Audit of Vaginal Route and Abdominal Route of Hysterectomy at a Tertiary Care Hospital

Background: Hysterectomy is “Surgical removal of all or part of uterus”. Abdominal and vaginal route of hysterectomies are both predominant operative techniques being employed by the gynecologists all the world for various uterine conditions. Indications to select any particular technique in any of the hospital setting might not be optimally defined. This study was planned to evaluate particular route of hysterectomy (vaginal hysterectomy and abdominal hysterectomy) as there was no such study available which could document the data of our local population so this study was planned to be conducted to determine burden of problem and deficiencies for clinicians to opt better treatment options among targeted population. The results of this study will not only add in national data but will also be comparable with other international studies. Objective: To determine mean duration of surgery, mean duration of hospital stay and post-operative pyrexia in vaginal route and abdominal route of hysterectomy. Material and methods: A total of 240 women meeting inclusion and exclusion criteria of this study were registered in this study. Informed consent was taken from each patient. All the relevant data were recorded on pre-designed proforma. Data were entered and analyzed using SPSS-17. Results: A total of 240 subjects fulfilling the inclusion and exclusion criteria were registered in this study for abdominal hysterectomy and vaginal hysterectomy. Out of these 240 cases, 79 (32.9%) had undergone vaginal hysterectomy and 161 (67.1%) underwent through abdominal hysterectomy. Mean age of the study cases was 42.72±5.18 years (minimum age was 31 years while maximum age was up to 50 years). Mean parity of the study cases was 5.67±2.08 (minimum para 1 and maximum para 10). Pyrexia was seen in 90 (37.5%) of the study cases, of these 27 (30%) had undergone through vaginal hysterectomy and 63 (70%) underwent abdominal hysterectomy. Minimum duration of the surgery was 45 minutes and maximum duration of the surgery was 90 minutes, mean duration of the surgery was 69.75±14.92 minutes. Minimum Hospital stay was 3 days ranging to maximum hospital stay being 10 days, mean hospital stay in these study cases was observed to be 4.42±1.65 days. Conclusion: Vaginal route of hysterectomy is associated with lesser postoperative complications in terms short duration surgery, significantly short hospital stays and lower rates of postoperative pyrexia than that of abdominal route of hysterectomy. Keywords: Abdominal Hysterectomy, Vaginal hysterectomy, Uterovaginal prolapse

Acute Myocardial Infarction as Predictor of Mortality in Patients with Premature Coronay Disease

Background: Recent data from various parts of the world have led to the conclusion that more than 80 % of CVD deaths occur in developing countries like Pakistan. This high burden of heart diseases is largely attributed to the industrial and technological progress which is associated with economic and social transformations which have lead to life style modification and sedentary life style. This study was planned to ascertain mortality rate of premature coronary artery disease in patients with AMI as it directly affects main workforce of our national economy. Objective: To determine rate of mortality in premature coronary artery disease patients with acute myocardial infarction.  Material and methods: A total of 145 patients having premature coronary artery disease presenting with acute myocardial infarction were included in this descriptive study. This study was conducted in the department of medicine, District Headquarters Hospital, Rajan Pur from June 2017 to September 2017. These patients were followed during current hospitalization to see mortality in these patients and all the findings were noted in the proforma. Results:Of these 145 study cases, 96 (66.2%) were male patients and 49 (33.8%) were female patients. Mean age of our study cases was noted to be 47.67 ± 7.59 years. Mean time taken before presentation at hospital was 113.79 ± 54.36 minutes. Diabetes was present in 48 (33.1%) of our study cases, hypertension was present in 58 (40%), smoking in 39 (26.9%), family history of IHD in 67 (46.2%) and obesity in 49 (33.8%) of our study cases. Mortality was noted to be in 19 (13.1%) of our study cases, post MI angina was seen in 36 (24.8%) and cardiogenic shock was noted in 29 (20%). Conclusion: Our study results indicate that patients with premature coronary artery disease having acute myocardial infarction (AMI) have high frequency of adverse clinical outcomes. Positive family history, hypertension, obesity and diabetes were major risk factors noted in our study. Keywords: Premature coronary artery disease, mortality, acute myocardial infarction

Assessment of ameliorative effect of Aab-e-Shifa polyherbal formulation in experimentally-induced wound in rabbits

Purpose: The aim of the current study is to evaluate the wound healing potential of a polyherbal formulation (PHF) Aab-e-Shifa in normal and diabetic albino rabbits. Methods: The activity of PHF application was evaluated in comparison to tetrachlorodecaoxide (TCDO) on experimentally-induced excision wound in the thigh of normal and diabetic rabbits under ketamine anesthesia. Preliminary phytochemical analysis, total phenolic contents, wound contraction, as well as toxicological and histopathological studies were also investigated. Results: PHF exhibited parallel (p < 0.05) activity for initial wound healing in both normal (48.07 %) and diabetic groups (36.32 %), when compared to their respective control groups. Phytochemical analysis showed the presence of high levels of total phenolic contents in Allilum sativum L. (54.25 ± 0.15 GAE mg/g), Curcuma longa L. (25.45 ± 0.48 GAE mg/g), Zingiber officinale Rosc. (29.08 ± 0.35 GAE mg/g) and some phytochemicals such as flavonoids, couramins, terpenoids in these plants. No adverse sign of PHF was observed when applied at a dose of 2000 - 3000 g on rabbit skin. Conclusion: Aab-e-Shifa has great potential in wound healing and may be used as an alternative treatment for the healing of wounds in animals. The phytochemicals present in PHF might play a role in the wound healing activity possibly due to their antioxidant potential. However, further detailed studies are required to buttress this

MLGOPerf: An ML Guided Inliner to Optimize Performance

For the past 25 years, we have witnessed an extensive application of Machine Learning to the Compiler space; the selection and the phase-ordering problem. However, limited works have been upstreamed into the state-of-the-art compilers, i.e., LLVM, to seamlessly integrate the former into the optimization pipeline of a compiler to be readily deployed by the user. MLGO was among the first of such projects and it only strives to reduce the code size of a binary with an ML-based Inliner using Reinforcement Learning. This paper presents MLGOPerf; the first end-to-end framework capable of optimizing performance using LLVM's ML-Inliner. It employs a secondary ML model to generate rewards used for training a retargeted Reinforcement learning agent, previously used as the primary model by MLGO. It does so by predicting the post-inlining speedup of a function under analysis and it enables a fast training framework for the primary model which otherwise wouldn't be practical. The experimental results show MLGOPerf is able to gain up to 1.8% and 2.2% with respect to LLVM's optimization at O3 when trained for performance on SPEC CPU2006 and Cbench benchmarks, respectively. Furthermore, the proposed approach provides up to 26% increased opportunities to autotune code regions for our benchmarks which can be translated into an additional 3.7% speedup value.Comment: Version 2: Added the missing Table 6. The short version of this work is accepted at ACM/IEEE CASES 202

Impact of Bronchoscopic Lavage and Aggressive Chest Physiotherapy on Clinical Pulmonary Infection Score of Patients of Severe Traumatic Brain Injury

Introduction:  Traumatic brain injury patients present in the emergency room with a variable conscious status depending upon the severity of the injury. The process of aspiration starts from the scene of trauma as the patients with Traumatic brain injury and chest trauma have higher rates of aspiration pneumonia. Materials and Methods:  We conducted a prospective study to assess the impact of bronchoscopy lavage and aggressive chest physiotherapy on the Critical Pulmonary Infection Score of Patients with Severe Traumatic Brain Injury in the Neurocritical Care Unit. Patients with severe traumatic brain injury who met the inclusion criteria were enrolled in the study. Patients of both genders, ages ranging from 05 – 70 years were included in the study. Results:  48 patients who met the inclusion criteria were enrolled in the study. 8 patients expired before 7 days and were excluded from the study. 88% were male and 12 % were females. Out of 40 patients, 30 were ventilated and 10 were managed without ventilation. Brain contusion was the most common CT scan finding. Out of 40 patients, 18 underwent surgical intervention, with decompressive hemicraniectomy being the most commonly performed procedure. Out of 40 patients, 32 patients underwent bronchoscopy. 8 patients out of 32 had more than two sessions of bronchoscopy. Conclusion:  As Critical Pulmonary Infection Score is an important indicator for pneumonia in the neurocritical care unit, the importance of standardized chest care with the help of bronchoscopic lavage and chest physiotherapy in keeping the Critical Pulmonary Infection Score on the lower side can prevent patients from developing life-threatening pneumonia

Machine Learning Based Diagnostic Paradigm in Viral and Non-Viral Hepatocellular Carcinoma

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Viral and non-viral hepatocellular carcinoma (HCC) is becoming predominant in developing countries. A major issue linked to HCC-related mortality rate is the late diagnosis of cancer development. Although traditional approaches to diagnosing HCC have become gold-standard, there remain several limitations due to which the confirmation of cancer progression takes a longer period. The recent emergence of artificial intelligence tools with the capacity to analyze biomedical datasets is assisting traditional diagnostic approaches for early diagnosis with certainty. Here we present a review of traditional HCC diagnostic approaches versus the use of artificial intelligence (Machine Learning and Deep Learning) for HCC diagnosis. The overview of the cancer-related databases along with the use of AI in histopathology, radiology, biomarker, and electronic health records (EHRs) based HCC diagnosis is given.Peer reviewe

Correlation between serum ferritin level and liver function tests in thalassemic patients receiving multiple blood transfusions

Background:Multiple blood transfusions are the mainstay of thalassemic patients in order to combat the severe anemia. These frequent blood transfusions result in the excessive iron deposition, leading to multiple injuries to a variety of organs in the body. In response to these injuries, the levels of various enzymes are disturbed. The whole phenomena usually involve the interrelation of one parameter with some other. The present study aimed to estimate the levels of serum ferritin and hepatic enzymes and to find out any possible correlation between them in thalassemic patients receiving multiple blood transfusions.  Methods:A total number of 90 thalassemic patients of both sexes ranging from 10-15 years, receiving multiple blood transfusions were included in the present study. Blood samples from all the patients were withdrawn and analyzed for the values of serum ferritin, hemoglobin and hepatic enzymes (serum alanine transaminase, serum aspartate transaminase, serum alkaline phosphatase). Pearson correlation coefficient was applied to observe correlation between serum ferritin level and hepatic enzymes. A P value of ≤0.05 was considered statistically significant.Results:The overall values of serum ferritin, and hepatic enzymes (serum Alanine Transaminase, serum Aspartate Transaminase, serum Alkaline Phosphatase) were remarkably increased than their normal values. However, hemoglobin level was considerably decreased in thalassemic patients. A weak positive insignificant correlation was observed between serum ferritin with hepatic enzymes and hemoglobin in thalassemic patients.Conclusion:Multiple blood transfusions cause iron overload in the body, which in turn, lead to increased serum ferritin levels in thalassemic patients. High levels of hepatic enzymes are somewhat correlated to serum ferritin concentration. However, the exact reason of elevated levels is still unclear. Further detailed studies should be conducted in order to identify the exact mechanism behind this and to search for the promising correlations of various parameters in thalassemic patients receiving multiple blood transfusions.

Karachi cancer registry (KCR): Age-standardized incidence rate by age-group and gender in a mega city of Pakistan

Objectives: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19.Settings: The population of Karachi division is 16.1 million according to national census 2017. \u27Karachi Cancer Registry\u27 which is a part of \u27National Cancer Registry\u27 is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0-14, 15-19 and ≥20 years), in both genders and all cancer site/type.Methods: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories.Results: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12), leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56), leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively.Conclusion: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.

ACPO: AI-Enabled Compiler-Driven Program Optimization

The key to performance optimization of a program is to decide correctly when a certain transformation should be applied by a compiler. This is an ideal opportunity to apply machine-learning models to speed up the tuning process; while this realization has been around since the late 90s, only recent advancements in ML enabled a practical application of ML to compilers as an end-to-end framework. This paper presents ACPO: \textbf{\underline{A}}I-Enabled \textbf{\underline{C}}ompiler-driven \textbf{\underline{P}}rogram \textbf{\underline{O}}ptimization; a novel framework to provide LLVM with simple and comprehensive tools to benefit from employing ML models for different optimization passes. We first showcase the high-level view, class hierarchy, and functionalities of ACPO and subsequently, demonstrate a couple of use cases of ACPO by ML-enabling the Loop Unroll and Function Inlining passes and describe how ACPO can be leveraged to optimize other passes. Experimental results reveal that ACPO model for Loop Unroll is able to gain on average 4\% compared to LLVM's O3 optimization when deployed on Polybench. Furthermore, by adding the Inliner model as well, ACPO is able to provide up to 4.5\% and 2.4\% on Polybench and Cbench compared with LLVM's O3 optimization, respectively.Comment: Preprint version of ACPO (12 pages

Outcome of surgical treatment for neglected congenital muscular torticollis: a series of 28 adolescent patients

Background: Congenital muscular torticollis (CMT) is a common musculoskeletal anomaly that can be excellently managed at birth with conservative physiotherapy; as a result, literature on neglected cases of CMT in older patients is sparse, and there is controversy regarding the ideal surgical approach. This report aims to provide the outcome of 28 adolescent patients with neglected CMT who underwent unipolar release at the distal sternocleidomastoid muscle (SCM). Methods: Twenty-eight adolescent patients with untreated CMT presented to our department between 2016 and 2019 and underwent unipolar release at the distal end of their SCM. All patients had no other anomaly based on clinical examination and radiological investigations. At the time of surgery, the mean age of patients was 15.8 years (range 13–18 years). There were 10 male and 18 female patients with the right side affected in 20 cases. All patients were followed up for 2 years. Patients were evaluated using an adapted version of the modified Lee’s scoring system to assess cosmesis and the cervical-mandibular angle (CMA) to assess radiological change. Results: The adapted modified Lee’s scoring system indicated 17 patients (60.7%) had an excellent outcome, 6 patients (21.4%) had a good outcome, and 5 patients (17.9%) had a fair outcome. In particular, scarring was fine in 23 patients (82.1%) and only slight in the remaining. Independent to the categorical outcome, all patients subjectively reported high satisfaction with their cosmesis. The preoperative mean CMA was 19.6° (range, 8.5–31.5°), which was reduced to a mean of CMA of 14.0° (range, 3–28°) after surgery (P Conclusion: In uncomplicated cases of neglected CMT in adolescent patients, unipolar tenotomy of the distal SCM is a safe and reliable technique with good clinical outcomes