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With rapid proliferation of digitalization and compulsion by COVID-19 pandemic, learning formats have been changing from face-To-face to online. Online education enables learners to take courses from anywhere, anytime, but it can also cause some problems for learners who struggle to maintain motivation. In addition, for STEAM education, it is important to engage in hands-on activities, but the ongoing pandemic has made it difficult for students to gather in one place to perform such activities. Incorporating gamification into online education can potentially motivate students and make STEAM education more interactive. On this premise, we have developed PhyGame as a learning system to help high-school students learn Physics. The system includes common game elements such as badges and leaderboards, and interactive simulation of Physics concepts embodying game-like charm. It also includes three modes of learning that allow students to adjust the difficulty according to their own learning levels, and a function that automatically saves learning log. For evaluation, PhyGame was used by students (N=23) at a high school in central Tokyo. The students rated the system on a scale of 1 to 10, and the main results are as follows: (1) Using PhyGame made learning enjoyable (mean score: 7.74);(2) PhyGame provided a good UI/UX (mean score: 7.83);(3) The overall experience with PhyGame was satisfactory (mean: 7.00). Our evaluation results show that interactive and gamified learning systems like PhyGame have a positive impact on user engagement and motivation. © 2023 IEEE.
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Background: Coronavirus disease (COVID-19) has now morphed into the most serious healthcare challenge that the world has faced in a century. The coronavirus disease (COVID-19) was declared as a public health emergency of international concern (PHEIC) on January 30, 2020, and a pandemic on March 11 by the World Health Organization (WHO). The number of cases and the death toll are rapidly increasing frequently because of its fast transmission from human to human through droplets, contaminated hands or body, and inanimate surfaces. Objective(s): SDS has been found to exhibit broad-spectrum and effective microbicidal and viral inactivation agents through the denaturation of both envelope and non-envelop proteins Methods: Viable SARS-COV-2 particles may also be found on contaminated sites such as steel surfaces, plastic surfaces, stainless steel, cardboard, and glass surfaces that can serve as a source of virus transmission. We reviewed the available literature about the SARS-CoV-2 persistence on inanimate surfaces as well as the decontamination strategies of corona and other viruses by using Sodium dodecyl sulfate (SDS) as well as other cleaning chemicals and disinfectants. Result(s): The efficacy of SDS has been amply demonstrated in several studies involving human immunodeficiency virus (HIV), human papillomavirus (HPV) and herpes simplex virus (HSV). SDS has also been found as deactivator of SARS-CoV-2. In toxic profile, up to 1% concentration of SDS is safe for humans and showed no toxic effect if ingested. Conclusion(s): Since no specific treatment is available as yet so containment and prevention continue to be important strategies against COVID-19. In this context, SDS can be an effective chemical disinfectant to slow and stop the further transmissions and spread of COVID-19.Copyright © 2021 Bentham Science Publishers.
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OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers;neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st wave compared with the 4th wave regarding inflammatory markers;CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7 on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality. CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19.
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Background: The newly emerged delta and omicron variants of severe acute respiratory syn-drome coronavirus (SARS-CoV-2) have affected millions of individuals globally with increased transmis-sible and infectivity rates. Although, numerous vaccines are available or under clinical trials to combat the SARS-CoV-2 and its variant, still, a therapeutic agent is awaited. Objective(s): The present work is focused on rigorous screening of chemical constituents of Azadirachta indica (A. indica) against delta and omicron variants of SARS-CoV-2 via inhibition of S-glycoprotein. Method(s): Total, 10 compounds of A. indica were subjected to molecular docking and pharmacophore modeling studies against the S-glycoprotein of delta and omicron variants of SARS-CoV-2. Furthermore, homology modeling was performed for omicron S-glycoprotein with the help of SWISS-MODEL and aligned by PyMOL software. Later on, the residues of protein were verified in the allowed region via Ramachandran plot. In addition, our docking results have also been validated by MMGBSA binding free energy calculations. Result(s): Our computed study demonstrated that nimbolinin B12-methyl ether and nimbidinin showed promising docking scores (>-6.0) as compared to docking scores (< 6.0) of reference drug 'camostat' against S-glycoproteins of both delta and omicron variants. Redocking by using MMGBSA calculation also reveals that both these compounds can effectively bind within the pockets of said protein receptors Conclusion(s): Nimbolinin B12-methyl ether and nimbidinin have potent anti-SARS-CoV activity against delta and omicron variants and thus, A. indica might be a useful source for developing novel anti-SARS-CoV-2 therapeutic agents.Copyright © 2022 Bentham Science Publishers.
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Background: Vaccination plays an important role in the prevention of some infectious diseases but does it change the outcome in critically ill patients is obscure. Though vaccination leads to decreased emergency and hospital admission, still the vaccinated patients with severe diseases requiring intensive care are being reported. This case series reports the outcome of 20 critically ill patients admitted to the COVID Intensive Care Unit (ICU). Methodology: All vaccinated patients admitted to COVID-ICU at the University Hospital between January 2021 and June 2021 were reviewed. The demographics, comorbidities, vaccination status, systemic manifestations, organ support, complications, pharmacological therapy, outcome and length of ICU as well as hospital stay were recorded. To draw a comparison for all the demographics and clinical characteristics of patients, stratification analysis was performed for the outcome variables. Result(s): A total of 20 patients were included in the study among which only 7 (35%) survived. The mortality rate for patients over 60 was 84.6 %. Four of the patients had no comorbidities and all of them survived. Among the complications, acute kidney injury was the most common (70%). The median (IQR) ICU stay was 10 (7) days and hospital stay was 13.5 (11) days. Conclusion(s): The vaccinated patients admitted with COVID-19 ICU had a poor outcome and irrespective of the type of vaccine. The factors leading to increased mortality in this group of patients were male gender, age >= 60 years, and associated chronic medical illness. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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Monosaccharide derivatives are of importance in the field of carbohydrate chemistry because of their effectiveness in the synthesis of biologically active products. As a consequence, the chemistry and biochemistry of carbohydrate derivatives are an essential part of biochemical and medicinal research. In this work, we have explored the speciation of acylated methyl 6-O-myristoyl-α-D-glucopyranoside derivatives (2−9) to find the pharmacodynamics, toxicity profiles, and biological activities by using ADMET studies. PASS prediction also indicated that these acylated derivatives (2−9) are more potent as anticarcinogenic agents than as antioxidant agents. Quantum mechanical study employing density functional theory with B3LYP/6-31G(d,p) for investigating the enthalpies (ΔH), Gibbs free energies (ΔG), entropies (ΔS), and molecular orbital (HOMO−LUMO gap, hardness, softness, chemical potential, and electrophilicity index), dipole moment and natural bond orbital revealed that these derivatives are thermodynamically stable. The molecular docking study revealed that ivermectin has the highest binding affinity (−8.1 kcal mol−1) and, among the tested compounds, 2 and 3 (−5.7 kcal mol−1) showed the highest binding affinity, followed by 4 and 5 (−5.5 kcal mol−1). These results of acylated derivatives (2−9) could be useful for the development of drugs. © 2022, Department of Science and Technology. All rights reserved.
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Background: Coronavirus disease-2019 (COVID-19) has recently emerged as a pandemic respiratory disease with mild to severe pneumonia symptoms. No clinical antiviral agent is available so far. However, several repurposing drugs and vaccines are being given to individuals or in clinical trials against SARS-CoV-2 Objective: The aim of this study is to uncover the potential effects of Luteolin (Lut) as an inhibitor of SARS-CoV2 encoded proteins via utilizing computational tools. Methods: Molecular modelling to unfold the anti-SARS-CoV2 potential of Lut along with reference drugs namely remdesivir and nafamostat was performed by the use of molecular docking, molecular dynamic (MD) simulation, absorption, distribution, metabolism, excretion, toxicity (ADMET) and density functional theory (DFT) methods against the five different SARS-CoV-2 encoded key proteins and one human receptor protein. The chemical reactivity of Luteolin is done through prediction of HOMO-LUMO gap energy and other chemical descriptors analysis. Results: In the present study, Lut binds effectively in the binding pockets of spike glycoprotein (6VSB), ADP phosphatase of NSP3 (6W02), and RNA dependent RNA polymerase (7AAP) protein receptors with significant values of docking scores-7.00,-7.25, and-6.46 respectively as compared to reference drugs remdesivir and nafamostat. Conclusion: Thus, Lut can act as a therapeutic agent and is orally safe for human consumption as predicted by molecular modelling against SARS-CoV-2 in the treatment of COVID-19.
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SUMMARY. Covid-19 was announced as a pandemic in March 2020, since then scientists are trying to find out effective therapeutics as treatment. Many medicinal herbs contain antiviral compounds, such as rutin, and flavonoid glycosides that are efficient against viruses. Diplotaxis acris is a famous plant traditionally used to prepare rocket salad. LC-MS of methanol extract revealed the presence of 12 compounds, quercetin 3-O-β-rhamnoside, isorhamnetin 7-O-β-glucoside, kaempferol 3,7-diglucoside, apigenin 7-rhamnoside, and apigenin 7-O-β-glucoside as major compounds. The computational studies showed that all flavonoids form strong interaction with SARS-CoV-2 main protease with good CDOCKER interaction energy (Kcal/mol) of-53.1,-51.7,-44.1,-48.0, and-49.7, respectively, which are apigenin 7-rhamnoside as a suitable contender for oral administration. Results suggest that Diplotaxis acris have potential against SARS-CoV-2 and could be a good source of lead compounds against the novel coronavirus.
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The coronavirus pandemic of 2019 (COVID-19) has adversely affected public health and the socioeconomic situation worldwide. Although there is no therapeutic drug to treat COVID, several treatment options are being considered to alleviate symptoms. Hence, researches on prophylactic treatment for COVID are being encouraged. Searching natural products is a rational strategy since it has served as a valuable source of lead compounds in drug discovery. In this study, three machine learning approaches, including Support Vector Machine (SVM), Random Forest (RF) and Gradient Boosting Machine (GBM), have been used to develop the classification model. The molecular docking was performed on AutoDock vina. Further, molecular dynamics (MD) simulation of the potential inhibitors was conducted using the AmberTools package. The accuracy for SVM, RF and GBM was found to be 60.45 %, 63.43 % and 64.93 %, respectively. Further, the model has demonstrated specificity range of 41.67 % to 50.00 % and sensitivity range of 74.32 % to 79.73 %. Application of the model on the NuBBE database, a repository of natural compounds, led us to identify 322 unique natural compounds, likely possessing anti-SARS-CoV-2activity. Further, molecular docking study has yielded three flavonoids and one lignoid compounds with comparable binding affinities to the standard compound. In addition, MD showed that these compounds form stable complexes with different magnitude of binding energy. The in silico investigations suggest that these four compounds likely demonstrate their anti-SARS-CoV-2activity by inhibiting the main protease enzyme. Our developed and validated in silico high-throughput investigations may assist in identifying and developing antiviral drug-like compounds from natural sources.
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C oronavirus December irresistible 2019 hasspecialistblowout introducing inworldwidea broad a genuine frompestilence general the timeis wellbeing vitalwhentoits emergency. therevelationachievement The in Hubei capacity ofProvince,isolate to recognize endeavorsChina an in notwithstanding the delicate and precise screening of expected instances of disease from patients in a clinical setting. Structural proteins the basic key role-playing in SARS-CoV2 identification include a spike, envelope membrane, nucleocapsid, and helper proteins. N-protein ties to the infection single positive-strand RNA that permits the infection to assume control over human cells and transform them into infection industrial facilities inside the capsid and E-protein shows a significant part in infection gathering, film permeability of the host cell, and infection has cell correspondence. Nucleic-Acid base testing presently offers the most touchy and early discovery of COVID-19. Notwithstanding, analytic advancements have explicit impediments and announced a few false negative and false positive cases, particularly during the beginning phases of contamination. Presently, more refined diagnostics are being created to improve the COVID-19 determination. This article presents an outline of diagnostic approaches to address a few inquiries and issues identified with the constraints of flow innovations and future innovative work difficulties to empower ideal, fast, minimal effort, and precise analysis of arising irresistible illnesses We depict purpose of-care diagnostics that are not too far off and urge scholastics to propel their advancements past origination. Creating fitting and-play diagnostics to deal with the SARS-CoV-2 flare-up would be valuable in forestalling forthcoming pandemics. © 2021. Advancements in Life Sciences. All rights reserved.
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Background: Coronavirus Disease-2019 (COVID-19) has appeared as a deadly pandemic affecting most of the countries across the world. The disease has caught humanity unprepared;therefore, there has been a lack of awareness about the causes, and transmission and mortality rates. It has also affected the overall socioeconomics from individual to worldwide levels. COVID-19 is an unprecedented and first-time challenge for Pakistan and a lockdown imposed by the Government of Pakistan has further devastated the economy of the country. This online survey was conducted to know the effects of the Covid-19 pandemic on the social life and economic status of the people of Pakistan. In this article, we mainly focused on teachers and students from different Universities of Pakistan for data generation because they can provide better information due to the use of modern technologies as a source of information. Methods: An online questionnaire survey covering 11 parameters including age, gender, employment status, mortality rate, education, marital status and, information about the pathogen responsible for the disease was filled by 1260 individuals from Pakistan. Results: The results obtained show that 56.6% of the responders were males,43.4% were females, 59.9% were unmarried, 37.7% were graduate students and, 48.7% unemployed. Most of the responders (55.6%) said that COVID-19 negatively affected the jobs of the people. We found (93%) of the responders with good knowledge about COVID-19. Conclusion: We conclude from the results that most of the responders were males, educated and they knew the pathogenic effect of the COVID-19 virus on humans. These results also show that the disease has drastically affected the economy and social life of the people of Pakistan.
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INTRODUCTION: As the surge of COVID-19 continues, low resource settings such as Pakistan have encountered an acute shortage of ICU facilities and trained intensivists. The dearth of resources is apparent in the remote region of Northern Pakistan. Therefore, we established a tele-ICU consultation service model to address these concerns and leverage critical care capacity in these remote settings. METHODOLOGY: This study was conducted in Gilgit and Chitral secondary care hospital in Northern Pakistan. Gilgit is a 46-bedded hospital with 6 ventilators, and Chitral is a 25-bedded hospital with 3 ventilators in their ICU. The study duration is 1 year from July 2020 till June 2021. This is a centralised and decentralised hub-and-spoke tele-ICU model. The main hub is located in Aga Khan University Hospital (AKUH) in the metropolitan city Karachi. The distance from the main hub to the remote facilities is approximately 1800km. The tele-ICU followed a 24/7 Scheduled Care Model (periodic consultations on a predetermined time) and Responsive Care Model (unscheduled teleconsultations prompted by an alert) to provide care. The mode of communication is teleconference calls, video calls, and text messaging. This service is provided by 24/7 AKUH trained intensivists. Patient information such as demographics, clinical course, teleconsultation interventions, and management were obtained from these remote ICUs. RESULTS: A total of 157 patients presented to the tele-ICU from Pakistan's remote regions of Gilgit and Chitral. Of these, 60% were male (n=95). 86% (n=135) patients presented with COVID-19. 64% (n=97) patients had comorbidities with hypertension (47%, n=46) being the most common. Invasive mechanical ventilation was provided to 12% (n=18) of the tele-ICU patients, while 62% patients (n=98) received noninvasive mechanical ventilation interventions. Average length of stay of patients in the tele-ICU was 9 days with a range of 1-41 days. 72% (n=113) patients were discharged home from the hospital. Tele-ICU mortality was 29% (n=44). CONCLUSION: We utilized a peer-to-peer tele-consult model to support critical care services in Northern Pakistan. The survival rate achieved by this model is comparable to national and international hospital published data. This was possible through use of multimodal information technology in Pakistan.
