IoMT Meets Machine Learning: From Edge to Cloud Chronic Diseases Diagnosis System.

In conventional healthcare, real-time monitoring of patient records and information mining for timely diagnosis of chronic diseases under certain health conditions is a crucial process. Chronic diseases, if not diagnosed in time, may result in patients' death. In modern medical and healthcare systems, Internet of Things (IoT) driven ecosystems use autonomous sensors to sense and track patients' medical conditions and suggest appropriate actions. In this paper, a novel IoT and machine learning (ML)-based hybrid approach is proposed that considers multiple perspectives for early detection and monitoring of 6 different chronic diseases such as COVID-19, pneumonia, diabetes, heart disease, brain tumor, and Alzheimer's. The results from multiple ML models are compared for accuracy, precision, recall, F1 score, and area under the curve (AUC) as a performance measure. The proposed approach is validated in the cloud-based environment using benchmark and real-world datasets. The statistical analyses on the datasets using ANOVA tests show that the accuracy results of different classifiers are significantly different. This will help the healthcare sector and doctors in the early diagnosis of chronic diseases.

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa.

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019-20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.

Food availability and shopping channels during the disasters: Has the COVID-19 pandemic changed peoples' online food purchasing behavior?

COVID-19 caused online buying channels to flourish across the globe. However, the extent to which online channels in Pakistan assisted peoples in coping with the pandemic remains unknown. This study aims to examine peoples behavior and perceptions regarding online food purchasing and its impact on different aspects of food security. The data were collected through online surveys of 1067 respondents in Punjab and Sindh provinces during the COVID-19 pandemic. We find that peoples access to food was adversely affected by the pandemic. However, people are increasingly purchasing food online, which has improved their accessibility to food. According to the findings, 62.51% of respondents reported to have changed their perception and behavior regarding online food purchasing. In addition, almost 46.40% of peoples reported that online shopping increased their access to food during the pandemic. Using logit regression, economic analysis shows that education, monthly income, and access to basic necessities such as clean drinking water, better sanitation, and better employment are positively related to online buying behavior. For future disaster situations in Pakistan to mitigate the adverse effects on food security, strengthening and promoting the use of online purchasing channels could be an important policy instrument.

Psychometric development and validation of ostracism experience scale (OES): across sample of young adults from Pakistan

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.

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019–20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.

Therapeutic significance of nano- and biosensor technology in combating SARS-CoV-2: a review.

The diagnosis of novel coronavirus (COVID-19) has gained the spotlight of the world's scientific community since December 2019 and it remains an important issue due to the emergence of novel variants around the globe. Early diagnosis of coronavirus is captious to prevent and hard to control. This pandemic can be eradicated by implementing suppressing strategies which can lead to better outcomes and more lives being saved. Therefore, the analysis showed that COVID-19 can only be managed by adopting public health measures, such as testing, isolation and social distancing. Much work has been done to diagnose coronavirus. Various testing technologies have been developed, opted and modified for rapid and accurate detection. The advanced molecular diagnosis relies on the detection of SARS-CoV-2 as it has been considered the main causative agent of this pandemic. Studies have shown that several molecular tests are considered essential for the confirmation of coronavirus infection. Various serology-based tests are also used in the detection and diagnosis of coronavirus including point-of-care assays and high-throughput enzyme immunoassays that aid in the diagnosis of COVID-19. Both these assays are time-consuming and have less diagnostic accuracy. Nanotechnology has the potential to develop new strategies to combat COVID-19 by developing diagnostics and therapeutics. In this review, we have focused on the nanotechnology-based detection techniques including nanoparticles and biosensors to obstruct the spread of SARS-CoV-2.

Protocol of Pakistan randomized and observational trial to evaluate coronavirus treatment among newly diagnosed patients with COVID-19: Azithromycin, Oseltamivir, and Hydroxychloquine.

