Can Electronic Media Play Role in Polio Eradication in Pakistan? -secondary analysis of Pakistan Demographic and Health Survey 2012-2013

Objectives: Main objective was to find role of electronic media on received polio vaccine doses (1,2,3,0) in households in all regions of the country. The intention was to compare polio vaccination in households who had exposure to electronic media, TV and radio, with households who had no exposure to electronic media.Materials and Methods: Pakistan Demographic and Health Survey (PDHS) 2012-13, third country wide survey, data was used for the study. In the survey 14,000 households were selected (6,944 in urban areas and 7,056 in rural areas) and there were 12,943 occupied households. From these occupied households, 13,558 ever-married women and 3,134 ever married men age 15–49 were interviewed.  SPSS Multinomial Logistic Regression analyses was used to see statistical significance and to investigate the association between electronic media (radio and TV) and polio vaccine doses (1,2,3,0). A p-value of <0.05 was considered to be statistically significant.Results: Television was more effective than radio in polio vaccination. Children from households who had TV and radio received more polio vaccine doses (1,2,3,0) than children from households who had no TV and radio. Households who had television, had significantly higher polio vaccinated children, vaccination dates on cards and vaccination reported by mothers than those households who had no TV.Rural areas of the country, without radio and TV in households, have more polio unvaccinated children than urban areas. In Balochistan rural areas, households without radio had 37.7% to 76.3% and households without TV had 37.3% to 80.5% polio unvaccinated (1,2,3,0) children which is the highest deprived percentage in the country.Radio and TV were statistically significant and had association with polio vaccine doses (0,1,2,3).Conclusion:Electronic media, TV and radio, has an important role in polio vaccination and can play vital role in polio eradication in Pakistan. Proper designing and delivery of powerful media messages at proper time can create awareness about polio, change behaviour and attitude for polio vaccination

Does Early Tracheostomy Improve Outcome in Severe Head Injury?

Object:  To determine if early tracheostomy reduces the duration of mechanical ventilation, Intensive Care Unit (ICU) stay and morbidities associated with it in patients with severe head injury. Methods:  This 5-yr retrospective review included 60 ICU patients with severe traumatic head injury requiring mechanical ventilation and tracheostomy. Early tracheostomy (ET) was defined as tracheostomy within 7 days, and prolonged endotracheal intubation (EI) as endotracheal intubation for more than 7 days. Among 60 patients, 30 underwent early tracheostomy and 30 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator associated pneumonia (VAP), ICU stay and Glasgow Outcome Score (GOS). Results:  The incidence of Ventilator Associated Pneumonia (VAP) was significantly higher in prolonged Endotracheal Intubation EI group, relative to Early tracheostomy ET group (63% vs. 43%, respectively). ET group showed significantly less ventilator days (9 days vs. 12 days), ICU stay (10 days vs. 13 days), complication rate (13% vs. 18%) and mortality (10% vs.25%). Clinical outcome assessed on the basis of Glascow Outcome Score (GOS) was better in ET group. Conclusions:  In severe head injury early tracheostomy decreases total days of ventilation and ICU stay. Tracheostomy is associated with a decrease in the incidence of Ventilator Associated Pneumonia (VAP). Early tracheostomy should be considered in severe head injury patients requiring prolong ventilatory support. &nbsp

Role of neurosurgery in the management of stroke

Stroke is the second leading cause of death worldwide. The aim of treatment in stroke patients is to prevent further neurologic deterioration and prevent recurrence. Despite all advances in medical treatment, morbidity and mortality in stroke patients is still very high. The other alternative is surgical treatment, which still lacks class 1 evidence. However there is recent reconsideration of this form of treatment and ongoing trials are showing some promising results. In this review the recent advances in surgical treatment of stroke will be discussed along with recommendations from the latest randomized trials

Primary chiasmal sarcoid granuloma masquerading as glioma of the optic chiasm

A 37-year-old woman presented with a 6 months history of headaches and memory impairment. Examination showed no neurological deficit with normal vision. MRI scans showed an enlarged optic chiasm. There was no dural or leptomeningeal enhancement or hydrocephalus. Open biopsy of the suprasellar mass showed non-caseating chronic granulomatous inflammation compatible with sarcoidosis. Systemic features of sarcoid were absent. Patient showed marked improvement on steroid therapy

Craniocerebral injuries in war against terrorism --- A contemporary series from Pakistan

Objective: Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed.Methods: The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status.Results: A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints.Conclusion: The results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care

Composite split cord malformation associated with a dermal sinus tract, dermoid cyst, and epidural abscess: A case report and review of literature

Background: Split cord malformation (SCM) is typically present at a single level but rarely, may be present at multiple levels in the spinal cord and can be associated with a wide array of lesions such as myelomeningoceles, lipomas, teratomas, and dermal sinus tracts (DSTs).Case description: We describe a case of a 15-month-old female child who presented with high-grade fever and progressive motor weakness in the lower limbs. Magnetic resonance imaging revealed the presence of SCM along with an epidural abscess, DST, and dermoid cyst. The child underwent surgery for excision of DST along with removal of the dermoid cyst and drainage of epidural abscess. The postoperative course was uneventful. Elective repair of the SCM was performed 4 weeks later. The postoperative course was uneventful again.Conclusion: To the best of our knowledge, the combination of a composite SCM with a DST and dermoid cyst with associated epidural abscess has rarely been reported in literature

A Deep-Unfolded Spatiotemporal RPCA Network For L+S Decomposition

Low-rank and sparse decomposition based methods find their use in many applications involving background modeling such as clutter suppression and object tracking. While Robust Principal Component Analysis (RPCA) has achieved great success in performing this task, it can take hundreds of iterations to converge and its performance decreases in the presence of different phenomena such as occlusion, jitter and fast motion. The recently proposed deep unfolded networks, on the other hand, have demonstrated better accuracy and improved convergence over both their iterative equivalents as well as over other neural network architectures. In this work, we propose a novel deep unfolded spatiotemporal RPCA (DUST-RPCA) network, which explicitly takes advantage of the spatial and temporal continuity in the low-rank component. Our experimental results on the moving MNIST dataset indicate that DUST-RPCA gives better accuracy when compared with the existing state of the art deep unfolded RPCA networks

Feature Selection on Sentinel-2 Multi-spectral Imagery for Efficient Tree Cover Estimation

This paper proposes a multi-spectral random forest classifier with suitable feature selection and masking for tree cover estimation in urban areas. The key feature of the proposed classifier is filtering out the built-up region using spectral indices followed by random forest classification on the remaining mask with carefully selected features. Using Sentinel-2 satellite imagery, we evaluate the performance of the proposed technique on a specified area (approximately 82 acres) of Lahore University of Management Sciences (LUMS) and demonstrate that our method outperforms a conventional random forest classifier as well as state-of-the-art methods such as European Space Agency (ESA) WorldCover 10m 2020 product as well as a DeepLabv3 deep learning architecture.Comment: IEEE IGARSS 202

Prospective case control evaluation of epidural midazolam for improving pain and ambulation after microdiscectomy

Objective: To evaluate midazolam as an epidural analgesic in patients undergoing single-level microdiscectomy.Methods: This prospective case control study was carried out at the Aga Khan University Hospital, Karachi, from January 20 to September 20, 2007, on patients undergoing microdiscectomy. Cases (group A) received midazolam with saline, while controls (group B) received saline only, placed intra-operatively over involved nerve root. Post-operatively, patients were monitored for various variables. Data was analysed using SPSS 13.0 and groups were compared using student\u27s t-test for continuous variables and chi square for categorical variables. P-value \u3c0.05 was considered significant.Results: Patients in group A ambulated earlier (p = 0.005) and although they did not show significantly better post-operative pain control, but post-operative nausea and vomiting (PONV) score was better at six hours (p = 0.020). There was no difference in other variables such as requirement of analgesics, anti-emetics, hospital stay and complications.Conclusion: Midazolam may improve post-operative nausea and vomiting score, and may lead to earlier ambulation, without affecting patient\u27s vitals, consciousness, lower extremity power or sensations, and is not associated with adverse effects