The Impact of Urbanization and Energy Consumption on CO2 Emissions in South Asia

This paper explores the relationship between urbanization, CO2 emissions and energy consumption in South Asia for the period of 1983 to 2013, using Panel Co-integration and Granger causality approach. A long-run relationship exists between CO2, energy consumption and urbanization. The empirics also indicate that energy consumption and economic growth are playing a significant role in degrading the environment while trade is improving its quality. Bidirectional causality exists between CO2 and energy, and between urbanization and CO2 emissions both in the short run and long run

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

AN ASSESSMENT OF DETERMINING THE VARIATION IN THE LEVEL OF SODIUM IN CHILDREN DIAGNOSED WITH AWD (ACUTE WATERY DIARRHEA) BEFORE AND AFTER ORS (ORAL REHYDRATION SALE) SOLUTION MANAGEMENT

Background: The risk of death in a young age due to diarrhoea is minimized by oral rehydration salt (ORS) solution. This solution with decreased osmolarity may be very productive according to the suggestion of current studies. Therefore, hyponatremia with decreased osmolarity ORS is now considered. Objective: The objective of this research was to find out the difference in the serum sodium level in children with acute watery diarrhoea (AWD before and after the use of decreased osmolarity ORS solution). Patients and Methods: This research was conducted at Mayo Hospital, Lahore from September 2017 to October 2018. Total children selected for this study were one hundred. The age of the children was between two to sixty months. A written agreement was signed by patients which were consistent with the clinical case definition of AWD (passage of 3 or more loose stools per day) with a period of fewer than 14 days. Non-probability purposive sampling was used for gathering a sample. Decreased osmolarity ORS solution was given to each child. Before and after the use of ORS, paired sample t-test was used. Those children were excluded who were with serious dehydration or having clinical affirmation of systemic infection. SPSS was used for data entry and assessment. Results: Variation in serum sodium level after use of decreased osmolarity ORS solution was not valuable statistically P-value = 0.173. The serum sodium level before use was (133 ± 3.4) meq/L and after use was (133 ± 2.9) meq/L. For subgroups of age and gender, identical outcomes were observed. Conclusion: In children with AWD, the incidence of hyponatremia was not significantly associated with decreased osmolarity ORS solution. Keywords: Oral Rehydration Salt (ORS), Osmolarity, Sodium, Diarrhea and Solution