Areca nut chewing and the risk of re-hospitalization and mortality among patients with acute coronary syndrome in Pakistan

Objectives: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events

Diagnosing Carpal Tunnel Syndrome by Ultrasound

Background Carpal tunnel syndrome (CTS) istraditionally diagnosed by clinical evaluation and nerveconduction studies (NCS). Ultrasound is now widely usedin the diagnosis of musculoskeletal disorders. Theobjective of this study was to compare the sonographicmeasurements of median nerve in patients of CTS withNCS results, taking NCS as gold standard and to evaluatethe diagnostic role of ultrasound so that it could be used inthe diagnosis of CTS.Methods: This cross sectional Analytical study wascarried out at Department of Radiology, CombinedMilitary Hospital Lahore over a period of one year from21st August 2006 to 20th August 2007. One hundred andtwenty wrists in sixty CTS patients were imaged by highresolution ultrasound. The cross sectional area of themedian nerve was measured at the level of pisiform bone.All patients had nerve conduction studies. The ultrasoundmeasurements of the median nerve cross sectional area andthe results of nerve conduction studies were compared andanalyzed.Results: The mean cross sectional area of the mediannerve at the level of pisifom was 13mm2 in CTS patients.When NCS results were taken as gold standard, theultrasound yielded a sensitivity of 94.7%, specificity of63.6% and diagnostic accuracy of 87.8%.Conclusion: High resolution ultrasound is quiteaccurate and it can be used reliably and cost effectively inthe diagnosis of CTS especially for screening of largepopulation of CTS patients

Study of strange quark density fluctuations in Au+Au Collisions at sNN\sqrt{s_{NN}} = 7.7-200 GeV from AMPT Model

The strangeness production is an important observable to study the QCD phase diagram. The yield ratios of strange quark can be helpful to search for the QCD critical point and/or first order phase transition. In this work, we studied the production of $K^{\pm}$, $\Xi^-(\bar{\Xi}^{+})$, $\phi$ and $\Lambda (\bar \Lambda)$ in Au+Au collisions at $\sqrt{s_{NN}}$ = 7.7, 11.5, 14.5, 19.6, 27, 39, 54.4, 62.4 and 200 GeV from A Multi-Phase Transport model with string melting version (AMPT-SM). We calculated the invariant yield of these strange hadrons using a different set of parameters reported in earlier studies and also by varying the hadronic cascade time ($t_{max}$) in the AMPT-SM model. We also calculated the yield ratios, $\mathcal{O}_{K^{\pm}-\Xi^{-}(\bar \Xi^{+})-\phi-\Lambda (\bar \Lambda)}$ which are sensitive to the strange quark density fluctuations and found that the AMPT-SM model fails to describe the non-monotonic trend observed by the STAR experiment. The negative particle ratio are found to be higher than the ratio of positive particles which is consistent with the experimental data. A significant effect is also seen on these ratios by varying the $t_{max}$. This study based on the transport model can be helpful to provide possible constraints as well as reference for the search of CEP in future heavy-ion experiments. Our findings suggest that the ongoing Beam Energy Scan program at RHIC and the future heavy-ion experiments will be able to find/locate the possible CEP in the QCD phase diagram which results large quark density fluctuations.Comment: 7 pages, 2 figure

ANALYSIS OF DIFFERENT RISK FACTORS OF SURGICAL SITE INFECTION IN OBSTETRICS FEMALES IN PAKISTAN

Introduction: Infection is one of the most common causes of maternal mortality and morbidity in obstetrics. Surgical site infections (SSIs) are infections that occur at or near surgical incision within 30 days of operation or after 1 year if an implant is placed. Objectives of the study: The main objective of the study is to analysis of associated risk factors of surgical infection in obstetrics among females in Pakistan. Methodology of the study: The current study was conducted in the surgical department of Nishtar Hospital, Multan for a period of 9 months during March 2018 to December 2018. The information incorporates every one of those ladies who conveyed child through C-segment or by ordinary conveyance. Office based review observational study configuration was completed purposively to evaluate the prevalence of surgical site infections and related hazard factors among moms who had conveyance related medical procedure at obstetric ward of healing facility from the determined example estimate. Results: The socio-statistic estimations of the patients showed that these are reliant variables and SSI is likewise relying on these qualities. Socio statistic variable had no noteworthy relationship with SSIs aside from age, those ladies age under nineteen years were multiple times danger of creating surgical site infection as contrast with those ages run 20– 34. Conclusion: It is concluded that surgical site infection rate become high among young age women as compared to old age women. Duration of surgery and wound healing are not a dependent factor these are independent factors because it is not related to SSI. Key words: SSI, Infection, Pregnant, Women

Increasing Employee Organizational Commitment by Correlating Goal Setting, Employee Engagement and Optimism at Workplace

