Reliable relay assisted communications for IoT based fall detection.

Robust wireless communication using relaying system and Non-Orthogonal Multiple Access (NOMA) will be extensively used for future IoT applications. In this paper, we consider a fall detection IoT application in which elderly patients are equipped with wearable motion sensors. Patient motion data is sent to fog data servers via a NOMA-based relaying system, thereby improving the communication reliability. We analyze the average signal-to-interference-plus-noise (SINR) performance of the NOMA-based relaying system, where the source node transmits two different symbols to the relay and destination node by employing superposition coding over Rayleigh fading channels. In the amplify-and-forward (AF) based relaying, the relay re-transmits the received signal after amplification, whereas, in the decode-and-forward (DF) based relaying, the relay only re-transmits the symbol having lower NOMA power coefficient. We derive closed-form average SINR expressions for AF and DF relaying systems using NOMA. The average SINR expressions for AF and DF relaying systems are derived in terms of computationally efficient functions, namely Tricomi confluent hypergeometric and Meijer's G functions. Through simulations, it is shown that the average SINR values computed using the derived analytical expressions are in excellent agreement with the simulation-based average SINR results.

An atypical presentation of Salmonella enterica ser Dublin in an immunocompromised patient.

Mycotic aneurysms of the carotid artery are a rare entity that can be fatal if not diagnosed promptly. We present a 60-year-old man with a tender left-sided neck mass due to a ruptured aneurysm of the left internal carotid artery. Cultures taken intraoperatively grew Salmonella enterica ser Dublin.

Ventilator Alarms in Intensive Care Units: Frequency, Duration, Priority, and Relationship to Ventilator Parameters.

Ventilator alarms have long been presumed to contribute substantially to the overall alarm burden in the intensive care unit. In a prospective observational study, we determined that each ventilator triggered an alarm cascade of up to 8 separate notifications once every 6 minutes. In 1 intensive care unit with different ventilator manufacturers, the distribution of high-priority alarms was manufacturer dependent with 8.6% of alarms from 1 type and 89.8% of alarms from another type of ventilator. Alarm limits were not a function of patient-specific ventilator settings.

Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan.

BACKGROUND: The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. METHODS: A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. RESULTS: A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. CONCLUSION: We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.

Dental amalgam: effects of alloy/mercury mixing ratio, uses and waste management.

BACKGROUND: Silver dental amalgam is one of the oldest filling materials used in dentistry. The American Dental Association (ADA) has estimated that billions of amalgam restorations have been placed in patients in the last 150 years. Due to the presence of mercury and mishandling during the filling make it more controversial. The objective of this study was to conduct a survey of the use of different brands and to assess any deviations in practice from the hand mixing manual method of elemental mercury and alloy in a pestle/mortar and encapsulated form. METHODS: A questionnaire was sent to 250 of randomly selected dental practitioner in various localities of Karachi. Data was analysed to record the specified brands used along with their powder/liquid (P/L) ratio and the different methods for disposing off mercury in this study. RESULTS: The most commonly used form of dispensing method was hand mixing (57%) and only 30% of the dentists followed the manufacturer instruction for hand mixing ratio.Eighty-seven percent of dental amalgam restoration was performed and 13% removed by the dentist per month and the method of disposing the amalgam wastage that 55%, 25%, and 20% dentists were used the sink, bin and other methods respectively in their dental clinics. CONCLUSION: Amalgam restoration is still popular filling material in the posterior region of the mouth but we need to create awareness among the dentists who do not follow the ADA specifications.

Contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

Pro-inflammatory interleukins in patients operated on for proximal femur fracture.

