Arthralgia an indicator of Vitamin D3 Deficiency and Insufficiency

Objective: To determine the prevalence of Vitamin-D deficiency and insufficiency in patients complaining of arthralgia. Patients and Methods: This cross-sectional study included a group of 332 individuals complaining of arthralgia, selected by consecutive sampling technique. Vitamin-D blood level was performed by ELISA method. Data were entered and analyzed using SPSS Software (Version 15). Mean and Standard deviation was calculated for Quantitative variables and frequency with percentage was presented for Qualitative variables. Chi-Square test was applied to assess any association between Qualitative variables. P value less than 0.05 was considered significant. Results: Out of 332 individuals who had arthralgia, 9.03% (30).12% (17) and 85.84% (285) had Vitamin-D sufficiency, insufficiency and deficiency. Among total sample population, 75.0% (249) were females and 25.0% (83) were males. In females 8.83% (22), 6.02% (15) and 85.1% (212) had Vitamin-D sufficiency, insufficiency and deficiency (p-value 0.430). Out of 212 Vitamin-D deficient females,48.5% (103), 16.98% (36) and 34.4% (73) had severe, moderate and mild Vitamin-D deficiency(p-value=0.844). In male patients 9.63% (8),2.40% (2) and 87.95% (73) of males had Vitamin-D sufficiency, insufficiency and deficiency (p-value=0.430). Out of 73 Vitamin-D deficient males, 45.20%(33) ,16.43% (12) and 38.3% (28) had severe moderate and mild Vitamin-D deficiency(p-value=0.844). In females Vitamin-D deficiency was found to be most prevalent in age groups of 41-60 years. Whereas in males Vitamin-D deficiency was found to be most prevalent in age groups of 31-40years. Conclusion: Vitamin D deficiency/insufficiency is an important factor leading to arthralgia, keeping the prevalence rate of about 90% in mind.&nbsp

The role of augmentative and alternative communication in speech and language therapy: a mini review

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan

Sero-negative celiac disease with dermatitis herpetiformes: a case report

Introduction:We report a case of sero-negative celiac disease in Pakistan. Case Presentation: A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms. Conclusions: Negative serology should not rule out celiac disease, intestinal biopsy should be performed if there is strong clinical suspicion

COMBINATORIAL EFFECT OF LEPTIN, TUMOR NECROSIS FACTOR-ΑLPHA, AND VITAMIN D IN PROGRESSION OF TYPE 2 DIABETES IN KASHMIRI POPULATION

Objectives: Type 2 diabetes mellitus (T2DM) is a metabolic disorder usually characterized by hyperglycemia. Adipose tissue secretes bioactive substances known as adipocytokines including leptin, tumor necrosis factor-alpha (TNF-α), and adiponectin. These are considered as a bridge connecting obesity and insulin resistance. There is considerable epidemiological evidence to suggest a role of Vitamin D deficiency in the etiology of T2DM. This study was performed to evaluate and compare serum Vitamin D and adipocytokine levels in T2DM patients and healthy controls of Jammu and Kashmir region of India.Methods: A total of 200 T2DM patients and normal 200 healthy controls were considered for the study. Enzyme-linked immunosorbent assay was used to measure serum leptin and TNF-α levels. The Vitamin D levels were measured by chemiluminescent microparticle immunoassay method. Biochemical parameters were measured by the enzymatic method.Results: Our results concluded that basic metabolic parameters, TNF-α and leptin levels were significantly higher in cases than controls. The serum Vitamin D levels were found significantly lower among T2DM patients. No correlation of Vitamin D with leptin was observed in cases and controls. However, a positive correlation between leptin and TNF-α was noted in T2DM subjects as well as in controls with statistical significance being higher in females (r=0.500; p=0.001) as compared to males (r=0.298; p=0.036) in T2DM subjects as well as in controls (r=0.659; p=0.001; r=0.621; p=001).Conclusion: These results concluded that lowering of Vitamin D levels and upregulation of leptin and TNF-α altogether play an important role in the development of T2DM, and from correlation analysis, it could be predicted that leptin and TNF-α act in a synergistic manner toward the development of T2DM

Evaluation of Cervical Disc Degeneration in Patients with Neck Pain on Magnetic Resonance Imaging

Background: Cervical disc degeneration is the most common pathology that in most of the cases  clinically present as Objective: To evaluate the cervical region abnormalities in patients with neck pain on magnetic resonance imaging. Methodology: In this descriptive study 180 adult patients were included. All patients had been collected from DHQ hospital Gilgit and Ghurki Trust teaching hospital. After informed consent, data were collected through 1.5 tesla GE (closed bore) and 0.35 tesla Hitachi (open bore) MRI machines. Results:  Findings show that among 180 adult patients, 136 presented with disc degeneration among which 81 were males and 55 were females. Among 81 males, 63 had disc degeneration at multiple levels while 18 had single disc degeneration. In females 35 patients showed multiple disc degeneration while 20 involved a single disc. Conclusion: It is concluded that disc degeneration is prevalent in males than females. Disc degeneration at multiple levels is higher than single disc degeneration in both genders. Keywords: Disc degeneration, magnetic resonance imaging. DOI: 10.7176/JHMN/99-03 Publication date: April 30th 2022

Sonographic Incidence and Characteristics of Thyroid Nodules in Various Age Groups and Gender

