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Introduction The first confirmed case of COVID-19 in the United Kingdom (UK) was reported on 29 January 2020. The country saw the peak of infection between March and May of 2020. The result was a change in the practice of how we treat most surgical conditions including cancer. We continued providing service to our colorectal cancer patients at a District General Hospital. The aim of this study was to compare our provision of colorectal cancer service during the peak of the pandemic to that of the pre-COVID time in our hospital. Methods We collected data of all colorectal cancer patients who underwent surgery between 1 March 2020 and 30 April 2020 in our hospital. The comparative data were collected for similar patients during the same time frame in 2019. A detailed data set was compiled on Microsoft Excel (Microsoft Corp, Washington) and analysed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012. IBM Corp, Armonk, NY). Results The two groups were comparable in demographics including age, BMI, gender, and Charlson comorbidity index. Time from decision- to-treat to surgery, post-operative HDU/ITU stay, and overall length of stay was shorter in the COVID group than the Pre-COVID group without any significant statistical difference. There was no statistically significant difference between the two groups in Calvien-Dindo complications grade 1 and 2. No mortality was reported due to direct or indirect consequences of COVID-19 infection. More open procedures were performed in our department during the first wave of COVID-19 in the UK compared to Pre-COVID time. Conclusions Despite the challenges we faced during the peak of the COVID-19 pandemic, we managed to provide standard care to our colorectal cancer patients with comparable post-operative surgical and oncological outcomes.

Introduction: Mechanical thrombectomy has become the cornerstone and standard of care for acute stroke patients. Early reperfusion in patients experiencing acute ischemic stroke is the most important factor. The motivation behind this investigation is to display the aftereffects of mechanical thrombectomy in patients with large vessel occlusion in anterior and posterior circulation and to demonstrate that it lessens the level of handicap 3 months post stroke. Methods: A retrospective analysis was conducted of patients who presented with acute ischemic stroke at our center from 2015 to 2018 and received mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters without the bridging technique. Result factors including recanalization rate and modified Rankin Scale at 90 days post procedure were assessed. An aggregate of 30 patients were included. Results: About 30 patients presented at the institute and met the inclusion criteria for the study. Successful recanalization (the Thrombolysis in Cerebral Infarction Score [TICI 2B]) was accomplished in 90% of patients, TICI 3 score was accomplished in 56% of the patients. 67% of the patients had good modified Rankin Scale score 0-2 result at 90 days. There were 3 symptomatic hemorrhages and 3 procedure and comorbidity-related deaths (10%). Conclusion: Mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters alone without the bridging technique is an effective and safe procedure for endovascular revascularization of large vessel occlusion presenting with acute ischemic stroke.

BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Objective: To evaluate the result of a coiling of middle cerebral artery aneurysms without auxiliary techniques. Material and Methods: This study was conducted from June 2010 to September 2019 in the Department of Neuroradiology, Punjab Institute of Neurosciences, Lahore. There were a total of 500 patients with unilateral and bilateral cerebral aneurysms at the MCA level that have been included in this study which comprise of both sexes. Results: There was a total of 500 patients, which comprised of 200 (40%) men and 300 (60%) women. Their ages ranged from 22 to 65 years. The majority number of patients was in their fifth 180 (30%) and sixth decade 150 (30%) of life. In our study, a successful coiling was performed in 490 (98%) patients with minimal re-canalization of MCA aneurysms. In 10 (2%) procedure was unsuccessful due to vasospasm. Conclusion: The conventional coiling in middle cerebral artery aneurysms can be effective and safe without auxiliary techniques.

Pure subdural hematoma with subarachnoid haemorrhage brought about by ruptured intracranial aneurysm is uncommon and is related to delayed analysis and treatment. We present an uncommon instance of spontaneous subdural hematoma because of intracranial aneurysmal rupture. Case description A 26-year-old female presented with sudden onset of thunderclap headache at midnight followed by an episode of generalized tonic-clonic seizure and loss of consciousness. There was no associated history of trauma. Computed tomography showed convexity subdural hematoma extending into tentorium without subarachnoid haemorrhage. The catheter angiography revealed a distal anterior cerebral artery aneurysm at the anterior internal frontal artery. Consequently, this aneurysm was embolized with squid with no residual filling. The patient was neurologically intact and was discharged on the third post-procedure day with left partial third nerve palsy. Conclusion This paper demonstrates characteristics, diagnostics, and treatment modalities of this rare condition of intracranial aneurysmal rupture associated with subdural hematoma along with the literature review.

BACKGROUND AND PURPOSE: Direct injection of Oxygen-Ozone in to the discs has proved to be the effective alternative for surgery in patients with disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by lower backache, sciatica and pain cervical region (brachalgia) due to disc herniation including post operative recurrence or disc prolapse. MATERIAL & METHODS: Twenty-Three Thousand patients were treated with single two multiple sessions of Oxygen Ozone therapy. All the patients had CT or MRI evidence of annulus tear/ disc prolapse with clinical signs of nerve root compression. The procedure was performed under angio fluoroscopy using 22/23 G spinal needle without any form of anesthesia. All the patients received intra discal injection of Oxygen Ozone mixture with and without periganglionic infiltration at a ozone concentration 30 mcgr/mL. Among these patients 14000 were males and 9000 were females between the age of 14-80 years. Therapeutic outcome was assessed 5 months after treatment by using modified MacNab method. RESULTS: A satisfactory therapeutic outcome was obtained. 55% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic pain and with no limitation of occupational activity. 15% of cases showed insufficient improvement. 5% of cases had insufficient improvement and went for surgery. 10% of cases never turned up after the first visit. CONCLUSION: Intradiscal with and without periganglionic injection of Ozone for herniated discs has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently use in Pakistan.

Solar power has prominently been showing potential as a means to sustainable, dispatchable and affordable source of energy while attracting huge attention for scientists as a viable alternative for next-generation energy usage. Solar Salt, KNO3-NaNO3 (40–60 wt%) mixture, has been considered indispensable as it is the most technologically mature molten salt for CSP plants. However, molten salt-based heat transfer fluids (HTF) and/or thermal energy storage (TES) media have been facing critical challenging issues of severe corrosion and lower specific heat capacity. Considering these problems, more effective studies should be conducted to explore the alternative nitrate salt mixtures, chlorides, fluorides and carbonates focusing on the widening thermal stability range, and to enhance thermal properties and to lower corrosion rate. Thereafter, scientists and engineers would be able to incorporate these variations of molten salts with an economical industrial way into CSP applications. In this context, the present review thoroughly investigates the Solar Salt, HitecXL, Hitec, LiNaKNO3, NaKMg chloride, NaKZn chloride, LiNaK fluoride and (LiNaK)2CO3 salts in terms of their basic thermal properties, corrosion rate and their contingent behaviour on nanoparticles; regardless of discrepancies and incompatibilities. Moreover, this article highlighted some corrosion mitigation approaches that could enhance the efficacy of molten salts for next-generation CSP plants. Also, there is a still need to further investigate the long-term thermal stability of molten salt-based nanofluids by researchers on an urgent basis.

Mobile Adhoc Networks (MANETs) consist of a set of mobile nodes that form a dynamically changing network without the use of an existing infrastructure. Every node in the network acts as the peer to its immediate neighbor. Each node is thus responsible for relaying data to neighboring nodes for ensuring communication between distant nodes. This information dissemination mechanism pattern consumes extra node energy thus making energy a critical parameter for ensuring increased network lifetime. This paper proposes a new energy and mobility aware routing protocol referred to as Mobility and Energy Aware AODV (MEAODV) protocol. The proposed protocol has shown through simulations to achieve 4–5% increase in Packet Delivery Ratio, 20–24% reduction in Convergence time and 10 to 15% increase in Network Lifetime when compared to most promising stability based variants of AODV, PersonalizedAODV (RAODV) and MulticastAODV (MAODV-X).

Question Answering (QA) system is the task where arbitrary question IS posed in the form of natural language statements and a brief and concise text returned as an answer. Contrary to search engines where a long list of relevant documents returned as a result of a query, QA system aims at providing the direct answer or passage containing the answer. We propose a general purpose question answering system which can answer wh-interrogated questions. This system is using Wikipedia data as its knowledge source. We have implemented major components of a QA system which include challenging tasks of Named Entity Tagging, Question Classification, Information Retrieval and Answer Extraction. Implementation of state-of-the-art Entity Tagging mechanism has helped identify entities where systems like OpenEphyra or DBpedia spotlight have failed. The information retrieval task includes development of a framework to extract tabular information known as Infobox from Wikipedia pages which has ensured availability of latest updated information. Answer Extraction module has implemented an attributes mapping mechanism which is helpful to extract answer from data. The system is comparable in results with other available general purpose QA systems.

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Design and Duration: Quasi experimental study from September, 2006 to March, 2007. Setting: Surgical floor of Allied Hospital, (Punjab Medical College) Faisalabad. Methodology: Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Results: Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients (group A) were left open and closed on 4th day while that of next thirty patients (group B) closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence (16.66 %). Four belonged to group A(13.33%) and six belonged to group B(20 %) (p

The purpose of the study is to highlight the varied presentation of tuberculosis (TB) simulating a brain tumour. Headache and seizures are becoming frequent presenting complaints without any history of tuberculosis. The study comprises 1200 patients of both sexes with ages ranging from ten to sixty years. CT scan and MRI brain control with and without contrast medium were the investigations performed in these cases. In some patients Electroencephalography (EEG), cerebral angiography (DSA) and spectroscopy were also performed. The final diagnosis of tuberculosis was made on the basis of craniotomy, stereotactic and burr hole biopsies with histopathology in most of the cases. Forty per cent of the patients were followed up for eight months. They were put on anti-tuberculosis treatment with symptomatic and anti-epileptic drugs. The incidence was 544 and 757 per 100,000 in Africa and Indo Pakistan respectively. The male to female ratio was 1:1. Tuberculosis, especially with CNS involvement, is not only common in immunosuppressed patients in our setting, but TB has been and remains an important public health problem. TB may involve the CNS either as meningitis or as parenchymal granulomas or abscesses. Patients with brain TB usually present with fever, multiple cranial nerve involvement and occasional behavioural changes. CSF findings remain non specific in most cases. The most common sites are the cerebral hemisphere and basal ganglion in adults and the cerebellum in children. Tuberculosis has unique findings on brain CT and MRI. Cortical and subcortical locations are typical whereas the brain stem is a less common site. Tuberculosis lesions are usually solitary but multiple in 10% to 35% of cases. In spite of all these facts some cases of brain TB still need aggressive neurointervention to reach the final diagnosis of brain TB. Tuberculosis in the CNS may manifest in many different ways. So one should always include tuberculosis in the differential diagnosis in the etiology of delayed onset epilepsy and acute on chronic headache. In case of a discrepancy between clinical manifestations and CT/MRI findings, one can always anticipate tuberculous lesion in the brain.

We share our experience of 2000 spinal tuberculosis (TB) cases, including both typical and atypical presentations. The aim of the study is to estimate the incidence and types of spinal TB referred to our department for diagnosis. 2000 patients were selected by convenience sampling from January 2006 to September 2010. Study design was descriptive and among 2000 mostly unknown cases without evidence of symptoms of systemic TB (1080 males and 920 females). MRI without and with IV contrast, CECT with MPR, and in some cases not fit for MRI, CT myelography, were performed. Out of 2000 cases of tuberculous spine, 1080 (54%) were male and 920 (46%) were female. Their age ranged from 8–60 years. About 90% of patients were below the age of 40 years. Peak age among the males and females was 20–29 years and 14–35 years, respectively. The most common site of involvement was dorsal spine (45%) followed by lumbo-sacral spine (33%), cervical spine (10%) and at multiple levels (12%). Biopsies were done in 240 (12%) cases. Spinal TB should always be suspected when radiographs demonstrate a destructive spinal process. Awareness and prompt management of TB spine will help in reducing the continuing morbidity of this disease.