Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy.

OBJECTIVE: Acute subdural hematoma (ASDH) stands as a significant contributor to morbidity after severe traumatic brain injuries (TBI). The primary treatment approach for patients experiencing progressive neurological deficits or notable mass effects is the surgical removal of the hematoma, which can be achieved through craniotomy (CO) or decompressive craniectomy (DC). Nevertheless, the choice between these two procedures remains a subject of ongoing debate and controversy. MATERIALS AND METHODS: We conducted a comprehensive literature review, utilizing prominent online databases and manually searching references related to craniotomy and craniectomy for subdural hematoma evacuation up to November 2023. Our analysis focused on outcome variables such as the presence of residual subdural hematoma, the need for revision procedures, and overall clinical outcomes. RESULTS: We included a total of 11 comparative studies in our analysis, encompassing 4269 patients, with 2979 undergoing craniotomy and 1290 undergoing craniectomy, meeting the inclusion criteria. Patients who underwent craniectomy displayed significantly lower scores on the Glasgow Coma Scale (GCS) during their initial presentation. Following surgery, the DC group exhibited a significantly reduced rate of residual subdural (P = 0.009). Additionally, the likelihood of a poor outcome during follow-up was lower in the CO group. Likewise, the mortality rate was lower in the CO group compared to the craniectomy group (OR 0.63, 95% CI 0.41-0.98, I2 = 84%, P = 0.04). CONCLUSION: Our study found that CO was associated with more favorable outcomes in terms of mortality, reoperation rate, and functional outcome while DC was associated with less likelihood of residual subdural hematoma. Upon further investigation of patient characteristics who underwent into either of these interventions, it was very clear that patients in DC cohort have more serious and low pre-op characteristics than the CO group. Nonetheless, brain herniation and advanced age act as independent factor for predicting the outcome irrespective of the intervention.

A triangulation model for assessment of change in classroom behavior of medical teachers participating in faculty development program on lecturing skills.

BACKGROUND & AIMS: We utilized a triangulation method of a faculty development program's (FDP) evaluation comprising short-course workshops on classroom behaviors and lecturing skills of basic sciences faculty in a medical school. METHODS & RESULTS: This study utilized data from the pre and post evaluation of classroom lectures by an expert observer. Course participants were observed before the inception of a 4-month FDP and after 6-months of program completion. Findings at 6-month post-FDP interval were supplemented with students' and participant's self-evaluation. Expert evaluation of 15 participants showed that more participants were summarizing lectures at the end of their class (p = 0.021), utilizing more than one teaching tool (p = 0.008) and showing a well-structured flow of information (p = 0.013). Among the students, majority (95.5%, n = 728) agreed on "teachers were well-prepared for the lecture", however, a low number (66.1%, n = 504) agreed on "teachers were able to make the lecture interesting". On self-evaluation (n = 12), majority of the participants (91.7%, n = 11) thought these FDP workshops had a positive impact on their role as a teacher. CONCLUSIONS: Gathering feedback from multiple sources can provide a more holistic insight into the impact of an FDP and can provide a robust framework for setting up future FDP targets.

Incorporating Heterogeneous Features into the Random Subspace Method for Bearing Fault Diagnosis.

In bearing fault diagnosis, machine learning methods have been proven effective on the basis of the heterogeneous features extracted from multiple domains, including deep representation features. However, comparatively little research has been performed on fusing these multi-domain heterogeneous features while dealing with the interrelation and redundant problems to precisely discover the bearing faults. Thus, in the current study, a novel diagnostic method, namely the method of incorporating heterogeneous representative features into the random subspace, or IHF-RS, is proposed for accurate bearing fault diagnosis. Primarily, via signal processing methods, statistical features are extracted, and via the deep stack autoencoder (DSAE), deep representation features are acquired. Next, considering the different levels of predictive power of features, a modified lasso method incorporating the random subspace method is introduced to measure the features and produce better base classifiers. Finally, the majority voting strategy is applied to aggregate the outputs of these various base classifiers to enhance the diagnostic performance of the bearing fault. For the proposed method's validity, two bearing datasets provided by the Case Western Reserve University Bearing Data Center and Paderborn University were utilized for the experiments. The results of the experiment revealed that in bearing fault diagnosis, the proposed method of IHF-RS can be successfully utilized.

Optimization of ranitidine hydrochloride based on stability performance in directly compressible immediate and sustained release formulations.

Ranitidine hydrochloride (RTD), a moisture-sensitive drug, has issues of stability during shelf life especially when formulated through wet granulation method. In current study, RTD was blended with non-hygroscopic excipient like ethyl cellulose and compressed using direct compression method. The physical and physicochemical characteristics were evaluated including hardness, thickness, diameter, friability, weight variation, disintegration, dissolution and accelerated stability study to optimize findings. Subsequently, the optimized formulation was characterized for Fourier Transform Infrared (FTIR) analysis and in vitro drug release kinetics. The physical characterization was unaffected by polymer variation while the friability and weight variation were within the USP limits. In vitro drug release depicted that the release rate was sustained by increasing the amount of ethyl cellulose, with a 10% increase of ethyl cellulose 99.09% drug was released. FTIR analysis exhibited no interaction among the ingredients of the optimized formulation (E2). The optimized formulation followed Hixson-Crowell release kinetics. Formulation A5 displayed immediate release characters as plain uncoated formulation. Accelerated studies showed no significant change in the drug content. The RTD was successfully sustained to be released up to 6 h and accelerated stability showed that the optimized formulation (E2) containing 4% starch 1500 and 10% of ethyl cellulose, respectively, was stable up to 6 months.

Pre and post characterization of ODTs with emphasis on compression force and quality of super-disintegrants: In vivo analysis in healthy volunteers.

Oral dispersible tablets (ODTs) are patient compliant dosage forms which rapidly disintegrate in the mouth following active absorption with rapid onset of action. The current study was designed to resolve compression problems used for ODTs, as high compression force exhibited hardness and drug release problems. Formulations, F1-F9 were compressed at three different forces 44, 54 and 64 kN using cross-carmellose sodium (CCS) and sodium starch glycolate (SSG) and evaluated for pre and post compression. Formulations F1, F4 and F7 which were compressed at 44 kN showed hardness ranges between 5.09-6.15 with lowest DT (less than 15 s) and better LTZ release. While F2, F5 and F8 (compressed at 54 kN) demonstrated hardness in between 6.90-7.02. Similarly, F3, F6 and F9 compressed at 64 kN showed hardness values between 8.70-8.98 with increased DT and slow LTZ release. Friability results for all the formulations were within United States Pharmacopeial (USP) specifications (<1%). All formulations depicted t-test value <0.5, hence it found that all formulations showed significant statistical value within limits, however best compression force 44 kN showed low p value. It was concluded that optimized compression force for ODTs was 44 kN among all employed forces that exhibited desirable drug release.

Role of microRNAs in non-functioning pituitary adenoma.

Non-functioning pituitary adenomas account for 30% of anterior pituitary tumours. Based on their inability to secrete hormones, these are often diagnosed incidentally or due to pressure symptoms. Understanding the pathogenesis of these adenomas can provide insight into factors leading to its progression and serving as biomarkers for early recognition. A literature search was performed in the current narrative review for articles published in PubMed for the last 10 years till January 2020 on micro-ribonucleic acid involved in the pathogenesis of non-functioning pituitary adenomas. Of the 478 articles found, 21(4.4%) were filtered. In total, 106 micro-ribonucleic acids were identified, 25(23.5%) of which appeared in more than one study. Among them, 7(28%)were up-regulated, 11(44%) down-regulated, and 7(28%) were either up- or down-regulated. Micro- ribonucleic acids allow the screening, diagnosis and treatment of diseases in a relatively easy and inexpensive manner. This can revolutionise tumour management in the years ahead, especially in resource-constrained low- and middle-income countries.

