ASSOCIATION OF ADVERSE PERINATAL OUTCOMES WITH INCREASING AGE IN TWIN PREGNANCIES AT A TERTIARY CARE HOSPITAL.

Background; Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources which translate into insufficient care during pregnancy and delivery.  Due to inherent biological factors, twin pregnancies have increased rates of obstetric and perinatal complications such as preeclampsia, post-partum haemorrhage and preterm birth, which are known risk factors for maternal and perinatal mortality. Objective; To determine the frequency of adverse fetomaternal outcome in twin pregnancy in women of advanced age. Material and methods: A total of 181 patients with dichorionic diamniotic twin pregnancy on ultrasound having gestational age more than 24 weeks were taken in this cross-sectional study. Demographic information of patients (name, age, weight) was taken. Informed consent was taken from each patient, ensuring confidentiality and fact that there is no risk involved to the patient while taking part in this study. An obstetrical ultrasonography was done to confirm twin pregnancy. Blood samples were taken from all patients for assessment of anemia. Patients were followed up until pregnancy outcome. Results; Mean age of these study cases was noted to be 34.35 ± 2.41 years. Mean gestational age of our study cases was 34.67 ± 2.25 weeks. Mean BMI of our study cases was noted to be 22.45 ± 1.67 kg/m2 (with minimum BMI was 19.4 kg/m2 and maximum BMI was 32 kg/m2) and obesity was present in 27 (14.9 %) of our study cases. Of these 181 study cases, 126 (69.6%) delivered vaginally while 55 (30.4%) had to undergo cesarean section delivery. Mean hemoglobin level was noted to 8.67 ± 1.40 g/dl while anemia was seen in 126 (69.6%) of these study cases. Preterm labor was observed in 144 (79.6%), abruptio placentae in 19 (10.5%) and low birth weight in 123 (68 %) of our study cases. Conclusion; Twin pregnancy is associated with high risk of perinatal and pregnancy outcomes. There was higher frequency of anemia, cesarean section deliveries, preterm births and low birth weight babies in our study. There is a need for specialised prenatal care to reduce complications and adverse outcome in multiple pregnancies, and the need for ongoing social and medical care beyond the prenatal and perinatal periods to improve perinatal outcomes in these patients. Keywords; Preterm labor, anemia, twin pregnancy. DOI: 10.7176/JMPB/58-04 Publication date: August 31st 201

ASSOCATION OF NON – MODIFIABLE RISK FACTORS (DIABETES, HYPERTENSION AND OBESITY) WITH DYSLIPIDEMIA IN STROKE PATIENTS AT A TERTIARY CARE HOSPITAL

Background; Stroke is a global health problem. Stroke is responsible for major disabilities in adult population, and is 2nd leading cause of deaths all over the world. Different studies have reported dyslipidemia as major cause of stroke in different populations. Objective; To determine the association of non – modifiable risk factors such as diabetes, hypertension and obesity with dyslipidemias in patients with ischemic stroke at Nishtar Hospital Multan. Material and methods; All the cases of stroke (n=240) Patients having finding on CT scan brain (plain) consistent with ischemic stroke of either sex aged less than 80 years were enrolled in this cross-sectional study from department of Medicine, Nishtar Hospital, Multan. Complete history about onset of illness, diabetes, hypertension and cardiac illness of the patients was taken. Baseline laboratory investigations including lipid profile and Hb A1c were done. Results; Of these 240 study cases, 155 (64.6 %) were male patients and 85 (35.4%) were female patients. Mean age of our study cases was 68.37 ± 14.55 years (with minimum age was 34 years while maximum age was 79 years). Out of these 240 study cases, 138 (57.5 %) were from poor families, 53(22.1 %) were diabetic and only 11 out of 53 (20.75%) had controlled glycemic levels. Hypertension was present in 182 (75.8%) of our study cases and 39 (16.3 %) were obese. Smoking was present in 101 (42.1%), previous history of stroke was present in 35 (14.6%) and 83 (34.6%) were Saraikis. Mean duration of illness was 2.24 ± 0.53 months and 135 (56.3%) had disease duration more than 1 month. Mean serum cholesterol level was 202.06 ± 45.36 mg/dl, mean serum LDL level was 91.13 ± 10.24 mg/dl, mean serum triglyceride level was 147.51 ± 20.21 mg/dl and mean serum HDL level was 42.92 ± 3.85 mg/dl and dyslipidemia was present in 85 (35.4 %).  Conclusion; Frequency of dyslipidemia was high among patients having ischemic stroke in our study. Dyslipidemia was significantly associated with diabetes, hypertension, obesity, smoking, previous history of stroke and ethnicity. Early diagnosis followed by timely management can help reduce disease morbidity and improve clinical outcomes in these patients. Keywords; ischemic stroke, dyslipidemia, frequency. DOI: 10.7176/JMPB/58-03 Publication date: August 31st 201

Mitigation of power quality issues due to high penetration of renewable energy sources in electric grid systems using three-phase APF/STATCOM technologies: a review.

