Comparison of Hematological and Inflammatory Markers to Predict Outcome in Covid-19 in 1st and 4th Wave

OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers; neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st  wave compared with the 4th wave regarding inflammatory markers; CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7  on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality.  CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19

Incidence of External Ear Canal Folliculitis

To analyze the incidence of ExternalEar Canal Folliculitis (EECF) in adult population ofdistrict Bannu.Methods: In this descriptive study 100 patientswith ear ache, presented in four quarters of the yearwere included. Complaints, and findings on physicalexamination including otoscopy results, diagnosiswere recorded. Inclusion criteria was adults (18+)with ear pain as a major complaint. We included thecases with another major complaint only when itwas related to the ear pain (e.g. referred pain fromsinusitis, tonsillitis).Exclusion criteria was antibiotictreatment in the last 10 days was marked asexclusion criteria. Both the rates of external ear canalfolliculitis and the rate of Non-external ear canalfolliculitis were compared. We also subdivided thedifferent diagnostics under the title "folliculitischannel of the non-outer ear." The prevalence of theexternal ear canal folliculitis diagnosis wascalculated, including subdivisionby sex and agegroups, by location in the ear canal includingposterior vs. anterior and by the quarters of the year.Results: 35% of cases represented EECF wereincluded. The ratio of male to female was observed3: 2. The condition was maximum in 2nd& 3rd quarterof the year where as it was minimal in 1st and 4thquarters. Earache in adult patients was the mostcommon principal inflammation, which is generallytermed as EECF.Conclusion: Different factors are being involvedin its prevalence including poor hygiene, overcrowding, bath in a contaminated water, hotweather, ear wax and lack of specialized care. Sincetreatment is only possible upon clinical diagnosis,doctors will likely be more reserved about oralantibiotics if EECF can be diagnosed appropriatel

Nosocomial Transmission of SARS CoV-2 in a Tertiary Care Hospital in Peshawar, Pakistan

Objective The study aimed to determine the frequency of nosocomial transmission of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) in a tertiary care hospital in Peshawar, Pakistan. Methodology This cross sectional, analytical study was carried out in Hayatabad Medical Complex, Peshawar, Pakistan from 1st June 2021 to 31st August 2021. Consecutive patients aged 18 years and above admitted for conditions other than COVID-19 with a negative rapid antigen test for COVID-19 at admission were included. Patients with respiratory symptoms or those who were hospitalized for any reason in the preceding six weeks in any health care facility were excluded. The study protocol was completed by 90.9% of participants. The rapid antigen test was repeated for participants at the time of discharge or symptoms suggestive of COVID-19. Patients with a positive rapid antigen test for COVID-19 either at the time of discharge or symptom onset were considered to have acquired nosocomial SARS-CoV-2 infection. Statistical Package for the Social Sciences version 21 for Windows was used for data analysis. Results The frequency of nosocomial transmission of SARS-CoV-2 was 2.7% (13/482). Patients with nosocomial COVID-19 stayed longer in the hospital than those who tested negative (7.5±4.0 versus 4.8±3.6 days; p=0.006). Age (p=0.796), gender (p=0.453), department of inpatient stay (p=0.943), major surgery (p=0.678), minor surgery (p=0.576), and visit to the radiology department (p=0.707) did not affect nosocomial spread of SARS-CoV-2. Conclusion Nosocomial transmission of COVID-19 was infrequent, accounting for 2.7% of participants in this study

Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation

AbstractObjectiveStandard surgical closure of an atrial septal defect via sternotomy is a safe and effective procedure with low morbidity and mortality. Considering that young female patients are frequently operated on for atrial septal defects, a minimally invasive procedure avoiding sternotomy is convincingly desirable and led to the approach through a right anterolateral minithoracotomy. The recent clinical introduction of robotically assisted surgery further reduced skin incisions and enabled totally endoscopic procedures through ports. This article reports on a first series of atrial septal defect closures of which the first case was operated on August 24, 1999, in a totally endoscopic closed chest technique using a computer-enhanced telemanipulation system.MethodsWe performed totally endoscopic atrial septal repair using the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif) in 10 consecutive adult patients. Median age was 45.5 ± 10.0 years, and preoperative New York Heart Association functional class was 1.8 ± 0.1. Left ventricular ejection fraction was normal in all patients and mean pulmonary artery pressure amounted to 35 ± 7 mm Hg. Shunt volume ranged from 24% to 70%. All patients displayed a fossa ovalis type of atrial septal defect; 2 of them multiperforated.ResultsNeither intraoperative nor postoperative complications occurred. Two patients had to be converted to minithoracotomy due to endoaortic balloon clamp failure. Length of operation was 262 ± 37 minutes, and cardiopulmonary bypass time was 161 ± 26 minutes. Intraoperative transesophageal echocardiography certified complete closure of the atrial septal defect in all patients. The totally endoscopic computer-enhanced technique yielded excellent cosmetic results.ConclusionTotally endoscopic atrial septal repair is a feasible and safe procedure with good clinical results and excellent cosmetic outcomes. It may be considered as perfect adjunct to interventional treatment options. Further studies with larger cohorts and randomized trials are necessary to document potential benefits. Evolution in robotic technology and refinement of procedural flow may shorten procedural time and decrease costs

Effects of Packing Materials and Ethanol Concentrations on Removal of Astringency of ‘Rojo Brillante’ in Room Temperature

Most of the persimmons grown in Afghanistan are astringent and hence their fruits require de-astringency treatments in order to become edible at harvest time. CO2 with or without ethanol treatment provides an optimal method for the rapid removal of the persimmon astringency, but it is a bit sophisticated and currently not feasible for most of farmers. The present study is therefore carried out to assess a simple and suitable technique for de-astringency of the persimmons at farmer level. The fruits of ‘Rojo Brillante’, a Pollination Variant Astringent (PVA) Spanish cultivar which is astringent, were harvested in yellow-orange color and then quickly dipped in 0, 10, 20, and 40% ethanol concentrations. The treated fruits were packed and sealed in the paper cartons, plastic bags or left open in the room temperature. Firmness, total soluble solids and astringency level of fruits were measured each three days. The astringency of ‘Rojo Brillante’ was removed when fruits treated with 20% or 40% ethanol and packed in the plastic bags for 9 days. Total soluble solids content was not affected by any of the treatments, while commercial firmness (1.5-2.5 kg) obtained by packing the fruits in the plastic bags or paper cartons alone.

FireXnet: an explainable AI-based tailored deep learning model for wildfire detection on resource-constrained devices

BackgroundForests cover nearly one-third of the Earth’s land and are some of our most biodiverse ecosystems. Due to climate change, these essential habitats are endangered by increasing wildfires. Wildfires are not just a risk to the environment, but they also pose public health risks. Given these issues, there is an indispensable need for efficient and early detection methods. Conventional detection approaches fall short due to spatial limitations and manual feature engineering, which calls for the exploration and development of data-driven deep learning solutions. This paper, in this regard, proposes 'FireXnet', a tailored deep learning model designed for improved efficiency and accuracy in wildfire detection. FireXnet is tailored to have a lightweight architecture that exhibits high accuracy with significantly less training and testing time. It contains considerably reduced trainable and non-trainable parameters, which makes it suitable for resource-constrained devices. To make the FireXnet model visually explainable and trustable, a powerful explainable artificial intelligence (AI) tool, SHAP (SHapley Additive exPlanations) has been incorporated. It interprets FireXnet’s decisions by computing the contribution of each feature to the prediction. Furthermore, the performance of FireXnet is compared against five pre-trained models — VGG16, InceptionResNetV2, InceptionV3, DenseNet201, and MobileNetV2 — to benchmark its efficiency. For a fair comparison, transfer learning and fine-tuning have been applied to the aforementioned models to retrain the models on our dataset.ResultsThe test accuracy of the proposed FireXnet model is 98.42%, which is greater than all other models used for comparison. Furthermore, results of reliability parameters confirm the model’s reliability, i.e., a confidence interval of [0.97, 1.00] validates the certainty of the proposed model’s estimates and a Cohen’s kappa coefficient of 0.98 proves that decisions of FireXnet are in considerable accordance with the given data.ConclusionThe integration of the robust feature extraction of FireXnet with the transparency of explainable AI using SHAP enhances the model’s interpretability and allows for the identification of key characteristics triggering wildfire detections. Extensive experimentation reveals that in addition to being accurate, FireXnet has reduced computational complexity due to considerably fewer training and non-training parameters and has significantly fewer training and testing times

Primary plant nutrients modulate the reactive oxygen species metabolism and mitigate the impact of cold stress in overseeded perennial ryegrass

Overseeded perennial ryegrass (Lolium perenne L.) turf on dormant bermudagrass (Cynodon dactylon Pers. L) in transitional climatic zones (TCZ) experience a severe reduction in its growth due to cold stress. Primary plant nutrients play an important role in the cold stress tolerance of plants. To better understand the cold stress tolerance of overseeded perennial ryegrass under TCZ, a three-factor and five-level central composite rotatable design (CCRD) with a regression model was used to study the interactive effects of nitrogen (N), phosphorus (P), and potassium (K) fertilization on lipid peroxidation, electrolyte leakage, reactive oxygen species (ROS) production, and their detoxification by the photosynthetic pigments, enzymatic and non-enzymatic antioxidants. The study demonstrated substantial effects of N, P, and K fertilization on ROS production and their detoxification through enzymatic and non-enzymatic pathways in overseeded perennial ryegrass under cold stress. Our results demonstrated that the cold stress significantly enhanced malondialdehyde, electrolyte leakage, and hydrogen peroxide contents, while simultaneously decreasing ROS-scavenging enzymes, antioxidants, and photosynthetic pigments in overseeded perennial ryegrass. However, N, P, and K application mitigated cold stress-provoked adversities by enhancing soluble protein, superoxide dismutase, peroxide dismutase, catalase, and proline contents as compared to the control conditions. Moreover, N, P, and, K application enhanced chlorophyll a, chlorophyll b, total chlorophyll, and carotenoids in overseeded perennial ryegrass under cold stress as compared to the control treatments. Collectively, this 2−years study indicated that N, P, and K fertilization mitigated cold stress by activating enzymatic and non-enzymatic antioxidants defense systems, thereby concluding that efficient nutrient management is the key to enhanced cold stress tolerance of overseeded perennial ryegrass in a transitional climate. These findings revealed that turfgrass management will not only rely on breeding new varieties but also on the development of nutrient management strategies for coping cold stress

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Veränderung der systolischen und diastolischen Pumpfunktion des linken Ventrikels nach kardiopulmonalem Bypass im Tiermodell : Analyse mittels PV-Loops

ZIELSETZUNG: Die postoperative kardiale Ventrikelfunktion ist stark mit den Auswirkungen der kardialen Ischämie und den Auswirkungen der extrakorporalen Zirkulation (EKZ) assoziiert. Um die alleinigen Auswirkungen der EKZ auf die postoperative linksventrikuläre Herzfunktion zu untersuchen, wurde ein Leitfähigkeitskatheter verwendet mit dem die linksventrikuläre Funktion mit Hilfe der Druck-Volumen Beziehung vor und nach EKZ erfasst werden konnte. METHODEN: 22 drei Wochen alte Schweine wurden sternotomiert und einer normothermen EKZ von 1 h ausgesetzt. Der Leitfähigkeitskatheter wurde in den linken Ventrikel eingeführt. Die endsystolische Druck-Volumen-Beziehung (ESPVR), der linksventrikuläre enddiastolische Druck (LVEDP) und der systemische Gefässwiderstand (SVR) wurden in Ruhephasen vor und 15 Min nach EKZ in Gruppe A (n=11) gemessen. Gruppe B (n=11) diente als Kontrollgruppe ohne EKZ. ERGEBNISSE: Vor der Implementierung der EKZ wurden in beiden Gruppen keine signifikanten Unterschiede efunden. Als Mass für eine eingeschränkte LV Funktion wurde eine signifikant niedrigere Steigung der ESPVR (mmHg/ml) in der EKZ-Gruppe nach Abgang von der HLM im Vergleich zur Kontrollgruppe festgestellt (1,69 ± 0,51 vs. 1,86 ± 0,55; p<0.0081). In der EKZ-Gruppe war der maximale Druckanstiegsgeschwindigkeits- Index dP/dtmax index (mmHg/sec/kg) signifikant erniedrigt (1596,10 ± 339,51 vs. 2045,0 ± 205,57; p<0.03). In Gruppe A war die Steigung der EDPVR (mmHg/ml) signifikant erniedrigt (7,21 ± 2,20 vs. 5,43 ± 1,36; p = 0,0293), während der LVEDP (mmHg) signifikant erhöht war (11,67 ± 2,59 vs. 5,39 ± 0,92; p<0.001). Zudem konnte ein signifikant niedrigerer systemischer Gefässwiderstand- Index(SVR)(dyn.sec.cm-5/kg) in der Kontrollgruppe gemessen werden (1407,30 ± 176,44 vs. 1676,94 ± 312,96; p<0.0001). SCHLUSSFOLGERUNG: Auch ohne ischämischen Arrest führt der Einsatz der EKZ zu einer signifikanten Einschränkung der LV Funktion in der frühen post EKZ Phase. Dies sollte bei der Entscheidungsfindung für die Wahl der Operationsstrategie bedacht werden