Burns During Covid-19 Pandemic: Demographics, Etiological and Clinical Trends in 2021 at the National Burn Care Centre in Islamabad, Pakistan.

The scarcity of data on burn-related injuries in Pakistan prompted this study. The study is specifically aimed at assessing the burn patients who were admitted to a national burn care center (BCC) in Pakistan. This single-center retrospective analysis was conducted for 12 months from January to December 2021. During this time period, 14,069 patients visited BCC with burn injuries of diverse natures while 613 of them were admitted. The patients' information was abstracted from the hospital database. This information included age, sex, diagnosis, burn depth/degree, time of arrival, circumstances of burn injury, TBSA (total burn surface area), complications, outcome, and management plan. This information was shifted to Microsoft Office Excel Worksheet 2015 and then coded into the IBM Statistical Package for the Social Sciences (SPSS) version 24.0. Armonk, NY: IBM Corp. Of 14,069 patients, 613 were admitted to the burn care center, indicating an admission rate of 4.35%. Among these 613 patients, there was a high proportion of males (58.89%) and a mean age of 20.2±12.5 years. Most patients (40.4%) visited within the first hour after being burnt and flame burns were the most common (41.10%). Most patients were burnt due to accidents (97.7%). The mean length of hospital stay was 15.5 days. Flames were the main cause of burns among our cohort of patients. Most patients had a TBSA of >10% and generally had a second-degree burn, mostly in the pediatric population. An urgent appraisal of burn policies and related legislation is needed to halt the burn burden in the country.

Cette étude a été décidée en raison de la pauvreté des données épidémiologiques concernant les brûlures au Pakistan. Il s'agit d'une étude monocentrique rétrospective sur dossier conduite dans le CTB national d'Islamabad sur l'année 2021. Sur les 14 069 patients brûlés qui s'y sont présentés, 613 (4,35%) ont été hospitalisés. Nous avons recueilli l'âge, le sexe, la SCB, la profondeur, la cause, le délai de présentation, la stratégie thérapeutique, les complications et le devenir des patients. Les données ont été implantée dans Excel et analysées avec SSPS 24.0. Parmi les patients hospitalisés, 58,89% étaient des hommes âgés de 20,2±12,5 ans. Le délai de présentation était de moins de 1h dans 40,4% des cas et l'atteinte était quasiment toujours accidentelle (97,7%), majoritairement par flamme (41%). La DMS était de 15,5 j. L'atteinte était le plus souvent > 10% SCT, habituellement au 2ème degré en particulier en population pédiatrique. Une évaluation de la législation préventive est urgente, afin de mettre fin au fardeau que représentent les brûlures dans notre pays.

A Bayesian spatiotemporal approach to modelling arboviral diseases in Mexico.

BACKGROUND: The objective of this study was to evaluate the spatial and temporal patterns of disease prevalence clusters of dengue (DENV), chikungunya (CHIKV) and Zika (ZIKV) virus and how socio-economic and climatic variables simultaneously influence the risk and rate of occurrence of infection in Mexico. METHODS: To determine the spatiotemporal clustering and the effect of climatic and socio-economic covariates on the rate of occurrence of disease and risk in Mexico, we applied correlation methods, seasonal and trend decomposition using locally estimated scatterplot smoothing, hotspot analysis and conditional autoregressive Bayesian models. RESULTS: We found cases of the disease are decreasing and a significant association between DENV, CHIKV and ZIKV cases and climatic and socio-economic variables. An increment of cases was identified in the northeastern, central west and southeastern regions of Mexico. Climatic and socio-economic covariates were significantly associated with the rate of occurrence and risk of the three arboviral disease cases. CONCLUSION: The association of climatic and socio-economic factors is predominant in the northeastern, central west and southeastern regions of Mexico. DENV, CHIKV and ZIKV cases showed an increased risk in several states in these regions and need urgent attention to allocate public health resources to the most vulnerable regions in Mexico.

Computational imaging with spectral coding increases the spatial resolution of fiber optic bundles.

Fiber optic bundles are used in narrow-diameter medical and industrial instruments for acquiring images from confined locations. Images transmitted through these bundles contain only one pixel of information per fiber core and fail to capture information from the cladding region between cores. Both factors limit the spatial resolution attainable with fiber bundles. We show here that computational imaging (CI) can be combined with spectral coding to overcome these two fundamental limitations and improve spatial resolution in fiber bundle imaging. By acquiring multiple images of a scene with a high-resolution mask pattern imposed, up to 17 pixels of information can be recovered from each fiber core. A dispersive element at the distal end of the bundle imparts a wavelength-dependent lateral shift on light from the object. This enables light that would otherwise be lost at the inter-fiber cladding to be transmitted through adjacent fiber cores. We experimentally demonstrate this approach using synthetic and real objects. Using CI with spectral coding, object features 5× smaller than individual fiber cores were resolved, whereas conventional imaging could only resolve features at least 1.5× larger than each core. In summary, CI combined with spectral coding provides an approach for overcoming the two fundamental limitations of fiber optic bundle imaging.

Incidence and molecular characterization of extended-spectrum beta-lactamase (ESBL)-producing Salmonella enterica and Escherichia coli of avifauna origin in Pakistan.

Members of Enterobacteriaceae are known to produce extended-spectrum beta-lactamases (ESBL) which hydrolyze the beta-lactam group of antibiotics. The existence of ESBL-producing Salmonella enterica (S. enterica) and Escherichia coli (E. coli) harbored by urban avifauna was investigated in this study. Dropping samples (n= 180) were collected from six different bird species in the district Jhang, Punjab province, Pakistan. Isolation and identification of ESBL isolates were made by using cefotaxime- (4 mg/L) supplemented MacConkey agar and double disc synergy test (DDST). Polymerase chain reaction (PCR) was performed for the detection of four different ESBL genes including blaCTX-M, blaTEM, blaSHV and blaOXA. A total of 42.69% isolates were confirmed as ESBL via DDST including 30.64% S. enterica and 49.54% E. coli. The incidence of ESBL S. enterica and ESBL E. coli was found highest in egret (Ardea alba) and pigeon (Columba livia) as 64.28% and 78.95%, respectively. The blaCTX-M gene was detected in 57.89% and 64.81% of isolates of S. enterica and E. coli, respectively. Among other genes in S. enterica and E. coli, blaTEM (21.05%, 20.4%); blaSHV (15.78%, 9.26%), and blaOXA (5.26%, 5.56%) were detected, respectively. All of the tested isolates were found resistant to at least one of the thirteen antimicrobial agents except meropenem. To the best of our knowledge, this is the first study reporting the incidence and genetic diversity of ESBL bacteria associated with urban avifauna in Pakistan. The urban avifauna can serve as a potential subject of bio-surveillance to monitor the emergence of antimicrobial-resistant bacteria.

Analysis of Factors Affecting Burns Mortality: A National Burn Centre Experience From Pakistan 2007-2021.

Burns are a public health concern burdening the healthcare delivery system across the globe. Mortality rates are significant outcome parameters after a burn injury. The objective of the current study was to analyze the characteristics of the patients admitted to our burn care center and identify the factors related to mortality in the burn patients. This was a cross-sectional single-center study involving a retrospective analysis of mortality rates in burn patients over a period of 15 years from July 2007 to December 2021. During the study period, 7,866 burn patients were admitted to the ICU of the burn care center. Patients who died [Group 1] were compared to the group of survivors (control cases [Group 2]) to ascertain the contributing factors that might forecast a high risk for mortality. The mortality rate was calculated as 23.16% (1,822/7,866). The majority of the patients (both groups) had a total body surface area (TBSA) of >50% (p 0.001). The average duration of stay at the burn care center was 15.5 days for the survivors' group (Group 2) while it was 11.4 days for the patients who died (Group 1) during the course of their treatment. About 23.16% of all admitted patients died mostly from flame burns, and sepsis was the commonest cause of death. Patients with risk factors should be classified as high risk for mortality at the time of ICU admission. It is necessary to initiate educational and awareness programs for sensitization related to the prevention of burn injuries.

Les brûlures représentent une pathologie impactant les systèmes de santé du monde entier. Le taux de mortalité sont des marqueurs significatifs de l'évolution des brûlés. Cette étude rétrospective monocentrique cas- témoins analyse les caractéristiques des patients admis dans notre CTB pour brûlure pendant 15 ans (juillet 2007- Décembre 2021) et recherche les paramètres liés à la mortalité. Les 7 866 patients ont été répartis entre morts (1 822 ; 23,16%) et vivants. La majorité des patients, quel que soit le groupe, étaient brûlés sur au moins 50% de SCT. La DMS était plus longue chez les survivants (15,5 jours) que chez les morts (11,4 jours). La majorité des patients décédés étaient brûlés par flamme et le sepsis était la cause la plus fréquente de l'exitus. Ces patients devraient être classés comme à risque majeur de décès dès l'entrée. Il est nécessaire de mettre en œuvre des programmes d'éducation et de sensibilisation pour diminuer l'incidence des brûlures.

Pattern of Acute Adverse Transfusion Reactions in Patients With Burn Injuries: A Novel Initiative Towards Haemovigilance at the National Burn Centre of Pakistan.

The transfusion of blood and blood components is a life-saving medical procedure, however, it is linked with adverse reactions to transfusions. Information about different types of adverse transfusion reactions (ATRs) will assist in their early identification and subsequent management, as well as in devising strategies to minimize the occurrence of adverse reactions related to blood component transfusion. The current study was therefore executed to analyze the pattern of ATRs in patients with burn injuries at a national burn center. This was a cross-sectional, prospective study involving an analysis of immediate ATRs from January 2020 to June 2021 (18 months). ATRs observed during the study period were documented and analyzed. During the study period, 2,220 units of blood and blood components were transfused to 1,075 burn patients (2.06 transfusions per patient). A total of 27 ATRs were recorded (1.21%). Allergic reactions were the commonest (55.55%) followed by febrile non-haemolytic transfusion reaction (37.03%). The mean volume of blood unit transfused, when the reactions were noted, was approximately 75 ml (range: 15-230 ml). The mean time at which transfusion reactions were noted was 17 min (range: 5-220 minutes). The ATRs were more common in patients with multiple transfusions compared to those receiving a single transfusion. The common adverse reactions were allergic and febrile non-haemolytic transfusion reactions. It is vital to report all transfusion reactions to the attached blood center and hospital transfusion committee (HTC) on standardized reporting forms. Continuous medical education through seminars and sensitization workshops will support consolidating haemovigilance systems.

La transfusion de sang et de ses dérivés peut être salvatrice mais aussi être responsables d 'effets indésirables (EI). Les données concernant ces EI permettent de les diagnostiquer et les traiter précocement ainsi que de développer des protocoles destinés à en diminuer la prévalence. Cette étude rétrospective a analysé les EI transfusionnels survenus dans un CTB pakistanais sur une période de 18 mois (janvier 2020- juin 2021). Deux mille deux cent vingt unités ont été transfusées à 1 075 brûlés (2,06/patient). Vingt- sept (1,21%) EI ont été enregistrés. Les plus courantes étaient allergiques (55,55%), suivies des réactions fébriles non hémolytiques (37,03%). Cette réaction survenait à la 17ème minute (5- 220) lorsque 75 mL (15 à 230) avaient été passés. Ils étaient plus fréquents chez les multitransfusés que lors de la première perfusion. Il est crucial de rapporter tout EI au CTS et à l'hémovigilance locaux, sous un format standardisé et d'éduquer prescripteurs et utilisateurs.

Domain-Informed Neural Networks for Interaction Localization Within Astroparticle Experiments.

This work proposes a domain-informed neural network architecture for experimental particle physics, using particle interaction localization with the time-projection chamber (TPC) technology for dark matter research as an example application. A key feature of the signals generated within the TPC is that they allow localization of particle interactions through a process called reconstruction (i.e., inverse-problem regression). While multilayer perceptrons (MLPs) have emerged as a leading contender for reconstruction in TPCs, such a black-box approach does not reflect prior knowledge of the underlying scientific processes. This paper looks anew at neural network-based interaction localization and encodes prior detector knowledge, in terms of both signal characteristics and detector geometry, into the feature encoding and the output layers of a multilayer (deep) neural network. The resulting neural network, termed Domain-informed Neural Network (DiNN), limits the receptive fields of the neurons in the initial feature encoding layers in order to account for the spatially localized nature of the signals produced within the TPC. This aspect of the DiNN, which has similarities with the emerging area of graph neural networks in that the neurons in the initial layers only connect to a handful of neurons in their succeeding layer, significantly reduces the number of parameters in the network in comparison to an MLP. In addition, in order to account for the detector geometry, the output layers of the network are modified using two geometric transformations to ensure the DiNN produces localizations within the interior of the detector. The end result is a neural network architecture that has 60% fewer parameters than an MLP, but that still achieves similar localization performance and provides a path to future architectural developments with improved performance because of their ability to encode additional domain knowledge into the architecture.

Patient outcomes following transfer between intensive care units during the COVID-19 pandemic.

Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID-19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter-hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra-hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 h pre-transfer, immediately post-transfer and 24 h post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO2 /FI O2 ratio: from median (IQR [range]) 25.1 (17.8-33.7 [12.1-78.0]) kPa 6 h pre-transfer to 19.5 (14.6-28.9 [9.8-52.0]) kPa immediately post-transfer (p < 0.05). However, this had resolved at 24 h post-transfer: 25.4 (16.2-32.9 [9.4-51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO2 /FI O2 ratio. We also found no meaningful difference in pH; PaCO2 ;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic.

Liquiritin elicitation can increase the content of medicinally important glucosinolates and phenolic compounds in Chinese kale plants.

BACKGROUND: Brassica oleracea var. alboglabra (Chinese kale) is an important vegetable grown in southern China. This study was aimed at searching for environmentally friendly and affordable approaches to increase the production of medicinally relevant glucosinolates and phenolic compounds in Chinese kale plants. For this purpose, the foliar application of liquiritin at 0 (control), 250, 500 and 750 ppm was tested starting from the four-leaf stage and repeated every two weeks until plants were two months old. RESULTS: Foliar application of liquiritin in Chinese kale plants significantly increased glucosinolates and total phenolic content, in a dose-dependent manner. Compared with control plants, 2.3- and 1.9-fold increases in yields of glucosinolates and total phenolic content, respectively, were corroborated in Chinese kale plants treated with 750 ppm of liquiritin. Along with rises in the content of eight different glucosinolates, liquiritin elicitation effectively increased the concentration of glycosilated and acylated flavonoids and hydroxycinnamic acids. The expression of genes involved in glucosinolate and phenolic biosynthesis was significantly higher in liquiritin-treated plants as compared to controls. CONCLUSIONS: Liquiritin elicitation is a feasible and environmentally friendly practice for increasing the production of medicinally important glucosinolates and phenolic compounds in Chinese kale, which may improve this plant's value as a nutraceutical food. This study also contributes to understanding the molecular mechanisms underlying liquiritin elicitation. This is the first report documenting the use of liquiritin for an elicitation purpose in plants. © 2019 Society of Chemical Industry.

Computational endoscopy-a framework for improving spatial resolution in fiber bundle imaging.

This Letter presents a framework for computational imaging (CI) in fiber-bundle-based endoscopy systems. Multiple observations are acquired of objects spatially modulated with different random binary masks. Sparse-recovery algorithms then reconstruct images with more resolved pixels than individual fibers in the bundle. Object details lying within the diameter of single fibers are resolved, allowing images with 41,663 resolvable points to be generated through a bundle with 2,420 fibers. Computational fiber bundle imaging of micro- and macro-scale objects is demonstrated using fluorescent standards and biological tissues, including in vivo imaging of a human fingertip. In each case, CI recovers details that conventional endoscopy does not provide.

