Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children

Objective:To determine the correlation between initial levels of lactate and 30-day mortality rate in suspicious cases of sepsis in pediatrics. Methodology:  Study was prospective observational conducted upon 350 patients. The study was held among patients of pediatrics department of Nishtar hospital, Multan. Patients of sepsis were included in the study and were tested for the hypothesis that there is increased risk of mortality with serum lactate levels more than 36mg/dL rather than when levels are less than 36mg/dL. For this, different measurements were taken and compared at different levels of lactate among the patients with sepsis. SPSS version 24 was used to analyzed data and student t-test and chi-square test was applied to see association among variables. P value ≤ 0.05 was taken as significant. Results: There were 60% (n=105) males and 40% (n=70) females. Comorbidity, oncologic, nononcologic, none and central line present was observed as 74.9% (n=131), 27.4% (n=48), 45.1% (n=79), 32.6% (n=57) and 23.4% (n=41) respectively. Organ dysfunction, hypotension, hematologic, hepatic and renal was noted as 27.4% (n=48), 14.9% (n=26), 17.7% (n=31), 0.6% (n=1) and 16% (n=28) respectively. While, the mean age, heart rate, systolic blood pressure, temperature and pulse oximetry of the 3-day hospital mortality patients was 8.11±4.03 years, 143.21±2.54 bpm, 109.12±3.68 mm Hg, 38.06±1.96 °C and 93.69±2.78 respectively. Conclusion: when serum level of lactate is more than 36mg/dL, high risk of mortality is present but with less senistivity. A record of initial levels of lactate may prove to be useful in initial risk detection in sepsis in pediatrics. Keywords: Lactate, Mortality, Children, Sepsi

Occurrence of Cobalamin (B-12) Deficiency in Metformin using Type II Diabetes Mellitus Patients

Objective: To observe the occurrence of cobalamin (B12) deficiency and neuropathy in type II diabetic patients using metformin. Study Design: Prospective, cross-sectional study. Site and Duration of Study: Department of General Medicine and Diabetic Clinic, Nishtar Hospital Multan, from June 10, 2017 to February 25, 2018. Methodology: Ninety two patients underwent proper detailed clinical history and examination, after which weight, mean blood pressure, HbA1c, hemoglobin, mean corpuscular volume, serum cobalamin levels, Toronto Neuropathy Score were entered on a preformed performa. Electro-chemi-luminescence was used measurement of cobalamin. Toronto Neuropathy Score was calculated from history, clinical and neurological examination. Independent t-test was applied on continuous data and chi-square test was applied on nominal data using SPSS v.23. Confidence interval was taken as 95%. Results: Mean serum cobalamin (B12) levels were 373.13±166.78 pg/ml and 538.48±172.29 pg/ml in M-Group and N-Group, respectively, difference being statistically significant (p<0.001). In M-Group, cobalamin (B12) deficient patients were statistically more in number (p=0.006) and Toronto Neuropathy Score was statistically higher (p<0.001). Number of patients developing neuropathy was also statistically higher (p=0.002) in M-Group. Conclusion: After performing this study, we concluded that there is a strong association of metformin use with cobalamin (B12) deficiency in type-II diabetes mellitus patients. This can also lead to de novo development of peripheral neuropathy or can profoundly worsen the pre-existing diabetic neuropathy. Keywords: Cobalamin, Type II diabetes mellitus, neuropathy, metformin

Analyzing the career development barriers faced by rural women in India

In India, one of the most populous countries in the world, women make up approximately half of the country’s population. While most of Indian women hold the highest educational degrees and enter the workforce almost in every sector, rural women are lagging behind in their career development. The study was aimed at investigating the factors that inhibit and challenge rural women to progress in their career development. The study was conducted in two folds of data collection. The first fold is qualitative data using interviews with 10 rural women and their analysis using thematic analysis, and the second fold is quantitative research and data collection from 148 rural women using a semi-structured survey questionnaire based on the identified themes and analyzed using SPSS. The findings of the study illustrated various barriers related to personal, social, family, economic, and infrastructure issues. Respondents spoke about several challenges they face with not having support to continue their higher studies. Eighty-five percent of rural women demonstrated they are suppressed in society due to gender stereotypes and are predominantly overburdened with family responsibilities. Furthermore, the study recommends significant implications for Indian women and the government from a global perspective

Lemmel’s Syndrome: A Rare Cause of Obstructive Jaundice Secondary to Periampullary Diverticulum

In 1934 Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Obstructive jaundice caused by periampullary duodenal diverticulum (PAD) in absence of choledocholithiasis or tumor is known as Lemmel syndrome. A patient with an extraluminal duodenal diverticulum presenting with obstructive jaundice and pancreatitis is presented in this case. Although initially managed conservatively, the patient had recurrence of symptoms after 2 months but then had successful surgical resection of the duodenal diverticulum

Single channel speech enhancement by colored spectrograms

Speech enhancement concerns the processes required to remove unwanted background sounds from the target speech to improve its quality and intelligibility. In this paper, a novel approach for single-channel speech enhancement is presented, using colored spectrograms. We propose the use of a deep neural network (DNN) architecture adapted from the pix2pix generative adversarial network (GAN) and train it over colored spectrograms of speech to denoise them. After denoising, the colors of spectrograms are translated to magnitudes of short-time Fourier transform (STFT) using a shallow regression neural network. These estimated STFT magnitudes are later combined with the noisy phases to obtain an enhanced speech. The results show an improvement of almost 0.84 points in the perceptual evaluation of speech quality (PESQ) and 1% in the short-term objective intelligibility (STOI) over the unprocessed noisy data. The gain in quality and intelligibility over the unprocessed signal is almost equal to the gain achieved by the baseline methods used for comparison with the proposed model, but at a much reduced computational cost. The proposed solution offers a comparative PESQ score at almost 10 times reduced computational cost than a similar baseline model that has generated the highest PESQ score trained on grayscaled spectrograms, while it provides only a 1% deficit in STOI at 28 times reduced computational cost when compared to another baseline system based on convolutional neural network-GAN (CNN-GAN) that produces the most intelligible speech.Comment: 18 pages, 6 figures, 5 table

Dividend Policy as a Core Determinant of Earning Management: Evidence from Pakistan

The current study estimated the impact of dividend policy on earnings management for the non-financial firms of Pakistan listed at the Karachi Stock Exchange. The data covering the period from 2005 to 2017 were estimated by using a random effect-generalized least square regression. The study findings report that dividend policy is a significant determinant of earning management and limits the probability of a firm’s earning management practices. This research gives us some empirical evidence regarding the role of key contributing factors in the scope of earnings management. Regulators can implement corporate governance rules and regulations based on empirical tracts in place of motivational debates on politics. This study results offer a compact platform for investors to eradicate ambiguity by recognizing the likelihoods of resourceful goals and improving their policymaking process. The research findings will help to give investors a clear idea about the various factors that play a contributing part for making financial reporting and misreporting of profits.  These contributing factors allow investors to be careful about the ingenious purpose and effectiveness of management to obtain returns for their benefit

Drug utilization and prescribing pattern in the treatment of urolithiasis: a perspective on World Health Organization recommendations

Background: Drug utilization research (DUR) is essential in promoting rational use of medicine, aimed at understanding the patterns of prescription, administration, and utilization of medications. It provides valuable insights into the actual drug usage patterns for specific disease conditions. To evaluate the current utilization pattern of drugs in patients of urolithiasis in the Department of General Medicine and Surgery at Integral Institute of Medical Science and Research Hospital, Lucknow. Methods: Following the approval of the institutional ethics committee, a prospective observational study was conducted at Integral Institute of Medical Science and Research Department of general medicine and surgery over a six-month period. Urolithiasis patients’ prescriptions were analyzed to study the prescribing patterns. Information about patient demographics, co-morbidities, and the number and types of medications prescribed were collected and analyzed. Results: Out of 102 patients studied, a female preponderance over male patients was observed. The co-morbidities that are encountered most commonly were hydronephrosis, cystitis, and renal cyst. There is averaged 7 medicines per prescription, 15.25% of medicines written by the generic name, 83.33% of patients receiving antibiotics, 54.70% of patients receiving injections, and 83% of drugs prescribed are mentioned in the essential medicine list. Analgesics, antibiotics, nutritional supplements, antiemetic, alkalizing agents, and antispasmodics were among the class of medicines given. Conclusions: This study highlights the current use of medicines and drug utilization in urolithiasis management. The findings show important insights for healthcare professionals to enhance medication therapy, encourage cost-effective healthcare delivery and improve quality of patient in urolithiasis management

Linguistic based Movements for separation in South Asian States: A Case Study of Sri Lanka

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mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} The effect of linguistic is the integral part of the Social and political consideration in the multi-linguistic countries all over the World. South Asian countries are facing multi-linguistic problem and as a result separation movements exist in the region since decades. However, each state/country is confronting this issue according to its environment and local circumstances. This paper will focus the impacts of ethnicity on education and poverty in Sri Lanka. The existence of India, Pakistan and Bangladesh is one of the major reasons of linguistic issue. In case of Sri Lanka, the Tamil movement though could not succeed due to various reasons but originally initiated due to linguistic deprivation of Tamil community. The main reasons are not only language but the deprivation in education, employment and social status like poverty of particular community. If their problems are addressed properly then the linguistic issue cannot be highlighted. It is worth mentioning that all the linguistic based separation movement succeeded if supported by the International community otherwise failed. The good examples are Tamil and Khalistan separation movements. In addition to above, the Sri Lankan government took advantage of 9/11 incident and crushed the movement with force and international community remained silent. As a result this linguistic based separation movement could not succeeded in Sri Lanka despite the fact that these kind of movements succeeded in South Asia.  </p

The Experimental Study On the Effectiveness of Social Media Ad Campaign: Like, Comment, Share

The popularity of social media outlets has forced us to inquire about marketing effectiveness in any area of the industry. Social media has rapidly risen in popularity as a new advertising platform that allows users to connect with one another and engage with brands.  This research has attempted to explore the attitude of people over the advertisements in what formats most people prefer to like, comment or share. We focus top trended social media sites Facebook, Twitter and LinkedIn to demonstrate the consumer engagement on advertisements placed on these sites. This research has identified the factors which influence the users to keep an eye out on advertisements that make them want to continue watching it as they spend their daily time on these social media websites and apps. To determine what makes Ads and online marketing campaigns successful we used variables such as Vividness, Content of Posts, Position of Posts, Scheduling and Call to Action.  It was conducted on 300 respondents. We used the questionnaire to collect the data and used a semantic differential scale. We questioned about the ads to respondents which were based on our variables. Results showed that our research is decisive but the variable call to action has an insignificant effect and other variables such as vividness, the position of post, the content of the post, schedule have a significant relation with customer engagement