Emergency care of traumatic brain injuries in Pakistan: a multicenter study

Background: This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan. Methods: Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata. Results: ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged \u3c25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37). Conclusion: TBI patients\u27 access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan

Pattern of Congenital Heart Diseases in Paediatric Age Group

Background: To determine the pattern of differenttypes of congenital heart diseases, in paediatric agegroup.Methods: In this observational cross sectionalstudy cases of congenital heart defects (CHD) wereincluded, through simple random samplingirrespective of age and gender. Every patient’s dataon echocardiographic report clearly indicating hisCHD type along with age and gender was recorded.Variables of study i.e. type of CHDs, age, and genderwith relative frequencies were presented separatelygraphically.Results: Out of 298 diagnosed patients of CHD 156were males and 142 were females. Isolatedventricular septal defect found to be the mostcommon anomaly (32.6%). In combination atrialseptal defect and ventricular defect were found to bemost common with 5.4% burden rate. Out of 298patients Acyanotic CHDs were 67.1% while CyanoticCHDs were found to be 32.9%.Conclusion: Acyanotic CHDs were found to bedominant over Cyanotic CHDs with relativepercentages of 67.1% and 32.9% respectivel

Performance analysis of content discovery for ad-hoc tactile networks

Tactile Internet evolves communications to encompass sensory information such as smell and haptic sensations combining ultra-low latency with extremely high availability, reliability, and security. Tactile Internet is realized through underpinning technologies such as Multi-access Edge and Fog computing which facilitate decentralized infrastructures and machine to machine (M2M) communications. Mobile ad-hoc networks (MANETs) form the foundation layer of such infrastructures, enabling direct communication between autonomous and decentralized devices such as sensors and vehicles. Among other applications, autonomous ad hoc vehicular networks (VANETs) and vehicle to vehicle (V2V) communications require efficient content discovery and quality of data transfer. The mobility patterns of vehicles within this communication model could effect the quality of data exchanged between devices in a tactile network. Several mobility models exist describing mobility patterns of mobile users in MANETs. In this paper, we present a first performance study to evaluate the impact of different mobility models on content discovery techniques for tactile Internet comprising of fast-moving vehicles and devices. This study combines direct and derived mobility metrics evaluating impact on content discovery and content dissemination using NS-3. Our simulation results indicate that unstructured techniques may not scale well within a tactile network of fast moving vehicles while maintaining low latency and could suffer from performance degradation in a saturated environment. Furthermore, simulation results also demonstrate the resilience of the unstructured content discovery protocol in mobility scenarios with proactive routing and diverse behavior

Factors motivating smoking cessation: A cross-sectional study in a lower-middle-income country

Introduction: Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country.Methods: A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for \u3e 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem.Results: Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting cold turkey . Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one\u27s family (43%), and family\u27s health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one\u27s first attempt was associated with being married (OR: 4.47 [95% CI: 2.32-8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48-6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04-2.71]).Conclusion: In Pakistan, smoking cessation is motivated by concern for self-health and family\u27s health, family\u27s support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country.Implications: Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation

Planar SIW leaky wave antenna with electronically reconfigurable E-and H-plane scanning

This paper reports on a novel technique of switching radiation characteristics electronically between E-and H-planes of planar Substrate Integrated Waveguide Leaky Wave Antennas (SIW-LWAs). The leaky wave mode is achieved through increasing the pitch of bounding metallic via posts on one side of SIW transmission section. The radiation switching is achieved by extending the top and bottom metallic planes to a distance of 1 mm along the leakage side. The extended section acts as a parallel plate section which is conveniently connected or disconnected from the leaking side of SIW through PIN diodes. The ‘ON’ state of PIN diodes extends the metal guides and results in the H-plane leakage whereas ‘OFF’ state of PIN diodes truncates the extended metal earlier and alter the leakage line boundary condition towards E-plane. The whole concept is validated by series of simulations followed by the realization and testing of the SIW-LWA. The measured radiation pattern scans about 54° in the E-plane between 10.0 GHz to 11.7 GHz, and 58° in the H-plane from 9 GHz to 10.6 GHz. The proposed topology is a suitable candidate for remote sensing and airborne applications

Cowpea [Vigna unguiculata (L.) Walp] herbage yield and nutritional quality in cowpea-sorghum mixed strip intercropping systems

En los sistemas tradicionales de cultivo intercalado de frijol caupí y sorgo en franjas y filas, el rendimiento de forraje del frijol caupí se reduce significativamente debido a la intensa competencia y al dominio del sorgo en la adquisición de recursos para el cultivo. Este estudio de campo evaluó novedosos sistemas de cultivo intercalado en franjas mixtas de frijol caupí forrajero y sorgo con diferente número de filas de cultivo en diferentes disposiciones espaciales. El frijol caupí se intercaló con el sorgo en franjas de 8, 12 y 16 filas con un espaciamiento de 30, 45 y 60 cm entre las filas. En cada franja se mantuvo igual número de filas de frijol caupí y sorgo. Para la ejecución de los ensayos de campo durante las temporadas de verano de 2013 y 2014 se utilizó un diseño factorial en bloques completos aleatorizados con tres repeticiones. Las franjas con 12 filas y un espaciamiento de 60 cm entre las filas afectaron positivamente a todas las variables agronómicas del frijol caupí que condujeron al máximo rendimiento forrajero (22.2 y 23.7 t/ha en 2013 y 2014, respectivamente) y de biomasa de materia seca (6.63 y 6.94 t/ha en 2013 y 2014, respectivamente). En cambio, las franjas de 8 filas con un espaciamiento de 30 cm superaron a otros sistemas de cultivo intercalado al obtener el rendimiento máximo de hierba y de biomasa de materia seca del sorgo. El sistema de cultivo intercalado compuesto por franjas de 12 filas con un espaciamiento de 60 cm entre las filas siguió siendo superior, al registrar el contenido máximo de proteína bruta, grasas y cenizas junto con el mínimo contenido de fibra de frijol caupí. Además, este sistema de cultivo intercalado bajo el resto de las disposiciones espaciales también permaneció incomparable, mientras que las franjas de 16 filas bajo todas las geometrías de siembra permanecieron inferiores a otros sistemas de cultivo intercalado. Por lo tanto, el cultivo intercalado de frijol caupí con sorgo en franjas de 12 filas con un espaciado de 60 cm ofrece una solución biológicamente viable para mejorar la biomasa y la calidad del forraje del caupí en cultivo intercalado con sorgo.In traditional row and strip cowpea-sorghum intercropping systems, cowpea forage yield reduces significantly due to intense competition and dominance of sorghum in acquiring growth resources. This field study evaluated novel mixed strip intercropping systems of forage cowpea and sorghum having different number of crops rows arranged under different spatial arrangements. Cowpea was intercropped with sorghum in 8, 12 and 16 rows strips with row-row spacing of 30, 45 and 60 cm. In each strip, equal number of rows of cowpea and sorghum were maintained. Factorial arrangement of randomized complete block design with three replicates was used to execute the field trials during summer seasons of 2013 and 2014. Strips having 12 rows and 60 cm row-row spacing positively affected all agronomic variables of cowpea which led to maximum forage yield (22.2 and 23.7 t ha-1 during 2013 and 2014 respectively) and dry matter biomass (6.63 and 6.94 t ha-1 during 2013 and 2014 respectively). In contrast, 8-rows strips having line spacing of 30 cm outperformed other intercropping systems by yielding the maximum herbage yield and dry matter biomass of sorghum. The intercropping system comprising of 12-rows strips with 60 cm row-row spacing remained superior in recording the maximum crude protein, fats and total ash along with the minimum fiber content of cowpea. In addition, this intercropping system under rest of spatial arrangements also remained unmatched, while 16-rows strips under all planting geometries remained inferior to other intercropping systems. Thus, cowpea intercropping with sorghum in 12-rows strips having 60 cm spacing offers biologically viable solution to improve biomass and forage quality of cowpea in intercropping with sorghum

Point prevalence survey of antimicrobial use during the COVID-19 pandemic among different hospitals in Pakistan : findings and implications

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis