Outcomes of Subtrochanteric Fractures; A Prospective Study Focusing on the Comparison of Open and Closed Surgical Technique

Objective: To review the outcome of surgery by looking at function, deformity and pain according to Harris Hip Score comparing two surgical procedures i.e. open technique and closed technique using relatively recently developed implants. Methodology: This comparative prospective study was conducted in the department of orthopaedic surgery PIMS Islamabad, from June 2013 to May 2015. By using purposive sampling patients aged 20-50 years with closed subtrochanteric fractures of less than 2 weeks duration were included in the study. The patients with open fractures, pathological fractures, multiple fractures/ poly trauma, and old and neglected fractures of more than 2 weeks were excluded. All included cases of subtrochanteric fractures were managed by either closed technique, using Proximal Femur nail (PFN) or open technique using a Proximal Femur anatomical locking plate (PFP). This comparative study was planned to determine union rates, complications & functional outcome of fixation of subtrochanteric fractures.  Descriptive analysis was done using SPSS version 20. Chi-square test was applied for comparing qualitative variables.Results: A total of 100 cases were included in the study with the mean age was 38.5 ± 8.6 years in the open technique group () while 34.6 ± 1.2 years in closed technique (). There are 72 males and 28 females.  Union occurred 84% in open technique and 96% in closed technique.  In open technique group mean Harris hip score was 68.9 ±5.4 compared to 72.4 ± 6.2 in the closed technique group (p-value <0.001). In open technique group 6 (12.0%) cases had delayed union and 2 (4.0%) had non-union compared to 3 (6.0%) cases and 1 (2.0%) cases in closed technique group respectively.Conclusion: Outcome favours closed technique compared to open technique for subtrochanteric fractures fixation, when assessed on Harris hip Score. There was no statistically significant difference in the fracture union and frequency of complications between the two groups

Targeting Liver Biopsies For Optimal Biopsy Site In Diffused Liver Disease Using Real-Time Shear Wave Elastography: A Prospective, Single Center Study

Objective: The study aimed to pinpoint the precise site for liver biopsy using ultrasound and elastography guidance and to assess and compare the diagnostic accuracy of shear wave elastography (SWE) and transient elastography (TE) through histopathological correlation. Methodology: In this prospective single-centre study, the researchers divided the participants into two groups. One group (Group A) had their biopsy guided by ultrasound, which is a standard imaging technique. The other group (Group B) had their biopsy guided by a newer technique called elastography. For the group with elastography-guided biopsy, the researchers used this technique to find the stiffest part of the liver before taking the biopsy sample. Results: The study investigated how stiffness throughout the liver (mean liver stiffness) compared to stiffness measured in the biopsy samples (biopsy segment velocities). Even though the overall stiffness didn't differ much between different sections of the liver, the stiffness measured in the biopsy samples itself did vary. This suggests scarring (fibrosis) may not be evenly distributed throughout the liver. There was a strong link between the stiffness measured in the biopsy samples and the overall average stiffness. The traditional technique (TE) worked well for identifying moderate and severe stages of scarring (F2, F3, and F4). The new sound wave technique (SWE) was good at identifying moderate fibrosis (F2) but less accurate for mild stages (F1). However, it performed similarly to the traditional technique for moderate to severe stages (F2 and F3). The new technique (SWE) could distinguish between mild or no scarring and moderate/severe scarring with good accuracy (over 95%) if the stiffness measured by the sound waves was at least 1.92 meters per second (m/s). Conclusions: This study compared a new sound wave technique (SWE) to a traditional method (TE) for diagnosing liver scarring (fibrosis) in people with chronic liver disease.  The findings suggest that the new technique is just as accurate as the traditional one for diagnosing moderate and severe scarring stages. Importantly, the study also found that scarring may not be evenly distributed throughout the liver.  This is why the new sound wave technique, done at the time of biopsy, may be helpful.  It can potentially help doctors pinpoint the best location for the biopsy sample, which could lead to more accurate diagnoses

A Rare Case of Nasal-Orbital-Cranial Aneurysmal Bone Cyst

case of aneurysmal bone cyst involving ethmoidal sinuses, maxillary sinuses, frontal sinuses, sphenoidal sinuses, basisphenoid bone, and left orbit with intracranial extension in a 9 year old female. The diagnosis was confirmed using CT, MRI-brain, CT-angio brain imaging. The finding of nasal-orbital-cranial aneurysmal bone cyst was confirmed on Histopathology. Two staged surgical excision planned and done, i.e. trans-cranial and trans-nasal excision

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 Potential Approach to Enhance the Seebeck Coefficient of UHMWPE by Using the Graphene Oxide

Thermoelectric materials have been a competent source for the production of energy in the present decade. The most important and potential parameter required for the material to have better thermoelectric characteristics is the Seebeck coefficient. In this work, ultra high molecular weight polyethylene (UHMWPE) and graphene oxide (GO) nanocomposites were prepared by mechanical mixing by containing 10000ppm, 50000ppm, 70000ppm, 100000ppm, 150000ppm, and 200000ppm loadings of graphene oxide. Due to the intrinsic insulating nature of UHMWPE, the value of Seebeck for pristine UHMWPE and its nanocomposites with 10000ppm & 50000ppm of GO concentration was too low to be detected. However, the Seebeck coefficient for composites with 70000ppm, 100000ppm, 150000ppm, and 200000ppm loadings of GO was found to be 180, 206, 230, and 235 µV/ K, respectively. These higher values of Seebeck coefficients were attributed to the superior thermal insulating nature of UHMWPE and the conductive network induced by the GO within the UHMWPE insulating matrix. Although, the values of the figure of merit and power factor were negligibly small due to the lower concentration of charge carriers in UHMWPE/ GO nanocomposites but still reported, results are extremely hopeful for considering the composite as the potential candidate for thermoelectric applications

