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BackgroundThe objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC).MethodsThis cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis.ResultsOf the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm2 (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure.ConclusionPatients who had favorable Wilkin’s score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.

Background: Forequarter amputation (FQA) is the surgical treatment of choice for tumours in the upper extremity and shoulder girdle that infiltrate the neurovascular bundle, shoulder joint and muscles of the shoulder girdle in non-salvageable cases. In both curative and palliative settings, FQA can serve as an effective oncological treatment for local control of tumour. Methods: All patients who underwent FQA in our unit from January 2016 till August 2019 for oncological indications were included in our study and their clinical outcomes were calculated. Results: Thirteen patients were included in the study including 8 male patients. Mean age of patients at surgery was 20 years (Range 10–53 years) with a minimum follow up of 6 months or till patient was deceased earlier. Six patients had primary osteosarcoma, 4 had Ewing’s sarcoma, 2 had Spindle cell sarcoma while 1 had Giant cell tumour. Six patients underwent surgery with curative intent. No major per operative complication was encountered in any of the cases with a mean blood loss of 350 ml and mean duration of surgery being 75 minutes. At last, follow up only 6 patients were alive, with 2 patients alive with disease (Metastasis) and undergoing palliative treatment. None of our patients had local recurrence. Mean survivorship for the whole cohort was 9.2 months (Range 3-18 months) with a mean survivorship for the deceased group was 7.1 months (Range 3–16 months) and mean survivorship for alive patients was 11.6 months (range 9–18 months). All the alive patients had phantom limb sensations and only one had a prosthesis in place only for cosmetic reasons, at last follow up. Conclusion: Although FQA is a significantly body disfiguring procedure, but in large tumours of shoulder girdle, this is a viable option for local control of the disease. Based on our study, although relatively small sample size, we propose the combined anteroposterior approach to be safe and reliable for advanced shoulder girdle tumours.

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Social allostasis is a mechanism of adaptation that permits individuals to dynamically adapt their physiology to changing physical and social conditions. Oxytocin (OT) is widely considered to be one of the hormones that drives and adapts social behaviours. While its precise effects remain unclear, two areas where OT may promote adaptation are by affecting social salience, and affecting internal responses of performing social behaviours. Working towards a model of dynamic adaptation through social allostasis in simulated embodied agents, and extending our previous work studying OT-inspired modulation of social salience, we present a model and experiments that investigate the effects and adaptive value of allostatic processes based on hormonal (OT) modulation of affective elements of a social behaviour. In particular, we investigate and test the effects and adaptive value of modulating the degree of satisfaction of tactile contact in a social motivation context in a small simulated agent society across different environmental challenges (related to availability of food) and effects of OT modulation of social salience as a motivational incentive. Our results show that the effects of these modulatory mechanisms have different (positive or negative) adaptive value across different groups and under different environmental circumstance in a way that supports the context-dependent nature of OT, put forward by the interactionist approach to OT modulation in biological agents. In terms of simulation models, this means that OT modulation of the mechanisms that we have described should be context-dependent in order to maximise viability of our socially adaptive agents, illustrating the relevance of social allostasis mechanisms.

The "social buffering" phenomenon proposes that social support facilitates wellbeing by reducing stress in a number of different ways. While this phenomenon may benefit agents with social support from others, its potential effects on the wider social group are less clear. Using a biologicallyinspired artificial life model, we have investigated how some of the hypothesised hormonal mechanisms that underpin the "social buffering" phenomenon affect the wellbeing and interactions of agents without social support across numerous social and physical contexts. We tested these effects in a small, rank-based society, with half of the agents endowed with numerous hormonal mechanisms associated with "social buffering", and half without. Surprisingly, our results found that these "social buffering" mechanisms provided survivalrelated advantages to agents without social support across numerous conditions. We found that agents with sociallyadaptive mechanisms themselves become a proxy for adaptation, and suggest that, in some (artificial) societies, "social buffering" may be a contagious phenomenon.

Background & Objective:Everolimus-eluting stents, compared with bare metal stents, reduced the risk of restenosis in clinical trials with strict inclusion and exclusion criteria. The objective of this study was to determine the three months clinical outcomes of Everolimus Eluting Stents in patients with stable angina pectoris in Pakistani population.Methods:It was a descriptive cross-sectional study and the data was collected from Catheterization Laboratory Cardiology Department Lady Readings Hospital Peshawar. Our study included all the patients with stable coronary artery disease who had received Everolimus eluting stents from August, 2013, to April, 2014. Total study duration was 09 months. The primary end points were the rate of target vessel revascularization, myocardial infarction at three months. All those patients who received Everolimus coronary stents were recalled after three months from the index procedure and enquired about target vessel revascularization (TVR), myocardial infarction and hospitalization over the last three months. Data analysis was done using SPSS version 16.Results:Our study included 378 patients with stable ischemic heart disease who underwent revascularization with Everolimus eluting stent. These patients were followed up for a period of 3 months for target vessel revascularization(TVR) and myocardial infarction(MI). Mean age was 57.04±9.307, males were (72%). Left Anterior Descending (LAD) and Left circumflex (LCx) were the predominant vessels vascularized. Mean length of Everolimus eluting stent was 21.91± 4.6 while mean diameter of stent was 2.90±0.248. Thirteen (3.4%) patients had TVR and 14 (3.7%) patients had MI during three months follow up after PCI. TVR and MI were prevalent in patients who received longer Everolimus stents as compared to those who received shorter stents at three months, and the difference between the two was statistically significant.Conclusion:Short-term results from this study suggest that real-world outcomes among 378 patients are comparable to those reported in other registries and trials, and safety outcomes as measured by rates of TVR, MI were low. The long-term safety of Everolimus-eluting stents needs to be ascertained in large, randomized trials.

Objectives:To analyse the demographics, mechanism, nature, anatomical distribution, management and complications in trauma patients presenting to the plastic surgery unit.Study Design:Descriptive cross-sectional study.Setting:This study was conducted in the Plastic and Reconstructive Surgery Unit, Hayatabad Medical Complex, Peshawar, from 1st January 2009 to 30th April 2012.Materials and Methods:All trauma patients referred from emergency department and other departments irrespective of age and gender were enrolled in the study, excluding acute burns and trauma sequelae patients. The details were obtained from the data sheets of the patients. All the data were analysed and projected in the form of tables and figures.Results:A total of 1034 patients including 855 (82.7%) males and 179 (17.3%) females presented with plastic surgical trauma, with age ranging from 1 to 86 years, with a mean age of 20.84 ± 15.469 SD. The upper limb was affected in 492 (47.6%) patients, followed by head and neck in 273 (26.4%) cases. Road traffic accidents (RTAs) were the main cause of trauma, affecting 340 (32.9%) patients. Wound excision and closure was performed in 473 (45.7%) patients, followed by skin grafting and flap coverage in 232 (22.4%) and 132 (13.2%) patients, respectively. Postoperative complications were observed in 45 (4.35%) patients.Conclusion:Males in their young age mainly presented with plastic surgical trauma with RTA as the main mechanism and laceration as the most common type of these injuries. The upper limb was the most commonly affected region. The frequency of different types of surgical procedures and postoperative complications observed are comparable with international literature except for the microvascular surgery which is not performed in our centre. Regular audit of the plastic surgical trauma should be conducted in all plastic surgical units to both improve trauma care and reaffirm the role of Plastic Surgery in the new age trauma.