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Objective: To determine the role of high altitude in thrombosis of appendicular artery and pathogenesis of acute appendicitis. Study Design: Cross Sectional study Place and Duration of Study: Forward Treatment Centre, Goma, Pakistan from June 2020 - May 2024. Methodology: A total of 86 patients undergoing open appendectomy at high altitude, were enrolled in the study. All patients underwent open appendectomy. Standard operating procedures were followed. Appendix and mesoappendix were examined and intraoperative findings were recorded. Appendix specimens were sent for histo-pathological examination. Patients who had more than 01 month stay at high altitude at time of development of acute appendicitis were considered as “Exposed” to High Altitude whereas patients with less than 01 month stay at high altitude were considered as “Not Exposed”. Outcomes were evaluated in terms of post operative fever, surgical site infection or organ space infection. Operative time and length of Hospital stay recorded Results: Eighty six patients were included in the study ranging from 18–52 years. There were 17(19.7%) females and 69(80.2%) males. Seventy one (81.3%) were Exposed to high altitude & 16(18.6%) were Not Exposed to High Altitude. The mean total operative time was 47.53±11.46 minutes. The hospital stay ranged from 02 to 05 days. Fecolith was found in 45(52.3%) cases and inflammatory pathology was found in 29(33.7%) cases. Six cases (6.9%) were found to have thrombosis of appendicular artery.  Conclusion: Faecolith was the most common cause of acute appendicitis at high altitude. However, Extended exposure of high altitude can incite ...

Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary. The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose. A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink. More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis.

Objective: To determine the outcomes of T-Tube drainage versus Primary Duct Closure after open common bile duct exploration in management of choledocholithiasis. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Kharian Pakistan, from Aug 2019 to Jul 2022. Methodology: All patients aged 26-64 years of either gender and undergoing open Common Bile Duct exploration for choledocholithiasis, were recruited in the study. Group-A consisted of 30 patients who underwent T-tube drainage, while Group-B consisted of 30 patients who underwent primary ductal closure. Results: Total 60 patients were included in the study ranging from 26–64 years. There were 49(81.6%) females and 11(18.3%) males. Operative time in Group-A was 118.2±5.06 minutes, whereas, in Group-B it was 100.37±2.93 minutes. The duration of sub hepatic drain in Group-A was 16.37±1.75 days, and in Group-B was 7.47±2.71 days. In Group-A, hospital stay was 17.07±1.92 days, and in Group-B, the average hospital stay was 9.61±2.63 days. The total number of complications in Group-A was 05(16.7%). Total complications in Group-B were 02(6.67 %). Conclusion: Primary closure of CBD is a safe and effective alternative to T-tube drainage in selective patients. Our study recommends the use of the primary closure technique strongly except for cases where the distal patency of CBD is doubtful.

Axially magnetized ferrite loaded microstrip patch antenna (MPA) with tunable beam scanning properties is presented. Ferrite cylinders are optimally positioned within the near field region of the patch to introduce Ey phase tapers needed for beam scanning. The interaction between the radiated EM wave and the gyrotropic properties of ferrites is controlled by varying the magnetizing fields. A beam scan of ±30° is achieved for a DC biasing range of 0–0.19 T. Simulated antenna properties are verified using experimental results. Recent LTCC technology allows the biasing coils to be embedded within the ferrite material to considerably reduce the required external magnetizing field.

Objective: To evaluate and compare the results between the long posterior Burgess flap and skew flap surgical approach in below knee amputations among diabetic patients and to determine which approach produces better outcomes in terms of mobility, mortality rate, revision status, hospital stay, follow-up, limb fitted, and wound healing. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Kharian, Pakistan, from Jul 2021 to Jul 2023. Methods: This quasi-experimental study was conducted on 60 patients undergoing below-knee amputation, comparing skew flap and Burgess flap techniques. Outcomes including mobility, wound healing, and hospital stay were analyzed with independent sample t-tests using SPSS v26 where a p-value of ≤0.05 was considered as significant. Results: Mean age of participants was 60.38±5.88 years. Wound exudate was noted in 2(7%) patients in Burgess flap and 6(20%) in skew flap while major flap necrosis was observed in 10(33%) patients with Burgess flap and 17(56%) patients with skew flap, 16(54%) patients with Burgess flap completed follow-up after 6 months while 18(60%) patients in skew flap group did. A further 20 patients died (8 in Burgess flap and 12 in skew flap) during the follow-up period,15 patients were immobile (50%), 8 patients were dependent (26%) and 7 patients were independent (24%). By comparing the two groups’ outcomes, there was significant difference noted. Conclusion: This study suggests that the long posterior Burgess flap technique may be a more favorable choice for below knee amputation among patients with diabetes mellitus.

A comparative study of the performance characteristics of a printed 8-element V-shaped circular antenna array and an 8-element Yagi circular array operating at 2.45 GHz for vehicular direction finding applications is presented. Two operating modes are investigated; switched and phased modes. The arrays were fabricated on FR-4 substrates with 0.8 mm thickness. Measured and simulated results were compared. Radiation gain patterns were measured on a 1 m diameter ground plane that resembles the rooftop of a vehicle. The HPBW of the Yagi was found to be about 3° narrower than its V-shaped counterpart when measured above a reflecting ground plane and operated in switched mode. The printed V-shaped antenna array offers 2.5 dB extra gain compared to the printed Yagi array.

In radars and wireless communication devices, phased array antennas are widely used to steer the direction of the main beam. Typically, array of radiating patches with progressively phased excitation are used to realize beam scan, resulting in complex antenna structures. In this dissertation, two different techniques to scan the main beam of a Fabry-Perot cavity (FPC) antenna without using phased excitation signals are presented. These alternative scanning mechanisms use a multilayered dielectric-ferrite superstrate to control the E-field distribution of the radiation path. Low-loss operating regions of the ferrite rods are analytically identified from the characteristic equation and are used in the simulations and measurements. Using the first technique, a single 10 GHz microstrip patch antenna (MPA) is loaded with a foam-ferrite superstrate to demonstrate a measured beam scan of ±30° for a differential biasing field of H0=0.1875 T. By integrating an additional dielectric layer, the resulting FPC excited with an MPA shows a 1.4 dB increase in directivity at the cost of reduced scanning angle. To optimize the design, the FPC antenna with multilayer superstrate is excited with a thinned 2-patch linear array. The foam-ferrite layer of the superstrate, now with three axially magnetized ferrite rods, is optimized to control Ey-phase taper needed for the beam scan. By individually biasing the ferrite rods, the main beam of the structure is scanned up to ±12° for a differential magnetization field of 0.182T (H0=150 kA/m). This method also reduces the side lobe level by 3.56 dB for maximum scan angle; which is important as typical FPC antenna demonstrates an increase in side lobe level with increasing scan angle. The second technique involves integrating the ferrite superstrate with split-ring resonators (SRR) to decrease the biasing field requirements. Two different configurations, with one or two SRR integrated ferrite rods, are designed and simulated. The resulting structures demonstrate equivalent beam scans at significantly lower biasing fields with reduced cavity heights as well. Although the presented designs are not low-profile, use of low temperature co-fired ceramics (LTCC) can reduce the cavity heights and also help incorporating the biasing coils within the ferrite rods.

Small array antennas with directive coverage are an attractive solution for size limitation in wireless devices. In this paper, the design of a directive 10 GHz antenna with reduced size microstrip array and frequency selective superstrate (FSS) is presented. Inductive loading and reduced patch separation is used to incorporate 7-elements within a 100x30 mm2 array aperture. The superstrate (FSS) layer is optimized to properly excite the Fabry-Perot cavity and further increase the antenna directivity. Using HFSS software, the reflection response and the radiation pattern of the antenna array is optimized. The simulated responses agreed well with the measured results.

The use of wireless sensor networks in environmental monitoring applications has increased rapidly. Due to the presence of extremely versatile as well as low cost devices in the market, setting up a network now has become easy. A custom build wireless sensor node, named the KFUPM node, has been successfully designed, implemented and tested with the network for monitoring temperature and light. An expansion port for adding external sensors has been provided to ease the need for sensing multiple phenomenon. Widely employed MAC protocol, SMAC, has been implemented with unique algorithm which exhibits much better energy conservation as compared to basic S-MAC. A routing protocol based on cluster head rotation has been designed and implemented. By employing a cluster head rotation policy, the new protocol promises better energy consumption as compared to the existing protocols thus leading to the enhancement of the overall network life. A network design utility has been created to provide complete specifications for a network setup for a given network cost and an acceptable message reception rate

The frequency and severity of climatic extremes is expected to escalate in the future primarily because of the increasing greenhouse gas concentrations in the atmosphere. This study aims to assess the impact of climate change on the extreme temperature and precipitation scenarios using climate indices in the Kashmir Himalaya. The analysis has been carried out for the twenty-first century under different representative concentration pathways (RCPs) through the Statistical Downscaling Model (SDSM) and ClimPACT2. The simulation reveals that the climate in the region will get progressively warmer in the future by increments of 0.36–1.48 °C and 0.65–1.07 °C in mean maximum and minimum temperatures respectively, during 2080s (2071–2100) relative to 1980–2010 under RCP8.5. The annual precipitation is likely to decrease by a maximum of 2.09–6.61% (2080s) under RCP8.5. The seasonal distribution of precipitation is expected to alter significantly with winter, spring, and summer seasons marking reductions of 9%, 5.7%, and 1.7%, respectively during 2080s under RCP8.5. The results of extreme climate evaluation show significant increasing trends for warm temperature-based indices and decreasing trends for cold temperature-based indices. Precipitation indices on the other hand show weaker and spatially incoherent trends with a general tendency towards dry regimes. The projected scenarios of extreme climate indices may result in large-scale adverse impacts on the environment and ecological resource base of the Kashmir Himalaya.