Serum tumour necrosis factor alpha in osteopenic and osteoporotic postmenopausal females: A cross-sectional study in Pakistan

Objective: To compare biochemical parameters serum tumour necrosis factor alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D in postmenopausal women.Methods: This cross-sectional study was carried out from June 2015 to July 2016 at Jinnah Medical and Dental College, Karachi, and comprised postmenopausal women. Bone mineral density done by dual energy X-ray absorptiometryscan categorised subjects by World Health Organisation classification into normal (T score \u3e -1) osteopenic (T score between -1 and -2.5) and osteoporotic (T score \u3c -2.5). Biochemical parameters like tumour necrosis alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D were measured by solid phase enzyme amplified sensitivity immunoassay method. SPSS 16 was used to analyse the data.Results: Of the 146 women, 34(23%) were normal, 93(67%) were osteopenic and 19(13%) were osteoporotic. There was significant difference in mean body mass index, serum tumour necrosis factor alpha and calcium in all the three groups (p\u3c0.01). Significant mean difference was observed in serum calcium levels between normal and osteopenic, and between normal and osteoporotic group (p\u3c0.05 each) without any significant mean difference between osteopenic and osteoporotic groups (p\u3e0.05). A significant difference was observed for mean tumour necrosis factor alpha values between normal and osteoporotic groups (p\u3c0.05). Tumour necrosis factor alpha showed negative correlation with bone mineral density in osteopenic and osteoporotic groups (p\u3e0.05).Conclusions: Increased bone turnover in postmenopausal osteopenic women can be predicted by increased serum cytokine

Comparison of serum levels of vitamin D and vitamin D-binding protein in normal, osteopenic and osteoporotic postmenopausal women

Objective: To compare the serum levels of vitamin D, vitamin D binding protein (VDBP) calcium and phosphate in normal, osteopenic and osteoporotic postmenopausal women categorized on the basis of bone mineral density (BMD) scores.Methods: A cross sectional study carried out from May 2017 to August 2018. BMD measured by Dual energy X-ray Absorptiometry categorized women (aged 20- 70 years) into normal (n=37) (T score ≥ -1.0) osteopenic (n=25) (-2.5\u3c T score, \u3c -1) and osteoporotic (n= 26) (T score \u3c -2.5) according to WHO classification. Serum concentrations of vitamin D, VDBP, calcium, phosphate analyzed by enzyme linked immunosorbent assay were compared by Analysis of Variance.Results: In normal females higher levels of vitamin D and VDBP were observed [15.82 (8 - 69.18), 469.9 (269.57 - 875.55)] vs. osteopenic [(7.45 (4.66 - 15.1), 296.05 (232.58 - 420.23)] and osteoporotic women [(7.25 (3.97 - 17.49), 272.94 (202.23 - 351.24)]; [median interquartile range]; p value \u3c 0.0001.Conclusion: Vitamin D and VDBP are linked with bone health and estimation of VDBP appears to be a valuable tool for the assessment of increased bone loss and possible risks of bone fractures especially in postmenopausal women

The Impact of Intellectual Capital on the Financial Performance in Insurance Firms Listed in Amman Stock Exchange: Using the (VAIC) Model

Purpose: The aim of this study is to examine the impact of intellectual capital (human capital, structural capital, and employed capital) on the financial performance of listed insurance companies in the Amman Stock Exchange   Theoretical framework: Intellectual capital has become increasingly important in generating value for companies, and many researchers have linked it to corporate financial performance and strategic competitive advantage.   Design/methodology/approach: The study population consist of 21 insurance companies listed on the Amman Stock Exchange in Jordan during the period of 2011-2020. Intellectual capital was measured using the value added intellectual coefficient model (Pulic, 2000), and its impact on financial performance was analyzed using published financial statements of the insurance companies.   Findings:  The results of the study found a statistically significant positive effect of human and employed capital on financial performance as measured by the rate of return on assets and return on equity. Furthermore, the study revealed a significant positive effect of intellectual capital, specifically human capital, on financial performance measured by market value (Tobin's Q).   Research, Practical & Social implications: The study suggests that insurance companies should treat intellectual capital as a strategic resource and monitor and invest in it periodically for continuous development. The study suggests building a positive organizational culture that supports intellectual capital is recommended   Originality/value:  This study contributes to the understanding of the relationship between intellectual capital and financial performance for the first time in the insurance industry in Amman Stock Exchange. The findings highlight the importance of managing and investing in intellectual capital as a strategic resource to enhance financial performance

Application of Artificial Neural Network-Based Tool for Short Circuit Currents Estimation in Power Systems With High Penetration of Power Electronics-Based Renewables

The increasing integration of Power Electronics (PE)-based renewable energy sources into the electric power system has significantly affected the traditional levels and characteristics of fault currents compared to the ones observed in power systems dominated by synchronous generating units. The secure operation of a renewable rich power system requires the proper estimation of fault currents with wide range of scenarios of the high share of renewables. Although the utilization of detailed and complex time-domain dynamic simulations allows for calculating the fault currents, the resulting modeling complexity and computational burden might not be adequate from the operational perspective. Thus, it is necessary to develop alternative quicker data-driven fault current estimation approaches to support the system operator. For this purpose, this paper utilizes an Artificial Neural Network (ANN)-based tool to estimate the characteristics of short circuit currents in power systems with high penetration of power electronics-based renewables. The short circuits against different penetration of renewables are produced offline using the DIgSILENT PowerFactory considering the control requirements for renewables (e.g., fault ride through requirement). The resulting dataset is utilized to train the ANN to provide the mapping between the penetration level and the characteristics of the short circuit currents. The application of the approach using the modified IEEE 9-bus test system demonstrates its effectiveness to estimate the components of short circuit currents (sub-transient current, transient current, and peak current) with high accuracy based only on the penetration of power electronics-based renewables.©2023 Authors. Published by IEEE. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. For more information, see https://creativecommons.org/licenses/by-nc-nd/4.0/fi=vertaisarvioitu|en=peerReviewed

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prisoners in Karachi -A Health and Nutritional Perspective

Abstract Objective: The aim of this study was to assess the health and nutritional status of prisoners in Karachi, Pakistan. Methods: This cross sectional study was conducted from September 2012 to February 2013. Convenient sampling technique was used. A sample of 433 prisoners was taken from Karachi prison. Selected inmates were interviewed using a structured questionnaire. Prisoners were assessed with measurements of height, weight, body mass index (BMI) status, Blood pressure, Random Blood Sugar levels, dietary pattern, occupational status, source of food, duration of exercise, history of diseases and addictions were recorded. Results: Age of the prisoners varied between 18-65 years. Among 433 prisoners, 39.7% were under weight and 8.3% were malnourished. Exercise was not reported in 80% of prisoners. It was noted that 11.8% prisoners were having respiratory tract infections at time the study was conducted. Among 433 inmates, 386 were addicted to at least one addiction such as smoking, naswar, pan, gutka and manpuri, heroin, ganja (cannabis), charas (hashish form of cannabis), and opium. Conclusions: This study showed that the diet of the prisoners was insufficient and nutritionally imbalanced and has led to malnourished and underweight prisoners. Substance abuse is common among inmates

Relationship between Fault Level and System Strength in Future Renewable-Rich Power Grids

The fault level is used as a simple indicator for scanning the system strength in power systems. To an extent, this has proven its efficacy in classical power systems based on synchronous generation (SG). However, power electronics-based renewable energy sources (RESs), due to their controlled and limited fault current contribution, may affect the impedance, fault level, and system strength in a non-linear manner. Hence, this raises a question about the validity of using the fault level as a measure reflecting the system strength in future grids. This paper intends to shed light on the above question by examining the correlation between the fault level and the system strength in future grid scenarios. This is achieved in two steps: first, by employing the measure-based Thevenin impedance for fault level estimation in renewable-rich grids, and second, by comparing these estimated fault levels with those obtained from steady-state and dynamic simulations. While the results have demonstrated the suitability of using the fault level for system strength scanning in scenarios of low penetration of RESs, they revealed that such a tool might be misleading with very high RES penetrations. The findings have been verified using the adjusted IEEE nine-bus test system in DIgSILENT PowerFactory

Investigating the Maximum Instantaneous Fault Current in Power Systems with High Penetration of Type-4 Wind

The increased attention towards Renewable Energy Sources (RESs), such as wind generation, has become a priority for systems operators and policymakers worldwide. Type-4 wind generators are considered one of the most common types of wind for large-scale integration of RESs. Type-4 wind generators employ converters for their interface to the AC grid. In such generators, the power exchange with the grid is fully controlled by the converter interface that utilizes power electronic switches of limited current-carrying capability during normal and faulty conditions. Hence, type-4 wind generators have different and limited fault current contributions compared to the traditional conventional generation units based on Synchronous Generators (SGs). In future scenarios where such RESs are extensively integrated, and the SGs are also decommissioned, the SC current behavior of the systems would be affected significantly, and a fault level reduction would be witnessed too. The maximum instantaneous SC current is one of the key SC current components that should be monitored in such scenarios due to its importance for several applications such as faults detection, proper settings of the protection settings, and the design of circuit breakers …etc. This paper is aimed at investigating the effect of the increased penetration of type-4 wind generation on the maximum instantaneous fault current in power grids with the increased penetration of type-4 wind RESs. The results and findings of this research are tested on the IEEE 9-Bus test system modeled in Matlab.©2023 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.fi=vertaisarvioitu|en=peerReviewed