Multidisciplinary management of high-grade pediatric liver injuries.

OBJECTIVE: To present our experience of multidisciplinary management of high-grade pediatric liver injuries. INTRODUCTION: Pediatric high-grade liver injuries pose significant challenge to management due to associated morbidity and mortality. Emergency surgical intervention to control hemorrhage and biliary leak in these patients is usually suboptimal. Conservative management in selected high-grade liver injuries is now becoming standard of care. Management of hemobilia due to pseudoaneurysm formation and traumatic bile leaks requires multidisciplinary management. METHODS: A retrospective review was undertaken for patients presenting with blunt liver injuries at two tertiary care centers in Karachi, Pakistan, from March 2021 to December 2022. Twenty-eight patients were identified, and four patients fulfilled the criteria for grade 4 and above blunt liver injury during this period. RESULTS: One case with grade 4 liver injury developed hemobilia on 7th day of injury. He required two settings of angioembolization but had recurrent leak from pseudoaneurysm. He ultimately needed right hepatic artery ligation. Second patient presented with massive biliary peritonitis 2 days following injury. He was managed initially with tube laparostomy followed by ERCP and stent placement. The third patient developed large hemoperitoneum managed conservatively. One case with grade 5 injury expired during emergency surgery. CONCLUSION: Conservative management of advanced liver injuries can result in significant morbidity and mortality due to high risk of complications. Trauma surgeons need to have multidisciplinary team for management of these patients to gain optimal outcome.

The step towards environmental mitigation in Pakistan: do transportation services, urbanization, and financial development matter?

This study is a scholarly effort to broaden the existing literature on the impact of transportation services, urbanization, and financial development on ecological footprints in Pakistan. Data used in this study covers the period of 39 years from 1980 to 2018. This study adopted the QARDL model to tackle the non-linear association of variables and test their long-run stability across the different quantiles. The findings of this study indicated a significant negative association of transportation services and financial development with ecological footprints in Pakistan at almost all quantiles whereas, the urban population was found to be positively associated with the ecological footprint in Pakistan. Results also justify the existence of the EKC hypothesis in the scenario of Pakistan. Policymakers are advised to frame strategies for investors to invest more in eco-friendly projects to curtail the ecological footprints in Pakistan. Minimizing the dependency of the transportation sector on fossil fuel, and increased use of energy-efficient appliances in the urban population would be beneficial to control the negative influence on ecological footprints in Pakistan.

TRAIL and guardian angel of genome integrity: ATM boards TRAIL blazer.

Prostate cancer is a multifaceted progressive multistep disorder that arises because of accumulation of genetic and epigenetic abnormalities, which escort to the transformation of normal cells into malignant derivatives. Despite tremendous strides have been made in the understanding of prostate cancer biology, yet approaches towards cancer-targeted therapy still face confrontations in standardization. This review brings to attention, the regulators in complex genetic backgrounds to enlighten our understanding of transformation and metastasis in human systems. Recent evidence gives a clue that prostate cancer may be linked to deregulated DNA damage repair processes, as various combinations of targeted deletions in genes controlling cell-cycle checkpoints; apoptosis and DNA repair result in prostate cancer progression and aggressiveness. An insight of the orchestration between DNA damage-based molecular responses and TRAIL provides an understanding of the mechanisms that cause apoptosis and may provide rationale for the development of novel therapeutic strategies.

Modification of Mathieu procedure to repair anterior hypospadias.

OBJECTIVE: To assess the results of one-stage repair of anterior hypospadias using modified Mathieu procedure. DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Department of Paediatric Surgery, Dow Medical College and Civil Hospital Karachi, from September 1997 to December 2003. PATIENTS AND METHODS: All the patients with anterior hypospadias without or with minimal chordee were included. Patients with hypoplastic urethra or re-do surgery were excluded. Modified Mathieu repair was performed in all cases. The modifications used were interrupted inverting sutures of 5/0 polyglycolic acid for urethroplasty; neourethra covering with subcutaneous (dartos) pedicle flap, developed from the preputial or penile shaft skin and dorsal / anterior meatotomy for meatal stenosis. RESULTS: A total of 69 patients with anterior hypospadias were operated using modified Mathieu s repair. Only two patients (2.89%) developed urethrocutaneous fistula. Five patients developed partial devitalisation of the covering skin while one patient had complete breakdown. CONCLUSION: Modified Mathieu s procedure is an effective method, to repair the anterior hypospadias without or with minimal chordee.