Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.Case description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient\u27s neurological status did not improve, and he died following a complicated clinical course.Conclusion: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization

Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder. Case Description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient’s neurological status did not improve, and he died following a complicated clinical course. Conclusion: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization. </jats:sec

Spinal cord hemangioblastomas with a focus on clinical presentation, diagnosis, and treatment at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review

Background: Hemangioblastomas are benign neoplasms that consist of stromal cells and small blood vessels. They are highly vascular tumors and can arise throughout the central nervous system. This study aims to provide an overview of our experience with this rare tumor’s presentation, radiology, histopathology, and outcomes as literature regarding this pathology is sparse from our country. Methods: The study is a retrospective review of cases that were histopathology proven cases of spinal cord hemangioblastomas. The clinical characteristics of these patients were examined, and their presentation was recorded. The radiology was also reviewed to describe classic appearance on magnetic resonance imaging. A detailed review of immunohistochemistry was also performed and outcome was described. Results: A total of 25 cases of spinal hemangioblastomas were found in our records in the period of 2001–2019. There were 20 males (80%) and only 5 female patients (20%). Gross tumor fragments ranged in size from 0.24 cm2 to 10.5 cm2 (mean 3.28 ± 2.65). Histologically, tumor was composed of nests of large stromal cells with clear to vacuolated cytoplasm separated by thin-walled capillaries. Focal intratumoral hemorrhage was noted. No significant cytological atypia or mitotic figures were noted. Immunohistochemical stains were performed to confirm the diagnosis and exclude other tumors. Inhibin was tested in 20 cases and it was positive in 16 cases (80%). Neuron-specific enolase was positive in 6/8 cases. Cluster of differentiation (CD) CD68 was positive in 6/6 cases and vimentin in 4/4 cases. Glial fibrillary acidic protein (GFAP) and epithelial membrane antigen were performed in 14 and 8 cases, respectively, and all were negative. Cytokeratin AE1/AE3 was negative in 13/13 cases. CD34 highlighted vasculature in the 8 cases in which it was performed and was negative in tumor cells. Follow-up was available in 17 out of 25 cases and ranged from 12 months to 216 months (mean 61.8 ± 60.6 months). Recurrence occurred in 2 out of 17 (11.7%) patients for whom follow-up information was available. Conclusion: Our experience shows that spinal cord hemangioblastomas can be surgically removed in most cases with a low risk of recurrence. Most patients in our study were male and unlike other studies, none of our cases showed GFAP positivity. </jats:sec

Key determinants of quality in the pharmaceutical supply chain

PurposeEmpirical studies on the supply chain quality management (SCQM) of the pharmaceutical sector are scarce and scattered. This paper investigates a set of key quality determinants in the pharmaceutical sector to offer a holistic quality control framework for its supply chain (SC).Design/methodology/approachA mixed-method design was used. A focused group discussion with seven pharmaceutical SC managers summarized the narratives of the SCQM in this sector and helped to develop a questionnaire. The survey data were collected from the managers of 299 pharmaceutical firms.FindingsThe statistical results show the key determinants are leadership (LS), customer focus (CF), process integration and management (PIM), supplier relations (SR), quality practice (QP), human resource practices (HRP) and safety (SF). Unlike many other sectors, in the pharmaceutical SC, logistics and inventory costs have been proved to be not as important as other measures in the eyes of the SC managers and as part of SCQM performance measures, which can be a result of the priority systems influenced by the World Health Organization standards.Originality/valueThe study is distinctive in its scope as is carried out in a developing country with focus on concept of SCQM with reference to pharmaceutical SC. It shows great potential for further studies and improvements in logistics and warehousing in this sector, for the interest of the pharmaceutical SC managers and regulators who aim to ensure safety and quality in the health-care sector.</jats:sec

Risk Factors Causing Unintentional Home Injuries in Children Under 5 Years of Age Presenting to Emergency Department of Ziauddin University Hospital

Objective: To determine the predisposing factors contributing to unintentional home injuries in children under 5 years of age presenting to Emergency department of Ziauddin medical university and hospital, Karachi Place and duration of study: The study is conducted at Department of Emergency, Ziauddin Medical University and Hospital, Karachi And the duration of study is 13th October 2019 To 12th April 2020. It is a cross-sectional study design having having 200 patients, in which non-probability consecutive sampling technique is used. Material and Method: There were 200 patients in total with Injuries that happened at home environment. Mothers participated in an interview. After each child received the recommended care, data were gathered.Calculated descriptive statistics were used. Stratification was used to manage effect modifiers. The chi-square test was used after stratification. P-values lower than 0.05 were regarded as significant. Results: There were 46% male and 54% female patients. Mean age was 35.02±13.79 months. Most of the children were injured &gt;3 times in last one month. 57% patients were found with injury due to falling down while most of the injuries (32.5%) were occurred at stairs. In our study, 39% of children caused injury due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Practical implications: From the standpoint of injury prevention, this study suggests that the risk of non-fatal injury in children under the age of five is complicated and multidimensional, and that effective prevention measures must target numerous components. To effectively increase children's comprehension of the safety issue and lower their risk of hazard, health care providers, parents, or both should design alternative strategic teaching methods. Conclusion: Most prevalent cause of injury was falling down. 39% children injured due to lack of care, 11.5% due to availability of hazardous material and 49.5% due to unsafe home environment. Keywords: Unintentional Home injuries, Children, predisposing factors, falling down, Injuries</jats:p

