Calcium levels and metabolic disturbance in renal disease patients receiving hemodialysis: a cross sectional study highlighting its association in dialysis patients

Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study

Stop Voicing and F0 Perturbation in Pahari

The present study has been carried out to investigate the perturbation effect of the voicing of initial stops on the fundamental frequency (F0) of the following vowels in Pahari. Results show that F0 values are significantly higher following voiceless unaspirated stops than voiced stops. F0 contours indicate an initially falling pattern for vowel [a:] after voiced and voiceless unaspirated stops. A rising pattern after voiced stops and a falling pattern after voiceless unaspirated stops is observed after [i:] and [u:]. These results match Umeda (1981) who found that F0 of a vowel following voiceless stops starts high and drops sharply, but when the vowel follows a voiced stop, F0 starts at a relatively low frequency followed by a gradual rise. The present data show no statistically significant difference between the F0 values of vowels with different places of articulation. Place of articulation is thus the least influencing factor

Renal bone disease in patients on hemodialysis: an observational study focusing on the variation of calcium metabolism

Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level <250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level >650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively  (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P <0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin

Phylogenetic study of 46 Ancient Mitochondrial Human Genomes

Background: In the third era of ancient DNA field, it has endured the mesmerising modifications, which should be revealed. From side to side period, analysis of mitochondrial DNA permits to determine the evolutionary relationship among the species, to expose the terrestrial roots of the entities, to standardise the molecular clocks and to study the demographic pasts. Methods: In the current study we used bioinformatics tools for prediction of mitochondrial haplogroups and phylogenetic analysis. The ancient complete mitochondrial genomes were retrieved from online resources and were further used for phylogenetic analysis to know the evolutionary position of the ancient populations lived thousands of years ago. Results: We aligned 46 ancient genomes, collected online and estimated trees by using neighbour-joining, maximum parsimony and maximum-likelihood. Support for nodes was assessed with bootstrap replicates. During our analysis a strong bond between genomes of Altai Neanderthal, Motala 12, Motala 1, Loschbour, Ust'-Ishim, LBK, Mezmaiskaya Neanderthal, Denisova, RISE391(ERR844272), Clovis Anzick-1, RISE395(ERR844275) and RISE210(ERR844262) were found. In this context these ancient samples recommended the presence of a mutual earliest genomic signature. Conclusion: A significant population immigrations and alternates, accountable for influencing main parts of current demographic structure together in Europe and Asia is supported by the Bot15 (ERR668415) and RISE family. In the initial bronze period, ancestral similarity among these populations also share the theorised blow-out of Indo-European languages. Mechanisms of pathogen development and alteration for evolving and reappearing toxicities is also explained by this study. We aim that this study will help researchers in understanding the evolutionary position of ancient populations resided around the world.

Latest Advancements and Future Patterns in Wireless Sensor Networks

Wireless Sensor systems (WSNs) have turned out to be a standout amongst the most intriguing ranges of research in the previous couple of years. A WSN is made out of various remote sensor hubs which frame a sensor field and a sink. These vast quantities of hubs, having the   capacities            to                     detect                 their environment,       perform       constrained calculation and impart remotely frame the WSNs. Late advances in remote and electronic advances have empowered an extensive variety of uses of WSNs in military, activity reconnaissance, target following, environment checking, human services observing, et cetera. There are numerous new difficulties that have surfaced for the creators of WSNs, keeping in mind the end goal to meet the necessities of different applications like detected amounts, size of hubs, and hubs'       independence.       Accordingly, upgrades in the present advancements and better answers for these difficulties are required. The future advancements in sensor hubs must create capable and financially savvy gadgets, with the goal that they might be utilized as a part of utilizations like submerged acoustic sensor frameworks, detecting based digital physical frameworks, time-basic applications, subjective detecting and range administration, and security and protection administration. This paper likewise     portrays          the      examination challenges for WSNs

Transthoracic ultrasound guided fine needle aspiration cytology of peripheral lung lesions: an experience of a pulmonologist

Background: Ultrasound (USG) guided fine needle aspiration cytology (FNAC) is a simple and cost-effective method for the diagnosis of various peripheral lung lesions. Being radiation free and easily available in most of centres, it has become an important diagnostic modality for early diagnosis of peripheral lung lesions. Besides procedure is simple and complications if occur, can be managed by a pulmonologist effectively. This study was aimed to evaluate the role of Transthoracic ultrasound guided FNAC in diagnosis of peripheral lung lesion.Methods: This prospective observational study was conducted at Government Chest Diseases Hospital Srinagar over a period of one year from January 2018-December 2018. 61 patients who fulfilled inclusion criteria were included in this study. After properly explaining the procedure and taking informed consent, USG guided FNAC was done in patients with peripheral lung lesions under local anaesthesia. Radiological and cytological data of enrolled patients was collected prospectively and analysed.Result: About 61 patients were included in this study comprising of 39 males and 22 females in age range of 17- 90 years. Malignancy was the most common cytological diagnosis (78.57%). while as benign diagnosis was reached in 21.43%. In 8.19% of patients, FNAC was inconclusive. Among the malignant group, adenocarcinoma (47.72%) was most common cytological diagnosis. The overall diagnostic yield of USG guided FNAC in this study was 91.8%.Conclusion: USG guided FNAC of peripheral lung lesions is a simple procedure with high accuracy and less complication rate which can be performed by a pulmonologist for diagnosis

Real time endobronchial ultrasound guided transbronchial needle aspiration of intrathoracic lymphadenopathy: an initial experience

Background: Conventional TBNA has been used in the evaluation of intrathoracic lymphadenopathy with varied success rates depending upon size, site and aetiology of the node. Although mediastinoscopy has higher successes but it comes at the cost of general anaesthesia, more complications and limited access to the inferior and posterior mediastinum. Endobronchial ultrasound guided transbronchial needle aspiration has the advantage of real time nodal sampling with good success rates and minimal complications. The aim of our study was to assess the diagnostic yield and safety of EBUS TBNA in the evaluation of intrathoracic lymphadenopathy.Methods: This prospective observational study was conducted at government chest diseases hospital Srinagar over a period of two years from January 2016-December 2018 on 100 consecutive patients who underwent EBUS TBNA procedure for evaluation mediastinal and hilar lymphadenopathy. The data was collected and analysed for diagnostic yield and safety profile.Results: Out of the 100 subjects included in the study 52% were males and 48% were females. Mean age of the study population was 48.5±16.65 years. Most of the nodes sampled were subcarinal in location followed by paratracheal and hilar group. Granulomatous pathology (tuberculosis and sarcoidosis) was present in 41 patients followed by malignancy in 39 patients. Anthracosis was the cause of lymphadenopathy in 4 of the patients. There were no major complications in our study.Conclusions: EBUS TBNA is an effective and safe procedure for evaluation of mediastinal and hilar lymphadenopathy

Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

INTRODUCTION: There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. METHODS AND MATERIALS: We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. RESULTS: Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. DISCUSSION: Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

IntroductionThere is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation.Methods and materialsWe collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors.ResultsImplementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits.DiscussionPrograms need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Agronomic and physiological indices for reproductive stage heat stress tolerance in green super rice

Optimum growing temperature is necessary for maximum yield-potential in any crop. The global atmospheric temperature is changing more rapidly and irregularly every year. High temperature at the flowering/reproductive stage in rice causes partial to complete pollen sterility, resulting in significant reduction in grain yield. Green Super Rice (GSR) is an effort to develop an elite rice type that can withstand multiple environmental stresses and maintain yield in different agro-ecological zones. The current study was performed to assess the effect of heat stress on agronomic and physiological attributes of GSR at flowering stage. Twenty-two GSR lines and four local checks were evaluated under normal and heat-stress conditions for different agro-physiological parameters, including plant height (PH), tillers per plant (TPP), grain yield per plant (GY), straw yield per plant (SY), harvest index (HI), 1000-grain weight (GW), grain length (GL), cell membrane stability (CMS), normalized difference vegetative index (NDVI), and pollen fertility percentage (PFP). Genotypes showed high significant variations for all the studied parameters except NDVI. Association and principal component analysis (PCA) explained the genetic diversity of the genotypes, and relationship between the particular parameters and grain yield. We found that GY, along with other agronomic traits, such as TPP, SY, HI, and CMS, were greatly affected by heat stress in most of the genotypes, while PH, GW, GL, PFP, and NDVI were affected only in a few genotypes. Outperforming NGSR-16 and NGSR-18 in heat stress could be utilized as a parent for the development of heat-tolerant rice. Moreover, these findings will be helpful in the prevention and management of heat stress in rice