This study summarizes an analytical review on the comparison of three-phase static compensator (STATCOM) and active power filter (APF) inverter topologies and their control schemes using industrial standards and advanced high-power configurations. Transformerless and reduced switch count topologies are the leading technologies in power electronics that aim to reduce system cost and offer the additional benefits of small volumetric size, lightweight and compact structure, and high reliability. A detailed comparison of the topologies, control strategies and implementation structures of grid-connected high-power converters is presented. However, reducing the number of power semiconductor devices, sensors, and control circuits requires complex control strategies. This study focuses on different topological devices, namely, passive filters, shunt and hybrid filters, and STATCOMs, which are typically used for power quality improvement. Additionally, appropriate control schemes, such as sinusoidal pulse width modulation (SPWM) and space vector PWM techniques, are selected. According to recent developments in shunt APF/STATCOM inverters, simulation and experimental results prove the effectiveness of APF/STATCOM systems for harmonic mitigation based on the defined limit in IEEE-519

Incidence of Ventriculoperitoneal (VP) Shunt Infection In Vancomycin-Drenched VP Shunts

Objective:  To determine the occurrence of infection in patients with VP (Ventriculoperitoneal) shunts that were drenched in vancomycin. Materials and Methods:  A descriptive case series study was done in The Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from 10 September 2019 to 31 December 2020 to ascertain the frequency of VP shunt infections in vancomycin-drenched VP shunts. The patients were followed for 06 months. Results:  A total of 100 patients were included in this study. There were 44 (44%) men and 56 (56%) women. Age ranged from birth to 18 years. Patients younger than 1 year were 44 (44%), older than 1 to 10 years were 33 (33%) and older than 10 years were 23 (23%). Congenital hydrocephalus was the most common type observed in 49 (49%) patients. Shunt infection occurred in 7 patients (7%) within 6 months after surgery. Staphylococcus aureus was the most common pathogen identified in 05 of 07 (71%) infected patients. P value <0.05 was observed in Vancomycin-soaked VP shunts and shunt infection, which is significant. Conclusion:  The rate of shunt infection was significantly reduced when 2 mg/mL topical vancomycin was used intraoperatively (intra- and peri-shunt) in conjunction with a multi-step shunt infection prevention program. This treatment may be less expensive than using an antibiotic-impregnated catheter (AIC)

Improving Security Architecture of Internet of Medical Things: A Systematic Literature Review

Ever since its emergence, the concept internet of things (IoT) has been applied in many fields. In the area of medical sciences, a new concept “Internet of Medical Things” (IoMT) has been explored. IoMT establishes a connection between humans & machines and serves both of them. It has been expected that, by 2025, services of IoMT would reach the entire world. IoMT has covered a wide scope pertaining to health but unfortunately been facing many security challenges. Healthcare systems consist of sensitive and significant data, which is unorganized and noisy and needs additional power to be calculated for effective analysis & workable results. This data is worked upon for the purpose of making critical decisions. Therefore, it has become the main target of Cyber Criminals. The need of robust security and privacy (S&P) is gradually increasing as more and more devices are getting connected to the IoMT. The S&P of the IoMT has now become a great challenge, considering the utmost significance and vulnerability of the data in the healthcare industry. Lack of sufficient S&P in IoMT devices keeps the patient’ privacy at high stake. This research is intended to propose a Security Model to cope with these Security threats, attacks, issues and challenges. The proposed model has been developed by thoroughly investigating all the major security models through a detailed systematic literature review. The SLR has been conducted to explore all the security threats, security attacks, security issues and security challenges. Extensive meta-analysis has been performed for each of the defined category in order to prioritize these risks. After analyzing these risks, a comprehensive security model has been proposed. The interface has been developed in Python which is well structured, user friendly and easy to implement. The developed module not only identify and prioritize the risks but also automatically control different level of threats. The developed system also contain user intimation modules in case of any threat. This research is based on a very flexible and comprehensive model, which would be highly beneficial to future researchers who desire to work on existing models for the improvement as well as to those who wish to create new security models for IoMT

Tunable quantized spin Hall effect of light in graphene

The spin Hall effect of light is an appealing toolset for metrology that holds incredible potential for precision measurements due to its high sensitivity to the refractive index and nanostructure physical parameters. Here, we theoretically examine the quantized spin Hall effect of light on the surface of a monolayer graphene–substrate system subjected to an external perpendicular magnetic field. We discuss the impact of Landau levels induced by the external magnetic field B and the photon energy on magneto-optical conductivities and Fresnel reflection coefficients. We find that the spin-dependent splittings in graphene exhibit quantized characteristics due to the Landau levels quantization of the magneto-optical conductivities and Fresnel’s reflection coefficients near the Brewster angle. Moreover, the spin-dependent shifts are quantized and show oscillatory behavior with changes in the magnetic field and the photon energy. Our results manifest that the quantized photonic spin-dependent separations are sensitive to variations in the incidence angle, magnetic field, and incident photonic energies. The quantized spin-dependent splitting opens a promising route to find the quantized Hall conductivity and discrete Landau levels in the monolayer graphene by a direct optical weak measurement

OCCURRENCE AND TRANSPLACENTAL TRANSMISSION OF Anaplasma marginale IN DAIRY CATTLE

