Improvement of Headache in Patients after Occipital Extradural Hematoma (EDH) with Less Than 15 ml of Volume after Single Burr Hole Evacuation and Placement of Drain

Objective:  We hypothesized that if we operate occipital extradural hematoma (EDH) having a volume less than 15 ml by single burr hole evacuation of extradural hematoma (EDH) and placement of drain without doing craniotomy then clinical status of the patients particularly headache improves. Method:  An observational study of 15 patients (with presenting GCS: 8–13) was conducted on patients who were operated in Punjab Institute of Neurosciences (PINS). All patients had acute extradural hematoma less than 15 ml after a road traffic accident (RTA). The age range was 22 – 45 years. All patients were operated on within 12 hours of road traffic accident. The timing of surgery was in the range of 1-2 hours. Results:  In all patients, surgery was performed by a single burr hole at the occipital region at the site of occipital EDH and the drain was placed in an extradural position. Co-morbidities in our patients were DM, polytrauma. Receiving GCS was 9 in 2 (13.33%) patients, was 13 in 10 (66.67%), was 8 in 1 (6.66%) patient and receiving GCS was 15 in 2 (13.33%) patients. All patients were assessed clinically on 5th post-operative day. It was seen headache was relieved on 5th post-operative day in all patients except 1 (6.66%) patient. Our 1 (6.66%) patients came for follow-up with the complaint of headache and vomiting which was managed conservatively. Conclusion: Surgery by single burr hole evacuation and placement of drain is a safe method if occipital EDH is less than 15 ml in volum

Niche partitioning and competition between different rabbit breeds using stable isotopes

[EN] Stable isotope analysis (SIA) is an evolving method for determining diet, understanding food web and resolving biogeochemical issues in the ecosystem. This study aims to trace out ecological niche preferences/partitioning and competition among the lagomorphs, including two different breeds of European rabbit (Oryctolagus cuniculus), New Zealand rabbit and American Dutch rabbit, using SIA. Thirty-two samples of tooth enamel were analysed, which were collected from different districts of Punjab, Pakistan, including Okara, Sahiwal and Kasur. Among these samples, 16 belonged to the New Zealand breed (08 male and 08 female rabbits) and 16 to the American Dutch breed (08 male and 08 female rabbits). Significant (P<0.001) intergender differences in the isotope content of ?13C in the enamel for New Zealand and American Dutch rabbit were found. The European rabbits showed significant differences for both genders in the stable isotope of oxygen in the enamel (?18O) values (P=0.05). Nitrogen stable isotope results showed no significant intergender differences between American Dutch and New Zealand rabbits (P=0.24). The stable isotope results for ?13C, ?15N, and ?18O indicate that the trophic niche partitioning of both breeds overlaps, which can potentially cause competition for resources, whereas the water intake may differ among different genders, which may reflect differential gender-related activities. The archaeological and fossilised data of lagomorphs is present, but there is no significant literature available for living lagomorphs (rabbits). In general, this study provides a basic and first dataset for ?13C, ?15N, and ?18O of living lagomorphs, which can serve as a comparative dataset for future studies.Shouket, U.; Ahmad, RM.; Waseem, MT.; Khan, AM.; Zubaid, S. (2024). Niche partitioning and competition between different rabbit breeds using stable isotopes. World Rabbit Science. 32(1):73-81. https://doi.org/10.4995/wrs.2024.19934738132

Wheat in the Era of Genomics and Transgenics

Wheat, as one of the most important cereal crops in the world and second major caloric source in the world after rice, is the major staple food in South Asia and many other countries of the world. Prior to onset of “Green Revolution,” South Asian countries were facing the threat of severe famine. Green Revolution wheat genotypes brought out these countries from the crisis they were facing and has helped them to sustain their productions for more than half a century. With the emergence of molecular biology and biotechnology, another window of opportunity is opened to sustain wheat yields by using modern techniques of genes identification and utilization. Through this chapter, we have tried to gather information that was generated for wheat improvement in last 3 decades. These afforest included the development of molecular markers, mapping of genes, sequencing of markers genes, and their utilization through marker-assisted selection. The other part recorded various efforts to genetically transform wheat for traits improvements and/or to study their molecular control

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Feminist Analysis of Drinking from a Bitter Cup by Angela Jackson Brown

This article is the feminist analysis of the novel Drinking from a Bitter Cup by Angela Jackson Brown. Researcher has used the theoretical lens of “intersectionality” by Patricia Hill Collins. In this article, researcher has explored different systems of oppression in the life of Sylvia Butler. The interconnection between those different systems of oppression is analyzed according to the analytical frame work of intersectionality. This study also shows the transformation of the character, Sylvia Butler, despite her difficult circumstances

Reinforcing customer journey through artificial intelligence: a review and research agenda

Purpose – This study defines a three-angled research plan to intensify the knowledge and development undergoing in the retail sector. It proposes a theoretical framework of the customer journey to explain the customers’ intent to adopt artificial intelligence (AI) and machine learning (ML) as a protective measure for interaction between the customer and the brand. Design/methodology/approach – This study presents a research agenda from a three-dimensional online search, ML and AI algorithms. This paper enhances the readers’ understanding by reviewing the literature present in utilizing AI in the customer journey and presenting a theoretical framework. Findings – Using AI tools like Chatbots, Recommenders, Virtual Assistance and Interactive Voice Recognition (IVR) helps create improved brand awareness, better customer relationships marketing and personalized product modification. Originality/value – This study intends to identify a research plan based on investigating customer journey trends in today’s changing times with AI incorporation. The research provides a novel model framework of the customer journey by directing customers into different stages and providing different touchpoints in each stage, all supported with AI and M

Comparison of Outcomes of Early and Late Surgical Interventions in Lipomeningomyelocele (LMMC) and Lipomeningocele (LMC)

Objectives:&nbsp;&nbsp;The study compared the signs and symptoms of post-operative complications in early vs. late intervention lipomeningomyelocele (LMMC) and lipomeningocele (LMC). Materials and Methods:&nbsp;&nbsp;We compared the clinical and surgical data between two groups i.e., lipomeningomyelocele (n = 189) and lipomeningocele (n = 64), and their early vs. late surgical interventions for 3 years from January 2018 to July 2021. We included patients of both genders (n = 253) with lipomeningomyelocele or lipomeningocele aged up to 7 years. A detailed neurological exam i.e., sensory, motor, and cerebellar signs was performed to evaluate the patients. Results:&nbsp;&nbsp;The presentation of LMMC (74.7%) was very high compared to LMC (25.3%). 74.7% underwent detethering of the spinal cord, as they had cord tissue coming out of the defect. 25.2% had only meninges coming out of the bony deficiency and performed dural repairs. 47 patients had incontinence which was improved postoperatively. Sixty-nine patients had hydrocephalus which was treated with VP shunt or ETV. 23 patients had diastematomyelia which is a bony spur duly repaired intra-operatively. 50 presented with paraplegia and 19 cases with club feet. The majority of patients in both groups, reported for Power would fall between 3/5-4/5. For patients who underwent late intervention, 7 presented with post-operative incontinence, 12 with hydrocephalus, 12 with CSF leakage, and 13 with paraplegia. Conclusion:&nbsp;&nbsp;If performed on time, surgical intervention in lipomeningocele and lipomeningomyelocele yields good results. Early intervention is substantially better for managing post-op CSF leakage and incontinence than late intervention