Atresia of the descending aorta in a young woman requiring bypass graft

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta and the descending aorta, using partial occlusion clamps. Patient tolerated the procedure well and was discharged on ACE Inhibitors and beta blockers, which were then weaned off over a period of one year. She remained stable and had no further complaints

ResViT: A Framework for Deepfake Videos Detection

Deepfake makes it quite easy to synthesize videos or images using deep learning techniques, which leads to substantial danger and worry for most of the world\u27s renowned people. Spreading false news or synthesizing one\u27s video or image can harm people and their lack of trust on social and electronic media. To efficiently identify deepfake images, we propose ResViT, which uses the ResNet model for feature extraction, while the vision transformer is used for classification. The ResViT architecture uses the feature extractor to extract features from the images of the videos, which are used to classify the input as fake or real. Moreover, the ResViT architectures focus equally on data pre-processing, as it improves performance. We conducted extensive experiments on the five mostly used datasets our results with the baseline model on the following datasets of Celeb-DF, Celeb-DFv2, FaceForensics++, FF-Deepfake Detection, and DFDC2. Our analysis revealed that ResViT performed better than the baseline and achieved the prediction accuracy of 80.48%, 87.23%, 75.62%, 78.45%, and 84.55% on Celeb-DF, Celeb-DFv2, FaceForensics++, FF-Deepfake Detection, and DFDC2 datasets, respectively

Quality of inpatient care of small and sick newborns in Pakistan: Perceptions of key stakeholders

Background: In LMICs including Pakistan, neonatal health and survival is a critical challenge, and therefore improving the quality of facility-based newborn care services is instrumental in averting newborn mortality. This paper presents the perceptions of the key stakeholders in the public sector to explore factors influencing the care of small and sick newborns and young infants in inpatient care settings across Pakistan.Methods: This exploratory study was part of a larger study assessing the situation of newborn and young infant in-patient care provided across all four provinces and administrative regions of Pakistan. We conducted 43 interviews. Thirty interviews were conducted with the public sector health care providers involved in newborn and young infant care and 13 interviews were carried out with health planners and managers working at the provincial level. A semi-structured interview guide was used to explore participants\u27 perspectives on enablers and barriers to the quality of care provided to small and sick newborns at the facility level. The interviews were manually analyzed using thematic content analysis.Findings: The study respondents identified multiple barriers contributing to the poor quality of small and sick newborn care at inpatient care settings. This includes an absence of neonatal care standards, inadequate infrastructure and equipment for the care of small and sick newborns, deficient workforce for neonatal case management, inadequate thermal care management for newborns, inadequate referral system, absence of multidisciplinary approach in neonatal case management and need to institute strong monitoring system to prevent neonatal deaths and stillbirths. The only potential enabling factor was the improved federal and provincial oversight for reproductive, maternal, and newborn care.Conclusion: This qualitative study was insightful in identifying the challenges that influence the quality of inpatient care for small and sick newborns and the resources needed to fix these. There is a need to equip Sick Newborn Care Units with needed supplies, equipment and medicines, deployment of specialist staff, strengthening of in-service training and staff supervision, liaison with the neonatal experts in customizing neonatal care guidelines for inpatient care settings and to inculcate the culture for inter-disciplinary team meetings at inpatient care settings across the country

Antioxidant enzymes as bio-markers for copper tolerance in safflower (Carthamus tinctorius L.)

Activities of antioxidants enzymes were investigated in order to evaluate protective mechanism of plants against oxidative stress induced by high concentration of copper. Safflower (Carthamus tinctorius L.) plants were exposed to 100 μM copper (Cu) for two weeks under controlled environmental conditions using hydroponic culture. Cu induced changes in chlorophyll and carotenoids pigments. More Cu accumulated in the roots as compared with the leaves. Level of lipid peroxidation and antioxidative enzyme activities (peroxidase, catalase and superoxide dismutase) also correlated with the Cu content of the plant tissues. However, restricted transfer of the metal to the foliage and enhanced activity of peroxidase, catalase and superoxide dismutase may be of great significance for scavenging oxidative stress caused by excessive copper in safflower plants. Thus, these antioxidant enzymes served as good predictors for the evaluation of heavy metal tolerance.Keywords: Carthamus tinctorius, copper stress, oxidative damage, antioxidant defenseAfrican Journal of Biotechnology Vol. 9(33), pp. 5441-5444, 16 August, 201

Operability, usefulness, and task-technology fit of an mHealth App for delivering primary health care services by community health workers in underserved areas of Pakistan and Afghanistan: Qualitative study

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems.Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis.Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants.Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology

Advances in Nematode Identification: A Journey from Fundamentals to Evolutionary Aspects

Nematodes are non-segmented roundworms evenly distributed with various habitats ranging to approximately every ecological extremity. These are the least studied organisms despite being the most diversified group. Nematodes are the most critical equilibrium-maintaining factors, having implications on the yield and health of plants as well as well-being of animals. However, taxonomic knowledge about nematodes is scarce. As a result of the lack of precise taxonomic features, nematode taxonomy remains uncertain. Morphology-based identification has proved inefficacious in identifying and exploring the diversity of nematodes, as there are insufficient morphological variations. Different molecular and new evolving methodologies have been employed to augment morphology-based approaches and bypass these difficulties with varying effectiveness. These identification techniques vary from molecular-based targeting DNA or protein-based targeting amino acid sequences to methods for image processing. High-throughput approaches such as next-generation sequencing have also been added to this league. These alternative approaches have helped to classify nematodes and enhanced the base for increased diversity and phylogeny of nematodes, thus helping to formulate increasingly more nematode bases for use as model organisms to study different hot topics about human well-being. Here, we discuss all the methods of nematode identification as an essential shift from classical morphometric studies to the most important modern-day and molecular approaches for their identification. Classification varies from DNA/protein-based methods to the use of new emerging methods. However, the priority of the method relies on the quality, quantity, and availability of nematode resources and down-streaming applications. This paper reviews all currently offered methods for the detection of nematodes and known/unknown and cryptic or sibling species, emphasizing modern-day methods and budding molecular techniques

Patient safety through the lens of human factors system approach : qualitative exploratory-descriptive study of public and private tertiary care hospitals of Karachi

Patient safety is an integral component of high quality service delivery but despite this, annually, worldwide there are around 42.7 million adverse events. Medical errors are also one of the major issues in Neonatal Intensive Care Unit (N ICUs) and it estimated that 27% of reported errors result in harm to patient and increases the mortality and morbidity of neonates. Worldwide 98% of 5 million global neonatal deaths occur in developing countries. Those occurring due to neonatal infections are about 1.6 million deaths. Health care associated infections constitute a major portion of it and those occurring in the Neonatal Intensive Care Unit (NICU) are the most significant cause of morbidity and mortality among critically ill neonates. Lack of infection control policies in developing countries causes the hospital-born babies to be at a 30-20 times at a greater risk of getting neonatal infections as compared to those born in developed countries. Objectives: The study aimed to assess the patient safety climate and identify the factors which influence the patient safety in the NICU of a public and private tertiary care hospital. Method: It was a qualitative exploratory-descriptive study with concurrent data collection. The study was conducted from July to August\u2718 at the NICU of one public and one private tertiary care level hospital of Karachi, Sindh. The study participants were the health care professionals of the NICU from the respective hospitals. It included management personnel, doctors, nurses and technicians. The data collection was concurrent with qualitative data being collected along with the quantitative data collection. The purposive sampling technique was used for the qualitative data collection whereas convenience sampling was used for the quantitative data collection. In the first phase of the study qualitative and quantitative data was collected simultaneously. Qualitative data comprised of in-depth interviews with different cadres of healthcare professionals and observation of study sites. The quantitative data was collected by using a self-administrated safety attitude questionnaire. In the second phase of the study we analyzed the quantitative data using IBM SPSS version 19. The qualitative data which included IDIs verbatim was translated and transcribed. It was then coded and emerging themes were then • identified and analyzed using N-Vivo 10. In phase three of the study triangulation of the quantitative and qualitative data was done which provided rigor and integrity to the study Results: The perceptions regarding patient safety climate in the NICU of public as well private hospital were not high as the general mean score of both was lower than the recommended score of \u3e75. In the domains analysis there was no significant variation in the means of the scores of both of the hospitals. All of the six domains of patient safety climate scored lower than 75 in the NICU of the public sector hospital while in private hospital except job satisfaction all of the remaining domains scored less than 75. In positive percent agreement the NICU of public sector hospital scored lower than the private hospital in all of the domains except stress recognition. The key barriers of limited resources, shortage of personnel, lack of proper error reporting system, inadequate monitoring systems and lack of policies regarding infection control practices were identified from the N1CU of public sector hospital. Stress due to workload, lack of stress management and cultural were identified in both of the hospitals. Conclusion: The patient safety climate was perceived as inferior in the NICUs of both of the hospitals. There was no significant variation in the scores of the domains of the patient safety climate survey. The proportion of positive respondents was higher in the N1CU of private hospital as compared to the public one. The major barriers identified were resource limitation, lack of policies regarding infection control, shortage of trained staff, unorganized task distribution, cultural and social challenges in work place and lack of adequate error repoiting and monitoring system. They main facilitators that emerged were the presence of an active infection control committee along with a biomedical department, proper error reporting system with root cause analysis, using of standardized tools (International patient safety goals and SBAR) and monitoring through proper key performance indicators and statistics

Pierson Syndrome Associated with Hypothyroidism and Septic Shock

Pierson syndrome is caused by mutations in the laminin β2 gene causing absent β2 laminin, which is a normal component of the basement membranes of the mature glomerulus, structures in the anterior eye and neuromuscular junctions. The mutations manifest as congenital nephrotic syndrome and microcoria which are characteristic ocular features of this disease. These mutations may also result in neurological abnormalities such as hypotonia and psychomotor retardation. We report a two-month old boy who presented to the Pediatrics Department of Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan, in 2015, with the typical features of microcoria and congenital nephrotic syndrome. The hypocalcaemia, hypoproteinaemia and probable immunocompromised state consequent to nephrotic syndrome resulted in seizures, hypothyroidism and urosepsis. Despite being treated aggressively with high dose antibiotics, ionotropic support, angiotensin-converting enzyme inhibitors, thyroxine replacement and nutritional support, the infant died due to significant multiorgan disease including renal failure and septic shock. Keywords: Pierson Syndrome; Microcoria and Congenital Nephrotic Syndrome; Congenital Microcoria; Hypothyroidism; Septic Shock; Case Report; Pakistan