Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case-control study in Karachi, Pakistan.

OBJECTIVES: The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. DESIGN: A multicentre hospital-based case-control study. SETTING: Four leading maternity hospitals of Karachi. PARTICIPANTS: A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. PRIMARY AND SECONDARY OUTCOME MEASURES: Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). RESULTS: Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. CONCLUSIONS: This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events

A systematic review of observational studies, demonstrating smoking among school going adolescents

Objective: To characterize the methods of design and analysis currently adopted in survey research of school-based observational studies for smoking, and to identify the common pitfalls made by researchers.Methods: The systematic review was conducted in 2009 and consisted of observational studies in school settings published between January 2005 and January 2009. Smoking status was the main outcome of interest. Following Cochrane style, five steps were followed: setting selection criteria for studies and conducting a literature search; review of abstracts; review of complete articles; data extraction and quality assessment of included studies; and, finally, synthesis of studies.Results: Of the 292 abstracts retrieved, 45 (15.4%) articles were selected for the final review. Inconsistencies were found in the definition of smoking behaviour which impeded generalisability. Individual-level factors had importance, but environmental level factors were also important in studying the aetiology of smoking. Results showed that studies inappropriately reported sample size estimation and important confounding factors. Hierarchical linear modelling, random effects modelling and structural equation modelling were employed in comparatively few studies.Conclusions: There were concerns regarding data analysis of complex surveys. Fifty five percent of reviewed studies ignored environmental effects which may have produced unreliable inferences. Multi-level analysis assisted in understanding school-level effects

Corrosion trends of Ti based Shape Memory Alloys having biomedical applications: A perspective study

Ti-based shape memory alloys (SMAs) have been investigated as materials for medical devices and as a biomaterial that can be implanted in a living system as an alternative of any part. The behavior of such materials is evaluated by its activity, corrosion resistance, stability and compatibility with the living body. The direction of this paper is to deliver a brief description of the trends of corrosion in these materials. Titanium (Ti) shows satisfactory resistance to corrosion in natural and acidic environment but it has a trend toward corrosion in reducing acids. The shape memory alloys based on Ti are much favorable corrosion resistant materials to use in reducing acids. Normally human body fluid is analogous to a solution of about 0.9% NaCl which has a pH value 7.4. During surgery this value can be changed, with an increase of 7.8 and then dropping it to 5.5. Later some days the standard pH value of 7.4 can be re-gained. To evaluate corrosion rate of Ti based shape memory alloys in human body fluid, 0.9% NaCl solution was used as a medium. The basics of the shape memory material i.e. the mechanisms for shape memory, the shape memory effect and characterization of the evaluation of corrosion in systems based on Ti shape memory alloy is also reviewed in this article

A COMPARATIVE STUDY OF MECHANICAL PROPERTIES AND MICROSTRUCTURES OF DEFORMED BARS (GRADE-60) LOCALLY MANUFACTURED IN PAKISTAN

The MS deformed bars are widely used in construction, housing, bridges, flyovers, dams etc. And often the properties claimed by the industries may or may not be compatible with ASTM Standards. In order to check their compatibility with ASTM standards, MS deformed bar samples of Grade 60 of one inch (25 mm) diameter of five different companies were taken from open market. As One of Pakistan's popular examples of consistent business success has been the stainless steel and mild steel production. The hypothesis explored in this paper is that meeting such standards requires greater properties, both among producers as well as mechanical properties obtained by Tensometer and Universal Hydralic Tensile Machine. The study draws on qualitative data to examine either how much difference or similarity is drawn within samples of various industries. And these samples were coded as S-1, S-2, S-3, S-4 and S-5. First of all composition was determined by using Optical Spectrometer then Tensile performed at universal hydraulic Testing Machine and time load graphs were taken as this test is commercially used, and also Tensile was performed on Tensometer at laboratory level and Stress-Strain graph was obtained and calculated. It was concluded that the experimental results of most of the industries were in good agreement with ASTM but only a few did not show compatibility with ASTM standards

Role of Credit Information Sharing and the Funding Cost of Banks: Evidence from the Top Ten “AA Rating” Commercial Banks of Pakistan

Purpose - The objective of the study is to investigate the relationship between the credit information sharing and the funding cost of banks of the top ten “AA rating” commercial banks of Pakistan as the Commercial banks also play a significant role in the economy of every country. Design/Methodology - In this study, panel data were analyzed from 2011 to 2017. We selected the top ten “AA rating” banks from Pakistan credit rating agency (PACRA) website, and data related to another related variables are obtained from financial statements of the respective banks. Generalized Method of Moments (GMM) statistical technique was employed to measure the relationship among related variables. Findings - The result of the study shows that there is a negative and significant relationship between credit information sharing, operation efficiency, and funding cost. On the other side, profitability has a positive and significant relationship with the funding cost of the bank. Practical Implications - To manage the funding cost policymakers must focus two key findings which are credit information sharing and operational efficiency of bank and set up a credit information sharing institutions which help to reduce information irregularity and ultimately manage the funding cost of the banks

Evaluating the Biocompatibility of materials: Routes and strategies of exploring the host response

A Biomaterial is a synthetic material which is used in living body as replacement of any part and its evaluation and performance is measured by its activity, stability and compatibility with living system. Usually in the field of biomaterial characterization its performance is based upon Biocompatibility. The aim of the present research is to describe the parameters and standards for evaluation of biocompatibility of biomaterials. In this study various techniques of biocompatibility testing have been described such as  Cytotoxicity Testing, Genotoxicology / Mutagenicity Testing, Hemocompatibility Testing, Implantation Testing, Irritation/Intracutaneous Reactivity Testing, Pyrogenicity Testing (In Vivo), Sensitization Testing, Subacute/Subchronic Toxicity Testing, Systemic (Acute) Toxicity Testing, Chronic Toxicity and Carcinogenicity Testing, Immunogenicity testing, Pharmacokinetics and Pharmacodynamics testing, Cell Culture Test, Mucosal damage and Mucosa usage tests, Periapical tissue damage and endodontic usage test, Intraosseous Implant test, Diagnostic tests on patients, Patch test, Prick Test, Radio allegro sorbent test (RAST) and Corrosion testing. The description of the basics of these techniques along with evaluation standards is also the fundamental objective of this work

Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period. Findings Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. Interpretation The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings.publishedVersio

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries. Funding: Bill & Melinda Gates Foundation