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Tyrosine kinase inhibitors (TKIs) have been widely used to treat various malignancies, dramatically improving survival. The use of these treatments has been limited by adverse effects. Ibrutinib, a Bruton’s tyrosine kinase (BTK) inhibitor, has been associated with increased prevalence of atrial fibrillation (AF) in approximately 5%–16% of patients, especially those with prior history of AF,1 and often leads to treatment discontinuation in a significant proportion of patients. Management of AF in this patient population also presents a unique challenge. Current guidelines recommend rate control as the primary strategy,2,3 which can be challenging, since pharmacological management is limited by significant drug interactions with cancer therapies as well as potential side effects. Additionally, the need for anticoagulation in this strategy is challenged by increased risk of bleeding owing to inhibition of collagen-induced platelet aggregation by ibrutinib.4 Recent studies document the long-term benefits of catheter ablation in maintaining sinus rhythm in the general population. We present a case of ibrutinib-associated symptomatic AF, which was successfully treated with ablation therapy, and allowed the patient to return to ibrutinib therapy for adequate management of his cancer (Figure 1). Open in a separate window Figure 1 Timeline showing cardiovascular and hematologic disease and treatment course. AF = atrial fibrillation; CLL = chronic lymphocytic leukemia; AAD = antiarrhythmic drug; OAC = oral anticoagulant. (Figure created with BioRender.com.)

Muhammad Fazal Hameed,1 Yanan Chen,1 Ying Wang,2 Muhammad Shafiq,3 Hazrat Bilal,1 Linqing Liu,4 Jinming Ma,1 Pengying Gu,4 Honghua Ge1 1Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China; 2Department of Laboratory Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of China; 3College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, People’s Republic of China; 4The Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of ChinaCorrespondence: Honghua GeInstitutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of ChinaTel +86-551-63861773Email hhge@ahu.edu.cnPengying GuThe Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of ChinaEmail hellengpy@163.comPurpose: Antimicrobial resistance, especially carbapenem resistance Enterobacteriaceae and plasmid mediated mobile colistin resistance, is a serious issue worldwide. This study was designed to determine the epidemiological characteristics of plasmid mediated colistin resistance and carbapenem resistant Enterobacteriaceae from tertiary A hospital located in Hefei, China.Methods: Totally, 158 carbapenems resistant Enterobacteriaceae (CRE) were screened for antibiotic susceptibility, mcr-1, extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs), and fosfomycin resistance genes using PCR and sequencing. The sequence types were identified by multilocus sequence typing (MLST). Plasmid profiles were determined by PCR based replicon typing (PBRT), and the plasmid sizes were confirmed by southern blotting.Results: The isolates showed high MIC50 and MIC90 for all antimicrobials, except tigecycline, meropenem, and colistin. The main Carbapenemase genes were blaKPC-2 (90.5%), blaNDM-1(3.7%), blaOXA-48(5.6%) and fosA3 (14.5%). The blaCTXM-15 found 36.7%, mcr-1 (3.7%) recorded in six isolates. PBRT revealed blaKPC-2 in K. pneumoniae on IncR, IncFII, and IncA/C. blaNDM-1 in E. coli on IncFII, whereas in E. cloacae noticed on IncHI2 plasmid. mcr-1 was recorded among IncFIIK, IncFII, and IncF in E. coli, K. pneumoniae, and E. cloacae. Resistance genes (mcr-1, blaNDM-1, blaKPC-2) harboring plasmids are successfully trans-conjugant to EC-600. A high incidence of ST11 was observed in K. pneumoniae carbapenem resistant isolates. While in E. coli, multiple STs were identified. However, mcr-1 in ST23 was identified for the first time in Anhui Province. Among Enterobacter cloacae, ST270 detected carrying blaNDM-1. Southern-hybridization confirmed the plasmid sizes 35– 150kb.Conclusion: This study indicates the co-carrying of mcr-1, blaKPC-2, and blaNDM-1 among clinical isolates, the prevalence of different Enterobacteriaceae STs is alarming, especially in E. coli. Holding such a resistance profile is a threat for humans and animals, which may be transferred between the strains through plasmid transfusion. Persistent control actions are immediately necessary to combat this hazard.Keywords: ESBL, MBL, KPC2, mcr-1, NDM-1, CTXM-15

Background During the last six decades, extensive use of antibiotics has selected resistant strains, increasing the rate of fatal infectious diseases, and exerting an economic burden on society. This situation is widely accepted as a global problem, yet its degree is not well elucidated in many regions of the world. Up till now, no systemic analysis of Antimicrobial resistance (AMR) in Pakistan has been published. The current study aims to describe the antibiotic-resistance scenario of Pakistan from human samples of the last 10 y, to find the gaps in surveillances and methodology and recommendations for researchers and prescribers founded on these outcomes. Methods Original research articles analyzed the pattern of Antibiotic resistance of any World Health Organization (WHO) enlisted priority pathogens in Pakistan (published onward 2009 till March 2020), were collected from PubMed, Google scholar, and PakMedi Net search engines. These articles were selected based on predefined inclusion and exclusion criteria. Data about the study characteristics and antibiotic-resistance for a given bacterium were excluded from literature. Antibiotic resistance to a particular bacterium was calculated as a median resistance with 95% Confidence Interval (CI). Results Studies published in the last 10 y showed that Urinary Tract Infection (UTI) is the most reported clinical diagnosis (16.1%) in Pakistan. E. coli were reported in 28 (30.11%) studies showing high resistance to antibiotics’ first line. Methicillin-resistant Staphylococcus aureus (MRSA) was found in 49% of S. aureus’ total reported cases. Phenotypic resistance pattern has mostly been evaluated by Disk Diffusion Method (DDM) (82.8%), taken Clinical Laboratory Standards Institute (CLSI) as a breakpoint reference guideline (in 79.6% studies). Only 28 (30.11%) studies have made molecular identification of the resistance gene. blaTEM (78.94% in Shigella spp) and blaNDM-1 (32.75% in Klebsiella spp) are the prominent reported resistant genes followed by VanA (45.53% in Enterococcus spp), mcr-1 (1.61% in Acinetobacter spp), and blaKPC-2 (31.67% in E. coli). Most of the studies were from Sindh (40.86%), followed by Punjab (35.48%), while Baluchistan’s AMR data was not available. Conclusion Outcomes of our study emphasize that most of the pathogens show high resistance to commonly used antibiotics; also, we find gaps in surveillances and breaches in methodological data. Based on these findings, we recommend the regularization of surveillance practice and precise actions to combat the region’s AMR.

The Human epidermal growth factor receptor 2 positive (HER2+) breast cancer (BC) is a more aggressive tumor with 5 years median survival rates after metastasis. Despite successful treatment, unfortunately, the majority of affected patients die. Defects in cell cycle and transcription regulation phases which are governed by cyclin-dependent kinases (CDKs) are the hallmark of many cancers that underpinning the progression of the disease. Therefore, the current study looked at the alteration of six CDKs mRNA expression levels in pre- and postmenopausal lung metastasis BC groups; the majority were HER2+. Two hundred pre-and postmenopausal lung metastasis breast cancer and healthy control blood samples were taken for RNA isolation. Quantitative PCR was done for CDKs mRNA expressions. We observed overexpression of CDK11, CDK12, CDK17, CDK18, and CDK19 in both pre- and postmenopausal groups. However, CDK20 showed progressive downregulation from early to advanced stages in both groups of patients. Collectively, this data revealed that CDKs overexpression levels may predict BC disease progression and provide further rationale for novel anticancer strategies for HER2+ BC cancers.

Aims: The aim of current study is to find out the prevalence of depression in doctors in different hospitals of Karachi and its association with lifestyle, the field of specialty and coping mechanisms. Place and Duration of Study: The sample was collected from 10 different hospitals of Karachi, in a period of one Year i.e., March 2019 to February 2020. Methodology: A descriptive cross-sectional study design using non-probability consecutive type of sampling technique was used. Sample size was calculated at 95% confidence interval and was found to be 368. The sample was classified in two broader categories Surgery & Allied and Medicine & Allied. For identification of depression level, Public Health Questionnaire (PHQ-9) was used. A 28-item questionnaire Brief COPE was used to asses coping mechanisms. Results: In total 400 forms were used for data analysis. The mean age of doctors was 35 ± 4 years, 65% were males while 35% were females, there was a statistically significant association of female gender with depression. Chi-Square was applied to determine the association of depression and departments and it was found to be highly significant with a P < .001. Highest level of depression was found in Orthopedics and Psychiatry departments followed by Surgery and Gynecology. While Otolaryngology was the least depressed department. Chi-square was applied and a statistically significant association of low monthly income and depression with a p-value of 0.02. In Surgery and allied there was a statistically significant association of depression with extensive working hours and lack of facilities with a p-value of 0.01 and 0.04. While in Medicine and allied there was a statistically significant association of depression with a harsh attitude of seniors and an uncomfortable working environment with a p-value of 0.02 and 0.03. A linear regression model comparing depression and its associations with coping strategies was applied. Conclusion: Our study shows that depression is present in a vast majority of doctors from multiple specialties. Various risk factors for depression have also been identified so appropriate coping strategies should be formulated to deal with it.

Plantar Fasciitis is among the major causes of heel pain. Mechanical stress of plantar aponeurosis usually causes inflammation thus result in problem with weight bearing and difficulty in walking. Pain often exacerbates and may stick at for months with unremitting activity, limiting the activities of daily living and the functional status. The objective of the study was to compare the effects of low level laser and ultrasound therapy in patients for pain and their functional status presents with plantar fasciitis. This study was a Quasi-experimental trial and conducted at Physical therapy Center for Arthritis & Rehabilitation Excellence (PT CARE), Gulberg III Lahore. The study completed in the time duration of six months (Aug 2019 – Jan 2020). Consecutive sampling technique was used to collect the data. A sample size of `total 28 patients were taken in this study; patients were divided into two groups. Conventional Physiotherapy protocol was given to both groups as baseline treatment. (Group A patients were treated with low level laser protocol whereas Group B was treated with ultrasound therapy protocol). Functional Foot Index (FFI) score was used to ask some questions related to patients symptoms and daily activities and to measure the intensity of pain Numeric Pain Rating Scale (NPRS) was used. All participants of the study filled the FFI & NPRS score and Numeric pain rating scale on day 1 in first cycle as pretreatment values and at the end of 5th session and 10th session as first and second cycles as post treatment values respectively. Data was analyzed on SPSS 21.The means of pre-treatment NPRS in group A was 7.78 and in group B means of pre-treatment NPRS was 7.35 with p value

Uncertainty and isolation have been linked to mental health problems. Uncertainty surrounding the COVID-19 pandemic has the potential to trigger mental health problems, which include anxiety, stress, and depression. This paper evaluates the prevalence, psychological responses, and associated correlates of depression, anxiety, and stress in a global population during the Coronavirus Disease (COVID-19) pandemic. A cross-sectional study design was adopted. 678 completed forms were collected during the COVID-19 quarantine/lockdown. An online questionnaire was designed and DASS-21 was used as the screening tool. A non-probability sampling technique strategy was applied. 50.9% of participants showed traits of anxiety, 57.4% showed signs of stress, and 58.6% exhibited depression. Stress, anxiety, and depression are overwhelmingly prevalent across the globe during this COVID-19 pandemic, and multiple factors can influence the rates of these mental health conditions. Our factorial analysis showed notable associations and manifestations of stress, anxiety, and depressive symptoms. People aged 18-24, females, and people in non-marital relationships experienced stress, anxiety, and depression. Separated individuals experienced stress and anxiety. Married people experienced anxiety. Single and divorced people experienced depression. Unemployed individuals experienced stress and depression. Students experienced anxiety and depression. Canada, the UK, and Pakistan are all countries that are experiencing stress and depression as a whole. An extended number of days in quarantine was associated with increased stress, anxiety, and depression. Family presence yielded lower levels of stress, anxiety, and depression. Lastly, lack of exercise was associated with increased stress, anxiety, and depression.

Objectives: To evaluate the role of RIPASA scoring system for diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Prospective Study. Setting: Department of General Surgery, Nishter Hospital Multan. Period: February 2016 to February 2017. Material & Methods: One hundred and sixty 160 patients were included in this study. Study was started after ethical approval from ethical board of institution and informed consent from patients was taken. Non probability consecutive sampling was used. Main outcome variables were sensitivity, specificity and diagnostic accuracy of RIPASA score. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: Estimated sensitivity was 97.9%, which means that of the patients with acute appendicitis, 97.9% were diagnosed correctly. The estimated specificity was 76.9%, which means that of the patients not having acute appendicitis, 76.9% were diagnosed correctly. Positive predictive value was 86.1% and negative predictive value was 96.2%. The overall accuracy was 89.4% for diagnosing acute appendicitis. Conclusion: RIPASA scoring system is efficient, reliable and more diagnostic in cases of acute appendicitis. Abdominal ultrasonography is not suitable diagnostic tool to rule out negative appendectomy.

Background:Lungs are the second most common reported site of distant metastasis in Breast cancer after bone. Mostly the studies were conducted in cell lines and animal model. To date, there is no blood biomarker reported that could determine the breast cancer progression in terms of lung metastasis.Objective:The aim of this study is to determine Nidogen-1 (NID1)’s mRNA and protein expressions in non-invasive blood samples of breast cancer, in early (II) and lung metastasis advanced stages (III & IV) of naive and treated groups. To determine the functional association of NID1, we employed an in silico analysis, STRING database version 11.Methods:A total of n = 175 cases of breast cancer were recruited in our study. Real time quantitative PCR and ELISA were performed to analyze the mRNA and protein expressions of NID1 respectively. An in silico method is also used to assess NID1’s interactome. Some significant patents related to this topic were also studied and discussed in this research paper.Results:The results show high levels of NID1’s mRNA in the naive group (Group A) as compared to treated group (Group B). Similar trend of increased NID1’s protein expressions was also observed among naive and treated groups, respectively. Our results also show the significant impact of treatment on NID1’s gene and protein expressions. In silico analysis has revealed the functional association of NID1 with its different interactome protein partners.Conclusions:The increased expression of NID1 in early to advanced naive as compared to the treated groups with lung metastasis makes it a promising marker which has pro-metastatic role in breast cancer.

Background: A needlestick injury (NSI) is a serious occupational hazard among healthcare personnel (HCP), as it can cause transmission of blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This study aimed to determine the frequency and distribution of reported NSIs, associated factors, use of post-exposure prophylaxis (PEP), and percentage of seroconversion among HCP in a major tertiary care hospital in Qatar. Methods: This retrospective study analyzed NSIs among HCP reported in Hamad Medical Corporation facilities in Doha between May 01, 2017, and May 01, 2018. A surveillance follow-up period of 6 months commenced after the 1-year study period. Results: A total of 130 NSIs were reported during the study period, with an overall incidence of eight injuries per 1000 HCP. The mean age was 34.6 ± 7.9 years. Among the reported cases, the proportion of female HCP (n = 72, 55.4%) was greater than that of male HCP (n = 58, 44.6%). Of 130 NSIs, 79 (60.8%) occurred in nurses, followed by 35 (26.9%) cases in doctors and 16 (12.3%) in other HCP. The total healthcare population comprised 49.6% of nurses and 18% of doctors. NSIs occurred in 10.1 per 1000 nurses and in 12.4 per 1000 doctors. Exposures mainly occurred in the operating theater, 35 (31.5%); inpatient wards, 24 (21.6%); and emergency department, 20 (18%). Common modes of injury were after use or before disposal of the device in 44 (44.4%) cases and during surgical interventions in 35 (35.4%) cases. Hollow-bore needles (64/98, 65.3%) were the most common devices involved. Source serology was documented in 71 (54.6%) cases of which 52 (73.2%) were normal, 9 (12.7%) were abnormal, and 10 (14.1%) were incomplete. Among the exposed HCP, 124 (95.4%) had adequate immunity to HBV. PEP for HBV was indicated in 6 (4.6%) and received by 4 (3.1%) HCP. NSI cases were followed up for 6 months post-exposure, and during this surveillance period, no seroconversion to HBV, HCV, or HIV was detected. Conclusion: NSIs are common among HCP. In this study, most of the exposed HCP had adequate immunity to HBV. There was no hepatitis B, hepatitis C, or HIV transmission among the study cohort. Adherence to proper needle/sharps disposal techniques and safe practices during procedures will help prevent NSIs.

Charge density mapping of atrial fibrillation (AF) reveals dynamic localized rotational activation (LRA), irregular activation (LIA) and focal firing (FF). Their spatial stability, conduction characteristics and the optimal duration of mapping required to reveal these phenomena and has not been explored.Bi-atrial mapping of AF propagation was undertaken using AcQMap (Acutus Medical) and variability of activation patterns quantified up to a duration of 30 s. The frequency of each pattern was quantified at each unique point of the chamber over two separate 30-s recordings before ablation and RIn 21 patients, 62 paired LA and RA maps were obtained. LIA was highly spatially stable with RIrregular activation patterns characterized by changing wavefront direction are temporally and spatially stable in contrast with LRA that is transient with least spatial stability. Focal activation appears of intermediate stability. Regions of LIA show increased heterogeneity following extrastimulus pacing and may represent fixed anatomical substrate.

Pakistani children of school going age significantly differed from WHO references in which overweight and obesity were significantly higher and underweight was lower than normal when compare to WHO references. Due to this huge discrepancy and lack of data, there was a dire need to establish age appropriate BMI ranges for Pakistani population. The basic aim of the study is to find out the BMI ranges among the school going children/adolescents of Karachi Pakistan. A cross sectional study was conducted among children belonging to different ethnic groups in primary, middle, secondary schools and Maddarsa (religious educational institutes) of Karachi. Height in centimeters (cm) and weight in kilogram (kg) were measured. BMI was calculated using height and weight. WHO’s BMI graph was used to find out the percentile for labelling underweight, normal healthy individual, overweight and obese. A total of about 1244 samples of children and adolescents aged seven to eighteen years were included. The mean age of the study participants was 12.96±2.8 years, in which boys having mean age of 13.1±2.7 years while for girls mean age was 12.66±2.8 years. The mean height (cm) and weight (kg) among the study participants were 146.92±15.84 and 41.20±15.69 respectively. Among younger age group, the girls were taller than the boys but after reaching the age of 15 the girls having approximately the same height up to the age of 18th and as for boys, the findings were vice versa. Majority of the participants reported normal BMI while for over abnormality, the higher prevalence of participants being overweight rather than underweight when comparing with the WHO references. Measures must be taken to assess what current set up is doing right, and then it must be implemented at a larger scale.

Background: Electroencephalogram (EEG) is defined as a method of detecting brain waves signifying the electrical conductivity of the brain. Globally, EEG is used to further classify neuropsychiatric disorders. Objective: To evaluate the prevalence of abnormal EEGs and related neurological disorders and it’s correlation with age and gender. Methodology: A descriptive cross sectional study was conducted in Neurology department, Ziauddin hospital, Karachi, Pakistan from June 2018 to May 2019. A total of 440 individuals based on inclusion criteria were selected through Non-probability consecutive sampling. Informed consent was obtained from study participants. A self-designed structured questionnaire and EEG record were used for data collection. Data were entered and analyzed using SPSS v 20. Mean and standard deviation was calculated for numerical variable and frequency and percentages were calculated for categorical variable. Independent t-test and chi square was used to check association of abnormal EEG with age and gender. P value of ≤0.05 was considered statistically significant. Results: The mean age of study participants was 52.98 ± 22.68 years. There were 54.5% (n = 240) males. Approximately 45.2% (n = 199) participants had predisposing condition which can lead to abnormal EEG. EEG records of 39.8% (n = 175) of the patients was normal while 60.2% (n = 265) had abnormal records. Diffuse neuronal dysfunction consistent with encephalopathy was found in 45.2%. Mild neuronal dysfunction consistent with encephalopathy accounted for 33.5% of cases. Significant difference was found in Abnormal EEG among different age group (p = 0.01). Chi square shows an association between abnormal EEG and male gender (p = 0.025). Conclusion: EEG plays a vital role in the diagnosis of neuropsychiatric conditions in developing countries. EEGs can further help to determine the relationship of different neuropsychiatric conditions and can help in early diagnosis and better prognosis.

ntroduction: Due to widespread incidence and prevalence, human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV), syphilis and malaria are the most common viral infections transmitted via blood transfusions. Yet there is insufficient information available about the exact prevalence of these infections among blood donors in Pakistan. The objectives of current study are to highlight the importance of blood screening among blood donors by finding the prevalence of high-risk transmissible diseases such as hepatitis B, hepatitis C, HIV, syphilis and malaria in the population of Nawabshah (Sindh) and to compare it with other provinces. Methods: A descriptive type of cross-sectional study was conducted on 37,845 blood donor volunteers at the blood bank of a tertiary care hospital, Peoples University of Medical and Health Sciences Hospital, in Nawabshah Sindh from 1st January 2018 to 31st December 2018. The data was taken from the well-maintained yearly record of the hospital blood bank. Analysis of all the data regarding blood donors was done using Statistical Program of Special Sciences (SPSS) version 20. Results: The most common age group was between 18 - 40 years. Donors were predominantly male (90%). HBV is the most prevalent disease amongst the blood donors of Peoples Medical College with a prevalence of 6.52% while HIV, HCV and malaria were 6.33%, 5.83% and 1.24% respectively whereas Syphilis is the least prevalent disease with a prevalence of 1.11%. Comparing with other provinces, the highest prevalence of hepatitis B was seen in Peoples Medical College, Nawabshah, Sindh whereas for hepatitis C it was the highest in Isra University Hospital, Hyderabad, Sindh. Moreover, Hayatabad Medical Complex in Peshawar was the least burdened with Hepatitis B (1.46%) and C (1.34%). Conclusion: Accidental diagnosis of blood-borne infections including Hepatitis B, C, HIV, Syphilis and malaria highlights importance of blood screening among the blood donors. There is a need of public education regarding infection prevention and transmission.

IntroductionPoint-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes.MethodsWe conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received cardiac or lung POCUS with a 12-zone protocol. Images were interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was ICU admission incidence. Secondary outcomes included intubation and supplemental oxygen usage.ResultsN=160 patients (N=201 scans) were included. Scans were collected a median 23 hours (IQR:7-80) from emergency department triage. Triage POCUS findings associated with ICU admission included B-lines (OR 4.41 [95% CI:1.71-14.30]; pConsolidations present on triage were associated with the need for oxygen at discharge (OR 2.16 [95% CI: 1.01-4.70]; p=0.047). A normal lung triage scan was protective for ICU admission (OR 0.28 [95% CI:0.09-0.75; pDiscussionLung POCUS findings detected early in the hospitalization may provide expedient risk stratification for important COVID-19 clinical outcomes, including ICU admission, intubation, or need for oxygen on discharge. A normal admission scan appears protective against adverse outcomes, which may aid in triage decisions of patients.

Introduction: Point-of-care ultrasound (POCUS) can detect the cardiopulmonary manifestations of COVID-19 and may predict patient outcomes in an expedient and cost-effective manner. Methods: We conducted a prospective cohort study at four medical centers from 3/2020 to 9/2020 to evaluate the relationship between POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received lung ultrasound (LUS) examinations at the bedside with a 12-zone protocol. All images were interpreted by at least two reviewers who were blinded to clinical outcomes. Results: N=99 patients met inclusion criteria. The median time from ED triage to LUS was 0.9 days (IQR: 0.1-2.9). LUS was rarely normal (11% of patients), with B-lines (90%) and subpleural consolidations (62%) representing the most prevalent findings. Findings associated with ICU admission included anterior B-lines (OR: 3.1 [95% CI: 1.2-9.7]), anterior consolidations (OR: 3.1 [95% CI: 1.1-9.9]) and lateral consolidations (OR: 4.1 [95% CI: 1.3-15.5]), while a normal scan was strongly protective against ICU admission (OR 0.08 [95% CI: 0.00-0.68]). LUS findings remained stable over a period of 28 days from symptom onset. Discussion: Anterior and/or lateral lung involvement on POCUS may portend a three to four-fold risk of critical illness among COVID-19 patients. The location, rather than the absolute appearance of POCUS findings, may be important harbingers of severe disease. POCUS findings did not change over a 28-day scanning period, suggesting that their detection at any time point may be clinically important. Funding Statement: None to declare Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the Institutional Review Boards of Stanford University and the University of California, San Francisco. A waiver of consent was obtained by both institutions.

Background It has been noted that there is high prevalence of depression among medical personnel whether it is a student or an on-duty doctor. However, no study has been done to highlight these two vulnerable groups. Accordingly, the objective of current study is to compare the prevalence of depression among medical students and doctors working in hospitals, and its correlation with demographic variables, associated symptoms and history of any recent trauma. A descriptive cross-sectional study design was selected for this study. PHQ-9 was used as study tool. Result Mean age of students was 21 ± 1.83 while the mean age of the doctors included in study was 31 ± 7.8. A multivariate analysis model (MANOVA) was applied where male doctor and students were found to have a significantly high association (p = < 0.001) with depression scores as compared to their counterpart and students. Positive association was observed among sector and symptom of hopelessness, sleep changes and appetite/weight changes. The most common symptom among both groups was sleep changes while the least common symptom among doctors was concentration problem and among students was feeling of helplessness. It was also found that 26% of the students were having suicidal thoughts while only 16% of the doctors were having suicidal intentions. Conclusion It is concluded that depression is highly prevalent among medical students when comparing with on-duty doctors, so they should be screened with regular intervals and good counselling sessions to prepare them for a better health care system.

Objective The goal of this study was to compare the efficacy of tramadol and paroxetine in the treatment of primary premature ejaculation (PE). Study design This study was a randomized controlled trial performed in the outpatient department of Nishtar Hospital, Multan, from January 2017 to January 2018. Methodology One hundred six patients were diagnosed with PE and included in the study. The patients were categorized into two groups receiving either tramadol or paroxetine through a lottery randomization method. The main variables were baseline PE, baseline satisfaction after intercourse, baseline intravaginal ejaculatory latency time (IELT), ejaculation control, difficulty in ejaculation, and after-treatment satisfaction with sexual intercourse and IELT. We used IBM SPSS Statistics for Windows, Version 23.0 (Armonk, NY: IBM Corp.) for data analysis, and p≤0.05 was considered statistically significant. Results Ejaculation control, difficulty in ejaculation, and distress due to ejaculation in patients in the tramadol group was noted as 24.5%, 7.5%, and 7.5%, respectively. Ejaculation control, difficulty in ejaculation, and distress due to ejaculation in the paroxetine group was noted as 49.1%, 17%, and 24.5%, respectively. The differences were statistically significant within the groups at baseline and after treatment of PE (p

Globally, cervical cancer remains as the foremost prevailing cancer in females. Hence, it is necessary to distinguish the importance of risk factors of cervical cancer to classify potential patients. The present work proposes a cervical cancer prediction model (CCPM) that offers early prediction of cervical cancer using risk factors as inputs. The CCPM first removes outliers by using outlier detection methods such as density-based spatial clustering of applications with noise (DBSCAN) and isolation forest (iForest) and by increasing the number of cases in the dataset in a balanced way, for example, through synthetic minority over-sampling technique (SMOTE) and SMOTE with Tomek link (SMOTETomek). Finally, it employs random forest (RF) as a classifier. Thus, CCPM lies on four scenarios: (1) DBSCAN + SMOTETomek + RF, (2) DBSCAN + SMOTE+ RF, (3) iForest + SMOTETomek + RF, and (4) iForest + SMOTE + RF. A dataset of 858 potential patients was used to validate the performance of the proposed method. We found that combinations of iForest with SMOTE and iForest with SMOTETomek provided better performances than those of DBSCAN with SMOTE and DBSCAN with SMOTETomek. We also observed that RF performed the best among several popular machine learning classifiers. Furthermore, the proposed CCPM showed better accuracy than previously proposed methods for forecasting cervical cancer. In addition, a mobile application that can collect cervical cancer risk factors data and provides results from CCPM is developed for instant and proper action at the initial stage of cervical cancer.

Objective The goal of this study was to compare the effectiveness and complications of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (SWL) in the management of patients with proximal ureteral stones. Methods In this trial, 150 patients presenting with proximal ureteral stones at the Department of Urology of Nishter Hospital Multan from November 2018 to November 2019 were allocated 1:1 to undergo URS or SWL. The presence of stone fragments

Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs.We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs.A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce.We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills.Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.تعليم الصحة العامة واحتياجات النظام الصحي بباكستان: دراسة باتباع مزيج من الطرق.محمد فضل ذيشان، عثمان رضا، سعيد أنور، دردانة خان، عامر عباس، نويد صادق، عميرقاضي.شهدت باكستان مؤخرا نموًّا كبيرًا في برامج التعليم في الصحة العامة. إن المعلومات قليلة حول بنية برامج التعليم في الصحة العامة وما إذا كانت استجابتها كافية لتلبية احتياجات النظام الصحي الوطني.استعرضنا البرامج الموجودة حاليًّا لمنح الشهادات الدراسية في الصحة العامة في باكستان إلى جانب استكشاف سوق الصحة العامة واحتياجات النظام الصحي على الصعيد الوطني.أجرينا دراسة بمزيج من الطرق في الفترة بين يناير/كانون الثاني 2015 ومارس/آذار 2016. استعرضنا المواصفات البرنامجية والتلقينية في 17 برنامجًا يمنح شهادة في الصحة العامة. أجرينا 13 مقابلة مع أشخاص ذوي أهمية رئيسية كمصادر للمعلومات لاستكشاف احتياجات النظام الصحي والتحديات ذات الصلة بالقوى العاملة في الصحة العامة.وجدنا اختلافًا كبيرًا بين البرامج الأكاديمية في مجال الصحة العامة من حيثُ الدورات التعليمية التي تقدمها والساعات المعتمدة التي تحتسبها وعدد أعضاء هيئة التدريس فيها والرسوم الدراسية التي تطلبها. واتضح لنا أن حوالي 70 % البرامج التي تمنح شهادات في الصحة العامة كانت عامة (أي أنها لا تركِّز على مسار تخصصي) ، وأن نسبة التدريب العملي الذي تقدمه لا يزيد على 18 % فقط. وكان متوسط تكلفة رسوم التعليم في عام 2016 مقدرة بالدولارات الأمريكية 10350. أثناء المقابلات مع الأشخاص ذوي الأهمية الرئيسية كمصادر للمعلومات اتضح لنا مواضيع التحديات ومنها الافتقار إلى المهارات العملية في مجال الصحة العامة، والمعرفة المحدودة النطاق بأحدث المبادئ النظرية، وتدني مستوى مهارات الاتصال، وعدم كفاية التوجه نحو تكنولوجيا المعلومات. وحددنا المواضيع التي تدور حول مجالات المعلومات والمهارات اللازمة لمواجهة التحديات المستقبلية في مجال الصحة العامة في باكستان ومنها توجيه الذهن نحو التفكير بالنظام، ومهارات تكنولوجيا المعلومات في الرعاية الصحية، ومهارات القيادة ومهارات الإدارة.لا يلبي التعليم في مجال الصحة العامة في باكستان مقتضيات التحديات الوطنية الحالية. تحتاج باكستان إلى هيئة اعتماد وطنية في الصحة العامة لتنظيم التعليم، ومواءمة المعايير العالمية مع السياق المحلي وتطوير مسارات المستقبل المهني ذات الصلة.Enseignement en santé publique et besoins du système de santé au Pakistan : étude à méthodologie mixte.Le Pakistan connaît depuis peu une forte augmentation du nombre de ses programmes d’enseignement en santé publique. La structure de ces programmes et leur adéquation aux besoins du système de santé national restent méconnues.Nous avons examiné les programmes en santé publique diplômants qui existent actuellement au Pakistan et nous avons étudié le marché national pour ce domaine ainsi que les besoins du système de santé.Une étude à méthodologie mixte a été réalisée entre janvier 2015 et mars 2016. Dix-sept programmes en santé publique diplômants ont été passés en revue afin de déterminer leurs caractéristiques programmatiques et pédagogiques. Treize entretiens avec des informateurs clés ont été menés afin d’analyser les besoins du système de santé et les problèmes des personnels dans le secteur de la santé publique.Nous avons constaté des différences considérables entre les filières académiques en santé publique, tant sur le plan des cours proposés que des heures d’étude, des effectifs du corps enseignant et des frais de scolarité. Environ 70 % des programmes diplômants en santé publique étaient génériques (c’est-à-dire sans filière spécialisée) et seuls 18 % proposaient des stages pratiques. La valeur médiane des frais de scolarité généraux (en 2016) s’élevait à 10 350 dollars US. Au cours des entretiens avec les informateurs clés, les problématiques soulevées comprenaient le manque de compétences pratiques en matière de santé publique, les connaissances limitées concernant les derniers principes théoriques, les faibles compétences en communication et l’orientation insuffisante vers les moyens informatisés. Les thématiques identifiées dans les domaines des connaissances et des compétences nécessaires afin de relever les défis futurs du Pakistan en matière de santé publique comprenaient une approche intellectuelle systémique, des compétences informatiques axées sur les soins de santé et des aptitudes en leadership et en gestion.L’enseignement en santé publique au Pakistan n’est pas à la hauteur des difficultés auxquelles le pays fait face à l’heure actuelle. Le Pakistan a besoin d’un organisme d’accréditation national en santé publique capable de réglementer l’enseignement, d’harmoniser les normes mondiales en fonction du contexte local et de développer des filières professionnelles pertinentes.

Hospital waste management (HWM) rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization (WHO)-recommended questionnaire has not been done in all teaching hospitals of Peshawar District.This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices.Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests.Most surveyed hospitals lacked formal HWM plans (70%), written procedures (80%), related job descriptions (80%) or records (90%). Many hospitals neither had trained HWM supervisors (56%) nor did they organize formal HWM trainings for new staff (40%). None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals.Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules (and ensure their implementation) to facilitate effective HWM practice across provincial healthcare facilities.ممارسات وتنفيذ القواعد الوطنية لإدارة نفاقات المستشفيات لعام 2005 في باكستان.محمد فضل ذيشان، أحمد العباد، عبد العزيز، افتاب سبحاني، آصف شاه، طاهر خان، هداية الله، عمير قاضي.صدرت قواعد إدارة نفايات المستشفيات في باكستان في عام 2005. وعلى الرغم من مرور عقد على سن هذه القواعد، ظل الامتثال لها يفتقر إلى الاتساق، ولم يُر أي تقييم منهجي للامتثال باستخدام استبيان موصى به من منظمة الصحة العالمية في جميع المستشفيات التعليمية في منطقة بيشاور.عمدت هذه الدراسة إلى تقييم الامتثال لقواعد إدارة نفايات المستشفيات لعام 2005 في مستشفيات الرعاية الثلاثية التعليمية في منطقة بيشاور بالنسبة للمختصين بإدارة نفايات المستشفيات وسياساتها وممارساتها.استُخدمت استبيانات منظمّة ومجرّبة سلفاً استناداً إلى توصيات منظمة الصحة العالمية لمسح جميع المستشفيات التعليمية في منطقة بيشاور في الفترة من يناير إلى مارس 2015. وجمعت بيانات أيضا بشأن البنية التحتية لإدارة نفايات المستشفيات وعملياتها من وحدة واحدة من كل من أقسام الباطنة، الجراحة، طب الأطفال، النساء والولادة اختيرت عشوائياً في كل مستشفى. وبالإضافة إلى الإحصاءات الوصفية، أجريت مقارنة بين مستشفيات عامة وخاصة باستخدام اختبار فيشر الدقيق واختبار ويلكوكسون لحساب مجموع الرتب.افتقرت معظم المستشفيات الخاضعة للاستقصاء لأي خطط رسمية لإدارة نفايات المستشفيات (70 %) أو إجراءات مكتوبة (80 %) أو توصيف للوظائف ذات الصلة (80 %) أو سجلات (90 %). ولم يقدم كثير من المستشفيات أي تدريب للمشرفين (56 %) ولا تنظيم دورات تدريبية رسمية بشأن إدارة نفايات المستشفيات للموظفين الجدد (40 %). ولم تلتزم أي من المستشفيات بفصل النفايات والترميز اللوني. وعند مقارنة هذه القواعد بالقواعد الوطنية لإدارة نفايات المستشفيات لعام 2005 ، ظهرت عدة فجوات تتصل بالنقل والتخزين والتخلص الملائم مع عدم ظهور أي فرق ذي دلالة إحصائية بين المستشفيات العامة والخاصة.توجد فجوات خطيرة في الامتثال لقواعد إدارة نفايات المستشفيات لعام 2005 في المستشفيات الخاضعة للمسح. وبعد إلغاء الوظيفة البيئية مؤخراً، ينبغي لحكومة خيبر باختونخوا سن قواعد لإدارة نفايات المستشفيات على مستوى المقاطعات (وكفالة تنفيذها) لتيسير ممارسة إدارة نفايات المستشفيات بفعالية في جميع مرافق الرعاية الصحية على مستوى المقاطعات.Pratiques et application des réglementations nationales en matière de gestion des déchets hospitaliers 2005 : étude de cas au Pakistan.Les réglementations en matière de gestion des déchets hospitaliers au Pakistan ont été publiées en 2005. Dix ans après leur adoption, l’observation des réglementations de 2005 en matière de gestion des déchets hospitaliers demeure incohérente, et une évaluation systématique de la conformité à l’aide d’un questionnaire recommandé par l'Organistation mondiale de la Santé (OMS) n’a pas été effectuée dans tous les hôpitaux universitaires du district de Peshawar (Khyber Pakhtunkhwa).La présente étude a évalué l’observation des réglementations de 2005 en matière de gestion des déchets hospitaliers par les hôpitaux universitaires de soins tertiaires dans le district de Peshawar eu égard au personnel, aux politiques et aux pratiques de gestion des déchets hospitaliers.Des questionnaires structurés prétestés reposant sur les recommandations de l’OMS ont été utilisés pour enquêter dans tous les hôpitaux universitaires du district de Peshawar entre janvier et mars 2015. Des données ont également été recueillies sur les infrastructures et les processus de gestion des déchets hospitaliers auprès de départements de médecine, de chirurgie, de pédiatrie, de gynécologie/d’obstétrique sélectionnés de façon aléatoire dans chaque hôpital. Outre les statistiques descriptives, les hôpitaux publics et privés ont été comparés à l’aide du test exact de Fisher et du test des rangs signés de Wilcoxon.La plupart des hôpitaux enquêtés n'avaient pas de plans officiels (70 %), de procédures écrites (80 %), de descriptifs de postes associés (80 %) ou de dossiers (90 %) pour la gestion des déchets hospitaliers. De nombreux hôpitaux n’avaient pas formé de responsables en gestion des déchets hospitaliers (56 %), ou organisé de formations officielles dans le domaine pour les nouveaux membres du personnel (40 %). Aucun des hôpitaux ne procédait à un tri des déchets ou n’appliquait le code couleurs. Eu égard aux réglementations nationales en matière de gestion des déchets hospitaliers, des lacunes multiples en matière de transports, d’entreposage et d’élimination appropriés ont été révélées, sans différences significatives entre les hôpitaux publics et privés.Il existe de sérieuses lacunes concernant le respect des réglementations de 2005 en matière de gestion des déchets hospitaliers dans les hôpitaux ayant fait l’objet de l’enquête. Au vu de la décentralisation récente de la gestion environnementale, le gouvernement de Khyber Pakhtunkhwa devrait adopter des réglementations en matière de gestion des déchets hospitaliers à l’échelle de la province (et garantir leur application) afin de faciliter la mise en place de pratiques efficaces de gestion des déchets hospitaliers au sein des établissements de soins de santé dans la province.

Aim: The purpose of this study was to estimate the present incidence of Treatable Retinopathy of prematurity (ROP) in Dubai. To share our experience following bevacizumab monotherapy for treatable ROP. Design: It is a prospective nonrandomized, interventional case series. Method: Infants of two major government hospital in Dubai, Latifa hospital and Dubai Hospital, Neonatal Intensive care unit (NICU) were screened for Retinopathy of prematurity (ROP). ROP screening was based on American Academy of Pediatrics (AAP) guidelines. The Inclusion Criteria for treatable ROP were the infants with Type 1 ROP; Stage 2 plus and Vascular stage 3 plus ROP in zone I and II disease. Intravitreal injection of 0.75 mg/0.03 ml bevacizumab was given under topical anesthesia. The follow up period was from 6 months to 1 year after the treatment. Results: Eight hundred and ten premature infants were screened from April 2010 to April 2014. Among them 215 had ROP (26.54%). One hundred and twelve eyes of 56 neonates (6.9%) developed treatable ROP. Ninety- four eyes of 47 infants underwent bevacizumab monotherapy. In 92.6% eye the ROP regressed. There was recurrence of ROP in 7.4%. Conclusion: The incidence of pre-term births is rising in Dubai due to increase in the population and fertility treatment trend in Dubai. Anti-VEGFs are effective treatment for vascular ROP with back up laser being mandatory. However, long term effects of Anti-VEGFs on neuro motor development needs to be monitored

In the Neurology Clerkship at our institution, we introduced a medical education curriculum to increase student competency in providing discharge education to patients with neurologic disease, and to increase knowledge of QI principles. The curriculum was peer-based, in that it was developed by medical students, experienced by medical student clerks, and modified over time with their feedback, which was tracked using exit surveys. Patients counseled were predominantly male (67%) and white (55%), with stroke or TIA together representing the most common diagnoses (58%). A high proportion of students (>85%) agreed that the clerkship project was effective in teaching discharge education, the risk factors for readmission, and increased confidence in providing discharge education. We conclude that medical students are poised to learn QI principals through practice-based curricula, and through practice may improve the quality and safety of care for patients with neurologic disease. This curriculum can be implemented within other services, and with different learners., Highlights • Ninety-one percent (91%) of students felt more confident educating Neurology patients. • About half of patients counseled suffered a stroke or TIA. • The curriculum evolved using ongoing collection of student feedback.

Objective As supermarkets continue to expand their healthcare categories, consumers now have more choice and access to non-prescription medicines. The aim of this current research is to empirically examine the drivers and barriers of consumer purchase intentions, namely trust and perceived risk, of non-prescription medicines in both supermarkets and community pharmacy settings. Method Data were collected using an in-store intercept survey of 402 supermarket shoppers and 310 community pharmacy shoppers. Confirmatory factor analysis including a measurement and structural model tests were employed using AMOS software package to identify variances in the drivers and barriers of purchase intentions between these retail settings. Key findings This study found an association between the purchase intention of non-prescription medicines in community pharmacies with their perceived competence, benevolence and provision accurate information. Other than time risk, no other elements of risk were associated with purchase intentions within this setting. In contrast, the perceived risks associated with the purchase of non-prescription medicines within the supermarkets setting – specifically physical and social risk, were present. Results indicate respondents were more likely to intend to purchase medicines from a supermarket if they perceived that the retailer was competent in providing access to safe non-prescription medicines and had the ability to handle transactions. Conclusions This is the first study to examine the psychological drivers and barriers of purchase intentions of non-prescription medicines in supermarkets and community pharmacies, finding very different results across both retail settings. The study presents a comprehensive model of purchase intentions of non-prescription medicines and recommends directions for pharmacy practitioners and supermarkets.

Introduction Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. Objective Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. Methods We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. Results A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P

OBJECTIVES To assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB-GYN) procedures at different hospitals in Pakistan. METHODS Study was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet-based questionnaire was administered from October 2016 through January 2017 among post-op OB-GYN patients. RESULTS About 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P

As the risk of diseases diabetes and hypertension increases, machine learning algorithms are being utilized to improve early stage diagnosis. This study proposes a Hybrid Prediction Model (HPM), which can provide early prediction of type 2 diabetes (T2D) and hypertension based on input risk-factors from individuals. The proposed HPM consists of Density-based Spatial Clustering of Applications with Noise (DBSCAN)-based outlier detection to remove the outlier data, Synthetic Minority Over-Sampling Technique (SMOTE) to balance the distribution of class, and Random Forest (RF) to classify the diseases. Three benchmark datasets were utilized to predict the risk of diabetes and hypertension at the initial stage. The result showed that by integrating DBSCAN-based outlier detection, SMOTE, and RF, diabetes and hypertension could be successfully predicted. The proposed HPM provided the best performance result as compared to other models for predicting diabetes as well as hypertension. Furthermore, our study has demonstrated that the proposed HPM can be applied in real cases in the IoT-based Health-care Monitoring System, so that the input risk-factors from end-user android application can be stored and analyzed in a secure remote server. The prediction result from the proposed HPM can be accessed by users through an Android application, thus, it is expected to provide an effective way to find the risk of diabetes and hypertension at the initial stage.

Current technology provides an efficient way of monitoring the personal health of individuals. Bluetooth Low Energy (BLE)-based sensors can be considered as a solution for monitoring personal vital signs data. In this study, we propose a personalized healthcare monitoring system by utilizing a BLE-based sensor device, real-time data processing, and machine learning-based algorithms to help diabetic patients to better self-manage their chronic condition. BLEs were used to gather users&rsquo, vital signs data such as blood pressure, heart rate, weight, and blood glucose (BG) from sensor nodes to smartphones, while real-time data processing was utilized to manage the large amount of continuously generated sensor data. The proposed real-time data processing utilized Apache Kafka as a streaming platform and MongoDB to store the sensor data from the patient. The results show that commercial versions of the BLE-based sensors and the proposed real-time data processing are sufficiently efficient to monitor the vital signs data of diabetic patients. Furthermore, machine learning&ndash, based classification methods were tested on a diabetes dataset and showed that a Multilayer Perceptron can provide early prediction of diabetes given the user&rsquo, s sensor data as input. The results also reveal that Long Short-Term Memory can accurately predict the future BG level based on the current sensor data. In addition, the proposed diabetes classification and BG prediction could be combined with personalized diet and physical activity suggestions in order to improve the health quality of patients and to avoid critical conditions in the future.