Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

Spectrum of Breast Diseases in a Breast Clinic of a Tertiary Care Hospital

Background: To determine the pattern and clinical presentation of breast diseases in different age groups presenting to a breast clinic. Methods: It was a retrospective descriptive study which included all patients presenting to a breast clinic for three years. Age at presentation, symptoms, clinical features, investigations, operative findings and specimen reports were recorded and submitted for analysis. . Results: A total of 3568 patients were included. Mastalgia was the commonest findings (39.42%) followed by fibroadenoma(15.83%) and carcinoma of breast (12.61%). Pain in the breast was the commonest presenting symptom (40.38%). Lump in the breast was found in 22.84%, while pain and lump were present in 27.27% of patients. Among carcinoma breast, intra ductal carcinoma was the commonest (57.55%) followed by malignant phyllodes tumour (17.77%). Conclusion: Most common breast diseases presenting in our setting are mastalgia, fibroadenoma and breast carcinoma. Dedicated breast clinic in our public sector hospitals is need of time. It will help to create awareness about breast diseases among general public and will be a source to collect data about disease burden so that future policies can be streamline

Impact of Endoscopic Retrograde Cholangiopancreatography on Laparoscopic Cholecystectomy

Background: For Common Bile Duct (CBD) stones an Endoscopic Retrograde Cholangiopancreatography (ERCP) is done prior to cholecystectomy. However, the ideal timing of cholecystectomy following ERCP is still a matter of debate. The aim of the present study was to observe the possible impact of ERCP on subsequent laparoscopic cholecystectomy.Material and Methods: This case control study was carried out in the Department of Surgery Unit 1, Holy Family hospital, Rawalpindi, from January 2018 to March 2019. A total number of 300 patients of symptomatic gallstones presenting to outpatient department were enrolled. Two groups, A (control group) and B (case group) were made on the basis of absence or presence of CBD stones, respectively. Group A underwent laparoscopic cholecystectomy within three working days of admission. In group B, ERCP was performed prior to cholecystectomy. Primary operating surgeon filled structured questionnaires for each patient immediately after surgery to compare operative differences between both groups. The baseline demographic details, clinical characteristics, laboratory investigations and peri-operative findings of both groups were recorded. Means and percentages were calculated with P value <0.05 regarded as statistically significant.Results: Majority of patients in this study were females (81%) of middle age group (42.5+15 years). Biliary colic was most common presenting complaint in both groups (33%). Dissection in triangle of Calot (P=0.00) and removal of gallbladder from liver bed (P=0.00) was significantly more difficult in group B than A. Intra-abdominal lavage was also done more often in post ERCP group (P=0.00). However procedural time did not vary between the two groups (P=0.19).Conclusions: Preoperative ERCP increases difficulty in laparoscopic cholecystectomy but does not prolong procedural time.Key words: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectom

Myelodysplastic Syndrome with Transfusion Dependence Treated with Venetoclax

Myelodysplastic syndromes are characterized by ineffective hematopoiesis in one or more lineages of the bone marrow. They are a group of heterogeneous clonal stem cell malignancies with a high risk to progress to acute myeloid leukemia. Currently, there are no curative FDA-approved medications for myelodysplastic syndromes. Hematopoietic cell transplantation is potentially the only curative option; however, treatment is often unavailable due to age and comorbidities. Hypomethylating agents, azacitidine and decitabine, and the immunomodulatory agent, lenalidomide, are the only FDA approved medications for the treatment of MDS, all of which are noncurative. Venetoclax, an inhibitor of the antiapoptotic protein BCL-2 used to treat chronic lymphocytic leukemia, is currently being evaluated in clinical trials as a monotherapy in high-risk myelodysplastic syndromes/acute myeloid leukemia. We present a patient with transfusion-dependent myelodysplastic syndromes refractory to the current standard of care treatment not a candidate for hematopoietic cell transplantation who responded well to monotherapy treatment with venetoclax and has since remained transfusion-independent

Impact of Globalization on Youth: (A Case Study of Southern Punjab)

The study was conducted on the topic “Impact of Globalization on Youth (A Case Study of Southern Punjab)” with the aim to evaluate the level of awareness about globalization, positive and negative impact of globalization, impacts of changing and restructuring the social structure of the society due to global village and values changing due to globalization. For purpose of data collection interview schedule was use as tool and selects 200 respondents from four Districts of Southern Punjab by using convenient sampling technique. The results showed that the globalization has its negative effects on youth some of the effects are; values for elder decrease, people become materialistic, having love for others instead of parents, people adopting new fashion and trends due to the globalization. All these factors affect the culture and society negatively

Electron-Acoustic (Un)Modulated Structures in a Plasma Having (<i>r</i>, <i>q</i>)-Distributed Electrons: Solitons, Super Rogue Waves, and Breathers

The propagation of electron-acoustic waves (EAWs) in an unmagnetized plasma, comprising (r,q)-distributed hot electrons, cold inertial electrons, and stationary positive ions, is investigated. Both the unmodulated and modulated EAWs, such as solitary waves, rogue waves (RWs), and breathers are discussed. The Sagdeev potential approach is employed to determine the existence domain of electron acoustic solitary structures and study the perfectly symmetric planar nonlinear unmodulated structures. Moreover, the nonlinear Schrödinger equation (NLSE) is derived and its modulated solutions, including first order RWs (Peregrine soliton), higher-order RWs (super RWs), and breathers (Akhmediev breathers and Kuznetsov–Ma soliton) are presented. The effects of plasma parameters and, in particular, the effects of spectral indices r and q, of distribution functions on the characteristics of both unmodulated and modulated EAWs, are examined in detail. In a limited cases, the (r,q) distribution is compared with Maxwellian and kappa distributions. The present investigation may be beneficial to comprehend and predict the modulated and unmodulated electron acoustic structures in laboratory and space plasmas

Compressive Strength Estimation of Geopolymer Composites through Novel Computational Approaches

The application of artificial intelligence approaches like machine learning (ML) to forecast material properties is an effective strategy to reduce multiple trials during experimentation. This study performed ML modeling on 481 mixes of geopolymer concrete with nine input variables, including curing time, curing temperature, specimen age, alkali/fly ash ratio, Na2SiO3/NaOH ratio, NaOH molarity, aggregate volume, superplasticizer, and water, with CS as the output variable. Four types of ML models were employed to anticipate the compressive strength of geopolymer concrete, and their performance was compared to find out the most accurate ML model. Two individual ML techniques, support vector machine and multi-layer perceptron neural network, and two ensembled ML methods, AdaBoost regressor and random forest, were employed to achieve the study’s aims. The performance of all models was confirmed using statistical analysis, k-fold evaluation, and correlation coefficient (R2). Moreover, the divergence of the estimated outcomes from those of the experimental results was noted to check the accuracy of the models. It was discovered that ensembled ML models estimated the compressive strength of the geopolymer concrete with higher precision than individual ML models, with random forest having the highest accuracy. Using these computational strategies will accelerate the application of construction materials by decreasing the experimental efforts