Radial forearm free flap: A dynamic flap for single-staged multiple subunit reconstruction

We report the case of a middle aged patient with biopsy proven squamous cell carcinoma of buccal mucosa who presented to us in Aga Khan University Hospital Karachi in April, 2017 and required reconstruction of buccal mucosa, upper lip and lower lip. As per protocol of our institute the lesion was excised by the head and neck surgeon and the defect was reconstructed by our team. The defect was large comprising of buccal mucosa including the left oral commissure, upper lip and the lower lip. It was reconstructed via a free flap and a radial forearm free flap. A specially designed radial forearm free flap was harvested and used for reconstruction which resulted in a good aesthetic and functional outcome

Versatility of the anterolateral thigh flap : an AKUH experience.

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects of various soft tissue and bulk requirements. Adequate outcomes were achieved pertaining to the reconstruction of the soft tissue defects. Anterolateral thigh flap can be used to reconstruct soft tissue defects almost anywhere and almost of any complexity

An Empirical study on adoption of Agile Project Management Methodology and its effect on Project Success with moderating role of Organizational Culture

Purpose of this research is to investigate the impact of agile project management methodology on project success, as well as the role organizational support as moderator between agile project management methodology and project success. The data for this study has been collected from Telecommunication Services Provider Industry of Pakistan. Total sample size of 197 professionals was recorded. A questionnaire was distributed among the participants via hard copy and internet survey websites. Using collected data, we tested the effect of agile project management methodology on project success and further examined the moderating effect of organizational support between agile project management methodology and project success. The examination included Pearson’s correlation coefficient as well as regression using IBM SPSS Statistics Version 20. Results indicated that project management methodology has a strong correlation with project success and this correlation is not moderated by organizational support. The research findings have practical implications both in organization and project manager’s perspectives. Our research was limited to specific geographic area due to time and cost constraints. Future researchers may opt to conduct the study in other geographic areas of Pakistan and different industry including additional and different moderating variables

Dural Tear, a Feared Complication of Spine Surgery

OBJECTIVES To investigate the incidence, risk factors and clinical presentation of complications in patients undergoing spinal surgery with and without Dural Tear. METHODOLOGY A one-year prospective case-control study was conducted in the department of orthopaedics and spinal surgery at the Hayatabad Medical Complex (HMC) and Rahman Medical and surgical centre Dagger Buner. The spine surgeon used a discrete surgical approach. The questionnaire was used to collect patient demographic data, surgical information, and data on perioperative and postoperative complications. SPSS version 21.0 statistical software was used for all statistical analyses. RESULTS Dural tears were observed in 3.4% of the patients, among whom 20% experienced a Dural leak. After controlling for potentially confounding variables of age, sex, primary disease, and type of procedure, the surgery-related complications that were more likely to occur in the Dural Tear group than in the non-TD group were surgical site complications OR 2.69 and postoperative neurological defect O 3.28. The proportion of postoperative delirium OR 3.22 was significantly high in the Dural Tear group as perioperative complications CONCLUSION A higher proportion of surgical site infections, postoperative neurological defects and delirium in the Dural Tear group are due to direct complications, such as Dural leakage

Use of cephalic vein for venous anastomosis in head and neck reconstruction: A case series

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck

Assessment of Influence of Reinforcement Detailing on Blast Resistance of Reinforced Concrete Beam-column Connections

This study investigates the influence of blast loading on Reinforced Concrete (RC) beam-column connections, which are critical components for maintaining the structural integrity of buildings during extreme events like explosions. The impact of varying blast loads, detonation distance, and reinforcement detailing on the extent of damage in the RC frame and connections is analyzed using ABAQUS/CAE Finite Element Method (FEM) software. Joint rotation is used as a damage indicator to assess the damage level in the structure. The study evaluates the effect of reinforcement detailing on the blast damage resistance of the RC frame and connections and proposes recommendations for reducing damage in the connections through the effective placement of steel reinforcement. The effectiveness of different configurations of reinforcing steel bars is also analyzed, and the presence of shear and diagonal reinforcements is found to reduce joint damage by 3-4 times. This study highlights the significance of reinforcement detailing and recommends its careful consideration in the design of blast-resistant structures

Weighted Multi-Skill Resource Constrained Project Scheduling: A Greedy and Parallel Scheduling Approach

This study addresses the Weighted Multi-Skill Resource Constrained Project Scheduling Problem (W-MSRCSPSP) with the aim of minimizing software project makespan. Unlike previous works, our investigation regards heterogeneous resources characterized by varying skill proficiency levels. Another major problem with existing methodologies is the potential underutilization of human resources due to varying task durations. This work introduces an innovative scheduling approach known as the Greedy and Parallel Scheduling (GPS) algorithm to handle the said issues. GPS focuses on assigning the most suitable resources available to project activities at each scheduling point. The fundamental goal of our proposed approach is to reduce resource wastage while efficiently allocating surplus resources, if any, to project tasks, ultimately leading to a decrease in the makespan. To empirically evaluate the efficacy of the GPS algorithm, we conduct a comparative analysis against the Parallel Scheduling Scheme (PSS). The advantage of our proposed approach lies in its ability to optimize the utilization of available resources, resulting in accelerated project completion. Results from extensive simulations substantiate this claim, demonstrating that the GPS scheme outperforms the PSS approach in minimizing project duration

Morphological Identification and Resistance Profile of Antibiotic and Heavy Metals-Resistant Bacteria in Hospital Sewage of Peshawar

Background: Increased resistance of microorganisms to commonly prescribed antibiotics has emerged as a significant hurdle in contemporary medical practice. The World Health Organization (WHO) has declared antibiotic resistance as a " major threat to public health.". In the present study, bacterial isolates were selected based on high antibiotic and heavy metal tolerance from a water sample taken from hospital sewage.Methods: Antibiotic-resistant bacteria were isolated through the disk diffusion method. Gram staining was done for morphological identification. For molecular identification, the 16s rDNA PCR amplification was done with universal primers. Results: The strain BC1 was found resistant to ampicillin (10μg/ml), and cefixime (5μg/ml). While, susceptible to kanamycin (30μg/ml), azithromycin (15μg/ml) and intermediate in response to amoxicillin (30μg/ml). The strain BC2 was resistant to ampicillin (10μg/ml), cefixime (5μg/ml) and kanamycin (30μg/ml). While, Susceptible to amoxicillin (30μg/ml), and intermediate in response to azithromycin (15μg/ml). The strains were also found resistant to heavy metals.Conclusion: The recent investigation on bacterial strains from hospital effluent found interesting candidates for understanding the AMR bacteria and developing novel active biomolecules to combat the antibiotics problem. The isolated strains could be a source of novel resistant genes however; a comprehensive molecular analysis is needed for advanced studies