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BACKGROUND: The knee joint assessment to detect anterior cruciate ligament (ACL) injury after trauma involves clinical examination and radiography. The gold standard method is doing arthroscopy. We did this study seeking to evaluate the effectiveness of other non-invasive diagnostic methods, including the Anterior Drawer test, Lachman test and magnetic resonance imaging (MRI) in detecting ACL tears after trauma, compared to the reference standard method (the arthroscopy). METHODOLOGY: This descriptive cross-sectional study was conducted in the Orthopaedic Department of the Khyber Teaching Hospital, Peshawar, for six months. A total of 86 participants with knee injuries fulfilling the inclusion criteria were recruited for the study. Mechanism of injury, side of injury and body weight were recorded. The Anterior Drawer test and Lachman test for ACL injury were performed by orthopaedic surgeons with at least five years of post-fellowship experience in orthopaedic surgery. Sensitivities, specificities and accuracy of the clinical tests and MRI were calculated. RESULTS: The statistical analysis revealed that the mean age of participants was 35.73 (SD 12.7) years, with a range from 18 to 55 years. Among the participants, 67 (77.91%) were male and 19 (22.09%) were female. The side of injury was predominantly right in 50 (58.14%) and left in 36 (41.86%) participants. Road traffic accidents (RTAs) were the leading cause of knee injury, accounting for 63.95% (55) of cases, followed by sports injuries at 23.26% (20). Regarding diagnostic accuracy, MRI showed a sensitivity of 98.57%, specificity of 87.50% and diagnostic accuracy of 96.51% in detecting ACL tears. The Lachman test demonstrated a sensitivity of 90%, specificity of 87.5% and diagnostic accuracy of 89.53% compared to arthroscopy. Similarly, the anterior Drawer test exhibited a sensitivity of 88.57%, specificity of 87.50% and diagnostic accuracy of 88.37% against the gold standard of arthroscopy. These findings underscore the effectiveness of these diagnostic modalities in identifying ACL injuries. CONCLUSIONS: All three tests (MRI, Lachman test and anterior Drawer test) can be used for the diagnosis of anterior cruciate ligament injury with optimal results.
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Network operations involve several decision-making tasks. Some of these tasks are related to operators, such as extending the footprint or upgrading the network capacity. Other decision tasks are related to network functions, such as traffic classifications, scheduling, capacity, coverage trade-offs, and policy enforcement. These decisions are often decentralized, and each network node makes its own decisions based on the preconfigured rules or policies. To ensure effectiveness, it is essential that planning and functional decisions are in harmony. However, human intervention-based decisions are subject to high costs, delays, and mistakes. On the other hand, machine learning has been used in different fields of life to automate decision processes intelligently. Similarly, future intelligent networks are also expected to see an intense use of machine learning and artificial intelligence techniques for functional and operational automation. This article investigates the current state-of-the-art methods for packet scheduling and related decision processes. Furthermore, it proposes a machine learning-based approach for packet scheduling for agile and cost-effective networks to address various issues and challenges. The analysis of the experimental results shows that the proposed deep learning-based approach can successfully address the challenges without compromising the network performance. For example, it has been seen that with mean absolute error from 6.38 to 8.41 using the proposed deep learning model, the packet scheduling can maintain 99.95% throughput, 99.97% delay, and 99.94% jitter, which are much better as compared to the statically configured traffic profiles.
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OBJECTIVE: Gliomas are immune system suppressive tumors, and the role of vitamin D is pivotal in the immune system. This study aimed to observe if there is any significant association between the serum levels of 25-hydroxyvitamin D with hematological indices and anthropometric measurements. METHODS: A total of 75 glioma patients were included, and the information was collected on gender, age group, area, socioeconomic status, intake of vitamin D and calcium in food and supplements, skin color, sunlight exposure, body mass index, and muscle strength. A nonparametric Kendall's tau-b correlation test was performed to find a correlation between 25-hydroxyvitamin D levels and blood counts, body mass index, and muscle strength. RESULTS: The majority of patients (72%) were having low lymphocytes followed by high granulocytes and high white blood cells. The majority were having low levels of both 25-hydroxyvitamin D (84%) and calcium (73%). Patients were mainly from urban areas, and the majority belonged to middle-class families having sedentary lifestyles. The majority of patients were not taking vitamin D supplements. An insufficient amount of sunlight exposure was found in most of them. The majority of the patients were although had normal weight but weak muscle strength (74.6%). An insignificant correlation was found between 25-hydroxyvitamin D levels with the hematological indices or anthropometric measurements in brain tumor patients. CONCLUSION: Vitamin D is a powerful immune modulator, and there is a great need for sufficient amounts of sunlight exposure and vitamin D-enriched diets to prevent cancer.
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Calcio , Glioma , Humanos , Calcifediol , Vitamina D , Antropometría , VitaminasRESUMEN
SUMMARY OBJECTIVE: Gliomas are immune system suppressive tumors, and the role of vitamin D is pivotal in the immune system. This study aimed to observe if there is any significant association between the serum levels of 25-hydroxyvitamin D with hematological indices and anthropometric measurements. METHODS: A total of 75 glioma patients were included, and the information was collected on gender, age group, area, socioeconomic status, intake of vitamin D and calcium in food and supplements, skin color, sunlight exposure, body mass index, and muscle strength. A nonparametric Kendall's tau-b correlation test was performed to find a correlation between 25-hydroxyvitamin D levels and blood counts, body mass index, and muscle strength. RESULTS: The majority of patients (72%) were having low lymphocytes followed by high granulocytes and high white blood cells. The majority were having low levels of both 25-hydroxyvitamin D (84%) and calcium (73%). Patients were mainly from urban areas, and the majority belonged to middle-class families having sedentary lifestyles. The majority of patients were not taking vitamin D supplements. An insufficient amount of sunlight exposure was found in most of them. The majority of the patients were although had normal weight but weak muscle strength (74.6%). An insignificant correlation was found between 25-hydroxyvitamin D levels with the hematological indices or anthropometric measurements in brain tumor patients. CONCLUSION: Vitamin D is a powerful immune modulator, and there is a great need for sufficient amounts of sunlight exposure and vitamin D-enriched diets to prevent cancer.
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Objective To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methods Forty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paper-based and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical. Results For all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). Conclusion Electronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.
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AIMS: This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year. METHODS: A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples t-test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61). CONCLUSION: COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: Bone Jt Open 2021;2(12):1017-1026.
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The COVID-19 pandemic has brought attention back to its spread in medical staff. A survey-based study was conducted to combine general information related to COVID-19 exposures, acceptances, vaccines received, and side effects. The majority (62.3%) of healthcare professionals had acquired COVID-19 infection from hospital environment (51.5%) mainly who treated (64%) COVID-19 patients. 54% healthcare respondents expressed 'high acceptance' towards COVID-19 vaccines. 88% received COVID-19 vaccination. The majority of healthcare personnel received SinoPharm (65%). 82.3% did not acquire COVID-19 post-vaccination. 38% mild side effects were observed from vaccination. Following were the general side-effects: myalgia (18.2%), the feeling of sickness (16%), fever (15.6%), dizziness (7.8%), joint pain (7.4%), chills (4.8%), and flu (4.8%). Following were the common neurological side-effects reported: headache (18.2%), fatigue (16.5%), muscle pain (16%), numbness/tingling (3%), and migraine (2.6%). Nausea and diarrhoea were reported in only 3.5% of respondents. Bad taste was reported in only 3% of respondents. The 1.7% reported rash and itching. The majority of the healthcare professionals did not report significant side effects related to neurological, gastroenterological, skin and oral categories. To assess the vaccines' potential for substantial and long-term or chronic effects, more study with a larger sample size and a longer follow-up time is required.
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Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Salud Laboral , Vacunación , Adulto , COVID-19/inmunología , COVID-19/transmisión , Vacunas contra la COVID-19/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Exposición Profesional/efectos adversos , Pakistán , Factores de Tiempo , Resultado del Tratamiento , Vacunación/efectos adversos , Vacilación a la VacunaciónRESUMEN
With continuously rising trends in applications of information and communication technologies in diverse sectors of life, the networks are challenged to meet the stringent performance requirements. Increasing the bandwidth is one of the most common solutions to ensure that suitable resources are available to meet performance objectives such as sustained high data rates, minimal delays, and restricted delay variations. Guaranteed throughput, minimal latency, and the lowest probability of loss of the packets can ensure the quality of services over the networks. However, the traffic volumes that networks need to handle are not fixed and it changes with time, origin, and other factors. The traffic distributions generally follow some peak intervals and most of the time traffic remains on moderate levels. The network capacity determined by peak interval demands often requires higher capacities in comparison to the capacities required during the moderate intervals. Such an approach increases the cost of the network infrastructure and results in underutilized networks in moderate intervals. Suitable methods that can increase the network utilization in peak and moderate intervals can help the operators to contain the cost of network intrastate. This article proposes a novel technique to improve the network utilization and quality of services over networks by exploiting the packet scheduling-based erlang distribution of different serving areas. The experimental results show that significant improvement can be achieved in congested networks during the peak intervals with the proposed approach both in terms of utilization and quality of service in comparison to the traditional approaches of packet scheduling in the networks. Extensive experiments have been conducted to study the effects of the erlang-based packet scheduling in terms of packet-loss, end-to-end latency, delay variance and network utilization.
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INTRODUCTION: Spinal intramedullary dermoid is very rare, accounting for <1% of intraspinal tumors. It can be congenital or acquired. They usually present in 2nd or 3rd decade of life in adults. It may or may not associated with spinal dysraphism. It is asymptomatic in most cases, manifest acutely if it ruptures. Long segment involvement of spinal intramedullary tumor in adult without the history of trauma makes this case unique. Fat suppression imaging helps to distinguish adipose tissue from lesions causing hematomyelia in patients presented with intramedullary hyperintensity in both T1 & T2 sequences of MRI spine. CASE PRESENTATION: We report here a rare case of 30 years old male who presented to us with sudden urinary retention followed by rapidly progressive quadriparesis and paresthesia in his right arm. In MRI, spinal intramedullary tumor was noted from medulla till D5 vertebra. We performed subtotal excision of tumor and sample sent for histopathology which proved it to be intramedullary spinal dermoid cyst. CONCLUSION: Long segment involvement of spinal intramedullary dermoid cyst in adult without history of trauma makes this case different. Fat suppression imaging must be done in patients with intramedullary hyperintensity in both T1 and T2 sequences of MRI spine. Early diagnosis and appropriate management will be helpful in reducing morbidity.
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The cloud is a shared pool of systems that provides multiple resources through the Internet, users can access a lot of computing power using their computer. However, with the strong migration rate of multiple applications towards the cloud, more disks and servers are required to store huge data. Most of the cloud storage service providers are replicating full copies of data over multiple data centers to ensure data availability. Further, the replication is not only a costly process but also a wastage of energy resources. Furthermore, erasure codes reduce the storage cost by splitting data in n chunks and storing these chunks into n + k different data centers, to tolerate k failures. Moreover, it also needs extra computation cost to regenerate the data object. Cache-A Replica On Modification (CAROM) is a hybrid file system that gets combined benefits from both the replication and erasure codes to reduce access latency and bandwidth consumption. However, in the literature, no formal analysis of CAROM is available which can validate its performance. To address this issue, this research firstly presents a colored Petri net based formal model of CAROM. The research proceeds by presenting a formal analysis and simulation to validate the performance of the proposed system. This paper contributes towards the utilization of resources in clouds by presenting a comprehensive formal analysis of CAROM.
