The use of folic acid in dengue: Has it any value?

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in both groups A and B ( P = 0.89). In conclusion, there is no significant difference in the recovery of thrombocytopenia in patients with dengue fever who received folic and those who did not receive folic acid

Resection of posterior mediastinal tumors by video assisted thoracic surgery

Abstract This case report illustrates successful Video Assisted Thoracic Surgery (VATS) performed on a 45-year-old woman and 52-year-old man presenting with a mass in left and right paravertebral space on the CT scan respectively. VATS has many benefits over traditional open operation (thoracotomy), resulting in less pain and shorten recovery time. However, VATS has higher equipment cost but when an experienced surgeon performs the surgery, better outcomes are achieved. VATS is not common in Pakistan\u27s surgical setup as it is an expensive method of eradicating mediastinal pathologies and not every patient undergoes VATS. The primary objective of presenting these cases is to promote the use of VATS specifically for removal of posterior mediastinal tumors and improve the surgical outcomes

Reduction in Packaging Wastes Through Identification of Lean Wastes to Deliver Efficient Waste Controlling Techniques for a Pharmaceutical Industry

The purpose of this paper is to propose a method of reducing material and time waste during packaging in the pharmaceutical industry. This is done by means of identifying the four major lean wastes i.e., motion, inadequate processing, waiting, and defects. These wastes are identified and reduced by means of using lean tools and proposing other cost-effective solutions that would increase process efficiency. Material waste is dealt with through selecting optimal requirements under the constraint limits of ergonomics, engineering, and machine space availability. Along with reduction in change over time, a strategy ensuring improvement in the primary packaging area was developed. The validity of this research has been brought about by means of a case study of a multinational pharmaceutical company. The proposed system proves to be highly beneficial in ensuring wastage and time reduction in changeovers. This strategy provides improved results without any new costs introduced and the production targets were met faster. There is also a special consideration given to the ergonomic aspect of the production processes

Influence of Type of Product on Brand and Cause Images in a Cause-Related Marketing Campaign: Evidence from Pakistan

Luxury brands and non-profit organizations (NPOs) are increasingly involved in cause-related marketing (CRM) programs. This research aims to explain how product’s nature (hedonic vs. utilitarian) may influence consumer’s decisions to purchase cause-related products. Prior and post attitude of brands analyze with repeated measure ANOVA. The results show that brand attitude increased both in case of ahedonic and utilitarian partnership. However,partnering with a luxury brand ismore efficient to raise theimage of thebrand ascompared to apartnership with non-luxury brands.In general, these results provide clear insights to marketing managers for planning and positioning of their CRM campaigns

Hypotension at presentation is an indicator of poor prognosis in acute intracerebral haemorrhage

OBJECTIVE: To identify frequency of hypotension in a large cohort of patients with intracerebral haemorrhage and its prognostic significance. METHODS: We retrospectively reviewed medical records of 920 patients with spontaneous intracerebral haemorrhage (ICH). Patients were divided in three groups based on Diastolic blood pressure (DBP); hypotensive group (DBP \u3c 70 mmHg), normotensive group (DBP; 71-90 mmHg) and hypertensive group (DBP \u3e 90 mmHg). RESULTS: Of the total patients with ICH, 7% (64) presented with hypotension, 13% (120) were normotensive and 80% (736) were hypertensive. In the hypotensive group, 37% (24) patients died as compared to 25%(30) in normotensive group and 25% (182) in hypertensive group (p = 0.03). Hypotension at presentation, thalamic and lobar haemorrhages were predictors of poor outcome. Patients with diastolic BP of less than 70 were significantly more likely to die than with DBP 71-90 (OR = 1.9, 95% CI; 1.1-2.9, p = 0.03). This relationship was still significant after adjusting for age, sex, history of presentation, coma at presentation and location of haemorrhage (OR = 1.45, 95% CI; 1.0-2.2, p = 0.045). CONCLUSION: Our findings suggest that hypotension at presentation is a predictor of poor outcome in patients with ICH. Patients with diastolic blood pressure less than 70 are more likely to have a fatal outcome as compared to those with normal blood pressure

Successful tricuspid valvectomy in a septic patient with tricuspid valve endocarditis

Abstract Endocarditis is characterized by vegetations, which is a mass of platelets, fibrin, micro-colonies of micro-organisms, and inflammatory cells, in the endocardium. Over the past three decades, the incidence of right-sided endocarditis has risen dramatically in Pakistan. We report a 36-year woman with a history of repeated intravenous analgesic injections for low back pain, presenting with high grade fever, sepsis and a white cell count of 44,000 with 90% neutrophils. Echocardiography showed large mobile vegetations on TricuspidValve (TV). Tricuspid Valve Endocarditis (TVE) is generally responsive to medical treatment; however, about 25% of TVE patients require surgical intervention. Long-term survival of a patient is possible without a prosthetic TV replacement, particularly if the pulmonary artery pressure is normal

Nias-mukalla web based systems success measurement and students satisfaction evaluation based on security factor of systems quality engineering theory (ISO 25010) and other factors

Latest studies reported that systems success measure suffers from mix of results and limited models that help in success measurement and evaluation. Because of systems models are domain specific and context related, there is a dire need for taking the measure to other perspectives like using related external factors such as management support or using software engineering theories such as ISO 25010. This study aimed to move the measure from a business perspective to other perspectives. This study investigated NIAS-Mukalla student satisfaction based on security, management support, computer anxiety and usefulness. All these independent variables found to be positively and significantly affected the satisfaction of the users. NIAS-Mukalla students were satisfied with the web-based systems

An Adaptive Learning Rate for RBFNN Using Time-Domain Feedback Analysis

Radial basis function neural networks are used in a variety of applications such as pattern recognition, nonlinear identification, control and time series prediction. In this paper, the learning algorithm of radial basis function neural networks is analyzed in a feedback structure. The robustness of the learning algorithm is discussed in the presence of uncertainties that might be due to noisy perturbations at the input or to modeling mismatch. An intelligent adaptation rule is developed for the learning rate of RBFNN which gives faster convergence via an estimate of error energy while giving guarantee to the l2 stability governed by the upper bounding via small gain theorem. Simulation results are presented to support our theoretical development

Patients\u27 satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan - a cross sectional study

Background: It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.Methods: It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.Results: A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.CONCLUSION: Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients