Enhancing Knowledge of Family Caregivers and Quality of Life of Patients with Ischemic Stroke

Objectives:  A Quasi-Experimental study was conducted to determine the impact of Attend-trial-based interventions on the knowledge of the caregivers and the quality of life of Ischemic stroke survivors. Material and Methods:  The study was conducted in the acute care hospital located in the rural area, Khyber Pukhtoonkha. A sample of 115 patients and informal caregivers participated in a multifaceted intervention including educational sessions, training and demonstration, and post-training discussion via WhatsApp. A pre-post evaluation of the quality of life, stroke knowledge, functioning, and activities of daily living was completed using validated tools. All information was collected using predesign pro forma and questionnaire. Results:  The interventions significantly improved all four outcomes in caregivers and patients. The mean score for the WHOQOL-BREF pre-intervention was 2.91 ± 1.10 which was increased to 4.18 ± 0.86. The pre-knowledge scores were 34.00 which increased to 39.95. There was a statistically significant change between pre and post knowledge scores [t (114) = -3.394, p = 0.001]. Conclusion:  The study contributed towards the usefulness of multifaceted education intervention to enhance the rehabilitation efforts of patients and their caregivers in community settings

Monitoring the dynamic changes in vegetation cover using spatio-temporal remote sensing data from 1984 to 2020

Anthropogenic activities and natural climate changes are the central driving forces of global ecosystems and agriculture changes. Climate changes, such as rainfall and temperature changes, have had the greatest impact on different types of plant production around the world. In the present study, we investigated the spatiotemporal variation of major crops (cotton, rice, wheat, and sugarcane) in the District Vehari, Pakistan, from 1984 to 2020 using remote sensing (RS) technology. The crop identification was pre-processed in ArcGIS software based on Landsat images. After pre-processing, supervised classification was used, which explains the maximum likelihood classification (MLC) to identify the vegetation changes. Our results showed that in the study area cultivated areas under wheat and cotton decreased by almost 5.4% and 9.1% from 1984 to 2020, respectively. Vegetated areas have maximum values of NDVI (>0.4), and built-up areas showed fewer NDVI values (0 to 0.2) in the District Vehari. During the Rabi season, the temperature was increased from 19.93 °C to 21.17 °C. The average temperature was calculated at 34.28 °C to 35.54 °C during the Kharif season in the District Vehari. Our results showed that temperature negatively affects sugarcane, rice, and cotton crops during the Rabi season, and precipitation positively affects sugarcane, rice, and cotton crops during the Kharif season in the study area. Accurate and timely assessment of crop estimation and relation to climate change can give very useful information for decision-makers, governments, and planners in formulating policies regarding crop management and improving agriculture yields

Lower Backache after Pelvic Surgeries can be an Indicator of Tuberculosis of Lumbar Spine

Objective: To find out that lower backache after pelvic surgeries can be an indicator of tuberculosis of lumbar spine. Materials and Methods: It was retrospective study performed in Lady Reading Hospital Peshawar at Neurosurgical Department from Jan. 2012 to Dec. 2015 of 4 years duration. Patients who presented with backache after pelvic surgeries and diagnosed as tuberculosis lumbar spine were included in this study and other cases of tuberculosis lumbar spine without pelvic surgeries were excluded from this study. Results: There were 11 patients, 4 (36.3%) were female and 7 (63.7%) were male. Mean age was 58 years and age range was from 35 to 73 years. Three patients (27.3%) had gone through haemorrhoidectomy, 2 (18%) had done TURP (Transurethral prostatectomy), 2 (18.1%) had done transvaginal hysterectomy and other 2 (18.1%) had gone uterine dilatation curettage (D&C). Only 1 (9.1%) patient had done manipulation for lower backache elsewhere. Conclusion: Lower backache after pelvic surgeries is an alarming sign for tuberculosis lumbar spine and patients should be evaluated by hematological and radiological images like, CT and MRI of lumbosacral spine

SuprasellarArachnoid Cyst as a Cause of Triventricular Hydrocephalus, Found Incidentally During Endoscopic Third Ventriculostomy

Background: Arachniod cyst is a rare congenital disorder of the brain accounting 1% of all intracranial masses. They may also be acquired following head trauma, meningitis, tumors or surgery. They may be the cause of triventricular hydrocephalus (TVH). It occupies the third ventricle so flow of CSF is obstructed at aqueduct of Sylvius. Per operatively, it differs from colloid cyst in consistency, its capsule is transparent and blood vessels are visible. Objectives: To determine the frequency of suprasellar arachnoid cyst as cause of triventricular hydrocephalus and outcome of ventriculocystocisternotomy performed for these cysts at Lady Reading Hospital, Peshawar. Materials and Methods: A retrospective study of 18 cases who undergone ETV for congenital TVH from January, 2013 to December 2015 at Neurosurgery department LRH was performed. On pre operative CT scan brain they were having triventricular hydrocephalus. Ventriculocysto-cisternotomy was performed in all these cases. Biopsy was taken in all cases. Results: Out of these 18 cases, 11 (61%) were males. The presenting symptoms in our study were that infants presented with increased head circumference (n = 3) 16.6%. In pediatric and middle age group the symptoms were those of elevated ICP (n = 13) 72.22%. No endoscopic complication occurred during the procedure except for clinically non-significant bleeds. We followed all cases for a period of 6 months. Clinical and radiological improvement occurred in all cases. Conclusion: Arachnoid cyst should also be considered as a differential for congenital TVH. Endoscopic Ventriculocystocisternotomy is the treatment option of choice forsuprasellararachnoid cyst.  Abbreviations: TVH: Triventricular Hydrocephalus. CSF: Cerebral Scleral Fluid. ICP: Intracranial Pressure. AC: Arachnoid Cyst. SSCs: Suprasellar arachnoid cysts. VC: Ventriculocystostomy. VCC: Ventriculocystocisternotomy. CT: Computer Tomography

The in vitro a-glucosidase inhibition activity of various solvent fractions of Tamarix dioica and 1H-NMR based metabolite identification and molecular docking analysis

The Tamarix dioica (T. dioica) is widely used medicinal plant to cure many chronic ailments. T. dioica is being used to manage diabetes mellitus in traditional medicinal system; however, very little scientific evidence is available on this plant in this context. The current study involves the fractionation of crude methanolic extract of T. dioica using n-hexane, ethyl acetate, chloroform, and n-butanol. The screening for antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was carried out. The in vitro antidiabetic potential was assessed by measuring α-glucosidase inhibition. Total phenolic and flavonoid contents were also determined for each fraction. The metabolites were identified using highly sensitive and emerging 1H-NMR technique. The results revealed the ethyl acetate fraction as the most potent with DPPH scavenging activity of 84.44 ± 0.21% and α-glucosidase inhibition with IC50 value of 122.81 ± 2.05 µg/mL. The total phenolic and flavonoid content values of 205.45 ± 1.36 mg gallic acid equivalent per gram dried extract and 156.85 ± 1.33 mg quercetin equivalent per gram dried extract were obtained for ethyl acetate fraction. The bucketing of 1H-NMR spectra identified 22 metabolites including some pharmacologically important like tamarixetin, tamaridone, quercetin, rutin, apigenin, catechin, kaempferol, myricetin and isorhamnetin. Leucine, lysine, glutamic acid, aspartic acid, serine, and tyrosine were the major amino acids identified in ethyl acetate fraction. The molecular docking analysis provided significant information on the binding affinity among secondary metabolites and α-glucosidase. These metabolites were most probably responsible for the antioxidant activity and α-glucosidase inhibitory potential of ethyl acetate fraction. The study ascertained the ethnomedicinal use of T. dioica to manage diabetes mellitus and may be a helpful lead towards naturopathic mode for anti-hyperglycemia

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Computational Modeling of Dynamic Stability Derivatives for Generic Airfoils

This paper presents a method for the computation of the static and dynamic stability derivatives of generic airfoils using high fidelity Computational Fluid Dynamics. Aerodynamic coefficients are calculated for NACA 0012 airfoil and flat plate at different angles of attack. Results of lift coefficient are validated with experimental data. Static and dynamic stability derivatives are calculated by oscillating the airfoil geometry at suitable frequency. Simulations are performed at various flight conditions in terms of angles of attack, frequencies and oscillation amplitudes. The aim of the work is to decipher the behaviour of longitudinal damping derivatives used in flight mechanics through CFD. This approach enables the efficient and accurate computation of dynamic derivatives. Calculations are done for constant air velocity altering only the angle of attack. Inviscid model is tested since its results nearly match with experimental data. The simulations show that the nonlinear characteristics of the stability derivatives are captured by varying angle of attack

Structural Improvements in Consensus-Based Cooperative Control of DC Microgrids

This study is dedicated to establishing a comparative analysis of the performance of different local controllers on the cooperative control of DC microgrids. One of the elementary and challenging issues in DC microgrids is the assurance of fairness in proportional current sharing while accomplishing voltage regulation in parallelly connected distributed energy sources. In this work, structural improvements are proposed to enhance the system stability and control performance. A finite-gain controller was employed in the outer voltage control loop with a simple proportional (P) controller in the inner current control loop of a converter. Due to the finite-gain controller, droop-like power sharing was achieved without droop coefficient. In order to further enhance the power-sharing accuracy and DC voltage regulation, a different method was adopted in consensus-based cooperative control to estimate the average current and average voltage difference. Moreover, small signal analysis was used to scrutinize the stability and control performance of the local controller, while different communication delays and current disturbances were applied to examine the performance of the controller. Finally, a four-node-based DC microgrid setup was developed in MATLAB/Simulink environment, and simulation results of the proposed and existing techniques were scrutinized. The simulations results demonstrated the effectiveness of the proposed controller