Concussion: A review of epidemiology, presentation and treatment.

A direct impact on the head can cause a Mild Traumatic Brain Injury or Concussion. It is a neuronal brain injury with or without loss of consciousness. Each year, approximately 69 million people are estimated to suffer from Concussion. Around 80-90% of these Concussion cases resolve within a week. The most commonly reported post-concussion symptoms include headache, cognitive changes, sleep disturbances, and depression. Essential in the approach to patients with concussion includes a detailed history taking and physical examination. Imaging modalities like Magnetic Resonance Images (MRI) of the brain may not show any significant changes; therefore more sensitive tests, like Functional MRI (fMRI), Diffusion Tensor Imaging (DTI), Magnetic Resonance Spectroscopy (MRS) and Positive Emission Tomography (PET) can be used. The treatment approach depends on the underlying cause and presentation. Patients should be encouraged to resume physical activity as soon as possible. Symptoms like headache can be treated with Analgesics. Sleep disturbances should be handled with proper sleep routine and drugs including Zolpidem. Cognitive disturbances can be improved with drugs and Cognitive Behavioral Therapy. In all patients, follow-up and counseling are always required. We discuss the epidemiology, symptoms, and treatment approach of mild traumatic brain injury in the world and Pakistan

Gastrointestinal complications in critically ill children: Experience from a resource-limited country

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated.Results: GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropes.Conclusion: GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors

Impact of Continuing Medical Education on Health Care Provider Performance in a Medical University, Karachi, Pakistan.

Introduction: Basic life support (BLS), is the chain of survival and decreases the rate of cardiac arrest; health care professionals should know at least how to perform BLS individually as they may encounter such emergency very often. In the developed world, sudden cardiac death represents the single largest cause of natural death accounting for 12–18% of total mortality and 50% of cardiac mortality. Objectives: To determine the level of awareness regarding Basic Life Support and knowledge of involved skills and its practice among medical and non-medical personnel. Methodology: A retrospective study conducted by using valid questionnaire regarding Basic Life Support by 323 personnel. The results were analyzed with SPSS version 16. Results: Twenty-five questions were used to assess the level of knowledge/awareness and skills after BLS training. The percentage of correct answer varied from 33.1% to 95.7% for knowledge related items; and for skills items, it was varied from 35.3% to 68.4%. Conclusion: We recommend that Cardio Pulmonary Resuscitation/Basic Life Support should be a basic skill across all medical and non-medical personnel. Key words: Cardio-pulmonary resuscitation, Basic Life Support, KAP

Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa

Abstract: Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications. Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI <25kg/m2. Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.  In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c <7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17. Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c. Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medication

IMPACT OF THE FUNCTIONAL LEADERSHIP DIMENSIONS ON ORGANIZATIONAL PERFORMANCE IN DIVERSE ORGANIZATION IN PAKISTAN

This paper examines the connections among the dimensions of functional leadership of situation clarification, strategy clarification, coordination leadership, and organizational performance within highly gender-diverse organizations in Pakistan. A sample of 500 employees from universities in Pakistan was taken. The data collection process was conducted among the university employees. For data analysis PLS-SEM through SmartPLS3 was employed. The results of the study indicate that within the higher education sector in Pakistan, the distinct dimensions of functional leadership of situation clarification, strategy clarification and coordination leadership individually exert a positive and noteworthy influence on organizational performance. These results carry strong message for leaders to adopt and apply these functional leadership dimensions to improve the overall performance of the organization. The findings strongly support the notion that implementing effective functional leadership dimensions of situation clarification, strategy clarification and coordination leadership can significantly enhance organizational performance. The outcomes robustly affirm the idea that the efficacy that these dimensions of functional leadership are pivotal in augmenting organizational performance

E-waste Reduction via Virtualization in Green Computing

As Virtualization, Green Data Center, Cloud computing, grid computing, Power optimization are the technologies of green computing. This study focuses on need of E-waste reduction that support through virtualization to save over all expenditures on hardware resources that is costly and even after some time causes e-waste. It is aimed to highlight the harms of the e-waste, importance of its reduction, how it can be reduced through virtualization, functionality of Virtualization and its contribution as an essential feature in Green Computing. Innovation in the technology to reduce energy/power consumption, creating data centers and virtual environment to optimize the use of computing in Information & Communication technology, revealed as Virtualization. Through systematic Research, it is revealed that virtualization is an optimization technique which is used to find the solution of resource management, server utilization, load balancing, e-waste collection and recycling etc. It has been changing information facilities due to its capability to consolidate hardware resources and decrease energy costs. Thus, harmful effects of computing on environment can be reduced which cause environmental sustainability

Comparison Of Quality Of Sleep Between Diabetic And Non-Diabetic Population Using Pittsburgh Sleep Quality Index

Background: Sleep is an essential event that effects quality of life and hormonal balance in human body. The association between sleep and diabetes is bi-directional. Methods: This study was conducted with a case control design in the Department of Medicine of Combined Military Hospital Peshawar between June 2022 to November 2022. Results: . Mean age of study population was 51.1±12.94 years with 46% females and 54% males. Majority population was educated up to matriculation with BMI in normal (18.5-24.9 kg/m2) range. There was no statistical difference in demographic data amongst diabetic and control group . Avg HbA1c was 8.546% ± 1.57% in the diabetic group and 5.712% ± 0.49% in control group. As per PSQI questionnaire 47 (47%) participants were good sleeper across the study population, which included 17 out 50 (34%) individuals in the diabetic and 30 out of 50 (60%) in control group. This equated to statistically significant difference amongst two group with a p value 0.007. A statistically significant difference (p = 0.001) was also seen in PSQI score between diabetic and control groups (9.40 ± 5.82 vs 5.98 ± 4.85 respectively). Diabetics had 2.9 times odds (95% confidence interval 1.29-6.57, p = 0.01) of having bad quality sleep as compared to controls. In the diabetic group majority were males educated up to matriculate having medium adherence treated with both oral hypoglycemic drugs and insulin having 3 or more comorbid condition with hypertension being most prevalent single comorbid disease. Conclusion: By strict glycemic control in diabetics we can imove their quality of sleep Interventions to improve sleep hygiene can be suggested to patients by diabetes educators as part of diabetes self-management education programs

Precision pollination strategies for advancing horticultural tomato crop production

Global climate change and anthropological activities have led to a decline in insect pollinators worldwide. Agricultural globalisation and intensification have also removed crops from their natural insect pollinators, and sparked research to identify alternate natural insect pollinators and artificial technologies. In certain countries such as Australia the importation of commercial insect pollinators is prohibited, necessitating manual labour to stimulate floral pollination. Artificial pollination technologies are now increasingly essential as the demand for food grown in protected facilities increases worldwide. For tomato fruits, precision pollination has the ability to vastly improve their seed set, size, yield, and quality under optimal environmental conditions and has become financially beneficial. Like many crops from the Solanaceae, tomatoes have a unique self-pollinating mechanism that requires stimulation of the floral organs to release pollen from the poricidal anthers. This review investigates various mechanisms employed to pollinate tomato flowers and discusses emerging precision pollination technologies. The advantages and disadvantages of various pollinating technologies currently available in the protected-cropping industry are described. We provide a buzz perspective on new promising pollination technologies involving robotic air and acoustic devices that are still in their nascency and could provide non-contact techniques to automate pollination for the tomato horticultural industry