Potential barriers amongst health care professionals of Pakistan in managing COVID-19 patients

Objectives: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients.Methods: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media.Results: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the knowledge about basic infection control measure like donning/doffing and understanding about high-risk procedures. On job training, professional and administrative support is compromising. Many of HCPs are anxious nowadays, having symptoms related to burn out with logical reasons behind. Even with all those hurdles they are committed and ready to volunteer themselves.Conclusion: The HCPs of Pakistan needs urgent attention for providing them Formal training regarding infection control measure. Administrative and professional support is required from institutions and scientific societies. Online teaching modules and webinar is a suitable option. The symptoms of burn out are significant and would increase with passage of time. This needs to be supported by occupational health committees

Prevalence of obesity in school-going children of Karachi.

Background: Obesity is an emerging problem in Pakistan. The authors sought to determine prevalence of obesity and malnutrition in school-going children, from grades 6(th) to 8(th) of different schools of Karachi and assess associations that affect the weight of the children. Methodology/Principal Findings: A cross sectional Study Design with children studying in grades 6(th) to 8(th) grade, in different schools of Karachi. We visited 10 schools of which 4 consented, two subsidized government schools and two private schools. A questionnaire was developed in consultation with a qualified nutritionist. Height and weight were measured on calibrated scales. A modified BMI criterion for Asian populations was used. Data was collected from 284 students. Of our sample, 52% were found to be underweight whereas 34% of all the children were normal. Of the population, 6% was obese and 8% overweight. Of all obese children, 70% belonged to the higher socio-economic status (SES) group, while of the underweight children, 63.3% were in the lower SES. Amongst obese children in our study, 65% ate meat every day, compared to 33% of normal kids. Conclusion: Obesity and undernutrition co-exist in Pakistani school-children. Our study shows that socio-economic factors are important since obesity and overweight increase with SES. Higher SES groups should be targeted for overweight while underweight is a problem of lower SES. Meat intake and lack of physical activity are some of the other factors that have been highlighted in our study.

Endovascular approach as primary treatment for traumatic carotid cavernous fistula: Local experience from Pakistan

Objective: To evaluate the technical success, complications and outcome of endovascular management of post traumatic carotid cavernous fistula (CCF) in patients presenting at a tertiary care hospital in Karahci.Methods: Descriptive case series of 26 patients of post traumatic CCF treated by endovascular techniques was carried out at Radiology and Neurosurgery departments of Aga Khan University hospital between January 2010 to March 2010. Medical records and radiology reports were retrospectively reviewed from November 2000 to December 2009. The diagnosis was primarily clinical and was confirmed in all cases by CT or MRI. Endovascular procedures were performed under general anaesthesia through femoral artery or femoral vein approach. Detachable balloons pushable coils and/or glue was used for fistula closure. Follow up was done via medical records and on phone. Technical success and safety of the procedure were analyzed and outcome in terms of symptomatic improvement was recorded wherever available.Results: Out of a total of 26 patients; 20 were male and 6 were female, with age range of 14 to 62 years, mean age 31.4 +/- 12.6 years. Technical success rate of endovascular embolization was 92.3% (24 out of 26 patients). Procedure could not be performed in 2 patients. In 20 out of 24 patients (83.3%) single session of embolization was performed while 4 patients required 2 sessions due to recurrence. In one of these patients the detachable balloon deflated after 2 hours of deployment and another session of embolization was immediately carried out by deploying a larger sized balloon. Complication rate was 15.3% (n = 4) one patient had infarction which recovered completely in 6 months. There was no procedure related mortality. Five patients were lost to follow up. In rest of the 19 patients follow up ranged from 1 to 14 months (Mean 11.0 +/- 11.8 months) 8 out of 19 (42.1%) patients showed complete resolution of symptoms and 9 (47.3%) reported improvement.Conclusion: Endovascular approach is a safe and useful option for treatment of traumatic carotid cavernous fistula

Axial Load-carrying Capacity of Steel Tubed Concrete Short Columns Confined with Advanced FRP Composites

