An electronic health record system implementation in a resource limited country—lessons learned

Electronic health records have revolutionized the medical world by improving medical care, refining provider documentation, standardizing care, and minimizing sentinel events. Successful implementation of electronic health records remains a daunting task and requires careful strategic planning and buy-in from key stakeholders. Much has been published in resource-rich settings and high-income countries about implementations of electronic health records. However, little is known about the experience in resource-limited settings where challenges remain unique and distinct from other parts of the world. Our intention is to share lessons learned during implementation of a web-based electronic health record at a tertiary care center in Kenya

EDDense-Net: Fully Dense Encoder Decoder Network for Joint Segmentation of Optic Cup and Disc

Glaucoma is an eye disease that causes damage to the optic nerve, which can lead to visual loss and permanent blindness. Early glaucoma detection is therefore critical in order to avoid permanent blindness. The estimation of the cup-to-disc ratio (CDR) during an examination of the optical disc (OD) is used for the diagnosis of glaucoma. In this paper, we present the EDDense-Net segmentation network for the joint segmentation of OC and OD. The encoder and decoder in this network are made up of dense blocks with a grouped convolutional layer in each block, allowing the network to acquire and convey spatial information from the image while simultaneously reducing the network's complexity. To reduce spatial information loss, the optimal number of filters in all convolution layers were utilised. In semantic segmentation, dice pixel classification is employed in the decoder to alleviate the problem of class imbalance. The proposed network was evaluated on two publicly available datasets where it outperformed existing state-of-the-art methods in terms of accuracy and efficiency. For the diagnosis and analysis of glaucoma, this method can be used as a second opinion system to assist medical ophthalmologists

Association of Type D personality with cardiovascular disease and its prognosis

Objective: To evaluate the association of Type D personality with cardiovascular disease and its prognosis. Methodology: This cross sectional study study was conducted in cardiology department of MBBS medical college Mirpur, from February 2019 to February 2020 in a period of one year. A total of 281 patients with cardiovascular diseases were included. Demographic information and risk factors were noted. Screening for metabolic syndrome was done using international diabetes federation criteria based upon central obesity. The assessment of type D personality was made through DS-14, type D scale, which is the most widely used instrument for type D personality measurement. In which all the 14 items are score on a 5-point Likert scale. Results: There were 77 (27.40%) patients having type D personality, with significantly less mean age (45.36 ± 6.2 vs. 53.45 ± 9.6) in comparison to patients without type D personality. No significant (p-value > 0.05) difference was noted in gender, education, occupation and marital status of the patients having type D personality. The rate of diabetes mellitus (44.46% vs. 37.25%), hypertension (59.74% vs. 47.06%), smoking status (62.34% vs. 53.43%) and metabolic syndrome (48.05% vs. 40.69%) were similar in both groups. The mean values of systolic (124.53 ± 12.35 vs. 116.28 ± 14.30, p-value = 0.000) and diastolic (78.44 ± 6.92 vs. 74.62 ± 7.48, p-value = 0.0001) blood pressure were significantly higher in patients having type D personality. Conclusions: A considerable number of cardiac patients in our study had type D personality trait. This trait was more common in younger age and male patients showing raised levels of blood pressure and HDL cholesterol. Key words: Cardiovascular disease, Type D personality, low HDL cholesterol, Prognosi

Big data assisted CRAN enabled 5G SON architecture

The recent development of Big Data, Internet of Things (IoT) and 5G network technology offers a plethora of opportunities to the IT industry and mobile network operators. 5G cellular technology promises to offer connectivity to massive numbers of IoT devices while meeting low-latency data transmission requirements. A deficiency of the current 4G networks is that the data from IoT devices and mobile nodes are merely passed on to the cloud and the communication infrastructure does not play a part in data analysis. Instead of only passing data on to the cloud, the system could also contribute to data analysis and decision-making. In this work, a Big Data driven self-optimized 5G network design is proposed using the knowledge of emerging technologies CRAN, NVF and SDN. Also, some technical impediments in 5G network optimization are discussed. A case study is presented to demonstrate the assistance of Big Data in solving the resource allocation problem

QUALITY CONTROL ANALYSIS AND ASSESSMENT OF DIFFERENT MARKET BRANDS OF CIPROFLOXACIN

Dose structures are basically pharmaceutical items in the structure in which they are showcased for use, normally including a blend of dynamic medication parts and nondrug segments (excipients), alongside other non-reusable material that may not be considered either fixing or bundling, (for example, a container shell, for instance). The term unit measurements can now and then envelop non-reusable bundling too (particularly when every medication item is exclusively packaged. Different measurements structures might exist for a solitary specific medication, since various medicinal conditions can warrant distinctive courses of organization. For instance, steady queasiness and heaving might make it hard to utilize an oral dose structure, and in such a case, it might be important to use a backup course of action, for example, inhalational, buccal, sublingual, nasal, suppository or parenteral. The primary objective was in vitro comparative study of 5 different brands of Ciprofloxacin Tablets available in markets of Pakistan by The in vitro comparative study of 5 different brands of Ciprofloxacin Tablets available in markets of Pakistan Weight variation Test, Disintegration Test, Hardness Test, Chemical Assay and In vitro dissolution study was conducted. After conducting color, friability, weight variation, hardness test and disintegration tests of various brands of Ciprofloxacin, the results were found under the acceptance range. The hardness showed variation among the tablets of various brands but there was no significant variation of hardness among the tablets of same brand. The Axcin indicated maximum drug potency (102%) and (101%) respectively while minimum potency was 93.07%. The in-vitro evaluation of 5 different F.P.Ps of Ciprofloxacin HCl film coated tablets available in the pharmaceutical market of Pakistan showed that all of brands of Ciprofloxacin satisfied the USP potency specifications and showed evidences of satisfactory initial in-vitro dissolution behavior

Depression and anxiety in glaucoma patients using mono drug therapy vs polydrug therapy

Objective: To evaluate the frequency of depression, anxiety, and stress scores among glaucoma patients and assess factors attributing to severe scores. Methodology: This Analytical, Cross-sectional study was conducted at the Armed Forces Institute of Ophthalmology from June 2020 to July 2021. Data was collected through nonprobability consecutive sampling. Individuals with diagnosed primary open-angle glaucoma were selected irrespective of age and gender. Dass-21 (self-assessment scale) was used in Urdu to document patient scores for anxiety, depression, and stress. Results: The frequency of males (n=204, 54%) and females (n=173, 45.8%) in the two groups was almost the same (p=0.164). The mean age in the mono-drug group (mean= 48.81±10.58 years) was slightly lower than the polydrug group (mean=53.67±11.16years) (p=0.000018). Overall depression score of the sample fell in the severe category (score=21-27), with individuals showing more depression scores in the poly group (n=99, 26%) than in the mono drug group (n=76, 20%) (p=0.000002). Individuals on polydrug therapy showed severe scores for depression, anxiety, and stress. Conclusion: Among the glaucoma patient, those on polydrug therapy have higher incidences of anxiety among young patients and depression among older patients. This not only causes poor compliance to treatment but also increases the risk of progression of glaucoma hence augmenting the crippling effects of the disease. Keywords: Depression, anxiety, DASS-21, Glaucom

First report on detection of Hepatozoon ayorgbor in Rhipicephalus haemaphysaloides and Hepatozoon colubri in Haemaphysalis sulcata and Hyalomma anatolicum: risks of spillover of Hepatozoon spp. from wildlife to domestic animals

This study aimed to detect Hepatozoon spp. in ticks infesting asymptomatic domestic animals and to provide insight into their potential spillover from wild to domestic animals. In total, 537 tick specimens were collected in Khyber Pakhtunkhwa, Pakistan, and morphologically identified. The most prevalent tick species was Haemaphysalis cornupunctata (69; 12.8%), followed by Haemaphysalis kashmirensis (62; 11.5%), Rhipicephalus microplus (58; 10.8%), Haemaphysalis montgomeryi (51; 9.5%), Rhipicephalus sanguineus (49; 9.1%), each Haemaphysalis bispinosa and Haemaphysalis sulcata (43; 8.0%), each Hyalomma anatolicum and Rhipicephalus turanicus (37; 6.9%), Rhipicephalus haemaphysaloides (33; 6.1%) Hyalomma scupense (30; 5.6%), and Hyalomma isaaci (25; 4.7%). The extracted DNA from a subset of each tick species was subjected to PCR to amplify 18S rRNA fragments of Hepatozoon spp. By BLAST analysis, the Hepatozoon sp. detected in Hy. anatolicum infesting cows and in Ha. sulcata infesting sheep showed 99.7% maximum identity with Hepatozoon colubri. Similarly, the Hepatozoon sp. detected in R. haemaphysaloides infesting goats shared 99.49% maximum identity with Hepatozoon ayorgbor, and the Hepatozoon sp. detected in R. sanguineus infesting dogs exhibited 99.7% identity with Hepatozoon canis. Having an overall infection rate (9.3%; 16/172), the highest infection rate was recorded for each H. canis, and H. colubri (3.5%; 6/172), followed by H. ayorgbor (2.3%; 4/172). In the phylogenetic tree, H. colubri clustered with corresponding species from Iran, H. ayorgbor clustered with the same species from Croatia, Ghana, and Portugal, and H. canis clustered with the conspecifics from Iran, Israel, Romania, and Zambia. Regarding the potential spillover of Hepatozoon spp. from wildlife through ticks, free ranging animals was at higher risk compared to confined animals (RR = 3.05), animals consuming food from wildlife habitats were at higher risk compared to those consuming domestic food (RR = 3.06), and animals residing in farm buildings located in wildlife habitats were at higher risk compared to those residing in farm buildings located in villages (RR = 3.28). In addition to the first report on H. canis in R. sanguineus in Pakistan, this is the earliest data showing H. ayorgbor in R. haemaphysaloides and H. colubri in Ha. sulcata and Hy. anatolicum. These preliminary findings suggest a potential spillover of Hepatozoon spp. from wild to domestic animals via ticks under certain risk factors

Identifying obstacles encountered at different stages of the disaster management cycle (DMC) and its implications for rural flooding in Pakistan

The world has seen a number of natural hazards, but among them, floods are perhaps the most frequent devastating natural hazard, resulting in more human causalities and financial losses. Rural inundation has become an issue of concern in various parts of the world, including Pakistan. Over the past few decades, it has been hard for local institutions and rural populations to recover from the trauma inflicted by these events. The disaster risk management cycle is a well-known tool for coping with disasters and their consequences. Yet, the DRM cycle efficacy has been questioned in various rural settings. Thus, this paper applied a programmatic strategy to understand the challenges disaster management authorities and communities face in managing flood risks through the conventional disaster management cycle in Khyber Pakhtunkhwa province, Pakistan. The study objective was accomplished by using both qualitative and exploratory research designs. Four communities (namely, Peshawar, Charsadda, Nowshera, and Dera Ismail Khan) with a historical record of flooding were chosen for focus group discussion (32 in total) using a purposive sampling method. Additionally, 31 key informant interviews were undertaken from pertinent local disaster risk management institutions. We employed a thematic analysis to classify responses and obstacles into the various stages of the disaster management cycle. The findings of this study from interviews and focus groups provided some new insight into the conventional DRM cycle. The issues and challenges encountered by institutions and the community members were divided into four stages: 1-mitigation, 2-preparedness, 3-rescue and relief (R&R), and 4-rehabilitation and recovery (R&R). Based on the findings, it seems that local disaster management institutions still rely on reactive strategies and deal with flood hazards on an ad hoc basis. Poor governance and a lack of responses for present development trajectories were also highlighted as reasons why flood risk management is still challenging. There is an urgent need to perform susceptibility and risk assessments for multiple hazards and develop specialized plans that follow disaster risk reduction principles and adaptation to climate change. This study recommends incorporating resilience and adaptation to climate change into the current disaster management cycle to prevent or reduce future hazards and risks in rural areas

Community Based Assessment of Behavior and Awareness of Risk Factors of Cystic Echinococcosis in Major Cities of Pakistan: A One Health Perspective.

Background: The parasitic disease, cystic echinococcosis (CE), is a serious health problem in Pakistan. Risk of disease transmission is increased by economic and political instability, poor living conditions, and limited awareness of hygienic practices. The current study aimed to investigate the community perception and awareness regarding the risk factors of CE in Pakistan, from a One Health perspective. Methods: We conducted a community-based survey involving 454 participants in the major cities of Pakistan. Quantitative data based on knowledge, attitude, and practices (KAP), the One Health concept, risk factors, and community perception of CE among the general population of the major cities of Pakistan were collected. The questions included those related to knowledge, attitude, practices, One Health concept, risk factors, and community perception. The Chi-squared test was applied to determine the associations regarding KAPs across socio-demographic parameters. Results: KAPs had no significant associations with sociodemographic aspects such as age, sex, religion, ethnicity, education, marital status, occupation, or financial status of the participants. The findings indicated a lack of awareness about CE among the participants. Respondents were unaware of the risk factors and the One Health concept of CE. However, the community attitude and perception were positive toward the control of CE. Conclusion: Illiteracy, deficient sanitation systems and lack of awareness are the contributing factors to CE in Pakistan. It is necessary to make the community aware regarding CE and its importance. Increasing this awareness represents an important step toward the eradication and control of CE

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life