The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well

Dc Shock Simulator

Defibrillators are electronic devices that carry shock electrical signals (pulses) to the heart muscle to maintain myocardial depolarization that is undergoing cardiac fibrillation (ventricular fibrillation or atrial fibrillation) (Bronzino, 2000). There are several conditions that must be met for the occurrence of shock processes including shock time, energy to be provided, patient and operator safety. In this defibrillator the use of selectors / energy selection is linear in the range 1-30 Joules with the use of tools at 10, 15, 20, 25, 30 Joules. The energy will then be discarded or given to the patient via a paddle when pressed the Discharge / shock button. The result of the signal given to the patient is monophasic. This study used a pre-experimental type with a One Group post test design research design. Measurements were made 5 times the volt meter at the test points determined by the compiler

Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are characterized by proliferation of mucin-secreting cells in the main pancreatic duct (PD) or its branches. The secreted thick mucin usually leads to PD obstruction and dilation. A common complication of IPMN is recurrent acute pancreatitis secondary to poor pancreatic fluid drainage, and rarely, pancreatobiliary and pancreatointestinal fistulae. We describe a unique case of IPMN in a 57-year-old male who was referred to our institution for evaluation of recurrent acute pancreatitis. After extensive evaluation, he was diagnosed with main duct IPMN. Intraductal PD biopsy revealed intestinal type IPMN with intermediate grade dysplasia. Patient was managed clinically by large caliber (10 French) PD stenting which eliminated his recurrent acute pancreatitis. The patient was initially referred for pancreatic resection; however, surgery was aborted and evaluated to be high risk with high morbidity secondary to the extensive adhesions between the pancreas and surrounding structures. Patient remained clinically stable for a few years except for an episode of acute pancreatitis that happened after a trial of stent removal. Subsequently, the patient did well after the PD stent was replaced. Recently, repeat abdominal imaging revealed a large pancreatoduodenal fistula which was confirmed on repeat endoscopic retrograde cholangiopancreatography. We were able to perform pancreatoscopy by advancing a regular upper scope through the fistula and into the PD. Interestingly, the fistula relieved the symptoms of obstruction and subsequently decreased the frequency of recurrent pancreatitis episodes with no further episodes at 6 months follow-up. This case highlights the importance of providing adequate PD drainage to reduce the frequency of recurrent acute pancreatitis in the setting of main duct IPMN, especially if the patient is not a surgical candidate. Also, physicians need to monitor for complications such as fistula formation between the pancreas and surrounding structures in the setting of chronic inflammation due to recurrent episodes of pancreatitis. Early identification of a fistula is important for surgical planning. Furthermore, since recent studies suggested a higher incidence of additional primary malignancies in patients with IPMN of the pancreas compared to the general population, patients may be considered for screening for other primary malignancies

Central Monitor Based on Personal Computer Using One Wireless Receiver

Central monitor is a tool in the health field that serves to monitor the patient's condition which is centralized in one monitor display centrally. In this scientific paper raised wireless systems for sending data to one monitor. In this module there are Electrocardiograph (EKG) parameters which are a parameter to detect and measure the electrical activity of the heart muscle using measurements of biopotential signals obtained from the surface of the body. From these measurements, an ECG signal will be obtained to produce a heart rate per minute (BPM). ECG signals are obtained from measurements of the electrical activity of the heart through electrodes placed on the patient's skin using the bipolar lead method. ECG signals will be processed using a  microcontroller circuit as processors. Then the data will be sent to the PC using wireless HC-11. The data received by the PC, then processed using the Delphi application which will then display ECG charts and BPM results and abnormalities indicators if the BPM is in a condition above or below normal. By comparing the module with a standard measuring instrument, the biggest error is 0.99% which is still in tolerance because the tolerance limit is 5

Hypocenter Distribution of Low Frequency Event at Papandayan Volcano

Papandayan volcano is a stratovolcano with irregular cone-shaped has eight craters around the peak. The most active crater in Papandayan is a Mas crater. Distribution of relocated event calculated using Geiger Adaptive Damping Algorithm (GAD) shows that the epicenter of the event centered below Mas crater with maximum rms 0.114. While depth of the hypocenter range between 0-2 km and 5-6 km due to activity of steam and gas

Dimensi Sosial dalam Novel Negeri Para Bedebah Karya Tere Liya (Perspektif Analisis Wacana Kritis)

Penelitian ini bertujuan untuk mendeskripsikan dimensi sosial Fairclough dengan menggunakan prosedur analisis wacana kritis yang digambarkan secara simultan. Berdasarkan tujuan tersebut mendorong peneliti untuk mengkaji dalam sebuah studi pustaka berjudul “Dimensi Sosial dalam Novel Negeri Para Bedebah karya Tere Liye (Perspektif Analisis Wacana Kritis). Metode tulisan ini adalah deskriptif kualitatif. Hasil tulisan menunjukkan bahwa terdapat tiga dimensi sosial: pertama, dimensi teks bahasa sebagai piranti linguistik yang di dalamnya tersembunyi ideologi dan kekuasaan. Kedua, dimensi praksis wacana sebagai interpretasi teks dan interpretasi konteks. Ketiga, dimensi praksis sosiokultural dimana wacana ditentukan oleh proses sosial dan praksis sosial

Analisis Perkembangan Efisiensi Teknis Banksyariahdi Indonesia dengan Metode Dataenvelopment Analysis (Dea) Tahun 2005-2009

Economic development of a country, requires a well planned and directedprogram and also requires a sufficient capital or development found. Therefore,Banking will be required as the financial institution and as the center ofdevelopment. The government has implemented several improvement towards theperformance of Banking by establising several policies. One of those policies is,Banks is free to determine their own interest rate. Which that policy sah motivatesthe development of establishment of Syariah Banks which its basis is on the profitsharing and not on the interest rate.The rapid development of the Syariah Bankingwhether perceiency improvement of the Syariah Bank it self. In this research, the writer was attemted to observe the efficiency rate of theeconomic activities unit (UKE) of Syariah Bank. Data was used here is the Inputsecondary data and Output on the period of 2005-2009. Input could be classifiedinto the general expense and administration, personnel expense, operations expense.Mean while, the output is operational income, and income from lending. The result of this research showed that, the efficiency rate of 4 UKEs (BankSyariahMandiri, Bank Mega Syariah, Bank MuamalatSyariah, dan Bank BukopinSyariah) that was examined, During 2005-2009, there is only one Islamic bank canmaintain a constant level of maximum efficiency of 100% is Bank SyariahMandiri