DIABETES AS A RISK FACTOR OF IN – HOSPITAL MORTALITY IN PATIENTS WITH PREMATURE CORONAY DISEASE PRESENTING WITH ACUTE MYOCARDIAL INFARCTION.

Background; Recent data from various parts of the world have led to the conclusion that more than 80 % of CVD deaths occur in developing countries like Pakistan. This high burden of heart diseases is largely attributed to the industrial and technological progress which is associated with economic and social transformations which have lead to life style modification and sedentary life style. This study was planned to ascertain mortality rate of premature coronary artery disease in patients with AMI as it directly affects main workforce of our national economy. Objective; To determine role of diabetes with mortality in premature coronary artery disease patients with acute myocardial infarction.  Material and methods; A total of 145 patients having premature coronary artery disease presenting with acute myocardial infarction were included in this descriptive study. This study was conducted in the department of medicine, Nishtar Hospital, Multan from June 2018 to May 2019. These patients were followed during current hospitalization to see mortality in these patients and all the findings were noted in the proforma. Results; Of these 145 study cases, 96 (66.2%) were male patients and 49 (33.8%) were female patients. Mean age of our study cases was noted to be 47.67 ± 7.59 years. Mean time taken before presentation at hospital was 113.79 ± 54.36 minutes. Hypertension was present in 58 (40%), smoking in 39 (26.9%), family history of IHD in 67 (46.2%) and obesity in 49 (33.8%) of our study cases. Mortality was noted to be in 19 (13.1%) of our study cases, post MI angina was seen in 36 (24.8%) and cardiogenic shock was noted in 29 (20%). Diabetes was present in 48 (33.1%) of our study cases while in – hospital mortality among diabetic patients was 18 /48 (37.5%) (p=0.001). Conclusion; Our study results indicate that diabetic patients with premature coronary artery disease having acute myocardial infarction (AMI) have high rates of mortality. Positive family history, hypertension, obesity and diabetes were major risk factors noted in our study. Life style modification and early screening of the cases with positive family history in first degree relatives can help prevent heart diseases in our population as it hits main workforce and has negative impact on national productivity. Keywords; Premature coronary artery disease, mortality, diabetes, Myocardial infarction. DOI: 10.7176/JMPB/55-14 Publication date:May 31st 201

OUTCOME OF VAGINAL VERSUS ABDOMINAL ROUTE OF HYSTERECTOMY

Background; Hysterectomy is “Surgical removal of all or part of uterus”. Abdominal and vaginal route of hysterectomies are both predominant operative techniques being employed by the gynecologists all the world for various uterine conditions. Indications to select any particular technique in any of the hospital setting might not be optimally defined. This study was planned to evaluate particular route of hysterectomy (vaginal hysterectomy and abdominal hysterectomy) as there was no such study available which could document the data of our local population so this study was planned to be conducted to determine burden of problem and deficiencies for clinicians to opt better treatment options among targeted population. The results of this study will not only add in national data but will also be comparable with other international studies. Objective; To determine outcome of vaginal versus abdominal route of hysterectomy at a tertiary care hospital. Material and methods: A total of 240 women meeting inclusion and exclusion criteria of this study were registered in this study. Informed consent was taken from each patient. All the relevant data were recorded on pre-designed proforma. Data were entered and analyzed using SPSS-17. Results: A total of 240 subjects fulfilling the inclusion and exclusion criteria were registered in this study for abdominal hysterectomy and vaginal hysterectomy. Out of these 240 cases, 79 (32.9%) had undergone vaginal hysterectomy and 161 (67.1%) underwent through abdominal hysterectomy. Mean age of the study cases was 42.72±5.18 years (minimum age was 31 years while maximum age was up to 50 years). Mean parity of the study cases was 5.67±2.08 (minimum para 1 and maximum para 10). Pyrexia was seen in 90 (37.5%) of the study cases, of these 27 (30%) had undergone through vaginal hysterectomy and 63 (70%) underwent abdominal hysterectomy. Minimum duration of the surgery was 45 minutes and maximum duration of the surgery was 90 minutes, mean duration of the surgery was 69.75±14.92 minutes. Minimum Hospital stay was 3 days ranging to maximum hospital stay being 10 days, mean hospital stay in these study cases was observed to be 4.42±1.65 days. Conclusion; Vaginal route of hysterectomy is associated with lesser postoperative complications in terms short duration surgery, significantly short hospital stays and lower rates of postoperative pyrexia than that of abdominal route of hysterectomy. Keywords; Abdominal Hysterectomy, Vaginal hysterectomy, Uterovaginal prolapse. DOI: 10.7176/JMPB/55-05 Publication date:May 31st 201

A User-Centric QoS-Aware Multi-Path Service Provisioning in Mobile Edge Computing

Recent development in modern wireless applications and services, such as augmented reality, image processing, and network gaming requires persistent computing on average commercial wireless devices to perform complex tasks with low latency. The traditional cloud systems are unable to meet those requirements solely. In the said perspective, Mobile Edge Computing (MEC) serves as a proxy between the things (devices) and the cloud, pushing the computations at the edge of the network. The MEC provides an effective solution to fulfill the demands of low-latency applications and services by executing most of the tasks within the proximity of users. The main challenge, however, is that too many simultaneous service requests created by wireless access produce severe interference, resulting in a decreased rate of data transmission. In this paper, we made an attempt to overcome the aforesaid limitation by proposing a user-centric QoS-aware multi-path service provisioning approach. A densely deployed base station MEC environment has overlapping coverage regions. We exploit such regions to distribute the service requests in a way that avoid hotspots and bottlenecks. Our approach is adaptive and can tune to different parameters based on service requirements. We performed several experiments to evaluate the effectiveness of our approach and compared it with the traditional Greedy approach. The results revealed that our approach improves the network state by 26.95% and average waiting time by 35.56% as compared to the Greedy approach. In addition, the QoS violations were also reduced by the fraction of 16

Glyphosate: cancerous or not? Perspectives from both ends of the debate

Glyphosate is non-selective herbicide. Studies published in the last decade, point towards glyphosate toxicity. Shikimic acid pathway for the biosynthesis of folates and aromatic amino acids is inhibited by glyphosate. Glyphosate carcinogenicity is still considered to be a controversial issue. The World Health Organizations’ International Agency recently concluded that glyphosate is “probably carcinogenic to humans.” Some researchers believed that glyphosate is not linked with carcinogenicity

A comparison of four fibrosis indexes in chronic HCV: Development of new fibrosis-cirrhosis index (FCI)

<p>Abstract</p> <p>Background</p> <p>Hepatitis C can lead to liver fibrosis and cirrhosis. We compared readily available non-invasive fibrosis indexes for the fibrosis progression discrimination to find a better combination of existing non-invasive markers.</p> <p>Methods</p> <p>We studied 157 HCV infected patients who underwent liver biopsy. In order to differentiate HCV fibrosis progression, readily available AAR, APRI, FI and FIB-4 serum indexes were tested in the patients. We derived a new fibrosis-cirrhosis index (FCI) comprised of ALP, bilirubin, serum albumin and platelet count. FCI = [(ALP × Bilirubin) / (Albumin × Platelet count)].</p> <p>Results</p> <p>Already established serum indexes AAR, APRI, FI and FIB-4 were able to stage liver fibrosis with correlation coefficient indexes 0.130, 0.444, 0.578 and 0.494, respectively. Our new fibrosis cirrhosis index FCI significantly correlated with the histological fibrosis stages F0-F1, F2-F3 and F4 (r = 0.818, p < 0.05) with AUROCs 0.932 and 0.996, respectively. The sensitivity and PPV of FCI at a cutoff value < 0.130 for predicting fibrosis stage F0-F1 was 81% and 82%, respectively with AUROC 0.932. Corresponding value of FCI at a cutoff value ≥1.25 for the prediction of cirrhosis was 86% and 100%.</p> <p>Conclusions</p> <p>The fibrosis-cirrhosis index (FCI) accurately predicted fibrosis stages in HCV infected patients and seems more efficient than frequently used serum indexes.</p

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe