Impacts of economic crises and reform on the informal textile industry in Karachi

"To date, no empirical research has examined the local impacts of economic crises and reform on cities in Pakistan, including Karachi. This study addresses this gap by examining how the textile industry – as one of Pakistan’s most productive economic sectors – has been impacted, with a focus on the informal power loom sub-sector. The factors that have contributed to the decline of the textile industry and the repercussions for this sub-sector, including one of the settlements in which it operates, are discussed. The conclusions contemplate the challenges of formulating urban policy responses to an economic problem that is shaped simultaneously by local, regional and global pressures.

Bi li COVID-19 mogla biti hemoglobinopatija?

The world is struggling to deal with the corona pandemic. Effective therapies are still awaited due to the lack of understanding of the pathophysiological mechanism of the disease. Bearing recent research and clinical observations in mind, the authors propose a novel physiological mechanism of COVID-19 and explain development of COVID-19 related acute respiratory distress syndrome (ARDS) secondary to COVID-19 related hemoglobinopathy. It is a consistent observation that the radiological picture of COVID-19 related ARDS bears more resemblance to high altitude pulmonary edema (HAPE) than typical ARDS. There has been great controversy regarding this proposed similarity. The main argument from those objecting to this comparison is that the etiology is hypoxia in case of HAPE and inflammation in COVID-19 related ARDS. We propose that considering the recent bioinformatics prediction models, COVID-19 might first infect red blood cells via CD147 and cause hemoglobin damage. The resulting hypoxemia may cause pulmonary hypoxic vasoconstriction leading to HAPE-like lung lesions. The now introduced alveolar hypoxia further exaggerates hemoglobinopathy hypoxemia leading to a vicious cycle. In this review, the authors recommend laboratory experiments to prove these hypotheses. The proposed physiological mechanism has significant therapeutic implications. If proven, the authors suggest the use of exchange transfusion as adjunct therapy and development of anti-CD147 drugs.Cijeli svijet se bori kako bi svladao pandemiju koronavirusa. Patofiziološki mehanizam ove bolesti i dalje je nepoznat, što znači da se učinkoviti lijekovi tek očekuju. Vodeći računa o novijim istraživanjima i kliničkim zapažanjima, autori predlažu novi fiziološki mehanizam bolesti COVID-19 i objašnjavaju razvoj sindroma akutnog respiracijskog distresa (ARDS) nakon hemoglobinopatije povezane s COVID-19. Dosljedno se bilježi da radiološka slika hemoglobinopatije povezane s COVID-19 ima više sličnosti s visinskim plućnim edemom (HAPE) negoli s tipičnim ARDS. Ova sličnost izaziva velika proturječja. Glavni argument onih koji se protive ovoj usporedbi jest da je etiologija kod HAPE hipoksija, a kod ARDS povezanog s COVID-19 je to upala. Mi pretpostavljamo da bi, uzimajući u obzir novije bioinformatičke modele predviđanja, COVID-19 mogao najprije zaraziti eritrocite putem CD147 i uzrokovati oštećenje hemoglobina. Tako nastala hipoksemija može uzrokovati plućnu hipoksičnu vazokonstrikciju, što onda dovodi do oštećenja pluća sličnih HAPE. Tako uvedena alveolarna hipoksija dalje pogoršava hipoksemiju hemoglobinopatije i stvara se začarani krug. U ovom pregledu autori preporučuju laboratorijske eksperimente kako bi se dokazale ove hipoteze. Predloženi fiziološki mehanizam ima značajne terapijske implikacije. Ako se dokaže, autori predlažu primjenu izmjenske transfuzije kao dopunske terapije i razvoj lijekova protiv CD147

Impacts of economic crises and reform on the informal textile industry in Karachi

"To date, no empirical research has examined the local impacts of economic crises and reform on cities in Pakistan, including Karachi. This study addresses this gap by examining how the textile industry – as one of Pakistan’s most productive economic sectors – has been impacted, with a focus on the informal power loom sub-sector. The factors that have contributed to the decline of the textile industry and the repercussions for this sub-sector, including one of the settlements in which it operates, are discussed. The conclusions contemplate the challenges of formulating urban policy responses to an economic problem that is shaped simultaneously by local, regional and global pressures.

A Potential Approach to Enhance the Seebeck Coefficient of UHMWPE by Using the Graphene Oxide

Thermoelectric materials have been a competent source for the production of energy in the present decade. The most important and potential parameter required for the material to have better thermoelectric characteristics is the Seebeck coefficient. In this work, ultra high molecular weight polyethylene (UHMWPE) and graphene oxide (GO) nanocomposites were prepared by mechanical mixing by containing 10000ppm, 50000ppm, 70000ppm, 100000ppm, 150000ppm, and 200000ppm loadings of graphene oxide. Due to the intrinsic insulating nature of UHMWPE, the value of Seebeck for pristine UHMWPE and its nanocomposites with 10000ppm & 50000ppm of GO concentration was too low to be detected. However, the Seebeck coefficient for composites with 70000ppm, 100000ppm, 150000ppm, and 200000ppm loadings of GO was found to be 180, 206, 230, and 235 µV/ K, respectively. These higher values of Seebeck coefficients were attributed to the superior thermal insulating nature of UHMWPE and the conductive network induced by the GO within the UHMWPE insulating matrix. Although, the values of the figure of merit and power factor were negligibly small due to the lower concentration of charge carriers in UHMWPE/ GO nanocomposites but still reported, results are extremely hopeful for considering the composite as the potential candidate for thermoelectric applications

General practitioner\u27s knowledge regarding the diagnosis and drug therapy for acute myocardial infarction

OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of \u3c 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice

Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients.</p> <p>Methods</p> <p>This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan.</p> <p>Results</p> <p>We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001).</p> <p>Conclusion</p> <p>We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.</p

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients