Post Traumatic Hydrocephalus: A Review of 68 Cases

Objective: To evaluate different factors affecting post traumatic hydrocephalus.Material and Methods: This retrospective study was conducted in the department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from July 2009 to June 2011. Record of all head injury patients was reviewed. Out of 5438 admitted patients with head injury, those who developed post traumatic hydrocephalus were included in the study.Results: A total of 68 patients with post traumatic hydrocephalus were diagnosed over the last two years. Out of these 47 (69%) were male and 21 (31%) female. Mostly they were of young age group between 08 years to 41 years. Mean age of presentation being 20 years. A large group 56 (82%) out of 68 patients were in state of moderate to severe head injury, diagnosed within matter of hours or days, as acute post traumatic hydrocephalus. Those who developed after two weeks, fall in group chronic post traumatic hydrocephalus. Out of these, 55 (81%) patients underwent some sort of CSF diversion procedure like external ventricular drain (EVD) or Ventriculo Peritoneal (VP) Shunt. Subarachnoid hemorrhage, intraventricular hemorrhage, intracranial hematoma, posterior fossa bleed, meningitis and craniotomy were recognized associative factors for development of PTH. There was improvement in about 59% after surgery. And the long term prognosis, expressed in GOS, was good in 44% of the cases.Conclusion: Post traumatic hydrocephalus is a dangerous complication and needs critical consideration and early diagnosis in severe head injury cases

To Evaluate the Outcome of Endoscopic Removal of 3rd Ventricle Colloid Cyst

Objective: To analyze the outcome of 3rd ventricle colloid cyst removal by endoscopic approach. Material and Methods: It is a prospective observational case series study. About 11 patients of third ventricle colloid cyst were included. Site of the study was Neurosurgery B department, Lady Reading Hospital, Peshawar. Study duration was from July 2015 to June 2017. All routine investigations were done including CT brain and MRI .The clinical presentation, radiological findings, post-surgery outcome was analyzed. Endoscopic approach was applied in all cases using a rigid endoscope through right pre-coronal burr hole. Results: our study consisted of total 11 patients. Headache and giddiness were the most common presentations (n = 9). 5 patients had change in vision. 2 patients suffered ataxia. One patient presented with urinary incontinence. Post-operative hydrocephalus was observed in only one patient.no recurrence was noted on follow-up visits, Conclusions: Endoscopic approach to colloid cyst treatment is safe and effective with low complications rate

Cardiac myotropes as a novel inotropic treatment for patients of heart failure with reduced ejection fraction

Heart failure with reduced ejection (HFrEF) fraction is a common affliction of heart failure patients. It is defined as an ejection fraction of less or equal to 35% caused by a decrease in systolic function5 (1). Causes include coronary artery disease, myocardial infarction, congenital heart defects, high blood pressure and diabetes. Heart failure is a common condition in Pakistan estimated by some studies to have 2.8 million patients in the country (2). As heart transplants are to date not performed in Pakistan, physicians rely on treatments such as mechanical circulatory assist devices such as left ventricular assist devices, drugs such as inotropes, diuretics and beta blockers for patient’s treatment. Among the medical treatments, a new class of inotropes, cardiac myotrope, omecamtive mecarbil is pending US FDA approval. Omecamtiv mecarbil promotes increased interaction between myosin and actin, increasing the force, efficiency and duration of cardiac muscle contraction without affecting cytosolic calcium thereby having no negative outcomes such as arrhythmias or ischemia(3). Whereas traditional inotropic agents such as catecholamines, phosphodiesterase-3 inhibitors, sodium-potassium adenosine triphosphatase inhibitors have shown- through their calcium-based mechanisms- to have negative side effects such as arrhythmias, increased oxygen demand and mortality(4). Long-term use of catecholamines and phosphodiesterase-3 inhibitors such been shown through both observational cohort and randomized clinical trials to increase mortality in heart failure patients with reduced ejection fraction (3).  Conventional inotropes are widely used in heart failure patients experiencing cardiogenic shock (3) thereby increasing the likelihood of long-term negative effects. The recent GALACTIC-HF double blind trial has shown omecamtiv mecarbil to improve cardiac function, ventricular wall stress and reverse ventricular remodeling without any negative effects on renal function, blood pressure or heart rate shown by current heart failure therapies (1). While continued research and drug development is needed, myotropes such as omecamtiv mecarbil seem to be a promising, less dangerous alternative to traditional inotropic treatments for HFrEF patients. Further drug development may produce even more effective drugs of the same class. More detailed analysis of the GALACTIC-HF trial as well as subsequent trials are still needed to cement the effectiveness and safety of myotropes. The large number of chronic heart failure patients in the country will need a safe, long term treatment for the foreseeable future, this need can easily be filled by current and future mytotropic drugs for improved heart function

Modelling and characterising the fatigue behaviour of asphaltic concrete mixtures

This paper investigates the fatigue behaviour of asphaltic concrete mixtures subjected to Indirect Tensile Fatigue Test (ITFT) under a stress-controlled mode. The conventional stress/strain based approach is used to determine the number of cycles to failure and initial strain value under specified repeated load levels. The fatigue test results indicate that the MS-2 mix (containing 60% and 40% of coarser and finer particles, respectively) prepared with the 40/50 penetration grade binder accumulates less initial strain, and has a relatively better resistance to fatigue than the other tested mixtures. Furthermore, this fatigue behaviour is modelled using a power, intrinsically linear, and non-linear functional specifications. Among these, a non-linear model formulation is found to be the best suited, expressing the number of cycles to fatigue failure as a function of the initial strain, the viscosity, the optimum bitumen content, and the resilient modulus. The fatigue model captures high variability in the data (R2 = 0.86) with a reasonable prediction error (of 15%) as compared to other models. The findings of this study can serve as the basis for selection of asphaltic concrete mixtures based upon the fatigue life criterion; the models proposed in this study can be used as a precursor to determining the fatigue behaviour without performing laborious laboratory testing.</p

Investigation of factors affecting dynamic modulus and phase angle of various asphalt concrete mixtures

This study investigated the dynamic response of various asphalt concrete (AC) mixtures subjected to sinusoidal loading. Eight AC mixtures (four wearing and four base course) were selected including (but not limited to): superpave, asphalt institute manual series, and dense bituminous macadam. The uniaxial dynamic modulus (|E*|) test at various temperatures (4.4–54.4\ua0°C) and frequencies (0.1–25\ua0Hz) was conducted using asphalt mixture performance tester. Statistical analysis of two-level factorial was employed to regulate the factors affecting the AC mixtures. The results revealed that an increase in temperature (from 21.1 to 37.8\ua0°C), translated into 45 and 43\ua0% drop in |E*| values on average while 80 and 67\ua0% decrease in |E*| values was attributed to the sweep of frequency (from 25 to 0.1\ua0Hz) for wearing and base course mixes, respectively. Non-linear regression model was developed to express the dynamic modulus as a function of test temperature, loading frequency and mixture volumetric parameter. Furthermore, Witczak model of dynamic modulus prediction was evaluated and the results indicated a close fit with an average under prediction error of 0.20. The study characterized and ranked the representative AC mixtures that could help in selecting the material/gradation for mechanistic-empirical pavement design approach

Comparison of efficacy of Kabat rehabilitation and facial exercises along with nerve stimulation in patients with Bell's palsy

OBJECTIVES: The aim of this study is to compare the role of Kabat rehabilitation and facial exercise techniques with nerve stimulation common in both for Bell's palsy treatment and its effectiveness in improving physical and social function. MATERIALS AND METHODS: A randomized control trial conducted at the Department of Physiotherapy, Mayo Hospital, Lahore. Two equal Groups (A and B) consist of 26 patients each. Patients were employed Kabat rehabilitation technique in GroupA and with facial exercise in Group-B. Patients in both treatment groups were followed until 3 weeks and improvement in Sunnybrook facial grading scale (SFGS) and facial disability index (FDI) scale were recorded at the end of treatment. RESULTS: In this study, 52 patients were enrolled into the study. At the end of 3 weeks, more improvement was seen in SFGS in Group-A (81.58 + 11.321) versus Group-B (63.77 + 21.645). Similarly, the improvement in physical and social function on FDI in Group-A was more than Group-B (>0.05). CONCLUSION: Kabat technique is more effective as compared to facial exercise technique in improving physical and social function