Impact of Motivation to Learn and Job Attitudes on Organizational Learning Culture in a Public Service Organization of Pakistan

The present study investigates the concept of organizational learning culture in a public service organization and focuses on its relationship with motivation to learn, job satisfaction, organizational commitment and job involvement. Data was collected from 119 employees of a public service organization. In all, 200 questionnaires were distributed and participation was voluntary and confidentiality was ensured. One hundred and nineteen fully completed questionnaires were returned for a response rate of 60%. It was found that organizational learning culture is significantly and positively related to the satisfaction, organizational commitment and job involvement but not with motivation to learn. Age also proved to be an important demographic variable that explained significant part of the variance. Based on the findings of the study, recommendations and policy implications are discussed and directions for future research are provided

Management and Complications of Arnold Chiari Hydrocephalus at Tertiary Health Care Center

Objective: to investigate the role of CT and MRI in diagnosis of Arnold chiari malformation of hydrocephalus and its treatment with VP shunt along with complications. Study Design: Prospective study Place and duration: Department of Neurosurgery, DG Khan Medical College from May 4, 2018 to May 4, 2019. Methodology: Fifty patients of congenital hydrocephalus who were not treated previously were selected. Detailed history about disease and clinical examination of patients was performed. Follow ups were done at neurosurgery OPD. SPSS software for data analysis was used and mean ± SD, frequency and percentages were calculated for variables. P value ≤0.05 was considered as significant. Results: Treatment in case of congenital hydrocephalus as VP shunt, intra-aneurysmal coiling, excision of meningomyelocele with VP shunt and suboccipital craniectomy + upper cervical laminectomy (scucl) were observed as 10%, 6%, 8% and 8% respectively.  Twelve percent of patients were not treated. Conclusion: CT and MRI are the main diagnostic tools for diagnosis of Arnold chiari malformation and VP shunt is the treatment of choice. Among complications of VP shunt infection of shunt and shunt block are the main complications

Cloning and expression of hepatitis B surface gene in E. coli

Background: Hepatitis B virus (HBV) is among the smallest DNA viruses resulting in ~800,000 deaths each year. Pakistan is considered a country affected by HBV. In Pakistan, the most dominant genotype is D. HBV is an enveloped virus of 3.2 kb. The study's goal was to express hepatitis B surface antigen in a bacterial host to produce a recombinant protein.Method: Blood samples were collected in EDTA coated vacutainer from patients after their consent. DNA was extracted from serum through the phenol-chloroform method; Hepatitis B surface gene was cloned in TA cloning vector, subclone in pET 28a expression vector. An expression vector containing the Surface gene was then transformed into a competent bacterial host BL21 and inducted with IPTG at 0.1-0.2mM concentration for expression. The expressed proteins (soluble and pellet form) were analyzed on SDS PAGE.Results: Hepatitis B Surface gene of 681bp after PCR were detected under UV light then successfully cloned and subcloned in pET 28 expression vector. The restricted fragment indicating the gene of interest was 681bp when analyzed on 1.2% Agarose gel under UV light. The required protein of 25kDa was obtained in soluble form when detected on 12% SDS PAGE after staining with Coomassie Blue dye.Conclusion: Hepatitis B surface gene was successfully expressed in both insoluble and pellet forms using E.coli. The expression of surface protein needs to maximize through optimizing conditions to be used as potent candidate for vaccine production to prevent hepatitis B infection.Keywords: Hepatitis B virus; Surface gene; Cloning vector; pET expression vector  

Quality of life among patients undergoing decompressive craniectomy for traumatic brain injury using glasgow outcome scale extended and quality of life after brain injury scale

Objective: To assess quality of life of patients who underwent decompressive craniectomy (DC) for traumatic brain injury and satisfaction of caregivers with outcomes.Methods: This cross-sectional study was conducted at a tertiary care urban center in Pakistan. All patients with severe traumatic brain injury who underwent DC and survived \u3e6 months were included. Outcomes were assessed using 2 scales: Glasgow Outcome Scale Extended and Quality of Life After Traumatic Brain Injury (QOLIBRI). The proforma was translated and validated into the national language. Patient caregivers were interviewed to ask if they would opt for DC in a similar situation in future.Results: The study comprised 40 patients, including 35 male (88%) and 5 female (12%) patients. Mean age of patients was 26.5 ± 9.5 years. Mean Glasgow Coma Scale score at presentation was 8.34 ± 3.22. Median follow-up was 12 months (range, 6-18 months). Mean Glasgow Outcome Scale Extended score was 5.35 ± 1.9, which correlates with an unfavorable outcome. Mean QOLIBRI score was 59.65 ± 21.27. Family members of 38 (95%) patients were content with their decision to give consent for DC in their patients. Spearman correlation for different domains of QOLIBRI and Glasgow Outcome Scale Extended was statistically significant for all parameters except social relationship.Conclusions: Mean QOLIBRI score of patients undergoing DC was 59.65 ± 21.27. Most caregivers (95%) were satisfied with their decision to consent for DC. Patient-reported health-related quality of life assessment is necessary to assess impact of traumatic brain injury