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Background Recent studies have shown a decline in theatre efficiency and productivity coinciding with the coronavirus disease 2019 (COVID-19) pandemic. In this study, we evaluate trauma theatre task efficiency in three different time periods (April 2019, April 2020, and November 2020), and analyse if productivity has altered since the start of the pandemic. Methods The records of a total of 320 patients who underwent orthopaedic trauma surgery at a large district general hospital in April 2019, April 2020 (during the first wave of the pandemic) and November 2020 (during the second wave of the pandemic) were analysed. Primary outcomes measured include time to get to the theatre, anaesthetic preparation time, the sum of time of anaesthesia and surgical preparation time, duration of surgery and time to transfer to recovery. Patient demographics as well as the type of surgery were also analysed. Results The time to get to the theatre and anaesthetic preparation time significantly increased in April 2020 (p<0.05) but fell in November 2020 with no significant difference in comparison to before the pandemic in April 2019 (p>0.05). The duration of surgery and time to transfer to recovery significantly increased in April 2020 (p<0.05) and though reduced in November 2020, was still significantly greater in comparison to April 2019 (p<0.05). In April 2020, the proportion of patients aged 18-65 was just 26% as compared to 35% in April 2019. This figure rose again to 45% in November 2020. The number of hip fracture procedures remained similar during the three time periods, with 32, 32 and 36 hip fracture operations in April 2019, April 2020 and November 2020, respectively. Conclusion While operating theatres' efficiency decreased during the first wave of the COVID-19 pandemic, it increased again in the second wave, coming close to the 'normal' levels before the pandemic struck.
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PURPOSE: This retrospective study presents a comparative analysis of the overall survival and toxicities, as side effects, of docetaxel plus cyclophosphamide (TC) and doxorubicin plus cyclophosphamide (AC). The study measured their efficacies during adjuvant chemotherapy, treating Pakistani breast cancer patients by validating the results obtained, with the published analysis of the same treatment given to US patients. PATIENTS AND METHODS: Between June 2015 and September 2017, for four chemotherapy cycles, 189 patients out of 358 received TC (75 mg/m2 of docetaxel, 600 mg/m2 of cyclophosphamide) and 169 were treated with AC (60 mg/m2 of doxorubicin, 600 mg/m2 of cyclophosphamide). On the basis of using pathological markers to assess patients, toxicities, as side effects, (due to docetaxel, doxorubicin, and cyclophosphamide) were listed in the database of this study. Common factors with respect to common terminology criteria for adverse events version 5.0 and side effects listed in MedlinePlus, NIH US database, and from the database of this study were then separated to be included in comparison for this study. Statistically, chi-squared test was used at α=0.05. RESULTS: There was no statistically significant difference between the proportions of patients with vomiting, extreme tiredness, diarrhea, mild anemia, stability, and overall survival because P-value >0.05. However, AC remained less toxic (P-value <0.05) by 22.6%, 25.7%, 25.3%, 12.4%, 20.8%, and 16.4% compared to TC for changes in taste, muscle pain, burning hands, change in hemoglobin level, moderate anemia, and needing blood transfusion respectively, whereas TC remained less toxic by 52.9%, 32.5%, and 26.3% for dizziness, weight loss, and sores in throat and mouth, respectively. CONCLUSION: At 27 months, TC was more toxic than AC, whereas both combinations had the same overall survival rate.
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Hepatotoxicity is appreciably escalating health dilemma worldwide and the degree of the problem has encouraged importance in the exploration for hepatotherapeutic agents from plants. In the current research work, the hepatoprotective/hepatocurative activity of methanolic extract of Spilanthes acmella Murr aerial parts in paracetamol induced hepatotoxicity was investigated in rabbits by the analysis of different liver enzymes including ALT, AST, ALP along with histopathological investigations. In first phase of the study, paracetamol toxicated rabbits were treated with extract and standard drug jatepar TM. The hepatotoxicant (paracetamol) significantly increased the levels of aspartate transaminase, alanine transaminase, alkaline phosphatase compared to normal control. Spilanthes acmella Murr at (400 mg/kg) reversed the elevation in the level of ALP, AST and ALT caused by the hepatotoxicants and jeteparR TM (standard) also reversed the deleterious effects of the hepatotoxicants. In second phase of this study, extract of Spilanthes acmella Murr was given to rabbits for ten days then paracetamol was administered in one group and level of liver parameters was paralleled with regular control group and the group that was receiving the extract. It is concluded that methanolic extract of Spilanthes acmella Murr aerial parts possesses hepatocurative and hepatoprotective activity.
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Acetaminofén/toxicidad , Analgésicos no Narcóticos/toxicidad , Asteraceae , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Extractos Vegetales/uso terapéutico , Animales , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Femenino , Masculino , Extractos Vegetales/aislamiento & purificación , Conejos , Resultado del TratamientoRESUMEN
BACKGROUND: Dengue fever is viral disease which spreads due to the bite of the Aedes aegypti mosquito. In recent years, it has affected around 40% population of the world. Its endemic flow has led to a large disease burden, in terms of human and financial resources. METHODS: Geographical Information Systems (GIS) are normally used to develop epidemiological thematic maps. This study explores the patterns and hotspots, associated with the catastrophic outbreak of dengue, in Punjab, in 2011. The ArcView software was used to analyze the data reported by the district hospitals of Punjab. Twenty-one-thousand cases were reported from March to December 2011, with 300 causalities. RESULTS AND CONCLUSION: This research reveals that from among the total 37 epidemiological weeks, the maximum impact was observed between weeks 22 and 27. The geographical flow and hotspots associated with dengue have been shown through thematic maps. A positive correlation between the risk for dengue and age was observed. The findings of this research can help health officials and decision-makers alert the public about future outbreaks and take preventive measures to considerably reduce the mortality and morbidity associated with the disease.
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Dengue/epidemiología , Dengue/prevención & control , Monitoreo Epidemiológico , Adolescente , Adulto , Aedes/virología , Factores de Edad , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Dengue/mortalidad , Dengue/virología , Virus del Dengue/aislamiento & purificación , Brotes de Enfermedades , Femenino , Sistemas de Información Geográfica , Geografía , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Factores de Riesgo , Estaciones del Año , Adulto JovenRESUMEN
Computer navigation in total hip arthroplasty is used to improve accuracy of component implantation. Reaming of the acetabular cavity during total hip arthroplasty (THA) can be navigated although this is not done routinely. We hypothesised that navigating the reaming of the acetabular cavity will improve implantation accuracy. A single surgeon series of 100 navigated THAs were analysed retrospectively. In 49 the reaming of the acetabular cavity was done using navigation and in 51 this was done freehand. The verified cup position and the error from the planned position were recorded. The mean error from planned to verified inclination was 2.20 degrees (SD 1.59°) in the navigated group versus 2.33 degrees (SD 1.96°) in the freehand group. The mean anteversion error was 1.92 degrees (SD 1.51°) for the navigated group and 1.45 degrees (SD 1.38°) for the freehand group. This was not statistically significant. This rejects our hypothesis. Navigating the reaming of the acetabular cavity did not improve the accuracy of the implantation against the set inclination and anteversion target during computer navigated THA.
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Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/normas , Ajuste de Prótesis/métodos , Cirugía Asistida por Computador/métodos , Acetábulo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/normas , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Persona de Mediana Edad , Ajuste de Prótesis/normas , Estudios Retrospectivos , Cirugía Asistida por Computador/normas , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Vitamin B12 deficiency is one of the common conditions in the elderly population leading to confusion, depression, memory loss and balance problems. Unfortunately there is no gold standard test for the diagnosis of cobalamin deficiency and a wide range of variation in reference levels according to country, and laboratory assay used. This poses a problem in diagnosing this condition making it a commonly misdiagnosed medical entity. There is current emphasis on need for clearer guidelines and much research is still being done to pave ways to determine better reference values for serum B12 and other screening tests. It is advised that screening methods are used adjunctively for the purpose of screening individuals.