Outcome of pediatric living donor liver transplant: Experience from Pakistan; a resource limited setting.

INTRODUCTION: Liver transplantation (LT) has emerged as a lifesaving modality for many liver diseases in children. Pediatric LT is an established treatment in the Western world but is relatively a new procedure in resource-limited countries like Pakistan. The study aims to highlight the outcomes and survival of pediatric recipients from the first pediatric liver transplant center in Pakistan. METHOD: A retrospective analysis of pediatric LT was done from 2012 to 2019. The study was conducted in the Hepatobiliary and liver transplant department of Shifa International Hospital (SIH), Islamabad. A detailed analysis for indications for pediatric LT, survival, and complications was done. RESULTS: Forty-five patients under 18 years of age underwent Living donor liver transplant (LDLT) in SIH. Median age was 9 years and M:F of 2:1. Cryptogenic liver disease followed by Wilson disease were the two most common indications of LT. The majority of patients had chronic liver disease 34 (75%) while 11 (24%) had acute liver failure. The right lobe graft was the most common type of graft 19 (42.2%). Thirty days, 1-year, 3-year, and 5-year survival was 77.8%, 75.6%, 73.3%, and 60.6% respectively. Mortality was highest in patients with biliary atresia 4 (33%). Causes of death included pulmonary embolism, sepsis, surgical complications, and acute kidney injury. Mean survival was 88.850 months (±7.899) (CI 73.369-104.331). CONCLUSION: Pediatric LDLT has offered disease-free survival for patients. Survival can improve further with nutritional rehabilitation and anticipation and management of post-operative complications.

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses.

BACKGROUND: Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people's access or intention to healthcare systems. OBJECTIVE: To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. METHODS: Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. RESULT: There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. CONCLUSIONS: COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.

Visual Sentiment Analysis from Disaster Images in Social Media.

The increasing popularity of social networks and users' tendency towards sharing their feelings, expressions, and opinions in text, visual, and audio content have opened new opportunities and challenges in sentiment analysis. While sentiment analysis of text streams has been widely explored in the literature, sentiment analysis from images and videos is relatively new. This article focuses on visual sentiment analysis in a societally important domain, namely disaster analysis in social media. To this aim, we propose a deep visual sentiment analyzer for disaster-related images, covering different aspects of visual sentiment analysis starting from data collection, annotation, model selection, implementation, and evaluations. For data annotation and analyzing people's sentiments towards natural disasters and associated images in social media, a crowd-sourcing study has been conducted with a large number of participants worldwide. The crowd-sourcing study resulted in a large-scale benchmark dataset with four different sets of annotations, each aiming at a separate task. The presented analysis and the associated dataset, which is made public, will provide a baseline/benchmark for future research in the domain. We believe the proposed system can contribute toward more livable communities by helping different stakeholders, such as news broadcasters, humanitarian organizations, as well as the general public.

Post-operative endophthalmitis after immediate sequential bilateral cataract Surgery: A retrospective study from Pakistan.

OBJECTIVE: To assess the frequency of post-operative complications after immediate sequential bilateral cataract surgery. METHODS: The retrospective study was conducted at the department of surgery/section of ophthalmology, Aga Khan University Hospital, Karachi, and comprised data of patients who underwent immediate sequential bilateral cataract surgery between January 1, 2009, and December 31, 2018. A structured proforma was used to collect data. The primary outcome measure was the incidence of endophthalmitis. Data was analysed using SPSS 23. RESULTS: Of the 352 patients identified, data of 298(84.6%) patients (596 eyes) was analysed. The mean age of the sample was 33.14±25.83 years, with 117(39.26 %) subjects aged <16 years and 181(60.73) aged >16 years. Best-corrected visual acuity improved from -0.5650±8.2027 to -0.0043±4.05. Among 596 eyes, there was no case of unilateral or bilateral post-operative endophthalmitis at 6-week follow-up. CONCLUSIONS: Immediate sequential bilateral cataract surgery was found to be a safe procedure in selected patients undergoing cataract surgery in a low-middle income country.

An Automated System for Classification of Chronic Obstructive Pulmonary Disease and Pneumonia Patients Using Lung Sound Analysis.

Chronic obstructive pulmonary disease (COPD) and pneumonia are two of the few fatal lung diseases which share common adventitious lung sounds. Diagnosing the disease from lung sound analysis to design a noninvasive technique for telemedicine is a challenging task. A novel framework is presented to perform a diagnosis of COPD and Pneumonia via application of the signal processing and machine learning approach. This model will help the pulmonologist to accurately detect disease A and B. COPD, normal and pneumonia lung sound (LS) data from the ICBHI respiratory database is used in this research. The performance analysis is evidence of the improved performance of the quadratic discriminate classifier with an accuracy of 99.70% on selected fused features after experimentation. The fusion of time domain, cepstral, and spectral features are employed. Feature selection for fusion is performed through the back-elimination method whereas empirical mode decomposition (EMD) and discrete wavelet transform (DWT)-based techniques are used to denoise and segment the pulmonic signal. Class imbalance is catered with the implementation of the adaptive synthetic (ADASYN) sampling technique.

Acute syphilitic posterior placoid chorioretinopathy: A case report.

A 25-year-old male presented with a complaint of acute visual loss in his right eye for two days. There was a history of visual loss in the left eye six months ago. Comprehensive eye examination showed evidence of posterior uveitis, and a placoid lesion on the right fundus. Further physical examination showed maculopapular rashes on the upper back which was highly suggestive of syphilis. Blood tests for venereal disease research laboratory (VDRL) test and fluorescent treponemal antibody absorption (FTA-ABS) test were ordered, which were both positive. Ocular syphilis should be suspected in all cases of uveitis. Early diagnosis and prompt treatment with appropriate antibiotics can prevent permanent visual loss.

Nottingham Hip Fracture Score as a predictor of 3 months postoperative mortality in patients undergoing surgical fixation of hip fractures: A prospective study.

OBJECTIVE: Nottingham Hip Fracture Score was utilized to evaluate its efficacy to identify high risk pateints interms of 3 months postoperative mortality.NHFS comprises of seven independent predictors that were incorporated into a risk score to identify patients who were high risk for post-operative mortality with hip fracture.. METHODS: NHFS was prospectively calculated for 88 patients who underwent surgeries for hip fracture from 25th December 2014 to 25th June 2015 at the Indus Hospital Karachi. Both neck of femur and Intertrochanteric fracture were included. NHFS of ≤4 was considered as low risk and a score of ≥5 as high risk for mortality. RESULTS: The 3 months post-operative mortality was 22%. Increase in number of mortality was observed in patients who belonged to the high risk (NHFS ≥5) group, with statistically significant relationship when compared with the low risk (NHFS ≤4) group (p=0.01). CONCLUSIONS: NHFS can be used to predict the risk of 3 months postoperative mortality in patients undergoing hip fracture surgery.

Development and validation of RP-HPLC method for simultaneous determination of cefpodoxime proxetil and H2 receptor antagonists in pharmaceutical dosage forms.

A new method on RP-HPLC is devised and validated, as per ICH guidelines, for the synchronous estimation of cefpodoxime proxetil and H2-receptor antagonits that are Cimetidine, Famotidine and Ranitidine. The method is simple, accurate, expeditious, reproducible, robust and precise. Chromatography was done on a C18 (250 x 4.6mm) column with methanol: water as mobile phae in the ratio of 70:30 (v/v), pumped at a flow rate of 1ml/min and pH was maintained using 85% ortho-phosphoric acid at 3. The λ max 240 nm was preferred for UV detection. A good linear relationship was attained, over the concentration ranges of 20-70 µg/ml and 5-30µg/ml, for cefpodoxime proxetil and H2 blockers respectively, with a correlation coefficient of R= 0.9987 to 0.9992. The method was validated and found precised (i.e. intra day and interday analysis) with RSD <2%. LOD and LOQ observations were under 0.4806 to 2.6069µg/ml which proved the method to be sensitive. The method provided satisfactory results of robustness and reproducibility, when validated and applied successfully for analysis of dosage forms.

Development of quality standard and phytochemical analysis of Carica papaya Linn leaves.

Carica papaya Linn is the member of Caricaceae family of Kingdom Plantae. The study was executed for the development of qualitative standards of male and female leaves of the plant. The study included evaluation of macroscopial, physico-chemical and preliminary phytochemical parameters to authorize the purity and authenticity of leaf of Carica papaya Linn based on guidelines provided by WHO. Qualitative phytochemical screening of extracts revealed the existence of alkaloids, flavonoids, tannins, phenolic compounds, glycosides including cardiac glycosides, proteins and carbohydrate in different extracts of Carica papaya Linn which are majorly rich in female leaves as compared to male. Mean ash values, acid insoluble ash, water soluble ash, foaming index, swelling index and moisture contents were also evaluated which are more or less similar. FTIR profile of the samples were also generated that confirmed distinct peak values with respective functional groups exhibited by Carica papaya male and female plant. The current research reflected that female and male plant showed variations in phyto-constituents. This data will be utilized for additional Pharmacological and Instrumental evaluation of the plant which can not only be beneficial in discriminating and refining the type as well as nature of various phytochemicals present in Carica papaya male and female leaves but also establish the quality standards for future researches.

Using an AI-based avatar for interviewer training at Children's Advocacy Centers: Proof of Concept.

This proof-of- concept study focused on interviewers' behaviors and perceptions when interacting with a dynamic AI child avatar alleging abuse. Professionals (N = 68) took part in a virtual reality (VR) study in which they questioned an avatar presented as a child victim of sexual or physical abuse. Of interest was how interviewers questioned the avatar, how productive the child avatar was in response, and how interviewers perceived the VR interaction. Findings suggested alignment between interviewers' virtual questioning approaches and interviewers' typical questioning behavior in real-world investigative interviews, with a diverse range of questions used to elicit disclosures from the child avatar. The avatar responded to most question types as children typically do, though more nuanced programming of the avatar's productivity in response to complex question types is needed. Participants rated the avatar positively and felt comfortable with the VR experience. Results underscored the potential of AI-based interview training as a scalable, standardized alternative to traditional methods.

Informed consent in balloon Eustachian tuboplasty: a systematic review of possible complications and preventive measures.

OBJECTIVE: To systematically identify the complications associated with balloon Eustachian tuboplasty and their frequency of occurrence. This study will also highlight the measures that can be employed to avoid these complications and perform this procedure more safely. METHODS: Systematically reviewed relevant papers published until January 2023. Each reference was checked and evaluated for any potential manuscripts. There was no registered protocol; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. RESULTS: Sixty-nine publications were found, from which 14 publications met our inclusion criteria: 2 randomised clinical trials, 5 retrospective studies, 2 systematic reviews, 2 case series and 3 case reports. Studies with balloon Eustachian tuboplasty procedure only were included, regardless of ethnicity, gender and age. All studies were excluded in which more than one procedure was performed. CONCLUSION: Balloon Eustachian tuboplasty is a relatively safe procedure with an overall complication risk of 1.66 per cent. Major complication rate was 0.43 per cent. Surgical emphysema was the most common, around 0.40 per cent.

Relationship of Gender With Laser Retinopexy for Retinal Breaks.

PURPOSE: To explore the relationship of gender with laser retinopexy for retinal breaks in the Pakistani population. MATERIALS AND METHODS: This was a 10-year retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients who underwent laser retinopexy between January 2009 and December 2018 for a retinal tear or high-risk retinal degeneration (such as lattice degeneration) were included in this study. Data were collected from patients' files. Index eyes with a history of or treatment for retinal detachment were excluded. A structured pro forma was used to collect information. Descriptive statistics were used to explore the relationship between gender and laser retinopexy. RESULTS: We identified 12,457 patients through the coding system of our hospital who underwent various laser procedures from January 2009 to December 2018. Yttrium aluminium garnet (YAG) laser, laser peripheral iridotomy (PI), and laser trabeculoplasty procedures were all excluded. A total of 3,472 patients' files were reviewed for this study, out of which 958 patients met the inclusion criteria. Males accounted for a higher number (n=515, 53.87%). The mean age was 43.99±15.37 years. For exploratory analysis, participants were divided into five age groups: <30 years (24.16%); 31-40 years (16.59%); 41-50 years (19.45%); 51-60 years (26.40%); and >60 years (13.49%). Bilateral laser retinopexy was performed in 48.12% of patients; 24.79% and 27.13% of patients underwent unilateral laser retinopexy for the right and left eyes, respectively. CONCLUSION: In our cohort study, laser retinopexy was more commonly performed in men than in women. The ratio was not significantly different from the prevalence of retinal tears and retinal detachment in the general population, which has a slightly higher male preponderance. We did not find evidence of significant gender bias among patients who underwent laser retinopexy in our study.

Rare Cause of Skull Base Osteomyelitis: A Challenging Diagnosis and Management With a Literature Review.

This is a case of skull base osteomyelitis (SBO) caused by a rare fungal species, Scedosporium apiospermum. This is a clinical case report with a review of the literature. SBO is a potentially life-threatening infection of the temporal bone. The patient presented to our hospital with a two-month history of left otalgia, otorrhea and reduced hearing, after failed initial intravenous antibiotic therapy. Thorough examination and further investigation confirmed the diagnosis of SBO caused by a rare fungal species, S. apiospermum. The patient was subsequently started on a long-term course of antifungals which led to an improvement of symptoms. This case highlights the importance of early recognition and considering early antifungal treatment in patients with persistent otalgia and otorrhea, particularly in those who have failed to respond to intravenous antibiotics. Further research is needed to better understand the optimal timing and duration of antifungal therapy in these patients.

Enhancing investigative interview training using a child avatar system: a comparative study of interactive environments.

The impact of investigative interviews by police and Child Protective Services (CPS) on abused children can be profound, making effective training vital. Quality in these interviews often falls short and current training programs are insufficient in enabling adherence to best practice. We present a system for simulating an interactive environment with alleged abuse victims using a child avatar. The purpose of the system is to improve the quality of investigative interviewing by providing a realistic and engaging training experience for police and CPS personnel. We conducted a user study to assess the efficacy of four interactive platforms: VR, 2D desktop, audio, and text chat. CPS workers and child welfare students rated the quality of experience (QoE), realism, responsiveness, immersion, and flow. We also evaluated perceived learning impact, engagement in learning, self-efficacy, and alignment with best practice guidelines. Our findings indicate VR as superior in four out of five quality aspects, with 66% participants favoring it for immersive, realistic training. Quality of questions posed is crucial to these interviews. Distinguishing between appropriate and inappropriate questions, we achieved 87% balanced accuracy in providing effective feedback using our question classification model. Furthermore, CPS professionals demonstrated superior interview quality compared to non-professionals, independent of the platform.

Enhancing questioning skills through child avatar chatbot training with feedback.

Training child investigative interviewing skills is a specialized task. Those being trained need opportunities to practice their skills in realistic settings and receive immediate feedback. A key step in ensuring the availability of such opportunities is to develop a dynamic, conversational avatar, using artificial intelligence (AI) technology that can provide implicit and explicit feedback to trainees. In the iterative process, use of a chatbot avatar to test the language and conversation model is crucial. The model is fine-tuned with interview data and realistic scenarios. This study used a pre-post training design to assess the learning effects on questioning skills across four child interview sessions that involved training with a child avatar chatbot fine-tuned with interview data and realistic scenarios. Thirty university students from the areas of child welfare, social work, and psychology were divided into two groups; one group received direct feedback (n = 12), whereas the other received no feedback (n = 18). An automatic coding function in the language model identified the question types. Information on question types was provided as feedback in the direct feedback group only. The scenario included a 6-year-old girl being interviewed about alleged physical abuse. After the first interview session (baseline), all participants watched a video lecture on memory, witness psychology, and questioning before they conducted two additional interview sessions and completed a post-experience survey. One week later, they conducted a fourth interview and completed another post-experience survey. All chatbot transcripts were coded for interview quality. The language model's automatic feedback function was found to be highly reliable in classifying question types, reflecting the substantial agreement among the raters [Cohen's kappa (κ) = 0.80] in coding open-ended, cued recall, and closed questions. Participants who received direct feedback showed a significantly higher improvement in open-ended questioning than those in the non-feedback group, with a significant increase in the number of open-ended questions used between the baseline and each of the other three chat sessions. This study demonstrates that child avatar chatbot training improves interview quality with regard to recommended questioning, especially when combined with direct feedback on questioning.

Ototoxicity of Topical Antibiotic Ear Drops in Chronic Suppurative Otitis Media in Humans: A Review of the Literature.

An electronic search of the literature was performed for reported cases of ototoxicity associated with the use of topical antibiotic ear drops in humans. The dosage, duration, and type of ototoxic preparations involved were recorded. Due to the scant quantity of low-quality information that is currently available, there was uncertainty about the usefulness of topical antibiotics in enhancing the resolution of ear discharge in patients with chronic suppurative otitis media. However, despite this uncertainty, there are some data to show that using topical antibiotics in comparison to a placebo or in conjunction with a systemic antibiotic may be useful. Additionally, there is ambiguity regarding the relative efficacy of various kinds of antibiotics; it is impossible to say with absolute certainty whether quinolones are superior to or inferior to aminoglycosides. Although the adverse impact profiles of these two classes of chemicals varied, there are not enough data from the included trials to draw any conclusions about them. Negative effects were generally underreported.

Embedded system design for classification of COPD and pneumonia patients by lung sound analysis.

Chronic obstructive pulmonary disease (COPD) and pneumonia are lethal pulmonary illnesses with equivocal nature of abnormal pulmonic acoustics. Using lung sound signals, the classification of pulmonary abnormalities is a difficult task. A standalone system was conceived for screening COPD and Pneumonia patients through signal processing and machine learning methodologies. The proposed system will assist practitioners and pulmonologists in the accurate classification of disease. In this research work, ICBHI's and self-collected lung sound (LS) databases are used to investigate COPD and pneumonia patient. In this scheme, empirical mode decomposition (EMD), discrete wavelet transform (DWT), and analysis of variance (ANOVA) techniques are employed for segmentation, noise elimination, and feature selection, respectively. To overcome the inherent limitation of ICBHI's LS database, the adaptive synthetic (ADASYN) sampling technique is used to eradicate class imbalance. Lung sound features are used to train fine Gaussian support vector machine (FG-SVM) for classification of COPD, pneumonia, and heathy healthy subjects. This machine learning scheme is implemented on low cost and portable Raspberry pi 3 model B+ (Cortex-A53 (ARMv8) 64-bit SoC @ 1.4 GHz through hardware-supported language. Resultant hardware is capable of screening COPD and pneumonia patients accurately and assist health professionals.

Migratory Foreign Bodies in the Aerodigestive Tract: The Importance of CT Imaging.

Accidental ingestion of foreign bodies forms a major part of otorhinolaryngological emergencies. It is dangerous, as the foreign bodies tend to perforate the aerodigestive tract. Since endoscopy is diagnostic as well as therapeutic, it is preferred over computed tomography (CT) scan, especially in developing countries. We present a case of a middle-aged man who presented with fever, neck swelling, and a five-day history of accidental ingestion of a foreign body. He underwent upper gastrointestinal endoscopy, which came out as normal. CT) imaging was performed, which showed migration of the foreign body to the parapharyngeal space and resulting abscess formation. The abscess was drained, and the foreign body was removed transcervically. We discuss this case to stress the role of CT imaging in the diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for the management of such cases. Upper gastrointestinal endoscopy alone would be insufficient to diagnose perforating and migrating foreign bodies, which may cause severe complications if left undiagnosed.

A Prolonged History of Denture Impaction for 12 Weeks In Situ.

Foreign body ingestion has serious consequences if left untreated. Impacted dentures for a prolonged period can lead to life-threatening complications. Therefore, prompt diagnosis and immediate intervention are lifesaving. Our patient presented to his local accident and emergency department after having swallowed his dentures during a meal. Initial investigations and workup detected no abnormalities and he was discharged back to the community. Twelve weeks following ingestion, he had developed dysphagia and weight loss which prompted an urgent referral for oesophago-gastro-duodenoscopy (OGD). This identified the dentures impacted within the upper oesophagus and initial attempts at removal were unsuccessful, therefore he required hospital admission for alternative feeding in the interim. A joint procedure with the Ear, Nose and Throat and upper gastrointestinal surgeons was carried out to successfully remove the dentures endoscopically. The patient made an immediate recovery, resuming his normal oral diet with appropriate follow up after discharge. It is suspected our patient had an impacted denture for a period of 12 weeks without sustaining any life-threatening complications, which makes this case rather unique. This case highlights the importance of thorough and careful clinical history taking and examination.

Aseptic meningitis after 20 years of endoscopic transsphenoidal pituitary surgery: a rare complication.

A transsphenoidal surgical (TSS) approach is used for pituitary gland surgery involving pituitary adenomas, as well as for the biopsy of various neurosurgical tumors. TSS, although a relatively safe procedure, can lead to complications like hypopituitarism, visual impairment, nasal septal perforation, diabetes insipidus, carotid artery injury, and cerebrospinal fluid (CSF) leaks. Aseptic meningitis is also one of the complications of this procedure with an incidence of 1-2%, presenting with symptoms similar to bacterial meningitis, but with a low-grade fever of <102 F or even apyrexia. Here, we present a rare case of aseptic meningitis due to CSF leakage, presenting after 20 years of endoscopic surgery. A ventriculoperitoneal shunt was placed to stem the leak after two unsuccessful attempts of endonasal repair.