Efficacy of Tranexamic Acid in Reducing the Blood Loss During Cesarean Section in Primigravida Patients with Breech Presentation

OBJECTIVES: The objective of the study was to evaluate the efficacy of tranexamic acid in decreasing blood loss at the caesarian section (CS). METHODOLOGY: A descriptive case series study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, Pakistan. Data were collected from September 24, 2018, to March 24, 2019. A total of 114 term women (18-35 years age)  with singleton term breech cases were analyzed for a period of six months RESULTS: In this study the mean age was 30 years with SD±2.341 and the mean period of gestation was 38 weeks with SD±4.76. Moreover, tranexamic acid was effective in 91% of patients and was not effective in 9% of patients. CONCLUSION: Our study concludes that the efficacy of tranexamic acid was 91% in reducing the blood loss during CS in primigravida patients with breech presentation

ARTERY FIRST TECHNIQUE FOR MANAGEMENT OF ABERRANT HEPATIC ARTERIAL ANATOMY DURING PANCREATICODUODENECTOMY-EXPERIENCE FROM A SPECIALIZED HEPATO-PANCREATO-BILIARY UNIT

Purpose: Aberrant hepatic arterial anatomy poses a challenge for surgeon during pancreaticoduodenectomy (PD). These anomalies are best picked up on pre-operative imaging to avoid inadvertent injury to the aberrant vasculature resulting in liver ischaemia or biliary-enteric anastomotic failure. We present our experience of dealing with aberrant hepatic vessels during PD. Methods: Patients with aberrant hepatic vasculature who underwent PD between September 2014 and August 2015 were included in the study. We used artery rst technique for dissection in cases identified on pre operative imaging. Aberrations were classed according to Hiatt classi cation. Results: A total of 23 PD were performed with aberrant arterial anatomy in 10 (43%) cases. These vessels were recognised and preserved in nine cases. In one patient, the replaced right hepatic artery (RRHA) arising from superior mesenteric artery (SMA) was coursing through pancreatic parenchyma needing resection and reconstruction with uneventful post-operative recovery. We also identified one RRHA arising from SMA coursing lateral to common bile duct and entering liver parenchyma in gallbladder fossa. Conclusion: Aberrant hepatic arterial anomalies are common and should ideally be picked up by pre-operative imaging. It is possible to preserve these vessels in most cases with careful surgical dissection using artery first technique. Surgeons performing PD should be well versed with the aberrant vascular anatomy to minimise any inadvertent damage. Key words: Aberrant hepatic artery, artery first technique, pancreaticoduodenectomy

Impact of Firm's Capital Expenditure on Working Capital Management: An Empirical Study across Industries in Pakistan

Various researchers have studied the Impact of capital expenditure on working capital management. This paper aims to analyze the impact of capital expenditure in the light of the fixed effect model on 96 listed companies with respect to working capital management. Data related to the specific time period of 2007-2010 has been focused. The impact of capital expenditure, operating expenditure and finance expenditure on working capital has been analyzed. In this connection, keeping in mind nature of the variables of the study, Net Liquidity Balance (NLB) and Working Capital Requirement (WCR) has been applied as a proxy of working capital management. Then six hypotheses were conducted in two groups. In the first group, we examine the impact of capital expenditure, operating expenditure and financial expenditure on Net Liquidity Balance and in the second group, we investigate the impact of capital expenditures, operating expenditures and financial expenditures on Working Capital Requirement. Capital expenditure has the insignificant relationship with Net Liquidity Balance and Working Capital Requirement. Operating expense has the significant negative relationship with Net Liquidity Balance and significant positive relationship with Working Capital Requirement. Finance expense has the significant negative relationship with Net Liquidity Balance and significant positive relationship with Working Capital Requirement

CLINICOPATHOLOGICAL CHARACTERISTICS OF PATIENTS WITH SYNCHRONOUS PRIMARY OVARIAN AND ENDOMETRIAL CANCERS

Purpose: Synchronous primary endometrial and ovarian cancers are infrequent. The objective of this study is to evaluate clinicopathological characteristics of synchronous endometrial and ovarian cancers treated in our institution.Materials and Methods: The clinicopathological characteristics of 12 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from July 2005 to July 2015, were reviewed retrospectively in depth from hospital database. The WHO committee classification was used for the histologic determination and staged based on International Federation of Gynaecology and Obstetrics (FIGO) staging. Results: The median age at the time of diagnosis was 50 years (range 23–66 years). The incidence of synchronous primary endometrial and ovarian cancers was 2.01% in patients with endometrial cancer. A total of seven patients were menopausal (58%) and eight patients were nulliparous (66%); the median body mass index (BMI) was 29 kg/m2 (range, 20–38). Abnormal uterine bleeding was the most common presenting symptom. According to FIGO stage, 10 cases of endometrial were Stage I/II (84%) and two cases were Stage III (16%). Of the ovarian cancers, nine cases were Stage I/II (83.3%) and two cases were Stage III (16.7%). Endometrial cancer was the main pathological type in uterine carcinoma (86%) followed by serous carcinoma (14%), and similarly, for ovarian cancer, endometrial was the most common pathology (67%) followed by serous/clear cell (16%) and mucinous (16.7%). Most endometrial and ovarian primaries in our series were Grade I and II tumours, 83% and 66%, respectively. 8 patients (66%) had similar histology in both primaries. All patients underwent surgical intervention. Only one patient did not receive any post-operative adjuvant therapy. 10 patients received platinum-based adjuvant chemotherapy and six patients received adjuvant radiotherapy. Conclusion: Synchronous primary endometrial and ovarian cancers are infrequent and distinct set of patients. Abnormal per vaginal bleed was the most common symptom which helped in early detection. Majority of the patients belong to concordant endometrial histology, low grade, had younger age and high BMI. Treatment should be tailored to the stage, histology and grade of the individual tumours. Key words: Endometrial cancer, ovarian cancer, synchronous tumour

CommuNety: deep learning-based face recognition system for the prediction of cohesive communities

Effective mining of social media, which consists of a large number of users is a challenging task. Traditional approaches rely on the analysis of text data related to users to accomplish this task. However, text data lacks significant information about the social users and their associated groups. In this paper, we propose CommuNety, a deep learning system for the prediction of cohesive networks using face images from photo albums. The proposed deep learning model consists of hierarchical CNN architecture to learn descriptive features related to each cohesive network. The paper also proposes a novel Face Co-occurrence Frequency algorithm to quantify existence of people in images, and a novel photo ranking method to analyze the strength of relationship between different individuals in a predicted social network. We extensively evaluate the proposed technique on PIPA dataset and compare with state-of-the-art methods. Our experimental results demonstrate the superior performance of the proposed technique for the prediction of relationship between different individuals and the cohesiveness of communities

PNEUMATOSIS INTESTINALIS - A RARE CLINICAL FINDING REQUIRING MULTIMODALITY TREATMENT

This is a case report of Pneumatosis intestinalis (PI), which has traditionally been associated with immediate operative intervention and a high mortality rate. We present a case of ulcerative colitis that developed Pneumatosis intestinalis and was managed at our hospital. A 29 year old male with known history of ulcerative colitis presented with an acute exacerbation. A week into his treatment, PI developed. Emergency total colectomy with end ileostomy was performed. Postoperatively, he remained critically ill and expired during same hospitalization after 45 days.Key words: Pneumatosis intestinalis, Ulcerative Colitis, Adalumima

Effect of Spectacle Centration on Stereoacuity

To determine the percentage of decentered spectacles ,the possible relationship of decentration of spectacles on stereoacuity,the difference between interpupillary distance (IPD) and optical centration distance (OCD), the relationship between decentration of spectacles and asthenopic symptoms, magnitude of prismatic effect and the direction of base of prism in decentered spectacles. Methods:A hospital based cross-sectional study conducted on the 100 students, with the age range of 18 to 26 years.Horizontal decentartion of spectacles was assessed by taking the difference between the interpupillary distance and the optical centration distance. Vertical decentration was assessed by difference between the optical centre of the spectacles and the centre of the pupils. Direction of decentration determines the prism base direction and stereoacuity was assessed by titmus fly test.Results: All individuals were using decentered spectacles in both horizontal and vertical direction. Decentration was highest (33%) in the range of 0 – 1.49 (mm) horizontally in both eyes. Vertical decentration in the range of 3 – 5 (mm) was highest, 39% in right eye and 48% in the left eye of the individuals. 56% of the individuals have horizontal prismatic effect in their spectacles in right and left eye within the range of 0 – 0.49 prism diopters. Vertical prismatic effect was within range of 0 – 0.99 prism diopters in maximum number of individuals. Majority (76%) had base-in prisms induced in their spectacles in both right and left eyes. Vertically induced prism was in the base-up direction in 87% and 90% of the individuals in their right and left eyes respectively and 8% and 7% base-down prisms in their right and left eyes respectively. Difference between IPD (inter-pupillary distance) and OCD (optical centration distance) of individuals was quite significant with p-value 0.000. The mean difference between IPD and OCD was -3.57000. Mean IPD was less than the mean OCD. Horizontal prismatic effect in right eye caused decline in the stereo-acuity with p-value 0.019. Highest number of individuals (42) had reduction of stereo-acuity within the range of 20 – 100 minutes of arc having horizontal prismatic effect in the range of 0 – 1.49 in their right eyes.Conclusions: Due to improper dispensing of the spectacles, prismatic effect is induced in the spectacles that shifts the image position formed on the retina and results in the reduction of the stereoacuity of the individuals

Model predictive control of consensus-based energy management system for DC microgrid

The increasing deployment and exploitation of distributed renewable energy source (DRES) units and battery energy storage systems (BESS) in DC microgrids lead to a promising research field currently. Individual DRES and BESS controllers can operate as grid-forming (GFM) or grid-feeding (GFE) units independently, depending on the microgrid operational requirements. In standalone mode, at least one controller should operate as a GFM unit. In grid-connected mode, all the controllers may operate as GFE units. This article proposes a consensus-based energy management system based upon Model Predictive Control (MPC) for DRES and BESS individual controllers to operate in both configurations (GFM or GFE). Energy management system determines the mode of power flow based on the amount of generated power, load power, solar irradiance, wind speed, rated power of every DG, and state of charge (SOC) of BESS. Based on selection of power flow mode, the role of DRES and BESS individual controllers to operate as GFM or GFE units, is decided. MPC hybrid cost function with auto-tuning weighing factors will enable DRES and BESS converters to switch between GFM and GFE. In this paper, a single hybrid cost function has been proposed for both GFM and GFE. The performance of the proposed energy management system has been validated on an EU low voltage benchmark DC microgrid by MATLAB/SIMULINK simulation and also compared with Proportional Integral (PI) & Sliding Mode Control (SMC) technique. It has been noted that as compared to PI & SMC, MPC technique exhibits settling time of less than 1µsec and 5% overshoot

IMPROVING PROJECT MANAGEMENT PLANNING AND CONTROL IN THE SERVICES OPERATION ENVIRONMENT BY USING THE 6S TECHNIQUE

In today's business land-scape, more is needed for companies to have a solid organizational system and values; they must also continuously improve their quality management systems to ensure zero accidents and complete safety. With intense competition among organizations to produce quality products, creating a positive and productive workplace for employees is a common challenge. Modern technology and the latest methods must be utilized to achieve desired goals and overcome industry challenges. One of the most modern and latest techniques available to organizations is the 6S methodology, which can help achieve industry goals. This study targets to assess the current level of project management planning and control, determine the awareness and understanding of the 6S methodology, and evaluate its impact on project management planning and control. We have chosen a questionnaire methodology for this quantitative research to examine the relationship between familiarity with the 6S methodology and its implementation in a service operating environment. This study will provide insights and recommendations on incorporating the 6S methodology into project management planning and control in a service operating environment. To ensure the successful implementation of the 6S methodology, organizations should provide adequate training and resources to their project management teams and encourage collaboration and communication among team members