Scalp Lipofibromatosis - A case report on comprehensive management in a two-year-old child from Pakistan.

Lipofibromatosis is a rare benign soft tissue tumor that primarily affects children. There is limited cytological description and management of this rare condition in the literature which leads to misdiagnosis. The two years old patient first presented with a big, non-tender swelling on the scalp's right temporoparietal area.

Distal positioning of the skin paddle of pectoralis major myocutaneous flap in head and neck reconstruction.

Background: To assess outcomes of pectoralis major myocutaneous flap (PMF) wherein the skin paddle (SP) was positioned with its distal portion extending beyond the lower border of pectoralis major by ≥2 cm (PMF-d).

Methods: Consecutive head and neck reconstructions with PMF-d (n = 110). SP dimensions l (distal extent below the lower border of pectoralis major), l (proximal extent above lower border of pectoralis major), and b (breadth) were recorded.

Impact of Risk Factors and Long Term Survival Analysis of Patients With Primary Refractory Hodgkin Lymphoma Who Underwent High Dose Chemotherapy and Autologous Stem Cell Transplant.

Patients with primary refractory Hodgkin lymphoma (ref-HL) can still be salvaged with high-dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT). Outcomes of patients with ref-HL is poorer than those with relapsed HL, but most studies have included patients with both relapsed and refractory diseases, and separate analyses or studies on patients with ref-HL are limited. This study aimed to evaluate the outcomes of HDC auto-SCT and impact of various prognostic factors in patients with ref-HL at the time of primary treatment failure and subsequent survival at the time of failure post-HDC auto-SCT.

The Standard Operating Procedures in COVID-19 Pandemic for Periodontal Aerosol-Generating Procedures: A Process Audit.

Objective:  This study aims to audit the process of patient management with aerosol-generating procedure (ultrasonic scaling) while adherence to the guidelines for health care workers (HCWs) during the coronavirus disease 2019 (COVID-19).

Materials And Methods:  Audits records at the Department of Periodontology at University College of Medicine and Dentistry Hospital, Lahore, Pakistan were collected (prospectively) over the period of October 1 to November 30, 2020 (1st cycle) and December 14, 2020 to February 12, 2021 (2nd cycle). The audit was divided into three components based on the guidelines: (1) physical environment, (2) patients/appointments, and (3) COVID standard operating procedures related to HCWs.

A model-based approach for detecting and identifying faults on the D.C. side of a P.V. system using electrical signatures from I-V characteristics.

With the development of distributed generation and the corresponding importance of the P.V. (photovoltaic) system, it is desired to operate a P.

A novel semi-supervised framework for UAV based crop/weed classification.

Excessive use of agrochemicals for weed controlling infestation has serious agronomic and environmental repercussions associated. An appropriate amount of pesticide/ chemicals is essential for achieving the desired smart farming and precision agriculture (PA). In this regard, targeted weed control will be a critical component significantly helping in achieving the goal.

Real-time recognition of spraying area for UAV sprayers using a deep learning approach.

Agricultural production is vital for the stability of the country's economy. Controlling weed infestation through agrochemicals is necessary for increasing crop productivity. However, its excessive use has severe repercussions on the environment (damaging the ecosystem) and the human operators exposed to it.

One-year outcomes of supersaturated oxygen therapy in acute anterior myocardial infarction: The IC-HOT study.

Background: Supersaturated oxygen (SSO ) has recently been approved by the U.S. Food and Drug Administration for administration after primary percutaneous coronary intervention (pPCI) in patients with anterior ST-segment elevation myocardial infarction (STEMI) based on its demonstration of infarct size reduction in the IC-HOT study.

Inquiring Voluntary Turnover For Female Nurses In Pakistan Through Focused Ethnography.

Background: Pakistan is a country with very low nurses to population rate. This problem becomes more prominent due to voluntary turnover; especially among female nurses. This problem could be attributed to several social and demographic factors.

Evaluation of intracoronary hyperoxemic oxygen therapy in acute anterior myocardial infarction: The IC-HOT study.

Background: In the randomized AMIHOT-II trial, supersaturated oxygen [SSO ] delivered into the left anterior descending (LAD) artery via an indwelling intracoronary infusion catheter following primary percutaneous coronary intervention (PCI) significantly reduced infarct size in patients with anterior ST-segment elevation myocardial infarction (STEMI) but resulted in a numerically higher incidence of safety events.

Objectives: The IC-HOT study evaluated the safety of SSO therapy selectively delivered to the left main coronary artery (LMCA) for 60 minutes after PCI in patients with anterior STEMI.

Methods: SSO therapy was administered to the LMCA after stent implantation in 100 patients with anterior STEMI and proximal or mid-LAD occlusion presenting within 6 hours of symptom onset.

Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation).

Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.

Safety of Electro-Medical Equipment in Floods in Austere Environment.

Pakistan is prone to floods. In 2010, floods in North-Western Pakistan caused devastation in wide areas. Electro-medical equipment is very expensive and without proper equipment adequate surgery is not possible.

Occult invasion of sternothyroid muscle by differentiated thyroid cancer.

Purpose: To determine the incidence of occult invasion of sternothyroid by differentiated thyroid cancer (DTC) and identify clinico-pathological features associated with the same.

Methods: Retrospective study of a consecutive series of DTC patients undergoing surgery, with preoperative ultrasound showing no evidence of strap muscle invasion. All had en bloc excision of sternothyroid muscle along with thyroidectomy.

Valvular Heart Disease in Adults: Infective Endocarditis.

A variety of microorganisms can cause infective endocarditis (IE) in patients with native valves. Staphylococci and streptococci are most common in community-acquired IE; staphylococci are most common in nosocomial IE. Microbiology of prosthetic valve endocarditis (PVE) depends on timing.

External Compression of Epicardial Coronary Arteries with Partial Calcific Pericarditis.

Calcific pericarditis (CP) is a rare disease which results from long-standing pericardial inflammation. Pericardial calcification may completely or partially encase the ventricles, resulting in impaired diastolic filling. We present a case of a 53-year-old male who was incidentally found to have annular CP resulting in external compression of a large territory diagonal branch (D1) reaching the apex with likely chronically occluded left anterior descending artery with collateral circulation from the right coronary artery with hemodynamic compromise on coronary angiography.

Management strategies and possible risk factors for ventricular septal defects after transcatheter aortic valve replacement: Case series from a single center and review of literature.

Development of membranous ventricular septal defects (VSD) is a rare complication of transcatheter aortic valve replacements (TAVR), and is recognized using intraoperative and postoperative imaging. We present two cases of this rare but serious complication; one was successfully managed conservatively and the other with valve-in-valve therapy. Management strategies for post-TAVR VSDs varies, but should be individualized to the clinical scenario.

Ventricular fibrillation with intracoronary adenosine during fractional flow reserve assessment.

Fractional flow reserve (FFR) measurement provides useful hemodynamic assessment of intermediate coronary stenoses affecting long term outcomes. While the gold standard remains intravenous adenosine, intracoronary (IC) bolus administration of adenosine is routinely used in clinical practice because of its ease of use and lower dose providing comparative hyperemia with the most common side effect being a transient atrioventricular block. A 62year old male underwent left heart catheterization after ruling in for non-ST elevation myocardial infarction (NSTEMI).

When we should say no to TAVR-Defining the line between utility and futility.

History of prior coronary artery bypass surgery (CABG) is a frequent scenario encountered in patients with severe symptomatic aortic stenosis deemed inoperable and referred for transcatheter aortic valve replacement (TAVR). Aside from indices of frailty and other comorbidities, these patients remain at higher risk for peri-operative mortality and morbidity compared to their counterparts without prior CABG. Presence of concomitant peripheral arterial disease and patent left internal mammary artery (LIMA) graft pose further access related challenges.

Sacrificing the buccal branch of the facial nerve during parotidectomy.

Background: The need for and consequence of sacrificing the buccal branch of the facial nerve during parotidectomy is unknown. We sought to determine the indication, frequency, and functional outcome of buccal branch sacrifice.

Methods: We conducted a prospective study of all cases of parotidectomy at a tertiary referral center.

Prospective risk factors for increased central augmentation index in men and women.

Background: Arterial wave reflections are important determinants of central pressure pulsatility and left ventricular afterload. The augmentation index (AIx) is the most widely used surrogate of arterial wave reflections. Despite multiple cross-sectional studies assessing the correlates of AIx, little prospective data exist regarding changes in AIx over time.

The role of hybrid SPECT/CT for lymphatic mapping in patients with melanoma.

Introduction: Lymphoscintigraphy in melanoma provides important information on the dynamic drainage of the primary tumour and the location of the sentinel lymph node (SLN). Unfortunately these images lack anatomical detail. Single positron emission computed tomography/computed tomography (SPECT/CT) provides extremely detailed information on the location of the SLN and its relationship with surrounding structures and it is the aim of this study to report our initial experience with this technology.

Central pulse pressure and its hemodynamic determinants in middle-aged adults with impaired fasting glucose and diabetes: the Asklepios study.

Objective: Pulse pressure (PP), a strong predictor of cardiovascular events in type 2 diabetes, is a composite measure affected by several hemodynamic factors. Little is known about the hemodynamic determinants of central PP in type 2 diabetes or whether abnormalities in central pulsatile hemodynamics are already present in individuals with impaired fasting glucose (IFG). In a population-based study, we aimed to compare central PP and its hemodynamic determinants among adults with normal fasting glucose (n = 1654), IFG (n = 240), and type 2 diabetes (n = 33).

Normative values and correlates of carotid artery intima-media thickness and carotid atherosclerosis in Andean-Hispanics: The Prevencion Study.

Objectives: Carotid intima-media thickness (cIMT) is an independent predictor of cardiovascular risk. Furthermore, ethnicity and gender-specific normative data are required to assess cIMT, which are not available for Andean-Hispanics. In addition, data regarding correlates of subclinical atherosclerosis in ethnic population are needed.