Background & Objective: This study aimed to assess the clinical effectiveness of Hydroxychloroquine Sulfate (200 mg orally 8 hourlies thrice a day for 5 days), oseltamivir (75 mg orally twice a day for 5 days), and Azithromycin (500 mg orally daily on day 1, followed by 250 mg orally twice a day on days 2-5) alone and in combination (in seven groups). Methods & Analysis: An adaptive design is deployed, set within a comprehensive cohort study, to permit flexibility in fast-changing clinical and public health scenario. Primary outcomes include turning the test negative for coronavirus nucliec acid and in bringing about clinical improvement on day 7 of follow-up on a seven-point ordinal scale. The randomized study will recruit participants of either gender above 18 years of age who will test positive for SARS-CoV-2 on Quantitative Reverse Transcription Polymerase Chain Reaction (PCR). Pregnant or lactating females, and those with severe respiratory distress, or with serious comorbidities will be excluded. Randomization will be done maintaining concealment of allocation sequence using a computer-generated random number list. The sample size will be subjected to periodic reviews by National Data Safety and Monitoring Board. Ethics and Dissemination: The trial is approved by the National Bioethics Committee (No.4-87/NBC-471-COVID-19-05/20/) and institutional Ethical Review Committee. This clinical trial conducted under Good Clinical Practice is expected to inform patients clinical guidelines for the use of these drugs in newly diagnosed with SARS-CoV-2. Trial Registration: The trial was prospectively registered on April 08, 2020 at clinicaltrials.gov with ID: NCT04338698.

Optimal control problem arising from COVID-19 transmission model with rapid-test.

The world health organization (WHO) has declared the Coronavirus (COVID-19) a pandemic. In light of this ongoing global issue, different health and safety measure has been recommended by the WHO to ensure the proactive, comprehensive, and coordinated steps to bring back the whole world into a normal situation. This is an infectious disease and can be modeled as a system of non-linear differential equations with reaction rates which consider the rapid-test as the intervention program. Therefore, we have developed the biologically feasible region, i.e., positively invariant for the model and boundedness solution of the system. Our system becomes well-posed mathematically and epidemiologically for sensitive analysis and our analytical result shows an occurrence of a forward bifurcation when the basic reproduction number is equal to unity. Further, the local sensitivities for each model state concerning the model parameters are computed using three different techniques: non-normalizations, half-normalizations, and full normalizations. The numerical approximations have been measured by using System Biology Toolbox (SBedit) with MATLAB, and the model is analyzed graphically. Our result on the sensitivity analysis shows a potential of rapid-test for the eradication program of COVID-19. Therefore, we continue our result by reconstructing our model as an optimal control problem. Our numerical simulation shows a time-dependent rapid test intervention succeeded in suppressing the spread of COVID-19 effectively with a low cost of the intervention. Finally, we forecast three COVID-19 incidence data from China, Italy, and Pakistan. Our result suggests that Italy already shows a decreasing trend of cases, while Pakistan is getting closer to the peak of COVID-19.

Digital Twins in Built Environments: An Investigation of the Characteristics, Applications, and Challenges

The concept of digital twins is proposed as a new technology-led advancement to support the processes of the design, construction, and operation of built assets. Commonalities between the emerging definitions of digital twins describe them as digital or cyber environments that are bidirectionally-linked to their physical or real-life replica to enable simulation and data-centric decision making. Studies have started to investigate their role in the digitalization of asset delivery, including the management of built assets at different levels within the building and infrastructure sectors. However, questions persist regarding their actual applications and implementation challenges, including their integration with other digital technologies (i.e., building information modeling, virtual and augmented reality, Internet of Things, artificial intelligence, and cloud computing). Within the built environment context, this study seeks to analyze the definitions and characteristics of a digital twin, its interactions with other digital technologies used in built asset delivery and operation, and its applications and challenges. To achieve this aim, the research utilizes a thorough literature review and semi-structured interviews with ten industry experts. The literature review explores the merits and the relevance of digital twins relative to existing digital technologies and highlights potential applications and challenges for their implementation. The data from the semi-structured interviews are classified into five themes: definitions and enablers of digital twins, applications and benefits, implementation challenges, existing practical applications, and future development. The findings provide a point of departure for future research aimed at clarifying the relationship between digital twins and other digital technologies and their key implementation challenges.

The need for national livestock surveillance in Pakistan.

Ranked amongst the top five milk-producing countries globally, the Pakistan dairy industry can help to overcome food shortage and hunger, alleviate poverty and positively impact economic growth. This influencing role could potentially be more significant while the COVID-19 pandemic severely affects humanity, challenges the economy and increases the risk of global food shortage. However, its large national population of dairy livestock contrasts with Pakistan's top-five ranking, indeed, four to five Pakistani cows produce milk equivalent to one dairy cow of countries with a well-developed dairy industry. Low milk yield per cow negatively impacts the national production and compromises the development of an efficient processing sector, such that consumers are very often forced to use adulterated milk sold by local 'milkmen.' As a consequence, while committed to alleviating global hunger, Pakistan imports in excess of half a million tons of milk and milk-based products annually. Many studies have identified unproductive, inefficient and imprecise management issues combined with poor genetics and imbalanced nutrition as the leading barriers to improvement in the Pakistani dairy livestock sector. At an individual level, lack of awareness, affordability issues, illiteracy and low ambition of a large percentile of dairy farmers creates additional significant barriers. To address low productivity and poor genetics, Pakistani corporate farms and wealthier individual farmers import genetically improved breeds to attain high milk yields. However, they are then faced with the challenge of managing such breeds to attain sustainable and persistent milk yields under Pakistani climatic conditions, often risking excessive culling even to the point of business liquidation. In developed dairy industries, automated sensor-based livestock management systems are now available to help monitor, compute, and optimize procedures in real-time and are proven to increase productivity and profitability. The term precision livestock farming (PLF) is used to describe systems that monitor individual animals or groups of animals to overcome management deficiencies and optimize productivity. My stance in this Opinion Paper is that adopting and utilizing such precision technologies may support Pakistan in raising its livestock resources toward greater productivity, thereby helping to overcome the global food shortage.

Eyelid Myokymia-a Presumed Manifestation of Coronavirus Disease 2019 (COVID-19).

The purpose of this study is to report eyelid myokymia in patients recently recovered from COVID-19 disease. A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Median [IQR] myokymia recovery time was 42 [31,60] days. Age and duration of hospitalization had a significant linear relationship with myokymia recovery time. Recovery was delayed by 2.64 days with every 1-year increment in age and by 6.19 days with every additional day of hospital stay. Recovery time was independent of severity of systemic disease (P = .055) and gender (P = 0.2). Eyelid myokymia can be a possible manifestation of COVID-19 recovery phase. While myokymia recovers gradually in all these patients, older age and a longer duration of hospitalization are associated with slower recovery.

Eyelid Myokymia—a Presumed Manifestation of Coronavirus Disease 2019 (COVID-19)

The purpose of this study is to report eyelid myokymia in patients recently recovered from COVID-19 disease. A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Median [IQR] myokymia recovery time was 42 [31,60] days. Age and duration of hospitalization had a significant linear relationship with myokymia recovery time. Recovery was delayed by 2.64 days with every 1-year increment in age and by 6.19 days with every additional day of hospital stay. Recovery time was independent of severity of systemic disease (P = .055) and gender (P = 0.2). Eyelid myokymia can be a possible manifestation of COVID-19 recovery phase. While myokymia recovers gradually in all these patients, older age and a longer duration of hospitalization are associated with slower recovery.

Fake News Data Exploration and Analytics

Before the internet, people acquired their news from the radio, television, and newspapers. With the internet, the news moved online, and suddenly, anyone could post information on websites such as Facebook and Twitter. The spread of fake news has also increased with social media. It has become one of the most significant issues of this century. People use the method of fake news to pollute the reputation of a well-reputed organization for their benefit. The most important reason for such a project is to frame a device to examine the language designs that describe fake and right news through machine learning. This paper proposes models of machine learning that can successfully detect fake news. These models identify which news is real or fake and specify the accuracy of said news, even in a complex environment. After data-preprocessing and exploration, we applied three machine learning models;random forest classifier, logistic regression, and term frequency-inverse document frequency (TF-IDF) vectorizer. The accuracy of the TFIDF vectorizer, logistic regression, random forest classifier, and decision tree classifier models was approximately 99.52%, 98.63%, 99.63%, and 99.68%, respectively. Machine learning models can be considered a great choice to find reality-based results and applied to other unstructured data for various sentiment analysis applications.

Owren's Disease: A Rare Deficiency.

Factor V deficiency is a rare bleeding disorder, which may be due to acquired inhibitors or biallelic mutations. Factor V deficiency due to homozygous or compound heterozygous mutation (also known as Owren's disease or parahemophilia) has an estimated prevalence of one in one million people. A 22-year-old female was admitted for evaluation of longstanding menorrhagia. Anatomic abnormalities were excluded, and prolonged prothrombin time (PT) and partial thromboplastin time (PTT) were identified. Mixing studies followed by specific factor assays and genetic testing enable identification of factor V deficiency, for which fresh frozen plasma (FFP) or factor V concentrates are therapeutic. Specific clotting factor assay followed by mixing studies and genetic studies is essential for the diagnosis of congenital factor V deficiency. Deranged PT and activated partial thromboplastin time (APTT) with normal factor I level must be evaluated for the disorder of clotting factors and must be managed by FFP administration or plasma-derived factor V concentrate wherever available.

Tobacco Control Laws of South Asian Countries: A Quantitative-Comparative Analysis of Compliance with FCTC and their Effects on Smoking Prevalence

Smoking has been the topic of research for long time. Scholars have written on this issue from different dimensions like revenue generation, employment creation, environmental and health hazards. However, it exposes a person to more than 400 carcinogenic chemicals, causing many detrimental diseases like lung cancer, coronary artery disease, heart attack, stroke which kill more than 7 million people annually. Due to high smoking attributable mortality and morbidity;the World Health Organization (hereafter WHO) passed Framework Convention on Tobacco Control (hereafter FCTC). WHO-FCTC stipulates certain obligatory rules for the control of smoking prevalence and tobacco hazards to its member states. This paper aimed to examine the compliance of tobacco control laws with the FCTC guidelines and their effects on smoking prevalence in South Asian countries. The work hypothesized that higher compliance of tobacco control laws with the WHO-FCTC rules reduces smoking prevalence. The study employed positivist approach using descriptive statistics to determine the role of compliance with tobacco control laws in controlling of smoking prevalence rates. The study used data from different sources like the official Gazette books, reports of the World Health Organization (WHO), website (tobacco control laws) of the campaign for Tobacco-free Kids, Our World in Data (OWID), population pyramid.net and The World Bank. We compared and contrasted the national laws governing tobacco control in South Asia with the WHO-FCTC guidelines to test our hypothesis. We constructed an overall compliance index for the countries. We found non-compliance with the FCTC proposed tax share and heterogeneities in tax rates among the countries to reduce the smoking prevalence rates. Bangladesh has attained the highest index score of 0.748 followed by Sri Lanka with 0.650 index score whereas, Nepal and India have the least scores on compliance. The least scores of India and Nepal go against our hypothesis because the countries have achieved maximum reduction in tobacco control despite their low scores on the index

COVID-19 Pandemic, Determinants of Food Insecurity, and Household Mitigation Measures: A Case Study of Punjab, Pakistan.

Policies centered to respond to the COVID-19 pandemic have created recessionary economic impacts. Adverse income shocks have caused malnutrition and food insecurity and have increased the need for food assistance. The present study examines the impact of the COVID-19 pandemic on food insecurity and investigates the determinants of food security and coping strategies in the Punjab province of Pakistan. Data were collected through the internet and received responses from 370 respondents. The household food insecurity access scale (HFIAS) model was applied to examine food insecurity, and a logit regression model was used to analyze its determining factors. The results illustrate that food insecurity substantially increased during the COVID-19 pandemic. Households' demographics and socioeconomic factors have influence on food insecurity. Households with a large family size and people in quarantine found more food insecurity during the COVID-19 pandemic, while financial assistance played a role in a decline in food insecurity. Households handle the negative income shocks by eating less preferred food and getting support from government and charity organizations. It is suggested that stakeholders and responsible institutes provide financial assistance to support low-income families in order to enhance food security. Furthermore, policymakers should strengthen social safety nets and aid programs such as the Ehsas income program in the province of the country.

Impact of early detection and vaccination strategy in COVID-19 eradication program in Jakarta, Indonesia.

OBJECTIVE: Several essential factors have played a crucial role in the spreading mechanism of COVID-19 (Coronavirus disease 2019) in the human population. These factors include undetected cases, asymptomatic cases, and several non-pharmaceutical interventions. Because of the rapid spread of COVID-19 worldwide, understanding the significance of these factors is crucial in determining whether COVID-19 will be eradicated or persist in the population. Hence, in this study, we establish a new mathematical model to predict the spread of COVID-19 considering mentioned factors. RESULTS: Infection detection and vaccination have the potential to eradicate COVID-19 from Jakarta. From the sensitivity analysis, we find that rapid testing is crucial in reducing the basic reproduction number when COVID-19 is endemic in the population rather than contact trace. Furthermore, our results indicate that a vaccination strategy has the potential to relax social distancing rules, while maintaining the basic reproduction number at the minimum possible, and also eradicate COVID-19 from the population with a higher vaccination rate. In conclusion, our model proposed a mathematical model that can be used by Jakarta's government to relax social distancing policy by relying on future COVID-19 vaccine potential.

Spontaneous Tension Pneumothorax as a Complication of COVID-19.

Key Clinical Message. Tension pneumothorax is an uncommon presentation in patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) or COVID-19 pneumonia. We present a case of tension pneumothorax in a patient with COVID-19 pneumonia and myocarditis. This was an unlikely diagnosis in a patient with no known underlying lung condition and no other precipitating factors such as barotrauma. In an acute deterioration of patients with SARS-CoV-2, it is important to always consider alternative diagnoses and repeat imaging.