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Introduction Tracheostomy, although a common surgical procedure, is associated with potential complications. Complications can be avoided with accurate technique and proper operative and postoperative care. A surgeon should know the complications of the procedure and how to avoid them so that complications may be prevented or minimized. Objective To determine the frequency of complications in patients undergoing elective and emergency tracheostomies. Methods The cross-sectional study was conducted at the Department of Otorhinolaryngology - Head and Neck Surgery, and Intensive Care Unit (ICU) of PIMS Hospital, Islamabad, from March 1 to August 31, 2023, with a total duration of six months. A total of 110 patients admitted to the ICU and presented in an emergency falling within the inclusion criteria were counted in the study. Patients were split into two groups, i.e., elective tracheostomy (group A) and emergency tracheostomy (group B). All patients were followed for three months for adverse events related to the tracheostomy. All information was collected on Proforma and analyzed using the SPSS 23 version (IBM Corp., Armonk, NY). Results The mean age of participants was 48.47±12.68 years in group A and 49.54±10.99 years in group B (p=0.636). 40 (72.7%) and 37 (67.3%) patients were male and 15 (27.3%) and 18 (32.7%) female in groups A and B, respectively. The results of post-operative complications in both groups A and B were observed, respectively, for surgical emphysema (2 [3.6%] vs. 5 [9.1%], p=0.241), hemorrhage (2 [3.6%] vs. 4 [7.3%], p=0.401), wound infection (3 [3.6%] vs. 6 [10.9%], p=0.279), tube blockage (0 [0.0%] vs. 1 [1.8%], p=0.315), tube displacement (0 [0.0%] vs. 3 [5.5%], p=0.079), and tracheoesophageal fistula (0 [0.0%] vs. 2 [3.6%], p=0.154). The overall complications in elective tracheostomies were 7 (12.7%) and in emergency tracheostomies were 21 (38.2%). Conclusion We concluded that patients who had an emergency tracheostomy experienced more postoperative complications than those who underwent an elective tracheostomy.

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Environmental and health monitoring requires low-cost, high-performance diethylamine (DEA) sensors. Materials based on metal-organic frameworks (MOFs) can detect hazardous gases due to their large specific surface area, many metal sites, unsaturated sites, functional connectivity, and easy calcination to remove the scaffold. However, developing facile materials with high sensitivity and selectivity in harsh environments for accurate DEA detection at a low detection limit (LOD) at room temperature (RT) is challenging. In this study, p-type semiconducting porous CuOx sensing materials were synthesized using a simple solvothermal process and annealed in an argon atmosphere at three different temperatures (x = 400, 600, and 800 °C). Significant variations in particle size, specific area, crystallite size, and shape were noticed when the annealing temperature was elevated. Cu-MIL-53 annealed at 400 °C (CuO-400) has a typical nanoellipsoid (NEs) shape with a length of 61.5 nm and a diameter of 33.2 nm. Surprisingly, CuO-400 NEs showed an excellent response to DEA with an ultra-LOD (Rg/Ra = 7.3 @ 100 ppb, 55% relative humidity), excellent selectivity and sensitivity (Rg/Ra = 236 @ 15 ppm), exceptional long-term stability and repeatability, and a fast response/recovery period at RT, outperforming most previously reported materials. CuO-400 NEs have outstanding gas-sensing characteristics due to their high porosity, 1D nanostructure, unsaturated Cu sites (Cu+ and Cu2+), large specific surface area, and numerous oxygen vacancies. This study presents a generic approach to produce future CuO derived from Cu-MOFs-sensitive materials, revealing new insights into the design of effective sensors for environmental monitoring at RT.

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Purpose: To study whether age, gender, body mass index(BMI) and disease duration influence the clinical outcomes in kellgren-Lawrence(K-L) grade II,III knee osteoarthritis(KOA) patients treated with serial injections of platelet rich plasma(PRP). Patients and methods: 65 patients were given three monthly intra-articular injections of PRP in this prospective interventional study. The patients were divided into subgroups depending on the factor studied: by age(in years) into young <45(n = 7), middle age 45-60(n = 35), and elderly >60(n = 23): by BMI(in kg/m2) into; normal <25(n = 25), overweight 25-30(n = 27) and obese >30(n = 13) and disease duration; less(n = 32) or more than 1 year(n = 33) symptom duration. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used as outcome measures and assessed before each injection and then at 6 and 9 months post injection. Groups were homogenous with respect to baseline characteristics. Results: Mean VAS and WOMAC scores showed a statistically significant improvement (P < 0.0001) across all groups and subgroups (age,gender,BMI,disease duration) at follow up. On intra-subgroup comparison, we found no significant differences(P > 0.05) among age, BMI or gender subgroups, however the scores were significantly better in patients with disease duration of less than 1 year than those with more than 1 year duration at both 6 and 9 months[P < 0.001(RC = 9.630,95% CI = 4.037-15.222,P = 0.001)]. Conclusion: PRP injections if given serially can improve the short term subjective scores of VAS and WOMAC scores in patients with K-L grade II and III KOA irrespective of age, gender, BMI or disease duration, however, clinical benefits can be maximized if given early in the disease course.

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Underwater wireless sensor networks (UWSNs) have gained prominence in wireless sensor technology, featuring resource-limited sensor nodes deployed in challenging underwater environments. To address challenges like power consumption, network lifetime, node deployment, topology, and propagation delays, cooperative transmission protocols like co-operative (Co-UWSN) and co-operative energy-efficient routing (CEER) have been proposed. These protocols utilize broadcast capabilities and neighbor head node (NHN) selection for cooperative routing. This research introduces NBEER, a novel neighbor-based energy-efficient routing protocol tailored for UWSNs. NBEER aims to surpass the limitations of Co-UWSN and CEER by optimizing NHNS and cooperative mechanisms to achieve load balancing and enhance network performance. Through comprehensive MATLAB simulations, we evaluated NBEER against Co-UWSN and CEER, demonstrating its superior performance across various metrics. NBEER significantly maximizes end-to-end delay, reduces energy consumption, improves packet delivery ratio, extends network lifetime, and enhances total received packets analysis compared to the existing protocols.

Assuntos

Benchmarking, Reprodução, Fenômenos Físicos, Tecnologia sem Fio

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Purpose: To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods: 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid (methylprednisolone acetate [n = 31]). Clinical assessment was done with Visual analogue scale (VAS), modified Oswestry low back pain disability index (MODI), and straight leg raise test (SLRT). Baseline assessment of outcomes was done followed by post-intervention evaluation at 1, 3, and 6 months. Both groups had similar baseline characteristics. Results: There was a significant statistical improvement of VAS and MODI in both groups at follow-up (P < 0.05). In PRP group, minimal clinically important change (> 2 cm difference of mean for VAS and > 10-point change in MODI) for both outcome scores was achieved at all follow-up intervals (1, 3, 6 months), while as in steroid group, it was seen only at 1 and 3 months for both VAS and MODI. On intergroup comparison, better results were seen in steroid group at 1 month (P < 0.001 for both VAS and MODI), and in PRP group at 6 months (P < 0.001 for both VAS and MODI) with non-significant difference at 3 months (P = 0.605 for MODI and P = 0.612 for VAS). More than 90% tested SLRT negative in PRP group and 62% in steroid group at 6 months. No serious complications were seen. Conclusion: Transforaminal injections of PRP and steroid improve short-term (up to 3 months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6 months were provided by PRP only.

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Objective: To evaluate and compare clinical efficacy and effect on specific serum biomarker with serial injections of growth factor concentrate (GFC) for knee osteoarthritis (KOA) in a randomized triple blinded placebo controlled interventional study. Methods: Final assessment was done on 58 patients. Patients with Kellgren-Lawrence grade II, III knee osteoarthritis were administered monthly intraarticular injections(3 injections) of GFC(n = 31) or saline(n = 27) and evaluated clinically with visual analogue scale(VAS) and Western Ontario and McMaster Universities Arthritis Index(WOMAC) at 3,6 and 12 months post therapy. Biochemical analysis was done with serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), estimated at baseline and at final follow up. Results: Both the groups exhibited statistically significant improvements (P < 0.05) in VAS at 3,6 and 12 months. WOMAC improvement reached statistical significance for GFC group at every evaluation (P < 0.001) but only at 12 months in NS group (P = 0.029). The improvements were clinically meaningful only in GFC group throughout follow up (Minimal clinically important differences >12% of baseline in WOMAC and >2 cm difference in mean for VAS). Intergroup comparison revealed GFC to be much better for both scores at every evaluation (95% CI of 0.2-1.5,[P = 0.008], 1.4-2.9,[P < 0.0001], and 2.7-4.2,[P < 0.0001] for VAS, 7.3-16.0 [P < 0.001], 11.6-21.9 [P < 0.001] and 18.1-31.1[P < 0.001] for WOMAC). Statistically significant decrease in serum Coll2-1 levels were observed for GFC group only. No serious complications were seen. Conclusion: Serial(three) monthly GFC injections result in clinically meaningful improvement of subjective pain and function outcome scores, sustaining up to 12 months in KOA grade II and III. GFC also lead to significant reduction in serum levels of cartilage degradation biomarker coll2-1.

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FeOOH nanorods, as one-dimensional nanomaterials, have been widely used in many fields due to their stable properties, low cost, and easy synthesis, but their application in the field of chemiluminescence (CL) is rarely reported. In this work, FeOOH nanorods were synthesized by a simple and environmentally friendly one-pot hydrothermal method and used for the first time as a catalyst for generating strong CL with luminol without additional oxidant. Remarkably, luminol-FeOOH exhibits about 250 times stronger CL than the luminol-H2O2 system. Its CL intensity was significantly quenched by uric acid. We established a simple, rapid, sensitive, and selective CL method for the detection of uric acid with a linear range of 20-1000 nM and a detection limit of 6.3 nM (S/N = 3). In addition, we successfully applied this method to the detection of uric acid in human serum, and the standard recoveries were 95.6-106.4%.

Assuntos

Luminol, Nanotubos, Humanos, Oxirredutases, Ácido Úrico, Peróxido de Hidrogênio, Luminescência, Medições Luminescentes/métodos, Limite de Detecção

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Metal-organic frameworks (MOFs) are ideal sensing materials due to their distinctive morphologies, high surface area, and simple calcination to remove sacrificial MOF scaffolds. Oxygen vacancies (Ovs) can be efficiently generated by the thermal annealing of metal oxides in an inert atmosphere. Herein, MIL-53-based Fe and Fe/Ni-MOFs nanorices (NRs) were first prepared by using a solvothermal method, and then one-dimensional (1D) Fe2O3 and Ni0.4Fe2.6O4 NRs were derived from the MOFs after calcination at 350 °C in an air and argon (Ar) atmosphere, respectively. It was found that Ar-annealed Ni0.4Fe2.6O4 NRs have higher Ovs concentrations (82.11%) and smaller NRs (24.3 nm) than air-annealed NRs (65.68% & 31.5 nm). Beneficially, among the synthesized NRs, the Ar-Ni0.4Fe2.6O4 NRs show a higher sensitivity to diethylamine (DEA) (Ra/Rg = 23 @ 5 ppm, 175 °C), low detection limit (Ra/Rg = 1.2 @ 200 ppb), wide dynamic response (Ra/Rg = 93.5@ 30 ppm), high stability (30 days), and faster response/recovery time (4 s/38 s). Moreover, the 1D nanostructure containing heterostructures offers excellent sensing selectivity and a wide detection range from 200 ppb to 30 ppm in the presence of DEA. The outstanding gas sensing behavior can be attributable to synergistic impact, structural advantages, high concentration of Ovs, and the heterojunction interface, which can have profound effects on gas sensor performance. This study provides a unique technique for constructing high-performance gas sensors for ppb-level DEA detection and the formation of Ovs in metal oxides without the need for any additives.

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Since the first human case in 2013, H7N9 avian influenza viruses (AIVs) have caused more than 1500 human infections with a mortality rate of approximately 40%. Despite large-scale poultry vaccination regimes across China, the H7N9 AIVs continue to persist and evolve rapidly in poultry. Recently, several strains of H7N9 AIVs have been isolated and shown the ability to escape vaccine-induced immunity. To assess the zoonotic risk of the recent H7N9 AIV isolates, we rescued viruses with hemagglutinin (HA) and neuraminidase (NA) from these H7N9 AIVs and six internal segments from PR8 virus and characterized their receptor binding, pH of fusion, thermal stability, plaque morphology and in ovo virus replication. We also assessed the cross-reactivity of the viruses with human monoclonal antibodies (mAbs) against H7N9 HA and ferret antisera against H7N9 AIV candidate vaccines. The H7N9 AIVs from the early epidemic waves had dual sialic acid receptor binding characteristics, whereas the more recent H7N9 AIVs completely lost or retained only weak human sialic acid receptor binding. Compared with the H7N9 AIVs from the first epidemic wave, the 2020/21 viruses formed larger plaques in Madin-Darby canine kidney (MDCK) cells and replicated to higher titres in ovo, demonstrating increased acid stability but reduced thermal stability. Further analysis showed that these recent H7N9 AIVs had poor cross-reactivity with the human mAbs and ferret antisera, highlighting the need to update the vaccine candidates. To conclude, the newly emerged H7N9 AIVs showed characteristics of typical AIVs, posing reduced zoonotic risk but a heightened threat for poultry.

Assuntos

Subtipo H7N9 do Vírus da Influenza A, Influenza Aviária, Influenza Humana, Animais, Cães, Humanos, Furões, Hemaglutininas, Aves Domésticas, Medição de Risco, Soros Imunes, Glicoproteínas de Hemaglutininação de Vírus da Influenza

RESUMO

As an effective approach for materials synthesis, bipolar electrochemistry has been earning a renewed interest nowadays thanks to its unique features compared to conventional electrochemistry. Indeed, the wireless mode of electrode reactions and the generation of a gradient potential distribution above the bipolar electrode are among the most appealing qualities of bipolar electrochemistry. In particular, the gradient potential distribution is a highly attractive characteristic for the fabrication of surfaces with gradients in their chemical properties or molecular functionalities. Herein, we report the high-throughput electrosynthesis of gradient polypyrrole films by means of a new electrochemical cell design named the single-electrode electrochemical system (SEES). SEESs are made by attaching an inert plastic board with holes onto an indium tin oxide electrode, constructing multiple microelectrochemical cells on the same electrode. This type of arrangement enables parallel electrochemical reactions to be carried out simultaneously and controlled in a contactless manner by a single electrode. Several experimental conditions for polypyrrole film growth were extensively investigated. Furthermore, the gradient property of the polymer films was evaluated by thickness determination, surface morphology analysis, and contact angle measurements. The use of SEES has been demonstrated as a convenient and cost-effective strategy for high-throughput electrosynthesis and electroanalytical applications and has opened up a new door for gradient film preparation via a rapid condition screening process.

RESUMO

Based on the Pakistan Demographic and Health Survey (PDHS) 2017-18 data, the study intends to present the relative status of a particular fuel (type) in terms of its level of use in different regions of Pakistan. At the same time, the study investigates the determinants of the household type of fuel used for cooking in Pakistan. Socioeconomic characteristics of the households and household heads are taken as determinants of the main type of fuel (clean or dirty) used for cooking by the households. Binary logistic regression is applied as an estimation technique. Over the country, wood stands first as the most widely used type of fuel followed by natural gas followed by LPG. Animal dung and charcoal are respectively ranked as the fourth and fifth most commonly used types of fuel for cooking by households in Pakistan. In comparison amongst the four provinces of Pakistan, the use of wood as well as charcoal as the fuel type for cooking (in relative terms) is the most common in Balochistan province. Likewise, Punjab province is the most frequent user of liquefied petroleum gas (LPG), crop residues, and animal dung, while Sindh province is the most frequent user of natural gas. Households possessing agricultural land and livestock and with large household sizes had more probability to use dirty sources of fuel for cooking. Households with better wealth status and residing in urban areas were more likely to use clean sources of fuel for cooking. Household head's higher educational status and male-gender had more likelihood to use clean sources of fuel for cooking.

Assuntos

Poluição do Ar em Ambientes Fechados, Petróleo, Masculino, Animais, Poluição do Ar em Ambientes Fechados/análise, Gás Natural, Paquistão, Carvão Vegetal, Culinária/métodos

