Role of N-Acetylcysteine in Clearance of Secretions in Mechanical Ventilated Patients

Objective: To determine the role of nebulized N-acetylcysteine in mechanical ventilation in clearing the airway of these patients Study Design: A Randomized Control Trial. Place and Duration of Study: Department of Anaesthesia and Intensive Care Unit Nishtar Medical University Hospital and Jinnah Hosptal, Lahore. From January 2017 to July 2018. Material and Methods: In this project total 50 patients were enrolled by consecutive sampling who remained on mechanical ventilation for more than 24 hours and were between ages 15 to 80 years old. Written consent of this project was taken from relative of each patient. These patients were divided into two groups by lottery method into case and control. The case group received 2 ml of NAC 20% with 8 ml normal saline 3 times a day for 1 day. The control group only received 10 ml normal saline via their nebulizers 3 times a day at 8 AM, 2 PM, and 9 PM. Data was collected and was analyzed. SPSS 22 was used for this purpose. All numerical variables of this research such as mean FiO2, mean peak and plateau pressure of airway, mean blood pressure, mean age and importantly mean density of secretions were calculated. In these values t test was applied and p value was calculated. If it was less than .005, then it was considered significant. Similarly, qualitative data such as type of disease were calculated in percentage and chi square test was used to check the significance. Results: The mean O2 saturation of baseline, 12 hours and 24 hours of the controls was 93.84±2.28, 94.27±2.33 and 94.08±1.81 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the controls was 23.16±3.49, 25.38±8.86 and 24.01±4.91 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the controls was 19.04±7.79, 21.37±4.86 and 21.85±8.93 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the controls was 1.04±0.024, 1.05±0.03 and 1.03±0.002 respectively. While, the mean O2 saturation of baseline, 12 hours and 24 hours of the cases was 93.08±2.37, 94.61±2.56 and 94.11±2.34 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the cases was 26.58±5.81, 23.81±8.28 and 24.34±6.15 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the cases was 21.88±78.01, 24.88±6.67 and 23.51±7.55 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the cases was 1.01±0.021, 1.08±0.022 and 1.008±0.0195 respectively. The differences were statistically insignificant. P-value ≤ 0.05 is considered as significant. Conclusion: It is concluded from our observations that use of N-acetylcysteine in patients on mechanical ventilation is very effective in clearance of secretion and to maintain airway clear. Key words: N-acetylcysteine, mechanical ventilation, airway clearance, normal saline DOI: 10.7176/JMPB/54-07 Publication date: April 30th 201

Relationship of platelet-lymphocyte ratio with severity of obstructive sleep apnea syndrome.

Objective: Objective of study was to assess the inflammation in obstructive sleep apnea syndrome patients by using platelet lymphocyte ratio and relationship between platelet lymphocyte ratio and severity of obstructive sleep apnea. Study Design: Cross sectional study Place and Duration: Pulmonology department of Nishtar Hospital Multan and Jinnah Hospital, Lahore  from June 2018 to March 2019. Methods: This cross sectional study was conducted in Pulmonology department of Nishtar Hospital Multan from June 2016 to March 2017.Total 280 patients were selected by non-probability consecutive sampling. All patients underwent whole night polysomnography. Patients were divided into control group (AHI <5), mild OSAS group (AHI 5-15), moderate OSAS group (AHI 15-30) and sever OSAS group (AHI >30) according to their AHI score. Numerical variables like age, body mass index, white cell count, platelets, hemoglobin (Hb) and platelet lymphocyte ratio were statistically analyzed by mean and standard deviation and t-test applied to assess their significance. Qualitative variables like gender and smoking status were statistically analyzed by frequency and percentage. Chi square test was applied to check the significance. P value <0.05 was regarded as significant. Results: Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Significant differences were found between age (p =0.000), ESR (p =0.000), CRP (p =0.003), Cholesterol (p =0.000), Platelets (p =0.048), Hb (p =0.000), PLR (p =0.000) and white blood cells (p =0.000), in groups. Association was found between gender (p =0.000) and smoking status (p =0.030) in groups. So, gender and smoking were the effect modifiers. Conclusion: the observations of our study suggest that Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Key words: Obstructive sleep apnea syndrome, Platelet lymphocyte ratio, polysomnography DOI: 10.7176/JMPB/54-08 Publication date: April 30th 201

Manual loop in laparoscopic appendectomy: A retrospective cohort study and literature review

Objectives: To determine the incidence of complications [Surgical site infection (SSI), intra-abdominal abscess (IAA), stump leak] related to stump ligation with manual loop of sliding extracorporeal suture knot in laparoscopic appendectomy. Methods: This cohort study was conducted on patients who underwent laparoscopic appendectomy from June 2014 to November 2020 performed by the same surgeon with almost similar technique. Stump was ligated with manual loops, applied by the surgeon or trainee or both (one by surgeon and other by trainee). SSI and IAA were classified according to Centers for Disease Control and Prevention (CDC) criteria. Results: Total 120 patients were included with median (Interquartile range, IQR) age of 24 (19-35) years and male predominance i.e. 81 (67.5%). Median (IQR) for the duration of symptoms, time from presentation to surgery and duration of surgery was 2(1-4) days, 10 (4-15) hours and 60 (44-70) minutes, respectively. SSI was documented in 9(7.5%) patients, managed by wound hygiene and antibiotics. IAA was observed in one(0.8%) patient who required readmission for antibiotics and radiology guided drain placement. No stump leak was observed.Conclusions: Manual endo-loop is a safe, reliable and cost effective technique for stump ligation in LA, and can safely be incorporated into teaching of surgical trainees

Impact of Deceptive Marketing on Consumers Behavior: A Case of Cellular Industry of Pakistan

The research study discusses the relationship between deceptive marketing and consumer behavior regarding the telecommunication industry of Pakistan. As Pakistan is the third largest telecommunication emerging market in the world so, the factors that affect the reaction of consumers are important.  Many customers who use different cellular networks are deceived through false marketing and deceptive features shown in the advertising. The factors that are considered deceptive according to the consumers are examined, that are incorrect interpretation, financial and emotional loss and misleading claims to determine consumer behavior. Moreover, the reaction to these factors is also considered when the customer is exposed to deception in marketing. Keywords: Deceptive marketing, Consumers behavior, incorrect interpretation, financial and emotional loss, misleading claims and cellular industry

Primary Hepatic Carcinoid Tumor with Poor Outcome

Primary Hepatic Carcinoid Tumor (PHCT) represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 opted for palliative care and expired in one month’s time. Surgical resection was advised to the second case, but he left against medical advice

Accuracy of specimen radiography in assessing complete local excision with breast-conservation surgery

OBJECTIVE: The aim of this study was to evaluate the accuracy of “X- ray examination of surgically resected specimen‘‘ in assessing complete local excision (CLE). MATERIALS AND METHODS: In this retrospective cross sectional study, data were collected for all female breast cancer cases who underwent breast-conserving surgery after needle localization of mammographically visible disease. Males, patients with mammographically invisible disease and cases with benign or inconclusive histopathology, those undergoing modified radical mastectomy and individuals with dense breast parenchyma were excluded. We evaluated radiography of resected specimens to assess margin spiculation, distance of mass/microcalcification from the excised margin, presence of a mass, and presence of any adjacent microcalcification, Other features including mass size, nuclear grade and patient’s age were also recorded and all were analyzed for any association with CLE. RESULTS: Absence of adjacent microcalcification and the presence of a mass on radiographs showed significant associations with CLE, but no links were evident with other features. Specimen radiography was found to be a sufficient tool to predict CLE with a positive predictive value of 83.3%, a sensitivity of 80.7% and a specificity of 81%. CONCLUSION: Specimen radiography is an important and sensitive tool to predict CLE

A decade of in-text citation analysis based on natural language processing and machine learning techniques: an overview of empirical studies

In-text citation analysis is one of the most frequently used methods in research evaluation. We are seeing significant growth in citation analysis through bibliometric metadata, primarily due to the availability of citation databases such as the Web of Science, Scopus, Google Scholar, Microsoft Academic, and Dimensions. Due to better access to full-text publication corpora in recent years, information scientists have gone far beyond traditional bibliometrics by tapping into advancements in full-text data processing techniques to measure the impact of scientific publications in contextual terms. This has led to technical developments in citation classifications, citation sentiment analysis, citation summarisation, and citation-based recommendation. This article aims to narratively review the studies on these developments. Its primary focus is on publications that have used natural language processing and machine learning techniques to analyse citations

Impact of duration of therapy on side effect profile of anti-HCV protocol: A retrospective cohort study from two tertiary health facilities in Pakistan

Purpose: To evaluate the plausible risks and adverse effects related to the duration of therapy in hepatitis C (HCV) patients in Lahore, Pakistan.Method: A retrospective observational study involving 250 HCV patients who received combination therapy with ribavirin and interferon was conducted. The patients were segregated into two groups on the basis of duration of therapy (≤ 6 months and > 6 months). Adverse effect profiles of patients under treatment were collected using a pre-validated questionnaire and compared using Pearson’s Chi- Square Test/Chi-Square Goodness-of-Fit tests and unpaired t-test.Results: Patients who underwent treatment for ≤ 6 months frequently encountered side-effects such as GIT disturbance (23.77 %) and joint pains (29.63 %). Additionally, diabetes mellitus (27.86 %) and frequent injections (74.59 %) were the most commonly observed co-morbid condition and disease risk, respectively. On the other hand, in patients who underwent therapy for > 6 months, skin disorders (30.46 %) and gastric acidity (10.15 %) were the most frequently observed side-effects with less frequent reporting on co-morbid conditions and disease risk factors. Moreover, there was a significant reduction in body weight (p = 0.03), serum bilirubin (p = 0.0005), albumin (p = 0.003) and triglycerides (p = 0.006) levels due to longer duration of treatment.Conclusion: The data suggest that treatment-related risks are higher among HCV patients on shorter treatment duration whereas adverse events subside in patients on longer duration of therapy (>6 months). Changes in biochemical profile were also more evident in those receiving treatment for periods >6 months.Keywords: Interferon, Ribavirin, Side effects, Duration of therapy, Outcomes of therap

Sentiment analysis of tweets through Altmetrics: A machine learning approach

The purpose of the study is to (a) contribute to annotating an Altmetrics dataset across five disciplines, (b) undertake sentiment analysis using various machine learning and natural language processing–based algorithms, (c) identify the best-performing model and (d) provide a Python library for sentiment analysis of an Altmetrics dataset. First, the researchers gave a set of guidelines to two human annotators familiar with the task of related tweet annotation of scientific literature. They duly labelled the sentiments, achieving an inter-annotator agreement (IAA) of 0.80 (Cohen’s Kappa). Then, the same experiments were run on two versions of the dataset: one with tweets in English and the other with tweets in 23 languages, including English. Using 6388 tweets about 300 papers indexed in Web of Science, the effectiveness of employed machine learning and natural language processing models was measured by comparing with well-known sentiment analysis models, that is, SentiStrength and Sentiment140, as the baseline. It was proved that Support Vector Machine with uni-gram outperformed all the other classifiers and baseline methods employed, with an accuracy of over 85%, followed by Logistic Regression at 83% accuracy and Naïve Bayes at 80%. The precision, recall and F1 scores for Support Vector Machine, Logistic Regression and Naïve Bayes were (0.89, 0.86, 0.86), (0.86, 0.83, 0.80) and (0.85, 0.81, 0.76), respectively