Data analytics and knowledge management approach for COVID-19 prediction and control.

The Coronavirus Disease (COVID-19) caused by SARS-CoV-2, continues to be a global threat. The major global concern among scientists and researchers is to develop innovative digital solutions for prediction and control of infection and to discover drugs for its cure. In this paper we developed a strategic technical solution for surveillance and control of COVID-19 in Delhi-National Capital Region (NCR). This work aims to elucidate the Delhi COVID-19 Data Management Framework, the backend mechanism of integrated Command and Control Center (iCCC) with plugged-in modules for various administrative, medical and field operations. Based on the time-series data extracted from iCCC repository, the forecasting of COVID-19 spread has been carried out for Delhi using the Auto-Regressive Integrated Moving Average (ARIMA) model as it can effectively predict the logistics requirements, active cases, positive patients, and death rate. The intelligence generated through this research has paved the way for the Government of National Capital Territory Delhi to strategize COVID-19 related policies formulation and implementation on real time basis. The outcome of this innovative work has led to the drastic reduction in COVID-19 positive cases and deaths in Delhi-NCR.

iQMS: IoT-based QMS framework for tracking of quarantined subjects.

The outbreak of Coronavirus Disease as a pandemic has resulted in a huge saddle on health infrastructure. Preventive measures such as quarantine, social distancing, isolation, and community containment play a pivotal role to contain the spread of exponentially growing COVID cases. This huge burden permitted authorities for institutional/home quarantine for the suspected persons. The biggest challenge for institutional/home quarantine is to monitor and track the movement of quarantined persons. These suspected cases pose a serious threat in outbreak and transmission of the disease. In this paper, an intelligent-Quarantine Monitoring System (iQMS) has been presented which comprises of a wearable IoT-based wristband, bundled with an android mobile app to track and report the absconding quarantined subjects in near real-time. The iQMS incorporates a cloud-based solution with IoT sensors using a global positioning system (GPS) based tracker for geo-fencing breach. The proposed system will facilitate the authorities in remote monitoring and tracking of identified subjects.

An Indian eye to personalized medicine.

Acknowledging the successful sequencing of the human genome and the valuable insights it has rendered, genetic drafting of non-human organisms can further enhance the understanding of modern biology. The price of sequencing technology has plummeted with time, and there is a noticeable enhancement in its implementation and recurrent usage. Sequenced genome information can be contained in a microarray chip, and then processed by a computer system for inferring analytics and predictions. Specifically, smart cards have been significantly applicable to assimilate and retrieve complex data, with ease and implicit mobility. Herein, we propose "The G-Card", a development with respect to the prevalent smart card, and an extension to the Electronic Health Record (EHR), that will hold the genome sequence of an individual, so that the medical practitioner can better investigate irregularities in a patient's health and hence recommend a precise prognosis.

Mining Gene Expression Data Focusing Cancer Therapeutics: A Digest.

An understanding towards genetics and epigenetics is essential to cope up with the paradigm shift which is underway. Personalized medicine and gene therapy will confluence the days to come. This review highlights traditional approaches as well as current advancements in the analysis of the gene expression data from cancer perspective. Due to improvements in biometric instrumentation and automation, it has become easier to collect a lot of experimental data in molecular biology. Analysis of such data is extremely important as it leads to knowledge discovery that can be validated by experiments. Previously, the diagnosis of complex genetic diseases has conventionally been done based on the non-molecular characteristics like kind of tumor tissue, pathological characteristics, and clinical phase. The microarray data can be well accounted for high dimensional space and noise. Same were the reasons for ineffective and imprecise results. Several machine learning and data mining techniques are presently applied for identifying cancer using gene expression data. While differences in efficiency do exist, none of the well-established approaches is uniformly superior to others. The quality of algorithm is important, but is not in itself a guarantee of the quality of a specific data analysis.

Pediatric kidney transplantation in the developing world: challenges and solutions.

The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided "free of cost" with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1- and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.

Necrotizing colitis complicating necrotized pancreatitis: look out for intestinal pneumatosis.

Acute pancreatitis is a common cause of acute abdominal pain and is associated with a wide variety of complications. Pancreatic necrosis is one of the most important complications and is considered to be the most important indicator of disease severity as the increased frequency of death in acute pancreatitis is directly correlated with the development and extent of pancreatic necrosis. In addition to pancreatic necrosis, wide spectrums of colonic complications have been described, including functional and mechanical ileus, ischemic necrosis and fistula formation. In acute pancreatitis bowel ischemia usually involves the transverse colon or the hepatic and splenic flexures and may range in severity from mild superficial mural involvement to transmural colonic necrosis.This article reports a case of large bowel infarction as a complication of severe necrotizing pancreatitis in a 35-year-old male patient.

Experience of fibrosing cholestatic hepatitis with hepatitis C virus in kidney transplant recipients.

BACKGROUND: Fibrosing cholestatic hepatitis C (FCH-C) is a rare entity that occurs among immune-compromised patients resulting from the direct hepatotoxicity of a high intracellular viral load along with an ineffective immune system ultimately leading to a fatal outcome. We have describes herein 4 renal transplant recipients who were diagnosed with FCH-C at our institution in the last 8 months. METHODS: Four renal transplant recipients presented with jaundice and deteriorating liver function tests. They were diagnosed to display FCH-C based on the presence of hepatitis C virus (HCV) RNA and characteristic liver biopsy findings; there was no evidence of any other cause of cholestasis or biliary obstruction. RESULTS: The patients were men of ages 40, 25, 20, and 27 years. The durations after transplantation were 1.5, 10, 1.5 and 2.0 years, respectively. In all cases pretransplantation screening was negative for HCV antibody, HCV RNA, and hepatitis B surface antigen (HBsAg). All 4 patients were infected with genotype 1, whereas case 2 had coinfection with type 3. Cases 1 and 2 who were treated with interferon and ribavirin, showed improvement in cholestasis but did not achieve a rapid virological response. Case 1 developed graft dysfunction secondary to acute cellular rejection at 4 months after initiation of interferon treatment, which was treated with pulse steroids. Interferon-based therapy was stopped prematurely in both cases due to pancytopenia. Case 3 developed florid pyelonephritis and died without receiving therapy for hepatitis C. Case 4 was managed conservatively by decreasing the immunosuppression with regular monitoring. CONCLUSION: FCH-C is difficult to treat and shows high morbidity and mortality rates. Treatment is associated with a risk of graft rejection.

A renal transplantation model for developing countries.

The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.

Role of magnetic resonance imaging in evaluation of tubercular spondylitis: pattern of disease in 100 patients with review of literature.

INTRODUCTION: The purpose of this study is to evaluate the role of magnetic resonance imaging (MRI) in evaluation of tubercular spondylitis and to correlate imaging findings with clinical severity of the disease. METHODS: One hundred consecutive patients, who presented with features suggestive of spinal infections, were subjected to MRI examination. T1W and STIR images were obtained followed by T2W and post-contrast T1W images. Various imaging characteristics of spinal infections were noted and correlated with the clinical severity of the disease. RESULTS: Backache was the most common presenting symptom present in 86 %, while paraparesis was the most common sign seen in 62 %. The neurological status of the patients correlated well with MRI findings in the majority of the cases with an overall good correlation obtained in 96 % of cases. The majority of the vertebrae and intervertebral discs affected showed hypointensity or isointensity on T1W images and hyperintensity on T2W images. Epidural/dural disease was present in 74 % while 68 % of patients demonstrated decreased intervertebral disc height. Epidural extension and subligamentous spread was in 74 % and 90 % of patients respectively. CONCLUSIONS: MRI plays a vital role in early and accurate diagnosis of spinal infections. It is non-invasive and clearly demonstrates soft tissue anatomy and pathology which makes it superior to X-rays and Computed Tomography (CT). Imaging findings of tubercular spondylitis were also found to have a good correlation with the clinical status of the patients. Hence, it is of much help in the evaluation and assessment of patients presenting with features of spinal infections.

Surgical treatment and histopathological analysis of proptosis.

INTRODUCTION: Inflammations and tumors of the orbit and para-orbital regions may present as proptosis. Management depends on clinical, radiological, histo-pathological and biochemical evaluation. OBJECTIVE: To analyze the clinical and histopathological profile of the lesions causing proptosis and to report the outcome of their surgical management. MATERIALS AND METHODS: In a retrospective study, 25 cases of proptosis due to orbital and paraorbital tumours were analyzed in relation to their age, sex, and clinical and histopathological profiles. CT Scan was considered as the first line investigation modality. According to location and type of tumour, different surgical options like anterior orbitotomy, lateral orbitotomy and medial orbitotomy were considered. RESULTS: The majority of the patients were of the age group 50-59 years (28%). Primary orbital tumors were encountered in 15 cases (60%) and para-orbital in 10 (40%). Of 15 primary orbital tumors, 7 (46.66%) were excised by lateral orbitotomy, another 7 (46.66%) were approached via anterior orbitotomy, whereas 1 (6.67%) was removed by medial orbitotomy. Pediatric orbital tumors were quite common {7 (46.66%)}. Three cases of rhabdomyosarcoma, 3 cases of dermoid cyst and 1 case each of optic nerve glioma were found in pediatric age group. The most common benign adult tumor found in our study was pleomorphic adenoma of the lacrimal gland {3 (20%)}. CONCLUSION: The majority of the patients with proptosis are of the age group 50-59 years. Proptosis due to primary orbital tumors is more common than para-orbital tumors. Early diagnosis and timely surgical intervention provide good functional and cosmetic results.