RESUMO

Semiconductor metal-oxide materials have a high surface-to-volume ratio and many active sites, making them potentially useful for gas sensing. Dopants introduced into the lattice can improve the catalytic activity of oxides and promote the formation of oxygen vacancies, hence improving the sensing performance of the materials. However, the simple preparation of materials with high sensitivity, selectivity, and a low detection limit remains a challenge. Herein, we report on the synthesis of Ni-P2O5/MoO3 and Pd-doped Ni-P2O5/MoO3 hollow polyhedral heterostructures (HPHSs) and their application in diethylamine (DEA) sensing for the first time. The Pd-doped Ni-P2O5/MoO3 HPHS was synthesized by doping different proportions of palladium-containing precursors using hydrothermal and solid-state reaction techniques. The concentration of oxygen vacancies in the HPHS composite increased by increasing Pd doping from 2 to 6 weight percent (wt %) but later reduced, according to X-ray photoelectron spectroscopy (XPS) measurements. Pd6%Ni-P2O5/MoO3 has the highest sensitivity to DEA (Ra/Rg = 42.5) and is 5.0 times and 42.5 times more sensitive than the pure Ni-P2O5/MoO3 HPHS (Ra/Rg = 8.5) and commercial ammonium phosphomolybdate (Ra/Rg = 1) at 175 °C toward 10 ppm DEA. Moreover, the DEA sensor exhibits a low detection limit (Ra/Rg = 3.5@1 ppm) with a wide dynamic response (Ra/Rg = 145.5@50 ppm). The remarkable improvement in DEA sensitivity is attributed to the hollow polyhedral structure, heterostructures, and oxygen vacancies formed by Pd doping. This study confirms that developing Pd-doped Ni-P2O5/MoO3 HPHSs provides an innovative approach for DEA sensors.

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Purpose: The purpose of this study was to evaluate whether serial intra-articular (IA) Platelet-Rich Plasma (PRP) injections improve pain and function in patients of Kellgren-Lawrence (K-L) Grade IV primary knee osteoarthritis (KOA), not willing for arthroplasty or having relative contraindications to surgery. Methods: 90 patients (84 available at final follow-up) of Grade IV KOA were given 3 PRP or Normal Saline injections at 1-month interval. Pain and functional assessment was done with Visual analog scale (VAS) and Western Ontario and McMaster universities osteoarthritis index (WOMAC) respectively, at baseline and then at three and six months of follow-up. Both groups were homogenous with similar baseline characteristics. Results: Both groups showed statistically significant improvements in the outcome scores but only PRP showed minimal clinically important difference (25% in WOMAC and > 2 cm difference of mean in VAS at follow-up). For inter-group comparison, PRP showed better results as there was statistically significant difference in WOMAC at 3 months (Difference = - 9.220, 95% CI = - 13.1945 to - 5.2455, P < 0.0001) and at 6 months (Difference = - 10.360, 95% CI = - 14.5358 to - 6.1842, P < 0.0001). Similar results were seen for VAS also (Difference = - 0.580, 95% CI = - 1.1412 to - 0.0188, P = 0.04 at 3 months, Difference = - 0.870, 95% CI - 1.3993 to - 0.3407, P = 0.001 at 6 months). Outcome scores significantly correlated with age and sex but not with body mass index (BMI). Conclusion: Serial Intra-articular Injections of autologous PRP mildly improve short-term subjective pain and knee function scores in patients of Grade IV KOA without any major complications.

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Objective: The aim of this study was to evaluate the efficacy of serum cartilage oligomeric matrix protein (sCOMP) and  serum C-terminal cross-linked telopeptide of type I collagen (sCTX-I) in identifying disease severity in knee osteoarthritis (KOA) cases. Methods: A total of 150 individuals (100 cases and 50 controls) were recruited. They were assessed clinically and radiologically with WOMAC score and knee radiographs respectively, while biochemical assessment was done by serum COMP and serum CTX-I level. Results: There were significant differences in serum levels between healthy individuals and KOA patients of both, sCOMP (01.16 ± 0.39 vs 17.38 ± 4.99 U/L; p = 0.01) and sCTX-I (0.35 ± 0.14 vs 4.59 ± 1.69; p = 0.02). There was a statistically significant difference between serum levels of CTX-I between K-L grade I and grade II (4.59 ± 1.69 vs 4.60 ± 1.17 ng/mL; p = 0.03) but no significant difference was seen in the sCOMP levels between K-L grade I and grade II (14.60 ± 6.47 vs 17.47 ± 4.99 U/L; p = 0.14). Conclusion: Our findings reveal that both sCOMP and sCTX-I are very effective in distinguishing between healthy adults and those affected by KOA. Only CTX-I was also able to distinguish between K-L grades I and II, while sCOMP failed. Further, use of these two biomarkers to differentiate between K-L grade II, III and IV is limited and lacks sufficient discriminating power, hence not recommended.

