Simulation and Modelling of Maximum and Minimum Temperature of Karachi

In the recent past weather derivatives have developed significant interest in surface air temperature and its modeling. In this work, we modelled and simulated daily average temperature. We used three different methods to model and simulate the recorded data at Karachi airport from 2010-2014. The methods used in this work are moving average method, polynomial fitting and maximum entropy method. Both polynomial fitting and maximum entropy methods can be used to find missing data. The simulated graphs and graphs of recorded data are in good agreement.  Keywords: Karachi airport, surface air temperature, moving average, polynomial curve fitting. Maximum Entropy method

Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery

We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome

Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery

We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome

Sublethal and transgenerational effects of synthetic insecticides on the biological parameters and functional response of Coccinella septempunctata (Coleoptera: Coccinellidae) under laboratory conditions

Synthetic insecticides have been an inevitable part of plant protection throughout the world. Sublethal effects of these chemicals on beneficial insect species are one of the contemporary issues these days. Using the age-stage, two-sex life table model, this study evaluated the sublethal and transgenerational effects of six synthetic insecticides (imidacloprid, thiamethoxam, lambda-cyhalothrin, cypermethrin, chlorpyrifos and profenofos) commonly applied to winter vegetables, on the fitness and predation of the seven-spotted ladybeetle, Coccinella septempunctata, which is an efficient predator of aphids worldwide. According to results, all insecticides at their sublethal doses (LC30) significantly suppressed the emergence of adults, adult weight, fertility and fecundity of the parental generation compared to control treatment. The larval stage was prolonged and oviposition, fecundity and total longevity of the adult beetles were decreased in unexposed progeny whose parents were exposed to sublethal doses of all insecticides. Moreover, the biological parameters of adults, including the intrinsic rate of increase (r), finite rate of increase (λ) and net reproductive rate (R0) were significantly reduced when exposed to sublethal doses of insecticides. The predation rate of the F1 generation adults was also decreased after exposure to the sublethal doses of insecticides. However, chlorpyrifos, profenofos, lambda-cyhalothrin and cypermethrin exhibited more deleterious effects on the fitness and population parameters of beetles than imidacloprid and thiamethoxam

A multidisciplinary approach to triage patients with breast disease during the COVID-19 pandemic: Experience from a tertiary care center in the developing world

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.Methods and results: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers\u27 schedules, operating room reallocation, and protocols. We also describe the Virtual Blended Clinics , a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine.Conclusion: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians\u27 clinical judgment to provide the best quality care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Green Supply Chain Management Practices’ Impact on Operational Performance with the Mediation of Technological Innovation

Industries strive to prevent ecologically destructive actions in their supply chains. At the same time, the optimization of their resources is a major concern for industries to minimize carbon emissions, boost sustainable practices, and improve a country’s long-term economic development. Therefore, the objective of this study is to examine the impact of Green Supply Chain Management (GSCM) methods on operational performance with the mediation of technological innovation, in the context of Pakistani manufacturing firms. The partial least square-structural modeling (PLS-SEM) method is adopted in this paper. Data were gathered from 223 different manufacturing firms in Pakistan and then analyzed among these variables. The data show good validity and reliability, and structural model explains 61% of the variance in operational performance and 45.4% of the variance in technical innovation, demonstrating its predictive validity. The R-square criteria classify R-square entities of 0.67, 0.33, and 0.19 as considerable, moderate, and weak, respectively. It is demonstrated that all the f-square values are greater than 0.020 and 0.35, indicating a significant effect on the model’s validity. The findings of this study reveal that GSCM practices have a significantly positive effect on both technological innovation and operational performance. Technological innovation has a direct influence on operational performance and has a partial mediating effect on the relationship between GSCM practices and operational performance. Therefore, this research offers managers insight into the importance of technological innovation and GSCM practice adoption to achieve competitive advantages. It further provides the groundwork for managers, practitioners, and environmental management researchers to emphasize the value of GSCM practice in improving operational performance

Comparison of Primary Simple Closure and Limberg Flap Technique in Pilonidal Sinus

Introduction Pilonidal sinus is a disease affecting the intergluteal region. Many surgical techniques have been described for the treatment of this condition. The objective of this study was to compare Limberg flap technique and primary simple closure in terms of postoperative discharge. Materials and methods It was a randomized prospective study conducted at the Department of Surgery—removed for blind review-- from December 2018 to June 2021. Sixty male patients aged 15-30 years presenting with pilonidal sinus for the first time were included in the study. Patients with comorbidities and the American Society of Anesthesiologists (ASA) class three and above were excluded from the study. Patients were divided into two groups by lottery method. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 23.0. Chi-square tests were applied. A p-value of ≤ 0.05 was considered significant. Results The postoperative discharge was found in just five (16.3%) of the patients in group A (Limberg flap technique), while the discharge was present in 12 (40%) of the patients in group B (primary simple closure; p = 0.045). Conclusion Limberg flap technique is superior to primary simple closure in terms of postoperative discharge

Comparison of Laparoscopic Total Extra Peritoneal (TEP)Techniques versus Transabdominal Preperitoneal (TAPP) Technique for Inguinal Hernia Repair

Background: To Compare laparoscopic total extra peritoneal (TEP)techniques with transabdominal preperitoneal (TAPP) technique for inguinal hernia repair Methods: In this randomized controlled trial 120 patients undergoing herniorraphy were divided into two groups .Sixty patients into Laparoscopic Total Extra Peritoneal (TEP)Techniques group and 60 into Transabdominal Preperitoneal (TAPP) Technique group. TAPP required access to the peritoneal cavity with placement of a mesh through a peritoneal incision. Mesh was placed in the preperitoneal space covering all potential hernias sites in the inguinal region leaving it between the preperitoneal tissues and the abdominal wall where it becomes incorporated by fibrous tissue. In TAPP pneumo-peritoneum was created by open technique, circular incision was given on peritoneum. Peritoneum was lifted, proline light weight mesh was placed, and peritoneum was stitched with continued suture. In TEP, the peritoneal cavity was not entered, infra-umbilical trocar was inserted in the preperitoneal space, space was created with camera, and mesh was used to seal the hernia from outside the peritoneum. Both techniques were compared in terms of mean operative time, conversion to open procedure, post operative pain, length of hospital stay, port site infection, mesh infection, return to daily activity, deep infection and recurrence.All patients were followed for a period of 1 year Results: Mean operative time in TEP repair was 45.1 ± 3.54 minutes, whereas in TAPP repair was 70 ± 6.01 minutes (p=0.000). Five laparoscopic TEP were converted to open repair due to major breach in peritoneum. In TEP group 40 patients complained mild pain. In TAPP group 25 patients complained mild pain and 30 complained moderate pain(p= 0.015). Average requirement of analgesia in TEP group was 2 doses of I/M dicloran whereas average requirement of analgesia in TAPP group was 3 doses. Length of hospital stay in both groups was one day. In TEP group no patient developed port site infection whereas 1 patient in TAPP group developed port site infection. One patient developed mesh infection in each group. In TEP group return to daily activity was 4 days where as in TAPP group return to daily activity was 5 days. No patient developed deep site infection in both groups. There was no recurrence in one year follow up.Conclusion: TEP has advantage of short operative time and less post operative pain and therefore less requirement of analgesia and early return to daily activity, where as TAPP is superior, there being less chance of conversio