The Sonographic Measurement of the Inferior Vena Cava Diameter versus the Central Venous Pressure in Assessing Fluid Responsiveness in Patients after Coronary Artery Bypass Graft Surgery

Background: Fluid status assessment and management post coronary artery bypass grafting (CABG) is a clinical challenge. The study aimed to establish whether central venous pressure (CVP) and ultrasound measures of respiratory variability of inferior vena cava (IVC) diameter might predict fluid responsiveness in mechanically ventilated patients after CABG. Methods: This comparative study included 200 consecutive adult patients who underwent elective CABG. We recorded the following parameters: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), central venous pressure (CVP), inferior vena cava maximum (IVCmax), and minimum (IVCmin) diameters, left ventricular ejection fraction (LVEF), and velocity-time integral in the left ventricular outflow tract (VTI-LVOT). Results: The age of the patients ranged from 45 to 71 years, and 147 were males (73.5%). Patients were grouped into fluid responders (n= 135), defined as stroke volume variation (SVV) of 15% or greater following fluid bolus administration, and fluid non-responders (n= 65), defined SVV of less than 15% following fluid bolus administration. There was no statistically significant difference between the groups regarding their CVP, maximum and minimum IVC diameters, inferior vena cava distensibility index (IVC-DI), and other markers of fluid responsiveness (p-value 0.47, 0.34, 0.59, and 0.64, respectively). There was a significant difference in SVV between fluid responders (18.33±2.767) and non-responders (10.95±1.940) (p-value <0.001). Conclusion: Neither CVP nor sonographic measures of IVC diameter respiratory variability provided an accurate method to distinguish between fluid responders and non-responders in the early postoperative period after CABG

Oil palm fruit bunch grading system using red, green and blue digital number

This research deals with the ripeness grading of oil palm fruit bunches. The current practice in the oil palm mills is to grade the oil palm bunches manually using human graders. This method is subjective and subject to disputes. In this research, we developed an automated grading system for oil palm bunches using the RGB color model. This grading system was developed to distinguish between the three different categories of oil palm fruit bunches. The maturity or color ripening index was based on different color intensity. Our grading system employs a computer and camera to analyze and interpret images equivalent to the human eye and brain. The colors namely Red, Green and Blue (RGB) of the palm oil fruit bunch were investigated using this grading system. The computer program developed and used the mean color intensity to differentiate between the different color and ripeness of the fruits such as oil palm FFB. The program results showed that the ripeness of fruit bunch could be differentiated between different categories of fruit bunches based on RGB intensity

Hypertensive supratentorial intracerebral Hemorrhage: early surgery and functional Outcome; a tertiary care hospital experience from Karachi, Pakistan.

BACKGROUND: Spontaneous supratentorialintracerebral hemorrhage (ICH) has a high morbidity and mortality and places a significant burden on health and social services.The role and timing of operative neurosurgical intervention remain controversial and the practice and timing of surgery continue to be haphazard. METHODOLOGY: Our study was a descriptive study conducted at Civil hospital Karachi, Pakistan. Sample size was calculated. The sampling technique of our study was non probability. The data was collected and analyzed using spssvs 17. Data was observed for any descriptive and inferential statistics. RESULTS: There were 38 males (63.3%) and 22 females (36.7%). The mean age of patients was 52.7 years. 36 patients (60%) had right hemispheric hemorrhage while 24 patients (40%) had left hemispheric hemorrhage. 48 patients (80%) had typical putaminal hemorrhage while 6 (5%) patients had subcortical and 6 (5%) occipital bleed. Regarding the improvement of neurological status, 16 patients (26%) were able to perform daily activities. 9 patients (15%) were able to take care of themselves at home while 07 patients (11%) required partial care. 10 patients (16%) were vegetative and 18 (30%) patients died. CONCLUSION: Our study revealed that early evacuation of large hematoma resulted in short ICU and short hospital stay, less postoperative complications and overall good functional recovery particularly in middle aged and younger patients with non dominant hemispheric hemorrhage therefore early surgical intervention definitely has the role in the management of extensive intracerebral hemorrhage

A Massive Tuberculosis Abscess at the Erector Spinae Muscles and Subcutaneous Tissues in a Young Man

Tuberculosis (TB) is a chronic granulomatous infection which can present in an atypical form. Isolated muscle involvement is very rare. We report a 25-year-old man who presented with a massive cystic swelling on the right side of his back, extending from the lower thoracic to the gluteal region. He had a history of contact with a friend who was suspected of having TB. Magnetic resonance imaging (MRI) showed that the origin of the cyst was from the erector spinae muscles. The result of a fluid aspirate showed acid fast bacilli. The swelling disappeared after treatment with anti-tuberculous medications. Muscular involvement in TB is very rare. In our patient, the reports of an ultrasound and MRI confirmed isolated muscle and subcutaneous involvement without bony lesions. This case is reported to increase physician awareness regarding soft tissue TB. Although it is rare, similar cases may be seen in the future

Third ventricular tumors: A comprehensive literature review

Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment

Design technique to mitigate unwanted coupling in densely packed radiating elements of an antenna array for electronic devices and wireless communication systems operating in the millimeter-wave band

An innovative design is presented of a metamaterial inspired antenna array for millimeter-wave band applications where non-mechanical beam-steering is required such as in 5G and 6G communications, automotive and radar systems. In communication systems beam-steering antennas can significantly improve signal-to-noise ratio, spatial directivity, and the efficiency of data transmission. However, in tightly packed arrays the effects of mutual coupling between the radiating elements can severely limit the array’s performance. The proposed antenna array consists of a 3×3 matrix of patch radiators that are tightly packed and interconnected to each other. Rows of radiators are demarcated by a horizontal microstrip transmission-line whose ends are short-circuited to the ground-plane. This technique reduces unwanted surface waves that contribute to undesired coupling. Embedded in the square patch radiators is a rhombus shaped slot that increases the effective aperture of the antenna with no impact on the antenna’s size. As the antenna is excited via a single feedline the edge-to-edge spacing between the radiators and the interconnected feedlines are made such that there is phase coherency at the radiating elements. Measured results show that the effectiveness of the proposed array in simultaneously improving its impedance bandwidth and radiation characteristics. The measured peak gain and radiation efficiency are 13.6 dBi and 89.54%, respectively

Design and performance evaluation of a novel metamaterial broadband THz filter for 6G applications

Terahertz (THz) radiation, which has applications in the imaging of objects, non-destructive testing, satellite communication, medical diagnostics, and biosensing, has generated a great deal of attention due to its remarkable properties. This paper proposes a novel broadband filter for THz applications. The main idea is to overcome the insertion loss and bandwidth issues by modeling a frequency-domain finite difference method and guided-mode resonance (GMR). The optimal design scheme of the wideband pass filter based on the circular resonant ring is discussed by comparing the transmission parameters under various parameters. This scheme overcomes the restriction of the narrow passband bandwidth of the prior THz filters and achieves approximately 3 dB bandwidth of 0.54 THz. The proposed THz filter paper also has the advantages of a straightforward structure, low processing costs, and ease of conformal with other structures, and it can be used for stealth fighters, new communication technology, and precise instruments. In addition, when compared to existing models, the suggested filter offers higher 3 dB BW operation, increased transmittance, low insertion loss, and stable performance at various oblique angles

Genetic diversity and multiplicity of infection in Fasciola gigantica isolates of Pakistani livestock

Fasciola spp. are responsible for over 3 billion US dollars of production loss annually in livestock and cause widespread zoonotic disease. Nevertheless, understating of the emergence and spread of the trematode species is poor. The multiplicity of F. gigantica infection and its spread is potentially influenced by multiple factors, including the abundance of suitable intermediate hosts, climatic conditions favouring the completion of the parasite's lifecycle, and translocation of infected animals, or free-living parasite stages between regions. Here we describe the development of a ‘tremabiome’ metabarcoding sequencing method to explore the numbers of F. gigantica genotypes per infection and patterns of parasite spread, based on genetic characteristics of the mitochondrial NADH dehydrogenase 1 (mt-ND-1) locus. We collected F. gigantica from three abattoirs in the Punjab and Balochistan provinces of Pakistan, and our results show a high level of genetic diversity in 20 F. gigantica populations derived from small and large ruminants consigned to slaughter in both provinces. This implies that F. gigantica can reproduce in its definitive hosts through meiosis involving cross- and self-breeding, as described in the closely related species, Fasciola hepatica. The genetic diversity between the 20 populations derived from different locations also illustrates the impact of animal movements on gene flow. Our results demonstrate the predominance of single haplotypes, consistent with a single introduction of F. gigantica infection in 85% of the hosts from which the parasite populations were derived. This is consistent with clonal reproduction in the intermediate snail hosts.[Display omitted]•To confirm the species identity of recovered Fasciola spp.•To identify the presence of single or multiple genotypes per infection (multiplicity of infection)•Demonstrate the spread of F. gigantica mt-ND-1 haplotype