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Aim center dot To find changes in hematologic parameters in patients who are COVID-19-positive with respect to high resolution computed tomography (HRCT) chest scan so that the exact picture of the disease course can be identified and an adequate treatment protocol can be planned to combat the COVID-19 pandemic. Methods center dot Patients' health-related data including age, gender, symptomatology, associated co- morbidities, laboratory test results and HRCT results were collected. Results center dot The radiologic findings showed ground glass opacities (GGOs) was the most common manifestation. Analysis of HRCTs of patients with COVID-19 showed that lesions were mainly confined to the right and left lower lobes, suggesting that the COVID-19 virus is mainly harbored in the basal areas of the lungs. Conclusion center dot Radiologic and laboratory investigations can greatly help in early detection of COVID-19, thus allowing for timely interventions.
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Background: Since February 2020, there have been 825,519 confirmed COVID-19 cases and 17,957 fatalities across Pakistan. The number of ICU beds in Pakistan is approximately 2166, a ratio of 0.7 beds per 100,000 population. Critical care resources are concentrated in metropolitan cities with limited availability in rural areas. These gross shortages have escalated during the COVID-19 pandemic, leaving large parts of the country without access to skilled personnel or ICU beds. The Aga Khan University established a free 24/7 teleICU consultation service to rapidly increase access to trained personnel during the COVID-19 pandemic. Methods: The tele-ICU service adheres to a Scheduled and Responsive Care Model delivered through a centralized and decentralized structure. Using two-way audio-visual technology, the tele-ICU leverages critical care expertise and connects to clinical teams in rural and remote hospital settings. Endto- end encrypted Zoom and WhatsApp applications or telephone calls are utilized. Initially, only COVID-19 patients were consulted;however, coverage was broadened to include surgical and medical patients requiring intensive care. Results: Between June 2020 and April 2021, 1709 teleconsultations have been conducted on 404 patients. These include 339 COVID-19 patients, 231 of which were severe and critically ill. An estimated 20,394 minutes of consultative services have been provided covering 26 hospitals across 4 provinces. The mean call duration of each teleconsultation was 13.29 (1-60) minutes. The major mode of communication was Zoom (45.58%) followed by Telephone (43.30%) and WhatsApp (11.12%). The overall hospital discharge outcome for the teleICU is 58.27% with a mortality rate of 29.13%. The remaining patients (12.60%) were transferred or left against medical advice. Conclusion: To combat the insufficient critical care capacity, Aga Khan University implemented a novel tele-ICU service to provide an innovative solution for coordination of care and increase availability of intensivists in remote settings across Pakistan.
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BACKGROUND: Coronavirus disease-19 has a wide range of clinical presentations and varied outcomes. It is a new disease and researchers are trying to explore its clinical presentation and outcome to know more about the course of the disease. The objective of the present study was to determine the clinical and laboratory characteristics of Coronavirus disease-19 associated with severity of the disease. METHODS: This cross-sectional study was conducted at Rehman Medical Institute, Peshawar from April to August 2020. All patients presented to the hospital and were diagnosed as COVID-19 were enrolled in this study. Disease characteristics and clinical outcomes were noted in both mild and severe cases. Patients were divided into 2 groups based on the disease severity and a comparison was made between these groups in terms of demographics, lab parameters and outcomes. Data were analysed by using SPSS version 24. RESULTS: Out of 227 patients, 80.2% (n=182) were males while 19.8% (n=45) were females. The mean age of the patients was 54.44±14.35 yrs. 61.2% (n=139) had co-morbidities with diabetes being the most common. 26.9% (n=61) had severe disease and 18.1% (n=41) died.20.7% (n=47) had lymphopenia, 48.45% (n=110) had leucocytosis and thrombocytopenia was seen in 11.89% (n=27). CRP, D-dimers, ferritin and LDH were raised in 83.25% (n=189), 80.17% (n=182), 81.05% (n=184), 77.09% (n=175) of the patients respectively. Comparing our designated patient groups revealed that old age, comorbidities, leucocytosis, lymphopenia, raised inflammatory markers were associated with severe disease and that mortality was high in the severe disease group. CONCLUSION: Middle-aged males with comorbidities were the most affected subset of patients. Disease severity was associated with old age, comorbidities and certain lab abnormalities. The outcome was poor in case of severe disease. However, no gender correlation was found with disease severity.
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Background: Recently, Coronavirus Disease-2019 (COVID-19), caused by a fatal strain of coronavirus named Severe Acute Respiratory Syndrome-2 (SARS-CoV-2), has been declared as a pandemic by the World Health Organisation (WHO) on 11 March 2020. Globally, no therapy such as vaccines and specific therapeutic agents is available so far despite some protease inhibitors and antiviral agents. Introduction: Due to no therapeutic drug or vaccine against SARS-CoV-2 so far, phytomedicine may be developed as therapeutic agents in the prevention and treatment of current COVID-19 disease. Thus, the aim of this study was to find out a suitable therapeutic agent from selected 17 dietary molecules, which could target SARS-CoV-2 encoded proteins. Materials and Methods: In this study, 3D structures of selected dietary molecules were obtained from the PubChem database, which have previously been reported for their antiviral and anti-inflammatory effects. Then, molecular docking analysis by using AutoDoc4 and AutoDockVina software was conducted to evaluate their anti-SARS-CoV-2 activity. Lipinski's rule of five and drug-likeness properties were also discussed with the help of Molinspiration and the OSIRIS property explorer methods. Results: Our results revealed that, among all, epigallocatechin gallate (EGCG) (7) is a lead compound that could fit well into the binding sites of docked proteins of SARS-CoV-2. EGCG showed very strong molecular interactions with the free enzyme of main protease (6y2e), chimeric receptorbinding domain complexed with human ACE2 (6vw1), and NSP15 endoribonuclease (6vww) encoded proteins of SARS-CoV-2, by showing binding energies -9.30, -8.66, and -8.38, kcal/mole, respectively. Conclusion: In the present study, EGCG (7) is more active than two standard drugs that are currently being used in COVID 19, namely remdesivir and nafamostat. Therefore, EGCG (7), as per our results, might be explored as a therapeutic agent for the treatment of COVID-19.
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AIM: To find changes in hematologic parameters in patients who are COVID-19-positive with respect to high resolution computed tomography (HRCT) chest scan so that the exact picture of the disease course can be identified and an adequate treatment protocol can be planned to combat the COVID-19 pandemic. METHODS: Patients' health-related data including age, gender, symptomatology, associated co-morbidities, laboratory test results and HRCT results were collected. RESULTS: The radiologic findings showed ground glass opacities (GGOs) was the most common manifestation. Analysis of HRCTs of patients with COVID-19 showed that lesions were mainly confined to the right and left lower lobes, suggesting that the COVID-19 virus is mainly harbored in the basal areas of the lungs. CONCLUSION: Radiologic and laboratory investigations can greatly help in early detection of COVID-19, thus allowing for timely interventions.
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Introduction: The COVID-19 pandemic caused the UK to enter lockdown from 23rd March to 8th May 2020, necessitating Urology clinics to be conducted virtually. Our study aimed to assess whether new Urology referrals could be triaged and have an outcome arranged virtually before being seen by a specialist in clinic, thereby reducing referral to investigation wait-times. Method: Retrospective data was collected from 23rd March to 8th May 2020 of new patient referrals consulted virtually in Urology outpatient clinics. Referrals were grouped into categories of presentation and outcome. Results: 642 new patients were consulted virtually during the study period. 181 (28.1%) had further imaging requested;of these, the presentations with the greatest proportion of patients with this outcome were those referred with imaging findings (50%), UTI/cystitis (43.1%) and scrotal symptoms (34.3%). 116 patients (18.1%) were added to the waiting list for procedures;85 were for flexible cystoscopy, for which the commonest indications were UTI/cystitis (36;55.4%) and haematuria (15;55.5%). Conclusions: Certain urological presentations can be triaged straight to investigation by when directly referred from Primary Care, thus reducing referral to investigation wait-time and increasing outpatient protocol efficiency.