Demographic Characteristics of COVID-19 Patients in District Gujrat

Objective: To determine the prevalence of Covid-19 in the district of Gujrat, its association with gender, age, its correlation with respiratory and cardiac symptoms and to find the link of this disease with travel history of patients to affected areas. Methodology: A total of 222 COVID-19 -Positive patients (Male and Female) out of 514 clinically suspected cases (fever, cough, dyspnoea, lethargy & anosmia) as per WHO guidelines were selected. The use of the data for research purposes was explained to patients, and informed consent was taken. The study was approved by the ethical committee of Aziz Bhatti Shaheed Hospital. Samples were extracted from nasopharyngeal swabs using standard extraction protocol. Statistical tools used was SPSS Version 24. Chi-square test and correlation of age with respiratory and cardiac symptoms was calculated. Results: Male gender was significantly affected by this disease (P=0.001) as compared to the female gender. Regarding the prevalence of respiratory symptoms, 31(14%) were asymptomatic. 37(16.7%) had Dyspnea, 45 (65.3%) cough (P= 0.001). Nine (4.1%) developed pneumonia. Fever and Cough was the most common symptom in the age group 21-40 yrs(P=0.001). While pneumonia developed in the older age group. The cardiac symptoms appeared in young age group (p=0.000) in the age group 21-40 yrs (70.9% n=78).38 patients (17.2%) had the symptom of chest pain, 24(10.9%) tachycardia and 1(0.5%) developed arrhythmia. Out of 222 COVID positive patients, 67.1% (149) gave a history of direct contact with positive patients, 19.8% (n=44) gave travel history,4.5% (n=10) had a history of going to Raiwind Ijtamah and 8.6% (n=19) were zaireen/pilgrims from Taftan. Conclusion: The COVID -19 is comparatively more common in male patients. 50% of the patients were of age group 21-40 years showing the symptoms of fever and cough along with mild cardiac symptoms. Acute pneumonia developed in older age groups while cardiac symptoms were significant in young age. In Gujrat District, the majority of the patients (67.1%) developed Covid-19 due to travelling

Alanine Transaminase levels in Patients of Dengue Fever in the Suburbs of Islamabad

Introduction: Hepatic dysfunction is a highly varied condition that can show up as minor damage with elevated levels of transaminases, or appear as extensive damage and failure of liver cells. Thus, in order to reduce associated morbidity and mortality, this ailment should be diagnosed at the earliest possible so that appropriate therapy can be instituted. Our study was carried out to observe hepatic damage in patients with dengue fever (DF) by measuring alanine transaminase levels. Materials and Methods: A cross-sectional study of three months duration was carried out in the Department of Medicine, Dr. Akbar Niazi Teaching Hospital affiliated with Islamabad Medical & Dental College, Pakistan. The sampling technique was Non-Random consecutive sampling and 118 patients were included in our study. Serum Alanine Transaminase (ALT) (normal = 7-56 IU/L), serum Aspartate Transaminase (AST) (normal = 10-40 IU/L) were determined and ultra-sound abdomen was performed. Statistical analysis was done using SPSS Version 24. The Chi-square test was used to observe the relationship between categorical variables. Phi, Cramer’s V, Pearson’s, and Spearman’s Correlation tests were used to study the association of age and gender with ALT levels. Results: There were 72% males (n=85) and 28% females (n=33). Patients were grouped according to age and mean ALT (95+86 IU/L) and AST (134.7+ 98 IU/L) levels were calculated in the different age groups. These levels were found to be significantly raised (P=0.00) in the age groups of 9-18 years and 19-25 years as compared to the other age groups. Moreover, males had high ALT levels as compared to females, however, a significant difference was not observed. There was also no association seen of gender with raised ALT levels (P=0.564), Phi & Cramer’s V=0.56, and Spearman’s correlation coefficient=0.320.Conclusions: ALT and AST levels were elevated above the normal in our sample indicating hepatic involvement

Multi-objective optimisation for minimum quantity lubrication assisted milling process based on hybrid response surface methodology and multi-objective genetic algorithm

© 2019 by SAGE Publications Ltd.Parametric modelling and optimisation play an important role in choosing the best or optimal cutting conditions and parameters during machining to achieve the desirable results. However, analysis of optimisation of minimum quantity lubrication–assisted milling process has not been addressed in detail. Minimum quantity lubrication method is very effective for cost reduction and promotes green machining. Hence, this article focuses on minimum quantity lubrication–assisted milling machining parameters on AISI 1045 material surface roughness and power consumption. A novel low-cost power measurement system is developed to measure the power consumption. A predictive mathematical model is developed for surface roughness and power consumption. The effects of minimum quantity lubrication and machining parameters are examined to determine the optimum conditions with minimum surface roughness and minimum power consumption. Empirical models are developed to predict surface roughness and power of machine tool effectively and accurately using response surface methodology and multi-objective optimisation genetic algorithm. Comparison of results obtained from response surface methodology and multi-objective optimisation genetic algorithm depict that both measured and predicted values have a close agreement. This model could be helpful to select the best combination of end-milling machining parameters to save power consumption and time, consequently, increasing both productivity and profitability.Peer reviewedFinal Published versio

Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement. Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ≤3) was considered after 12 months. Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement. Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF

Exhaust emission profiling of fatty acid methyl esters and NOx control studies using selective synthetic and natural additives

The present study was focused on the optimized biodiesel production using Moringa oleifera (M. oleifera) and rice bran oils, characterization, and comparative evaluation of the exhaust emission profile using artificial and natural additives resulting from synthesized biodiesel. Furthermore, various biodiesel blends (B10, B20, B50, and B100) of Moringa oleifera (M. oleifera) and rice bran oils were studied in a four-cylinder, direct injection engine at different engine speeds (1800–3000 rpm). The optimal yields (%) for both the M. oleifera and rice bran oil-based biodiesel were found to be 87 ± 2.0 and 93 ± 2.6%, respectively, using sodium methoxide as the catalyst. The optimized reaction parameters involved in the transesterification of the M. oleifera and rice bran oils were revealed to be catalyst concentration (1.25%), methanol-to-oil molar ratio (9:1), reaction temperature (60 °C), and reaction time (90 min). The fuel properties of the M. oleifera and rice bran oil-based biodiesel were found to be in compliance with ASTM D6751 and EN 14214. The exhaust emission levels of the synthesized biodiesel and its blends with conventional diesel showed a significant reduction in the particulate matter and carbon monoxide levels comparative to the fossil fuel-based diesel combustion, whereas an increasing trend was observed in case of the oxides of nitrogen (NOx) emission. The results of the engine performance test indicated that the brake power in all of the samples had approximately similar values for each load and the enriched blends showed a distinct improvement in brake-specific fuel consumption. The effect of antioxidants on the NOx emission levels resulting from the combustion of the biodiesel and its blends showed that the synthetic additives (butylated hydroxyl anisole (BHA), butylated hydroxyl toluene (BHT), t-butyl hydroquinone (TBHQ), and propyl gallate (PG)) were more effective than the natural methanolic antioxidant extracts (extract of P. pinnata (EPPL), extract of A. lebbeck (EPPL), extract of P. guajava (EPG), and extract of M. azedarcah (EMA) for reduction in the NOx emission level

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio