Localizing an occult insulinoma by selective calcium arterial stimulation test: First ever experience and a new dimension to diagnosis in Pakistan

Insulinomas are rare, usually benign, solitary tumours accounting for 60% of islet cell tumours. These tumours can be difficult to localize preoperatively due to their small size. We present a challenging case of a 40 year old male with frequent hypoglycaemic spells and endogenous hypoglycaemia who presented as a diagnostic dilemma. Patient had an occult insulinoma with inconclusive CT Abdomen, MRI Abdomen and Octreotide scan. The final localization of the tumour was made by selective arterial calcium stimulation testing (SCAT), done for the first time in Pakistan at Aga Khan University Hospital. This was followed by successful distal pancreatectomy as localizd by SACT yielding a well differentiated neuroendocrine tumour. After surgery patient made a robust recovery with no further hypoglycaemic symptoms. Hence successful localization and management of occult insulinomas can be challenging but can be achieved with the advent of newer invasive modalities

Numerical optimization of (FTO/ZnO/CdS/CH₃NH₃SnI₃/GaAs/Au) perovskite solar cell using solar capacitance simulator with efficiency above 23% predicted

The presented study deals with the investigations of the methyl ammonium tin halide (CH3NH3SnI3) based perovskite solar cells for optimized device performance using solar capacitance simulations software. Several necessary parameters such as metal work functions, thickness of structural layers, charge carrier’s mobility and defect density have been explored to evaluate the device performance. Calculations reveal that for the best efficiency of device the maximum thickness of the perovskite (CH3NH3SnI3) absorber layer must be 4.2 μm. The thickness values of 0.01 μm for ZnO electron transport layer (ETL), 0.871 μm for GaAs hole transport layer and 0.001 μm for CdS buffer layer have been found which proved to be optimum for maximum power conversion efficiency (PCE) of 23.80% for the device. The variation of open circuit voltage (Voc), Short circuit current (Jsc), Fill Factor (FF %), quantum efficiency (QE) against thickness of all layers and interface defect densities in FTO/ZnO/CdS/CH3NH3SnI3/GaAs/Au composition have been critically explored and their crucial role for the device performance has been reported. Heterojunctions between ZnO-ETL and CdS buffer layers have shown improved device performance and PCE. Current investigations may prove to be useful for designing and fabrication of climate friendly, non-toxic and highly efficient solar cells

DIABETIC KETOACIDOSIS CHARACTERISTICS AND DIFFERENCES IN TYPE 1 VERSUS TYPE 2 DIABETES PATIENTS

Background: Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA. Methods: This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of \u3e16 years of age irrespective of gender and type of diabetes were included. Information regarding patient’s demographics, presenting symptoms, precipitating causes of DKA, biochemical profiles and outcome at the time of discharge was collected. Results: Majority (54.7%) had moderate and 12.4% had severe DKA at presentation. Previous history of DKA was found higher in type 1 diabetes patients (T1DM) (14%) as compare to (4%) type 2 diabetes patients (T2DM) (p\u3c0.05). DKA severity was observed more (12%) in newly diagnosed (T1DM) (p\u3c0.05). Comorbidities were found more (81%) in (T2DM) (p\u3c0.05) Mortality was also observed higher in Type 2 diabetes patients (p\u3c0.05). Conclusion: Majority of the diabetics had moderate to severe DKA at presentation. Mortality and morbidity related with DKA was found considerably higher among patients with T2DM while infection, myocardial infarction and stroke found as triggering factors in these patients

Three siblings with familial non-medullary thyroid carcinoma: a case series

Abstract BACKGROUND: In 2015, thyroid carcinoma affected approximately 63,000 people in the USA, yet it remains one of the most treatable cancers. It is mainly classified into medullary and non-medullary types. Conventionally, medullary carcinoma was associated with heritability but increasing reports have now begun to associate non-medullary thyroid carcinoma with a genetic predisposition as well. It is important to identify a possible familial association in patients diagnosed with non-medullary thyroid carcinoma because these cancers behave more destructively than would otherwise be expected. Therefore, it is important to aggressively manage such patients and screening of close relatives might be justified. Our case series presents a diagnosis of familial, non-syndromic, non-medullarycarcinoma of the thyroid gland in three brothers diagnosed over a span of 6 years. CASE PRESENTATIONS: We report the history, signs and symptoms, laboratory results, imaging, and histopathology of the thyroid gland of three Pakistani brothers of 58 years, 55 years, and 52 years from Sindh with non-medullary thyroid carcinoma. Only Patients 1 and 3 had active complaints of swelling and pruritus, respectively, whereas Patient 2 was asymptomatic. Patients 2 and 3 had advanced disease at presentation with lymph node metastasis. All patients underwent a total thyroidectomy with Patients 2 and 3 requiring a neck dissection as well. No previous exposure to radiation was present in any of the patients. Their mother had died from adrenal carcinoma but also had a swelling in the front of her neck which was never investigated. All patients remained stable at follow-up. CONCLUSIONS: Non-medullary thyroid carcinoma is classically considered a sporadic condition. Our case report emphasizes a high index of suspicion, a detailed family history, and screening of first degree relatives when evaluating patients with non-medullarythyroid carcinoma to rule out familial cases which might behave more aggressively

Analysis and Design of Secure Sampled-Data Control Subject to Denial-of-Service Attacks

This study addresses the issue of secure control design for cyber-physical systems (CPS) against denial of service (DoS) attacks. We take into account a continuous-time linear system with a convex quadratic performance measure and a sampled linear state feedback control. DoS attacks impose constraints on the CPS, where packets may be jammed between the sensor and controller by a malicious entity, potentially resulting in system instability and performance degradation. We assume that the attacker can perform DoS attacks with a limited time and frequency due to energy restrictions. We devise an efficient procedure using the linear matrix inequality approach to compute an upper bound on the performance degradation brought on by the DoS attack. We also propose a redesign of the controller to minimize this performance degradation. Finally, a simulation example illustrates the computation of the performance degradation under a bounded DoS attack and the design of a secure controller. Simulation results show that the designed controller effectively keeps the feedback loop’s performance and stability under attack

Unforeseen complications: a case of dengue shock syndrome presenting with multi-organ dysfunction in a subtropical region

Abstract Overview Dengue fever, a viral illness transmitted by the Aedes mosquito, is capable of causing a range of serious complications, including fulminant hepatic failure, renal dysfunction, encephalitis, encephalopathy, neuromuscular and ophthalmic disorders, seizures, and cardiomyopathy. Case description This report details the case of a 30-year-old lactating woman with no notable medical history who presented to the emergency department with symptoms of high-grade fever, altered mental status, and seizures. Upon imaging, bilateral infarcts in the thalami and cerebellar hemispheres were observed, consistent with cerebellitis and dengue encephalitis. Patient treatment and outcome The patient was admitted to the intensive care unit and received appropriate treatment. Following a critical phase and successful patient stabilization, she was transferred to a high dependency unit for a week before being discharged with recommendations for follow-up care. Conclusion This case illustrates the broad spectrum of complications that can arise as a result of dengue infection and the importance of timely diagnosis and management in improving patient outcomes. Further investigation is required to better understand the mechanisms underlying these complications and to formulate specific guidelines for the prevention and treatment of dengue shock syndrome

Development of low-cost and high-efficiency solar modules based on perovskite solar cells for large-scale applications

Solar energy has emerged as a viable and competitive renewable resource due to its abundance and cost-effectiveness. To meet the global energy demands, there is a growing need for efficient devices with unique compositions. In this study, we designed and analyzed a perovskite solar cell (PSC) incorporating methylammonium tin iodide (CH3NH3SnI3) as the active optical absorber material, tin iodide (SnO2) as the electron transport layer (ETL), and copper thiocyanate (CuSCN) as the hole transport layer (HTL) using SCAPS-1D software for numerical investigations. Subsequently, the optimized outcomes were implemented in the PVSyst software package to derive the characteristics of a solar module based on the proposed novel solar cell composition. The objective of our research was to enhance the stability of solar cell for use in solar module. This was achieved by optimizing the thicknesses of the compositional layers which resulted in the enhancement of excess electron and hole mobilities and a reduction in defect densities, thereby leading to an improvement in the device performance. The optimization of excess electron and hole mobilities, as well as defect densities, was conducted to improve the device performance. SCAPS calculations indicated that the perovskite absorber layer (CH3NH3SnI3) may achieve the best possible performance with a maximum optimized thickness of 3.2 μm. The optimized thickness value for CuSCN-HTL and SnO2-ETL were found to be 0.07 μm and 0.05 μm respectively resulting in a maximum power conversion efficiency (PCE) of 23.57%. Variations in open circuit voltage (Voc), short circuit current (Jsc), fill factor (FF %), and quantum efficiency (QE) associated with the optimized thickness values of all layers in the ITO/SnO2/CH3NH3SnI3/CuSCN/Mo composition were critically analyzed. The use of these input parameters resulted in power creation of 557.4 W for a module consisting of 72 cells with an annual performance ratio of 80.3%. These recent investigations are expected to be effective in the design and fabrication of eco-friendly and high-performance solar cells in terms of efficiency

Primary trauma care course: Alternative basic trauma course in developing countries. The need of the hour

Objective: Low- and middle-income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan.Method: Two days of PTC courses were organised and conducted in various regions of Pakistan, participants per course comprising medical students, doctors, house officers, residents, and paramedics. The course comprises lectures of 5 hours and 30 minutes, skills workshops for 3 hours and discussion and multisystem trauma scenarios for 3 hours. Trauma management knowledge and clinical confidence of candidates were assessed using a predetermined multiple-choice questionnaire of 30 MCQs both at pre- and post-course, and using clinical scenarios, confidence matrix was assessed.Results: A total 7852 of participants were trained, an average of 2 courses per month and 302 total courses. Mean score of pre-course MCQs was 60% and mean score of post-course MCQs was 82%. Among the participant postgraduate trainees, average in trauma knowledge and trauma clinical confidence were significantly higher in both pre- and post-course. The mean score of pre-course confidence matrix was 70% and the mean score of post-course confidence matrix was 93%; at the end of course, all participants showed a high level of confidence in managing trauma mock scenarios. A total of 5889 (75%) participants had a ≥78.5% post-workshop knowledge score. However, only 1963 (25%) participants had a trauma skill score with ≤75 marks.Conclusion: PTC workshop could be an alternative and cost-effective flexible course for gaining knowledge and clinical skills of initial trauma management and strengthening the capacity of trauma management training in developing countries with minimal resources for saving the life of trauma victims

Proficient Lignocellulolytic Novel Bacterial Isolates from Diversified Galiyat Forests of Lower Himalaya

Lignocellulosic biomass needs attention as an alternative energy source to overcome the adverse impacts of fossil fuels. Diversified Galiyat forests of Lower Himalaya may represent the potential source of lignocellulose degrading microbiota, particularly the lytic bacteria. Therefore, soil and wood samples were collected from different sites of Nathiagali and Thandiani of Galiyat forests. The soil samples collected were clayey, with a pH between 6.7 and 7.0, and with an organic matter of 2.8%–2.9% in Nathiagali and 2.1%–2.2% in Thandiani. The soils were enriched with more diversified cultivable bacteria (9 Log CFU/g) than the respective wood samples (7.4–8.6 Log CFU/g). Out of 90 bacteria, 22 isolates were efficient for cellulose degradation, 14 for xylanase activity, and 10 for laccase production. Cluster analysis showed that lignocellulolytic bacteria were grouped based on the sample medium (soil–wood) rather than the sampling site (Thandiani–Nathiagali). Efficient bacteria were also sequenced, and we found that cellulase production was prevalent in Pseudomonas spp. while laccase activity was diverse among taxonomically varied bacteria. Moreover, Stenotrophomonas sp. TS2B1 performed the best for corncob xylose degradation. Overall, the results suggest that Galiyat forests represent diverse lignocellulolytic microbial populations which should be further evaluated for applications in lignocellulosic waste management and for potential consequent fuel production