Association of Extradural Hematoma with Linear Skull Fracture: a Clinical Study of 79 Cases in a Teaching Institute

Objectives: To determine the frequency of extra dural hematoma in patients with linear skull fracture due to head injury.Material and Methods: This cross-sectional study was conducted in the Department of Neurosurgery, Mardan Medical Complex, Mardan from June 2016 to May 2017. Patients of either gender with linear skull fracture and above 2 years of age were included in the study, while patients with bleeding disorder or on anti-coagulants and those presenting 72 hours after injury were excluded from the study. Patient’s demographic profile, type of injury, location of injury and CT findings were recorded and documented on pre designed proforma. Data was analyzed using SPSS version 20.0Results: Out of 79 patients, 55 (70%) were male and 24 (30.3%) were female. Age ranged from 2 years to 60 years (mean 33 years ± 2.54 years). Among these patients the most common cause of head injury was road traffic accident in 44 (55%), followed by fall from height in 20 (25.3%) and assault in 10 (12.6%) of patients. The most commonly fractures skull bone was parietal in 38 (48%) of patients, followed by temporal bone in 21 (26.5%), frontal in 12 (15.1%), and occipital in 8 (10%) of patients. The frequency of extradural hematoma in linear skull fracture was 21 (26.5%).Conclusion: There is strong association of extradrual hematoma with linear skull fracture, therefore a fully conscious person having head injury with skull fracture should be highly suspected for intracranial hematoma

Variables that Predict Significant Intracranial Damage in Mild Head Injury

Objective: To identify patients, at risk of intracranial complications, after mild head injury.Study Design: It was an observational study.Place and Duration: Patients received at the emergency department or OPD or referred to Pakistan institute of Medical Sciences, Islamabad were included in the study. Pakistan institute of Medical Sciences is a tertiary care hospital that recruits patients from Punjab and northern areas. The data was collected over a period of six mon-ths from 1st August 2008 till 31st January 2009. A total of 206 patients were included in our study.Methodology: Data were analyzed relating to a consecutive series of 206 patients who presented to the emer-gency department of Pakistan Institute of Medical Sciences, Islamabad. Data was collected through non-pro-bability convenience sampling. Characteristics studied, were age, gender, mode of trauma, level of consciousness and CT scan brain findings.Result: Our study included 206 patients with mild head injury. Their age ranged from 1 to 90 years with a mean age of 32.06 19.86 years. Maximum patients (59 patients 28.6%) were in the age range of 21 – 30 years. Only 34 (16.5%) patients were above 50 years of age and 26 (12.6%) were below the age of 10 years.163 (79%) were males and remaining 43 (21%) were females. 124 (60.2%) were due to road traffic accidents, 62 (30.1%) were due to falls, 18 (8.7%) were assault injuries and 2 (0.9%) were sports injuries. All patients had a GCS score of 13 – 15; with a mean score of 14.35 0.902. Majority of the patients (132 patient, 64%) had a GCS of 15, 14 (6.8%) had a GCS of 14 and 60 (29%) had a GCS of 13. 127 (61.7%) patients presented with vomiting after head injury and 79 (38.3%) patients did not vomit. 49 (23.8%) vomited once and 78 (37.9%) vomited on multiple occasions. CT scan was done without contrast in all patients. It was reported as normal in 68 (33%) patients, 39 (18%) had extradural hematoma, 15 (7.3%) had subdural hematoma, 4 (1.9%) showed intracerebral hemor-rhage, 30 (14.6%) had cerebral contusion, 6 (2.9%) had subarachnoid hemorrhage, 20 (9.7%) had diffuse axonal injury and 9 (11.7%) patients had skull fracture.Conclusion: Our study was conducted to derive and validate a set of criteria that could be used to identify patients with minor head injury in whom CT could be forgone. It concluded that men, in their twenties, suffered from mild head injury, most commonly from a road traffic accident and were more likely to have an intracranial surgical lesion, such as an extra dural haematom

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

On-site microextraction technologies for the comprehensive investigation of breath composition in lung cancer patients

