Preserving lung after traumatic transection of left lower lobe bronchus from bullet injury.

A 22-year-old soldier was shot in the left chest by a bullet from close range. He was found to have a left haemothorax and remained shocked despite aggressive resuscitation. Due to difficult terrain and night time movement restrictions, there were limitations to the transfer of patient. So he was attended at a peripheral hospital. At emergency thoracotomy, three segmental arteries to left upper lobe were ligated and haemostasis was secured. The level of transection of left lower lobe bronchus was identified to be below the origin of the apical segmental bronchus. The lower lobe bronchus was successfully re-attached and followed up with a daily bronchoscopic clearance of distal airway. The patient made a full recovery. Anastomosis of left lower lobe bronchus after traumatic transection is a viable option for preserving an amputated lobe, in trauma settings, provided haemostatic control has been adequately achieved.

Development of low-cost and high-efficiency solar modules based on perovskite solar cells for large-scale applications.

Solar energy has emerged as a viable and competitive renewable resource due to its abundance and cost-effectiveness. To meet the global energy demands, there is a growing need for efficient devices with unique compositions. In this study, we designed and analyzed a perovskite solar cell (PSC) incorporating methylammonium tin iodide (CH3NH3SnI3) as the active optical absorber material, tin iodide (SnO2) as the electron transport layer (ETL), and copper thiocyanate (CuSCN) as the hole transport layer (HTL) using SCAPS-1D software for numerical investigations. Subsequently, the optimized outcomes were implemented in the PVSyst software package to derive the characteristics of a solar module based on the proposed novel solar cell composition. The objective of our research was to enhance the stability of solar cell for use in solar module. This was achieved by optimizing the thicknesses of the compositional layers which resulted in the enhancement of excess electron and hole mobilities and a reduction in defect densities, thereby leading to an improvement in the device performance. The optimization of excess electron and hole mobilities, as well as defect densities, was conducted to improve the device performance. SCAPS calculations indicated that the perovskite absorber layer (CH3NH3SnI3) may achieve the best possible performance with a maximum optimized thickness of 3.2 µm. The optimized thickness value for CuSCN-HTL and SnO2-ETL were found to be 0.07 µm and 0.05 µm respectively resulting in a maximum power conversion efficiency (PCE) of 23.57%. Variations in open circuit voltage (Voc), short circuit current (Jsc), fill factor (FF %), and quantum efficiency (QE) associated with the optimized thickness values of all layers in the ITO/SnO2/CH3NH3SnI3/CuSCN/Mo composition were critically analyzed. The use of these input parameters resulted in power creation of 557.4 W for a module consisting of 72 cells with an annual performance ratio of 80.3%. These recent investigations are expected to be effective in the design and fabrication of eco-friendly and high-performance solar cells in terms of efficiency.

Tracheal schwannoma: a rare tracheal tumour.

Primary tracheal tumours are histologically similar but 100 times less common than main stem tumours. We report a case of primary tracheal schwannoma in a middle aged man. He had chronic cough for 2 years, and developed hemoptysis and stridor in the days preceding to presentation. He was treated by resection of the tumour and primary anatomosis of the trachea. The patient recovered well after surgery and had a near normal PEFR after one and a half year of follow-up and bronchoscopic examination excluded any recurrence.

Gastropleural fistula: an unusual sequel of blunt chest trauma.

In the October 2005 Earthquake in mountainous Azad Kashmir and adjacent areas in Pakistan, a young female sustained crush injury chest and upper abdomen. She remained hospitalized with lower chest pain. All initial investigations were normal and she was discharged symptom-free on conservative management. Six months later, she developed acute left sided chest pain and dyspnoea. Provisional diagnosis of empyema was made on X-ray, and tube thoracostomy was done. Diagnostic VATS revealed gastropleural fistula secondary to necrosis of herniated stomach. Resection of necrosed stomach, repair of diaphragm and decortication and transthoracic repair with lower thoracoplasty two months later was performed but both were unsuccessful. After another 02 months, a Roux-en-Y gastrojejunostomy at fistula site was fashioned which proved curative.

Improvised Laparostomy Pack to Manage Laparostomy for Injuries due to Improvised Explosive Devices (IEDs).

Splinters of improvised explosive devices [IEDs] cause multiple intestinal perforations and random pattern visceral injuries causing contamination of peritoneal cavity. This necessitates multiple peritoneal toilets and relook surgeries. Surgical management is to perform laparostomy to avoid life threatening complication, like abdominal compartment syndrome and fulminant sepsis. "Peshawar pack" is a three-layer temporary abdominal dressing pack for managing laparostomy. It is prepared in operation room and applied on patients with ease. Patients with abdominal injuries due to blasts of IEDs, managed with Peshawar pack during June 2014 to June 2016, were studied to determine the effectiveness and practical utility of Peshawar pack. Data was analysed by SPSS version 22. Total numbers, means +SD and frequencies with percentages were described. In fifty-five patients selected for the study, effective drainage of peritoneal cavity and control of peritoneal sepsis was achieved in all cases. Mobilisation out of bed was possible in 38 cases [70%] within 3-5 days and evisceration during mobilisation occurred in 02 cases [3.6%]. There was no case of iatrogenic gut injury. Complete fascial closure in staged manner was achieved in 53 cases [96%]. Peshawar pack is a simple, practical, and effective method for laparostomy care in abdominal injuries due to blast of IEDs.

Planned external fixation to locked intramedullary nailing conversion for open fractures of shaft of femur and tibia.

OBJECTIVE: To determine the outcome of initial external fixation and then conversion to intramedullary nailing in patients having open fracture of shaft of femur or tibia. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Combined Military Hospital (CMH), Quetta, from July 2002 to July 2004. SUBJECTS AND METHODS: Out of 59 patients with fractures of shaft of tibia and femur, 16 were selected for the study who had open fractures in Gustilio type I, II and III. They were initially managed with external fixators and later on converted to planned locked intramedullary nailing. Interlocking nailing was done on routine operation list in the third week after Ex Fix (external fixator) was removed. Record of patients was kept, and was statistically analyzed on SPSS. RESULTS: Out of the 16 patients, 12 had fractures of femur and 4 had fractures of tibia. Male to female ratio was 7:1. Mean duration of external fixation was 6.22 weeks. Six patients underwent closed interlocking nailing and 10 patients with open method. Fifteen fractures (94%) united within 6 months, and one fracture had delayed union. Two patients had superficial wound infection and one patient had deep infection. CONCLUSION: Immediate external fixation followed by early closed interlocking nailing is a safe and effective treatment for open fractures of shaft of femur and tibia.