FRAX calculation with and without bone mineral density for assessment of osteoporotic fracture risk in patients of rheumatic disease: a cross-sectional study.

To compare fracture risk assessment (FRAX) calculation with and without bone mineral density (BMD) in predicting 10-year probability of hip and major osteoporotic fracture in patients of rheumatic diseases. Methodology: A cross-sectional was conducted at outpatient Department of Rheumatology. Eighty-one Patients of more than 40 years of age having either sex. Diagnosed case of Rheumatic diseases were according to American College of Rheumatology (ACR) /European Alliance of Associations for Rheumatology (EULAR) criteria were included in our study. FRAX score without BMD was calculated and information was recorded in proforma. These patients were advised dual energy X-ray absorptiometry Scan and after that FRAX with BMD was calculated, after which comparison between result of two scores was made. The data were analyzed by SPSS software version 24. Effect modifiers were controlled by stratification. Post-stratification χ2 test were applied. P value less than 0.05 was considered as significant. Results: This study consisted of 63 participants, who were assessed for osteoporotic risk fracture, with and without BMD. Data analysis revealed a significant association between the type of fracture and age (p value=0.009), previous fracture (p value=0.25), parent fractured hip (p values) and treatment with bone mineral dismissal. There was no statistically significant association seen of fractures with bone deterioration with sex, weight, height, or current smoking. Conclusion: FRAX may be crucial in rural areas where dual energy X-ray absorptiometry scanning is not available since it is a readily available instrument. FRAX is a useful substitute for estimating osteoporosis risk when funds are scarce. Given the possible effect it will have on healthcare costs, this is extremely pertinent.

Burnout in South Asian rheumatologists in the COVID-19 pandemic: an online survey.

Physician burnout is recognized as a global crisis and an epidemic. However, burnout in rheumatology is an understudied phenomenon. We explored the prevalence of physician burnout among rheumatologists from South Asia in the peri-pandemic period (2021-2022). Rheumatologists from Asian countries were invited to participate in an anonymized, validated, and pilot-tested e-survey via social media platforms from December 2021 to April 2022. Demographic information, social aspects (marital status, income, vacation time, daily exercise), substance abuse, EHR (electronic health record) use, and years in practice were obtained. In addition, burnout was estimated using Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), and intergroup comparisons were made using independent t test and one-way ANOVA using SPSS v27. Of 146 respondents who participated in the survey, 134 belonged to Asian nations. The highest number of respondents was from Pakistan (56/134, 38.36%), followed by India (49/134, 33.56%). Slightly more respondents were male, 75 (51.4%), than females, 71 (48.6%). Over two-thirds of our respondents (99/134, 67.8%) reported burnout in at least one domain. Notably, we found statistically significant increased depersonalization scores in males. (P < 0.05). Females scored significantly higher on the following items: #5 (I feel I treat some patients as if they were impersonal objects), item# 10 (I've become more insensitive toward people since I took this job and item#22 (I feel patients blame me for some of their problems) (P < 0.05). We found differences in monthly salaries among South Asian (1484 ± 2717 USD) and non-South Asian respondents (5672 ± 8874 USD) (P < 0.01). A substantial proportion of rheumatologists in our survey report burnout, suggesting a felt need to introduce organizational measures to prevent and mitigate burnout and preserve the rheumatology workforce.

Hughes-Stovin Syndrome: A Case Report on a Rare, Life-Threatening Vasculitis.

Hughes-Stovin Syndrome (HSS) is a rare vasculitic disorder characterised by widespread pulmonary artery aneurysms. It shares some features with Behçet disease. Currently, the diagnosis is based on clinical suspicion. Our case describes a young male who presented with haemoptysis and previous history of pulmonary embolism. Workup was essentially unremarkable, but imaging revealed multiple pulmonary artery aneurysms. Timely initiation of glucocorticoids and immunosuppression with cyclophosphamide led to improvement. High-dose glucocorticoids and immunosuppressants are the mainstays of treatment. Untreated cases can result in fatal outcomes.

The prevalence of fibromyalgia among doctors in the tertiary care hospital: A cross-sectional study.

Background: Fibromyalgia syndrome (FMS) is an umbrella term for chronic pain syndrome, associated with tenderness, fatigue, reduced pain thresholds, and paresthesia in the limbs. The field of medicine places doctors in constant work-related stress, sleep deprivation, and depression, thus increasing their vulnerability to developing FMS. This study aims to evaluate the prevalence and severity of FM (fibromyalgia) among physicians in a tertiary care hospital setting. Methods: The cross-sectional study was performed at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from December 2019 to December 2020.243 physicians of either gender, and from all the departments being house officers, medical officers, and post-graduate trainees were included & divided into 3 age groups from 20 to more than 45 years. Widespread Pain Index (WPI) equal to or more than 7 and Symptom Severity Score (SSS) equal to or more than 5 OR WPI = 3 to 6 and SSS equal to or more than 9 were required, according to the modified American College of Rheumatology preliminary diagnostic criteria 2016 for fibromyalgia diagnosis. Data was analyzed using SPSS 25. Results: Among a total of 243 participants, FMS was diagnosed in 69 (28.40%) individuals. The predominant FMS population was the youngest age group 20-35 (56 = 81.16%). Increased BMI, increasing pain score category, gender, and comorbidities are significantly associated with FMS (p ≤ 0.05). Whereas, advancing age is insignificantly linked with FMS (p > 0.05). Conclusions: The prevalence of fibromyalgia was found to be high among doctors working in stressful hospital settings, particularly among the youngest ones.

Optimizing Deep Learning Model for Software Cost Estimation Using Hybrid Meta-Heuristic Algorithmic Approach.

Effective software cost estimation significantly contributes to decision-making. The rising trend of using nature-inspired meta-heuristic algorithms has been seen in software cost estimation problems. The constructive cost model (COCOMO) method is a well-known regression-based algorithmic technique for estimating software costs. The limitation of the COCOMO models is that the values of these coefficients are constant for similar kinds of projects whereas, in reality, these parameters vary from one organization to another organization. Therefore, for accurate estimation, it is necessary to fine-tune the coefficients. The research community is now examining deep learning (DL) as a forward-looking solution to improve cost estimation. Although deep learning architectures provide some improvements over existing flat technologies, they also have some shortcomings, such as large training delays, over-fitting, and under-fitting. Deep learning models usually require fine-tuning to a large number of parameters. The meta-heuristic algorithm supports finding a good optimal solution at a reasonable computational cost. Additionally, heuristic approaches allow for the location of an optimum solution. So, it can be used with deep neural networks to minimize training delays. The hybrid of ant colony optimization with BAT (HACO-BA) algorithm is a hybrid optimization technique that combines the most common global optimum search technique for ant colonies (ACO) in association with one of the newest search techniques called the BAT algorithm (BA). This technology supports the solution of multivariable problems and has been applied to the optimization of a large number of engineering problems. This work will perform a two-fold assessment of algorithms: (i) comparing the efficacy of ACO, BA, and HACO-BA in optimizing COCOMO II coefficients; and (ii) using HACO-BA algorithms to optimize and improve the deep learning training process. The experimental results show that the hybrid HACO-BA performs better as compared to ACO and BA for tuning COCOMO II. HACO-BA also performs better in the optimization of DNN in terms of execution time and accuracy. The process is executed upto 100 epochs, and the accuracy achieved by the proposed DNN approach is almost 98% while NN achieved accuracy of up to 85% on the same datasets.

Comparison of efficacy three-site versus single-site steroid injections for the treatment of adhesive capsulitis.

Background: Frozen shoulder or adhesion capsulitis is a frequent ailment that causes pain and progressively restricts both active and passive shoulder motions. It is estimated that it affects 2%-5% of the general population and up to 20% of diabetes mellitus patients.We aimed to compare the effectiveness of three-site steroid injections against one-site injections in the treatment of adhesive capsulitis. Methodology: The Rheumatology Department of Pakistan Institute of Medical Sciences in Islamabad conducted this cross-sectional study. Between August 2021 to December 2021. The study comprised a total of 98 patients. This study included patients of both genders with shoulder pain between the ages of 40 and 70.Patients were divided into two groups & dosage was given at Sub-coracoid, Subacromial, and Posterior Capsule.The CONSTANT score was used to assess patients three times (Initial, 3months & 6 months later). Results: The average age, gender distribution, and dominant/non-dominant side ratio of the participants were nearly identical between the two groups. More patients in group B (77.22 8.17) had a higher mean CONSTANT score than those in group A (72.73 7.05). Patients were checked in on again after three and six months. Conclusion: The three-site injection technique is a safe and effective method for frozen shoulder. It provides an early recovery and improved shoulder function with a reduced frequency of relapse as compared to single-site injection techniques.

Not Another Case Of Juvenile Idiopathic Arthritis: Congenital Insensitivity To Pain Presenting With Joint Problems.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare condition with protean manifestations. Occasionally, these diseases may present with musculoskeletal problems. Here we report a case of young child who presented with joint problems in our clinic. Since the child had a number of musculoskeletal manifestations her diagnosis was difficult and delayed. She was given supportive treatment and a team of doctors from different specialties was involved in her management.

Association Of Tumour Necrosis Factor-Alpha -308 G/A Promoter Polymorphism With Susceptibility And Disease Profile Of Rheumatoid Arthritis.

BACKGROUND: Single nucleotide polymorphism underlying the auto-immune process governing the pathologic manifestations of rheumatoid arthritis has been the focus of study for quite a while. TNF-alpha -308 G/A promoter polymorphism have been reported to be responsible for a number of manifestations of rheumatoid arthritis. METHODS: This case-control study was conducted at the department of Rheumatology at Pakistan Institute of Medical Sciences Islamabad from 9th May to 9th August 2019 with a focus to determine the Association of tumour necrosis factor-alpha -308 G/A promoter polymorphism with susceptibility and disease profile of rheumatoid arthritis. One hundred and fifty cases with diagnosed rheumatoid arthritis and 150 age and gender matched controls were enrolled in the study. Their genotyping was done for tumour necrosis factor-alpha - 308 G/A promoter polymorphism. RESULTS: The genotypic analysis showed that GG genotype was the most common genotype found in 118 cases (78.66%) followed by GA (18.66%) and AA genotype (2.6%) p=0.0096 in both cases and controls. Overall, G allele was more common than A in both cases and controls pointing towards the preponderance of G genotype in our population. (p=0.003). However, the GA genotype and A allelotype was more common among cases with rheumatoid arthritis (p <0.05). No significant association of G/A polymorphism with smoking and gender, however, within gender, males had a significantly more expression of the GA genotype and A allelotype (p <0.05). CONCLUSIONS: There is a significantly more expression of the GA genotype and the A allelotype of the TNF-alpha -308 G/A promoter gene in rheumatoid arthritis patients in our population. Similarly, more males, compared to females have increased expression of the GA genotype as well as the A allelotype.

The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis.

Background Ankylosing spondylitis (AS) is a chronic rheumatological condition affecting sacroiliac joint and spine and occurs more often in younger patients than in the elderly population. Objective The purpose of the study was to determine the association of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the disease activity of AS. Methodology This case-control study was conducted in the rheumatology department at the Pakistan Institute of Medical Sciences (PIMS) hospital in Islamabad from September 2018 to July 2019. The study consisted of two groups of 59 patients per group. We assessed a full blood count with erythrocyte sedimentation rate (ESR) for each participant using the PIMS hospital laboratory. NLR and PLR were calculated. Results The mean age of the participants in the control group and the cases group was the same (32 ± 4 years). The control group NLR was 1.30 ± 0.16, the PLR was 94.98 ± 17.96, and the ESR was 16.88 ± 3.76 mm/hour. For the cases group, the NLR was 3.08 ± 0.91, the PLR was 171.50 ± 38.06, and the ESR was 29.30 ± 9.20 mm/hour. There was a significant increase in cases for NLR, PLR, and ESR as compared to control samples (p<0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of participants with active diseases was 5.91±1.28. In the same group, the mean ESR was 27.65 ± 9.07 mm/hour, the NLR was 3.46 ± 0.80, and the PLR was 184.39 ± 36.13. For those in the inactive disease group, the mean BASDAI score was 2.84 ± 0.46, the ESR was 33.42 ± 8.48 mm/hour, the NLR was 2.17 ± 0.37, and the PLR was 139.71 ± 26.05. NLR and PLR were significantly higher in the active disease group (p<0.05). Conclusion NLR and PLR are good markers of inflammation in AS patients, and higher values indicate more active disease activity.