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Objective To develop and validate a clinical score that will identify potential admittance in an intensive care unit (ICU) for a coronavirus disease 2019 (COVID-19) case. Materials and methods The clinical scoring is built using Least Absolute Shrinkages and Selection Operator logistic regression. The prediction algorithm was constructed and cross-validated using the development cohort of 313 COVID-19 patients and was validated using independent retrospective set of 64 COVID-19 patients. Results Majority of patients are Omani in nationality (n=181, 58%). Multivariate logistic regression identified 8 independent predictors of ICU admission that were included in the clinical score: hospitalization (OR, 1.079; 95% CI, 1.058 - 1.100), absolute lymphocyte count (OR, 0.526; 95%CI, 0.379- 0.729), C-reactive protein (OR, 1.009; 95%CI, 1.006-1.011), lactate dehydrogenase (OR, 1.0008; 95%CI, 1.0004-1.0012), CURB-65 score (OR, 2.666; 95%CI, 2.212-3.213), chronic kidney disease with estimated glomerular filtration rate of less than 70 (OR, 0.249; 95%CI, 0.155-0.402), shortness of breath (OR, 3.494; 95%CI, 2.528-6.168), and bilateral infiltrates in chest radiography (OR, 6.335; 95%CI, 3.427-11.713). The mean of area under a curve (AUC) from the development cohort was 0.86 (95%CI, 0.85-0.87) and of the validation cohort was 0.85 (95%CI, 0.82-0.88). Conclusion We provided a web application for identifying potential admittance in an ICU for COVID-19 case by clinical risk score based on 8 significant characteristics of patient ( http://3.14.27.202/cov19-icu-score/ ).

Introduction: Wounds and their management are fundamental aspects of the practice of surgery. A closed wound that heals in a timely fashion is considered to be a good indicator of surgical intervention. Many experimental studies have shown that precisely sutured incision with good haemostasis gets sealed with fibrin within 6 to 24 hours and the wound becomes adequately protected from outside moisture. Hence, early exposure to clean surgical wounds would be a cost-effective measure, especially in a resource-poor country like ours by avoiding unnecessary dressings for a long period of time. Aim: To assess the effectiveness of early exposure (24 hours) and delayed exposure (72 hours) in wound management after elective inguinal hernia surgery. Materials and Methods: A longitudinal study was conducted in the Department of General Surgery of Government Medical College, Kottayam, Kerala, India from September 2020 to August 2021. All elective cases (n=200) posted for inguinal hernia of age more than 18 years were consecutively allocated to two groups, group A early exposure of surgical wound site and group B delayed exposure. The wound site examination, on the third day along with white blood cell count was assessed. Wound site examination on 7th day and 30th postoperative day and length of hospital day were recorded. Southampton wound grading system was used for recording healing parameters. All data was described using means for continuous variables and percentages for categorical variables Chi-square test was used for categorical variables with significance level at p0.05). Conclusion: There is not much difference in wound healing and incidence of surgical site infection in patients, whose wounds were kept open 24 hours after surgery when compared to those, whose wounds were dressed daily for the next two days consecutively.

Tetanus, a vaccine-preventable disease, is still a disease of concern for public health considering the high morbidity and mortality. Even though the vaccine against tetanus infection is universally available and cheap, the immunization levels among adults are low. Tetanus continues to cater to the pool of new cases in India. The rarity of presentation poses diagnostic challenges to the clinicians. The case series is one among the few recent reports from India on tetanus. The series describes the clinical characteristics, immunization status, diagnostic challenges, treatment outcomes, and complications of tetanus patients presented to tertiary care hospital in Kerala from 2008 to 2019. Total of six patients were diagnosed with tetanus during the 12 years. The age of patients ranged from 32 years to 64 years, pre-dating the initiation of a universal immunization program in India. Most of the initial symptoms were related to the musculoskeletal system and problems with the mouth and pharynx. The classical feature of trismus was not primarily evident in these cases. The average time taken for diagnosis varied from 4 to 8 days and mortality rate was 33%.The cold spatula test was positive in all six cases and can be used as a clinical test in the early diagnosis of Tetanus.The disease persistence indicate the need of robust measures for improving public awareness, effective wound management and vaccination programs.

Shortened or missed dialysis treatments are directly associated with increased hospitalization and mortality rates among end-stage renal disease (ESRD) patients. The purpose of this study was to in...

The current outbreak of COVID-19 continues to threaten across the globe even after 9 months of its starting. The preventive measures and self-protecting measures are the suggested and viable solution to mitigate the spread of pandemic till new vaccine is discovered. The preventive measures are framed based on the detailed analysis of the current data of the ongoing pandemic. The correctness of the policies relies on the quality of the data and its analysis with a meaningful interpretation. In this paper, the present status of the epidemic across the world is analyzed using a control measure score which is computed using adaptive neuro-fuzzy inference system (ANFIS) where partition of data is performed using fuzzy c-means clustering. We have used transmission rate and recovery rate independently obtained from the discrete version of the Susceptible-Infected-Recovered (SIR) model to predict the score. Since the transmission parameters depends on incubation period, recovery and death, the parameter has been calculated based on active cases where its mean value changes significantly. It is observed that the recovery rate is more than the transmission rate of all Gulf countries at present which shows that the outbreak reached its highest value. The current control measure score emphasizes on the normal working atmosphere keeping strict social distancing measures. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

The present novel coronavirus (COVID-19) infection has engendered a worldwide crisis on an enormous scale within a very short period. The effective solution for this pandemic is to recognize the nature and spread of the disease so that appropriate policies can be framed. Mathematical modelling is always at the forefront to understand and provide an adequate description of the transmission of any disease. In this research work, we have formulated a deterministic compartmental model (SEAMHCRD) including various stages of infection, such as Mild, Moderate, Severe and Critical to study the spreading of COVID-19 and estimated the model parameters by fitting the model with the reported data of ongoing pandemic in Oman. The steady-state, stability and final pandemic size of the model has been proved mathematically. The various transmission as well as transition parameters are estimated during the period from June 4th to July 30th, 2020. Based on the currently estimated parameters, the pandemic size is also predicted for another 100 days. Sensitivity analysis is performed to identify the key model parameters, and the parameter gamma due to contact with the symptomatic moderately infected is found to be more significant in spreading the disease. Accordingly, the corresponding basic reproduction number has also been computed using the Next Generation Matrix (NGM) method. As the value of the basic reproduction number (R0) is 0.9761 during the period from June 4th to July 30th, 2020, the disease-free equilibrium is stable. Isolation and tracing the contact of infected individuals are recommended to control the spread of disease.

Without kidney transplant, treatment for end-stage renal disease is considered lifelong. Non-emergency medical transportation through Medicaid and the complementary paratransit services under the A...

In this paper, we develop a new computational approach which is based on minimizing the difference of two convex functions (DC) to solve a broader class of phase retrieval problems. The approach splits a standard nonlinear least squares minimizing function associated with the phase retrieval problem into the difference of two convex functions and then solves a sequence of convex minimization subproblems. For each subproblem, the Nesterov accelerated gradient descent algorithm or the Barzilai-Borwein (BB) algorithm is adopted. In addition, we apply the alternating projection method to improve the initial guess in [20] and make it much more closer to the true solution. In the setting of sparse phase retrieval, a standard l1 norm term is added to guarantee the sparsity, and the subproblem is solved approximately by a proximal gradient method with the shrinkage-threshold technique directly. Furthermore, a modified Attouch-Peypouquet technique is used to accelerate the iterative computation, which leads to more effective algorithms than the Wirtinger flow (WF) algorithm and the Gauss-Newton (GN) algorithm and etc. Indeed, DC based algorithms are able to recover the solution with high probability when the measurement number m ≈ 2n in the real case and m ≈ 3n in the complex case, where n is the dimension of the true solution. When m ≈ n, the l1-DC based algorithm is able to recover the sparse signals with high probability. Our main results show that the DC based methods converge to a critical point linearly. Our study is a deterministic analysis while the study for the Wirtinger flow (WF) algorithm and its variants, the Gauss-Newton (GN) algorithm, the trust region algorithm is based on the probability analysis. Finally, the paper discusses the existence and the number of distinct solutions for phase retrieval problem.

BACKGROUND Hernia repair surgeries underwent a lot of modifications over time. These modifications were an attempt to reduce the recurrence rate and post-operative complications. Current techniques for Inguinal hernia show similar recurrence rate. Therefore, recurrence is no longer the main issue discussed when considering improving the current standards for groin hernia repair. Post-surgical chronic pain presents a major, largely unrecognized clinical problem. Consequently, there is a need to not only decrease an extensive dissection in the inguinal canal but also to minimize the interaction between the mesh and major surrounding structures. As a result, placing a mesh in the preperitoneal space is a viable option. Likewise, studies have shown that return to normal activity and return to work is comparatively quicker in Rives. In this study I am comparing the post op period complications in Rives and Lichtenstein hernia surgeries to know whether Rives is superior to Lichtenstein’s repair. MATERIALS AND METHODS After obtaining approval for the study from Institutional Review Board, written informed consent from 100 male patients planning to undergo elective hernia repair surgery at the General Surgery wards in Government Medical College, Kottayam & who were willing to participate in the study were obtained and randomly allocated into two groups, 50 undergoing Rives hernia repair & 50 Lichtenstein hernia repair. The patients were evaluated and followed up according to the protocol. In early postop period, patients were assessed for pain using a numeric rating scale. Complications like haematoma, seroma, wound infection and early recurrence were compared. Chronic inguinal pain/Inguinodynia is a significant, though under reported problem. Moderate to severe pain persisting more than 3 months should be considered pathological. Inguinodynia, if present was assessed using a numerical scale. Another parameter that was assessed was testicular atrophy. For this preoperative and postoperative testicular volumes were measured using an orchidometer and compared. All the patients were followed up for a period of 3 months postoperatively to assess recurrence, testicular atrophy and Inguinodynia. RESULTS Out of the total 100 patients included in the study, 50 patients were in Rives series and 50 in Lichtenstein series. All the patients were males. Average age of the patients was 53.56 in Rives and 55.08 in Lichtenstein series. There were 49 unilateral hernias and 1 bilateral hernia in Rives series and 48 unilateral hernias and 2 bilateral hernias in Lichtenstein group. Among these, 27 were direct and 23 indirect hernias in Rives series, and 18 direct 31 indirect and 1 pantaloon hernia in Lichtenstein series. The mean immediate post-operative pain score was 3.54 in Rives group and 4.26 in Lichtenstein group. The immediate postoperative pain was significantly low in Rives group with a p value of

BACKGROUND Despite major advances in infection control interventions, health care-associated infections (HAI) remain a major public health problem and patient safety threat worldwide. The global data suggests that the SSI incidence rate varies from 0.5 to 20% depending upon the type of operation and underlying patient status. Several factors preoperative, intraoperative & postoperative, determine the occurrence of surgical site infections, Preoperative hair removal is considered as a risk for the development of surgical site infections. The objective of the study is to find out the difference in the incidence of surgical site infections in patients undergoing pre-operative hair removal by shaving with Razor blades and hair trimmers prior to elective inguinal hernia surgery. MATERIALS AND METHODS Written informed consent from 160 patients with no significant comorbidities planning to undergo elective inguinal hernia surgery at the general surgery wards in Government Medical College Kottayam and who were willing to participate in the study were to be obtained. 80 of them to undergo pre-operative hair removal with hair trimmers and 80 to undergo preoperative hair removal by shaving with razor blades on the day prior to the surgery randomised into two groups. During their stay in the postoperative ward the surgical wounds of the patients were examined daily for the development of erythema, pain, discharge, induration and gaping of the wound. The daily findings were noted down till the patient was discharged from the ward. The patients were again reassessed 2 weeks later, when they came for review in the Surgery OPD after their discharge from the ward; finally the patients were examined on the 30th day post-surgery to look for the clinical features of surgical site infections. RESULTS Out of the total 160 patients who were studied, 29 (18.1%) of them had post-operative infection within 30 days, in the form of erythema, induration, discharge and gaping. Most of the symptoms of surgical site infections were during the initial 3 days (69%), with the most common symptom being erythema (18.1%) followed by induration (12.5%). Gaping (0.6%) and discharge from wound (3%) were very minimal. Those individuals who had undergone preoperative hair removal with trimmers (11.2%) had a lower incidence of surgical site infection when compared to those with razors (20%). The difference was statistically significant, with a p value of 0.024 by Chi-Square tests. The difference in erythema (p- 0.024) and induration (p-0.017) between the two groups was also found to be statistically significant. Other factors, namely type of surgery, age of the individual and sex did not have a statistically significant difference. CONCLUSION In this study there is evidence of definite reduction in surgical site infection rates when trimmers were used for pre-operative hair removal than razors in elective inguinal hernia surgery. The difference is statistically significant (p Value – 0.024).

End-stage Renal Disease (ESRD) or chronic kidney disease constitutes a serious public health problem in the United States. The purpose of this study is to examine the causal relationship of perceiv...

BACKGROUND Hospital-associated infections are an important cause of patient morbidity and mortality. Cell phones and pens are ubiquitous accessories of doctors and other Healthcare Workers (HCWs) in a hospital as well as outside for various purposes. But, they may serve as reservoirs of infection allowing the transportation of the contaminating bacteria to many different clinical environments. The aim of the study is to find out the prevalence of various bacteria in mobile phones and pens of doctors and other staff working in operation theatres of Government Medical College, Kottayam, Kerala, for a period of one year. MATERIALS AND METHODS 400 samples of microbiological swabs were collected from pens and mobile phones of medical personnel working in the operation theatres of Government Medical College, Kottayam, for one year. If growth was present in cultures, identification of organisms and sensitivity to routine antibiotics was checked by disc diffusion method according to the organism isolated. RESULTS About 2/3rd of mobile phones and pens carried by healthcare workers inside operation theatres contained bacteria, of which, skin commensals prevailed in number. Presence of faecal microflora and multidrug-resistant bacteria detected in some of the samples are alarming. CONCLUSION This study emphasises the need for creating awareness among healthcare workers regarding the role of mobile phones and pens as carriers in transmission of nosocomial infections.

BACKGROUND Critical Limb Ischaemia (CLI) was defined for the first time in 1982 by P. R. F. Bell as a manifestation of peripheral artery disease, which describes patient with typical chronic ischaemic rest pain or ischaemic skin ulcers or gangrene.1 This term of CLI should only be used in patients with chronic ischaemic disease defined as presence of recurring rest pain that persists for more than two weeks requiring regular analgesics and with ulceration or gangrene of the foot or toes. These criteria correspond to stage 3 and 4 of Fontaine’s classification of POVD. Observational studies have shown that one year after diagnosis of CLI, 25% of patients experience a major amputation, 25% had died and only 50% survived without requiring a major amputation, though some have rest pain, ulcer or gangrene persisting. The primary goals in treating CLI are to relieve claudication pain and rest pain, to heal the ulcer, to prevent amputation of limbs, to improve quality of life and to prolong survival. The aim of the study is to study the improvement of claudication pain, rest pain and improvement of the level of amputation in patients with diffuse peripheral arterial disease (CLI) after administration of PGE1. MATERIALS AND METHODS From June 2013 to November 2014, a total of 45 patients having advanced CLI (Fontaine’s grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of PGE1. 20 patients (44.44%) received 6 full courses of PGE1,3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (alprostadil 100mcg) over 10 hours a day for 5 days in one month (1course). The reduction in claudication and rest pain, improvement in level of amputation and complications were assessed. RESULTS In all cases, there was reduction in pain scale and Fontaine’s grade irrespective of the courses of PGE1 taken. 14 patients (31.1%) did not require amputation of limbs/toes, 24 patients (53.3%) have the same amputated status, while 7 patients (15.6%) required higher amputation. CONCLUSION PGE1 is an alternative treatment for amputation in patient presenting with advanced CLI and it is effective in reducing the claudication pain, rest pain and improving the level of amputation.

Background: Symptomatic Urinary tract infection (UTI) is among the most common infection described in hospital settings. Inappropriate use of antibiotics initiated before the laboratory results of urine culture contribute to increasing resistance to antibiotics in uropathogens. Awareness of the disease, knowledge of the spectrum of antibiotics and common complication of UTI will help to reduce morbidity and mortality. This study compares common empirical antibiotics used with their clinical outcomes and microbiological sensitivity pattern among patients admitted with UTI in a tertiary care hospital.Methods: It is a cross sectional study conducted in inpatients of Pushpagiri medical college, Thiruvalla from January 2017 – June 2018. Assuming that 50% of organisms will show sensitivity to empirical antibiotic therapy with a relative precision of 20% and alpha error of 5 %. Sample size is calculated as 100. Those patient satisfying the inclusion criteria was recruited into the study after obtaining informed consent till the sample size attained. Symptoms on the day of admission was assessed using the questionnaire for Clinical profile. Primary outcome was matching of empirical antibiotics with culture and sensitivity pattern. Secondary outcomes were Symptom resolution on third day with empirical antibiotics and profile organisms causing UTI.Results: Majority of the population belonged to 61-80 year of age (57%). The study population had 44 percent male and 56 females.72 percent of total population was diabetic. The most common antibiotic used to treat empirically was piperacillin –tazobactum accounting for 47.2 percent followed by ceftriaxone 45 percent. Others contributed less than 8 percent.75 percent of empirical antibiotics matched with culture and sensitivity report in the study population.The most common organisms found was Escherichia coli (61%) followed by Klebsiella pneumonia(15 %) The most common resistant organism was E Coli followed by Klebsiella pneumonia. Esbl resistance was encountered in 28 cases and carbepenamase resistance in 2 percent cases. 27 percent of diabetic patient had resistant organism infection in urine. Symptoms of urinary tract infections were better resolved when empirical antibiotics used had matched microbiological sensitivity pattern.Conclusions: After the age of 60 year UTI occurred almost equal in male and females There was only 75 percent agreement with empirical antibiotics and culture sensitivity report. Resistant organism were common in the diabetic population. Most common organism encountered in symptomatic UTI is E coli. Symptomatic resolution occurred in majority of cases where the empirical antibiotic was sensitive than compared to resistant case. Some of the resistant cases had symptomatic resolution possibly explained by the in vivo sensitivity. As the agreement with empirical antibiotics became low, hospital antibiotic policies must reviewed and changed according to resistance pattern and type of organism that is locally prevalent

Poverty is a major social problem in the United States: in 2014, the U.S. Census Bureau reported 46.7 million people living in poverty and an estimated 14.8 percent poverty rate. The poverty rate has been steadily increasing in the United States, with a 2 percent increase in 2012 over 2007. Federal and state governments have initiated many anti-poverty programs, starting with the New Deal Program in the 1930s. With the advent of a new governance approach in the 1990s, many hierarchical bureaucratic government agencies were replaced with public, private, network, and collaborative approaches to solve this complex national problem. Tax expenditures, vouchers, and grants are the three major governance tools used by the U.S. federal and state governments to fight poverty. This article addresses three important programs—the Earned Income Tax Credit (EITC), the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF)—used in fighting poverty in the United States and discusses the problem of poverty, the effectiveness of these governance tools, suggestions for future research, and policy implications

Effective teaching depends on the ability to channel the knowledge from different sources properly to the students that enhances the total development of their mental growth as well as creative thinking. Therefore, it is essential to have a systematic mechanism to ensure the intended objectives of the lecture have reached the students. The assessment method should be in such a way that it has to mind each and every parameter that contributes to effective learning in a continuous and systematic fashion. With this focus, the purpose of this chapter is to present an efficient way of assessing the course learning outcome with the help of fuzzy logic concepts. The advantage of this approach relies on its efficacy to give more or less unique output corresponding to each and every input, which is not in the case of traditional assessment methods. This Mamdani rule-based approach gives an accurate measure to assess the attainment level of the course by considering every parameter enabling the learning process.

High impedance faults are generally not detected by conventional protection functions like over current, ground fault, distance, differential etc. because of the magnitude of impedance involved in the fault path and the nature and characteristic of the fault current are special and different than the conventional fault current profiles. Each type of high impedance fault is unique in terms of magnitude of fault current, nature, characteristic and waveshape. Majority of the high impedance faults are single phase to ground faults but this can involve phase to phase elements as well. Because of the inability of the conventional protection functions to detect high impedance faults especially high impedance phase to ground faults, the electrical conductor remains live under such condition and as can be imagined, poses a huge and significant risk to wild life and more importantly human life. Atmospheric and geographical conditions have a significant role to play in high impedance phase to ground faults since they have a direct impact on the magnitude and characteristic of the fault current. This paper describes different techniques to detect high impedance phase to ground faults and focuses on the proven algorithms that have been implemented in protection relays, had been verified by real site tests and fault inception on live power lines. The paper is broadly organized as a tutorial. The characteristics of high impedance faults and the challenges involved in detecting them are described first. The paper then goes on to detail some of the important techniques in use for high impedance fault detection highlighting their strengths and weaknesses, and some modern approaches proposed to improve the dependability of protection schemes. In particular, a technique combining the fundamental and harmonic analysis of the fault waveform is presented, along with its performance in field trials carried out in co-operation with utilities.