Search

Patients with inflammatory bowel disease (IBD) have numerous risk factors for low bone mineral density (BMD). We aimed to study the prevalence of low BMD in IBD and the factors associated with it. BMD was measured by radial quantitative ultrasound, and clinical and biochemical characteristics were compared in prospectively enrolled patients and healthy age and gender-matched controls. Chi-square test, t test for independent samples, analysis of variance (ANOVA), Mann–Whitney U test and Kruskal–Wallis H tests were used as appropriate for univariate analysis to compare the characteristics between patients with and without abnormal BMD. Binary logistic regression analysis was done to determine the factors associated with low BMD in IBD patients. One hundred and six patients (Crohn’s disease [CD] = 35, ulcerative colitis [UC] = 71) and 55 controls were included. Low BMD was equally prevalent in CD, UC and controls (42.9%, 36.6%, 36.4% respectively, p = 0.791). Serum calcium and vitamin D were significantly lower in IBD patients compared to controls (p

Background The standard treatment of displaced femoral neck fracture is arthroplasty. THA is reportedly superior to BHA in terms of hip pain, function and reoperation rate. On the other hand THA has a higher rate of dislocation. Total hip replacement with dual mobility cup increases the range of motion and reduces the chances of dislocation. The aim of this study is to compare the functional outcome, rate of dislocation, complications and mortality between BHA and THA with dual mobility cuff for the treatment of displaced neck of femur fracture. Patients and method This is a non-commercialized retrospective cohort study conducted at our tertiary care level 1 trauma centre. Patients of age group 60 years and above who underwent hip arthroplasty (BHA or THA with dual mobility implant) between 2015 and 2017 for displaced neck of femur fracture with a complete follow up for one year were included. Both groups were assessed for postoperative surgical complications including dislocation, fracture, surgical site infection, and medical complications, one-year mortality and functional outcome were analysed via Harris Hip Score (HHS) at the latest follow up. Results Overall 104 patients were included in the study out of which 77 patients underwent BHA while 27 underwent THA with dual mobility cup. Baseline characteristics were found to be similar in both groups. Mean pre-op HHS for bipolar group was found to be 71.01 while for THA with dual mobility cup group it was 73.52 with the difference being statistically insignificant (P = 0.12). Mean post-op HHS for bipolar group was noted to be 68.82 whereas for THA with dual mobility cup group it was 76.81. The difference was found to be statistically significant with a P-value of, Highlights • The standard treatment of displaced femoral neck fracture is arthroplasty. • Total Hip Arthroplasty is reportedly superior to Bipolar Hemiarthroplasty in terms of hip pain, function and reoperation rate. • Total Hip Arthroplasty has a higher rate of dislocation rate than Bipolar Hemiarthroplasty. • Total Hip Arthroplasty with Dual mobility cup increases the functional outcome and reduces the chances of dislocation.

Background Hip fractures usually occur in old aged patients with osteoporotic bone. Management of hip fractures in old aged patient is aimed to ambulate patient immediately and to restore the pre-operative ambulation. Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. It allow immediate weight bearing and early return to preoperative ambulatory status and minimizes the chances of systemic complication associated with prolong bed rest associated with internal fixation. This study is aimed to review the outcome of the patients whom underwent proximal femur replacement as primary treatment for the patient with comminuted intertrochanteric and sub trochanteric fracture. Patients and method This is a study conducted in our university hospital which is a tertiary-care level-1 trauma center. A retrospective analysis of 21 patients who underwent proximal femur replacement for comminuted intertrochanteric and sub trochanteric fracture, age more than 60 years during the period from April 2011 to March 2018 was conducted. Data collected included: age, gender, comorbidities, mechanism of injury, type of fracture, functional outcome (calculated via Harris Hip Score) and one year mortality. Results The mean age of the patients was 74.05(range 64–91) years, out of which 13 (61.8%) were female and 8 (38.0%) were male. The mean follow up was 32.6(8–91 months).Immediate post-operative ambulation status was full weight bearing (FWB) in 17 patients (80.9%) of the patients while three patients (19.0%) had non-weight bearing (NWB) due to associated co-morbidities. The mean preoperative Harris Hip score was 68.0, while the mean postoperative Harris Hip score was 66.5 at last follow up. Post operatively one patient (4.7%) developed pulmonary embolism, one patient developed dislocation. One patent (4.7%) died of sepsis from implant infection at 8 months after surgery Conclusion Primary Proximal femoral replacement in a viable option in old aged patients with poor bone quality who developed intertrochanteric and subtrochanteric fracture. According to our study, with mortality rate comparable to that of primary fixation, yet with the added advantage of immediate post op ambulation and reduced incidences of decubitus ulcers, atelectasis and DVT., Highlights • Management of hip fractures in old aged patient is aimed to ambulate patient immediately. • Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. • Proximal femur replacement allows immediate weight bearing and early return to preoperative ambulatory status.

Colorectal cancer (CRC) is the third most common type of cancer with the liver being the most common site for cancer spread. A precise understanding of patient liver anatomy and pathology, as well as surgical planning based on that, plays a critical role in the treatment process. In some cases, surgeons request a 3D reconstruction, which requires a thorough analysis of the available images to be converted into 3D models of relevant objects through a segmentation process. Liver vessel segmentation is challenging due to the large variations in size and directions of the vessel structures as well as difficult contrasting conditions. In recent years, deep learning-based methods had been outperforming the conventional image analysis methods in the field of medical imaging. Though Convolutional Neural Networks (CNN) have been proved to be efficient for the task of medical image segmentation, the way of handling the image data and the preprocessing techniques play an important role in segmentation. Our work focuses on the combination of different vesselness enhancement filters and preprocessing methods to enhance the hepatic vessels prior to segmentation. In the first experiment, the effect of enhancement using individual vesselness filters was studied. In the second experiment, the effect of gamma correction on vesselness filters was studied. Lastly, the effect of fused vesselness filters over individual filters was studied. The methods were evaluated on clinical CT data. The quantitative analysis of the results in terms of different evaluation metrics from experiments can be summed up as (i) each of the filtered methods shows an improvement as compared to unenhanced with the best mean DICE score of 0.800 in comparison to 0.740 for unenhanced, (ii) applied gamma correction provides a statistically significant improvement in the performance of each filter with improvement in mean DICE of around 2%, (iii) both the fused filtered images and fused segmentation give the best results (mean DICE score of 0.818 and 0.830, respectively) with the statistically significant improvement compared to the individual filters with and without Gamma correction. The results have further been verified by qualitative analysis and hence show the importance of our proposed fused filter and segmentation approaches.

Background The first case of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed in Wuhan, China, in 2019. By the first half of 2020, coronavirus disease 2019 (COVID-19) turned into a global pandemic. Objectives The aim of this study is to describe the clinical and demographic characteristics including comorbidities and their outcomes among patients hospitalized with COVID-19 in four tertiary care hospitals across Lahore. This retrospective study was conducted at Fatima Memorial Hospital, Sir Ganga Ram Hospital, Lahore General Hospital, and Jinnah Hospital, all in Lahore, Pakistan, from May 1, 2020, to June 30, 2020. The sample size was 445, which was derived using the convenient sampling method. Clinical outcomes during hospitalization included the requirement of invasive positive pressure ventilation, need for renal replacement therapy (RRT), and death. Data regarding demographics, baseline comorbidities, important vital signs on reporting, and initial workup with results were also collected. Results A total of 445 patients' data were studied, of whom 291 (65.4%) were male patients and 154 (34.6%) female patients. The median age was 54 years (interquartile range [IQR]: 24). The most common comorbidities were hypertension (HTN) (195; 43.8%) followed by diabetes mellitus (DM) (168; 37.8%) and cardiovascular disease (CVD) (61; 13.7%). The median length of hospital stay was eight days (IQR: 3). Of the total patients, 137 (30.7%) were treated in intensive care unit settings, 40 (9%) received invasive mechanical ventilation, 40 (9%) patients had acute kidney injury, 38 (8.5%) received RRT, and 37 (8.3%) died. It was seen that more patients who were either diabetic or hypertensive received invasive mechanical ventilation as compared to those who did not have these comorbidities. The most common radiological finding on chest X-ray was the classical ground-glass appearance of COVID-19, which was found in 318 (71.4%) patients. Conclusions Patients with one or more underlying comorbidities had poor clinical outcomes compared to those with no comorbidities, with the most vulnerable group being patients with chronic kidney disease, DM, HTN, and CVD in descending order.

Laparoscopic videos can be affected by different distortions which may impact the performance of surgery and introduce surgical errors. In this work, we propose a framework for automatically detecting and identifying such distortions and their severity using video quality assessment. There are three major contributions presented in this work (i) a proposal for a novel video enhancement framework for laparoscopic surgery; (ii) a publicly available database for quality assessment of laparoscopic videos evaluated by expert as well as non-expert observers and (iii) objective video quality assessment of laparoscopic videos including their correlations with expert and non-expert scores., SPIE Medical Imaging 2020 (Draft version)

To study the clinical and biochemical profiles across the different ranges of impaired fasting glucose (IFG) based on American Diabetes Association (ADA) and World Health Organization (WHO) criteria. A cross-sectional study was conducted on 149 subjects, of which 63 belonged to group 1 (IFG = 100–110 mg/dl) and 86 to group 2 (IFG = 111–125 mg/dl). Basic anthropometric and clinical examinations were done for all subjects. Data was collected from patient by a questionnaire, which included the history of hypertension and diabetes and other comorbidities and complications. Biochemical profiles including Fasting Plasma Glucose (FPG), Oral Glucose Tolerance Test (OGTT), HbA1c, Fasting insulin levels and Fasting Lipid Profile were measured. Assessment of insulin resistance and beta cell function was done by Homeostasis Model Assessment (HOMA). Data were analysed using SPSS software version 15 and p

Appropriate doses of fluoride (F) have therapeutic action against dental caries, but higher levels can cause disturbances in soft and mineralized tissues. Interestingly, the susceptibility to the toxic effects of F is genetically determined. This study evaluated the effects of F on the liver proteome of mice susceptible (A/J) or resistant (129P3/J) to the effects of F. Weanling male A/J (n = 12) and 129P3/J (n = 12) mice were housed in pairs and assigned to two groups given low-F food and drinking water containing 15 or 50 ppm F for 6 weeks. Liver proteome profiles were examined using nano-LC-ESI-MS/MS. Difference in expression among the groups was determined using the PLGS software. Treatment with the lower F concentration provoked more pronounced alterations in fold change in liver proteins in comparison to the treatment with the higher F concentration. Interestingly, most of the proteins with fold change upon treatment with 15 ppm F were increased in the A/J mice compared with their 129P3/J counterparts, suggesting an attempt of the former to fight the deleterious effects of F. However, upon treatment with 50 ppm F, most proteins with fold change were decreased in the A/J mice compared with their 129P3/J counterparts, especially proteins related to oxidative stress and protein folding, which might be related to the higher susceptibility of the A/J animals to the deleterious effects of F. Our findings add light into the mechanisms underlying genetic susceptibility to fluorosis.

Fluoride exposure is widespread, with drinking water commonly containing natural and artificially added sources of the ion. Ingested fluoride undergoes absorption across the gastric and intestinal epithelia. Previous studies have reported adverse gastrointestinal effects with high levels of fluoride exposure. Here, we examined the effects of fluoride on the transepithelial ion transport and resistance of three intestinal epithelia. We used the Caco-2 cell line as a model of human intestinal epithelium, and rat and mouse colonic epithelia for purposes of comparison. Fluoride caused a concentration-dependent decline in forskolin-induced Cl- secretion and transepithelial resistance of Caco-2 cell monolayers, with an IC50 for fluoride of about 3 mM for both parameters. In the presence of 5 mM fluoride, transepithelial resistance fell exponentially with time, with a t1/2 of about 7 hours. Subsequent imaging by immunofluorescence and scanning electron microscopy showed structural abnormalities in Caco-2 cell monolayers exposed to fluoride. The Young's modulus of the epithelium was not affected by fluoride, although proteomic analysis revealed changes in expression of a number of proteins, particularly those involved in cell-cell adhesion. In line with its effects on Caco-2 cell monolayers, fluoride, at 5 mM, also had profound effects on Cl- secretion and transepithelial resistance of both rat and mouse colonic epithelia. Our results show that treatment with fluoride has major effects on the structure, function, and proteome of intestinal epithelia, but only at concentrations considerably higher than those likely to be encountered in vivo, when much lower fluoride doses are normally ingested on a chronic basis.

Introduction Hypogonadism is characterized by clinical and biochemical evidence of testosterone deficiency. Low testosterone levels have been reported in patients with type 2 diabetes mellitus (T2DM), which can predispose to coronary artery disease (CAD). It has been proposed that diabetic men with proven CAD have lower androgen levels than patients with normal coronary arteriograms. We conducted this study with the objective to determine the frequency of hypogonadism in patients with diabetes mellitus and its relationship with CAD. Materials and Methods It was a comparative cross-sectional study conducted at a tertiary care hospital. We recruited a total of 108 patients, divided into two groups, 54 patients in each arm of the study. Group A comprised patients with CAD, whereas group B consisted of diabetic patients without CAD. Hypogonadism was defined on the basis of erectile dysfunction clinically and total testosterone levels biochemically. CAD was diagnosed on the basis of findings of coronary angiography. Fasting blood samples were drawn and evaluated for fasting plasma glucose, HbA1c, fasting lipid profile, thyroid-stimulating hormone (TSH), serum prolactin, blood urea, serum creatinine, liver function tests (LFT), total testosterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) levels. Hypogonadism among two study groups was compared using chi-square and serum testosterone level was compared using independent t-test with p < 0.05 considered as statistically significant. Results There were 108 subjects in the study with the mean age of 54.4 ± 4.29 (range: 22 to 68) years. The mean duration of T2DM was 12.6 ± 8.2 years. The mean BMI of patients with and without CAD was 25.7 ± 2.37 and 26.9 ± 4.21 kg/m2, respectively. There was no significant difference in waist circumference and obesity between both the groups (p-value > 0.05). Fasting plasma glucose and HbA1c in both groups were not significantly different. Testosterone levels and erectile dysfunction score were found lower in T2DM with CAD compared to T2DM patients without CAD, although this difference was not statistically significant (p-value: 0.051). The majority of the subjects with hypogonadism in both groups had a hypogonadotrophic hypogonadism (39/42, 92.9% versus 16/20, 80.0%). No statistically significant difference was seen in serum levels of LH and FSH between the study groups. The frequency of hypogonadism was found higher in the group with CAD (72.2%, 39/54) as compared with T2DM patients without CAD (37.03%, 20/54; p-value = 0.000). Conclusion Testosterone deficiency is a significant problem of males with T2DM. Patients with CAD have markedly low levels of testosterone as compared with patients without any CAD.

Background: Diabetes Mellitus (DM) is a serious worldwide health concern. Pakistan is among the top 10 countries with the highest prevalence of diabetes in the world with estimates reaching as high as 21.6% in adults aged 30–79 years. HbA1C is the most useful diagnostic tool to assess the control and progression of disease and related complications. However, the predictors of good and bad control are not well established in our population. Objective: 1). To assess the level of A1C control among type 2 diabetic patients. 2). To find out factors which can predict uncontrolled A1C. Study Design: Retrospective observational study. Setting: Among type 2 diabetes mellitus patients attending the outpatient of Diabetes Endocrine and Metabolic Centre (DEMC) of Lahore General Hospital, Lahore. Period: June 2012 to Feb 2014. Material and methods: Total of 809 patients were randomly selected to assess A1C in this population. At the same time, we assessed other factors associated with uncontrolled A1C. Chart review of the included patients was done using a data collection sheet, structured for this purpose. Patient demographic data was gathered. Specific information including complications and laboratory results (HbA1C, Triglycerides (TG), Dyslipidemias) was collected. Diabetes complication data was obtained clinically and through laboratory workup. The outcome was calculated. Patients with A1C of

Background: Stroke is a leading cause of disability and the second principal cause of death in the world. The aim of this study was to analyze different characteristics in stroke patients in Medical Unit 1 of Lahore General Hospital, which is biggest referral hospital for Neurology patients in Punjab, to identify the risk factors and help in targeting prevention in our patients. Study Design: Descriptive study. Setting: Lahore General Hospital, Lahore. Period: January 2016, including data from January to November 2015. Methods: The demographic data, clinical manifestations, risk factors, side of weakness, cranial nerves involved, neurological weakness and Glasgow Coma Scale, duration of stay in hospital and outcome were included in the data. For the comparison between categorical variables Chi-square test was used. For other variables, t-test was used. Results: A total of 235 patients with stroke, age 20 to 105 (mean ±SD= 58±14.6) were included. 127 (54%) had Ischemic stroke (IS) and 100 (42.6%) had hemorrhagic stroke (HS). 127 (54%) were men and 108 (46%) were women. 17.9% of the patients with IS and 21.7% of the patients with HS died (OR 0.65 95% CI 0.48-0.89). Hypertension, diabetes and dyslipidemia were the most common risk factors. Conclusion: Burden of stroke is high in Pakistan. Mean age of patients with stroke is less. Hypertension, diabetes, dyslipidemia and smoking are highly prevalent and hypertension is the most common. Ischemic strokes are more common, mortality of intra-cerebral hemorrhage is higher.

Objective Although many studies worldwide explained the risk factors for developing Diabetic Foot Ulceration (DFU), little has been done to assess medical factors in DFU formation and link them in patients of Pakistan. This study aimed to link the DFU with different risk factors. Methods This descriptive cross-sectional retrospective study was conducted in Diabetes Endocrine and Metabolic Centre / Post Graduate Medical Institute / Lahore General Hospital. Data of all patients presenting between July 2017 to June 2018 were analyzed for risk factors. Analysis was done on SPSS version 21. Results Total of 3301 patient were seen during this period, out of which 2052 patient data was picked up as it was complete in respect to the information needed. Middle age, Male gender, Type 2 diabetes, and Hypertension, were insignificantly co-related. High waist circumference, Comorbidity like Neuropathy, Dyslipidemia, Greater body mass index, Poor compliance with Medication and type of medication used (combination of oral and injectable) were found statistically significant predictor for DFU. However retinopathy was not found to be a risk factor of DFU. This result was statistically significant. Conclusion Factors like obesity, waist circumference, combination of oral along with injectable therapies, neuropathy, dyslipidemia, retinopathy and poor compliance with medication were statistically significant and can be strongly linked with diabetic foot ulcer. Middle age, Male gender, Type 2 diabetes, and Hypertension were insignificantly co-related. However, further studies are needed in larger population to support these findings.

A/J and 129P3/J mice strains have been widely studied over the last few years because they respond quite differently to fluoride (F) exposure. 129P3/J mice are remarkably resistant to the development of dental fluorosis, despite excreting less F in urine and having higher circulating F levels. These two strains also present different characteristics regardless of F exposure. Objective In this study, we investigated the differential pattern of protein expression in the liver of these mice to provide insights on why they have different responses to F. Material and Methods Weanling male A/J and 129P3/J mice (n=10 from each strain) were pared and housed in metabolic cages with ad libitum access to low-F food and deionized water for 42 days. Liver proteome profiles were examined using nLC-MS/MS. Protein function was classified by GO biological process (Cluego v2.0.7 + Clupedia v1.0.8) and protein-protein interaction network was constructed (PSICQUIC, Cytoscape). Results Most proteins with fold change were increased in A/J mice. The functional category with the highest percentage of altered genes was oxidation-reduction process (20%). Subnetwork analysis revealed that proteins with fold change interacted with Disks large homolog 4 and Calcium-activated potassium channel subunit alpha-1. A/J mice had an increase in proteins related to energy flux and oxidative stress. Conclusion This could be a possible explanation for the high susceptibility of these mice to the effects of F, since the exposure also induces oxidative stress.

Cystatin B was recently identified as an acid-resistant protein in acquired enamel pellicle; it could therefore be included in oral products to protect against caries and erosion. However, human recombinant cystatin is very expensive, and alternatives to its use are necessary. Phytocystatins are reversible inhibitors of cysteine peptidases that are found naturally in plants. In plants, they have several biological and physiological functions, such as the regulation of endogenous processes, defense against pathogens, and response to abiotic stress. Previous studies performed by our research group have reported high inhibitory activity and potential agricultural and medical applications of several sugarcane cystatins, including CaneCPI-1, CaneCPI-2, CaneCPI-3, and CaneCPI-4. In the present study, we report the characterization of a novel sugarcane cystatin, named CaneCPI-5. This cystatin was efficiently expressed in Escherichia coli, and inhibitory assays demonstrated that it was a potent inhibitor of human cathepsins B, K, and L ( Ki = 6.87, 0.49, and 0.34 nM, respectively). The ability of CaneCPI-5 to bind to dental enamel was evaluated using atomic force microscopy. Its capacity to protect against initial enamel erosion was also tested in vitro via changes in surface hardness. CaneCPI-5 showed a very large force of interaction with enamel (e.g., compared with mucin and casein) and significantly reduced initial enamel erosion. These results suggest that the inclusion of CaneCPIs in dental products might confer protection against enamel erosion.

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3.

Medical image segmentation has gained greater attention over the past decade, especially in the field of image-guided surgery. Here, robust, accurate and fast segmentation tools are important for planning and navigation. In this work, we explore the Convolutional Neural Network (CNN) based approaches for multi-dataset segmentation from CT examinations. We hypothesize that selection of certain parameters in the network architecture design critically influence the segmentation results. We have employed two different CNN architectures, 3D-UNet and VGG-16, given that both networks are well accepted in the medical domain for segmentation tasks. In order to understand the efficiency of different parameter choices, we have adopted two different approaches. The first one combines different weight initialization schemes with different activation functions, whereas the second approach combines different weight initialization methods with a set of loss functions and optimizers. For evaluation, the 3D-UNet was trained with the Medical Segmentation Decathlon dataset and VGG-16 using LiTS data. The quality assessment done using eight quantitative metrics enhances the probability of using our proposed strategies for enhancing the segmentation results. Following a systematic approach in the evaluation of the results, we propose a few strategies that can be adopted for obtaining good segmentation results. Both of the architectures used in this work were selected on the basis of general acceptance in segmentation tasks for medical images based on their promising results compared to other state-of-the art networks. The highest Dice score obtained in 3D-UNet for the liver, pancreas and cardiac data was 0.897, 0.691 and 0.892. In the case of VGG-16, it was solely developed to work with liver data and delivered a Dice score of 0.921. From all the experiments conducted, we observed that two of the combinations with Xavier weight initialization (also known as Glorot), Adam optimiser, Cross Entropy loss (GloCEAdam) and LeCun weight initialization, cross entropy loss and Adam optimiser LecCEAdam worked best for most of the metrics in a 3D-UNet setting, while Xavier together with cross entropy loss and Tanh activation function (GloCEtanh) worked best for the VGG-16 network. Here, the parameter combinations are proposed on the basis of their contributions in obtaining optimal outcomes in segmentation evaluations. Moreover, we discuss that the preliminary evaluation results show that these parameters could later on be used for gaining more insights into model convergence and optimal solutions.The results from the quality assessment metrics and the statistical analysis validate our conclusions and we propose that the presented work can be used as a guide in choosing parameters for the best possible segmentation results for future works.