Efficacy and Safety of Empagliflozin as Add-On Therapy in Patients of Type-2 Diabetes Mellitus

OBJECTIVES: To assess efficacy of two doses i.e., 10 mg and 25 mg in lowering the glycated haemoglobin (HbA1C) and fasting blood glucose (FBG) in patients of type 2 diabetes mellitus (T2DM) having suboptimal glycaemic control on maximal doses of Metformin and Sitagliptin, and to see the frequency of its side-effects. METHODOLOGY: The study design was a randomized control trial. Fifty nine adult patients of T2DM who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycaemic control (HBA1C >7% and <12%) were randomized to two groups, one group receiving 10 mg (Group A) and the other group receiving 25 mg of empagliflozin (Group B) as an additional treatment. HbA1C and FBG were taken before and 12 weeks after addition of empagliflozin in both the groups. Side effects of empagliflozin such as urinary tract infections (UTI) and genital mycotic infections were also recorded in both the groups. RESULTS: Total patients in-group A were 31 and their mean age was 51.48±4.29 years. In-group B there were 28 patients and their mean age was 52.39±5.20 years. There was a statistically significant reduction of both HbA1C and FBG in both the groups after empagliflozin treatment; (p=0.000) for both HbA1C and FBG in both the groups. Although numerically UTI and genital mycotic infections were more than pre-treatment numbers, they were not statistically significant (p>0.05). CONCLUSION: Empagliflozin can be safely added to the oral anti-diabetic regimen of patients with type 2 diabetes mellitus who have suboptimal glycaemic control and results in significant improvement in HbA1C

Evaluating Impact of Empagliflozin on Lipid Profile of Patients of Type 2 Diabetes Mellitus

OBJECTIVES: To assess the effect of two doses, i.e., 10 mg and 25 mg of empagliflozin, on the lipid profile of patients with type 2 diabetes mellitus (T2DM) with suboptimal glycemic control on maximal doses of metformin and sitagliptin. METHODOLOGY: The study design was a randomized, open-label clinical trial. Fifty-nine adult patients of T2DM who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycaemic control (HBA1C > 7% <12%) were randomly allocated in 1:1 ratio to two groups, one group receiving 10 mg (Group A) and the other group receiving 25 mg of Empagliflozin (Group B) as an additional treatment. Fasting lipid profiles, including total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and triglycerides (TG), were taken before and 12 weeks after the addition of empagliflozin in both the groups.   RESULTS:   Total patients in group A were 31, and their mean age was 51.48±4.29 years. In group B, there were 28 patients, whose mean age was 52.39 ± 5.20 years. There was an increase in TC, LDL-C and HDL-C and a reduction of TG in both the groups after treatment with empagliflozin, but it was not statistically significant (p > 0.05). CONCLUSION: Both doses of Empagliflozin (10 and 25 mg) modestly elevates total cholesterol, LDL-C and HDL-C and modestly reduce triglyceride levels in T2DM patients, but the change is not statistically significant. KEYWORDS: Empagliflozin, Type 2 diabetes mellitus, Total cholesterol, Low-density cholesterol, High-density cholesterol, Triglyceride

A Framework for Classification and Visualization of Elephant Flows in SDN-Based Networks

AbstractLong-lived flows termed as elephant flows normally transport large volumes of data in enterprise networks, particularly data center networks. These flows tend to consume a lot of bandwidth and fill up network buffers end-to-end. This causes non-trivial delays for short-lived flows referred to as mice flows which are usually delay-sensitive. Therefore, identifying and handling elephant flows is important for QoS provisioning. In this paper, we present a framework for real-time detection and visualization of elephant flows in SDN-based networks using sFlow. Using our proposed framework, network operators can examine elephant flows through each switch by double-clicking the switch node in the topology visualization UI. Although not in the scope of this paper, but in order to meet traffic engineering requirements, the elephant flows detected and visualized by our proposed framework can be reprioritized, re-scheduled, or routed via dedicated high speed links. We evaluate the proposed framework by using a physical SDN testbed as well as a Mininet-based testbed

Usefulness of hook wire localization biopsy under imaging guidance for nonpalpable breast lesions detected radiologically

Background: The purpose of this study was to evaluate the usefulness of hook wire localization biopsy under imaging guidance for nonpalpable breast lesions detected radiologically.Methods: This was a descriptive study conducted at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients undergoing needle localization biopsy of a nonpalpable breast lesion under mammographic or ultrasound guidance between January 2009 to December 2010 were included in the study. Patients with incomplete medical records were excluded. All patients\u27 mammograms or ultrasound were categorized using BI-RADS() assessment categories. The percentages of benign and malignant lesions were determined by pathological examination of surgically removed specimens. A correlation was sought between preoperative imaging assessment and the final diagnosis. The complications associated with the procedure were also recorded.Results: A total of 151 biopsies were carried out, of which 80 were performed under mammographic guidance and 71 were performed under ultrasound guidance. The mean age of the patients was 51.89 years. The overall malignancy rate was 25.16%. Of 93 cases reported radiologically as malignant, 60 turned out to be malignant, and of the 58 cases reported as benign on imaging, three proved to be malignant on histopathology. The sensitivity of imaging findings was 95% and the specificity was 62%. The malignancy rate was 5% for benign lesions and 64% for malignant lesions, respectively. There were no complications related to wire localization, and only two patients had minor complications following surgical excision, giving a complication rate of 1.32%.CONCLUSION: Hook wire localization biopsy is a safe and effective procedure for definitive diagnosis of suspicious lesions on imaging, and is more helpful if the imaging findings are suspicious

A Roadmap for Benchmarking in Wireless Networks

Experimentation is evolving as a viable and realistic performance analysis approach in wireless networking research. Realism is provisioned by deploying real software (network stack, drivers, OS), and hardware (wireless cards, network equipment, etc.) in the actual physical environment. However, the experimenter is more likely to be dogged by tricky issues because of calibration problems and bugs in the software/hardware tools. This, coupled with difficulty of dealing with multitude of hardware/software parameters and unpredictable characteristics of the wireless channel in the wild, poses significant challenges in the way of experiment repeatability and reproducibility. Furthermore, experimentation has been impeded by the lack of standard definitions, measurement methodologies and full disclosure reports that are particularly important to understand the suitability of protocols and services to emerging wireless application scenarios. Lack of tools to manage large number experiment runs, deal with huge amount of measurement data and facilitate peer-verifiable analysis further complicates the process. In this paper, we present a holistic view of benchmarking in wireless networks and formulate a procedure complemented by step-by-step case study to help drive future efforts on benchmarking in wireless network applications and protocols

Benchmarking in Wireless Networks

Experimentation is evolving as a viable and realistic performance analysis approach in wireless networking research. Realism is provisioned by deploying real software (network stack, drivers, OS), and hardware (wireless cards, network equipment, etc.) in the actual physical environment. However, the experimenter is more likely to be dogged by tricky issues because of calibration problems and bugs in the software/hardware tools. This, coupled with difficulty of dealing with multitude of controllable and uncontrollable hardware/software parameters and unpredictable characteristics of the wireless channel in the wild, poses significant challenges in the way of experiments repeatability and reproducibility. Furthermore, experimentation has been impeded by the lack of standard definitions, measurement methodologies and full disclosure reports that are particularly important to understand the suitability of protocols and services to emerging wireless application scenarios. Lack of tools to manage experiments, large amount of data and facilitate reproducible analysis further complicates the process. In this report, we present a holistic view of benchmarking in wireless networks; introduce key definitions and formulate a procedure complemented by step-by-step case study to help drive future efforts on benchmarking of wireless network applications and protocols

Effect of Empagliflozin On Liver Enzymes of Patients In Non-Alcoholic Steatohepatitis In Type 2 Diabetes Mellitus

OBJECTIVES To assess the effect of 10 mg and 25 mg once daily Empagliflozin on liver enzymes of patients of non-alcoholic steatohepatitis in patients of type 2 diabetes mellitus (T2DM). METHODOLOGY The study design was Quasi Experimental. Thirty three adult patients of  Type 2 diabetes mellitus (T2DM) who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycemic control (HBA1C > 7% <12%), had elevated Alanine Transaminase (ALT) levels and had ultrasonographic features consistent with non-alcoholic fatty liver disease (NAFLD) were divided into three groups, one group receiving 10 mg Empagliglozin as add-on treatment (Group A), the second group receiving 25 mg of Empagliflozin (Group B) as an additional treatment, and the third group continued with previous medications without any additional treatment (Group C). HbA1C levels and ALT levels of all the three groups were taken at baseline and at 12 weeks. RESULTS Total patients and their mean ages in group A, B and C were 10, 12 and 11 and 52.40 ±4.24 years, 52.42 ± 5.27 years and 52.34 ± 4.37 years, respectively. There was a statistically significant (p > 0.05) decrease mean ALT levels in Group A pre-treatment and 12 weeks post-treatment. Similarly, there was a statistically significant (p > 0.05) decrease mean ALT levels in Group B pre-treatment and 12 weeks post-treatment.CONCLUSION Empagliflozin in both 10mg and 25 mg once daily doses cause statistically significant reduction in ALT levels in patients with NASH associated with T2D

Sonographic Association Between Fatty Liver and Gall Baldder Stone

Background: Fatty liver (chronic liver disease) was most frequently found associated with gall stones. It arises due to accumulation of lipid in hepatocytes mainly triglyceride. Due to high existence of obesity in the population, the risk of fatty liver and gall stones also increases. In Pakistan the prevalence of fatty liver was 15-20 %. Fatty liver and gall stones could easily be observed on ultrasound. Objective: To evaluate the sonographic association between fatty liver and gall bladder Stone. Study Design: Descriptive Study was conducted Settings: Sanabil health services. Lahore Period: Four months Material & Methods: In our study patients presents with epigastric pain high cholesterol level and previous history of gall stones.While patient with the history of cholecystectomy were excluded. All the data had been composed from Sanabil Health Services Lahore. After informed consent, data was composed through ultrasound machine GE LOGIQ P7 with convex probe (frequency 2.5- 5MHZ) Results: According to results total volume of patient was 220. Now we were comparing between cholelithiasis and grading of fatty liver. Total no of GRADE 1 fatty liver patients were 63 out of 220 in which 13 patients were showing absence of GS while 50 patients showed GS. Total no of GRADE II fatty liver patients were 89 out of 220 in which 36 patients were showing absence of GS while 53 patients showed GS. Total no of GRADE III fatty liver patients were 68 out of 250 in which 20 patients were showing absence of GS while 48 patients showed GS. Total no of 69 out of 220 patients showed absence of GS while 151 patients out of 220 showed with GS. Conclusion: We concluded that the patients who had high cholesterol level, gall stones are associated with fatty liver disease. Moreover fatty liver disease was more common in females than males. Keywords: Nonalcoholic fatty liver, chronic liver disease, Gallbladder, Gall stones, Ultrasound and cholecystokinin. DOI: 10.7176/JHMN/91-09 Publication date:July 31st 202

Diagnostic Accuracy of Barium Enema for the Diagnosis of Hirsch-sprung Disease in Children

Objective: To determine the diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease, taking histopathology as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2019 to May 2021. Methodology: A total of 251 patients with symptoms of Hirsch-sprung disease were included. All patients were assessed with a Barium enema and full-thickness rectal biopsy. Barium enema was reported for the presence of contrast in the rectum after 24 hours, the presence or absence of transitional zone and a Recto Sigmoid Index less than 1. Full-thickness rectal biopsy was taken 2 cm above the dentate line, and histopathology was performed to see the ganglion cells in Meissner`s and Myenteric plexus. Results: Histo-pathologically confirmed cases were 120(true positive), where 12(false positive) had no Hirsch-sprung disease on histopathology. In Barium enema negative patients, 113 were true negatives while 06 were false negatives. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease were 95.24%, 90.40%, 90.91%, 94.96% and 92.83%, respectively. Conclusion: We concluded that the diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease is quite high, taking histopathology as the gold standard

Frequency of Disc Degeneration at Different Levels of Lumbar Vertebrae in Adult Patients with Backache on Magnetic Resonance Imaging

Objective:To Determine the Frequency of Disc Degeneration at Different Levels of lumbar Vertebrae in Adult Patients with lower back Pain on Magnetic Resonance Imaging. Study Design: An analytical cross-sectional descriptive study was performed. Settings: The study was performed in Bashir Neurospine Institute and Al-Razi Healthcare center, Lahore. Period: An Analytical cross sectional study was conducted from 15 October,2020 to 15 January 2021. Material and Methods: In our study, all those adult patients with lower back pain, obese, dull ache, numbness, tingling, pins and needle sensations, muscles spasms were included. And those patients who were not giving consent, spondylosis, lumbar spine stenosis, cervical and thoracic abnormalities, paedes, and those who were uncooperative were excluded. Data was tabulated and analyze with the help of statistical package for the social science (SPSS version 24). The data was reported using cross sectional descriptive statistics. Results: In our research out of 160 patients 89 females and 51 males were those who  diagnosed with disc degeneration and 10 females and 10 male in which disc degeneration was absent. 10 patients out of 160 patients were those who diagnosed with disc degeneration at the level of L1 - L2 between the age of 24 to 87, 8 patients were those in which disc degeneration present at the level of L2- L3 between the age of 43 to 87, 31 patients were those in which disc degeneration present at the level of L3-L4 and  96 patients diagnosed with  disc degeneration present at the level of L4- L5 which is the lowest lumbar vertebra between the age of 55 to 80 years. Overall out of 160 patients only 3 patients were those who represent with mild pain (25yrs) and 102 were those who came with moderate pain (27-90yrs) and 55 patients who represent with severe backache (30 to 89yrs). In this research out of 160(100%) patients only 102  patients (63%) are those who present with moderate pain and 55 patients (34%)with severe pain .At L1-L2   disc degeneration only 5 patients (50%) were those who came with moderate and 5( 50% )with severe pain. At L2-L3 disc degeneration two patients (25%) with moderate and six patients (75%)with severe pain .At L3-L4 disc degeneration 11 patients (35.4%) with moderate and 20(64.5%) with severe pain. At L4-L5 disc degeneration 51 patients (53%) with moderate pain and 45 patients (46.8%) with severe pain. Our study also revealed that elevated BMI patients had high frequency of disc degeneration. Conclusion: This study conclude that lumbar disc degeneration was approximately in women than men who were represented with lower back pain. Minority of patients had normal lumbar MRI findings. Most of the degeneration occurs at the lowest lumbar vertebrae i.e. L4- L5 and patients who were presented with elevated BMI have increased risk of disc degeneration. Keywords: Lumbar vertebrae, Magnetic resonance imaging, lower back pain. Degenerative disc disease. DOI: 10.7176/JHMN/90-17 Publication date:June 30th 2021