Ilizarov fixator pin site infection: A comparison between transverse wires and half pins.

OBJECTIVE: To evaluate the difference in the infection rates between Ilizarov wires and half-pins in routine practice. METHODS: This was an observational, prospective; single-centre study approved by the institutional ethics committee. Hundred cases were treated from June 2014 to May 2018 at Ilizarov Surgery Unit, Department of Orthopaedic Surgery & Traumatology Liaquat University of Medical & Health Sciences Jamshoro Sindh Pakistan. All patients were subjected to an evaluation of half-pins and Ilizarov wires. Patients with monolateral fixators were excluded from the study. The demographic data included patient's age and sex, surgical indication, application and removal of Ilizarov fixator, follow-up duration and type of pin (transverse wire or half pin) used. Non probability consecutive sampling technique was used and sample size was calculated randomly. RESULTS: Of the total 100 cases, 79(79%) were male and 21(21%) were female with a mean age of 42.8±8.2 years. A total of 890 pins were applied in 100 patients with 170(19.10%) Half pins and 720(80.89%) wires. The transverse wire's infection rate according to Paley's grading system of Pin tract infection was, 46(53.48%), 25(29.06%) and 15(17.44%) in Grade I, Grade II and Grade III respectively. In case of half pin's infection, the majority of the cases were categories in grade II 22(55.0%) followed by Grade I 12(30.0%) and Grade III 06(15.0%). CONCLUSIONS: The tensioned transverse wires had a significantly low infection rate as compared to half pins.

Unexplained anemia: A case report of metachronous adenocarcinoma arising in the transverse colon following right hemicolectomy for a primary cecal carcinoma.

Metachronous colonic carcinomas arise from months to years after the resection of the first or index primary colorectal cancer. They are not a result of tumor recurrence or metastasis and likely arise as a result of the field cancerization effect. This report presents the case of a 63-year-old male patient without family history of a colorectal cancer but had an index primary adenocarcinoma of the cecum (stage IIIC) five years ago that was treated with surgical resection and adjuvant radiotherapy and chemotherapy. He presented with fatigue and anemia of 6-month duration secondary to recurrent melena, and the specific cause of which remained obscure despite intensive diagnostic workup. Recurrence of a malignancy at the previous anastomosis site was ruled out. The patient continued to have recurrent and intermittent gastrointestinal bleeding until a nuclear red blood cell scan detected a bleeding spot in the epigastric region, which actually turned out to be a second primary carcinoma (stage I) arising from an adenoma in the transverse colon. The patient underwent a left colectomy with ileosigmoid anastomosis formation. During a two-month postoperative follow-up, the patient did not experience any episode of melena or anemia. Even though metachronous colon cancers rarely present with a recurrent and intermittent gastrointestinal bleeding with melena, an aggressive workup must be aimed at ruling out a second independent malignancy in patients who are in remission after an index primary colorectal cancer resection through hemicolectomy. Any neoteric lesion found on colonoscopy in such cases should be dealt with a higher degree of suspicion. Therefore, the need for surveillance colonoscopy as recommended by the National Comprehensive Cancer Network guidelines is imperative and should be practiced in resource-limited countries.

Monitoring Transepidermal Water Loss and Skin Wettedness Factor with Battery-Free NFC Sensor.

The transepidermal water loss (TEWL) and the skin wettedness factor (SWF) are considered parts of a key perspective related to skincare. The former is used to determine the loss of water content from the stratum corneum (SC), while the latter is used to determine the human skin comfort level. Herein, we developed two novel approaches: (1) determination of the TEWL and the SWF based on a battery-free humidity sensor, and (2) the design of a battery-free smart skincare sensor device tag that can harvest energy from a near field communication (NFC)-enabled smartphone, making it a battery-free design approach. The designed skincare device tag has a diameter of 2.6 cm and could harvest energy (~3 V) from the NFC-enabled smartphone. A series of experimental tests involving the participation of eight and six subjects were conducted in vivo for the indoor and outdoor environments, respectively. During the experimental analysis, the skin moisture content level was measured at different times of the day using an android smartphone. The TEWL and SWF values were calculated based on these sensor readings. For the TEWL case: if the skin moisture is high, the TEWL is high, and if the skin moisture is low, the TEWL is low, ensuring that the skin moisture and the TEWL follow the same trend. Our smart skincare device is enclosed in a 3D flexible design print, and it is battery-free with an android application interface that is more convenient to carry outside than other commercially available battery-based devices.

Open proximal & distal fractures of tibia treated with Naseer Awais External Fixator with T-clamp.

OBJECTIVE: To compare the outcome of the open proximal and distal fractures of tibia treated by Nasser Awais External Fixtator with T-clamp. METHODS: The descriptive case series was conducted from August 2009 to July 2012 at Department of Orthopaedic Surgery & Traumatology, Liaquat University of Medical & Health Sciences, Jamshoro, and comprised in-patients of open proximal and distal fractures of tibia who were divided into two equal groups: group A had distal and group B had proximal patients. All patients had extra-articular open fractures Gustilo I, II, IIIA and IIIB of proximal and distal end of tibia between 15 and 60 years of age who had arrived within 8 hours of the injury. Below-knee plaster cast was applied for 02 to 03 weeks after the removal of Nasser Awais External Fixtator and all patients were followed up for 12 months. SPSS 17 was used for statistical analysis. RESULTS: Overall, there were 30 patients; 15(50%) in each of the two groups. The mean age in group A was 28.9±9.43 years and 34.3±14.60 years in group B. There were 11(73.3%) males and 4(26.7%) females in group A, and 15(100%) males in-group B. Mean fracture union time in group A was 17.20±2.93 weeks (range: 11-23 weeks) and in group B it was 23.53±2.44 weeks (range: 19-28 weeks). Ankle joint stiffness occurred in 2(6.7%) cases that were in group A, and knee joint stiffness was seen in 2(6.7%) cases and they were in group B. CONCLUSIONS: Nasser Awais External Fixator with T-Clamp was a safe technique and promoted the union with a low complication rate with less union time in distal tibial fracture compared to proximal fracture.

Foreign body in the liver: Case report and review of literature.

Foreign bodies in the liver, although rare, have been described previously in the literature. While more common in children, adults may also swallow foreign bodies that can reach the liver by penetrating the stomach, duodenum or colon. We describe the case of a young lady who accidentally swallowed a needle, which was later found in the liver by abdominal X-ray and computed tomography (CT). It was removed intact by laparoscopy. A foreign body in the liver is a rare occurrence. Radiology is important in diagnosis through modalities including plain X-ray, ultrasonography and abdominal CT. Removal can be achieved by laparotomy or laparoscopy.

Risk factors for intraventricular haemorrhage in preterm infants from a tertiary care hospital of Karachi, Pakistan.

OBJECTIVE: To determine the incidence of Intraventricular Haemorrhage in pre-term infants, along with adverse neonatal outcomes associated with the disease. METHODS: The retrospective case control study was conducted at Aga Khan University Hospital, Karachi, and comprised patients' records from January 2004 to December 2009 of preterm babies from 26-35 weeks of gestation who had Intraventricular Haemorrhage of any grade. The diagnosis was confirmed by ultrasound scan. Controls were preterm births matched with the cases according to gestational age (±1 week) and birth weight (±150 grams). SPSS 19 was used for statistical analysis. RESULT: Of the total 201 preterm babies in the study, there were 67(33.33%) cases and 134(66.66%) controls; the respective ratio being 1:2.The incidence of Intraventricular Haemorrhage in the study population was 22.1 per 1000 live births.The odds of developing Intraventricular Haemorrhage was substantially higher in babies with respiratory distress syndrome (odds ratio: 3.77; 95% Confidence Interval: 1.52-9.37; p < 0.004) and who were given mechanical ventilation (odds ratio: 23.6; 95% Confidence Interval: 5.09-109.5; p < 0.001). There was a four-fold increase in risk of Intraventricular Haemorrhage in babies who received surfactant administration (odds ratio: 4.26; 95% Confidence Interval: 1.77-10.22; p < 0.001). Out of 67 cases, 50 (74.6%) re-demonstrated the same grade, 13 (19.4%) were resolved, and 4 (6%) progressed. Overall, there were 38 death; the mortality rate being 56.71. CONCLUSION: The risk of Intraventricular Haemorrhage was substantially higher in preterm neonates with respiratory distress syndrome, etc., and the mortality rate was higher in babies with severe disease.

Unveiling the enigma: A challenging case of protein C deficiency concealed by fever and epistaxis.

Protein C deficiency is a rare genetic disorder caused by mutations in the protein C, inactivator of coagulation factors Va and VIIA gene, affecting approximately 1 in 200-500 individuals. It leads to a hypercoagulable state, increasing the risk of blood clots. Symptoms vary with age, ranging from life-threatening purpura fulminans in neonates to venous thromboembolism, particularly deep vein thrombosis, in adults. A recent case involved a 21-year-old South Asian male presenting with persistent fever, weight loss, epistaxis, abdominal tenderness, and acute pain in the right thigh and leg, raising suspicion of deep vein thrombosis. Tests confirmed deep vein thrombosis in multiple leg veins and a pulmonary embolism. The patient was diagnosed with protein C deficiency and received anticoagulant therapy, thrombolysis, and an inferior vena cava filter. Complications of protein C deficiency include deep vein thrombosis, pulmonary embolism, stroke, and ischemic colitis. Diagnosis involves immunoassays and genetic analysis. Treatment includes heparin followed by anticoagulation therapy with warfarin. In severe cases, an inferior vena cava filter may be implanted. The described case required extensive treatment due to multiple deep vein thrombosis and a pulmonary embolism, with lifelong anticoagulant therapy. Early diagnosis and appropriate management are crucial in young patients with a history of venous thromboembolism to prevent and manage complications associated with protein C deficiency.

Effectiveness of Propranolol in Preventing Severe Retinopathy of Prematurity: A Comprehensive Systematic Review and Meta-Analysis.

PURPOSE: To learn more about the effectiveness of oral propranolol as a therapeutic alternative for preterm newborns with pre-existing retinopathy of prematurity (ROP) as well as an early prevention method for ROP, one of the most common but avoidable causes of juvenile blindness. STUDY DESIGN: Meta-analysis of relevant literature. METHODS: A total of 3464 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, finally, a total of 8 studies were deemed suitable for review. Following the PRISMA guidelines, published literature was systematically assessed up to May 10, 2023. Trials and observational studies were included in which beta blockage was used to prevent severe ROP (defined as stage ≥3 or requiring treatment). A total of 3646 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, a total of 8 studies were deemed suitable for review. RESULTS: The use of propranolol is linked to a lower risk of disease development in ROP compared to other therapies or control groups, according to the overall risk ratio of 0.59 (95% CI = 0.42, 0.82; P = .002, I2 = 41%). Additionally, the overall risk ratio for plus disease is 0.42 (95% CI = 0.23, 0.78; P = .006, I2 = 0%), for laser photocoagulation is 0.48 (95% CI = 0.31, 0.74; P = .001; I2 = 2%), and for intravitreal injection of VEGF is 0.43 (95% CI = 0.24, 0.74; P = 0.003, I2 = 0%), suggesting that use of propranolol may reduce the likelihood of developing a disease such as plus disease, requiring laser photocoagulation or necessitating intravitreal injection of vascular endothelial growth factor for ROP, respectively. No statistically significant heterogeneity was found in this study (P > .10, I2 = 50%). It can be concluded from this that the results of the chosen studies were sufficiently comparable and consistent. CONCLUSION: This study showed that oral propranolol given as a preventive treatment in premature newborns successfully prevented severe ROP. Propranolol dosage and timing must now be carefully considered in the context of the study population, as these factors may have a major impact on the observed outcomes and treatment success.