Frequency of Congenital Heart Disease in Patients with Down Syndrome

OBJECTIVES Frequency of congenital heart disease in patients with Down syndrome.METHODOLOGY This study was conducted in Hayatabad Medical Complex, Peshawar from 10th May 2021 to 9th November 2021. A total of 377 patients of age 1 to 10 years and both gender were included in the study. Those with already diagnosed cases of congenital heart disease and dysmorphic features other than Down syndrome were excluded from the study. All patients were undergone echocardiography and patient with PDA, VSD, ASD, ASVSD, and TOF were labeled as having congenital heart diseases.RESULTSMean age was 5.96 ±1.954, Males were 176 (46.7%) while females were 201 (53.3%), Mean birth weight was 3.45 ± 0.801 kg, Mean age of the mother was 38.25 ± 6.797 years, Congenital heart diseases were present in 157 (41.6%) of the patient while it was not present in 220 (58.4%) of patients, there was no association between congenital heart disease and age of mother, age of the child, sex of child or weight of the child (P >0.05).CONCLUSIONCongenital heart disease is very common in patients with Down syndrome. It is recommended that at the time of diagnosis of this disease, the patient should be screened for congenital heart disease

Surgical Outcome of Anterior Skull Base Approach for Combined ENT and Neurosurgical Lesions

Objective:  To determine surgical outcome of Anterior Skull Base approach for combined ENT   and Neurosurgical Lesions. Material and Methods:  This descriptive study was conducted at the departments of ENT, Head, Neck Surgery and Neurosurgery Postgraduate Medical Institute (PGMI) Lady Reading Hospital Peshawar from March 2003 to Feb. 2008, with a total duration of five years. All these patients were admitted in ENT department. These patients were evaluated in terms of detailed history, thorough examination and radiological investigations. Incisional biopsy of the nasal mass was taken in cases where angiofibroma was excluded clinically, and then proper approach for excision of the lesion was planned. A well informed consent was taken from patient explaining the procedure, its risks, benefits and associated complications. The intracranial lesion was completely excised by neurosurgeons with help of microscope while the extracranial portion of the lesion was excised by ENT surgeon .The specimen of the lesions was examined by Histopathologist. Results:  This study included 23 patients in the age range of 12-51 years, mean age 25 years. Eighteen patients were male and five were female with female to male ratio of 1:3.6. These patients presented mainly with complaints of nasal obstruction, epistaxis and headache. CT scans were performed in all 23 cases (100%) while MRI in 5 cases (21.73%). These patients presented with advanced disease on radiological findings and they were treated by combined approach by Neurosurgeons and Otorhinolaryngologists. On histopathology of the specimen angiofibroma was on top. Two patients were subjected to radiotherapy postoperatively. There was no mortality and no recurrence of the disease. Conclusion:  The anterior skull base approach has good surgical outcome in terms of complete clearance of the disease and minimum morbidity for combined neurosurgical and ENT lesions irrespective of the nature of the lesion

Big data reduction framework for value creation in sustainable enterprises

Value creation is a major sustainability factor for enterprises, in addition to profit maximization and revenue generation. Modern enterprises collect big data from various inbound and outbound data sources. The inbound data sources handle data generated from the results of business operations, such as manufacturing, supply chain management, marketing, and human resource management, among others. Outbound data sources handle customer-generated data which are acquired directly or indirectly from customers, market analysis, surveys, product reviews, and transactional histories. However, cloud service utilization costs increase because of big data analytics and value creation activities for enterprises and customers. This article presents a novel concept of big data reduction at the customer end in which early data reduction operations are performed to achieve multiple objectives, such as a) lowering the service utilization cost, b) enhancing the trust between customers and enterprises, c) preserving privacy of customers, d) enabling secure data sharing, and e) delegating data sharing control to customers. We also propose a framework for early data reduction at customer end and present a business model for end-to-end data reduction in enterprise applications. The article further presents a business model canvas and maps the future application areas with its nine components. Finally, the article discusses the technology adoption challenges for value creation through big data reduction in enterprise applications

Thermal analysis of proposed heat sink design under natural convection for the thermal management of electronics

The rapid development in the field of electronics has led to high power densities and miniaturization of electronic packages. Because of the compact size of electronic devices, the rate of heat dissipation has increased drastically. Due to this reason, the air-cooling system with a conventional heat sink is insufficient to remove large quantity of heat. A novel macro-channel ?L-shaped heat sink? is pro-posed and analyzed to overcome this problem. The thermal resistance and fluid-flow behavior under natural convection, of the novel and conventional air-cooled heat sink designs, are analyzed. Governing equations are discretized and solved across the computational domain of the heat sink, with 3-D conjugate heat transfer model. Numerical results are validated through experimentation. The effect of parameters i.e., fin height, number of fins and heat sink size, on the thermal resistance and fluid-flow are reported. Examination of these parameters provide a better physical understanding from energy conservation and management view point. Substantial increase in the thermal performance is noted for the novel ?L-shaped heat sink? compared to the conventional design

Thermal analysis and optimization of L-shape fin heat sink under natural convection using ANOVA and Taguchi

Advancement in electronic systems resulted in miniaturization and high-power densities. Therefore, the rate of heat generation in circuit board increased dramatically. To overcome the problem of overheating, numerous heat sink designs are proposed including L-shape fins heat sink. The thermo-fluidic flow behavior and temperature difference are analyzed to get better understanding of heat transfer from the sink to ambient air. Governing equations for the model of conjugate heat transfer in 3-D environment are solved and discretized across the computational domain. Numerous experiments are carried out to validate the numerical results. The effect of fin numbers, height, and heat sink size at three different input power is reported. Furthermore, ANOVA and Taguchi statistical methods are used to predict parameters that affect the heat transfer. The study revealed that fin height affects the heat transfer rate the most, and accounts for 25.3% increase in heat transfer rate. Optimization of the heat sink is carried out to ensure better efficiency of the proposed heat sink. The optimized conditions for the sink are observed to be heat sink size of 90 mm, 9 number of fins, and 33 mm of fin height

Carbonic anhydrase influences asymmetric sodium and acetate transport across omasum of sheep

Objective Omasum is an important site for the absorption of short chain fatty acids. The major route for the transport of acetate is via sodium hydrogen exchanger (NHE). However, a discrepancy in the symmetry of sodium and acetate transport has been previously reported, the mechanism of which is unclear. In this study, we investigated the possible role of carbonic anhydrase (CA) for this asymmetry. Methods Omasal tissues were isolated from healthy sheep (N = 3) and divided into four groups; pH 7.4 and 6.4 alone and in combination with Ethoxzolamide. Electrophysiological measurements were made using Ussing chamber and the electrical measurements were made using computer controlled voltage clamp apparatus. Effect(s) of CA inhibitor on acetate and sodium transport flux rate of Na22 and 14C-acetate was measured in three different flux time periods. Data were presented as mean±standard deviation and level of significance was ascertained at p≤0.05. Results Mucosal to serosal flux of Na (JmsNa) was greater than mucosal to serosal flux of acetate (JmsAc) when the pH was decreased from 7.4 to 6.4. However, the addition of CA inhibitor almost completely abolished this discrepancy (JmsNa ≈ JmsAc). Conclusion The results of the present study suggest that the additional protons required to drive the NHE were provided by the CA enzyme in the isolated omasal epithelium. The findings of this study also suggest that the functions of CA may be exploited for better absorption in omasum

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