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Sodium Glucose co-transporter 2 inhibitors (SGLT2) paved their way into traditional science books less than a decade ago as a new class of drugs treating diabetes. However, the ongoing discovery of their ever-widening array of uses shows that we are still yet to tap into their full potential. SGLT2 inhibitors or the “gliflozins” selectively target SGLT2 co-transporters in proximal tubules of the nephron. The inhibition reduces the renal threshold for glucose reabsorption, resulting in glucosuria and lowering blood glucose levels. They have added benefits in kidney and cardiovascular outcomes in diabetics. These positive reno-protective effects are not just exclusively for diabetic patients- non-diabetic chronic kidney disease (CKD) may benefit from gliflozins. Ig-A nephropathy (IGAN) is the most common glomerulonephritis worldwide. There is no population-based prevalence in Pakistan, but various centres have reported a prevalence between 2-20.83%(1).A multitude of drug candidates have been investigated to halt disease progression, including RAAS inhibitors, steroids and immunosuppressants, but have not shown significant utility. ---Continue

How attitudes toward neuroanatomy and preferences of studying resources vary among neurosurgeons is unknown. The impact of the coronavirus disease 2019 (COVID-19) pandemic on anatomy learning habits is also yet to be elucidated. In this study, we explore these objectives, to guide the development of future neurosurgeon-tailored anatomy education and resources.This was a 2-stage, cross-sectional study design comprising a local pilot survey followed by a structured 17-item questionnaire, distributed to both neurosurgical trainees and consultants. Grade and nationality differences in sentiment agreement were statistically compared.A total of 365 responses were received from 32 countries (overall response rate, 23.2%). Neuroanatomy is highly regarded among most neurosurgeons and takes a central role in their professional identity. Yet, 69% of neurosurgeons wanted to spend more time learning. Common study prompts included perceived operative complexity, lack of familiarity and teaching. Financial barriers and motivation were obstacles limiting neuroanatomy learning, more so among trainee neurosurgeons, with personal commitment barriers significantly varying with geographic location. Surgical relevance, accessibility, and image quality were important factors when selecting anatomy resources, with cost and up-to-datedness being important for juniors. The COVID-19 pandemic saw a shift toward virtual resources, particularly affecting United Kingdom-based trainees.Although neuroanatomy is well regarded, barriers exist that impede further neuroanatomy learning. Neurosurgical training programs should tailor anatomy education according to the seniority and background of their residents. Furthermore, resources that are surgically relevant and accessible and are of high image quality are more likely to be better used.

Over the last decade, many advancements have been made in the management of low-grade gliomas (LGGs). Overall survival outcomes are correlated with factors such as postoperative residual volumes and specific tumor biomolecular profiles such as IDH mutation status. It is unclear whether these advancements have benefited LGG patients in Africa. This scoping review protocol outlines how the authors will evaluate the epidemiology, presentations, management and outcomes of LGGs in Africa.MEDLINE, Embase and African Journals Online will be searched from database inception to date in order to identify the relevant studies. Patients of all ages with histologically and/or radiologically confirmed LGGs that were managed in an African country will be included. Surgical and chemoradiation management of LGG tumours will be considered. Original research, reviews, commentaries, editorials and case reports will be included.Primary outcomes of the review will include LGG management, morbidity and mortality. Secondary outcomes include epidemiology and recurrence of LGGs.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research as well as health system strengthening efforts by policymakers and stakeholders.The protocol has been registered on the Open Science Framework (OSF; registration link:LGGs account for 17% to 22% of total brain tumours and have a median survival time between 5.6 and 13.3 years.Despite many recent advancements in the management of LGGs, there is a paucity in the data within the African landscape.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research and policymaking efforts.

Sellar, suprasellar or parasellar masses refer to space-occupying lesions that arise from the area surrounding the pituitary gland and many other vital structures, which can impact quality of life if damaged. Therefore, optimal management by a multidisciplinary team, which includes neurosurgeons, would be required to ensure that patients receive timely intervention to prevent long-term co-morbidities. The landscape of management of these masses in high-income countries are well described in the literature, however, there is a lack of clarity in the counterpart low- and middle-income countries, thus necessitating an evaluation of the literature. This protocol outlines how we will conduct our scoping review on the topic of interest. MEDLINE, Embase, Global Index Medicus and African Journals Online will be searched from year 2000 to date in order to identify the relevant studies. Patients with a sellar, suprasellar or parasellar masses managed in an LMIC will be included. Surgical, medical and conservative management of the relevant masses will be considered. Articles in English and French will be included. Primary outcome will describe the management of sellar, suprasellar, or parasellar masses in LMICs. Secondary outcomes will include describing the epidemiology, presentation and outcomes of patients with sellar, suprasellar or parasellar masses. This scoping review will be the first to evaluate the current landscape of the management and outcomes of sellar, suprasellar and parasellar masses in LMICs, highlighting important themes that may be used to guide further research as well as health system strengthening efforts by policymakers, governments and stakeholders.

Pharmacological prophylaxis of venous thromboembolism (VTE) requires nuanced decision-making to balance the risk of VTE against haemorrhage. This problem is compounded in neurosurgical patients, in whom postoperative intracranial haemorrhage (ICH) may be catastrophic, compared to non-neuraxial bleeding in other types of surgery. Current major guidelines recommend caution when using pharmacological prophylaxis in elective cranial surgery, but incorporate low-quality evidence and lack precise guidance on timing and duration of anticoagulation.We aimed to answer the following questions for patients undergoing elective cranial surgery: (1) when is the optimal time to initiate postoperative anticoagulation, and (2) how long should postoperative anticoagulation be continued for? In this systematic review, we screened randomised and non-randomised studies reporting original data on pharmacological VTE prophylaxis in elective cranial surgery. Outcomes of interest were VTE and ICH.Three retrospective, single-centre observational studies met eligibility criteria, with a total of 923 participants. Meta-analysis was not performed due to a high risk of bias across all studies. Through narrative synthesis, we found that patients who developed VTE were significantly more likely to receive their first postoperative dose at a later time (mean: 144 vs. 29 h,The limited evidence favours earlier initiation and shorter courses of thromboprophylactic anticoagulation. These findings are specific to patients undergoing surgery for meningioma or glioma and may not apply to other populations. Randomised controlled trials or robustly designed observational studies are necessary to establish a clearer evidence base.

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Objective: How attitudes towards neuroanatomy and preferences of studying resources vary by grade or geographical location amongst neurosurgeons is currently unknown. The impact of the COVID-19 pandemic on anatomy learning habits is also yet to be elucidated. In this study we explore these objectives, aiming to guide the development of future neurosurgeon-tailored anatomy education and resources.Methods: This was a 2-stage, cross-sectional survey. A local pilot survey was followed by a structured 17-item questionnaire which was distributed to neurosurgical trainees and consultants via social media, newsletters, and mailing lists. Survey data was collected from 20/09/2021 to 20/12/2021. Grade and nationality differences in sentiment agreement and frequency were statistically compared.Results: A total of 365 responses were received, with an overall survey response rate of 23.2% (25% U.K. response rate; 15.2-30.7% international response rate). Overall, neuroanatomy is highly regarded among most neurosurgeons and takes a central role in their professional identity. Yet, 69% of neurosurgeons stated they would like to spend more time learning neuroanatomy. Frequent prompts to study included perceived operative complexity (90%), lack of familiarity (92%) and teaching (89%) whereas factors such as operative responsibility and patient risk significantly varied by grade. Grade-dependent obstacles limiting neuroanatomy learning included financial barriers and lack of motivation, with personal commitments barriers significantly varying across geographical location. Surgical relevance (89%), accessibility (90%) and image quality (90%) were important factors when selecting anatomy resources, with cost and up-to-datedness being significantly more important to trainees than consultants. Online image searches, case-based and multidisciplinary discussions were the most frequently used learning method outside of theater. Finally, the COVID-19 pandemic saw a shift towards online or virtual resources, whilst also causing a greater impact on neuroanatomy learning amongst trainees and U.K.-based neurosurgeons.Conclusions: Attitudes towards neuroanatomy and preferences of resources vary by grade and location of neurosurgeons. Although neuroanatomy is a highly regarded, barriers exist which impede those who wish to pursue further neuroanatomy learning. Neurosurgical training programs should tailor anatomy education according to the seniority and background of their residents. Furthermore, resources that are surgically relevant, accessible and of high image-quality or more likely to be better utilized. Remedial learning after the COVID-19 pandemic must account for persistent gaps in teaching, utilizing cadaveric and operative exposure which cannot be replicated virtually.

Introduction Early surgery is recommended in hip fractures to reduce morbidity and mortality. Surgery is often delayed in patients on novel direct oral anticoagulants (DOACs). The purpose of our study was to investigate the impact of DOACs on patients with hip fractures. Methods A retrospective comparative analysis was performed. A total of 766 patients presented with neck of femur fractures in the study period. Patients under the age of 60, those managed conservatively and those on alternative anticoagulation (including warfarin, clopidogrel and aspirin) were excluded. Forty-seven (6.1%) patients were on DOACs, to which a group of 47 patients was matched for age, gender, fracture type and intervention to minimise confounding. Primary outcome data on time to surgery (TTS), pre-/postoperative haemoglobin, haemoglobin drop, length of stay (LOS) and 30-day mortality were collected, as well as secondary outcome data on blood transfusion and wound complications. The Charlson Comorbidity Index (CCI) was calculated for all patients. Results The mean Charlson Comorbidity Index was significantly increased in the DOAC group (p0.0001). The mean time to surgery was 49.5 hours in the DOAC group versus 31.3 hours in the control group (p=0.0002). Haemoglobin drop for DOAC patients was 16.9 g/L and 15.9 g/L for control patients (p=0.6). Similarly, no significant increase in transfusion was required (p=0.74). Six DOAC patients and two control group patients died within 30 days of surgery (p=0.13). Wound complications were seen in five (10.6%) patients on DOAC and two (4.2%) patients in the control group (p=0.02). Conclusion The results demonstrate statistically significantly higher comorbidities, delay in surgery and higher wound complications in patients on DOAC but no significant difference in haemoglobin drop, blood transfusion and mortality.

Background: Concurrent thyroid cancer and hyperthyroidism is a rare finding. The frequency of this association is very variable. A rare case of papillary thyroid cancer associated with hyperthyroidism is described here. Case: A 49-year-old male presented to the authors’ outpatient clinic with complaints of a painless left-sided anterior neck swelling that had persisted for the past 8 months. He also reported weight loss for the same duration. The anterolateral swelling was non-tender, asymmetrical, mobile, and rubbery. Investigations: Biochemical analysis confirmed hyperthyroidism. Ultrasound examination of the neck showed a well-defined, solid, and cystic lesion in the left lobe and isthmus of thyroid gland. The solid portion had few specks of calcification. A radioactive thyroid scan showed increased tracer uptake in the left lobe. Papillary carcinoma of thyroid origin was discovered after fine-needle aspiration of the left anterior cervical lymph node. After preparation, a total thyroidectomy was done. Examination of histopathology confirmed papillary thyroid carcinoma. Treatment: Following radioactive thyroid ablation, the patient was started on suppressive doses of thyroxine daily. Conclusion: Although thyroid cancer with hyperthyroidism is a rare finding, it should not be disregarded. To avoid missing this unusual yet uncommon discovery, a detailed history and physical examination should be performed, as well as all required investigations.

IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

IntroductionThe protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.Methods and analysisThe scoping review will be conducted in accordance with the Arksey and O’Malley’s framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.Ethics and disseminationThis study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.

Idiopathic hypogonadotropic hypogonadism (IHH) is a medical condition where there is a deficiency or insensitivity of gonadotropin-releasing hormone (GnRH) without a known cause. Not only are the sexual characteristics of a person affected by this condition but also are the psychological and physical development, thus necessitating its early recognition and treatment. This research was carried out to identify the laboratory parameters and to present symptoms of the patients with complaints of IHH.This retrospective, center, single-center, cross-sectional study was carried out in Aga Khan University from December 2000 until December 2020 on the patients that presented to the clinic with IHH. The patients included in the study were those that presented with hypogonadism, a low concentration of sex steroid hormone, and an abnormal gonadotropin level without any expansive pituitary or hypothalamic lesion.Seventy nine patients presenting with IHH were included with their mean age of 24.2 ± 7.5 years. Of these, 64 (81.0%) had genital atrophy, 50 (63.6%) showed an absence of secondary sexual characteristics, 53 (67.1%) complained of infertility, 44 (55.7%) had not shown signs of puberty, 52 (65.8%) had erectile dysfunction, 46 (58.2%) had a decrease in libido, 11(13.9%) had a previous familial history, 24 (30.3%) had gynecomastia, 9 (11.4%) had non-descended testes, and 6 (7.6%) had anosmia. These patients had serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels of 26.3 ± 60, 1.3 ± 2.4, and 2.7 ± 5.0 (IU/L), respectively.Thus, it can be stated that small genitalia is the most common complaint among patients with IHH, followed by infertility and lack of secondary sexual characteristics. The testosterone level in serum is also found to be low among these patients.

We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing stereoelectroencephalography (SEEG)-guided resective epilepsy surgery.Patients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Outcome was classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.Twenty-nine patients underwent resection of whom 22 had sufficient imaging data for analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p 0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p = 0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome.The percentage of SOZ contacts resected was not associated with SF in children undergoing SEEG-guided resective epilepsy surgery.Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.

Background: The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection.Methods: A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms “neurosurgery,” “cranial surgery,” “spine surgery,” and “survey” and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact-test, Wilcoxon rank-sum test, and Spearman's correlation.Results: We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI = 22.5–28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI = 70.0–80.6%) and there was a significant increase in dissemination via social media during the pandemic (OR = 3.50, 95% CI = 1.30–12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5, P = 0.01) and had higher total responses (247.0 vs. 206.4, P = 0.01), but lower response rates (34.5 vs. 51.0%, P < 0.001) than pre-COVID-19 surveys.Conclusion: The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.

Botrytis cinerea is one of the most destructive ascomycete pathogens affecting crops worldwide and causing severe yield losses. Broad-spectrum fungicides are used to control fungal pathogenic diseases, but pathogens develop resistance toward these fungicides through point mutations. In this study, we isolated and observed resistance mechanisms in B. cinerea. All five isolates considered in this study belonged to this pathogen species, which affects tomato fruits. The phenotypic resistance profile was analyzed in terms of specific resistance to multiple succinate dehydrogenase inhibitors (SDHI) and benzimidazole-based fungicides (boscalid, BosR, flypyram, FluR, carbendazim, CarMR), (BosRFluMRCarMR), (BosMRFluRCarR), (BosMRFluMRCarMR) (BosSFluSCarS). The Half maximal effective concentration (EC50) (µg/mL) value ranges were 1.10–3.51 forboscalid-resistant isolates, 1.05–2.25 for fluopyram-resistant isolates, and 0.89–3.82 for carbendazim-resistant isolates. To investigate the molecular mechanism of resistance, the Sdh-B and β-tubulin genes of the respective SDHI-resistant and carbendazim-resistant isolates were amplified, and their amino acid sequences were compared with those of sensitive strains. The SDHI-resistant isolate of B. cinerea showed mutations G282A and G372V, while the carbendazim-resistant one presented mutation E947A. Integrated disease management and the application of new fungicides with low resistance risk should be implemented in order to reduce the risk of resistance development in B. cinerea.

Introduction Despite recent advancements in the management of low-grade gliomas (LGGs), there is a paucity in the data within the African landscape. We aim to evaluate the epidemiology, management, and outcomes of LGGs in Africa. Methods Systematic searches of MEDLINE, Embase and African Journals Online were performed from database inception to January 27, 2021, for studies reporting on LGGs in Africa. Pooled statistics were calculated using measures of central tendency and spread. Results 554 unique studies were identified, of which 25 were included. The mean age of patients was 15.7 years (95% confidence interval (CI): 11.8–19.6) and 56.4% were male (95% CI: 55.6–62.6%). Most patients had solitary lesions (86.0%, 95% CI: 82.8–89.1%) located in the infratentorial region (71.6%, 95% CI: 66.1–77.1%). Most LGGs received histopathological diagnosis (71.7%, 95% CI: 69.2–74.2%) and astrocytoma was the most common type (81.1%, 95% CI: 78.5–83.7%). 37 patients had awake surgery (3.1%, 95% CI: 2.0–4.0%) and there were no reports of molecular pathology testing, intraoperative neuroimaging, or 5-aminolevulinic acid. Gross total resection was achieved in 74.8% (95% CI: 69.6–80.0%) and there was a recurrence rate of 1.7% (95% CI: 0.9–2.4%), with a mean follow-up of 19.4 months (95% CI: 6.9–31.9). Conclusion LGGs are underreported in Africa. We found a lag in the uptake of techniques established in high-income countries for improving patient outcomes. Future efforts will require further training and funding in molecular pathology testing and advanced surgical adjuncts., Highlights • Highlights for ‘Management and Outcomes of Low Grade Gliomas in Africa’. • The burden of low-grade gliomas in Africa is underreported. • There was no reported use of molecular pathology testing or intraoperative adjuncts. • There were low rates of awake surgery for patients with supratentorial tumours. • There was a lag in the uptake of techniques and technologies used in the management of low-grade gliomas.

Wireless chip area network which enables wireless communication among chips fosters development in wireless communication and it is envisioned that future hardware system and developmental functionality will require multimaterial. However, the traditional system architecture is limited by channel bandwidth-limited interfaces, throughput, delay, and power consumption and as a result limits the efficiency and system performance. Wireless interconnect has been proposed to overcome scalability and performance limitations of multihop wired architectures. Characterization and modeling of channel become more important for specification of choice of modulation or demodulation techniques, channel bandwidths, and other mitigation techniques for channel distortion and interference such as equalization. This paper presents an analytical channel model for characterization, modeling, and analysis of wireless chip-to-chip or interchip interconnects in wireless chip area network with a particular focus on large-scale analysis. The proposed model accounts for both static and dynamic channel losses/attenuation in high-speed systems. Simulation and evaluation of the model with experimental data conducted in a computer desktop casing depict that proposed model matched measurement data very closely. The transmission of EM waves via a medium introduces molecular absorption due to various molecules within the material substance. This model is a representative of channel loss profile in wireless chip-area-network communication and good for future electronic circuits and high-speed systems design.

Background: The incidence of non-traumatic intracranial haemorrhage among neonates is less than among adults. However, the outcomes are generally poor, with high rates of morbidity and mortality. Non-traumatic intracranial haemorrhage can cause a sudden increase in intracranial pressure, requiring emergency craniotomy for evacuation. Methods: We report 4 cases following craniotomy for non-traumatic acute intracranial haematoma in very young children. The surgical technique and postoperative course are discussed, with emphasis on dural repair to avoid resistant pseudomeningocele. Results: Despite successful management of the acutely raised intracranial pressure, all patients afterwards developed tense pseudomeningoceles and required formal dural repair. This led to a change in institutional practice and modifications to the surgical technique. Conclusion: The authors highlight the postoperative occurrence of resistant pseudomeningoceles in young children after clot evacuations and leaving the dura open. They describe the surgical procedures to avoid these pseudomeningoceles.

Background: SGLT-2 inhibitors are a group of oral medications that work independently of insulin working as anti-diabetics by enhancing the excretion of glucose. The purpose of our study was to assess the improvement in terms of HbA1c, weight, blood pressure and BMI and the hepatics and renal effect in terms of SGPT and Creatinine in patients already on three oral glucose lowering agents when SGLT-2 inhibitor was added to their medications. Methods: This retrospective, real world, single center study included 99 patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly control type 2 diabetes. Data was recorded at three times, before the addition of SGLT-2 inhibitor and then at 3 and 6 month follow up after the drug had been added in patient’s medications. Physical parameters namely weight, BMI and blood pressure were recorded in the clinic while HbA1c, SGPT and Creatinine were checked by laboratory. Results: Improvement was seen in all parameters at both 3 and 6 month follow up interval. The reduction in HbA1c was statistically significant (P-value < 0.001) with (Mean Reduction [Standard Deviation)) 0.81[1.02] % at 3 months and 1.07[1.11] % at 6 months. Weight was also significantly reduced (P-value < 0.001) with (MR [SD]) 1.83[2.32] kg at 3 and 4.02[6.04] kg at 6 months. Statistically significant reduction (P-value < 0.001) in BMI was also seen with 0.69[0.95] kgm-2 at 3 months and 2.13[3.41] kgm-2 at 6 months of follow up. The systolic blood pressure showed significant reduction (P-value < 0.05) of 5.9[15.76] mmHg at 3 months and 6.37[18.33] mmHg at 6 months. The creatinine and SGPT values of the patient showed minimal variation over the course of these 6 months of follow up. Conclusion: Our study showed that SGPT-2 can be reliably used in patients in which diabetes is not being controlled by other glucose lowering agents and is safe for use in patients in which hepatic and renal function needs to be preserved. Keywords: SGLT-2 inhibitors, Type 2 Diabetes Mellitus, Pakistan

Ship detection in SAR images is a challenge and has traditionally been carried out using pixel based algorithms such as CFAR, in this paper we use a deep learning based algorithm called YOLOv2 for the aforementioned task and test its performance on three datasets, at different resolution and quality, with two datasets called DS1 and DS2 consisting of over 400 high resolution SAR images with a high ship to image ratio, in which DS1 consists of raw, unfiltered images and the third dataset called DS3 which consists of full scale 5500 single ship images of lower resolution. High detection results are observed which further improve once we train the network by applying transfer learning using weights from DS3 by truncating the last layer of the network and continue training on the combined first two datasets.

A wideband CG---CS-based balun-LNA is proposed, with high linearity (IIP2 and IIP3) for multi-standard radio applications. By taking advantage of the common-gate transistor's noise and distortion cancellation property in CG---CS-based balun topology, this balun-LNA just focuses on CS-stage's noise and linearity improvement. Post-distortion technique with a p-MOSFET as auxiliary transistor is adopted to suppress the 2nd and 3rd nonlinear terms of the main transistor in CS-stage, and then across 0.2---4.35 GHz, above 34 dBm IIP2 and 7.5 dBm IIP3 with typical process corner is achieved. In addition, in order to reduce the considerable substrate noise from the main transistor in CS-stage, a large resistor is connected between its bulk and source terminal, which reduces the substrate noise contribution from 7.68 to 0.2 % and improves the noise figure (NF) at 1 GHz about 0.38 dB. This balun-LNA was designed in 0.18-μm CMOS, operates from 0.2 to 4.35 GHz, and dissipates 17.8 mW with 1.5-V supply. With typical process corner, this amplifier provides 17.2-dB maximum voltage gain and 2.5---3.2 dB NF.

Majority of the Kargil sheep populations are indigenous. Very scanty information is available for morphological characterization of Purky sheep population. Therefore, the present study was undertaken with the objectives to study the morpho-metric characteristics and body measurements for phenotypic characterization of the local sheep. A stratified random sample survey was conducted on various parameters (horn size, tail size, chest girth, punch girth, body length, height at wither and body weight) in seven different age groups. Data were collected randomly from 510 sheep of either sex. The local sheep population of Kargil which was selected for the present investigation is named as ‘Purky’ by the name of the community that reared this breed. In Purky sheep white body colour was predominant in both the sexes. The sheep breed was of low to medium body weight. The chest girth, punch girth, height at withers of Purky sheep showed it to be medium sized. Sex had significant effect (P is less than 0.05) on height at wither only. For males the least squares means were higher for all the traits of all age groups baring few exceptions. The phenotypic correlations of age groups with different morpho-metric traits were very high. The phenotypic correlations of body weight with other body measurements like tail size, chest girth, paunch girth, body length and height at wither were very high. Further studies should be carried out to fully exploit their genetic potential and to register the breed and in-situ conservation of this population.