The study objective was to estimate trachoma prevalence in relation to seasonal variation among children.Study Design was cross sectional and data was collected during all seasons of the year. After randomization of population units, 10% of them were identified by lottery and 5% of them were selected and examined for active trachoma case detection by simple random sampling technique. Total number of study participants were nine thousand seven hundred and ten (n=9710) from both urban and rural population units. The study was conducted during January -December 2018 during all three seasons of the year. After clinical examination, data was entered into a questionnaire Performa, which was used as tool for data collection. A Chi-square test was applied to compare trachoma cases among different seasons and among both boys and girls.Maximum burden of disease (62.4%) was reported during spring and winter season. Both spring and winter seasons have six months duration. During summer season, 70(37.6%) cases were reported. A highly significant (<0.01) relationship was reported between summer and spring seasons and trachoma prevalence (p < 0.01). A high prevalence was noted among female children.Higher prevalence of active trachoma was noted during summer season.
Intracranial hemorrhage (ICH) remains a major complication of endovascular thrombectomy for stroke. Both symptomatic ICH and asymptomatic ICH have been shown to portend a worse prognosis after thrombectomy in patients with ASPECTS >6. Incidence of ICH and its effect on the outcomes after endovascular thrombectomy for patients with large cores remains unknown. This study evaluated the incidence and effect of ICH in a subset analysis of the SELECT2 trial.
Methods
SELECT2 was a prospective, randomized, controlled, open-label, adaptive, international trial to assess endovascular thrombectomy vs medical management in patients with a large core stroke (CT ASPECTS 3-5 and/or ischemic core volume ≥ 50ml) due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery, who presented within 24 hours of last known well. We performed a subgroup analysis of SELECT2 data to understand baseline characteristics and outcomes associated with subjects experiencing any ICH, defined by the Heidelberg bleeding criteria (HBC).
Results
A total of 352 patients were included– 172 received medical management (MM) and 180 received endovascular thrombectomy (EVT) plus medical management (EVT + MM). Any intracranial hemorrhage was observed in 34.9% (60/172) in the MM group versus 74.9% (134/180) of patients in the EVT + MM group (p<0.001). Hemorrhagic transformation (HBC 1a or 1b) accounted for 93% of the intracranial hemorrhages in both the MM group (56/60) and the EVT + MM group (125/134). Among those receiving EVT + MM, successful reperfusion was achieved in 75.6% (34/45) of patients without intracranial hemorrhage versus 81.3% (109/134) of patients with intracranial hemorrhage (p=0.40). Early neurological worsening occurred in 8.9% (4/45) of EVT + MM patients without intracranial hemorrhage versus 29.9% (40/134) with any intracranial hemorrhage (adj. RR: 2.67, 95% CI: 1.01-7.08, p=0.049). This; however, did not result in statistically significant differences in 90-day mRS scores (adj. GenOR: 0.88, 95% CI: 0.68-1.13, p=0.32), functional independence (adj RR: 1.10, 95% CI: 0.61-1.96, p=0.57), independent ambulation (adj. RR: 0.85, 95% CI: 0.61-1.20,p=0.36), or 90-day all-cause mortality (adj. RR: 1.09, 95% CI: 0.84-1.41, p=0.52) between patients with any intracranial hemorrhage versus those without, after adjusting for treatment modality, age, NIHSS, time from last known well to randomization, ASPECTS and ischemic core volume estimates.
Conclusion
In a subset analysis of SELECT2 trial, patients receiving EVT had a higher rate of any intracranial hemorrhage when compared with those receiving medical management. Although EVT patients with ICH had a higher incidence of early neurological worsening, there was no difference in 90-day mRS, mortality and discharge dispositions between those with or without ICH.
Disclosures
M. Chen: None. K. Joshi: None. B. Kolb: None. M. Hill: None. M. Abraham: None. A. Hassan: None. S. Ortega-Gutiérrez: None. M. Hussain: None. D. Pujara: None. C. Sitton: None. V. Pereira: None. M. Ribo: None. G. Albers: None. B. Campbell: None. A. Sarraj: None.
Background: Otic barotrauma (OBT) is defined as traumatic inflammation in human middle ear that occurs at the time of avian drop. However, it can be avoided using its adequate knowledge. The objective of present study was to evaluate the knowledge of the trauma among air travelers in Sialkot city of Punjab, Pakistan.
Material and Methods: This cross-sectional study enlisted male adult International air travelers (n=50) from Sialkot city, Pakistan between November 2018 and April 2019 using purposive sampling technique. A specially developed questionnaire (Cronbach’s alpha = .82) having 12 close-ended items on barotrauma (total possible score 12) was administered to the participants at their home. Level of knowledge was categorized as inadequate (score 0-6), moderate (7-9) and adequate (10-12). Pearson’s chi-squared test was used to see the association between adequate knowledge on the OBT and sociodemographic variables using a P-value < .05 as statistically significant.
Results: Mean age of the participants was 47.60±9.9 years. Most of them (n=36; 72%) travelled for work reason. Almost all i.e. 46 (92%) gave correct response against item 1 (information provider about air trauma) and 12 (treatment of otic barotrauma) of the administered questionnaire. The rate of adequate knowledge on OBT was found to be higher among those having more than two-time travelling experience (82.9%, P = .02). However, there was no significant difference in knowledge of the barotrauma between people having less than or more than 12 years of science education (P = .59). All the business tourists (n = 5) had adequate knowledge of barotrauma followed by jobbers (n=25) and pilgrims (n=3), respectively.
Conclusions: Business tourists have adequate knowledge on otic barotrauma associated with air travel than jobbers or Hajj/Umrah pilgrims.
Abstract Termites are a significant pest of buildings, agriculture, and trees, and are mainly controlled by baiting. However, baiting systems are available for only lower termites (Rhinotermitidae) not for higher termites (Termitidae). Termite foraging behavior associated with baiting systems varies among species and families, and plays a significant role in baiting success. Here, foraging behavior of Odontotermes obesus (Blattodea: Termitidae: Macrotermitinae), a fungus-growing higher termite, was investigated relative to three bait-station sizes (small, medium, and large) containing different quantities of food. Significantly more workers recruited to large stations (470/station) compared to medium (246/station) and small (124/station) stations. Abundance of O. obesus in large and medium stations significantly positively correlated with relative humidity whereas negative but non-significant correlations were observed with temperature in large and medium stations. Total and continuous contacts with the stations increased with time and were greater in large stations. Station abandonment due to disturbance was significantly less in large stations (3%) followed by medium (9%) and small stations (20%). Our results suggest that large stations (≈8 litres volume) work best for population management of O. obesus and other related fungus-growing higher termites.
Deep brain stimulation for movement disorders is becoming a commonly used procedure. In this article we describe a complication which has not been described previously. Post op intra-cranial air must be considered as a possible complication of DBS insertion and should be on the list of differentials if a patient presents with post operative neurological deficit.
The study was conducted to know whether bulk inflow of Non Emergency Calls (NECs) acts as an independent predictor for depression in call handlers of Rescue 1122, Punjab, Pakistan. Forty five (45) call handlers were recruited from evening shift of 9 districts. Similarly, same-sized control group was made out of field rescuers. The groups were compared for rate and severity level of depression using Beck’s Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996). Probable predictors (except workplace stress) for depression in call handlers were evaluated through risk estimates. For workplace stress, a purposefully developed close- ended Workplace Stress Questionnaire including two subscales i.e. Non Emergency call and Control Room Environment of 30 items each was administrated. Twenty nine (64.4%) subjects of study group reported depression on BDI. Consequently, the same group had significantly higher mean depression score than control (18.2 vs. 12.6; p = .00). The scores also showed insignificant association with any of the probable predictors (demographic variables) of the call attendees. The respondents perceived more occupational stress against NECs. The findings attract the attention of authorities towards the severity of the concern.
The role of sex in the outcomes of patients with peripheral arterial disease (PAD) has been poorly studied. We sought to investigate differences in the long-term adverse cardiovascular and limb outcomes between men and women with PAD.We conducted a population-based cohort study with up to 7 years of follow-up using linked administrative databases in Ontario, Canada. Patients aged 40 years or older who visited a vascular surgeon between Apr. 1, 2004, and Mar. 31, 2007 (index date), and carried a diagnosis of PAD comprised the study cohort. The primary outcome was a composite of death or hospital admission for stroke or myocardial infarction. Secondary outcomes included lower limb amputation or revascularization. We used Cox proportional hazards modelling to compute unadjusted hazard ratios (HRs) and HRs adjusted for baseline covariates.A total of 6915 patients were studied, of whom 2461 (35.6%) were women. No significant differences in the risk of the primary outcome were observed between men and women (adjusted HR 0.99 [95% confidence interval (CI) 0.92-1.05]). Women were less likely than men to undergo minor amputation (adjusted HR 0.73 [95% CI 0.62-0.85]) and arterial bypass surgery (adjusted HR 0.82 [95% CI 0.71-0.94]) but were more likely to be admitted to hospital for acute myocardial infarction (adjusted HR 1.15 [95% CI 1.00-1.31]). There were no sex differences in the rates of major amputation or transluminal percutaneous angioplasty.We identified no significant differences in the composite risk of major adverse cardiovascular events between women and men with PAD, although our findings suggest men may be at increased risk for adverse limb events compared with women. Cardiovascular health campaigns should focus on both women and men to promote early diagnosis and management of PAD.
Mechanical thrombectomy is the standard of care treatment for large-vessel acute ischemic stroke and associated with significant improvement in long-term functional outcomes. Early and complete recanalization are paramount in achieving optimal patient outcomes. Though several revascularization techniques have been described, direct contact aspiration and clot removal via stent-retriever remain the foundation of endovascular stroke thrombectomy. Utilizing the NeuroVascular Quality Initiative - Quality Outcomes Database (NVQI-QOD) Acute Ischemic Stroke Registry, we present real-world data on first-line practice for treatment of emergent large vessel occlusions (ELVOs), comparing angiographic and clinical outcomes between direct contact aspiration and stent-retriever mechanical thrombectomy techniques.
Methods
Retrospective analysis of the NVQI-QOD registry data was performed. We included patients with ELVOs that underwent mechanical thrombectomy with age > 18 years and presenting NIHSS ≥ 6. We compared procedural times, recanalization efficacy, and clinical outcomes, including in-hospital mortality and discharge NIHSS.
Results
We identified a total of 2381 patients that met inclusion criteria. 998 (41.9%) underwent treatment with direct contact aspiration alone and 1383 (58.1%) underwent treatment utilizing a stent-retriever (with or without local aspiration). There were no significant differences in baseline median NIHSS scores (16 vs. 17, p = 0.25) or median ASPECTS scores (9 vs. 9, p = 0.7). No significant differences were seen in time last known well to puncture times (282 min vs. 280 min, p = 0.22) or recanalization time (323 min vs. 322 min, p= 0.39), ED to puncture time (75 min vs. 71 min, p = 0.25) or recanalization time (158 min vs. 160 min, p = 0.55), or median procedure times between the two groups (23 vs. 23 min, p = 0.64). The median number of passes required for recanalization was lower in the direct aspiration group (1 vs. 2, p = 0.01). Although there was no difference in successful recanalization (TICI 2b-3) between the groups (86.1% vs. 88%, p = 0.71), there was a lower rate of complete recanalization (TICI 2c-3) in the direct aspiration group (46% vs. 51.7%, p = 0.007). There was also a lower rate of adjunctive treatments (defined as the use of GP IIb/IIIa inhibitors, P2Y12 inhibitors, and/or salvage angioplasty and/or stenting) required in the direct contact aspiration group (36.1% vs. 44.4%, p < 0.001). There were no differences in discharge NIHSS scores (5 vs. 4, p = 0.21) or in-hospital mortality (22.2% vs. 22.5%, p = 0.92).
Conclusions
In the NVQI-QOD registry, stent-retriever techniques were associated with higher rates of complete recanalization when compared to direct contact aspiration alone, but successful (TICI 2b-3) recanalization rates were similar. There were no statistically significant differences in procedure times, clinical outcomes at discharge, or in-hospital mortality.
Disclosures
A. Mahapatra: None. Y. Moazeni: None. T. Patterson: None. R. Abdalla: None. J. Tsai: None. N. Moore: None. M. Bain: None. G. Toth: None. S. Ansari: None. M. Hussain: None.
Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of Influenza A Subtype H1N1 and SARS-CoV-2. Material and methods: A retrospective cohort study was conducted in order to compare clinical characteristics, complications, and outcomes of hospitalized patients with PCR-confirmed H1N1 influenza pneumonia and COVID-19 at a tertiary care center in Karachi, Pakistan. Results: A total of 115 patients hospitalized with COVID-19 were compared with 55 patients with H1N1 Influenza A pneumonia. Median age was similar in both COVID-19 patients (54 years) and in patients with H1N1 influenza (59 years), but there was male predominance in COVID-19 patients (OR = 2.95; 95% CI: 1.12–7.79). Patients with COVID-19 pneumonia were 1.34 (95% CI: 1.14–1.62) times more likely to have a greater duration of illness prior to presentation compared to H1N1 influenza patients. COVID-19 patients were 4.59 times (95% CI: 1.32–15.94) more likely to be admitted to a general ward compared to H1N1 pneumonia patients. Moreover, patients with COVID-19 were 7.62 times (95% CI: 2.42–24.00) more likely to be treated with systemic steroids compared to patients with H1N1 pneumonia. The rate of nosocomial infections as well as mortality was similar in both H1N1 and COVID-19 pneumonia. Conclusion: Our study found a male predominance and longer duration of illness in hospitalized patients with COVID-19 compared to H1N1 influenza patients but no difference in outcomes with either infection.
Objective: To assess the knowledge of Zika virus infection in gynecologistsand pediatricians Study Design: Cross sectional. Setting: Tertiary care public hospitalsincluding Sardar Begam, and Allama Iqbal Memorial Hospitals, Sialkot; Services Institute ofMedical Sciences and Jinnah Hospital, Lahore; and Pakistan Air Force Hospital, Islamabad(Pakistan). Period: July to December, 2016. Method: Calculation of sample size using p =0.5 (inavailability of secondary data) in n = z2pq/d2 was followed by convenience samplingbasedrecruitment of the specialists. An indigenously developed questionnaire (Cronbach’s α= 0.79) was administrated to each subject for recording sociodemographic and professionalinformation; and self-reporting to 12 close-ended items on Zika virus infection (ZVI) in women;and microcephaly in newborns. The knowledge was categorized as adequate/inadequate.Results: Overall 172 respondents included (response rate = 97.2%); and substantially higherrate i.e. ≥ 91.9% was found against each of the correct options. Consequently, 94.8% (n= 163) of them showed adequate knowledge (score 10-12 out of possible total = 12) onthe infection and microcephaly. The knowledge had insignificant association with any of thesociodemographic/professional variables e.g. specialty (p ˃ 0.05; χ2 test). Similarly, post hocmultiple comparisons using Tukey’s HSD test revealed insignificant difference among themean values of score (p ˃ 0.05) in 3 occupational positions viz. Foundation doctors (M =11.29, SD = 1.13), trainee doctors (M = 11.26, SD = 0.81), and consultants (M = 11.40, SD= 0.82). Conclusion: Gynecologists and pediatricians had adequate level of the infection andmicrocephaly-related knowledge; though lack disease-oriented attitude and practical handling.
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