Association between PM₁₀ exposure and risk of myocardial infarction in adults:A systematic review and meta-analysis

Background: Air pollution has several negative health effects. Particulate matter (PM) is a pollutant that is often linked to health adversities. PM2.5 (PM with an aerodynamic diameter of ≤2.5μm) exposure has been associated with negative cardiovascular (CV) outcomes. However, the impact of PM10 (PM with an aerodynamic diameter of ≤10μm) exposure is often overlooked due to its limited ability to pass the alveolar barrier. This study aims to assess the association between PM10 exposure and risk of myocardial infarction (MI) amongst adults (≥18 years of age) as this has been poorly studied. Methods: The study protocol was published on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023409796) on March 31, 2023. Literature searches were conducted on 4 databases (Ovid Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science) on January 17, 2023, for studies looking at associations between PM and MI. English studies from all time periods were assessed. Studies selected for review were time-series, case-crossover, and cohort studies which investigated the risk of MI as an outcome upon PM10 exposure. The quality of evidence was assessed using Cochrane’s Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Data for different risk outcomes (risk ratio (RR), odds ratio (OR), hazard ratio (HR)) and 3 lags was meta-analyzed using an inverse variance statistical analysis using a random effects model. The pooled effect sizes and the 95% confidence intervals (CIs) were reported in forest plots. Results: Among the 1,099 studies identified, 41 were included for review and 23 were deemed eligible for meta-analysis. Our analysis revealed that there is an increased risk (OR=1.01; 95% CI:1.00 - 1.02) of MI with a 10 μg/m3 increase in PM10 after a lag 0 and lag 1 delay.Conclusions: Our findings indicate that PM10 exposure is associated with an increased risk of MI. This can aid in informing environmental policy-making, personal-level preventative measures, and global public health action.<br/

A New Approach to Information Extraction in User-Centric E-Recruitment Systems

In modern society, people are heavily reliant on information available online through various channels, such as websites, social media, and web portals. Examples include searching for product prices, news, weather, and jobs. This paper focuses on an area of information extraction in e-recruitment, or job searching, which is increasingly used by a large population of users in across the world. Given the enormous volume of information related to job descriptions and users’ profiles, it is complicated to appropriately match a user’s profile with a job description, and vice versa. Existing information extraction techniques are unable to extract contextual entities. Thus, they fall short of extracting domain-specific information entities and consequently affect the matching of the user profile with the job description. The work presented in this paper aims to extract entities from job descriptions using a domain-specific dictionary. The extracted information entities are enriched with knowledge using Linked Open Data. Furthermore, job context information is expanded using a job description domain ontology based on the contextual and knowledge information. The proposed approach appropriately matches users’ profiles/queries and job descriptions. The proposed approach is tested using various experiments on data from real life jobs’ portals. The results show that the proposed approach enriches extracted data from job descriptions, and can help users to find more relevant jobs

Maximising access to timely trauma care across population of Karachi and its districts: A geospatial approach to develop a trauma care network

Objectives: To develop and propose a cost-effective trauma care network for Karachi, Pakistan, by calculating maximum timely trauma care (TTC) coverage achieved with the addition of potential designated private and public level 1 and level 2 trauma centres (TCs). Setting: A lower middle-income country metropolis, Karachi is Pakistan\u27s largest city with a population of 16 million and a total of 56 hospitals as per government registry data. Participants: 41 potential TCs selected using a two-level, contextually-relevant TC designation criteria adapted from various international guidelines. Primary and secondary outcome measures: Maximum TTC coverage achievable with the addition of potential TCs. Proposed trauma care network composition to achieve maximum TTC coverage. Results: Coverage with five public level 1 hospitals alone is 74.4%. Marginal benefit with stepwise addition of five potential private level 1 TCs, four public level 2 TCs and two private level 2 TCs is 12.2%, 7.1% and 3.1%, respectively. Maximum possible TTC coverage is 96.7%. Poorest coverage with the proposed 16 hospital network is noted in Malir district while 100% coverage is achieved in the centrally located South, Central and East districts. Conclusion: Addition of private level 1 and private and public level 2 hospitals to the trauma care network is necessary. Implementation of the proposed trauma care network requires strong stewardship from the government and coordinated effort of multiple stakeholders is needed to ensure standard TC designation. The study exhibits an effective method to scientifically plan and develop a cost-effective trauma system which can be applied in other resource-limited geographical area

Fetal Anomalies in Ultrasonographically Detected Polyhydramnios

Background: To determine the frequency and types of fetal anomalies in cases of polyhydramnios detected on ultrasonography and to compare maternal age and parity of these subjects with fetal anomalies and those without fetal anomalies. Methods: In this cross sectional study, using colour and power Doppler ultrasound machine, one hundred diagnosed patients with ultrasonographically detected polyhydramnios were included . Sonographic examination was conducted between 12 to 40 weeks of gestation and fetal anomalies were examined. Results: Out of 100 patients, 35 fetal anomalies were found in 30(30%) patients. The age of the patients included in the study ranged from 18 to 40 years. Majority of the anomalies (73%) were found between age group 30 – 40 years and in multigravida (83%). Central Nervous System was the commonest site with fetal anomalies (46%) followed by gastrointestinal tract (20%) Conclusion: Prenatal detection of fetal anomalies has a decisive effect on the outcome of pregnancy and helps the obstetrician in planning the intrapartum management and for post delivery resuscitative measures, if require

794 Evaluating disability in adult burn injury patients treated at a tertiary-care burn unit in Karachi, Pakistan: a longitudinal study using who disability assessment schedule II

Abstract Background Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan. Methods This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(\u3e18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related to cognition, mobility, self-care, getting along, life activities and participation. The score range was 12–60 with higher score being worse. Ethical approval was taken from collaborating and participating sites. Results Of the 59 eligible patients, 53 completed all follow-ups. There were 69.8% males. Mean age of all patients was 36.8 ± 14.0 years, 71.7% were married and 17.0% had no/informal education. About half the patients were breadwinners. More than half of burn incidents occurred at home. Flame burns (50.9%) and scalds (17%) were the most common type of burns. The average surface area burnt was 43.0 ± 14.2%. The mean-scores for all patients at baseline, 2-week, 6-week and 12-week were 13.9 ± 4.9, 35.3 ± 13.8, 26.8 ± 11.9 and 20.1 ± 9.1, respectively. The mean-scores for males were lower than that of females for the four assessments (Males: 13.5 ± 1.8, 34.2 ± 14.1, 25.3 ± 10.7, 19.2 ± 8.4 and females: 16.1 ± 8.5, 37.3 ± 13.3, 30.5 ± 14.4, 22.1 ± 10.6). The two-week score was higher for those with \u3e15% burn(36.7 ± 13.9) compared to those with ≤15% burn(34.6 ± 14.2) while the score were similar at 12-week follow-up. Conclusions This analysis shows that the burn injury patients tend to recover from their injury over a period of 12 weeks after discharge. Future work should focus on larger group of patients and long term follow-up at one and two years after burn injury

Proximal Migration of Lumboperitoneal Shunt Catheter Up To Cervical Spine

Lumboperitoneal (LP) shunt had been in use as an internal cerebrospinal fluid (CSF) diversion for a variety of different indications, namely benign intracranial hypertension, communicating hydrocephalus, slit ventricle syndrome and CSF fistulas. Generally considered to be a simple surgical procedure but certain potential complications are associated with this technique, including chronic subdural hematoma, subarachnoid haemorrhage, acquired Chiari malformations and migration of the shunt tubing.1, 2 Proximal intrathecal migration of LP shunt catheter tip, high up in the cervical spine is a rare reported complication.3, 4, 5, 6, 7, 8 If doubtful on X-rays, Computed Topography (CT) scan confirms the diagnosis. Although multi factorial, this proximal migration is usually because of a faulty technique when anchoring sutures are loosened or cut. Measures employed to avoid this potential complication include appropriate technique for securing the LP shunt tube at the proximal lumbar and the distal peritoneal insertion sites with suture collars, thus enabling fixation of the tube. We report a case of an obese middle age female who developed proximal migration of the lumbar tube up to cervical spine, after having undergone LP shunt for pseudotumor cerebri

Speckle suppression in medical ultrasound images through Schur decomposition

A technique based on Schur decomposition to supress the multiplicative (speckle) noise from medical ultrasound images is presented in this study. An image which carries the speckle noise is divided into small overlapping segments, size of these segments depends on the nature of speckle carried by the image and a global covariance matrix is calculated for the whole image by averaging the covariances of all segments. The global covariance matrix is decomposed through Schur decomposition to obtain the orthogonal vectors. A subset of these orthogonal vectors that correspond to largest magnitudes of eigenvalues are selected to filter out the speckle noise from the image. The proposed approach is compared with four benchmark filtering techniques, homomorphic wavelet despeckling, Wiener, Frost and Gamma. Two types of simulated ultrasound images and five types of real ultrasound images of foetal neck, left kidney, right kidney, musculo skeletal nerve and lymph node are tested. The proposed approach performed maximum suppression of speckle noise in all types of the images with optimal resolution and edge detection. The despeckling performance of the proposed approach is even better compared with the benchmark schemes once the speckle noise is rough, which is usually the case for soft tissue. © The Institution of Engineering and Technology 2017

Implementation of an infant male circumcision programme, Pakistan

Objective: To retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.Methods: Based on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1-92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing adverse events with infants facing no complications using multivariate logistic regression.Findings: Between August 2016 and August 2018, 2822 circumcised male infants with mean age 22.8 days were eligible for the study. Of these, 2617 infants (92.7%) were followed up by telephone interviews of caretakers. Older infants were more likely to experience adverse events than infants circumcised between 1-30 days of age: 31-60 days: adjusted odds ratio, aOR: 2.03; 95% confidence interval, CI: 1.31-3.15; 61-92 days: aOR: 2.14; 95% CI: 1.13-4.05. Minor adverse events (100 infants; 3.8%) included failure of the bell to shed (90 infants) and minimal bleeding (10 infants). Major adverse events (eight infants; 0.3%) included bleeding that required intervention (four infants), infection (three infants) and skin tear (one infant).Conclusion: Standardized training protocols and close monitoring enabled nonphysician health providers to perform safe circumcisions on infants aged three months or younger