Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey.

Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. How to cite this article: Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M et al. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023;27(1):38-51.

What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review.

OBJECTIVES: Impairment of cardiac function and arrhythmias often coexist in patients with liver diseases. Many studies have proved this coexistence and put forward various theories toward its pathophysiology. This narrative review tries to find the answers with supporting evidence on five main questions:Do high serum bilirubin levels have a strong association with cardiac arrhythmias?Can corrected QT interval (QTc) be relied upon for predicting a risk factor toward imminent arrhythmias?Is there an association between QTc prolongation and mortality?Are high serum bilirubin and cardiac dysfunction closely associated?What is the probable pathophysiology behind this association? MATERIALS AND METHODS: Clinical evidence was obtained by using search engines, namely, Cochrane Library, PubMed, and Google Scholar. Studies published in journals in the English language, between January 1969 and December 2019, which mentioned the relationship between cardiac arrhythmia and liver disease, were included. We used the keywords: jaundice, bilirubin, arrhythmia, ECG, QTc interval, QT dispersion, liver, and cirrhosis. Relevant animal or human studies answering the five main questions were extracted and reviewed. CONCLUSION: The evidence included in our review sheds light on the fact that approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy (CC) and there has been an association between liver abnormalities and cardiac pathology. The present review also supports that there exists a strong association between high levels of serum bilirubin levels and cardiac arrhythmias, QTc value can be relied upon as a risk factor for predicting imminent arrhythmias, and that it is associated with mortality. Its basic pathophysiology can be explained by the potential action of bile acids in prolonging the QT interval. It also causes cardiac hypertrophy and apoptosis of cardiomyocytes leading to cardiac dysfunction. HOW TO CITE THIS ARTICLE: Arya S, Kumar P, Tiwari B, Belwal S, Saxena S, Abbas H. What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review. Indian J Crit Care Med 2020;24(12):1251-1255.

CATSWoTS: Context Aware Trustworthy Social Web of Things System.

The inevitable revolution of the Internet of Things (IoT) and its benefits can be witnessed everywhere. Two major issues related to IoT are the interoperability and the identification of trustworthy things. The proposed Context-Aware Trustworthy Social Web of Things System (CATSWoTS) addresses the interoperability issue by incorporating web technologies including Service Oriented Architecture where each thing plays the role of a service provider as well as a role of service consumer. The aspect of social web helps in getting recommendations from social relations. It was identified that the context dependency of trust along with Quality of Service (QoS) criteria, for identifying and recommending trustworthy Web of Things (WoT), require more attention. For this purpose, the parameters of context awareness and the constraints of QoS are considered. The research focuses on the idea of a user-centric system where the profiles of each thing (level of trustworthiness) are being maintained at a centralized level and at a distributed level as well. The CATSWoTS evaluates service providers based on the mentioned parameters and the constraints and then identifies a suitable service provider. For this, a rule-based collaborative filtering approach is used. The efficacy of CATSWoTS is evaluated with a specifically designed environment using a real QoS data set. The results showed that the proposed novel technique fills the gap present in the state of the art. It performed well by dynamically identifying and recommending trustworthy services as per the requirements of a service seeker.

MARC: A Novel Framework for Detecting MITM Attacks in eHealthcare BLE Systems.

Real-time and ubiquitous patient monitoring demands the use of wireless data acquisition through resource constrained medical sensors, mostly configured with No-input No-output (NiNo) capabilities. Bluetooth is one of the most popular and widely adopted means of communicating this sensed information to a mobile terminal. However, over simplified implementations of Bluetooth low energy (BLE) protocol in eHealth sector is susceptible to several wireless attacks, in particular the Man-in-the-Middle (MITM) attack. The issue arises due to a lack of mutual authentication and integrity protection between the communicating devices, which may lead to compromise of confidentiality, availability and even the integrity of this safety-critical information. This research paper presents a novel framework named MARC to detect, analyze, and mitigate Bluetooth security flaws while focusing upon MITM attack against NiNo devices. For this purpose, a comprehensive solution has been proposed, which can detect MITM signatures based upon four novel anomaly detection metrics: analyzing Malicious scan requests, Advertisement intervals, RSSI levels, and Cloned node addresses. The proposed solution has been evaluated through practical implementation and demonstration of different attack scenarios, which show promising results concerning accurate and efficient detection of MITM attacks.

Accelerated Dynamic MRI Using Kernel-Based Low Rank Constraint.

