Spatial distribution of health facilities in Islamabad, Pakistan.

There are no comprehensive, spatially referenced databases of public and private health facilities in any of the countries of the Eastern Mediterranean Region. This study in Pakistan was conducted to demonstrate the feasibility of creating a spatially referenced health facility database for a medium-sized city, in a low-cost, non-resource intensive manner and to visualize the spatial relationship between hospitals and clinics in the city of Islamabad. Cumulatively, 166 (77.6% of all clinics mapped) were in close proximity (within 1 km) to a hospital. Repeating such studies elsewhere would help us to better understand different spatial distribution patterns, the reasons for them and the implications for health-care planning.

Evaluating the Role of AI in Predicting the Success of Dental Implants Based on Preoperative CBCT Images: A Randomized Controlled Trial.

Background: Dental implant surgery has become a widely accepted method for replacing missing teeth. However, the success of dental implant procedures can be influenced by various factors, including the quality of preoperative planning and assessment. Cone beam computed tomography (CBCT) imaging provides valuable insights into a patient's oral anatomy, but accurately predicting implant success remains a challenge. Materials and Methods: In this randomized controlled trial (RCT), a cohort of 150 patients requiring dental implants was randomly divided into two groups: an artificial intelligence (AI)-assisted group and a traditional assessment group. Preoperative CBCT images of all patients were acquired and processed. The AI-assisted group utilized a machine learning model trained on historical data to assess implant success probability based on CBCT images, while the traditional assessment group relied on conventional methods and clinician expertise. Key parameters such as bone density, bone quality, and anatomical features were considered in the AI model. Results: After the completion of the study, the AI-assisted group demonstrated a significantly higher implant success rate, with 92% of implants successfully integrating into the bone compared to 78% in the traditional assessment group. The AI model showed an accuracy of 87% in predicting implant success, whereas traditional assessment methods achieved an accuracy of 71%. Additionally, the AI-assisted group had a lower rate of complications and required fewer postoperative interventions compared to the traditional assessment group. Conclusion: The AI-assisted approach significantly improved implant success rates and reduced complications, underscoring the importance of incorporating AI into the dental implant planning process.

Road rage and road traffic accidents among commercial vehicle drivers in Lahore, Pakistan.

Road rage and road traffic accidents increase the burden of morbidity and mortality in a population. A cross-sectional survey with convenience sampling was conducted among commercial vehicle drivers in Lahore, Pakistan (n = 901) to record their behaviours/experiences regarding road rage and road traffic accidents. Respondents were asked about incidents of shouting/cursing/rude gestures or threats to physically hurt the person/vehicle, by others or themselves, in the previous 24 hours or 3 months, and their involvement in road traffic accidents in the previous 12 months. Auto-rickshaw drivers were significantly more likely to report various road rage experiences/behaviours and involvement in accidents compared with bus and wagon drivers. A total of 112 respondents (12.4%) reported being involved in a road traffic accident in the previous 12 months but traffic police did not record the accident in 52.7% of cases. The results of this study underline the need to improve road safety in Pakistan.

Beliefs about euthanasia among university students: perspectives from Pakistan.

Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students (316 males and 520 females) completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it. Students who opposed legalization (74.4%) cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia.

Road rage behaviour and experiences of rickshaw drivers in Rawalpindi, Pakistan.

A cross-sectional survey with convenience sampling was conducted among rickshaw drivers in Rawalpindi, Pakistan to study their road rage behaviour and experiences. Cumulatively 318 male drivers participated in this study. The most common forms of road rage reported were: having been shouted at; and having experienced rude gestures from other drivers (78.9% each). Least common forms of road rage reported were: threats of physical hurt or having actually been physically hurt ( < or = 3% each). Rickshaw drivers with shorter driving time (< or = 10 years) had significantly more road rage experiences than those who had been driving for more than 10 years (P < 0.01). There is a need for nationally representative surveys to study road age in commercial vehicle drivers so as to improve road safety in Pakistan.

Ictal autonomic activity recorded via wearable-sensors plus machine learning can discriminate epileptic and psychogenic nonepileptic seizures.

Differentiating epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is commonly based on electroencephalogram and concurrent video recordings (vEEG). Here, we demonstrate that these two types of seizures can be discriminated based on signals related to autonomic nervous system activity recorded via wearable sensors. We used Empatica E4 Wristband sensors worn on both arms in vEEG confirmed seizures, and machine learning methods to train classifiers, specifically, extreme gradient boosting (XGBoost). Classification performance achieved a predictive accuracy of 78 ± 1.5% on previously unseen data for whether a seizure was epileptic or psychogenic, which is 6 standard deviations above the baseline of 68% accuracy. Our dataset contained altogether 35 seizures from 18 patients out of which 8 patients had 13 convulsive seizures. Prediction of seizure type was based on simple features derived from the segments of autonomic activity measurements (electrodermal activity, body temperature, blood volume pulse, and heart rate) and forearm acceleration. Features related to heart rate and electrodermal activity were ranked as the top predictors in XGBoost classifiers. We found that patients with PNES had a higher ictal heart rate and electrodermal activity than patients with ES. In contrast to existing published studies of mainly convulsive seizures, our classifier focuses on autonomic signals to differentiate convulsive or nonconvulsive semiology ES from PNES. Our results show that autonomic activity recorded via wearable sensors provides promising signals for detection and discrimination of psychogenic and epileptic seizures, but more work is necessary to improve the predictive power of the model.

HMX based enhanced energy LOVA gun propellant.

Efforts to develop gun propellants with low vulnerability have recently been focused on enhancing the energy with a further improvement in its sensitivity characteristics. These propellants not only prevent catastrophic disasters due to unplanned initiation of currently used gun propellants (based on nitrate esters) but also realize enhanced energy levels to increase the muzzle velocity of the projectiles. Now, in order to replace nitroglycerine, which is highly sensitive to friction and impact, nitramines meet the requirements as they offer superior energy due to positive heat of formation, typical stoichiometry with higher decomposition temperatures and also owing to negative oxygen balance are less sensitive than stoichiometrically balanced NG. RDX has been widely reported for use in LOVA propellant. In this paper we have made an effort to present the work on scantily reported nitramine HMX based LOVA gun propellant while incorporating energetic plasticizer glycidyl azide polymer to enhance the energy level. HMX is known to be thermally stable at higher temperature than RDX and also proved to be less vulnerable to small scale shaped charge jet attack as its decomposition temperature is 270 degrees C. HMX also offers improved impulse due to its superior heat of formation (+17 kcal/mol) as compared to RDX (+14 kcal/mol). It has also been reported that a break point will not appear until 35,000 psi for propellant comprising of 5 microm HMX. Since no work has been reported in open literature regarding replacement of RDX by HMX, the present studies were carried out.

Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients.

OBJECTIVE: To understand the influence of diabetes on the clinical and bacteriological aspects and treatment outcome of pulmonary tuberculosis (PTB) patients. SETTING AND DESIGN: Records of 692 consecutive smear-positive PTB patients admitted to a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively. The characteristics of 187 patients with diabetes mellitus (PTB-DM group) were compared to 505 patients without DM (PTB group). RESULTS: In the PTB-DM group, 65.2% of the patients had numerous acid-fast bacilli (AFB) on sputum smear examination compared to 54.1% in the control group (P = 0.008). Among new cases, PTB-DM patients had a lower prevalence of resistance to any anti-tuberculosis drug (6.4% vs. 16.0%, P = 0.007) and achieved higher sputum conversion rates at the end of 3 months of treatment (98.9% vs. 94.7%, P = 0.013). Favourable outcomes (cured/treatment completed), failure, death and default were comparable in both groups (P = 0.7005). CONCLUSIONS: PTB-DM patients have a higher pre-treatment bacillary load, a lower prevalence of anti-tuberculosis drug resistance and achieve slightly higher sputum conversion by the end of 3 months of treatment compared to non-diabetic patients. The association of diabetes does not alter the final treatment outcome among PTB patients.

Knowledge and misconceptions about sexually transmitted infections in married women--perspective from Islamabad.

OBJECTIVE: To study the knowledge of married women regarding existence of sexually transmitted infection (STI) their complications, treatment seeking, ways of preventing STI acquisition and opinion about sex education in schools/colleges and media. SETTING: The Mother and Child Health Center, a tertiary care hospital in Islamabad. METHODS: A cross-sectional survey based on sample of convenience was conducted, using a structured questionnaire with both close and open-ended questions. Trained women physician interviewers conducted the interviews after obtaining verbal consent. RESULTS: Out of 218 women approached for interviewing, only two refused to participate in the study. The mean age of the respondents was 28.5 years (range 18-53 years). One hundred and sixty-eight (77.8%) respondents had heard/knew about sexually transmitted infections (STIs). Two hundred and ten (97.2%) respondents had heard/ knew about AIDS and out of these 162 (77.1%) knew that it is also transmitted through sexual contact. One hundred and eighty two (84.2%) felt a need for sex education in the media, both print and electronic and 204 (94.4%) respondents said that they would like to learn more about sexually transmitted infections. One hundred ninety four (98.8%) respondents had heard the Latin term Leukorrhoea. Of these 158 (81.5%) thought it was a gynecological disease. Majority thought it caused weakness. CONCLUSION: Widespread misperceptions were found to exist, which does not augur well for the effective prevention of STIs in the country. Population based studies are required to study the knowledge and epidemiology of STIs, as well as a need for a health education campaign in the country (JPMA 51:389; 2001).

Effect of mitral regurgitation on diastolic filling with left ventricular hypertrophy.

Earlier studies have suggested that mitral regurgitation (MR) augments early left ventricular (LV) diastolic filling. To determine whether MR affects early diastolic filling in patients with abnormal diastolic filling, transmitral pulsed-wave Doppler recordings were used to study 32 normal subjects, 21 patients with LV hypertrophy, 23 with LV hypertrophy and MR and 15 patients with MR. Patients with MR had increased peak early filling velocities (MR 108 +/- 27 cm/s, normal 80 +/- 16 cm/s, p less than 0.01), peak atrial filling velocities (MR 72 +/- 18 cm/s, normal 55 +/- 12 cm/s, p less than 0.05) and increased deceleration rates (MR 5.0 +/- 1.9 m/s2, normal 3.5 +/- 1.2 m/s2, p less than 0.05). Patients with LV hypertrophy had reduced peak early filling velocities (69 +/- 14 cm/s, p less than 0.05) and increased peak atrial filling velocities (83 +/- 16 cm/s, p less than 0.001). There was also an increase in the atrial filling fraction and reduction in the rapid filling fraction as compared with normal patients. Patients with LV hypertrophy and MR had increased peak early filling velocities (98 +/- 26 cm/s, p less than 0.01 vs normal, p less than 0.001 vs LV hypertrophy patients), increased atrial filling velocities (84 +/- 27 cm/s, p less than 0.001 vs normal), increased deceleration rates (4.4 +/- 2.4 m/s2, p less than 0.05 vs normal) and a normal distribution of diastolic filling. Within the LV hypertrophy and MR group, diastolic filling parameters were similar when patients were subgrouped on the basis of auscultability of MR. MR augments early diastolic filling and may tend to normalize diastolic filling patterns in LV hypertrophy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of anti-tuberculosis drug resistance on the treatment outcome of pulmonary tuberculosis patients receiving DOTS in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the influence of anti-tuberculosis drug resistance existing prior to treatment on the outcome of pulmonary tuberculosis patients receiving standard short-course chemotherapy (SCC) under direct observation under national programme guidelines. DESIGN: Treatment outcomes of sputum smear- and culture-positive pulmonary tuberculosis patients admitted consecutively from 1998 through 1999 in a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively. RESULTS: A total of 515 patients were reviewed; 139 patients were deported or transferred out. Treatment outcomes and follow-up for about 2 years were analysed for the remaining 376 patients. Among 315 patients with sensitive isolates, 301 achieved favourable outcome, none relapsed or failed, 10 defaulted, one died and three were lost to follow-up at 6 months. Mono-resistance to isoniazid, streptomycin or ethambutol did not influence the treatment outcome. All the 18 patients with mono-resistance to rifampicin were cured, but two relapsed later. Among 39 patients with any rifampicin resistance, 37 patients had favourable outcome and two failed treatment; three later relapsed. Among eight patients with MDR-TB, six had favourable outcome and two failed treatment; one later relapsed. Sputum smear conversion rates at the end of 3 months of treatment in patients with any rifampicin resistance or with multidrug resistance were inferior to those of patients with sensitive strains (89.8% vs. 96.3%, P = 0.016 and 80% vs. 96.3%, P = 0.008, respectively). CONCLUSIONS: Anti-tuberculosis drug resistance existing prior to treatment, especially rifampicin and multidrug resistance, has an adverse effect on treatment outcome, even with directly observed standard SCC under national programme guidelines.

Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment.

SETTING: Studies have shown that adverse outcomes are more likely in patients showing persistent sputum positivity at the end of 2 months of anti-tuberculosis treatment. OBJECTIVE: To identify simple clinical, microbiological or radiological factors associated with persistent sputum positivity under national programme conditions. DESIGN: Sputum smear-positive pulmonary tuberculosis patients admitted in 2 consecutive years to a referral hospital, and who received standard short-course chemotherapy under direct observation, were reviewed retrospectively. Factors associated with persistent sputum smear positivity were analysed. RESULTS: A total of 514 patients were available for review. Logistic regression analysis showed that age groups 41-60 years and more than 60 years, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases were significant factors associated with persistent sputum positivity at the end of 2 months of treatment (P < 0.0001). CONCLUSIONS: Identification of high risk factors associated with persistent sputum positivity, such as specific age groups, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases, may be helpful in stratifying the patients according to the risk of adverse outcome, thus allowing greater efficiency in resource utilisation.

A study of cloud classification with neural networks using spectral and textural features.

The problem of cloud data classification from satellite imagery using neural networks is considered in this paper. Several image transformations such as singular value decomposition (SVD) and wavelet packet (WP) were used to extract the salient spectral and textural features attributed to satellite cloud data in both visible and infrared (IR) channels. In addition, the well-known gray-level cooccurrence matrix (GLCM) method and spectral features were examined for the sake of comparison. Two different neural-network paradigms namely probability neural network (PNN) and unsupervised Kohonen self-organized feature map (SOM) were examined and their performance were also benchmarked on the geostationary operational environmental satellite (GOES) 8 data. Additionally, a postprocessing scheme was developed which utilizes the contextual information in the satellite images to improve the final classification accuracy. Overall, the performance of the PNN when used in conjunction with these feature extraction and postprocessing schemes showed the potential of this neural-network-based cloud classification system.

Knowledge and attitudes of medical students to people with HIV and AIDS.

PIP: 244 fourth- and fifth-year medical students of Sindh Medical College, Karachi, completed questionnaires during November-December 1994 designed to assess their knowledge and attitudes toward HIV/AIDS. 96.7% correctly answered survey questions on the cause of AIDS. 87.7% correctly responded on the existence of HIV transmission through blood transfusion, 96.3% on transmission through sexual contact, and 77% on mother-to-child transmission. 25% of respondents believed that people with AIDS should not be allowed to use common toilets and that health personnel should attend such patients only while wearing special clothing. 72.1% were aware of the HIV antibody test for diagnosis. Further, 85% had correct knowledge on counseling to family members of HIV-infected individuals to avoid blood and body secretions, sexual activity, and condom use. 27% incorrectly believed that HIV-infected children should be removed from school and 34% did not know that HIV-infected persons remain healthy for a long period of time.^ieng

Domestic violence against women--perspective from Pakistan.

OBJECTIVE: Domestic violence is an important public health concern. This study assessed the prevalence and type of domestic violence perpetrated by men on their wives. SETTING: The study was conducted in a public sector hospital among men accompanying patients. METHODS: A cross-sectional survey based on a sample of convenience was conducted by the author, using a pre-tested questionnaire with mostly close-ended questions. RESULTS: All the respondents admitted to ever shouting or yelling at their wives, including while she was pregnant. Twenty-three (32.8%) respondents admitted to ever having slapped their wives and 54 (77.1%) admitted to ever engaging in a non-consensual sex with their wives. CONCLUSION: Population based studies are required to assess the type, frequency, risk factors and sequel of wife abuse, so as to establish practice guidelines.

Sexual harassment in medical profession--perspective from Pakistan.

OBJECTIVE: To assess the extent of Sexual harassment of female nurses by male physicians, patients or patient's relatives. SETTING: A general hospital in Islamabad. METHOD: A cross sectional written study through a self administered brief questionnaire. RESULTS: Male physicians were identified as the major perpetrators of sexual harassment, followed by the patients and their relatives. CONCLUSION: The nurses and hospital administration need to work together for fostering work environment conducive to healthy environment for effective health care delivery.

Hazard perception and occupational injuries in the welders and lathe machine operators of Rawalpindi and Islamabad.

OBJECTIVE: To study the prevalence of occupational injuries in the welders and lathe machine operators and their hazard perception. SETTING: This study was conducted in the welders and lathe machine operators working in the welding and metal working shops in Rawalpindi and Islamabad. METHODS: A cross-sectional survey was conducted by two trained health interviewers using uniform questionnaire with both close and open-ended questions. RESULTS: Two hundred and eight welders and 104 lathe machine operators were interviewed. Thirty nine (18.7%) welders and 27 (26%) lathe machine operators reported an injury in the past three months, while 63 (30.3%) welders and 76 (73.8%) lathe machine operators reported sustaining an injury in the past twelve months. However, only half of the welders and 31 (29.8%) lathe machine operators believed that their occupation was hazardous for health. CONCLUSION: For effective public health policy there is a need preventive education and enforcement of safety regulations for the informal occupational sector in Pakistan.

Adolescent's knowledge about AIDS--perspective from Islamabad.

OBJECTIVE: To study the adolescent student's knowledge and its sources about AIDS, and its mode of spread in Islamabad. SETTING: One boys and two girls schools in Islamabad. METHODS: A cross-sectional survey was conducted, using an anonymous, self-administered, brief Urdu questionnaire which was distributed among 100 boys and 182 girls. RESULTS: The response rate was 100% and the average age of respondents was 14.6 years in boys and 12 years in girls. Most respondents knew about AIDS and reported television as their main source of knowledge. Most respondents also correctly believed that AIDS patient can pass on the disease to others, however, they had erroneous beliefs about its mode of transmission. CONCLUSION: This study testifies to the effectiveness of the successful television based health education campaign regarding AIDS in the adolescent boys and girls, in Islamabad.

Knowledge and misconceptions about sexually transmitted infections in married women--perspective from Islamabad.

OBJECTIVE: To study the knowledge of married women regarding existence of sexually transmitted infection (STI) their complications, treatment seeking, ways of preventing STI acquisition and opinion about sex education in schools/colleges and media. SETTING: The Mother and Child Health Center, a tertiary care hospital in Islamabad. METHODS: A cross-sectional survey based on sample of convenience was conducted, using a structured questionnaire with both close and open-ended questions. Trained women physician interviewers conducted the interviews after obtaining verbal consent. RESULTS: Out of 218 women approached for interviewing, only two refused to participate in the study. The mean age of the respondents was 28.5 years (range 18-53 years). One hundred and sixty-eight (77.8%) respondents had heard/knew about sexually transmitted infections STIs. Two hundred and ten (97.2%) respondents had heard/knew about AIDS and out of these 162 (77.1%) knew that it is also transmitted through sexual contact. One hundred and eight two (84.2%) felt a need for sex education in the media, both print and electronic and 204 (94.4%) respondents said that they would like to learn more about sexually transmitted infections. One hundred ninety four (98.8%) respondents had heard the Latin term Luekorrhoea. Of these 158 (81.5%) thought it was a gynecological disease. Majority thought it caused weakness. CONCLUSION: Widespread misperceptions were found to exist, which does not augur well for the effective prevention of STIs in the country. Population based studies are required to study the knowledge and epidemiology of STIs, as well as a need for a health education campaign in the country.