Lumbar Disc Herniation, Clinical Analysis Muzaffarabad, AK

Objective: Analysis of different variables in patients operated for lumbar disc prolapsed.Materials and Method:Study design: Observational study.Sample size: Twelve hundred forty eight consecutive patients operated for lumbar disc herniation.Settings: Abbas Institute of Medical and Health Sciences.Duration: The study duration was four years from January 2005 to December 2009.Inclusion criteria: Patients irrespective of age and sex with lumbar disc herniation having. Failed conservative treatment for 3 weeks. Intractable pain or impending neurological deficit.Exclusion criteria: Spinal stenosis. Spinal tumors. Spinal tuberculosis. Spondylolysthesis. Psychological problems.Results: Out of 1248 patients 812 were male and 416 were female with male to female ratio of 2:1. The age ranged from 20 to 60. Majority 672 (56%) of patients were from Muzzafrabad and its suburbs. Straight leg raising test was impaired in1180 cases. The ratio between contained and ruptured disc was 3:1. About 44.9% of patients (560) had left lateral disc prolapse, while right sided in 29.5% cases and bilateral in 25.6% cases. The common level affected was L4-L5 in 900 (72.1%) patient. Fenestration and discectomy was suitable in 900 patients, 232 patients had Hemilaminectomy and in 116 laminectomy was carried out. The removed disc tissue was sent for histopathology in all cases. Out of which three were reported as tuberculosis, two metastasis and two plamacytoma. Forty patients developed discitis postoperatively.Conclusion: From this study we conclude that lumber disc herniation is common in male gender in 4th decade. Left lateral disc at L4-L5 level is involved in the majority of patients. Sciatica with backache and impaired straight leg raising test are important clinical features. Contained disc is more common than ruptured discs. Minimal invasive procedures like fenestration and disectomy gives good results. It is also concluded that all disc material should be sent for histopathology examination to over look unusual pathologie

Development and evaluation of biodegradable controlled release microspheres of venlafaxine

  In this study we developed and evaluated stable, biodegradable microspheres for controlled release of venlafaxine. For this purpose, polycaprolactone, a hydrophobic polymer was used in different ratios. Following are the drug to polymer ratios P1 (1:1), P2 (1:1.5), P3 (1:2), P4 (1:2.5) and P5 (1:3); employed to develop controlled release microspheres. Drug loading efficiency increased with increasing quantity of polycaprolactone. The mechanism of venlafaxine release was studied by applying First order, Zero order, Higuchi’s, Hixon-Crowell and korsmeyer-Peppas models to dissolution data. Higuchi model was found the best fit model followed by First order release. The mechanism of release was non-Fickian diffusion. All formulations showed an initial burst of 69.53%, 62.37%, 55.45%, 53.76% and 49.32% from P1, P2, P3, P4 and P5 formulations, respectively at the end of 1st h dissolution. P5 was the superior formulation in terms of reduced initial burst and after which sustained release occurred up to 8 hours. The developed microspheres were characterized by Fourier transform infra-red spectroscopy, scanning electron spectroscopy, differential scanning calorimetry and thermogravimetric analysis

On commutativity of quotient semirings through generalized derivations

This research article aims to study quotient MA-semirings determined by the prime ideals. Derivations are important tools to study algebraic structures. We establish some theorems on commutativity of quotient MA-semirings under certain differential identities. Results of this paper are extensions of many well known facts of this topic

Surgical Outcome of Spontaneous Intracebellar Haemorrhage

Introduction: The management of spontaneous intracerebellar hemorrhage has always been a challenge for neurosurgeons and neurophysicians. So far, neither medical nor surgical intervention has been shown consis-tently to improve the outcome. In this study, we described our experience of surgery for the treatment of sponta-neous cerebellar haemorrhage.Objective: To determine the frequency of good outcome of surgical evacuation of intracerebellar hematoma.Materials and Methods: This was a descriptive prospective study conducted at the department of Neurosurgery PGMI / Lahore General Hospital Lahore. Duration of study was 1 year from 6th August 2010 to 6th August 2011. This study included 75 patients with spontaneous intracerebellar haemorrhage that underwent surgical treatment. Patients were followed for 30 days to see the frequency of good outcome.Results: The mean age of the patients was 60.60, SD 9.43 years (range 43 – 77). There were 15 (20%) patients of age range of 40 – 50 years, 19 (25.3%) patients of age range of 51 – 60 years, 33 (44%) patients of age range of 61 – 70 years, and 08 (10.7%) patients in the age range of 71 – 80 years). There were 51 (68%) male patients and 24 (32 %) female patient in the study. There were 33 (44%) patients who showed good outcome after surgical treatment of spontaneous intracerebellar haemorrhage.Conclusions: Surgery for spontaneous intracerebellar hemorrhage holds good outcome and should be conside-red for intracerebellar hemorrhage

Diathermy Stimulation to Avoid Nerve Injuries during Trans-pedicular Screw Placement in Dorso-lumbar Spine

Objective: To demonstrate the utility of diathermy in avoiding nerve injuries due to misplacement of trans-pedicular screws (TPSs) during Dorso-lumbar spinal fusion.Study Design: Retrospective studyPlace and Duration of the Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from Oct. – 2007 to Oct. 2012.Materials and Methods: In this retrospective study, diathermy was used to assess whether a screw deviated from the pedicle by observing synchronous leg movements caused by intermittently touching a diathermy to the pedi-cular instrument. Diathermy was performed in 159 cases in which 561 pedicle screws had been placed.Results: Leg movements were observed in 36 cases and the sensitivity of diathermy was 82.7%, the specificity of 98.6%. No neurological complications associated with the placement of pedicular screws were observed after adding diathermy stimulation to the conventional methods.Conclusion: Diathermy may be helpful to avoid nerve injuries during transpedicular screw placement

Use of Drains Versus No Drains After Burr-Hole Evacuation of Chronic Subdural Hematoma

Objectives: To compare the recurrence of chronic subdural hematoma after burr hole evacuation with and without use of subdural drain. Study Design: It was multicenter randomized control trial. Setting: Department of Neurosurgery, SKBZ/CMH Muzaffarabad, Department of Neurosurgery, Lahore General Hospital Lahore. Duration: This study was conducted between June 2017 to December 2017. Inclusion Criteria: Male and female 18-80 years and chronic subdural Hematoma with midline shift of more than 5mm on CT scan. Exclusion Criteria: Bilateral chronic subdural hematoma on CT scan, recurrent CSDH, patients with CSF shunt in-situ, patient with bleeding disorders (INR > 2.5, BT > 7 min, platelet count < 60000) or on anticoagulant drugs, patients with severe systemic ailment like renal failure (Serum Creatinine > 2.5), chronic liver disease (ultrasound shows liver cirrhosis and splenomegaly) and uncontrolled diabetes (BSF > 126) and known ischemic heart disease were excluded from this study. Materials and Methods: In this study, 80 patients were included and randomly divided into two equal groups. Patient fulfilling the inclusion criteria were included in the study through the emergency and outdoor. All Patients were prepared for the surgery and informed consent was taken from all patients. All patients were treated in exactly the same way as per standard ward routine practice except that the treatment option (whether to use the drain or not) was decided through randomization; Group A with drain and Group B without drain. All patients were discharged at 3rd post op day and followed for six months. Results: There were only 16 (20%) patients in which recurrence occurred. Out of these 16 patients 4 (25%) belong to drain group while 12 (75%) belong to without drain group. While in 64 (80%) patients no recurrence was observed [group A: 36 (56.25%) vs. group B: 28 (43.75%)]. The difference between both groups was insignificant, (p-value = 0.235). Conclusion: It was concluded form the results of this study that there is no significant difference between both groups and recurrence will occur whether drain would be placed or not but it was also noticed that rate of recurrence was lower with subdural drain than without drain after burr hole evacuation of chronic subdural hematoma. Some other factor may be involved for recurrence so a long study is required to reach proper conclusion

Development of a STEP-compliant design and manufacturing framework for discrete sheet metal bend parts

Metal sheets have the ability to be formed into nonstandard sizes and sections. Displacement-controlled computer numerical control press brakes are used for three-dimensional sheet metal forming. Although the subject of vendor neutral computer-aided technologies (computer-aided design, computer-aided process planning and computer-aided manufacturing) is widely researched for machined parts, research in the field of sheet metal parts is very sparse. Blank development from three-dimensional computer-aided design model depends on the bending tools geometry and metal sheet properties. Furthermore, generation and propagation of bending errors depend on individual bend sequences. Bend sequence planning is carried out to minimize bending errors, keeping in view the available tooling geometry and the sheet material properties’ variation. Research reported in this article attempts to develop a STEP-compliant, vendor neutral design and manufacturing framework for discrete sheet metal bend parts to provide a capability of bidirectional communication between design and manufacturing cycles. Proposed framework will facilitate the use of design information downstream at the manufacturing stage in the form of bending workplan, bending workingsteps and a feedback mechanism to the upstage product designer. In order to realize this vendor neutral framework, STEP (ISO 10303), AP203, AP207, and AP219 along with STEP-NC (ISO14649) have been used to provide a basis of vendor neutral data modeling.N/

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

The Role of Intellectuals in Preaching Islam during the Era of the Prophet Muhammadﷺ

This research paper investigates the pivotal role played by intellectuals in the spread and preaching of Islam during the era of the Prophet Muhammadﷺ. The study explores the multifaceted contributions, including interpretation of the Qur'an, providing education, preserving Prophetic traditions, advocating, and defending Islam, and documenting important records, as well as offering advice and counseling. By examining historical sources, primary texts, and scholarly works, this research highlights the indispensable role intellectuals played in disseminating, understanding, and safeguarding the message of Islam. The findings underscore the significance of their knowledge, wisdom, and dedication in shaping the development and dissemination of Islamic teachings to subsequent generations. This research sheds light on a crucial aspect of early Islamic history and offers valuable insights into the role of intellectuals in societal and religious transformations

PAIN MANAGEMENT IN CIRCUMCISION: A COMPARATIVE STUDY

Objective: To assess the effectiveness and safety of interventions of reducing pain at neonatal circumcision.Study Design: Quasi-experimental designPlace and Duration of Study: Departments of Pediatric Surgery and Plastic Surgery, Allied Hospital, Madina TeachingHospital, Faisal Hospital, Abdullah Medical Complex, Jail Road, Faisalabad from June 2005 to July 2010.Methodology: Neonates presenting for circumcision during the first month of life were included in the study. A total of 102neonates were enrolled in this study. Plastibell was used in all cases. They were divided into two groups. Group A(n=51)received dorsal penile nerve block(DPNB)& ring block by injecting lignocaine along with sucrose solution 25%. GroupB(n=51) received 20 ml of 25% sucrose solution only during procedure. The pain was assessed by measuring physiologicalchanges e.g.pulse rate, oxygen saturation and crying time.Results: There were significant differences among the groups A and B with respect to physiological changes associated withthe pain from the procedure. The group A has marked reduction in pain as compared with group B.Conclusion: These findings suggest that sucrose along with DPNB & ring block is an effective method for the managementof pain during circumcision with plasti bell. It has marked reduction in physiological change like heart rate and crying timeas compared with sucrose solution alone