Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan. Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients.  I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease.  Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs.    Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infectio

Human beings create their own destruction: Critical discourse analysis of Once Upon a Time by Nadine Gordimer

The prezzie study is a Critical Discourse Analysis of Nadine Gordimer’s short story “Once Upon a Time”. The idea is to spotlight that is in Nadine Gordimer’s mind how human beings create their own destruction. Gordimer’s work is full of racial discrimination and social insecurity in the people of the South-African society and this insecurity and racial discrimination show how insecure they people are. The study is the scrutiny of Ruth Wodak Model. Research explores the human race is responsible for creating its own devastation. Moreover, the study tells us how we prepare ourselves in the danger of insecurity and how we can prevent ourselves in such circumstances.

Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan

Objective:  The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods:  This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results:  80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion:  Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern. 

Development and in vitro characterization of 5-flurouracilloaded, colon-targeted drug delivery system

Purpose: To prepare chondroitin sulphate–polyvinyl alcohol cross-linked microcapsules (miCAPs) for controlled delivery of 5-flurouracil (5-FU) in cancer patients.Method: Nine different miCAP formulations were prepared using emulsion cross-linking procedure. The formulations were evaluated for their physicochemical properties, complex formation, stability at variable temperatures, safety, as well as drug-loading and drug-release characteristics. The effects of glutaraldehyde (GA), polymer concentration and stirring speed on 5-FU release at various pH were also assessed.Results: One of the miCAP formulations (miCAP-1) was adjudged the most suitable based on its particle size, high drug loading (75.3 %, p = 0.034), and high entrapment efficiency (85.2 %, p = 0.031). Best-fit drug release model was Higuchi model based on regression coefficient value (R2) while drug release mechanism was Fickian.Conclusion: Highly stable, crosslinked, amorphous and drug delivery system has been successfully developed. The delivery system is potentially suitable for acid-sensitive therapeutic moieties and where controlled release is desired.Keywords: Emulsion cross-linking, Colon-specific delivery, 5-Flurouracil, Glutaraldehyde, Kinetic model

Depression, Anxiety and Stress in Female Doctors: A Cross Sectional Study from Rawalpindi

Introduction: Studies have shown that toiling in the medical field, especially in comparison to other professions is stressful. There is evidence that depression leads to reduced productivity in the workplace. Poor clinical judgement, increased chances of error in patient care and absenteeism all lead to reduced quality of work. Female doctors, in particular, are vulnerable to mental health issues owing to elements such as bullying, workplace sexual harassment, long working hours, frantic shifts, and domestic commitments. Materials and Methods: Over a six-month period (June 2020 to November 2020), we conducted a cross-sectional survey in three tertiary care hospitals in Rawalpindi, two of which were public sector and one private sector. We collected 328 samples by means of non-probability consecutive sampling. We used the Depression, Anxiety, and Stress Scale (DASS), a 42-item questionnaire via Lovibond and Lovibond with a Cronbach’s alpha of 0.89. Mean and SD of DASS total and subscale scores were compared for subjects stratified by age, marital status, designation, hospital status, and monthly household income via Student t-test and ANOVA. Results: The total mean DASS score reported by our participants was 31±26.92. Total mean DASS scores were significantly greater in House Officers and decreased as the designation rank increased (p=0.007). Mean DASS subscale scores showed that the junior female doctors were significantly more anxious (p=0.004) and depressed (p=0.041) compared to the senior doctors. However, there was no significant difference in stress scores, indicating that all the female doctors that participated were experiencing stress regardless of their designation. There was also no significant difference in DASS scores between private and public sector hospitals. Conclusion: Female doctors working in tertiary care hospitals of Rawalpindi reported depression, anxiety, and stress. Steps need to be taken to reduce risk factors for these mental health issues in order to boost workplace satisfaction and productivity

Technological advancements in stroke rehabilitation

Early, coordinated, and multidisciplinary rehabilitation plays a major part in motor recovery after stroke. The conventional stroke rehabilitation primarily includes physical therapy, occupational therapy, and speech therapy. However, with these conventional methods, many stroke survivors still have a residual functional disability which impairs their ability to perform activities of daily living. This could be attributed to the insufficient therapy dose, low engagement and motivation of the patient, and lack of objective feedback to achieve significant improvements in function. Various technology-based stroke rehabilitation interventions have been developed in the last few decades which have shown promising results in improving stroke patients' functional mobility and independence. The use of technology promotes repetitive, task-specific training, active engagement of patients, integrating constructive and concurrent feedback, and accurately measuring functional improvement. This review summarizes the important technological advances in stroke rehabilitation, including exergames, telerehabilitation, robotic-assisted systems, virtual and augmented reality, wearable sensors, and smartphone application

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH