Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study.

PURPOSE: This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. METHODS: A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. RESULTS: Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. CONCLUSION: This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.

"Seasonal Dynamics in Burn Profiles: A Comprehensive Analysis at the Burn Care Centre, Islamabad."

Seasons have a major impact on the frequency and characteristics of burn injuries; in warmer months, thermal burns from outdoor activities are more common, while in cooler months, incidents involving heating sources and fires are more common. It is essential to comprehend these trends in order to customise safety precautions and awareness initiatives. Studies on the impact of seasonal variations help burn centres allocate resources more effectively in order to prepare for variations in patient volume and severity. Data from January 2016 to December 2022, with an emphasis on burn types excluding non-burn cases, were analysed retrospectively over a seven-year period at the Burn Care Centre in PIMS, Islamabad. The research examined hospital stays, demographics, burn causes, admissions, total burned surface area, and death rates while dividing the years into winter and summer seasons for analysis. With 4,014 admitted patients, the study found that winter admissions increased by 11.007%, with winter admissions accounting for 55.503% of all admissions and summer admissions for 44.496%. The gender distribution stayed the same, with 54.59% of the population being male and 45.99% being female. Hospital stays were longer for summer admissions (16.428) than for winter admissions (11.285). Summertime saw a rise in electric burn cases (307 cases), with a 43 case fatality rate. With 1699 cases, flame burns predominated in the epidemiology of burns, followed by scald burns with 1384 cases. In conclusion, seasonal differences have a substantial impact on burn profiles, with winter seeing a marked rise in occurrences. Men are also more likely to sustain electric burns, particularly in the summer. Effective management and prevention techniques depend on an understanding of these patterns.

Achieving optimal balance: tuning electrical and optical characteristics of carbon electrodes for emerging photovoltaics.

Transparent and conductive electrodes (TCEs) are essential for various optoelectronic and photovoltaic applications, but they often require expensive and complex fabrication methods. In this paper, a unique low-cost, eco-friendly, and scalable method of fabricating TCEs using spray-coated carbon ink is investigated. Firstly the carbon particles used for this process underwent a size reduction from 20 microns to 0.96 microns via ball milling. Then ink was prepared by mixing graphite powder (for conductivity), ethyl cellulose (for viscosity), and toluene (for solubility) with different weight-per-volume ratios (w/v) of 5%, 10%, and 15%. The TCEs were fabricated by spray coating the ink onto glass substrates using an airbrush. The sheet resistance (Ω sq-1) and transparency (%) of the TCEs were measured by a digital multimeter (DMM) probe method and a UV-vis spectrophotometer, respectively. The sheet resistance of the TCEs decreased linearly from 60 to 20 Ω sq-1, while the transparency decreased exponentially from 37.18% to 18.88% as the ink concentration increased from 5% to 15% w/v. This paper also reports the reflectance and absorbance values for each ink concentration. The results demonstrate that spray-coated carbon ink TCEs achieve sheet resistance and transparency values of 20 Ω sq-1 and 18.88%, respectively, with low-cost and eco-friendly materials and methods, which are desirable for optoelectronic and photovoltaic applications. These TCEs can play an important role as electrodes in semi-transparent perovskite cells enhancing their stability and overall efficiency.

Applying a Random Encounter Model to Estimate the Asiatic Black Bear (Ursus thibetanus) Density from Camera Traps in the Hindu Raj Mountains, Pakistan.

Estimating the population density of vulnerable species, such as the elusive and nocturnal Asiatic black bear (Ursus thibetanus), is essential for wildlife conservation and management. We used camera traps and a Random Encounter Model (REM) to estimate the population density of U. thibetanus during the autumn and winter seasons in the Hindu Raj Mountains. We installed 23 camera traps from October to December 2020 and acquired 66 independent pictures of Asiatic black bears over 428 trap nights. Our results showed that the bears preferred lowland areas with the presence of Quercus spp. We estimated, using the REM, a population density of U. thibetanus of 1.875 (standard error = 0.185) per square kilometer, which is significantly higher than that in other habitats. Our results showed that during autumn and winter, the bear population density tends to concentrate at lower elevations. Forest cover showed a positive correlation with the rates of bear encounters unlike the Euclidean distance to human settlements, altitude, and aspect variables. The approaches used here are cost-effective for estimating the population density of rare and vulnerable species such as U. thibetanus, and can be used to estimate their population density in Pakistan. Population density estimation can identify areas where the bears live and human-bear conflicts occurred and use this information in future wildlife management plans.

Resilient event-triggered observer-based control of non-linear systems under denial-of-service attacks with actuator saturation.

This paper studies the control problem for a continuous-time networked system with non-linearity in the state equation as well as in the input, as saturation. The system is considered under denial-of-service (DoS), attacks which cause the blockage of input and/or output components in the overall closed-loop model. An event-triggering scheme that is resilient in nature, along with an observer-based control, has been considered under DoS attacks. The resultant scheme ensures efficient network resources and excludes Zeno behavior naturally due to the presence of a minimum positive interevent delay. Then, an event-based switched non-linear model is presented to address both the event-triggering scheme and the presence of DoS blocking attacks. A piece-wise Lyapunov-Krasovskii functional method on the described non-linear model, resulting in the switched system, is considered for achieving an exponentially stable response by driving the required feasibility conditions. In the presence of a non-linear system with saturation in the actuator, the presented design establishes quantitative relationships among the exponential decay rate, active/sleeping intervals of attacks, parameters of the event-triggering condition, and sampling period of the system. After that, linear matrix inequalities are presented for designing an event-triggered controller with an observer, while the design also includes the region of convergence for dealing with the input non-linearity. Finally, comparative results for an offshore structure model with non-linearity in states as well as in actuator, are demonstrated to verify the results of the control scheme that is developed. It has been verified that our design is less conservative than the previous designs, and can handle the non-linearities in the dynamics of plant and actuator saturation more efficiently, while DoS attacks are also present. By applying our proposed method, the overshoot and undershoot are less than ±2.5 percent, while system states converge to the origin within 55 s.

Hematological Trends in Severe Burn Patients: A Comprehensive Study for Prognosis and Clinical Insights.

Severe burn injuries pose diagnostic challenges, contributing to increased fatality rates with delayed diagnoses. This study aims to identify early risk factors and understand their impact on clinical outcomes by examining hematological dynamics in severe burn cases. The focus includes age-related patterns, Total Body Surface Area (TBSA) affected by burns, hospital stay duration, and changes in hematological markers during burn injuries. An analytical cross-sectional study at the Burn Care Centre involved 135 participants hospitalized between January 2018 and December 2021. Demographic data and hematological markers were recorded, with statistical analysis using IBM SPSS 25.0. Non-survivors exhibited a greater mean TBSA, shorter hospital stay, and an enhanced early immune response indicated by WBC count on the first day. Hematological markers, including HGB, RCC, and PLT, showed dynamic patterns over the study period. Marginal variations in platelet counts and intriguing patterns in RCC suggested potential consequences like disseminated intravascular coagulation. The study provides crucial insights into hematological responses to severe burn injuries. Early identification of risk factors, particularly age-related patterns and immune responses, informs clinicians about predicting outcomes and guiding therapeutic interventions. Despite limitations, this work underscores the need for further multi-center research to comprehensively understand the complex relationships between burn injuries, hematological responses, and clinical outcomes.

A novel output feedback consensus control approach for generic linear multi-agent systems under input saturation over a directed graph topology.

This paper considers an output feedback consensus control approach for the generic linear multi-agent systems (MASs) under input saturation over a directed graph. A region of stability-based approach has been established for dealing with the input saturation. A conventional Luenberger observer for estimating the states of followers by themselves and an advanced cooperative observer for estimating the state of leader by followers have been applied for an estimated state feedback control. The stability conditions have been derived by considering a three-term-based combined Lyapunov function. Moreover, computationally simple controller and estimator design conditions have been obtained by resorting to a decoupling approach A set of initial conditions has been investigated to achieve the leader-following consensus of MASs under the input saturation constraint. To the best of our knowledge, an output feedback consensus approach, providing a consensus region, for generic linear MASs under input saturation over directed graphs without requiring the exact state of the leader has been explored for the first time. In contrast to the existing methods, the proposed approach considers an output feedback approach (rather than the state feedback), accounts for both linear and nonlinear saturation regions, applies an estimate of the state of the leader through cooperative observer, and is based on a generalized sector condition for the saturation nonlinearity. In addition, it offers a computationally simple design solution owing to the proposed decoupling method. Simulation results are provided to validate the efficacy of the designed protocol for F-18 aircraft and unmanned ground vehicles.

