Outcomes of Vascular Intervention in Diabetic Patients with Peripheral Arterial Disease

BACKGROUND:   Peripheral arterial disease (PAD) is more prevalent and often presents as more severe in patients with diabetes mellitus (DM) compared with those without DM. Although some patients may be asymptomatic, symptoms ranging from exertional leg heaviness and fatigue to acute limb loss are possible. PAD has significant physical and psychiatric health consequences, thus management with medical therapy and lifestyle changes are indicated. However, peripheral vascular intervention (PVI) is an increasingly popular method used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined.   METHODS: We analyzed the clinical response to PVI in DM (n=203, 52%) compared with non-DM patients (n=183, 48%), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. 502 patients participated with an exclusion of 116 patients from our analysis due to progression of acute limb ischemia and incomplete data collection. Our finalized study population comprised 386 consecutive patients with symptomatic PAD who had also received PVI treatment during the aforementioned time frame. Our patient population received PVI treatment in the year 2012 at the St. John Hospital and Medical Center in Detroit, MI. We used the PAQ summary score, which summarizes the patients’ level of physical and social function, patient symptoms, and overall quality of life before and after the procedure. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality).     RESULTS: Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 +/- 20 vs 37.5 +/- 20.6, p=0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups. This suggests similar symptomatic and functional improvement in non-DM and DM patients post-PVI.    CONCLUSIONS: Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful.    Key Words: peripheral arterial disease, peripheral vascular intervention, diabetes mellitus, quality of life    Figure or Table:  Table 5. Comparison of the Summary Score of 6 PAQ Domains Using Median Scores from Mann Whitney U Test of DM and Non-DM Patients in Detroit, MI, USA   PAQ domain DM Non-DM P-Value Physical limitation 16.6 (75.4) 25.0 (79.8) 0.06 Symptoms 23.6 (75.4) 27.7 (79.8) 0.24 Symptom stability 25.0 (75.4) 25.0 (79.8) 0.28 Social limitation 16.6 (75.4) 25.0 (79.8) 0.07 Treatment satisfaction 0.0 (75.4) 0.0 (79.8) 0.42 Quality of life 16.6 (75.4) 25.0 (79.8) 0.06 Summary score 18.7 (75.4) 26.0 (79.8) 0.049 &nbsp

Switching modulation strategies for multilevel inverter

There is always a need to create efficient and optimized converters to deliver the best possible results to achieve a better THD profile in the waveform output. One way is by controlling the switching of the power switches of the converters using appropriate modulation schemes. While numerous works have been done in proposing new switching modulation strategies for multilevel inverters, this work will compare multicarrier PWM and near-to-level control (NLC) modulation schemes. In this paper, multicarrier PWM variants, namely, PD-PWM, POD-PWM, and APOD-PWM, are designed and simulated. Their voltage THD and spectrum performance are discussed when applied to single-phase 7, 9, and 11-level cascaded multilevel inverters. Then NLC modulation will be designed and applied to similar multilevel inverter circuits. It will be shown that the NLC exhibits some superior performances compared to PWM-based but with several drawbacks that can be optimized

A community scale hybrid renewable energy system for sustainable power supply during load shedding

Load shedding is an operating condition in which the electrical grid is temporarily disconnected from the load. The objective is to minimize the gap between available generation capacity and load demand while maintaining an equitable supply for all consumers. Load shedding is a prominent problem for many developing countries. To address this issue, this paper explores the potential of a hybrid energy system (HES) to provide uninterrupted power supply at the distribution feeder despite load shedding from electrical grid. The proposed HES in this work combines photovoltaic (PV) array, battery storage system (BSS) and diesel generator (DG). The HES is equipped with energy management scheme (EMS) that ensures continuous power supply, improves energy efficiency, and minimizes the electricity cost. To accomplish these tasks, the EMS operates the system in one of three modes: grid mode, renewable energy source mode and the diesel generator mode. Besides, the proposed methodology allows injecting surplus PV energy into the grid, thus maximizing PV utilization and improving power system’s reliability. The results of this study will assist policymakers to determine the prospect of renewable based hybrid system to supply sustainable power and eliminate the energy problems in the power deficit countries

Mortality causes in goldsmiths of Bangladesh: Findings from verbal autopsy

Background: Information on the mortality causes of goldsmiths in Bangladesh is limited. This study aimed to find out the mortality causes in a selected group of goldsmiths. Methods: A World Health Organization recommended questionnaire was adapted to conduct verbal autopsy of 20 deceased goldsmiths. Death-related information was gathered from the family members present during deceased’s illness preceding death. The mortality causes were determined by the interview outcomes and medical records-review. Results: The mean age of the goldsmiths at death was 59.2± 9.3 years. Among then, 70.0% were smokers and 50.0% were alcohol consumers. Cardiovascular diseases (CVD) were the most common immediate and underlying cause of death (60.0% and 45.0%, respectively). Conclusion: The life expectancy of goldsmiths was much lower than the average life expectancy of Bangladeshi population, where CVD was the primary cause of death. Smoking and alcohol consumption were prevalent among them. Awareness about healthy lifestyles should be prioritized for highly CVD prevention among the goldsmiths.  Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 87-9

Types and distribution of cancer patients attending in a tertiary care hospital of Bangladesh

Bangladesh, similar to other countries is experiencing an increased burden of cancer. Absence of a national cancer registry has created a gap in the information regarding the presentation of cancer statistics of the country. The objective of this study was to assess the types and distribution of the cancer patients attending a tertiary academic medical center hospital in Bangladesh. A cross-sectional study was conducted among all the confirmed cancer patients attending the in-patient and out-patient, and daycare facilities in Bangabandhu Sheikh Mujib Medical University in October, 2019. A validated questionnaire, recommended by International Agency for the Cancer Registry was used to collect data. Written informed consent was obtained from every respondent. This study had received its ethical clearance from Institutional Review Board of BSMMU. Among the 1656 respondents, 78.8% were adult and 25.2% were from paediatric age groups. Leading cancer for adult males were lung cancer (9.6%), leukaemia (9.4%) and lymphoma (9.0%); and breast cancer (28.1%), thyroid cancer (16.1%), and cervical cancer (12.2%) for females. Leukaemia was the most frequent cancer in the paediatric group for both males (71.5%) and females (66.5%). Establishing a hospital-based cancer registry with high quality data in an academic medical center setting is feasible and can set the stage for establishing nationwide hospital-based as well as establishing a popula- tion-based cancer registry in Bangladesh, which is necessary to identify and tackle the rising burden of cancer in this country. BSMMU J 2022; 15(1): 43-4

Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach

Background A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine learning to characterise mortality in the 30-days following admission and the 180-days after discharge from nine hospitals in low and middle-income countries (LMIC). Methods A cohort of 3101 children aged 2–24 months were recruited at admission to hospital for any acute illness in Bangladesh (Dhaka and Matlab Hospitals), Pakistan (Civil Hospital Karachi), Kenya (Kilifi, Mbagathi, and Migori Hospitals), Uganda (Mulago Hospital), Malawi (Queen Elizabeth Central Hospital), and Burkina Faso (Banfora Hospital) from November 2016 to January 2019. To record mortality, children were observed during their hospitalisation and for 180 days post-discharge. Extreme gradient boosted models of death within 30 days of admission and mortality in the 180 days following discharge were built. Clusters of mortality sharing similar characteristics were identified from the models using Shapley additive values with spectral clustering. Findings Anthropometric and laboratory parameters were the most influential predictors of both 30-day and post-discharge mortality. No WHO/IMCI syndromes were among the 25 most influential mortality predictors of mortality. For 30-day mortality, two lower-risk clusters (N = 1915, 61%) included children with higher-than-average anthropometry (1% died, 95% CI: 0–2), and children without signs of severe illness (3% died, 95% CI: 2–4%). The two highest risk 30-day mortality clusters (N = 118, 4%) were characterised by high urea and creatinine (70% died, 95% CI: 62–82%); and nutritional oedema with low platelets and reduced consciousness (97% died, 95% CI: 92–100%). For post-discharge mortality risk, two low-risk clusters (N = 1753, 61%) were defined by higher-than-average anthropometry (0% died, 95% CI: 0–1%), and gastroenteritis with lower-than-average anthropometry and without major laboratory abnormalities (0% died, 95% CI: 0–1%). Two highest risk post-discharge clusters (N = 267, 9%) included children leaving against medical advice (30% died, 95% CI: 25–37%), and severely-low anthropometry with signs of illness at discharge (46% died, 95% CI: 34–62%). Interpretation WHO clinical syndromes are not sufficient at predicting risk. Integrating basic laboratory features such as urea, creatinine, red blood cell, lymphocyte and platelet counts into guidelines may strengthen efforts to identify high-risk children during paediatric hospitalisations. Funding Bill & Melinda Gates Foundation OPP1131320