Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion

Simultaneous hemorrhagic and ischemic strokes have been previously reported in the literature. Typically, these occur in patients secondary to dialysis, cerebral amyloid angiopathy, or thrombotic thrombocytopenic purpura.1,2,3 However, this is the unique case of a 62-year-old Asian female who presented with a hemorrhagic stroke suspected to be secondary to refractory hypertension from intracranial large vessel atherosclerotic flow limiting stenosis, with rapid subsequent large vessel occlusion and ischemic stroke. Questions arise such as ideal blood pressure parameters for dual management, timeliness of computed tomography angiography imaging in the emergency department for detection of large vessel occlusion during intracranial hemorrhage, and subsequent selection of treatment plan in the dual-lesion patient population

In patients with radiologically-staged resectable oesophago-gastric junctional tumours, is diagnostic laparoscopy useful as an additional staging procedure?

AbstractA best evidence topic in surgery was written according to a structured protocol. The question addressed was in patients with oesophago-gastric junctional tumours which have been radiologically-staged as potentially resectable, is diagnostic laparoscopy useful as an additional staging procedure. 292 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that as an additional tool following radiological staging of oesophago-gastric junctional tumours, diagnostic laparoscopy does appear to detect previously occult peritoneal metastases as well as liver metastases and lymph nodes and these findings do in turn lead to changes in management in over ten percent of patients. The procedure is however associated with some morbidity and its efficacy in changing management in the era of routine PET scanning remains to be evaluated

Global Health Education: International Collaboration at ICDDR,B

The purpose of this commentary is to provide an overview of the growing interest in global health education at ICDDR,B and to review examples of how this has grown from public-health research and education to include clinical education (medical and nursing) as well. This parallels the growth of the institution, with an increased focus on educational linkages within and beyond Bangladesh and the rise in interest in global health at western medical schools. Specific collaborations, their setup and structure are described. This is presented as a model for other centres of excellence in developing countries to engage their partners in the South and North on matters of education and research for mutual cooperation and benefit

Hernia of morgagni presenting as constipation in a 65-year-old male

Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up

Leading sustainable schools in the era of Education 4.0: Identifying school leadership competencies in Malaysian secondary schools

The purpose of the study was to develop an empirical School Leadership Competency Model for the era of Education 4.0 (SLCMEduc4.0) to identify school leadership competencies that facilitate and maximize effectiveness in leading sustainable schools in Malaysia. Exploratory Factor Analysis (EFA) was employed to identify the underlying factors whereas Confirmatory Factor Analysis (CFA) was applied to test the measurement models using Structural Equation Modelling. A total of 444 and 931 respondents completed the survey with usable data for EFA and CFA respectively. The results suggested that the SLCMEdu4.0 can be explained by eight factors namely; Leading for Learning, Emotional Intelligence, Critical Thinking, Communication and Ethics, Collaboration, Decision Making and Problem Solving, Digital Dexterity and Entrepreneurial with good fit statistics; normed x2=2.628, TLI=.950, CFI=.954 and RMSEA=.042. With a total of 40 items, the model also features good convergent and discriminant validity and construct reliability. The SLCMEduc4.0 is a coherent premier model that provides useful feedback for practitioners in planning, designing and evaluating future professional development programmes for school leaders. The study encourages a fresh look at educational leadership development locally and globally specifically in enhancing the leadership development of Malaysian school leaders towards productive change in the era of Education 4.0

Pharmacological Threat to Lungs: A Case Series and Literature Review

Drug-induced organ damage stands as a prevalent yet much-neglected issue globally. Keeping in view it\u27s rising frequency, health care providers stand obliged to be well versed with the de-merits of the agents they prescribe. Drug therapies causing damage present with a non-specific clinical presentation, histological findings or radiology, which further elaborates on the necessity of a conscientious diagnosis. Pulmonary architecture ranging from the airways, lung parenchyma, mediastinum, pleura, pulmonary vasculature or the neuromuscular system, all can fall victim to the dreaded outcomes of this menace. In order to establish successful diagnosis, the definite temporal relation between initiation of drug therapy and the development of the respiratory symptoms needs to be drawn. The most common form of pharmacologically arising lung toxicity is drug-induced pneumonitis or interstitial lung disease. Unfortunately, there is no adequate data available to review the extensiveness of this medication-associated risk in Pakistan which further highlights the necessity of carefully monitoring this overlooked yet assessable malady. Furthermore, identification and surveillance of this drug attributed peril shall help diminish burden on healthcare resources of the country. We present three recent cases of different types of drug-induced lung damage under treatment at our University Hospital

Octonionization of three player, two strategy maximally entangled quantum games

We develop an octonionic representation of the payoff function for three player, two strategy, maximally entangled quantum games in order to obtain computationally friendly version of this function. This computational capability is then exploited to analyze and potentially classify the Nash equilibria in the quantum games

Correlation of TP53 overexpression and clinical parameters with five-year survival in oral squamous cell carcinoma patients

Abstract Introduction TP53 mutation and overexpression have been correlated with poor survival in many cancers including oral squamous cell carcinoma (OSCC). We aim to understand the role of TP53 overexpression in OSCC in our population and correlate it with five-year survival to test its viability as a prognostic marker for OSCC patients. Materials and methods Patients with biopsy proven OSCC at Aga Khan University Hospital from January 2000 to January 2008 were recruited. Immunohistochemistry was used to establish TP53 status and the results were published. Following up on these patients, five-year data were collected and correlated with TP53 status and other clinicopathologic parameters. Results Overexpression of TP53 was not significantly associated with five-year survival (hazard ratio [HR]: 1.543; 95% CI: 0.911-2.612; p = 0.107). Conclusion Although we had proven statistical relevance when correlated with overall survival in our previous study, we were unable to extend the same relevance to TP53 overexpression when it comes to five-year survival