BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary dra...BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.展开更多
In this paper measurement of real part of permittivity and loss tangent of (1-x) Zn.xMg.TiO3 (ZMT) material in powder form in S-band of microwave frequencies is presented and the associated accuracy estimated. This ap...In this paper measurement of real part of permittivity and loss tangent of (1-x) Zn.xMg.TiO3 (ZMT) material in powder form in S-band of microwave frequencies is presented and the associated accuracy estimated. This approach is based on the measurement of transmitted power from the cavity at and off resonance. Details of the design and fabrication of the rectangular cavity and the input and output coupling are given. The variation of dielectric properties of (1-x) Zn.xMg.TiO3 (ZMT) with x-value and calcination temperature (for x = 0.1) is presented. The effect of doping of V2O5 is also studied. The results of present work may provide useful design guidelines for development of microwave compo-nents including dielectric resonator antennas.展开更多
BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest cli...BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.展开更多
Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis di...Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis differs in the South Asian region compared to the West,with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time.Comorbid malnutrition worsens outcomes for cirrhosis patients.Urgent attention to address malnutrition is needed to improve patient outcomes.The etiology and pathophysiology of malnutrition in liver diseases is multifactorial,as reduction in liver function affects both macronutrients and micronutrients.A need for nutritional status assessment for liver disease patients exists in all parts of the world.There are many widely studied tools in use to perform a thorough nutritional assessment,of which some tools are low cost and do not require extensive training.These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan.Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world,but the knowledge and practice of nutritional counseling in Pakistan is poor,both amongst patients and physicians.Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed.Simultaneously,treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.展开更多
In the present communication, we have obtained the optimum probability distribution with which the messages should be delivered so that the average redundancy of the source is minimized. Here, we have taken the case o...In the present communication, we have obtained the optimum probability distribution with which the messages should be delivered so that the average redundancy of the source is minimized. Here, we have taken the case of various generalized mean codeword lengths. Moreover, the upper bound to these codeword lengths has been found for the case of Huffman encoding.展开更多
The present communication offers a method to determine an unknown discrete probability distribution with specified Tsallis entropy close to uniform distribution. The relative error of the distribution obtained has bee...The present communication offers a method to determine an unknown discrete probability distribution with specified Tsallis entropy close to uniform distribution. The relative error of the distribution obtained has been compared with the distribution obtained with the help of mathematica software. The applications of the proposed algorithm with respect to Tsallis source coding, Huffman coding and cross entropy optimization principles have been provided.展开更多
Bacille Calmette Guerin (BCG), which has been used since 1921 as the only vaccine against tuber-culosis (TB), protects poorly, if at all, against pulmonary tuberculosis among adults in high incident developing countri...Bacille Calmette Guerin (BCG), which has been used since 1921 as the only vaccine against tuber-culosis (TB), protects poorly, if at all, against pulmonary tuberculosis among adults in high incident developing countries. This failure has been attributed to the possible down modulating action of T regulatory cells (Tregs), which can be stimulated by environmental mycobacteria and expanded by BCG vaccination. Tregs induced at the site of BCG vaccination may interfere with protection against tuberculosis. This communication describes the contribution of Tregs towards dampening the efficacy of BCG and plausible approaches to countering this down modulating effect of Tregs. Probably, antigen specific inhibition of the local recruitment of Tregs whilst avoiding generalised disturbance of immune homeostasis could prove to be worthwhile. Alternatively, drugs with short half life may achieve more acceptable transient inhibition of Tregs function than the prolonged action of monoclonal antibodies. Evolving novel safe strategies is a challenge for developing a better anti TB vaccine.展开更多
文摘BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.
文摘In this paper measurement of real part of permittivity and loss tangent of (1-x) Zn.xMg.TiO3 (ZMT) material in powder form in S-band of microwave frequencies is presented and the associated accuracy estimated. This approach is based on the measurement of transmitted power from the cavity at and off resonance. Details of the design and fabrication of the rectangular cavity and the input and output coupling are given. The variation of dielectric properties of (1-x) Zn.xMg.TiO3 (ZMT) with x-value and calcination temperature (for x = 0.1) is presented. The effect of doping of V2O5 is also studied. The results of present work may provide useful design guidelines for development of microwave compo-nents including dielectric resonator antennas.
文摘BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.
文摘Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia.The presence of malnutrition causes a severe impact on patients with liver cirrhosis.The etiology of cirrhosis differs in the South Asian region compared to the West,with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time.Comorbid malnutrition worsens outcomes for cirrhosis patients.Urgent attention to address malnutrition is needed to improve patient outcomes.The etiology and pathophysiology of malnutrition in liver diseases is multifactorial,as reduction in liver function affects both macronutrients and micronutrients.A need for nutritional status assessment for liver disease patients exists in all parts of the world.There are many widely studied tools in use to perform a thorough nutritional assessment,of which some tools are low cost and do not require extensive training.These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan.Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world,but the knowledge and practice of nutritional counseling in Pakistan is poor,both amongst patients and physicians.Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed.Simultaneously,treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.
文摘In the present communication, we have obtained the optimum probability distribution with which the messages should be delivered so that the average redundancy of the source is minimized. Here, we have taken the case of various generalized mean codeword lengths. Moreover, the upper bound to these codeword lengths has been found for the case of Huffman encoding.
文摘The present communication offers a method to determine an unknown discrete probability distribution with specified Tsallis entropy close to uniform distribution. The relative error of the distribution obtained has been compared with the distribution obtained with the help of mathematica software. The applications of the proposed algorithm with respect to Tsallis source coding, Huffman coding and cross entropy optimization principles have been provided.
文摘Bacille Calmette Guerin (BCG), which has been used since 1921 as the only vaccine against tuber-culosis (TB), protects poorly, if at all, against pulmonary tuberculosis among adults in high incident developing countries. This failure has been attributed to the possible down modulating action of T regulatory cells (Tregs), which can be stimulated by environmental mycobacteria and expanded by BCG vaccination. Tregs induced at the site of BCG vaccination may interfere with protection against tuberculosis. This communication describes the contribution of Tregs towards dampening the efficacy of BCG and plausible approaches to countering this down modulating effect of Tregs. Probably, antigen specific inhibition of the local recruitment of Tregs whilst avoiding generalised disturbance of immune homeostasis could prove to be worthwhile. Alternatively, drugs with short half life may achieve more acceptable transient inhibition of Tregs function than the prolonged action of monoclonal antibodies. Evolving novel safe strategies is a challenge for developing a better anti TB vaccine.