Micro and Nanoporous Membrane Platforms for Carbon Neutrality: Membrane Gas Separation Prospects.

Recently, carbon neutrality has been promoted as a potentially practical solution to global CO2 emissions and increasing energy-consumption challenges. Many attempts have been made to remove CO2 from the environment to address climate change and rising sea levels owing to anthropogenic CO2 emissions. Herein, membrane technology is proposed as a suitable solution for carbon neutrality. This review aims to comprehensively evaluate the currently available scientific research on membranes for carbon capture, focusing on innovative microporous material membranes used for CO2 separation and considering their material, chemical, and physical characteristics and permeability factors. Membranes from such materials comprise metal-organic frameworks, zeolites, silica, porous organic frameworks, and microporous polymers. The critical obstacles related to membrane design, growth, and CO2 capture and usage processes are summarized to establish novel membranes and strategies and accelerate their scaleup.

Domestic Cylinder Blasts: A Neglected Torpedo.

High-pressure cylinders are used to store liquefied petroleum gas (LPG). An instant and swift explosion of these cylinders can result in serious burn injuries. This current research was conducted to study the epidemiological characteristics of LPG-related burns to highlight a major public health issue. Analysis was conducted on patients with LPG-related burns over a span of 10 years admitted to our center between January 2011 and December 2020. The data recorded included demographic features, site of burn, %TBSA, associated injuries, and outcomes. The variable data were documented for every patient in a Microsoft Excel file and analyzed by IBM SPSS version 25.0. Over the span of 10 years, 678 patients were affected by LPG-related accidents. The peak incidence was seen in 2019 when there was a surge to 18.03%. The patient's age ranged from 1 to 79 years, with a median of 40.86 ± 15.27 years. Of the 678 patients, 52.50% were males and 47.50% were females. The majority (57.96%) of patients had a total BSA of >60% and 86.72% were diagnosed with inhalation injury. The majority of burns (84.66%) occurred at home. The mean hospital stay was 24.5 days. The total mortality rate was 59.58%. This study concludes that LPG cylinder blast is a preventable cause that can be minimized by making people aware of its safe use and by arranging awareness programs at every national level.

Improving the Device Performance of CZTSSe Thin-Film Solar Cells via Indium Doping.

Cation incorporation emerges as a promising approach for improving the performance of the kesterite Cu2ZnSn(S,Se)4 (CZTSSe) device. Herein, we report indium (In) doping using the chemical bath deposition (CBD) technique to enhance the optoelectronic properties of CZTSSe thin-film solar cells (TFSCs). To incorporate a small amount of the In element into the CZTSSe absorber thin films, an ultrathin (<10 nm) layer of In2S3 is deposited on soft-annealed precursor (Zn-Sn-Cu) thin films prior to the sulfo-selenization process. The successful doping of In improved crystal growth and promoted the formation of larger grains. Furthermore, the CZTSSe TFSCs fabricated with In doping exhibited improved device performance. In particular, the In-CZTSSe-2-based device showed an improved power conversion efficiency (PCE) of 9.53%, open-circuit voltage (Voc) of 486 mV, and fill factor (FF) of 61% compared to the undoped device. Moreover, the small amount of In incorporated into the CZTSSe absorber demonstrated reduced nonradiative recombination, improved carrier separation, and enhanced carrier transport properties. This study suggests a simple and effective way to incorporate In to achieve high efficiency and low Voc loss.

Review on microgrids design and monitoring approaches for sustainable green energy networks.

Microgrids are power distribution systems that can operate either in a grid-connected configuration or in an islanded manner, depending on the availability of decentralized power resources, such as sustainable or non-sustainable power sources, battery backup systems, and power demands. The extensive adoption of inverter-based systems poses numerous technological challenges, necessitating a centralized management system to assure the system reliability and monitoring of the energy delivery networks. Thus, this research begins by highlighting these significant obstacles and then analyzes the present-day advances in multilevel control architecture for delivering on promised functionality. This article also discusses the development of innovative control technologies, such as introducing collaborative distributed approaches and reducing conventional three-stage patriarchal administration to fewer stages of system integration and functioning.

Efficacy and safety of itopride SR for upper gastrointestinal symptoms in patients with diabetic gastroparesis: real-world evidence from Pakistan.

Background: Gastroparesis is a serious condition that can be caused by diabetes, surgery or infection, or can be idiopathic. When there is no mechanical obstruction, gastroparesis is characterized by delayed stomach emptying. Itopride, a prokinetic drug, inhibits acetylcholinesterase activity in addition to antagonizing dopamine D2 receptors. Methods: This prospective, multicentre study is based on real-world data from 988 patients with a diagnosis of diabetic gastroparesis for index (PAGI-SYM2) evaluation at baseline and week 4 of treatment for upper gastrointestinal disorder symptoms. Results: Upper gastrointestinal symptom severity scores improved significantly after 4 weeks of treatment (p<0.001), with significant improvement across all categories of gastroparesis (very mild (37-58.6%), mild degree (24.6-31.6%), moderate (29.3-7.3%) and severe (8.8-2.6%). Conclusion: Itopride SR (Nogerd SR) in a 150 mg once-daily dose showed promising results in reducing the severity of upper gastrointestinal disorder symptoms associated with diabetic gastroparesis. Both statistical and clinical effectiveness were observed. Moreover, the treatment demonstrated a favourable tolerability profile, with a low incidence of adverse effects.

Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

BACKGROUND AND AIM: While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. METHODS: This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. RESULTS: Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the second week of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. CONCLUSIONS: The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Smart capsules for sensing and sampling the gut: status, challenges and prospects.

Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including the measurement of gut physiological parameters such as temperature, pH, pressure and gas sensing, and the development of sampling devices for better insight into gut health. In this review, the status of smart capsules for sensing gut parameters is presented to provide a broad picture of these state-of-the-art devices while focusing on the technical and clinical challenges the devices need to overcome to realise their value in clinical settings. Smart capsules are developed to perform sensing operations throughout the length of the gut to better understand the body's response under various conditions. Furthermore, the prospects of such sensing devices are discussed that might help readers, especially health practitioners, to adapt to this inevitable transformation in healthcare. As a compliment to gut sensing smart capsules, significant amount of effort has been put into the development of robotic capsules to collect tissue biopsy and gut microbiota samples to perform in-depth analysis after capsule retrieval which will be a game changer for gut health diagnosis, and this advancement is also covered in this review. The expansion of smart capsules to robotic capsules for gut microbiota collection has opened new avenues for research with a great promise to revolutionise human health diagnosis, monitoring and intervention.

Shrapnel in carotid sheath: A rare penetrating neck injury.

Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% - 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.

The effects of trade, renewable energy, and financial development on consumption-based carbon emissions (comparative policy analysis for the G20 and European Union countries).

Recently, there has been a lot of focus on global trade and consumption-based carbon (CCO2) emissions. More research, however, has examined how financial development (FD) and international trade in renewable energy affect CO2 emissions. Furthermore, there are no distinct trends in the research about how globalization affects environmental quality. Our research analyzes and empirically investigates the relationship between CCO2 emissions and renewable energy, FD, and trade. A large panel of data from 41 G20 and European Union (EU) countries is assembled for empirical analysis from 1990 to 2019. The practical outcomes of panel quantile regression and feasible generalized least square (FGLS) approaches display that renewable energy and FD positively relate to CCO2 emissions; furthermore, trade to GDP hurts CCO2 emissions; market classification has been taken as a control variable which shows that the developed countries released more carbon than non-developed countries. These results suggest that the financial sector focuses more on supporting companies that use ecologically friendly techniques and pushing them to use other energy well-organized technologies in their production processes. As a result, CCO2 emissions will be reduced, preventing environmental damage at the non-renewable energy plant.