Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Technique for Management of Extra Articular Distal Tibial Fractures

Objective: To assess the outcome of the minimally invasive percutaneous plate osteosynthesis (MIPPO) method applied for the management of extra-articular distal tibial fractures.Materials and Methods: This quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Total 57 patients have included extra-articular type A distal tibial fracture, duration of injury <1 week, and competent neurological and vascular status of the fractured site. All the patients were treated with MIPPO Technique by using the distal tibial medial locking plate and the outcome of all patients was assessed radiologically in terms of union and functionally by using the Ovadia-Beals clinical scoring system. Data were analysed by using SPSS v. 21. Results: As per sample size calculation, 57 patients were included with a mean age of 37.19 ± 9.22 years. There were 45 (78.94%) male patients and 12 (21.05%) female patients. According to AO classification; the most common type was 43A1 with 31 patients (54.38%) whereas 18 (31.57%) were in Type 43A2 and 8 (14.03%) in Type 43A3. In our study, fracture union was achieved in a mean duration of 19.6 ± 3.45 weeks. When the functional outcome was analyzed, 41 (71.92%) patients had excellent outcome, 8 (14.03%) had good results, 5 (8.77%) had fair and 3 (5.26%) had poor outcome based on the subjective result and 44 (77.19%) patients had excellent, 7 (12.28%) had good, 3 (5.26%) had fair and 3 (5.26%) had poor result based on an objective result of Ovadia-Beals clinical scoring system. Conclusion: Thus MIPPO can be highly successful in achieving good to excellent outcomes in the maximum number of patients presented with a distal tibia fracture. So in the future, we can rely on this technique for such types of fractures. &nbsp

Neural network-based adaptive global sliding mode MPPT controller design for stand-alone photovoltaic systems

The increasing energy demand and the target to reduce environmental pollution make it essential to use efficient and environment-friendly renewable energy systems. One of these systems is the Photovoltaic (PV) system which generates energy subject to variation in environmental conditions such as temperature and solar radiations. In the presence of these variations, it is necessary to extract the maximum power via the maximum power point tracking (MPPT) controller. This paper presents a nonlinear generalized global sliding mode controller (GGSMC) to harvest maximum power from a PV array using a DC-DC buck-boost converter. A feed-forward neural network (FFNN) is used to provide a reference voltage. A GGSMC is designed to track the FFNN generated reference subject to varying temperature and sunlight. The proposed control strategy, along with a modified sliding mode control, eliminates the reaching phase so that the sliding mode exists throughout the time. The system response observes no chattering and harmonic distortions. Finally, the simulation results using MATLAB/Simulink environment demonstrate the effectiveness, accuracy, and rapid tracking of the proposed control strategy. The results are compared with standard results of the nonlinear backstepping controller under abrupt changes in environmental conditions for further validation

Establishing Reference Intervals for HBA1C in all three Trimesters of Pregnancy; A Cross-Sectional Study on Healthy Pregnant Women of Quetta, Baluchistan

Objective: To establish the reference intervals in healthy pregnant females of Quetta, Baluchistan, for Glycosylated Hemoglobin (HbA1c) in all three trimesters of pregnancy. Study Design: Cross-sectional study. Place and Duration of Study: Pathology Department Combined Military Hospital, Quetta Pakistan, from Jun 2018 to Jun 2019. Methodology: Blood samples of healthy pregnant females were drawn for Glycosylated haemoglobin (HbA1c). Fasting plasma glucose and haemoglobin were also measured to rule out hyperglycemia and anaemia. Samples for Glycated haemoglobin(HbA1c) were analyzed by Turbidimetric Immuno-inhibition (TINIA) method. For all the trimesters, 5th and 95th percentiles were taken as reference intervals for Glycosylated haemoglobin (HbA1c) and compared for each trimester. Results: A total of 388 samples were taken, of which 136(35.05%) females were from the first trimester, 128(32.98%) and 124(31.97%) from the second and third trimesters, respectively. The mean age of the study population was 25.1±3.7 years in the first trimester, 26.7±4.5 years in the second-trimester while and the third trimester it was 26.8±4.8 years. In the first, second,and third trimesters, the reference intervals for Glycosylated haemoglobin (HbA1c) were 3.8-5.2%, 4.1-5.4%, and 4.2-5.7%,respectively. Conclusion: For the exact diagnosis of hyperglycemia in pregnancy, each laboratory should establish its reference intervals of Glycated haemoglobin (HbA1c) for each trimester as it varies from trimester to trimester

Identification, Genotyping and Antimicrobial Susceptibility Testing of Brucella spp. Isolated from Livestock in Egypt

Brucellosis is a highly contagious zoonosis worldwide with economic and public health impacts. The aim of the present study was to identify Brucella (B.) spp. isolated from animal populations located in different districts of Egypt and to determine their antimicrobial resistance. In total, 34-suspected Brucella isolates were recovered from lymph nodes, milk, and fetal abomasal contents of infected cattle, buffaloes, sheep, and goats from nine districts in Egypt. The isolates were identified by microbiological methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Differentiation and genotyping were confirmed using multiplex PCR for B. abortus, Brucella melitensis, Brucella ovis, and Brucella suis (AMOS) and Bruce-ladder PCR. Antimicrobial susceptibility testing against clinically used antimicrobial agents (chloramphenicol, ciprofloxacin, erythromycin, gentamicin, imipenem, rifampicin, streptomycin, and tetracycline) was performed using E-Test. The antimicrobial resistance-associated genes and mutations in Brucella isolates were confirmed using molecular tools. In total, 29 Brucella isolates (eight B. abortus biovar 1 and 21 B. melitensis biovar 3) were identified and typed. The resistance of B. melitensis to ciprofloxacin, erythromycin, imipenem, rifampicin, and streptomycin were 76.2%, 19.0%, 76.2%, 66.7%, and 4.8%, respectively. Whereas, 25.0%, 87.5%, 25.0%, and 37.5% of B. abortus were resistant to ciprofloxacin, erythromycin, imipenem, and rifampicin, respectively. Mutations in the rpoB gene associated with rifampicin resistance were identified in all phenotypically resistant isolates. Mutations in gyrA and gyrB genes associated with ciprofloxacin resistance were identified in four phenotypically resistant isolates of B. melitensis. This is the first study highlighting the antimicrobial resistance in Brucella isolated from different animal species in Egypt. Mutations detected in genes associated with antimicrobial resistance unravel the molecular mechanisms of resistance in Brucella isolates from Egypt. The mutations in the rpoB gene in phenotypically resistant B. abortus isolates in this study were reported for the first time in Egypt

Seroepidemiological Analysis of Contagious Caprine Pleuropneumonia through cELISA in Selected Districts of Khyber Pakhtunkhwa-Pakistan

Contagious caprine pleuropneumonia (CCPP) is a fatal disease of goats caused by Mycoplasma capricolum subsp. capripneumoniae (Mccp).This disease has been causing huge economic losses to goat rearing farmers in Khyber Pakhtunkhwa.  Seroepidemiological study of this disease was conducted for the first time in selected districts of Khyber Pakhtunkhwa namely Swat, Peshawar, Kohat and Dera Ismail Khan. Total 384 serum samples were collected randomly from goats having different ages and both sexes showing respiratory signs belonging to flocks with no vaccination history against CCPP. The serum samples were examined for Mccp directed antibodies using monoclonal antibody based cELISA. Out of total 384 samples 15 samples were detected positive on cELISA with 3.91% overall seroprevalence in the selected districts. The highest CCPP seroprevalence was recorded in district Swat (8.33%) followed by district Kohat and D.I Khan (3.13% in each district) and the lowest seroprevalence was observed in district Peshawar (1.04%). Age based CCPP seroprevalence was found highest (6.73%) in the goat kids of age 1 to 180 days followed by the (3.85%) young goat of 181 to 365 days while the lowest was found in the adult goats (2%) with age more than one year.Sex based seroprevalence was found more in female goats (4.01%) as compare to male goats (3.33%). This study determined the load of CCPP using highly specific monoclonal antibody based cELISA kit in the selected districts of Khyber Pakhtunkhwa for the first time. Further study on CCPP is needed with increased sample size, that cover wider region of Khyber Pakhtunkhwa as necessary for limiting this disease through effective control measures.

Physico-chemical, Microbiological Parameters and Adulteration in Processed Dairy Products in Pakistan

Adulteration of dairy products with chemicals such as Caustic soda, Urea, Antibiotics and Microbiological contamination (high Total plate count, Coliform count and S. aureus) in processed dairy products samples constitute a potential public health hazard. A study was carried out to determine the microbiological quality and adulteration in various processed dairy products from various brands prevalent in the market.Samples of different dairy products including: (i) Yogurt, (ii) Cheese, (iii) Butter, (iv) Ice cream and v) Milk powder were collected from various places and processed in the laboratory for physic-chemical, microbiological and adultration analysis was carried out. (i)Yogurt samples from different Brands showed non-significant (P>0.05) difference in Total Plate Count (TPC), Coliform Count (CC) whereas significant (P<0.05) difference was observed in Streptococcus aureus Count (SAC), (ii) Cheese samples showed non-significant (P>0.05) difference in TPC whereas significant (P<0.05) difference was observed in SAC, (iii) Butter samples showed significant (P<0.05) difference in TPC, CC and SAC, (iv) Ice cream samples showed significant (P<0.05) difference in TPC, CC and SAC; and (v) Milk powder from various brands showed non-significant (P>0.05) difference in CC and SAC. All dairy products were negative for chemical adulterants tests i.e. urea, formaldehyde, neutralizers, starch, boric acid, quaternary ammonium compounds, while H2O2 was slightly positive in yogurt, milk powder and Ice cream samples of different brands. It is concluded that the dairy product in the market are safe from adulterants. Further butter and ice cream are showing a significant TPC, CC, and SAC.

INTRAMUSCULAR PHENYLEPHRINE DOSE COMPARISON FOR PREVENTION OF SPINAL ANESTHESIA INDUCED HYPOTENSION DURING CESAREAN SECTION: A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY

OBJECTIVE: to determine the more effective dose of intramuscular (IM) Phenylephrine in preventing hypotension due to spinal anesthesia (SA) administered for cesarean section. METHODS: The study was conducted from January1, 2020 to July 31, 2020, at Rehman Medical Institute, Peshawar, Pakistan. Sixty participants of American Society of Anesthesiologists (ASA) physical status 1 and 2, scheduled for elective cesarean section (CS) under SA were enrolled in this prospective double-blind study and randomized into two equal groups, P4-group and P8-group. P4-group received IM Phenylephrine 04 mg and P8-group received IM Phenylephrine 08 mg before SA. The incidence and intensity of hypotension, rescue doses of Phenylephrine and any adverse event, were recorded. Data collected was analyzed using Epi lnfo ™ version 7.2.5. RESULTS: Mean age of patients from P4-Group and P8-Group was 28.10±4.39 years and 28.33±4.95 years respectively. There were no statistically significant differences in the two groups with respect to demographic and clinical characteristics. Hypotension occurred in 33.3% (n=20/60) of participants. The incidence of hypotension in P4-group and P8-group were 46.7% (n=14/30) and 20% (n=6/30) respectively. In P8-group, risk of hypotension was 1.5 times less common compared with P4-group with 95% confidence interval of 1.02–2.19 (p=0.02). There was also no statistically significant difference between the onset of hypotension in the two groups. Those who developed hypotension had consumed a lesser amount of rescue Phenylephrine in P8-group compared with P4-group (p-value <0.01). CONCLUSION: Phenylephrine 08 mg IM preemptively controls SA induced hypotension in a sustained way in the fit participants