Factors associated with geriatric morbidity and impairment in a megacity of Pakistan

Background: The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan.Methods: A cross-sectional study was conducted during 2013-2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged ≥60 years, using standardized questionnaires. Geriatric impairment was assessed through validated questions and tools. We screened for depression, dementia, mobility and functional status. Descriptive statistics were computed for socio-demographic factors. We estimated the prevalence and 95% CI for geriatric impairments and comorbidities.Results: A total of 1200 community-dwelling elderly participated in this study. More than half (n = 663, 55.3%) were females. The average age of the participants was 68.7 (SD = 7.8) years. Two-thirds suffered from chronic illness and the most common impairments were psychological and cognitive. Females were 2.45 times more at risk of developing three or more geriatric impairments. Participants with no formal education had the highest proportion (43.8%) of geriatric impairments. Participants living with more children were more likely to have three or more impairments.Conclusion: A high burden of non-communicable diseases and associated impairments were identified among elderly in Karachi, Pakistan. High rates of psychological and cognitive impairments require urgent attention for resources and strategic planning in anticipation of a growing geriatric population

QoS enhancement with deep learning-based interference prediction in mobile IoT

© 2019 Elsevier B.V. With the acceleration in mobile broadband, wireless infrastructure plays a significant role in Internet-of-Things (IoT) to ensure ubiquitous connectivity in mobile environment, making mobile IoT (mIoT) as center of attraction. Usually intelligent systems are accomplished through mIoT which demands for the increased data traffic. To meet the ever-increasing demands of mobile users, integration of small cells is a promising solution. For mIoT, small cells provide enhanced Quality-of-Service (QoS) with improved data rates. In this paper, mIoT-small cell based network in vehicular environment focusing city bus transit system is presented. However, integrating small cells in vehicles for mIoT makes resource allocation challenging because of the dynamic interference present between small cells which may impact cellular coverage and capacity negatively. This article proposes Threshold Percentage Dependent Interference Graph (TPDIG) using Deep Learning-based resource allocation algorithm for city buses mounted with moving small cells (mSCs). Long–Short Term Memory (LSTM) based neural networks are considered to predict city buses locations for interference determination between mSCs. Comparative analysis of resource allocation using TPDIG, Time Interval Dependent Interference Graph (TIDIG), and Global Positioning System Dependent Interference Graph (GPSDIG) is presented in terms of Resource Block (RB) usage and average achievable data rate of mIoT-mSC network

Resource Allocation in Moving Small Cell Network using Deep Learning based Interference Determination

© 2019 IEEE. Mobile cellular users traveling in city buses are experiencing poor quality of signals due to the interference and the large number of mobile devices. To enhance the Quality-of-Service (QoS), deployment of small cell networks in city buses is a promising solution. The deployment of small cells in vehicular environment makes the resource allocation more challenging because of the dynamic interference relationships experienced by them. Therefore, resource allocation in vehicular environment within moving small cells (MSCs) needs to be handled carefully. In this study, we investigate the problem of resource allocation in city bus transit system with multiple routes. Then, we propose a Percentage Threshold Interference Graph (PTIG) based allocation of resources to MSCs in a network. City buses of multiple routes travel with variable speed and may share some of the same road segments which make it difficult to extract the exact interference patterns between them. Therefore, Long Short Term Memory (LSTM) neural networks are used to predict the city buses locations. The predicted locations of city buses are then used to generate PTIG by finding the dynamic interference relationship between MSCs. Graph coloring algorithm is used to allocate the resources to PTIG. Numerical results are presented to show the comparison of resource allocation using PTIG and Time Interval based Interference Graph (TIIG) in terms of resource block utilization and time complexity

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Comparison of exhaled carbon monoxide levels among commuters and roadside vendors in an urban and a suburban population in Pakistan

Carbon monoxide (CO) is one of the six criteria air pollutants related to urbanization and has a wide range of health effects. The study measured and compared the exhaled CO levels among commuters and roadside vendors in potentially heavy and low traffic volume areas of Karachi, a megacity in Pakistan. Saddar town [areas of M. A. Jinnah Road (Tibet Center, Denso Hall) and Empress Market] was selected to represent an area of high traffic volume and the suburban town of Gadap (Gadap and Gulshan-e-Maymar) was selected to represent an area of no or low traffic volume. The study compared the CO exposure of commuters and roadside vendors in high and low traffic volume in Karachi. CO exposure was measured in expired air using the breath analyzer module of Bacharach Monoxor-II, USA. A total of 326 individuals (115 commuters and 211 stationary roadside vendors) from Saddar town (n = 193) and Gadap town (n = 133) were selected. In addition, CO levels in ambient air in the same areas, using portable CO analyzer (Bacharach, Monoxor-II, USA), were measured. The mean ambient CO level at Saddar town was 15.6 (SE +/- 2.6) ppm compared to 3.3 (SE +/- 0.3) ppm at Gadap town. The mean CO level in expired air was significantly higher among nonsmokers at Saddar town (12.8 +/- 0.5 ppm) compared to the nonsmokers at Gadap town (7.8 +/- 0.4 ppm). The mean CO level in expired air among smokers was twice that of nonsmokers (21.6 vs. 10.6 ppm). CO in expired air was greater among high traffic volume commuters and roadside stationary population in Karachi, Pakistan. The population in Karachi is exposed to high concentration of air pollutants. These pollutants need to be characterized for health effects and interventions needs to be developed

Association of IL1 beta gene polymorphism and allograft functions in renal transplant recipients :a case control study from Kashmir Valley

Abstract Background Cytokines have been found to be the important mediators during renal graft outcome. Therefore, we designed this study to investigate the role of recipients’ IL-1 β promoter (−511) and IL-1 β exon-5 (+3954) polymorphisms with the risk of graft outcome. Methodology We enrolled one hundred recipients of living-related renal transplants together with the age and sex matched controls from the healthy population not having any renal abnormality for this study. Genotype frequencies of the IL-1 β promoter (−511) and IL-1 β exon-5 (+3954) were analyzed using PCR-RFLP technique. Results Our results revealed significant differences in the healthy control group and patient group in IL 1β +3954 (p < 0.001). The frequency of variant type TT genotype was higher in RE group as compared to SGF and showed 4 fold risk of rejection (OR = 4.54, p < 0.069) although p value was not significant. The frequency of wild type CC genotype and CT was not significant (p value 0.89 and 0.74 respectively). Conclusion Our findings suggest that there is a prevalence of mutated allele of IL-1 gene cluster in our population, which may be responsible for renal dysfunction

Chronic urticaria merits serum vitamin D evaluation and supplementation; a randomized case control study

Background Several studies suggest that Vitamin D (Vit-D3) supplementation reduces Chronic Urticaria (CU) symptoms.Objectives Evaluation of serum 25-hydroxyvitamin-D (25 (OH)2D) level and assessment of therapeutic effect of VitD3in CU patients.Methods 192 subjects were stratified according to the baseline 25(OH)2D levels and subsequently randomized into three subgroups to receive Vit-D3 alone (VD) or antihistamine and systemic corticosteroid (H+S) or VitD3 with antihistamine and systemic corticosteroid (VD+H+S) for 6 weeks between July 2012 to Oct 2014. 130 healthy controls (HC) were followed without any intervention. The patients were evaluated for reduction in urticarial symptoms using visual analogue scale (VAS) and 5-D itch score.Results Low serum levels of 25 (OH)2D was observed in 91% of CU patients and 64% of the healthy controls (P < 0.0001). VAS and 5-D Score in subgroups VD, H + S and VD + H + S decreased significantly from 6 · 7 ± 0 · 043, 6 · 6 ± 0 · 42 and 6 · 68 ± 0 · 40 at baseline to 5 · 2 ± 0 · 70 (P = 0 · 0088), 3 · 3 ± 0 · 50 (P < 0 · 0001) and1 · 86 ± 0 · 39 (P < 0 · 0001) after treatment and from 14 · 5 ± 0 · 72, 13 · 9 ± 0 · 77 and 13 · 9 ± 0 · 221 to 12 · 06 ± 1 · 10 (P = 0 · 0072), 8 · 1 ± 1 · 13 (P < 0 · 0001) and 5 · 01 ± 0 · 94 (P < 0 · 0001) respectively.Conclusions CU patients have low serum 25(OH)2D levels and Vit-D3 supplementation in combination with antihistamine and systemic corticosteroid show elevated response in resolving the symptoms of CU. This study also warrants that each subject with CU should be screened for serum 25 (OH)2D levels before starting a treatment. Keywords: 25 (OH) vitamin D, 5-D itch score, Chronic Urticaria, Visual analogue scale, Ig