We present a novel reconstruction method for dynamic MR images from highly under-sampled k-space measurements. The reconstruction problem is posed as spectrally regularized matrix recovery problem, where kernel-based low rank constraint is employed to effectively utilize the non-linear correlations between the images in the dynamic sequence. Unlike other kernel-based methods, we use a single-step regularized reconstruction approach to simultaneously learn the kernel basis functions and the weights. The objective function is optimized using variable splitting and alternating direction method of multipliers. The framework can seamlessly handle additional sparsity constraints such as spatio-temporal total variation. The algorithm performance is evaluated on a numerical phantom and in vivo data sets and it shows significant improvement over the comparison methods.

A study on the resistance switching of Ag2Se and Ta2O5 heterojunctions using structural engineering.

The resistive random access memory (RRAM) devices with heterostuctures have been investigated due to cycling stability, nonlinear switching, complementary resistive switching and self-compliance. The heterostructured devices can modulate the resistive switching (RS) behavior appropriately by bilayer structure with a variety of materials. In this study, the bipolar resistive switching characteristics of the bilayer structures composed of Ta2O5 and Ag2Se, which are transition-metal oxide (TMO) and silver chalcogenide, were investigated. The bilayer devices of Ta2O5 deposited on Ag2Se (Ta2O5/Ag2Se) and Ag2Se deposited on Ta2O5 (Ag2Se/Ta2O5) were fabricated for investigation of the RS characteristics by stacking sequence of Ta2O5 and Ag2Se. All operating voltages were applied to the Ag top electrode with the Pt bottom electrode grounded. The Ta2O5/Ag2Se device showed that a negative voltage sweep switched the device from high resistance state (HRS) to low resistance state (LRS) and a positive voltage sweep switched the device from LRS to HRS. On the contrary, for the Ag2Se/Ta2O5 device a positive voltage sweep switched the device from HRS to LRS, and a negative voltage sweep switched it from LRS to HRS. The polarity dependence of RS was attributed to the stacking sequence of Ta2O5 and Ag2Se. In addition, the combined heterostructured device of both bilayer stacks, Ta2O5/Ag2Se and Ag2Se/Ta2O5, exhibited the complementary switching characteristics. By using threshold switching devices, sneak path leakage can be reduced without additional selectors. The bilayer heterostructures of Ta2O5 and Ag2Se have various advantages such as self-compliance, reproducibility and forming-free stable RS. It confirms the possible applications of TMO and silver chalcogenide heterostructures in RRAM.

Adaptive Interference Cancellation of ECG Signals.

As an important biological signal, electrocardiogram (ECG) signals provide a valuable basis for the clinical diagnosis and treatment of several diseases. However, its reference significance is based on the effective acquisition and correct recognition of ECG signals. In fact, this mV-level weak signal can be easily affected by various interferences caused by the power of magnetic field, patient respiratory motion or contraction, and so on from the sampling terminal to the receiving and display end. The overlapping interference affects the quality of ECG waveform, leading to the false detection and recognition of wave groups, and thus causing misdiagnosis or faulty treatment. Therefore, the elimination of the interference of the ECG signal and the subsequent wave group identification technology has been a hot research topic, and their study has important significance. Based on the above, this paper introduces two improved adaptive algorithms based on the classical least mean square (LMS) algorithm by introducing symbolic functions and block-processing concepts.

First-principles study of interaction of serine with nucleobases of DNA and RNA.

The nature of interaction between serine-a vital molecule for cancer cell proliferation and nucleic acid bases-adenine (A), guanine (G), cytosine (C), thymine (T), and uracil (U) is investigated within the framework of Møller-Plesset perturbation theory (MP2) and density functional theory (DFT). To quantify the interaction strength between serine and nucleobases, the corresponding binding energies were computed, showing energetic ordering such that G > C > T > A > U. This shows that the interaction energy of serine with guanine is the highest, while with uracil it is the lowest. The amount of charge transferred is the lowest in case of the serine-guanine complex and highest in case of the serine-uracil complex. The results show the serine-guanine complex to be more stable and to have a salt bridge structure involving the -COOH group. Theoretical analysis based on MP2 and DFT shows that the interaction between the serine and nucleobases is mainly determined by hydrogen bonding.

A Survey of Authentication Schemes in Telecare Medicine Information Systems.

E-Healthcare is an emerging field that provides mobility to its users. The protected health information of the users are stored at a remote server (Telecare Medical Information System) and can be accessed by the users at anytime. Many authentication protocols have been proposed to ensure the secure authenticated access to the Telecare Medical Information System. These protocols are designed to provide certain properties such as: anonymity, untraceability, unlinkability, privacy, confidentiality, availability and integrity. They also aim to build a key exchange mechanism, which provides security against some attacks such as: identity theft, password guessing, denial of service, impersonation and insider attacks. This paper reviews these proposed authentication protocols and discusses their strengths and weaknesses in terms of ensured security and privacy properties, and computation cost. The schemes are divided in three broad categories of one-factor, two-factor and three-factor authentication schemes. Inter-category and intra-category comparison has been performed for these schemes and based on the derived results we propose future directions and recommendations that can be very helpful to the researchers who work on the design and implementation of authentication protocols.

Data Privacy in Cloud-assisted Healthcare Systems: State of the Art and Future Challenges.

The widespread deployment and utility of Wireless Body Area Networks (WBAN's) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN's. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient's data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient's data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Results from the review show that most of the patient's data privacy techniques do not fully address the privacy concerns and therefore require more efforts. The summary presented in this paper would help in setting research directions for the techniques and mechanisms that are needed to address the patient's data privacy concerns in a balanced and light-weight manner by considering all the aspects and limitations of the cloud-assisted healthcare systems.

Distributed Denial of Service Attack Source Detection Using Efficient Traceback Technique (ETT) in Cloud-Assisted Healthcare Environment.

Security and privacy are the first and foremost concerns that should be given special attention when dealing with Wireless Body Area Networks (WBANs). As WBAN sensors operate in an unattended environment and carry critical patient health information, Distributed Denial of Service (DDoS) attack is one of the major attacks in WBAN environment that not only exhausts the available resources but also influence the reliability of information being transmitted. This research work is an extension of our previous work in which a machine learning based attack detection algorithm is proposed to detect DDoS attack in WBAN environment. However, in order to avoid complexity, no consideration was given to the traceback mechanism. During traceback, the challenge lies in reconstructing the attack path leading to identify the attack source. Among existing traceback techniques, Probabilistic Packet Marking (PPM) approach is the most commonly used technique in conventional IP- based networks. However, since marking probability assignment has significant effect on both the convergence time and performance of a scheme, it is not directly applicable in WBAN environment due to high convergence time and overhead on intermediate nodes. Therefore, in this paper we have proposed a new scheme called Efficient Traceback Technique (ETT) based on Dynamic Probability Packet Marking (DPPM) approach and uses MAC header in place of IP header. Instead of using fixed marking probability, the proposed scheme uses variable marking probability based on the number of hops travelled by a packet to reach the target node. Finally, path reconstruction algorithms are proposed to traceback an attacker. Evaluation and simulation results indicate that the proposed solution outperforms fixed PPM in terms of convergence time and computational overhead on nodes.

Plasma cell-rich acute rejections in living-related kidney transplantation: a clinicopathological study of 50 cases.

BACKGROUND: Acute rejections (ARs) with plasma cell-rich infiltrates (PCARs) are associated with poor outcomes. PATIENTS AND METHODS: Between February 2012 and December 2013, 1630 dysfunctional renal graft biopsies were performed. Of these, 50 (3%) showed PCAR. ARs with >10% plasma cells were defined as PCAR. Human leukocyte antigen (HLA) antibodies were tested in historic sera and at the time of PCAR. Treatment for PCAR comprised methylprednisolone, antithymocyte globulin, plasmapheresis, and anti-CD20 antibody. RESULTS: Of the 1630 dysfunctional biopsies, 50 (3%) had PCAR which occurred 3.1 ± 2.55 yr after transplant. The percentage of plasma cells was 28.8 ± 11.7, and CD138, 29.0 ± 12.4. Donor-specific antibodies (DSAs) were found in 32 (64%) overall, Class I in 15% and Class II in 65%. Post-treatment serum creatinine improved from 3.80 ± 2.59 to 2.66 ± 1.59 mg/dL in DSA positive (p < 0.003) and from 2.59 ± 1.09 to 2.08 ± 0.86 mg/dL in DSA negative (p < 0.008). One- and two-yr graft survival after PCAR was 72%, 42% in the DSA-positive vs. 89%, 82% in the DSA-negative group, respectively (p = 0.071). CONCLUSIONS: Our results show that PCAR occurs late after transplant and in many cases is associated with DSAs. Graft outcome was poor when PCAR was associated with DSAs.

