Functional outcome of anorectal malformations and associated anomalies in era of krickenbeck classification

Abstract OBJECTIVE: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. METHODOLOGY: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. RESULTS: There were 84 children in study group. Most common associated anomaly was cardiac (38%), followed by urological anomaly (33%). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76%) cases. The most common fistula was rectourethral (33%), followed by recto vestibular (31%). According to Krickenbeck classification, continence was achieved in 62% children; however 27% children were constipated, followed by 12% children having fecal soiling. CONCLUSION: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38%) and genitourinary abnormalities (33%)

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma

Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive.Methods: The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis.Results: Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p\u3e0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up.Conclusions: Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed sonography is positive

Pediatric laparoscopic surgery; initial experience from Pakistan; first 100 cases in single center

Abstract In a developing country like Pakistan, laparoscopic surgeries are not considered favourable by many, possibly because of high costs or a lack of expertise. It is an established fact that laparoscopic surgery offers better surgical treatments with a shorter hospital stay and fewer complications. The current retrospective study was conducted at a tertiary care hospital in Karachi and comprised of laparoscopy cases performed by a single surgeon from March 2012 to September of 2014. A total of 100laparoscopic surgeries were performed; mostly appendectomies 49(49%) and undescended testes (UDTs) 34(34%). Overall, there were 70(70%) male patients. The mean age of the patients was 7.1 years and standard deviation (SD) of 2. Four (4%) patients had cellulitis. Laparoscopy paediatric surgery offered advantages of fewer wound-associated complications, less incisional pain, a shorter recovery time, and improved cosmesis

Efficacy of Insecticides against Fall Armyworm, Spodoptera frugiperda (Lepidoptera, Noctuidae) in Maize

Fall armyworm (FAW), Spodoptera frugiperda (Lepidoptera: Noctuidae) is most destructive specie of genus Spodoptera for several agricultural crops. In Pakistan\u27s Sindh province, the invasive fall armyworm Spodoptera frugiperda was first documented causing serious maize damage in 2019. There is need to develop management strategies against this pest in the country. The current study was conducted to check the toxicity of different insecticides against FAW in maize field. The results showed among tested insecticides, deltamethrin was recorded most toxic insecticide followed by chlorantraniliprole and emamectin benzoate. At 1d days after first spray, least number of larvae were recorded with deltamethrin (0.07 larvae/plant), chlorantraniliprole (0.11d larvae/plant) and emamectin benzoate (0.13 larvae/plant). After three days application of first spray, significantly a minimum number of larvae were recorded with deltamethrin (1.11bcd larvae/plant) chlorantraniliprole (1.13d larvae/plant) and emamectin benzoate (1.17d larvae/plant). The maximum and minimum population of larvae was recorded at 1st day of first spray and 14 days of spray, respectively. The least number of larvae were recorded at 14 days of second spray. At 14 days after 2nd spray, 0.07ab, 0.10e and 0.10de larvae per plant were recorded with deltamethrin, chlorantraniliprole and emamectin benzoate, respectively

Isolated splenic abscess in children, role of splenic preservation

Purpose: Splenic abscess (SA) is rare life threatening clinical condition in children. Diagnosis is delayed because of its non-specific clinical presentation. It has a high mortality rate even in the era of antibiotics. This study aim to determine the role of splenic preservation in the management of isolated splenic abscess in children, and to compare different treatment modalities for it.Methods: A retrospective cross-sectional study of 20years was conducted including all children Splenic abscess . We have excluded all splenic abscesses occurring after penetrating or blunt abdominal trauma.Results: Total of 17 children were managed during the study period. Most of our patients were older than 10years of age. Majority of patients had a significant delay in presentation. Fever, abdominal pain, and vomiting were the main mode of presentation. Splenomegaly on abdominal examination was present in 12 patients. 15 (88%) children were managed conservatively; however, 2 children required surgical intervention.Conclusion: Splenic abscess in children is a rare disease and its diagnosis is often delayed. Delay in diagnosis of SA in children can lead to life threatening complications. A high index of suspicion is needed to reduce delay in diagnosis. Children presenting with non-specific high grade fever vomiting and abdominal pain should be evaluated for SA. Timely ultrasound and CT scan will lead to earlier diagnosis. A conservative approach with intravenous antibiotics and early percutaneous drainage especially in immunocompetent children can preserve spleen to continue immune function

Prevalence of Blood-Borne Viruses in Health Care Workers of a Northern District in Pakistan: Risk Factors and Preventive Behaviors

Background. Blood-borne viral infections like viral hepatitis are highly prevalent in Pakistan. There is also a potential threat of human immunodeficiency virus (HIV) spread in the country. Health care workers (HCWs) are a high risk population for acquiring such viral infections and potential spread to the patients. This study aimed to determine the frequency of three blood-borne viruses: HCV, HBV, and HIV in HCWs of district Malakand in northern Khyber Pakhtunkhwa (KPK) province of Pakistan. Moreover, risk factors and preventive behaviors among HCWs were investigated in detail. Materials and Methods. Prevalence was investigated using serological assays followed by real time polymerase chain reaction (RT-PCR) based characterization. A total of 626 health care workers working at 17 different health care units, belonging to 6 different job categories, were included in this study. Results. HIV was not detected in the HCWs while rate of prevalence of HCV and HBV was far less (0.8 % and 0.64 %, resp.) as compared to general population (4.7%–38%). The majority of HCWs were aware of the mode of spread of these viruses and associated risk factors. Needle stick injury was found to be the most important risk factor for possible acquisition of these infections

Expired Pharmaceutical Drugs as Tribopositive Material for Triboelectric Nanogenerator

The disposal of expired pharmaceutical drugs is largely unattended, which leads to massive environmental pollution. Herein, a novel strategy is demonstrated to turn expired drugs into a novel tribopositive material in a triboelectric nanogenerator (TENG). To realize the proposed method, three types of expired tablets such as paracetamol, nimesulide, and guaiphenesin are employed as tribopositive materials in TENG devices. Owing to their high electron donating capability with hydroxyl and carbonyl functional groups, these drugs reveal strong positive triboelectric potential. The proposed TENG devices yield open circuit voltages ranging from 267 to 561 V, while the short circuit current varies from 28 to 53 µA under a pneumatic air cylinder of 10 Hz. Impressively, the drug-based TENG can scavenge energy to light up to 169 commercial light-emitting diodes (LEDs). This excellent performance makes these expired drugs a promising positive tribomaterial, providing a possible solution to recycle a huge amount of pharmaceutical waste. These materials and reuse strategies are expected to aid the development of alternative sustainable energy conversion technology.</p

Histomorphometric Variations of the Placenta in Normal and Hypertensive Pregnancies

Background: Pregnancy-induced hypertension is a leading cause of deleterious changes in the placenta resulting in decreased blood supply towards the placenta. The objective of the current study was to analyze the histo-morphometric variations in the placenta of women with or without known pregnancy-induced hypertension. Methods: Cross-sectional study was carried out in the Gynecology and obstetrics section of Nazeer Hussain Medical Complex, Hyderabad in collaboration with Isra University, Hyderabad from March 2019 to August 2019. A total of 100 placentae were selected and divided into two groups (control and study groups) based on the presence or absence of hypertension in pregnancy. The observations of the control group placenta were compared with the study group placentas. All placentae were observed for morphometric and histological changes. SPSS ver. 22 was used to analyze the collected data. Results: There was an increase in the mean weight of placentae among the control group as compared to the group having known hypertension cases and the difference was statistically significant (p-value &lt;0.05). The fetoplacental weight ratio was increased among the hypertension group when compared to the statistically insignificant control group (p-value &lt;0.05). Various gross (infarction, calcification) and histological changes (hyalinised villi, intervillous hemorrhage, decreased villous vascularity) were observed in the placentae of the hypertensive group as compared to the normal group. Conclusion: The findings of the study concluded that Preeclampsia/PIH poses harmful and serious histo-morphometric variations in the placental tissues that affect fetal outcome

Ionic liquid multistate resistive switching characteristics in two terminal soft and flexible discrete channels for neuromorphic computing

By exploiting ion transport phenomena in a soft and flexible discrete channel, liquid material conductance can be controlled by using an electrical input signal, which results in analog neuromorphic behavior. This paper proposes an ionic liquid (IL) multistate resistive switching device capable of mimicking synapse analog behavior by using IL BMIM FeCL4 and H2O into the two ends of a discrete polydimethylsiloxane (PDMS) channel. The spike rate-dependent plasticity (SRDP) and spike-timing-dependent plasticity (STDP) behavior are highly stable by modulating the input signal. Furthermore, the discrete channel device presents highly durable performance under mechanical bending and stretching. Using the obtained parameters from the proposed ionic liquid-based synaptic device, convolutional neural network simulation runs to an image recognition task, reaching an accuracy of 84%. The bending test of a device opens a new gateway for the future of soft and flexible brain-inspired neuromorphic computing systems for various shaped artificial intelligence applications

Triboelectric nanogenerator based on coastal bio-waste Ulva lactuca from Jeju island for sustainable energy harvesting

In the past, the occurrence of macro alga Ulva lactuca on the coastal areas of Jeju Island, Korea, has resulted in the expansion of devastating green tides, thus affecting coastal sustainability, aesthetic appearances, and tourism activities. Taking consideration of the above scenario, substantial economic costs are required for the environmental protection of the island, and it is highly recommended to employ Ulva lactuca in an alternative useful way. Hence, this paper proposes a new strategy to utilize Ulva lactuca as a tribopositive layer in a triboelectric nanogenerator (TENG). Based on the coastal bio-waste Ulva lactuca, the fabricated TENG device generates a maximum output voltage of 875 V, output current of 52 μA, and power density of 272.72 μW/cm2. Furthermore, the device presents excellent cyclic stability with no degradation in the output voltage even after 10000 consecutive cycles at a frequency of 2 Hz. The proposed TENG is further employed to charge the various commercially available capacitors, lightning LEDs, power stopwatches, and scavenge energy from body motions. It is anticipated that the proposed TENG device will pave a new way towards Ulva lactuca management for sustainable energy harvesting and clean coastlines