Stanford type B aortic dissection in a middle aged female in civil hospital Karachi, Pakistan

Aortic dissection is a potentially catastrophic illness that presents very rarely usually in sixth or seventh decade. There are two types of dissection; Stanford type A, which is treated surgically while type B is managed pharmacologically. Mortality is high for both types of aortic dissections.  However, when an aortic dissection is detected early and treated promptly, the chance of survival greatly improves.  It usually presents as a sharp tearing pain radiating to interscapular region but can also present atypically hence a high index of clinical suspicion is needed. We register a case a 50 year old female who was a known case of HTN presented with complain of dyspnea. On further investigation she was found to have aortic dissection involving descending aorta. She was managed conservatively but unfortunately died

Policy on SMEs in Pakistan:: Relationship between Entrepreneurial Orientation, Firm Performance and Ownership Structure

To strengthen growth of SMEs in Pakistan, it is important for the policy makers to understand some significant related variables. For instance, Entrepreneurial Orientation (EO) is one such variable which can affect the performance of any business substantially; however, it is debatable if some of its dimensions do not affect the firm performance. This research investigates the relationship among the EO dimensions, firms’ performance and ownership structure. In this study, the collection of data was done by using a self-administered questionnaire survey using a 5-point Likert scale and Statistical Package for social sciences (SPSS) version 24. The findings revealed that EO has a statistically significant effect on firms’ performance and when checked individually for each dimension of the EO, it was clear that results for innovation were statistically insignificant, because innovation needs certain time and specific environmental conditions to yield significant results, whereas results for risk-seeking, proactive approach, autonomy, aggressive attitude, and competitive spirit were statistically significant and positively linked with the firms’ performance. The findings of this research reveal that ownership structure does play a significant moderating role on the relationship between performance of the firm and EO dimensions (Innovativeness, Proactiveness and competitive Energy) while Ownership structure doesn't play any significant moderating role between firm performance and few other EO dimensions (risk-attitude, autonomy and aggressiveness). Keywords:     Public Policy, Entrepreneurial Orientation, Firm Performance, Ownership Structure, Small & Medium Enterprises (SMEs), Pakista

Particulate Matter Concentration in Ambient Air at Gulshan e Iqbal, Karachi

The aim of this study is to measure the PM concentration (PM2.5, PM10) at different times and at different locations of the Gulshan-e-Iqbal town and comparison of the obtained results with the permissible limits of Pak-EPA for assessment of the air quality. A total of 12 sampling locations were selected in different blocks of Gulshan-e-Iqbal town. The PM 2.5 concentration in the study area ranged from 47 to 81.3 µg/m3, with a mean value of 65.4 µg/m3. The results revealed that values of PM2.5 at all the sampling stations were above the permissible limits (35 µg/m3) set by Environmental Protection Agency Pakistan (Pak-EPA). The PM 10 concentration in the study area ranged from 55.6 to 99.0 µg/m3, with a mean value of 79.9 µg/m3. The results revealed that values of PM10 at all the sampling stations were within the permissible limits (150 µg/m3) set by Environmental Protection Agency Pakistan (Pak-EPA). The concentration of PM (PM2.5, PM10) was found to vary with time at all the sampling stations. Maximum concentrations were recorded at 2 PM and 7 PM while minimum concentrations were recorded at 12 AM. The worst air quality in terms of particulate matter concentration in the study area was observed at Block 11 of Gulshan-e-Iqbal, whereas better air quality in terms of PM was recorded at Block

Influence of artificial aging and ZrO2 nanoparticle-reinforced repair resin on the denture repair strength

Background: The purpose of this study was to evaluate the effect of aging process on the tensile strength (TS) of repaired acrylic denture base using ZrO2 nanoparticles (nano-ZrO2)-reinforced autopolymerized resin. Material and Methods: A total of 240 heat-polymerized acrylic resin specimens (n=10) were prepared and sectioned creating 2 mm-repair-gap. Autopolymerized acrylic resin, pure and modified with 2.5, 5, and 7.5wt% nano-ZrO2were used for specimens repair. TS of repaired specimens were measured using the universal testing machine af-ter water immersion at 37oC for 2, 7 and 30 days. At each time interval, half the immersed specimens underwent thermo-cycling aging process (5000 cycles at 5/55°C) before TS testing. One-way ANOVA and Tukey-Kramer multiple-comparison tests were used for data analysis at ?=0.05. Results: Aging process for all groups showed significant differences in TS between unreinforced and nano-ZrO2reinforced groups (p<0.05). Within immersed nano-ZrO2-reinforced specimens, 5% group immersed for 30-days showed the highest significant TS value (p<0.05). With regards to thermocycling, 5% group showed the highest TS values after 2-days and 30-days groups while after 7-days, significant differences were found between 2.5% group and 5% and 7.5% groups (p?0.05). SEM images analysis displayed the ductile fracture type for nano-ZrO2reinforced groups.Conclusions: In summary, 5.0%-nano-ZrO2 addition to repair resin showed an improvement in tensile strength of repaired acrylic resin with different aging processes

Patient-Level Cost Estimation for Health Services at Secondary Hospital, Saudi Arabia

Cost information can help to improve the quality of medical care budgeting, and it can also improve the efficient allocation of resources and patient outcomes. The objective of this study was to estimate the inpatient unit cost of healthcare services in a secondary hospital in Saudi Arabia. A cross-sectional retrospective approach was applied to categorize the inpatients discharged from the hospital from January to December 2018. A top-down costing method for cost estimation was used. We found that the overhead cost center holds 40.17% of the total hospital cost, and intermediate and final care cost centers consumed 25.50% and 34.33%, respectively. Among inpatients wards, the Surgical ward had the highest operational cost (39.27%). Human resources consumed the hospital's highest resources (75%) on salaries. The hospital's cost structure was not remarkable and needs revolutionary changes to adopt the new payment mechanism envisioned in the 2030 Saudi vision

Parametric optimisation of friction stir welding on aluminium alloy (EN AW-1100) plates

Friction stir welding is a solid-state welding process used extensively for aluminium alloys. EN AW-1100 alloy is mostly used for its exceptional corrosion resistance, high ductility, high thermal and electrical conductivities, and cost-effectiveness. This study is focused on the optimisation of friction stir welding parameters to achieve enhanced mechanical properties of 5mm thick EN AW-1100 alloy plates welded with a single pass, using Taguchi L9 orthogonal array and ANOVA analysis. Experimental results revealed that maximum tensile strength of 79 MPa and percentage elongation of 38.87 % were achieved. The maximum Vickers hardness achieved in the stir zone was 34.15. These results were used for optimisation using Minitab and it was determined that 2000 RPM, 30 mm·min−1 traverse speed and square probe profile came out to be the best parameters for maximum tensile strength. 4000 RPM, 30 mm·min−1 traverse speed and square probe geometry were the best parameters for maximum hardness in the stir zone. ANOVA analysis showed that the most significant parameter for tensile strength was traverse speed. None of the considered parameters were influencing the hardness value in the stir zone at a 95 % confidence level

Synthesis of cerium, zirconium, and copper doped zinc oxide nanoparticles as potential biomaterials for tissue engineering applications

A novel eco-friendly high throughput continuous hydrothermal flow system was used to synthesise phase pure ZnO and doped ZnO in order to explore their properties for tissue engineering applications. Cerium, zirconium, and copper were introduced as dopants during flow synthesis of ZnO nanoparticles, Zirconium doped ZnO were successfully synthesised, however secondary phases of CeO and CuO were detected in X-ray diffraction (XRD). The nanoparticles were characterised using X-ray diffraction, Brunauer-Emmett-Teller (BET), Dynamic Light scattering Measurements, Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR) and RAMAN spectroscopy was used to evaluate physical, chemical, and structural properties. The change in BET surface area was also significant, the surface area increased from 11.35 (ZnO_2) to 26.18 (ZrZnO_5). However. In case of CeZnO_5 and CuZnO_5 was not significant 13.68 (CeZnO_5) and 12.16 (CuZnO_5) respectively. Cell metabolic activity analysis using osteoblast-like cells (MG63) and human embryonic derived mesenchymal stem cells (hES-MP) demonstrated that doped ZnO nanoparticles supported higher cell metabolic activity compared to cells grown in standard media with no nanoparticles added, or pure zinc oxide nanoparticles. The ZrZnO_5 demonstrated the highest cell metabolic activity and non-cytotoxicity over the duration of 28 days as compared to un doped or Ce or Cu incorporated nanoparticles. The current data suggests that Zirconium doping positively enhances the properties of ZnO nanoparticles by increasing the surface area and cell proliferation. Therefore, are potential additives within biomaterials or for tissue engineering applications

Comparison of nutrients uptake in different varieties of rice in Pakistan

The objective of this research was to determine the uptake of different elements (K, Mg, Ca, Na, Fe, Co, Mn, Pb, Cu, Zn and Ni) which are used as nutrients by the rice crop. Different types of rice seeds KSK-282, KSK-134, BAS-515, IR6, BAS-2000, KSK-133 and super-BAS were collected from National Agricultural Research Centre (NARC) Islamabad Pakistan and grown in different plastic pots containing soil under the same condition. Ten days old immature plants of different varieties of rice were dried and their roots were separated from the whole plants. The dried roots were ground into fine powder followed by acid digestion (HNO , H SO and 3 2 4 HClO ) solution in a ratio of (5:1:0.1) individually. After digestion the solutions were filtered and the filtrates 4 were diluted by adding distilled water. The diluted solutions of all the above mentioned varieties of rice were analyzed by Atomic Absorption Spectrophotometer (AAS) for nutrients (K, Mg, Ca, Na, Fe, Co, Mn, Pb, Cu, Zn and Ni) concentration. The different values obtained from AAS had shown that some rice varieties had taken up nutrients (elements) in large amount (e.g., KSK-134 had taken up maximum Fe while KSK-133 had taken up minimum) as compared to other varieties. Similarly, several verities absorbed comparatively minimum concentration of elements. The results obtained in this research work clearly indicated that the absorption of these elements from the soil was dependent on the rice variety (e.g., BAS-2000 absorbed maximum Mg while minimum Super-BAS). Interestingly most of the rice vaities had absorbed the beneficial elements in large quantity as compared to other toxic elements

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic