PROLONGED DURATION OF NEPHROTIC SYNRDROM AND TREATMENT FAILURE AMONG CHILDREN WITH NEPHROTIC SYNDROME IS ASSOCIATED WITH INCREASED HYPERTENSION.

Background; Nephrotic syndrome (NS) is one of the most common renal diseases found in the paediatric population and is associated with significant complications, including infection and thrombosis. A high proportion of children enter sustained remission before adulthood, and therapy must therefore mitigate the childhood complications, while minimising the long-term risk to health. Objective; To determine the frequency of hypertension in children with nephrotic syndrome presenting at a tertiary care hospital. Material and Methods; All the patients (n = 146) who meet inclusion of this study were registered from OPD of Department of Pediatrics, Nishtar Hospital, Multan, Pakistan. Informed consent was taken from the parents of these children describing them objectives of this study, ensuring them confidentiality of the information provided and fact that there was no risk involved to the patient while taking part in this study. Children with steroid sensitive nephrotic syndrome were taken in this study. Systolic and diastolic blood pressure was measured by researcher. Results; Of these 146 study cases, 92 (63%) were male patients while 54 (37 %) were female patients. Mean age of our study cases was 7.61 ± 2.55 years. Our study results have indicated that majority of our study cases i.e. 91 (62.3 %) were aged more than 7 years. Of these 146 study cases, 76 (52.1 %) belonged to rural areas and 70 (47.9 %) belonged to urban areas. Positive family history was noted in 11 (7.5%) and 129 (88.4%) mothers of these patients were illiterate. Compliance with the treatment was noted only in 31 (21.2%) of our study cases. Mean disease duration was 18.51 ± 10.26 months and 86 (58.9%) had duration of illness more than 12 months. Mean duration of treatment was 6.58± 2.28 months and 113 (77.4%) were taking their treatment for equal/less than 1 year. Mean systolic blood pressure was 135.85 ± 5.12 mmHg while diastolic blood pressure was 90.87 ± 3.25 mmHg. Hypertension was noted in 54 (37%) of our study cases. Conclusion; Frequency of hypertension was high among children having nephrotic syndrome in our study. Hypertension was significantly associated with family history, treatment compliance and prolonged disease duration. All clinicians treating such patients should monitor such children for hypertension for timely diagnosis and early management which will improve clinical outcomes and decrease disease morbidity. This will help to improve quality of life of our patients and also save them from future hardships. Keywords; Hypertension, Nephrotic Syndrome, Frequency

OVARIAN MASSES AMONG YOUNG WOMEN PREDICT HIGH FREQUENCY OF MALIGNANCY WITH POSITIVE FAMILY HISTORY.

Background; Ovarian masses are very common in pre- and postmenopausal women and are usually an incidental finding. The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was done to ascertain malignancy in adolescent women having ovarian masses. Objective; To determine the frequency of malignancy in adolescents and young women presenting with ovarian masses. Material and Methods; Patients (n = 98) fulfilling inclusion criteria from outpatient department of Nishtar Hospital, Multan, Pakistan were included in the study. Informed consent was taken from each patient ensuring confidentiality and the fact that there was no risk to the patient while taking part in this study other than the disease itself. Detailed history and physical examination of our study cases were arranged by the researcher itself. Data were entered and analyzed by SPSS. Results; Mean age of our study cases was 24.27 ± 5.19 years (with minimum age of our study cases was 15 years while maximum age was 34 years). Our study results have indicated that majority of our study cases i.e. 59 (60.2 %) were aged equal/less than 25 years. Of these 98 study cases, 43 (43.9 %) belonged to rural areas and 55 (56.1%) belonged to urban areas. Monthly family income up to Rs. 35000 was noted in 58 (59.2%) and more than Rs. 35000 was noted in 40 (40.8%) of our study cases. Of these 98 study cases, 66 (67.3%) were illiterate and 32 (32.7%) were literate. Family history of family cancer was noted in 19 (19.4%) of our study cases. Mean disease duration was 14.78 ± 5.13 months. Mean body mass index of our study cases was 26.02 ± 2.13 kg/m2 and obesity was present in 23 (23.5 %) of our study cases. Of these 98 study cases, 27 (27.6 %) were having history of use of oral contraceptives. Malignancy was diagnosed in 23 (23.5 %) of our study cases.  Conclusion; There was high frequency of malignancy noted among women having ovarian masses in our study cases. Ovarian masses were significantly associated with residential status and family history. Gynecologists treating such patients should monitor such suspected cases for early diagnosis which will improve treatment rate and quality of life of our patients. Keywords; Ovarian Masses, Malignancy, Frequency, adolescents

Development of an active fixture for ultrasonically assisted micro electro-discharge machining

Micromachining technologies have enjoyed a recent resurgence due to massive demands in many engineering, production and manufacturing sectors. Micro Electric Discharge Machining (μ-EDM) is one of the most popular techniques available to produce microscopic features and components for various industries. This technique can ensure better machining performance in terms of reduced Heat Affected Zones and surface finishing. It also comes with inherent disadvantages such as high machining time, low material removal rate (MRR) and unstable machining. To overcome these factors vigorous flushing of dielectric fluid is performed. The flushing is achieved through imparting ultrasonic vibration on either of the tool, dielectric fluid or workpiece. The vibration aids in carrying away the debris accumulated in the spark-gap region. In this paper, a novel design of an ultrasonic vibration fixture has been proposed. This fixture will facilitate vibration of the workpiece that is required to improve machining performance. Further enhancement of the design leads to better machining performance. System Identification helps to determine the nature of the system and model the input-output response. The oscillation of the system can be easily characterized and validated using System Identification. Machining results are compared to gain some more insight about the nature of ultrasonic vibration assisted μ-EDM

Efficacy of Balloon Kyphoplasty in Compression Fractures of the Thoracolumbar Spine

Objective:  To study the Efficacy of Balloon Kyphoplasty in compression fractures of the thoracolumbar spine. Material and Methods:  This study was conducted on 95 patients with thoracolumbar wedge fractures from 2017 to 2022. Complete neurological examination and CT and MRI scans of the spine of all patients were done. All patients have been treated with a balloon kyphoplasty procedure. Data was collected on VAS score, SF-36 score, kyphotic angle and percentage of vertebral body destruction both preoperatively and post-operatively. Statistical analysis was done by using paired sample t-test. Results:  The mean age was 57 years. Males were 58.9% and females 41.0%. Osteoporosis was the cause of fracture in 90.5% and trauma in 9.4% of patients. VAS improved from 7.42 ± 1.24 to post-procedure 3.24 ± 1.51, P < 0.0001. SF-36 improved from 35.31 ± 17.4 to post-procedure 49.23 ± 19.2, P < 0.0001. Kyphosis angle restoration from 18.42 ± 7.41 to post-procedure 10.61 ± 6.32, P value < 0.0001. Percentage loss of vertebral height from 32.91% to postoperatively 17.64% (SD-17.2 and P < 0.0001). 10.5% of patients developed cement leakage and there is no leakage in 89.4%. The adjacent level fracture occurred in 4 patients. Conclusion:  Balloon Kyphoplasty is an effective procedure for thoracolumbar wedge fractures. It improves pain, activities of daily living, kyphosis angle improvement, and restoration of vertebral height

Computerized Tomographic Based Study of Thoracic Spine Morphology in Relevance to Pedicle Screw Fixation in Pakistani Population

Objective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography. Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width. Results:  Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (21.2 ± 1.07 mm). Interpedicular (IPD) canal dimensions were minimum at T6 (19.18 ± 1.6 mm) and maximum at T3 (23.18 ± 1.2 mm). Anterior vertebral body height was minimum at T1 (16.9 ± 1.34 mm) and maximum at T12 (27.14 ± 1.34mm). Posterior vertebral body height was minimum at T1 (18.8 ± 1.13 mm) and maximum at T12 (29.76 ± 1.43 mm). Conclusion:  A detailed anatomy of the thoracic spine is essential for surgical planning to decrease postoperative complications

Effect of process parameters on the laser microdrilling performance of stainless steel, aluminium and copper

Micromachining techniques are being used regularly in various engineering and production sectors such as Micro Electromechanical Systems, Aerospace, Automotive, Electronics and Biomedical industries. For Laser Beam Micromachining, highly energized laser beam is focused on a small region of the workpiece surface. As a result, it is heated up rapidly to sufficiently high temperatures, then the material starts to melt and/or vaporize from the surface. This phenomenon of material removal is called laser ablation. The holes that are produced by one-dimensional laser beam drilling (LBD) can come with defects like taper, heat affected zone (HAZ) and Recast Layer. On the other hand, LBD process offers high control, high efficiency, precision, and production rate, particularly for drilling microscopic holes in a variety of materials. LBD performance is measured on different parameters such as taper and recast layer of the machined holes. Previous studies report many observations regarding the performance parameters and the process input parameters. But a thorough study of the performance parameters with respect to different material properties has not been reported yet. The research work for this paper focuses on the experimental investigation for different materials such as stainless steel (type SS304), Aluminum and Copper to observe the effects of Laser input parameters (namely laser power, scanning speed, and pulse repetition rate) on the performance of the LBD. The study also considers different thermophysical as well as optical properties such as thermal conductivity, specific heat, melting point, absorptivity and how it affects the outcome of LBD in a combined manner. Characterization of different output parameters such as Entry area, Exit Area and Recast Area is done by SEM (Scanning Electron Microscope) machine. For 75 Loop count, 90% Laser Power, 950 mm/s Scanning Speed and 10kHz pulse repetition rate, the highest amount of Recast Area is observed in SS, valued at 0.053 mm2. The largest amount of taperness is found in Cu at 44.404º. Scanning Speed and Laser Power has been identified as the most significant process factors for LBD performance

Mediation of Integrations in Supply Chain Information Management and Supply Chain Performance: An Empirical Study from a Developing Economy

Purpose – This study aims to investigate how the management of supply chain information impacts the performance of the supply chain. This relationship is explored by considering the mediating influence of internal and external integration, which is underpinned by the principles of resource-based theory. Design/methodology/approach – Data was collected from 144 supply chain professionals across different manufacturing companies. The proposed hypotheses were subjected to quantitative analysis using partial least squares structural equation modeling, and the validity of the measurement model was assessed with the assistance of SmartPLS software. Findings – This study identified that information management (IM) significantly and positively affects internal integration (II), customer integration (CI) and supply chain performance (SCP). Similarly, the results showed that II significantly and positively affects SCP. Likewise, CI positively and significantly affected SCP. At the same time, II found a positive yet significant mediating role in the relationship between IM and SCP. CI was found to play a positive but insignificant mediating role in the relationship between IM and SCP. Originality/value – This research evaluated a second-order model and tested the SCP in conjunction with the resource-based view in the manufacturing industry. This research could be beneficial for researchers, manufacturers and policymakers to attain organizational objectives by implementing an efficient IM system for better integration and SCP

Outcome of perforator propeller flap for the coverage of soft tissue defects over middle and distal part of leg

Background: Plastic surgery is a constant battle between blood supply and beauty. The end result of a reconstructive procedure is primarily attributable to the stability of the vascular component, which is fundamental in that it ensures survival and proper functioning of tissues that have been transferred to the recipient site. The aim of the study was to evaluate the clinical outcome of perforator propeller flap for coverage of soft tissue defects in middle and distal legs. Methods: This was a prospective observational study and was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from September 2018 to February 2020. The study population includes the total of 30 patients having soft tissue defects of the middle and distal thirds of leg necessary for flap coverage in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh. Results: In total 30 patients maximum 11 (36.7%) were in 31-40 years age group. Majority 27 (90%) were male and 3 (10%) were female in our study. Out of 22 flaps in distal leg necrosis occurred in 4 (18.19%) and among 8 flaps in middle leg necrosis occurred in 1 (12.5%). Conclusions: This study observed that that perforator propeller flaps are ideal in reconstructing soft tissue defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor site morbidity

Effects of Fallow Management Practices on Soil Water, Crop Yield and Water Use Efficiency in Winter Wheat Monoculture System: A Meta-Analysis

Winter wheat monoculture is a predominant cropping system for agricultural production in dry areas. However, fallow management effects on soil water conservation and crop yield and water use have been inconsistent among studies. We selected 137 studies and performed a meta-analysis to test the effects of tillage and mulching during the fallow period on precipitation storage efficiency (PSE), soil water storage at wheat planting (SWSp), crop yield, evapotranspiration (ET), and water use efficiency (WUE). Compared to conventional tillage (CT), conservation tillage during fallow period overall increased PSE, SWSp and wheat yield by 31.0, 6.4, and 7.9%, respectively, but did not affect ET and WUE. No tillage (NT) had a better performance on soil water conservation during fallow period but a similar effect on wheat yield and WUE compared to reduced tillage (RT) and subsoil tillage (ST). Compared to no mulching, fallow mulching practices overall increased PSE by 19.4%, but had a non-significant impact on SWSp, wheat yield, and ET. Compared to straw mulching, film mulching, and stubble mulching during fallow period, cover cropping as a biological mulching decreased SWSp, wheat yield, and WUE significantly. Wheat WUE was improved by straw mulching but not affected by film mulching and stubble mulching. Strong interactions between tillage method and mulching practices were found for most variables. NT with fallow mulching or with no mulching exhibited a greater impact on soil water conservation during fallow period compared to other combinations. The effects of tillage and mulching during fallow period on soil water conservation and wheat yield and water use also varied with soil and climatic conditions. Overall, NT in combination with straw mulching significantly increased SWSp, PSE, wheat yield, and WUE and can be the best fallow management practice for winter wheat production in varying edaphic and climatic conditions

Non‑traditional machining techniques for silicon wafers

Silicon (Si) micromachining techniques have recently witnessed significant advancement, attributable to the high surge in demand for microelectromechanical and microelectronic devices. Micromachining techniques are widely used to cut or pattern Si, in order to obtain high-quality surface finishes for the fabrication of devices. Micromachining techniques are used for the fabrication of three-dimensional (3D) microstructures for microelectromechanical devices. In this work, the capabilities and competencies of non-traditional Si micromachining techniques, including ultrasonic, ion beam milling, laser machining, and electrical discharge machining, are discussed and compared accordingly. The working principles, advantages, limitations, and Si microstructures that have been fabricated before are discussed in detail. Additionally, this work covers the performance reported by multiple researchers on these micromachining methods, spanning the temporal range of 1990 to 2020. The key outcomes of this study are explored and summarized