Frequency of silent myocardial ischaemia in diabetics: a single centre study

OBJECTIVE: To find the frequency of silent myocardial ischaemia in diabetics as compared to non-diabetics. METHODS: This was a cross sectional study conducted between November 2008 and March 2010. Two hundred subjects were recruited by convenience sampling after informed consent. All were subjected to an exercise stress test. Electrocardiographic changes were noted for silent Ischaemia Descriptive Statistics were applied for significance. RESULT: Of the 200 subjects included in the study, 31 had diabetes and 1 69 were non-diabetics. The mean age was 46 +/- 10 years. Twenty eight subjects tested positive for silent ischaemia, of whom six were diabetics (19%) and 22 were non-diabetics (13%). Hypertension and obesity were found more frequently in diabetics (48% Vs 27%) p = 0.019 and (35% Vs 18%) p = 0.027 respectively. Despite the greater proportion of diabetics having asymptomatic myocardial ischaemia as compared to nondiabetics statistical significance (p = 0.397) was not observed. CONCLUSION: There was no significant difference in the frequency of silent ischaemia amongst the two groups

Anaphylactic reaction after intramuscular injection of cyanocobalamin (vitamin B12): a case report

We report a case of anaphylactic reaction to intramuscular injection of cyanocobalamin. This 52-year-old lady was diagnosed as a case of megaloblastic anemia secondary to dietary vitamin B12 deficiency. She had severe anaphylactic reaction after the parenteral administration of cyanocobalamine. Later she received oral vitamin B12 with no adverse effects. The purpose of this case report is to draw attention to the hypersensitive reaction to injectable vitamin B12, which is rarely seen. This could be due to sensitization to the vitamin B12 molecule itself or an IgE mediated reaction. We concluded that anaphylactic reaction to vitamin B12 is a rare but serious side effect and it should be kept in mind while the drug is being administered to the patient, especially via the parenteral route

A performance simulation tool for the analysis of data gathering in both terrestrial and underwater sensor networks

Wireless sensor networks (WSNs) have greatly contributed to human-associated technologies. The deployment of WSNs has transcended several paradigms. Two of the most significant features of WSNs are the intensity of deployment and the criticalness of the applications that they govern. The tradeoff between volume and cost requires justified investments for evaluating the multitudes of hardware and complementary software options. In underwater sensor networks (USNs), testing any technique is not only costly but also difficult in terms of full deployment. Therefore, evaluation prior to the actual procurement and setup of a WSN and USN is an extremely important step. The spectrum of performance analysis tools encompassing the test-bed, analysis, and simulation has been able to provide the prerequisites that these evaluations require. Simulations have proven to be an extensively used tool for analysis in the computer network field. A number of simulation tools have been developed for wired/wireless radio networks. However, each simulation tool has several restrictions when extended to the analysis of WSNs. These restrictions are largely attributed to the unique nature of each WSN within a designated area of research. In addition, these tools cannot be used for underwater environments with an acoustic communication medium, because there is a wide range of differences between radio and acoustic communications. The primary purpose of this paper is to present, propose, and develop a discrete event simulation designed specifically for mobile data gathering in WSNs. In addition, this simulator has the ability to simulate 2-D USNs. This simulator has been tailored to cater to both mobile and static data gathering techniques for both topologies, which are either dense or light. The results obtained using this simulator have shown an evolving efficient simulator for both WSNs and USNs. The developed simulator has been extensively tested in terms of its validity and scope of governance

Effect of Dietary Supplementation of Organic Acids on Performance, Intestinal Histomorphology, and Serum Biochemistry of Broiler Chicken

The aim of the study was to determine the effect of dietary supplementation of organic acids on the performance, intestinal histomorphology, and blood biochemistry of broiler chicken. The birds in the control (T1) group were fed the basal diet whereas in other treatment groups basal diet was supplemented with 2% butyric acid (T2), 3% butyric acid (T4), 2% fumaric acid (T4), 3% fumaric acid (T5), 2% lactic acid (T6), and 3% lactic acid (T7). Broiler chicken fed diets supplemented with organic acids had significantly (P < .05) improved body weight gains and feed conversion ratio. No effect (P < .05) on cumulative feed consumption was observed. The addition of organic increased villus height in the small intestines but the differences were not significant (P < .05) in case of the ileum. Serum calcium and phosphorus concentrations were increased (P < .05) but no effect (P < .05) on the concentration of serum glucose and cholesterol, serum glutamic pyruvic transaminase (SGPT), and serum glutamic oxaloacetate transaminase (SGOT) was observed. The results indicated that the organic acid supplementation, irrespective of type and level of acid used, had a beneficial effect on the performance of broiler chicken

Short-term complications after bilateral internal mammary artery grafting--a retrospective study

Objectives: To analyze our experience of conducting Bilateral Internal Mammary Artery (BIMA) grafting, using both pedicled and free grafts for coronary revascularization, assessing the safety and efficacy of the procedure and comparing any differences observed between the two techniques of harvesting the grafts.Methods: A retrospective cross sectional study was conducted in July 2010 in which all 48 patients undergoing bilateral internal mammary artery grafting for coronary bypass surgery at the Aga Khan University Hospital from 1996 to 2010 were reviewed and evaluated. The main outcome measures were perioperative mortality and early morbidity with particular reference to cerebrovascular accidents, sternal wound complications and re-opening for bleeding. Chi-square test was used to elicit any meaningful associations between patient characteristics and post-operative outcomes.Results: Of the 48 patients undergoing bilateral IMA grafting, 46 were males and 2 females. The mean age was 48 +/- 9.4 years. Dyslipidaemia and smoking were the most common identifiable risk factors for coronary vascular disease. Following the 40 elective and 8 emergent surgeries, there was one hospital death. The most common post-operative complications were arrhythmias and wound infection. Diabetes and obesity were not observed to be associated with an increased risk of developing surgical site infection.CONCLUSIONS: Our study suggests that the short-term efficacy and the safety profile of bilateral IMA grafting for coronary revascularization is clinically acceptable. Long-term follow-up studies should be done to assess the cardiac event-free survival of these individuals evaluating its applicability as a routine for coronary artery bypass grafting in Pakistan

An unusual case of frost bite autoamputation of toes

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Vehicle-to-Grid Integration for Enhancement of Grid: A Distributed Resource Allocation Approach

In the future grids, to reduce greenhouse gas emissions Electric Vehicles (EVs) seems to be an important means of transportation. One of the major disadvantages of the future grid is the demand-supply mismatch which can be mitigated by incorporating the EVs into the grid. The paper introduces the concept of the Distributed Resource Allocation (DRA) approach for incorporating a large number of Plug-in EV (PEVs) with the power grid utilizing the concept of achieving output consensus. The charging/discharging time of all the participating PEVs are separated with respect to time slots and are considered as strategies. The major aim of the paper is to obtain a favorable charging strategy for each grid-connected PEVs in such a way that it satisfies both grid objectives in terms of load profile smoothening and minimizing of load shifting as well as economic and social interests of vehicle owners i.e. a fair share of the rate of charging for all connected PEVs. The three-fold contribution of the paper in smoothening of load profile, load shifting minimization, and fair charging rate is validated using a representative case study. The results confirm improvement in load profile and also highlight a fair deal in the charging rate for each PEV

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT.  No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too

Reconstruction of soft tissue defects in Fournier’s gangrene at a tertiary care centre

Background: Fournier’s gangrene is an acute and potentially lethal multi-bacterial necrotizing infection that primarily involves the scrotum but may extend beyond its confines to perineum and abdominal wall. The disease may result in sepsis and death if treatment is delayed. Management consists of timely diagnosis, aggressive debridement, broad-spectrum antibiotics followed by reconstruction which still remains a surgical challenge.Methods: It is a prospective study conducted from Jan 2006 to Dec 2015 on 29 patients of Fournier’s gangrene who were referred to the department of Plastic and Reconstructive Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, for reconstruction after initial debridement by general surgeon/urologist. The patient’s age, predisposing factors, site and the size of the defects, reconstructive options used and outcome were evaluated. Assessment of testicular function was done at 6 months by sperm count and morphology.Results: A total of 29 patients of Fournier’s gangrene consisting of 28 males and one female were included in the study. The mean age was 37 years and the most common comorbidity was diabetes mellitus in 18 patients (62%). Wounds were allowed to heal by secondary intension in 8 patients. Scrotal advancement flap was done in seven patients. Split thickness skin grafting (STSG) of extensive wounds was done in 11 patients and testes were placed in medial thigh subcutaneous pocket in one patient. Two elderly diabetic patients succumbed to sepsis and multi organ failure. Overall complication rate was 18.5%.Conclusions: Thorough debridement and early wound cover are essential in the management of Fournier’s gangrene for successful rehabilitation. Various reconstructive options are available with no conclusive evidence to support flap rather than skin graft and most of the procedures result in preservation of testicular function in the long term

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity