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Almajirai (singular almajiri) are male children who leave the care of their parents to learn the Qur’an and gain Islamic knowledge under the tutelage of a Malam at an Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and Malam, and which was the dominant mode of education in precolonial Hausaland, the region which today straddles Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about Hausaland, and has associated almajiranci with non-participation in formal education, child abuse, poverty and underdevelopment. Some of this attention has come during the context of the Boko Haram insurgency, most associated with Nigeria’s Northeastern Borno State, and several other crises of violence still ongoing throughout the region. The limited access to resources that almajirai may encounter upon emergence from their schools and into the workforce may influence their likelihood to support or participate in these types of crises. Attention has been given to the health of almajiri children. Pieces in popular media have reported physical and sexual abuse in Islamiyyas, and, recently, the effect of the COVID-19 pandemic on almajirai, including what has been perceived as an increased burden of COVID-19 within this population. (CBS News, 2019; BBC News, 2020) Articles in the academic literature have additionally considered health in almajiri populations, evaluating, among much else, their public health awareness and knowledge (Dahiru, 2017) as well as their internal displacement in the face of the COVID-19 pandemic (Akintunde et al., 2020). Despite this, the peer-reviewed literature around health among almajirai remains limited. For neglected groups, such as almajirai, with evidence of severe, population-wide health challenges, work reviewing extant research may support work towards addressing these issues by synthesizing evidence for specific health problems, drawing links between related findings, identifying gaps in the literature, and indicating areas for potential intervention, altogether a considerable contribution to public health. Scoping reviews are "preliminary assessment of potential size and scope of available research literature” which help “identify the nature and extent of research evidence” (Grant and Booth, 2009). Scoping reviews are particularly appropriate "when a body of literature has not yet been comprehensively reviewed, or exhibits a large, complex, or heterogeneous nature not amenable to a more precise systematic review”. (Peters et al., 2015). In the poorly-defined research area around health in almajiri populations, a scoping review may allow identification of emergent patterns from grey and peer-reviewed literature, to help serve as a basis for future work. Given the appropriateness of this design to our topic of study, we propose a scoping review of the peer-reviewed and grey literature regarding health in almajiri populations. Our scoping review will include all articles on the Embase, MEDLINE, OVID, Scopus, Web of Science, Google Scholar and EBSCO Africa-wide information databases relating to health in almajiri populations, from 1990 through to 2022. The review will also include both English- and French-language articles, to best capture accounts from Nigeria and Niger respectively. Our specific aims are as follows: 1.Synthesizing evidence for specific health findings among almajirai 2.Drawing links between related health findings for almajirai 3.Identifying specific gaps in the literature around health in almajiri populations 4.Indicating areas for potential intervention in improving health in almajiri populations

Climate change is bringing an inevitable change to planet earth. One of the recent victims of climate change is Pakistan, in the form of a disastrous flood that leads to severe food insecurity throughout the country. Recent food insecurity results from damage done by the flood to agricultural land, which have an extreme effect on districts marked by highly malnourished populations.

This repository hosts Nigerian Health Providers’ responses to the African Federation of Emergency Medicine’s (AFEM) Emergency Care Assessment Tool (ECAT) in raw and transformed formats.

This study was undertaken to determine the dose-response relation between epileptiform activity burden and outcomes in acutely ill patients.A single center retrospective analysis was made of 1,967 neurologic, medical, and surgical patients who underwent16 hours of continuous electroencephalography (EEG) between 2011 and 2017. We developed an artificial intelligence algorithm to annotate 11.02 terabytes of EEG and quantify epileptiform activity burden within 72 hours of recording. We evaluated burden (1) in the first 24 hours of recording, (2) in the 12-hours epoch with highest burden (peak burden), and (3) cumulatively through the first 72 hours of monitoring. Machine learning was applied to estimate the effect of epileptiform burden on outcome. Outcome measure was discharge modified Rankin Scale, dichotomized as good (0-4) versus poor (5-6).Peak epileptiform burden was independently associated with poor outcomes (p 0.0001). Other independent associations included age, Acute Physiology and Chronic Health Evaluation II score, seizure on presentation, and diagnosis of hypoxic-ischemic encephalopathy. Model calibration error was calculated across 3 strata based on the time interval between last EEG measurement (up to 72 hours of monitoring) and discharge: (1) 5 days between last measurement and discharge, 0.0941 (95% confidence interval [CI] = 0.0706-0.1191); 5 to 10 days between last measurement and discharge, 0.0946 (95% CI = 0.0631-0.1290);10 days between last measurement and discharge, 0.0998 (95% CI = 0.0698-0.1335). After adjusting for covariates, increase in peak epileptiform activity burden from 0 to 100% increased the probability of poor outcome by 35%.Automated measurement of peak epileptiform activity burden affords a convenient, consistent, and quantifiable target for future multicenter randomized trials investigating whether suppressing epileptiform activity improves outcomes. ANN NEUROL 2021;90:300-311.

Review of the published articles does not show any study done to see if children with torus fracture are with Vitamin D deficiency. The aim of this study was to determine association of inadequacy of Vitamin D level with torus fracture and its predictors in children in Karachi Pakistan.Patient underage of 13 years came with torus fracture were included in study, and managed non-operatively with below elbow cast. Proforma was made which includes demographic data (age, gender, nutritional status) and exposure to sunlight, dietary habits, kind to apparel and type of accommodation they were living at. All participants underwent measurement of serum vitamin D level.Out of 558 children presented with limb fractures in emergency department, 190 (34.05%) had torus fracture, with mean age of 6.0 ± 4.2 years. 93 (48.94%) in pre-school group, 59 (31.05%) in school and 38 (20%) were breast-fed. On nutritional status, malnourished were 72 (37.89%), out of which 32 (44.44%) had first-degree malnutrition. On vitamin D level status only 52 (27.36%) participants had Vitamin D within normal range while 86 (45.26%) were found Vitamin D deficient. We found that vitamin D level is directly related to nutritional status, duration of sun exposure maternal vitamin d levels and not significantly related to age, gender, type of accommodation and different fabric types.In this study torus fracture in children is significantly associated with Vitamin D deficiency, with common predictors including nutritional status, maternal Vitamin D level for lactating mothers and duration of exposure of sunlight. Vitamin D supplementation in children can prevent a significant number of fractures via national programs for food fortification and increase the awareness of general population on the importance of sunlight exposure and intake of food rich in Vitamin D.

Use of magnetic fields (MFs) for underwater wireless communication is very promising nowadays due to its advantages such as low power, low cost, no multipath, no Doppler effect, and instant communication. Considering the importance and potential of MF communication for underwater wireless sensor networks, this article presents a review on the fundamental concepts and theory of MF communication by identifying the main blocks, describing the limitation of each block and mentioning the advancements being done. The three fundamental blocks identified are: 1) the transmit and receive coils; 2) the matching network; and 3) the channel characteristics of the MFs. The first block explains how a single-dimensional coil is used to establish a directional communication link between a transmitter and a receiver and then the method by which the directionality problem is solved using multidimensional coils and metamaterial coils. Furthermore, the matching network explains the difference between the induction and resonance phenomena and their effect on the range and capacity. In the third block, the factors affecting the MFs are mentioned, which are critical to underwater wireless communication with MFs. Finally, this article introduces the recent advancements at the physical, MAC, and network layers.

To improve morbidity and mortality outcomes in mass casualty victims it is pertinent that a system of prehospital triage be implemented. The objectives of this study are to determine the knowledge, attitude and practices of emergency care transporters and ambulance personnel towards onsite triage, pre-hospital management and transportation to hospital of critically injured and wounded patients in mass casualty incidents and other emergencies in Karachi, Pakistan.All ambulance personnel and emergency care transporters who transported patients to the hospital were included in the study. Pre-tested questionnaire was selfadministered after obtaining written consent.Among 250 emergency care transporters (ambulance personnel), mostly belonged to age group 21-25 years 73 (29.2%). Most of emergency transport provider teams were composed of only 1 person who was the driver of ambulance 22 (80%) and only 44 (17.6%) had the facility of paramedics. Regarding lifesaving equipment facilities in ambulance, 188 (75.2%) ambulances did not have these and only 62 (24.8%) were equipped. Predominantly, the ambulance personnel performed the 'scoop and run' practice and the ambulance works as a transport vehicle 188(75.2%), while facilities of basic life support were available in only 45 (18%) and advance life support facility in 17 (6.8%). Among all 203 (81.2%) did not think they are able to decide who is severely injured and 183(73.2%) believe they are unable to do triage in mass causalities.Our study showed significant gaps in the knowledge of the emergency care providers regarding triage of patients especially in mass casualty incidents. Though the response time and time to the hospital center is comparable, no prehospital lifesaving interventions are attempted en-route. A coordinated effort by the ambulance services, hospitals and the government are detrimental for a swift functioning of a trauma system.

BACKGROUND This study aims to evaluate the awareness of osteoporosis and related risk factors in elderly Asian patients who present with distal radius fractures. The distal radius fracture is one of the most frequent fractures in the elderly cohort, owing to osteoporosis, and maybe a harbinger for further fractures, however, data is scarce regarding awareness of this condition among these patients. METHOD This cross-sectional study was conducted on patients aged 45 and above that presented in the emergency department with low-energy distal radial fractures in Karachi from January-December 2018. Data were collected via a self-designed questionnaire, assessing the demographic information, knowledge about osteoporosis and its risk factors. The data was analysed using SPSS 20 for statistical significance. RESULTS From a total of 550 patients with a mean age of 70.5 ± 32.82 years, there were 442 (80.36%) females and 108 (19.63%) males. On educational consideration, 243 (44.18%) patients could not read or write and only 110 (20%) of the patients received secondary school education. Only 123 (22.36%) were well informed about osteoporosis, the predominant source of information being their physician. There were 427 (77.63%) patients who were unaware of osteoporosis, 16% of which were smokers, 26% indicated they exercised at least 30 minutes daily, and 2% reported drinking alcohol occasionally. On dietary supplements, 24.27% of patients reported calcium and 17.81% reported vitamin D supplement consumption on regular basis. CONCLUSION We found a positive correlation between a patient's education status and osteoporosis awareness We believe that the role of the physician could be crucial in preventing further fractures in such patients via physician lead educational campaigns to target modifiable risk factors.

Purpose To investigate the orthopedic injuries sustained while driving and using social media on cellular phones from an orthopedic resident's perspective. Methods A total of 118 patients who presented with a history of road traffic accident secondary to social media usage and suffered from fractures were included in this cross-sectional study. These patients were reported from October 2018 to April 2019. We collected the data including the type of collision, type of social media usage during driving, location of injury, wearing of safety equipment's such as helmet and seat belt during driving. Results The mean age of patients was (34.86 ± 12.73) (range 15–71) years. The common types of accident on the basis of collision of vehicles were: car versus motorbike 45 (38.1%), motorbike versus motorbike 28 (23.7%), and motorbike versus pedestrian 22 (18.6%). Most of the accidents (61, 51.7%) occurred due to mistake of motor-bikers. Out of them, 44 (37.3%) occurred on traffic signals, followed by 29 (24.6%) while driving on main roads. The common timing of accident was normal hours with frequency of 44 (37.3%), followed by 39 (33.1%) at late night. According to fracture type, closed injuries were 98 (83.1%) and open fractures were 20 (16.9%). The most common fracture was clavicular fracture (21, 22.5%) followed by soft tissue injury in 19 (16.1%) patients. The most common social media application usage during driving was Facebook 43 (36.4%), followed by Whatsapp 24 (20.3%), Google 19 (16.1%), and Instagram 15 (12.7%). Conclusion This study provides evidence that social media usage while driving put the drivers and other road users' lives at high risk. The most common social media addiction while driving is Facebook and Whatsapp. So there is a need to make strict rules and penalties for using cell phone during driving so as to save the lives of drivers and other people using road.

Underwater wireless sensor networks (UWSNs) have become highly efficient in performing different operations in oceanic environments. Compared to terrestrial wireless sensor networks (TWSNs), MAC and routing protocols in UWSNs are prone to low bandwidth, low throughput, high energy consumption, and high propagation delay. UWSNs are located remotely and do not need to operate with any human involvement. In UWSNs, the majority of sensor batteries have limited energy and very difficult to replace. The uneven use of energy resources is one of the main problems for UWSNs, which reduce the lifetime of the network. Therefore, an energy-efficient MAC and routing techniques are required to address the aforementioned challenges. Several important research projects have been tried to realize this objective by designing energy-efficient MAC and routing protocols to improve efficient data packet routing from Tx anchor node to sensor Rx node. In this article, we concentrate on discussing about different energy-efficient MAC and routing protocols which are presently accessible for UWSNs, categorize both MAC and routing protocols with a new taxonomy, as well as provide a comparative discussion. Finally, we conclude by presenting various current problems and research difficulties for future research.

Efficient exploration of techniques for underwater communication is still needed to reduce energy consumption, transmission losses and should also provide high speed communication. This paper presents a simple yet high speed communication system based on visible light communication, also recognised as light fidelity (Li-fi), for underwater applications. The concept of Li-fi for use in underwater wireless communication is borrowed from a novel approach presented by Dr Harald Haas of Germany to improve data transfer and information security for in air applications. This paper presents basic design of a Li-Fi underwater communication system and novel concepts that can help to reduce the overall power consumption. Simulation and comparative study is also given in the paper to provide useful insight of this new technology.

Introduction Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma and is the most common type of non-Hodgkin's lymphoma (NHL) worldwide. The World Health Organization (WHO) classification of hematopoietic tumors has recognized three morphological variants of DLBCL: centroblastic, immunoblastic, and anaplastic. Some studies have shown that the anaplastic variant of DLBCL is associated with aggressive clinicopathological features. Anaplastic DLBCL is rare, and the clinicopathological characteristics of this subtype of DLBCL are not widely studied in our population. Therefore, in this study, we evaluated the frequency of the anaplastic variant of DLBCL and its association with other clinicopathological parameters. Methods A retrospective study was conducted in the Department of Histopathology at the Liaquat National Hospital and Medical College over a period of six years, from January 2015 to December 2020. All cases diagnosed as DLBCL based on morphology and immunohistochemical (IHC) profile were included in the study. The diagnosis of anaplastic DLBCL was rendered based on morphology (large bizarre pleomorphic cells in a cohesive or sheet-like growth pattern), combined with CD30 IHC expression. Results The mean age of the patients was 52.90 ±16.42 years, and the mean Ki67 index was 73.18 ±16.52%. Of the 220 cases of DLBCL, 47.3% cases were germinal center B-cell (GCB) subtype, and 59.1% cases were nodal. BCL-2, BCL-6, MUM1, c-MYC, and CD10 positivity were noted in 60%, 45.5%, 40.9%, 44.1, and 38.6% cases, respectively. Only 14 cases (6.4%) were recognized as anaplastic variants of DLBCL according to the previously defined criterion. The only significant association of anaplastic-variant DLBCL was noted with a lack of BCL-2 expression. No significant association of anaplastic-variant DLBCL was noted with age, gender, Ki67 index, DLBCL subtype, or any other IHC marker expression. Conclusion We found a low frequency of the anaplastic variant of DLBCL in our study. No significant association of this DLBCL variant was noted with any of the clinicopathological parameters, except for the lack of BCL-2 expression. Alternatively, from a pathological perspective, it is important to recognize this variant of DLBCL as it often mimics other CD30-positive lymphoma and undifferentiated carcinoma.

Introduction The two broad subcategories of neuroendocrine neoplasms (NENs) are well-differentiated neuroendocrine tumors (WDNETs) and poorly differentiated neuroendocrine carcinomas (PDNECs), based on tumor architecture and cytology. Grade 3 WDNETs are a subset of WDNETs that not only are high grade by mitotic activity or proliferative index but exhibit a well-differentiated histology. In this study, we evaluated the clinicopathological features of primary neuroendocrine tumors of the gastrointestinal (GI)/pancreatobiliary tract with emphasis on high-grade WDNETs, as it is a newly defined entity. Methods We conducted a retrospective observational study, including a total number of 122 cases of primary GI and pancreatobiliary tract NENs. Slides and blocks of all cases were retrieved from the departmental archives. Immunohistochemical stains including Ki67 were applied to selected tissue blocks of all cases. Tumors were then evaluated for their histological differentiation and tumor grade. Results Our results showed that the mean age of patients was 46.8 ± 17.1 years. Majority of the NENs were GI tract origin (86.9%). The most common site of tumor in gastroenteropancreatic tract was the small bowel (31.1%), followed by the stomach (26.2%). Ninety five percent of the tumors were WDNETs, of which the most common grade was G2. The mean Ki67 index was 15.8 ± 23.8. Grade 3 WDNETs were noted to have an older mean age than grades 1 and 2 WDNETs. Ten out of 102 (9.8%) WDNETs of GI tract were grade 3, compared with four out of 14 (28.6%) of pancreatobiliary tract. Conclusion In this study, we found that high-grade (grade 3) WDNETs were more frequent in pancreatobiliary tract than GI tract. Moreover, high-grade WDNETs were associated with a higher mean age than low-grade (grade 1-2) WDNETs. It is extremely important to recognize this subset (high grade) of WDNETs and to distinguish it from PDNECs, as the latter are known to be associated with a worse overall survival. Despite high mitotic rate/proliferative index, high-grade WDNETs are characterized by organoid architecture and monomorphic cell population.

Objective Low- and middle-income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan. Method Two days of PTC courses were organised and conducted in various regions of Pakistan, participants per course comprising medical students, doctors, house officers, residents, and paramedics. The course comprises lectures of 5 hours and 30 minutes, skills workshops for 3 hours and discussion and multisystem trauma scenarios for 3 hours. Trauma management knowledge and clinical confidence of candidates were assessed using a predetermined multiple-choice questionnaire of 30 MCQs both at pre- and post-course, and using clinical scenarios, confidence matrix was assessed. Results A total 7852 of participants were trained, an average of 2 courses per month and 302 total courses. Mean score of pre-course MCQs was 60% and mean score of post-course MCQs was 82%. Among the participant postgraduate trainees, average in trauma knowledge and trauma clinical confidence were significantly higher in both pre- and post-course. The mean score of pre-course confidence matrix was 70% and the mean score of post-course confidence matrix was 93%; at the end of course, all participants showed a high level of confidence in managing trauma mock scenarios. A total of 5889 (75%) participants had a ≥78.5% post-workshop knowledge score. However, only 1963 (25%) participants had a trauma skill score with ≤75 marks. Conclusion PTC workshop could be an alternative and cost-effective flexible course for gaining knowledge and clinical skills of initial trauma management and strengthening the capacity of trauma management training in developing countries with minimal resources for saving the life of trauma victims.

Introduction The Killip classification system was introduced for clinical assessment of patients with acute myocardial infarction (MI). It stratifies individuals according to the severity of their post-MI heart failure. This system provides effective stratification of long-term and short-term outcomes in patients with acute MI and influences the treatment strategies. Revalidation of Killip class in our local population is mandatory. We planned this study to increase cardiologist's readiness to tackle the risks associated with increased mortality in each class post ST-segment elevation MI (STEMI). Objectives were to determine the frequency of Killip classes I, II, III, and IV and in-hospital mortality in each Killip class in patients with left ventricular failure secondary to STEMI. Methods A retrospective cross-sectional study was conducted in the Department of Cardiology, Jinnah Hospital, Lahore, over a period of three years. Patients with STEMI were stratified using Killip classification, and validation was performed by determining the within 15 days in-hospital mortality in each Killip class. Results The frequency (percentage) of patients with STEMI in each Killip class from I to IV was 395 (81.4%), 46 (9.5%), 27 (5.6%), and 17 (3.5%), respectively, while the in-hospital mortality in each Killip class came out to be 39 (9.9%), 4 (8.7%), 25 (92.6%) and 17 (100%), respectively. The presence of diabetes, history of smoking, and body mass index (BMI) of more than 30 kg/m2 were significant contributors to mortality, along with higher Killip class and age of presentation. Conclusions It is concluded that the Killip classification system is a valid tool for risk stratification for patients after STEMI, especially in resource-limited countries.

Objectives Malnutrition is a crucial health problem predominantly in the developing countries. Malnutrition in children is one of the main risk factors for diseases and mortality. Club foot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopaedic abnormality. Over the past 20 years, the Ponseti method is considered the gold standard for the treatment of clubfoot. Our objective is to determine the prevalence of malnutrition in clubfoot patients, and its effects on the outcome of Ponseti technique in patients presenting to the Orthopaedic Clinic of tertiary care Hospital in Karachi, Pakistan. Method The cross-sectional study was conducted from January to December 2018. Total 153 clubfoot patients were treated and the World Health Organization (WHO) classification of weight-for-age index was used to assess the nutritional status of patients, and its impact on outcome of Ponseti technique was recorded and analysed with a P value ≤ .05 as significant. Results Of the 153 patients, 112 (79.7%) were found in good nutritional status and 42 (20.6%) were malnourished. The average number of casts per patient and patients requiring 6+ casts in the undernutrition group was higher compared with good nutrition group (45.5% vs 21.42%, respectively). The number of Achilles tenotomy performed in the undernutrition group was also higher (76.4% vs 51.8%). Conclusion A significant correlation between patients' nutritional status and outcome of the Ponseti technique is found as it influences the number of casts, possible relapse and failure of treatment.

BACKGROUND In the light working under the constant threat of getting infected while treating orthopedic related patients, and trying to minimize their exposure as much as possible to avoid the contagion, has stressed out even the more seasoned orthopedicians. So we decided to initiate an anonymous online survey, and our target was to solely involve the orthopedic surgeons of our country to figure out how much this ongoing pandemic has affected their mental well-being, how prepared they feel they are to face this threat and what, according to them in the end-game solution to this pandemic. OBJECTIVE The objective of our study is to assess the impact of COVID-19 pandemic on clinical practice as well as psychological impact on orthopedic surgeons of Pakistan. METHODS An online survey involving orthopedic surgeons working in different regions of Pakistan through social media platforms like whatsapp and facebook and also through email, to assess the impact of COVID-19 pandemic. The questionnaire comprises of multiple options all carefully chosen with a definitive aim to understand the impact of COVID-19 on their day to day practice and how well equipped they feel they are , in terms of knowledge as well as personal protective equipment . Our survey also aims to evaluate their state of mind and physical as well as emotional wellbeing in the wake of COVID-19 pandemic. RESULTS Among 77 respondents, mean age of participants was 47 ± 12 years, mostly 31 (40.3%) were consultant and mostly 28(36.4%) having experience in field of orthopedics was between 5-10 years.This data revealed 48(62.3%) respondent did not received any specific training or recommendations about COVID pandemic from their institute and principle source of knowledge among them was social media 46 (59.7%) and only 37(48.1%) reported they are well informed on latest COVID guidelines. During pandemic 73(94.8%) did not operate any covid patient and among them 31(40.3%) not declared willingness to do elective orthopedic surgery on covid positive patient. Interestingly, this data revealed the willingness of orthopedic surgeons 30(39%) to take care of COVID-19 positive patients and support their colleagues in intensive care units, if needed. Concerning their orthopedic practice, mostly 35(45.5%) stopped planned surgeries and 20(26%) reported decrease in emergency surgeries during pandemic, this might be due to decrease in road traffic accident notified by study participant 24(31.2%). For consultation 56(72.7%) respondent used telemedicine and video conference during pandemic. During pandemic respondent revealed that in suspicious of covid infection mostly 34(44.2%) agreed on go through covid test and isolation while 28(36.4%) agreed to stay at home and observe and 65(84.4%) agreed on complete isolation on positive testing. 67(87%) feel anxious, stressed, furious, angry or depressed due to pandemic and most common fear among them was to infect their family members followed by getting infected and loss of their life and health. As the age decreased, the percentage of orthopaedic surgeons feeling stressed out increased and only 4(5.8%) estimate their protection as well protected. 40(51.9%) did not think their institute is well equipped to deal COVID pandemic and 31(40.3%) did not agreed to strategy of their institute to face COVID pandemic. Mostly agreed on specific vaccine 25(32.5%) quarantine 26(33.8%) would be best solution to preventive method to handle pandemic. CONCLUSIONS COVID-19 pandemic has pitted our orthopedic community against challenges rarely encountered in the field of health care professionals. They nevertheless have to play an important role in the face of an increasing psycological and emotional stress which comes from working in a post COVID era . The dread of getting infected while treating and operating on patients and the sinking feeling of spreading the contagion to their loved ones has put a massive toll on the emotional well being of our orthopedic community and needs to be addressed through open and fair discussion . So during these trying times, we need to rise to the occasion and work as a close knitted team to overcome every obstacle encountered in the face of COVID-19 pandemic.

Magneto-inductive (MI) waveguide technology is often proposed to increase the MI communication distance without adding significant cost and power consumption to the wireless sensor network. The idea is to add intermediate relaying nodes between transmitter (Tx) and receiver (Rx) to relay the information from Tx to Rx. Our study of MI wave-guides has realized that adding a relay node improves the communication distance, however, the performance is greatly dependent on the position of the relaying node in the network. We therefore, in this work have investigated the effect of placement of a relay node and have determined the optimal relay position. We have performed various sets of experiments to thoroughly understand the behavior and identified three main regions: a) for region 1, when the distance between Tx and Rx is equal or less than the diameter of the coils ( d &le, 2 r ), the optimal relay position is close to Tx , b) for region 2, when the distance between Tx and Rx is greater than diameter of the coils but less than twice the diameter ( 2 r &lt, d &lt, 4 r ), the optimal relay position lies in the center of Tx and Rx , and c) for region 3, when the distance between the Tx and Rx is equal or greater than twice the diameter of the coils ( d &ge, 4 r ), the optimal relay position is close to Rx.

Background: In traumatic patients there is increase loss of blood and requires excessive blood transfusion as compared to other diseases. Clinical efficacy and clinical safety of tranexamic acid in decreasing blood loss assess during this study in post traumatic patients. Method: Prospectively conducted randomized doubleblind placebo controlled study carried out. Patients were blindly randomized into two groups to receive either intravenous 1gm tranexamic acid 20 min or similar volume of 0.9% saline as placebo (P). Inclusion criteria was based on pulse rate >110 per min or systolic pressure level

Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan. Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated either by lateral locking plate fixation by anterolateral approach or dual plating through double incisions. These all cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 20.0 to analyze the data. Results: A total of 94 patients (45 Single Plating and 49 Dual Plating)were operated during the study period of 2 years. However, four patients (4 single plating and 0 dual plating) were lost during follow-up who could not be tracked. Both groups were somewhat similar in relation to the age, mechanism of injury, fracture pattern, and soft tissue injury. Preoperatively, there was a significant increase in surgical time with the dual plating group; however, the mean time of reduction between the two groups was not significant. The decision to put bone graft was at the choice of the operating surgeon and was an intra operative decision with 74 (78.7%) patients receiving the bone graft. Post-operatively, there was no immediate difference in between the groups considering thermal alignment and reduction. It took approximately 4–5 months for the fractures to get united. There was normal union,non union or implant failure seen among those patients. There were 10 cases with superficial infection in wounds of dual plating group which were treated with culture sensitive antibiotics for average 2 weeks, healed subsequently. There were three patients found having an incidence of deep infection in a double plating group, wherein 2 patients were positive with Staphylococcus aureus and 1 patient with Escherichia coli was isolated. Extensive wound irrigation and lavage with antibiotic cement beads were given. Repeated irrigation and lavage were done again after 2 weeks with the removal of beads followed by prolonged course of antibiotic therapy for 6 weeks after which the infection resolved.A total of 38 (77%) patients in a double plating group regained full flexion (135°) and full extension (0°) with a good alignment and no pain and instability as compared to single plating group, seen in 30 (66%) patients at follow-up. Conclusion: Dual plating by two-incision method resulted in better functional outcome regarding limb alignment and range of movements at knee joint with an acceptable soft tissue complication rate in young patients. Keywords: Complicated tibial plateau fracture, Young patients, Double incision, Dual plating.

We present a multimodal method combining quantitative electroencephalography (EEG), behavior and pharmacology for pre-clinical screening of analgesic efficacy in vivo. The method consists of an objective and non-invasive approach for realtime assessment of spontaneous nociceptive states based on EEG recordings of theta power over primary somatosensory cortex in awake rats. Three drugs were chosen: (1) pregabalin, a CNS-acting calcium channel inhibitor; (2) EMA 401, a PNS-acting angiotensin II type 2 receptor inhibitor; and (3) minocycline, a CNS-acting glial inhibitor. Optimal doses were determined based on pharmacokinetic studies and/or published data. The effects of these drugs at single or multiple doses were tested on the attenuation of theta power and paw withdrawal latency (PWL) in a rat model of neuropathic pain. We report mostly parallel trends in the reversal of theta power and PWL in response to administration of pregabalin and EMA 401, but not minocycline. We also note divergent trends at non-optimal doses and following prolonged drug administration, suggesting that EEG theta power can be used to detect false positive and false negative outcomes of the withdrawal reflex behavior, and yielding novel insights into the analgesic effects of these drugs on spontaneous nociceptive states in rats.

BACKGROUND: Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventing burst suppression might reduce mortality, have not been quantified. METHODS: The dataset contains 471 adults from seven ICUs, after excluding anoxic encephalopathy due to cardiac arrest or intentional burst suppression for therapeutic reasons. We used multiple prediction and causal inference methods to estimate the effects connecting burst suppression, propofol, critical illness, and in-hospital mortality in an observational retrospective study. We also estimated the effects mediated by burst suppression. Sensitivity analysis was used to assess for unmeasured confounding. RESULTS: The expected outcomes in a “counterfactual” Randomized Controlled Trial (cRCT) that assigned patients to mild vs. severe illness is expected to show a difference in burst suppression burden of 39%, 95% CI [8–66]%, and in mortality of 35% [29–41]%. Assigning patients to maximal (100%) burst suppression burden is expected to increase mortality by 12% [7–17]% compared to 0% burden. Burst suppression mediates 10% [2–21]% of the effect of critical illness on mortality. A high cumulative propofol dose (1316 mg/kg) is expected to increase burst suppression burden by 6% [0.8–12]% compared to a low dose (284 mg/kg). Propofol exposure has no significant direct effect on mortality; its effect is entirely mediated through burst suppression. CONCLUSIONS: Our analysis clarifies how important factors contribute to mortality in ICU patients. Burst suppression appears to contribute to mortality but is primarily an effect of critical illness rather than iatrogenic use of propofol.

Magneto-Coupled (MC) system uses wounded coil as the front end to generate the magnetic field. The stronger the magnetic field, the more distance it can achieve. The strength of the magnetic field depends on the current flowing through the coil, number of turns and area of the coil. However, there exist tradeoffs which limit one to increase these parameters beyond certain point, and hence limits the communication distance too. To overcome the problem, MC communication with relay has been proposed that help to strengthen the magnetic field, therefore, larger communication distance can be achieved. It is observed that the work done so far has used only circular coil structure and we identify a need of investigating different coil structures. We therefore in this paper, use three different coil structures: circular, rectangular and hexagonal and presents the effect on communication distance of the MC communication systems with and without relays. From the lab experiment, it is observed that communication distance is better with use of circular coil structure. Furthermore, it is also observed that MC communication systems with passive relays are capable to increase the communication distance.

Background The proximal tibia with the meta-diaphysis junction is a critical weight-bearing area. An injury around this region may be restricted to the tibia or associated with a significant soft-tissue injury. The objective of the present study is to assess the results of closed reduction and Ilizarov external fixation in the management of complex tibial plateau fractures. Patients and methods The study included 26 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 60 years, with an average of 35 years. The trauma was a road traffic accident in 19 cases and a fall from a height in eight cases. The fractures were closed in 18 cases and open in five. The open fractures were Gustilo-Anderson type I in three cases and type II in five cases. Soft-tissue injuries associated with closed fractures were classified according to the Tscherne system. The follow-up period averaged 24 months. The average time of surgery was 85 mins (range: 60-120 min). The mean time to union was 12 weeks. At the final follow-up, the average total range of knee flexion was 120° (range: 0-170°). Results Results were satisfactory in 22 cases and unsatisfactory in four cases according to Rasmussen's knee functional score. Complications included pin-tract infection in 10 cases, an extension lag in three cases and varus deformity of about 17° in one case. Conclusion Hybrid external fixation is a good method for the treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.

Accurate Doppler scale estimation and compensation in the challenging underwater acoustic (UWA) communication channels are the essential requirement for the performance of the orthogonal frequency division multiplexing (OFDM) systems. In UWA OFDM systems, increasing the correlation accuracy between the received cyclic prefix (CP) and OFDM symbol for Doppler scale estimation depends on the sampling rate of the signal. Increased sampling rate results in an increased accuracy at the cost of an increased computational complexity. Therefore, in this paper, we adopted a less computational complex auto-correlation approach, where we first derived the closed form expression for auto-correlation based Doppler scale estimation in CP-OFDM signal, and then proposed three different fine Doppler scale estimation methods. From the simulations, it is observed that in single path channel, methods 2 and 3 perform better in terms of RMSE and BER, while method 1 shows better performance in multipath channels.

Objectives Ki67 is the most commonly used marker to evaluate proliferative index in breast cancer, however no cutoff values have been clearly defined for high ki67 index. Cancer management should be according to loco-regional profile; therefore, we aimed to determine ki67 index in 1951 cases of intrinsic breast cancer subtypes and its association with other prognostic parameters in our set up. Results Triple negative breast cancers showed highest ki67 index (mean 50.9 ± 23.7%) followed by Her2neu (mean 42.6 ± 21.6%) and luminal B cancers (mean 34.9 ± 20.05%). Metaplastic and medullary breast cancers significantly showed higher ki67 index as compared to ductal carcinoma, NOS. No significant association of ki67 index was noted with any of the histologic parameters in different subtypes of breast cancer expect for tumor grade. Although, ki67 index is a valuable biomarker in breast cancer, however no independent prognostic significance of ki67 could be established in our study.

Magneto-Coupled (MC) systems are best suited for underwater wireless sensor networks applications that are short range, high-data-rate and require low power consumption. MC systems are very sensitive to orientation and mapping the directionality pattern can highly predict the communication performance. In this work, we present a study of directivity pattern of circular and rectangular coils and also propose a hexagonal coil structure for magneto-coupled communication systems. Experiments are performed in the lab and it is observed that the directivity can be improved when hexagonal coil is used as a transmitter and circular coil is used as a receiver.

Offshore pipelines are laid on the seabed to extract oil and gas. Deployment of wireless sensor network and micro-sensing within these pipelines promise wide range of applications, however wireless communication offers significant challenges through fluids. This paper presents a use of simple, low-power and cost effective Magneto-Coupled (MC) wireless communication that outperforms acoustic, optics and radio waves when it comes to water and underground. Magneto-Coupled systems are generally suited for short range applications (50 m) and to achieve long distance (2 km), this paper proposes a novel approach of installing relay coils between the transmit and receive points, over the available pipeline structure. Simulation and lab experiments are performed and results are presented to show how relay coils between the transmit and receive points help the reception.