicates good physical properties. Optimized formulations exhibited successful loading of extract in the film matrix without any interaction as confirmed by FTIR. Maximum zone of inhibition against Gram-positive and Gram-negative bacteria was achieved by optimum formulation (B6), i.e., 19 mm and 9 mm, respectively, with > 90% scavenging activity. Furthermore, this optimum formulation (B6) was able to achieve 93% wound contraction in rats. Histograms of the optimized formulation treated group also revealed complete reepithelization of wounds. Conclusively, our extract-loaded hydrogel dressing successfully demonstrated its potential for cutaneous wound healing

Numerical Assessment of Pipe Pile Response under Seismic Excitation

The axial capacity and pile transference of loads under static loading have both been well reported, but further research is needed to understand the dynamic lateral responses. The pile load imposed during an earthquake may increase, but the soil’s ability to support it may fall as a side effect of the vibration leading to more settlement. The key objective of this work is to identify what led to the substantial lateral destruction of the piles during the seismic event due to the kinematic effects. These failures were related to discontinuities in the subsoil as a result of sudden changes in soil strength due to shaking. The kinematic stresses exerted in a single pipe pile constructed in two sand layers under two different situations (dry and saturated states) are investigated in this study using numerical modeling. The bending moments were higher in the saturated sand soil than in the dry one which may be attributed to liquefaction. Generally, the acceleration increased through the loose layer (from bottom to top), and then significantly settled within the dense layer. It could be shown that using this modeling, one can estimate how a pile foundation will behave under "kinematic" loading driven by earthquakes. Therefore, the design and installation of drilled aluminum or steel piles in sand soil could make use of these present observations