Postmortem imaging in congenital heart disease: preliminary experience.

BACKGROUND: Despite the importance of the autopsy for quality improvement, autopsy rates have declined dramatically in recent decades due to poor acceptance by families and physicians and high costs to institutions. PURPOSE: To compare postmortem imaging (PMI) with autopsy in patients with congenital heart defects to see if PMI could substitute in some or all cases and to compare costs of the two methods. MATERIAL AND METHODS: Ten patients with congenital heart disease dying in hospital during the study period in whom an autopsy was planned underwent PMI using postmortem magnetic resonance imaging (PMMRI) (6 patients) and postmortem computed tomographic angiography (PMCTA) (10 patients) with permission of the family. Four patients were excluded from PMMR because of metal ECMO cannulas. PMI was interpreted before autopsy using an organ system checklist and results compared to autopsy. The costs of each method were tracked. RESULTS: When both PMMR and PMCTA were performed the PMI findings corresponded closely with autopsy. PMI correctly diagnosed the principal heart defects in all six cases and correctly imaged central vessels, heart valves and chambers, brain, abdominal organs, and bone. Weak points were visualization of the coronary arteries and distinguishing postmortem pulmonary atelectasis from lung pathology. The cause of death by PMI matched autopsy findings in 5/6 cases in which both PMMR and PMCTA were performed and was incomplete in the other five cases. The cost of PMI was about 15% lower than the cost of autopsy. CONCLUSION: PMI provided most gross anatomic cardiac diagnoses available by autopsy in our series of patients with congenital heart defects and the cost appears to be lower.

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial.

BACKGROUND: Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer. METHODS: For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0-2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179. FINDINGS: Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 3·73 months, 95% CI 3·23-4·50, for gefitinib vs 3·67 months, 95% CI 2·97-4·37, for placebo; hazard ratio [HR] 0·90, 95% CI 0·74-1·09, p=0·29). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference -8·61, 95% CI -14·49 to -2·73; n=227; p=0·004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (2·69, 95% CI -2·33 to 7·72, n=231, p=0·293), dysphagia (-3·18, 95% CI -8·36 to 2·00, n=231, p=0·228), and eating (-4·11, 95% CI -9·96 to 1·75, n=229, p=0·168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (1·57 months, 95% CI 1·23-1·90 in the gefitinib group vs 1·17 months, 95% CI 1·07-1·37 in the placebo group; HR 0·80, 95% CI 0·66-0·96, p=0·020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3-4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0·023). INTERPRETATION: The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients. FUNDING: Cancer Research UK.

Distributed denial of service (DDoS) attack in cloud- assisted wireless body area networks: a systematic literature review.

Wireless Body Area Networks (WBANs) have emerged as a promising technology that has shown enormous potential in improving the quality of healthcare, and has thus found a broad range of medical applications from ubiquitous health monitoring to emergency medical response systems. The huge amount of highly sensitive data collected and generated by WBAN nodes requires an ascendable and secure storage and processing infrastructure. Given the limited resources of WBAN nodes for storage and processing, the integration of WBANs and cloud computing may provide a powerful solution. However, despite the benefits of cloud-assisted WBAN, several security issues and challenges remain. Among these, data availability is the most nagging security issue. The most serious threat to data availability is a distributed denial of service (DDoS) attack that directly affects the all-time availability of a patient's data. The existing solutions for standalone WBANs and sensor networks are not applicable in the cloud. The purpose of this review paper is to identify the most threatening types of DDoS attacks affecting the availability of a cloud-assisted WBAN and review the state-of-the-art detection mechanisms for the identified DDoS attacks.

Assessment of Different Indices as Predictors of Difficult Airway in Obese Patients.

Introduction Difficulties with tracheal intubation contribute to the morbidity and mortality associated with anesthesia. Suggested predictors for difficult airway include, history of obstructive sleep apnea, high Mallampati score, elderly, male, short neck, and high Wilson score. However, none of these has high diagnostic accuracy particularly in obese population. Parameters used to quantify obesity such as Body Mass Index(BMI), mid arm circumference, skin fold thickness, etc. have not been used as independent predictors of difficult airway. This study has been designed to evaluate the accuracy of commonly used tools to assess difficult airway and to test other obesity markers as scale for assessing difficult airway i.e. Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3. Aim To assess BMI, Mallampati grading, Neck circumference and Thyromental distance as predictors of difficult airway in obese patients and to validate neck circumference to thyromental distance ratio and skin fold thickness as a tool for assessment of difficult airway (Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3.) in obese patients. Methods This prospective observational study was carried out on 51 obese patients (as per BMI) of ASA grade II, either sex, aged 23 to 57 years posted for elective surgery under general anesthesia with endotracheal intubation. After subjective assessment of difficult airway following data sets and variables were obtained - sex, weight, height, body mass index (BMI), Modified Mallampati class (MPG), Cormack-Lehane (CL) grade, adequacy of bag mask ventilation (BMV), number of endotracheal intubation attempts, patient's neck circumference (NC), thyromental distance (TMD), waist-hip ratio (WHR) and Skin fold thickness. The observations made during the study were statistically analyzed and correlated as predictors for difficult airway. Result Correlation of MPG to CL-grade (r-0.41, p-0.003), BMV (r-0.31, p-0.028) & No. of intubation attempts (r-0.37, p-0.007) was mild & statistically significant. Correlation of Neck Circumference with CL-grade (r-0.57, p-0.000), & No. of intubation attempts (r-0.62, p-0.000), found moderate & statistically significant, & with BMV was mild and statistically significant (r-0.48, p-0.000). Correlation of Thyromental Distance to CL-grade (r-0.65, p-0.000), BMV (r-0.70, p-0.000) & No. of intubation attempts (r-0.61, p-0.000) was moderate & statistically significant. Correlation of BMI to CL-grade (r-0.11, p-0.428), BMV (r-0.04, p-0.757) & No. of intubation attempts (r-0.16, p-0.257) was weak & not significant. Skin Fold Thickness showed no significant association with Difficult airway i.e., CL Grade (p-0.478), BMV (p-0.101), and No. of intubation attempts (p-0.143). Correlation of NC/TMD ratio with BMV (r-0.74, p-0.000), CL-grade (r-0.76, p-0.000), & No. of intubation attempts (r-0.77, p-0.000) was moderate & statistically significant. Conclusion NC, TMD and NC/TMD Ratio depicted a close association with airway difficulty in obese patients. Obesity grade is a risk factor for difficult airway but predictors of obesity including Skin Fold Thickness, individually did not show association with difficult airway (small sample size may be a limiting factor). None of the commonly performed tests alone has proven to be adequate in predicting difficult intubation in the obese population.

Stegomyia indices and pattern recognition of Aedes aegypti (Diptera: Culicidae) in selected agrogeoclimatic zones of Punjab, Pakistan.

Mosquito-borne diseases especially, dengue is gaining currency nowadays in Pakistan. As there is no approved dengue vaccine available worldwide, prevention and control of vector is the only solution amid prevailing circumstances. The present study is a maiden attempt to screen indoor and outdoor breeding containers for the presence of Aedes (Ae.) aegypti larvae from selected study districts of Punjab, Pakistan i.e., Dera Ghazi Khan (DG Khan), Chakwal, and Faisalabad. A total of 384 houses from each study districts were surveyed for a calendar year. Mosquito larvae were collected, preserved, and identified using standard taxonomic keys. House Index (HI), Container Index (CI), and Breteau Index (BI) were estimated. Chi-square analysis was applied to calculate the association between Ae. aegypti larvae and breeding containers. Chakwal was identified with the highest values of Stegomyia indices (HI = 46.61 %, BI = 91.67 %, and CI = 15.28 %) followed by Faisalabad (HI = 34.11 %, BI = 68.75 % and, CI = 13.04 %) and DG Khan (HI = 28.39 %, BI = 68.23 % and, CI = 11.29 %). Earthen jars, tree holes, and water tanks were found significantly (p < 0.05) associated with the abundance of larvae irrespective of the geographical location. However, flower tubs and plastic buckets were found significantly (p < 0.05) associated in Faisalabad and Chakwal while, tyres and plastic bottles were found associated (p < 0.05) with the abundance of Ae. aegypti larvae in Faisalabad and DG Khan. These findings will help the stakeholders to devise appropriate preventive measures in combating the risk of dengue transmission.

Exploring mosquito abundance and Plasmodium infection through nested-PCR: implications for disease surveillance and control.

The Plasmodium is responsible for malaria which poses a major health threat, globally. This study is based on the estimation of the relative abundance of mosquitoes, and finding out the correlations of meteorological parameters (temperature, humidity and rainfall) with the abundance of mosquitoes. In addition, this study also focused on the use of nested PCR (species-specific nucleotide sequences of 18S rRNA genes) to explore the Plasmodium spp. in female Anopheles. In the current study, the percentage relative abundance of Culex mosquitoes was 57.65% and Anopheles 42.34% among the study areas. In addition, the highest number of mosquitoes was found in March in district Mandi Bahauddin at 21 °C (Tmax = 27, Tmin = 15) average temperature, 69% average relative humidity and 131 mm rainfall, and these climatic factors were found to affect the abundance of the mosquitoes, directly or indirectly. Molecular analysis showed that overall, 41.3% of the female Anopheles pools were positive for genus Plasmodium. Among species, the prevalence of Plasmodium (P.) vivax (78.1%) was significantly higher than P. falciparum (21.9%). This study will be helpful in the estimation of future risk of mosquito-borne diseases along with population dynamic of mosquitoes to enhance the effectiveness of vector surveillance and control programs.

Fabrication of Multifunctional Tents Using Canvas Fabric.

Herein, this study was compiled to investigate a suitable solution for the fabrication and development of the multifunctional defense tent from previously reported research. The military always needs to protect their soldiers and equipment from detection. The advancement of infrared detection technology emphasizes the significance of infrared camouflage materials, reducing thermal emissions for various applications. Objects emit infrared radiation detectable by devices, making military targets easily identifiable. Infrared camouflage mitigates detection by lowering an object's infrared radiation, achieved by methods such as reducing surface temperature, which is crucial in designing military tents with infrared (IR) camouflage, considering water repellency and antibacterial features. Water repellency, as well as antimicrobial properties, in army tents is also important as they have to survive in different situations. All these problems should be addressed with the required properties; therefore, the authors try to introduce a new method from which multifunctional tents can be produced through economical, multifunctional, and sustainable materials that have IR protection, water repellency, ultraviolet (UV) protection, air filtration and permeability, and antimicrobial properties. There is still no tent that performs multiple functions at a time, even those functions that do not correlate with each other such as water repellency, IR protection, antimicrobial, and air permeability. So, a multifunctional tent could be the solution to all these problems having all the properties discussed above. In this study based on the literature review, authors concluded a method for the required tent for canvas fabric coated with zinc sulfide (ZnS), graphene oxide (GO), and zinc oxide (ZnO), or these materials should be incorporated in fiber formation because fiber composition has more impact. These multifunctional tents will be very beneficial due to their multifunctions like weather resistance, durability, and long life. These would help the army in their missions by concealing their soldiers and equipment from detection by cameras and providing filtered air inside the tent in case of gases or explosions. The proposed method will help to fulfill the stated and implied needs of customers.

Tumor necrosis factor gene polymorphism results in high TNF level in sepsis and septic shock.

INTRODUCTION: Systemic sepsis releases several cytokines among which tumor necrosis factor alfa (TNFα) has emerged as key cytokine causing septic shock. Single Nucleotide Polymorphisms (SNPs) at positions -238, -308, -376 and +489 in the promoter region of TNF gene exhibit differential association to inflammation and increased TNF production in sepsis. MATERIALS AND METHODS: This research work was carried out in 278 critically ill patients and 115 controls. The patients were divided into four groups: Healthy controls, SIRS, Sepsis and Septic shock. Plasma cytokine level was evaluated by ELISA. Specific sequences of TNF gene (-238, -308, -376, +489) were amplified using polychromase chain reaction (PCR). SNP detected by BamHiI, NcoI, FokI, TaiI restriction enzymes. RESULTS: Mean plasma TNFα level in healthy Control group was 8.37 ± 2.23 pg/ml, in SIRS group, the mean plasma TNFα level was 77.99 ± 5.51 pg/ml, in Sepsis patients 187.1 ± 14.33 pg/ml and in septic shock 202.2 ± 14.85 pg/ml; range 56.17-417.1 pg/ml. SNP was studied among different patient groups, which showed a higher frequency of mutants among sepsis and shock patients as compared to control. CONCLUSION: Plasma TNF alpha level was significantly high in patients with sepsis and septic shock. SNP of TNF gene showed significant association between polymorphism and development of severe sepsis and septic shock, this would help us in evaluating patients at high risk for septic shock and such patients needed to obtain a rational basis for therapy.