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

Response of Gaussian-modulated guided wave in aluminum: An analytical, numerical, and experimental study

The application of guided-wave ultrasonic testing in structural health monitoring has been widely accepted. Comprehensive experimental works have been performed in the past but their validation with possible analytical and numerical solutions still requires serious efforts. In this paper, behavior and detection of the Gaussian-modulated sinusoidal guided-wave pulse traveling in an aluminum plate are presented. An analytical solution is derived for sensing guided wave at a given distance from the actuator. This solution can predict the primary wave modes separately. Numerical analysis is also carried out in COMSOL® Multiphysics software. An experimental setup comprising piezoelectric transducers is used for the validation. Comparison of experimental results with those obtained from analytical and numerical solutions shows close agreement

Investigating the relationship between human activity and the urban heat island effect in Melbourne and four other international cities impacted by COVID-19

Climate change is one of the biggest challenges of our times, even before the onset of the Coronavirus (COVID-19) pandemic. One of the main contributors to climate change is greenhouse gas (GHG) emissions, which are mostly caused by human activities such as the burning of fossil fuels. As the lockdown due to the pandemic has minimised human activity in major cities, GHG emissions have been reduced. This, in turn, is expected to lead to a reduction in the urban heat island (UHI) effect in the cities. The aim of this paper is to understand the relationship between human activity and the UHI intensity and to provide recommendations towards developing a sustainable approach to minimise the UHI effect and improve urban resilience. In this study, historical records of the monthly mean of daily maximum surface air temperatures collected from official weather stations in Melbourne, New York City, Tokyo, Dublin, and Oslo were used to estimate the UHI intensity in these cities. The results showed that factors such as global climate and geographic features could dominate the overall temperature. However, a direct relationship between COVID-19 lockdown timelines and the UHI intensity was observed, which suggests that a reduction in human activity can diminish the UHI intensity. As lockdowns due to COVID-19 are only temporary events, this study also provides recommendations to urban planners towards long-term measures to mitigate the UHI effect, which can be implemented when human activity returns to normal. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Kinetic and thermodynamic study of oxidative degradation of acid yellow 17 dye by Fenton-like process: Effect of HCO3−, CO32−, Cl− and SO42− on dye degradation

We report here the degradation of AY-17 dye using Fenton-like process (H2O2/Fe3+). The maximum degradation (83%) of AY17 dye is achieved at pH 3 in 60 min, with optimum concentrations of AY 17 (0.06 mM), H2O2 (0.9 mM), and Fe2+ (0.06 mM). The scavenging effects of HCO3−, CO32−, Cl− and SO42− on dye degradation are also examined. The activation energy (Ea), activation enthalpy (rH*), and activation entropy (rS*) are calculated for the dye degradation using pseudo-first-order kinetics at various temperature.               KEY WORDS: Acid Yellow 17, H2O2/Fe3+, Fenton-like process, Oxidative degradation, Scavenging effects Bull. Chem. Soc. Ethiop. 2019, 33(2), 243-254.DOI: https://dx.doi.org/10.4314/bcse.v33i2.

Banti\u27s syndrome: case report and review of literature.

In 1898 Banti described a disorder characterized by splenomegaly and hypersplenism, resulting in portal hypertension and anemia in the absence of hematological disease. 1 Banti\u27s syndrome is also known as non-cirrhotic portal hypertension (NCPH) in India and Idiopathic Portal Hypertension (IPH) in Japan. Hepatoportal sclerosis seems to be its counterpart in the United States. 2,3 Banti\u27s syndrome is a disorder of unknown etiology, clinically characterized by portal hypertension (varices and portosystemic collateral vessels), splenomegaly, and anemia (hypersplenism). 3 It has been reported from Indian subcontinent. 4-6 In a Pakistani case series of portal hypertension, 18 out of 37 patients were found to have IPH as the etiology. 6 We report a case of Banti\u27s syndrome in an 20-year old girl presenting to us with anemia and splenomegaly

Design and analysis of bending motion in single and dual chamber bellows structured soft actuators

As one of the most important characteristics of soft actuators, bending motion has been widely used in the field of soft robotics to perform different manipulation and tasks. In this study, we design silicone rubber material based soft actuators consisting of single and dual chambers, and a bellows structure. Several models of bellows soft actuators were designed, simulated and analyzed using finite element analysis (FEA) software MARC®, in order to understand the characteristics of bellows structured soft actuator with single and dual chambers and to optimize the performance of bending motion of bellows soft actuators. The results confirm that the bellows structured pneumatic soft actuator model 4 of single chamber and model 5 of dual chamber produces the best bending motion and bending angles

An unusual presentation of metastatic adenocarcinoma of lung: a case report

We report an unusual patient with primary adenocarcinoma of lung causing malignant pleural and pericardial effusions. The diagnosis was made only at autopsy as his staging computed tomography scan of chest was negative for an obvious mass lesion within the lung or pleura. Prior to his death, his symptoms were erroneously managed as left ventricular failure and community-acquired pneumonia

MoO3 altered ZnO: A suitable choice for the photocatalytic removal of chloro-acetic acids in natural sunlight exposure

The MoO3 coated ZnO photocatalysts were synthesized for the optimum harvesting of the absorbed ultraviolet sunlight photons by initially permeating Mo6+ ions at the surface of pre-synthesized ZnO and finally transformed to MoO3 by thermal treatment in the air. The absorption spectra of the synthesized powders revealed the extension of the absorption edge in the visible region whereas, the photoluminescence spectroscopy established the supporting role of the MoO3 coating in gradually plummeting the excitons recombination. The growth of additional peaks in Raman as well as X-ray photoelectron spectra and the appearance of the corresponding low-intensity reflection substantiated the surface prevalence of MoO3. The absence of the individual particles of MoO3 in FESEM and the verification of coated layer by HRTEM images validated the authenticity of the adopted synthetic route. The electrochemical evaluation of the synthesized powders under illumination revealed the complete elimination of photocorrosion and the synergic role of the MoO3 layer for improved trap and transfer of charge carriers. The evaluation of the flat-band potentials of the coated powders by Mott-Schottky analysis revealed the suitability of the conduction band edges for the generation of superoxide anion radicals. The photocatalytic activity of the synthesized powders was assessed for the removal of chloro derivatives (mono-, di-, trichloroacetic acids) in comparison to pure acetic acid. A significant effect of the stability, polarity and stereochemical structure of the substrate on the photocatalytic removal process was observed and discussed. The experimental evidences from the time-scale chemical analysis were interpreted for the identification of the reactive oxygen species (ROS) involved in the degradation/mineralization process. The validation of the Langmuir-Hinshelwood kinetic model was also examined. Efforts were made to estimate the plausible route of the degradation/mineralization process