Management of penetrating injury to thoracic inlet and lower neck with retained foreign body using video assisted thoracoscopic surgery

Penetrating neck and chest injuries are a common form of occupational injuries. We hereby report a unique case in which a metallic rod had penetrated the left chest and neck of a plastic factory worker. The patient was vitally stable when he presented to Emergency Room. Chest X-ray was performed and the patient was rushed to the operating room. VATS (video assisted thoracoscopic surgery) and neck dissection was done for retrieval of the metallic rod. On table, endoscopy was also done to rule out injury to oesophagus. No injury to vital structures was found and the subsequent recovery was uneventful

Assessment of factors affecting the sleep hygiene of medical students in Bahawalpur, Pakistan: a cross-sectional study

Objective: To identify the factors which have a statistically significant association with sleep hygiene of medical students. Material and Methods: This study was done on 100 medical students. The questionnaire that was used for the collection of data had two parts. First was related to demographic variables and second was a validated Pittsburgh sleep quality index (PSQI). All participants were from the first to fifth years of Bachelor of Medicine and Bachelor of Surgery (MBBS). Data were analysed using SPSS 23. The association was found by applying chi-square test. Results: Our study revealed that out of 100 students, 61% had poor sleep hygiene (PSQI ≥ 5). Global PSQI scores among women were slightly higher than males. A statistical association was found between the residence and habit of studying at night of medical students with their sleep hygiene. Discussion: Medical students should ensure good sleep hygiene in order to maintain their academic performance, physical health, and mental health

Comparative Analysis of Antidyslipidemic Effects of Fenugreek Seed Extract and Standard Pharmacological Therapy in Diet Induced Animal Model of Dyslipidemia: An Experimental Study

Objectives: The objective of this study was to compare the antidyslipidemic effects of fenugreek seed extract in comparison to standard drugs used for dyslipidemia in an animal model of dyslipidemia. Methods: It was an experimental study conducted on 42 male, 9 weeks old Wistar albino rats for a period of 7 weeks. Animals were randomly divided into 7 groups, out of which 6 groups were given lipid rich diet to induce dyslipidemia for 28 days while one group served as control given normal diet. After 28 days standard drugs alone as well as in combinations (statins 10 mg/kg and fibrates 100 mg/kg) and fenugreek seed extract in two different doses, 250 mg/kg and 500 mg/kg were administered once a day for 21 days to all the respective groups except positive (lipid rich diet) and negative control groups (on normal diet), both were administered normal saline. Baseline body weights of all groups of animals were measured at the start of the study. At the end of the study period, body weights of all groups of animal groups were measured again and their blood was drawn through cardiac puncture for the assessment of TC, LDL-C, HDL, TGs, D/B, I/B and ALT. All the intervention groups were compared on the basis of above mentioned parameters and changes in weight. Results: Amongst all the groups, lipid parameters (TC, LDL, TGs) showed a significant reduction and increase in HDL in the group on FSE in a dose dependent manner. Moreover, FSE also showed significant decrease in the levels of liver enzymes including ALT, D/B and in body weight when compared to other groups. While we did not find any significant change for urea, creatinine and I/B amongst all the groups. Conclusion: It is concluded that the fenugreek seed extract showed superior effects when compared to traditional pharmacological therapy against dyslipidemia

Socio-demographic characteristics of children and young people with primary brain tumours: comparison between a public and private sector tertiary hospital in Karachi, Pakistan

Primary brain tumours (PBTs) are the commonest solid tumours in children and young people (CYP). A study was conducted at a private and a public sector hospital in Karachi, Pakistan, to determine the socio-demographic and tumour-related characteristics of CYP with PBTs between those presenting to the public and private hospitals. A total of 49 patients were included. The commonest PBT was pilocytic astrocytoma (29%). There were no differences in tumour-related characteristics between the two groups. However, parents of CYP with PBTs presenting to the public sector hospital were significantly less educated and had lower household incomes. No significant differences in age, gender, educational status, and ethnicity of CYP with PBTs were observed. Since CYP with PBTs presenting at the public sector hospital were from significantly lower socioeconomic backgrounds and their parents were less educated, it suggests socio-economic disparities in PBT care for CYPs in Karachi, Pakistan

Socio-demographic and antenatal risk factors of brain tumor in children and young people: A matched case-control study from Karachi, Pakistan

Background: Brain tumors are a common cause of morbidity, disability, cognitive deterioration and mortality in children, even after treatment. Little is know about the specific causes. The study aimed to assess potential socio-demographic and antenatal factors in primary brain tumor (PBTs) in children and young people (CYP) in Karachi, Pakistan. Designs and methods: A single center hospital based matched case control study in Karachi, Pakistan. Cases were defined as CYP aged between 5 and 21 years with any histological type and grade of primary brain tumor of any histology, stage or grade. Data were collected from parents of 244 patients at the selected center between 2017 and 2021 via telephonic interview. Controls were 5-21 years old CYP admitted with non-oncological diagnoses matched on age and sex. Matched Odds Ratios for predictors of brain tumor in children were derived. Those of statistical significance were included in a multivariable logistic regression model. Results: In the adjusted model, lower paternal education (matched adjusted odds ratio (maOR) 2.46; 95% CI 1.09-5.55), higher household monthly income (maOR 3.4; 95% CI 1.1-10.2), antenatal paternal use of addictive substances (maOR 19.5; 95% CI 2.1-179.8), and antenatal maternal use of analgesics during pregnancy (maOR 3.0; 95% CI 1.2-7.9) were all independently predictive of brain tumors. Conclusion: This matched case-control study found novel associations between maternal use of analgesics, paternal use of addictive substances, higher household income, and lower paternal education and Primary Brain Tumors in Children and Young People. Longitudinal multicenter studies will be required to test these associations prospectivel

An empirical mediation analysis of technological innovation based on artificial intelligence in the relationship between economic development and corporate governance mechanism

Although strong recommendations and steps have been developed and taken to adopt the latest technological trend through corporate governance reforms for improving the economic development, however, the trend toward adopting the latest technology has not been adopted and thus has remained a big issue in the non-financial sector for the last two decades around the globe. The study used GLS (random effect) regression estimator to a sample composed of 1600 firm-year observations from 2017 to 2021. The findings indicated that the majority of the firms were involved in an income-decreasing economic situation. Moreover, the findings evidenced that compliance with some specific CG attributes welcomed the technological innovation and significantly had an impact on the economic development. However, some CG attributes of the models did not play any significant role in technological innovation and economic development which needs improvement. Moreover, this study also evidenced that the impact of CG attributes is not directly affecting economic development but is mediated by the technological innovation, which is of importance to managers of a firm, who hold responsibility for investing and financing activities. In addition, this study revealed a fully significant mediating role of technological innovation in the relationship of BOD meetings, audit committee size, managerial ownership, and foreign ownership with economic development. However, no significant mediating role of technological innovation was observed in the relationship of independent BOD and economic development. All in all, the results of this study have significance for regulatory bodies, researchers, academic researchers, practitioners, publicly listed companies in Malaysia, the Bursa Malaysia and the security commission to uplift their financial performance and curb EM activities through the effective use of CG mechanisms

Hydrazinyl thiazole linked indenoquinoxaline hybrids: Potential leads to treat hyperglycemia and oxidative stress; Multistep synthesis, alpha-amylase, and antioxidant activities

A library of hydrazinyl thiazole-linked indenoquinoxaline hybrids 1-36 were synthesized via a multistep reaction scheme. All synthesized compounds were characterized by various spectroscopic techniques including EI-MS (electron ionization mass spectrometry) and 1H NMR (nuclear magnetic resonance spectroscopy). Compounds 1-36 were evaluated for their inhibitory potential against alpha-amylase, and alpha-glucosidase enzymes. Among thirty-six, compounds 2, 9, 10, 13, 15, 17, 21, 22, 31, and 36 showed excellent inhibition against alpha-amylase (IC50 = 0.3-76.6 mu M) and alpha-glucosidase (IC50 = 1.1-92.2 mu M). Results were compared to the standard acarbose (IC50 = 13.5 +/- 0.2 mu M). All compounds were also evaluated for their DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity and compounds 2, 9, 10, 17, 21, 31, and 36 showed (SC50 = 7.58-125.86 mu M) as compared to the standard ascorbic acid (SC50 = 21.50 +/- 0.18 mu M). Among this library, compounds 9 and 10 with a hydroxy group on the phenyl rings and thiosemicarbazide bearing intermediate 21 were identified as the most potent inhibitors against alpha-amylase, and alpha-glucosidase enzymes. The remaining compounds were found to be moderately active. The molecular docking studies were conducted to understand the binding mode of active inhibitors and kinetic studies of the active compounds followed competitive modes of inhibition.Sindh Higher Ed-ucation Commission (SHEC) , Pakistan SHEC/1-14/2014 SHEC/SRSP/Med-3/15/2021-

Quality of life in children operated for spina bifida; low- and middle-income country perspective

Introduction: Spina bifida is a potentially disabling congenital condition and affects the quality of life (QOL). We aimed to assess clinical outcomes and QOL in children who underwent spina bifida repair at our hospital.Methods: This was a retrospective cohort study on children who underwent spina bifida repair at our hospital over 10 years. Phone calls were made to parents of the children, and the Health Utility Index Mark 3 (HUI 3) score was used to assess QoL, and degree of disability. Demographics and clinical data were obtained from the medical chart review. Statistical analysis was done using SPSS (version 21).Results: Eighty children with a median age of 1.1 months (IQR 0.03-2.0) at the time of presentation, were included in this study. The mean follow-up period was 6.04 ± 2.54 years and the median HUI-3 score was 0.64 (IQR: 0.40 - 0.96) on a scale of 0 (dead) to 1 (perfectly healthy). Based on the severity of disability, 12 (23.1%) children had mild disability, 4 (7.7%) had moderate disability, and 23 (44.2%) had severe disability. Factors including a leaking spina bifida and paraplegia at presentation; radiological findings of hydrocephalus and Chiari malformation, were associated with a significantly low QOL. Children who required CSF diversion (EVD/ VP shunt) during the repair or at a later stage also had significantly low QOL.Conclusion: In LMIC, children with myelomeningocele (MMC) born with lower limb weakness, hydrocephalus, Chiari malformation, and those presenting with leaking MMC, have a significantly low QoL at a mean follow-up of 6 years

Proposed novel classification of circumscribed Lower-Grade Gliomas (cLGG) vs. infiltrating Lower-Grade Gliomas (iLGG): Correlations of radiological features and clinical outcomes

Purpose: We hypothesize that lower grade gliomas (LGG) can be identified and classified into two distinct subtypes: radiologically circumscribed Lower-Grade Gliomas (cLGG) and infiltrating Lower-Grade Gliomas (iLGG) based on radiological parameters and that these two different subtypes behave differently in terms of clinical outcomes.Methods: We conducted a retrospective cohort study on surgical patients diagnosed with lower grade glioma over five years. Patient records and MRIs were reviewed, and neurosurgeons classified tumors into cLGG and iLGG groups.Results: From the 165 patients in our cohort, 30 (18.2%) patients were classified as cLGG and 135 (81.8%) patients were classified as iLGG Mean age in cLGG was 31.4 years while mean age in iLGG was 37.9 years (p = 0.004). There was significant difference in mean blood loss between cLGG and iLGG groups (270 and 411 ml respectively, p = 0.020). cLGG had a significantly higher proportion of grade II tumors (p \u3c 0.001). The overall mean survival time for the iLGG group was 14.96 ± 1.23 months, and 18.77 ± 2.72 months for the cLGG group. In univariate cox regression, the survival difference between LGG groups was not significant (HR = 0.888, p = 0.581), however on multivariate regression cLGG showed a significant (aHZ = 0.443, p = 0.015) positive correlation with survival. Intense contrast enhancement (HZ = 41.468, p = 0.018), blood loss (HZ = 1.002, p = 0.049), and moderately high Ki-67 (HZ = 4.589, p = 0.032) were also significant on univariate analyses.Conclusion: cLGG and iLGG are radiologically distinct groups with separate prognoses, surgical experience, and associations

A national overview of paediatric and adolescent and young adult surgical neuro-oncology in Pakistan

Objective: To build a comprehensive brain tumour database that will allow us to analyse in detail the prevalence, demographics, and outcomes of the disease in paediatric, adolescent, and young adult age groups. Method: A national cross-sectional study was conducted at 32 centres, and data regarding patient demographics and brain tumours were collected. This data was then stratified based on age groups, healthcare sectors, socioeconomic status, tumour types, and surgical outcomes. Result: Most of the patients who were diagnosed with brain tumours belonged to a lower socioeconomic background and went to public sector hospitals. More males were diagnosed with and treated for brain tumours in the paediatric, adolescent, and young adult populations. The most common tumour in the paediatric population was medulloblastoma (23.7%) and the most common tumour in the adolescent (27.8%) and young adult population (34.7%) was glioma. Significant improvement in KPS scores were seen for: craniopharyngioma (p = 0.001), meningioma (p < 0.0005) and pituitary adenoma (p < 0.0005) Conclusion: This study shows that in all three age groups, there was a greater prevalence in males. Most of the patients belonged to a lower-middle-income class background and most patients presented to public sector hospitals. Greater knowledge of these parameters unique to each age group is the key to understanding and alleviating the burden of disease. Cancer registries, specifically brain tumour registries that keep up-to-date records of these patients, are essential to identify and keep track of these unique parameters to advance medical research and treatment strategies, ultimately lowering the disease burden. Keywords:  Pediatric, Neuro-oncology, Adolescent and young adult, AYA, Medulloblastoma, Craniopharyngioma, Epidemiology