FREQUENCY OF HYPOTHYROIDISM IN CHILDREN WITH CELIAC DISEASE AT A TERTIARY CARE HOSPITAL

Background; The prevalence of thyroid disease is likely increased among children with celiac disease (CD). In addition, exposure to gluten-free treatment may be associated with a risk of thyroid disease, but this association remains controversial. This study was conducted to determine frequency of hypothyroidism in these children as there is no such study done in our local population of Southern Punjab. Objective; The objective of this study is to determine the frequency of hypothyroidism in children with celiac disease at a tertiary care hospital.  Material and methods; A total of 115 children with celiac disease were registered in this cross - sectional study which was conducted at department of pediatric medicine, Nishtar Hospital Multan from June 2015 to December 2016. These children were screened for their thyroid hormone levels to diagnose hypothyroidism. Results; Of these 115 study cases, 49 (42.6%) were male patients and 66 (57.4%) were female patients.  Mean age of our study cases was 6.31 ± 2.05 years. Of these 115 study cases, 59 (51.3%) belonged to rural areas while 56 (48.7%) from urban areas, 45 (39.1%) were from poor families while 70 (60.9%) were from middle income families. Of these 115 study cases, 31 (27 %) were from urdu speaking families, 38.3 % Punjabi, 30 (26.1%) Saraikis and 10 (8.7%) were Baloch.  Of these 115 study cases, mothers were illiterate in 75 (65.2%) and literate in 40 (34.8%). Mean disease duration was 5.27 ± 2.11 months and 69 (60%) had disease duration up to 6 months and 46 (40%) had more than 6 months. Mean T3 level was 86.43 ± 26.25 ng/dl, mean T4 level was 5.02 ± 1.69 µg/dl and mean TSH level was 3.80 ± 1.21 IU/ml and hypothyroidism was present in 44 (38.3%). Conclusion; High Frequency of hypothyroidism was noted in children with celiac disease in our study. Hypothyroidism was significantly associated with age, ethnicity and prolonged disease duration. Clinicians treating children having celiac disease should monitor thyroid hormone levels so as to decrease disease morbidity which will save them future hardships and improve quality of life of such patients. Keywords; Celiac disease, hypothyroidism, thyroid dysfunction

IDENTIFICATION OF CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS AND THEIR SENSITIVITY PATTERNS

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. High degree of drug resistance was observed among  these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli

Understanding COVID-19: From Origin to Potential Therapeutics

Currently, a global pandemic era of public health concerns is going on with the Coronavirus Disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first case of COVID-19 was reported from Wuhan’s Huanan seafood market in China late December 2019. Bats, pangolins, and snakes have been nominated as salient carriers of the virus. Thanks to its high pathogenicity, it can cause severe respiratory infections. Fever, dry cough, sore throat, pneumonia, septic shock, and ground-glass opacities are the foremost clinical manifestations of COVID-19. Immunocompromised patients are at high risk for COVID-19 infection and may lead to death. Scientist and government agencies around the globe are putting forward their best efforts and resources for the effective treatment of human coronavirus infections; however, neither vaccines nor antiviral drugs are available for the treatment of human coronaviruses (HCoV) infections such as SARS (severe acute respiratory syndrome), MERS (Middle Eastern respiratory syndrome), and COVID-19. Since the outbreak, a plethora of research and review articles have been published. Moreover, the mass media has bombarded the public with conflicting opinions about the pandemic. There is a dire need for accurate and reliable information concerning this pandemic. In this review, we have compiled the up to date information about the origins, evolution, epidemiology, and pathogenesis of this disease. Moreover, very few reports have addressed the clinical features and current status of treatment for COVID-19; we have adequately addressed these topics in detail in this review. Finally, a detailed account of clinical trials of vaccines and other therapeutics currently in progress has been delineated

Hereditary multiple exostoses and porencephaly in a Nigerian child: a case report

Hereditary multiple exostoses (HME) is a rare condition that is characterised by the development of bony swellings, usually at the growth ends of long bones. It is autosomal dominant, and may result in debilitating deformities. Porencephaly on the other hand is a cystic degeneration of the brain that is associated with the development of encephalomalacia. There is no established link between HME and porencephaly. This case report describes a seven year old female that has features of coexisting HME and porencephaly. She presented with afebrile seizures, learning impairment, stunted growth, macrocephaly and multiple bony swellings. Similar bony swellings were observed in the mother and the sibling of the index case. The coexistence of HME and porencephaly is rarely encountered in clinical practice. This presentation should stimulate the search for a possible link, which may perhaps herald the discovery of a new syndrome

Interventional programs for community reintegration after spinal cord injury: a scoping review

Advances in healthcare and technology have led to increased survival rates after spinal cord injury (SCI). To facilitate recovery, regain function, and promote quality of life after SCI, rehabilitation in the acute care setting is of paramount importance. After discharge from acute care, there is difficulty in accessing appropriate intervention to facilitate community rein-tegration. This review examined the content, strengths, limitations, and effectiveness of existing community reintegration intervention programs after SCI to promote the adoption of the existing programs or the development of new interventions for individuals with SCI in a low-resource setting. We conducted a review of the literature using Arksey and O’Malley’s methodological framework. Six electronic databases were searched from the database inception to September 2022, including Medline, CINAHL, Web of Science, PsycINFO, Sabinet, and Global Health. A manual search of the selected references was also conducted. Seven articles met our inclusion criteria. Overall, 290 individuals participated in the included studies, 80% of the participants were males, and the majority of the participants had an injury at the thoracic level. The studies presented different interventional programs with varying contents addressing different aspects of community reintegration such as household duties, mobility, health maintenance, and recre-ation. All the identified programs have evidence of preliminary effectiveness in some domains of community reintegration (e.g., household duties, mobility, and health). However, most available programs are geared toward addressing a specific aspect of community reintegration and may not be suitable for individuals with complex needs. A robust program that encompasses all critical aspects of community reintegration (housing and household duties, mobility, recreation, health maintenance, pain management, sexuality, social support, and employment) may be required. Therefore, further development and validation of existing programs are warranted

Automated deep bottleneck residual 82-layered architecture with Bayesian optimization for the classification of brain and common maternal fetal ultrasound planes

Despite a worldwide decline in maternal mortality over the past two decades, a significant gap persists between low- and high-income countries, with 94% of maternal mortality concentrated in low and middle-income nations. Ultrasound serves as a prevalent diagnostic tool in prenatal care for monitoring fetal growth and development. Nevertheless, acquiring standard fetal ultrasound planes with accurate anatomical structures proves challenging and time-intensive, even for skilled sonographers. Therefore, for determining common maternal fetuses from ultrasound images, an automated computer-aided diagnostic (CAD) system is required. A new residual bottleneck mechanism-based deep learning architecture has been proposed that includes 82 layers deep. The proposed architecture has added three residual blocks, each including two highway paths and one skip connection. In addition, a convolutional layer has been added of size 3 × 3 before each residual block. In the training process, several hyper parameters have been initialized using Bayesian optimization (BO) rather than manual initialization. Deep features are extracted from the average pooling layer and performed the classification. In the classification process, an increase occurred in the computational time; therefore, we proposed an improved search-based moth flame optimization algorithm for optimal feature selection. The data is then classified using neural network classifiers based on the selected features. The experimental phase involved the analysis of ultrasound images, specifically focusing on fetal brain and common maternal fetal images. The proposed method achieved 78.5% and 79.4% accuracy for brain fetal planes and common maternal fetal planes. Comparison with several pre-trained neural nets and state-of-the-art (SOTA) optimization algorithms shows improved accuracy

Thermal process enhancement of HNCPCM filled heat sink: Effect of hybrid nanoparticles ratio and shape

The present study based on the numerical investigation of a hybrid nanocomposite phase change material (HNCPCM) filled heat sink for passive cooling of electronic devices. The combination of graphene oxide (GO) and silver (Ag) hybrid nanoparticles are added inside the RT-28HC to enhance thermal performance. The volume fraction ratios of Ag:GO are varied from 0:0, 0:4, 1:3, 2:2, 3:1 and 4:0. Four different shape factor values of 3.7, 4.9, 5.7 and 16.1 of Ag-GO are varied. The transient simulations are carried out to solve the governing equations using the finite volume method scheme. The results depicted that employing HNCPCM has better heat transfer enhancement compared to the pure PCM because of the addition of nanoparticles. The results showed that adding the Ag-GO inside the RT-28HC improved the thermal conductivity and uniformity in the melting process compared to the RT-28HC based heat sink. With the addition of Ag-GO, melting time of HNCPCM filled heat sink is reduced and heat transfer rate in increased. The optimum ratio of 1:3 of Ag:GO nanoparticles and shape factor value of 16.1 show the higher thermal conductivity of 0.348 W/m.K, 12.93% reduction in melting time, 8.65% enhancement in heat storage capacity and rate of heat transfer

A novel routing protocol for underwater wireless sensor networks based on shifted energy efficiency and priority

Underwater Wireless Sensor Networks (UWSNs) are among the most promising research areas these days due to their unique characteristics and diverse underwater applications. Though a number of routing protocols have been designed and implemented for UWSNs over the past few years, the researchers face several challenges, e.g., low speed of propagation, small bandwidth, limited battery power, etc., while designing routing protocols for communication in UWSNs. Acoustic sensor nodes are equipped with batteries with limited power and it is quite costly to replace or recharge them. The network will not survive for the desired period of time if the power of node batteries is not efficiently used. To effectively resolve this issue, this paper proposes a Shifted Energy Efficiency and Priority (SHEEP) routing protocol for UWSNs. The proposed protocol aims to enhance the efficiency of the state-of-the-art Energy Balanced Efficient and Reliable Routing (EBER2) protocol for UWSNs. SHEEP is built upon the depth and energy of the current forwarding node, the depth of the expected next forwarding node, and the average energy difference among the expected forwarders. Simulation results demonstrate that SHEEP improves the energy efficiency and packet delivery ratio in comparison to EBER2 by 7.4% and 13% respectively

Transient simulation of finned heat sinks embedded with PCM for electronics cooling

This paper reports the two-dimensional (2D) transient numerical simulation of a phase change material (PCM) based finned heat sink to investigate the heat transfer performance for passive cooling of electronic devices. The finned heat sinks of 2 mm and 3 mm fin thickness are employed with a constant fin volume fraction of 9%, acting as thermal conductivity enhancer (TCE). The n-eicosane is employed as a PCM inside the heat sink to store the heat generated from the electronic device applied at the heat sink base. Transient numerical simulations are performed using finite-volume-method and conjugate heat transfer and melting/solidification phenomenon are investigated by applying various power levels. The numerical results show that the employed PCM with low temperature keeps the heat sink base temperature in lower limits and uniform melting is observed inside the finned heat sink. With the increase of heating power level, the PCM melting time is decreased for fin thickness heat sinks. By increasing the power level from 4 to 6 W, for the case of 3 mm fin thickness, the melting time increases by 6.63%, 3.59% and 1.90% by 3 mm fin thickness heat sink, compared to the 2 mm fin thickness heat sink. The developed equations of liquid fraction and modified Nusselt number are obtained as function of modified Fourier number, Stefan number, and Rayleigh number which provide guidelines for generalizing the thermal performance of PCM based finned heat sinks

Graphene Based Functional Hybrids: Design and Technological Applications

Because of the versatile chemical, physical, and electrical properties, graphene as well as its nanocomposites are regarded as the backbone of engineering and scientific innovation. Different physical and chemical methods are used to create sustainable carbon materials. Furthermore, fabrication methods are employed in order to produce the composites, which are of constituents with desirable properties. Because of their biocompatibility, graphene nanomaterials have enormous potential for improving biology and drug delivery. The proposed chapter provides a variety of fabrication methods for sustainable graphene composites and highlights various applications of graphene. Furthermore, graphene nanocomposites are promising multifunctional materials with improved tensile strength and elastic modulus. Despite some challenges and the fact that carbon nanotube/polymer composites are sometimes better in some specific performance, graphene nanocomposites may have a wide range of potential applications due to their outstanding properties and the low cost of graphene. Because these graphene composites have a controllable porous structure, a large surface area, high conductivity, high temperature stability, excellent anti-corrosion properties, and composite compatibility, they can be used in energy storage as electrocatalysts, electro-conductive additives, intercalation hosts, and an ideal substrate for active materials. Meanwhile, the chapter summaries the graphene nanocomposites requirements for technological innovation and scientific applied research