Retrospective cost-utility and budget impact assessments of Hypericum perforatum in contrast with Fluoxetine treatment for depression in Karachi, Pakistan

In this study we have compared two different types of therapies i.e. herbal and allopathic system of therapies for Depression and studied them from the social perspectives. The Hypericum perforatum is compared with Fluoxetine [HCL] in terms of cost-utility and financial savings thereby evaluating its influence on annual expenditure of depressive patients that were randomly selected from 178 union councils of the city of Karachi, Pakistan. For both system of therapies a total of 356 patients were selected by stratified random sampling. Taking frequency of depression as ‘1’ annually with discount rate at 3% for calculating the burden-of-illness in terms of disability-adjusted-life-years. The cost-utility and the budget-impact assessments were carried out to assess incremental-cost-effectiveness-ratio, and the budget-impact-per-onset as well as budget-impact-per-year values. In comparison with the Fluoxetine therapy, the Hypericum perforatum was found to relieve symptoms in 21.47% less cost; owing 29.23% less disability-adjusted-life-years and 21.45% less budget-impact-per-onset as well as budget-impact-peryear. The annual mean incremental-cost-effectiveness-ratio was found to be at 36.95±270.74 (less than GDP per capita threshold of Rs. 38,173.02). Hypericum perforatum provide the optimal utility with less impact on budget of a patient in comparison with the treatment of symptoms of depression with Fluoxetine

Cleaning Methods for Ultrasound Probes

Objective: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Study Design: Experimental study. Place and Duration of Study: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. Patients and Methods: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A (n=25), group B (n=25) and group C (n=25) respectively. Number of Colony Forming Unit (CFU) of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. Results: There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning (p Conclusion: Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients’ body contact with the ultrasound probes

Enhanced fault detection models with real-life applications

Nonconforming events are rare in high-quality processes, and the time between events (TBE) may follow a skewed distribution, such as the gamma distribution. This study proposes one- and two-sided triple homogeneously weighted moving average charts for monitoring TBE data modeled by the gamma distribution. These charts are labeled as the THWMA TBE charts. Monte Carlo simulations are performed to approximate the run length distribution of the one- and two-sided THWMA TBE charts. The THWMA TBE charts are compared to competing charts like the DHWMA TBE, HWMA TBE, THWMA TBE, DEWMA TBE, and EWMA TBE charts at a single shift and over a range of shifts. For the single shift comparison, the average run length (ARL) and standard deviation run length (SDRL) measures are used, whereas the extra quadratic loss (EQL), relative average run length (RARL) and performance comparison index (PCI) measures are employed for a range of shifts comparison. The comparison reveals that the THWMA TBE charts outperform the competing charts at a single shift as well as at a certain range of shifts. Finally, two real-life data applications are presented to evaluate the applicability of the THWMA TBE charts in practical situations, one with boring machine failure data and the other with hospital stay time for traumatic brain injury patients

Extracting True Number of Clusters for Segmenting Image through Adaptive Finite Gaussian Mixture Model

Knowing exact number of clusters in a digital image significantly facilitates in precisely clustering an image. This paper proposes a new technique for extracting exact number of clusters from grey scale images. It analyzes the contents of the input image and adaptively reserves one distinct cluster for one distinct grey value. The total count of the grey values found in an image determines the exact number of clusters. Based on the contents of image, this number of clusters keeps on changing from image to image. After obtaining this number, it is given as an input to Gaussian Mixture Model (GMM) which clusters the image.GMM works with finite number of clusters and forms mixture of various spectral densities contained in that image. The proposed method facilitates GMM to adapt itself according to the changing number of clusters. Therefore, the proposed model along with the inclusion of GMM, is named as Adaptive Finite Gaussian Mixture Model (AFGMM).  The clustering performance of AFGMM is evaluated through Mean Squared Error (MSE) and Peak Signal to Noise Ratio (PSNR). Both of these performance measuring methods confirmed that exact number of clusters is essentially important for reliably analyzing an image

A Curious Case of Dengue Fever: A Case Report of Unorthodox Manifestations

Dengue is the major cause of arthropod-borne viral disease in the world. It presents with high fever, headache, rash, myalgia, and arthralgia and it is a self-limiting illness. Severe dengue can occur in some cases resulting in dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). We present a case of a 32-year-old male patient of high-grade fever, bilateral subconjunctival hemorrhages, swelling on hands and lips, and nasal bleeding. After investigations, he was diagnosed with dengue fever and it was observed that he developed systemic fungal infection secondary to Candida tropicalis infection. The patient’s bone marrow biopsy showed hemophagocytic activity. He also developed hepatitis E infection while hepatitis A, B, or C serology profile showed no active infection. The bilateral iliopsoas hematoma was also observed on CT scan manifested by decreased power in bilateral lower limbs and pain in the right leg. The patient was treated in the hospital with antibiotics (ceftriaxone 2 g once daily for 14 days) and antifungal (fluconazole 200 mg per oral initially for one day then 100 mg daily for 13 days) medicines, and his condition improved on discharge. There is evidence of variable presentations of dengue fever after the disease burden is increased, and thus, diagnosing with such manifestations can be very challenging

Study of prevalence and etiological factors in relation with recurrent admissions of patients in Psychiatric department at Hospital Tengku Ampuan Afzan, Kuantan,Pahang, Malaysia

Background & Aims: With reduction in number of patients in the Psychiatric hospitals in Malaysia, the Psychiatric department of general hospitals became overloaded. High readmission rate has been often measured as poor prognostic out comes. A huge amount of budget consumed on patients admissions and the readmission rate is considered as a performance indicator. Therefore, the aim of this study is to find out the social, demographic, and clinical profile of frequently re-hospitalized psychiatric patients. Methods: cross sectional study, sample size 250 patients, 6 months duration. • Consent obtained. •Inclusion criteria: 1. Age: 18 years and above. 2. Participants: diagnosed and admitted by psychiatrist. 3. Conversant in Malay or English. • To interview, using questionnaires about mental illness, precipitating factors, high expressed emotion, and psychiatric services. Results: In 5 months admitted patients 172 (Males: 92, Females: 80). 132 (76.7%) were re admitted. GENDER: A. Males: 74 (55.3%) B. Females: 58 (44.7%) DIAGNOSIS: Schizophrenia: 101 Bipolar : 6 MDD : 5 Substance abuse: 13 MR : 7 REASONS: Poor compliance : 89 Family rejection : 9 Discharge without full remission: 10 Others : 24 Conclusion: Ongoing unfinished study but trend has shown that majority of patients are readmitted and the leading cause is poor compliance in schizophrenics

Assessment of social support, expressed emotion and compliance to treatment among hospital admitted schizophrenic patients in Malaysia

One of the important factors that may predict the relapse in schizophrenia is having poor social support, high Expressed Emotion (EE)and poor compliance. The family is an important factor that affects the patient’s mental well-being and outcome, this study aimed to assess the social support, expressed emotion and treatment compliance among hospital admitted schizophrenic patients. A cross sectional study conducted among a sample of 162 patients diagnosed with schizophrenia admitted in psychiatric ward. Various factors were being assessed including age, gender, ethnicity monthly income, duration of the illness, number of admissions to the psychiatric ward, assessment of expressed emotion and compliance with treatment. The multidimensional scale of perceived social support (MSPSS) was used to measures perceived social support. Although there was no significant association between males and female in total scale social support, only the friend subscale social support was found significantly higher in males (p=0.038). Males have significant better compliance to medication than females (p=0.000). The prevalence of concurrent substance abuse was 14.8 % and it is significantly higher among male schizophrenic patients than female patients (p=0.000). There was no significant association between gender and high EE level. Having no history of co-morbid drug misuse (mean=4.39; p=0.039), and having high level of psychoeducation within the family (mean=4,48; p=0.004) were significantly associated with higher mean scores in total scale social support. Efforts to improve social support are essential in managing patients with schizophrenia competently. The level of psychoeducation within the family is a very important factor in relation to patients’ social support. Early detection and intervention toward co-morbid substance use disorder among schizophrenic patients is vital as it has been associated with poor social support. There is no difference between male or female patients in relation to high EE and family intervention should include steps to reduce it in both genders