Développement d’un outil d’évaluation de la performance municipale en gestion des matières résiduelles

De nos jours, la gestion des matières résiduelles constitue une part significative des finances publiques municipales et les tentatives d’améliorations ou de comparaison sont peu nombreuses. Il faut comprendre que dans la majorité des cas, les opérations, notamment pour ce qui est de la collecte et dans une certaine mesure pour le traitement, sont confiées à partir d’appels d’offres. En absence de données quantitatives comparatives entre les municipalités ou entre des compétiteurs, la valeur qualitative des services offerts est difficile de déterminer. Malheureusement, cette situation s’applique à un grand nombre de municipalités du Québec. À l’heure actuelle, aucune méthodologie de calcul n’existe sur l’évaluation comparative des coûts de la gestion des matières résiduelles. Dans le but d’adresser cette problématique, cet essai de maîtrise analyse la gestion des matières résiduelles résidentielles du secteur municipal sous l’angle des coûts afin de développer un outil d’évaluation de la performance comparatif et créer une échelle de performance comparative des municipalités du Québec. L’outil d’évaluation intègre les influences des variables de la population, du poids, du coût annuel de la gestion des matières résiduelles, du kilométrage de rues de la municipalité, et de la densité sur la performance de la gestion des matières résiduelles municipale. Cruciale à l’évaluation de la performance, la variable du coût annuel est élaborée en grand détail afin d’adresser la majorité des paramètres pouvant impacter le coût de la gestion des matières résiduelles. L’application de l’outil développer sur quatre municipalités a permis d’évaluer leurs performances, cibler les améliorations nécessaires, et comparer leurs performances aux autres municipalités du Québec. Des améliorations peuvent être apportées à l’outil d’évaluation de performance développé, notamment par l’intégration de données quantitatives plus récentes et une élaboration plus approfondie des coûts technologiques, opérationnels, et administratifs des opérations de traitement de la matière. Entre temps, cet outil peut être utilisé pour évaluer la valeur qualitative des services de la GMR offerts par les entreprises et concentrer les efforts aux aspects municipaux nécessitant une amélioration

The Impact of Inflation on Pakistan Stock Exchange

The aim of the study is to determine the impact of inflation on equity prices in Pakistan's economy. The examination time frame is 2012-2018; monthly information was gathered from the State Bank of Pakistan and the Pakistan Stock Exchange. The information was dissected utilizing the relapse model and factual consequences of these investigations to demonstrate a negative connection among expansion and stock costs. All exploration as of late has demonstrated that inflation and stock costs have a positive relationship universally. Some studies, however, indicated that inflation and equity prices were negative. In general, the stock market provides an overview of investors whether they want to invest in the financial market. Equity prices also affect inflation. Keywords Stock price, Inflation, Karachi Stock Exchange, KSE 100 index, CPI DOI: 10.7176/EJBM/11-16-11 Publication date:June 30th 201

Fear of getting Covid-19: A challenge to elective surgical practice and ways to overcome

Background: Covid-19, a global pandemic has a huge impact on surgical practice. There is transmission risk of Covid-19 during the elective surgery and nowadays it is a part of informed consent process. This has an impact on patient decision making as it creates anxiety and fear. Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Methods: This study was an observational cross-sectional survey and it has been conducted in General Surgery Department of Dr Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval of Institutional Review Board (IRB). Participants for elective surgery and their negative report of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Fear of Covid-19 infection was measured through “fear of Covid-19 scale” by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi square was used to find out the patient’s dropout due to getting Covid-19 infection from surgery. Results: Total 200 patients were included; 62% patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified FCV-19 scale with education status of all patients there was a very significant association between them (p=0.001). The patient’s observations regarding FCV-19 questionnaire, most of the patients were disagreed (46.3%) to getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. The actual dropout of patients from elective surgery due to fear of getting Covid-19 infection during surgery or staying in hospital was 7.5%. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level. Key words: Covid-19; Fear; Fear of Covid-19 Scale; Elective Surgical Procedures

Fear of getting Covid-19: A challenge to elective surgical practice and ways to overcome

Background: Covid-19, a global pandemic has a huge impact on surgical practice. There is transmission risk of Covid-19 during the elective surgery and nowadays it is a part of informed consent process. This has an impact on patient decision making as it creates anxiety and fear. Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Methods: This study was an observational cross-sectional survey and it has been conducted in General Surgery Department of Dr Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval of Institutional Review Board (IRB). Participants for elective surgery and their negative report of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Fear of Covid-19 infection was measured through “fear of Covid-19 scale” by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi square was used to find out the patient’s dropout due to getting Covid-19 infection from surgery. Results: Total 200 patients were included; 62% patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified FCV-19 scale with education status of all patients there was a very significant association between them (p=0.001). The patient’s observations regarding FCV-19 questionnaire, most of the patients were disagreed (46.3%) to getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. The actual dropout of patients from elective surgery due to fear of getting Covid-19 infection during surgery or staying in hospital was 7.5%. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level. Key words: Covid-19; Fear; Fear of Covid-19 Scale; Elective Surgical Procedures

Molecular probing of Aflatoxigenic fungi in rice grains collected from local markets of Lahore, Pakistan

Background: Aflatoxigenic Aspergillus strains have emerged as a serious threat to food safety and quality assurance. The objective of this study was to identify the aflatoxigenic Aspergillus sp. by targeting the amplification of aflatoxigenic genes i.e., aflR, nor1, omt1, ver1, in different fugal strains isolated from the rice grains being marketed in local markets of Lahore city, Pakistan.Methods: Total eleven (11) Aspergillus strains were isolated from rice grains and aflatoxigenic genes i.e., aflR, nor1, omt1, ver1 were amplified to differentiate between aflatoxin producing and non-producing strains.Results: Four (04) out of total eleven (11) strains showed the presence of aflatoxins producing genes, indicating the possible contamination of aflatoxins in rice grains being sold in local markets of Lahore.Conclusion: This research provides the basis for the quantification of aflatoxins; a significant threat to the quality of foodstuffs and consumers. The situation demands the attention of rice growers, processors as well as government officials to tackle the problem to assure the safety of rice eaters.Keywords: Aflatoxins; Aspergillus; Cereal grains; Contamination; Mycotoxigenic

Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary care hospital in Karachi, Pakistan

Background: Anaphylaxis is a potentially fatal condition requiring immediate resuscitation. Data regarding the epidemiology of anaphylaxis are limited and inconsistent. A reason for the variability was unavailability of a universally acceptable case definition till 2005. We reviewed cases using this new definition Aim: To review the incidence, clinical presentation, cause and outcome of anaphylaxis at a tertiary care center in a low income country. Design: Retrospective, case series Methods: Chart review of all patients discharged from Aga Khan University Hospital between January 1988 - December 2012 (24 years) with anaphylaxis definition as per second National Institute of Allergy and Infection disease/Food Allergy and Anaphylaxis Network Symposium Results: Total of 129 cases were found with mean age of 41.6 years (SD 18.8). Majority of patients had cutaneous features (76.7 %), followed by respiratory (68.9 %), cardiac (64.3 %) and gastrointestinal (20.9 %) symptoms respectively. About 22.4 % of patients had positive history for allergens out of which 31% (n=9) were exposed to the same allergens. The common causes identified for anaphylaxis were drugs (60.5 %), food (16.3 %) and intravenous contrast (10.9 %) respectively. Only 22.5 % of cases received epinephrine as part of their initial management. In 4 patients (3.1 %) the cause of death was attributed to anaphylaxis. Conclusion: Anaphylaxis is a rare but life threatening condition. Though cutaneous features are most common, their absence does not exclude the diagnosis. Drugs were the most common cause and epinephrine was not commonly used as first line agent for its management

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly

Endometrial cancer

Endometrial cancer is the most common gynecological malignancy in well-developed countries. Biologically and clinicopathologically, endometrial carcinomas are divided into two types: type 1 or estrogen-dependent carcinomas and type 2 or estrogen-independent carcinomas. Type 1 cancers correspond mainly to endometrioid carcinomas and account for approximately 90 % of endometrial cancers, whereas type 2 cancers correspond to the majority of the other histopathological subtypes. The vast majority of endometrial cancers present as abnormal vaginal bleedings in postmenopausal women. Therefore, 75 % of cancers are diagnosed at an early stage, which makes the overall prognosis favorable. The first diagnostic step to evaluate women with an abnormal vaginal bleeding is the measurement of the endometrial thickness with transvaginal ultrasound. If endometrial thickening or heterogeneity is confirmed, a biopsy should be performed to establish a definite histopathological diagnosis. Magnetic resonance imaging is not considered in the International Federation of Gynaecology and Obstetrics staging system. Nonetheless it plays a relevant role in the preoperative staging of endometrial carcinoma, helping to define the best therapeutic management. Moreover, it is important in the diagnosis of treatment complications, in the surveillance of therapy response, and in the assessment of recurrent disease.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