Pituitary Tuberculoma

Tuberculosis rarely involves the hypothalamo-pituitary region and constitutes only 1% of the lesions involving the sellar and/or suprasellar region. Coleman and Meredith first reported pituitary tuberculosis in 1940, and only a handful of cases have been reported ever since. It may manifest as a chiasmal syndrome due to compression of the optic chiasm or as hypopituitarism due to pituitary destruction. It has a characteristic radiological appearance and can mimic a pituitary adenoma. Diagnostic procedures, such as trans-sphenoidal biopsy, are crucial for accurate diagnosis. We report a case of a 32-year male, who presented with complaints of headache and decreased visual acuity for the past 6 months. Eye examination revealed bitemporal hemianopsia. Brain MRI scan showed a mass in the sella with features suggestive of pituitary adenoma. Transcranial resection of the mass was performed; histopathology of the excised mass proved it to be a pituitary tuberculoma

School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan

Background School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting. Findings A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were 923 school injury cases. Mean age of children involved was 8.3 years (SD ± 3.3) with male female ratio 2.9:1. Most injuries occurred while playing 85.6% (n = 789); of which the most common mechanism was falls (n = 797, 86.4%). Nineteen of twenty cases were directly discharged home from the ED (N = 861). Compared to ED discharged cases, injury characteristics overrepresented in hospital admitted cases (n = 46) were age 10–14 years (65.2% vs. 40.9%, p = 0.005), male (88.6% vs. 25.9%), involved in educational activities (39.1% vs. 5.3%), injured from fire/heat (37.8% vs. 0.6%), had burns (39.5% vs. 0.9%) and head injuries (27.9% vs. 6.4%). Conclusion Falls while playing are the commonest injury mechanism in school-based injuries reported in our ED sample. School officials need to prevent these injuries. Studying injury hazards present in school environment in Pakistan might facilitate developing specific prevention strategies

Prognostic factors in patients with salivary gland malignancy: A retrospective cohort study

Our objective was to determine the factors affecting the prognosis in patients with major salivary gland malignancy presenting to Aga Khan University Hospital in Karachi. Retrospective cohort study was carried out at our center on patients diagnosed and treated for salivary gland cancers. Presentation and treatment offered was reviewed from medical charts. Telephonic interviews were conducted to assess the survival of patients who were lost to follow-up. Log rank test was used to compare the mean survival times. A total of 36 patients were included in the study. The mean age was 45.1 +/- 14.6 years. Majority were male 21 (58.3%). The most common malignancy was mucoepidermoid carcinoma (36.1%) followed by adenoid cystic carcinoma (22.2%). Node positivity, grade of tumor, radiotherapy and chemotherapy were a significant indication of survival times on log rank test

Road traffic injuries in Rawalpindi city, Pakistan.

Data on road traffic accident (RTA) injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries (n = 19 828) accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males (21.3% versus 11.4%), whereas this trend reversed for the age group 15-24 years (41.9% versus 21.7%). One-fifth of injuries were either fractures or concussion. Severity and outcome of injuries were worse for the age group 45 years and older. For every road traffic death in Rawalpindi city, 29 more people were hospitalized and 177 more received emergency department care. These results suggest the need for better RTA injury surveillance to identify preventive and control measures for the increasingly high road disease burden in this city

Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan

Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital\u27s ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR) = 4.41], when the poisoning occurred at home (OR = 21.84), and was related to self-harm (OR = 18.73) or assault (OR = 7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages

Has laparoscopic approach replaced the open technique to perform appendectomy?—evolution over more than a decade

Background: Approximately 8% of the population suffers from acute appendicitis during the second and third decade of life. Appendectomy remains the recommended treatment for patients suffering from acute appendicitis. Lack of laparoscopic surgical expertise and relatively high cost have hindered the adoption of laparoscopic approach to appendectomy especially in developing countries. Objective of our study is to report adaptation trend of laparoscopic appendectomy over a period of 12 years and lessons learnt from it.Methods: All adult patients of age 16 years and above, admitted with acute appendicitis and underwent laparoscopic appendectomy from January 01, 2004 to December 31, 2015 were included in the study. Data was entered and analyzed using SPSS version 22.Results: A total of 1,163 patients underwent laparoscopic appendectomy during the study period out of which 831 met inclusion criteria. Proportion of patients who underwent laparoscopic appendectomy as opposed to open surgery increased over time. In 2004 only 13% of the cases were attempted laparoscopically while this proportion was 100% in 2015 (P\u3c0.001). Conversion to open was done in 7% [59] cases mainly due to dense adhesions of the appendix to surrounding structures. Mean duration of surgery was 64.5 (+/−23) minutes. Overall negative appendectomy rate was 7.82%. Surgical site infection was the most common post-operative complication affecting 4.5% [37] of our patients; this included 19 (2.28%) patients with intra-abdominal abscess.Conclusions: Laparoscopic appendectomy has replaced open technique as treatment of acute appendicitis and results are favorable

Fall-related injuries in a low-income setting: Results from a pilot injury surveillance system in Rawalpindi, Pakistan

AbstractThis study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments (EDs) of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% (N=27,109) were due to falls. Children (0–15years) accounted for about two out of five of all fall-related injuries. Compared with women aged 16–45years, more men of the same age group presented with fall-related injuries (50% vs. 42%); however, compared with men aged 45years or more, about twice as many women of the same age group presented with fall-related injuries (16% vs. 9%, P<0.001). For each reported death due to falls (n=57), 43 more were admitted (n=2443, 9%), and another 423 were discharged from the EDs (n=24,142, 91%). Factors associated with death or inpatient admission were: aged 0–15years (adjusted odds ratio [aOR]=1.35), aged 45years or more (aOR=1.94), male gender (aOR=1.15), falls occurring at home (aOR=3.38), in markets (aOR=1.43), on work sites (aOR=4.80), and during playing activities (aOR=1.68). This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites

Electric Discharge Machining of Ti6Al4V ELI in Biomedical Industry: Parametric Analysis of Surface Functionalization and Tribological Characterization

The superior engineering properties and excellent biocompatibility of titanium alloy (Ti6Al4V) stimulate applications in biomedical industries. Electric discharge machining, a widely used process in advanced applications, is an attractive option that simultaneously offers machining and surface modification. In this study, a comprehensive list of roughening levels of process variables such as pulse current, pulse ON time, pulse OFF time, and polarity, along with four tool electrodes of graphite, copper, brass, and aluminum are evaluated (against two experimentation phases) using a SiC powder-mixed dielectric. The process is modeled using the adaptive neural fuzzy inference system (ANFIS) to produce surfaces with relatively low roughness. A thorough parametric, microscopical, and tribological analysis campaign is established to explore the physical science of the process. For the case of the surface generated through aluminum, a minimum friction force of ~25 N is observed compared with the other surfaces. The analysis of variance shows that the electrode material (32.65%) is found to be significant for the material removal rate, and the pulse ON time (32.15%) is found to be significant for arithmetic roughness. The increase in pulse current to 14 A shows that the roughness increased to ~4.6 µm with a 33% rise using the aluminum electrode. The increase in pulse ON time from 50 µs to 125 µs using the graphite tool resulted in a rise in roughness from ~4.5 µm to ~5.3 µm, showing a 17% rise