The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well

Synergistic effect of energy drinks and overweight/obesity on cardiac autonomic testing using the Valsalva maneuver in university students

BACKGROUND: Obesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders. OBJECTIVES: To determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks. DESIGN: Cross-sectional, analytical. SETTING: Physiology department at a university in Saudi Arabia. SUBJECTS AND METHODS: University students, 18–22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption. MAIN OUTCOME MEASURE(S): Autonomic disturbance, hemodynamic changes. RESULTS: In 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes. CONCLUSION: Obesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects. LIMITATIONS: Due to time and resource restraints, only the acute effects of energy drinks were examined

The distance to the SNR CTB109 deduced from its environment

We conducted a study of the environment around the supernova remnant CTB109. We found that the SNR is part of a large complex of HII regions extending over an area of 400 pc along the Galactic plane at a distance of about 3 kpc at the closer edge of the Perseus spiral arm. At this distance CTB109 has a diameter of about 24 pc. We demonstrated that including spiral shocks in the distance estimation is an ultimate requirement to determine reliable distances to objects located in the Perseus arm. The most likely explanation for the high concentration of HII regions and SNRs is that the star formation in this part of the Perseus arm is triggered by the spiral shock.Comment: 6 pages, 6 figures. accepted for publication in the Astrophysical Journa

Research on the improvement of mixed titania and Co(Mn) oxide nano-composite coatings

The structure and the properties of the oxide films formed on titanium in the diphosphate based electrolytes by means of plasma electrolytic oxidizing at direct current density of 2-2.5 A·dm⁻² have been studied. Oxide layers of different composition and content of alloying elements were obtained by modification of electrolytes and variation in current density. The interelectrode voltage during PEO, chemical and phase composition, topography and microstructure of the formed layers depend on the electrolyte composition and applied current density. The spark-discharge regime was shown to be reached at inter-electrode voltage 100 to 130 V depending on the composition of electrolyte. The effect of chemical composition and surface morphology formed mixed oxide films on the corrosion resistance and catalytic activity has been discussed

Pain interventions for organ transplant patients undergoing incisional hernia repair: Is epidural or transversus abdominus plane block a better option?

Background Postoperative pain management in transplant recipients undergoing incisional herniorraphy is challenging. Historically limited to intravenous or oral opioids, alternatives including transversus abdominus plane (TAP) block catheters and thoracic epidural catheters have been introduced. The aim of this study was to determine whether TAP catheters and thoracic epidural analgesia significantly impacted on postoperative pain and opioid usage in transplant recipients undergoing incisional hernia repair. Methods This single‐center retrospective study included 154 patients undergoing incisional hernia repair from January 2011 to June 2015. Of these, 56 received epidurals, 51 received TAP catheters, and 47 received no intervention. Results Demographic profiles were comparable among the three groups including type of previous transplant and type of hernia surgery. Thoracic epidural analgesia was associated with lower median, mean, and maximum pain scores (P < 0.001) and less opioid requirement (P < 0.001). There was no difference in pain scores and opioid usage among the TAP catheter and no intervention groups. There was no difference in time to first flatus or first bowel movement, length of hospital stay, individual opioid‐related side effects, and adverse reactions among the three groups. Conclusion This study supports the use of thoracic epidural analgesia in patients undergoing hernia repair after transplant surgery

A natural histone H2A variant lacking the Bub1 phosphorylation site and regulated depletion of centromeric histone CENP-A foster evolvability in Candida albicans.

Eukaryotes have evolved elaborate mechanisms to ensure that chromosomes segregate with high fidelity during mitosis and meiosis, and yet specific aneuploidies can be adaptive during environmental stress. Here, we identify a chromatin-based system required for inducible aneuploidy in a human pathogen. Candida albicans utilizes chromosome missegregation to acquire tolerance to antifungal drugs and for nonmeiotic ploidy reduction after mating. We discovered that the ancestor of C. albicans and 2 related pathogens evolved a variant of histone 2A (H2A) that lacks the conserved phosphorylation site for kinetochore-associated Bub1 kinase, a key regulator of chromosome segregation. Using engineered strains, we show that the relative gene dosage of this variant versus canonical H2A controls the fidelity of chromosome segregation and the rate of acquisition of tolerance to antifungal drugs via aneuploidy. Furthermore, whole-genome chromatin precipitation analysis reveals that Centromere Protein A/ Centromeric Histone H3-like Protein (CENP-A/Cse4), a centromeric histone H3 variant that forms the platform of the eukaryotic kinetochore, is depleted from tetraploid-mating products relative to diploid parents and is virtually eliminated from cells exposed to aneuploidy-promoting cues. We conclude that genetically programmed and environmentally induced changes in chromatin can confer the capacity for enhanced evolvability via chromosome missegregation

Mixed alumina and cobalt containing plasma electrolytic oxide coatings

Principles of plasma electrolytic oxidation of the AL25 aluminum alloy in diphosphate alkali solutions containing cobalt(2+) cations are discussed. It has been established that a variation in the concentration of the electrolyte components provides the formation of mixed-oxide coatings consisting of the basic matrix materials and the cobalt oxides of different content. An increase in the cobalt oxide content in the coating is achieved by the variation in electrolysis current density as well as the treatment time due to both the electrochemical and thermo-chemical reactions at substrate surface and in spark region. Current density intervals that provide micro-globular surface formation and uniform cobalt distribution in the coating are determined. The composition and morphology of the surface causes high catalytic properties of synthesized materials, which confirmed the results of testing in model reaction CO and benzene oxidation as well as fuel combustion for various modes of engine operation

Is the Cygnus Loop two supernova remnants?

The Cygnus Loop is classified as a middle-aged supernova remnant (SNR) located below the Galactic equator (l=74, b=-8.6) and 770 pc away from us. Its large size and little confusion with Galactic emission makes it an ideal test ground for evolutionary and structural theories of SNRs. New radio continuum mapping of the Cygnus Loop at 2695 MHz with the Effelsberg 100-m telescope provides indications that the Cygnus Loop consists of two separate SNRs. Combining this result with data from the literature we argue that a secondary SNR exists in the south with a recently detected neutron star close to its center. Two interacting SNRs seem to be the best explanation to account for the Cygnus Loop observations at all wavelengths.Comment: 4 pages, 2 figures, Astron. Astrophys., accepte