A district-level vulnerability assessment of next COVID-19 variant (Omicron BA.2) in Uttarakhand using quantitative SWOT analysis.

COVID-19 has had an impact on the entire humankind and has been proved to spread in deadly waves. As a result, preparedness and planning are required to better deal with the epidemic's upcoming waves. Effective planning, on the other hand, necessitates detailed vulnerability assessments at all levels, from the national to the state or regional. There are several issues at the regional level, and each region has its own features. As a result, each region needs its own COVID-19 vulnerability assessment. In terms of climate, terrain and demographics, the state of Uttarakhand differs significantly from the rest of India. As a result, a vulnerability assessment of the next COVID-19 variation (Omicron BA.2) is required for district-level planning to meet regional concerns. A total of 17 variables were chosen for this study, including demographic, socio-economic, infrastructure, epidemiological and tourism-related factors. AHP was used to compute their weights. After applying min-max normalisation to the data, a district-level quantitative SWOT is created to compare the performance of 13 Uttarakhand districts. A COVID-19 vulnerability index (normalised R i ) ranging between 0 and 1 was produced, and district-level vulnerabilities were mapped. Quantitative SWOT results depict that Dehradun is a best performing district followed by Haridwar, while Bageshwar, Rudra Prayag, Champawat and Pithoragarh are on the weaker side and the normalised Ri proves Dehradun, Nainital, Champawat, Bageshwar and Chamoli to be least vulnerable to COVID-19 (normalised R i ≤ 0.25) and Pithoragarh to be the most vulnerable district (normalised R i > 0.90). Pauri Garwal and Uttarkashi are moderately vulnerable (normalised R i 0.50 to 0.75).

A GIS-based novel approach for suitable sanitary landfill site selection using integrated fuzzy analytic hierarchy process and machine learning algorithms.

Disposal of waste without treatment is the least preferable way of sustainable solid waste management (SWM). But most cities in developing nations still use open dumps, causing negative impacts on the environment and human health. This study offered a novel approach for selecting landfill sites and sustainable SWM in Aligarh city, India. This was done through data collection, selecting models for criterion weighting, and validation. In order to prepare a landfill site suitability map, a geographic information system (GIS)-based ensemble fuzzy analytic hierarchy process-support vector machine (FAHP-SVM) and fuzzy analytic hierarchy process-random forest (FAHP-RF) models were implemented. Considering the previous studies and the study area characteristics, eighteen thematic layers were selected. The result revealed that land value; distance from residential roads, hospitals and clinics, and waste bins; and normalized difference built-up index (NDBI) have a fuzzy weight greater than 0.10, indicating significant factors. In contrast, land elevation, land slope, surface temperature, soil moisture index, normalized difference vegetation index (NDVI), and urban classification have a zero fuzzy weight, indicating these criteria have no importance. The result further revealed that FAHP-RF with an area under curve (AUC) value of 0.91 is the more accurate model than FAHP-SVM. According to the final weight-based overlay result, seven potential landfill sites were identified, out of which three were determined as most suitable by considering current land cover, public opinions, and environmental and economic concerns. This research proposed a zonal division model based on landfill sites location for sustainable SWM in Aligarh city. However, the findings may provide a guideline to the decision-makers and planners for optimal landfill site selection in other cities of developing countries.

Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan.

OBJECTIVES: Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. METHODS: In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). RESULTS: A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91-0.99), (phase-II: AOR: 0.84; 95% CI: 0.68-0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86-0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. CONCLUSIONS: Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.

Maximum standardized uptake value from quantitative bone single-photon emission computed tomography/computed tomography in differentiating metastatic and degenerative joint disease of the spine in prostate cancer patients.

OBJECTIVE: Qualitative interpretation in bone scan is often complicated by the presence of degenerative joint disease (DJD), especially in the elderly patient. The aim of this study is to compare objectively 99mTc-MDP tracer uptake between DJD and osseous metastases of the spine using semi-quantitative assessment with SPECT SUV. METHODS: Bone scan with SPECT/CT using 99mTc-MDP was performed in 34 patients diagnosed with prostate carcinoma. SPECT/CT was performed based on our institutional standard guidelines. SUVmax based on body weight in 238 normal vertebrae visualized on SPECT/CT was quantified as baseline. A total of 211 lesions in the spine were identified on bone scan. Lesions were characterized into DJD or bone metastases based on its morphology on low-dose CT. Semi-quantitative evaluation using SUVmax was then performed on 89 DJD and 122 metastatic bone lesions. As most of the bone lesions were small in volume, the effect of partial volume effect (PVE) on SUVmax was also assessed. The corrected SUVmax values were obtained based on the recovery coefficient (RC) method. RESULTS: The mean SUVmax for normal vertebrae was 7.08 ± 1.97, 12.59 ± 9.01 for DJD and 36.64 ± 24.84 for bone metastases. The SUVmax of bone metastases was significantly greater than DJD (p value < 0.05). To assess for diagnostic accuracy, receiver operating characteristic (ROC) curve was performed. The area under the curve (AUC) was found to be fairly high at 0.874 (95% CI 0.826-0.921). The cutoff SUVmax value ≥ 20 gave a sensitivity of 73.8% and specificity of 85.4% in differentiating bone metastases from DJD. The corrected SUVmax for both DJD and bone metastases was smaller with a mean of 6.82 ± 6.02 and 24.77 ± 20.61, respectively. The cutoff SUVmax value was also lower with a value of 10, which gave a sensitivity of 73.8% and specificity of 86.5%. CONCLUSION: SPECT SUVmax was significantly higher in bone metastases than DJD. Semi-quantitative assessment with SUVmax can complement qualitative analysis. A cutoff SUVmax of ≥ 20 can be used to differentiate bone metastases from DJD. Partial volume effect should be taken into consideration in the quantification of small lesion size.

Clinical determinants of fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)iodine whole body scans after (131)iodine therapy.

BACKGROUND: A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative (131)Iodine ((131)I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells. METHODS: Thirty-five patients with histologically proven DTC that have undergone total or near total thyroidectomy, and post (131)I radioactive iodine ablation therapy, were selected and prospectively analysed. The patients also had to show at least one negative whole body scan and Tg levels of 10 µg/L and above. The results of the FDG-Positron Emission Tomography/Computed Tomography (PET/CT) were then studied to determine the association and the predictors influencing the outcome by using univariable and multivariable analyses. RESULTS: Out of the thirty-five patients, 60% of them (twenty-one) showed positive results and 40% (fourteen) showed negative. Age, gender, and type of histopathology (HPE) showed significant associations with the positive results of the FDG-PET/CT. The results also showed no correlations observed between the Tg levels and standardised uptake value (SUV)max in the DTC patients with positive disease findings in the FDG-PET/CT. The predictor for this study was age. CONCLUSION: The prevalence of the conversion of differentiated to dedifferentiated thyroid cancer among patients with negative (131)I and elevated Tg was 60%, with age as the predictor. DTC patients aged 45 year-old and older were seven times more likely to have positive results of FDG-PET/CT imaging.

Intra-abdominal desmoplastic small round cell tumor: Presentation of four cases and review of the literature.

Desmoplastic small round cell tumor (DSRCT) of the abdomen is a recently identified aggressive neoplasm. Very few cases have been reported in the literature. Thus, the treatment guidelines are yet to be defined. The role of chemotherapy, radiotherapy and surgery is evolving. We treated four cases of DSRCT involving the abdomen using combination chemotherapy and/or tumor cytoreductive surgery. There were two men and two women. The chemotherapy drugs consisted of cisplatin, adriamycin, etoposide, ifosphamide, vincristine and cyclophsophamide. All patients achieved meaningful partial response to chemotherapy, which maintained for 6-9 months. There were very minimal chemotherapy-related complications. At the time of reporting, the median survival time was 15 months. Thus, DSRCT is an aggressive intra-abdominal tumor with excellent chemoresponsiveness, but relapse is frequent.

Prevalence and patterns of headache in school children in Karachi.

OBJECTIVE: To determine the prevalence of headache, its different patterns and associated symptoms in school children. METHODS: A population based, cross-sectional, questionnaire study, followed by interviews of selected cases and their opthalmoscopic examination was conducted in eight secondary schools from different parts of Karachi to cover all socioeconomic groups. A total of 1211 school children aged 12 to 20 years, were included. The main outcome measures studied were, prevalence of headache, associated symptoms and impact of positive family history. RESULTS: The estimated prevalence rate of headache in school children was 85.5%. Of them 43.1% had mild, 46.6% had moderate and 8.8% had severe headache. Nearly half of them (49.6%) had a frequency of 3 or less episodes per month. Majority (58.7%) had no warning symptoms. The most common symptom prior to headache was subjective weakness (19.0%) followed by sensitivity to light (11.5%). The most common site was frontal headache (30.4%) and in 66.7% of the cases it was aching in character. Complaint of noise and light intolerance during headache was reported by 38.2%, 17.1% sought medical advice and only 0.4% needed hospitalization ever. Of those taking medicines (n =424 (41%) majority (82.3%) were self medicated. A positive family history was present in 52.5% children. All selected study subjects were found to have normal optic discs on ophthalmoscopic examination. CONCLUSION: Headache is a major health problem in school children. It is inappropriately treated and there is strong impact of family history.

Antibacterial effect of Melia azedarach flowers on rabbits.

A methanol extract of Melia azedarach flowers showed potent antibacterial action in rabbits suffering from a skin infection produced by Stapyhlococcus aureus. The healing effects were found comparable to neomycin.