Fiber Reinforced Polymers (FRPs) have wide applications in the field of concrete construction due to their superior performance over conventional materials. This research focuses on the structural behavior of steel tube FRP jacket–confined concrete (STFC) columns under axial concentric loading and proposes a new empirical equation for predicting the axial load-carrying capacity of STFC columns having thickness of FRP-fabric ranging from 0.09 mm to 5.9 mm. A large database of 700 FRP-confined concrete specimens is developed with the detailed information of critical parameters, i.e. elastic modulus of FRPs (Ef), compressive strength of unconfined concrete (fc’o), diameter of specimen (D), height of specimen (H), total thickness of FRPs (N.tf), and the ultimate strength of confined concrete (fc’c). After the preliminary evaluation of constructed database, a new empirical model is proposed for the prediction of axial compressive strength of FRP-confined specimens using general regression analysis by minimizing the error functions such as root mean squared error (RMSE) and coefficient of determination (R2). The proposed FRP-confinement strength model presented higher accuracy as compared with previously proposed models. Finally, an equation is proposed for the predictions of axial load carrying capacity of STFC columns. For the validation of proposed equation, an extensive parametric study is performed using the proposed nonlinear finite element model (FEM). The FEM is calibrated using the load-deflection results of STFC columns from literature. A close agreement was observed between the predictions of proposed finite element model and proposed capacity equation

Development of a STEP-compliant design and manufacturing framework for discrete sheet metal bend parts

Metal sheets have the ability to be formed into nonstandard sizes and sections. Displacement-controlled computer numerical control press brakes are used for three-dimensional sheet metal forming. Although the subject of vendor neutral computer-aided technologies (computer-aided design, computer-aided process planning and computer-aided manufacturing) is widely researched for machined parts, research in the field of sheet metal parts is very sparse. Blank development from three-dimensional computer-aided design model depends on the bending tools geometry and metal sheet properties. Furthermore, generation and propagation of bending errors depend on individual bend sequences. Bend sequence planning is carried out to minimize bending errors, keeping in view the available tooling geometry and the sheet material properties’ variation. Research reported in this article attempts to develop a STEP-compliant, vendor neutral design and manufacturing framework for discrete sheet metal bend parts to provide a capability of bidirectional communication between design and manufacturing cycles. Proposed framework will facilitate the use of design information downstream at the manufacturing stage in the form of bending workplan, bending workingsteps and a feedback mechanism to the upstage product designer. In order to realize this vendor neutral framework, STEP (ISO 10303), AP203, AP207, and AP219 along with STEP-NC (ISO14649) have been used to provide a basis of vendor neutral data modeling.N/

E-Healthcare Using Block Chain Technology and Cryptographic Techniques: A Review

The potential of information technology has influenced the efficiency and quality of healthcare worldwide. Currently, several republics are incorporating electronic health records (EHRs). Due to reluctance of technological adaptation & implementational complexities, electronic health record systems are not in practice. Due to the emphasis on achieving general compatibility, users may perceive systems as being imposed and providing insufficient customizability, which may exacerbate issues in a setting of national implementation. EHS improves patient safety and confidentiality and ensures operative, effective, well-timed, reasonable, and patient-centred care, all of which substantially impact healthcare quality. Blockchain technology has been used by the EHS system, which supports web-based accessibility and availability. The difficulties of exchanging medical data can now be overcome by consumers using an infrastructure based on cloud computing. A variety of cryptographic approaches have been employed to encrypt and safeguard the data. This review paper aims to highlight the role and impact of blockchain in EHR. The proposed research describes cryptography methods, their classifications, and the challenges associated with EHR to identify gaps and countermeasures

A hydraulic analysis of shock wave generation mechanism on flat spillway chutes through physical modeling

Shock waves are generated downstream of spillways during flood operations, which have adverse effects on spillway operations. This paper presents the physical model study of shock waves at the Mohmand Dam Spillway project, Pakistan. In this study, hydraulic analysis of shock waves was carried out to investigate its generation mechanism. Different experiments were performed to analyze the rooster tail on a flat spillway chute and to examine the factors affecting the characteristics of the rooster tail. The study results show that shock wave height is influenced by spillway chute slope, pier shape, and flow depth. Moreover, the height of the shock wave can be minimized by installing a semi-elliptical pier on the tail part of the main pier. Further modifications in the geometry of the extended tail part of the pier are recommended for the elimination of the shock wave. Based on observed data collected from the model study, an empirical equation was developed to estimate the shock wave height generated on the flat slope spillway chutes (5◦ to 10◦ )