Post partum headache: a case series

Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein  thrombosis , NCCT followed by MR venogram  revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

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

Copy + Paste : The Legacy of Sameness

In the eyes of many contemporary urban planners and theorists, our current approach to housing exists as an unfortunate amalgamation of corporate ideals and social stratification. To many artists and creatives, it represents a stale repetition of uninspired nothingness. From capitalism, transnationalism, and alienation; to greed, envy, and security; there are countless motivators, both internal and external, that have dictated the way in which we have shaped the world around us. It can be observed at every scale, from single-family dwellings to major comprehensive developments. While the claims of an enterprise-driven homogeneity are certainly valid, there is another perspective that doubtlessly factors into how we have actualized our built environment. I grew up in an East Vancouver neighbourhood that typified copy and paste housing. I was the child of immigrant parents who didn’t quite fit in. Yet still, we hold those years in high regard with a fondness and sense of pride that is unquestionably related to place. Though we did not always look or act like our neighbours, the apparent resemblance of our respective dwellings provided us with an intangible, but definite social capital. Particularly, for a group of outsiders seeking integration and involvement, the neutrality that is inherited by likeness served as an unspoken, but nevertheless invaluable tool of inclusion. As such, this thesis turned from an eager scrutinization of the principal disconnect between space-making and desire into a sympathetic defence. An inquiry on how we might leverage the evolving legacy of architectural sameness in a manner that equally engages nonpartisanship, symbiosis, and enterprise.Applied Science, Faculty ofArchitecture and Landscape Architecture (SALA), School ofUnreviewedGraduat

Morphometric Analysis of Adult Human Vertebrae: An Institutional Based Study

Background: The vertebral column is composed of Vertebrae and intervertebral discs. It stretches right from the skull extending upto coccyx. The vertebral body is made up of trabecular bone (comprised of red marrow) surrounded by compact bone layer. Posteriorly and inferiorly, the spinous process projects from vertebral arch. T12 vertebra is exclusive in the sense that it marks the transition from thoracic to the lumbar vertebra. Hence; the present morphometric study was planned for assessing the adult human vertebrae.Materials &amp;Methods: A total of 40 dried human lumbar vertebras were collected. Vertebra with presence of congenital anomaly, disfigured or distorted structure was excluded. Pedicle height and pedicle width of all the specimens were measured. Pedicle height was assessed by measuring points just opposite each other on the upper and lower margins of the Pedicles in the vertical plane. Pedicle width was assessed by measuring the points on the medial and lateral surfaces of each Pedicle at right angle to the long axis of Pedicle.Results: A total of 40 dried human lumbar vertebras were collected. Mean lumbar vertebra height of L1, L2, L3, L4 and L5 was 5.11 mm, 15.56 mm, 14.95 mm, 13.95 mm and 13.65 mm respectively. Mean lumbar vertebra width of L1, L2, L3, L4 and L5 was 8.39 mm, 8.93 mm, 9.42 mm, 10.45 mm and 12.08 mm respectively.Conclusion: A constant increase in the mean pedicle width along with decrease in pedicle height is seen lumbar vertebra in the present study

A Cross Sectional Analysis of Correlation of Heart Diameter and Cardio-Thoracic Ratio with Body Habitus for Evaluating Cardiac Enlargement: An Institutional Based Study

Background: The present study was conducted for assessing the correlation of Heart Diameter and Cardio-Thoracic Ratio with Body Habitus for Evaluating Cardiac Enlargement. Materials &amp; Methods: A total of 100 subjects were enrolled for the present study. All the patients were within the age range of 20 to 65 years. A postero-anterior chest radiograph was obtained followed by transverse Thoracic Diameter measurement. The transverse diameter of heart was the sum of maximum projections with the right and left heart borders. Heart Diameter and Cardio-Thoracic Ratio with Body Habitus was assessed. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Results: Mean CTR among subjects with less than 30 years of age, 30 to 50 years of age and 51 to 65 years of age was 42.1%, 44.6% and 46.2% respectively. Mean HD among subjects with less than 30 years of age, 30 to 50 years of age and 51 to 65 years of age was 11.8 cm, 12.8 cm and 14.6 cm respectively. Mean CTR among males and female subjects was 43.2% and 44.1% respectively. Mean HD among males and females was 12.3 cm and 13.2 cm respectively. Mean CTR among subjects with BMI of less than 25 Kg/m2, 25 to 29.9 Kg/m2 and 30 &amp; above Kg/m2 was 44.6%, 45.9% and 46.1% respectively. Mean HD among subjects with BMI of less than 25 Kg/m2, 25 to 29.9 Kg/m2 and 30 &amp; above Kg/m2 was 12.3 cm, 13.9 cm and 14.1 cm respectively. Conclusion: Age was found to be significant predictor of cardiac enlargement as measured by Heart Diameter and Cardio-Thoracic Ratio with Body Habitus. Although non-significant, gender and BMI were also found to show considerable association with cardiac enlargement

Minipterional Transsylvian Approach for Resection of a Cavernous Malformation in the Optic Chiasm

Optic chiasm cavernous malformations (CMs) are rare. Patients with these CMs typically present with progressive vision loss and are treated via microsurgical resection. We present a middle-aged man with a CM of the optic chiasm and right optic nerve treated via microsurgical resection. We used a minipterional-transsylvian approach. The CM capsule was incised at the lateral surface of the optic chiasm, and the lesion was entered. The malformation was debulked and resected in a piecemeal fashion. A plane was developed circumferentially around the CM borders to separate it from the surrounding neural tissue until removal was complete. At 6-week follow-up, the patient reported stabilized vision in his right eye, and a transient postoperative deficit in his left eye had fully resolved. Postoperative magnetic resonance imaging showed that gross total resection was achieved. Optic apparatus CMs are approached using technical principles similar to brainstem CM resections