Dielectric and impedance spectroscopy of K+-doped MgAl₂O₄ nanoparticles

In this study, the dielectric response of Potassium (K[Formula: see text])-doped magnesium aluminates nanoparticles (Mg[Formula: see text]K[Formula: see text]Al2O4, x = 0.0, 0.25, 0.5, 0.75, 1.0) have been investigated as a function of frequency (20 Hz to 2 MHz) at room-temperature. Interestingly, the behavior of dielectric constant indicated the ionic or space charge polarization in the low-frequency range and it remains almost constant at high frequency. However, the value of conductivity increases at higher frequencies which is consistent with the previously reported results for the parent compound MgAl2O4. Moreover, the Cole–Cole plots represent various relaxation phenomena reflecting the existence of grain (boundaries) resistance effects. </jats:p

Synthesis, Characterization and Photocatalytic Activity of MoS2/ZnSe Heterostructures for the Degradation of Levofloxacin

Antibiotics have been extensively used over the last few decades. Due to their extensive usage and persistence in the environment, they are considered as emergent pollutants. It is, therefore, important to synthesize new materials for efficient antibiotic degradation. Herein, we report the MoS2/ZnSe heterostructures prepared by a simple ultrasonication method. Heterostructures were prepared with different ratios of MoS2 and ZnSe, i.e., 1:3, 1:1 and 3:1. Characterization of the heterostructures was done by UV-vis diffused reflectance spectroscopy (UV-vis-DRS), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and photoluminescence (PL) techniques to understand the morphology and surface chemistry. The results show that an efficient interface was formed to harness the visible light and degrade levofloxacin, which was monitored by gradual decreases in the UV-vis absorbance signal of levofloxacin. Among the prepared heterostructures and their pure counter parts, MoS2/ZnSe 3:1 (3:1 MZ) showed a better degradation activity of 73.2% as compared to pure MoS2 (29%) and ZnSe (17.1%) in the presence of visible light in a time span of two hours. The reusability studies showed that the catalytic performance of 3:1 MZ did not decrease significantly after three cycles. Moreover, the morphology and the crystal structure also remained unchanged.</jats:p

Key determinants of quality in the pharmaceutical supply chain

PurposeEmpirical studies on the supply chain quality management (SCQM) of the pharmaceutical sector are scarce and scattered. This paper investigates a set of key quality determinants in the pharmaceutical sector to offer a holistic quality control framework for its supply chain (SC).Design/methodology/approachA mixed-method design was used. A focused group discussion with seven pharmaceutical SC managers summarized the narratives of the SCQM in this sector and helped to develop a questionnaire. The survey data were collected from the managers of 299 pharmaceutical firms.FindingsThe statistical results show the key determinants are leadership (LS), customer focus (CF), process integration and management (PIM), supplier relations (SR), quality practice (QP), human resource practices (HRP) and safety (SF). Unlike many other sectors, in the pharmaceutical SC, logistics and inventory costs have been proved to be not as important as other measures in the eyes of the SC managers and as part of SCQM performance measures, which can be a result of the priority systems influenced by the World Health Organization standards.Originality/valueThe study is distinctive in its scope as is carried out in a developing country with focus on concept of SCQM with reference to pharmaceutical SC. It shows great potential for further studies and improvements in logistics and warehousing in this sector, for the interest of the pharmaceutical SC managers and regulators who aim to ensure safety and quality in the health-care sector.</div

Efficient Photoelectrochemical Water Splitting by Tailoring MoS2/CoTe Heterojunction in a Photoelectrochemical Cell

Solar energy conversion through photoelectrochemical water splitting (PEC) is an upcoming promising technique. MoS2/CoTe heterostructures were successfully prepared and utilized for PEC studies. MoS2 and CoTe were prepared by a hydrothermal method which were then ultrasonicated with wt. % ratios of 1:3, 1:1 and 3:1 to prepare MoS2/CoTe (1:3), MoS2/CoTe (1:1) and MoS2/CoTe (3:1) heterostructure, respectively. The pure materials and heterostructures were characterized by XRD, UV–vis-DRS, SEM, XPS, PL and Raman spectroscopy. Photoelectrochemical measurements were carried out by linear sweep voltammetry and electrochemical impedance spectroscopic measurements. A maximum photocurrent density of 2.791 mA/cm2 was observed for the MoS2/CoTe (1:1) heterojunction which is about 11 times higher than the pristine MoS2. This current density was obtained at an applied bias of 0.62 V vs. Ag/AgCl (1.23 V vs. RHE) under the light intensity of 100 mW/cm2 of AM 1.5G illumination. The enhanced photocurrent density may be attributed to the efficient electron–hole pair separation. The solar to hydrogen conversion efficiency was found to be 0.84% for 1:1 MoS2/CoTe, signifying the efficient formation of the p-n junction. This study offers a novel heterojunction photocatalyst, for PEC water splitting.</jats:p