ABSTRACT
An efficient algorithm for the persistence operation of data routing is crucial due to the uniqueness and challenges of the aqueous medium of the underwater acoustic wireless sensor networks (UA-WSNs). The existing multi-hop algorithms have a high energy cost, data loss, and less stability due to many forwarders for a single-packet delivery. In order to tackle these constraints and limitations, two algorithms using sink mobility and cooperative technique for UA-WSNs are devised. The first one is sink mobility for reliable and persistence operation (SiM-RPO) in UA-WSNs, and the second is the enhanced version of the SiM-RPO named CoSiM-RPO, which utilizes the cooperative technique for better exchanging of the information and minimizes data loss probability. To cover all of the network through mobile sinks (MSs), the division of the network into small portions is accomplished. The path pattern is determined for MSs in a manner to receive data even from a single node in the network. The MSs pick the data directly from the nodes and check them for the errors. When erroneous data are received at the MS, then the relay cooperates to receive correct data. The proposed algorithm boosts the network lifespan, throughput, delay, and stability more than the existing counterpart schemes.
ABSTRACT
OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of < 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice.
Subject(s)
Clinical Competence , Myocardial Infarction/diagnosis , Physicians, Family/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Acute Disease , Drug Prescriptions , Electrocardiography , Female , Humans , Male , Myocardial Infarction/therapy , Professional Practice , Surveys and Questionnaires , Thrombolytic TherapyABSTRACT
OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD). METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization. RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. Five patients developed ST-segment elevation MI (STEMI). One patient developed non-STEMI. Emergency Coronary Artery Bypass Grafting (CABG) was done in two patients. Repeat (PCI) was carried in three (1.46%) patients for acute in-stent thrombosis. Diabetes Mellitus and multivessel stenting were found to be the independent predictors for acute in-stent thrombosis (P-value < 0.02 and 0.05 respectively). CONCLUSION: SES implantation in coronary artery disease can be safe and effective MACE at one and six months follow-ups.
