Title: Correlation between hyper-uricemia and renal resistivity index in normoglycemic normotensive patients

Abstract:Introduction: Hyperuricemia is associated strongly with the development of renal disease and progression. Medical therapy decreases serum uric acid levels by inhibiting the enzyme xanthine oxidase. Objective of the study: To evaluate correlation of mean uric acid level and Renal Resistive Index in normoglycemic and normotensive adult subjects. Material and methods: This descriptive cross-sectional study was conducted in Allied hospital, Faisalabad, during 31-10-2018 to 30-04-2019. One hundred (n=100) non-diabetic, non-hypertensive, recently diagnosed hyperuricemic otherwise healthy subjects irrespective of gender between age 20-40 years were included in the study. After complete history taking and full physical examination laboratory testing including: serum uric acid, serum creatinine to exclude renal decompensation patients, fasting blood sugar and 2 h post prandial were advised. Results: 55.0% (n=55) of patients were males with the mean age of 33.40 years ± 3.85 SD and 45.0% (n=45) of patients were females with mean age of 34.67 years ± 3.33 SD. Cumulative mean age was 33.97 years ± 3.66 SD. The mean value of the RI of the renal arterial vasculature was 0.765 ± 0.0155 SD. The maximum, minimum and range values of the RI were 0.79, 0.74, and 0.04 respectively. The mean serum uric acid value found to be 10.947±0.562 SD. The maximum, minimum and range values of the RI were 0.79, 0.74 and 0.05 respectively. Correlation between the serum uric acid and renal arterial RI prior to the medical therapy and 3 weeks after therapy. A positive correlation was found between both values with a Pearson’s correlation coefficient = 0.103 and p-value 0.308. Conclusions: It is concluded that that medical treatment of hyperuricemia results in lowering of serum uric acid which correlates with the decrease in renal resistive index.

Title: Frequency of Pulmonary manifestations of in patients with Gastroesophageal Reflux Disease

Abstract:Introduction: Pulmonary manifestations of GERD are attracting increasing attention. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. The gastric contents can cause throat irritation, postnasal drip and hoarseness also recurrent cough. Objectives: This study is to determine frequency of pulmonary manifestations in patients with gastroesophageal reflux disease. Settings: This study was conducted through Lahore General Hospital, Lahore during June 2019 to July 2019. Study Design: It was a Cross sectional study. Subjects: All patients with heartburn .both males and females of 20 -70 years of age. Results: Out of 150 patients laryngeal symptoms were 10 % have dry cough 8 % have hoarseness and dry cough hoarseness both in 10 % in patients with heartburn . 34% patients with GERD were found to be asthmatic. Nasal symptoms were infrequent 2%. Out of 150 patients 36% do not have any pulmonary manifestations. Conclusion: There is high prevalence of pulmonary manifestations in patients with GERD.

Title: Outcome of Alvarado scoring system in the diagnosis of acute appendicitis

Abstract:Abstract:\nDiagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for the surgical residents and consultants to the miss the diagnosis.\nObjective:\nThe objective of this study was to evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. \nMaterial & Methods:\nA retrospective observational study was conducted at the DHQ teaching hospital, Sargodha. The data was collected from117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS version 23.\nResults:\nDemographic results showed 73(62.4 %) males and 44(37.6 %) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain (percentage % 100) was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by the on-call team which consisted of senior registrars and surgical residents. Negative appendectomy rate was 3.4%. Diagnostic sensitivity of the Alvarado score was 75.2%. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages.

Title: Nonlinear Parameter Identification for A Bolted Large Deformed Beam

Abstract:The dynamics of a bolted large deformed beam is very complex because of the interactions of geometric nonlinearity and contact nonlinearity. To better simulate the nonlinear dynamic behavior of the beam, an improved nonlinear modal analysis method based on Quasi-Static Modal Analysis method (QSMA) is presented and validated in this paper. The method can obtain the frequency and damping property of nonlinear modes quickly and accurately by taking the change of the mode shapes into account. First, the properties of nonlinear modes of a bolted large deformed beam are extracted from the measurements of impact tests processed with Hilbert Transform curve fitting in oeder to provide the parameter identification procedure below with experimental data. Then, a finite element model of the bolted beam is presented that captures the geometric nonlinearity introduced by a co-rotational formulation, and the contact nonlinearity introduced by a four-parameter Iwan model. Finally, a parameter identification procedure is applied to the structure, which employs the Multi-Objective Optimization of Genetic Algorithm (GA) in order to acquire the optimal set of parameters of the FEM. The frequency shifts and damping ratio are used as two different objects, and the final optimized solution is Pareto optimal. The comparison of numerical and experimental responses by impact tests under the same condition validates the capability of the model to capture the effects of both nonlinearities on dynamic responses of the bolted large deformed beam structure, as well as the efficacy of the parameter identification method.

Title: Prevalence of neuroendocrine tumors in the ampulla of Vater and periampullary region

Abstract:BACKGROUND: Tumors of the Ampulla and the periampullary region are rare and often malignant. Their prognosis is generally better than for other digestive malignancies, due to their different histology and because the clinical manifestations tend to manifest themselves earlier. OBJECTIVE: To see the frequency of malignant lesions of ampullary and periampullary region in patients with obstructive Jaundice and its association with smoking.\nMETHODS: This was an analytical study. Study was done at District Head Quarter Teaching Hospital, Sargodha during March 2020 to November 2020. Total 94 patients were included in the study. Patients selection was done by using a pre defined inclusion and exclusion criteria. The collected samples were processed for histopathology and only data of the patients present with obstructive jaundice, ampullary swelling and periampullary masses were recorded in the specially designed proforma for this study. RESULTS: Mean age of all patients was 58.20±12.02 years. Age range of patients was 35 -80 years. Gender distribution shows that there were 66% male and 34% female patients. Male patients were greater in number as that of female patients. Smoking status shows that 47% of the patients were smokers. According to histopathology report there were 72(77%) patients who had malignancy. There were 34% patients who had well differentiated adenocarcinoma, 13.8% had moderately differentiated adenocarcinoma and 12.8% had chronic non specific enteritis. These are the top 3 tumors diagnosed with histological findings. Other types of tumors can be seen in above table. CONCLUSION: Frequency of malignant lesions of ampullary and periampullary region in patients with obstructive Jaundice is quite high. Malignancy occurs more commonly in the ampulla of Vater than any other area in the small intestines. The proximity of these ampullary and periampullary malignancies close to the vital structures of pancreaticobiliary system results in clinical challenges to be faced in managing these pathologies.

Title: Revision TKA after Periprosthetic knee fracture with Metaphyseal Sleeves and Cones

Abstract:Objective: A complex periprosthetic knee fracture with bone defects usually requires revision total knee arthroplasty. Different renovation options exist for unstable fractures with bone loss. The objective of our study is to report on conservative renovation for peri-prosthetic fractures in revision TKA by using of metaphyseal sleeves or cone. \nMethod: 22 patients were assessed who underwent revision TKA along with a metaphyseal sleeve or trabecular metal cone from January 2017 to December 2019. The Knee Society score (KSS) were evaluated at each follow-up. Follow up radiographs were taken at each visit to observe osseointegration and bone ingrowth around implant. \nResults: From 22 patients, 16 were female (72.8%). and 6 were male (27.2%). The patients’ age were ranging from 45-80 years with mean of 66.91±11.47 years. Preoperatively periprosthetic fracture of distal femur after TKA was classified according Rorabeck & Tylor which included 11 type 2 and 6 type 3 and Felix classification included 5cases type 2 as proximal tibial fracture respectively. Bone loss defects were classified according to the AORI classifications included 1 type 1, 4 type 2A, 3 type 2B and 4 type 3 femoral defects; and 2 type 2B , 3 type 3 tibial defects. The follow-up period was 3-35 months with mean of 18.3 months.At final follow up the mean knee score and functional score was 83.27±4.82 and 77.27±5.71 respectively. The mean flexion contracture was 5° (range 0°–25°) preoperatively and at the time of the last follow-up the average flexion contracture reduced to 3° (range 0°–15°).Mean range of motion was 80° (70° - 90°) pre-operatively and 105°( 90°-120°) post-operatively. \nConclusion: After physical and radiographic evaluations from the follow up visits we reached to the conclusion that both metaphyseal devices sleeves and cones are feasible and executable option for a stable reconstruction of revision total knee arthroplasty after periprosthetic fractures with bone defects AORI type 2 and type 3.

Title: Long noncoding RNA KCNQ1OT1 targets miRNA let-7a-5p to regulate Osteoarthritis development and progression

Abstract:Background Osteoarthritis (OA) is a common disease of the joints among old populace until today. The treatment possibilities and roles of miRNA and long non-coding RNA (lncRNA) in therapy of OA has previously been explored. However, the functional roles of Long noncoding RNA KCNQ1OT1 and miRNA let-7a-5p on Osteoarthritis development and progression remains unclear. This study aimed at investigating the influence of KCNQ1OT1 on let-7a-5p in moderation of OA development and advancement.\nMaterials and Methods RT-qPCR examined expression of KCNQ1OT1and let-7a-5p in cultured human primary chondrocyte cell lines. Cell transfection overexpressed or knocked down the genes and CCK-8 assay measured cell viability in the proliferation biomarkers Ki87 and PCNA. While caspase-8 and caspase-3 activity determined rate of apoptosis. Furthermore, luciferase assay analyzed the luciferase activity and western blotting analysis determined the protein expression of KCNQ1OT1 and let-7a-5p in proliferation and apoptosis biomarkers.\nResults The results demonstrated that KCNQ1OT1 is upregulated in OA-mimic cells and promotes the cell viability. KCNQ1OT1 knockdown suppresses cell viability of OA cells. Furthermore KCNQ1OT1 directly binds the 3\'-UTR of let-7a-5p to negatively regulate let-7a-5p expression and OA progression. While upregulated let-7a-5p abolishes the proliferation effect of KCNQ1OT1 in OA cells.\nConclusion In summary, our study provides further insights into the underlying molecular mechanisms of KCNQ1OT1 and let-7a-5p suggesting a novel therapeutic approach to OA

Title: Comparison of the Tableting Properties of Pre-Processed Paracetamol Powders by Using QbD Approach by Compaction Simulator

Abstract:Pre-processed active pharmaceutical and excipient usage have been widely spreading in recent years. Active Pharmaceutical Ingredient producers are inclined to producing a pre-processed form of powders that are poorly compressible to improve their chemical and physical characteristics. With the application of the Quality by Design approach during the development of active ingredients in the pharmaceutical industry, these companies could assure the quality of the end product without spending more time for reproducing the pre-processed from the beginning. This study aims to employ the Quality by Design approach to develop and improve the quality of paracetamol contains tablets with the optimal Critical Process Parameters by using two different types of paracetamol. Critical Quality Attributes and Critical Process Parameters were identified according to risk assessment results. The chosen Critical Quality Attributes and Critical Process Parameters were included in the creation of a design space. Minitab 18 and Modde programs were used to identify the Critical Process Parameters effect on Critical Quality Attributes and the degree of their effects using factor effect plots, contour plots, and sweet spot plots were done based on these artificial intelligence programs. For the best product outcome, the study showed that using a smaller mesh size with intra-granular pre-gelled starch inclusion in a specific range of compaction force will generate a higher quality product with the best powder flow characteristic and the best tableting properties.

Title: Drinking Water Quality Measurement using gas sensor in Shaheed benazirabad District, Sindh (Pakistan)

Abstract:Nowadays, a variety of diseases such as malaria, dengue is due to contaminated water. One main reason of contaminated water is accidental mixed-up. It causes a massive number of deaths in Pakistan. Therefore, quality of drinking water must be checked before drink the water. In this paper, authors assessed the quality of drinking water from district of Shaheed Benaziarabad, Sindh Pakistan. Authors presented a simple system for water quality assessment at low cost using sensor node. Testing of water has been carried out on the different samples collected from various cities of the Shaheed benazirabad district. Results show that the proposed design has great view and can be practically used at home.

Title: Pattern of cardiac arrhythmias in patients with st-elevation myocardial infarction in 1st 48 hours at CCU medical college and Teaching hospital D.G Khan

Abstract:Acute myocardial infarction is a major public health issue in developing countries. 20-30% of patients with coronary artery disease has been reported in hospital settings. Cardiac arrhythmias are frequent serious complication of myocardial infarction. Arrhythmias are the direct cause of death in patients with acute myocardial infarction. The study aimed to evaluate the pattern of cardiac arrhythmias in patients with myocardial infarction in the first 48 hours. This descriptive observational study was conducted in DG Khan Medical College and teaching hospital, DG Khan. 60 patient who presented with symptoms of myocardial infarction fulfilling the inclusion criteria were included in the study. Detailed history was taken which including onset of, nature of chest pain and risk factor associated with respect to gender. Clinical examination history including electrocardiogram was recorded at the time of admission, 12 hours, 24 hours and 48 hours interval. Routine investigation like complete blood picture (CBC), blood sugar level, fasting lipid profile, CK-MB, 2D-echo were carried out. Out of 60 males were 42 and females were 18. Incidence of arrhythmias as a complication of myocardial infarction were 74%. Incidence of cardiac arrhythmias increase with the risk factors, hypertension and smoking were the leading cause of MI and arrhythmias. Most common arrhythmias recorded in this study were ventricular premature contraction (VPC). The patients who developed cardiac arrhythmias has detrimental effect on morbidity.