Termination simpliciter, a dismissal without just cause and excuse? an analysis of Omar bin Othman v Kulim Advanced Technologies Sdn Bhd (previously known as KTPC Technologies Sdn Bhd)[2019] 1 MLJ 625 (CA)

This article addresses on the requirements of establishing just cause or excuse before terminating the employment relationship. In relation to the above, the recent Court of Appeal’s decision in Omar bin Othman v Kulim Advanced Technologies Sdn Bhd (previously known as KTPC Technologies Sdn Bhd), is discussed where the High Court held inter alia, that termination by mutual consent of the parties is not termination simpliciter, and that the acceptance of the payment in lieu of notice with no objection ends lawfully the employment relationship

Conceptual framework for a cardiac surgery simulation laboratory and competency-based curriculum in Pakistan - a short innovation report

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: a simple bench model, a virtual reality simulator and a unique human performance simulator. Our multitiered approach allows for appropriate sequential trainee skill progression. Finally, we hope that our model inspires the development of similar curricula and modules for trainees belonging to other surgica

A rare presentation of acute flaccid myelitis in covid-19 patient: a case report

SARS-CoV-2 virus enters human cells via ACE-2 receptors and causes multiple organs dysfunction. These ACE-2 receptors are in cells surface of human lung, liver, heart, kidney and blood vessels. The expression of ACE2 receptors in cortical neurons, glial cells and spinal cord cells create nervous system susceptible to SARS-CoV-2 attack and may be a source of different neurological deficits including myelitis in COVID-19 patients

Response of a maize composite to selfed progeny recurrent selection for earliness and yield traits

Population improvement through recurrent selection is a traditional breeding method that has been used in maize for over 60 years. Objectives of the research were to: a) evaluate effect of selfed progeny recurrent selection on earliness and yield traits, b) compare responses of cycle-1 (S1-line) and cycle-2 (S2-line) populations, and c) determine better strategy for improvement of maize source population «PSEV3». The experiments were carried out in partially balanced lattice square design with two replications. In cycle-1 and cycle-2 populations, the differ- ences were highly significant for all studied traits. Selfing in both cycles of selection, resulted increase in days to tasseling while reduction in population means for yield traits. In selected progenies, an increase was seen in mean values of yield traits; however, not in days to tasseling and grain moisture in both cycles of selection. Moderate to high heritability values were observed for almost all the traits in both cycles. Selection differential values were positive and high for grain yield, ear height, prolificacy, ear length, and 100-grain weight in cycle-1 and cycle-2. However, negative values of selection differential were seen for days to tasseling and grain moisture in cycle-1 and 2 populations. The expected responses for days to tasseling and grain moisture were negative in first and second selection cycles. Comparatively, larger and positive responses were noted in cycle-2 than cycle-1 for grain yield and its components. Selfed progeny recurrent selection method was found more effective in improving the maize source population «PSEV3” for earliness and yield traits

Apoptosis-like cell death in Leishmania donovani treated with KalsomeTM10, a new liposomal amphotericin B

The present study aimed to elucidate the cell death mechanism in Leishmania donovani upon treatment with KalsomeTM10, a new liposomal amphotericin B. Methodology/Principal findings We studied morphological alterations in promastigotes through phase contrast and scanning electron microscopy. Phosphatidylserine (PS) exposure, loss of mitochondrial membrane potential and disruption of mitochondrial integrity was determined by flow cytometry using annexinV-FITC, JC-1 and mitotraker, respectively. For analysing oxidative stress, generation of H2O2 (bioluminescence kit) and mitochondrial superoxide O2 − (mitosox) were measured. DNA fragmentation was evaluated using terminal deoxyribonucleotidyl transferase mediated dUTP nick-end labelling (TUNEL) and DNA laddering assay. We found that KalsomeTM10 is more effective then Ambisome against the promastigote as well as intracellular amastigote forms. The mechanistic study showed that KalsomeTM10 induced several morphological alterations in promastigotes typical of apoptosis. KalsomeTM10 treatment showed a dose- and time-dependent exposure of PS in promastigotes. Further,study on mitochondrial pathway revealed loss of mitochondrial membrane potential as well as disruption in mitochondrial integrity with depletion of intracellular pool of ATP. KalsomeTM10 treated promastigotes showed increased ROS production, diminished GSH levels and increased caspase-like activity. DNA fragmentation and cell cycle arrest was observed in KalsomeTM10 treated promastigotes. Apoptotic DNA fragmentation was also observed in KalsomeTM10 treated intracellular amastigotes. KalsomeTM10 induced generation of ROS and nitric oxide leads to the killing of the intracellular parasites. Moreover, endocytosis is indispensable for KalsomeTM10 mediated anti-leishmanial effect in host macrophag

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

The Effects of Aerobic Exercise on the Levels of Leptin and Adiponectin in Overweight Women

Background & Objectives: Several epidemiological studies have indicated factors such as Leptin level, Adiponectin and plasma adiponectin-to-leptin index to be the predicting biomarkers for cardiovascular diseases. Given the importance of healthy nutrition and adequate exercise in reducing the risk of Atherosclerosis, this study aimed to investigate the effects of fasting and aerobic exercise on the level of leptin and adiponectin in overweight women.   Materials and Methods: In this study, 27 overweight and obese women with the body mass index (BMI) of ≥25 kg/m2 and the age range of 45-20 years were selected by targeted sampling and were divided into two groups of fasting accompanied with aerobic exercise (N=15), and fasting only (N=12). The active group had an exercise protocol including three 60-minute sessions of aerobic exercise per week, with the maximum heart rate of 50-65%. Anthropometric dimensions and blood levels of leptin and adiponectin were measured in all the subjects before, at the second week and the fourth week and one week after Ramadan. Data analysis was carried out using repeated measures, and a P value of ≤0.05 was considered significant.   Results: In this study, one month of fasting accompanied with aerobic exercise had a significant effect on the amount of leptin, adiponectin and leptin-to-adiponectin ratio (