The aim of this study is to explore the link among important factors with effect organizational commitment. Secondly this study focuses to make a positive significant relation in setting of goals, engagement of employee and optimistic approach of behavior at work place environment in order to enhance organizational commitment level of employee. The data for that hypothesized model will be collected form individual belongs to from different organizations and research institutions. The results of this study will contribute new improved ways to achieve maximum level of organizational commitment from employees. This study will provide new insight for the field of performance management. Key words: Organizational commitment, Employee engagement, Work place optimism, Enhancing performance, Goal Settin

Corporate Governance and Corporate Financing Decisions Impact on Firm Performance a Cement Industry Perspective of Pakistan

This paper empirically examines the impact of corporate governance and corporate financing decisions on the performance of cement industry of Pakistan. Multiple regression analysis is used in estimating the impact of corporate governance and corporate financing decisions on firm performance measures such as return on assets (ROA), return on equity (ROE), earning per share (EPS) and net profit margin (NPM) by using sample of 19 cement industry listed in Karachi Stock Exchange (KSE) for the  period 2006-2016 and E-views technique used to apply the correlation and regression analysis. The data are collected from annual reports of cement industry of Pakistan. The results of this study indicate that firm with larger board size (BS) and managerial ownership (MO) leads higher return on assets (ROA). CEO duality (CD), firm size (FS), short term debt ratio (STDR) and debt equity ratio (DER) negatively influence the return on equity (ROE). Larger firm size, long term debt (LTD), dividend policy (DP) positively influence the earning per share (EPS) and net profit margin (NPM). In short these results indicate that corporate governance and corporate financing decision impact the performance of cement industry of Pakistan.The result of this study may be helpful for investors, financial management consultants, financial managers and overall management of the company to understand the effect of board size, CEO duality, managerial ownership, board meeting, firm size, capital structure, debt maturity structure and dividend policy on the performance of firms. This study add value to the literature by exploring the impact of corporate governance and corporate financing decisions and on the factors that have impact on firm performance

Oxidative stress and male infertility: A cross sectional study

Objective: To compare stress markers and antioxidants in fertile and infertile males, and to explore their effects on reproductive hormones and fertility.Methods: The cross-sectional case-control study was conducted from July 2017 to July 2018 at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, and comprised male subjects aged 25-55 years. Infertile subjects were the cases, while healthy fertile males acted as the controls. Stress hormones cortisol and adrenaline and antioxidants glutathione peroxidase and superoxide dismutase were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22.Results: Of the 376 subjects, 241(64%) were cases and 135(36%) were controls. Median cortisol, adrenaline, superoxide dismutase and glutathione levels were significantly higher among the cases compared to te controls (p\u3c0.05). Follicle stimulating hormone and luteinizing hormone levels were higher in cases compared to the controls (p=0.05). Mean testosterone level was higher among the controls than the cases (p\u3c0.001). After adjusting for other covariates, every increase of 7 units in cortisol increased the prevalence of infertility by 3% (p=0.001). There was significant interaction between luteinizing hormone and testosterone in the final model (p\u3c0.05).Conclusion: Stress together with decrease in antioxidants was found to play a significant role in reducing the fertilising potential of male infertile subjects

Future Time Perspective and Frustration Intolerance in Medical students

Background: The future perception of students is affected by a series of events happening throughout their course of studies. The objective of this study is to measure the Future time perspective (FTP) and Future intolerance (FI) among medical students during the COVID-19 lockdown.Materials and Methods: It was a descriptive cross-sectional study done from January 15, 2020 to July 20, 2020 among MBBS students of Rawalpindi Medical University. The questionnaire consisted of 1) Socio-demographic details, 2) Future Time Perspective scale, and 3) Frustration Discomfort scale. An online survey was done using Google Forms. An ANOVA was run to check for differences in FTP and FI between the classes. Bivariate analysis for continuous variables was applied. The data were analysed using the Statistical Package for Social Sciences (SPSS) v.23.0 (IBM, Armonk, US). Results: Mean age of participants was 21.8 (SD=1.66) with majority females 331(58.4%). The mean FTP score and mean FI scores were 50.8(SD=19.43) and 91.46(SD=17.65) respectively. Final-year students had the highest mean score (Mean=57.94(SD=7.72)) for FI. On the other hand, mean scores for FDS were highest in first-year students (Mean=102.89 (SD=13.52)) while lowest in fourth-year students (Mean=81.73(SD=17.49)) with P=.005. There was a significant difference in the dimensions of Emotional Intolerance and achievement among females and males. Bivariate analysis showed a significant negative correlation was found between FTP and the dimension of discomfort intolerance (r = -0.158, p < 0.001), while a significant positive correlation was found between FTP and the dimension of achievement (r = 0.225, p < 0.001). Conclusion: Our study concludes that final-year students have a much higher tolerance level for adversities. Furthermore, they also have a much more positive perspective and a clearer vision regarding their future