Is it time to replace propranolol with carvedilol for portal hypertension?

Beta-adrenergic receptor antagonists (beta-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective beta-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt assess whether carvedilol can be used instead of propranolol in patients with cirrhosis. Carvedilol is a promising agent among the beta blockers of recent time that has shown significant effects in portal hypertension hemodynamics. It has also demonstrated an effective profile in its clinical application specifically for the prevention of variceal bleeding. Carvedilol has more potent desired physiological effects when compared to Propranolol. However, it is uncertain at the present juncture whether the improvement in hemodynamics also translates into a decreased rate of disease progression and complications when compared to propranolol. Currently Carvedilol shows promise as a therapy for portal hypertension but more clinical trials need to be carried out before we can consider it as a superior option and a replacement for propranolol

Being Dissimilar: Religious Dissimilarity, Gender Dissimilarity, Value Dissimilarity and Job Satisfaction

The aim of this research is to study the impact of religious dissimilarity, and gender dissimilarity on job satisfaction. Religious dissimilarity and sexual dissimilarity definitely exaggerated supposed value dissimilarity, which in line, detained a pessimistic relationship with job satisfaction. These properties are capable, though, by a considerable religious difference, religious personal identity relations such that, for people whose religious values are a vital element of who they are, becoming religiously dissimilar in the place of work robustly impact their supposed value dissimilarity

On Combined Effects of Heat Transfer and Chemical Reaction for the Flow through an Asymmetric Channel with Orthogonally Deformable Porous Walls

The combined effects of heat transfer and chemical reaction are studied for the flow through a semi-infinite asymmetric channel with orthogonally deformable porous walls. The similarity transforms have been used to reduce the conservation laws to a corresponding system of nonlinear ordinary differential equations. The resulting equations are solved, both analytically and numerically, by using Homotopy Analysis Method (HAM) and the fourth-order Runge-Kutta (RK-4) method, respectively. The convergence of the analytical solution is assured through the so-called total squared residual error analysis. The optimal values of auxiliary parameters are obtained by minimizing the total squared residual error

Advances in the synthesis and application of anti-fouling membranes using two-dimensional nanomaterials

This article provides a comprehensive review of the recent progress in the application of advanced two-dimensional nanomaterials (2DNMs) in membranes fabrication and application for water purification. The membranes fouling, its types, and anti-fouling mechanisms of different 2DNMs containing membrane systems are also discussed. The developments in membrane synthesis and modification using 2DNMs, especially graphene and graphene family materials, carbon nanotubes (CNTs), MXenes, and others are critically reviewed. Further, the application potential of next-generation 2DNMs-based membranes in water/wastewater treatment systems is surveyed. Finally, the current problems and future opportunities of applying 2DNMs for anti-fouling membranes are also debated

Antihyperuricemic activity of gum of Calophyllum inophyllum ultra high dilutions in potassium oxonate induced wister albino rats

356-359  Hyperuricemia is a biochemical abnormality and it affects the quality of life. Many medicinal substances are used in lowering the uric acid. The study designed to find hypouricemic effects ofultrahigh dilutions, the gum of Calophyllum inophyllum, Acid benzoicum in oxonate of potassium induced hyperuricemic wistar albinomodel.   The experiment consist of 11 groups of albino rats. All the groups were treated with oxonate of potassium except normal control. Healthy group of animals received only distilled water, hyperuricemic control group were given alcohol mixed in distilled water. A standard allopathic medical substance Allopurinol and Acid benzoicum ultra high dilutions were given in time dependent manner (single dose/day) in different experimental groups. Blood samples were collected by rat tail vein bleeding. The uric acid and creatinine levels of serum were analyzed by using standard measuring kits. The Student's t-test was used for statistical analysis of difference between the groups p ≤ 0.05 was reflected significant.   Oral intake of Acid benzoicum ultrahigh dilutions reduceduric acid levels of hyperuricemic wistar albino rats in time dependent mode. At 3rd day and 7th day administration of Acid benzoicum ultrahigh dilutions decreased the level of uric acid more ominously as compared to one day administration. However, allopurinol a standard allopathic drug normalized the uric acid level in all experimental groups.   The current work showed significant hypouricemic effects of Acid benzoicum ultrahigh dilutions in hyperuricemic wistar albino model. However, clear conclusion of hypouricemic activity of Acid benzoicum needed repetition of experimental work

Critical Success Factors for Economic Development & Growth in Developing Countries: A Case Study of Pakistan

Multiple economic indicators and tools are intensively discussed in the academic literature. In the current piece of art, the factors like FDI, Gross Domestic Productivity (GDP), Human development, literacy rate, youth and unemployment have been primarily analyzed to define the current economic situation in the country. Specifically the indicator of ‘Foreign Direct Investment’ (FDI) has been focused to define the economic growth of Pakistan. For the research secondary source of data has been gathered for the time duration of last 5 years. Findings show that, factors such as FDI, GDP and Human development are of significant importance for the economic growth and development of Pakistan, while the factors like literacy rate, youth and unemployment are relatively less important. The paper is of great importance. This study can play a vital role in compelling the government authorities to focus their intention towards the economic and growth indicators of high importance. The study can also be an effectual case for other countries facing alike economic situation

Critical Success Factors for Economic Development & Growth in Developing Countries: A Case Study of Pakistan

Multiple economic indicators and tools are intensively discussed in the academic literature. In the current piece of art, the factors like FDI, Gross Domestic Productivity (GDP), Human development, literacy rate, youth and unemployment have been primarily analyzed to define the current economic situation in the country. Specifically the indicator of ‘Foreign Direct Investment’ (FDI) has been focused to define the economic growth of Pakistan. For the research secondary source of data has been gathered for the time duration of last 5 years. Findings show that, factors such as FDI, GDP and Human development are of significant importance for the economic growth and development of Pakistan, while the factors like literacy rate, youth and unemployment are relatively less important. The paper is of great importance. This study can play a vital role in compelling the government authorities to focus their intention towards the economic and growth indicators of high importance. The study can also be an effectual case for other countries facing alike economic situation

Papillary Renal Cell Carcinoma: Demographics, Survival Analysis, Racial Disparities, and Genomic Landscape

Papillary renal cell carcinoma (PRCC) is the second most common histological subtype of renal cell cancer. This research aims to present a large database study highlighting the demographic, clinical, and pathological factors, racial disparities, prognosis, and survival of PRCC. The clinical and demographic data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and molecular data was cured from the Catalogue Of Somatic Mutations in Cancer (COSMIC) database. PRCC had a median age of diagnosis at 64 years, with a higher incidence in men (77%), and Whites (68%). 70.3% of cases were Grades I–IV (13, 53, 31, and 3%, respectively). In patients with known data, 85% were localized to the kidney, and 84% of cases were 7 cm in size. No metastasis occurred in 97% of the known data. The most common treatment offered was surgical resection (9%). The 5-year overall survival was 79%, with patients undergoing surgery having a 90.6% 5-year survival. Multivariable analysis revealed age > 60 years, Black race, poor histologic differentiation, distant metastases, and tumor size > 10 cm as independent risk factors for mortality. The most common mutations identified from the COSMIC database were MET, KMT2D, KMT2C, ARID1A, and SPEN. PRCC affects male individuals in the sixth decade of life. Increased age, Black race, distant metastases, and tumors > 10 cm are associated with a worse prognosis. Surgical resection offers a favorable survival outcome. Next-generation sequencing (NGS) could identify potentially targetable alterations and future personalized therapeutic approaches

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0–74 years) from scores for select age groups: the young (ages 0–14 years), working (ages 15–64 years), and post-working (ages 65–74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9–21·3), as well as among the young (22·5, 19·9–24·7), working (17·2, 15·2–19·1), and post-working (15·1, 13·2–17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6–33·0) on average in low-SDI countries to 83·4 (82·4–84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4–89·0), working (33·8–82·8), and post-working (30·4–79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. Funding: Bill & Melinda Gates Foundation