Time series analysis and short-term forecasting of monkeypox outbreak trends in the 10 major affected countries.

BACKGROUND: Considering the rapidly spreading monkeypox outbreak, WHO has declared a global health emergency. Still in the category of being endemic, the monkeypox disease shares numerous clinical characters with smallpox. This study focuses on determining the most effective combination of autoregressive integrated moving average model to encapsulate time dependent flow behaviour of the virus with short run prediction. METHODS: This study includes the data of confirmed reported cases and cumulative cases from eight most burdened countries across the globe, over the span of May 18, 2022, to December 31, 2022. The data was assembled from the website of Our World in Data and it involves countries such as United States, Brazil, Spain, France, Colombia, Mexico, Peru, United Kingdom, Germany and Canada. The job of modelling and short-term forecasting is facilitated by the employment of autoregressive integrated moving average. The legitimacy of the estimated models is argued by offering numerous model performance indices such as, root mean square error, mean absolute error and mean absolute prediction error. RESULTS: The best fit models were deduced for each country by using the data of confirmed reported cases of monkeypox infections. Based on diverse set of performance evaluation criteria, the best fit models were then employed to provide forecasting of next twenty days. Our results indicate that the USA is expected to be the hardest-hit country, with an average of 58 cases per day with 95% confidence interval of (00-400). The second most burdened country remained Brazil with expected average cases of 23 (00-130). The outlook is not much better for Spain and France, with average forecasts of 52 (00-241) and 24 (00-121), respectively. CONCLUSION: This research provides profile of ten most severely hit countries by monkeypox transmission around the world and thus assists in epidemiological management. The prediction trends indicate that the confirmed cases in the USA may exceed than other contemporaries. Based on the findings of this study, it remains plausible to recommend that more robust health surveillance strategy is required to control the transmission flow of the virus especially in USA.

Intraoperative Epidural Analgesia Practices And Their Outcomes In Major Abdominal Surgeries At A Tertiary Care Hospital In Karachi.

OBJECTIVE: To investigate the association involving site, concentrations and dosing of local anaesthetics used intraoperatively on postoperative pain scores, motor block and need for rescue analgesia. METHODS: The observational study was conducted from June 1, 2020, to May 31, 2021, at the Aga Khan University Hospital, Karachi, and comprised patients planned for major abdominal surgeries with epidurals as primary analgesic modality. They were followed prospectively from placement of epidurals to 24h postoperatively. Data was collected from anaesthesia chart and pain management notes. Data was analysed using SPSS 19. RESULTS: Of the 170 patients, 96(56.4%) were females and 74(43.5%) were males. The overall mean age was 54.1±12.6 years and mean body mass index was 26.7±5.5Kg/m2. More than half of the patients 110(64.7%) had thoracic epidural, while 60(35.3%) had lumber epidural. Requirement of opioid co-analgesia intraoperatively was significantly high with higher compared to lower concentration of local anaesthetics (p=0.004). The difference in frequencies of motor block was significantly associated with catheter length (p=0.006). CONCLUSIONS: Intraoperative management of epidurals is an essential but overlooked component of perioperative pain management. Guidelines should be formulated for intraoperative epidural analgesic regimens to improve postoperative outcomes.

Effective utilization of time for non-operating room anaesthesia services at Aga Khan University Hospital Karachi: A prospective quality improvement audit.

OBJECTIVE: To identify service quality gaps by reviewing out-of-operating-room anaesthesia services in a tertiary care hospital. METHODS: This quality improvement audit was conducted at The Aga Khan University Hospital Karachi from July to September 2019, and comprised procedures conducted outside the operating room under anaesthesia and sedation from 8am to 5pm. A data collection form was designed to collect information related to the non-operating-room anaesthesia services. Data was analysed using SPSS Version 19. RESULTS: A total of 123 radiological procedures were observed in 48 working days and endoscopic/radio-therapeutic procedures observed were 98 over 31 days. The mean anaesthesia coverage time was 2.96±1.71 hours per day for radiological procedures, and 2.59±1.07 hours for endoscopic/radio-therapeutic procedures, indicating underutlisation of resources both human and material. CONCLUSIONS: A multideciplinary team consisting of all stakeholders should be developed to facilitate the patients and enhance healthcare quality.

The Biomechanical Profile of an Osseo-Integrated Rectangular Block Implant: A Pilot In Vivo Strain Analysis.

Aim: To load-test the osseo-integrated rectangular block implant (RBI), measure the generated cortical peri-implant strains, and relate these findings to known human physiological parameters. Materials and methods: Two RBIs were placed into the posterior mandibular saddle in a mature greyhound dog and allowed to osseo-integrate. The half mandible (implants in situ) was mounted in a servohydraulic system. Four triple-stacked rosette gauges were placed cortically (mesial, distal, buccal, and lingual). A modified ISO-14801 protocol was used (1000 N, 300, 2 Hz, 1 h) and the generated principal strains (ep, eq) and their angular orientations (F), were calculated. Results: (1) Bucco-lingual "horizontal" dimension: dominant "horizontal" compressive stresses were on the lingual aspect and "horizontal" tensile stresses on the buccal aspect. The buccal cortex was elastically tensile-stretched, while the lingual cortex was elastically compressed. (2) Bucco-lingual "vertical" dimension: dominant vertical torsional stresses were oriented buccally and apically, with an overall buccally inclined torsional effect. This was also evidenced on the lingual aspect, where there remained high torsional rotation elements (high F and e2). (3) Mesio-distal "horizontal" dimension: dominant torsional stresses oriented as a distal-lingual "counter-clockwise" rotation. Conclusions: The applied off-axial loads generated a heterogeneous pattern of bucco-lingual and mesio-distal cortical strains, both vertically and horizontally. The short dimensioned osseo-integrated RBI design appeared to biomechanically withstand the applied loads and to maintain the strains generated to levels that were within physiological limits. More studies and statistical analyses are needed to confirm these findings.

Pharmacological Interventions for the Treatment and Control of Shivering in Adult Patients Undergoing Elective Surgery Under Regional Anaesthesia: A Systematic Review and Meta-Analysis.

Intraoperative shivering is quite common after regional anaesthesia, which not only increases the total body oxygen requirement but also causes discomfort to the patients. The aim of this systematic review is to determine the effectiveness of pharmacological agents administered intra-operatively for treating shivering in adult patients who are undergoing elective surgery under regional (i.e., central neuraxial) anaesthesia so that an optimal choice of an agent can be recommended for clinical application. A literature search was carried out using PubMed, Cochrane Library, CINAHL databases, and hand searches to identify relevant studies. After literature screening and information extraction, a systematic review was performed. Meta-analysis was performed for the primary outcome. The primary outcome was to evaluate the effectiveness of pharmacological agents used for the treatment and control of intraoperative shivering and the time taken to control shivering. The secondary outcome includes recurrence of shivering after pharmacological intervention and identification of common adverse effects related to them. In total, 10 studies (791 patients) were included. Common interventions were opioids, central α2 receptor agonist, and few other medications like magnesium sulfate, ondansetron, nefopam, and amitriptyline. Tramadol and dexmedetomidine were the most frequently documented drugs compared with other drugs to resolve shivering. The most effective drug with approximately 100% response rate was dexmedetomidine with the dose of 0.5 µg kg-1 intravenously given just after the appearance of shivering. Studies showed that tramadol is also an effective drug used to control shivering in most patients, and its effect is comparable with the pethidine.

Alkyl Silica Hybrid Nanowire Assembly in Improved Superhydrophobic Membranes for RO Filtration.

Alkyl silica membranes and wires were synthesized by a sol-gel method, which has the capacity to control the size of the particles or membranes by controlling the reactions. Trimethoxyoctylsilane (C8TMOS) was used as a chemical surfactant; poly(vinylpyrrolidone) (PVP) as an emulsifier, dissolved in butanol for emulsion; and tetraethylorthosilicate (TEOS) as a precursor and a source of silica. An assembly of silica wires was fabricated on glass and cotton substrates by the dip-coating technique. Porous membranes and silica wires were observed using scanning electron microscopy (SEM) images. The contact angles of all of the samples were in the range of 140-154° as measured by ImageJ software, which confirmed the hydrophobic nature of the samples. The contact angle was increased by increasing the amount of the surfactant. Phase changes of silica wires and membranes were investigated by thermogravimetric analysis. Chemical bonds of the sample were studied using Fourier transform infrared (FTIR) spectroscopy. The band gap of silica nanowires was measured to be 3.8-3.4 eV using the UV-visible spectrum and decreased as compared to that of bulk silica. These silica-based porous membranes with enhanced transport properties can be used in filtration and separation techniques. This fabricated hybrid silica membrane showed ∼96% salt rejection within a permeation flux of 3.04 L/m2 h.

Hospital based prevalence of smoking among surgical patients in tertiary care hospitals of Karachi Pakistan.

OBJECTIVE: To determine the prevalence of smoking and to evaluate the knowledge about preoperative smoking cessation in patients coming for elective surgery. METHODS: The cross-sectional study was conducted from July 30, 2019, to March 17, 2020, in the preoperative anaesthesia assessment clinic and surgical wards of Aga Khan University Hospital, Civil Hospital Karachi, and Abbasi Shaheed Hospital, Karachi, and comprised all patients of either gender aged >12 years scheduled for elective surgery having American Society of Anaesthesiologists physical status I-IV. Data was analysed using Stata 13. RESULTS: Of the 811 patients, 478(59%) were male and 333(41%) were female. The overall mean age was 43.4±16.4 years and mean BMI was 25.0±5.8kg/m2. There were 164(20.2%) smokers in the sample. The overall knowledge about preoperative smoking cessation was significantly associated with the level of education and gender (p<0.05). CONCLUSIONS: Smoking in surgical patients was about one-fifth of the overall sample, and knowledge related to preoperative smoking abstinence was significantly associated with educational status and gender.

Securing Bio-Cyber Interface for the Internet of Bio-Nano Things using Particle Swarm Optimization and Artificial Neural Networks based parameter profiling.

Internet of bio-nano things (IoBNT) is a novel communication paradigm where tiny, biocompatible and non-intrusive devices collect and sense biological signals from the environment and send them to data centers for processing through the internet. The concept of the IoBNT has stemmed from the combination of synthetic biology and nanotechnology tools which enable the fabrication of biological computing devices called Bio-nano things. Bio-nano things are nanoscale (1-100 nm) devices that are ideal for in vivo applications, where non-intrusive devices can reach hard-to-access areas of the human body (such as deep inside the tissue) to collect biological information. Bio-nano things work collaboratively in the form of a network called nanonetwork. The interconnection of the biological world and the cyber world of the Internet is made possible by a powerful hybrid device called Bio Cyber Interface. Bio Cyber Interface translates biochemical signals from in-body nanonetworks into electromagnetic signals and vice versa. Bio Cyber Interface can be designed using several technologies. In this paper, we have selected bio field-effect transistor (BioFET) technology, due to its characteristics of being fast, low-cost, and simple The main concern in this work is the security of IoBNT, which must be the preliminary requirement, especially for healthcare applications of IoBNT. Once the human body is accessible through the Internet, there is always a chance that it will be done with malicious intent. To address the issue of security in IoBNT, we propose a framework that utilizes Particle Swarm Optimization (PSO) algorithm to optimize Artificial Neural Networks (ANN) and to detect anomalous activities in the IoBNT transmission. Our proposed PSO-based ANN model was tested for the simulated dataset of BioFET based Bio Cyber Interface communication features. The results show an improved accuracy of 98.9% when compared with Adam based optimization function.

Thyrotoxic Hypokalemic Periodic Paralysis: A Success Story of a Diagnostic Challenge.

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but life-threatening complication of hyperthyroidism seen predominantly in males. It is generally characterized by hypokalemia and skeletal muscle paralysis requiring intensive care admission. Hypokalemia occurs due to the massive intracellular shift of potassium because of the hyperactivity of the sodium-potassium adenosine triphosphates pump (Na+ K+ ATPase). Its differential diagnosis from the other common causes of hypokalemic paralysis is essential to provide targeted therapy. We present a rare case of THPP in a female patient with no prior history of thyroid disease. THPP in this patient was precipitated by trauma and emotional stress, which served as a diagnostic challenge. Both hypokalemia and elevated levels of T3 and T4 are important diagnostic features during the acute episode. Treatment of THPP includes nonselective beta-blockade, which prevents the shift of intracellular potassium, and potassium replacement. THPP is curable once a euthyroid state is achieved.

Prioritization of Information Security Controls through Fuzzy AHP for Cloud Computing Networks and Wireless Sensor Networks.

With the advent of cloud computing and wireless sensor networks, the number of cyberattacks has rapidly increased. Therefore, the proportionate security of networks has become a challenge for organizations. Information security advisors of organizations face difficult and complex decisions in the evaluation and selection of information security controls that permit the defense of their resources and assets. Information security controls must be selected based on an appropriate level of security. However, their selection needs intensive investigation regarding vulnerabilities, risks, and threats prevailing in the organization as well as consideration of the implementation, mitigation, and budgetary constraints of the organization. The goal of this paper was to improve the information security control analysis method by proposing a formalized approach, i.e., fuzzy Analytical Hierarchy Process (AHP). This approach was used to prioritize and select the most relevant set of information security controls to satisfy the information security requirements of an organization. We argue that the prioritization of the information security controls using fuzzy AHP leads to an efficient and cost-effective assessment and evaluation of information security controls for an organization in order to select the most appropriate ones. The proposed formalized approach and prioritization processes are based on International Organization for Standardization and the International Electrotechnical Commission (ISO/IEC) 27001:2013. But in practice, organizations may apply this approach to any information security baseline manual.