Bovine anaplasmosis, caused by Anaplasma marginale, is a non-contagious tick borne disease. The main objective of the current study was to investigate comparative frequency of anaplasmosis in three different cattle breeds (European breed/ Holstein Friesian and Jersey breed, indigenous breed and cross breed (1st and 2nd pedigree) and transplacental transmission using real time polymerase chain reaction for detection. Of the total 96 blood samples analyzed, our results indicated an overall incidence 45.83% (44/96) of A. marginale with highest incidence 62.5% (20/32) in European breed, followed by 42.4% (14/33) in cross breed and 35.4% (11/31) in indigenous breed. Most importantly, our results indicated that 13.7% (4/29) calves were found positive for the presence of A. marginale indicating transplacental transmission. Furthermore, indirect ELISA revealed an overall incidence rate of 34.3% (33/96) more likely indicating current or previous exposure. Finally, Giemsa staining determined that 15% (15/96) animals were found positive by examining red blood cells. Statistical analysis showed significantly higher (P0.05) difference was found among the crossbred and indigenous breed of cattle. Moreover, non significant (P> 0.05) effect of age group was observed on the incidence of A. marginale. White blood cell count and mean corpuscular volume were significantly (P<0.05) higher in infected cattle, while, red blood cells, packed cell volume hemoglobin concentration, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were significantly (P<0.05) higher in non-infected as compare to infected animals. Key words: Anaplasma marginale; cattle breeds; enzyme linked immuno sorbent assay; real-time polymerase chain reaction; transplacental transmission   POJAVNOST IN PRENOS Anaplasma marginale PREKO POSTELJICE PRI MLEČNEM GOVEDU Povzetek: Goveja anaplazmoza, ki jo povzroča Anaplasma marginale, je bolezen, ki ni kužna in jo prenašajo klopi. Glavni namen študije je bil raziskati in primerjati pogostost anaplazmoze pri različnih pasmah goveda in sicer dveh evropskih pasmah (holstein-frizijske pasma in pasma jersey) pri avtohtoni pasmi ter pri križancih med evropskimi pasmami in avtohtonimi pasmami (1. In 2. generacija križancev) ter prenos preko posteljice z uporabo verižne rekacije s polimerazo v realnem času (PCR). Od skupno 96 pregledanih vzorcev krvi so rezultati pokazali skupno incidenco 45,83 % (44/96) A. marginale z največjo incidenco 62,5 % (20/32) pri evropskih pasmah, nato 42,4 % (14/33) pri križanih živalih in 35,4 % (11/31) pri avtohtonih pasmah. Rezultati so tudi pokazali pozitivno rekacijo na prisotnost A. marginale pri 13,7 % (4/29) telet, kar kaže na prenos anaplazmoze preko posteljice. Metoda posrednega testa ELISA, ki pokaže na trenutno ali predhodno izpostavljenost, je pokazala 34,3-odstotno pojavnost pri vseh živalih skupaj (33/96 živali). Proučitev rdečih krvničk z barvanjem Giemsa je pokazalo 15 % (15/96) pozitivnih živali. Statistična analiza je pokazala statistično značilno razliko v pojavnosti anaplazmoze med evropskima pasmama v primerjavi s križanci in avtohtono pasmo (p < 0,05), razlika med križanci in avtohtono pasmo goveda pa ni bila statistično značilna. Poleg tega je bil pri pojavnosti A. marginale opazen neznaten (statistično neznačilen) učinek starosti proučevanih živali. Število belih krvnih celic in povprečni volumen telesne mase sta bila pri okuženih govedih statistično značilno povečana (p < 0,05), medtem ko so bile rdeče krvne celice, koncentracija hemoglobina v celicah in povprečna količina hemoglobina v posameznem eritrocitu (MCHC) v neokuženi skupini višja kot v skupini z okuženimi živalmi (p <0,05). Ključne besede: Anaplasma marginale; pasme goveda; test ELISA; verižna reakcija s polimerazo v realnem času; prenos preko posteljic

Mitigation of Power Quality Issues Due to High Penetration of Renewable Energy Sources in Electric Grid Systems Using Three-Phase APF/STATCOM Technologies: A Review

This study summarizes an analytical review on the comparison of three-phase static compensator (STATCOM) and active power filter (APF) inverter topologies and their control schemes using industrial standards and advanced high-power configurations. Transformerless and reduced switch count topologies are the leading technologies in power electronics that aim to reduce system cost and offer the additional benefits of small volumetric size, lightweight and compact structure, and high reliability. A detailed comparison of the topologies, control strategies and implementation structures of grid-connected high-power converters is presented. However, reducing the number of power semiconductor devices, sensors, and control circuits requires complex control strategies. This study focuses on different topological devices, namely, passive filters, shunt and hybrid filters, and STATCOMs, which are typically used for power quality improvement. Additionally, appropriate control schemes, such as sinusoidal pulse width modulation (SPWM) and space vector PWM techniques, are selected. According to recent developments in shunt APF/STATCOM inverters, simulation and experimental results prove the effectiveness of APF/STATCOM systems for harmonic mitigation based on the defined limit in IEEE-519