Results of Conservative Management of CSF Rhinorrhea in Post Traumatic Patients

Objectives:  We aimed to see the results of conservative management of CSF rhinorrhea in post-traumatic patients. Material and Methods:  An observational study was conducted on 50 patients for 3 months from 1st November 2021 to 31th Jan 2022. Patients presented to neurosurgery unit II, PINS. All patients had a history of road traffic accidents (RTA). Results:  The age range was 10 – 50 years. The mean age was 25 years. All patients were managed conservatively for one week. We advised complete bed rest to all patients for 2 weeks. Head ends of all patients were slightly inclined from 15 – 30 degrees to reduce pressure in basal cisterns. We gave acetazolamide, mannitol, antibiotics, and anti-epileptic medication to all patients. CSF rhinorrhea in our 43 (86%) patients was stopped completely. In our 5 (10%) patients, CSF rhinorrhea was cured completely after doing a lumbar puncture with drainage of CSF and with the placement of a lumbar drain at a rate of 10 ml per hour. In our 2 (4%) patients, CSF rhinorrhea was not cured. We have to do surgery either by trans cranial or endoscopic repair of CSF rhinorrhea. Conclusion:  CSF rhinorrhea is best cured by conservative management except in 4% of cases

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

WaveletBased Despeckling of Synthetic Aperture Radar Images Using Adaptive and Mean Filters

Abstract—In this paper we introduced new wavelet based algorithm for speckle reduction of synthetic aperture radar images, which uses combination of undecimated wavelet transformation, wiener filter (which is an adaptive filter) and mean filter. Further more instead of using existing thresholding techniques such as sure shrinkage, Bayesian shrinkage, universal thresholding, normal thresholding, visu thresholding, soft and hard thresholding, we use brute force thresholding, which iteratively run the whole algorithm for each possible candidate value of threshold and saves each result in array and finally selects the value for threshold that gives best possible results. That is why it is slow as compared to existing thresholding techniques but gives best results under the given algorithm for speckle reduction. Keywords—Brute force thresholding, Directional smoothing, Direction dependent mask, undecimated wavelet transformation

Impact of Active Physiotherapy Rehabilitation on Pain and Global and Functional Improvement 1–2 Months after Lumbar Disk Surgery: A Systematic Review and Meta-Analysis

Introduction: Lumbar disc surgery is a common procedure for patients with lower back pain associated with lumbar disc herniation. This study aims to evaluate the impact of active physiotherapeutic rehabilitation on global/functional improvement and subjective pain score reduction among patients 1–2 months following lumbar disc surgery. The outcomes of this study are to assess the impact of active physiotherapeutic rehabilitation on functional improvement and subjective improvement in pain behavior post active rehabilitation. The outcomes are measured as pain assessed using the visual analog scale, global measurement of improvement, back pain functional status, and return to work. Methods: Databases, including MEDLINE/PubMed (10 June 1996, 2022), Web of Science (10 June 1997, 2022), Scopus (15 March, 10 June 2004, 2022), CINAHL Plus (10 June 1961, 2022), and Cochrane (10 June 1993, 2022) were reviewed without any language restrictions. All studies were systematically screened; however, only randomized controlled trials were eligible against the inclusion/exclusion criteria. All statistical tests were conducted in Review Manager (RevMan) 5.4. The quality of studies was appraised using the grading of recommendations assessment, development, and evaluation (GRADE) approach and the risk-of-bias 2 (RoB 2) tool. Results: Fifteen articles were identified, enrolling a total of 2188 patients, where the majority of active rehabilitation interventions continued for 3 months. All these interventions began 1–2 months postoperatively, and quantitative findings were presented as mean scores. The subjective pain scores were significantly lower in the interventional group, with a mean difference (MD) of −7.01 (p = 0.004). The pain disability score was considerably lower in the interventional group, with an MD of −3.94 (p = 0.002). Global improvement was higher in the interventional group (OR = 1.94, p = 0.0001). Conclusions: This study presents significant improvement in all parameters concerning pain and functionality. Postoperative rehabilitation requires optimization concerning timing, duration, intensity, and associated components to benefit patients post lumbar disc surgery

A Robust Method for Encrypted Data Hiding Technique Based on Neighborhood Pixels

Informatio

Experimental Investigation of Strength and Stiffness Characteristics of Hot Mix Asphalt (HMA)

AbstractRutting is a common phenomenon on pavements in Pakistan. Resilient modulus is one the important properties used in the mechanistic analysis of pavement response under dynamic traffic loads as well as used to study the rutting behavior of pavement. This research study investigates the effect of specimen diameter, bitumen grade and compactive effort on the resilient modulus (stiffness) and Indirect tensile strength (Strength) of asphalt concrete. The analysis of experimental results revealed that both the strength and stiffness values for Polymer Modified Bitumen grade were greater than that of unmodified penetration grade bitumen. Similarly, the resilient modulus and indirect tensile strength values of specimens prepared with 100mm diameter and compacted with Marshall Hammer were more than that of specimens prepared with 150mm diameter and compacted with gyratory compactor. This research will help the highway agencies in modifying their design methods for asphalt concrete pavements