Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques

Objective: Our goal is to share our two decades of experience with implantable electrical device explanation at our electrophysiology centre at Hayat Abad Medical Complex in Peshawar. Methodology: After baseline patient were brought nil by mouth to catheterization laboratory (Cath: lab). A temporary pacemaker (TPM) implanted for backup.  In case of box change, a new device is attached after checking the integrity of the lead and device placed in the same pocket. But if of lead extraction was also needed, then stylet was put inside the lead and with twisting movement and mild traction the lead removed and new lead implanted with Seldinger,s technique, battery attached and wound closed in layers. Results:  Out of 1670, there were 1535 (91.9%) new implantations and 135 (8.08%) repeat procedures. The pulse generator was replaced without lead replacement in 59 (3.5%) patients. In 36 (2.15%) patients, the ventricular lead or atrial lead was successfully reposition. A total of 32 (1.9%) successful explanations were performed in the study period. Conclusion: The explanation of devices like implantation needs special gadgets and training for the safe and successful procedure

Synthesis of novel cyanoacetamides derivatives and their urease inhibition studies

The present study reports a convenient approach for the synthesis of cyanoacetamide based derivatives (7-27) via two-step process involving Knoevenagel reaction, followed by three component reaction to avail desired compounds. All the synthesized compounds were obtained in good to excellent yield and extensively characterized employing 1H NMR, 13C NMR, mass spectrometry and physical parameters. Further, these compounds were screened for urease inhibition. All of the synthesized compounds exhibited good to excellent urease activity notably compound 15 and 19 showed excellent urease inhibition activity with IC50 value ~17.34 μg/mL and 36.75 μg/mL in comparison to thiourea (used as standard) having IC50 value ~27.5 μg/mL

Optimal sizing and technical assessment of a hybrid renewable energy solution for off-grid community center power

Decentralized energy generation systems based on renewable sources have significant potential to assist in the sustainable development of developing countries. The small-scale integration of hybrid renewable energy systems in off-grid communities has not been thoroughly researched. The primary objective is to develop a preliminary design for a PV/biogas hybrid system that can meet the energy needs of an off-grid community center. A survey was conducted to calculate the energy demands of an off-grid community center and a hybrid renewable system has been designed to supply the electricity. The optimum designed system is evaluated by the PVSYST simulation software and SuperPro Designer software. The annual production of the PV system is 34428 kWh/year, specific production is 1118 kWh/kWp/year, and the performance ratio is 81.72%. All the factors that contribute to energy loss are considered in designing a PV system. The average operating efficiency of the inverter is 92.6%, and global inverter losses are 2752.4 kWh. The biogas simulation findings show an adequate match with the composition of conventional biogas and contains 89.64% methane and 5.99% carbon dioxide content. Two sensitivity analyses of biogas based on hydraulic retention time and moisture content have been performed. Measurements readings of hourly data are used to analyse the performance of PV, biogas system as well as the hybrid system performance. At day time, the maximum power generation of the hybrid PV/Biogas and the maximum load demand of the community at that time are 25.2 kW and 24.31 kW, respectively. At night time, the maximum power generation of the hybrid system and the maximum load demand are 9 kW and 8.3 kW, respectively. The power factor (PF) of the system fluctuates between 0.92 and 0.98 and the frequency of the system is constant at 50 HZ

A nationwide virtual research education program for medical students in Pakistan: Methodological framework, feasibility testing, and outcomes

Introduction: Equipping young medical trainees with fundamental research skills can be a promising strategy to address the need for professionals who can understand and responsibly communicate evolving scientific evidence during a pandemic. Despite an ardent interest to partake in research, most educational institutions in Pakistan and other low-middle income countries have not yet adopted a comprehensive strategy for research skills education. The authors aimed to design and assess the feasibility of implementing the first nation-wide virtual research workshop for medical students in Pakistan. Methods: The course Beginners Guide to Research, designed as a nation-wide virtual research workshop series, was conducted for medical students across Pakistan in June 2020. Four interactive live workshops took place online on alternate days from June 22nd, 2020, to June 27th, 2020, each lasting 1-2 h. Outcomes included: (i) reach, (ii) efficacy as indexed by pre-post change in score pertaining to knowledge and application of research and (iii) self-rated perceptions about understanding of research on a Likert scale. Results: 3,862 participants enrolled from 41 cities and 123 institutions. Enrolled participants belonged to the following provinces: Sindh (n = 1,852, 48.0%), Punjab (n = 1,767, 45.8%), Khyber Pakhtunkhwa (n = 109, 2.8%), Azad Jammu and Kashmir (n = 84, 2.2%) Balochistan (n = 42, 1.1%). We also saw a few registrations from international students (n = 8, 0.2%). Mean (SD) age of enrolled medical students was 21.1 (2.1) years, 2,453 (63.5%) participants were female and 2,394 (62.0%) were from private-sector medical colleges. Two thousand ninety-three participants participants filled out all four pre-test and post-test forms. The total median knowledge score improved from 39.7 to 60.3% with the highest improvements in concepts of research bioethics and literature search (p \u3c 0.001) with greater change for females compared to males (+20.6 vs. +16.2%, p \u3c 0.001) and private institutions compared to public ones (+16.2 vs. +22.1%, p \u3c 0.001). Conclusion: The overwhelming enrollment and significant improvement in learning outcomes (\u3e50% of baseline) indicate feasibility of a medical student-led research course during a pandemic, highlighting its role in catering to the research needs in the LMICs

Role of Personal Networks in the Growth of Entrepreneurship Ventures of Ethnic Minority Female Entrepreneurs

The main objective of the paper is to explore and explain the differences/similarities in personal networks of, and their use by, immigrant and British born Pakistani female entrepreneurs for business growth.A broad range of studies has explored the social context of ethnic minority and immigrant entrepreneurship by assuming all minority entrepreneurs as a cohesive group without taking into account intergroup (geographical categorisation) and intra-group (generational) differences. These differences are explained by socio-economic and cultural factors such as family background and support, ethnicity, religion, education, and more importantly personal network (Metcalf et. al., 1996; Basu, 1998). The blend of culture and religion depicted in entrepreneurial practices of Pakistani entrepreneurs is an interesting but under-researched area. Our particular interest is to explore the scope, depth, variations and limitations of the personal networks of Pakistani female entrepreneurs in their effort to grow their business

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

The role of personal networks in the growth aspirations of ethnic minority female entrepreneurs : the contrasting and comparable experiences of first and second generation female entrepreneurs of Pakistani origin in the UK

This comparative study explores the personal networks-of immigrant and British born Pakistani female entrepreneurs in relation to their growth aspirations, in a pluralistic context of London. Stereotypically, assumptions about low growth orientations characterize ethnic minority female entrepreneurs who are presented as being 'doubly-disadvantaged' because of their association with a minority group and gender. These views overlook the diversity within ethnic groups resulting in a failure to comprehend their varied and unique experiences. This study addresses the hitherto ignored inter-group (geographical categorisation) and intra-group (generational) differences between ethnic minority entrepreneurs. It proposes an embedded view of the entrepreneur where her personal network and growth orientations are socially constructed. Growth is a personal choice that emerges through meanings attached to the diverse social relationships. These meanings are explored through a qualitative research design, in-depth interviews were carried out to generate data and the results around pertinent themes were produced using grounded theory methods. Results shows that growth is the 'preference' of ethnic minority entrepreneurs where their personal networks are a product of an ongoing socio-spatial dialectic. Both immigrants and British born female entrepreneurs use. normative frameworks in constructing their personal networks where the former emphasize ethnicity while the latter anchors around religion. The fluid ethnic and pervasive religious boundaries shape their personal networks over time. Growth is not the default outcome of a special type of network rather it mainly depends on the choices made by Pakistani female entrepreneurs. These choices arise from a variety of intentional and unintended processes where mistrust plays a key role in the introduction of weak ties and expansion of networks. It offers new insights into ethnic minority entrepreneurship by explaining the subjective manifestations of the growth aspirations and their two way relationship with personal networks.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Comparison of Oral and Vaginal Route of Misoprostol for Induction of Labour at Term

Background: To compare the Induction – Deliveryinterval between Oral and Vaginal route of Misoprostol atterm.Methods: In this comparative study , one hundredwomen at term with indications for induction of labourand Bishop score < 5, having no other obstetric andmaternal contraindications for induction of labour wererandomly assigned to receive Misoprostol 50 g orally and50 g vaginally every 6 hours for 24 hours for a total offour doses. Repeated doses were given until Bishop score> 8 was achieved or spontaneous rupture of membranesoccurred. Student’s t test was applied to compareinduction delivery interval between oral and vaginalgroups and statistical significance was assigned to P- value< 0.05.Results: The median induction to delivery interval timewas significantly shorter with vaginal Misoprostol (11.0 h),compared with oral Misoprostol (14.1 h, p= 0.036). Therewas no difference between two routes of administrationwith respect to rates of hyperstimulation or neonatalasphyxia.Conclusions: Compared with oral Misoprostol,vaginal Misoprostol for induction of labour at term resultsin a shorter induction to delivery interval time. There weremore caesarean section in the vaginal Misoprostol group