Secondary Brain Injury in Early and Late Tracheostomy in Severe Head Injury Patients

Objective: To determine the risk of secondary brain injury during tracheostomy in severe head injury patients.Material and Methods: The study was carried on 180 patients of severe head injury admitted to Neuro ICU in Lady Reading hospital, Peshawar from March 2015 to March 2017. Early tracheostomy was performed in 95 and late tracheostomy in 85 patients. Patients on ventilator with spontaneous breathing and vitally stable were included and those with no spontaneous breathing, vitally unstable or had already tracheostomy been excluded.Results: From a total of 180 patients, 95 (53%) and 85(47%) patients went under early and late tracheostomy group respectively. In the early group, 35 (37%) patients dropped GCS and 60 (63%) were static or improved. Further, patients who dropped GCS in early group, 32(91%) died while 3 (9%) improved or static. Even patients who improved in early group, 10 (17%) died while 50 (83%) improved or static. While in the late group, 9 (11%) dropped GCS more than 2 points and 76 (89%) were static or improved. Further, patients who dropped GCS in late group, 7 (78%) died while 2 (22%) improved or static. Even patients who improved in late group, 6(8%) died while 70 (92%) improved or static. Overall results of the study show that morbidity and mortality is high among early tracheostomy group than late group.Conclusion: It is concluded that there is risk of secondary brain injury during tracheostomy

Risk factors for Hepatitis B

Abstract Background: To evaluate the risk factors fo

New Fossils of Giraffokeryx (Mammalia: Cetartiodactyla: Giraffidae) from Chinji Formation, Pakistan

Abstract.-This paper describes new fossils of Giraffokeryx originating from the Chinji Formation of northern Pakistan. The fossils, representing worth describing hemimandibles, are collected from the Middle Miocene outcrops of the Chakwal district, Punjab, Pakistan. A detailed description of the newly discovered fossils is being provided. The Chinji sample adds new information on the anatomical morphology of Giraffokeryx and conforms to an early distribution of the genus in the Middle Miocene of the Siwaliks

Giraffa punjabiensis (Giraffidae: Mammalia) from middle Siwaliks of Pakistan.

Abstract.-Giraffa fossils constitute rare findings in the Dhok Pathan Formation of the Middle Siwaliks. The described remains comprise two maxillar fragments of Giraffa punjabiensis. This paper deals with the study of the upper dentition of G. punjabiensis, recovered from the Padhri outcrops of the Pakistani Middle Siwaliks (Late Miocene). The giraffid suggests a woodland habitat with swamps

Trends in traumatic brain injuries during the COVID-19 pandemic: a single-center review of patient charts from Pakistan

Introduction: A traumatic brain injury (TBI) is one of the leading causes of injury-related deaths, making it a public health concern of extreme importance. In a developing country such as Pakistan, TBIs are significantly underreported, with the treatment frequently being delayed and inadequate, especially in rural healthcare setups all across the country. This concern is further magnified by insufficient epidemiological data on TBIs available in Pakistan. The coronavirus disease 2019 (COVID-19) pandemic brought consequential changes to the healthcare system with the priority shifting toward COVID-19 patients, resulting in considerable changes to the workflow and management of TBIs. The primary objective of this study is to offer valuable insights into the epidemiology of TBIs in Pakistan and its relationship with the impact of the COVID-19 pandemic. Methods: A retrospective study was conducted at a tertiary care center in a metropolitan city in Pakistan. Patient charts were reviewed from January to August 2020, and data was extracted including demographics, clinical presentation, management, and outcomes for cases of TBI. Results: The total number of patients is 2126, male 78% and female 21.4%. The mean age of the patients was 28.85. The state of admissions at the hospital is at 99.7% for EME admissions and 0.282% for OPD admissions. Participants presented with loss of consciousness (70.7%), nosebleeds, (53.2%), vomiting (69.0%), and seizures (11.5%). The majority (51.1%) were related to road traffic accidents, followed by falls (20.7%), and assaults (4%). While 1202 (58.5%) of these were managed conservatively, others underwent surgical treatment in the form of craniotomy (28.0%), Burr holes (3.20%), and fracture elevation and repair (10.5%). A decrease in the number of reported TBI cases was observed with lockdown implementation in Pakistan. Conclusion: The transportation sector in Pakistan was severely affected by the COVID-19 pandemic, leading to a decline in road traffic injuries and TBIs. Stringent mobility constraints and changes in societal and cultural norms have contributed to this reduction

Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

Objective: To evaluate the importance of post-operative hemoglobin and electrolyte monitoring after transurethral resection of the prostate (TURP) and establish the parameters to be considered for monitoring.Materials and Methods:Data of patients who underwent TURP between 2007 and 2017 were reviewed. Data regarding prostate size, irrigation fluid volume, resection time, pre- and post-operative electrolytes, hemoglobin levels taken within 48 hours before and after surgery, and blood transfusion information were collected. In order to establish parameters for post-operative laboratory monitoring, we categorized prostate size, resection time, and irrigation fluid into groups i.e. (80 g), (60 min) and (40 L) respectively.Results:A total of 1.000 patients were included. The median age was 66 years with the minimum of 46 years and maximum of 98 years. The median prostate size was 54.26 g. Among all pre- and post-operative laboratory parameters, only hemoglobin and sodium showed a significant change, which were analyzed further. Drop in hemoglobin was significantly associated with increasing prostate size and volume of irrigation fluid. Patients with a prostate size of >80 g had 27.3 times higher chance of significant (>2 g) drop in hemoglobin while 5.1 times higher when irrigation volume exceeded 40 liters. Low levels of sodium were strongly associated with prostate size, irrigation fluid volume, and resection time. However, all these factors become insignificant (p≥0.05) for their effect on low sodium, when these variables were adjusted with each other. Blood transfusion was performed in 27 patients. All these patients belonged to a group of patients with prostate size of more than 80 g with high resection time and irrigation fluid volume. Three patients had TUR syndrome. Post-operative hemoglobin and electrolytes monitoring contributed to a change in the management of only 14% of patients.Conclusion:Routine post-operative hemoglobin and electrolyte measurement is not required in every patient undergoing TURP. Use of risk stratification approach will help us to decide which patient needs post-operative lab testing

Protected areas: a resource or constraint for local people?

We investigated local people’s perceptions, knowledge, and attitudes toward conservation planning and management in Chitral Gol National Park in North West Frontier Province (NWFP) of Pakistan. A literature review was undertaken to unravel the historic drivers behind the formation of this protected area. Key informant interviews and questionnaire surveys were conducted to evaluate the effectiveness of current governance approaches adopted by the park management authorities. Community-based questionnaire surveys and key-informant interviews focused on local communities’ knowledge and awareness of the objectives of the park, people’s role in decision-making, social characteristics, and resource use structures. The information from these surveys was evaluated within the context of good governance and sustainability of park management. Results show a lack of awareness and a low level of participation in protected area management, but a high degree of willingness in the communities to participate in conservation activities. An analysis of the survey data suggests that the park authorities enforce strict protection measures within the park, but this approach lacks a strong vision of sustainability. The surveys reveal that the local people have a very strong sense of belonging to the place and are willing to contribute to the protection of the PA. A large majority of the respondents rely on electronic media as their main source of information, which could potentially form the best medium for conservation campaigning in the region. With these findings in mind, we propose changes to the current governance model for effective and sustainable management of the park in the future

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Genome-wide association analysis of more than 120,000 individuals identifies 15 new susceptibility loci for breast cancer.

Genome-wide association studies (GWAS) and large-scale replication studies have identified common variants in 79 loci associated with breast cancer, explaining ∼14% of the familial risk of the disease. To identify new susceptibility loci, we performed a meta-analysis of 11 GWAS, comprising 15,748 breast cancer cases and 18,084 controls together with 46,785 cases and 42,892 controls from 41 studies genotyped on a 211,155-marker custom array (iCOGS). Analyses were restricted to women of European ancestry. We generated genotypes for more than 11 million SNPs by imputation using the 1000 Genomes Project reference panel, and we identified 15 new loci associated with breast cancer at P < 5 × 10(-8). Combining association analysis with ChIP-seq chromatin binding data in mammary cell lines and ChIA-PET chromatin interaction data from ENCODE, we identified likely target genes in two regions: SETBP1 at 18q12.3 and RNF115 and PDZK1 at 1q21.1. One association appears to be driven by an amino acid substitution encoded in EXO1.BCAC is funded by Cancer Research UK (C1287/A10118, C1287/A12014) and by the European Community's Seventh Framework Programme under grant agreement 223175 (HEALTH-F2-2009-223175) (COGS). Meetings of the BCAC have been funded by the European Union COST programme (BM0606). Genotyping on the iCOGS array was funded by the European Union (HEALTH-F2-2009-223175), Cancer Research UK (C1287/A10710, C8197/A16565), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer program and the Ministry of Economic Development, Innovation and Export Trade of Quebec, grant PSR-SIIRI-701. Combination of the GWAS data was supported in part by the US National Institutes of Health (NIH) Cancer Post-Cancer GWAS initiative, grant 1 U19 CA148065-01 (DRIVE, part of the GAME-ON initiative). For a full description of funding and acknowledgments, see the Supplementary Note.This is the author accepted manuscript. The final version is available from NPG via http://dx.doi.org/10.1038/ng.324

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention