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

Souhra v tvorbě inovací založených na principech cirkulární ekonomiky, inovací obchodních modelů, cílech udržitelného rozvoje a vládními pobídkami: Srovnávací analýza pákistánských, malajských a čínských malých a středních podniků

This study aims to examine the effects of circular economy innovation and BMI (business model innovation) on SMEs (Small and Medium Enterprises) economic, environmental, and social performance along with the mediating role of government incentives in Pakistan, Malaysia, and China. Data were collected through a structured questionnaire in online survey from the owners, CEO, and senior managers of SMEs in Pakistan, Malaysia, and China, and analyzed using PLS-SEM. The results revealed that circular economy innovation and BMI have positive significant effects on SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. The study also found that government incentives have mediating effects on the relationship between circular economy innovation, BMI, and SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. This study provides interesting insights about SMEs economic, environmental, and social performance by evaluating the impacts of circular economy innovation, BMI, and amid mediation of government incentives. These useful insights will enable policy makers and practitioners to develop more effective strategies to enhance the economic, environmental, and social performance of SMEs. By reviewing the literature on circular economy innovation, BMI, and government incentives, the main contribution of this study is the evaluation and analysis of circular economy innovation, BMI, and government incentives as they affect SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. The theoretical and practical implications for academics and practitioners are displayed at the end of the study.Tato studie si klade za cíl prozkoumat dopady inovací založených na principech cirkulární ekonomiky a BMI (inovace obchodního modelu) na ekonomickou, environmentální a sociální výkonnost malých a středních podniků (malé a střední podniky) spolu se zprostředkovatelskou úlohou vládních pobídek v Pákistánu, Malajsii a Číně

Linkages between Trade, CO2 Emissions and Healthcare Spending in China

China has remained top among the carbon dioxide (CO2) emitting countries in the world, while it has a significant contribution to world trade after World Trade Organization (WTO) reforms in China. The dramatic increase in CO2 emissions has been witnessed. This study examines the linkages between trade openness, CO2 emissions, and healthcare expenditures in China using time series data for the period 1990&ndash;2017. The study extended a theoretical model by adding healthcare expenditures, CO2 emissions, and trade openness with some constraints. We used simultaneous equation method for the analysis, and the outcomes suggest that trade is significantly affecting the CO2 emissions in the country, resulting in an increase of healthcare expenditures. The government needs reforms and trade policy embodied green energy consumption in the industrial sector, especially in export sector industries. In addition, carbon tax may be an important tool to reduce CO2 emissions and it may compensate the healthcare spending in the country

Livestock Depredation by Large Carnivores and Human–Wildlife Conflict in Two Districts of Balochistan Province, Pakistan

Livestock herding is a vital practice in Balochistan, contributing to the economy and culture. The livestock sector is significant in Balochistan, providing 20% of the national stock. Large predators and their prey species, including livestock, have coexisted in these mountainous landscapes for centuries. The aim of the present research is to investigate the impacts of livestock depredation by large predators on livelihoods and predator conservation in two districts of Balochistan, Pakistan. A human–carnivore conflict survey was conducted from July to September 2019, collecting data from 311 residents in a selected study area. Large predators in the study area preyed on a total of 876 livestock during a one-year period, including 560 goats, 292 sheep, 19 cows, and 5 donkeys. The gray wolf is the leading predator, responsible for 66.3% of livestock depredation, followed by the caracal (24.3%), Asiatic jackal (8.9%), and striped hyena (0.6%). The total economic loss was USD 78,694. Overall, 80% of respondents had a negative perception of wolves compared to 24.4% for caracals. Only 20.6% of respondents knew about the importance of conserving carnivores. Livestock depredation by carnivores in the study area created a negative perception of these animals among people. There is a lack of awareness about the importance of conserving carnivore species and their role in the ecosystem. This lack of understanding has ultimately led to detrimental effects on predator populations. It is imperative to raise awareness among people about the ecological significance of carnivores through community meetings, seminars in educational institutions, and providing basic education to herders about effective livestock guarding practices

Knowledge management process, knowledge based innovation: Does academic researcher’s productivity mediate during the pandemic of covid-19?

Drucker’s knowledge-worker productivity theory and knowledge-based view of the firm theory are widely employed in many disciplines but there is little application of these theories in knowledge-based innovation among academic researchers. Therefore, this study intends to evaluate the effects of the knowledge management process on knowledge-based innovation alongside with mediating role of Malaysian academic researchers’ productivity during the Pandemic of COVID-19. Using a random sampling technique, data was collected from 382 academic researchers. Questionnaires were self-administered and data was analyzed via Smart PLS-SEM. Knowledge management process and knowledge workers’ productivity have a positive and significant relationship with the knowledge-based innovation among academic researchers during the Pandemic of COVID-19. In addition, knowledge workers’ productivity mediates the relationship between the knowledge management process (knowledge creation, knowledge acquisition, knowledge sharing, and knowledge utilization) and knowledge-based innovation during the Pandemic of COVID-19. Results have also directed knowledge sharing as the key factor in knowledge-based innovation and a stimulating task for management discipline around the world during the Pandemic of COVID-19. This study provides interesting insights on Malaysian academic researchers’ productivity by evaluating the effects of knowledge creation, acquisition, sharing, and application on the knowledge-based innovation among academic researchers during the Pandemic of COVID-19. These useful insights would enable policymakers to develop more influential educational strategies. By assimilating the literature of defined variables, the main contribution of this study is the evaluation of knowledge creation, acquisition, sharing, and utilization into knowledge-based innovation alongside the mediating role of knowledge workers productivity in the higher education sector of Malaysia during the Pandemic of COVID-19

Comparative Evaluation of Biomedical Applications of Zinc Nanoparticles Synthesized by Using Withania somnifera Plant Extracts

Green synthesis of metal nanoparticles is of great importance in the modern health care system. In this study, zinc nanoparticles (ZnONPs) were synthesized using leaf and root extracts of Withania somnifera using four different solvents. ZnONPs were characterized by UV-vis spectrophotometer with a range between 350&ndash;400 nm. Scanning electron microscope revealed spherical morphology with an overall size of 70&ndash;90 nm and XRD pattern confirmed the crystalline structure. The total flavonoids, phenolic, and alkaloid contents were significantly greater in the crude extracts as compared to ZnONPs. The highest scavenging activity was observed in ZnONPs from n-hexane and ethyl-acetate extracts of roots with IC50 values of 27.36 &micro;g/mL and 39.44 &micro;g/mL, respectively. ZnONPs from methanol and aqueous extracts showed significant antibacterial activity against Escherichia coli, Staphylococcus aureus, and Bacillus subtilis while none of the extracts were found to have significant antifungal activity. Maximum cytotoxic activity was observed in ZnONPs synthesized from aqueous and n-hexane root extracts with LC50 values of 9.36 &micro;g/mL and 18.84 &micro;g/mL, respectively. The highest antidiabetic potential was exhibited by ZnONPs from n-hexane leaf extracts, i.e., 47.67 &plusmn; 0.25%. Maximum protein kinase inhibitory potential was observed in ZnONPs of ethyl-acetate extract of roots with a bald zone of 12 mm. These results indicated that Withania somnifera-based ZnONPs showed significant biological activities compared to crude extracts. These findings can further be utilized for in-vivo analysis of nano-directed drug delivery systems

From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient

Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient’s physicians is suggested

Oral cancer via the bargain bin: The risk of oral cancer associated with a smokeless tobacco product (<i>Naswar</i>)

<div><p>In the wake of smokeless tobacco (SLT) being advocated as a mean of tobacco harm reduction, it is pertinent to establish individual health risks associated with each SLT product. This case-control study was aimed at assessing the risk of oral cancer associated with a smokeless tobacco product (<i>Naswar</i>). The study was conducted from September 2014 till May 2015 in Khyber Pakhtunkhwa, Pakistan. Exposure and covariate information was collected through a structured questionnaire. Conditional logistic regression was used to calculate odds ratios (OR) along with their 95% confidence intervals (CI). 84 oral cancer cases (62% males) and 174 age- and sex-matched controls were recruited. Ever users of <i>Naswar</i> had more than a 20-fold higher risk of oral cancer compared to never-users (OR 21.2, 95% CI 8.4–53.8). Females had a higher risk of oral cancer with the use of <i>Naswar</i> (OR 29.0, 95% CI 5.4–153.9) as compared to males (OR 21.0, 95% CI 6.1–72.1). Based on this result, 68% (men) and 38% (women) of the oral cancer burden in Pakistan is attributable to <i>Naswar</i>. The risk estimates observed in this study are comparable to risk estimates reported by previous studies on other forms of SLT use and the risk of oral cancer in Pakistan. The exposure-response relationship also supports a strong role of <i>Naswar</i> in the etiology of oral cancer in Pakistan. Although still requiring further validation through independent studies, these findings may be used for smokeless tobacco control in countries where <i>Naswar</i> use is common.</p></div

Distribution of the lifestyle risk factors for oral cancer, by sex, among cases (n = 84) and controls (n = 174) in Khyber Pakhtunkhwa, Pakistan.

<p>Distribution of the lifestyle risk factors for oral cancer, by sex, among cases (n = 84) and controls (n = 174) in Khyber Pakhtunkhwa, Pakistan.</p