Diversity in conception of COVID-19 in pastoral and metropolis areas of Pakistan

Background: SARS (severe acute respiratory syndrome) COV-2 has become a global problem since its emergence in 2019 from Wuhan, China as it is most deadly pandemic since Spanish flu in 1918. Primary Study Objective: This study analyzed the people ‘s perception regarding COVID-19 and precautionary measures taken by them during COVID- 19 peak time. Methods/Design: An observational concurrent study was performed in which data was collected from population in rural and urban areas of Punjab and Azad Kashmir using questionnaires. Setting: This survey was carried out in rural and urban areas of Punjab and Azad Jammu and Kashmir Participants: 305 participants were included in the study Intervention: Data was collected from the educated participants of different age groups belongs to different profession. Primary Outcome Measures: Purpose of the study is to know about that conception of COVID -19 in both rural and urban areas of Pakistan so that effective therapy can be given to the nation. Results: It was found that people from both populations had adequate knowledge about COVID-19 and followed restriction imposed by the government during lockdown period. Moreover, population in rural areas was more likely to believe in the myths and rumors about COVID-19 existence. Conclusion: It was concluded that there is need of generating awareness among general population through adequate means which provide authentic information to people and lockdown is not a solution. Everyone should take of his own life by wearing masks and following protocols

Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis.

BackgroundSuicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia.AimsTo estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia.MethodIn this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic.ResultsThe pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths.ConclusionsOne in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia

Cytomegalovirus infection in a patient with systemic lupus erythematosus and acute myocardial infarction – cause or causal relationship?

The possible role of infectious and inflammatory states in the pathogenesis of atherosclerotic disease has been a matter of debate in the literature. There are case reports of active cytomegalovirus (CMV) infection unmasking underlying dormant systemic lupus erythematosus (SLE). CMV infection has also been postulated to be associated with atherosclerosis development in the coronaries. We present a unique case where a patient with newly diagnosed SLE and acute myocardial infarction was found to have high anti-CMV titers suggesting concomitant active CMV infection. A literature review has postulated strong affiliation of CMV infection with the development of coronary artery disease, an avenue which has yet to be explored further by ongoing research

Infiltration of MHD liquid into a deformable porous material

We analyze the capillary rise dynamics for magnetohydrodynamics (MHD) fluid flow through deformable porous material in the presence of gravity effects. The modeling is performed using mixture theory approach and mathematical manipulation yields a nonlinear free boundary problem. Due to the capillary rise action, the pressure gradient in the liquid generates a stress gradient that results in the deformation of porous substrate. The capillary rise process for MHD fluid slows down as compared to Newtonian fluid case. Numerical solutions are obtained using a method of lines approach. The graphical results are presented for important physical parameters, and comparison is presented with Newtonian fluid case

Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project

Smoking causes an estimated 480,000 deaths every year. At our institute, tobacco treatment services (TTS) provide inpatient counseling and hospitalists have an essential role in providing education and replacement medications at discharge. Our project focused on increasing knowledge among hospitalists to improve the frequency of smoking cessation consultation and utilization of pharmacotherapy, accompanied by appropriate documentation and billing. We used baseline data from March 2018 to February 2019. Educational intervention was implemented from March 2019 to June 2019. Post-intervention results are reported from July 2019 to February 2020. Pre- and post-intervention periods’ results were compared. A significantly higher number of patients received TTS counseling during the post-intervention phase compared to pre-intervention (54 vs. 41%, p < 0.0001). A significantly higher number of patients were prescribed inpatient medications (42% to 48%, p = 0.004) and at the time of discharge (22% to 31%, p < 0.0001). However, there was a significant decrease in physician billing from pre-intervention to post-intervention, dropping from 19.5% to 16.2% (p = 0.012). Physicians’ gender, experience level, and loss of incentives impacted their consultation and billing behaviors. Future studies should continue to address the importance of TTS and physician behavior on increasing inpatient smoking cessation counseling and treatment

Newtonian and Joule Heating Effects in Two-Dimensional Flow of Williamson Fluid

In this article, we have studied the combined effects of Newtonian and Joule heating in two-dimensional flow of Williamson fluid over the stretching surface. Mathematical analysis is presented in the presence of viscous dissipation. The governing partial differential equations are reduced into the ordinary differential equations by appropriate transformations. Both series and numerical solutions are constructed. Graphical results for the velocity and temperature fields are displayed and discussed for various sundry parameters. Numerical values of local skin friction coefficient and the local Nusselt number are tabulated and analyzed

On Estimation of Distribution Function Using Dual Auxiliary Information under Nonresponse Using Simple Random Sampling

In this paper, we proposed two new families of estimators using the supplementary information on the auxiliary variable and exponential function for the population distribution functions in case of nonresponse under simple random sampling. The estimations are done in two nonresponse scenarios. These are nonresponse on study variable and nonresponse on both study and auxiliary variables. As we have highlighted above that two new families of estimators are proposed, in the first family, the mean was used, while in the second family, ranks were used as auxiliary variables. Expression of biases and mean squared error of the proposed and existing estimators are obtained up to the first order of approximation. The performances of the proposed and existing estimators are compared theoretically. On these theoretical comparisons, we demonstrate that the proposed families of estimators are better in performance than the existing estimators available in the literature, under the obtained conditions. Furthermore, these theoretical findings are braced numerically by an empirical study offering the proposed relative efficiencies of the proposed families of estimators

