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Internet of things is progressing very rapidly and involving multiple domains of everyday life including environment, governance, healthcare system, transportation system, energy management system, etc. smart city is a platform for collecting and storing the information that is accessed through various sensor-based IoT devices and make their information available in required and authorized domains. This interoperability can be achieved by semantic web technology. In this paper, I have reviewed multiple papers related to IoT in Smart Cities and presented a comparison among the semantic parameters. Moreover, I've presented my future domain of research which is about delivering the COVID-19 patients report to the concerned domains by the healthcare system domain. © 2023 IEEE.
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Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Method(s): We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700-bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Finding(s): A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24;95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87;95% CI: (0.82-0.92) (p<0.001). Conclusion(s): Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19.Copyright © 2023
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Objectives: This study describes three surges of COVID-19 hypoxemic respiratory failure and our experience with using iCPAP in patients with cardiovascular diseases at a tertiary cardiac care centre. Methodology: This observational study was conducted from March 23rd 2020 to May 31st 2021, analysis of data from the PRICE Network Registry. Data was collected for all adult patients with cardiovascular diseases admitted with acute hypoxemic respiratory failure and a confirmed Results: Among 362 patients with 'severe' or 'critical' COVID-19 were hospitalized;163 (45%) in the 1st surge, 92 (25.4%) in the 2nd and 107 (29.6 %) in the 3rd surge. All-cause mortality was 118 (32.6%). iCPAP was used in 39% (141) patients, 19% (69) patients required oxygen only, 25.4% (92) were on BiPAP support and 16.6% (60) were intubated. 'iCPAP failure' occurred in 48/141 (34%) patients. iCPAP failure occurred in patients with higher APACHE II scores (16.3 +/- 5.7 v/s 21.3 +/- 6, p <= 0.001), lower ROX index on admission (5.0 +/- 2.2 vs. 10.4 +/- 5.4, p <= 0.001), lesser degree of improvement in ROX index at 48 hours (Day 3 ROX 18.7 +/- 8.9 vs. 9.9 +/- 6.3, p <= 0.001). Mortality rate on iCPAP was 44 (31.2%). Conclusion: COVID-19 outcomes in a resource-limited setting in patients having cardiovascular diseases, appear comparable to global reports. A modification of standard CPAP (iCPAP) appeared to be safe and effective. This modification of standard CPAP (iCPAP) identifies an option for resource-limited or resource-exhausted critical care units.
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OBJECTIVES: Sociocultural factors in the aftermath of any pandemic can play a role in increasing suicidal behavior like suicidal ideation, suicidal attempts, or suicide. The authors discuss the risk and predisposing factors for suicidal ideation among mental health patients in four developing countries (Bangladesh, Colombia, India and Pakistan), this aims to grasp the heterogeneity of these motivators and to elaborate specific interventions regarding suicide in the COVID-19 pandemic. METHODS: We searched PubMed, Medline, and Google Scholar through March, 2021 for articles using a combination of the keywords and generic terms for suicide, suicide ideation, COVID-19, developing countries, low-middle-income countries, Sociocultural factors, Suicidal behavior, predisposing factors and predictive factors, for articles in English language only, and without publication time restriction. RESULTS: This narrative review summarizes the sociocultural risk and predisposing factors for suicidal behavior in developing countries during the COVID-19 pandemic. The findings reveal those factors such as fear of being infected, growing economic pressure, lack of resources due to lockdown are mostly responsible in the four countries for the current increase in suicides. There are a few cultural differences that are specified in the narrative. CONCLUSION: The COVID-19 pandemic is a public health challenge, in which prevention and intervention of suicidal behavior have been suboptimal, especially in low-middle-income countries. Based on literature results, we provide practical suggestions (e.g., reducing infodemic, specialized helplines, improving mental health services availability) in order to tackle main challenges of suicide prevention, such as lack of adequate manpower, fragile health system and poverty.
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COVID-19 , Suicidal Ideation , Communicable Disease Control , Developing Countries , Humans , Pandemics , Risk Factors , SARS-CoV-2ABSTRACT
Purpose Since the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Isolation strategy with quarantine is a useful model in controlling transmission and rapid spread. As a result, people remained at home and disrupted their outside daily activities. It led to the closure of educational institutes, which is a source of many students to cope with numerous personal and familial issues. This study aims to focus on exploring the relationships and potential mediational pathways between mental health problems, illness perception, anxiety and depression disorders. Design/methodology/approach The study incorporated snowball sampling techniques through a cross-sectional, Web-based survey and recruited 500 students from different universities of twin cities, Rawalpindi and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. The study used four instruments, Beck Depression Scale, Beck Anxiety Inventory, Revised Illness Perception Questionnaire and The Warwick-Edinburgh Mental Well-being Scale for assessing depression, anxiety, illness perception and mental health disorders. Findings The findings indicated normal (43.2%), mild (20.5%), moderate (13.6%) and severe (22.7%) levels of anxiety prevalence in students. Results specified a normal (65.9%), mild (9.10%), moderate (9.12%) and severe (15.90%) depression prevalence and findings stipulated that anxiety disorder prevalence was higher than depression disorder. The correlational results specified a negative and significant relationship between mental health, illness perception, anxiety and depression symptoms. The multiple regression analysis stated that anxiety and depression disorders mediated the relationship between mental health and present illness perception. The perception of illness exhibited a relation to depression and anxiety disorders. Originality/value The study proposed a model to address mental health problems during the lockdown. The (2019-nCoV) illness perception developed mental disorders, including anxiety and depression, which has declined individuals' mental health. There is an urgent need for ongoing clinical examination and management to address psychological disorders and findings suggest assessing mental health to combatting the pandemic worldwide. Findings recommend developing strategies to promote mental health-care facilities during COVID-19 wide-ranging disasters. These results highlight the impending importance of devising strategies to treat mental health problems.
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Purpose: Ostracism is being socially ignored or excluded by others. Ostracism leads to serious psychological distress and health issues in the young adults being ostracized. However, there are no psychometrically designed instruments to measure this phenomenon in young adults. This study aims to develop a scale that measures ostracism efficiently and establishes the scale’s psychometric properties. Design/methodology/approach: The research design used for the study is “a mixed-method study using non-experimental research with an exploratory sequential approach and instrument development design.” For the formation of the item pool, theoretical evidence was collected and focus group discussions were conducted. Afterward, content validity was established with the help of subject matter experts, followed by Velicer’s minimum average partial method and maximum likelihood factor analysis to form the instrument’s factorial structure. Findings: Velicer’s minimum average partial method and maximum likelihood factor analysis made two factors as follows: ostracism experience and psychological effect. The instrument developed has a high value of alpha reliability i.e. a = 0.97 and a = 0.96, a = 0.92 for the subscales, respectively. Research limitations/implications: The sample used for the research was enough to run the analysis, but future studies can go for a more extensive and more diverse sample. The sample was based solely on university students. The current research focused only on the target of the phenomenon, and the whole research process was conducted online because of the Covid-19 pandemic going on. The scale developed can be used in several settings to find out if the individual is being ostracized or not. Practical implications: The scale’s most important implication is in the colleges and universities where young adults are found and face this problem daily. Likewise, psychologists can also use it in clinical settings. The other important implication of this scale is that it is opening a route to future research as different variables can be studied in ostracism such as depression, physical health and anxiety. Social implications: Ostracism is a hidden evil in societies that is not usually talked about. When people are not given equal importance in groups or settings, it leads to serious psychological issues in those individuals. This scale will in the identification of the problem that will lead to a proper solution to this evil. Originality/value: This work is original and not copied from anywhere. The research was conducted with the sole purpose of developing a scale on the ostracism experiences in young adults. The data is collected in the form of online surveys. The current scale is an attempt at developing a more reliable and valid scale that can be used in social settings. © 2021, Emerald Publishing Limited.
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INTRODUCTION: Since its first reported from Wuhan in December 2019, the clinical symptoms of COVID-19 and its complications are still evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema and pneumomediastinum. We report the case series of 10 patients of COVID-19, with subcutaneous emphysema along with pneumomediastinum. METHODS: All patients were admitted to the critical care area from April to June 2020 at Aga Khan University Hospital, Karachi, Pakistan. Electronic records and medical files reviewed for the patient's baseline characteristics, days of ventilation before subcutaneous emphysema, treatment given for COVID-19, cytokine release syndrome (CRS) grade, and with in-hospital mortality. RESULTS: The mean (±SD) age of the patients was 59±8 years (range, 23-97). The majority of them were men (80%), and common symptoms were dyspnea (100%), fever (80%), and cough (80%). None of them had underlying lung disorder. Six patients had hypertension, and five had diabetes. All patients had acute respiratory distress syndrome (ARDS) on admission, with a median PaO2/FiO2 ratio of 122.5. Eight patients with CRS grade III were being managed in high dependency units at the time of development of subcutaneous emphysema, and two with CRS grade IV were treated in ICU. The median duration of assisted ventilation before the development of subcutaneous emphysema was 7 days (interquartile range, 5-10 days). The highest PEEP for invasively ventilated patients was 10, while the CPAP ranged from 12-16, in non-invasive ventilation patients. Eventually, all required intubation. Chest tubes thoracostomy was done in five patients. All received corticosteroids, 6 received tocilizumab, and 7 received convalescent plasma therapy. Seven patients died during their hospital stay. Obstructive shock with tension pneumothorax was the cause of death in 1 patient, while four died of septic shock. Two patients had their ventilator withdrawn due to multiorgan dysfunction syndrome. CONCLUSIONS: High risk COVID-19 patients requiring positive pressure ventilation can develop subcutaneous emphysema and pneumomediastinum. One has to be vigilant about lung-protective ventilator strategies for the management of hypoxia in COVID -19 patients.
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Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.