Health related quality of life assessment in patients with hepatitis: a case of Pakistan

The intention of this study is to dig out the demographic, medical, economic and psychosocial factors that affect the health related quality of life of the hepatitis B and C patient in district Sargodha. 120 patients of hepatitis B and C virus were interviewed. WHOQOL-BREF questionnaire was followed for the construction of health-related quality of life (HRQOL) instrument. Age of the patient, disease severity, use of drug, pain, depression, financial hindrance and threat of death negatively affect the HRQOL of the hepatitis patient while, vaccination, income, education, sleep, opportunity of leisure and better living condition affect HRQOL positively.HRQOL, HBV, HCV, Pakistan

Another D in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis.

Ketogenic diet or very-low-carbohydrate diet gained widespread popularity in the 1990s due to their favorable effects on weight loss and diabetes among others with good short-term safety data. People on ketogenic diets exist in a state of dietary ketosis in which the body production of ketone is equal to consumption and no harmful effects of ketonemia occur. However, in face of stress, the harmless dietary ketosis can lead to profound acid-base disturbances due to massive overproduction of ketone bodies that overwhelms the acid buffer system of the body. A handful of case reports have been published on this topic calling the safety of ketogenic diet into question. In this article, we chronicle a unique case of ketogenic (Atkins) diet-associated ketoacidosis, and we present a comprehensive literature review on the etiology of ketoacidosis

Hemodynamic Comparison between modified saddle block and subarachnoid block for Transurethral Resection of Prostate

BACKGROUND:   Spinal anesthesia is often the mode of anesthesia in transurethral resection of prostate (TURP) albeit with risk of hypotension. However, hemodynamic derangement is often less pronounced in saddle block. This study was conducted to compare the mean fall in Mean arterial Pressure (MAP) and Heart rate (HR) between modified saddle block and subarachnoid block for TURP.  OBJECTIVE:   To compare the mean fall in MAP and HR between modified saddle block and subarachnoid block for TURP.  METHODS:   In this randomized controlled trial 120 patients undergoing elective TURP were included and divided into two groups. Group A Patients received subarachnoid block and Group B received modified saddle block. Baseline hemodynamics were recorded before and then at 5 minutes after anesthesia. All the collected data was entered into SPSS version 22 and analyzed. Quantitative data like age, BMI, ASA-PS score, duration of surgery and baseline hemodynamics were presented as means and standard deviations. The fall of mean arterial pressure (MAP) & heart rate (HR) were compared among groups by independent t test and P value < 0.05 was considered as statistically significant.   RESULTS:  Mean fall in MAP was 8.98±1.28 mmHg and 3.13±0.68 mmHg (p<0.001) in group A and B, respectively. Mean fall in HR was 7.17±0.98 and 2.78±0.59 (p<0.001) in group A and group B, respectively.  CONCLUSION:   Modified saddle block resulted in significantly decreased fall in MAP and HR as compared with subarachnoid block for TURP.  KEY WORDS:   Modified Saddle Block; Subarachnoid Block; Mean Arterial Pressure &nbsp

Lafora Disease Masquerading as Hepatic Dysfunction

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson\u27s disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this rare disorder initially manifesting with abnormal liver enzymes. It underscores the importance of clinical suspicion of Lafora disease in cases with unexplained hepatic dysfunction. Prompt liver biopsy and genetic testing should be performed to antedate the onset of symptoms in these patients

WhatsApp Network Forensics: Discovering the IP Addresses of Suspects

Call record analysis is the most critical task for the Law Enforcement Agencies (LEAs) in a cyber-investigation process. It provides valuable information in the investigation, such as time and date and the duration of incoming and outgoing calls. The technological advancement of smartphones and the versatility of Instant Messaging (IM) applications provide multiple communication channels to cybercriminals for communication, making it difficult for the LEAs to monitor/investigate using traditional forensics tools and techniques. The most challenging part is to retrieve specific information from the network traffic of a particular IM Application such as WhatsApp. This research article’s primary purpose is to find the IP address of the cybercriminal using WhatsApp through existing sniffing techniques and tools. A method called rule-based extraction for sniffing packets is proposed for extracting the most relevant data from the network traffic. The results support LEAs to identify the cybercriminals’ specific traffic and help in analyzing and comparing the mobile phone data with the network traffic

Absorbed Radiation Dose in Radiosensitive Organs Using 64- and 320-Row Multidetector Computed Tomography: A Comparative Study

Aim. To determine absorbed radiation dose (ARD) in radiosensitive organs during prospective and full phase dose modulation using ECG-gated MDCTA scanner under 64- and 320-row detector modes. Methods:. Female phantom was used to measure organ radiation dose. Five DP-3 radiation detectors were used to measure ARD to lungs, breast, and thyroid using the Aquilion ONE scanner in 64- and 320-row modes using both prospective and dose modulation in full phase acquisition. Five measurements were made using three tube voltages: 100, 120, and 135 kVp at 400 mA at heart rate (HR) of 60 and 75 bpm for each protocol. Mean acquisition was recorded in milligrays (mGy). Results:. Mean ARD was less for 320-row versus 64-row mode for each imaging protocol. Prospective EKG-gated imaging protocol resulted in a statistically lower ARD using 320-row versus 64-row modes for midbreast (6.728 versus 19.687 mGy, P < 0.001), lung (6.102 versus 21.841 mGy, P < 0.001), and thyroid gland (0.208 versus 0.913 mGy; P < 0.001). Retrospective imaging using 320- versus 64-row modes showed lower ARD for midbreast (10.839 versus 43.169 mGy, P < 0.001), lung (8.848 versus 47.877 mGy, P < 0.001), and thyroid gland (0.057 versus 2.091 mGy; P < 0.001). ARD reduction was observed at lower kVp and heart rate. Conclusions:. Dose reduction to radiosensitive organs is achieved using 320-row compared to 64-row modes for both prospective and retrospective gating, whereas 64-row mode is equivalent to the same model 64-row MDCT scanner

Outcomes of post-neurosurgical ventriculostomy-associated infections

Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months after procedure. Other outcomes included 30-day mortality and total length of hospital stay.Results: We included 256 patients in the study. 66 patients (25.8%) developed VAI. EVD was the primary procedure in 21 (31.8%) cases. Most patients, 24 (36.4%), had EVD as a secondary procedure for tumor surgery. Median interval between EVD placement and diagnosis of infection was 3 days. Mean length of stay in VAI patients was 31.85 ± 20.53 days. Seven patients required ICU care. Ten patients (15.2%) expired during hospital stay or within 30 days of discharge and further four had GOS of 2 or 3. A total of 52 patients had a favorable outcome after 6 months.Conclusions: Rate of VAI in this cohort was high. VAI is associated with increased morbidity, mortality, and prolonged hospital stay

Influence of Image Acquisition on Radiation Dose and Image Quality: Full versus Narrow Phase Window Acquisition Using 320 MDCT

Purpose. To compare radiation dose and image quality using predefined narrow phase window versus complete phase window with dose modulation during R-R using 320-row MDCTA. Methods:. 114 patients underwent coronary CTA study using 320-row MDCT scanner. 87 patients with mean age (61 + 13 years), mean BMI (29 + 6), and mean heart rate (HR) (58 + 7 bpm) were imaged at predefined 66–80% R-R interval and then reconstructed at 75% while 27 patients with mean age (63 + 16 years), mean BMI (28 + 5), and mean HR (57 + 7 bpm) were scanned throughout the complete R-R interval with tube current modulation. The effective dose (ED) was calculated from dose length product (DLP) and conversion k (0.014 mSv/mGy/cm). Image quality was assessed using a three-point ordinal scale (1 = excellent, 2 = good, and 3 = nondiagnostic). Results:. Both groups were statistically similar to each other with reference of HR (P = 0.59), BMI (P = 0.17), and tube current mAs (P = 0.68). The median radiation dose was significantly higher in those scanned with complete R-R phase window versus narrow phase window (P < 0.0001). Independently of patient and scan parameters, increased phase window was associated with higher radiation dose (P < 0.001). Image quality was better among those scanned with narrow phase window versus complete phase window (P < 0.0001). Conclusion:. Our study supports that good HR control and predefined narrow window acquisition result in lower radiation dose without compromising diagnostic image quality for coronary disease evaluation

Comparative analysis of AC and DC distribution system with respect to harmonic distortion considering daily load profile

Electrical energy is the most efficient and the cleanest form of energy at the moment that is being transmitted and distributed amongst end-users. From its earlier days, the AC system was preferred as an economical solution for transmission and distribution. However, the development in the power electronics technology and the evolution of highly efficient power electronic converters have established the resurgence of DC power system. Furthermore, the trend is shifting towards DC loads as various energy efficient appliances, such as DC inverter air conditioners, operate on DC nowadays. This further advocates the shift towards the DC power system. This research works is an effort to perform the comparative analysis of AC Distribution System (ACDS) and DC Distribution System (DCDS), with regards to power quality and harmonic distortion in particular. The comparison is performed considering load profile and load variation on daily basis. Simulations are performed in MATLAB. It has been concluded at the end that ACDS is better than DCDS in terms of power quality as total harmonic distortion of the DCDS under the same loading and same load variation during the whole day was significantly higher than that of ACDS