Mean Fall Research Articles

Improving HbA1c Control in Type1 or Type2 Diabetes Using Flash Glucose Monitoring: A Retrospective Observational Analysis in Two German Centres.

IntroductionThe aim of this study was to evaluate change in laboratory-measured HbA1c in patients with either type 1 diabetes (T1D) or type 2 diabetes (T2D) on insulin therapy following initiation of the FreeStyle Libre™ flash glucose monitoring system.MethodsThis was a retrospective observational study on adults with T1D or T2D on insulin, who were started on the FreeStyle Libre system as part of standard care. HbA1c was recorded at initiation and at 3-month intervals thereafter.ResultsThe analysis included 131 patients with T1D and 176 patients with T2D on insulin. Mean HbA1c decreased significantly by 3 months following initiation of the FreeStyle Libre system, both in T1D (− 0.75%, p < 0.001) and in T2D (− 0.54%, p < 0.001). Reductions were maintained for 12 months. Change from 3 to 12 months was not significant either in T1D or T2D. Subgroup analysis showed significant reduction in patients with a baseline HbA1c > 7.5–10%, both in T1D (− 0.59%, p < 0.001) and in T2D on insulin (− 0.62%, p < 0.005) at 12 months. Reductions for subjects with HbA1c > 10% were − 4.66% in T1D and − 3.73% in T2D. No change was seen for subjects with a baseline HbA1c ≤ 7.5% (58 mmol/mol). Linear regression confirms that baseline HbA1c is strongly negatively correlated with subsequent change in HbA1c in T1D and in T2D.ConclusionsPatients with T1D or T2D show a reduction in HbA1c by 3 months following initiation of the FreeStyle Libre system. The mean fall in HbA1c at 3 months is strongly negatively correlated with starting HbA1c. This reduction is maintained over 12 months. The significant benefit is seen in patients with a starting HbA1c > 7.5% (58 mmol/mol).

Seasonal Sampling Influence on Population Dynamics and Yield of Channel Catfish and Walleye in a Large Great Plains Reservoir

AbstractFish samples collected during different times of the year can be subject to various biases, but the influence of sampling during different seasons on population dynamics and yield metrics in large reservoirs is not well reported. This study compared the age structure, growth, mortality, and yield estimates of Channel Catfish Ictalurus punctatus and Walleye Sander vitreus collected during spring and fall with standardized gill netting in a large Nebraska, USA, reservoir. We sampled fish by using the Nebraska Game and Parks Commission standardized gill net survey methodology. We estimated ages from pectoral spines of Channel Catfish and from sagittal otoliths of Walleye, derived age-length keys, and compared mean spring and fall ages with t-tests. We compared spring and fall von Bertalanffy growth curves with likelihood-ratio tests and mortality estimates from weighted catch curves with an analysis of variance. We visually compared spring and fall yield estimates derived from yield-per-recruit models to assess the impact of variable population dynamics estimates. Estimates of mean age, growth coefficient, mean asymptotic length, total annual mortality, and yield of Channel Catfish did not differ between spring and fall. Conversely, older age structure of Walleye in spring resulted in lower estimates of total annual mortality and higher yield than in fall. Estimates of mean asymptotic length and growth coefficient differed between spring and fall for female Walleye, and mean asymptotic length, growth coefficient, and theoretical time at age 0 estimates varied between spring and fall for male Walleye. Fall yield estimates were substantially lower than spring estimates for both male and female Walleye. These results demonstrate that the sample collection season can impact population dynamics estimates for certain species, whereas others remain relatively unaffected.

Concomitant weekly cisplatin-based chemoradiotherapy in head and neck cancer: the value of a second measured glomerular filtration rate during treatment.

To assess the efficacy of the second measured glomerular filtration rate (GFR) during the course of weekly cisplatin-based chemoradiotherapy in head and neck cancer. Data was collected on consecutive 221 head and neck cancer patients who underwent cisplatin-based chemoradiotherapy. 68% patients managed to complete at least five out six proposed cycles of cisplatin, with a cumulative dose of ≥200 mg/m2. 181 patients underwent second measured GFR and it showed a mean fall in measured GFR by 12.0 ml/min/1.73 m2 (p < 0.0001). Out of these 181 patients, in 16 patients (9%), the decision to discontinue cisplatin was purely based on a low second measured GFR (below 50 ml/min/1.73 m2). Our study has shown that obtaining a second measured GFR is valuable in 9% of these patients. We propose that this should be considered as a standard procedure in these settings and also should be considered incorporating this additional safety measure, into future clinical trials as a mandatory procedure. To the best of author's knowledge, this is first study of its kind. The results of our study suggest that it should be a standard procedure of obtaining a second GFR in these settings.

Infall of galaxies onto groups

Context. The growth of the structure within the Universe manifests in the form of accretion flows of galaxies onto groups and clusters. Thus, the present-day properties of groups and their member galaxies are influenced by the characteristics of this continuous infall pattern. Several works both theoretical (in numerical simulations) and observational, have studied this process and provided useful steps for a better understanding of galaxy systems and their evolution. Aims. We aim to explore the streaming flow of galaxies onto groups using observational peculiar velocity data. The effects of distance uncertainties are also analyzed, as well as the relation between the infall pattern and the group and environment properties. Methods. This work deals with the analysis of peculiar velocity data and their projection in the direction of group centers, in order to determine the mean galaxy infall flow. We applied this analysis to the galaxies and groups extracted from the Cosmicflows–3 catalog. We also used mock catalogs derived from numerical simulations to explore the effects of distance uncertainties on the derivation of the galaxy velocity flow onto groups. Results. We determine the infalling velocity field onto galaxy groups with cz &lt; 0.033 using peculiar velocity data. We measured the mean infall velocity onto group samples of different mass ranges, and also explored the impact of the environment where the group resides. Far beyond the group virial radius, the surrounding large-scale galaxy overdensity may impose additional infalling streaming amplitudes in the range of 200−400 km s−1. Also, we find that groups in samples with a well-controlled galaxy density environment show an infalling velocity amplitude that increases with group mass, consistent with the predictions of the linear model. These results from observational data are in excellent agreement with those derived from the mock catalogs.

Thermal balance of spinal cord injured divers during cold water diving: A case control study.

This study compared the thermal balance of spinal cord injured (SCI) divers and able-bodied (AB) divers during recreational cold-water dives. Ten divers (5 AB, 5 SCI) in matched pairs dived in a shallow lake (temperature 6°C) for 30 to 36 min wearing 5 mm 'Long John' neoprene wetsuits. A gastrointestinal temperature radio pill recorded gastro-intestinal temperature (Tgi) prior to, immediately after and at 5, 10, 15, 30, 60, 120 min post-dive. Subjective ratings of temperature perception were recorded concomitantly using a visual analogue scale (VAS). No difference between SCI and AB divers in Tgi before the dive was observed (P = 0.85). After the dive, SCI divers cooled significantly more than AB at all measured time intervals (P < 0.001). Post dive, the mean maximum fall in Tgi during the recovery phase in SCI divers was 0.85°C (SD 0.20) and in the AB group was 0.48°C (0.48). In addition, there was greater individual variation in SCI divers compared to AB divers. There were no statistically significant differences in temperature perception between the groups either before or at any time after the dives. In contrast to AB divers, divers with SCI were unable to maintain Tgi during short shallow dives in 6°C water and their temperatures fell further post-dive. The reduction in Tgi was not reflected in the subjective ratings of temperature perception by the SCI divers. The study was too small to assess how the level of spinal injury influenced thermal balance.

Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up.

Background:The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period.Materials and Methods:This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding.Results:The median age of the patients was 5.5 months (3.5–96 months), and the median body weight was 4.7 kg (3.2–22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7–23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery.Conclusions:Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.

Hypophosphataemia after ferric carboxymaltose is unrelated to symptoms, intestinal inflammation or vitamin D status

BackgroundIntravenous iron replacement is recommended for iron-deficient patients with inflammatory bowel disease (IBD), but may be associated with hypophosphataemia, predisposing to osteomalacia and fractures. This study aimed to evaluate the incidence and risk factors for hypophosphataemia following intravenous ferric carboxymaltose (FCM) in patients with IBD.MethodsThis prospective observational study of patients with and without IBD evaluated serum phosphate for 28 days following intravenous FCM, and assessed associations with symptoms, markers of inflammation and vitamin D status.ResultsTwenty-four patients with IBD (11 with Crohn’s disease [CD], 13 with ulcerative colitis [UC], mean age 45 years [range 19–90], 7 female), and 20 patients without IBD (mean age 56 [22–88] y, 11 female), were included. Overall, serum phosphate declined by a mean of 36% at Day 7, with a mean fall of 42% (SD 19%) at some time point over 28 days (p < 0.001). Twenty-four of 44 (55%) patients developed moderate to severe hypophosphataemia (serum phosphate < 0.6 mmol/L). No differences between patients with and without IBD were seen, but patients with CD had greater decline in phosphate than those with UC. There was no association between hypophosphataemia and symptomatic adverse events, faecal calprotectin, C-reactive protein, albumin, platelet count, 25(OH) vitamin D, or 1,25(di-OH) vitamin D. Serum phosphate < 1.05 mmol/L on Day 2 predicted susceptibility to moderate-severe hypophosphataemia (OR 7.0).ConclusionsHypophosphataemia following FCM is common, unrelated to symptomatic adverse events, baseline intestinal or systemic inflammation, or vitamin D status.

Shapes and Fall Speeds of Freezing and Frozen Raindrops

AbstractThis study investigates the shapes and fall speeds of freezing and frozen raindrops through field observations using an instrument called the high-speed optical disdrometer (HOD) that we developed recently. Our field observations showed that while the shapes of all of the observed freezing raindrops and a portion of the frozen raindrops (39% of the frozen raindrops that are larger than 1.0 mm in volume equivalent diameter D) resemble the shapes of warm raindrops, majority of frozen raindrops (61% of the frozen raindrops with D &gt; 1.0 mm) exhibited a distinct feature such as a spicule, bulge, cavity, or aggregation. Field observations of axis ratios (i.e., ratio of the vertical to horizontal chord) and fall speeds were compared with the predictions of available models. Separate empirical axis ratio parameterizations were developed for the freezing and frozen raindrops using the HOD field observations and extensions to an available shape model were also incorporated. For the fall speeds of freezing and frozen raindrops, field observations demonstrated a good agreement with the predictions of the available parameterizations. Frozen raindrops showed a larger scatter of fall speeds around the mean fall speed of a given drop size than those of the freezing raindrops due to the shape variety among the frozen raindrops with the aforementioned distinct features. The drag coefficients for the observed hydrometeors were compared with the predictions of the available drag coefficient models. Separate “drag coefficient–Reynolds number” relationships for freezing and frozen raindrops were developed.

Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center

IntroductionAlthough there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. Patients and methodsA Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. ResultsOf the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). ConclusionsThe observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.

MP13: Injuries presenting to the ED following jumps from bridges into water: a multi-agency retrospective case series

Introduction: Suicidal jumps from bridges into water are a unique blunt trauma mechanism. Impact into water produces substantial variation in injuries as compared to falls onto hard surfaces. Outcomes can be further complicated by submersion injuries. We identified cases through a multi-agency review in order to analyze injury patterns seen in EDs. Methods: Cases in British Columbia's Lower Mainland of jumps from bridges &gt;12m into water between 2006 and 2017 were identified by retrospective review of Coast Guard and Police records. Records pertaining to identified incidents were located in ambulance and then hospital records. This multi-agency approach was necessary to generate a comprehensive case series, as case identification was not possible at the hospital level. Patient hospital charts were abstracted and injury incidence rates were analyzed. Results: Records were available for 41 of 52 patients. The population was 63% (26/41) male, median age 37 (IQR 29-48). Thirty-two cases were admitted to hospital, seven were deceased in the ED, one was discharged, and disposition is unknown for one. Most patients (85%) presented to Level One trauma centers. Bridge heights ranged from 15m to 70m; the mean fall height was 40.1m. Pulmonary injuries were nearly universal, including pneumothorax (51%), haemothorax (22%), and pulmonary infiltrate (34%). The primary cardiovascular concern was cardiac arrhythmia (51%). A quarter of cases had intraabdominal lacerations or ruptures (27%). Vertebral fractures at all levels were frequent (59%), although there was only one case each of cord transection and contusion. Neurological injuries were rare; 59% of patients presented to the ED with GCS ≥14 and the incidence of intracranial bleeding was low (7%). Rib fractures were commonly reported (37%) along with other fractures (32%). Body temperature was reported in 24 cases with 3 reports of moderate and 6 reports of mild hypothermia. Conclusion: This case series is the first to characterize injury patterns of jumps from bridges into water in Canada. Patterns are similar to reports in the literature from other countries. However, we found lower injury severity, and higher incidences of spinal fractures and cardiac arrhythmias. The low injury severity reflects the survivorship bias inherent to the sample: data was only obtained from patients who survived to be assessed the ED. These results suggest that patients with this mechanism of injury should be treated for both suspected trauma and cold-water immersion injuries.

Individual and Environmental Factors Associated with Recurrent Falls in Elderly Patients Hospitalized after Falls.

Falls and recurrent falls cause great health and social consequences in older people. However, these problems are poorly understood in Vietnam. A cross-sectional study was performed at seven hospitals in Thai Binh province, Vietnam, to investigate the individual and environmental factors associated with recurrent falls among elderly patients hospitalized due to fall injuries in Vietnam. A history of recurrent falls within the last 12 months, sociodemographic, health, and clinical characteristics, as well as environmental conditions, were obtained via self-reported interviews. Multivariate logistic and Poisson regression models were used to identify associated factors. Overall, the mean fall episodes in the last 12 months were 1.8 (Standard deviation—SD = 1.2) episodes, and the 12-month prevalence of recurrent falls was 40.5%. The individual risk factors included not receiving fall prevention guidelines, walking with devices, loss of sensation in hand or foot, and using pain relief medications. The environmental risk factors comprised having too-high stairs and not having dry, clean, and nonslippery bathrooms. This study highlights a significantly high 12-month prevalence of recurrent falls in older patients hospitalized after falls in Vietnam. Moreover, regular assessments of functional disabilities and hazardous environmental conditions, as well as the provision of prevention programs, have potential to prevent falls and recurrent falls.

The change of rainfall kinetic energy content with altitude

Erosion is the process of land degradation due to rainfall and other environmental factors, and it can be described by indices such as the kinetic energy of rainfall (KE). Microphysical data from disdrometers have been used to determine the relationship between kinetic energy content (KEmm, in J m−2 mm−1) and rainfall intensity (R, in mm h−1). Optical disdrometer (PWS100) measurements were gathered between 2014 and 2018 at five sampling sites across Mexico, and the data analyzed to study the characteristics of KEmm–R relationships with altitude. A PWS100 unit at each of the sampling sites was collocated a few meters from a tipping-bucket rain gauge to record R simultaneously. Individual raindrops fall speeds measured with the disdrometers were found to agree well with theoretical estimations using the environmental conditions at each sampling site. The mean fall velocities indicated that raindrops detected at the continental sampling sites (medium and high altitudes) have greater speeds than those near coastal areas (low altitudes). Comparisons of the estimated KEmm for rainy periods with comparable R show greater values as the altitude increases. This result is attributed to the increase of raindrop fall speed due to the air density decrement with altitude. Exponential relations between KEmm and R based on one-minute sampling periods were fitted for each sampling site, producing high values of coefficients of determination and suggesting a good response. Finally, the maximum kinetic energy parameter, KEmax, in the empirical KEmm–R equations was found to increase with altitude. These findings indicate that the detachment of soil particles by individual drops are magnified at higher altitude locations.

The effect of DAFNE education, continuous subcutaneous insulin infusion, or both in a population with type 1 diabetes in Scotland.

To investigate the effect of DAFNE and continuous subcutaneous insulin infusion in clinical practice. Within NHS Lothian, continuous subcutaneous insulin infusion started in 2004 and DAFNE education began in 2006. We extracted anonymized data from the national database for all those aged > 18 years with type 1 diabetes having a Dose Adjustment For Normal Eating course or continuous subcutaneous insulin infusion start date (n = 4617). In total, 956 persons received DAFNE education, and 505 had received an insulin pump, 208 of whom had DAFNE education followed by insulin pump. Mean (SD) HbA1c before DAFNE education was 68 (15) mmol/mol (8.4% [1.4%]) and 66 (13) mmol/mol (8.2% [1.2%]) before continuous subcutaneous insulin infusion. In the year following DAFNE education, the mean fall in within-person HbA1c was 3.8 mmol/mol (95% CI 4.0 to 3.4; 0.3% [0.4% to 0.3%]). Those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]) experienced the largest decline (15.7 mmol/mol [1.4%]). Those in the lowest HbA1c band at initiation (< 53 mmol/mmol [7.0%]) experienced a rise. In the year following continuous subcutaneous insulin infusion initiation there was a mean fall in within-person HbA1c of 6.6 mmol/mol (6.8 to 6.4; 0.6% [0.6% to 0.6%]). In those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]), the mean fall in HbA1c was 22.2 mmol/mol (23 to 21; 2.0% [2.1% to 1.9%]). Continuous subcutaneous insulin infusion effectiveness was not different with or without DAFNE education. The effects of both interventions were sustained over 5 years. Both DAFNE education and insulin pump therapy had the greatest effect on HbA1c in those with higher baseline values. There was little difference to attained HbA1c when Dose Adjustment For Normal Eating education was introduced before insulin pump therapy.

Vertical Wind Effect on Slope and Shape Parameters of Gamma Drop Size Distribution

AbstractApproximate equations for slope Λ and shape μ parameters of the gamma raindrop size distribution (DSD) are derived from theoretical considerations on the basis of the reflectivity-weighted mean terminal velocity VT and Doppler spectral width σp of the raindrop echoes. These approximate equations are then corrected to reduce the error by using the long-term ground-based disdrometer measurements. We applied these equations on the VHF-radar measurements (i.e., reflectivity-weighted mean fall velocity and Doppler spectral width) to estimate μ and Λ aloft. The effects of the vertical wind velocity on the VHF radar-estimated μ–Λ and σp–VT values are investigated. The result shows that there is a tendency for the μ and Λ values to increase with an increase of the upward wind velocity. In addition, the terminal velocity and the spread of the DSD estimated from the precipitation echoes are strongly related to the vertical air velocity. The stronger the upward vertical air velocity is, the larger the terminal velocity and the smaller the spread of the DSD will be. The dependence of the estimated μ and Λ values on the vertical wind velocity is very likely caused by the updraft that can support and carry away the smaller raindrops in the original drop size distribution in the radar volume. Consequently, the DSDs aloft are truncated and the corresponding μ and Λ values estimated from the radar returns tend to be larger. To confirm this assertion, we intentionally truncate disdrometer-measured DSDs at small drop size end and calculate corresponding μ and Λ values. The results show that the distribution patterns of the μ–Λ scatter diagrams of the truncated DSDs bear strong resemblance to those of the radar observations, both of which are very different from those obtained on the ground.

Drill and broadcast establishment methods influence interseeded cover crop performance in organic corn

AbstractOrganic grain producers are interested in interseeding cover crops into corn (Zea mays L.) in regions that have a narrow growing season window for post-harvest establishment of cover crops. A field experiment was replicated across 2 years on three commercial organic farms in Pennsylvania to compare the effects of drill- and broadcast-interseeding to standard grower practices, which included post-harvest seeding cereal rye (Secale cereale L.) at the more southern location and winter fallow at the more northern locations. Drill- and broadcast-interseeding treatments occurred just after last cultivation and used a cover crop mixture of annual ryegrass [Lolium perenne L. ssp. multiflorum (Lam.) Husnot] + orchardgrass (Dactylis glomerata L.) + forage radish (Raphanus sativus L. ssp. longipinnatus). Higher mean fall cover crop biomass and forage radish abundance (% of total) was observed in drill-interseeding treatments compared with broadcast-interseeding. However, corn grain yield and weed suppression and N retention in late-fall and spring were similar among interseeding treatments, which suggests that broadcast-interseeding at last cultivation has the potential to produce similar production and conservation benefits at lower labor and equipment costs in organic systems. Post-harvest seeding cereal rye resulted in greater spring biomass production and N retention compared with interseeded cover crops at the southern location, whereas variable interseeding establishment success and dominance of winter-killed forage radish produced conditions that increased the likelihood of N loss at more northern locations. Additional research is needed to contrast conservation benefits and management tradeoffs between interseeding and post-harvest establishment methods.

Examining the glacial lake dynamics in a warming climate and GLOF modelling in parts of Chandra basin, Himachal Pradesh, India

The presented study reports applicability of Lake Detection Algorithm (LDA) for an automated extraction of glacial lakes over a large geographical region and dynamics of Samudra Tapu and Gepang Gath glacial lakes. The areal extent of lake boundary extracted through LDA and areal extent of manually interpreted lake boundary exhibit a remarkable agreement (R2~0.99). Glacial lake dynamics is assessed in terms of areal and volumetric expansion for two selected glacial lakes from 1979 to 2017, i.e. Samudra Tapu (0.95 km2), and Gepang Gath (0.67 km2). They show volumetric expansion from 8.52 × 106 m3 (1979) to 80.34 × 106 m3 (2017) and 2.04 × 106 m3 (1979) to 32.44 × 106 m3 (2017) respectively. Statistical analysis (Mann-Kendall and Sen's slope) of climate data indicates rise in mean annual temperature (0.021 °C yr−1; 1961–2015) and fall in annual precipitation (−2.74 mm yr−1; 1951–2015) at different confidence intervals. Further Glacial Lake Outburst Flood (GLOF) is modelled using empirical relationship and Simplified Dam Breach Model (SMPDBK). The SMPDBK demonstrates discharge of 3866.52 and 2100.90 m3 s−1 reaching Chhatru and Sissu village posing threat to life and property. The study also exhibits that glacial shrinkage under the influence of climate change causes expansion of glacial lakes. This expansion is expected to intensify catastrophic GLOF and resultant fatalities and destruction in the downstream region.

Correlation of fall efficacy scale and hendrich fall risk model in elder population of Rawalpindi-Islamabad

To determine the correlation of fall efficacy scale and Hendrich fall risk model in elderly population. The correlational study was conducted from February to July 2018 in the twin cities of Islamabad and Rawalpindi, Pakistan, and comprised subjects of either gender aged >65 years from Railway General Hospital, Rawalpindi Eye Donors Organisation Eye Hospital, Water and Power Development Authority General Hospital, as well as Baghban and Mukhtar Ghulam Qadir(MGQ)old people's homes. A pre-designed semi structured questionnaire consisting of Fall Efficacy Scale-International, Hendrich fall risk model along with the necessary demographic information was used for data collection. Data was analysed using SPSS 21. Of the 336 subjects, 270(80.35%) were males. The overall mean age was 70.03±4.52 years. The mean fall risk total score was 5.77±3.43. Mean fall efficacy score was 35.64±16.40. The correlation coefficient for both scales (r=0.420) indicated a direct/intermediate correlation. There was a positive intermediate relationship between apprehension and risk of fall among the elderly population.

Biochemical Changes Using Sterile Water and 1.5% Glycine in TURP: A Randomized Study

Introduction: Endoscopic procedures in urology require irrigating fluid to provide a clear field of vision and to wash away debris. Glycine (1.5%) has been widely used, however sterile water is easily available and inexpensive. Excessive absorption of irrigation fluid can lead to dyselectrolytemia, hemolysis and systemic complications. In this study we compare 1.5% glycine with sterile water as irrigation fluid for Trans Urethral Resection Of Prostate (TURP). Materials and Method: In this prospective randomized study, we analysed 60 patients with symptomatic Benign Prostatic Hyperplasia (BPH) undergoing TURP with either 1.5% glycine or sterile water as irrigation fluid. The duration of surgery, weight of prostate resected, volume of fluid absorbed were compared. Post-operative levels of hemoglobin, hematocrit, electrolytes and renal function tests at 15 mins, 3 hrs and 6 hrs were analysed. Results: The mean decrease in hemoglobin at 6 hrs was more with 1.5% glycine (1.05±0.28 vs 0.89±0.14g/dL) and was statistically significant (P = 0.031). The mean fall in haematocrit at 6 hrs was significantly more with 1.5% glycine (4.87±1.41 vs 3.94±1.32%) (P = 0.046). The post-operative levels of blood urea were significantly less with 1.5% glycine at 15 mins, 3 hrs and 6 hrs (P 0.05). Nine patients (30%) who received 1.5% glycine and 8 patients (26.6%) receiving sterile water had dilutional hyponatremia at 6 hrs, but there were no significant difference between the two groups (P = 0.38). None of the patients developed TURP syndrome. Conclusion: Biochemical changes with sterile water was significantly less when compared with 1.5% glycine in TURP. Most of the changes observed were at 6 hrs after surgery. Hence sterile water can be considered as a safer and inexpensive alternative to glycine in resource-limited settings of low-income countries.

Comparison of blood loss between intra-articular and intra-venous administration of tranexamic acid in primary total knee arthroplasty.

Objective: To compare the blood loss between intra-articular and intra-venous administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. Design of study: It was a randomized controlled trial. Study duration and settings: This study was carried out at the Orthopedic Departments of Combined Military Hospital Lahore and Rawalpindi from Jan 2016 to March 2018. Methodology: Patients of both the genders were involved this study who had age in the rage of 40–80 years undergoing primary unilateral total knee arthroplasty for degenerative conditions like osteoarthritis and rheumatoid arthritis. These patients were randomly divided into two treatment groups. Patients in IA group received intra-articular tranexamic acid while those in IV group received intravenous tranexamic acid. From all the patients, a written signed consent was taken. Findings: Females were predominant with male-to-female ratio of 1:3.7. The mean age of the patients was 67.3 ± 8.2 years while the mean BMI was 30.9 ± 2.9 Kg/m2. Majority (n = 191, 95.5%) of the patients had osteoarthritis while remaining 9 (4.5%) patients had rheumatoid arthritis. There was no statistically significant difference between intra-articular and intra-venous administration of tranexamic acid in terms of mean post-operative hemoglobin (9.93 ± 1.14 vs. 9.87 ± 1.26 g/dL; p-value = 0.724), mean post-operative hematocrit (34.8 ± 1.66 vs. 34.73 ± 1.27%; p-value = 0.594), and mean fall in hemoglobin (2.27 ± 0.34 vs. 2.25 ± 0.30 g/dL; p-value = 0.587) and hematocrit (2.34 ± 0.94 vs. 2.46 ± 0.28%; p-value = 0.216). Conclusion: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty. Due to convenience, the use of intra-articular administration of tranexamic acid after primary TKA may be considered in future practice.

Efficacy and Safety of Supracostal Access for Mini Percutaneous Nephrolithotomy in Pediatric Patients

To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P=.885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P=.852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P=.11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P=.37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P=.088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.