Pulse Oximeter Perfusion Index as an Early Indicator of Onset of Sympathectomy After Epidural Anaesthesia

Objective: To establish a reliable indicator of epidural effectiveness, we compared the frequency of subjects achieving sympathectomy onset in patients undergoing lower limb surgeries under lumbar epidural anaesthesia in terms of changes in perfusion index (PI), mean arterial pressures (MAP), and toe temperature. Methodology:  This descriptive case series study was conducted at the Department of Anesthesiology, Holy Family Hospital, Rawalpindi from July 2018 - January 2019. A total of 96 patients were included, all of them received lumbar epidural catheters for lower limb surgeries and were given 10 ml of epidural bupivacaine 0.5% through the epidural catheter. Baseline values were recorded for PI in toe, MAP and temperature of toe. At 5, 10 and 20 minutes after epidural anaesthesia, these values were re-recorded. Data collection was completed before the start of surgery. Criteria for clinically evident sympathectomy was defined beforehand. The frequency of subjects reaching these predefined targets were analyzed at said time intervals using Mc-Nemar test at each time interval. Results: For PI 66/96, 88/96 and 96/96 of subjects in the study fulfilled the criteria of achieving sympathectomy at 5, 10 and 20 minutes , respectively, compared to 7/96 , 15/96 and 59/96 for MAP changes and 0/96, 29/96 and 45/96 for changes in temperature of toe. Conclusion: As per this study, PI seemed to be a faster, clearer and a more objective indicator of the onset of sympathectomy after epidural anaesthesia than toe temperature or MAP

Comparison of Fully Deflated with Partially Inflated Technique for Ease of Insertion of Laryngeal Mask Airways in Adults

Objective: To compare the frequency of ease of insertion of the laryngeal mask airway (LMA) between fully deflated and partially inflated laryngeal mask airway, in anesthetized mechanically ventilated adult patients undergoing different non-emergency short-term surgical and gynecological procedures. Methodology: A total of 104 patients were recruited in this RCT. Using computer generated random numbers, patients were allocated to two groups: fully deflated LMAs in A and partially inflated LMAs in B. Pre-operative assessment was done and informed consent was taken. All subjects were 20–40 years of age, ASA-I and ASA- II, planned for short surgical and gynaecological cases (elective) that required general anaesthesia with mechanical ventilation. Premedication with 2 mg midazolam IV was done 30 minutes before the start of the operation. Monitors were attached. One 18G cannula was maintained. IV fluids were administered to each patient as per patient’s and procedure's requirements. Pre-oxygenation was done with 100% oxygen with a face mask for three minutes. Glycopyrrolate IV 0.2mg/kg and nalbuphine IV 0.15mg/kg were given to all at induction by an anesthetist. Results:  In Group A, 98% of patients had ease of insertion while 2% of patients didn’t have ease of insertion, whereas in Group B 90% of patients had ease of insertion and 10% of patients didn’t. Ease of insertion was measured by the number of attempts (first attempt insertion – ease of insertion). Conclusion: Our study concludes that the fully deflated technique is superior as compared to the partially inflated technique in terms of easier insertion in Laryngeal mask airways

Chiral AuI- and AuIII-isothiourea complexes : synthesis, characterization and application

ADS thanks the Royal Society for a Wolfson Research Merit Award. We also thank the EPSRC UK National Mass Spectrometry Facility at Swansea University. SPN thanks King Abdullah University of Science and Technology (Award No. SR-2015-CCF-1974-03) and King Saud University for support.During an investigation into the potential union of Lewis basic isothiourea organocatalysis and gold catalysis, the formation of gold‐isothiourea complexes was observed. These novel gold complexes were formed in high yield and were found to be air‐ and moisture stable. A series of neutral and cationic chiral gold(I) and gold(III) complexes bearing enantiopure isothiourea ligands was therefore synthesized and fully characterized. The steric and electronic properties of the isothiourea ligands was assessed through calculation of their percent buried volume and the synthesis and analysis of novel iridium(I)‐isothiourea carbonyl complexes. The novel gold(I)‐ and gold(III)‐isothiourea complexes have been applied in preliminary catalytic and biological studies, and display promising preliminary levels of catalytic activity and potency towards cancerous cell lines and clinically‐relevant enzymes.PostprintPeer reviewe

Reflection phenomena of waves through rotating elastic medium with micro-temperature effect

In this article, we analyzed the effect of variable thermal conductivity on reflected elastic waves. The waves are propagating through a thermoelastic medium rotating with some angular frequency. The concept of micro-temperature is also been considered, in which microelements of the medium contain a high temperature. A heat conduction phenomenon is encountered by dual phase-lag heat conduction model. P (or SV)-type wave is incident on the medium with some specific angle of incidence. After reflection from the surface incident, P-wave is converted into quasi longitudinal and quasi transverse waves and propagates back into the medium. Helmholtz’s potential function along with the harmonic wave solution is used to obtain the solution of the model. Analytically, we calculated the amplitude ratios and attenuation factor for each reflected wave against the angle of incidence. The obtained results are also represented graphically for different values of rotational frequency and variable thermal conductivity for a particular material

Experience in prenatal genetic testing and reproductive decision-making for monogenic disorders from a single tertiary care genetics clinic in a low-middle income country

Objectives: Explore health-care seeking behaviour among couples with pregnancies at-risk of monogenic disorders and compare time duration for obtaining Prenatal Genetic Test (PGT) results based on (i) amniocentesis and Chorionic Villus Sampling (CVS) (ii) in-house testing and out-sourced testing. Report the spectrum of monogenic disorders in our cohort.Methods: Medical records of women consulting prenatal genetic counselling clinic at Aga Khan University Hospital, Karachi from December-2015 to March-2021 with history of miscarriage or a monogenic disorder in previous children were reviewed.Results: Forty-three pregnancies in 40 couples were evaluated, 37(93%) were consanguineous. Twenty-five (63%) couples consulted before and 15(37%) after conception. Thirty-one (71%) pregnancies underwent CVS at the mean gestational age of 13-weeks and 6-days ± 1-week and 3-days and amniocentesis at 16-weeks and 2-days ± 1-week and 4-days. PGT for 30 (70%) pregnancies was outsourced. The mean number of days for in-house PGT was 16.92 ± 7.80 days whereas for outsourced was 25.45 ± 7.7 days. Mean duration from procedure to PGT result was 20.55 days after CVS compared to 28.75 days after amniocentesis. Eight (18%) fetuses were homozygous for disease-causing variant for whom couples opted for termination of pregnancy (TOP). Twenty-six monogenetic disorders were identified in 40 families.Conclusion: Proactive health-care seeking behaviour and TOP acceptance is present amongst couples who have experienced a genetic disorder

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019–20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii

Detection and prediction of traffic accidents using deep learning techniques

Road transportation is a statutory organ in a modern society; however it costs the global economy over a million lives and billions of dollars each year due to increase in road accidents. Researchers make use of machine learning to detect and predict road accidents by incorporating the social media which has an enormous corpus of geo-tagged data. Twitter, for example, has become an increasingly vital source of information in many aspects of smart societies. Twitter data mining for detection and prediction of road accidents is one such topic with several applications and immense promise, although there exist challenges related to huge data management. In recent years, various approaches to the issue have been offered, but the techniques and conclusions are still in their infancy. This paper proposes a deep learning accident prediction model that combines information extracted from tweet messages with extended features like sentiment analysis, emotions, weather, geo-coded locations, and time information. The results obtained show that the accuracy is increased by 8% for accident detection, making test accuracy reach 94%. In comparison with the existing state-of-the-art approaches, the proposed algorithm outperformed by achieving an increase in the accuracy by 2% and 3% respectively making the accuracy reach 97.5% and 90%. Our solution also resolved high-performance computing limitations induced by detector-based accident detection which involved huge data computation. The results achieved has further strengthened confidence that using advanced features aid in the better detection and prediction of traffic accidents

Table1_Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa.DOCX

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019–20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.</p

Image2_Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa.JPEG

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019–20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.</p