Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials.

PURPOSE: Propofol has become the sedative of choice for endoscopy and colonoscopy. However, it has shown associations with various adverse effects, specifically in the geriatric population. In contrast, remimazolam is a novel benzodiazepine, demonstrating a superior clinical safety profile. Hence, this systematic review and meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol in elderly patients (≥ 60 years) undergoing gastrointestinal endoscopic and colonoscopy procedures. METHODS: Electronic databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were explored from inception till January 7, 2024. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB-2) was utilized to evaluate the quality of each included study reported in this meta-analysis. RESULTS: Seven randomized control trials were included, resulting in the pooling of 1,466 patients (remimazolam: 731 patients; propofol: 735 patients). Propofol demonstrated a significantly lower time to loss of consciousness (P < 0.00001, 4 studies, 784 patients) and a greater sedation success after first dose (P = 0.05, 5 studies, 1,271 patients). Remimazolam reported a significantly lower risk of bradycardia (P = 0.02, 5 studies, 1,323 patients), hypoxemia (P < 0.00001, 6 studies, 1,389 patients), and pain on injection site (P < 0.00001, 5 studies, 1,184 patients). No statistically significant differences in sedation time, number of supplemental doses, procedural parameters, and other adverse outcomes were reported. CONCLUSION: As per the results of our analyses, propofol demonstrated comparatively superior efficacy, however, remimazolam demonstrated comparatively superior safety. The debatable evidence generated from this meta-analysis may not currently be powerful enough to advocate for the use of remimazolam in elderly patients undergoing gastrointestinal procedures; hence, further comprehensive studies are necessary in order to arrive at a robust conclusion.

A comparative analysis of postoperative visual outcomes following cataract surgery with different brands of Monofocal Intraocular Lenses.

Objective: To compare visual outcomes after cataract surgery using three intraocular lenses (IOL) of different prices but similar properties. Methods: A comparative study with retrospective data of patients operated for phacoemulsification with monofocal IOL implants was carried out at Al-Ibrahim Eye Hospital (AIEH) from April 2021 to Feb 2022. Patients with diabetes, any preoperative ocular morbidity and unclear diagnosis were excluded from the study. Pre and post-operative best corrected visual acuity (BCVA) on 1st day, 7th day and 4-6 weeks were analyzed. IOLs were categorized on the basis of price into economical, standard and premium lenses. To minimize surgical bias, data was further stratified on the basis of surgical expertise. Results: Data of 3237 patients was analyzed. Economical lens (A) was implanted in 2647, standard (B) in 254 and premium (C) in 336 patients. On average BCVA (6/6 to 6/12) was achieved in 88.2% of patients. No significant difference was found at third follow up among BCVA of three IOls operated by senior surgeon, χ2(2) = 3.216, p = 0.20, with median (IQR) is 0.2(0.2) logMAR for Group-A, 0.1(0.2) logMAR for Group-B and 0.2(0.1) logMAR for Group-C. When results of the rest of the surgeons was considered, significant difference was found among BCVA at 3rd follow-up, χ2(2) = 6.661, p = 0.036, with median (IQR) is 0.3(0.2) logMAR for Group-A, 0.2(0.1) logMAR for Group-B and 0.2(0.3) logMAR for Group-C. Conclusion: When surgical factors mainly, surgeon bias is removed, all three types of monofocal IOL had similar visual outcomes.

Ocular Complications Associated With Diabetes And The Risk Of Sustainable Blindness; A Real World Analysis.

OBJECTIVE: To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. METHODS: The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. RESULTS: Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision 28 threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). CONCLUSIONS: Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications.

AI-Driven Aeronautical Ad Hoc Networks for 6G Wireless: Challenges, Opportunities, and the Road Ahead.

Aeronautical ad hoc network (AANET) has been considered a promising candidate to complete the vision of "Internet in the sky" by supporting high-speed broadband connections on airplanes for 6G networks. However, the specific characteristics of AANET restrict the applicability of conventional topology and routing management algorithms. Here, these conventional methodologies reduce the packet delivery success of AANET with higher transfer delay. At that point, the artificial intelligence (AI)-driven solutions have been adapted to AANET to provide intelligent frameworks and architectures to cope with the high complexity. The AI-driven AANET can provide intelligent topology formation, sustainability, and routing management decisions in an automated fashion by considering its specific characteristics during the learning operations. More clearly, AI-driven AANETs support intelligent management architectures, overcoming conventional methodologies' drawbacks. Although AI-based management approaches are widely used in terrestrial networks, there is a lack of a comprehensive study that supports AI-driven solutions for AANETs. To this end, this article explores the possible utilization of primary AI methodologies on the road to AI-driven AANET. Specifically, the article addresses unsupervised, supervised, and reinforcement learning as primary AI methodologies to enable intelligent AANET topology formation, sustainability, and routing management. Here, we identify the challenges and opportunities of these primary AI methodologies during the execution of AANET management. Furthermore, we discuss the critical issue of security in AANET before providing open issues.

Effect of lip thickness and competency on soft-tissue changes.

INTRODUCTION: Improvement in facial esthetics is a major reason for seeking orthodontic treatment. Soft tissues responsible for esthetics show a variable response to the movement of underlying teeth during orthodontics. METHODS: The purpose of this cross-sectional study was to analyze the response of soft tissues and compare it among groups presenting with different lip thickness and competence. It was carried out on 37 patients with Class I and Class II Division 1 malocclusion who had undergone extractions of maxillary first premolars and had completed their orthodontic treatment. Data were obtained by corresponding lateral cephalometric radiographs taken before and at the end of orthodontic treatment. Association was analyzed with a Pearson correlation test. Differences among groups exhibiting varying competency and lip thickness were tested with an independent sample t test. A P value of ≤0.05 was considered statistically significant. RESULTS: Pearson correlation revealed significant associations among incisor tip retraction with lip base retraction (r = 0.68), lip base thinning (r = 0.41) and vermilion retraction (UV) (r = 0.73). Regression analysis showed a moderate increase in lip length (AB) and thickness at vermilion, which were 0.11 mm and 0.15 mm for each mm of incisor retraction at the tip, whereas stronger effects were observed for UV (0.38 mm) and lip base retraction (0.55 mm). There was significantly more lip base thinning (P = 0.03) and UV (P = 0.04) in the incompetent group compared with the competent group. The AB increased significantly in the sample with thicker lips (P = 0.01). Pearson correlation coefficient showed a strong association of lip retraction at the base and vermilion with the incisor movement at the cervical area, for competent and incompetent lips, and thicker and thinner lips. CONCLUSIONS: Lip retraction at vermilion and lip base thinning was significantly more in patients with incompetent lips, whereas the AB increased significantly more in the group with thicker lips.

Reasons for refusing orthognathic surgery by orthodontic patients: A cross-sectional survey.

Objective: To find out the most common reasons for refusing orthognathic surgery and to compare the responses along gender lines and in terms of open-ended and closed-ended approaches. METHODS: The cross-sectional retrospective study was conducted from August to December 2020 at the Orthodontics Department of Bahria University Medical and Dental College, Karachi, Pakistan, and comprised of patients who were planned for but refused orthognathic surgical treatment between January 2018 and July 2020. Data was collected through telephone-based interviews to record reasons of avoiding orthognathic surgery. The data-collection tool had both open-ended and closed-ended questions. Data was analysed using SPSS 23. RESULTS: Of the 60 patients, 42(70%) were females and 18(30%) were males with a mean age range of 23.25±2.19years. Overall, 19(31.7%) patients avoided surgery due to additional expense, while post-operative pain was cited as a reason by 35(58.3%) patients. Males were 9 times more concerned about their dental alignment compared to females (p=0.005). Fear of tooth injury (p<0.0001) and intra-operation and post-operation bleeding (p<0.0001) were found twice in males than females. Conclusion: The most common reasons for refusal to have orthognathic surgery were increased cost and post-operative pain. Males were more concerned about dental alignment and had higher fear of post-surgical tooth injury and intra- and post-operative bleeding compared to the females.

Validity of Hand Held Fundus Camera by Optometrist using Slit lamp 90D bio microscopy as a reference standard for screening of Diabetes Retinopathy.

OBJECTIVE: To find out the validity of hand-held fundus camera by optometrist using slit lamp 90D biomicroscopy as reference standard for screening of diabetes retinopathy. METHODS: The observational cross-sectional study was conducted at the diabetic clinic of Al-Ibrahim Eye Hospital, Karachi, from August 2020 to May 2021, and comprised diabetics of either gender aged >16 years visiting the outpatient department. Un-dilated fundus photograph of both eyes were taken with non-mydriatic fundus camera. Pupils were then mid-dilated with one drop of tropicamide 1% before capturing retinal images by handheld fundus camera by another optometrist. Both the optometrists identified and recorded the presence and absence of diabetic retinopathy. Subsequently, a retinal specialist examined the fundus with slit lamp 90 D biomicroscopy. Data was analysed using SPSS 23. RESULTS: Of the 500 subjects, 291(58.2%) were males and 209(41.8%) were females. The overall mean age was 54.49±9.16 years (range: 16-83 years). Of the 1000 eyes, fundus was not readable in 130(13%) by hand-held fundus camera, 296(29.6%) eyes by non-mydriatic fundus camera and 76(7.6%) eyes by slit lamp. Sensitivity and specificity of hand-held fundus camera compared to non-mydriatic fundus camera was 89.86% and 80.36%, respectively. In comparison with slit lamp, the sensitivity was 91.71% and specificity was 71.10%. Kappa statistic for diabetic retinopathy detection by hand-held fundus camera versus non-mydriatic fundus camera was 0.705, indicating substantial agreement. Kappa statistic for diabetic retinopathy detection with hand-held fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy. CONCLUSIONS: Handheld fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy.

Nonsense-mediated mRNA decay modulates Arabidopsis flowering time via the SET DOMAIN GROUP 40-FLOWERING LOCUS C module.

The nonsense-mediated mRNA decay (NMD) surveillance system clears aberrant mRNAs from the cell, thus preventing the accumulation of truncated proteins. Although loss of the core NMD proteins UP-FRAMESHIFT1 (UPF1) and UPF3 leads to late flowering in Arabidopsis, the underlying mechanism remains elusive. Here, we showed that mutations in UPF1 and UPF3 cause temperature- and photoperiod-independent late flowering. Expression analyses revealed high FLOWERING LOCUS C (FLC) mRNA levels in upf mutants; in agreement with this, the flc mutation strongly suppressed the late flowering of upf mutants. Vernalization accelerated flowering of upf mutants in a temperature-independent manner. FLC transcript levels rose in wild-type plants upon NMD inhibition. In upf mutants, we observed increased enrichment of H3K4me3 and reduced enrichment of H3K27me3 in FLC chromatin. Transcriptome analyses showed that SET DOMAIN GROUP 40 (SDG40) mRNA levels increased in upf mutants, and the SDG40 transcript underwent NMD-coupled alternative splicing, suggesting that SDG40 affects flowering time in upf mutants. Furthermore, NMD directly regulated SDG40 transcript stability. The sdg40 mutants showed decreased H3K4me3 and increased H3K27me3 levels in FLC chromatin, flowered early, and rescued the late flowering of upf mutants. Taken together, these results suggest that NMD epigenetically regulates FLC through SDG40 to modulate flowering time in Arabidopsis.

Monitoring of heavy metal pollution in urban and rural environments across Pakistan using House crows (Corvus splendens) as bioindicator.

A widely distributed urban bird, the house crow (Corvus splendens), was used to assess bioavailable heavy metals in urban and rural environments across Pakistan. Bioaccumulation of arsenic (As), zinc (Zn), lead (Pb), cadmium (Cd), nickel (Ni), iron (Fe), manganese (Mn), chromium (Cr), and copper (Cu) was investigated in wing feathers of 96 crows collected from eight locations and categorized into four groups pertaining to their geographical and environmental similarities. Results revealed that the concentrations of Pb, Ni, Mn, Cu, and Cr were positively correlated and varied significantly among the four groups. Zn, Fe, Cr, and Cu regarded as industrial outputs, were observed in birds both in industrialized cities and in adjoining rural agricultural areas irrigated through the Indus Basin Irrigation System. Birds in both urban regions accrued Pb more than the metal toxicity thresholds for birds. The house crow was ranked in the middle on the metal accumulation levels in feathers between highly accumulating raptor and piscivore and less contaminated insectivore and granivore species in the studied areas,. This study suggests that the house crow is an efficient bioindicator and supports the feasibility of using feathers to discriminate the local pollution differences among terrestrial environments having different levels and kinds of anthropogenic activities.

Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan.

OBJECTIVES: To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi. METHODS: An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient's BCVA was found to be ≤ 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 - 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment. RESULTS: A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have "good vision", 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week. CONCLUSIONS: The institution achieved WHO recommended criteria of "good visual outcome" (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.

Strengthening the referral Chain and providing one window diabetes eye care facility to people with Type-2 Diabetes: A six-year follow-up study from Pakistan.

OBJECTIVE: To report the results of implementation of two-pronged system for strengthening of referral and receiving end of referral chain for people with Type-2 diabetes mellitus (T2DM) at a tertiary eye care hospital in Karachi. METHODS: This observational, cross sectional study was conducted from the data collected in "Strengthening Pakistan's response to Diabetic Retinopathy" project. Peripheral referral was improved through community awareness camps (n=48), refreshing knowledge of primary healthcare professionals (PHCP) and conducting retinopathy screening camps (n=85) in the community. T2DM patients with best corrected visual acuity (BCVA) <6/18 or had retinopathy sign on screening were referred to tertiary center. The receiving end of the referral was improved by establishing "one window facility" at tertiary eye care center. Facility consisted of eight stations starting from registration, visual assessment, fundus photographs, consultation with ophthalmologist, anthropometry measurement, consultation with diabetologist to finally meeting with diabetes educator. At every station, patient's information was directly entered in HIMS software. RESULTS: A total of 50,595 patients attended tertiary center over six years. Among all 34685 (68.5%) were new registration and 15910 (31.4%) were follow ups. During first year (2014-15) out of total registered individuals with DM, newly registered were 4414 (89.5%) and 518 (10.5%) were follow-ups. In the final year (2019-20) new cases registered reached to 62% (n= 7916) with 38% (n=4852) follow-ups. Patients referred by PHCP increased from 6.5% in 2014-15 to 43.7% in 2019-20. An increased uptake of all treatment modalities for retinopathy like laser (increased by 16.76%), intra-vitreal injections (by 14.72%) and vitrectomy (by 51.47%) were also observed. CONCLUSION: Implementation of two prong system resulted in improved service uptake, better referral system, enhanced follow-ups and increased intervention uptake.

Role of AT1G72910, AT1G72940, and ADR1-LIKE 2 in Plant Immunity under Nonsense-Mediated mRNA Decay-Compromised Conditions at Low Temperatures.

Nonsense-mediated mRNA decay (NMD) removes aberrant transcripts to avoid the accumulation of truncated proteins. NMD regulates nucleotide-binding, leucine-rich repeat (NLR) genes to prevent autoimmunity; however, the function of a large number of NLRs still remains poorly understood. Here, we show that three NLR genes (AT1G72910, AT1G72940, and ADR1-LIKE 2) are important for NMD-mediated regulation of defense signaling at lower temperatures. At 16 °C, the NMD-compromised up-frameshift protein1 (upf1) upf3 mutants showed growth arrest that can be rescued by the artificial miRNA-mediated knockdown of the three NLR genes. mRNA levels of these NLRs are induced by Pseudomonas syringae inoculation and exogenous SA treatment. Mutations in AT1G72910, AT1G72940, and ADR1-LIKE 2 genes resulted in increased susceptibility to Pseudomonas syringae, whereas their overexpression resulted in severely stunted growth, which was dependent on basal disease resistance genes. The NMD-deficient upf1 upf3 mutants accumulated higher levels of NMD signature-containing transcripts from these NLR genes at 16 °C. Furthermore, mRNA degradation kinetics showed that these NMD signature-containing transcripts were more stable in upf1 upf3 mutants. Based on these findings, we propose that AT1G72910, AT1G72940, and ADR1-LIKE 2 are directly regulated by NMD in a temperature-dependent manner and play an important role in modulating plant immunity at lower temperatures.

Pain perception of orthodontic treatment - A cross-sectional study.

OBJECTIVES: The objectives were to evaluate the intensity of pain perceived 24 hours following insertion of fixed orthodontic appliance components i-e separators, bands and brackets. METHODS: This cross-sectional study conducted at a Dental College in Karachi (July 2017-March 2018) investigated the amount of pain perceived during different stages of fixed orthodontic treatment. The inclusion criteria were healthy individuals without systemic disease, age 13-26 years, fixed orthodontic treatment candidates having healthy permanent first molars. The exclusion criteria were missing permanent first molars, patients requiring brass wire separators instead of elastomeric separators and molar tubes instead of bands, ongoing or previous periodontal disease and syndromic patients. Pain intensity was assessed in ninety eight patients using a Numeric Rating scale (NRS) at baseline (T0) before insertion, and 24 hours after insertion (T1) of a component. This procedure was repeated six times, twice each for separators, bands and brackets. Scoring was done on the NRS from 0 to 10 where 0 indicated no pain and 10 indicated worst pain possible. RESULTS: A significant difference in perceived pain was found between baseline and after 24 hours of placement of all components (P-value 0.000). Odds ratio indicated that males were at a greater risk to feel pain than females at baseline and after 24 hours of insertion of all components. Mann-Whitney U test showed that the most painful components at baseline were bands (Mean value=0.56) and after 24 hours were brackets (Mean value 6.25). CONCLUSIONS: Significant increase in pain was noted 24 hours after insertion of separators, bands and brackets. The most painful components were bands at baseline and brackets after 24 hours of insertion. There were no significant variations in pain perception based on age. However, males perceived higher pain than females both at baseline and after 24 hours.

Comparison of neck length, relative neck length and height with incidence of cervical spondylosis.

OBJECTIVE: To compare the neck length, relative neck length and height between patients with cervical spondylosis and healthy subjects. METHODS: This case control study was conducted at Patel hospital, Karachi after the ethical approval of Bahria University Medical and Dental College (BUMDC) and Patel hospital from September 2018 - February 2019. It enrolled eighty eight cases of cervical spondylosis and eighty eight healthy subjects. Radiographs were taken in the lateral view and neck length was measured as the distance from external occipital protuberance to seventh cervical vertebra spinous process. Then relative neck length was measured by dividing the neck length with height and multiplying it by 100. The Kellgren Lawrence grade scale was used to assess the severity of cervical spondylosis. RESULTS: A total of 176 participants were analyzed. It was found that the height remains the significant determinant. The comparison of cases with control group was done using independent T-test which showed that the cases were significantly shorter than controls with a p-value < 0.05. The other variables such as neck length, and relative neck length were insignificant. CONCLUSION: Short height can be considered as a risk factor for cervical spondylosis. Short-statured individuals should be counseled to adopt measures for the prevention of cervical spondylosis.

Identification of stressors and Perceptional difference of stress in first and final year Doctor of Physical Therapy students; a comparative study.

The aim of the study is to identify the main causes of stress and to identify the perception difference of stress in first and final year DPT students Students in universities can experience stress in balancing the different demands on them - academic, interpersonal, intrapersonal, and professional or work related. A comparative Cross-sectional study was conducted using self-administered questionnaires including socio demographics A total of 177 university students (first year 109 & final year 68 students) were included in the period March, to September 2015 in a private medical college Islamabad. Significantly valid tool (The Medical Student Stressor Questionnaire) (MSSQ) was used to measure the stress level. The research was conducted according to the principles of the Declaration of Helsinki. Three stressors academic related inter/intrapersonal related and group activities related stressors were causing high stress in all DPT students. There was significant difference in perception of stressors among first and final year DPT students.

Diagnostic accuracy of non-mydriatic fundus camera for screening of diabetic retinopathy: A hospital based observational study in Pakistan.

OBJECTIVE: To determine the diagnostic accuracy of non-mydriatic fundus camera for the detection of diabetic retinopathy. METHODS: The cross-sectional study was conducted at Al Ibrahim Eye Hospital, Karachi, from January to May 2015, and comprised patients with type 2 diabetes who were screened for diabetic retinopathy. Single 45° fundus image focussed at macula was obtained and labelled using non-mydriatic fundus camera by a trained optometrist. Photos were labelled as positive (diabetic retinopathy present), negative (no diabetic retinopathy) or unreadable. The pupil was then dilated and fundi were examined by ophthalmologist with slit-lamp and fundus lens. Results of fundus examination were labelled as positive, negative or invisible/indecisive. Results of ophthalmologist were taken as the standard reference to evaluate sensitivity and speci?city for detecting diabetic retinopathy with non-mydriatic fundus camera. SPSS 20 was used for data analysis. RESULTS: Total eyes screened numbered 2970 related to 1485 patients. Diabetic retinopathy was found in 646(21.8%) eyes, 485(20.9%) photographs were unreadable and 1839(57.3%) were normal. Ophthalmologist on slit lamp bio-microscopy labelled 736(25%) eyes as positive for diabetes retinopathy, 335(15%) as indecisive and 1899(60%) as normal. The sensitivity of non-mydriatic fundus camera was 400/556 (72%) while specificity was 1548/1794 (86.3%). Positive predictive value and negative predictive value were 400/646 (62%) and 1548/1704 (90%) respectively. The level of agreement was moderate (k=0.0551) for optometrist compared to ophthalmologist. False positive diagnosis by optometrist numbered 78/1839 (4.24%) and false negative was 123/646(19%). CONCLUSIONS: Non-mydriatic fundus camera was found to be a reliable screening tool for detecting and referral diabetic retinopathy cases to ophthalmologist for further evaluation and management.

Polycystic Ovarian Syndrome: Correlation between clinical hyperandrogenism, anthropometric, metabolic and endocrine parameters.

OBJECTIVE: To evaluate the correlation between clinical hyperandrogenism-hirsutism assessed by modified Ferriman-Gallwey (F-G) score, anthropometric, metabolic and endocrine parameters among PCOS infertile women. METHODS: This observational study after approval of FRC & ERC of BUMDC was conducted from September 2018-March 2019. It included seventy women aged 20-40 years who presented in infertility clinic of a local Hospital in Karachi. After written informed consent participants were enrolled as per the inclusion criteria of the study and evaluated for cyclical pattern (oligomenorrhoea, amenorrhoea, polymenorrhea), physical (weight, height, BMI), anthropometric, (waist circumference, hip circumference, waist to hip ratio, hirsutism), metabolic (carbohydrate, lipid & protein) and endocrine parameters (serum FSH, LH, LH/FSH ratio, serum testosterone, prolactin and progesterone level). Hirsutism was assessed by visual method through modified F-G score and Pearson correlation was determined between hirsutism and other study parameters. RESULTS: A positive Pearson correlation is found between hirsutism and body weight, BMI, waist and hip circumference, waist to hip ratio (WHR), very low density lipoprotein, cholesterol, triglycerides and testosterone levels. CONCLUSION: Hirsutism has correlation with anthropometric, metabolic and hyperandrgenic disorders in PCOS infertile women as assessed by modified F-G score.

Context Mining of Sedentary Behaviour for Promoting Self-Awareness Using a Smartphone.

Sedentary behaviour is increasing due to societal changes and is related to prolonged periods of sitting. There is sufficient evidence proving that sedentary behaviour has a negative impact on people's health and wellness. This paper presents our research findings on how to mine the temporal contexts of sedentary behaviour by utilizing the on-board sensors of a smartphone. We use the accelerometer sensor of the smartphone to recognize user situations (i.e., still or active). If our model confirms that the user context is still, then there is a high probability of being sedentary. Then, we process the environmental sound to recognize the micro-context, such as working on a computer or watching television during leisure time. Our goal is to reduce sedentary behaviour by suggesting preventive interventions to take short breaks during prolonged sitting to be more active. We achieve this goal by providing the visualization to the user, who wants to monitor his/her sedentary behaviour to reduce unhealthy routines for self-management purposes. The main contribution of this paper is two-fold: (i) an initial implementation of the proposed framework supporting real-time context identification; (ii) testing and evaluation of the framework, which suggest that our application is capable of substantially reducing sedentary behaviour and assisting users to be active.

Raised intraocular pressure following Intravitreal Triamcinolone Acetonide in diabetic versus non-diabetic patients.

OBJECTIVE: To determine the frequency of an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide (IVTA) in diabetic versus non-diabetic patients with various chorio-retinal disorders. METHODS: This prospective, interventional comparative case series was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi from May 2012 to April 2014. Two hundred thirty seven eyes of 180 patients were enrolled with 90 patients each in diabetic and non-diabetic group, requiring IVTA. IVTA 4mg/0.1ml was injected and IOP was measured at one week, one month, three months and six months in both groups of patients. RESULTS: In diabetic group, 43 patients were male (47.8%) and 47 were female (52.2%), while in non-diabetic group, 56 (62.2%) patients were male and 34 (37.8%) were female. Mean age of patients in diabetic group was 52.21 ± 9.6 years and in non-diabetic group was 51.13 ± 10.75 years. The mean preoperative IOP was 13.6 ± 2.8 mmHg and 14.1 ± 2.4 mmHg in diabetic and non-diabetic group respectively. In diabetic group, mean (±SD) IOP was 16.4 ±4.9 mmHg, 14.6 ±3.6 mmHg, 17.6 ± 9.7 mmHg and 15.5 ± 7.09 mmHg at one week, one month, three months and 6 months post injection. While in non-diabetic cases, mean (±SD) IOP was 14.8 ± 3.33 mmHg, 15.9 ± 4.2 mmHg, 15.5 ± 4.2 mmHg and 14.1 ± 3.2 mmHg at one week, one month, three months and 6 months follow up. The raised IOP was observed in 117 eyes (49%) in both groups of patients, with 78 eyes (65%) in diabetic group and 39 eyes (33%) in non-diabetic group. CONCLUSIONS: After IVTA, an IOP rise was observed more in diabetics than non-diabetic patients.

Prevalence of diabetic retinopathy in Pakistan; A systematic review.

OBJECTIVES: Primary aim was to review the literature on the prevalence of diabetic retinopathy (DR) and Vision threatening diabetic retinopathy (VTDR) in Pakistan. METHODS: A search of the bibliographic databases (Medline, Pub med, and Google scholar) was conducted from 1990 to March 2017. Articles about prevalence of DR and VTDR in Pakistan were retrieved and scrutinized. The studies satisfying the inclusion/exclusion criteria were considered for detail review. RESULTS: Forty one articles on prevalence of DR were traced out. Exclusion and inclusion criteria were met in 29 studies. In selected studies (29), pooled Prevalence of DR was found to be 28.78% with a variation of 10.6% to 91.3%. Out of 29 studies, DR was classified in 19 studies. Pooled Prevalence of VTDR in these 19 studies was found to be 28.2% (variation of 4% to 46.3%) of patient with retinopathy and 8.6% of all diabetics. CONCLUSION: A great variation in the values of DR and VTDR was observed in this study. Researchers suggest a community based study with uniform methodology to find out a comparable value of prevalence of DR and VTDR in all provinces of Pakistan.