OBJECTIVES: The aims of this study were to measure plasma IL 6 and IL 8 in patients with proximal femoral fracture (PFF) during the early phases of trauma and operation and to find out if there was any correlation between these ILs and the post-operative lower limb oedema. MATERIAL AND METHODS: Thirty patients with a median age of 81 years were grouped into pertrochanteric fracture (PTF) (n = 16) and femoral cervical fracture (FCF) (n = 14). Plasma interleukin levels were determined on blood samples obtained from the common femoral vein, immediately after hospital admission, 1 h before operation, and post-operatively at 1, 6, 12, 24, 48 h and on the 7th day. Thigh oedema was calculated by the frustum method. RESULTS: In the patients with PTF, maximum mean plasma IL-6 and IL-8 values were found, respectively at 24 h (45.12 pg/mL) and 6 hours (21.7 pg/mL) postoperatively. Whereas, in the patients with FCF, it was respectively, at 12 h (33.1 pg/mL) and 6 h (17.0 pg/mL), for IL-6 and IL-8 post operatively. The patients with PTF and FCF had respectively, 34.1% and 27.4% more thigh oedema in the operated limb on the 7th post-operative day as compared to the preoperative oedema volume (p<0.001). No significant correlation could be found between the plasma IL-6 and IL-8 levels and oedema in the operated limb. CONCLUSION: Increased levels of IL 6 and IL 8 suggest ongoing inflammation.

Secondary prevention of heart disease--knowledge among cardiologists and omega-3 (omega-3) fatty acid prescribing behaviors in Karachi, Pakistan.

BACKGROUND: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription. The aim of the study was to determine the practices and associations of dietary fish prescribing among cardiologists of Karachi and to assess their knowledge of fish oil supplementation and attitudes toward dietary practices. METHODS: A cross sectional survey was conducted during the period of January to March, 2008. A self report questionnaire was employed. All practicing cardiologists of Karachi were included in the study. Multiple logistic regression analysis was performed to determine the independent factors associated with high fish prescribers. RESULTS: The sample comprised of a total of 163 cardiologists practicing in Karachi, Pakistan. Most (73.6%) of the cardiologists fell in the age range of 28-45 years and were male (90.8%). High fish prescribers only comprised 36.2% of the respondents. After adjusting for age and gender, multivariate analysis revealed that only the variable of knowledge about fish oil's role in reducing sudden cardiac death was independently associated with high fish prescribers OR = 6.38 [95% CI 2.58-15.78]. CONCLUSION: The level of knowledge about the benefits of omega-3 fatty acids is high and the cardiologists harbor a favorable attitude towards dispensing dietary fish advice. However, the prescription practices are less than optimal and not concordant with recommendations of organisations such as the American Heart Association and National Heart Foundation of Australia. The knowledge of prevention of sudden cardiac death in CVD patients has been identified as an important predictor of high fish prescription. This particular life-saving property of omega-3 fatty acids should be the focus of any implemented educational strategy targeted to improve secondary CVD prevention via omega-3 fatty acid supplementation.

Angioleiomyoma: magnetic resonance imaging features in ten cases.

OBJECTIVES: Angioleiomyoma is a rare, benign smooth muscle tumour arising from the tunica media of small veins and arteries and can occur anywhere in the body. The histological appearances are well documented, but there are relatively few descriptions of the magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: A retrospective study of the clinical presentation, MRI appearances and histological findings of ten angioleiomyomas presenting as extremity soft tissue masses. RESULTS: MRI typically demonstrated a well-defined, oval mass located superficial to the fascia with the commonest sites being the hand (three cases) and ankle/foot (five cases). The lesion was isointense to muscle on T1-weighted spin echo images with heterogeneous increased internal T2W/short tau inversion recovery (STIR) signal intensity, which commonly appeared as multiple linear or branching areas of hyperintensity. Enhancement after IV gadolinium ranged from diffuse to heterogeneous. In a single case, central fat signal intensity was seen, while a further case showed marked T2W/STIR hypointensity due to diffuse hyalinisation within the lesion. CONCLUSIONS: This is the largest reported MRI series of extremity musculoskeletal angioleiomyoma. Angioleiomyoma should be considered in the differential diagnosis of a superficial mass in the hand or foot, particularly when characteristic linear or branching hyperintensity is seen on T2W or STIR images.

Edema in the lower limb of patients operated on for proximal femoral fractures.

BACKGROUND: Patients with proximal femoral fracture (PFF) often develop postoperative edema in the operated limb. This may lead to reduced mobilization, increasing the length of hospitalization. It is therefore relevant to gain information about the extent and pathogenesis of this edema formation. METHODS: Forty-one patients with PFF (30 women and 11 men) were studied pre- and postoperatively. Patients were grouped into pertrochanteric fractures and femoral cervical fractures, according to the AO/ASIF classification of PFF. Thigh and calf volumes were calculated in both fractured and contralateral limbs preoperatively and on postoperative days 3, 5, 7, and 30. RESULTS: All patients with PFF developed edema in the operated limb. The greatest volume increase occurred on postoperative day 7 (p < 0.0005). The magnitude of edema in the thigh and the leg of patients with pertrochanteric fractures as compared with the nonoperative side was approximately twice as great as in those with femoral cervical fractures (p < 0.0001). There was a statistically significant daily increase in the volume of the operative limb as compared with the nonoperative side. Age and sex were not correlated with the extent of edema formation. Functionally significant deep venous thrombosis and local infection could be excluded as causative factors. CONCLUSIONS: Postoperative edema in the thigh and leg of the operated limb was considerable. The magnitude of edema formation was related to the severity of primary trauma and the type of osteosynthesis. Therefore, the operation performed for PFF should be minimally traumatic.

Rheological characteristics of intermediate moisture blends of pregelatinized and raw wheat starch.

Rheological properties of intermediate moisture (35-45% wet basis) doughs from pregelatinized and raw wheat starch blends of various ratios were characterized using off-line capillary rheometry and online slit-die extrusion. In the case of capillary rheometer, viscosity of blends decreased by up to 50% as pregel starch concentration increased from 5 to 45%, whereas tests could not be conducted beyond 45% pregel starch concentration. For slit-die extrusion, viscosity was at a minimum at 60% pregel concentration, and it decreased by as much as 65% as pregel concentration increased from 0 to 60%. As pregel concentration increased (from 5 to 45% for the rheometer and from 0 to 60% for the extruder), the amount of water available in the system for gelatinization of existing raw starch granules decreased due to the stronger water-binding capacity of pregelatinized starch. This led to decreased additional conversion in the rheometer and extruder, which in turn caused a decrease in the volume fraction of starch and a reduction in viscosity.

Isolated pleural fluid lactic dehydrogenase level: a cost effective way of characterizing pleural effusions.

BACKGROUND: Characterization of pleural effusion into an exudate or transudate is usually the first step in diagnostic evaluation. Light's criteria have been universally accepted as gold standard in this regard. We wanted to see the utility of isolated pleural fluid lactic dehydrogenase level (representing one of Light's classical criteria) in characterizing pleural effusion in our setting. We also wanted to compare the accuracy of commonly used conventional criteria with Light's criteria of isolated pleural fluid lactic dehydrogenase. METHODS: Patients who underwent diagnostic thoracentesis for one-year period were studied. Characterization of pleural effusions using biochemical criteria including pleural fluid protein, lactic dehydrogenase level (LDH), red blood cell (RBC) count and white blood cell (WBC) count were identified and compared with predetermined clinical criteria (gold standard). For each biochemical criteria sensitivity, specificity, positive predictive value and negative predictive value were calculated. RESULTS: Sixty-two patients underwent diagnostic thoracentesis. Sixteen were excluded, as they did not fulfill predetermined clinical criteria. Eight patients had transudative effusion vs. 38 exudates. LDH was found to be the most sensitive (97.2%) while WBC > 1000/mm3 was the most specific (100%) of all the criteria looked at. The overall accuracy was highest for Light's criteria of isolated LDH > 200 IU/litre (95.6%) followed by pleural fluid protein, WBC count and RBC count. CONCLUSION: We conclude that isolated pleural fluid LDH, as a representative of classical Light's criteria, is the most accurate criteria for characterizing pleural effusions. Due to its low accuracy isolated pleural fluid protein should not be ordered routinely. This approach may result into potential cost savings in our economically restraint society.