General physicians\u27 perspective of sleep apnea from a developing country

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, but 55% did not recognize its association with hypertension. A significant number of doctors were not aware that OSA could occur in non-obese individuals (33%), women (42%) and children (39%). Only 25% of responders recognized that a history and blood tests were insufficient to make a reliable diagnosis of OSA. Half of the responders were aware of CPAP therapy for OSA, whereas 18% would have prescribed sedatives to treat sleep disturbances in OSA

Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients

Objective: To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB. Methods: A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose. Results: A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the source of infection by 81 (47.6%) and 96 (57%) considered emotional trauma/stress the causative agent of TB. No counseling about preventing spread was received by 81 (50%) patients and 97 (57%) considered separating dishes as an important means of preventing spread. Thirty one (18%) patients would have discontinued their medications following relief of symptoms. Thirty nine (23%) of the respondents thought that TB could lead to infertility and 66 (38.8%) believed that there were reduced chances of getting married following infection. Conclusion: Misconceptions concerning TB are common in Pakistani patients. Lack of knowledge on Tuberculosis is alarming. (JPMA:56:211;2006

IoT-Flock: An Open-source Framework for IoT Traffic Generation

Network traffic generation is one of the primary techniques that is used to design and analyze the performance of network security systems. However, due to the diversity of IoT networks in terms of devices, applications and protocols, the traditional network traffic generator tools are unable to generate the IoT specific protocols traffic. Hence, the traditional traffic generator tools cannot be used for designing and testing the performance of IoT-specific security solutions. In order to design an IoT-based traffic generation framework, two main challenges include IoT device modelling and generating the IoT normal and attack traffic simultaneously. Therefore, in this work, we propose an open-source framework for IoT traffic generation which supports the two widely used IoT application layer protocols, i.e., MQTT and CoAP. The proposed framework allows a user to create an IoT use case, add customized IoT devices into it and generate normal and malicious IoT traffic over a real-time network. Furthermore, we set up a real-time IoT smart home use case to manifest the applicability of the proposed framework for developing the security solutions for IoT smart home by emulating the real world IoT devices. The experimental results demonstrate that the proposed framework can be effectively used to develop better security solutions for IoT networks without physically deploying the real-time use case.Comment: 6 Pages, 2 Figures, 4 Tables. Accepted in IEEE International Conference on Emerging Trends in Smart Technologies(ICETST) 202

Community acquired pneumonia: risk factors associated with mortality in a tertiary care hospitalized patients

OBJECTIVE: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country. METHODS: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality. RESULTS: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors were identified on initial clinical assessment, laboratory and radiological features and during hospital course. On admission elevated blood urea, new onset of confusion, abnormal liver function test, low serum albumin, cardiomegaly and presence of underlying malignancy were strongly associated with increased mortality. Failure to respond to therapy was associated with a high risk of mortality as depicted by complication during hospital stay (Odds Ratio = 23.3, 95% Confidence Interval = 10.3-52.8), need for mechanical ventilation (OR = 17.1, 95% CI = 7.4-39.8) and need for intensive care unit (OR = 9, 95% CI = 4.2-19.3). CONCLUSIONS: Abnormal liver function test, low albumin and presence of cardiomegaly were more significant mortality risk factors than age, respiratory rate and blood pressure. Elevated blood urea and confusion remain strong risk factors on admission. Failure of response to therapy and onset of complications heralded a high risk of death

Post Total Thyroidectomy Hypocalcaemia and relation with the Age of the Patient

Objective: To find the magnitude of clinically overt hypocalcaemia post-total thyroidectomy and its relation with the age of the patient. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2017 to Dec 2019. Methodology: Sixty patients who were to undergo total thyroidectomy were included in the study in strict compliance with the inclusion and exclusion criteria. Patients were divided into two groups according to their ages. In Group-A, patients younger than 50 and Group-B, patients older than 50 years were included. All the patients were followed up by clinical examination for the development of clinically overt hypocalcaemia and confirmed by measurement of serum calcium. Results: Mean age of the patients was 42.75±13.05 years, with an age range of 20 to 68 years. Of all the patients, 14(23.3%) were male, and 46(76.7%) were females. Seven patients in Group-A developed post-thyroidectomy hypocalcaemia clinically,whereas, in Group-B, only one developed this condition. Clinical post-thyroidectomy hypocalcaemia developed more often in the younger age group and these results were statistically significant (p= 0.023). Conclusion: Clinically overt hypocalcaemia develops more often in younger patients after total thyroidectomy. Keywords: Biochemical hypocalcaemia, Clinical hypocalcaemia, Post thyroidectomy hypocalcaemia, Total thyroidectom

