Background: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. Methods: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. Results: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome Conclusion: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise

Objective: To assess the use of anteromedial plating in the shaft of humerus fractures concerning the union of fracture and to assess the frequency of complications associated with this approach. Study Design: Cross Sectional study. Setting: United Medical and Dental College, Shaheed Muhatarma Benazir Bhutto Medical College Lyari and Khairpur Medical College. Period: 15 January 2016 to 15 January 2019. Material & Methods: All the patients aged 18 years or over presenting with the shaft of humerus fracture were included in the study. The anterolateral approach was used to expose the fracture, and the plate was applied on the anteromedial surface of the humerus. Rodriguez Merchan criteria assessed the functional outcome. All the data was recorded on designated Performa and entered and analyzed by SPSS version 20. Results: Two hundred twenty-five patients of both sexes were included in the study. The mean age of the patients in the study was 38.06 ± 11.51. The mean union time of fracture in our study was 11.76 ± 2.72 weeks.  Functional outcome was assessed using Rodriguez Merchan criteria excellent functional outcome was achieved in 165(73.3%) of the cases and good functional outcome in 58 (25.8%) of cases. A fair outcome was achieved in 2 (0.9%) cases. Conclusion: Anteromedial plating is the viable option for treating shaft of humerus fractures as it is associated with a high union rate and low or no complications.

Conventional energy generation technologies face unreliability due to the depletion of fossil fuels, soaring energy prices, greenhouse gas emissions, and continuously increasing energy demand. As a result, researchers are searching for reliable, cheap, and environmentally friendly renewable energy technologies. Solar photovoltaic (PV) technology, which directly converts sunlight into electricity, is the most attractive sustainable energy source due to the sun's ubiquitous presence. However, the non-linear behaviour of solar PV demands maximum power point tracking (MPPT) to ensure optimal power production. Although Hill Climbing (HC) is a simple, cheap, and efficient MPPT algorithm, it has a drawback of steady-state oscillations around MPP under uniform weather conditions. To overcome this weakness, we propose some modifications in the tracking structure of the HC algorithm. The proposed optimized HC (OHC) algorithm achieves zero steady-state oscillations without compromising the strength of the conventional HC algorithm. We applied both algorithms to an off-grid PV system under constant and changing weather conditions, and the results demonstrate the superiority of the proposed OHC algorithm over the conventional HC algorithm.

Objective This study's main purpose is to determine the functional outcome of volar locking plates in the management of intraarticular fracture of the distal radius. Methodology This cross-sectional study was conducted from August 2016 to August 2019. Forty-nine patients with the intraarticular distal radius fractures managed by the volar locking plate were included in the study. Patients with open fractures, ipsilateral other limb injuries, polytrauma patients, pathological fractures, and patients having neurovascular injuries were excluded from the study. AO Classification was used to classify fractures. The fracture was approached through the volar approach and fixed by the volar locking plate. A modified mayo wrist score evaluated the functional outcome. All the data were recorded on predesigned performa, and Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) was used to analyze the data. Results A total of 49 patients with intraarticular fractures of the distal radius were included in the study. The mean age of the patient was 37.20 ± 10.05 years. Out of 49 patients, 29 (59.2%) were males, and 20 (40.8%) were females. Union was achieved in almost all fractures except one case, which went into non-union despite the adequate initial reduction, and the mean time of union was 11.98 ± 1.64 weeks. With respect to the stratification of functional outcome very good and good functional outcome was achieved in 46 patients (93.8%) in both the groups, the satisfactory outcome was achieved in two (4.1%) cases and one patient had a bad outcome in which union was not achieved and went into non-union. Conclusion Open reduction and internal fixation of intraarticular fracture of the distal radius using a volar locking plate is a good option for managing these fractures as it provides stable fixation, and good to excellent outcomes can be achieved by using these plates.

To evaluate the association of chronic low back pain with levels of vitamin D in the affected population.