Impact of a global pandemic on surgical education and training- review, response, and reflection

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions\u27 response to the situation in order to continue surgical training, and lessons learnt from the pandemic

In a digitally connected world through likes, hashtags and followers - advancing surgical research through a social media: A narrative review

In this era of modern information technology, the world is now digitally connected through various platforms on social media, which has changed the way medical professionals work, communicate and learn. The use of social media in surgery is expanding, and it is now becoming an essential tool for surgical training, research and networking. Articles, journal clubs and surgical conferences are within reach of everyone regardless of geographical location worldwide. Electronic publications have now resoundingly replaced printed editions of journals. Collaborative research through social media platforms helps collect diverse data, enhancing the research\u27s global generalisability. The current narrative review was planned to discuss the importance of social media in advancing surgical research and the use of different social media applications in the context of promoting and disseminating surgical research alongside its evolving ethical challenges

Prevalence and risk factors of Hepatitis B among pregnant women.

Introduction: Globally Hep C virus (HBV) a public health problem account for 2 billion infection and 400 million of them were chronically infected1,2,3. In Pakistan prevalence among general population is 4.3 % with carrier rate 3-5% (7-9 million) 4.  The prevalence of HBV among pregnant women 5% (range 0.6% to >20%) worldwide, leading mother to child transmission causing fetal and neonatal hepatitis, attributed for 30% to 50% of chronic carriers. Methodology: A cross-sectional study was conducted among randomly selected 140pregnantwomen attended the antenatal clinic of the District hospital of Rahim-Yar-Khan in June-July 2013. Rapid diagnostic tests kits were used to access for HB surface antigen (HBsAg).  A face to face interview was carried out by using structured pre-tested questionnaire to obtain demographic and other information. Results: 16(9.3%) out of 140 pregnant women were found to be positive for HBsAg, higher risk age group was 20-29 years 10(62.5%) , 16(100%) out of 16 infected women and 6(4.83%) out of 124 non-infected women had Negative history of HBV in Husband. Blood transfusion in last pregnancy was 14(87.5%) out of 16 infected women and 52(41.93%) out of 124 non-infected women. 10(62.5%) out of 16 infected women and 5(4.03%) out of 124 non-infected women has passed through dental procedures. Therefore, negative history of HBV in Husband, blood transfusion and dental procedures in last pregnancy were the most prevalent risk factors among infected women. Among the total 124, 76(61.29%) were vaccinated against HBV, while 0(0%) out of 16 infected women were not vaccinated. Conclusion: Prevalence of the HBV among pregnant women in Rahim-Yar-Khan is of intermediate endemicity (11.4%). Past history of blood transfusion and HBV infected Husband was the most prevalent risk factor. Health education regarding risk factors, preventive measures should be given to pregnant women with the involvement of Lady Health Worker and mass media. Free screening and immunization of pregnant women should be incorporated in antenatal and postnatal program of hospital

Pattern of acute diarrhea and its management among children at DHQ Hospital, Attock city from July-August 2014.

Introduction: Acute diarrhea is the 2nd most common cause of death among children under 5 years age countrywide. It is the passage of watery or loose stools 3 or more times in 24 hours and lasting less than 14 days. Methodology: This Comparative study was carried out at DHQ Hospital Attock City from July-August 2014 by using a close ended questionnaire. Results: From July 2014-August 2014, a total of 40 children having acute diarrhea were hospitalized in the DHQ Hospital Pediatric ward. There were more males n=24(60%) then females n=16 (40%) and the male to female ratio was 1.5: 1. 50% of the patients presented in 2nd half of 1st year.  n=32 (80%) children presented with 4 days of illness. All patients had passed 8-10 stools per day. One had passed 15-20 stools per day. n=9 (22.5%) child pass small amount of blood/ mucous in stools. Exclusive breastfeeding was reported in n=8 (20%) of the patients. n=18 (45%) children did not show any signs of dehydration, n=15 (37.5%) showed some dehydration and n=7 (17.5%) showed severe dehydration. Symptoms associated with diarrhea were fever n=31 (77.5%), cough n=17 (17.5%), vomiting n=8 (20%), oral thrush n=1 (2.5%). Blood CP n=39 (97.5%), ESR, Stool Examination n=31 (77.5%), X-Ray Chest n=8 (20%) were the investigations done in children. ORS/OEM use rate was 40 (100%) while rate of antibiotic (ceftriaxone) was n=7 (17.5%), n=33 (82.5%) received  Zinc Sulphate in syrup form, n=31 (77.5%) received Syrup Paracetamol. Conclusion: Diarrhea is a common illness among children under 1-year age. Fever is the most common associated symptom with diarrhea. Parenteral diarrhea due to abdominal infections is also predominant condition. Key Words: Diarrhea, Abdominal infections, Oral rehydration salt

Why do patients with limb ischaemia present late to a vascular surgeon? A prospective cohort study from the developing world

OBJECTIVE: To look into the factors responsible for delay in presentation of Iimb ischemia patients to a vascular surgeon. METHODS: The prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from October 01, 2016, to August 10, 2018. Patients coming with delayed presentation of both acute and chronic limb ischemia were included. All the patients were assessed by qualified vascular surgeons. SPSS 23 was used for data analysis. RESULTS: Of the 55 patients, 33(60%) had acute and 22(40%) had chronic limb ischaemia. Mean age of acute cases was 44±23.72 years and it was 60±12.49 years for chronic cases. Overall, the commonest reason behind delay was non-referral by primary physician which was the case with 11(33.3%) patients in the acute group, and 13(59%) in the chronic group. The limb loss in the acute group was 20(60%) and 8(36%) in the chronic group.. CONCLUSION: Delayed presentation of patients with limb ischaemia is mainly due to non-referral. A robust campaign needs to be launched to reduce the rate of limb loss

Accuracy of Uterine Artery Doppler in Second Trimester in Determining Pre-Eclampsia

Background: To determine the accuracy of uterine artery doppler in the second trimester (18-24 weeks) in determining preeclampsia.Methods: In this descriptive study, a total of 89 women with singleton pregnancy attending routine second-trimester anomaly scan were included. Uterine artery doppler sonography was conducted in the women coming for routine anomaly scan. Flow velocity waveforms of right and left uterine artery were imaged with the patient in the semi-recumbent position and the uterine artery was identified in the longitudinal scan, lateral to the uterus. Resistive index, pulsatility index and presence and absence of early diastolic notch and its depth in terms of notch index were calculated.Results: Uterine artery doppler finding in second trimester in determining preeclampsia showed abnormal findings in 41.57% women in which 24.32% had type I (Resistive index >0.58), 45.95% (17/37) type II (Mild notching of uterine artery at beginning of diastole) and 29.73% had type III [(Severe notching + abnormal Resistive index (>0.58)]. After the follow-up of each patient, we found that pre-eclampsia was developed in 28.09% (25/89) cases. The accuracy, sensitivity, specificity, positive and negative predictive values of uterine artery doppler were 75.28%, 80%, 73.44%, 54.05% and 90.38% respectivelyConclusion: By detecting abnormal uterine artery Doppler indices (high RI) between 18-24 weeks of pregnancy can identify those women who are at risk for development of preeclampsia

Enhancement of Solar PV Hosting Capacity in a Remote Industrial Microgrid: A Methodical Techno-Economic Approach

To meet the zero-carbon electricity generation target as part of the sustainable development goals (SDG7), remote industrial microgrids worldwide are considering the uptake of more and more renewable energy resources, especially solar PV systems. Estimating the grid PV hosting capacity plays an essential role in designing and planning such microgrids. PV hosting capacity assessment determines the maximum PV capacity suitable for the grid and the appropriate electrical location for PV placement. This research reveals that conventional static criteria to assess the PV hosting capacity fail to ensure the grid’s operational robustness. It hence demands a reduction in the theoretical hosting capacity estimation to ensure grid compatible post-fault voltage and frequency recovery. Energy storage technologies, particularly fast-responsive batteries, can potentially prevent such undesirable scenarios; nevertheless, careful integration is required to ensure an affordable cost of energy. This study proposes a novel methodical techno-economic approach for an off-grid remote industrial microgrid to enhance the PV hosting capacity by integrating battery energy storage considering grid disturbance and recovery scenarios. The method has been validated in an industrial microgrid with a 2.6 MW peak demand in a ready-made garment (RMG) factory having a distinctive demand pattern and unique constraints in remote Bangladesh. According to the analysis, integrating 2.5 MW of PV capacity and a 1.2 MVA battery bank to offset existing diesel and grid consumption would result in an energy cost of BDT 14.60 per kWh (USD 0.1719 per kWh). For high PV penetration scenarios, the application of this method offers higher system robustness, and the financial analysis indicates that the industries would not only benefit from positive environmental impact but also make an economic profit

Innovative Methods of Mosquito Management

As the global human and animal population increases, deadly pathogens and parasites may be transmitted by arthropods. There are a number of vectors that pose a threat to human health due to their role in transmitting dangerous pathogens, including mosquitoes (Diptera: Culicidae). The most important drawback of these products is the incidence of insecticide resistance, which has increased rapidly in recent years. New approaches and vector-control tools targeting aquatic stages and adults are urgently needed. The three main mosquito genera, Anopheles, Aedes, and Culex, transmit the causative agents of numerous important diseases to humans as well as animals. A technique that involves the use of genetically modified (GM) mosquitoes for the purpose of vector control is another potential option. Other best ways to control the mosquito are by chemical, biological and genetic means

Proteome level analysis of drug-resistant Prevotella melaninogenica for the identification of novel therapeutic candidates

The management of infectious diseases has become more critical due to the development of novel pathogenic strains with enhanced resistance. Prevotella melaninogenica, a gram-negative bacterium, was found to be involved in various infections of the respiratory tract, aerodigestive tract, and gastrointestinal tract. The need to explore novel drug and vaccine targets against this pathogen was triggered by the emergence of antimicrobial resistance against reported antibiotics to combat P. melaninogenica infections. The study involves core genes acquired from 14 complete P. melaninogenica strain genome sequences, where promiscuous drug and vaccine candidates were explored by state-of-the-art subtractive proteomics and reverse vaccinology approaches. A stringent bioinformatics analysis enlisted 18 targets as novel, essential, and non-homologous to humans and having druggability potential. Moreover, the extracellular and outer membrane proteins were subjected to antigenicity, allergenicity, and physicochemical analysis for the identification of the candidate proteins to design multi-epitope vaccines. Two candidate proteins (ADK95685.1 and ADK97014.1) were selected as the best target for the designing of a vaccine construct. Lead B- and T-cell overlapped epitopes were joined to generate potential chimeric vaccine constructs in combination with adjuvants and linkers. Finally, a prioritized vaccine construct was found to have stable interactions with the human immune cell receptors as confirmed by molecular docking and MD simulation studies. The vaccine construct was found to have cloning and expression ability in the bacterial cloning system. Immune simulation ensured the elicitation of significant immune responses against the designed vaccine. In conclusion, our study reported novel drug and vaccine targets and designed a multi-epitope vaccine against the P. melaninogenica infection. Further experimental validation will help open new avenues in the treatment of this multi-drug-resistant pathogen