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Uniquely, thiourea dioxide not only can reduce carbonyl compounds but also generate an oxidant to trigger luminol chemiluminescence. Herein, derivatization-free carbonyl compound detection using bifunctional chemiluminescence coreactant thiourea dioxide has been developed for the first time with the second most crucial flavor benzaldehyde as a representative.

Assuntos

Luminescência, Medições Luminescentes, Luminol, Tioureia/análogos & derivados

RESUMO

For almost one and a half year the world is facing the pandemic called COVID-19, which is an acute respiratory distress syndrome caused by coronavirus 2 (SARS-CoV2). This disease has already engulfed many lives and has not been tamed so far. Physicians all over the world still, trying to get a hold of this global health issue, are faced with another life-threatening challenge associated with COVID-19, called black fungus-Mucormycosis. Within a span of few weeks, we have encountered three cases of black fungus in our institute which has stirred a serious concern among physicians in Pakistan.

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COVID-19, Fungos, Humanos, Paquistão/epidemiologia, RNA Viral, SARS-CoV-2, Centros de Atenção Terciária

RESUMO

Car crashes are among the top ten leading causes of death; they could mainly be attributed to distracted drivers. An advanced driver-assistance technique (ADAT) is a procedure that can notify the driver about a dangerous scenario, reduce traffic crashes, and improve road safety. The main contribution of this work involved utilizing the driver's attention to build an efficient ADAT. To obtain this "attention value", the gaze tracking method is proposed. The gaze direction of the driver is critical toward understanding/discerning fatal distractions, pertaining to when it is obligatory to notify the driver about the risks on the road. A real-time gaze tracking system is proposed in this paper for the development of an ADAT that obtains and communicates the gaze information of the driver. The developed ADAT system detects various head poses of the driver and estimates eye gaze directions, which play important roles in assisting the driver and avoiding any unwanted circumstances. The first (and more significant) task in this research work involved the development of a benchmark image dataset consisting of head poses and horizontal and vertical direction gazes of the driver's eyes. To detect the driver's face accurately and efficiently, the You Only Look Once (YOLO-V4) face detector was used by modifying it with the Inception-v3 CNN model for robust feature learning and improved face detection. Finally, transfer learning in the InceptionResNet-v2 CNN model was performed, where the CNN was used as a classification model for head pose detection and eye gaze angle estimation; a regression layer to the InceptionResNet-v2 CNN was added instead of SoftMax and the classification output layer. The proposed model detects and estimates head pose directions and eye directions with higher accuracy. The average accuracy achieved by the head pose detection system was 91%; the model achieved a RMSE of 2.68 for vertical and 3.61 for horizontal eye gaze estimations.

Assuntos

Aprendizado Profundo, Movimentos Oculares, Olho, Fixação Ocular, Movimentos da Cabeça

RESUMO

Human Activity Recognition is an active research area with several Convolutional Neural Network (CNN) based features extraction and classification methods employed for surveillance and other applications. However, accurate identification of HAR from a sequence of frames is a challenging task due to cluttered background, different viewpoints, low resolution, and partial occlusion. Current CNN-based techniques use large-scale computational classifiers along with convolutional operators having local receptive fields, limiting their performance to capture long-range temporal information. Therefore, in this work, we introduce a convolution-free approach for accurate HAR, which overcomes the above-mentioned problems and accurately encodes relative spatial information. In the proposed framework, the frame-level features are extracted via pretrained Vision Transformer; next, these features are passed to multilayer long short-term memory to capture the long-range dependencies of the actions in the surveillance videos. To validate the performance of the proposed framework, we carried out extensive experiments on UCF50 and HMDB51 benchmark HAR datasets and improved accuracy by 0.944% and 1.414%, respectively, when compared to state-of-the-art deep models.

