Maaz Ahmed - Academia.edu (original) (raw)
Papers by Maaz Ahmed
Toward deceiving the intrusion attacks in containerized cloud environment using virtual private cloud‐based moving target defense
Concurrency and Computation: Practice and Experience
Indian Pediatrics
Objective: To study the profile of neurological manifestation of rickettsial disease in children.... more Objective: To study the profile of neurological manifestation of rickettsial disease in children. Methods: Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results: Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion: Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.
BMJ Open
PurposeThe ‘DSD Pathways’ study was initiated to assess health status and patterns of care among ... more PurposeThe ‘DSD Pathways’ study was initiated to assess health status and patterns of care among people enrolled in large integrated healthcare systems and diagnosed with conditions comprising the broad category of disorders (differences) of sex development (DSD). The objectives of this communication are to describe methods of cohort ascertainment for two specific DSD conditions—classic congenital adrenal hyperplasia with 46,XX karyotype (46,XX CAH) and complete androgen insensitivity syndrome (CAIS).ParticipantsUsing electronic health records we developed an algorithm that combined diagnostic codes, clinical notes, laboratory data and pharmacy records to assign each cohort candidate a ‘strength-of-evidence’ score supporting the diagnosis of interest. A sample of cohort candidates underwent a review of the full medical record to determine the score cutoffs for final cohort validation.Findings to dateAmong 5404 classic 46,XX CAH cohort candidates the strength-of-evidence scores range...
This study was designed to investigate the relationship between parental rejection and social ski... more This study was designed to investigate the relationship between parental rejection and social skills among children of single parents. 100 children (49 boys, 51 girls) and 100 parents (42 fathers and 58 mothers) participated in this study. For data collection, the Urdu version of the Parental Acceptance Questionnaire and the Social Skills Scale were administered. Statistical analysis was performed by using Liner regression and single sample t-test. The results showed that parental rejection is a significant predictor of low social skills, showing the beta values (β=.278, t= 5.989, p<.05). Furthermore, 7.7% variance is explained by parental rejection towards low social skills. Findings evidenced that perceived parental rejection is a significant predictor of low-level social skills in children of single parents. Results are discussed in the context of cultural factors
Developing a test rig for testing different variation of crankpins and Needle bearings
Ranking of articles using open-access citation-metadata
Ranking of articles using open-access citation-metadata
![Research paper thumbnail of A Child with Microcephaly, Seizures and Skin Lesion [Skin Lesion: a Window to Diagnosis] CASE REPORT](https://attachments.academia-assets.com/98217494/thumbnails/1.jpg)
](Introduction: Skin lesions or are valuable in approach towards common genodermatosis. Neurocutane... more Introduction: Skin lesions or are valuable in approach towards common genodermatosis. Neurocutaneous markers are reflections of pathological process in the central nervous system. Case report: An 11 month old female child presented with convulsions, development delay, hyperpigmented macules in whorls, ocular lesions and MRI Brain suggestive of a multi-system genodermatosis affecting tissues of ectodermal origin like skin, nervous system, eye especially retinal, and dental abnormalities. A skilful history with complete clinical examination with due importance to skin lesion aids to diagnosis. Multidisciplinary follow-up is needed, particularly during the infancy to detect and manage possible neurological and ophthalmologic complications. Conclusion: Hence it is imperative to look for clues in form of skin lesions which help in prompt diagnosis.
Introduction: The skill of dealing with the fluids thus offering the hemodynamic aid is crucial w... more Introduction: The skill of dealing with the fluids thus offering the hemodynamic aid is crucial while treating critically ill. With alarm regarding rate of inappropriate transfusion being carried out especially as against the rainbow of adverse effects of transfusion. Aim of the study was to investigate the current transfusion practice in the critically ill children and see whether the transfusions were in accordance to the Indian Academy of Pediatrics [IAP] recommendations. Material and methods: Prospective observational exploratory study in Pediatric intensive care unit [PICU] of a Tertiary care center. The study enrolled 122 patients admitted in PICU with age 29 days to 12 years who received blood component therapy from the initiation of the study in 2012 over a period of 12 months. The qualitative data was represented in the form of frequency and percentage tables with the help of SPSS version 21. Results: We found in our study that a total of 161 transfusions, 74.53% patients r...
International Journal of Contemporary Pediatrics, 2021
Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a n... more Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a new method to provide respiratory support with bronchiolitis. Aim was to study outcome of HFNC therapy in children with bronchiolitis and pneumonia.Methods: The study was a prospective observational study involving children admitted to pediatric intensive care unit with respiratory distress (RD) in the age group of 1 month to 6 years over a period of 3 months (February 2017 till April 2017). Severity was assessed by clinical respiratory score (CRS). Children with RD were initiated with high flow nasal cannula. During treatment various parameters including CRS were documented at baseline and at 15 min and then hourly in a carefully designed performa. The primary outcome was failure of HFNC and need for ventilation.Results: Sixty children were included in the study of which 22 (37%) were in the bronchiolitis group and 38 (63%) were in the pneumonia group. 38 children presented with severe R...
Indications and outcome of tracheostomy in a pediatric intensive care unit: A prospective observational study
Journal of Pediatric Critical Care, 2021
Background: Over the past decades, the indications for tracheostomy in children and the routine p... more Background: Over the past decades, the indications for tracheostomy in children and the routine posttracheostomy course have changed significantly. The purpose of this study was to identify the indications, complications, and outcomes of pediatric tracheostomy. Subjects and Methods: This prospective observational study was conducted involving all children admitted to the pediatric intensive care unit (PICU) requiring tracheostomy from January 2018 to June 2019. A pre-structured proforma was used. The data regarding indications of tracheostomy, complications, and outcomes were analyzed. Patients were followed up till decannulation during the study period. Results: Out of 73 patients included in the study, 68.5% (n = 53) were males and 31.5% (n = 20) were females, with a mean age of 5.4 years. The most common primary indication for tracheostomy was neurological impairment (56.2%, n = 41) and airway obstruction (19.2%, n = 14). The average duration of PICU stay at the time of tracheostomy was 15.4 days. Prolonged mechanical ventilation was required in 62.3% of patients. Elective tracheostomy was done in 84.9% of patients. Complications due to tracheostomy were noted in 43.8% (n = 32) of cases, of which suprastomal granulations were the most common. The average length of PICU stay after tracheostomy was 21.8 days. The rate of successful decannulation was 69.9%. The most common cause for decannulation failure was subglottic stenosis. Conclusions: Neurological impairment requiring prolonged mechanical ventilation was the most common indication for tracheostomy. Suprastomal granulations were the most common complication and subglottic stenosis being the most common cause for decannulation failure.
Design and Development of IoT Based Aeroponics Growbox
2021 International Conference on Computing, Electronic and Electrical Engineering (ICE Cube), 2021
This paper aims to provide a robust solution to mitigate the adverse effects of climate change an... more This paper aims to provide a robust solution to mitigate the adverse effects of climate change and inefficient use of resources in Pakistan, one of the most vulnerable countries to global warming. The key problems that are aimed to resolve are, firstly, the food insecurity in Pakistan due to the decrease of cultivable land against a sharp rise in population, secondly, water scarcity due to inefficient use of water resources, particularly, in the agricultural sector and, lastly, irregularities in the environmental conditions resulting in stunted yield in arable areas. To overcome this, the proposed solution is a Grow Box based on hydroponics-based farming; a portable controlled environment allowing soilless gardening by implementing the Aeroponics method. The design of the grow box is such that it would monitor the many parameters crucial for farming such as the water quality, humidity, and temperature by the implementation of WSN (Wireless Sensor Network) and IoT (Internet of things) to ensure maximum yield of best quality plants in the limits of the grow box. The final product monitors the environmental parameters of the inert grow box via a developed WSN. The integration of IoT to let connection to the internet, allows remote streaming, and the mechanical design of the grow box are also completed and showcased in the paper.
James L. Barton's perspective on the Ottoman Empire
Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih... more Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2017.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Feyzullahoğlu, Burcu
Introduction: Many factors influence outcome in children admitted to the Pediatric Intensive Care... more Introduction: Many factors influence outcome in children admitted to the Pediatric Intensive Care Unit (PICU), including hyperglycemia, hypoglycemia and glucose variability. We conducted a study to determine the prevalence of hyperglycemia, hypoglycaemia and glucose variability in children admitted to the PICU and their association with mortality and morbidity. Material and methods: A prospective observational study was conducted over an 18-month period in the PICU of a teaching public hospital in Mumbai. 113 children aged 29days to12years admitted to the PICU were enrolled in the study. Hyperglycemia, hypoglycemia and glucose variability were recorded. Insulin by infusion was given for children with hyperglycemia. The outcome measures were recorded in terms of duration of PICU, discharge and death. Results: A total of 113 eligible patients wh o were enrolled in the study. Hyperglycemia was significantly associated with increasing length of PICU stay (χ2, p=0.045). Hypoglycemia was ...
State-of-the-Art Power Management Techniques
Proceedings of Second Doctoral Symposium on Computational Intelligence, 2021
Energy efficiency is one of the biggest challenges presently faced by high performance computing ... more Energy efficiency is one of the biggest challenges presently faced by high performance computing (HPC) systems. The need to build energy-efficient computer systems and applications in the field of scientific computing is growing every day. Numerous researches have been carried out in the fields of embedded systems and mobile computing to minimize the power consumed by devices. The components and algorithms developed for achieving energy efficiency in such systems can also be applied in the field of HPC. In this paper, we survey the power managing techniques for HPC systems. We discuss different power management techniques on several important parameters to identify the merits and demerits of such techniques. This paper is intended to help in developing more deep understanding of different power management techniques and designing more energy-efficient HPC systems of tomorrow.
A retrospective study of etiology, clinical features, management, and outcomes in children with necrotizing pneumonia
Journal of Pediatric Critical Care, 2020
Introduction: Necrotizing pneumonia (NP) is a severe and emerging complication in children with c... more Introduction: Necrotizing pneumonia (NP) is a severe and emerging complication in children with community-acquired pneumonia (CAP). The study was conducted to analyze the etiology, clinical features, treatment strategies, and outcome of NP in children admitted in a single pediatric tertiary referral care center. Materials and Methods: The study is a retrospective chart review which included children above 1 month and below 18 years who were admitted at Indira Gandhi Institute of Child Health, from January 2015 to December 2018, with community-acquired NP. Results: During the study period, 1393 cases of CAP were admitted in our institute. Three hundred and fifty-two cases (25.2%) of complicated pneumonia were admitted which include cases of NP, lung abscess, and empyema. Children who were diagnosed with NP were 3.3% (n = 46) of all CAP cases. All the cases with NP were immunocompetent, with the most common organism isolated being Staphylococcus aureus followed by Streptococcus pneumoniae. NP is associated with complications such as empyema, pneumothorax, and bronchopleural fistula. All the children in the study group survived except for mortality in one case. Conclusion: NP can be well managed with conservative approaches such as prolonged antibiotic therapy and pleural drainage. Although there are commonly associated with local complications, in general the clinical outcome is good.
Recurrent Diabetic Ketoacidosis and Extreme Insulin Resistance Due to Anti-Insulin Antibodies: Response to Immunosuppression and Plasma Exchange
Diabetes Technology & Therapeutics, 2020
Anti-insulin antibodies in patients with insulin-treated diabetes though common, correlate poorly... more Anti-insulin antibodies in patients with insulin-treated diabetes though common, correlate poorly with glycemic control, insulin requirement & insulin resistance. We are hereby reporting the clinical course and challenges in the management of a 70-year-old man who had severe insulin resistance as evidenced by recurrent diabetic ketoacidosis & poor glycemic control despite treatment with more than 9 U of insulin /kg body weight/day. He was found to have anti-insulin antibodies and responded clinically to plasmapheresis and immunosuppression with mycophenolate mofetil (MMF)and prednisolone. Improved glycemic control correlated well with falling titers of antibodies. This case emphasizes that clinicians should be alert to the possibility of insulin resistance due to anti-insulin antibodies and the role of immunosuppression & plasmapheresis in such cases.
Indian Journal of Child Health, 2016
Introduction: Pediatric risk of mortality score (PRISM-3) has been applied in pediatric intensive... more Introduction: Pediatric risk of mortality score (PRISM-3) has been applied in pediatric intensive care settings for varied diagnoses. We planned to study the outcome when PRISM score is applied to a single clinical diagnosis. Objectives: To study the applicability of PRISM score in predicting mortality in pediatric severe cerebral malaria cases. Methodology: This was a retrospective analysis of severe cerebral malaria cases admitted to the pediatric intensive care unit over 3 years from 2009 to 2012 whose peripheral blood smear was positive for Plasmodium falciparum. Cases that presented with single seizure without altered sensorium were excluded. The PRISM scores, predicted mortality and observed mortality, were studied from demographic and clinical data. Results: Of the total 38 cases, 22 (57.8%) cases were females and 16 (42.10%) cases were males. There were 4 (10.52%) infants, 15 (39.4%) children from 1 to 5 years age and 19 (50%) cases were above 5 year age. A total of 14 cases, 36.84% had PRISM score ≤10, whereas 16 cases (42.1%) had score 10-20 and 8 cases had scored above 20. Mean predicted mortality was 17.84%, whereas observed mortality was 21.05%. Observed mortality had statistically significant association with PRISM score and predicted mortality rate. Conclusion: PRISM score and the expected mortality rate were good indicators in expecting the outcome of severe cerebral malaria cases. PRISM score can be effectively applied in severe cerebral malaria cases in predicting the outcome.
Study of use of intravenous immunoglobulin in pediatric intensive care unit in a tertiary care center: An audit and review of evidence
Journal of Pediatric Critical Care, 2020
Introduction: The label and off-label use of intravenous immunoglobulin (IVIG) in pediatric inten... more Introduction: The label and off-label use of intravenous immunoglobulin (IVIG) in pediatric intensive care unit (PICU) is done as a replacement therapy also for immunomodulation. As there are no standard guidelines for the use of IVIG in PICU; hence, the need to study the pattern of indications for which IVIG has been used in critically ill children and review the quality of evidence as per the available data. Materials and Methods: The retrospective chart review of indications for IVIG therapy in children over a period of 4 years in a tertiary care PICU from January 2015 to December 2018. Collection of data included demographic profile, indication of transfusion of IVIG, dose of IVIG received, and outcome of the patients. Results: The IVIG therapy was given to 301 children under the following groups, 120 children for neuroimmunologic disorders, 73 children for cardiology-related indications, 65 children for infection and infection-related causes, 31 children for autoimmune diseases, seven and five children each for primary immunodeficiency and dermatological causes, respectively. The indications, for which IVIG therapy given included, approved by the Food and Drug Administration in 56 children, under evidence category Level Ia in 50 children and with strength of recommendation Grade A in 51 children. Conclusion: There is a rise in off-label use of IVIG as the quality of evidence is variable for different indications hence there is a need for better quality of evidence and more multicentric randomized control trials to define the precise impact of IVIG on various conditions.
Indian Journal of Child Health, 2019
rogenital sinus (UGS) is a congenital cloacal anomaly comprising of a solitary common passage bet... more rogenital sinus (UGS) is a congenital cloacal anomaly comprising of a solitary common passage between lower parts of the urinary and genital tract that is urethra and vagina [1-3]. It can present as hydrometrocolpos (HMC), which is enlargement of the vagina along with the uterus due to accumulation of fluid or hydrocolpos, which is the enlargement of vagina due to accumulation of fluid or fetal ascites [4,5]. HMC could occur as a result of a cloacal anomaly or due to syndromic association or vaginal atresia, transverse vaginal septum, and imperforate hymen [5]. We report a rare case of persistent UGS with fetal ascites, HMC, severe vaginal stenosis, and unilateral buphthalmos. Our report essentially underlines the necessity of early antenatal diagnosis and prompt post-natal management to reduce morbidity. Persistent urogenital sinus (UGS) is a rare congenital cloacal anomaly whereby the urinary and genital tracts fail to separate during embryonic development. It can present as hydrometrocolpos (HMC) with severe vaginal stenosis/atresia, ambiguous genitalia, and/or urinary ascites. A term neonate born to a primigravida showed on antenatal ultrasound scan features suggestive of gross fetal ascites with severe oligohydramnios and hydronephrosis. Postnatally, the neonate presented with respiratory distress, urinary ascites, and abdominal mass and unilateral buphthalmos. An ascitic tap was done and HMC was drained. The cystogenitoscopy revealed vaginal stenosis for which vaginoplasty was done. The child was discharged and on follow-up is gaining weight. Our report shows an unusual presentation of a persistent UGS and also emphasizes the importance of early antenatal diagnosis and prompt post-natal management to reduce morbidity.
The Indian Journal of Pediatrics, 2019
Toward deceiving the intrusion attacks in containerized cloud environment using virtual private cloud‐based moving target defense
Concurrency and Computation: Practice and Experience
Indian Pediatrics
Objective: To study the profile of neurological manifestation of rickettsial disease in children.... more Objective: To study the profile of neurological manifestation of rickettsial disease in children. Methods: Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results: Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion: Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.
BMJ Open
PurposeThe ‘DSD Pathways’ study was initiated to assess health status and patterns of care among ... more PurposeThe ‘DSD Pathways’ study was initiated to assess health status and patterns of care among people enrolled in large integrated healthcare systems and diagnosed with conditions comprising the broad category of disorders (differences) of sex development (DSD). The objectives of this communication are to describe methods of cohort ascertainment for two specific DSD conditions—classic congenital adrenal hyperplasia with 46,XX karyotype (46,XX CAH) and complete androgen insensitivity syndrome (CAIS).ParticipantsUsing electronic health records we developed an algorithm that combined diagnostic codes, clinical notes, laboratory data and pharmacy records to assign each cohort candidate a ‘strength-of-evidence’ score supporting the diagnosis of interest. A sample of cohort candidates underwent a review of the full medical record to determine the score cutoffs for final cohort validation.Findings to dateAmong 5404 classic 46,XX CAH cohort candidates the strength-of-evidence scores range...
This study was designed to investigate the relationship between parental rejection and social ski... more This study was designed to investigate the relationship between parental rejection and social skills among children of single parents. 100 children (49 boys, 51 girls) and 100 parents (42 fathers and 58 mothers) participated in this study. For data collection, the Urdu version of the Parental Acceptance Questionnaire and the Social Skills Scale were administered. Statistical analysis was performed by using Liner regression and single sample t-test. The results showed that parental rejection is a significant predictor of low social skills, showing the beta values (β=.278, t= 5.989, p<.05). Furthermore, 7.7% variance is explained by parental rejection towards low social skills. Findings evidenced that perceived parental rejection is a significant predictor of low-level social skills in children of single parents. Results are discussed in the context of cultural factors
Developing a test rig for testing different variation of crankpins and Needle bearings
Ranking of articles using open-access citation-metadata
Ranking of articles using open-access citation-metadata
Introduction: Skin lesions or are valuable in approach towards common genodermatosis. Neurocutane... more Introduction: Skin lesions or are valuable in approach towards common genodermatosis. Neurocutaneous markers are reflections of pathological process in the central nervous system. Case report: An 11 month old female child presented with convulsions, development delay, hyperpigmented macules in whorls, ocular lesions and MRI Brain suggestive of a multi-system genodermatosis affecting tissues of ectodermal origin like skin, nervous system, eye especially retinal, and dental abnormalities. A skilful history with complete clinical examination with due importance to skin lesion aids to diagnosis. Multidisciplinary follow-up is needed, particularly during the infancy to detect and manage possible neurological and ophthalmologic complications. Conclusion: Hence it is imperative to look for clues in form of skin lesions which help in prompt diagnosis.
Introduction: The skill of dealing with the fluids thus offering the hemodynamic aid is crucial w... more Introduction: The skill of dealing with the fluids thus offering the hemodynamic aid is crucial while treating critically ill. With alarm regarding rate of inappropriate transfusion being carried out especially as against the rainbow of adverse effects of transfusion. Aim of the study was to investigate the current transfusion practice in the critically ill children and see whether the transfusions were in accordance to the Indian Academy of Pediatrics [IAP] recommendations. Material and methods: Prospective observational exploratory study in Pediatric intensive care unit [PICU] of a Tertiary care center. The study enrolled 122 patients admitted in PICU with age 29 days to 12 years who received blood component therapy from the initiation of the study in 2012 over a period of 12 months. The qualitative data was represented in the form of frequency and percentage tables with the help of SPSS version 21. Results: We found in our study that a total of 161 transfusions, 74.53% patients r...
International Journal of Contemporary Pediatrics, 2021
Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a n... more Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a new method to provide respiratory support with bronchiolitis. Aim was to study outcome of HFNC therapy in children with bronchiolitis and pneumonia.Methods: The study was a prospective observational study involving children admitted to pediatric intensive care unit with respiratory distress (RD) in the age group of 1 month to 6 years over a period of 3 months (February 2017 till April 2017). Severity was assessed by clinical respiratory score (CRS). Children with RD were initiated with high flow nasal cannula. During treatment various parameters including CRS were documented at baseline and at 15 min and then hourly in a carefully designed performa. The primary outcome was failure of HFNC and need for ventilation.Results: Sixty children were included in the study of which 22 (37%) were in the bronchiolitis group and 38 (63%) were in the pneumonia group. 38 children presented with severe R...
Indications and outcome of tracheostomy in a pediatric intensive care unit: A prospective observational study
Journal of Pediatric Critical Care, 2021
Background: Over the past decades, the indications for tracheostomy in children and the routine p... more Background: Over the past decades, the indications for tracheostomy in children and the routine posttracheostomy course have changed significantly. The purpose of this study was to identify the indications, complications, and outcomes of pediatric tracheostomy. Subjects and Methods: This prospective observational study was conducted involving all children admitted to the pediatric intensive care unit (PICU) requiring tracheostomy from January 2018 to June 2019. A pre-structured proforma was used. The data regarding indications of tracheostomy, complications, and outcomes were analyzed. Patients were followed up till decannulation during the study period. Results: Out of 73 patients included in the study, 68.5% (n = 53) were males and 31.5% (n = 20) were females, with a mean age of 5.4 years. The most common primary indication for tracheostomy was neurological impairment (56.2%, n = 41) and airway obstruction (19.2%, n = 14). The average duration of PICU stay at the time of tracheostomy was 15.4 days. Prolonged mechanical ventilation was required in 62.3% of patients. Elective tracheostomy was done in 84.9% of patients. Complications due to tracheostomy were noted in 43.8% (n = 32) of cases, of which suprastomal granulations were the most common. The average length of PICU stay after tracheostomy was 21.8 days. The rate of successful decannulation was 69.9%. The most common cause for decannulation failure was subglottic stenosis. Conclusions: Neurological impairment requiring prolonged mechanical ventilation was the most common indication for tracheostomy. Suprastomal granulations were the most common complication and subglottic stenosis being the most common cause for decannulation failure.
Design and Development of IoT Based Aeroponics Growbox
2021 International Conference on Computing, Electronic and Electrical Engineering (ICE Cube), 2021
This paper aims to provide a robust solution to mitigate the adverse effects of climate change an... more This paper aims to provide a robust solution to mitigate the adverse effects of climate change and inefficient use of resources in Pakistan, one of the most vulnerable countries to global warming. The key problems that are aimed to resolve are, firstly, the food insecurity in Pakistan due to the decrease of cultivable land against a sharp rise in population, secondly, water scarcity due to inefficient use of water resources, particularly, in the agricultural sector and, lastly, irregularities in the environmental conditions resulting in stunted yield in arable areas. To overcome this, the proposed solution is a Grow Box based on hydroponics-based farming; a portable controlled environment allowing soilless gardening by implementing the Aeroponics method. The design of the grow box is such that it would monitor the many parameters crucial for farming such as the water quality, humidity, and temperature by the implementation of WSN (Wireless Sensor Network) and IoT (Internet of things) to ensure maximum yield of best quality plants in the limits of the grow box. The final product monitors the environmental parameters of the inert grow box via a developed WSN. The integration of IoT to let connection to the internet, allows remote streaming, and the mechanical design of the grow box are also completed and showcased in the paper.
James L. Barton's perspective on the Ottoman Empire
Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih... more Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2017.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Feyzullahoğlu, Burcu
Introduction: Many factors influence outcome in children admitted to the Pediatric Intensive Care... more Introduction: Many factors influence outcome in children admitted to the Pediatric Intensive Care Unit (PICU), including hyperglycemia, hypoglycemia and glucose variability. We conducted a study to determine the prevalence of hyperglycemia, hypoglycaemia and glucose variability in children admitted to the PICU and their association with mortality and morbidity. Material and methods: A prospective observational study was conducted over an 18-month period in the PICU of a teaching public hospital in Mumbai. 113 children aged 29days to12years admitted to the PICU were enrolled in the study. Hyperglycemia, hypoglycemia and glucose variability were recorded. Insulin by infusion was given for children with hyperglycemia. The outcome measures were recorded in terms of duration of PICU, discharge and death. Results: A total of 113 eligible patients wh o were enrolled in the study. Hyperglycemia was significantly associated with increasing length of PICU stay (χ2, p=0.045). Hypoglycemia was ...
State-of-the-Art Power Management Techniques
Proceedings of Second Doctoral Symposium on Computational Intelligence, 2021
Energy efficiency is one of the biggest challenges presently faced by high performance computing ... more Energy efficiency is one of the biggest challenges presently faced by high performance computing (HPC) systems. The need to build energy-efficient computer systems and applications in the field of scientific computing is growing every day. Numerous researches have been carried out in the fields of embedded systems and mobile computing to minimize the power consumed by devices. The components and algorithms developed for achieving energy efficiency in such systems can also be applied in the field of HPC. In this paper, we survey the power managing techniques for HPC systems. We discuss different power management techniques on several important parameters to identify the merits and demerits of such techniques. This paper is intended to help in developing more deep understanding of different power management techniques and designing more energy-efficient HPC systems of tomorrow.
A retrospective study of etiology, clinical features, management, and outcomes in children with necrotizing pneumonia
Journal of Pediatric Critical Care, 2020
Introduction: Necrotizing pneumonia (NP) is a severe and emerging complication in children with c... more Introduction: Necrotizing pneumonia (NP) is a severe and emerging complication in children with community-acquired pneumonia (CAP). The study was conducted to analyze the etiology, clinical features, treatment strategies, and outcome of NP in children admitted in a single pediatric tertiary referral care center. Materials and Methods: The study is a retrospective chart review which included children above 1 month and below 18 years who were admitted at Indira Gandhi Institute of Child Health, from January 2015 to December 2018, with community-acquired NP. Results: During the study period, 1393 cases of CAP were admitted in our institute. Three hundred and fifty-two cases (25.2%) of complicated pneumonia were admitted which include cases of NP, lung abscess, and empyema. Children who were diagnosed with NP were 3.3% (n = 46) of all CAP cases. All the cases with NP were immunocompetent, with the most common organism isolated being Staphylococcus aureus followed by Streptococcus pneumoniae. NP is associated with complications such as empyema, pneumothorax, and bronchopleural fistula. All the children in the study group survived except for mortality in one case. Conclusion: NP can be well managed with conservative approaches such as prolonged antibiotic therapy and pleural drainage. Although there are commonly associated with local complications, in general the clinical outcome is good.
Recurrent Diabetic Ketoacidosis and Extreme Insulin Resistance Due to Anti-Insulin Antibodies: Response to Immunosuppression and Plasma Exchange
Diabetes Technology & Therapeutics, 2020
Anti-insulin antibodies in patients with insulin-treated diabetes though common, correlate poorly... more Anti-insulin antibodies in patients with insulin-treated diabetes though common, correlate poorly with glycemic control, insulin requirement & insulin resistance. We are hereby reporting the clinical course and challenges in the management of a 70-year-old man who had severe insulin resistance as evidenced by recurrent diabetic ketoacidosis & poor glycemic control despite treatment with more than 9 U of insulin /kg body weight/day. He was found to have anti-insulin antibodies and responded clinically to plasmapheresis and immunosuppression with mycophenolate mofetil (MMF)and prednisolone. Improved glycemic control correlated well with falling titers of antibodies. This case emphasizes that clinicians should be alert to the possibility of insulin resistance due to anti-insulin antibodies and the role of immunosuppression & plasmapheresis in such cases.
Indian Journal of Child Health, 2016
Introduction: Pediatric risk of mortality score (PRISM-3) has been applied in pediatric intensive... more Introduction: Pediatric risk of mortality score (PRISM-3) has been applied in pediatric intensive care settings for varied diagnoses. We planned to study the outcome when PRISM score is applied to a single clinical diagnosis. Objectives: To study the applicability of PRISM score in predicting mortality in pediatric severe cerebral malaria cases. Methodology: This was a retrospective analysis of severe cerebral malaria cases admitted to the pediatric intensive care unit over 3 years from 2009 to 2012 whose peripheral blood smear was positive for Plasmodium falciparum. Cases that presented with single seizure without altered sensorium were excluded. The PRISM scores, predicted mortality and observed mortality, were studied from demographic and clinical data. Results: Of the total 38 cases, 22 (57.8%) cases were females and 16 (42.10%) cases were males. There were 4 (10.52%) infants, 15 (39.4%) children from 1 to 5 years age and 19 (50%) cases were above 5 year age. A total of 14 cases, 36.84% had PRISM score ≤10, whereas 16 cases (42.1%) had score 10-20 and 8 cases had scored above 20. Mean predicted mortality was 17.84%, whereas observed mortality was 21.05%. Observed mortality had statistically significant association with PRISM score and predicted mortality rate. Conclusion: PRISM score and the expected mortality rate were good indicators in expecting the outcome of severe cerebral malaria cases. PRISM score can be effectively applied in severe cerebral malaria cases in predicting the outcome.
Study of use of intravenous immunoglobulin in pediatric intensive care unit in a tertiary care center: An audit and review of evidence
Journal of Pediatric Critical Care, 2020
Introduction: The label and off-label use of intravenous immunoglobulin (IVIG) in pediatric inten... more Introduction: The label and off-label use of intravenous immunoglobulin (IVIG) in pediatric intensive care unit (PICU) is done as a replacement therapy also for immunomodulation. As there are no standard guidelines for the use of IVIG in PICU; hence, the need to study the pattern of indications for which IVIG has been used in critically ill children and review the quality of evidence as per the available data. Materials and Methods: The retrospective chart review of indications for IVIG therapy in children over a period of 4 years in a tertiary care PICU from January 2015 to December 2018. Collection of data included demographic profile, indication of transfusion of IVIG, dose of IVIG received, and outcome of the patients. Results: The IVIG therapy was given to 301 children under the following groups, 120 children for neuroimmunologic disorders, 73 children for cardiology-related indications, 65 children for infection and infection-related causes, 31 children for autoimmune diseases, seven and five children each for primary immunodeficiency and dermatological causes, respectively. The indications, for which IVIG therapy given included, approved by the Food and Drug Administration in 56 children, under evidence category Level Ia in 50 children and with strength of recommendation Grade A in 51 children. Conclusion: There is a rise in off-label use of IVIG as the quality of evidence is variable for different indications hence there is a need for better quality of evidence and more multicentric randomized control trials to define the precise impact of IVIG on various conditions.
Indian Journal of Child Health, 2019
rogenital sinus (UGS) is a congenital cloacal anomaly comprising of a solitary common passage bet... more rogenital sinus (UGS) is a congenital cloacal anomaly comprising of a solitary common passage between lower parts of the urinary and genital tract that is urethra and vagina [1-3]. It can present as hydrometrocolpos (HMC), which is enlargement of the vagina along with the uterus due to accumulation of fluid or hydrocolpos, which is the enlargement of vagina due to accumulation of fluid or fetal ascites [4,5]. HMC could occur as a result of a cloacal anomaly or due to syndromic association or vaginal atresia, transverse vaginal septum, and imperforate hymen [5]. We report a rare case of persistent UGS with fetal ascites, HMC, severe vaginal stenosis, and unilateral buphthalmos. Our report essentially underlines the necessity of early antenatal diagnosis and prompt post-natal management to reduce morbidity. Persistent urogenital sinus (UGS) is a rare congenital cloacal anomaly whereby the urinary and genital tracts fail to separate during embryonic development. It can present as hydrometrocolpos (HMC) with severe vaginal stenosis/atresia, ambiguous genitalia, and/or urinary ascites. A term neonate born to a primigravida showed on antenatal ultrasound scan features suggestive of gross fetal ascites with severe oligohydramnios and hydronephrosis. Postnatally, the neonate presented with respiratory distress, urinary ascites, and abdominal mass and unilateral buphthalmos. An ascitic tap was done and HMC was drained. The cystogenitoscopy revealed vaginal stenosis for which vaginoplasty was done. The child was discharged and on follow-up is gaining weight. Our report shows an unusual presentation of a persistent UGS and also emphasizes the importance of early antenatal diagnosis and prompt post-natal management to reduce morbidity.
The Indian Journal of Pediatrics, 2019