A Clinical Audit of blood component transfusion practices in Paediatric intensive care unit of a Tertiary Care Hospital, Rawalpindi

Background: To audit the practices involved in blood component transfusion in the management of patients in paediatric intensive care unit of our hospital and to determine the appropriateness of transfusion after comparing them with clinical practice guidelines recommended by Royal Children Hospital (RCH). Methods: All patients admitted in pediatric intensive care which were managed with blood component transfusions were retrospectively audited for 8 weeks. Management details including indications of transfusion and its appropriateness were recorded. Clinical practice guidelines recommended by Royal Children Hospital (RCH) were used as standards. Results: One hundred and ninety-two transfusions were done during the study period out of which 58 percent were done to males and 41 percent to females. Majority of transfusions were done in infants (44%) and O Positive blood group was found rampant among blood groups of all recipients (33.3%). Red cell concentrates were predominantly (55.7%) and appropriately (72%) transfusion among all blood components. Platelet concentrates were most inappropriately transfused (57%) followed by fresh frozen plasma (54%) and red cell concentrates (27%). There was significant percentage of inappropriate transfusion of all blood components (p=0.00). Conclusion: All blood components were significantly found inappropriately transfused, commonest component being platelet concentrates

Protagonist of Mineral Nutrients in Drought Stress Tolerance of Field Crops

The food demand is increasing hastily, that is inducing continuous pressure on agriculture sector and industries to fulfill rising dietary needs. To meet with increasing demand, the food production must be elevated up to 70% until the year 2050. On the other hand, changing climate is disturbing crop production around the World. Crops grown under field conditions are affected by more than one abiotic stress. It is continuous task and challenge for agronomists to make crops environment hardy to obtain maximum yield. It is considered that different agronomic managements, if done appropriately, could be beneficial for increasing crop production. The optimal provision of plant nutrients can assist the crops to fight in better way with environmental stress like drought; it can help them to continue their normal metabolism even under hostile abiotic circumstances. The regions that have reduced availability of water for crop production, a balanced nutrient management can assist crops to give adequate production. Some of nutrients have potential of not only maintaining plant metabolism but also to enhance the quality of product. This chapter highlights the protagonist of plant nutrients in alleviation of drought stress in field crops

DYNAMICS OF NOMINAL EXCHANGE RATE WITH PRICE LEVELS: WHAT HAPPENS IN INTERNATIONAL MARKETS?

Since inception exchange rate determination in Pakistan has been studied extensively but under various approaches. Current study explores empirically the relationship of the domestic price level & foreign price level with nominal exchange rate in Pakistan, using a daily data set for 13 years (July 2000- June 2013) as provided by State Bank of Pakistan. Variables are analyzed for stochastic properties and existence of unit root, for this purpose ADF is used. Along with regression analysis the co-integration is tested to detect long term co-movement between variables. It has been found that domestic price level has positive relationship with nominal exchange rate, whereas, foreign price level has a negative relationship with nominal exchange rate in the long run

Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan

Objectives:  In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). Materials and Methods:  This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. Results:  In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy.  Conclusion:  Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature

Heavy metals mitigation and growth promoting effect of endophytic Agrococcus terreus (MW 979614) in maize plants under zinc and nickel contaminated soil

IntroductionHeavy metals such as iron, copper, manganese, cobalt, silver, zinc, nickel, and arsenic have accumulated in soils for a long time due to the dumping of industrial waste and sewage. Various techniques have been adapted to overcome metal toxicity in agricultural land but utilizing a biological application using potential microorganisms in heavy metals contaminated soil may be a successful approach to decontaminate heavy metals soil. Therefore, the current study aimed to isolate endophytic bacteria from a medicinal plant (Viburnum grandiflorum) and to investigate the growth-promoting and heavy metal detoxification potential of the isolated endophytic bacteria Agrococus tereus (GenBank accession number MW 979614) under nickel and zinc contamination.MethodsZinc sulfate and nickel sulfate solutions were prepared at the rate of 100 mg/kg and 50 mg/kg in sterilized distilled water. The experiment was conducted using a completely random design (CRD) with three replicates for each treatment.Results and DiscussionInoculation of seeds with A. tereus significantly increased the plant growth, nutrient uptake, and defense system. Treatment T4 (inoculated seeds), T5 (inoculated seeds + Zn100 mg/kg), and T6 (inoculated seeds + Ni 100 mg/kg) were effective, but T5 (inoculated seeds + Zn100 mg/kg) was the most pronounced and increased shoot length, root length, leaf width, plant height, fresh weight, moisture content, and proline by 49%, 38%, 89%, 31%, 113%, and 146%, respectively. Moreover the antioxidant enzymes peroxidase and super oxidase dismutase were accelerated by 211 and 68% in contaminated soil when plants were inoculated by A. tereus respectively. Similarly the inoculation of A. tereus also enhanced maize plants’ absorption of Cu, Mn, Ni, Na, Cr, Fe, Ca, Mg, and K significantly. Results of the findings concluded that 100 mg/kg of Zn and Ni were toxic to maize growth, but seed inoculation with A. tereus helped the plants significantly in reducing zinc and nickel stress. The A. tereus strain may be employed as a potential strain for the detoxification of heavy metal