Assuntos

Atividades Humanas, Redes Neurais de Computação, Fontes de Energia Elétrica, Humanos, Memória de Longo Prazo, Reconhecimento Psicológico

RESUMO

PURPOSE: Sheehan's Syndrome (SS) is one of the most important causes of hypopituitarism in developing countries with patients having varying degrees and severity of anterior pituitary hormone deficiency including growth hormone deficiency (GHD). SS is characterized by increased clustering of metabolic and proinflammatory risk factors predisposing them to increased cardiovascular morbidity and mortality. Coronary calcium deposits (CCD), a marker for significant coronary atherosclerosis, is used for evaluation in asymptomatic individuals of global cardiac risk to develop events related to coronary heart disease (CHD). This study therefore aimed to evaluate the prevalence of coronary artery disease in patients with SS appropriately replaced for pituitary hormone deficiencies but untreated for GHD. METHODS: Thirty patients previously diagnosed with SS and stable on a conventional replacement treatment for at least 6 months before the study and thirty age and Body Mass Index (BMI) matched controls were enrolled in this observational study. The subjects underwent detailed clinical, biochemical, and hormone analysis. Coronary multidetector computed tomography was performed in 19 SS patients and 19 healthy participants by a 16-row multislice scanner. Non contrast acquisitions were performed to detect coronary calcifications. Calcium was quantified by the Agatston score (AS) in all subjects. AS > 10 indicates increased CHD risk. RESULTS: The mean (± SD) age was 38.30 ± 10.73 years and the diagnostic delay was 11.35 ± 4.74 years. Patients with SS had significantly higher mean triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The prevalence of CCD was significantly higher in patients of SS compared to controls (42.1% vs. 5.3%; P = 0.023). The presence of CCD and AS > 10 were detected in 42.1% and 31.6% of patients respectively. The presence of significant calcification (Agatston score > 10) was documented in 75% of patients (6/8) of the SS patients with CCD compared to none in the control group (P = 0.019). (Left anteriordescending, 1; left circumflex, 2; right coronary artery, 2 and posterior descending, 1) CONCLUSION: Since coronary artery calcium is an independent predictor of CHD events, the presence of significant prevalence of CCD in patients with SS compared to healthy matched controls, undermines the importance of early risk stratification of SS individuals with plethora of conventional cardiovascular risk factors that are at relatively high risk to avoid the adverse vascular consequences.

Assuntos

Hormônio do Crescimento Humano, Hipopituitarismo, Adulto, Cálcio, Diagnóstico Tardio, Humanos, Hipopituitarismo/epidemiologia, Pessoa de Meia-Idade, Prevalência, Fatores de Risco

RESUMO

BACKGROUND: Genu valgum is one of the commonest deformities seen by the orthopaedicians. The most common cause is idiopathic but genu valgum secondary to nutritional deficiency is also fairly common in developing and third world countries. Supracondylar osteotomy and internal fixation with plate and screws, is the treatment of choice in older children and young adults, which is costly, requires a wide exposure, a second surgery for implant removal and risk of infection is more. This study was undertaken to measure the outcome of simple oblique percutaneous wedge-less metaphyseal supracondylar osteotomy of the distal femur and casting in older children and adolescents with Genu Valgum in a small centre catering mostly to patients from middle and low income households. PATIENTS AND METHODS: Patients aged between 12 and 22 years with genu valgum deformity with a tibiofemoral angle ≥15°, and an intermalleolar distance of more than 7 cm in unilateral and more than 10 cm in bilateral cases, who are not amenable to be treated with guided growth techniques, were included. Patients having knee instability, restriction of knee range of motion, genu recurvatum, tibial deformity component, open physis, were excluded from the study. The correction was undertaken by a simple supracondylar wedge-less metaphyseal short oblique osteotomy of the distal femur followed by immobilization with a long leg plaster of Paris cast. Functional outcome was assessed using Böstman et al. score. RESULTS: 46 limbs in 29 patients with a mean age of 14.5 years were operated. The mean follow-up of patients was 6 months. The preoperative radiological tibiofemoral angle (TFA) had a mean value of 19.89° which improved to a mean of 5.31° postoperatively. Intermalleolar distance (IMD) improved from a mean of 13.81 cm to 3.15 cm post-correction. Mean Lateral distal femoral angle (LDFA) improved from 77.11° to 87.20°. Knee score was excellent in all patients at 3 months and 6 months post intervention. There were no serious complications except superficial plaster sores in 4 patients, which healed uneventfully and temporary restriction of knee range of motion in 5 patients. All patients achieved a full range of knee motion after physical therapy. CONCLUSION: Supracondylar wedge-less short oblique metaphyseal distal femoral osteotomy and immobilization with plaster of Paris cast is a simple, cheap, safe & viable option for the correction of genu valgum deformity originating from distal femur, with minimal complications in older children and adolescents with limited growth potential, especially in low income countries and small centres.