Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan : Evidence from two longitudinal cohort studies 15 years apart

Funding Information: Study 1 was funded through the Applied Diarrheal Disease Research Program at Harvard Institute for International Development with a grant from USAID (Project 936–5952, Cooperative Agreement # DPE-5952-A-00-5073-00), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan. Study 2 was funded by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4–421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funding bodies had no role in the design of the study, data collection, analysis, interpretation, or writing of the manuscript. Publisher Copyright: © 2020 The Author(s).Peer reviewedPublisher PD

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Overall and gender-based negative predictive value of a normal gated myocardial perfusion SPECT study: a single center experience

A normal gated myocardial perfusion imaging (GMPI) has been found to have high diagnostic and negative predictive value (NPV) in western population. The goal of the present study was to evaluate the overall and gender-based NPV of a normal GMPI in local population.This is a prospective study conducted at Nuclear Cardiology Department of Karachi Institute of Heart Diseases (KIHD), Karachi from December 2008 till May 2009. All Patients (with intermediate risk) with a normal GMPI with adequate dynamic or dipyridamole stress were included and followed up for 18 months (mean 15 +/- A 3 months) for fatal or non-fatal infarctions.The mean ejection fraction (EF) of studied population was 69 +/- A 8% while mean end diastolic (EDV) and end systolic volume (ESV) were 71 +/- A 19 and 22 +/- A 11 ml, respectively. In studied female cohort, the mean EF (%), EDV (ml) and ESV (ml) were 71 +/- A 08, 64 +/- A 15 and 19 +/- A 09, respectively. In studied male cohort, the mean EF (%), EDV (ml) and ESV (ml) were 66 +/- A 06, 82 +/- A 18 and 27 +/- A 11, respectively. At 18 months follow-up, one fatal (male Patient) and one non-fatal MI (male Patient) were reported. The overall NPV was 99.4% over 18 months follow-up with an event rate of 0.6% (95% CI 0.03-1.16%) and annualized event rate of 0.3%. The NPV and annualized event in subgroup analyses, was similar for female and male (P = 0.213).We conclude that a normal GMPI with adequate stress in our population has high NPVs for major cardiac events as in western population. In addition, the prognostic utility of GMPI is similar for both men and women

Reduced-Complexity LDPC Decoding for Next-Generation IoT Networks

Low-density parity-check (LDPC) codes have become the focal choice for next-generation Internet of things (IoT) networks. This correspondence proposes an efficient decoding algorithm, dual min-sum (DMS), to estimate the first two minima from a set of variable nodes for check-node update (CNU) operation of min-sum (MS) LDPC decoder. The proposed architecture entirely eliminates the large-sized multiplexing system of sorting-based architecture which results in a prominent decrement in hardware complexity and critical delay. Specifically, the DMS architecture eliminates a large number of comparators and multiplexors while keeping the critical delay equal to the most delay-efficient tree-based architecture. Based on experimental results, if the number of inputs is equal to 64, the proposed architecture saves 69%, 68%, and 52% area over the sorting-based, the tree-based, and the low-complexity tree-based architectures, respectively. Furthermore, the simulation results show that the proposed approach provides an excellent error-correction performance in terms of bit error rate (BER) and block error rate (BLER) over an additive white Gaussian noise (AWGN) channel