Long-term outcomes of transplant recipients referred for angiography for suspected transplant renal artery stenosis

Our aim was to study the long-term outcomes of all transplant recipients who underwent angiography for suspected TRAS at our institution. The patients were divided into TRAS+ve and TRAS−ve groups based upon angiographically confirmed results. TRAS was confirmed in 58.1% of 74 patients with median time of 8.9 months. Primary angioplasty alone was performed in 56% of patients with TRAS, while the remaining had PTA with stent (PTAS). There was reduction in systolic and diastolic BP (165 ± 19–136 ± 15 mmHg and 82 ± 14 mmHg to 68 ± 12 mmHg; p < 0.05) and number of antihypertensive drugs (3.5 ± 0.9–2.7 ± 1.0; p < 0.05). Overall, graft survival and patient survival from time of transplant were similar in both groups. Graft function was similar for the patients with treated TRAS+ve as compared to TRAS−ve over time. Graft survival and patient survival when compared to an age- and year of transplant-matched cohort control group were also similar. In conclusion, angiography for suspected TRAS is more likely to yield a confirmatory result early in the transplant course as compared to late. Treatment of TRAS in these patients had sustained long-term graft function. Alternative etiologies of HTN and graft dysfunction should be sought for recipients further out from transplant

Clinical Practice Variations in the Management of Ischemia With No Obstructive Coronary Artery Disease

Background Ischemia with no obstructive coronary artery disease is a condition associated with major adverse cardiovascular outcomes. To date, there are no specific American Heart Association or American College of Cardiology guidelines. The objective of this survey is to better understand the clinical practice and knowledge gaps that exist nationally. Methods and Results Participant‐specific links for a survey with 11 questions and 3 reminders were sent between September and October 2020 to the American College of Cardiology CardioSurve Panel. The panel consist of randomly selected cardiologists (n=437) who represent the current profile of the American College of Cardiology US membership. The survey received a 30% response rate. Of the 172 respondents, 130 (76%) indicated that they have treated patients with ischemia with no obstructive coronary artery disease. Although the majority (69%) are generally confident in their ability to manage this condition, 1 of 3 report lack of confidence or are neutral. The American College of Cardiology/American Heart Association Chronic Stable Angina Guidelines are the most commonly used reference for treating ischemia with no obstructive coronary artery disease (81%), with most cardiologists wanting additional clinical guidance, such as randomized controlled trials (61%). More than 4 of 5 cardiologists rarely or never order advanced imaging modalities to assess coronary flow reserve. Approximately 2 of 3 of respondents frequently prescribe statins (68%), aspirin (66%), calcium channel blockers (63%), and β blockers or α/β blockers (55%). However, nearly 70% never prescribe angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers. Conclusions This survey demonstrates heterogeneity in the management of ischemia with no obstructive coronary artery disease among US cardiologists, identifies support for guideline development, and outlines knowledge gaps for research and education in the therapeutic management of this condition

ANCA associated vasculitis: experience of a tertiary care referral center

ABSTRACT Background and objectives: Anti-neutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis is a small vessel vasculitis with insufficient epidemiologic estimates in the United States. We aimed to determine demographic and clinical features of ANCA associated vasculitis patients presenting to a large tertiary care referral center in Upstate New York. Design, setting, participants, and measurements: A retrospective analysis of cases with pauci-immune GN on renal biopsy and clinical diagnosis of ANCA vasculitis presenting over 11 years was conducted. Outcomes of interest were: demographics, ANCA antibody positivity, patient and renal survival, and regional trends. Results: 986 biopsies were reviewed, 41 cases met the criteria for inclusion: 18 GPA, 19 MPA, and 4 double positive (anti-GBM disease plus ANCA vasculitis). Mean age at presentation was 52.4 years (SD 23.7), 23 (56%) were male and median creatinine was 2.6 mg/dL. The median patient follow up was 77 weeks (IQR 10 - 263 weeks), with a 3-month mortality rate of 5.7% and a 1-year estimated mortality rate of 12%. Thirteen patients required hemodialysis at the time of diagnosis; 7 patients came off dialysis, with median time to renal recovery of 4.86 weeks (IQR 1.57 - 23.85 weeks). C-ANCA positivity (p < 0.001) and C-ANCA plus PR3 antibody pairing (p = 0.005) was statistically significant in GPA versus MPA. P-ANCA positivity was observed in MPA versus GPA (p = 0.02) and double positive versus GPA (p = 0.002), with P-ANCA and MPO antibody pairing in MPA versus GPA (p = 0.044). Thirty-seven of the 41 cases were referred locally, 16 cases were from within a 15-mile radius of Albany, Schenectady, and Saratoga counties. Conclusions: ANCA vasculitis is associated with end stage renal disease and increased mortality. Our study suggests the possibility of higher regional incidence of pauci-immune GN in Upstate New York. Further studies should investigate the causes of clustering of cases to specific regions