AWARENESS OF GOOD POSTURE AND COMPUTER ERGONOMICS AMONG MEDICAL STUDENTS OF ISRA UNIVERSITY

Background: Students tends to develop poor posture as their work requires prolong sitting, such as in taking lectures, working on computer, lab activities, assignments using laptops etc. Sitting for prolong periods of time in front of computer resulting in various types of muscular pain which are due to in appropriate computer ergonomics and poor body posture. The objective of the study is to evaluate the awareness of good working posture and computer ergonomics among medical students of isra university, Hyderabad. Methods: A cross sectional study has done on 100 medical students of Isra University Hyderabad. Study was convenient and self-structured questionnaire used. Data analysis was done by using statistical package for social sciences (SPSS) 14 version Results: Questionnaires of 100 participants were completed and returned back for analysis (response rate of 100%). 80% students said they are aware of good posture and computer ergonomics but only 34% selected the right answer regarding good posture.66% students are habitual to use support while using computer, especially back support and ergonomic chair only.55% students said they never had their posture assessed. Conclusion: This study reveals that majority of students clamed to aware of good posture but their answerers has shown that there is lack of knowledge regarding good posture. Students are habitual to use support while sitting which is limited to use of back support and chair and still they need to know the principles of computer ergonomics regarding screen, mouse, keyboard, and overall work station

Impact of Sporisorium scitamineum infection on the qualitative traits of commercial cultivars and advanced lines of sugarcane.

Whip smut disease of sugarcane, caused by Sporisorium scitamineum, is considered one of the main constraints in the successful cultivation of sugarcane. The pathogen infection can decrease the quantity and quality of the produce. Cultivation of resistant varieties is the most feasible strategy to combat the harms of this devastating disease. Development of varieties having disease-resistance together with improved important traits such as brix, pol, purity, CSS, and low fiber contents are desirable. Therefore, we documented the variances in quality traits of 104 sugarcane cultivars under disease pressure in split-plot design with 6 replications. The split ANOVA revealed a highly significant impact (p4.032) in brix, pol, purity, and CSS of more than 40% of the cultivars used, as compared to the uninoculated ones. On the other hand, the smut infection caused a highly significant (t>4.032) increase in fiber percentage of 41 cultivars. We found significant positive correlations between smut rating and reduction of brix, pol, purity, and CSS contents. The cultivars that were caught with greater disease severity, compromised a higher reduction of their useful contents. Similarly, a significant positive correlation was found between increased fiber percent and smut rating. Remarkably, cultivars that showed immune reactions to whip smut disease were not statistically different from uninoculated ones in brix, pol, purity, CSS, and fiber contents. Variable effects of whip smut infection to quality parameters of different cultivars depict the importance of further improvement through breeding programs

Development of Carbon-Nanodot-Loaded PLA Nanofibers and Study of Their Barrier Performance for Medical Applications

The COVID-19 pandemic has increased the usage of personal protective equipment (PPE) all round the world and, in turn, it has also increased the waste caused by disposable PPE. This has exerted a severe environmental impact, so in our work, we propose the utilization of a sustainable electrospun nanofiber based on poly lactic acid (PLA), as it is biobased and conditionally degradable. We optimized the weight percentage of the PLA-precursor solution and found that 19% PLA produces fine nanofibers with good morphology. We also introduced carbon nanodots (CNDs) in the nanofibers and evaluated their antibacterial efficiency. We used 1, 2, 3, and 4% CNDs with 19% PLA and found increased antibacterial activity with increased concentrations of CNDs. Additionally, we also applied a spunbond-nanofiber layered assembly for the medical face masks and found that with the addition of only 0.45 mg/cm2 on the nonwoven sheet, excellent particle filtration efficiency of 96.5% and a differential pressure of 39 Pa/cm2 were achieved, meeting the basic requirements for Type I medical face masks (ASTM-F2100)