Neurological complications in patients with plasmodium vivax malaria from Karachi, Pakistan

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide. Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan. Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing. Conclusion: P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax

Forecasting number of vulnerabilities using long short-term neural memory network

Cyber-attacks are launched through the exploitation of some existing vulnerabilities in the software, hardware, system and/or network. Machine learning algorithms can be used to forecast the number of post release vulnerabilities. Traditional neural networks work like a black box approach; hence it is unclear how reasoning is used in utilizing past data points in inferring the subsequent data points. However, the long short-term memory network (LSTM), a variant of the recurrent neural network, is able to address this limitation by introducing a lot of loops in its network to retain and utilize past data points for future calculations. Moving on from the previous finding, we further enhance the results to predict the number of vulnerabilities by developing a time series-based sequential model using a long short-term memory neural network. Specifically, this study developed a supervised machine learning based on the non-linear sequential time series forecasting model with a long short-term memory neural network to predict the number of vulnerabilities for three vendors having the highest number of vulnerabilities published in the national vulnerability database (NVD), namely microsoft, IBM and oracle. Our proposed model outperforms the existing models with a prediction result root mean squared error (RMSE) of as low as 0.072

Subcutaneous Dissociative Conscious Sedation (sDCS) a New Approach to Compromised Airway in Mediastinal Masses

ABSTRACT Purpose: Anesthesia and airway management for mediastinal masses are challenging and are accompanied by mortality and morbidity. Avoiding the loss of airway muscular tone in mediastinal masses has been confirmed necessary to avoid airway collapse. Sufficient spontaneous ventilation is of paramount importance in order to reduce the rate of mortality and morbidity. Various anesthetics and anesthesia techniques have been used for maintaining spontaneous ventilation and patent airway. In this report, a successful double lumen endobronchial intubation using "subcutaneous dissociative conscious sedation" as a novel method in the management of compromised airway (a case of a mediastinal mass) is presented. Clinical Features: A 42-year-old, 62 Kg man was presented for an open biopsy of a middle mediastinal mass. The patient had a history of chest pain, dyspnea, cough, fever and sweats for 2 months. Regarding to the life threatening nature of mediastinal masses resulting from unpredictable events of airway obstruction and the reported cases of deaths after induction of anesthesia in patients with mediastinal masses and regarding to the importance of not losing muscular tone and keeping airway tone intact in patients with mediastinal masses "subcutaneous Dissociative Conscious Sedation (a novel method of anesthesia)" was selected in order to guarantee the safety of the patient and keep the airway secure. Conclusion: Owing to the characteristics of the "subcutaneous dissociative conscious sedation" this method is suggested as an appropriate substitute to general anesthesia for Endobronchial Double Lumen Intubation in mediastinal masses and compromised airway

Impact of Minor Alloy Components on the Electrocapillarity and Electrochemistry of Liquid Metal Fractals

Exploring and controlling surface tension-driven phenomena in liquid metals may lead to unprecedented possibilities for next-generation microfluidics, electronics, catalysis, and materials synthesis. In pursuit of these goals, the impact of minor constituents within liquid alloys is largely overlooked. Herein, it is showed that the presence of a fraction of solute metals such as tin, bismuth, and zinc in liquid gallium can significantly influence their electrocapillarity and electrochemistry. The instability-driven fractal formation of liquid alloy droplets is investigated with different solutes and reveals the formation of distinctive non-branched droplets, unstable fractals, and stable fractal modes under controlled voltage and alkaline solution conditions. In their individually unique fractal morphology diagrams, different liquid alloys demonstrate significantly shifted voltage thresholds in transition between the three fractal modes, depending on the choice of the solute metal. Surface tension measurements, cycle voltammetry and surface compositional characterizations provide strong evidence that the minor alloy components drastically alter the surface tension, surface electrochemical oxidation, and oxide dissolution processes that govern the droplet deformation and instability dynamics. The findings that minor components are able to regulate liquid alloys’ surface tensions, surface element distributions and electrochemical activities offer great promises for harnessing the tunability and functionality of liquid metals.</p

Efficacy of Albendazole Against Soil-transmitted Helminthiasis among Children in Asia: Systematic Review

BACKGROUND: TheWorld health organization reported that 875 million children worldwide require antihelminth preventive chemotherapy annually. Vast majority of STH infections (67%) and YLDs (68%) occurred in Asia.METHODS: A systematic search was performed for relevant titles, abstract, and keywords from Cochrane Library, PubMed, and Scopus around October 2018 based on the PICO strategy. Out of 173 papers that were evaluated, final assessment for eligibility had yielded a total of five papers to be included for analysis covering period from 2013 to 2018.RESULTS: Of the five selected studies, three were randomized controlled trial, one was cohort and another one was described more like a quasi-experimental trial. All infection intensity showed improvement post-intervention. Four of the five studies used Kato Katz as diagnostic method with one combined it with Baermann techniques. One used McMaster egg counting method. All except one study tested albendazole efficacy in their study either alone or in combination with other chemotherapy such as diethyl carbazide or combining with education pamphlet. Egg reduction rate was reported as low as 63% and as high as 99.9%

Synthesis of non-edible biodiesel from crude jatropha oil and used cooking oil

This study focuses on a feasibility study of alternative nonedible crude oil such as jatropha and used cooking oil in biodiesel production. Crude jatropha oil (CJO) and used cooking oil (UCO) were converted to biodiesel using a two-step transesterification process with presents of acid-based and alkaline-based catalysts. Each three biodiesel blends (B5, B15 and B25) have been produced by blended with conventional diesel fuel (CDF). Determination of the fuel properties for each blend including CDF, Jatropha Methyl Ester (JME) and Used Cooking Oil Methyl Ester (UCOME) have been carried out. The average yield for jatropha and used cooking oil biodiesels production was 94.3% and 92% respectively. The increment of the percentage of JME or UCOME in its blends is proportional to fuels physical properties such as density, specific gravity, kinematic viscosity and surface tension, however inversely proportional to fuels calorific value. Based on the results of this study, it is acceptable to conclude that non-edible CJO and UCO are viable alternatives to edible oil as feedstock to renewable fuel in order to reduce the greenhouse gases produced

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

<p>Abstract</p> <p>Background</p> <p>Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research.</p> <p>Methods</p> <p>Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic.</p> <p>Results</p> <p>The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases.</p> <p>Conclusion</p> <p>Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.</p

Thalassemias in South Asia:clinical lessons learnt from Bangladesh

Abstract Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries

A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan

Background In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. Methods A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Conclusion Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan