Incorporating endoscope in middle ear surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (±15.57), which was significantly shorter than the duration of surgery (71.23 ± 15.65 min) for the 98 patients who underwent scutum lowering (p \u3c 0.005). A total of 50 patients required less than 60 minutes of surgical time-26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (±12.56%) when endoscopy was used and 58.62% (±12.60%) when scutum lowering was used-again, a statistically significant difference (p \u3c 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering

Term Back / Detention Policy Revision Measures in Academic Medical and Allied Institutions of Pakistan in the COVID-19 Epidemic for the Session 2019-2020

The Pakistan Medical and Dental Council (PM&DC) is the body concerned for the medical and dental education in Pakistan.1 The council was dissolved by an order of the President of Pakistan in October 2019, 2 but the order was revoked by the decision of the High Court of Pakistan.3 According to the PM&DC return/detention policy, a medical student has two chances of exam for his promotion in the next academic class and if one of the students could not pass the two chances provided in at least one of his subjects, the student must pass the exam in 3rd attempt with loss of his / her academic year and must pursue medical studies with the junior class. If one of these students could not pass this or these subjects by exceeding the 3rd chance, the conceded institution offers the 4th and last opportunity to the student.1 If the student still cannot pass the subject in 4th and last opportunity, he is expelled from the establishment with the cancellation of his admission, and the dreams of such a student to become a doctor are fulfilled until he will only be readmitted upon reappearing in the PM&DC competitive entrance test. But due to the sudden and unexpected outbreak of Covid-19, the medical community was the most affected. In some countries, more death rates have been reported among physicians who performed Covid-19 patient care tasks.4 Due to the lockdown policy of Govt. of Pakistan across the country, academic medical institutions were closed as a result of academic months of medical and dental students have also been wasted like other academic fields. The lockdown has been continued and we expect further academic waste from these students. The Pakistan Higher Education Commission has asked for conducting online courses for these students, but the clinical subjects of medical students cannot be taught online as they require direct clinical exposure to patients for the transmission of learning. required. Therefore, as a result of Covid-19, there is expected to be a waste of courses from almost all students across the country. However, in such circumstances, detained / term-back students will suffer a greater and irreparable waste of time as there may be many other technical difficulties regarding the continuation of medical education and the examinations of these students due to the Covid-19 disaster. Therefore, it may be good to revise the Term-Back / Detain policy for these medical, dental, and related students. The authors made the following suggestions for the PM&DC and the institutions to consider this review.         1) To Revise once the Term-Back / detention policy for the period 2019-2020 by allowing students to continue academic promotion during the next academic year with a unique relaxation in the policy.   2) Students who have not passed four chances and who are expelled from the establishment can be relaxed to have an additional chance to continue their medical studies, applicable for the year 2019-2020.   3) Relaxations are similar to those mentioned in the serial number. 1 and 2 for other courses such as Pharm-D, Bachelor of Nursing, etc.   Health workers are the main force in the fight against Covid-19 in the exercise of their functions to manage the patients of Covid-19. Mortality rates among healthcare providers have also been reported due to high viral load. There may be a shortage of health care providers around the world. Therefore, facilitation attempts are necessary to help the bona fide medical profession maintain their numbers and needs in the health sectors and to meet the future needs of the world for these health workers. Consequently, in implementing the suggestions of the authors, hundreds to thousands of health professionals and paramedical services will be able to save and secure their future in the service of the sacred mission of saving and serving the sick community

COVID-19 and Prophylactic Measures for HIV Children of Ratodero, Larkana

Ratodero is Taluka of population 224,000 in the district Larkana of Sindh, Pakistan. In the HIV outbreak (2019), 1132 HIV patients were reported in the Ratodero, amongst them, 901 (80%) were children, and the majority (735) below the age of 5 years.1 Larkana district is included among the cities where eight (8) COVID-19 carrier pilgrims from Iran were first confirmed as virus positive.2 Followed by community transmission in the area with the confirmation of the virus in the two individuals.3 There was reported shortage of the personnel protection equipment (PPEs) for the Medical Professional engaged in the tests of the COVID-19 as well as the shortage of Kits, so less number of COVID-19 tests were conducted, therefore the actual number of COVID-19 positive can abruptly raise with the availability of Kits and PPEs.4 There is a complete lockdown in the area since last week of March 2020. There is one medical University with an affiliated hospital. Collaborative efforts of the University teaching hospital and the district administration have constituted a team of experts for necessary actions to combat with expected Corona-19 outbreak. In such circumstances of the existence of HIV in Ratodero as an alarm of threats for another health risk for the poor HIV children of Ratodero Larkana. Dated 09 April 2020. there was a random selection of 20 such HIV children of Ratodero below the age 5,  to have look on their physical health and to confirm the quantity/availability of ART (antiretroviral treatment) at their home. It was found that 30% of children were found physically weak. The confirmed average availability of remaining ART drugs was found available for use in the next 14 days. Generally, the children are the population of developing immunity (vulnerable age group) hence there can be increased risk if Co-Infection of COVID-19 if hits the Ratodero Taluika. Therefore the District of Larkana in general but the Taluka Ratodero, in particular, need special attention from the health administration. Following preventive measures can be useful to prevent the spread of COVID-19 among the HIV children of Ratodero, Larkana. Better compliance of prophylactic SOPs verses COVID-19 through proper surveillance at the rural level in Ratodero. Availability of Rashan on priority for the families of registered HIV children of Ratodero, taking into account the inclusion of all requirements of good nutrients in the daily intake. COVID-19 screening of registered HIV children. HIV Screening of any COVID-19 career of Ratodero if the individual is not amongst already registered HIV patients. Establishment of a dedicated isolation ward in case of Co-Infection in these children along with the provision of special care to prevent the onset of COVID-19 symptoms in these patients. Advance Supply of 03 to 06 month ART at home as per instructions of the World Health Organization (WHO) for such HIV patients.

Synthesis of 1-phenylazo-2-naphthol and evaluation of its fungicidal potential against Sclerotium rolfsii

            Many azo compounds are known for their antifungal property. In the present study, synthesis of 1-phenylazo-2-naphthol (C16H12N2O) was carried out as an azo coupled dye through coupling reaction of phenyl diazonium salt and β- naphthol in ice-cold chilled water. The azo coupling preferably occurs at ortho position of the same ring since the charge density get reinforced at this position. The 1-phenylazo-2-naphthol-naphthol was characterized through FTIR. The antifungal activity was tested against a highly problematic soil-borne plant pathogen Sclerotium rolfsii. The compound was dissolved in dimethyl sulfoxide (DMSO) and mixed with malt extract broth to prepare 6 mL of 100 mg mL-1 growth medium. Its concentrations in the range of 0.78 to 100 mg mL-1 were tested against the fungal pathogen. None of the concentration was found antifungal. In contrast, all the concentrations increased the fungal biomass to variable extents ranging from 0 to 29%. This study concludes that 1-phenylazo-2-naphthol does not possess antifungal property against S. rolfsii

Optimal power flow and unified control strategy for multi-terminal HVDC systems

© 2019 IEEE. This paper presents an automation strategy for multi-terminal HVDC (MT-HVDC) systems combining a dc optimal power flow (dc OPF) routine and a unified reference controller (URC). In the presented automatic framework, the dc OPF algorithm is implemented at the power dispatch center (PDC) of the MT-HVDC system to find optimal reference operation points of the power converters to minimize the losses during the operation of the MT-HVDC grid and solves the contradiction between minimizing losses and preventing commutation failure. At the local control systems, the operating points of the voltage-source converter (VSC) stations are tuned based on the calculations executed in the PDC, which enables fast response to power fluctuation and ensures a stable dc voltage. However, if the communication between the two control layers is lost, the MT-HVDC grid remains stable based on the pre-defined $V$-$P$ droop characteristics for the power converter stations till the connection establishes again, and a set of new operating points is generated and sent. The static and dynamic simulations conducted on the CIGRE B4 HVDC test grid establish the efficient and effective grid control performance with the proposed automation strategy. The analysis shows that the proposed control scheme achieves the desired minimum losses while, at the same time, satisfying the system constraints

The Pakistan risk of myocardial infarction study: A resource for the study of genetic, lifestyle and other determinants of myocardial infarction in south Asia

The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead electrocardiogram. A range of biological samples has been collected and stored, including DNA, plasma, serum and whole blood. During its next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, to enrich the resource by collection of monocytes, establishment of lymphoblastoid cell lines, and by resurveying participants. Measurements in progress include profiling of candidate biochemical factors, assay of 45,000 variants in 2,100 candidate genes, and a genomewide association scan of over 650,000 genetic markers. We have established a large epidemiological resource for CHD in South Asia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advance scientific understanding and inform regionally appropriate disease prevention and control strategies

Hankel determinant of order three for familiar subsets of analytic functions related with sine function

In this paper we define and consider some familiar subsets of analytic functions associated with sine functions in the region of unit disk on the complex plane. For these classes our aim is to find the Hankel determinant of order three

A STUDY ON ORGANIZATIONAL COMMUNICATION: CONCEPTS AND IMPLICATIONS

The paper centres around managerial communication in the organization and its system and operation. It describes effective communication and its internal and external barriers. The contrast between the plans of the conventional communication framework is considered and the types of informal communication channels, which are existed in an organization. The study has also analysed the models understanding managerial communication and hierarchal goals incorporated with regards to viable influence and persuasion. The paper also examines the communication procedures and the various layers to get the fundamental procedure