Correlation of Ankle Brachial Index with Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Objective: The aim of this study was to correlate ankle brachial index (ABI) with peripheral vascular disease (PVD) in type 2 diabetes mellitus. Material and methods: This was a hospital based interdisciplinary prospective study. A total of 100 patients in the age group of 30 to 80 years having peripheral vascular disease with predefined inclusion criteria were included in the study. Patients with other causes of raised blood sugar or peripheral vascular disease were excluded by relevant investigations. Ankle Brachial Index (ABI) was calculated using sphygmomanometer, and Colour Doppler Ultrasound (CDU) was used to diagnose PVD. Both the ABI method and the CDU method were compared for detecting PVD. Results: In our study, mean age was 60.04 ± 5.03 years, mean body mass index was 27.10 ± 2.67 kg/m2 and mean duration of diabetes was 7.75 ± 1.50 years. Among the 68 diagnosed cases of PVD on CDU, 70.6% cases were detected to have PVD by the ABI method (true positive) whereas 20 (29.4%) cases remained undiagnosed when ABI alone was used for the diagnosis (false negative). Conversely, among 51 diagnosed cases of PVD by ABI method 5.9% cases were found to be normal on CDU (false positive). The ABI method was found to have specificity of 88.5% but the sensitivity was only 70.6%. Conclusion: ABI has a very high specificity but the sensitivity is low compared to colour Doppler ultrasound. Therefore, if ABI is abnormal, the diagnosis of PVD is almost certain but in symptomatic cases with normal ABI; colour Doppler should be performed to exclude the PVD. Keywords: Ankle Brachial Index, peripheral vascular disease, Colour Doppler Ultrasound, type 2 diabetes mellitus. DOI: 10.7176/JMPB/57-02 Publication date: July 31st 201

Evaluation of Iron Status in Patients of Chronic Kidney Disease - A study to assess the best Indicators Including Serum Transferrin Receptor Assay

Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an important contributor, more so in the Pakistani population. As routine standalone iron tests do not accurately reflect the actual status in the complex environment of CKD, there is a need to study better indicators. Serum iron, ferritin, total iron-binding capacity (TIBC), and serum transferrin receptor (sTfR) levels were estimated in 100 primary iron deficiency anemia (IDA) patients (controls-Group 1) and 68 newly diagnosed CKD cases. The CKD patients were divided into two groups: Serum ferritin <=100 μg/L (Group 2) and >100 μg/L (Group 3). The values of percentage saturation, log of ferritin (log_ferritin), and the ratio of sTfR to log ferritin (sTfR/log_f or sTfR index) were calculated. The CKD cases were further divided depending on ferritin cut-offs of 30, 50, 70, and 100 μg/L and statistically analyzed including ROC and AUC, to choose the best diagnostic parameter for accurate assessment of iron status in CKD cases. The mean serum ferritin was 11.34 μg/L, 28.70 μg/L, and 281.81 μg/L, and the mean sTfR was 2.34 μg/ml, 1.82 μg/ml, and 1.28 μg/ml in Groups 1, 2, and 3. Among all groups, the difference was found to be significant for serum iron, log_ferritin, and sTfR/log_f. The sTfR and sTfR/log_f showed good discrimination between IDA and Anemia of chronic disease in CKD cases, but sTfR/log_f gave the best discrimination at all cut-off levels of ferritin. At a ferritin cut-off of 50 μg/L, the sTfR/log_f value of 0.83 had a sensitivity of 93.5% and specificity of 95.45%, and at a ferritin cut-off 100 μg/L, the same value of 0.83 had a sensitivity of 95.5% and specificity of 86.5%. The ratio of sTfR/log_f is the best indicator for assessing iron status in CKD. Keywords: Anemia, chronic kidney disease, ferritin, transferrin receptor DOI: 10.7176/JMPB/57-03 Publication date: July 31st 201

Dual-Mode Time Domain Multiplexed Chirp Spread Spectrum

We propose a dual-mode (DM) time domain multiplexed (TDM) chirp spread spectrum (CSS) modulation for spectral and energy-efficient low-power wide-area networks (LPWANs). DM-CSS modulation that uses both the even and odd cyclic time shifts has been proposed for LPWANs to achieve noteworthy performance improvement over classical counterparts. However, its spectral efficiency (SE) is half of the in-phase and quadrature (IQ)-TDM-CSS scheme that employs IQ components with both up and down chirps, resulting in a SE that is four times relative to Long Range (LoRa) modulation. Nevertheless, the IQ-TDM-CSS scheme only allows coherent detection. Furthermore, it is also sensitive to carrier frequency and phase offsets, making it less practical for low-cost battery-powered LPWANs for Internet-of-Things (IoT) applications. DM-CSS uses either an up-chirp or a down-chirp. DM-TDM-CSS consists of two chirped symbols that are multiplexed in the time domain. One of these symbols consisting of even and odd frequency shifts (FSs) is chirped using an up-chirp. The second chirped symbol also consists of even and odd FSs, but they are chirped using a down-chirp. It shall be demonstrated that DM-TDM-CSS attains a maximum achievable SE close to IQ-TDM-CSS while also allowing both coherent and non-coherent detection. Additionally, unlike IQ-TDM-CSS, DM-TDM-CSS is robust against carrier frequency and phase offsets

Experience of Emergency Peripartum Hysterectomies at a Tertiary Care Hospital in Quetta, Pakistan

Emergency peripartum hysterectomy (EPH) is associated with significant morbidity and mortality worldwide. The purpose of our paper was to determine the incidence, morbidity, and mortality of EPH done at our institution; the largest tertiary care government hospital in the city of Quetta, Pakistan. During the study period there were 12,642 deliveries, out of which 46 women had undergone an EPH, translating into an incidence of ∼4 per 1,000 births. Disturbingly, 82.6% of these patients had received no antenatal care prior to their presentation. There were 4 (8.7%) maternal deaths and 31 (67.4%) perinatal deaths. The commonest indication noted was uterine rupture in 21 (45.7%) cases. Lack of antenatal care is indeed a modifiable factor that needs to be addressed to help reduce maternal and fetal morbidity/mortality not only from emergency hysterectomies but also from all other preventable causes

Incidence, Management, and Outcome of Molar Pregnancies at a Tertiary Care Hospital in Quetta, Pakistan

Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. The incidence appears to be higher in women from South Asia. The purpose of our prospective study was to determine the incidence, presentation, and outcomes of all molar pregnancies at our institution. During the study period, there were a total of 16,625 patients admitted to our department; out of whom 85 patients were diagnosed with a molar pregnancy. Vaginal bleeding was the commonest symptom (94.2%); theca lutein cysts were noted in 39% of the cases. Suction, dilatation, and curettage were noted to be the preferred method in almost all cases; hysterectomy was done in 12 (14.1%) patients. Single-agent chemotherapy was employed in high-risk patients and was well tolerated. Mean followup for these patients was 5.7 months (range 1–24 months). None of these patients developed persistent trophoblastic disease, invasive mole, or choriocarcinoma during the follow-up period

Factors That Motivates Fake News Sharing Among Social Media Users: A Case of an Emerging Economy

False news is not new but it is becoming more common, it has become a serious issue as a result of social media's expansion, which has permitted individuals to engage and share thoughts. The primary aim of the research is to investigate those factors that influence fake news sharing on social media in an emerging economy. It is necessary to target emerging economy as fake news create a massive panic in such challenging economies that ultimately affect various sectors. For this purpose, Uses and Gratification theory (U&G) is used. In this research, the independent variable is False information and dependent variables are Altruism, Information sharing, Socialization, Entertainment and Pass time. In this research, quantitative method is used to investigate concepts to find relationships between variables and forecast results. In this research, the correlation research approach is used. A survey was conducted with local students via questionnaire (n=150). For data analysis, SPSS and smart PLS-SEM is used in this research. According to the findings of the study, altruism is the foremost imperative indicator of fake news distribution among Pakistanis. We have come to the conclusion that Altruism, Entertainment and Pass the Time foresee the spread of bogus news positively while Sharing of Information and Socialization impacts negatively. We recommend that online platforms users must verify the veracity of the information they have encounter and then post on social media websites

Clinicopathologic features and prognostic grouping of gastrointestinal stromal tumors (GISTs) in Pakistani patients: An institutional perspective

Objectives: Gastrointestinal stromal tumors (GISTs) are rare tumors of gastrointestinal tract, prognosis of which largely depends upon histopathologic characteristics of resection specimens, which were not widely studied in our population. Therefore we aimed to evaluate the histopathologic characteristics of GISTs in our population and their prognostic grouping according to college of American pathologist’s guidelines. Results: Mean age of patients was 53.4 years (18–71 years). 92% of cases were of primary GISTs and stomach was the most common site (57.7%). 75% of cases were of spindle cell morphology and 53.8% belonged to high risk prognostic group. Comparison of stomach and intestinal GISTs showed that intestinal GISTs were found to be of high grade (70%) and of high risk prognostic group (75 and 80%) compared to stomach GISTs (43% were of high risk prognostic group), however this fnding was not statistically signifcant. GISTs are infrequent gastrointestinal tumors but early diagnosis and identifcation of adverse histological features are key to successful treatment. We found a large majority of GISTs to be located in stomach, however intestinal GISTs were found more likely to be associated with adverse prognostic parameters. However more large scale studies are warranted to establish this fnding

Hepatitis C Treatment: current and future perspectives

Hepatitis C virus (HCV) is a member of Flaviviridae family and one of the major causes of liver disease. There are about 175 million HCV infected patients worldwide that constitute 3% of world's population. The main route of HCV transmission is parental however 90% intravenous drug users are at highest risk. Standard interferon and ribavirin remained a gold standard of chronic HCV treatment having 38-43% sustained virological response rates. Currently the standard therapy for HCV is pegylated interferon (PEG-INF) with ribavirin. This therapy achieves 50% sustained virological response (SVR) for genotype 1 and 80% for genotype 2 & 3. As pegylated interferon is expensive, standard interferon is still the main therapy for HCV treatment in under developed countries. On the other hand, studies showed that pegylated IFN and RBV therapy has severe side effects like hematological complications. Herbal medicines (laccase, proanthocyandin, Rhodiola kirilowii) are also being in use as a natural and alternative way for treatment of HCV but there is not a single significant report documented yet. Best SVR indicators are genotype 3 and 2, < 0.2 million IU/mL pretreatment viral load, rapid virological response (RVR) rate and age <40 years. New therapeutic approaches are under study like interferon related systems, modified forms of ribavirin, internal ribosome entry site (HCV IRES) inhibitors, NS3 and NS5a inhibitors, novel immunomodulators and specifically targeted anti-viral therapy for hepatitis C compounds. More remedial therapies include caspase inhibitors, anti-fibrotic agents, antibody treatment and vaccines

Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques

BackgroundThis study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients.MethodsFollowing the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979).ResultsThis meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias.ConclusionOur study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979]