Covid Prognostic Score (CoPs) to predict prognostic outcome in Patients with Severe Covid-19 Pneumonia

Objectives: To assess the degree of medical intervention needed for treatment and its application in areas with low resources and testing facilities. Methodology: A Retrospective Cohort study was conducted on 141 patients from June 2020 to May 2021. All PCR positive covid patients were included; excluding those who died or left within 24 hours of admission. Data was obtained from hospital record. (HIMS), incorporating sociodemographic details, history of co-morbids and presenting complaints. A Covid-Prognostic Score was developed to predict hospital outcome and severity of covid disease. It comprised of age, comorbidity (diabetes and ischemic heart disease), chest-x ray score, neutrophil- lymphocyte ratio (NLR) and ferritin score. Using SPSS version 23, descriptive means were analyzed; Chi-square test was applied along with Mann- Whitney U and linear regression. P-value less than 0.05 was considered significant. Results: A significant association was found between health status (i.e., alive or dead) and diabetes (p=0.045) and ischemic heart disease (p=0.004), which reinforced their importance in the CoPS score. Association between CoPS and gender health status was highly significant; (p=0.003) (p=0.000) respectively. A positive correlation was found between CoPS and duration of hospital stay (R = 0.495) (p=0.216). Conclusion: The continuous surge of Covid-19 is causing hospital resource and facility burn out. The CoPS score aims to pave way for triage therapy from the point of admission. A multi-center approach and scoring of “severity strata” of disease would further corroborate the relevance of the CoPS scoring system

Frequency of severity of disability in patients with grade iII lumbar neural foraminal stenosis on magnetic resonance imaging

Background Low back pain is a common condition and carries substantial socioeconomic implications. Magnetic resonance imaging (MRI) is the imaging modality of choice with lumbar neural foraminal stenosis being one of the most common causes of lower back pain syndromes. Studies have shown a lack of correlation between patients\u27 severity of disability and radiologically determined nerve root constriction. Therefore, the goal of this study will be to determine the frequency of severity of disability in patients with severe (i.e., grade III) lumbar neural foraminal stenosis on MRI to ascertain the impact of MRI diagnosis on clinical outcomes. Materials and methods Two hundred fifty patients of either gender with a history of backache referred for MRI were included by purposive sampling. Of these 250 patients, 27 patients had grade II lumbar neural foraminal stenosis, and 21 had grade I neural foraminal stenosis on MRI and were excluded. Thirty-two patients had a spinal infection (e.g., tuberculosis), and 24 patients had a history of trauma. Further, 31 patients were having follow-up scans for previously diagnosed lumbar neural foraminal stenosis. Hence, after excluding these cases, 115 patients were enrolled in this cross-sectional study with grade III lumbar neural foraminal stenosis on MRI. Results The mean age was 51 years (range: 20 to 82 years). Most of the patients (55.6%) were older than 50 years. The most common site of grade III lumbar neural foraminal stenosis was L4-L5 (56.5%). According to the Oswestry disability index, 47 patients (40.9%) had a severe disability, 32 (27.8%) had a moderate disability, 16 (13.9%) were diabled, 14 (12.2%) had a mild disability, and six (5.2%) were bedridden. Conclusions While MRI is the imaging modality of choice in degenerative lumbar spinal stenosis, clinical disabilities can be more extensive than what radiological findings may indicate in approximately 40% of the cases. Therefore, lumbar spinal stenosis should be a neuro-radiological diagnosis, and surgical decisions should be based on clinical scenarios in addition to MRI findings

Portal biliopathy

Portal biliopathy (PB) is a rare disorder, which mostly presents as sub-clinically. It occurs most commonly due to idiopathic extrahepatic portal vein obstruction. We present three cases having features of portal biliopathy secondary to portal hypertension. Our first case did not have a prior history of chronic liver disease while next two patients had previous history of chronic liver disease resulting in portal hypertension. Cavernous transformation of the portal vein due to extrahepatic portal vein obstruction is not infrequent but biliary obstruction in association with this disorder is distinctly uncommon. Proper case management is very important as prolonged biliary duct obstruction can lead to the development of ascending cholangitis or later on secondary biliary cirrhosis

