The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration. Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government. Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23. Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months. Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well

Formation of supermassive black hole seeds

The detection of quasars at $z>6$ unveils the presence of supermassive black holes (BHs) of a few billion solar masses. The rapid formation process of these extreme objects remains a fascinating and open issue. Such discovery implies that seed black holes must have formed early on, and grown via either rapid accretion or BH/galaxy mergers. In this theoretical review, we discuss in detail various BH seed formation mechanisms and the physical processes at play during their assembly. We discuss the three most popular BH formation scenarios, involving the (i) core-collapse of massive stars, (ii) dynamical evolution of dense nuclear star clusters, (iii) collapse of a protogalactic metal free gas cloud. This article aims at giving a broad introduction and an overview of the most advanced research in the field.Comment: Invited review accepted for publication in PASA, comments are still welcom

How to Solve the Fronthaul Traffic Congestion Problem in H-CRAN?

The design of efficient wireless fronthaul connections for future heterogeneous networks incorporating emerging paradigms such as heterogeneous cloud radio access network (H-CRAN) has become a challenging task that requires the most effective utilization of fronthaul network resources. In this paper, we propose and analyze possible solutions to facilitate the fronthaul traffic congestion in the scenario of Coordinated Multi-Point (CoMP) for 5G cellular traffic which is expected to reach ZetaByte by 2017. In particular, we propose to use distributed compression to reduce the fronthaul traffic for H-CRAN. Unlike the conventional approach where each coordinating point quantizes and forwards its own observation to the processing centre, these observations are compressed before forwarding. At the processing centre, the decompression of the observations and the decoding of the user messages are conducted in a joint manner. Our results reveal that, in both dense and ultra-dense urban small cell deployment scenarios, the usage of distributed compression can efficiently reduce the required fronthaul rate by more than 50% via joint operation

Screening-Limited Response of NanoBiosensors

Despite tremendous potential of highly sensitive electronic detection of bio-molecules by nanoscale biosensors for genomics and proteomic applications, many aspects of experimentally observed sensor response (S) are unexplained within consistent theoretical frameworks of kinetic response or electrical screening. In this paper, we combine analytic solutions of Poisson-Boltzmann and reaction-diffusion equations to show that the electrical response of nanobiosensor varies logarithmically with the concentration of target molecules, time, the salt concentration, and inversely with the fractal dimension of sensor surface. Our analysis provides a coherent theoretical interpretation of wide variety of puzzling experimental data that have so far defied intuitive explanation.Comment: 7 pages, 2 figure