Online) An Open Access

ABSTRACT In contrast with the well established roles of microbes in the etiology of acute sinusitis, the exact roles of all of these microbes in the etiology of chronic sinusitis are uncertain. The objective of the study is to analyze micro-flora present in patients with chronic sinusitis in Kashmir valley. A cross sectional study was done to analyze the microorganisms of paranasal sinuses in patients having chronic sinusitis undergoing a functional endoscopic sinus surgery. Biopsy/Swabs were taken from the infected sinus of the patients during surgery and were sent for microbiological analysis within 4 hours of collection. Staphylococcus aureus was the most common isolate accounting for 43% of the patients followed by Klebsiella species in 9% and MRSA in 3%. Fungal organisms identified were Aspergillus and Candida spp. isolated from 9% of the patients. No anaerobes were isolated. The possibility of a fungal infection should always be considered in the differential diagnosis of difficult to treat diseases of the paranasal sinuses even in non endemic regions. Based on results we can vary the choice of antibiotics in chronic and acute rhino-sinusitis leading to a better management of the condition. Keywords: Chronic Sinusitis, FESS Surgery, Biopsy, Staphylococcus Aureus INTRODUCTION Chronic sinusitis is an infection of sinuses lasting for more than three months. Despite of its prevalence the disease continues with poorly understood origin, pathogenesis and natural history. The etiology of chronic sinusitis continues to be the focus of much debate and research in the field of rhinolog

Knowledge & Awareness about COVID-19 and the Practice of Respiratory Hygiene and Other Preventive Measures among Patients with Diabetes Mellitus in Pakistan

COVID-19 is a global pandemic that has emerged and it is rapidly spreading throughout the world and subsequently causing great damage to the global economy and health-care. Patients with diabetes or other comorbidities are at a greater risk of developing severe illness. Knowledge and awareness are key elements to stimulate practice of preventive measures. The present study evaluated the level of knowledge and awareness about COVID-19 among individuals with diabetes and their compliance with the preventive measures against it. A total of 242 individuals who were diagnosed with diabetes mellitus and were 18 years or older participated in the study. The data was collected using an interview based questionnaire. Data was analyzed using Statistical Package for Social Sciences(SPSS) version 24. The mean age ± SD of the study population was 50.78 ± 11.24 years. In this study, 215 (88.8%) participants were aware that COVID-19 is caused by a virus and the disease is spread through droplets after sneezing or touching and shaking hands with an infected person (78.5%). However, only half the study populace regularly monitored their glucose level and complied with the “sick day rules” that is applicable during this pandemic. The present study indicates that despite the adequate knowledge and awareness about the coronavirus disease, the study participants were non-compliant with the practice of preventive and precautionary measures against the pandemic

Essays on Energy Poverty: Exploring the Energy-Disaster Nexus, Fuel Choices, and Respiratory Health

Globally, approximately 3 billion people use solid fuels such as firewood, dung, crop residues, and charcoal for their energy needs. In Pakistan, solid fuels are also very popular among rural households. Fuelwood, a major fuel source, is collected from forest commons without any financial cost; however, an enormous private cost is involved, such as labor and time commitment. The private cost structure differs according to forest density, distance, forest access, demographics, and household characteristics. Cooking with solid fuels is associated with increased asthma risk. Asthma kills almost half a million people per year. Continued ambient air pollution, often caused by biomass fuel use, is a leading contributor to new asthma cases and worsens existing symptoms. Lack of modern energy is generally harmful for a vulnerable population, but women and children face the burden disproportionately. In developing countries, women spend many hours cooking, carrying wood and water, and caring for sick children. They suffer injuries, wounds, cuts, sexual assaults, and exposure to extreme weather. Moreover, extreme weather events and natural disasters can cause long-term disruption to the energy system. Floods affect rural households’ access to grid-based energy forcing unhealthy energy choices such as biomass fuels, resulting in deforestation, desertification, and land degradation. Therefore, exploring the disaster-energy nexus in varying contexts is critical to comprehensively assessing risks and evaluating the developmental trajectories to proposed adaptive mitigation and coping interventions. The dissertation examines three main research questions using a three-paper approach: (1) how flooding affects households’ monthly energy consumption behaviors, specifying the expenditures into total, clean and solid fuels; (2) how correlated are household attributes and time spent for collecting fuelwood and fodder among all men, women, and children; and (3) to what extent asthma/bronchitis is associated with ownership of cookstoves and the quantity of solid fuels used. I use the 2012 - 2014 Pakistan Rural Household Panel Survey (PPRHS), a representative survey conducted across three major provinces and sixteen districts of Pakistan. I apply various quantitative methods, including panel regression modeling, logit, and negative binomial regression modeling. The first paper does not report any significant association between flooding and monthly household expenditures. The second paper reveals that for children and females, household size, age of the household head, electricity connection, possession of livestock, and paid non-agricultural work positively correlated with time spent on fuelwood and fodder collection. Similarly, for men, ownership of a house, time spent on domestic activities, and paid non-agricultural work is positively correlated with fuelwood collection time; in contrast, flood and employment showed a negative trend with the collection time. The study refutes the energy ladder hypothesis and indicates that fuelwood remains a popular choice among wealthy and educated households. The third paper finds that families that own a cookstove are almost fifty percent less likely to develop asthma/bronchitis; the results also show a negative correlation between education and asthma/bronchitis among rural families. Surprisingly, results indicate no significant relationship between solid fuel usage, cooking hours, and the household head’s gender. The dissertation contributes to literature and policy in the following ways: first, it builds a baseline for the energy-disaster nexus and suggests how the limitation of the existing design can provide possibilities for future research, which is crucial for implementing, evaluating, and understanding linkages between two critical sustainable development goals: energy (SDG-7) and climate action (SDG-13). Moreover, it stresses the need for a coordinated energy policy for Pakistan to address the dynamic nature of energy poverty contrary to only supply-side interventions to address the energy issues. The supply-side interventions are crucial for sustainable supply; however, equally important is to introduce alternative demand-side programs to address affordability and socio-economic barriers

Challenges Facing Students with Visual Impairments in Online Learning at Higher Education Level

This qualitative research paper explores the challenges faced by students with visual impairments in online learning during the current pandemic situation. Interview method was employed to collect qualitative data from university students with visual impairments (n=4), through purposive sampling. Thematic analysis was used for analyzing the data. Findings revealed that incorporation of technology is very important in the education of these learners with diverse needs including computer access; assistive technology; web accessibility and related applications being used during online learning like zoom, google meet etc. In addition, motivation, encouragement and institutional support are also important factors. Major challenges identified include problems of funding; related assistive technology resources; relative limitations of students living with visual impairments during on-line learning; negative effects of technology on learning; health of students with visual impairments and false over-expectations by teachers and peers resulting from common myths regarding people with visual impairments. It is recommended that diverse learning needs of students with visual impairments should be considered while designing online learning material by making it accessible in order to ensure equal learning opportunities

Travel time prediction: issues and benefits

ABSTRACT This paper addresses the issues and benefits pertaining to travel time prediction and incorporates an on-line survey of the Tokyo Metropolitan Expressways (MEX) users. While travel time has the potential to mitigate congestion spatially and temporally, little is known about how the travel time information is used. The MEX survey found that 78% of drivers would change route or departure time if there is time savings. However, the amount of time savings to prompt drivers taking such action depends on the characteristic of the drivers. Not surprisingly drivers rate pre-trip information higher than on-route information as a more desired information because pre-trip information allows drivers to make a more informed travel decision. The MEX survey clearly shows that users' acceptance of prediction accuracy is dependent on the amount of time gain or lost and is insensitive to the trip length. Approximately 70% of the survey participants acknowledge that ±5 minutes as an acceptable level of accuracy. Therefore a more appropriate measure when evaluating travel time prediction models, taking users' expectation into account, would be to use percentage error within ±5 minutes or ±10 minutes

Comparison of induction characteristics of etomidate versus thiopentone sodium

Introduction: Induction with suitable drug by intravenous route for induction of anaesthesia is an important element of anaesthesia management. Patients are susceptible to hemodynamic liability at the time of induction. Thus, an agent with least effect on hemodynamics would be the agent of choice. Aim: To compare the induction characteristics of Etomidate and Thiopentone Sodium during induction of general anaesthesia. Objective: To observe the Hemodynamic changes during induction with Etomidate and Thiopentone sodium (Heart rate, Systolic Blood pressure, Diastolic Blood pressure, Mean arterial pressure). Settings and design: The study was conducted in the department of anaesthesia of BVP MCH, over a period of two year from June 2014-2016, on patients undergoing elective surgery under general anaesthesia. Methods: 60 adult patients aged 18 – 50 years, belonging to ASA grade 1 and 2, undergoing elective surgery under general anaesthesia, were divided randomly into two groups of 30 patients each. Group T patients were induced with injection thiopentone sodium 5 mg/kg, Group E with injection etomidate 0.3 mg/kg intravenously. Statistical analysis: Data are presented as mean and standard deviation. The statistical analysis was performed using SPSS version 20. A “p” value of less than 0.05 was taken as significant. Results: There was no significant change in mean heart rate at one, two and three minute after induction as compared with the mean heart rate at the time of induction in both groups(p>0.05). In Groups T and E there was a significant fall in systolic blood pressure, diastolic blood pressure and mean arterial pressure at one, two and three minute after induction, as compared to the induction value (p<0.05). Conclusion: Etomidate offers superior hemodynamic stability during induction compared to Thiopentone. Thus Etomidate is a better induction agent for general anaesthesia

Travel time prediction: issues and benefits

ABSTRACT This paper addresses the issues and benefits pertaining to travel time prediction and incorporates an on-line survey of the Tokyo Metropolitan Expressways (MEX) users. While travel time has the potential to mitigate congestion spatially and temporally, little is known about how the travel time information is used. The MEX survey found that 78% of drivers would change route or departure time if there is time savings. However, the amount of time savings to prompt drivers taking such action depends on the characteristic of the drivers. Not surprisingly drivers rate pre-trip information higher than on-route information as a more desired information because pre-trip information allows drivers to make a more informed travel decision. The MEX survey clearly shows that users' acceptance of prediction accuracy is dependent on the amount of time gain or lost and is insensitive to the trip length. Approximately 70% of the survey participants acknowledge that ±5 minutes as an acceptable level of accuracy. Therefore a more appropriate measure when evaluating travel time prediction models, taking users' expectation into account, would be to use percentage error within ±5 minutes or ±10 minutes

Management of palatal snoring, Z palatoplasty and uvulopalatopharyngoplasty

Introduction: Snoring is “to breathe during sleep with harsh, snorting noises caused by vibration of the soft palate”. Naturally occurring or drug-induced sleep is a requirement for its appearance. Snoring is the audible sign of increased upper airway resistance. It is known to be an important clinical hallmark of OSA (Nakano et al., 2003) and, as such, may be a useful and an easily accessible marker to screen for obstructive SDB. Materials and methods: This study was conducted in the Department of Otorhinolaryngology Head and Neck Surgery, Government Medical College, Srinagar and includes 37 patients who presented in our OPD themselves with complaints of snoring or are referred from some other speciality or institution. After thorough history taking and examination all patients were evaluated with Muller’s maneuver, overnight polysomnography and intensity of snoring sound were measured with the help of sound level meter. All patients with Muller’s maneuver documented soft palatal obstruction and PSG documented snoring were distributed into two treatment groups 17 patients in the Z palatoplasty group and 20 patients in the UP3 group depending on the grade of tonsillar hypertrophy. Results: This study showed that there was a statistically significant (P < 0.05) improvement in the percentage of snoring and intensity of snoring after 3 weeks, 3 months and 6 months of treatment in both Z palatoplasty and UP3 groups of patients. Conclusion: This study showed that Z palatoplasty and UP3 are best treatment options for patients with palatal snoring without tonsillar hypertrophy and with tonsillar hypertrophy respectively