Background: Thyroid nodules (TNs) are among the common diseases of the endocrine system, with 3%–7% prevalence by palpation. The prevalence by high-resolution ultrasonography among randomly selected individuals is 19%–67%, with annual increasing trends worldwide. 5% to 15% of TNs is thyroid cancer, which has become the fastest growing cancer.1 Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation.9 Objective: To characterize thyroid nodules in various age groups and gender.  Methodology: In this descriptive study, among 179 patients of thyroid nodule were selected with age and gender discrimination by convenient sampling, at Department of Radiology, Lahore General hospital and Inmol Cancer hospital Lahore. Mindray Z5 and Toshiba xario 100 with linear probe of 7.5-11MHz ultrasound machine was used. Results: Out of 179 collected, 105 were females and 74 were males who visited radiology department due to thyroid nodule. It shows 58.7% females and 41.3% males patients diagnosed. Out of 179 patients 106 patients 59.2% came with irregular margins thyroid nodules and remaining 73 patients 40.8% had thyroid nodules with regular margins. 127 patients 70.9% had hyperechoic thyroid nodules and 52 patients 29.1% had hypoechoic thyroid nodules. Out of 97 patients 54.2% developed (Multi Nodular Goiter) MNG, 66 patients 36.9% developed right thyroid nodules and 16 patients 8.9% developed left thyroid nodules. Females developed 56.2% MNG, 33.3% right thyroid nodule and 10.5% left thyroid nodule while males developed 51.4% MNG, 41.9% right thyroid nodule and 6.8% left thyroid nodule. Out of 179 patients 109 (60.9%) patients shows no perfusion of blood while remaining 70 (30.1%) shows some perfusion of blood on USG. Minimum age was 5 years and maximum were 90 years while their mean was 43. Age group between 41 to 50 years most likely develop thyroid nodules.  Conclusion: In this study we conclude that females most likely develop thyroid nodules than males.  Both males and females mostly develop multi nodular goiter and least develop left thyroid nodule. Patients in 4th decade most likely develop thyroid nodules. Key words: Thyroid nodules, Ultrasonography DOI: 10.7176/JHMN/80-15 Publication date:September 30th 202

Energy Efficiency and Throughput Optimization in 5G Heterogeneous Networks

Device to device communication offers an optimistic technology for 5G network which aims to enhance data rate, reduce latency and cost, improve energy efficiency as well as provide other desired features. 5G heterogeneous network (5GHN) with a decoupled association strategy of downlink (DL) and uplink (UL) is an optimistic solution for challenges which are faced in 4G heterogeneous network (4GHN). Research work presented in this paper evaluates performance of 4GHN along with DL and UL coupled (DU-CP) access scheme in comparison with 5GHN with UL and DL decoupled (DU-DCP) access scheme in terms of energy efficiency and network throughput in 4-tier heterogeneous networks. Energy and throughput are optimized for both scenarios i.e. DU-CP and DU-DCP and the results are compared. Detailed performance analysis of DU-CP and DU-DCP access schemes has been done with the help of comparisons of results achieved by implementing genetic algorithm (GA) and particle swarm optimization (PSO). Both these algorithms are suited for the non linear problem under investigation where the search space is large. Simulation results have shown that the DU-DCP access scheme gives better performance as compared to DU-CP scheme in a 4-tier heterogeneous network in terms of network throughput and energy efficiency. PSO achieves an energy efficiency of 12 Mbits/joule for DU-CP and 42 Mbits/joule for DU-DCP, whereas GA yields an energy efficiency of 28 Mbits/joule for DU-CP and 55 Mbits/joule for DU-DCP. Performance of the proposed method is compared with that of three other schemes. The results show that the DU-DCP scheme using GA outperforms the compared methods

Frequency and Anatomical Distribution of Pulmonary Embolism on CT Pulmonary Angiography

Background: Pulmonary embolism, with its growing prevalence, has become a potentially life-threatening medical condition with crucial symptoms. However, prognosis is good if timely diagnosis is made and to the level of segmental and sub segmental arteries as well. Standard computed tomography pulmonary angiography (CTPA) is thus used to diagnose acute pulmonary embolism. Objective: The primary objective of the current study was to determine and investigate the anatomical distribution frequency of pulmonary emboli, where segmental, sub segmental, and lobar arteries on CT pulmonary angiography are included. Methodology: In a descriptive cross-sectional study, single-centered studies and CTPA scans of 98 patients were included. Data was obtained from Shalimar Hospital and University of Lahore – Teaching Hospital, Lahore, Pakistan. Sample size included patients of all age groups with suspected pulmonary embolism, with no differentiation of male or female samples. Results: According to statistics and analysis, the current study results indicated the presence of pulmonary embolism in 36 patients and its absence in 62 patients. Results indicated that amongst the 98 patients scanned, the highest frequency of pulmonary emboli was found in the pulmonary trunk and lobar artery in 8 patients (8.2%). Furthermore, CTPA of the participants detected pulmonary emboli in segmental and sub-segmental arteries of 5 patients (5.1%), with another 2 patients showing pulmonary emboli in only the sub-segmental artery (2.0%). Another 2-2 patients showed pulmonary emboli in lobar and segmental artery and lobar, segmental and sub-segmental artery respectively (2.0%, 2.0%). Conclusion: The largest number of pulmonary emboli were found in the pulmonary trunk, followed by emboli of segmental and lobar arteries in patients. It is concluded that CTPA evaluates pulmonary embolism with great precision and anatomical distribution localized main trunk, and pulmonary artery emboli along with lobar, segmental and sub-segmental artery emboli. Keywords: Computed Tomography Pulmonary Angiography (CTPA), pulmonary emboli, segmental artery, sub segmental artery, lobar arteries DOI: 10.7176/JHMN/100-02 Publication date:May 31st 202