FREQUENCY AND PREDICTORS OF COPD AND RESTRICTIVE LUNG DISEASE IN PRIMARY CARE

ABSTRACT Background: To determine the frequency and risk factors of COPD and Restrictive Lung Diseases in a Primary Care Center in Karachi. Methods: All patients coming to Primary Health Care Center presenting with cough were enrolled in the study. They were seen by Consultant Family Physician who filled the questionnaires after informed consent. Chest was examined and the patients underwent PEF. If PEF was <70% then office based spirometry test was done. Those who did not achieve reversibility in FEV1 after bronchodilation were labeled COPDers. Data was analyzed using SPSS 20. Mean and standard deviation were taken out for numerical data. Categorical data was shown in frequency and percentage. Chi-square was taken out to see association of risk factors with the outcome. P-value <0.05 was considered significant. Results: In our study, 54 (35.7%) participants had obstructive lung pathology. Prevalence of COPD came out to be 6.62% whereas7 subjects (4.7%) had restrictive lung disease. COPD was seen more in females as compared to males (84.6% vs 15.4% p-value<0.00). Also smoking had statistically significant association with COPD (42.5% p-value <0.00). All those who had COPD, smoked more than 11 years. Manifestation of the disease with cough (63.3%) and wheeze (33.9%)came out to be statistically significant .Past history of exacerbation of restrictive lung disease(1.3%, p-value 0.054) and MRC dyspnea score of stage 2 (25%, p-value 0.001) revealed statistically significant association with restrictive pathology. Conclusion: The prevalence of COPD and restrictive lung diseases are soaring at an alarming rate owing to smoking and industrial pollution. It’s important to give smoking cessation advice to patients in primary care. A multidisciplinary approach with close cooperation of primary care physician, pulmonologist and cardiologist is imperative to put a halt to these ailments and thus reduce morbidity and mortality. Keywords: COPD, Bronchodilation, Spirometry, Restrictive Lung Disease, MRC, Dyspnea score

Perovskite LaNiO3/Ag3PO4 heterojunction photocatalyst for the degradation of dyes

Pristine lanthanum nickelate (LaNiO3), silver phosphate (Ag3PO4) and perovskite lanthanum nickelate silver phosphate composites (LaNiO3/Ag3PO4) were prepared using the facile hydrothermal method. Three composites were synthesized by varying the percentage of LaNiO3 in Ag3PO4. The physical properties of as-prepared samples were studied by powder X-ray diffraction (pXRD), Fourier-transform infrared (FT-IR), Scanning electron microscopy (SEM) and Energy-dispersive X-ray (EDX). Among all synthesized photocatalysts, 5%LaNiO3/Ag3PO4 composite has been proved to be an excellent visible light photocatalyst for the degradation of dyes i.e., rhodamine B (RhB) and methyl orange (MO). The photocatalytic activity and stability of Ag3PO4 were also enhanced by introducing LaNiO3 in Ag3PO4 heterojunction formation. Complete photodegradation of 50 mg/L of RhB and MO solutions using 25 mg of 5%LaNiO3/Ag3PO4 photocatalyst was observed in just 20 min. Photodegradation of RhB and MO using 5%LaNiO3/Ag3PO4 catalyst follows first-order kinetics with rate constants of 0.213 and 0.1804 min−1, respectively. Perovskite LaNiO3/Ag3PO4 photocatalyst showed the highest stability up to five cycles. The photodegradation mechanism suggests that the holes (h+) and superoxide anion radicals O2 •− plays a main role in the dye degradation of RhB and MO

The role of endophytes and rhizobacteria to combat drought stress in wheat

Wheat production suffers greatly from drought stress, resulting in yield losses. Endophytes and rhizobacteria have been recognized as a valuable source in mitigating of drought stress by improving plant resistance and growth. In this review, we discuss how endophytes and rhizobacteria help wheat cope with drought stress. During drought stress, endophytes have been found to increase plant water usage efficiency and decrease water loss. Endophytes are harmless microorganisms that live inside plant tissues. Rhizobacteria establish colonies in the root system through various procedures, including phytohormones production, modification of root architecture, and activation of stress-inducible genes, thereby promoting plant growth and enhancing stress resistance. Numerous studies have shown how endophytes and rhizobacteria can improve the potential of wheat to withstand drought. For instance, inoculation with endophytes like Piriformospora indica and Bacillus spp. has been proven to enhance wheat plant yield and drought resistance. Similarly, it has been proven that rhizobacteria like Pseudomonas spp. and Azospirillum brasilense enhance drought tolerance through a variety of mechanisms. To minimize the consequence of wheat under drought conditions, the efficient method is the use of endophytes and rhizobacteria as biofertilizers, which could ultimately boost yields and sustainability. More research needs to be done so that it can be used most effectively in the field and so that we can better understand how they work. We explained current understanding of the role and mechanisms of endophytes and rhizobacteria in minimizing drought stress effects in wheat. Additionally, we highlighted areas of limited knowledge and suggested directions for future research. This review will provide the new suggestion on the role of endophytes and rhizobacteria in mitigating the drought stress in plants

Determination of Renal Changes by Ultrasonography in Patients with Type-2 Diabetes Mellitus

Background: Diabetes Type 2 causes damage to the kidneys; leading to diabetic nephropathy and high blood pressure. The aim of this study is determination of renal changes on ultrasonography in diabetic patients. Objective: This study evaluates changes in kidneys in patients presenting with type II diabetes mellitus having normal renal function test as compared to non-diabetics. Methods: It was a cross sectional descriptive study conducted on 116 patients with type 2 diabetes mellitus by using convenient sampling technique. The study was conducted at Ultrasound Department of Gulab Devi hospital Hospital from July 2019 to September 2019. Results: Out of 116 patients there were 43(37.1%) female and 73(62.1%) were male. The mean age of the participants was 53.24 ±10.49. This study shows that the mean volume of Rt kidney was 1.229E2 ±38.39 ranging from 25ml to 218ml and mean volume of Lt kidney was 1.1691E2 ±41.96 ranging from 26ml to 231ml in patients presenting with DM Type 2 and mean parenchymal thickness of the Rt kidney 14.40 ±6 range from 0.86mm to 1.25mm and Lt kidney 13.7 ±5 range from1.2mm to 25mm.This study showed that mean volume of both kidneys and  parenchymal thickness increased in patients having diabetes mellitus. Conclusion: Ultrasound is a reliable and easily available modality to detect renal changes and complications in earlier stages of Diabetes mellitus. Keywords: Type II diabetes mellitus, Renal changes, Ultrasonography DOI: 10.7176/JHMN/68-07 Publication date: November 30th 201

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Reality versus Expectations: A Survey of University of the Punjab\u27s Libraries Using SERVQUAL

The purpose of this study was to determine the user\u27s priority expectations and their perceptions of quality services of university libraries. Survey method was used to assess user\u27s perceptions and expectations. A revised version of SERVQUAL was used to determine user\u27s perceived and expected service levels along seven point Likert scale. A sample of 390 respondents was chosen and selected using stratified random sampling through proportional allocation. The collected data was analyzed using SPSS. The results of the study revealed that respondent\u27s priority expectations are related to knowledgeable and competent staff, library staff’s ability to develop confidence in their users, convenient library timings, attractive physical appearance of library building and materials. On the other hand, respondents perceived only libraries\u27 opening and closing timings high. This study is particularly significant for librarians and university administrators to assess user\u27s perceptions and expectations of quality library services. They can improve library services according to user\u27s expectations and review their service policies