The construction industry (CI) has a significant impact on the environment and on climate change due to the emission of greenhouse gases like carbon dioxide. Globally accepted Sustainable Development Goals (SDG), specifically SDG 7 (Access to Affordable, Reliable, Sustainable and Modern Energy for All), SDG 9 (Industry, Innovation and Infrastructure), and SDG 11 (Sustainable Cities and Communities) stress the responsible utilization of energy in various industries, including construction. The CI uses almost half of the world’s produced energy. Therefore, this research presents insights into the efficient use of energy in the building sector and shows how energy efficiency can be achieved by altering different parameters and components like orientation, materials, glazing, and HVAC systems through a case study of a hospital building in Green Building Studio (GBS). This paper also aims to use the Building Information Modelling (BIM) approach to make environmentally sustainable decisions to reduce energy waste in projects. Initially, beneficial factors of BIM on green buildings were identified in the literature and later ranked, based on expert opinions collected using a set of questionnaires. Average Index was used for data analysis. The identified benefits were validated by conducting energy analyses on a hospital model through 3D BIM. It was concluded that a substantial share of energy cost, carbon dioxide (CO2), and electricity can be saved using this approach. It was determined that a quick and sustainable design process, improved energy efficiency, enhanced building performance, and provision of better design alternatives are the key benefits of the adoption of BIM by such projects. A Cronbach’s alpha value of 0.822 was obtained, which further validates the results. The proposed approach may lead future structures to be sustainable and enriches the culture of energy-efficient green buildings.
Concrete is the most important and most consumed construction material in global construction industry. The properties of concrete are greatly influenced by properties of its constituents and curing methods utilized for preparation of specimens. This study is focused on investigating the influence of three common curing methods, i.e., ponding, sprinkling and wet cover curing on compressive strength behavior of concrete. In total, 45 cubes were casted and tested after curing for 3, 7, 14, 28 and 56 days. The obtained results suggest that ponding method of concrete curing is most effective among all the three methods of concrete curing considered in this study. After ponding, the performance of concrete cured with wet cover curing method was quite acceptable. Moreover, the study also suggested that sprinkling method of curing gives lowest compressive strength due to greater moisture movement which abates the hydration of binder in concrete. This study will be helpful for construction practitioners in deciding the best-suited curing method under given conditions and available methods of preparation of concrete.
Introduction: The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients. Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis. Methods: This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1 st January 2022 to 30 th June 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant. Results: A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001). Conclusion: Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.
Aim: To determine the association of gestational diabetes with parental diabetic mellitus and impaired glucose tolerance Study design: A cross-sectional study Place and Duration: This study was conducted at Jahra Hospital Kuwait from February 2021 to February 2022 Methodology: This study includes 100 women with gestational diabetes. They were aged 35 (±5) years. They were tested by fasting plasma glucose (fpg). There were 61 women who either had diabetes or fasting hyperglycemia (fpg = >5.4 millimole/l). A total of 35 women had their parents alive. Of these 35 women’s parents, 14 women’s parents agreed to test their metabolism. Their metabolism was tested by CIGMA (continuous infusion of glucose with model assessment). Results: Among those 14 families, 7 probands had diabetes and the other 7 had impaired glucose tolerance (IGT). The women were aged 36 (±4) years with a BMI of 27 (±5) kilograms/m2. The parents were aged 63 (±5) with a BMI of 30 (±5) kilograms/m2. The presence of glucose intolerance defined their affection status (an age and obese matched population with fpg or post-infusion attained plasma glucose levels greater than 3 standard deviation). Among those 14 families, 5 probands did not have any parent affected, which represents 35.7%, 3 probands had both parents affected, which represents 21.4%, and 6 probands had only 1 parent affect, which represents 42.9%. Only 3 of proband’s parents were affected by diabetes as explained by WHO criteria. Practical implication This paper outlines some of the growing evidence showing pregnant women with gestational diabetes mellitus are more likely to give birth to diabetic mothers. These preliminary findings' are provocative implications to encourage additional research. Conclusion: In conclusion, examining women with gestational diabetes, who have both parents available for this research, helps to find probands with IGT or diabetes. Those who had neither parents impacted with diabetes nor IGT were representing a significant portion which was much the same as elementary families of NIDDM. Keywords: diabetes mellitus, gestational diabetes, parents, impaired glucose tolerance
Introduction: Most of the lactate in the body is cleared in the liver. Tissue hypoxia results in increased production of lactate and decreased utility of it. Hepatic insult results not only an increase in the blood lactate levels but also is an independent prognostic marker in critically ill cirrhotic patients. Alteration of liver function is indicated by rise in serum bilirubin. The aim of this study was to therefore to assess the utility of blood lactate to Bilirubin index (LBi) in predicting mortality in patients with acute on chronic liver failure (ACLF). Methods: This prospective observational study was conducted from January 2019 to June 2021 at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. Patients aged > 12 years and presenting ACLF were included and their baseline characteristics were recorded. Primary outcome was observed in terms of 30-days mortality and secondary outcome was six months mortality. These indices were then used to calculate the lactate to bilirubin index (LBi) as [1000 × lactate (mmol/L) × bilirubin (µmol/L)]/2. Area under Receiver operating curves (AUROC) for LBi, Child Turcotte Pugh score(CTP) and Model for End-stage Liver Disease score (MELD) were obtained in predicting both 30 days and six months mortality and at an optimal cutoff sensitivity, specificity and diagnostic accuracy for these scores were calculated. Results: A total number 159 patients with ACLF were included in the study. Most of the patients were young with mean age of 35.1 ±16.8 years. Males were 97(61%). Hepatitis C was the most common cause of chronic liver disease followed by hepatitis B and autoimmune hepatitis seen in 41 (25.8%), 39(24.5%) and 36 (22.6%) respectively. Hepatitis E was the most common cause of acute injury noted in 60 (37.7%) patients. The baseline characteristics showed mean serum lactate levels of 0.93±1.33 mmol/L, bilirubin levels of 258.5 ± 155.3 µmol/L, CTP score of 10.7 ± 1.8 and MELD score of 26 ±7.6. Out of 159 patients, 26 (16.4%) patients died within 30 days due to ACLF related complicaitons while 133 (83.6%) were discharged. AUROC obtained for LBi, CTP score and MELD score in predicting 30-day mortality in ACLF was 0.98, 0.79 and 0.78 respectively. A cut off of ≥11.8 for LBi Index, ≥30 for MELD score and ≥13 for CTP score were significantly associated with increased risk of 30-day mortality in ACLF patients in our population. However, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of LBi in predicting 30-day mortality was significantly higher than that of CTP and MELD score. The diagnostic accuracy of LBi in predicting 30 days mortality was 87.5%. Similarly, AUROC obtained for LBi, CTP score and MELD score in predicting 6-month mortality in ACLF was 0.89, 0.72 and 0.66 respectively and the diagnostic accuracy of LBi dropped down to 76.6% with a sensitivity of 49.28%, specificity of 97.28%, PPV of 94.4% and NPV of 71.54%. Conclusion: Our results showed that LBi score of >11.8 had an excellent sensitivity and specificity in predicting mortality in ACLF with an excellent diagnostic accuracy in predicting one month mortality as compared to the other scores. However, its utility in predicting long term mortality is yet to be proven. Further studies are needed to validate this index.
Hepatocellular carcinoma with portal vein thrombosis is rarely seen in young patients. Hepatitis B can lead to HCC with PVT in the absence of cirrhosis. However, it is uncommon in age less than 40 years. Here we present to you a case of an eight year old boy with a family history of hepatitis B who developed HCC with PVT.
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