Solid-State Carbon Dots with Efficient Cyan Emission towards White Light-Emitting Diodes.

Efficient cyan-emitting solid carbon dots (CDs) were synthesized via a one-pot hydrothermal method. The obtained solid CDs show a broad absorption from 270-460 nm with a maximum around 400 nm, and emit intense cyan light around 500 nm with an internal photoluminescence quantum efficiency of 34.1 % under 400 nm excitation. The emission maximum of the solid CDs remains unchanged under 320-400 nm excitations. Compared with dilute aqueous of CDs (2.5 mg mL-1 ), the emission of solid CDs shows an obvious red-shift of 50 nm. The red-shift is caused by resonant energy transfer due to larger spectral overlap and smaller interparticle distance, together with a new surface state caused by aggregation in solid CDs. A lamp with white LEDs was fabricated by dropping a mixture of solid CDs, CaAlSiN3 :Eu2+ and silicon resin on the top of a near-ultraviolet LED chip. Under an operating current of 20 mA, the as-fabricated white LED generates a high-quality, warm white light with a color rendering index of 86.1, a color temperature of 4340 K, and a luminescence efficiency of 31.3 lm W-1 .

Computational imaging with a highly parallel image-plane-coded architecture: challenges and solutions.

This paper investigates a highly parallel extension of the single-pixel camera based on a focal plane array. It discusses the practical challenges that arise when implementing such an architecture and demonstrates that system-specific optical effects must be measured and integrated within the system model for accurate image reconstruction. Three different projection lenses were used to evaluate the ability of the system to accommodate varying degrees of optical imperfection. Reconstruction of binary and grayscale objects using system-specific models and Nesterov's proximal gradient method produced images with higher spatial resolution and lower reconstruction error than using either bicubic interpolation or a theoretical system model that assumes ideal optical behavior. The high-quality images produced using relatively few observations suggest that higher throughput imaging may be achieved with such architectures than with conventional single-pixel cameras. The optical design considerations and quantitative performance metrics proposed here may lead to improved image reconstruction for similar highly parallel systems.

Characterization of Carbapenem-Resistant Enterobacteriaceae with High Rate of Autochthonous Transmission in the Arabian Peninsula.

To establish the role of local transmission versus possible pathogen import due to previous foreign exposure in infections caused by carbapenem non-susceptible Enterobacteriaceae in the Arabian Peninsula, 200 independent isolates collected in 16 hospitals of Saudi Arabia, Kuwait, Oman and the United Arab Emirates were studied. All strains were multidrug resistant; 42.5% of them also qualified as extremely drug resistant. The frequency of various carbapenemases varied according to the participating countries, but in the collection, as a whole, blaNDM-1 was the most frequently encountered carbapenemase gene (46.5%) followed by blaOXA-48-like gene (32.5%). A comparatively high rate (8.9%) of multi-clonal strains carrying both blaNDM and blaOXA-48-like genes in the United Arab Emirates, representing the most resistant subgroup, was encountered. No KPC-expressing isolates were detected. Three major clones of blaNDM-1 carrying Klebsiella pneumoniae of ST152 (n = 22, Saudi Arabia), ST14 (n = 7, United Arab Emirates) and ST147 types (n = 9, Oman) were identified, the latter two clones carrying similar, but not identical HI1b incompatibility type plasmids of >170 kb. While from 78.6% of the cases with documented foreign hospitalization blaNDM positive strains were isolated, these strains formed only 25.6% of all the isolates expressing this enzyme. In fact, 56.8% of the NDM, 75.7% of OXA-48-like and 90.9% of VIM positive strains were recovered from patients without documented foreign exposure, neither in the form of travel or prior hospitalization abroad, suggesting a high rate of autochthonous infections. This, considering the extensive links of these countries to the rest of the world, predicts that trends in the local epidemiology of carbapenem resistant strains may increasingly affect the spread of these pathogens on the global scale. These results call for improved surveillance of carbapenem resistant Enterobacteriaceae in the countries of the Arabian Peninsula.

Frequency of haemoglobinopathies: a single-centre, cross-sectional study from Islamabad, Pakistan.

Thalassaemia is the most frequent hereditary disorder in Pakistan, with an estimated 8-10 million carriers. This single-centre study reported the frequency of haemoglobinopathies among 504 consecutive cases visiting Islamabad Diagnostic Centre for haemoglobin electrophoresis from July 2010 to February 2011. Haemoglobin electrophoresis was performed on cellulose acetate membrane, followed by staining and densitometric scanning of bands. A total of 143 (28.4%) subjects had haemoglobinopathies. The most predominant was thalassaemia trait (25.6%), followed by thalassaemia major (1.4%) and HbS or HbD (1.4%). The gene frequencies for thalassaemia trait and major were 0.256 and 0.0139 respectively. The study provides support for continuing efforts towards early detection and characterization of haemoglobinopathies to control the affected births in Pakistan.

Frequency of haemoglobinopathies: a single-centre, cross-sectional study from Islamabad, Pakistan

Thalassaemia is the most frequent hereditary disorder in Pakistan, with an estimated 8-10 million carriers. This single-centre study reported the frequency of haemoglobinopathies among 504 consecutive cases visiting Islamabad Diagnostic Centre for haemoglobin electrophoresis from July 2010 to February 2011. Haemoglobin electrophoresis was performed on cellulose acetate membrane, followed by staining and densitometric scanning of bands. A total of 143 [28.4%] subjects had haemoglobinopathies. The most predominant was thalassaemia trait [25.6%], followed by thalassaemia major [1.4%] and HbS or HbD [1.4%]. The gene frequencies for thalassaemia trait and major were 0.256 and 0.0139 respectively. The study provides support for continuing efforts towards early detection and characterization of haemoglobinopathies to control the affected births in Pakistan

Acute starvation in pregnancy: a cause of severe metabolic acidosis.

We report a case of starvation-induced metabolic ketoacidosis in a previously healthy 29-year-old, nulliparous woman at 32 weeks of gestation. She was admitted to hospital with mild preeclampsia associated with persistent nausea and vomiting that progressed to severe preeclampsia requiring urgent control of hypertension before caesarean delivery. Prolonged and severe vomiting limited oral caloric intake and led to starvation ketoacidosis, characterised by ketonuria and a raised anion gap metabolic acidosis that required intensive care support. Despite significant metabolic derangement the patient appeared clinically well. Intravascular volume was replenished. Fluid restriction used as part of our preeclampsia treatment regimen delayed the therapeutic administration of sufficient dextrose, which rapidly corrected her metabolic derangement when commenced after delivery. Electrolyte supplementation was given to prevent re-feeding syndrome. Both mother and baby were discharged without sequelae.

Molecular characterisation of foot-and-mouth disease viruses from Pakistan, 2005-2008.

Foot-and-mouth disease (FMD), an economically important disease of cloven-hoofed animals, is endemic in Pakistan where three virus serotypes are present (O, A and Asia 1). Fifty-eight clinical samples collected between 2005 and 2008 from animals with suspected FMD in various locations in Pakistan were subjected to virus isolation on primary cell culture, antigen ELISA and real-time RT-PCR (rRT-PCR). Viruses were isolated from 32 of these samples and identified as FMDV type O (n = 31) or type A (n = 1). Foot-and-mouth disease virus (FMDV) genome was detected in a further 11 samples by real-time RT-PCR. Phylogenetic analyses of the VP1 nucleotide sequences showed that all of the type O viruses belonged to the MIDDLE EAST-SOUTH ASIA topotype with the majority belonging to the PanAsia-2 lineage; a single example of the older PanAsia lineage was identified. The single FMDV type A virus belonged to the ASIA topotype, but did not cluster with known strains that are currently circulating (such as Iran-05) and was not closely related to other type A viruses from the region. These findings demonstrate the widespread distribution of O-PanAsia-2 in Pakistan and the presence of undisclosed novel type A lineages in the region.