Areca nut chewing and the risk of re-hospitalization and mortality among patients with acute coronary syndrome in Pakistan

Objectives: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events

Needs assessment for curricular reform of a post graduate paediatric training programme at a private university hospital in Karachi, Pakistan

In order to make and sustain changes in the curriculum, needs assessment is the key. We conducted a need assessment survey using a questionnaire based on a 7 point Likert Scale by residents and alumni. Over all response rate in the study was 77.5%. Fifty eight percent participants were females. Highest level of agreement (mean score 5.7) was found between the alumni and residents regarding the need to revise the content, teaching and assessment strategies in the programme. Twenty seven alumni (n= 38, 71%) had cleared their FCPS exams. The alumni thought that the existing teaching and assessment strategies do not facilitate in passing professional certificate exams (mean score 3.6). The mean attempts required by the alumni for clearing this exam was 3.3, and 84.2% considered their weak clinical skills as the reason for their recurrent failure

Postoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting

ntroduction Postoperative atrial fibrillation (AF) is the commonest of all the known cardiac arrhythmias after cardiac surgery. The postoperative AF has both short- and long-term adverse impacts on patients, like prolonged intensive care unit (ICU) stay, increased frequency of reoperations, myocardial infarction, increased use of inotropes, and intra-aortic balloon pump (IABP). There is a paucity of data regarding the postoperative AF after isolated coronary artery bypass grafting (CABG) and its risk factors in our geographic location. Therefore, the aim of this study was to determine the frequency of postoperative atrial fibrillation among patients undergoing isolated CABG at a tertiary care hospital of Karachi, Pakistan. Methods This prospective observational study was conducted on 163 consecutively selected patients undergoing first time isolated CABG at the Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi. Patients with redo-sternotomy, preoperative atrial fibrillation and with other cardiac pathology were excluded from the study. Postoperative AF was defined in the patients with postoperative 12-lead electrocardiographic (ECG) finding of absence of P waves, replaced by unorganized electrical activity and irregular R-R intervals. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 163 patients were enrolled with the mean age of 58.66 ± 9.77 years ranging between 40 and 85 years with male predominance of 81% (132). The most common comorbidity was hypertension in about 68.1% (111), followed by diabetes mellitus in 54.6% (89) patients. Postoperative AF was observed in 42 (25.8%) patients. Most of the patients who developed postoperative AF, were overweight with mean body mass index (BMI) of 27.04 ± 4.85 kg/m2, 76.2% (32) had a history of hypertension, diabetes mellitus was associated with 33.3% (14) patients with postoperative AF and 50.0% (21) of them were smokers. Distribution of coronary artery disease in patients with postoperative AF was observed as three vessels coronary artery disease (3VCAD) in 83.3% (35), two-vessel coronary artery disease (2VCAD) was present in 7.1% (three), and rest of 9.5% (four) patients had single-vessel coronary artery disease (SVCAD). Conclusion The frequency of postoperative atrial fibrillation in our study was found to be 25.9% which is comparable to world literature. An important finding that comes through this study is a younger population undergoing CABG, which raises the possibility of early manifestation of ischemic heart disease in our region. This, however, needs further investigation. We were unable to point out the factors predictive of postoperative AF; studies with larger sample size would help in that regard

A Survey on Information-Centric Networking with Cloud Internet of Things and Artificial Intelligence

The Internet is evolving, and data is a critical component of today's Internet. People are more interested in data than data location. An information-centric network (ICN) uses this idea and makes data, instead of host addresses, an integral component. Another essential topic in the contemporary period is cloud or edge computing, as well as the Internet of Things (IoT) and Artificial Intelligence (AI), which becomes even more critical when combined with ICN. We initially rate the configuration of ICN with cloud or edge IoT and AI (ICN-CIoT-AI) in this study so that readers may learn about the latest trends and merging of ICN-CIoT-AI. As data rates rise and the Internet becomes a requirement for any technology, we require IoT settings in which data can be cached locally, which is possible when ICN collaborates with cloud or edge computing. To make this arrangement more intelligent, we require AI, and machine learning algorithms can help to overcome many obstacles. In this paper, we first discuss ICN, its deployment, and its unique features that distinguish it from its archrival TCP/IP. We then present the most recent research on ICN-CIoT-AI and provide a comprehensive analysis of this domain in terms of technology, AI/ML domain, IoT, and cloud technology. The study framework, simulation software, and results achieved by the researchers are also listed. Finally, we explore three broad categories of open issues and challenges raised by the researchers: security, performance, and in-network caching. We also exhibit the technologies that were employed in the study

Optimization of Power Plant for Telecom Sector Based on Embedded System

Modern Telecom Sector is eventually facing exceptionally tough challenges because of continuous and unexpected increase in power density requirement for the communicating machinery and equipment. To fulfil the power requirements for the equipment, a significant architecture and an optimal technique must be introduced. In this paper, a microcontroller-based optimization use of power-density has been carried out. Meeting above requirements, various equipment and electronic devices are employed. We have designed a microcontroller-based system via PROTEUS Virtual System Modeling to acquire efficient and effective results. The main focus of our work is to supply the power to Telecom equipment in meantime. The power is feeding on batteries and DG (Diesel Generator) set, depending on the condition of the power requirements. The changeover operations are performed by different relays, which are dully programmed via a microcontroller in Keil software. The power capacity of Telecom ((Telecommunication) equipment is ranged from 39-48 Volts DC. The rectification process is done by switch mode rectifiers instead of linear rectifiers. Because the switch-mode rectifier technology has brought fabulous improvements in power density as compared to linear rectifiers. This is done via simulation of the smart switch in PROTEUS software. The outcomes of the proposed system are costeffective in terms of fuel consumption of DG

A qualitative assessment of tourism research amidst COVID-19 pandemic in Pakistan

The COVID-19 pandemic presents a substantial threat to Pakistan's tourism industry, precipitated by diverse factors. Scholars have shown considerable interest in researching the developments within this industry. This study presents the findings of a qualitative thematic analysis conducted on the literature pertaining to the impact of COVID-19 on Pakistan's tourism industry. Employing ATLAS.ti 9 software, a comprehensive analysis was undertaken on 22 research publications spanning the years 2020 to 2023. The results of the study reveal the emergence of six recurring themes across the literature during this period, including the need for the development of a policy framework, provision of a favorable tourism environment considering the pandemic, building consumer and employee confidence, technological innovation, stakeholder cohesion, and domestic tourism and community belongingness. Additionally, the research offers recommendations for future investigations in this domain, shedding light on the limited scholarly efforts focused on conceptualizing the growth of the tourism industry in Pakistan amidst the COVID-19 pandemic. The study also elucidates the key themes that surfaced during the analytical process

Named Data Networking: A Survey on Routing Strategies

As the Internet grows in popularity, data become an increasingly crucial component. People now care more about the data than the data location. Named data network (NDN) takes this concept and pairs it with the idea of making data a core component rather than host addresses. As data traffic increases exponentially, NDN offers three main advantages over current Transmission Control Protocol and Internet Protocol-based networks. These advantages are in-network caching, smooth mobility, and robust content dissemination. NDN-related challenges are open for investigation as NDN becomes more invaluable. Routing in NDN is another essential domain that needs to be addressed, and several approaches are presented to address routing concerns in NDN. In this study, we discuss and highlight NDN and its routing strategies comprehensively. In addition, this research compares important routing paradigms to emphasize the breadth of routing research in NDN. Moreover, we investigate the routing attributes of NDN and expose the latest literature on this critical topic. Finally, this study provides useful insights into the emerging areas of guidance in NDN to assist future studies in addressing challenges and open research issues

Learning from crises : Building a resilient future for Pakistan's Tourism

Crippled by natural and man-made crises, the tourism industry stands at a crossroads, grappling with the unprecedented challenges of the global pandemic. This qualitative study, based on in-depth interviews with 10 individuals, delves into the resilience factors within Pakistan’s tourism landscape. Our analysis unearths eight core themes – government support, focusing on foreign tourists, proactive planning, technology innovation, domestic tourism, limited-scale opening of tourism, tourism education, and consumer and employee confidence – that form the foundation of a comprehensive resilience framework. This framework functions as a prescriptive roadmap, guiding the tourism industry’s proactive revival in the face of future pandemics and fostering its long-term sustainability in the post-pandemic era. Beyond Pakistan, our study’s inclusive resilience approach offers a transformative model for developing countries, potentially triggering a paradigm shift towards a novel economic framework. This research not only paves the way for the revitalization of tourism in Pakistan but also opens doors for futher exploration of tourism resilience during future crises