Elective tracheostomy in critically ill children: A 10-year single-center experience from a lower-middle income country

Objective: Tracheostomy is a commonly performed procedure amongst critically ill patients, especially in cases of prolonged mechanical ventilation (PMV). This study aimed to describe the indications, clinical characteristics, and outcomes of elective pediatric tracheostomies in critically ill children at our center.Methods: A retrospective review of medical records of children who underwent elective tracheostomies in our pediatric intensive care unit (PICU) was conducted from January 2009 to June 2018. Data were extracted based on demographics, indications of tracheostomy, and patient outcomes. Results were reported as mean with standard deviation and as frequencies with percentage.Results: Of the 3,200 patients admitted to the PICU during the study period, 1,130 were intubated. A total of 48 (4.2% of 1,130) children underwent an elective tracheostomy. 30/48 (62.5%) children had an early tracheostomy. 34/48 (71%) patients were males. Approximately 25% of our patients undergoing a tracheostomy had an underlying neurological condition as the primary diagnosis, followed by respiratory conditions (23%). The most common indications for elective tracheostomy were PMV (\u3e7 days) (n=24, 50%) and extubation failure (n=9, 18.7%). Early tracheostomy (\u3c14 days) had better patient outcomes in terms of ventilator-free days (8.57±4.64 in early tracheostomy vs. 6.38±6.17 days in late tracheostomy, P=0.04). The sedation-free days and ICU-free days were also significantly increased in the early tracheostomy group than in the late tracheostomy group. The successful weaning and ICU discharge rate were significantly higher in the early tracheostomy group than in the late tracheostomy group (78.1% vs. 59.7%, P\u3c0.05; and 69.2% vs. 49.5%, P\u3c0.05, respectively). Ventilator-associated pneumonia was more common in the late tracheostomy group (n= 14, 77%), compared to early tracheostomy group (n=12, 40%) (P=0.03). Two patients expired from tracheostomy-related complications.Conclusion: PMV was the most common indication for an elective tracheostomy. Early tracheostomy is associated with improved patient outcomes; therefore, a standardized approach toward mechanically ventilated children is recommended

Diagnostic accuracy of digital mammography in the detection of breast cancer

Introduction Breast cancer has a high prevalence in the community and places very high demands on resources. Digital mammography provides a good quality image with reduced radiation dose and can detect breast carcinoma in its earlier stages, resulting in good prognosis and improved patient survival. Objective To calculate the diagnostic accuracy of digital mammography in the detection of breast cancer, using histopathology as a gold standard in women aged over 30 years, who are undergoing mammography for screening and diagnostic purposes. Materials and methods This was a cross-sectional analytical study, conducted in the department of radiology, for a total duration of 10 months. A total of 122 patients of age above 30 years, referred for digital mammography for the evaluation of different symptoms related to breast diseases, followed by biopsy/surgery and histopathology, were included in the study. Result Our data confirmed that digital mammography is a highly accurate tool for breast cancer detection having a sensitivity of 97%, a specificity of 64.5%, a positive predictive value of 89%, and a negative predictive value of 90.9%, with a diagnostic accuracy of 89.3%. Conclusion Considering our results, we recommend that digital mammography should replace screen-film mammography as a basic tool to detect breast cancer for both screening and diagnostic purpose

Bridging Web 4.0 and Education 4.0 For Next Generation User Training in ERP Adoption

This study addresses the critical issue of user comprehension and application within the sphere of cloudbased Enterprise Resource Planning (ERP) systems, a recurrent challenge exacerbated by the intricate nature of these systems. To bridge the existing gaps in training methodologies, a novel paradigm that synergizes Web 4.0 and Education 4.0 modules with traditional ERP systems is proposed. This innovative framework ushers in a paradigm shift in ERP adoption strategies, promising a marked enhancement in user interaction and efficiency. Rigorous qualitative evaluations, conducted with expert panels and potential end-users, provided robust validation of the framework's transformative potential in the realm of user training for ERP systems. This pioneering approach not only makes a substantial academic contribution by reframing the perception of ERP systems but also holds a significant practical value in ameliorating the user experience with cloud-based ERP systems. In essence, the adoption of a Web 4.0-oriented approach in user training heralds a revolutionary shift in ERP adoption strategies, setting a solid foundation for future explorations in this domain

The impact of disease control measures on the spread of COVID-19 in the province of Sindh, Pakistan

The province of Sindh reported the first COVID-19 case in Pakistan on 26(th) February 2020. The Government of Sindh has employed numerous control measures to limit its spread. However, for low-and middle-income countries such as Pakistan, the management protocols for controlling a pandemic are not always as definitive as they would be in other developed nations. Given the dire socio-economic conditions of Sindh, continuation of province-wise lockdowns may inadvertently cause a potential economic breakdown. By using a data driven SEIR modelling framework, this paper describes the evolution of the epidemic projections because of government control measures. The data from reported COVID-19 prevalence and google mobility is used to parameterize the model at different time points. These time points correspond to the government’s call for advice on the prerequisite actions required to curtail the spread of COVID-19 in Sindh. Our model predicted the epidemic peak to occur by 18(th) June 2020 with approximately 3500 reported cases at that peak, this projection correlated with the actual recorded peak during the first wave of the disease in Sindh. The impact of the governmental control actions and religious ceremonies on the epidemic profile during this first wave of COVID-19 are clearly reflected in the model outcomes through variations in the epidemic peaks. We also report these variations by displaying the trajectory of the epidemics had the control measures been guided differently; the epidemic peak may have occurred as early as the end of May 2020 with approximately 5000 reported cases per day had there been no control measures and as late as August 2020 with only around 2000 cases at the peak had the lockdown continued, nearly flattening the epidemic curve

Current challenges of digital health interventions in Pakistan: Mixed methods analysis

Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan.Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan.Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization\u27s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy.Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations\u27 inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects.Conclusions: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries

Comparative Neurological and Behavioral Assessment of Central and Peripheral Stimulation Technologies for Induced Pain and Cognitive Tasks

Pain is a multifaceted, multisystem disorder that adversely affects neuro-psychological processes. This study compares the effectiveness of central stimulation (transcranial direct current stimulation—tDCS over F3/F4) and peripheral stimulation (transcutaneous electrical nerve stimulation—TENS over the median nerve) in pain inhibition during a cognitive task in healthy volunteers and to observe potential neuro-cognitive improvements. Eighty healthy participants underwent a comprehensive experimental protocol, including cognitive assessments, the Cold Pressor Test (CPT) for pain induction, and tDCS/TENS administration. EEG recordings were conducted pre- and post-intervention across all conditions. The protocol for this study was categorized into four groups: G1 (control), G2 (TENS), G3 (anodal-tDCS), and G4 (cathodal-tDCS). Paired t-tests (p < 0.05) were conducted to compare Pre-Stage, Post-Stage, and neuromodulation conditions, with t-values providing insights into effect magnitudes. The result showed a reduction in pain intensity with TENS (p = 0.002, t-value = −5.34) and cathodal-tDCS (p = 0.023, t-value = −5.08) and increased pain tolerance with TENS (p = 0.009, t-value = 4.98) and cathodal-tDCS (p = 0.001, t-value = 5.78). Anodal-tDCS (p = 0.041, t-value = 4.86) improved cognitive performance. The EEG analysis revealed distinct neural oscillatory patterns across the groups. Specifically, G2 and G4 showed delta-power reductions, while G3 observed an increase. Moreover, G2 exhibited increased theta-power in the occipital region during CPT and Post-Stages. In the alpha-band, G2, G3, and G4 had reductions Post-Stage, while G1 and G3 increased. Additionally, beta-power increased in the frontal region for G2 and G3, contrasting with a reduction in G4. Furthermore, gamma-power globally increased during CPT1, with G1, G2, and G3 showing reductions Post-Stage, while G4 displayed a global decrease. The findings confirm the efficacy of TENS and tDCS as possible non-drug therapeutic alternatives for cognition with alleviation from pain

Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery