Structural and mechanical characterization of custom design cranial implant created using additive manufacturing

Background: Reconstruction of customized cranial implants with a mesh structure using computer-assisted design and additive manufacturing improves the implant design, surgical planning, defect evaluation, implant-tissue interaction and surgeon's accuracy. The objective of this study is to design, develop and fabricate cranial implant with mechanical properties closer to that of bone and drastically decreases the implant failure and to improve the esthetic outcome in cranial surgery with precision fitting for a better quality of life. A customized cranial mesh implant is designed digitally, based on the Digital Imaging and Communication in Medicine files and fabricated using state of the Art-Electron Beam Melting an Additive Manufacturing technology. The EBM produced titanium implant was evaluated based on their mechanical strength and structural characterization. Results: The result shows, the produced mesh implants have a high permeability of bone ingrowth with its reduced weight and modulus of elasticity closer to that the natural bone thus reducing the stress shielding effect. Scanning electron microscope and micro-computed tomography (CT) scanning confirms, that the produced cranial implant has a highly regular pattern of the porous structure with interconnected channels without any internal defect and voids. Conclusions: The study reveals that the use of mesh implants in cranial reconstruction satisfies the need of lighter implants with an adequate mechanical strength, thus restoring better functionality and esthetic outcomes for the patients.

Fertilization rate and its determinants in intracytoplasmic sperm injection

Objective: To identify predictors of fertilization rate in patients of unexplained infertility after intracytoplasmic sperm injection [ICSI]

Methods: Retrospective analysis of females [282] enrolled in quasi experimental design for ICSI at "Islamabad Clinic Serving Infertile Couples" was carried out from July 2013 till June 2014. Females with unexplained infertility were included, whereas well defined male and female causes of infertility were excluded. Fertilization rate [FR] was calculated as percentage transformation of micro injected oocytes into two pronuclei. Categorical variable of FR defined on the basis of 50% FR grouped females; Group I with FR ?50% and Group II with FR >50%. The groups were compared in terms of demographic variables, base line hormones and oocyte parameters. Univariate logistic regression was executed to obtain odds ratio with 95% confidence interval to quantify the association of predictors like age, duration of infertility, oocytes parameters, hormones; Estradiol, progesterone, follicle stimulating hormone [FSH], luteinizing hormone, prolactin and cytokines interleukin-Ibeta [IL-Ibeta] with the FR

Results: In our study out of 282 females, 19 [6.73%] were in group I and 263 [93.26%] comprised of Group II. Females with high FR[group II] had low Progesterone and FSH [p=0.04,p=0.02] respectively. Mature oocytes [OR: 0.35; 95% CI 1 - 2.56] and IL-Ibeta in follicular phase [OR: 1.04; 95% CI: 0.000- 1.20] were significant positive predictors of FR while peak progesterone and FSH had significant negative effect on it

Conclusion: Fertilization of oocytes in females of unexplained infertility depended on maturity of oocytes and optimal amounts of ILI- beta released by developing follicles in the follicular phase of stimulation cycles of ICSI

Non opaque foreign body aspiration in children: should we be more vigilant and proactive?

To study the frequency of symptoms, composition and complications of clinically suspected non radio-opaque foreign body aspiration; which is a difficult diagnostic challenge resulting in delayed referral for bronchoscopy. This descriptive analysis of 400 cases of foreign body aspiration was done in the department of ENT and Head and Neck surgery. Lady Reading Hospital Peshawar from 2003-2006. One hundred cases were selected with presumptive diagnosis of foreign bodies in tracheobronchial tree. The inclusion criteria were not witness and non radio-opaque foreign bodies. We reviewed their hospital record to ascertain history diagnosis and treatment. Age, sex, location in tracheobronchial tree, witnessed or un-witnessed events, symptoms, radio graphic findings, anatomical abnormalities noted at endoscopy and complications were recorded. Radio opaque foreign bodies were excluded from the study. A total of hundred cases were included. Age range was from 2-5 years. Males were 70% and females were 30%. Delay in presentation was from 10 days to 4 years. Common symptoms at presentation were cough 55% and asthma 20%. Radiological findings were abnormal in 90% of cases. Upon bronchoscopy 70% were positive for foreign body and 30% were negative. Peanuts [30%] and whistles [28%] were the commonest foreign bodies. No death occurred in this study and minor complications of the procedure were only 15%. Aspiration of foreign bodies in children can lead to serious morbidity if not recognized and treated in time; hence early referral is essential

Changing trends in prevalence of different Plasmodium species with dominance of Plasmodium falciparum malaria infection in Aligarh (India)

OBJECTIVE@#To determine the prevalence of malaria in Aligarh and analyze species dominance in different years over a decade.@*METHODS@#Diagnosis of malaria was done using microscopy as gold standard, rapid antigen detection assays and quantitative buffy coat (QBC) assays. Giemsa stained blood smear examination was done, thick and thin films were examined for presence of different Plasmodium spp. Rapid antigen detection assays employing detection of HRP-2 and parasite lactate dehydrogenase antigen (pLDH) by immunochromatography was done in patients whose blood smear found to be negative by conventional Giemsa slide examination. QBC was done in cases where there is strong clinical suspicion of malaria with blood smear negative, in patients with chronic malaria, splenomegaly, or in those patients who had inadequate treatment and for post-treatment follow up.@*RESULTS@#Plasmodium vivax and Plasmodium falciparum were only species detected in our hospital. Overall prevalence of malaria in Aligarh was found to be 8.8%. The maximum prevalence of 20.1% was observed in year 2008 and lowest 2.3% in 2002.@*CONCLUSIONS@#High prevalence of malaria is observed in this part of country with dominance of both species particularly Plasmodium falciparum should be monitored and factors accounting for occurrence should be studied to employ effective control measures.

Intrathecal anti-tetanus human immunoglobulin in the treatment of neonatal tetanus

To determine the outcome of tetanus in neonates treated with intrathecal tetanus immunoglobulin in terms of mortality and hospital stay. Experimental study. Paediatric Unit I, Bahawal Victoria Hospital, Bahawalpur, from April 2004 to December 2007. Seventy neonates with diagnosis of neonatal tetanus were included in the study. The neonates with fits due to causes other than tetanus were excluded. Thirty five patients received intrathecal immunoglobulin in addition to standard treatment [group A] while, the other 35 patients received only standard treatment [group B]. The mortality and duration of hospital stay in 2 groups were recorded. In group A, mean duration of hospital stay was 10 days while, in group B it was 13 days [p<0.001]. One patient from group A and 8 patients from group B expired [p=0.026]. The occurrence of refractory fits, repeated apnoeic episodes and high grade fever did not show any statistically significant difference in the 2 groups. Intrathecal anti-tetanus immunoglobulin in addition to the standard improved the outcome of neonatal tetanus in terms of mortality and hospital stay

Intracranial complications of chronic suppurative otitis media

To study the presentations of various intra cranial complications of chronic suppurative otitis media [SOM]. This prospective and descriptive study was conducted in the department of ENT, Lady Reading Hospital Peshawar from April 2006 to march 2007. All the cases with suspected intra cranial complications were admitted to the department and assessed clinically and radiologically. Audiological, and laboratory investigations were done as well. Out of 50 cases 36 were male and 14 female ranging from 10-40years in age. Complications like meningitis and brain abscesses were more common in males in the 2[nd] and 3[rd] decade of life [72%]. Most of the complications were from atticoantral diseases. The main presenting features were foul smelling otorrhea, headache, and fever, neck stiffness, chloestosteatoma and granulations in the ear. Meningitis [46%], temporal lobe abscess [36%] and extra dural abscess [14%] were the commonest complications. Burr hole aspiration, for intra cranial abscess and radical/modified radical mastoidecomy for SOM were the main surgical procedure carried out for these patients. Otogenic intra cranial complications like meningitis and brain abscesses are still common in spite of advances in the medical sciences. Complications are common in 2[nd] and 3[rd] decade of life. Meningitis is the commonest complication followed by brain abscess Burr whole aspiration with modified, radical mastoidectomy is the main stay of treatment along with parenteral antibiotics

Bilateral simultaneous fractures neck of femur: a case report and review of literature

We report a case in an elderly lady who had an epileptic convulsion and sustained bilateral simultaneous fracture neck of femur. This lady was deaf and dumb and the diagnosis was therefore delayed. The patient was initially diagnosed as flaccid paralysis and was kept under observation. After 36 hours, x-rays of hip and dorsolumber spine was done that showed bilateral simultaneous fractures of hip. Both fractures were treated with bilateral modular hip hemiarthroplasties within 24 hours of diagnosis. She made uneventful recovery