Economic development and health status among the poor in squatter settlements of Karachi.

OBJECTIVE: Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor. SETTING: Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996. METHODS: A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets. RESULTS: Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p = 0.02) have lower contraceptive usage (CI; 2.11-2.64; p \u3c 0.001) and childhood immunization rates (CI; 2.08-2.40, p \u3c 0.001). No significant association was observed between economic levels and prevalence of diarrhea. The housing, literacy and employment status was consistently better in the higher economic stratum who were more likely to be Pushto-Punjabi speaking as compared to the Sindhi speaking population. CONCLUSION: To have sustainable improvement in the health status of the poor, those who are most vulnerable need to be identified and programs aiming to improve health should also undertake broader development initiatives like raising family income

Conservative Management of Spontaneous Coronary Artery Dissection: A Case Report

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare but fatal cause of acute coronary syndrome (ACS), often seen in young healthy women without any significant cardiovascular disease. If not treated early, it can lead to sudden cardiac death. We report an interesting case of ACS due to SCAD. Case Presentation: A 40-year-old woman presented to the emergency department with retrosternal chest pain at rest, associated with diaphoresis, palpitations, and nausea. Her past medical history was significant for hypertension and type 2 diabetes. On presentation, blood pressure was elevated to 150/81 mmHg, remaining vitals were normal. Initial electrocardiogram (ECG) showed normal sinus rhythm with no ischemic changes. Laboratory tests revealed an elevated high sensitivity troponin level to 104 ng/L (ref:/L). Given her clinical picture and biomarker elevation, there was concern for acute coronary syndrome. Echocardiography displayed an ejection fraction of 60% and no regional wall motion abnormalities. Coronary angiography was performed, which revealed non-obstructive coronary artery disease (CAD) with dissection of the mid-to-distal right posterolateral branch of the right coronary artery (RCA). No intervention was performed given mild extension of dissection and location. Of note, she did have recurrent chest pain with subsequent resolution. Given her overall symptomatic improvement, she was eventually discharged on metoprolol succinate, aspirin, and a moderate dose statin. Discussion: SCAD involves dissection of an epicardial coronary artery that is not secondary to atherosclerosis, trauma, or iatrogenic causes. It is the cause of up to 1-4% of ACS cases, occurs mostly in women, and is the most common cause of pregnancy-associated myocardial infarction (MI). The left anterior descending (LAD) artery is the most common artery affected, although it can affect any artery. The pathogenesis of SCAD involves the sudden disruption of the intimal layer, leading to dissection of the tunica media and subsequent formation of an intramural hematoma within a false lumen, and eventual compression of the true lumen. This leads to reduced coronary blood flow and MI. Acute coronary syndrome is the most common presentation, though clinical manifestations of SCAD can range from stable angina, to cardiogenic shock and life-threatening arrhythmias. When diagnosing SCAD, coronary angiography should be the first-line diagnostic imaging study. Other modalities including intravascular ultrasonography and optical coherence tomography allow for more detailed visualization of the artery wall and can be used to aid diagnosis. Management of SCAD varies depending on the case presentation and the severity of the condition. Patients with extensive dissections resulting in recurring symptoms and myocardial ischemia usually require percutaneous coronary intervention (PCI), while surgery is preferred for multi-vessel disease. Medical therapy is indicated for cases with mild involvement, and may include aspirin, P2Y12 inhibitors, beta blockers, and nitrates. Generally, patients with SCAD have a good prognosis especially with early detection and treatment. Recurrence of SCAD occurs in a minority of cases.https://scholarlycommons.henryford.com/merf2020caserpt/1052/thumbnail.jp

Mutation Analysis of the CYP21A2 Gene in the Iranian Population

Background: Defects in the CYP21A2 gene cause steroid 21-hydroxylase deficiency, which is the most frequent cause of congenital adrenal hyperplasia. Forty four affected families were investigated to identify the mutation spectrum of the CYP21A2 gene. Methods: Families were subjected to clinical, biochemical, and molecular analyses. Allele-specific polymerase chain reaction amplification was used for eight common mutations followed by dosage analysis to exclude CYP21A2 deletions. Results: The most frequent mutations detected were gene deletions and chimera (31.8). Other mutation frequencies were as follows: Q318X, 15.9; I2G, 14.8; I172N, 5.8; gene duplication, 5.7; R356W, 8; and E6 cluster mutations, 2.3. Direct sequencing of the CYP21A2 gene revealed R316X, P453S, c.484insT, and a change at the start codon. Different modules carried by patients were classified into five different haplotypes. The genotype phenotype correlation (positive predictive value) for group null, A, B, and C were 92.3, 85.7, 100, and 0, respectively. Conclusions: Methods used will be helpful for carrier detection and antenatal diagnosis, especially with inclusion of the multiplex ligation probe dependent amplification technique, which is easier for routine tests in comparison with other methods. Mutation frequencies indicate that Iranians are possible descendants of Asians and Europeans

Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan.

A cross-sectional study of Patient satisfaction with care was conducted over a period of 1 year from March 2004 to March 2005 in a secondary-level hospital in a peri-urban area of Karachi, Pakistan. Using the SERVQUAL tool and exit interviews, data were collected quarterly from a total of 1533 Patients. Results sharing and capacity-building workshops were arranged during the 4 phases of the survey to sensitize the staff of the hospital to work towards improving Patient satisfaction. The level of satisfaction of the Patients with the outPatient health services provided showed a gradual increase from 34.4% to 82.0% over the 1-year period

Flatness-based control of open-channel flow in an irrigation canal using SCADA

Open channels are used to distribute water to large irrigated areas. In these systems, ensuring timely water delivery is essential to reduce operational water losses. This article derives a method for open-loop control of open channel flow, based on the Hayami model, a parabolic partial differential equation resulting from a simplification of the Saint-Venant equations. The open-loop control is represented as infinite series using differential flatness. Experimental results show the effectiveness of the approach by applying the open-loop controller to a real irrigation canal located in South of France

DeepAngle: Fast calculation of contact angles in tomography images using deep learning

DeepAngle is a machine learning-based method to determine the contact angles of different phases in the tomography images of porous materials. Measurement of angles in 3--D needs to be done within the surface perpendicular to the angle planes, and it could become inaccurate when dealing with the discretized space of the image voxels. A computationally intensive solution is to correlate and vectorize all surfaces using an adaptable grid, and then measure the angles within the desired planes. On the contrary, the present study provides a rapid and low-cost technique powered by deep learning to estimate the interfacial angles directly from images. DeepAngle is tested on both synthetic and realistic images against the direct measurement technique and found to improve the r-squared by 5 to 16% while lowering the computational cost 20 times. This rapid method is especially applicable for processing large tomography data and time-resolved images, which is computationally intensive. The developed code and the dataset are available at an open repository on GitHub (https://www.github.com/ArashRabbani/DeepAngle)

Evacuation Route Calculation of Inner Buildings

Disastrous accidents (fire, chemical releases, earthquake, terrorist attacks, etc) in large public and residential buildings (discotheques, cafes, trade and industrial buildings) usually result in tragic consequences for people and environments. Such accidents have clearly showed that need for reliable systems supporting rescue operations is urgently appealing. Amongst all, giving appropriate information to the ordinary people in/around the af-fected area considering the disaster developments (available exists, assess-able corridors, etc.) and the human factors (age, gender, disability) are of critical importance for the success of the rescue operation. This paper promotes a new approach (based on 3D models) for giving evacuation instruction to people. The paper is organised in three general parts. The first part discusses briefly current approaches for alarming peo-ple in buildings showing their disadvantages. The second part presents the 3D system architecture and elaborates on the needed components. Discus-sion on the required developments concludes the paper.