Conversion of cardiac bypass into an extracorporeal membrane oxygenation circuit: a case from Pakistan

A 35 days old neonate with d-loop transposition of great arteries, underwent an arterial switch operation following which he developed hypotension attributed to left ventricular failure. During cardiopulmonary resuscitation decision was made to place him on cardiac bypass again. Due to limited resources and unavailability of a specialized extracorporeal membrane oxygenator machine, the CPB was modified and converted an ECMO. The neonate was successfully decannulated after 72 hours and discharged home after 3 weeks of the operation without any sequel. ECMO is a viable option in developing countries and may help in improving the outcome especially in neonatal congenital heart disease

Do parental stimulation practices modify the effect of child’s health status on early developmental risk? Findings from a hospitalized cohort

The current study conducted in Pakistan aimed to test if parental stimulation practices modify the effect of general child health status on early developmental risks in hospitalized children. Development was assessed using the Survey of Well-being of Young Children. Child health status was a global rating on a Likert scale. Parental engagement was categorized based on the number of activities with their children (low ≤ 3, high > 3). A total of 231 children were assessed. Children with poor health status were reported to be 1.9 (95% Confidence Intervals [CI] 1.4–2.8, p = 0.000) times at risk of developmental delay by parents who had lower engagement and about 3 times (3.63 for mothers CI 1.79–7.37, p = 0.003; 2.96 for fathers CI 1.17–7.49, p = 0.027) significantly at risk of behaviour–emotional concerns by parents with higher engagement. The authors conclude that parental engagement and developmental screening can be incorporated as part of in-patient paediatric assessment.publishedVersio

Generating evidence from contextual clinical research in low- to middle income countries: A roadmap based on theory of change

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity

3-(3-Bromo­benz­yl)-1H-isochromen-1-one

In the title compound, C16H11BrO2, the isocoumarin ring system is planar (r.m.s. deviation = 0.015 Å) and subtends a dihedral angle of 88.90 (2)° with the bromo­benzene ring. In the crystal, mol­ecules are linked, forming a three-dimensional packing pattern involving C—H⋯O inter­actions, Br⋯O contacts [3.4734 (10) Å] and π–π stacking inter­actions with centroid–centroid distances ranging from 3.667 (2) to 3.765 (2) Å

Use of machine learning algorithms for prediction of fetal risk using cardiotocographic data

Background: A major contributor to under-five mortality is the death of children in the 1st month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor.Aim: The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses.Methods: CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Ten different machine learning classification models were trained using CTG data. Sensitivity, precision, and F1 score for each class and overall accuracy of each model were obtained to predict normal, suspect, and pathological fetal states. Model with best performance on specified metrics was then identified.Results: Determined by obstetricians\u27 interpretation of CTGs as gold standard, 70% of them were normal, 20% were suspect, and 10% had a pathological fetal state. On training data, the classification models generated by XGBoost, decision tree, and random forest had high precision (\u3e96%) to predict the suspect and pathological state of the fetus based on the CTG tracings. However, on testing data, XGBoost model had the highest precision to predict a pathological fetal state (\u3e92%).Conclusion: The classification model developed using XGBoost technique had the highest prediction accuracy for an adverse fetal outcome. Lay health-care workers in low- and middle-income countries can use this model to triage pregnant women in remote areas for early referral and further management

Exploring the influence of socio-cultural factors and environmental resources on the health related quality of life of children and adolescents after congenital heart disease surgery: parental perspectives from a low middle income country

Background: Health related quality of life (HRQOL) is an important indicator of long-term well-being, influenced by environmental factors such as family, culture, societal norms and available resources. This study aimed to explore parental perspectives on the influence of socio-cultural factors and environmental resources on the HRQOL of children and adolescents after congenital heart disease (CHD) surgery.Methods: Using a descriptive, qualitative design, semi-structured interviews of children/adolescents who had CHD surgery in this low-middle income country (LMIC) were collected between July to December 2017. There were 20 families enrolled, which included 18 parent dyads (mother and father) and two single mothers, making a total of 38 participants. Initial inductive analysis was further refined using the Social Ecological Model as an analytic lens.Results: At the intrapersonal level, unrealistic expectations of surgery, residual CHD symptoms and difficulty maintaining educational progress were of great concern. There were low levels of health literacy and understanding about CHD among family and friends, however, strong kinship ties were an important resource at the interpersonal level. These families lived in poverty and mothers often carried the sole burden of care for their sick children. At the institutional level, there were unclear expectations of the child\u27s needs at school, and parents had poor access to psychological, family-planning and genetic counselling, and poor access to CHD education resources. At a sociocultural level, religion and trust in God were important coping factors, however, CHD was a gendered experience with particular concerns around scarring and the marriageability of girls. Parents noted the deficit of antenatal and specialist CHD services and felt the consequence of a lack of a universal health care system at the public policy level.Conclusion: Socio-ecological factors have the potential to explain the issues and challenges that children living in LMIC experience with CHD after surgery. The study findings will help to inform future interventions to be implemented in countries like Pakistan

Monolithic ontological methodology (MOM): An effective software project management approach

Due to rapid changes in software applications, especially incorporating the demands of self-regulating technologies becomes a major challenge in software projects. This research focuses on technological, managerial, and procedural challenges, which are believed to be the most significant factors contributing to projects failure. To address these issues, this study proposes Monolithic Ontological Methodology (MOM) which addresses the weakness in the existing benchmark methodologies including PRINCE2, Extreme Programming, and Scrum in terms of project management, quality control, and stakeholder involvement. The MOM consists of seven phases and each phase has the required number of iterations until it is approved by management. The updated information is recorded and shared with the respective teams. The standard documentation with control language is structured by descriptive logic (DL) that reduces ambiguity and technical debate. Furthermore, the illustration of the MOM includes figures, logical expressions, and descriptions. To demonstrate the effectiveness of the proposed methodology, an Analytic Hierarchy Process (AHP) was performed. The findings indicate the validity of MOM concerning considered performance metrics. Although the applicability of the proposed methodology involves relatively more documentation and formalities. The adaptive nature of MOM makes it suitable for the standard organization and brings sustainability to the organization by implementing distributed project management