Quercetin in semen extender improves frozen-thawed spermatozoa quality and in-vivo fertility in crossbred Kamori goats

This study investigated the antioxidant effect of quercetin-treated semen on frozen–thawed spermatozoa quality and in-vivo fertility in crossbred Kamori goats. In total, 32 ejaculates from four fertile bucks were diluted in Tris-based egg yolk extender with varying levels of quercetin (0, 1, 5, 10, and 15 μM). Qualified semen samples were pooled and frozen in French straws. The results revealed that the addition of quercetin in the semen extender increased (p < 0.05) frozen–thawed sperm total motility (TM), progressive motility (PM), rapid velocity (RV), average path velocity (VAP), straight line velocity (VSL), curvilinear velocity (VCL), and amplitude of lateral head (ALH) displacement in contrast to the control group. Quercetin supplementation had no effect on beat cross frequency (BCF), straightness (STR), and linearity (LIN) (p > 0.05). Quercetin showed significantly higher (p < 0.05) plasma membrane and acrosome integrity and viability (p < 0.05) of spermatozoa in contrast to the control group. Quercetin in the semen extender significantly increased (p < 0.05) superoxide dismutase (SOD), catalase (CAT), peroxidase (POD), ascorbate peroxidase (APX), and total antioxidant capacity (TAC) levels while reduced (p < 0.05) the contents of total oxidant status (TOS) and malondialdehyde (MDA), which were in contrast to the control group. Ultrasound results revealed that 24 out of 30 (80%) goats were found pregnant when semen was treated with 5 μM quercetin while the control group showed 18 out of 30 (60%) animals were pregnant. Thus, the study concluded that 5 μM quercetin-treated semen was found to be efficient, showed increased antioxidant status, and reduced oxidant production, leading to improved spermatozoa quality and in-vivo fertility in goats

Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study

Background: To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.Methods: Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.Results: Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term (beyond one year). Compliance with CPAP therapy was associated with higher body mass index, higher Epworth sleepiness scale score, history of witnessed apnea, and reduction in daytime sleepiness with CPAP therapy. OSA severity as assessed by apnea-hypopnea index did not affect compliance with CPAP therapy. Use of anti-depressants and CPAP induced sleep disturbances were associated with poor compliance with CPAP therapy.CONCLUSIONS: Obesity, excessive daytime sleepiness, witnessed apnea and improvement of daytime symptoms following use of CPAP were predictors of improved compliance. Use of antidepressants and CPAP induced sleep disturbances were predictors of poor compliance

Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries

Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion

Risk factors associated with development of ventilator associated pneumonia

Objective: To assess the risk factors associated with development of ventilator associated pneumonia (VAP).Design: A case control study. PLACE AND DURATION OF STUDY: Intensive Care Unit (ICU) at the Aga Khan University Hospital, Karachi, between January 1999 and June 2000. PATIENTS AND Methods: All patients with assisted mechanical ventilation were assessed for the development of VAP. Risk factors associated with development of VAP were determined. Adult patients who developed pneumonia, 48 hours after ventilation, were called cases while those who did not develop pneumonia were called controls. Results: Seventy (28%) out of 250 mechanically ventilated patients developed VAP (rate of VAP was 26 cases per 1000 ventilator days). Shock during first 48 hours of ventilation (odds ratio (OR), 5.95; 95% confidence interval (CI), 2.83-12.52), transport out of ICU during mechanical ventilation (OR, 6.0; 95% CI, 2.92-12.37), re-intubation (OR, 4.23; 95% CI, 2.53-9.85), prior episode of aspiration of gastric content (OR, 3.07; 95% CI, 1.35-7.01), and use of antibiotics prior to intubation (OR,2.55; 95% CI, 1.20-5.41) were found to be independently associated with a higher risk of developing VAP. Gram negative organisms and Staphylococcus aureus were responsible for over 90% of cases. Patients with VAP had higher crude mortality rate (57.1%) compared with controls (32.2%). CONCLUSION: Ventilator associated pneumonia is associated with a high mortality. This study has identified risk factors associated with VAP