Derangement in Serum Inflammatory Biomarkers Among Patients with End Stage Renal Disease

Background: End stage renal disease is an important public health problem. Renal replacement therapy, dialysis and transplantation are used to provide relief from the symptoms of end stage renal disease whilst also preserving the life of the patients though they are not curative. Haemodialysis is the widely used method although it produces a negative impact on quality of life of the patients. Hypoalbumianemia has been reported to be frequently present in haemodialysis patients and correlates strongly with mortality and morbidity. Objective: To determine the frequency of deranged  inflammatory biomarkers in patients with end stage renal disease on hemodialysis, in Nishtar Hospital Multan. Material and methods: One hundred thirty-one cases with ESRD were selected from Hemodialysis Department, Nishtar Hospital Multan and  3ml of venous blood sample was taken before starting a session of hemodialysis and sent to central laboratory of Nishtar Hospital Multan. Serum Albumin was obtained by an automatic analyzer, and serum CRP by slide test, free of cost, to measure deranged inflammatory biomarkers. Data was analyzed by using SPSS version 20. Results: Of these 131 study cases, 85 (64.9%) were male patients while 46 (35.1%) were female patients. Mean age of our study cases was 42.37 ± 5.98 years. Of these 131 patients with ESRD on hemodialysis 33 (25.2%) were diabetic, 65 (49.6%) were hypertensives and 13 (9.9%) were obese. Mean duration on hemodialysis was 19.51 ± 7.59 months, 80 (61.1%) had to undergo hemodialysis twice a week and 51 (38.9%) had to undergo three times a week. Mean serum albumin level was noted to be 3.37 ± 0.59 g/dl. Mean serum C-reactive protein level was noted to be 20.73 ± 15.84 mg/l. Frequency of deranged inflammatory biomarkers in our study was noted to be in 109 (83.2%) of the study cases. Conclusion: Very high frequency of derangement in inflammatory biomarkers have been noted in our study. This derangement in these inflammatory biomarkers was significantly associated with female gender, increasing age, increased duration on hemodialysis and increased frequency of hemodialysis. The early diagnosis of these derangements followed by preventive measures can help decrease disease morbidity and mortality among targeted population. Keywords: Inflammatory biomarkers, deranged, end-stage renal disease, hemodialysis

Multi crop high efficiency seed drill with solar hybrid seed metering: A step toward precision and sustainability

High crop production with limited energy resources is always the priority area of developing countries. Conventional agricultural experimenting and crop production methods are time-consuming, challenging, laborious, and energy intensive. Various developments and experimental studies have been carried out for advancement in agriculture technologies. This study is mainly focused on the design and development of a unique high-efficiency seed drill machine to increase the energy efficiency of agricultural experiments, and crop production and conserve the tillage, seed, fertilizer, and power requirement. This machine has a special seed dividing head and seed distributor triggered with a mechanical timer. The mechanical timer is responsible to deliver seed to the seed distributor as per fixed plotting intervals. The seed distribution unit distributes the seeds uniformly in all furrows as per the pre-decided seed rate aided with a centrifugal glider aided with a DC motor powered by a 30 W solar PV plate and backup battery. Moreover, the machine has 9 × 9 s-type spring tines for seed and fertilizer, which are mainly designed for better soil pulverization and aeration with significant in-field resource conservation as per conventional alternatives. The effective width is seven feet and adjustable rows with versatile seed rate options. Overall, the results from different field tests verified the uniform seed dispersal with improved germination rate. The analysis of power requirements compared to conventional machines results in the 40% less power requirement. Overall, the machine has customized unique features for experiments and energy-efficient precision agriculture to conserve input resources

Safety of untreated autologous cranioplasty after extracorporeal storage at -26 degrees celsius

Background: Given the improved survival of patients requiring decompressive craniectomies, the frequency of subsequent cranioplasties are on the rise. The most feared complication of autologous cranioplasty is infection and one method for reducing the rate of infection, is to store the bone flaps at subnormal temperatures. However, to date there is no defined temperature for flap storage and temperature ranges from - 18 to - 83°C have been described in literature. Considering our limited resources it has been the practice at our center to store bone flaps at - 26°C. In this study, we have retrospectively reviewed our practice and have audited this choice of temperature with respect to the frequency of infections.Methods: A retrospective review was conducted for all cranioplasties performed at our center between January 2001 to March 2011, using autologous bone which was cryopreserved according to institutional protocol. During this period the operative and cryopreservation protocol remained the same. All patient records including charts, notes and laboratory findings were reviewed with a specific focus to identify infections.Results: Of the 88 patients included in the study, only 3 (3.40%) patients were found to show signs of infection. Of these, two patients had superficial surgical site infections which resolved with oral antibiotics (Co-Amoxiclav 1 gm BD for 7 days). However the third patient developed deep surgical site infection requiring re-exploration and washout. All three patients had complete resolution of infection with preservation of autologous bone.Conclusion: Despite our method of keeping the bone flap in freezer at - 26°C we have reported an acceptable rate of infection and raised the notion whether there is a justification for sophisticated and costly equipment for bone flap preservation, especially in resource depleted setups

Use of Dark Chocolate for Diabetic Patients: A Review of the Literature and Current Evidence

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin resistance and endothelial function is a reciprocal one. Overall, the evidence from these studies suggests that cocoa may be useful in slowing the progression to type 2 diabetes and ameliorating insulin resistance in metabolic syndrome. Additionally, results from several small studies indicate that cocoa may also have therapeutic potential in preventing cardiovascular complications in diabetic patients. Studies highlighting the potential of cocoa-containing diets, in large-randomized controlled trials should be performed which might give us a better opportunity to analyze the potential health-care benefit for reducing the risk of complications in diabetic patients at molecular level

Significance and Challenges of Big Data in Healthcare: A Review

The infiltration of information and technology in all the important sectors of the world has influenced the efflux of data. Healthcare industry has greatly benefited more the blessings of advanced computing. This sector is getting digitized at a fast rate for more precision and accuracy. Hence, more data is produced from the healthcare sector. In this review paper, we discuss Big data's importance in the healthcare industry. We go over the qualities of big data, including volume, veracity, speed, variety, and value. The healthcare industry has been touched by big data in practically every way. The diagnosis, telemedicine, medical research, and enhancing patient care are the remaining key effects. The application of Big data gave rise to many challenges such as accuracy, security and privacy, storage and processing, data complexity, unified format, image preprocessing and data analytics. We also intend to investigate further big data uses in healthcare and to highlight the difficulties this industry face

Parametric analysis of wax printing technique for fabricating microfluidic paper-based analytic devices (µPAD) for milk adulteration analysis

Accurate prediction of hydrophobic–hydrophilic channel barriers is essential in the fabrication of paper-based microfluidic devices. This research presents a detailed parametric analysis of wax printing technique for fabricating µPADs. Utilizing commonly used Grade 1 filter paper, experimental results show that the wax spreading in the paper porous structure depends on the initially deposited wax line thickness, a threshold melting temperature and melting time. Initial width of the printed line has a linear relationship with the final width of the barrier; however, a less pronounced effect of temperature was observed. Based on the spreading behavior of the molten wax at different parameters, a generalized regression model has been developed and validated experimentally. The developed model accurately predicts wax spreading in Whatman filter paper: a non-uniform distribution of pores and fibers. Finally, tests were carried out for calorimetric detection of commonly used adulterants present in milk samples

The role of computed tomography for identifying mechanical bowel obstruction in a Pakistani population

Objective: To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction. Methods: It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was analyzed using SPSS version 16.0. Results: A total of 271 patient records were reviewed. The mean age was 46 +/- 19 years and (64%) were men. Mechanical intestinal obstruction was found in 104 patients on laparotomy and CT scan had diagnosed 97 of these. The sensitivity and specificity was 93% respectively. CT scanning correctly identified the cause of the obstruction in 72 (74%) cases. The common reasons for bowel obstruction identified by surgery were adhesions 29 (40%), neoplasm 12 (17 %) and hernias 7 (10%). Conclusion: CT scans are reliable at diagnosing intestinal obstruction with a high sensitivity and specificity but they are not as accurate at defining the etiology of the obstruction

Early complications after biliary enteric anastomosis for benign diseases: A retrospective analysis

Background:Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases. Methods: We reviewed the medical records of all Patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications. Results: Records of 79 Patients were reviewed. There were 34 (43%) males and 45 (57% females). Majority (53%) had choledocholithiasis with impacted stone or distal stricture, followed by traumatic injury to the biliary system (33%). Thirty-four Patients (43%) underwent a hepaticojejunostomy, 19 Patients (24%) underwent a choledochojejunostomy, and choledochoduodenostomy was performed in 26 Patients (33%). Early complications occurred in 39 (49%) Patients - 41% had local complications and 25% had systemic complications. Most frequent complications were wound infection (23%) and bile leak (10%). Four (5%) Patients died. On multivariate analysis, low serum albumin level (odds ratio = 16, 95% CI = 1.14-234.6) and higher ASA levels (odds ratio = 7, 95% CI: 1.22-33.34) were the independent factors predicting the early complications following BEA. Conclusions: Half of the Patients who underwent BEA for benign diseases had complications in our population. This high incidence may be explained by the high incidence of hypoalbuminemia and the high-risk group who underwent operation

Knowledge and perceptions towards cardiovascular disease prevention among patients with type 2 diabetes mellitus: A review of current assessments and recommendations

Introduction: Patients with type 2 diabetes mellitus (T2DM) are at significantly higher risk of developing cardiovascular disease (CVD). There is scarcity of literature reviews that describes and summarises T2DM patients' knowledge and perception about CVD prevention. Objectives: To describe and summarise the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM. Methods: A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics. Results: A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence. Conclusion: There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualised based on patients' characteristics and knowledge gaps, disease duration and estimated CVD risk

Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

Objective:  To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC). Materials and Methods:  A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes. Results:  85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates.  Conclusion:  Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously.&nbsp