Algal proteins: Production strategies and nutritional and functional properties

Animal-based proteins are the most consumed worldwide given their well-balanced nutritional composition. However, the growing demand for animal proteins will not be sustainable due to their low conversion efficiency and high environmental footprint. Specific consumers dietary restrictions and modern trends emphasize the importance of finding alternative sustainable non-animal sources to meet future food (and, in particular, protein) global needs. Algal biomass is considered a relevant alternative, presenting advantages over terrestrial biomass such as higher growth rate, low water consumption, no competition for arable land, carbonneutral emissions, and production of numerous bioactive compounds. This review provides an overview of recent research advances on algae as source of proteins, including production strategies from relevant protein-producing species. Particular emphasis will be given to algae protein current applications and forthcoming challenges of their use. Nutritional and functional aspects of algae biomass or its protein-enriched fractions will be overviewed.This research work was supported by ALGAVALOR - Lisboa-01-0247- FEDER-035234, supported by Operational Programme for Competitiveness and Internationalization (COMPETE2020), Lisbon Portugal Regional Operational Programme (Lisboa 2020) and Algarve Regional Operational Programme (Algarve 2020) under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). This study was also supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit and with a Ph.D. scholarship - SFRH/BD/07527/2020 - and BioTecNorte operation (NORTE-01-0145-FEDER 000004) funded by the ERDF under the scope of Norte2020 - Programa Operacional Regional do Norte. Ricardo N. Pereira acknowledge FCT for its Assistant Research program under the scope of Scientific Stimulus Employment with reference CEECIND/02903/2017.info:eu-repo/semantics/publishedVersio

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

HYPER-REALITY: BLURRING DEMARCATION BETWEEN SCIENTIFIC REALITY AND FICTION IN THE MOVIE “DR. STRANGE”; A MULTIMODAL ANALYSIS

The present research aims at investigating hyper-reality through multimodality in the movie, “Dr. Strange”, a scientific-fiction based on the Marvel Comics character of the same name. It’s a story of a surgeon who gains a new lease on life when a sorcerer trains him under her supervision to master mystic arts and manipulate time dimension and space. The research explores how hyper reality blurs the boundaries between physical reality and virtual reality. According to Baudrillard, “Hyper-reality is the reduplication of replicas of a real without origin or reality. These hyper-real effects are created through representations in the images portraying the virtual world as a real-world through different cinematic techniques” (Baudrillard, 1988). These representations are made in form of codes and signs in the words and images. The study provides a deep insight into visual narratives operating in each image/frame. It shows how the movie is particularly designed to recreate the world of illusions to have effects on the viewers. The study analyzes the visual narrative through systemic multimodal that how different metafunctions in visual narrative create hyper reality, and how it confuses the audience to the point that they fail to differentiate between the physical world and fictional world. This research has been conducted under a multi-modal approach of visual semiotics by Kress and Theo Van Leeuwen to identify the metafunctions. The research will be effective to understand and learn the application of systemic multimodal analysis of images in movies based on comics

TRANSITIVITY PATTERNS IN “I AM MALALA”; A SYSTEMIC MULTIMODAL ANALYSIS

The present research aims at systemic analysis of transitivity patterns in the documentary “He Named Me Malala” based on the book “I am Malala” written by Malala Yousafzai, the youngest recipient of the Nobel Peace Prize. The study will show how reality is constructed thought representations in the images portraying terrorism by Taliban in Sawat valley. These representations are made in form of codes and signs in words and images. The study will provide a deep insight of visual narratives operating in each image/frame. It will show how the documentary is particularly designed to carry the implied meanings in the images, to have effects on the viewers. It will also analyze how different factors in an image contribute to convey multiple meanings and make a documentary appealing, motivating and interesting to its viewers and make it popular in an exclusive manner.  The study will analyze the visual narrative through systemic multimodal that how different transitivity patterns in visual narrative reflect politics of representation. This research will be conducted under multi-modal approach of visual semiotics by Kress and Theo Van Leuween to identify the transitivity patterns in both linguistic and nonlinguistic tools in the text. The research will be effective to understand and learn the application of systemic multimodal analysis of visual images in documentaries based on books. This study will also helpful for those scholars who want to study transitivity patterns in the images and how politics of representation can direct the minds of people to think from planned perspective. The study will guide the future researchers who desire to research and learn visual semiotics as the main research discipline