Physico-Chemical Assessment of Drinking Water Available to the Inhabitants of Low Income and Thickly Populated Areas of Karachi City

The aim of this study was to investigate the physico-chemical properties of drinking water available to the population of low income areas of Karachi city. The study incorporated the attention towards the fluoride content in water being used for domestic and drinking purpose by the inhabitants of low income and thickly populated areas of Karachi. Samples were collected from selected locations from all the districts of Karachi city. Laboratory tests were performed to analyze both physical and chemical characteristics of drinking water. It was observed in this study that except few of the locations, fluoride content was present either in low concentration or in high concentration. Medical data of the areas under study was collected through questionnaires and survey forms. The consequence of the variation of fluoride concentration was found to be in agreement with the findings of medical data analyzed from concerned areas where both cases of Fluorosis and dental cavities were reported. Correlation of fluoride with other parameters was analyzed using principle component analysis determined PC1 & PC2 as most significant components. PC1 showed dominance of TDS with salts while PC2 indicated loadings were temperature DO & pH. Monitoring of fluoride ion concentration and other health related parameters are essential for the development of efficient water management system. Fluoride content in drinking water should be regulated by periodic assessment and elevated levels can be controlled by adsorption or membrane techniques. Keywords: Physico-chemical properties, drinking water, districts of Karachi, fluoride variation, correlation analysis, principle component analysis, water management system. DOI: 10.7176/JNSR/11-14-01 Publication date:July 31st 202

Five centuries of Upper Indus River flow from tree rings

Water wars are a prospect in coming years as nations struggle with the effects of climate change, growing water demand, and declining resources. The Indus River supplies water to the world’s largest contiguous irrigation system generating 90% of the food production in Pakistan as well as 13 gigawatts of hydroelectricity. Because any gap between water supply and demand has major and far-reaching ramifications, an understanding of natural flow variability is vital – especially when only 47 years of instrumental record is available. A network of tree-ring sites from the Upper Indus Basin (UIB) was used to reconstruct river discharge levels covering the period AD 1452–2008. Novel methods tree-ring detrending based on the ‘signal free’ method and estimation of reconstruction uncertainty based on the ‘maximum entropy bootstrap’ are used. This 557-year record displays strong inter-decadal fluctuations that could not have been deduced from the short gauged record. Recent discharge levels are high but not statistically unprecedented and are likely to be associated with increased meltwater from unusually heavy prior winter snowfall. A period of prolonged below-average discharge is indicated during AD 1572–1683. This unprecedented low-flow period may have been a time of persistently below-average winter snowfall and provides a warning for future water resource planning. Our reconstruction thus helps fill the hydrological information vacuum for modeling the Hindu Kush–Karakoram–Himalayan region and is useful for planning future development of UIB water resources in an effort to close Pakistan’s “water gap”. Finally, the river discharge reconstruction provides the basis for comparing past, present, and future hydrologic changes, which will be crucial for detection and attribution of hydroclimate change in the Upper Indus Basin

Inhibitory effect of Polyram DF and Capsicum annum on leaf spot of rose caused by Curvularia lunata in vitro and in planta

Rose plants are affected by several diseases caused by fungi, nematode, bacteria, viruses, and other pests. Among all of these, Curvularia lunata causes significant losses to Roses. Present study was focused on In-vitro and In-vivo management of the “Curvularia leaf spot of Rose” caused by Curvularia lunata by using different fungicides and phyto-extracts. Diseased samples were collected from floriculture area of University of Agriculture, Faisalabad for isolation of pathogen. Five fungicides i.e., Cabrio-Top, Curzate-M, Aliette, Polyram-DF and Recado @ (50ppm, 100ppm and 150ppm) and five plant extracts i.e., Allium cepa, Capsicum annuum, Aloe vera, Menthaand Calotropis gigantean with three concentrations @ (5%, 10% and 15%) were evaluated under lab conditions through poisoned food technique by using Complete Randomized Design (CRD), where C. annuum gave best results (9.129mm) followed by Calotropis gigantea (13.003mm), and Polyram-DF was effective (2.218mm) followed by Curzate-M (6.542mm). Best performing fungicides and plant-extracts were subjected to In-vivo management trials. Under green-house conditions, combination of Capsicum annuum + Calotropis gigantean and Polyram-DF + Curzate-M were shown least disease incidence (14.517 and 3.224%). LSD was used for comparing variations between treatments at 5% probability. The results of these experiments were to aid in the evaluation of fungicides and Phyto-extracts, which are the most effective chemicals and phyto-extracts against leaf Spot disease of Rose

Six Centuries of Upper Indus Basin Streamflow Variability and Its Climatic Drivers

Our understanding of the full range of natural variability in streamflow, including how modern flow compares to the past, is poorly understood for the Upper Indus Basin because of short instrumental gauge records. To help address this challenge, we use Hierarchical Bayesian Regression with partial pooling to develop six centuries long (1394–2008 CE) streamflow reconstructions at three Upper Indus Basin gauges (Doyian, Gilgit, and Kachora), concurrently demonstrating that Hierarchical Bayesian Regression can be used to reconstruct short records with interspersed missing data. At one gauge (Partab Bridge), with a longer instrumental record (47 years), we develop reconstructions using both Bayesian regression and the more conventionally used principal components regression. The reconstructions produced by principal components regression and Bayesian regression at Partab Bridge are nearly identical and yield comparable reconstruction skill statistics, highlighting that the resulting tree ring reconstruction of streamflow is not dependent on the choice of statistical method. Reconstructions at all four reconstructions indicate that flow levels in the 1990s were higher than mean flow for the past six centuries. While streamflow appears most sensitive to accumulated winter (January–March) precipitation and summer (May–September) temperature, with warm summers contributing to high flow through increased melt of snow and glaciers, shifts in winter precipitation and summer temperatures cannot explain the anomalously high flow during the 1990s. Regardless, the sensitivity of streamflow to summer temperatures suggests that projected warming may increase streamflow in coming decades, though long-term water risk will additionally depend on changes in snowfall and glacial mass balance

A multi-proxy reconstruction of spatial and temporal variations in Asian summer temperatures over the last millennium

To investigate climate variability in Asia during the last millennium, the spatial and temporal evolution of summer (June–July–August; JJA) temperature in eastern and south-central Asia is reconstructed using multi-proxy records and the regularized expectation maximization (RegEM) algorithm with truncated total least squares (TTLS), under a point-by-point regression (PPR) framework. The temperature index reconstructions show that the late 20th century was the warmest period in Asia over the past millennium. The temperature field reconstructions illustrate that temperatures in central, eastern, and southern China during the 11th and 13th centuries, and in western Asia during the 12th century, were significantly higher than those in other regions, and comparable to levels in the 20th century. Except for the most recent warming, all identified warm events showed distinct regional expressions and none were uniform over the entire reconstruction area. The main finding of the study is that spatial temperature patterns have, on centennial time-scales, varied greatly over the last millennium. Moreover, seven climate model simulations, from the Coupled Model Intercomparison Project Phase 5 (CMIP5), over the same region of Asia, are all consistent with the temperature index reconstruction at the 99 % confidence level. Only spatial temperature patterns extracted as the first empirical orthogonal function (EOF) from the GISS-E2-R and MPI-ESM-P model simulations are significant and consistent with the temperature field reconstruction over the past millennium in Asia at the 90 % confidence level. This indicates that both the reconstruction and the simulations depict the temporal climate variability well over the past millennium. However, the spatial simulation or reconstruction capability of climate variability over the past millennium could be still limited. For reconstruction, some grid points do not pass validation tests and reveal the need for more proxies with high temporal resolution, accurate dating, and sensitive temperature signals, especially in central Asia and before AD 1400

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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