Breath composition analysis is a fast and non-invasive alternative to commonly used methods of detecting lung cancer, such as biopsy. One issue in the study of breath composition is the availability of appropriate sampling and sample-preparation methods that are able to fully capture the gas and droplet phases of exhaled breath. In this article, we detail the application of a filter-incorporated needle-trap device (NTD) to capture gaseous compounds and droplets in breath samples. In addition, a thin-film microextraction method was also employed to conduct extractions from only the gas phase. In comparing the NTD (total concentration) and TFME (free concentration) results, it is possible to obtain a more comprehensive view of the sample, as this approach captures both the free and droplet-bound concentrations, which can in turn provide a better characterization of the cancer. Furthermore, the developed devices were applied for the on-site sampling of lung cancer patients. The complete interpretation of the results and their relationship to the state of the disease and patient health status requires a large cohort of patients and considerable medical expertise; therefore, this study focuses on method development and the application of the proposed device for fast and sensitive on-site detection of biomarkers in patients

Smart Warehouse Management System: Architecture, Real-Time Implementation and Prototype Design

The world has witnessed the digital transformation and Industry 4.0 technologies in the past decade. Nevertheless, there is still a lack of automation and digitalization in certain areas of the manufacturing industry; in particular, warehouse automation often has challenges in design and successful deployment. The effective management of the warehouse and inventory plays a pivotal role in the supply chain and production. In the literature, different architectures of Warehouse Management Systems (WMSs) and automation techniques have been proposed, but most of those have focused only on particular sections of warehouses and have lacked successful deployment. To achieve the goal of process automation, we propose an Internet-of-Things (IoT)-based architecture for real-time warehouse management by dividing the warehouse into multiple domains. Architecture viewpoints were used to present models based on the context diagram, functional view, and operational view specifically catering to the needs of the stakeholders. In addition, we present a generic IoT-based prototype system that enables efficient data collection and transmission in the proposed architecture. Finally, the developed IoT-based solution was deployed in the warehouse of a textile factory for validation testing, and the results are discussed. A comparison of the key performance parameters such as system resilience, efficiency, and latency rate showed the effectiveness of our proposed IoT-based WMS architecture

Smart Warehouse Management System: Architecture, Real-Time Implementation and Prototype Design

The world has witnessed the digital transformation and Industry 4.0 technologies in the past decade. Nevertheless, there is still a lack of automation and digitalization in certain areas of the manufacturing industry; in particular, warehouse automation often has challenges in design and successful deployment. The effective management of the warehouse and inventory plays a pivotal role in the supply chain and production. In the literature, different architectures of Warehouse Management Systems (WMSs) and automation techniques have been proposed, but most of those have focused only on particular sections of warehouses and have lacked successful deployment. To achieve the goal of process automation, we propose an Internet-of-Things (IoT)-based architecture for real-time warehouse management by dividing the warehouse into multiple domains. Architecture viewpoints were used to present models based on the context diagram, functional view, and operational view specifically catering to the needs of the stakeholders. In addition, we present a generic IoT-based prototype system that enables efficient data collection and transmission in the proposed architecture. Finally, the developed IoT-based solution was deployed in the warehouse of a textile factory for validation testing, and the results are discussed. A comparison of the key performance parameters such as system resilience, efficiency, and latency rate showed the effectiveness of our proposed IoT-based WMS architecture

Active hepatitis C infection and HCV genotypes prevalent among the IDUs of Khyber Pakhtunkhwa

<p>Abstract</p> <p>Injection drug users (IDUs) are considered as a high risk group to develop hepatitis C due to needle sharing. In this study we have examined 200 injection drug users from various regions of the Khyber Pakhtunkhwa province for the prevalence of active HCV infection and HCV genotypes by Immunochromatographic assays, RT-PCR and Type-specific PCR. Our results indicated that 24% of the IDUs were actively infected with HCV while anti HCV was detected among 31.5% cases. Prevalent HCV genotypes were HCV 2a, 3a, 4 and 1a. Majority of the IDUs were married and had attained primary or middle school education. 95% of the IDUs had a previous history of needle sharing. Our study indicates that the rate of active HCV infection among the IDUs is higher with comparatively more prevalence of the rarely found HCV types in KPK. The predominant mode of HCV transmission turned out to be needle sharing among the IDUs.</p