Development of Wearable Textile MIMO Antenna for Sub-6 GHz Band New Radio 5G Applications.

In this paper, an irregular octagonal two-port MIMO patch antenna is designed specifically for New Radio (NR) 5G applications in the mid-band sub-6 GHz. The proposed antenna comprises an irregularly shaped patch antenna equipped with a regular 50-ohm feed line and a parasitic strip line antenna, and is partially grounded. Jeans material serves as a substrate with an effective dielectric constant of 1.6 and a thickness of 1 mm. This material is studied experimentally. The proposed antenna design undergoes analysis and optimization using the ANSYS HFSS tool. Furthermore, the design incorporates the influence of the slot on both the ground plane and the parasitic strip line to optimize performance, enhance isolation, and improve impedance matching among antenna elements. The dimensions of the jeans substrate are 40 mm × 50 mm. The simulated impedance bandwidth ranged from 3.6 GHz to 7 GHz and the measured bandwidth was slightly narrower, from 4.35 GHz to 7 GHz. The simulation results demonstrated an isolation level greater than 12 dB between antenna elements, while the measured results reached 28.5 dB, and the peak gain for this proposed antenna stood at 6.74 dB. These qualities made this proposed antenna suitable for various New Radio mid-band 5G wireless applications within the sub-6 GHz band, such as N79, Wi-Fi-5/6, V2X, and DSRC applications.

First Intracardiac Kaposiform Hemangioendothelioma in an Infant Resolved With Sirolimus: A Case Report.

INTRODUCTION: Kaposiform hemangioendothelioma (KHE) is a rare and aggressive vascular tumor that can be associated with a consumptive coagulopathy and thrombocytopenia (Kasabach-Merritt phenomenon). Only one case of an intracardiac KHE has been reported which was treated with surgical excision and then expectant management. CASE PRESENTATION: We present a patient with an intracardiac KHE which presented as a large mass surrounding the atria, pulmonary veins, superior vena cava, and infiltrating the atrial septum with moderate compression of the superior vena cava and mild compression of the pulmonary veins. This tumor clinically presented as persistent tachypnea and was unresponsive to conventional therapy with vincristine and steroids but responded dramatically to Sirolimus with almost complete regression on follow-up. CONCLUSIONS: None of the current treatments for KHE, alone or in combination therapy have been found to be effective in a uniform or reproducible manner. Well designed, preferably randomized trials are required for a better understanding of the appropriate dosage and duration as well as response to treatment and a consensus of first and second line therapies.

Intra-arterial calcifications in the recipient twin in twin-to-twin transfusion syndrome.

Pulmonary artery, and rarely aortic, calcifications have been reported in sporadic case reports in the recipient twin of twin-to-twin transfusion syndrome. This presentation is more likely to be secondary to the haemodynamic alterations in the recipient twin, but must be differentiated from idiopathic infantile arterial calcification as the clinical implications, treatment, and prognosis may be drastically different.

A morphological study of the dorsum sellae in human skull / Estudio morfológico del dorsum sellae en el cráneo humano

Anatomical variations in the shape and dimension of the dorsum sellae and posterior clinoid process are common. Most textbooks describe its shape as a median rectangular plate, a square plate, or a transverse ledge on a slope behind the sella turcica (hypophyseal fossa). This work aims to study the dorsum sellae of human skull. One hundred and twenty five dried adult human skulls, irrespective of age, were used for the study. Detailed features of the dorsum sellae were noted and classified into five types: crest like, thin plate, frail quadrilateral plate, heavy square plate, thick elongated plate. Fusion of the posterior and middle clinoid processes in one (unilateral) and all the clinoid processes (anterior, middle, and posterior) in three skulls (unilateral in one, bilateral in two) were also noticed. Findings are discussed in the light of the literature.

Son frecuentes las variaciones anatómicas de la forma y dimensión de dorsum sellae y de los procesos clinoides posteriores. La mayoría de los textos describen su forma como una placa rectangular mediana, una placa cuadrada, o un plano transversal en una pendiente detrás de la sella turcica (fosa hipofisaria). Este trabajo tiene como objetivo estudiar el dorsum sellae en cráneo humano. Para el estudio se utilizaron 125 cráneos humanos adultos secos, de diferentes edades. Se observaron características detalladas de dorsum sellae y se clasificaron en cinco tipos: cresta, al igual que la placa delgada, lámina cuadrilátera, placa cuadrada gruesa, placa alargada gruesa. En tres cráneos se observó fusión de la parte posterior y los procesos clinoides intermedios (unilateral) y los procesos clinoides (anterior, medio y posterior) (unilateral en uno de ellos, bilateral en dos). Los resultados se discuten en consideracion de la literatura.

Retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys: Training and outcome.

INTRODUCTION: Between the two techniques of laparoscopic nephrectomy, retroperitoneoscopy has certain distinct advantages over transperitoneal access but may be a more difficult technique to learn. We present our experience of training novices in retroperitoneoscopic nephrectomy with a good outcome, making it a standard of care for nephrectomy at our institute. METHODS: The aim of this study was to report the initial experience, learning curve, and outcome of retroperitoneoscopic nephrectomy by novices under a mentored approach. The series included four novice urologists. The data from the initial forty retroperitoneoscopic nephrectomies performed by each of them were reviewed. RESULTS: Retroperitoneoscopic nephrectomies were successfully completed by novices in 88.1% (141/160) of the patients. Nine cases (5.6%) required the mentor's help because of nonprogression, and ten cases (6%) required conversion to open nephrectomy. The median operative time of all surgeons decreased with increased surgical experience. There was some intersurgeon variation in the learning curve ranging from 10 to 30 cases, but all surgeons showed a significant reduction in operative time across consecutive sets of ten cases. Seven cases required mentor help in the initial series (7/80) and only two in later half of cases (2/80). All minor complications were also significantly less in the later series. CONCLUSIONS: The present series represents the effectiveness of training in retroperitoneoscopic nephrectomy of novices by a responsible team and with the standard protocol and surgical steps. Through effective mentoring, the steep learning curve associated with retroperitoneoscopic nephrectomy has been overcome, making it standard of care for nephrectomy at our institute.

Hemoptysis from an aorto-pulmonary collateral vessel in a four month old resolved by embolization.

Hemoptysis in the children is a rare but serious diagnosis and is even more uncommon in infancy. Mortality is reported and depends on associated illnesses, underlying etiology, and amount of bleeding. A 4-month-old patient presented with significant hemoptysis. Flexible bronchoscopy with differential lavage confirmed the presence and site of origin of hemoptysis. She was managed with cardiac catheterization for embolization of an aorto-pulmonary collateral vessel with immediate complete resolution and no further recurrences. This highlights the importance of cardiac catheterization to detect collateral vessels as a cause for hemoptysis at this age and its successful resolution following embolization. Pediatr Pulmonol. 2016; 51:E31-E33. © 2016 Wiley Periodicals, Inc.

A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction.

INTRODUCTION: Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. These injuries are often missed or there is a delay in diagnosis which can lead to enlargement of the defect and the development of abdominal or respiratory symptoms. PRESENTATION OF CASE: We report a case of an otherwise healthy 37 year old male who was involved in a motor vehicle accident at age twelve. He presented 25 years later with vague lower abdominal symptoms and was found to have a large chronic left sided diaphragmatic hernia involving the majority of his intra-abdominal contents. Repair of the defect with a biologic mesh was undertaken and the patient also required complex abdominal wall reconstruction due to loss of intra-abdominal domain from the chronicity of the hernia. A staged closure of the abdomen was performed first with placement of a Wittmann patch. Medical management of intra-abdominal hypertension was successful and the midline fascia was sequentially approximated at the bedside for three days. The final closure was performed with a component separation and implantation of a fenestrated biologic fetal bovine mesh to reinforce the closure. In addition, a lightweight Ultrapro mesh was placed for additional lateral reinforcement. The patient recovered well and was discharged home. DISCUSSION: These injuries are rare and diagnosis is challenging. Mechanism and CT scan characteristics can aid clinicians. CONCLUSION: Blunt diaphragmatic injury is rare and remains a diagnostic challenge. Depending on the chronicity of the injury, repair may require complex surgical decision making.

DEMOGRAPHICS OF TUBERCULOSIS IN DISTRICT MANSEHRA.

BACKGROUND: Tuberculosis is one of the leading causes of morbidity and mortality across the globe. Pakistan is one of the 22 high tuberculosis burden countries of the world sharing more than 80% of the global burden of tuberculosis. METHODS: This study was a retrospective case-based study that analyzed secondary data obtained from TB-03 form at the office of the District Tuberculosis Control Officer (DTO), Mansehra. Data was entered into SPSS-20 and analysed. RESULTS: A total of 625 patients with a mean age of 32.1 ± 19.1 years were registered at the DTO office during the year 2013. Most of the patients were female (57%) as compared to males (43%). The most common treatment outcome was "treatment completed", recorded against 56% of the patients. The proportion of patients declared "cured" at the end of the treatment was 236 (37.8%). There were only 4 (0.64%) cases of treatment failure during 2013. CONCLUSION: Despite falling incidence of tuberculosis and mortality across the globe, tuberculosis is still a major determinant of disease in our society. Aggressive case detection and treatment is needed to manage this disease.

Optic nerve sheath diameter measurements by CT scan in ventriculoperitoneal shunt obstruction.

The objective of the study was to determine differences in optic nerve sheath diameter (ONSD) measurements taken from computed tomography (CT) scans of patients with ventriculoperitoneal shunt (VPS) obstruction versus controls. Inpatients 0-15 years with confirmed VPS obstruction requiring neurosurgical intervention were identified using ICD9 codes. ONSDs, orbit, cranium, and foramen magnum sizes were measured on their pre-surgical CT. Controls included cases at times when their VPS was not obstructed and age and gender matched patients with a CT scan done in the emergency room for head trauma (normal CT findings). Paired T-tests were used for both case-control comparisons. In order to compare the optic nerve sheath size more accurately, the ONSD width was divided by the width of the orbit and by the foramen magnum (antero-posterior) length. Twenty patients were identified with 25 events of VPS obstruction. The right ONSD (RON) was chosen to study. RON/orbit width and RON/foramen magnum diameter for the VPS obstruction versus self-controls, were 0.22 and 0.22, compared to 0.19 and 0.18, respectively, for the non-obstructed self-controls (P = .044 and P = .008, respectively). The same measurements for the VPS obstruction versus age and gender matched controls were 0.22 and 0.21 for the VPS obstruction cases, respectively, compared to 0.17 and 0.16, respectively for the age and gender matched controls (P < .001 and P < .001, respectively). This data confirms that the optic nerve diameter increases during a VPS obstruction. ONSD measurements by ultrasound could add to the evaluation for VPS obstruction.

Vicarious revenge and the death of Osama bin Laden.

Three hypotheses were derived from research on vicarious revenge and tested in the context of the assassination of Osama bin Laden in 2011. In line with the notion that revenge aims at delivering a message (the "message hypothesis"), Study 1 shows that Americans' vengeful desires in the aftermath of 9/11 predicted a sense of justice achieved after bin Laden's death, and that this effect was mediated by perceptions that his assassination sent a message to the perpetrators to not "mess" with the United States. In line with the "blood lust hypothesis," his assassination also sparked a desire to take further revenge and to continue the "war on terror." Finally, in line with the "intent hypothesis," Study 2 shows that Americans (but not Pakistanis or Germans) considered the fact that bin Laden was killed intentionally more satisfactory than the possibility of bin Laden being killed accidentally (e.g., in an airplane crash).

Clinical presentations of nephrotic syndrome in patients of a tertiary care hospital at Peshawar.

BACKGROUND: Nephrotic syndrome (NS) is manifested by presence of pitting oedema, profound proteinuria in excess of 3.5 g/day, serum albumin levels of less than 3.0 g/dL and hypercholesterolemia. This study was conducted to determine the frequency and clinical presentation of nephrotic syndrome in patients coming to a tertiary care hospital. METHODS: This cross-sectional study was done from March to November, 2012 (for 9 months). Patients with complaints of peri-orbital or generalized swelling, and proteinuria on urine examination were included in the study through emergency or outpatient department. RESULTS: Out of 360 suspected cases, nephrotic syndrome was found with a frequency of 67.05%. Among these patients, 69.55% were male and 30.45% female. Majority (65.85%) were between 41-60 years with mean age of 40.36 +/- 15.93 years. All (100%) patients had oedema, 43.20% had oliguria, 17.28% presented with abdominal tenderness, 15.22% patients had fever, 13.16% showed hematuria, 10.28% patients had uraemia and 2.5% of the patients had thrombosis. The majority of patients (56.80%) were diabetic, and 43.20% patients had hypertension. In 23.86% patient's high blood urea alone was recorded and 17.28% showed high serum creatinine along with raised blood urea. Rest of patients had normal renal function at the time of presentation. CONCLUSION: Frequency of nephrotic syndrome was 67.05%. Among these majorities were males. Oedema was the commonest presenting complaint while oliguria, abdominal tenderness, fever, hematuria, uraemia and thrombosis were found in descending orders. Diabetes mellitus was leading cause in majority of patients, followed by hypertension, high blood urea, and high serum creatinine.

Radiation exposure in different cardiac catheterization procedures in cath lab.

BACKGROUND: Interventional procedures render cardiologolists and their team members to high doses of radiations. This study was conducted to assess the radiation exposure in various cardiac catheterization procedures. METHODS: This descriptive cross sectional study was conducted at the catheterization laboratory of Lady Reading Hospital Peshawar from November 2008 to December 2009. Patients were categorized into four groups for procedures a. coronary angiography, b. percutaneous coronary intervention (PCI), c. permanent pacemakers (PPM) and d. percutaneous transvenous mitral commisurotomy (PTMC), two groups for operators (consultants and trainees), and three groups for various accesses (femoral, radial and sub-clavian). RESULTS: A total of 99 patients undergoing cardiac catheterization were studied. Coronary angiography was performed in 52 (52.5%) patients, PCI in 32 (32.3%)), pacemakers in 6 (6.1%), and PTMC in 9 (9.1%) patients. Consultants did 72 (72.7%) procedures and trainees did 27 (27.3%) procedures. Through radial access, 22 (22.2%) procedures were performed, 71 (71.7%) through femoral, and 6 (6.1%) through sub-clavian. The mean radiation dose for coronary angiography was (4907.862 +/- 15231.6358 microGym2), PCI (10375.16 +/- 16083.4385 microGym2), pacemakers (1406.823 +/- 785.489 microGym2), and PTMC (1157.91 +/- 760.437 microGym2). The mean radiation dose for radial (6147.33 +/- 8480.37 microGym2), femoral (6512.58 +/- 16566.73 microGym2), and sub-clavian was (1406.82 +/- 785.48 microGym2). While for various operators consultants (7489.5 +/- 16925.55 microGym2), and trainees (2475.25 +/- 1178.86 microGym2). The mean time for radial (8.59 +/- 7.28 min), femoral (6.95 +/- 6.43 min) and sub-clavian was (8.24 +/- 4.81 min). The mean time for coronary angiography (4.56 +/- 5.32 min), PCI (11.44 +/- 6.92 min), PPM (8.24 +/- 4.81 min), and PTMC (8.28 +/- 5.01 min). CONCLUSIONS: Radiation dose varies substantially across different groups by different operators and different routes.

Frequency of metabolic syndrome in patients with type-2 diabetes.

BACKGROUND: Diabetes, Hypertension, Obesity and Ischaemic Heart Disease have become a problem of public health magnitude with substantial economic burden both in the developed as well as the developing countries. Obesity is quite frequent in Type 2 diabetics and also plays a central role in causing Metabolic Syndrome (MetS). Metabolic Syndrome significantly increases the incidence of cardiovascular complications. This study was done to determine the frequency of MetS in our Type 2 diabetic patients as most of the components of MetS can be modified and identifying/managing these at an early stage might be of considerable help in reducing cardiovascular complications. METHODS: This cross-sectional study was done in Medical 'B' and Medical 'A' wards of Ayub Teaching Hospital, Abbottabad from Nov, 08 to April, 09. Type 2 Diabetic patients aged above 40 years who gave informed consent were included in the study. Data was collected through a structured proforma. Frequency of Metabolic Syndrome was estimated according to the IDF consensus worldwide definition of the MetS. RESULTS: Of the 100 patients enrolled in this study 56 were females and 44 were males with a mean age of 59.9 years. Out of these 100 participants seventy six (76%) were diagnosed to have metabolic syndrome. Of the 56 females, forty eight (85.71%) were having metabolic syndrome while twenty eight (63.63%) of the 44 male participants were having the syndrome. The difference was statistically significant (p < 0.05). CONCLUSION: Frequency of MetS was found to be significantly high in this study with female preponderance. All the components, except Hypertension were more frequent in females. Diabetic patients with metabolic syndrome need more aggressive approach in management so as to decrease the incidence of cardiovascular complications.

Per-operative findings of blocked ventriculoperitoneal shunt: a study of 72 cases.

BACKGROUND: Most patients with hydrocephalus are treated with ventriculo-peritoneal (VP) shunt placement; however, malfunction is common and is usually caused by mechanical failure. The aim of this study was to evaluate the per-operative findings accompanying presumed VP shunt malfunction. METHODS: This is a descriptive study of 72 patients operated for shunt malfunction in the Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January to December 2008. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. RESULTS: Common presenting features were vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upper end block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2 patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shunt revision was performed in most of cases (80.6%). CONCLUSION: The importance of clinical features cannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexus is common operative finding.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

OBJECTIVE: To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. STUDY DESIGN: It was a cohort study. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. PATIENTS AND METHODS: Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. RESULTS: In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. CONCLUSION: Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.