Multiple Sclerosis in Pakistan: Collaborative Working to Improve Care

We read the recent article by Zara Shah et al with great interest.1 We appreciate the effort to present and publish novel data on Multiple Sclerosis (MS) in Pakistan. Herein, we want to put some light on a very important aspect of management in MS, i.e., multidisciplinary neuro-rehabilitation, to be considered an integral part of treatment in MS to improve the quality of life. Neurological rehabilitation is considered to be a key component of treatment in MS but has largely been neglected in developing countries

Obturator Nerve Block with Aqueous Phenol Reduces Hip Adductor Spasticity – A Single Centre experience

ABSTRACT Aim: Spasticity is a cardinal symptom of upper motor neuron disorders. It affects different individuals differently. Spasticity in the hip adductor muscles can be very painful and may result in postural abnormalities and hip deformities that interfere with walking, transferring and perineal hygiene. The study aimed to assess the effectiveness of phenol obturator nerve block on hip adductor spasticity caused by the upper motor neuron lesions. Materials and methods: This is a single-centre retrospective study of all patients with known spasticity in the hip adductors who were assessed suitable for phenol nerve block of the obturator nerve. All patients had Modified Ashworth Scale (MAS) and the distance between the right and left femoral condyles measured in the supine position with the hip and knee flexed called as intercondylar distance (ICD) recorded before the procedure, 6 weeks and 24 weeks after phenol nerve block. Nonparametric Friedman test of differences among repeated measures was conducted from data at 0, 6 and 24 weeks

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®).

Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to

Effects of IV Magnesium Sulphate on Hemodynamic Response To Pneumoperitoneum In Laparoscopic Cholecyctectomy; A Randomized Control Trial

Objective: To determine the effect of IV Magnesium sulphate (MgSO4) in attenuating the hemodynamic effects of pneumoperitoneum. Methodology: Our single blind randomized control trial (based on computer generated randomize allocation) was carried out at Holy Family Hospital and included 60 patients, not allergic to MgSO4 and belonging to the American Society of Anesthesiology (class 1 and 2. Patients were divided into two groups with Intervention group (M group) receiving 30 mg/kg of MgSO4 and the control group (C group) receiving a placebo. Hemodynamic parameters were then measured at different points of time during surgery. Data was collected and analyzed by using statistical package for the social sciences (SPSS) version 25.0. Results: Out of 60 patients selected 86.7% were females while 13.3% were males. Mean age was 35.78(SD=8.26). As compared to group, patients belonging to group had significantly lower heart rate, systolic and diastolic blood pressure at 15 minutes, after release of pneumoperitoneum and at extubation with p values less than 0.05. Conclusion: Our study concludes that 30 mg/kg of MgSO4 given as a bolus just before creation of pneumoperitoneum protect against its possible adverse hemodynamic effects

Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Objective:  To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus. Material and Methods:  The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death. Results:  Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%). Conclusion:  Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes

Chikungunya outbreak in Bangladesh (2017) : clinical and hematological findings

A massive outbreak of Chikungunya occurred in Bangladesh during the period of April-September, 2017 and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological and long-term aspects of this outbreak. A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven clinically proven Chikungunya cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 Chikungunya patients was monitored for post-infection effects for 12 months. Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that, irrespective of age groups, hemoglobin level significantly decreased and erythrocyte sedimentation rate remarkably increased in Chikungunya confirmed patients. However, the majority of the patients had a normal range of whole WBC and platelet counts; RBC counts for mid aged (40 – 60 years) and senior (61+ years) patients (especially in the females) were beyond the reference values. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain and memory problems were the most significant aftereffects, which had an impact on daily activities of patients. This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of Chikungunya in Bangladesh as well as its chronic outcomes till the 12th month. It provides insights into the natural history of this disease which may help to improve management of the Chikungunya patients.Author summeryThe clinical profile, epidemiology and the economic impacts during the acute phase of Chikungunya infection has been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are very limited. In this study, a dataset of 187 clinically proven chikungunya patients were analyzed for the clinical and hematological features at acute phase of the infection. Additionally, the long-term consequences till month 12 after the infection were studied for a smaller group of 48 patients. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that, hemoglobin levels of the patients were significantly reduced and erythrocyte sedimentation rate increased remarkably. Also, RBC counts for mid-aged and older patients were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had moderate to severe impact on daily activities of the respondents. This study provides insights into the clinical and hematological aspects of Chikungunya infection during the acute phase as well as describes an account for its chronic outcomes which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improved patient management

Chikungunya outbreak in Bangladesh (2017) : clinical and hematological findings

Introduction: A massive outbreak of chikungunya virus (CHIKV) occurred in Bangladesh during the period of April-September 2017, and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological, and long-term aspects of this outbreak. Methods: A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven laboratory-confirmed CHIKV cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 chikungunya patients was monitored for post-infection effects for 12 months. Results: Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that irrespective of age and sex groups, CHIKV patients had a decreased level of hemoglobin (n = 64, p < 0.01) and elevated erythrocyte sedimentation rate (n = 131, p < 0.01). Besides, a significant portion of the patients represented abnormal values for RBC (n = 38, p = 0.0005) and WBC (n = 63, p < 0.01) counts. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain, and memory problems were the most significant aftereffects, which had an impact on the daily activities of patients. Conclusions: This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of CHIKV in Bangladesh as well as its chronic outcomes till the 12(th) month. It provides insights into the natural history of this disease, which may help to improve the management of CHIKV patients. Author summary: The clinical profile, epidemiology, and the economic impacts during the acute phase of chikungunya infection have been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are infrequent. In this study, we analyzed the clinical and hematological features of 187 chikungunya patients in the acute phase of the infection. Also, we monitored a smaller group of 48 patients until 12 months to study its post-infection consequences. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that CHIKV infection features a significantly reduced hemoglobin and remarkably elevated erythrocyte sedimentation rate. Besides, RBC and WBC counts, especially in children and females, were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had a moderate to severe impact on the daily activities of the respondents. This study provides insights into the clinical and hematological aspects of chikungunya infection during the acute phase as well as describes an account for its chronic outcomes, which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improve patient management

Identification of Software Bugs by Analyzing Natural Language-Based Requirements Using Optimized Deep Learning Features

© 2024 Tech Science Press. All rights reserved. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/Software project outcomes heavily depend on natural language requirements, often causing diverse interpretations and issues like ambiguities and incomplete or faulty requirements. Researchers are exploring machine learning to predict software bugs, but a more precise and general approach is needed. Accurate bug prediction is crucial for software evolution and user training, prompting an investigation into deep and ensemble learning methods. However, these studies are not generalized and efficient when extended to other datasets. Therefore, this paper proposed a hybrid approach combining multiple techniques to explore their effectiveness on bug identification problems. The methods involved feature selection, which is used to reduce the dimensionality and redundancy of features and select only the relevant ones; transfer learning is used to train and test the model on different datasets to analyze how much of the learning is passed to other datasets, and ensemble method is utilized to explore the increase in performance upon combining multiple classifiers in a model. Four National Aeronautics and Space Administration (NASA) and four Promise datasets are used in the study, showing an increase in the model’s performance by providing better Area Under the Receiver Operating Characteristic Curve (AUC-ROC) values when different classifiers were combined. It reveals that using an amalgam of techniques such as those used in this study, feature selection, transfer learning, and ensemble methods prove helpful in optimizing the software bug prediction models and providing high-performing, useful end mode.Peer reviewe

A Deep Learning-Based Framework for Feature Extraction and Classification of Intrusion Detection in Networks

An intrusion detection system, often known as an IDS, is extremely important for preventing attacks on a network, violating network policies, and gaining unauthorized access to a network. The effectiveness of IDS is highly dependent on data preprocessing techniques and classification models used to enhance accuracy and reduce model training and testing time. For the purpose of anomaly identification, researchers have developed several machine learning and deep learning-based algorithms; nonetheless, accurate anomaly detection with low test and train times remains a challenge. Using a hybrid feature selection approach and a deep neural network- (DNN-) based classifier, the authors of this research suggest an enhanced intrusion detection system (IDS). In order to construct a subset of reduced and optimal features that may be used for classification, a hybrid feature selection model that consists of three methods, namely, chi square, ANOVA, and principal component analysis (PCA), is applied. These methods are referred to as “the big three.” On the NSL-KDD dataset, the suggested model receives training and is then evaluated. The proposed method was successful in achieving the following results: a reduction of input data by 40%, an average accuracy of 99.73%, a precision score of 99.75%, an F1 score of 99.72%, and an average training and testing time of 138% and 2.7 seconds, respectively. The findings of the experiments demonstrate that the proposed model is superior to the performance of the other comparison approaches.publishedVersio

Robotic Semi-Automated Transcranial Doppler Assessment of Cerebrovascular Autoregulation in Post-Concussion Syndrome: Methodological Considerations.

Post-concussion syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence and impact, the underlying mechanisms of PCS are unclear. We hypothesized that impaired cerebral autoregulation (CA) is a contributor. In this article, we present our protocol for non-invasively assessing CA in patients with TBI and PCS in a real-world clinical setting. A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical center. Data points included: demographics, symptom profile (Post-Concussion Symptom Scale [PCSS]) and neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]). Cerebrovascular metrics (nMxa co-efficient and the transient hyperaemic-response ratio [THRR]) were collected using transcranial Doppler (TCD), finger plethysmography, and bespoke software (ICM+). Twelve participants were initially recruited but 2 were excluded after unsuccessful insonation of the middle cerebral artery (MCA); 10 participants (5 patients with TBI, 5 healthy controls) were included in the analysis (median age 26.5 years, male to female ratio: 7:3). Median PCSS scores were 6/126 for the TBI patient sub-groups. Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). nMxa was calculated for 90% of included patients, whereas THRR was calculated for 50%. Median study time was 127.5 min and feedback (n = 6) highlighted the perceived acceptability of the study. This pilot study has demonstrated a reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. This protocol is feasible and is acceptable to participants. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI