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Background This study aimed to assess the bacterial profile of diabetes patients with an infected foot and their antimicrobial susceptibility pattern in a tertiary care hospital. Methodology We conducted a six-month prospective study at a hospital in Peshawar, Pakistan. Demographics and clinical characteristics such as age, sex, type and duration of diabetes, glycemic control, presence of retinopathy, nephropathy, neuropathy, peripheral vascular disease, ulcer size, outcomes, and the number of admitted days at the facility were collected. Pus or discharges from the ulcer base and debrided necrotic tissue were obtained. Gram staining was performed on the samples which were isolated on chocolate agar and MacConkey agar. Incubation was done for 24 hours at a temperature of 37°C, and isolates were identified using standard bacteriological methods. The Kirby-Bauer testing method was used to assess antibiotic susceptibility. Results A total of 200 patients received a diagnosis of diabetic foot ulcer at the hospital during the study period. The age of the patients ranged from 24 to 92 years, with a mean age of 58.12 years (standard deviation (SD) = 12.494). The mean HbA1c level was 9.33% (SD = 2.050). The mean duration of diabetes mellitus was 12.3 years (SD = 6.181). In total, 96 (66.2%) isolates were gram-negative bacteria, while 49 (33.8%) were gram-positive bacteria. Among the gram-negative bacteria

Background Pressure ulcers (PUs) occur when the skin covering a weight-bearing part of the body is compressed for a long time between bone, any other part of the body, bed, chair, or any other hard surface. This study aimed to determine the prevalence of pressure ulcers at a tertiary care hospital in all specialty departments including COVID-19. Methods A retrospective study was conducted at North West General Hospital and Research Center, Peshawar, Pakistan. After obtaining ethical approval, data were obtained from the hospital database from July 2020 to June 2021. The keywords "bed sore," "pressure sore," and "pressure ulcer" were used to search for relevant cases, and patient demographics, including age and gender, site of pressure ulcer, stage of pressure ulcer, whether the pressure ulcer was single or multiple, length of stay at the hospital, and specialty department, were collected. Results In total, 99 patients met the inclusion criteria, of which 65 (65.7%) were males, while 34 (34.3%) were females. The age of the patients ranged from 15 to 92 years, with a mean age of 59.93 years. Of the patients, 87 (87.9%) had acquired only a single pressure ulcer. Stage 2 pressure ulcers were the most documented, making up 43.1% of the total cases reported, while stage 4 cases were only 3.3%. The sites most frequently affected by pressure ulcers were the gluteal and sacral regions, accounting for 34.4% and 30.3%, respectively. The incidence of pressure ulcers was the highest in the COVID-19 ward, i.e., 25.3%, followed by the neurosurgery ward with a 20.2% incidence. Conclusion Pressure ulcers occur frequently in almost all the specialty departments of a healthcare setting, especially in COVID-19 and neurosurgery wards, and impose significant physical, psychological, and financial burdens. The prevention of pressure ulcers is the best approach to avert patients and their families from all the burdens associated with pressure ulcers.

Virgin polymers based on petrochemical feedstock are mainly preferred by most plastic goods manufacturers instead of recycled plastic feedstock. Major reason for this is the lack of reliable information about the quality, suitability, and availability of recycled plastics, which is partly due to lack of proper segregation techniques. In this paper, we present our ongoing efforts to segregate plastics based on its types and improve the reliability of information about recycled plastics using the first-of-its-kind blockchain smart contracts powered by multi-sensor data-fusion algorithms using artificial intelligence. We have demonstrated how different data-fusion modes can be employed to retrieve various physico-chemical parameters of plastic waste for accurate segregation. We have discussed how these smart tools help in efficiently segregating commingled plastics and can be reliably used in the circular economy of plastic. Using these tools, segregators, recyclers, and manufacturers can reliably share data, plan the supply chain, execute purchase orders, and hence, finally increase the use of recycled plastic feedstock.

Interscalene block is used for shoulder surgeries however it almost always results in phrenic nerve palsy1,2. Some anaesthesiologists have described careful ultrasound guided low volume (5mls only) of local anesthetic interscalene block which does not cause hemidiaphragmatic paresis3. However we present to you a case where we implied a recently described technique of phrenic sparing involving a combination of oblique infraclavicular brachial plexus block with subomohyoid suprascapular nerve block. Keywords: Shoulder block, phrenic nerve palsy

Electronic health records driving over the hype of digitalization are currently booming in many hospitals. Despite advancements, plethora of challenges such as data interconnectivity, interoperability, and data sharing arises due to hospitals with their own hospital management information system form clusters of data. These can be solved by effectively employing blockchain platform. The authors in this work are proposing a novel consensus algorithm titled Proof of Authenticity over the distributed platform for all medical stakeholders. Unlike the previous approaches, wherein researchers were the miners, this work illustrates a methodology to implement blockchain for health care, where the hospitals and clinics are assumed the roles of both miners and validators. The peer-to-peer network is leveraged with a designed smart contract that follows the proof of authenticity mechanism. The medical stakeholders will access the medical data under security protocols and patient’s consent in a tamper-proof network. The proposed work aims for more patient centric and transparent health care.

The aim of this study was to develop a sustained release hydrophilic matrix tablet of Diltiazem HCl and evaluates the effect of formulation variables (e.g. lubricant, binder, polymer content and viscosity grades of HPMC) on drug release. Twelve different formulations (F1-F12) were prepared by direct compression. The results of the physical parameters and assay were found to be within the acceptable range. Rate of drug release was found to be slow as the fraction of the polymer was increased from 20-50%. The drug release rate from tablets containing K4M was effectively controlled by increasing the talc concentration, whereas the burst effect was reduced by increasing binder content. The drug release was higher with K4M as compare to K100M. Model-dependent and independent methods were used for data analysis and the best results were observed for K4M in Higuchi (R(2)=0.9903-0.9962) and K100M in Baker and Lonsdale (R(2)=0.9779-0.9941). The release mechanism of all formulations was non-Fickian. F7 (50% K4M, 2% talc, 10% Avicel PH101) and F11 (40% K100M) were very close to targeted release profile. F12 (50% K100M) exhibited highest degree of swelling and lowest erosion. The f1 and f2 test were performed taking F11 as a reference formulation.

Q-fever is a zoonotic disease caused by Coxiella burnetii that can create an acute or chronic form of the illness. In March 2014, Q-fever was identified by serology and Real-time Polymerase Chain Reaction (RT-PCR), in a 62 year-old male that was a Nepalese refugee. The male visited a livestock farm with a slaughterhouse in rural Central New York State, twenty-two days prior to onset of symptoms. He had direct handling of goats on this farm prior to slaughter. We describe the case presentation of his illness and the public health epidemiological investigation.