BackgroundTo evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.MethodsPatients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.ResultsOut of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term (beyond one year). Compliance with CPAP therapy was associated with higher body mass index, higher Epworth sleepiness scale score, history of witnessed apnea, and reduction in daytime sleepiness with CPAP therapy. OSA severity as assessed by apnea-hypopnea index did not affect compliance with CPAP therapy. Use of anti-depressants and CPAP induced sleep disturbances were associated with poor compliance with CPAP therapy.ConclusionsObesity, excessive daytime sleepiness, witnessed apnea and improvement of daytime symptoms following use of CPAP were predictors of improved compliance. Use of antidepressants and CPAP induced sleep disturbances were predictors of poor compliance.

Floods have become more severe and frequent as a result of climate change around the world, posing a hazard to public safety and economic development. This study investigates the use of distributed hydrological models in flash flood risk management in a small watershed in Hazara, Pakistan, with the goal of improving Pakistan's early warning lead time. First, the HEC-HMS model was built using geographic data and the river network's structure, then calibrated and verified using eight high rainfall events from 2013. demonstrating that the HEC-HMS model could simulate floods in the research area Second, given that rainfall and flood events have happened, this paper proposes an analysis approach for a flood forecasting and warning system, as well as criteria for sending urban-stream flash flood alerts based on rainfall, in order to provide sufficient lead time. The DEMs (digital elevation models) of the research regions were processed using HEC-Geo HMS, an ArcView GIS tool for catchment delineation, terrain pre-processing, and basin processing. The model was calibrated and verified using previously observed data. The proposed flood prediction and risk reduction methodology is nonstructural. The Hydrologic Modeling System (HEC-HMS), which provides a sufficient lead time forecast and computes the runoff/stage threshold conditions, is at the heart of the flood warning application. For flood risk assessment, data from the Pakistan Meteorological Department (PMD) is entered into a hydro-meteorological database and then into the HEC-HMS. A server-client application was utilised to visualise the real-time flood scenario and send out an early warning message. The outcomes of this study will be used to develop flood validation measures in the Hazara stream watershed to deal with potential flash floods.

No abstract

Pancreatic carcinoma is one of the most common and deadly cancer in the world. It typically presents with abdominal pain, vomiting and weight loss. In this case report we reported a case who presented with respiratory symptoms of cough, fever and decrease oral intake without any typical abdominal sign and symptoms. Later on her workup revealed that she had advanced/metastatic pancreatic carcinoma. Keywords: Pancreatic Carcinoma, Continuous....

All that wheezes is not asthma this adage accredited to Chevalier Jackson emphasizes the importance of differentiating asthma from its mimics, particularly if the patient is not responding to usual therapy. The above statement also warrants further diagnostic evaluation and management of non-asthma conditions that mimic asthma. We present here a case of a middle aged female who presented with severe bronchospasm, initially labeled as asthma but was resistant to usual anti-asthma therapy. After further workup she was eventually diagnosed to have esophageal achalasia

No abstract