The SER Analysis of Rayleigh, Rician and Nakagami Channels at Various Relay Locations in Cooperative Networks

Reliable communication between transmitter and receiver is accomplished by cooperative diversity techniques. Sending of data in various paths has greatly improved the performance of communication. We have studied the performance of Amplify-and-Forward (AF) based network in this work for diverse relay location at Nakagami, Rician and Rayleigh fading channels. The relay performance in Amplify-and-Forward (AF) protocol based on Symbol Error Rate (SER) against Signal-to-Noise Ratio (SNR) in dBs is calculated. The software that is used to construct Monte-Carlo link level simulation is MATLAB. The effects of a relay at changed location in diverse channels accompanied with Additive White Gaussian noise (AWGN) is also calculated. BPSK modulation scheme is used for the transfer of information between the source, relay and destination node. The signals are combined through Maximum Ratio Combining method (MRC).Reliable communication between transmitter and receiver is accomplished by cooperative diversity techniques. Sending of data in various paths have greatly improved the performance of communication. We have studied the performance of Amplify-and-Forward (AF) based network in this work for diverse relay location at Nakagami, Rician and Rayleigh fading channels. The relay performance in Amplify-and-Forward (AF) protocol based on Symbol Error Rate (SER) against Signal-to-Noise Ratio (SNR) in dBs is calculated. The software that is used to construct Monte-Carlo link level simulation is MATLAB. The effects of relay at changed location in diverse channels accompanied with Additive White Gaussian noise (AWGN) is also calculated. BPSK modulation scheme is used for the transfer of information between the source, relay and destination node. The signals are combined through Maximum Ratio Combining method (MRC)

Confusion is the first step towards understanding: Fixing the problems of E-learning in COVID-19 pandemic

Background: The COVID-19 pandemic forced institutions worldwide to adopt online learning, which opened a new era of challenges. Our research was designed to explore the effect of the pandemic on teaching and learning and identify the solutions to the problems based on participants’ perspectives. Methods: A qualitative study of the phenomenological design was conducted at a medical institute in Pakistan. The participants were selected using the purposive sampling technique. Semi-structured interviews were done which were later audio-recorded, transcribed, and subjected to manual thematic analysis. Credibility was ensured by using multiple data collection sources. Results: The 20 participants selected as interviewees were faculty with more than 5 years teaching experience in the medical institute and had gone through online teaching and learning during COVID-19 pandemic.  The thematic analyses of the data generated six themes which were: 1. “I see what you mean”; Re-exploration of educational psychology, 2. Reorganization of curriculum, 3. Mentoring and coaching, 4. Technology: as ubiquities as oxygen, 5. Constructive feedback: a stimulus in pearl formation and 6. Turn the tables: fixing the problem. Conclusion: Online education has emerged as an important mechanism in delivering medical education to undergraduate medical students. Instead of shying away, efforts are needed to restructure the curricula, incorporating various online innovative teaching, and learning tools that are at par with the changing global demands of medical education. Keywords: E-learning, COVID-19, Challenges                                                                                                          

Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country

Background and Aim: Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.Materials and Methods: Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012.Results: A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period.Conclusion: We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making

Multi-drug resistant gram negative infections and use of intravenous polymyxin B in critically ill children of developing country: Retrospective cohort study

Background: Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients.Methods: Files of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects of Polymyxin B were recorded.Results: A total of 44.8/1000(36/803) admitted patients developed MDR gram negative infections, of which 47.2%(17/36) were male, with mean age of 3.4 yrs(+/-4.16). Acinetobacter Species (25.5%) was the most frequently isolated MDR organisms followed by Klebsiella Pneumoniae (17%). Sensitivity of isolates was 100% to Polymyxin B, followed by Imipenem (50%), and piperacillin/tazobactem (45%). The crude mortality rate of patients with MDR gram negative infections was 44.4% (16/36). Fourteen of 36 patients received Polymyxin B and 57.1%; (8/14) of them were cured. Nephrotoxicity was observed in 21.4% (3/14) cases, none of the patients showed signs of neuropathy.Conclusion: Our study highlights high rates of Carbapenem resistant gram negative isolates, leading to increasing use of Polymyxin B as the only drug to combat against these critically ill children. Therefore, we emphasizeon Stewardship of Antibiotics and continuous surveillance system as strategies in overall management of these critically ill children

Pattern of unnatural deaths during COVID-19 lockdown in comparison with deaths reported during 2019 in Sahiwal city

Background:  Lockdown, a social isolation restriction measure has a direct impact on covid-19 transmission but its effect on unnatural deaths remains unknown. Objective:  This study has been designed to observe the effects of covid-19 lockdown on unnatural deaths in Sahiwal by comparing with the same period in 2019. Study design: Descriptive retrospective study. Setting: The study was conducted in mortuary of DHQ Teaching Hospital Sahiwal attached with the Department of Forensic Medicine & Toxicology Sahiwal medical college, Sahiwal. Study Duration: Covid-19 lockdown period from 24th March 2020 to 9th May 2020 and the same period in 2019. Materials and Methods: This study includes 62 cases of unnatural deaths, out of which 23 Cases in 2019 and 39 cases in 2020. We have included age, sex, marital status, area of belonging, manner of death, and cause of death as variables in our study. Results: In total 62 cases, in 2019 there were 15 males and 8 females with a mean age of 37.30±19.55 years and in 2020, there were 27 males and 12 females with a mean age of 32.85±15.16 years. The age group in which most number of deaths occurred was 30-59 years (46.8%). In 2019 majority of victims died due to homicide 15(65.2%) while during the lockdown period 14 (35.9%) victims lost their lives in accidents. Firearm injuries were the cause of death in 11(47.8%) cases in 2019 while in the COVID 19 lockdown period the majority of cases 13 (33.3%) were those who died due to roadside accidents. Conclusions: We could not detect significant difference in the two periods examined with respect to sociodemographic factors, but manner of death was significantly affected

Transnasal Endoscopic Surgical Repair of Cerebrospinal Fluid(CSF) Rhinorrhea by Inferior Turbinate Grafts

Objective: The study aims to evaluate the outcomes of transnasal endoscopic surgical repair of CSF rhinorrhoea.Materials and Methods: After approval from the institutional ethical committee (DME-396-18) and patient consent, a descriptive study of 27 patients with cerebrospinal fluid rhinorrhea was conducted at Aziz Fatimah Trust Hospital Faisalabad from August 21, 2018, to February 7, 2021. Transnasal endoscopic surgical repair of Cerebrospinal fluid leak was performed by using multilayer technique using a graft from the inferior turbinate. The data collected were analyzed using SPSS 20.Results: The most common site of the CSF leak was the left side of the cribriform plate (n=19,70%). The most common etiology was spontaneous (n=16,59%). At the same time, traumatic CSF leak (n=16,59%). was the second common etiological factor. The surgical procedure used in the study reported a 93%(n=25) success rate. The success rate was 97.5% on revision surgeries.Conclusion: Transnasal endoscopic surgical repair of CSF leak is one of the most effective and safe surgical interventions. Multilayer technique is not only safe but also has lesser complications. Moreover, this minimizes the risk for the development of secondary wounds as compared to other surgical processes

Abstract to publication conversion in pediatric critical care medicine in Pakistan

Background: To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country.Methods: We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication.Results: A total of 79 PCCM abstracts were presented in 17 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (p \u3c0.001).Conclusion: The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country