Evaluation of Fractal Dimension and Topographic Surface Roughness (Vertical Dissection) in Astore-Deosai-Skardu Region in GIS Environment Using ASTER GDEM

Fractal investigation is a valuable technique to model and quantify the composite patterns of natural similarobjects. This study investigates Neotectonics using ASTER-GDEM. Fractal technique for extraction of topographicfractal dimension (Dtopo) and vertical dissection (Rtopo-surf) were used to assess the Neotectonics deformation.Geomorphological regions can be demarcated by using above mentioned procedures as they reveal the topographicevolutionary stages as an evaluation of topographic textures. The idea is to recognize the zones that are stronglyinfluenced by Neotectonics. Astore-Deosai-Skardu (ADS) region in Gilgit-Baltistan was selected for this purpose as itlies between MKT and MMT which is experiencing surface topographic deformation (STD) caused by anti-clock-wiseprogression and subduction of Indian plate beneath Eurasia. The results obtained illustrates that Dtopo and Rtopo-surf showanomalies in the ADS region that clearly represent a robust control of nearby MMT, MKT and KkF and highlights theirsignificance to describe regions vulnerable to Neotectonics and related deadly events threatening precious human livesand infrastructure damages

Patterns of Admission in Intensive Care Unit of Tertiary Care Hospital

Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgical intensive care Unit. 684(41.4%) had undergone mortality while 968(58.6%) remained alive. Overall mean length of hospital stay was 7.4±4.1SD, mean length of mechanical ventilation 4.1±2.1SD and mean length of supplemental ventilation was 1.5±0.11SD. Acute abdomen (13.1%) and head injuries (12%) were most common causes for admission in ICU. Statistically significant association between years (2014, 2015 & 2016) and disease (p=0.000), years and mortality (p=0.000), years and age (p=0.000), intensive care unit and gender (p=0.01), intensive care unit and age (p=0.02) was reported.Conclusion: Acute abdomen and Head injuries had highest number of admissions in Medical and Surgical intensive care unit of PIMS hospital. Developing a well-equipped trauma ICU with adequately trained staff will help improve the outcome of patients

CASUAL COMPARATIVE ANALYSIS OF INCIDENCE & EXTENT OF ERECTILE DYSFUNCTION AMONG SMOKERS & NON-SMOKERS PRESENTING AT A MALE SEXUAL HEALTH CLINIC IN HYDERABAD

Background: The term ‘‘erectile dysfunction’’ (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual performance. ED affects millions of men throughout the world, with a strong negative effect on the quality of life and well-being of men and couples. The etiology of ED once was considered to be mainly psychogenic. However, because of advances in the understanding of the physiology of erection and the development of modern diagnostic techniques, it is now generally agreed that the etiology of ED is often multifactorial, with psychological, neurological, endocrine, vascular, traumatic or iatrogenic causes.Objective: Smoking, among many other causes, is believed to be associated with smoking. This study hopes to compare the incidence and extent of erectile dysfunction (ED) among smokers and non-smokers presenting at a male sexual health clinic in an attempt to further understand the association. Methodology: This casual-comparative analysis was conducted upon a total of 64 male patients presenting with erectile dysfunction at a sexual health clinic. Inquiries regarding the habit of smoking were made using a structured interview based questionnaire and extent of erectile dysfunction was investigated using the “International Index of Erectile Function (IIEF-5) Questionnaire”. The data obtained was analyzed using MS. Excel 2017 and SPSS v. 21.0. Results: Smokers showed a markedly high incidence when compared to non-smokers. The extent of erectile dysfunction too was observed to be significantly high among smokers in comparison to non-smokers. Ex-smokers too showed a more worrisome IIEF-5 score, when compared to non-smokers. Conclusion: The results obtained, make it abundantly clear that, the association between the incidence and extent of erectile dysfunction and smoking is strong. Although, the research does not attempt to control co-founding variables, the results can be regarded as reliable due to the sheer difference in incidence and extent of erectile dysfunction between smokers and non-smokers. Keywords: Erectile Dysfunction, Smoking, The International Index of Erectile Function (IIEF-5) Questionnaire, Sexual Health & Sex Related Quality of Life

COMPARATIVE ANALYSIS OF ASTHMA SEVERITY & CONTROL AMONG PATIENTS PRESENTING WITH & WITHOUT CO-MORBID RHINITIS

Objective: This study hopes to compare the severity and control of asthma among patients presenting with and without co-morbid rhinitis. Methodology:This retrospective, comparative analysis was conducted upon a total of 377 asthmatic patients, presenting at the medical out-patient department with and without co-morbid rhinitis. The data was collected using a structured interview based questionnaire (after taking written informed consent) which included in-depth inquiries regarding the asthma severity and control for the past 4 week. The data obtained was analyzed using SPSS v. 21. 0. Results: Among the 377 subjects, 200 were males while 177 were females. Mean age of the subjects was 36 years. 172 asthmatic patients in the sample suffered from the co-morbid rhinitis, while the remaining did not have the said comorbidity. Asthmatic patients with co-morbid rhinitis experienced more frequent asthmatic attacks. The incidence of visits to the emergency room and frequency of hospital admissions too was high among asthmatic patients with co-morbid rhinitis. Conclusion: The results reveal that, all attempts to draw a comparison of asthma severity and control among patients with and without comorbid rhinitis yield clear and unidirectional results, leading to a transparent conclusion i.e. the asthma severity and control is considerably poorer in asthmatics with co-morbid rhinitis. Keywords: Asthma, Severity, Control, Rhinitis and Co-morbidity

A Short History of Evolution of Indigenous Plants and Medicine System

The importance of plants is well known to us. Life and its growth cannot be imagined without plants. Food for our survival is produced by plants and they also create a healthy and eco-friendly environment to live (Sazada et al., 2009).The use of various parts of different medicinal plants to cure specific ailments has been common from ancient times in India. The indigenous system of medicine namely Ayurvedic, Siddha and Unani have been in existence for many centuries. Apart from India, these systems are also prominent in Korea, China, Singapore, West Asia and many other countries. The knowledge of medicinal plants has been inherited traditionally therefore; the utilization of this knowledge has become important for human existence. In the old times, plants were used as remedies for the diseases. The oldest religious book of the World “Rigveda” provides information about the medicinal use of plant “Soma” as a medicinal agent by the Indo-Aryans, which was written between 4000 and 1600 B.C. (Bhattacharjee, 2004).The plant “Soma” is considered to have intoxicating characteristics. This plant is used for sacrificial objectives by Aryans and they also identified its juice as a stimulating beverage (Steiner, 1986). The Aryans also played a vital role in the presentation of therapeutical properties of other medicinal herbs and plants. The knowledge of Aryans about a large number of medicinal plants is demonstrated by the work of Charaka and Sushruta (Kirtikar, 1958).The ancient Indian literature is helpful in driving the current knowledge of using cinchona in malaria, digitalis, strophanthus and physostigma in heart diseases and of quassia as a bitter tonic. The indigenous system of medicine in the Indian sub-continent known as Ayurveda goes back to 700 B.C. and its systematization is attributed mostly to Charaka and Sushruta who have cited about 700 medicinal plants. The book “Sushruta Samhita” compiled in 1000 B.C. includes a comprehensive chapter on herbal therapeutics and contains remarkable information about the use of medicinal plants (Singh and Abrar, 1990)

Patterns of Admission in Intensive Care Unit of Tertiary Care Hospital

Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgical intensive care Unit. 684(41.4%) had undergone mortality while 968(58.6%) remained alive. Overall mean length of hospital stay was 7.4±4.1SD, mean length of mechanical ventilation 4.1±2.1SD and mean length of supplemental ventilation was 1.5±0.11SD. Acute abdomen (13.1%) and head injuries (12%) were most common causes for admission in ICU. Statistically significant association between years (2014, 2015 & 2016) and disease (p=0.000), years and mortality (p=0.000), years and age (p=0.000), intensive care unit and gender (p=0.01), intensive care unit and age (p=0.02) was reported.Conclusion: Acute abdomen and Head injuries had highest number of admissions in Medical and Surgical intensive care unit of PIMS hospital. Developing a well-equipped trauma ICU with adequately trained staff will help improve the outcome of patients

A national survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan

Purpose: To describe the extent and variation of critical care services in Pakistan. Materials and methods: A cross-sectional survey was conducted in all intensive care units (ICUs) recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 151 hospitals recognised for training, providing 2166 ICU beds and 1473 ventilators. Regional distribution of ICU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units. One-to-one nurse-to-bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. Similarly, there was disparity in the availability of ventilators between provinces. All ICUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). Conclusion: Pakistan, a lower middle-income country, has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed

Assessment of patient safety in a low-resource health care system: Proposal for a multimethod study

Background: The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources.Objective: This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting.Methods: We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization\u27s Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. Results: The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs.Conclusions: A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs