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Abstract The electrocardiogram (ECG) can capture obesity-related cardiac changes. Artificial intelligence-enhanced ECG (AI-ECG) can identify subclinical disease. We trained an AI-ECG model to predict body mass index (BMI) from the ECG alone. Developed from 512,950 12-lead ECGs from the Beth Israel Deaconess Medical Center (BIDMC), a secondary care cohort, and validated on UK Biobank (UKB) (n = 42,386), the model achieved a Pearson correlation coefficient (r) of 0.65 and 0.62, and an R2 of 0.43 and 0.39 in the BIDMC cohort and UK Biobank, respectively for AI-ECG BMI vs. measured BMI. We found delta-BMI, the difference between measured BMI and AI-ECG-predicted BMI (AI-ECG-BMI), to be a biomarker of cardiometabolic health. The top tertile of delta-BMI showed increased risk of future cardiometabolic disease (BIDMC: HR 1.15, p

BackgroundImplementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems–based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. ObjectiveWe aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. MethodsA mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. ResultsA total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). ConclusionsThe recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of “virtual wards.” Trial RegistrationClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004

Background: Morbidly adherent placenta (MAP) is one of the most dreaded antenatal complications leading to massive hemorrhage, immense blood transfusion, hysterectomy, intensive care unit admission, mechanical ventilation, multi-organ failure and maternal mortality. The study aimed to determine the maternal outcome in terms of complications, interventions, and mortality in patients with MAP in a tertiary care hospital. Methods: During the study period of one year (2020-2021) a total of 68 patients with MAP were studied. Demographic profiles including age, parity, gestational age and history of previous cesarean sections were recorded. Other complications and interventions were also noted. Data was analyzed by using SPSS version 23 and a t-test was applied for comparison between the two groups. p-value 0.05). Peripartum hysterectomy was performed in 48.5% of patients. The complications noted were bladder injury 17.6%, ICU admission 45.5% and maternal mortality 4.4%. Conclusion: Morbidly adherent placenta (MAP) was found directly related to cesarean section (p>0.05). Appropriate measures should be taken to reduce the primary scars to reduce the incidence of repeat scars and ultimately MAP related severe maternal outcomes. Keywords: Morbidly Adherent Placenta (MAP); Caesarean Section; Placenta Previa.

Objective: To find the correlation bwteen hand grip strength with thumb muscle strength, flexibility and thumb pain in manual therapists and to find out the variation of these variables in healthy manual therapists. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Pakistan Society of Rehabilitation and Disability, Jinnah Hospital, Ittefaq Hospital, and Riphah University Pakistan, from Nov 2021 to Jan 2022. Methodology: One hundred thirty-five manual therapists were enrolled. Informed consent was taken from participants meeting inclusion and exclusion criteria. The questionnaire was filled out using a Dynamometer for Handgrip strength check, a Manual Muscle testing technique for Thumb muscle strength check, a Numeric pain rating scale for Pain intensity, and Goniometry for Flexibility of the Thumb muscles. Results: Results showed that most manual therapists had no wrist pain (99,73.3%) or thumb pain (104,77%). The majority of therapists (116 ,85.9%), had less than normal grip strength of hand, and 58(43%) had maximum thumb strength. There was a positive correlation between grip strength and thumb strength (r=0.234). There was a negative correlation between grip strength and thumb pain (r=-0.077). Conclusion: The study concluded that most manual therapists did not suffer from wrist and thumb pain. The majority had good thumb muscle strength but poor hand grip strength. Thumb strength positively correlates with grip strength, while thumb pain negatively correlates with handgrip strength.

Background and Objective: Manual therapy is a treatment approach by physical therapists where different techniques are applied to patients with hands for rehabilitation purposes. The objective of the study was to find the frequency of De’Quervain tenosynovitis and thumb and wrist pain in physical therapists working in different rehabilitation centers in relation to age, body mass index (BMI), and working hours. Methods: A cross-sectional study was conducted on 135 physical therapists working in different settings in Lahore, Pakistan. Physiotherapists were enrolled by convenience sampling. Data were recorded on a questionnaire form. Finkelstein test was performed to check De Quervain’s tenosynovitis. A numeric pain rating scale was sued to measure pain. The data were tested for significance using statistical tests. Results: On the dominant hand, 99 (73.3%) physical therapists had no wrist pain, 104 (77%) had no thumb pain, 28 (20.7%) had mild wrist pain and 20 (14.8%) had mild thumb pain. Only 21 (15.6%) physiotherapists were tested positive for Finkelstein (De Quervain’s tenosynovitis). Finkelstein test reported 100% negative result on the non-dominant side. There is a negative correlation between thumb pain with the age (r = -0.005), BMI (r = -0.110) and working hours (r = -0.033) of the physical therapists. Conclusion: The study concluded that the prevalence of De Quervain’s tenosynovitis, thumb, and wrist pain was more on the dominant hand than on the non-dominant side. The majority of the physical therapists reported mild to no pain in the wrist and thumb. There is a negative correlation of thumb pain with age, BMI and working hours.

Objective: To compare the intraoperative blood loss and adhesions, peri-operative blood and intravenous iron supplementation between hepatitis seropositive and seronegative pregnant women undergoing elective cesarean delivery. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesiology and Gynecology & Obstetrics, Combine Military Hospital, Okara Cantt Pakistan, from Oct 2018 to Mar 2019. Methodology: After approval of the hospital ethical committee, 134 (n=67 in each Group) pregnant women were included in our study by convenient sampling. Patients were divided into two groups. Group-A included seronegative pregnant women, whereas Group-B were seropositive pregnant women. Results: There was no difference in the age (p=0.357), gravidity (p=0.159), parity (p=0.226) and the number of cesarean sections (p=0.475) between the two groups. There was no difference in the two groups regarding peri-operative haemoglobin change,with an insignificant reduction of 0.60±1.21 g/dL in Group-A versus a reduction of 0.50±1.08 g/dL in Group-B. A mild level of adhesion was observed intraoperatively in 26(35.6%) in Group-A versus 27(37.5%) in Group-B; p=0.170. Mild difficulty securing hemostasis was reported in 25(34.2%) vs 29(40.2%) patients; p=0.329. 61(83.5%) did not require a peri-operative blood transfusion in Group-A versus 59(81.9%) in Group-B; p=0.528. Conclusion: Our study has shown that the peri-operative haemoglobin level, blood product and intravenous iron supplementation, intra-operative adhesions encountered, and difficulty in hemostasis were comparable between sero-positive and sero-negative viral hepatitis pregnant women.

Objectives: To compare 360-degree evaluation scores of postgraduate residents during 1st and 2nd cycles of evaluation to analyze the acquisition of core competencies. Materials & Methods: A cross-sectional analytical study was done to compare the acquisition of core competencies as per ACGME by MS/MD residents in 3 public sector teaching hospitals of Rawalpindi. The enrolled residents undergone 1st and 2nd cycle of 360-degree evaluation from Jan-June 2018 and July 2018 -Jan 2019 respectively. The data was gathered from supervisors, faculty, nursing staff, patients and their attendants by structured proforma. Data was analyzed by SPSS version 25.0. Specialty-wise scores were statistically presented with 95% CI. Differences in scores of core competencies during both cycles were determined by independent sample t-test. P < 0.05 was considered significant. Results: About 93 and 113 trainees were evaluated during 1st and 2nd cycle of evaluation respectively. Most (41.70%) of them were 1st year residents. 2nd cycle of evaluation revealed statistically significant improvement (P

Background: Lymph node tuberculosis (TB) is the most common form of extrapulmonary TB in India. Standards for TB care in India recommend microscopy/culture/CBNAAT/molecular test/histopathology examination and drug sensitivity testing on appropriate specimens from the presumed sites of involvement for all patients with presumptive extrapulmonary TB. Objectives: To analyze the utility of Xpert MTB/Rif assay in lymph node TB. Methods: All patients who underwent lymph node sampling between July 2014 and June 2017 and for whom Xpert MTB/Rif assay was done were included. Demographic profile, Xpert MTB/Rif assay result, histopathology/cytology findings, smear acid-fast bacillus (AFB), and AFB culture results were noted. A composite reference score (CRS) was made. Results: Xpert MTB/Rif assay was positive in 63 of the 81 patients. Xpert had a sensitivity of 82.14% and specificity of 86.18%when compared against AFB culture and 75.61% and 98.97% when compared against CRS. Conclusion: Xpert MTB/Rif assay is a valuable test for rapid diagnosis of lymph node TB.

Background: Traumatic Brain Injury (TBI) is a leading cause of death and disability worldwide. The objective of this study was to determine the impact of educational training on neurological assessment skill of female nurses in evaluating traumatic brain injury patients through Glasgow Coma Scale in Lahore General Hospital, Lahore, Pakistan. Material Methods: This quasi-experimental one group pre-posttest design study was conducted at Lahore School of Nursing, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan from April 3, 2021 to May 15, 2021. Pre-test neurological assessment skill of 70 nurses was noted by an observer, two weeks educational training was given and four weeks later on, post-test score was noted. For neurological assessment skill, a 20 items observatory checklist was used. Age groups, marital status, job experience, work experience in recent department and work place were four demographic, while neurological assessment skill score was one research variable. Paired sample t test was used for hypothesis testing. Results: Out 70 nurses, 26 (37.1%) were in age group 25-30 years, 18 (25.7%) in 31-35, 16 (22.9%) in 36-40, six (8.6%) in 41-45 and four (5.7%) in 46-50 years. Marital status was; 36 (51.4%) single, 27 (38.6%) married, three (4.3%) divorced and four (5.7%) widow. Job experience was; eight (11.4%) had 2 years, 33 (47.1%) 2-5 years, 25 (35.7%) 6-10 years and four (5.7%) had 10 years. Work experience in recent department was; 16 (22.9%) had 1 year, 39 (55.7%) 1-3 years, 13 (18.6%) 4-5 years and two (2.9%) had 5 years. Work place was Trauma Unit in 12 (17.1%), neurosurgery ICUs in 38 (54.3%) and surgical units in 20 (28.6%) cases. Mean 16.89±2.52 posttest skills score was significantly higher than mean 12.56±2.67 pretest skills score (p=.0001). Conclusion: Our study confirmed that the effect of educational training was significant in improving neurological assessment skills of nurses in evaluating traumatic brain injury patients through Glasgow Coma Scale in Lahore General Hospital, Lahore, Pakistan. Further studies are suggested with increased sample size and multiple research settings.

Abstract Cashmirins A (1) and B (2), new prenylated coumarins, have been isolated from the EtOAc- soluble fraction of the whole plant of Sorbus cashmiriana Hedlung, Monog. along with seselin (3), scopoletin (4), 3-hydroxyxanthyletin (5) and luteolin (6), reported for the first time from this species. Their structures were elucidated by spectroscopic techniques including MS, 1D and 2D NMR spectroscopy. Both new compounds 1 and 2 were investigated for biological activities and showed significant antifungal and urease inhibitory activities. Compounds 1 and 2 exhibited significant activity against Aspergillus flavus, Macrophomina phaseolina, Trichophyton simii, Trichophyton schoenleinii, and Pseudallescheria boydri. Both compounds also exhibited significant inhibitory activity against Jack bean urease with IC50 values of 28.2±0.12 µM and 30.3±0.18 µM, respectively compared to thiourea used as positive control.

Researchers are now looking to nanomaterials to fight serious infectious diseases that cause outbreaks and even pandemics. SARS-CoV-2 brought chaos to almost every walk of life in the past 2 years and has challenged every available treatment method. Although vaccines were developed in no time against it, the most pressing issue was the emergence of variants of concern arising because of the rapidly evolving viral strains. The higher pathogenicity and, in turn, the higher mortality rate of infections caused by these variants renders the existing vaccines less effective and the effort to produce further vaccines a costly endeavor. While several techniques, such as immunotherapy and repurposed pharmaceutical research, are being studied to minimize viral infection, the fundamentals of nanotechnology must also be considered to enhance the anti-SARS-CoV-2 efforts. For instance, silver nanoparticles (AgNPs) have been applied against SARS-CoV-2 effectively. Similarly, nanomaterials have been tested in masks, gloves, and disinfectants to aid in controlling SARS-CoV-2. Nanotechnology has also contributed to diagnoses such as rapid and accurate detection and treatment such as the delivery of mRNA vaccines and other antiviral agents into the body. The development of polymeric nanoparticles has been dubbed a strategy of choice over traditional drugs because of their tunable release kinetics, specificity, and multimodal drug composition. Our article explores the potential of nanomaterials in managing the variants of concern. This will be achieved by highlighting the inherent ability of nanomaterials to act against the virus on fronts such as inhibition of SARS-CoV-2 entry, inhibition of RNA replication in SARS-CoV-2, and finally, inhibition of their release. In this review, a detailed discussion on the potential of nanomaterials in these areas will be tallied with their potential against the current and emerging future variants of concern.

The factors associated with digital exclusion in the covid virtual ward population at a North West London teaching hospital were assessed in this study. Patients discharged from the covid virtual ward were contacted to give their feedback on their experience. Questions were tailored to whether or not the patient used the Huma app during their time on the virtual ward and were subsequently divided into 'app user' and 'non-app user' cohorts. The non-app user population accounted for 31.5% of the total patients referred to the virtual ward. Four major themes drove digital exclusion in this group: language barriers, access, inadequate information/training, and poor IT skills. In conclusion, incorporating additional languages and improving hospital-setting demonstration and information provision to patients prior to discharge were highlighted as key factors for reducing digital exclusion in the covid virtual ward patients.

Reinforced concrete (RC) members are designed to crack and the crack width usually remains within the service limit; however, these micro-cracks make structures susceptible to the infiltration of aggressive substances, especially near the coastline. Thus, the healing of these cracks is necessary before they further widen and spread. This study focused on the development and application of a crack-healing solution using microorganisms of the class bacillus; healing was observed through a crack-sensing camera. The aim was to regain the load-carrying capacity of the concrete member to meet the serviceability limit state requirements after healing the crack. The performance of the crack-healing solution was compared with the epoxy-injection method. Five full-scale RC beams of 100 × 200 × 1800 mm in dimension were cast using concrete designed with a cylindrical compressive strength of 21 MPa. After curing for up to 28 days, the beam specimens were tested and subjected to four-point bending to produce a flexural crack of width 1–3 mm. One of the beams was treated to fill the crack by injecting epoxy, while the three other similar beams were treated using a crack-healing solution consisting of bacteria (Bacillus subtilis), nutrient (calcium nitrate), and transporting agents. The healing solution was applied directly to the opened crack with silica gel and with cement slurry in three similar beams cracked under flexural load. The cracks in the beam treated with the crack-healing solution were sealed and kept moist for a further 14 days. After curing, all of the beams including the control (without treatment) were tested again and were subjected to four-point bending until failure to observe the effect of the crack repairs on the flexural response. It was observed that both systems were equally good at enhancing the serviceability limit state and improving the load-carrying capacity.

Objective: To identify the factors which have a statistically significant association with sleep hygiene of medical students. Material and Methods: This study was done on 100 medical students. The questionnaire that was used for the collection of data had two parts. First was related to demographic variables and second was a validated Pittsburgh sleep quality index (PSQI). All participants were from the first to fifth years of Bachelor of Medicine and Bachelor of Surgery (MBBS). Data were analysed using SPSS 23. The association was found by applying chi-square test. Results: Our study revealed that out of 100 students, 61% had poor sleep hygiene (PSQI ≥ 5). Global PSQI scores among women were slightly higher than males. A statistical association was found between the residence and habit of studying at night of medical students with their sleep hygiene. Discussion: Medical students should ensure good sleep hygiene in order to maintain their academic performance, physical health, and mental health.

Abstract Background The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. Methods A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. Results Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p

Bangladesh, as a newcomer country, is expecting to start her nuclear power journey by 2022. Due to evident reasons, newcomer nuclear countries face several key challenges concerning the development of national nuclear safety infrastructure. The paper investigates the status of the 7 key safety infrastructure issues out of the 19 and readiness of the supportive organizations, laboratories, and workforces following the International Atomic energy Agency’s status evaluation guide at milestone 3 and foreign countries’ practice. Much progress has been achieved at phase 3 regarding the establishments of a few Acts, a regulator, and an operator. However, comprehensive regulatory frameworks, skilled workforces, establishments of a few supportive organizations, and laboratories for managing environmental radioactivity, radiological accidents, and radioactive wastes are yet to ready. Several suggestions are made for establishing and expediting radiation monitoring laboratories, a radiological emergency management center, a radioactive waste management company, and technical support organizations for the safety infrastructure. To avoid perceived risks, policymakers and competent authorities need to emphasize creating an optimized safety infrastructure before commissioning and operating the 1stnuclear power plant safely, securely, and cost-sustainably.

Surface chemistry evaluation is crucial in assessing the efficacy of chemical decontamination products for titanium implants. This study aimed to investigate the effectiveness of chemical decontamination solutions in cleaning a contaminated dental implant surface and to evaluate the potential of combining Pluronic gel with hydrogen peroxide (NuBone®Clean) by evaluating pellicle disruption and re-formation on implant surfaces. In addition, ensuring safety with in vitro and human testing protocols. X-ray Photoelectron Spectroscopy (XPS) was utilised for surface analysis. All the tested gels had some effect on the surface cleanness except for PrefGel®. Among the tested chemical decontamination candidates, NuBone®Clean demonstrated effectiveness in providing a cleaner titanium surface. Furthermore, none of the tested chemical agents exhibited cytotoxic effects, and the safety assessment showed no adverse events. The results of this study highlight the significance of conducting comprehensive evaluations, encompassing safety and efficacy, before introducing new chemical agents for dental treatments. The findings suggest that NuBone®Clean shows potential as a chemical decontamination solution for implant surfaces. However, further investigation through randomised clinical trials is necessary. By adhering to rigorous testing protocols, the development of safe and efficient chemical decontamination strategies can be advanced, benefiting patients and promoting progress in implant dentistry.

Abstract Background SARS-CoV-2 has ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters preceding an adverse event. Wearable sensors can measure vital signs continuously and remotely, outside of hospital facilities, recognising early clinical deterioration. We aim to determine the feasibility & acceptability of remote monitoring systems for quarantined individuals in a hotel suspected of COVID-19. Methods A pilot, proof-of-concept, feasibility trial was conducted in engineered hotels near London airports (May–June 2020). Individuals arriving to London with mild suspected COVID-19 symptoms requiring quarantine, as recommended by Public Health England, or healthcare professionals with COVID-19 symptoms unable to isolate at home were eligible. The SensiumVitals™ patch, measuring temperature, heart & respiratory rates, was applied on arrival for the duration of their stay. Alerts were generated when pre-established thresholds were breeched; trained nursing staff could consequently intervene. Results Fourteen individuals (M = 7, F = 7) were recruited; the mean age was 34.9 (SD 11) years. Mean length of stay was 3 (SD 1.8) days. In total, 10 vital alerts were generated across 4 participants, resulting in telephone contact, reassurance, or adjustment of the sensor. No individuals required hospitalisation or virtual general practitioner review. Discussion This proof-of-concept trial demonstrated the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a pandemic at a hotel, acting as an extension to a healthcare trust. Benefits included reduced viral exposure to healthcare staff, with recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. Conclusion Remote monitoring systems can be applied to hotels to deliver healthcare safely in individuals suspected of COVID-19. Further work is required to evaluate this model on a larger scale. Trial registration Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04337489 (07/04/2020).

Abstract Background The outbreak of SARS-CoV-2 (coronavirus, COVID-19), declared a pandemic by the World Health Organization (WHO), is a global health problem with ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters often preceding an adverse event. Wearable sensors can measure vital signs continuously (e.g. heart rate, respiratory rate, temperature) remotely and can be utilised to recognise early clinical deterioration. Methods We describe the protocol for a pilot, proof-of-concept, observational study to be conducted in an engineered hotel near London airports, UK. The study is set to continue for the duration of the pandemic. Individuals arriving to London with mild symptoms suggestive of COVID-19 or returning from high-risk areas requiring quarantine, as recommended by the Public Health England, or healthcare professionals with symptoms suggestive of COVID-19 unable to isolate at home will be eligible for a wearable patch to be applied for the duration of their stay. Notifications will be generated should deterioration be detected through the sensor and displayed on a central monitoring hub viewed by nursing staff, allowing for trend deterioration to be noted. The primary objective is to determine the feasibility of remote monitoring systems in detecting clinical deterioration for quarantined individuals in a hotel. Discussion This trial should prove the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a global pandemic at a hotel, acting as an extension to a healthcare trust. Potential benefits would include reducing infection risk of COVID-19 to healthcare staff, with earlier recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. We hope our results can power future, robust randomised trials. Trial registration ClinicalTrials.gov Identifier: NCT04337489 .

BackgroundThe implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied. ObjectiveWe aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption. MethodsA mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire. ResultsEnrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022. ConclusionsThe results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future. Trial RegistrationClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004

Background: The implementation and efficacy of wearable sensors and alerting systems in acute secondary care have been poorly described.Objectives: to pragmatically test one such system and its influence on clinical outcomes in an acute surgical cohort.Methods: In this pragmatically designed, pre-post implementation trial, participants admitted to the acute surgical unit at our institution were recruited. In the pre-implementation phase (September 2017 to May 2019), the SensiumVitals™ monitoring system, which continuously measures temperature, heart, and respiratory rates, was used for monitoring alongside usual care (intermittent monitoring in accordance with the National Early Warning Score 2 [NEWS 2] protocol) without alerts being generated. In the post-implementation phase (May 2019 to March 2020), alerts were generated when pre-established thresholds for vital parameters were breached, requiring acknowledgement from healthcare staff on provided mobile devices. Hospital length of stay, intensive care use, and 28-days mortality were measured. Balanced cohorts were created with 1:1 ‘optimal’ propensity score logistic regression models.Results: The 1:1 matching method matched the post-implementation group (n = 141) with the same number of subjects from the pre-implementation group (n = 141). The median age of the entire cohort was 52 (range: 18–95) years and the median duration of wearing the sensor was 1.3 (interquartile range: 0.7–2.0) days. The median alert acknowledgement time was 111 (range: 1–2,146) minutes. There were no significant differences in critical care admission (planned or unplanned), hospital length of stay, or mortality.Conclusion: This study offered insight into the implementation of digital health technologies within our institution. Further work is required for optimisation of digital workflows, particularly given their more favourable acceptability in the post pandemic era. Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04638738.

BackgroundImmune checkpoint inhibitors (ICIs) are widely used in lung cancer management. However, myocarditis, which is a rare, yet potentially severe adverse-related event associated with ICIs, could be under-reported.ObjectivesThis study is aimed to prospectively evaluate the cumulative incidence rate of myocarditis, through systematic screening, among patients receiving ICIs for lung cancer.MethodsAll patients who received the first administration of ICIs for non-small cell (NSCLC) and small cell lung cancer (SCLC), between May and November 2020, in the pulmonary department of Bordeaux University Hospital, were included. Echocardiography (ECG), troponin-I, and natriuretic peptide dosages before ICIs' first administration and before each infusion were recorded. ECG and magnetic resonance imaging (MRI) were done additionally, in case of at least three times increase in troponin levels, ECG modifications, and the onset of cardiovascular symptoms. Second, if possible, coronarography than endomyocardial biopsy was assessed. The primary outcome was defined as ICIs related to myocarditis onset, while secondary outcomes included other cardiovascular events, disease-free, and overall survival.ResultsDuring the period of interest, 99 patients received their first infusion of ICIs for lung cancer (mean age 64 ± 9 years; 52 men, 67% with adenocarcinoma). Three cases of myocarditis without major adverse cardiac events (MACEs) occurred (two definite and one possible), and the mean duration between the first ICIs' administration and myocarditis onset was 144 ± 3 days. Median disease-free survival and overall survival were 169 [102; 233] days and 209 [147; 249] days, respectively.ConclusionIn our study, systematic screening of myocarditis associated with ICIs leads to a more frequent incidence and a later onset than previously reported. None of them were severe. Additional prospective evidence is needed before we could adopt routine cardiac screening in unselected patients starting ICIs; however, these data shed new light on the risk of myocarditis associated with ICIs administration.

Abstract Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.

Periodontitis, a chronic inflammatory disease of oral cavity, caused by the complex interactions between host immune system and sub-gingival microbiota leading to chronic gingival inflammation, loss of periodontal ligament attachment, dental impairment, and finally tooth loss. Prevalence of periodontal disease varies and reported a higher prevalence in Asian countries. The conventional diagnostic techniques used for periodontitis are inherently limited. Periodontitis immunopathogenesis studies and mediator analyzes in saliva allowed the identification of a number of disease-specific molecular biomarkers. In this review article, diagnostic role of various salivary biomarkers in periodontitis has been discussed. Original articles, systematic and narrative reviews related to relevant study, published since 2009-2019 were included in the literature search through PubMed, Google Scholar, Web of Science and Scopus. Convenient assessments of these salivary biomarkers with analytical chair facilities will yield more accurate diagnostic results which will further aid in early detection and better clinical management of periodontitis patients.

BackgroundContinuous vital sign monitoring by using wearable sensors may result in the earlier detection of patient deterioration and sepsis. Few studies have explored the perspectives of surgical team members on the use of such sensors in surgical patients. ObjectiveThis study aims to understand the views of surgical team members regarding novel wearable sensors for surgical patients. MethodsWearable sensors that monitor vital signs (heart rate, respiratory rate, and temperature) continuously were used by acute surgical patients. The opinions of surgical staff who were treating patients with these sensors were collated through in-depth semistructured interviews to thematic saturation. Interviews were audio recorded, transcribed, and analyzed via thematic analysis. ResultsA total of 48 interviews were performed with senior and junior surgeons and senior and junior nurses. The main themes of interest that emerged from the interviews were (1) problems with current monitoring, (2) the anticipated impact of wearables on patient safety, (3) the impact on staff, (4) the impact on patients overall, (5) potential new changes, and (6) the future and views on technology. ConclusionsOverall, the feedback from staff who were continuously monitoring surgical patients via wearable sensors was positive, and relatively few concerns were raised. Surgical staff members identify problems with current monitoring and anticipate that sensors will both improve patient safety and be the future of monitoring.

Objective Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative.Methods Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014.Results There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p

Atrial fibrillation (AF) is the most common sustained heart arrhythmia and significantly increases risk of stroke. Opportunistic AF testing in high-risk patients typically requires frequent electrocardiogram tests to capture the arrhythmia. Risk-prediction algorithms may help to more accurately identify people with undiagnosed AF and machine learning (ML) may aid in the diagnosis of AF. Here, we applied an AF-risk prediction algorithm to secondary care data linked to primary care data in the DISCOVER database in order to evaluate changes in model performance, and identify patients not previously detected in primary care. We identified an additional 5,444 patients who had an AF diagnosis only in secondary care during the data extraction period. 2,696 (49.5%) were accepted by the algorithm and the algorithm correctly assigned 2,637 (97.8%) patients to the AF cohort. Using a risk threshold of 7.4% in patients aged ≥ 30 years, algorithm sensitivity and specificity was 38% and 95%, respectively. Approximately 15% of AF patients assigned to the AF cohort by the algorithm had a secondary care diagnosis with no record of AF in primary care. These additional patients did not substantially alter algorithm performance. The additional detection of previously undiagnosed AF patients in secondary care highlights unexpected potential utility of this ML algorithm.

PURPOSE: Enteric fever continues to be an important public health challenge for the developing world. With the emergence of fluoroquinolone resistance in Salmonellae spp. azithromycin is increasingly being used for oral treatment of enteric fever. We investigated the antibiotic susceptibility pattern of azithromycin in Salmonellae spp. isolates from a tertiary care hospital to detect emerging resistance. METHODS: The study assessed the reliability of disc diffusion as a screening test to detect azithromycin resistance by comparing it with the minimum inhibitory concentrations (MICs) of the drug in 100 Salmonellae spp. strains. The strains of Salmonellae spp. showing resistance to azithromycin were further investigated for resistance markers – mphA, mphB, and mef B genes. RESULTS: This study was conducted on 100 Salmonella enterica strains recovered from blood culture samples between 2013 and 2017. Among these isolates, 18 showed resistance to azithromycin by disc diffusion methodology with zones of inhibition

Kiwifruit (Actinidia chinensis) is a rich nutritious fruit crop owing to a markedly higher content of vitamin C and minerals. To promote fruit set and to increase the yield of kiwifruit, forchlorfenuron (CPPU) has been widely applied. However, the molecular details regarding CPPU controlling kiwifruit development, especially at the fastest fruit growth stage, remain unknown. In the present study, we measured the effect of CPPU on developmental regulation in red-fleshed kiwifruit (Actinidia chinensis 'Hongyang'). Additionally, a cytological analysis was performed to clarify the precise changes in the cell structure of the CPPU-treated kiwifruits. Moreover, the concentration of endogenous phytohormones, including indoleacetic acid (IAA), zeatin (ZT), gibberellic acid 3 (GA3), and abscisic acid (ABA), were measured by Enzyme-linked Immunosorbent Assay (ELISA). Furthermore, RNA-Seq was performed to dissect the complicated molecular mechanisms, with a focus on biosynthesis, metabolism, and signaling compounds, such as endogenous hormones, sugars, and L-ascorbic acid. Our results demonstrated that CPPU treatment not only regulates the size and weight of a single fruit but also improves the quality in 'Hongyang' kiwifruit through the accumulation of both soluble sugar and vitamin C. It was also seen that CPPU regulates kiwifruit development by enhancing cell expansion of epidermal cells and parenchyma cells, while, promoting cell division of subepidermal cells. Additionally, CPPU significantly increased the gibberellin and cytokinin biosynthetic pathway and signaling, while repressing auxin and ABA biosynthetic pathway; thus, signaling plays an essential role in CPPU controlling kiwifruit development. Notably, transcriptomic analysis revealed that a total of 2244 genes, including 352 unannotated genes, were differentially expressed in kiwifruits because of CPPU treatment, including 127 transcription factors. These genes are mainly enriched in plant hormone signal transduction, photosynthesis, MAPK signaling pathway, starch and sucrose metabolism, and phenylpropanoid biosynthesis. Overall, our results highlight that CPPU regulation of kiwifruit development is mainly associated with an antagonistic and/or synergistic regulatory role of endogenous phytohormones, and enhancing the energy supply. This provides new insights into the molecular details of CPPU controlling kiwifruit development at the fastest fruit growth stage, which is of agricultural importance for kiwifruit breeding and crop improvement.

Fungal osteomyelitis is a rare disease which usually presents in an indolent manner. Opportunistic infections due to other non-aspergillus moulds are an emerging entity. We report a case of fungal osteomyelitis due to Acremonium spp in an immunocompetent adult which showed a chronic, indolent course but responded well to treatment with voriconazole. This case highlights the importance of diagnosing the causative agent in fungal osteomyelitis as species specific susceptibility can aid in the treatment of fungal osteomyelitis.

Background: Pakistan, like the rest of south-east Asia, is plagued with old trends and traditions that target the fairer sex in particular. Marriage tops all charts in this regard and every parent in our increasingly misogynistic society wishes to marry off their daughter as soon as possible. Doctor brides however have always been seen positively. Parents wish to benefit from this factor and get their daughters married even before they graduate. Objective: We hypothesize that the fear of an impending marriage leads to depression, anxiety and stress among female medical students. This study hopes to gauge the psychosocial and psychosomatic effects. Methodology: This observational cross sectional psychosocial analysis was carried out on a total of 100 female medical students of Liaquat University of Medical & Health Sciences and ISRA University from March to June 2014. Informed consent was obtained and complete anonymity guaranteed. “Google docs” was used to collect data via online structured questionnaire forms. The data obtained was analyzed in SPSS. v. 16.0. Results: 43 percent of the sample confessed that their families had, at least once, been approached for purpose of marriage. 16 percent admitted that they had themselves received marriage proposals. 88 percent of the sample held negative views regarding early marriage before graduation. Upon inquiry, 78 percent of those who had encountered prospects of marriage before graduation admitted to have felt depression, anxiety and stress along with mild psychosomatic symptoms. Conclusion: Females constitute a significant majority of medical students in Pakistan and early marriage is known to adversely affect the prospects of a successful career. On the basis of our result, we conclude that even the fear of impending marriage is inducing depression, anxiety and stress among female students and can potentially harm their education and health.

Watt's writings on Islam, particularly his biographical works on the Prophet Muhammad, are now considered an authority on the subject. They are not only diligently well-researched, but are path-breaking in that they permanently and decisively answered certain doubts and suspicions that were raised in the Western scholarly study of Islam and Muhammad. Moreover, his objective stance on many issues has caused a methodological shift in the way Islam is approached in the West. His work and opinions have both theoretically and in practical terms have helped the Westerners towards an unbiased understanding and estimation of the Islamic culture. Watt's works will, in the near future, remain significant, they will continue to be studied, and indeed, continue to be refuted where necessary.

The indoor microbial community is a mixture of microorganisms resulting from outdoor ecosystems that seed the built environment. However, the biogeography of the indoor microbial community is still inadequately studied. Dust from more than 3000 dwellings across France was analyzed by qPCR using 17 targets: 10 molds, 3 bacteria groups, and 4 mites. Thus, the first spatial description of the main indoor microbial allergens on the French territory, in relation with biogeographical factors influencing the distribution of microorganisms, was realized in this study. Ten microorganisms out of 17 exhibited increasing abundance profiles across the country: Five microorganisms (Dermatophagoïdes pteronyssinus, Dermatophagoïdes spp., Streptomyces spp., Cladosporium sphaerospermum, Epicoccum nigrum) from northeast to southwest, two (Cryptococcus spp., Alternaria alternata) from northwest to southeast, Mycobacteria from east to west, Aspergillus fumigatus from south to north, and Penicillium chrysogenum from south to northeast. These geographical patterns were partly linked to climate and land cover. Multivariate analysis showed that composition of communities seemed to depend on landscapes, with species related to closed and rather cold and humid landscapes (forests, located in the northeast) and others to more open, hot, and dry landscapes (herbaceous and coastal regions, located in the west). This study highlights the importance of geographical location and outdoor factors that shape communities. In order to study the effect of microorganisms on human health (allergic diseases in particular), it is important to identify biogeographic factors that structure microbial communities on large spatial scales and to quantify the exposure with quantitative tools, such as the multi-qPCR approach.

Objective: To assess the frequency of causative bacterial pathogen of sepsis in infant, their antibiotic susceptibility and to determine resistance pattern in commonly used antibiotics. Place and Duration of Study: Central Lab Civil Hospital, Karachi, 6 months. Study Design: Retrospective Descriptive observational study. Patients and Method: All 1414 reports of blood samples send for culture/sensitivity of infants admitted in CivilHospital Karachi during the study period were scrutinized for bacterial pathogen, their frequency, antibiotic susceptibility and resistance pattern. Result: Out of 1414 infants, 604 (42.7%) had positive blood culture. Gram positive bacteria were predominant(54.1%) than gram negative (45.9%). Male: female ratio was found to be approximately 1:0.9. Total 9 organismswere isolated, in which staphylococcus aureus predominates followed by Pseudomonas aeruginosa and Escherichiacoli respectively. The overall sensitivity of the organism to Amikacin and Cefotaxime were 60.87%and 36.67%respectively which are currently in use as empirical therapy in pediatric ward of CHK. The organisms weremost sensitive to Vancomycin (95.54%), Sparfloxacin (94.16%), Linezolid (93.56%), while mostly resistant tokanamycin (56.21%), cephalosporins (55.9%), Gentamycin (54.31%) and amoxicillin (51.11%). Conclusion: Gram-positive organisms were identified as the major threat for sepsis in infants. An emergingpattern of resistance was observed against commonly used antibiotic so there is a need to control the spread ofthese resistant strains through infection control programs and continuous monitoring of drug resistant patterns.

Objective: To report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008. Methods: A total of 14 639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened. Results: Among the 14 639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008. Conclusions: Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

ENGLISH ABSTRACT: Mindfulness flows over the West. It is often branded as a method rooted in Buddhism, but in academical research its relations to a series of Buddhist and spiritual concepts remain undefined. We’ve conducted a systematic reading of 63 self-presentations from women with breast cancer that have participated in mindfulness intervention. Through a simple count of words and meaning units we find that patients describe the effect as becoming more attentive of the present moment and not worrying about the past or the future as much as before. But in a linguistic analysis we find that beginner-meditators are strikingly unarticulated. Common phrases about ‘being more present in the now with an accepting attitude’ may be related to spiritual experiences, but are more frequently inserted in a phenomenology of attention in recent neuroscience. This branch of research lacks qualitative studies that can provide a better understanding of how the mindfulness-phenomenology is related to neuroscience, spirituality and religion. DANSK RESUME: Mindfulness bølgen strømmer ind over Vesten. Den markedsføres ofte som en metode, der har rødder i buddhisme; men set ud fra universitære forskningssammenhænge er dets forhold til en række buddhistiske og spirituelle begreber uafklarede. Vi har foretaget en systematisk læsning af 63 selvpræsentationer hos kvinder med brystkræft, som har gennemgået mindfulness intervention. Ved en simpel optælling af udsagn finder vi, at patienterne beskriver udbyttet som at være blevet mere opmærksomme på det nuværende øjeblik og ikke bekymre sig i ligeså høj grad om fortid eller fremtid som før behandlingen. Men ved en sproglig analyse finder vi, at begynder-meditatorerne er påfaldende uformulerede. Italesættelser om ‘at være mere tilstede i nu’et med en accepterende holdning’ kan dække over spirituelle oplevelser, men sættes hyppigere ind i en fænomenologi om opmærksomhedsfænomener knyttet til nyere neuroscience. Men denne forskning savner flere kvalitative undersøgelser for at kunne begrunde, hvorledes mindfulness fænomenologien sættes i relation til neuroscience og til spiritualitet og religion.

Objectives: To determine the minimum inhibitory concentration of ciprofloxacin among 50 blood stream isolates of Salmonella enterica. Material and Methods: A total of 50 consecutive isolates of Salmonella enterica were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Minimum inhibitory concentrations were determined using Hi-Comb strips. All results were interpreted according to the CLSI guidelines. Results: Of the 50 isolates 70%were Salmonella Typhi, 4% Salmonella paratyphi A, 2% Salmonella paratyphi B and the remaining 10% were identified only as Salmonella species. Using the CLSI 2011 breakpoints for disc diffusion, 86% (43/50) were resistant to nalidixic acid(NA), 22% (11/50) to ciprofloxacin, 12% to azithromycin, 6% to cotrimoxazole, 4% to ampicillin and 1% to chloramphenicol. The MIC50 and MIC90 of ciprofloxacin for S.Typhi were 0.181 μg/mL and 5.06 μg/mL respectively. While the same for S. paratyphi A was 0.212μg/mL and 0.228μg/mL respectively. None of the isolates were multi drug resistant and all were susceptible to ceftriaxone. Using the CLSI 2012 revised ciprofloxacin breakpoints for disc diffusion (>31mm) & MIC (