Comparison of Combined Nebulization of Salbutamol-Ipratropium Bromide with Salbutamol Alone in Children with Mild and Moderate Acute Asthma

ntroduction: The β2 agonists are potent bronchodilators but their repeated and high doses are related to adrenergic side effects. While ipratropium bromide, an anticholinergic bronchodilator has less adverse effects. Objective: To compare the efficacy of combined nebulization of salbutamol-ipratropium bromide with salbutamol alone in children with mild and moderate acute asthma. Materials and Methods: This randomised control trial was done on 80 children aged 5 to 12 years who presented with mild to moderate acute asthma in the emergency department of Children Hospital of Pakistan Institute of Medical Sciences (PIMS) from July 2014 to June 2016 and randomized into 2 groups. In the experimental group each child received 2 nebulizations of combined salbutamol (5mg) and ipratropium Bromide (0.25mg) at presentation and 20 minutes later. Similarly, each child of the control group received 2 nebulizations of 5mg Salbutamol and 2 ml of Normal saline. Asthma clinical score (ACS) was assessed at baseline and then after every 20 minutes up to one hour after the presentation. Results: In the experimental group, the mean + SD ACS at presentation and 60 minutes were 3.50±1.8 and 3.45±1.7 respectively with mean + SD change in ACS of 0.05 ± 0.1. In the control group, the mean + SD ACS at presentation and 60 minutes were 3.70 ± 1.2 and 3.60 ± 1.9, respectively with mean + SD change in ACS of 0.1 ± 0.7. This difference in mean + SD change in ACS between 2 groups was not statistically significant (P=0.6560). Conclusion: There is no statistically significant benefit of adding ipratropium bromide with salbutamol nebulization as compared to salbutamol alone for the management of children with mild to moderate asthma attacks

Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan

The objective of the study,isto compare the relationship between lack of sleep and the academic performance of the undergraduate students of a medical college of Pakistan. METHODS AND MATERIALS: A cross-sectional study was conducted in a medical college of Pakistanin April 2016. Subjects were recruited by non-probability convenient sampling. A total of 140 subjectswereasked questions about sleep by a properly designed questionnaire from 2nd to 5th Year MBBS. Students having a prior diagnosis of sleep disorder were excluded from study.Data was analyzed using SPSS version 18. RESULTS: A total of 101 females and 39 males participated in the study. Duringnon-exam days, 41.14% of the students slept less than seven hours. The figure approached 80% in exam days. Cross tabulation failed to reveal a correlation between hours of sleep and academic performanceSpearman correlation showed a negative academic performance with less sleep in fourth and fifth year students. CONCLUSION: Students sacrifice their sleep during exams particularly girls. However, the association of sleep hours and academic performance was not established in this study. In fact, there was a negative association between academic performance and decrease sleep in fourth and fifth year students

Cleveland Clinic Summer Scholar Program

Program Overview: The program lasts a total of 6 weeks, and you rotate through 3 different departments Dress code: Business professional attire + Cleveland Clinic white coat Every day will be different in terms of activity and length depending on your rotation site, if you have to do rounds, how early your first patient is coming into the clinic, etc. However, an average day will be from 8:30 a.m. - 5:30 p.m

Practical Measures for Disabled’s Empowerment-Time for Economic Growth!

The objective of this article is to advocate for persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness

Exploring Offshore Wind Development in Norway Through Heuristic Modelling

Global warming continues to be a significant humanitarian concern and Norway is committed to becoming climate-neutral by 2050. To achieve this, Norway has set a target of developing 30 GW of offshore wind power on the Norwegian continental shelf, aiming to become a leading nation in offshore wind. Incorporating 30 GW of offshore wind power into the Norwegian power system necessitates substantial development of the power system due to the intermittent nature of wind power compared to the more stable hydropower generation. This thesis investigates the deployment of offshore wind power in the Norwegian power system through heuristic scenario analysis. The study aims to determine the optimal configuration and necessary modifications to the Norwegian power systems for integrating the targeted 30 GW offshore wind power. The scenario analysis uses the open energy system model PyPSA-Eur to create an isolated model of the Nordic power system. In the scenario analysis, optimal offshore wind deployment is examined for three fundamental power system parameters: Line expansion, generator capacity expansions, and electricity demand. The findings show that offshore wind DC is the preferred choice over offshore wind AC for Norway to achieve its target of 30 GW offshore wind power, in terms of cost optimisation, sufficient electricity generation, and fulfilment of the target. Furthermore, the scenario analysis shows that, with an anticipated 50% increase in electricity demand from current levels, the optimal transmission capacity expansion is 48.3%, a substantial increase from the current power grid system. The findings align with Statnett's system development plan, which includes substantial investments in grid infrastructure. Furthermore, the results reveal that from a purely isolated perspective of the Norwegian power system decoupled from the rest of Europe, there is no significant incentive for Norway to develop offshore wind. On the contrary, the results indicate that onshore wind is more favourable. This highlights the interregional role of Norway in the development of offshore wind in the North Sea. The model has several limitations that could be addressed in future research. First, sector coupling can be considered and electricity demand assumptions can be improved. Additionally, the scope can be extended to include the North Sea countries to accurately assess power flow and the potential of an interconnected network. In conclusion, the results show that with optimal capacity expansion and strategic development of offshore wind, Norway can achieve its target of 30 GW offshore wind capacity. This will allow Norway to meet its offshore wind ambition and advance toward climate neutrality, contributing to the broader European effort

A Cross Country Growth Analysis of Pakistan and Bangladesh

It is unfortunate for Pakistan that the country has lost its competitiveness with other Asian countries and has come to a point where it must learn from the smaller states to overcome its economic hazard. One such country is Bangladesh. Once a part of the Islamic Republic of Pakistan, Bangladesh today has outrun Pakistan with its growing economy. The question is, is there something that Pakistan can learn from Bangladesh’s economic decisions to overcome its economic trap? This thesis explores the factors behind the contrasting economies of Pakistan and Bangladesh with a sharp focus on the garment industry of Bangladesh which has played a pivotal role in the country’s development. The thesis recognizes that both Pakistan and Bangladesh are developing countries with similar religious, cultural, social, and historical values, and therefore aims to identify strategies that have differentiated Bangladesh from Pakistan, thereby deriving findings that can help devise key lessons for Pakistan which the country can adopt for its economic development

Therapeutic Effects of Bee Venom on Rheumatoid Arthritis

Many beehive products such as propolis, Manuka honey, bee pollen, and royal jelly have been used by people due to their popular known health benefits. A novel bee product, bee venom, has demonstrated effective in treating various debilitating conditions, and thus bee venom therapy has been the subject of scientific studies to quantify its medical efficacy. Although bee venom has been used for millennia in Eastern medicine, modern bee venom therapy (BVT) originated in Europe in the 19th century, but was brought to the U.S. by Dr. Bodog Beck after World War I. The treatment became more widespread in the West as the 20th century progressed (Cooney et al, 2011). There are currently various application methods with the most popular being apipuncture (acupuncture with bee venom where needles are initially dipped into the venom before applied to the patient) and bee venom injections (Mohammadi et al, 2015). The multiple beneficial effects of bee venom include increased blood circulation, stimulation of the pituitary-cortical system, and reduced pain and inflammation (Mohammadi et al, 2015). These responses help treat the symptoms of many diseases and chronic inflammatory conditions. With additional research, the use of bee venom can be included as a means to safely alleviate the symptoms of several autoimmune diseases, especially rheumatoid arthritis (RA)

How the rising cost of living is widening inequality and affecting the most vulnerable

With consumer prices rising above wage increases, broadening gaps for disadvantaged groups in the UK have become increasingly apparent. Mahnoor Murad Khan and Yolanda Blavo look at the impacts of the crisis on specific groups such as gig workers and domestic abuse victims, and write that understanding the needs of disadvantaged groups requires re-examining systems already in place that sustain inequality