To compare the accuracy of prayer\u27s sign and mallampatti test in predicting difficult intubation in diabetic patients

Objective: To determine the accuracy of Prayer\u27s sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer\u27s sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer\u27s sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer\u27s sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer\u27s sign is not acceptable as a single best bedside test for prediction of difficult intubation

Simple human vulnerability index to climate change hazards for Pakistan

Appendix 3 - final technical reportAdult literacy rate, ownership of livestock, and access to electricity are the three (out of six) key variables that played a critical positive role in recovery after the 2010 floods in Pakistan. The study found that the Human Vulnerability Index (HVI) developed for this analysis is a useful tool for identifying vulnerable regions and districts for resource allocation. But the HVI is a poor tool for vulnerability assessment at community and household levels. Regression results further suggest that the sources of resilience in communities may come from the provision of critical services depending on their geographical areas

Incidence, outcome and risk factors for sepsis- a two year retrospective study at surgical intensive care unit of a teaching hospital in Pakistan

Background: Sepsis is amongst the leading causes of admission to the intensive care units and is associated with a high mortality. However, data from developing countries is scarse. Aim of conducting this study was to determine the incidence, outcome and risk factors for sepsis on admission to surgical intensive care unit (SICU) of a teaching hospital in Pakistan. Methods: Two year retrospective observational study included all consecutive adult admissions to the surgical intensive care unit (SICU) of a University Hospital, from January 2012 to December 2013. Results: Two hundred and twenty-nine patients met the inclusion criteria. Average age of the patients was 46.35±18.23 years (16–85), mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 15.92±8.13 and males were 67.6%. Median length of ICU stay was 4 [IQR 5]. 43% patients fulfilled the criteria of sepsis at the time of admission to the SICU and incidence of severe sepsis/septic shock was 35%. Abdominal sepsis was the most frequent source of infection (57.5%). The overall intensive care unit mortality was 32.31% but the mortality of sepsis-group was 51.15% as compared to 17.7% of the non-sepsis group. Stepwise logistic regression model showed that increasing age, female gender, non-operative admission, admission under general surgery and co-morbidities like ischaemic heart disease and chronic kidney disease were significant predictors of sepsis. Conclusion: The incidence of sepsis and severe sepsis/septic shock, on admission to SICU is high and mortality of the sepsis group is nearly three times the mortality of the non-sepsis group

Perioperative glycemic control and its outcome in patients following open heart surgery

Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population.Materials and methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016.Results: Of the 129 patients included in the study, male dominated 101 (78.3%). Most frequent surgery was coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus aortic valve replacement 4 (3.1%), and CABG plus mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on diet control, 112 (86.8%) on oral hypoglycemic agents (OHA), whereas 9 (7%) had control on both insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%) patients did not require insulin and 54 (41.9%) were treated with insulin intraoperatively to keep the blood glucose level less than 200 g/dl. Cardiac arrhythmias were frequent in the insulin group (P \u3c 0.05), which was also associated with increased stay in the cardiac intensive care unit.Conclusion: Inadequate glycemic control during open cardiac surgery can possibly lead to increased perioperative morbidity and mortality and with decreased long-term survival and recurrent ischemic events. Therefore, aiming for blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific glucose ranges for a clearer definition of recommended blood glucose goals in postoperative cardiac patients for the best outcomes in patients with diabetes mellitus

Does organizational justice enhance job performance through high-performance human resource practices?

[EN] This study aims to analyze the influence of organizational justice (OJ) on job performance (JP) intention via the mediating influence of high-performance human resource practices (HPHRPs) in a developing context. Equity theory and expectancy theory are widely employed in many disciplines but seldom applied to JP among Pakistan Telecommunication Limited (PTCL)  employees. The respondents in this study were 377 employees working in PTCL. Partial least square (PLS), specifically ̣ structural equation modeling was used for the data analysis. The study found a significant direct and indirect influence of distributive justice (DJ) on JP through the partial mediating role of selective staffing (SS) and extensive training (ET). Procedural justice (PJ) also, directly and indirectly, influenced JP through the partial mediating role of the incentive reward (IR). While interactional Justice (IJ), result-oriented appraisal (ROA), employment security (ES) had an insignificant influence on JP. OJ has to be synergized with HPHRPs to enhance JP. The results of this study would also augment the body of knowledge of JP in developed and under-developing countries. OJ has to be synergized with HPHRPs to enhance JP. The results of this study would also argue the body of knowledge of JP in developed and under-developing countries.Zeb, A.; Ur Rehman, F.; Arsalan, Y.; Usman Khan, M. (2021). Does organizational justice enhance job performance through high-performance human resource practices?. WPOM-Working Papers on Operations Management. 12(2):16-40. https://doi.org/10.4995/wpom.15497OJS1640122Abbasi, A., Baradari, F., Sheghariji, H., & Shahreki, J. (2020). Impact of Organizational Justice on Workplace Deviance with Mediating Effect of Job Satisfaction in SMEs of Malaysia. European Journal of Business and Management, 12(17), 11.Adams, J. S. (1965) "Inequity in social exchange. 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APACHE II analysis of a surgical intensive care unit population in a tertiary care hospital in Karachi (Pakistan)

Purpose: Performance of prognostic models deteriorates over time by changes in case-mix and clinical practice. This study was conducted to describe the case-mix of a surgical intensive care unit (SICU) and assess the performance of APACHE II scoring system in this cohort. Methodology: We analyzed 213adult patients admitted to the surgical intensive care unit (SICU) of Aga Khan University Hospital, from January 2011 to December 2012 and the performance of APACHE II scoring system was assessed in this population. Results: The mean age of patients was 46.31 years (SD ±18.43), 67.1% patients were male and mean length of ICU stay was 6.54 days (SD ± 7.18).Admissions to SICU were from seven service departments with the highest admissions from general surgery followed by trauma and neurosurgery. The mean APACHE II score of this SICU population was 15.89 (SD ±8.06), 12.88 (SD ±6.29) in survivors and 22.24 (SD ±7.66) in non-survivors (p Conclusion: APACHE II scoring system allows meaningful analysis of SICU population, therefore, it is recommend, that this simple and cost effective scoring system should be used to identify patients with high risk of death to justify the decisions of withholding expensive therapies in resource limited settings

Performance Evaluation of UK Acquiring Companies in the Pre and Post-Acquisitions Periods

This paper has two objectives: first, it examines the financial performance of twenty UK based acquiring companies over the period of five years (2009-2013) using financial ratios of Liquidity, Profitability and Solvency in order to empirically determine whether there is any significant financial performance changes in the operation of the underlying companies as a result of acquisitions. Both average ratio and paired t-test analysis have been conducted. The analysis concludes that none of the ratios proved statistical significance which shows that the underlying acquisitions did not influence changes in the financial performance of the acquiring companies. The paper also examines whether shareholders make short-term gain while opting for acquisitions by analyzing stocks return over 58 days window period i.e. 29 days prior to acquisition announcement and 29 days after acquisition announcement by applying CAPM model and AAR and CAAR analysis. The analysis concludes that none of the results show statistical significance which further asserts that UK shareholders do not make gain in the short-term as a result of the acquisition activities they have undertaken

Understanding the Role of Conservation in Sustainable Dev Elopment

Ghulkin Educational Social Welfare Conservation Organization (GESWCO), is a Community based organization (Co), working in a remote village “Ghulkin” Gojal in Gilgit-Baltistan, Pakistan which provides services in health, education and infrastructural development, water and sanitation and more importantly conservation of biodiversity. The purpose of the study is to investigate the role of GESWCO in sustainable development of the study area. To achieve this objective we conducted a survey and data were collected via semi-structured individual interviews and focus group discussions among the community. The results of the study showed that GESWNCO has played a vital role towards socio-economic development through using its scarce resources witnessed by the response of people about positive progress of the organization. JEL Classification: Q56 Keywords: Community Organization, Conservation, Sustainable    Development, Trophy Hunting