Safety and efficacy of Empagliflozin in Pakistani Muslim patients with type 2 diabetes (SAFE-PAK); a randomized clinical trial.

BACKGROUND: Sodium-Glucose-Co-Transporter 2 (SGLT2) inhibitor (Empagliflozin) is an effective drug in controlling blood glucose through predominantly glycosuria. Glycosuria increases the risk of genitourinary infections in diabetes. This study was aimed to establish the safety and efficacy of Empagliflozin (Group-A) versus standard care (Group-B) in Pakistani Muslim individuals with type 2 diabetes. METHODS: A multicenter, randomized clinical trial was conducted in five cities across Pakistan from July 2019 to August 2020. Patients of both genders aged 18-75 years, body mass index (BMI) ≤ 45 kg/m2, glycosylated hemoglobin (HbA1c) 7-10% (53 mmol/mol to 86 mmol/mol) and treatment-naive to Empagliflozin were included. Treatment was given for 24 weeks, and allocation was done through randomization. RESULTS: Out of 745 screened patients, 333 met the eligibility criteria, and a total of 244 (73.3%) patients were enrolled. More hypoglycemic events were reported in the standard care group, whereas positive urine culture, fungal infection, dehydration, and hypotension occurrence were comparable between the two groups. The 6 months mean HbA1c reduction was significant in both groups; (Group-A: 0.91 ± 0.15; p < 0.001 vs. Group-B2: 0.79 ± 0.14; p < 0.001). Efficacy comparison at 6 months revealed a significant reduction in weight and systolic blood pressure (SBP) in Group A only (Group-A: 1.4 ± 0.4 kg; p < 0.002 vs. Group-B: 0.01 ± 0.5 kg; p < 1.00), (Group-A: 5.1 ± 1.7 mmHg; p < 0.012 vs. Group-B: 2.3 ± 1.7 mmHg; p < 0.526). CONCLUSIONS: Empagliflozin was a safe drug compared to standard care in Pakistani Muslim patients with diabetes. It was as effective as standard care in the clinical setting but achieved glycemic control by reducing weight and SBP in type 2 diabetes patients. TRIAL REGISTRATION: This study was registered in the NIH US National Library of Medicine clinical trials registry at Clinicaltrials.gov with the registration number: NCT04665284 on 11/12/2020.

Asymptomatic urinary tract infections and associated risk factors in Pakistani Muslim type 2 diabetic patients.

BACKGROUND: One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. METHODS: This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients. RESULTS: A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value< 0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40-59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin. CONCLUSION: Diabetic Pakistani muslim female patients are identified to be at high risk of suffering from asymptomatic UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area.

Review on Comparison of Different Energy Storage Technologies Used in Micro-Energy Harvesting, WSNs, Low-Cost Microelectronic Devices: Challenges and Recommendations.

This paper reviews energy storage systems, in general, and for specific applications in low-cost micro-energy harvesting (MEH) systems, low-cost microelectronic devices, and wireless sensor networks (WSNs). With the development of electronic gadgets, low-cost microelectronic devices and WSNs, the need for an efficient, light and reliable energy storage device is increased. The current energy storage systems (ESS) have the disadvantages of self-discharging, energy density, life cycles, and cost. The ambient energy resources are the best option as an energy source, but the main challenge in harvesting energy from ambient sources is the instability of the source of energy. Due to the explosion of lithium batteries in many cases, and the pros associated with them, the design of an efficient device, which is more reliable and efficient than conventional batteries, is important. This review paper focused on the issues of the reliability and performance of electrical ESS, and, especially, discussed the technical challenges and suggested solutions for ESS (batteries, supercapacitors, and for a hybrid combination of supercapacitors and batteries) in detail. Nowadays, the main market of batteries is WSNs, but in the last decade, the world's attention has turned toward supercapacitors as a good alternative of batteries. The main advantages of supercapacitors are their light weight, volume, greater life cycle, turbo charging/discharging, high energy density and power density, low cost, easy maintenance, and no pollution. This study reviews supercapacitors as a better alternative of batteries in low-cost electronic devices, WSNs, and MEH systems.

Impact of a global pandemic on surgical education and training- review, response, and reflection.

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions' response to the situation in order to continue surgical training, and lessons learnt from the pandemic.

Reorienting goals in endodontic therapy: Pulp revitalisation, on the brink of a paradigm shift.

OBJECTIVE: To assess literature related to the various aspects of dental pulp tissue engineering, its myriad protocols, inclusive of adjuvant surgeries, and to summarise the testing methodologies of pulp vitality. METHODS: The multidisciplinary systematic review was conducted at the Army Medical College, Rawalpindi, the National University of Medical Sciences, Rawalpindi, and HITEC Dental College, Taxilla, Pakistan, and comprised literature search on PubMed, Scopus, MEDLINE, Cochrane and Science Direct databases related to articles about 'revitalisation', 'revascularisation', 'dental pulp' and 'regeneration' published from January 2017 to January 2020. RESULTS: Of the 5,986 articles found through search, 14(0.23%) studies were selected; 8(57.1%) clinical trials, 1(7.1%) case series, and 5(35.7%) case reports with platelet concentrates. All the studies (100%) had observed standard clinical treatment procedures for canal disinfection. Current strategies of pulpal regeneration reported commendable success. Histological analysis of clinical trials is essential to ensure confirmatory evidence of quality of revitalisation. CONCLUSIONS: The assessment of the impact of oral factors and a long-term follow up are required to produce a definitive understanding of the phenomenon.

Comparison of frequency of pain in root canal treatment using sodium hypochlorite and chlorhexidine as root canal irrigants.

OBJECTIVE: To compare the frequency of pain in root canal treatment using sodium hypochlorite and chlorhexidine as root canal irrigants. METHODS: The cross-sectional study was carried out from January to June 2016 at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, and comprised patients aged 18-40 years with irreversible pulpitis involving a posterior tooth. The patients were divided into two equal groups, with Group-I receiving 2% chlorhexidine, and Group-II receiving 5.25% sodium hypochlorite. Following the use of the irrigants, the selected teeth were evaluated for pain at 72 hours using Visual Analogue Scale. RESULTS: There were 60 patients divided into groups of 30(50%) each. The overall mean age was 27.97±5.9 years. There were 32 (53.3%) females and 28 (46.6%) males. The mean post-operative pain score was 1.70±1.9 in Group-I and 1.90 ± 2.3 in Group-II (p=0.5). In Group-I, 25(83.3%) patients had no pain while in Group-II, 20(66.7%) had no pain (p=0.1). CONCLUSIONS: There was no difference in post-operative pain at 72 hours between 2% chlorhexidine and 5.25% sodium hypochlorite when used as irrigants.

Comparison of frequency of post-obturation pain of single versus multiple visit root canal treatment of necrotic teeth with infected root canals. A Randomized Controlled Trial.

OBJECTIVE: To determine the pain of single versus multiple visit endodontic treatment after obturation in teeth with necrotic pulps and infected canals. METHODS: The randomized controlled study was conducted from January to June 2016 at Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. Dental patients aged 18-60 years of either gender were selected who were subjected to computer-generated randomisation. Both maxillary and mandibular single rooted teeth till second premolar were included. Single visit endodontic treatment to Group-I subjects was carried out by gaining access to canals, cleaning, shaping and obturation at same visit whereas in Group-II patients, who underwent multiple visits, cleaning and shaping was followed by placement of intra-canal medicament, while obturation was done 5 days later. Patients were recalled within 48 hours after obturation to record the pain score using visual analogue scale.. RESULTS: Of the 60 patients, 30(50%) were in each of the two groups. There was no significant difference in post-operative pain in the two groups (p=0.8). The frequency of post-operative pain was not significant either (p>0.05). The post-operative mean pain score was 2.23±1.736 in Group-I and 2.38±1.94 in Group-II (p=0.8).. CONCLUSIONS: Treatment carried out in single visit or multiple visits showed no difference in pain frequency.

The structural, morphological and thermal properties of grafted pH-sensitive interpenetrating highly porous polymeric composites of sodium alginate/acrylic acid copolymers for controlled delivery of diclofenac potassium.

In present investigation new formulations of Sodium Alginate/Acrylic acid hydrogels with high porous structure were synthesized by free radical polymerization technique for the controlled drug delivery of analgesic agent to colon. Many structural parameters like molecular weight between crosslinks (Mc ), crosslink density (Mr ), volume interaction parameter (v2,s ), Flory Huggins water interaction parameter and diffusion coefficient (Q) were calculated. Water uptake studies was conducted in different USP phosphate buffer solutions. All samples showed higher swelling ratio with increasing pH values because of ionization of carboxylic groups at higher pH values. Porosity and gel fraction of all the samples were calculated. New selected samples were loaded with the model drug (diclofenac potassium).The amount of drug loaded and released was determined and it was found that all the samples showed higher release of drug at higher pH values. Release of diclofenac potassium was found to be dependent on the ratio of sodium alginate/acrylic acid, EGDMA and pH of the medium. Experimental data was fitted to various model equations and corresponding parameters were calculated to study the release mechanism. The Structural, Morphological and Thermal Properties of interpenetrating hydrogels were studied by FTIR, XRD, DSC, and SEM.

Adrenal Insufficiency In Pakistani Hiv Infected Patients.

BACKGROUND: Adrenal insufficiency (AI) is the most common endocrine complication among patients with AIDS/HIV infection and there are number of causes of AI in HIV patients. Human immunodeficiency virus directly as well as indirectly destroys adrenal glands. The estimates of its prevalence and severity vary. AI is the most life threatening but readily correctable endocrine complication that occurs in persons with HIV infection. This study was carried out to determine the frequency of Adrenal Insufficiency in HIV patients and their clinical features as proper diagnosis and timely treatment have been shown to improve quality of life and long-term mortality in AIDS patients. METHODS: It was a cross sectional survey conducted at HIV clinic and Jinnah Allama Iqbal Institute of Diabetes and Endocrinology, Jinnah Hospital Lahore. Sixty-four HIV positive patients, both male and female, aged above 15 years were included in the study. HIV patients who had recently taken steroids, ketoconazole or rifampicin, determined on history, were excluded from the study. The data was collected on a structured proforma and analysis was performed in SPSS-21.0. Frequency and percentages for adrenal insufficiency and its characteristics were calculated. Chi-square test was used with p<0.05 as statistically significant. RESULTS: In this study, 9 (14.06%) HIV patients were diagnosed with adrenal insufficiency, male to female ratio was 3.5:1 and AI was found statistically significantly associated with fatigue (p<0.008) and weight loss (p<0.001). CONCLUSIONS: Adrenal insufficiency was high among the patients with HIV, it was not gender specific but it was found to be associated with fatigue and weight loss.

Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting.

BACKGROUND: Among five main pillars of Islam Fasting is one of the key elements, all healthy adult Muslims have to observe fast from dawn till dusk during the holy month of Ramadan. According to a 2009 demographic study, Islam has 1.57 billion believers, making up 23% of the world population of 6.8 billion, and is growing by 3% per year. EPIDIAR (epidemiology of diabetes and Ramadan) study showed that 43% patients with type 1 and 79% patients with type2 diabetes observe fast during the month of Ramadan. Whereas those people who are suffering from diabetes and are fasting may be at risk of adverse outcomes and the risks may rise with longer fasting periods. Ideal management of diabetic patients who wish to fast during Ramadan needs to be done to avoid the complications. The purpose of this study was to observe the effect of fasting on glycaemic control in type 2 diabetic patients during the month of Ramadan. METHODS: This was an observational cross sectional study; it was conducted at outpatient department Jinnah institute of diabetes and endocrinology Jinnah hospital Lahore during the month of Ramadan. Patients were advised to monitor blood sugar levels for two days before and after three meals (lunch, breakfast and dinner) before Ramadan and then during Ramadan blood sugar levels were monitored for four days in first Ashra before and two hours after Sehari, for four days at noon during second Ashra and then for four days pre and two hours after Iftar in last Ashra of Ramadan. Patients were educated Pre-Ramadan about glucose monitoring and drug dosage adjustments were done along with dietary counselling. RESULTS: Blood glucose levels two days before and during Ramadan fell within range of mean glucose level of 150-187 mg/dl showing no extreme fluctuations in blood glucose levels only one patient reported symptomatic and biochemical hypoglycaemia severe enough to break the fast at noon. CONCLUSIONS: We concluded that in Ramadan fasting, type 2 diabetic patients with proper education, dietary counselling and drug dosage adjustments glycaemic control can remain in safe acceptable range preventing any life-threatening complication.

Causes of short stature in Pakistani children found at an Endocrine Center.

BACKGROUND AND OBJECTIVE: Short stature is defined as height below 3rd centile. Causes of short stature can range from familial, endocrine disorders, chronic diseases to chromosomal disorders. Most common cause in literature being idiopathic short stature. Early detection and management of remedial disorders like malnutrition and vitamin D deficiency, Endocrine disorders like growth hormone deficiency & hypothyroidism can lead to attainment of expected height. Pakistani data shows idiopathic short stature as the most common cause of short stature. Our study aimed at detecting causes of short stature in children/adolescents at an Endocrine referral center. METHODS: A retrospective study was conducted at WILCARE Center for Diabetes, Endocrinology & Metabolism, Lahore on 70 well-nourished children/adolescents. The patients had been evaluated clinically, biochemically and radiologically as needed. Biochemical testing included hormonal testing as well to detect endocrine causes. Data was entered and analyzed in SPSS 20.0. RESULTS: Leading cause of short stature in our population was Growth Hormone (GH) deficiency seen in 48 out of 70 (69%) patients. Second most common endocrine abnormality seen in these patients was Vitamin D deficiency [44 out of 70 patients (63%)]. Primary hypothyroidism; pan-hypopituitarism & adrenal insufficiency were other endocrine causes. The weight for age was below 3rd percentile in 57 (81%) patients, with no association with other major causes. CONCLUSION: Growth hormone and Vitamin D deficiency constitute one of the major causes of short stature among well-nourished children with short stature in Pakistan.

Development and content validation of a financial and functional outcomes tool for diabetes-related foot disease in patients undergoing major lower limb amputation: a prospective observational study from Pakistan.

OBJECTIVE: To develop and content validate a questionnaire to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease. DESIGN: Prospective observational study. SETTING: This study was conducted at a tertiary care centre in Pakistan. PARTICIPANTS: We conducted a thorough literature review and a group interview with 10 participants, resulting in domain identification and item generation. The group included seven patients with diabetes-related foot disease who underwent major lower limb amputation and three caregivers. Subsequently, a focused group discussion was held to assess overlap and duplication among the items, and two rounds of content validation were carried out by five content and five lay experts in both English and Urdu. Question items with a Content Validity Index (CVI) score of >0.79 were retained, items with a CVI score between 0.70 and 0.79 were revised and items with a CVI score of <0.70 were excluded. RESULTS: The initial literature review and group interview resulted in 61 items in the financial and functional domains. After the focused group discussion, the questionnaire was reduced to 37 items. Following two rounds of content validation, the English questionnaire achieved the Scale-Content Validity Index/Average (S-CVI/Ave) of 0.92 and 0.89 on relevance and clarity, respectively. Similarly, the Urdu questionnaire achieved the S-CVI-Ave of 0.92 and 0.95, respectively. CONCLUSION: A 37-item multidimensional questionnaire was developed and rigorously content-validated to assess the financial and functional impact of major lower limb amputation in patients with diabetes-related foot disease. The questionnaire used in this study has shown robust content validity specifically for our population.

Micro energy harvesting for IoT platform: Review analysis toward future research opportunities.

Micro-energy harvesting (MEH) is a technology of renewable power generation which is a key technology for hosting the future low-powered electronic devices for wireless sensor networks (WSNs) and, the Internet of Things (IoT). Recent technological advancements have given rise to several resources and technologies that are boosting particular facets of society. Many researchers are now interested in studying MEH systems for ultra-low power IoT sensors and WSNs. A comprehensive study of IoT will help to manage a single MEH as a power source for multiple WSNs. The popular database from Scopus was used in this study to perform a review analysis of the MEH system for ultra-low power IoT sensors. All relevant and important literature studies published in this field were statistically analysed using a review analysis method by VOSviewer software, and research gaps, challenges and recommendations of this field were investigated. The findings of the study indicate that there has been an increasing number of literature studies published on the subject of MEH systems for IoT platforms throughout time, particularly from 2013 to 2023. The results demonstrate that 67% of manuscripts highlight problem-solving, modelling and technical overview, simulation, experimental setup and prototype. In observation, 27% of papers are based on bibliometric analysis, systematic review, survey, review and based on case study, and 2% of conference manuscripts are based on modelling, simulation, and review analysis. The top-cited articles are published in 5 different countries and 9 publishers including IEEE 51%, Elsevier 16%, MDPI 10% and others. In addition, several MEH system-related problems and challenges are noted to identify current limitations and research gaps, including technical, modelling, economic, power quality, and environmental concerns. Also, the study offers guidelines and recommendations for the improvement of future MEH technology to increase its energy efficiency, topologies, design, operational performance, and capabilities. This study's detailed information, perceptive analysis, and critical argument are expected to improve MEH research's viable future.

Portal vein thrombosis in patients with hepatocellular carcinoma and early cirrhosis-prevalence and risk factors.

Introduction: Hepatocellular carcinoma (HCC) is frequently associated with portal vein thrombosis (PVT) with prevalence ranging from 25% to 50%. PVT is associated with poor prognosis, limiting the available therapeutic options for these patients. Our objective was to determine the prevalence and risk factors for PVT in patients with HCC. Method: A retrospective analysis was performed on the prospectively collected data from January 2018 to March 2020. All patients with HCC discussed in our weekly multidisciplinary liver clinic were reviewed. Multivariate analysis was done to identify the independent risk factors for PVT in HCC patients. A p-value of <0.05 was considered significant. Result: Of 316 patients, the prevalence of PVT was 31% (n = 98). Larger tumour size (p < 0.001), raised Alpha Fetoprotein (AFP) level (p = 0.036) and higher Child-Pugh class (p = 0.008) were significantly associated with PVT. In 216 patients with preserved liver function (Child-Pugh class A), PVT was seen in 53 (24.5%) patients. Large tumour size (p < 0.001) and higher AFP levels (p = 0.021) were independent risk factors. Conclusion: Overall prevalence of PVT in HCC was 31% whereas 24.5% in patients with early cirrhosis (Child-Pugh class A). We identified various risk factors associated with PVT in our local population, highlighting the importance of early and regular screening of cirrhotic patients including Child-Pugh class A.

Micro Energy Storage Systems in Energy Harvesting Applications: Analytical Evaluation towards Future Research Improvement.

During the last decade, countless advancements have been made in the field of micro-energy storage systems (MESS) and ambient energy harvesting (EH) shows great potential for research and future improvement. A detailed historical overview with analysis, in the research area of MESS as a form of ambient EH, is presented in this study. The top-cited articles in the field of MESS ambient EH were selected from the Scopus database, and based on articles published from 2010 to 2021, and the number of citations. The search for these top-cited articles was conducted in the third week of December 2021. Mostly the manuscripts were technical and contained an experimental setup with algorithm development (65%), whereas 27.23% of the articles were survey-based. One important observation was that the top 20 selected articles, which are the most-cited articles in the different journals, come from numerous countries of origin. This study revealed that the MESS integrated renewable energy sources (RESs) are an enhancement field of research for EH applications. On the basis of this survey, we hope to identify and solve research problems in the field of MESS and RESs integration, and provide suggestions for future developments for EH applications.

A Bibliometric Analysis of Low-Cost Piezoelectric Micro-Energy Harvesting Systems from Ambient Energy Sources: Current Trends, Issues and Suggestions.

The scientific interest in piezoelectric micro-energy harvesting (PMEH) has been fast-growing, demonstrating that the field has made a major improvement in the long-term evolution of alternative energy sources. Although various research works have been performed and published over the years, only a few attempts have been made to examine the research's influence in this field. Therefore, this paper presents a bibliometric study into low-cost PMEH from ambient energy sources within the years 2010-2021, outlining current research trends, analytical assessment, novel insights, impacts, challenges and recommendations. The major goal of this paper is to provide a bibliometric evaluation that is based on the top-cited 100 articles employing the Scopus databases, information and refined keyword searches. This study analyses various key aspects, including PMEH emerging applications, authors' contributions, collaboration, research classification, keywords analysis, country's networks and state-of-the-art research areas. Moreover, several issues and concerns regarding PMEH are identified to determine the existing constraints and research gaps, such as technical, modeling, economics, power quality and environment. The paper also provides guidelines and suggestions for the development and enhancement of future PMEH towards improving energy efficiency, topologies, design, operational performance and capabilities. The in-depth information, critical discussion and analysis of this bibliometric study are expected to contribute to the advancement of the sustainable pathway for PMEH research.

Regenerating the Pulp-Dentine Complex Using Autologous Platelet Concentrates: A Critical Appraisal of the Current Histological Evidence.

BACKGROUND: Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. METHODS: To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp-dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. RESULTS: Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction. Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. CONCLUSION: PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.

Peripheral Arterial Injuries in Children: An Audit at a University Hospital in Developing Country.

Objectives: To review the prevalence, pattern, management, outcome, and predictive factors for limb loss of pediatric peripheral arterial injuries (PAIs) at a university hospital in Pakistan. Methods: Medical records of children (age <18 years) managed for PAIs at the university hospital between Jan 2008 and Dec 2018 were reviewed for demographic data; mechanism, type, and severity of injury; management; and outcome. Results: During the study period, of the 1718 children managed for trauma, 75 (67 males and 8 females) had PAI secondary to glass cut (33.3%), gunshot (28.0%), and road traffic accidents (24.0%). Forty-nine patients (65.3%) presented to the emergency room within 6 h of injury. Brachial (28.0%), superficial femoral (20.0%), and radial (20.0%) arteries were the frequently injured vessels. At presentation, the mean revised trauma score and Mangled Extremity Severity Score (MESS) were 3.86±0.55 and 3.4±1.92, respectively. Sixty-eight patients (90.66%) underwent vascular procedures: interposition saphenous vein bypass graft or PTFE graft in 38.7% and primary repair in 29.3%. Limb salvage was achieved in 92.65% of the patients. Late presentation (>6 h) was a risk factor for limb loss (p=0.014). Conclusion: Of the 23 children who presented with trauma, 1 had major PAI. Early presentation (<6 h) and appropriate vascular interventions can salvage limbs in most of the patients.

Identifying the Symptom Severity in Obsessive-Compulsive Disorder for Classification and Prediction: An Artificial Neural Network Approach.

The present study is aimed at identifying the most prominent determinants of OCD along with their strength to classify the OCD patients from healthy controls. The data for this cross-sectional study were collected from 200 diagnosed OCD patients and 400 healthy controls. The respondents were selected through purposive sampling and interviewed by using the Y-BOCS scale with the addition of a factor, worth of an individual in his family. The validity and reliability of data were assessed through Cronbach's alpha and confirmatory factor analysis. Artificial Neural Network (ANN) modeling was adopted to determine threatening determinants along with their strength to predict OCD in an individual. The results of ANN modeling depicted 98% accurate classification of OCD patients from healthy controls. The most contributing factors in determining the OCD patients according to normalized importance were the contamination and cleaning (100%); symmetric and perfection (72.5%); worth of an individual in the family (71.1%); aggressive, religious, and sexual obsession (50.5%); high-risk assessment (46.0%); and somatic obsessions and checking (24.0%).