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

An Integrated Review of Developmental Outcomes and Late‐Preterm Birth

Objective: To evaluate existing evidence on long‐term developmental outcomes of late‐preterm infants (LPI; infants born 34‐36 6/7 weeks gestation). Data Sources: Computerized bibliographic databases and hand search for English language articles published between January 1995 and November 2010 yielded 817 articles. Study Selection: Twelve studies (10 cohort and two cross‐sectional) were identified that defined late‐preterm (LP) birth as 34 to 36 6/7 weeks gestation and addressed growth and neurodevelopmental outcomes in LPI. Data Extraction: Using a modified Downs and Black scale for assessing the quality of experimental and observational studies, two reviewers who were blind to each other's ratings assessed study quality. Ratings ranged from 12.5 to 14 with moderate to very good interrater agreement. Kappa (κ) values were 0.83 (reporting), 0.63 (external validity), 0.73 (internal validity), and 0.83 (design) for the four subscales and 0.56 for the whole scale, with no major systematic disagreements between reviewers. Data Synthesis: Studies were divided into five categories to include the following developmental outcomes: neurodevelopment, behavioral, cognitive, growth, and function. Using the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) guidelines, synthesis of the findings is provided as an integrative review. Conclusion: Significant variations in study populations, methodology, and definition of LP exist. Due to paucity and heterogeneity of the existing data especially in infants born 34 to 36 6/7 weeks, there is no clear characterization of the long‐term risks, and future research is needed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86856/1/j.1552-6909.2011.01270.x.pd

Omani camel calves in a traditional management system

Le dromadaire Omani est une race particulière de la région du Golfe persique. C'est un animal à usages multiples et, depuis récemment, très demandé pour ses qualités de coureur. La population cameline à Oman était de 98 500 têtes en 1994 avec un taux de croissance annuel de 3,7 p. 100. Cette enquête a été réalisée entre 1992 et 1997. La reproduction a lieu en hiver (de novembre à mars). Vingt femelles adultes sur 364 ont été mises à la reproduction chaque année. En moyenne, 12 chamelons sont nés chaque année (taux de mise bas de 60 p. 100). Le taux moyen de conception a été de 4,5 p. 100, indiquant un sérieux problème dans le système d'élevage traditionnel. La plupart des chamelons (71,6 p. 100) sont nés de chamelles du groupe d'âge 11-20 ans. Les plus jeunes animaux en âge de se reproduire étaient utilisés pour la selle ou la course. Le rapport des chamelons femelles/mâles était de 1,14. Pour 53 gestations répertoriées, la durée moyenne de gestation a été de 384 jours (12,6 mois). Le taux de mortalité annuel a été de 2,66 p. 100. Tous les cas ont été répertoriés au cours du premier mois post-partum. Les causes de mortalité du chamelon comprenaient la pneumonie, les diarrhées et la sous-nutrition. Le système traditionnel d'élevage n'était pas adapté à une préparation adéquate de la mère pour l'allaitement post-partum. Trois chamelles ont mis bas deux fois avec des intervalles entre les mises bas de 3,3, 2,87 et 2,6 ans. Sept mâles reproducteurs étaient gardés séparément des femelles. Au cours des cinq années d'observation, 273 saillies ont été effectuées, conduisant à 60 naissances. Deux des mâles ont sailli 59 fois chacun, et chacun d'eux a participé à 11 conceptions. La gestion de la reproduction n'a pas permis une évaluation de la fertilité mâle ou femelle. (Résumé d'auteur

Enhancing FP-Growth Performance Using Multi-threading based on Comparative Study

The time required for generating frequent patterns plays an important role in mining association rules, especially when there exist a large number of patterns and/or long patterns. Association rule mining has been focused as a major challenge within the field of data mining in research for over a decade. Although tremendous progress has been made, algorithms still need improvements since databases are growing larger and larger. In this research we present a performance comparison between two frequent pattern extraction algorithms implemented in Java, they are the Recursive Elimination (RElim) and FP-Growth, these algorithms are used in finding frequent itemsets in the transaction database. We found that FP-growth outperformed RElim in term of execution time. In this context, multithreading is used to enhance the time efficiency of FP-growth algorithm. The results showed that multithreaded FP-growth is more efficient compared to single threaded FP-growth

Selenium and hydrogen selenide: essential micronutrient and the fourth gasotransmitter?

Selenium (Se) is an essential micronutrient required by organisms of diverse lineage. Dietary Se is converted to hydrogen selenide either enzymatically or by endogenous antioxidant proteins. This convergent biochemical step crucially underlies the subsequent biological activity of Se and argues for inclusion of hydrogen selenide as the fourth endogenous gasotransmitter alongside nitric oxide, carbon monoxide and hydrogen sulfide.Endogenously generated hydrogen selenide is incorporated into numerous 'selenoprotein' oxidoreductase enzymes, essential for maintaining redox-status homeostasis in health and disease. Direct effects of endogenous hydrogen selenide on cellular and molecular targets are currently unknown. Given exogenously, hydrogen selenide acts as a modulator of metabolism via transient inhibition of mitochondrial cytochrome C oxidase. Here we provide an overview of Se biology, its impact on several physiological systems (immune, endocrine, cardiovascular and metabolic) and its utility as a supplement in acute and critical illness states. We further explore the evidence base supporting its role as the fourth gasotransmitter and propose a strategic case towards generation of novel selenomimetic therapeutics

Chromohysteroscopy after failed intracytoplasmic sperm injection

Background: ICSI is the injection of a single sperm directly into the cytoplasm of the oocyte (ICSI). The failure to achieve pregnancy after ICSI has been studied over many years to reach the possible and preventable causes to avoid another failure. The aim of this study was to assess the value of using Chromohysteroscopy as a part of the work up of cases with one or more failed ICSI. The Ultimate goal is to detect the possible endometrial abnormalities and /or endometritis.Methods: Prospective cohort study was carried out with total of 50 infertile women recruited from infertility clinic in Elshatby Maternity University Hospital, Alexandria University, Egypt. Cases were allocated in 2 groups with 25 cases in each group. The first group included cases that had a failed trial of ICSI. The second group included control cases who were seeking for fertility treatment with no previous history of ICSI or any uterine surgery or anatomical abnormalities. In the postmenstrual period, Chromohysteroscopy was done by the same surgeon and documentation of all findings in the cavity and presence of endometritis.Results: There was a significant increase in the incidence of endometritis among the study group 68% in comparison to 16% in the control group.Conclusions: In this study endometrial dying with methylene blue at hysteroscopy improve the detection of chronic endometritis

WASP-39b: exo-Saturn with patchy cloud composition, moderate metallicity, and underdepleted S/O

WASP-39b is one of the first extrasolar giant gas planets that has been observed within the JWST ERS program. Fundamental properties that may enable the link to exoplanet formation differ amongst retrieval methods, for example metallicity and mineral ratios. In this work, the formation of clouds in the atmosphere of WASP-39b is explored to investigate how inhomogeneous cloud properties (particle sizes, material composition, opacity) may be for this intermediately warm gaseous exoplanet. WASP-39b's atmosphere has a comparable day-night temperature median with sufficiently low temperatures that clouds may form globally. The presence of clouds on WASP-39b can explain observations without resorting to a high (> 100x solar) metallicity atmosphere for a reduced vertical mixing efficiency. The assessment of mineral ratios shows an under-depletion of S/O due to condensation compared to C/O, Mg/O, Si/O, Fe/O ratios. Vertical patchiness due to heterogeneous cloud composition challenges simple cloud models. An equal mixture of silicates and metal oxides is expected to characterise the cloud top. Further, optical properties of Fe and Mg silicates in the mid-infrared differ significantly which will impact the interpretation of JWST observations. We conclude that WASP-39b's atmosphere contains clouds and the underdepletion of S/O by atmospheric condensation processes suggest the use of sulphur gas species as a possible link to primordial element abundances. Over-simplified cloud models do not capture the complex nature of mixed-condensate clouds in exoplanet atmospheres. The clouds in the observable upper atmosphere of WASP-39b are a mixture of different silicates and metal oxides. The use of constant particles sizes and/or one-material cloud particles alone to interpret spectra may not be sufficient to capture the full complexity available through JWST observations.Comment: 21 pages, 18 figures, submitted to A&A on 22. November 2022, in review since 8. December 202