Comparison of predictive protocols in chest pain patients in a tertiary care hospital in Karachi, Pakistan

Background: The most challenging aspect in evaluation of a patient presenting with chest pain in the Emergency Department (ED) is diagnosis of acute cardiac ischemia (ACI). Various decisions aids have been developed to aid the ED physician in the diagnosis of chest pain. Three different predictive protocols – the Goldman protocol, ACI-TIPI, and the Troponin protocol are used in predicting the occurrence of ACI. None of these decision aids have been tested in the Pakistani population, where risk factors and prevalence of CAD are much different than what is seen in other regions of the world.Aims: The aim of this study was to compare how three different predictive protocols for ACI fared in the Pakistani population.Methods:This retrospective case series included a consecutive sample of 212 patients who presented to the ED with symptoms of chest pain or its equivalent. Patient data was collected and retrospectively analyzed with each predictive protocol to analyze sensitivity, specificity, PPV, and NPV of each protocol.Results: 63% of patients were diagnosed with ACI. The sensitivities of the Goldman, ACI-TIPI, and Troponin protocols were 94%, 98%, and 38% respectively. The specificities of the Goldman, ACI-TIPI, and Troponin protocols were 14%, 29%, and 95% respectively. Conclusion: Sensitivities from a small sample size show promise in the use of predictive protocols for chest pain in the Pakistani population. However, prospective studies on a larger level need to be conducted to validate these findings

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

FACTORS CONTRIBUTORY TO SUCCESS: A STUDY OF PAKISTAN'S SMALL BUSINESS OWNERS

Small business and entrepreneurship have been at the heart of Pakistan's economy for almost 60 years, yet little (if any) research has been conducted that identifies factors crucial for small business success in Pakistan. In the past, studies identifying factors crucial for small business success have focused primarily on the United States and Western Europe. This paper presents survey results from 265 small business owners located in and around Karachi, the largest city and hub of economic activity in Pakistan. The survey was designed to identify the internal and external factors that Pakistani small businesspersons believe are critical for success.Small business, SME development, Pakistan, success factors, education

The Potential of α-Mangostin from Garcinia mangostana as an Effective Antimicrobial Agent—A Systematic Review and Meta-Analysis

This systematic review aims to evaluate the antimicrobial activity of α-mangostin derived from Garcinia mangostana against different microbes. A literature search was performed using PubMed and Science Direct until March 2022. The research question was developed based on a PICO (Population, Intervention, Control and Outcomes) model. In this study, the population of interest was microbes, α-mangostin extracted from Garcinia mangostana was used as exposure while antibiotics were used as control, followed by the outcome which is determined by the antimicrobial activity of α-mangostin against studied microbes. Two reviewers independently performed the comprehensive literature search following the predetermined inclusion and exclusion criteria. A methodological quality assessment was carried out using a scoring protocol and the risk of bias in the studies was analyzed. Reward screening was performed among the selected articles to perform a meta-analysis based on the pre-determined criteria. Case groups where α-mangostin extracted from Garcinia mangostana was incorporated were compared to groups using different antibiotics or antiseptic agents (control) to evaluate their effectiveness. A total of 30 studies were included; they were heterogeneous in their study design and the risk of bias was moderate. The results showed a reduction in microbial counts after the incorporation of α-mangostin, which resulted in better disinfection and effectiveness against multiple microbes. Additionally, the meta-analysis result revealed no significant difference (p > 0.05) in their effectiveness when α-mangostin was compared to commercially available antibiotics. α-mangostin worked effectively against the tested microbes and was shown to have inhibitory effects on microbes with antibiotic resistance

Distribution, Etiology, Molecular Genetics and Management Perspectives of Northern Corn Leaf Blight of Maize (Zea mays L.)

Not AvailableMaize is cultivated extensively throughout the world and has the highest production among cereals. However, Northern corn leaf blight (NCLB) disease caused by Exherohilum turcicum, is the most devastating limiting factor of maize production. The disease causes immense losses to corn yield if it develops prior or during the tasseling and silking stages of crop development. It has a worldwide distribution and its development is favoured by cool to moderate temperatures with high relative humidity. The prevalence of the disease has increased in recent years and new races of the pathogen have been reported worldwide. The fungus E. turcicum is highly variable in nature. Though different management strategies have proved effective to reduce economic losses from NCLB, the development of varieties with resistance to E. turcicum is the most efficient and inexpensive way for disease management. Qualitative resistance for NCLB governed by Ht genes is a race-specific resistance which leads to a higher level of resistance. However, some Ht genes can easily become ineffective under the high pressure of virulent strains of the pathogen. Hence, it is imperative to understand and examine the consistency of the genomic locations of quantitative trait loci for resistance to NCLB in diverse maize populations. The breeding approaches for pyramiding resistant genes against E. turcicum in maize can impart NCLB resistance under high disease pressure environments. Furthermore, the genome editing approaches like CRISPR-cas9 and RNAi can also prove vital for developing NCLB resistant maize cultivars. As such this review delivers emphasis on the importance and current status of the disease, racial spectrum of the pathogen, genetic nature and breeding approaches for resistance and management strategies of the disease in a sustainable manner.Not Availabl