Living related renal transplants with lifelong follow-up. A model for the developing world.

AIMS: To describe the dynamic of a model of public government partnership for dialysis and transplantation in developing countries. MATERIALS: A model was established on the philosophy of public-government partnership to provide an integrated dialysis and transplant service "Free with dignity" with lifelong follow-up care and medications. The government provided 50% of funds and the public was motivated to donate the rest. This included affluent individuals, corporations, business houses and the general public. RESULTS: This model has been sustained for the last two decades. In 2008, 655,000 patients were treated at SIUT. Over 600 patients are dialyzed each day with a total of 165,411 dialysis sessions/year. Thus far 2,249 transplants have been performed, 431 in 2008. One- and 5-year graft survival rates were 92% and 85%, respectively. The laboratory performed 4.1 million tests and radiological investigations numbered 164,217. Over $ 6 million were spent on medications. Free services offered by the model have motivated the government to increase its funding from $ 2.1 million in 1998 to $ 10 million in 2008 and the public has matched these figures with total donations exceeding $ 20 million. CONCLUSIONS: For transplantation to be successful in developing countries, it has to be made available to the common people who constitute 90% of the population. Our model of public-government partnership has made dialysis and transplantation available to the disenfranchised with lifelong follow-up and medications. Transplantation has become relevant to them, resulting in societal acceptance of transplantation as a preferred mode of therapy. This has motivated society to support both living related and deceased donor programs.

Human organ and tissue transplantation in Pakistan: when a regulation makes a difference.

Organ transplantation must be viewed in relation to the prevailing cultural, religious and economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities.

Physiological disproportions between un-corrected vision and degree of myopia.

INTRODUCTION: Anomalies of the refractive state of the eye are the commonest cause of defective vision. PURPOSE: To study the relationship between uncorrected visual acuity and refractive error in myopia in children, the prevalence of disparity between them and to find out the possible explanation for it. MATERIALS AND METHODS: 100 eyes of 50 myopic children were studied and analyzed to study relationship between the uncorrected visual acuity (UCVA) and its refractive status. 42 cases were chosen to study disparity, either in the form of uncorrected visual acuity or refractive error. To study these disparities, Keratometery for anterior corneal curvature and A-scan for axial length and anterior chamber depth were also done. STATISTICS: The results were analyzed statistically using student t-test while the relationship between uncorrected visual acuity (UCVA) and refractive error in myopia was obtained with Spearman's correlation coefficient (R). RESULTS: The strength of association of uncorrected visual acuity and myopia as indicated by the correlation coefficient (0.897, p less than 0.001) is a significant one. Out of 42 cases taken to study disparity, 24 (57 %) cases showed discrepancy either in the form of uncorrected visual acuity or refractive error. The reason for this disparity as proven statistically in our study is increased axial length (p value less than 0.001). CONCLUSIONS: There exists a linear relationship between UCVA and myopia, yet an accurate prediction of uncorrected visual acuity cannot be made on the basis of the refractive error or vice-versa for any single individual, as there exists a disparity either in form of UCVA or refractive error in myopia.

Development of sulforaphane-encapsulated microspheres for cancer epigenetic therapy.

Even though conventional chemotherapeutic management of cancer has reduced morbidity and mortality to a great extent, virtually all chemotherapeutic agents cause damage to healthy cells, necessitating exploration of novel anticancer agents that exert their effects through an alternate mode of action. Objectives of our research were twofold. First, we explored the promising potential of histone deacetylase inhibitor sulforaphane for epigenetic therapy for cancer as this therapeutic approach aims to reverse aberrant epigenetic modifications that affect gene expression. In vitro cell culture studies performed using B16 and S91 melanoma cells showed that sulforaphane inhibited growth and proliferation of cancer cells by downregulating deacetylation enzymes. The second part of our research investigated polymeric drug delivery systems to increase therapeutic efficacy and to minimize potential side effects of R,S-sulforaphane. Albumin microspheres encapsulating sulforaphane were developed by spray drying. Microspheres were characterized for their morphology, size and zeta potential. Cell culture studies using melanoma cells and in vivo studies in melanoma tumor-bearing C57BL/6 mice demonstrated that albumin based polymeric delivery system was efficacious and has the potential to enhance the therapeutic effect and anticancer activity of sulforaphane.

Health status and renal function evaluation of kidney vendors: a report from Pakistan.

