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OBJECTIVE To compare postoperative and long-term results (angina, myocardial and cerebrovascular events and coronary re-intervention) using single versus bilateral internal mammary arteries (SIMA vs. BIMA) in the setting of off-pump revascularisation (OPCAB) within a single-surgeon practice. METHODS Retrospective analysis of all isolated OPCAB performed in our institution by a single surgeon in the last 12 years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A propensity score matching was performed to compare the groups, reducing the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by telephone interviews or clinical visits, registering also late mortality and coronary re-intervention. Outcomes were compared to literature. RESULTS Demographic characteristics differed between groups, with BIMA offered predominantly to non-diabetic younger males (mean 59.4 years) with less comorbidity. In-hospital mortality was 2% for the SIMA group and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years, p < 0.001). Sternal wound infection was similar in both groups (2-3%). Long-term follow-up revealed good freedom from angina (94%) with low rates of neurological and myocardial events (3%) or need for repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers long-term survival benefit with similar postoperative complications. Rates of deep sternal wound infection were comparable between the two groups.Excellent outcomes can be achieved with OPCAB BIMA in real world practice with adequate patient selection.

AimsTotal knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design.MethodsPatients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2(21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up.ResultsAt final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001)ConclusionUse of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025–1032.

Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons. Materials and methods: This retrospective observational study was carried out at vascular surgery department of two tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which resulted in redo surgeries or adverse outcomes. Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with delayed complications of missed injuries. The omissions can be divided into: missed injuries (24/41), technical errors in initial repair (12/24), reperfusion of mangled Extremity (3/41) and non availability of a surgeon capable of undertaking vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury. Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma can be improved.

Across the globe, sustainable infrastructure development&mdash, in context of road networks, and recycling waste material and production&mdash, are the two predominant factors associated with the construction industry in making roads and developing transportation networks. Globally, millions of tons of basic hot mix asphalt are produced, which are being utilized to generate large volumes of the finished road material. This study deals with the method of modifying bitumen by adding a silicon mobile cover waste material in a cost-effective manner, that can yield improved characteristic properties to bitumen, in a sustainable way to save material, improve quality/performance and reduce costs. In this investigation, globally produced and used mobile silicon cover accessories were utilized as a partial replacement (at 10%, 20%, 30%, 40%, and 50%) with bitumen. A large quantity of used silicon phone covers are thrown in the garbage and dumped in grounds as a waste material worldwide. Modifying bitumen with up to 40% silicon, using a potentially viable waste available in large quantities, was proven to be stabilized according to ASTM Marshall Test criteria of stability (&gt, 9) and flow(within range 2&ndash, 4) in road construction. The results of the investigation are promising, and the use of silicon waste could mark a significant impact on the economics of road construction industry for sustainable infrastructure development by saving bitumen, which is a costly resource.

Energy consumption and material production are two major factors associated with the road construction industry. Worldwide, millions of tons of hot mix asphalt production consume a huge amount of fuel as an energy source in terms of quantity and cost to achieve the standard temperature of up to 170 °C during the mixing process. Modification of bitumen can not only reduce its usage but also the consumption of energy (fuel) during the asphalt mix production process at low temperatures. This study provides a method to save energy by proposing the addition of bitumen modifier in the road construction sector. Furthermore, to make it compatible with the field conditions for road construction, stability analysis is executed on the prepared samples by partially replacing the bitumen with polyurethane foam (PUF) and plastic waste (PW) (at 10%, 20%, 30%, 40%, and 50%). Experimental results demonstrate a reasonable saving in the amount of energy (33%) and material (40% bitumen) used and showed that similar strength of developed asphalt mix can be achieved using PUF. An extensive calculation concludes that these savings could make a huge difference in construction economics of mega road infrastructure projects, especially during an energy crisis.

Self-Compacting Concrete (SCC) differs from the normal concrete as it has the basic capacity to consolidate under its own weight. The increased awareness regarding environmental disturbances and its hazardous effects caused by blasting and crushing procedures of stone, it becomes a delicate and obvious issue for construction industry to develop an alternative remedy as material which can reduce the environmental hazards and enable high-performance strength to the concrete, which would make it durable and efficient for work. A growing trend is being established all over the world to use industrial byproducts and domestic wastes as a useful raw material in construction, as it provides an eco-friendly edge to the construction process and especially for concrete. This study aims to enlighten the use and comparative analysis for the performance of concrete with added industrial byproducts such as Ground Granulated Blast Furnace Slag (GGBFS), Silica fumes (SF) and Marble Powder (MP) in the preparation of SCC. This paper deals with the prediction of mechanical properties (i.e., compressive, tensile and flexural Strength) of self-compacting concrete by considering four major factors such as type of additive, percentage additive replaced, curing days and temperature using Artificial Neural Networks (ANNs). This project has been supported by PIET.

The use of negative pressure wound therapy (NPWT) in civilian and military wounds is found effective in promoting granulation tissue, decreasing exudate and improving patient comfort. The Use of gauze-based NPWT is increasing in civilian trauma cases with availability of proprietary systems using gauze as filler material rather than the traditionally used reticulated open-cell foam. Military trauma wounds differ from civilian trauma wounds in energy of impact, degree and nature of contamination as well as the hostile environments. The Use of gauze as filler material for NPWT in military trauma wounds is less well studied. This study is a retrospective analysis of use of improvised gauze-based NPWT in military trauma wounds. The whole assembly was constructed from commonly available operation theatre supplies and no proprietary system was used. Results were very encouraging and the use of this improvised method can be useful and cheap alternative to costly proprietary systems.

Budd Chiari syndrome (BCS) is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atrio cava junction. BCS could have serious consequences if not treated promptly. Comprehensive angiographic studies, computerised tomography, liver ultrasonography, histology and pathologic analyses are essential for establishing the disease severity, stratifying risk factors, choosing the appropriate therapy and objectively assessing the response. The main objective of therapy is to alleviate portal and IVC hypertension. Here we present a report of a young man with BCS who underwent mesocaval shunt. The eight months follow up showed that patient was free of symptoms and duplex scans confirmed the patency of the shunt.

Prophylaxis of deep vein thrombosis (DVT) is underutilised in Pakistan. This cross-sectional survey was designed to evaluate knowledge, attitude and practices of healthcare providers towards DVT prophylaxis in teaching hospitals in and around Rawalpindi.Knowledge, attitude and practices was assessed by a 12-item questionnaire filled-in by healthcare providers in five teaching hospitals. Eleven out of 12 questions were multiple-choice type and one was open ended.One hundred-sixty-nine, out of 200 questionnaires were returned and were analysed. Total 43.2% of the respondents were house-officers. Although 98.8% agreed that DVT prophylaxis is clinically important, but 39.4% actually prescribed it themselves. Out of these, only 10.3% respondents did it routinely. Low molecular weight heparin (LMWH) was the preferred prophylaxis used (36.7%). Most of the respondents underestimated the prevalence and consequences of DVT in hospitalised patients.Knowledge and practices of healthcare providers about DVT prophylaxis in hospitalised patients is less than ideal. Hospitals need to develop their own guidelines for DVT prophylaxis.

Coarctation of abdominal aorta, Middle aortic syndrome (MAS) is a rare disease with only 200 reported cases. MAS may present clinically as uncontrolled hypertension, abdominal claudication or lower limb claudication. Surgical treatment is effective in controlling symptoms and improves life expectancy. We present another case of this rare entity, diagnosed and treated at Armed Forced Institute of Cardiology and Combined Military Hospital, Rawalpindi. This is the second reported case of MAS diagnosed and treated in Pakistan.