Ileocolic Intussusception - A rare cause of acute intestinal obstruction in adults; Case report and literature review

Colonic Intussusception although common in children, is a rare cause of acute intestinal obstruction in adults. The etiology, clinical presentation and management of this condition is different in adults as compared to children. Pre-operative diagnosis is usually difficult due to the non specific and intermittent nature of the symptoms. CT scan can be a helpful adjunct in establishing the diagnosis. We present a case report of adult ileocolic intussusception with classical radiological signs and operative findings. A brief literature review is also presented with emphasis on the controversy of reduction of the intussusception before resection

Mechanical and Microstructural Analysis of Waste Ceramic Optimal Concrete Reinforced by Hybrid Fibers Materials: A Comprehensive Study

Combining different types of fibers inside a concrete mixture was revealed to improve the strength properties of cementitious matrices by monitoring crack initiation and propagation. The contribution of hybrid fibers needs to be thoroughly investigated, considering various parameters such as fibers type and content. The present study aims to carry out some mechanical and microstructural characteristics of Waste Ceramic Optimal Concrete (WOC) reinforced by hybrid fibers. Reinforcement materials consist of three different fiber types: hook-ended steel fiber (HK), crimped steel fiber (CR) and polyvinyl alcohol (PVA) fibers and the effect of their addition on the waste ceramic composites’ mechanical behaviour. Furthermore, a microstructural analysis was carried out to understand the waste ceramic matrix composition and its bonding to hybrid fibers. Results showed that the addition of hybrid fibers improved the strength characteristics of the ceramic waste composites. For instance, the existence of PVA-CR increased the tensile and flexural strength of the waste ceramic composite by 85.44% and 70.37%, respectively, with respect to the control sample (WOC). As well as hybrid fiber exhibits improved morphological properties as a result of increased pore filling with dense and compact structure, as well as increased C–H crystals and denser structure in pastes as a result of the incorporation of hybrid fibers into the concrete mix. The present experimental research shows the choice of using steel fiber with PVA as a reinforcement material. The idea of adding hybrid fiber is to prepare the economic, environmental, and technological concrete. Moreover, it offers a possibility for improving concrete’s durability, which is vital. Finally, it was concluded that steel fiber is more durable, and stiffer and provides adequate first crack strength and ultimate strength. In contrast, the PVA fiber is relatively flexible and improves the post-crack zone’s toughness and strain capacity

59. Early and late results of routine leaflet augmentation for complete atrio-ventricular septal defect repair

Complete AVSD (CAVSD) is characterized by the presence of a common atrio-ventricular (AV) orifice, an inter-atrial communication, and a ventricular septal defect (VSD). Results of surgical correction of atrio-ventricular septal defects (AVSDs) have improved over the last decades; however, the need for reoperation for left atrio-ventricular valve regurgitation, after primary AVSD repair remains a major concern. The aim of our study is to assess the outcome of the routine leaflet augmentation technique in CAVSD repair. A retrospective database and chart review analysis of all patients who underwent AV canal repair at king Abdul-Aziz Cardiac Center during period from 1999 to September 2014 was conducted. Demographic data, associated anomalies, operative data, ICU and hospital course were reviewed. Early outcomes were reviewed for postoperative complications (Chylothorax, complete AV block, Arrhythmias, early mortality) and late outcomes were reviewed for Left AV valve regurgitation requiring for re-intervention and late mortality. Two hundred and sixty patients underwent leaflet augmentation technique to repair complete AVSD, between January 1999 and September 2014. The mean age was (131.5months), and mean weight (6.06kg). A variety of concomitant procedures were performed at the time of repair of the CAVSD, including a total of 49 patients (18.8%) who underwent PDA ligation. Repair of TV (Right AV valve) was performed in 11 patients (4.2%), 9 patients (3.46%) required RVOTO resection, in 5 patients (1.92%), PA plasty was done and 2 patients (0.76%) required ECMO after CAVSD repair. Regarding reoperations, a total of 17 patients (of 260) required reoperation after initial CAVSD repair. The most common indication for reoperation was left AV valve regurgitation in 16 patients (6%) in the follow up period up to 15years. One patient (0.38%) required diaphragmatic plication. The overall mortality was 3 patients (1.1%). Leaflet augmentation for the repair of the complete AVSD, represent a good surgical alternative technique, allows for good exposure, good LAVV reconstruction and close to anatomical repair and results in reduced incidence of late Left atrio-ventricular valve regurgitation

Death certificate completion skills of hospital physicians in a developing country

Background Death certificates (DC) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. Incomplete and inaccurate DC data, on the other hand, can significantly impair the precision of a national health information database. In this study we evaluated the accuracy of death certificates at a tertiary care teaching hospital in a Karachi, Pakistan. Methods A retrospective study conducted at Aga Khan University Hospital, Karachi, Pakistan for a period of six months. Medical records and death certificates of all patients who died under adult medical service were studied. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. Accuracy of this information was validated using their medical records. Errors in the death certificates were classified into six categories, from 0 to 5 according to increasing severity; a grade 0 was assigned if no errors were identified, and 5, if an incorrect cause of death was attributed or placed in an improper sequence. Results 223 deaths occurred during the study period. 9 certificates were not accessible and 12 patients had incomplete medical records. 202 certificates were finally analyzed. Most frequent errors pertaining to patients’ demographics (92%) and cause/s of death (87%) were identified. 156 (77%) certificates had 3 or more errors and 124 (62%) certificates had a combination of errors that significantly changed the death certificate interpretation. Only 1% certificates were error free. Conclusion A very high rate of errors was identified in death certificates completed at our academic institution. There is a pressing need for appropriate intervention/s to resolve this important issue

Association Of Vitamin D Status And Diabetes Mellitus

To evaluate the association of 25-hydroxyvitamin D3 (25OHD)inadequacyand hyperglycaemia in a Pakistani adult population.Study Design:Case control studyPlace & Period of Study:Department of Pathology, PNS SHIFA Hospital, Karachi; Aug 2011 to Nov 2011.Method and Material:Plasma Glucose levels were measured in 86 patients divided on the basis of their 25-hydroxyvitamin D3(25OHD)levels in three groups, normal (>31 ng/ml), insufficient (20-31ng/ml) and deficient (<20ng/ml). Vitamin D insufficiency (VDI)and Vitamin D Deficiency (VDD) are collectively called Vitamin D inadequacy. 25OHD was measured by electrochemiluminescenceusing Roche Elecsys® Systems while glucose was estimated by routine methods on Roche Hitachi® Autoanalyser.Results:.Vitamin D levels were inversely correlated with plasma glucose levels(r=-0.38;p<0.01) with an Odd Ratio of 3.59(95%confidence interval 1.29 to 8.70).Fasting plasma glucose was significantly higher in VDD patientsas compared to patients withnormal vitamin D status (p<0.05).Conclusion:Higher glucose levels were found more frequent in patients with Vitamin D deficiency

The Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Endoscopic Biopsy Negative Upper Gastrointestinal Lesions

Objective To determine the diagnostic accuracy of endoscopic ultrasound guided (EUS) fine needle aspiration in patients who had inconclusive endoscopic biopsies of the same lesion Methodology This retrospective study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2018 to July 2020. Patients who underwent EUS guided FNAC from June 2017 to July 2020 were screened. The FNAC results of patients satisfying the inclusion ciritera were compared with either a surgical biopsy in patients in whom surgeries were done, while in the remaining patients, EUS FNAC results were compared with a 3 months radiological and/or 6 months clinical follow-up. The final diagnosis was defined based on the following criteria: (1) Malignant lesions (n=36), histopathologic diagnosis obtained based on surgery resected samples (n=18) or clinical diagnosis as neoplasm based on clinical follow-up of symptoms (n=30) or radiologic diagnosis based on imaging follow-up at 3 months (n=13) (2) Benign lesions (n=18), benign cytopathologic histopathologic findings and clinical follow-up with no evidence of malignant progression or metastasis. Results EUS-guided FNA cytology turned out to be malignant in 60 percent (n=36) of the specimens. 30 percent of the samples showed benign epithelial cytology ( n=18) while in 10 percent  of the cases (n=6), the tissue samples were deemed insufficient for cytological diagnosis. The accuracy came out to be 66.6 percent (n=10 were true negative), sensitivity 93.4 percent, and specificity 100 percent.  Conclusion EUS guided-FNA cytology of the sub-mucosal upper GI lesions is highly sensitive and specific for upper GI lesions, which are negative on endoscopic biopsies

Surgical Management & Clinical Outcome of Severe Brain Trauma due to Acute Subdural Hematoma.

Acute subdural hematoma (ASDH) is a collection of clotting blood that forms in the subdural space & it remains one of the most difficult tasks faced by neurosurgeons because of the high mortality and morbidity of the disease.The usual mechanism of an acute subdural hematoma is a high-speed impact to the skull. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures, tearing blood vessels. The aim of our study was to examine the clinical outcome of patients managed by urgent surgery wit

Changes in Liver Fibrosis as Determined by FIB-4 Score Following Sofosbuvir-Based Treatment Regimes Without Interferon

Objective: To determine the mean change in liver fibrosis as evaluated using the FIB-4 score following Sofosbuvir based treatment regimens without interferon. Methodology: This prospective observational study was conducted at the Department of Medicine, Federal Government Services Hospital, Islamabad, from January 09, 2019 to January 03, 2020. A total of seventy (n=70) patients of either gender between age 18-75 years who were diagnosed with cases of HCV infection were enrolled in this study. All patients were treated with Sofosbuvir-based treatment regimens and were assessed for liver fibrosis using the FIB-4 score at baseline, at end of treatment (EOT) and 12 weeks after EOT. Results: The mean FIB-4 score at baseline was 2.45±0.42, at EOT was 1.0981±0.33 and at 12 weeks after EOT was 1.51±0.32.  As compared to the baseline, the mean FIB-4 score was significantly lesser at EOT (P=0.001) and at 12 weeks after EOT (P=0.001). A similar trend was observed across all stratified groups, i.e., age, gender, and type of patients (P<0.05 across all groups). Conclusion: The sofosbuvir-based treatment regimen significantly reduced liver fibrosis at EOT and 12 weeks after EOT, as evidenced by FIB-4 scores that were significantly lower than baseline at EOT and 12 weeks after EOT

Movie Tags Prediction and Segmentation Using Deep Learning

The sheer volume of movies generated these days requires an automated analytics for ef cient classi cation, query-based search, and extraction of desired information. These tasks can only be ef ciently performed by a machine learning based algorithm. We address the same issue in this paper by proposing a deep learning based technique for predicting the relevant tags for a movie and segmenting the movie with respect to the predicted tags. We construct a tag vocabulary and create the corresponding dataset in order to train a deep learning model. Subsequently, we propose an ef cient shot detection algorithm to nd the key frames in the movie. The extracted key frames are analyzed by the deep learning model to predict the top three tags for each frame. The tags are then assigned weighted scores and are ltered to generate a compact set of most relevant tags. This process also generates a corpus which is further used to segment a movie based on a selected tag. We present a rigorous analysis of the segmentation quality with respect to the number of tags selected for the segmentation. Our detailed experiments demonstrate that the proposed technique is not only ef cacious in predicting the most relevant tags for a movie, but also in segmenting the movie with respect to the selected tags with a high accuracy

To explore the pharmacological mechanism of action using digital twin

With the advent of medical technology and science, the number of animals used in research has increased. For decades, the use of animals in research and product testing has been a point of conflict. Experts and pharmaceutical manufacturers are harming animals worldwide during laboratory research. Animals have also played a significant role in the advancement of science; animal testing has enabled the discovery of various novel drugs. The misery, suffering, and deaths of animals are not worth the potential human benefits. As a result, animals must not be exploited in research to assess the drug mechanism of action (MOA). Apart from the ethical concern, animal testing has a few more downsides, including the requirement for skilled labor, lengthy processes, and cost. Because it is critical to investigate adverse effects and toxicities in the development of potentially viable drugs. Assessment of each target will consume the range of resources as well as disturb living nature. As the digital twin works in an autonomous virtual world without influencing the physical structure and biological system. Our proposed framework suggests that the digital twin is a great reliable model of the physical system that will be beneficial in assessing the possible MOA prior to time without harming animals. The study describes the creation of a digital twin to combine the information and knowledge obtained by studying the different drug targets and diseases. Mechanism of Action using Digital twin (MOA-DT) will enable the experts to use an innovative approach without physical testing to save animals, time, and resources. DT reflects and simulates the actual drug and its relationships with its target, however presenting a more accurate depiction of the drug, which leads to maximize efficacy and decrease the toxicity of a drug. In conclusion, it has been shown that drug discovery and development can be safe, effective, and economical in no time through the combination of the digital and physical models of a pharmaceutical as compared to experimental animals