Unrelated kidney transplants have lead to commerce and kidney vending in Pakistan. This study on 104 vendors reports demographics, history, physical and systemic examination, ultrasound findings, renal and liver function and GFR by Cockcroft-Gault. Results were compared with 184 age, sex and nephrectomy duration matched living-related donors controls. Comparison of vendors versus controls showed mean age of 30.55 +/- 8.1 versus 30.65 +/- 7.85 (p = 0.91) years, M:F of 4.5:1 versus 4.2:1 and nephrectomy period of 33.89 +/- 30 versus 32.01 +/- 29.71 (p = 0.60) months respectively. Of the vendors 67% were bonded laborers earning <50 $/month as compared to controls where 68% were skilled laborers and self-employed earning >100 $/month. History of vendors revealed jaundice in 8%, stone disease in 2% and urinary tract symptoms in 4.8%. Postnephrectomy findings between vendors versus donors showed BMI of 21.02 +/- 2.8 versus 23.02 +/- 4.2 (p = 0.0001), hypertension in 17% versus 9.2% (p = 0.04), serum creatinine (mg/dL) of 1.17+/-0.21 versus 1.02 +/- 0.27 (p = 0.0001), GFR (mL/min) of 70.94 +/- 14.2 versus 95.4 +/- 20.44 (p = 0.0001), urine protein/creatinine of 0.150 +/- 0.109 versus 0.10 +/- 0.10 (p = 0.0001), hepatitis C positivity in 27% versus 1.0% (p = 0.0001) and hepatitis B positive 5.7% versus 0.5% (p = 0.04), respectively. In conclusion, vendors had compromised renal function suggesting inferior selection and high risk for developing chronic kidney disease in long term.

Maternal risk factors associated with low birth weight in Karachi: a case-control study.

To evaluate maternal risk factors associated with low birth weight (LBW) among women aged 15-35 years, we carried out a hospital-based, case-control study on 262 cases (mothers of neonates weighing < or = 2.5 kg) and 262 controls (mothers of neonates weighing > 2.5 kg). Odds of delivering a low-birth-weight baby decreased with increase in maternal haemoglobin [odds ratio (OR): 0.701; 95% confidence interval (CI): 0.62-0.79]. Odds were greater among mothers not using iron supplements during pregnancy (OR: 2.88; 95% CI: 1.83-4.54). Mothers of LBW babies had lower haemoglobin levels before delivery.

Anthropometric indices of middle socio-economic class school children in Karachi compared with NCHS standards--a pilot study.

OBJECTIVE: To measure height and weight of school going children (2-18 years of age) in Karachi. By means of these parameters we were able to document where the Pakistani paediatric population plot on NCHS growth centile charts. METHODS: A population based cross-sectional study (in government and private schools, Karachi), in which height and weight were taken using standardized techniques. Two thousand two hundred forty five healthy school-going children 2 to 16 years of age (calculated from date of birth); sex, height and weight were documented. After the survey was completed, height and weight of the children were plotted on NCHS centiles curves. RESULTS: P5, P25 and P50 centiles for height and weight of the Pakistani girls and boys was much below that of NCHS. However, P95 for boys and girls weight and height did not differ markedly in the Pakistani and NCHS centiles. CONCLUSION: Height and weight of these children is below the NCHS centile for height and weight. Children plotting near the P95 NCHS, indicates that obesity may be a serious concern in our population. However, further studies are required for support. This pilot study indicates the need for development of centile charts for Pakistani paediatric population.

Cyclosporine withdrawal in post-renal transplant thrombotic microangiopathy.

INTRODUCTION: Thrombotic microangiopathy (TMA) is a well known complication of cyclosporine (CsA)-treated renal transplantation but optimum treatment strategies are not clearly defined. PATIENTS AND METHODS: All patients transplanted between January 1996 and December 2001 at our center who had biopsy-proven TMA and in whom CsA was withdrawn were studied retrospectively. RESULTS: The TMA was found in nine of 688 patients (1.3%). All except one donor were living related. HLA matching was one haplotype in all except one where both haplotypes were different. There were five males and four females and the mean age was 24.9 +/- 9 yr. All of them developed TMA within 3 months of transplant. Five of nine had evidence of microangiopathic hemolysis on peripheral film. Serum creatinine at the time of diagnosis of TMA was 3.1 +/- 1.3 mg/dL. Cyclosporine was discontinued in all and mycophenolate mofetil was substituted for azathioprine. No episode of acute rejection occurred after CsA withdrawal. Graft function did not improve in four who eventually became dialysis-dependent after a mean duration of 12.6 +/- 8.3 months. Remaining patients showed stabilization or improvement in function and all had serum creatinine below 2 mg/dL after a mean follow up of 24 months. CONCLUSION: The CsA withdrawal in cases with TMA at a stage when significant functional deterioration has not taken place can salvage the graft.